Agenda item

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

The Associate Director highlighted some key points from the presentation provided. As previously mentioned, the local priorities for improving GP access were reflected in the delivery plan published in May 2023. Work had included:

-  empowering patients – Bromley practices had expanded the functions available through the NHS app. An increase in repeat prescriptions, appointment bookings, and general use of the app was being seen – each contact was potentially an avoided phone call.

-  implementing modern GP access – this related to patients understanding how their requests would be handled, based on clinical need, and respecting their preference for a response. There was an end to end reshaping of how patient requests were received, assessed and consultations offered.

-  building capacity – additional roles were implemented within the wider general practice teams. It was noted that eight new GP trainers had been supported in the borough to expand training places. The training hub was also offering virtual training.

-  cutting bureaucracy – the interface between primary and secondary care was important in ensuring there were as few handoffs as possible, and patients were not going back and forth to get the care, advice and support required.

The Chairman highlighted that it was positive to see the increased use of the NHS app and other online platforms. It was requested that an age breakdown of patients using these functions be provided in the next report to the Sub-Committee.

In response to questions, the Associate Director said it was recognised that practices sometime made changes without involving their patients as much as they needed to, and this was being emphasised to them through various forums. As mentioned at the last meeting, support guides had been developed to help structure conversation on access with the Patient Participation Groups. In one area of the borough major changes were due to take place with the introduction of a new system and they had been providing support to practices in terms of ongoing engagement with their patients. The GP Clinical Lead considered that there variation across the borough but there was a move to try and standardise access. It was highlighted that whichever means was used to contact a GP practice it should result in the same offer, and practices should be explaining this to their patients. A Member advised that their Patient Participation Group had introduced a newsletter to supplement the communication from the practice, which helped remind and direct patients to the NHS app.

The Clinical Director provided two examples of Bromley Primary Care Networks taking a neighbourhood approach to improving access – one related to frailty and the other children as a cohort. The frailty case study focussed on the Wellbeing Café in Orpington. This had been established over a year ago and was held twice a week – approximately 75-80 patients attended each café. This had helped improve access as they were educated on how to use digital platforms such as e-consult and the NHS app – every attendee had visited PCN and GP practice websites and knew how to utilise them. The café provided a safe space for attendees to meet and engage with healthcare professionals and helped to tackle social isolation. A joint project had been developed between the Orpington and Crays PCNs to look at frailty-specific health needs – focus groups had been involved in the co-design and focussed on cardiovascular disease, respiratory disease and diabetes. Following the success of the café other PCNs across the borough had been providing similar projects, some specific to the needs of their patients such as Mottingham, Downham and Chislehurst PCNs Young Mums Hub.

The Bromley Integrated Child Health (B-CHIP) project had initially been started within the Crays and Beckenham PCNs. This introduced a model whereby a child who visited their GP and needed to be referred to the hospital would immediately be added to a triage list – the GP surgery and consultant paediatrician discussed this triage list on a weekly basis and made a decision in terms of the best pathway. This model had resulted in referrals being avoided in 50% of cases and 20% were seen at the monthly paediatric clinic held in the GP surgery – this had reduced the number of GP appointments. This model would next be implemented in Penge, Bromley Common and Five Elms PCNs, with the aim for it to be scaled out across the whole borough next year.

In response to a question, the Clinical Director said that a wide range of care co-ordinators and social prescribers were involved with the Wellbeing Café, and both roles were vital in supporting patients. Social prescribers signposted patients to help with things such as financial difficulties, housing issues and other support. The impact of this had been seen in terms of the large number of referrals made by the café to external social prescriber appointments. Mytime Active also offered a huge amount of support to the café, including delivering exercise classes. Members commended the work being undertaken in relation to the new initiatives and expressed well wishes in terms of rolling them out to other areas of the borough.

The GP Clinical Lead highlighted that although general practice continued to maintain its responsibility of same day urgent care, prevention of long-term conditions the work at a neighbourhood level would be crucial. It was noted that an engagement session had also been held with Patient Participation Groups from across the borough and co-production would be an important part of the transformation journey.

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

RESOLVED that the update be noted.