Agenda item

The Chairman welcomed Cheryl Rehal, Associate Director of Primary and Community Care, Bromley – SEL ICS (“Associate Director”) and Dr Andrew Parson, Co-Chair and GP Clinical Lead – One Bromley Local Care Partnership (“GP Clinical Lead”) to the meeting to provide an update on GP access.

The Associate Director advised that the national GP Patient Survey results showed a downhill trend, however Bromley was not out of sync and was performing strongly in a couple of areas. In terms of the actions being taken, there was already a focus on improving phone experience, and it was noted that the allocated funding was still awaited to start the switchover process. Another area of continued focus was the overall experience of making an appointment and they were expanding the number of directly bookable appointments to relieve the pressure on phonelines. It was also hoped that the introduction of new websites would reflect a better score next year.

With regards to GP appointments in Bromley, the Associate Director highlighted that the data set was limited. The categorisations were relatively new, and the fluctuations related to improvements in the coding of the data. It was hoped that the reliability of the data would improve throughout the year. The GP Clinical Lead advised that generally there was a wide and broad range of access to primary care teams, however they needed to find a mixture of ways to provide access for patients. With regards to relieving pressure on telephone lines, it was highlighted that the use of e-consults was increasing, and websites were becoming clearer and more consistent. It was noted that repeat prescriptions created a lot of traffic. Members were advised that there was now a new national target of 14-day access, with 85-90% of appointments being offered within two weeks. It was highlighted that the percentage on the graph would not continue to rise as some follow-up appointments needed to be booked further into the future. The GP Clinical Lead informed Members that there were expanding roles within general practice. This had been a success story in a number of ways, with an increase in the number of roles employed through the primary care networks (PCNs).

In response to questions, the Associate Director said that practices were trialling different things to get the process run smoother, manage demand and ensure the patients who needed to see their GP were seen. A GP was currently working as the lead, focussing on digital triage and improving flow – they were looking at how they could support individual practices on the ground. There was a national expectation that practices would adopt the Modern GP Access model, having an upfront triage for every patient that contacted the practice to ensure they were being seen by the right professional. However, there would not be a single model as there were differences in how practices worked. The GP Clinical Lead said there was an expectation that practices were using new ways of working, but demand had risen greatly. The triage process was important – it required a certain amount of information and therefore a call back would be initiated so the patient was not sat waiting. The Member agreed that this made sense, however it was highlighted that this needed to be communicated to patients.

A Member asked if there was any way to persuade people to accept telephone appointments, rather than face to face appointments. The GP Clinical Lead advised that he now undertook less telephone appointments than he had pre-pandemic as previously a certain amount had been reserved. There needed to be a balance, and it was considered that discussions should be held with patient groups. There was variation across Bromley, but it would be helpful if the benefits of access could be spread – it was a conversation that everyone could support. The Associate Director noted that 20% of consultations were carried out by telephone. The type of appointment offered would sometimes depend on the mode initially used by the patient to contact the practice.

The Associate Director advised that in terms of anticipated peak demand, they would be introducing borough-wide additional capacity in primary care as part of this year’s winter response planning. It was highlighted that some dedicated work was underway in Bromley to engage with the public and ensure patients understood what was happening in their GP practices. In response to a question from the Chairman, the Associate Director said they were proud that Bromley was at the forefront of digital transformation. There were 42 practices in the borough, all at varying stages. They were supporting practices through the process – helping those who wanted to move at a quicker pace, sharing good practice and work closely with those who were more cautious. It was emphasised that there was a high appreciation that practices could not stay as they were. The GP Clinical Lead noted that there was leadership through Clinical Directors and PCNs, bringing practices together to try and adapt different ways of working.

In response to questions regarding the variation between practices and embracing the changes, the Associate Director said that Patient Participation Groups (PPGs) were an important and trusted channel. Topic guides had been developed, covering topics such as why the changes were coming into place, using the NHS app, telephone systems and online consultation, for practices to use as a tool to have conversations with their PPGs. There was a borough-wide forum, which provided an opportunity to bring together PPGs – a forum for the Chairs of the PPG’s was something that could be considered.

A Co-opted Member highlighted that some frail and elderly patients would not have access to technology. The Associate Director advised that it was about creating the space for those that needed to use traditional routes to access their GP practices, and it was recognised that some patients would be uncomfortable/unable to use the technology. It was noted that some advocates/family members found having access to the NHS app helpful as they could access it, with prior permission, on behalf of the person they cared for. It was emphasised that the improvements in technology would not stop people from using traditional access routes. The GP Clinical Lead said that work had been undertaken within primary care to anticipate the needs of the vulnerable. The different access routes allowed family members who did not live nearby to communicate directly with the practice.

The Chairman thanked the Associate Director and GP Clinical Lead for their update to the Sub-Committee.

RESOLVED that the update be noted.