Minutes:
The Director of Primary Care Transformation (DPCT) at Barking, Havering and Redbridge Integrated Care Partnership (North East London Clinical Commissioning Group) delivered a presentation on the community access to healthcare post-Covid-19, focusing on primary care access. The presentation detailed:
· The contact types and volumes of consultations pre-/throughout the pandemic (for all clinical consultations, and for GPs);
· Task and finish group work to test the new models of care with GP practices, residents and local stakeholders;
· Work being undertaken through the Winter Access Fund;
· Work to support the community access into primary care and the PCN Strategic Infrastructure planning programme;
· Means to improve digital access and work to support patients to better manage their own care (for example, through remote consultations for long-term conditions);
· Digital consultations; and
· Patient:workforce ratios and means to recruit and develop more clinical staff.
In response to questions from Members, the DPCT stated that:
· As part of the Winter Access Fund, the CCG was using a programme called Equip to look at trends in terms of GP appointment bookings, as well as the staff that were available and how they could be differently matched across the system. It was also using a programme called Time for Care, which was looking at appointments, in terms of improving access. The CCG was supporting all 16 GP practices in Barking and Dagenham to look into this work, as appointments needed to be booked via a flexible system, that was able to adapt to booking trends.
· Demand was currently very high, which was why the CCG was commissioning additional capacity in its GP practices and hubs. As part of the new ways of working, practices were working to triage patients appropriately, with appointments booked according to what was deemed clinically appropriate by GPs. This meant that those who needed an urgent appointment, were able to receive one, and it did not depend on which individuals were able to get through to the practice first on the telephone. The practices would then telephone less urgent patients back, to assign them an appointment. Most patients were understanding of this, as long as they did hear back from the practice within the time that they needed to. Practices also checked with the patient that they had the right phone number and would use their mobile numbers to contact them.
· Normal blood test results were filed, and it was then up to the patient to contact the practice to receive these, due to the high volume that GPs needed to deal with. GPs received blood test results every day and had a system to review these, to see who needed to be called back for further testing. If a patient needed a follow-up, they would be contacted by their practice.
· Two-way text messaging could also be used by practices, to contact patients with their blood test results, and the DCPT would take Committee feedback to the task and finish group, to consider whether patients could be messaged about their blood test results, when these were within the normal range.
· Practices were also trying to move more towards a self-management system, particularly for long-term conditions, and from April 2022, practices would enable patients to access more of their patient records; however, patients would not be able to see everything, particularly where it would be better for their results to be explained to them.
· Whilst clinical triage meant that some patients telephoned their practice, only to be told to be come in, this helped GPs to prioritise more urgent cases; however, GPs often did not take any risks with the elderly and the under-fives, and would ask them to come in regardless.
· The CCG wanted to work with Healthwatch, local residents and stakeholders to look into and improve the new ways of working, such as for people with learning disabilities, who may struggle with virtual consultations.
· The CCG was to receive around £8-9 million, in three pots of money. All practices across North East London would get an equal share of the first pot, which was for additional capacity and would be funded at £1.16 per patient. The second pot would be used to support certain practices with access issues. The third pot of money would be for the benefit of all general practice, in relation to the primary care family (such as urgent care into primary care, community pharmacies and GP practices).
· The NHS was still managing infection control and it maintained some measures as Covid-19 was still in circulation, to help keep staff and patients safer.
In response to questions from Members regarding concerns around patients not receiving appointment letters, the Director of Transformation (DoT) at NEL CCG stated that she received feedback quickly from GPs if there were lots of patients who were stating that they had not received appointment letters, and that they had been discharged as a result. She had only been notified of this happening three times in the last few months; however, she would monitor this issue, and would pick this up with the Deputy Chief Operating Officer (COO) at BHRUT (Barking, Havering and Redbridge University Trust), as the Committee had notified her of this happening on two recent occasions.
In response to further questions, the Associate Director of Communications and Engagement (ADCE) at NEL CCG stated that NEL CCG was undertaking some work with Healthwatch, looking into the barriers and issues that patients had in terms of understanding how to get help from their GP practice. Digital exclusion was a growing issue, particularly as digital means were becoming more relied upon, and Healthwatch and the CCG were working to look at what this meant for different parts of the community. The next step of the work was to work with practices, Healthwatch and stakeholders to think about means to improve the issues and ensure that people were getting access to their care, in the way that they needed.
The Cabinet Member for Social Care and Health Integration expressed her concern that the triage system could result in the later detection of cancers within Barking and Dagenham, with late presentation already being a major issue within the Borough, and that take-up rates could get worse when the community perceived an additional ‘hurdle’ in accessing care. As such, she stated that work needed to be undertaken around these potential behavioural issues and high-priority health conditions. The DPCT agreed, acknowledging that telephone consultations and triaging would not work for everybody. It was important to pick up on the cues that someone was displaying in terms of their health, and work needed to be done to support this. Work also needed to be undertaken locally with practices and with receptionists to keep their training up to date, as they acted as a gateway into GP practices.