Agenda item

To consider information on this scrutiny topic from the North East and North Cumbria Integrated Care Board (NENC ICB).

Following the Committee’s approval of the scope and plan for the Access to GPs and Primary Medical Care review (preceded by the consideration of a background briefing in relation to this scrutiny topic) at the last meeting in September 2023, this first evidence-gathering session involved an initial submission from the North East and North Cumbria Integrated Care Board (NENC ICB).  Led by the NENC ICB Commissioning Lead – Primary Care, an extensive presentation addressing several key lines of enquiry covered the following:

•           What is General Practice?

•           GP Contracts and Regulations

•           Other Key Agencies

•           Core Funding and Expenditure

•           Primary Care Networks (PCNs) and Directed Enhanced Services (DES)

•           Overview of General Practices in Stockton

•           Practice and PCN Workforce

•           Primary Care Appointment Activity

•           Enhanced Access Utilisation

•           GP Patient Survey – 2023 Results

•           Access Challenges

•           Primary Care Access Recovery Plan (PCARP)

•           Empowered Patients

•           Implementing Modern General Practice Access

•           Building Capacity and Cutting Bureaucracy

•           Progress To Date

•           PCN Capacity and Access Improvement Plans

•           National Public Relations Campaign for GP Access

•           Links to Key Documents

A ‘Stockton-on-Tees Data Pack’ had also been provided to supplement the presentation – this included a map of the Borough’s general practices and branch sites, practice list sizes, opening hours, current CQC ratings, staffing levels, GP numbers (headcount and full-time equivalent as a ratio to patient list size), and patient online management information.  Appointment data (at a Borough and Tees Valley level) was also detailed, as was a breakdown of GP survey results per Stockton-on-Tees practice.

Whilst the existing GP contract stated that ‘practices must provide essential services at such times, within core hours, as are appropriate to meet the reasonable needs of its patients’, it was noted that there was no precise definition as to what constituted ‘essential’ nor ‘reasonable needs’ (‘core hours’ were specified, though).  The current five-year contract was in its final year, though details regarding subsequent contract plans had yet to be communicated.

In terms of funding, in addition to the core funding via the Global Sum, practices rely on other forms of income to cover expenditure.  One of these streams is the Quality and Outcomes Framework (QOF) scheme which, whilst not part of the core contract, can be beneficial for practices and is therefore rarely ignored.  A patient list size of around 7,000-8,000 was considered financially sustainable – in Stockton-on-Tees, the average list size was 9,808 – the smallest being 2,303 and the largest 21,555 (as at 1 January 2023).

Regarding the primary care appointment activity, the data did not include ‘dropped’ calls which had previously been difficult to track – however, new telephony systems (as part of the phasing out of analogue phones) do collect this information, and the Borough’s practices could be asked to supply this data if required.  Statistics in relation to enhanced access utilisation indicated that significantly less people used the Sunday service in Eaglescliffe (it was stated that patients should be offered appointments during core hours as well as enhanced access options).

The 2023 results of the GP patient survey were probed by the Committee, though it was noted that the data represented a small sample (around 2,500) of the Borough’s 200,000+ population.  Focus was given to the percentage of patients who found it easy to get through to someone at their practice on the phone (52% in Stockton-on-Tees compared to 50% nationally), and Members expressed deep concern that most other types of business would not be in operation for long if customers were not answered on such a level (in related matters, Members also raised the problem of people attempting to cancel appointments which led to missed appointments if they failed to get through to notify the practice).  In response, the limited sample size was reiterated, as was the fact that access had become an issue across the whole country, hence the national recovery plan.  Despite the current situation, there was still a lot of good work going on by practices.

A plethora of challenges around access to practices were listed, the most significant of which was arguably the ongoing recruitment and retention difficulties for both clinical and administrative roles.  Practices were not an attractive place to work at present, and the abuse of staff was a real issue.  Cost-of-living factors also added to the pressure on services, with increases in wages not covered by practice income.  Ultimately, practices were limited in terms of changing their operations and financial reimbursements were not huge (despite practices giving very high value-for-money).

The ambitions of the Primary Care Access Recovery Plan (PCARP), published on 9 May 2023, were discussed.  The Committee heard that the high-profile aim to tackle the 8.00am rush did not translate into the existing GP contract, nor did it mean that an individual would get an appointment on the same day (despite some elements of the media interpreting this so).  However, if there was a clinically urgent need, a person should be offered an appointment on the same, or next, day.

Assurance was given that local practices were proactively changing the way they delivered their services, and several examples of progress were highlighted.  In addition, a national campaign in association with Healthwatch had been initiated with regards access, and the ICB was in the process of contacting practices to verify the accuracy of their opening times on websites / public platforms.

Reflecting on the list of Stockton-on-Tees practices, Members asked where the Lawson Street provision fitted into the local offer.  It was confirmed that whilst there were two practices located within the Lawson Street premises, other services that were delivered from there were not part of general practice services.

The Committee drew attention to the Patient Online Management Information (POMI) statistics included within the supplementary data pack, and noted the varying level of patients accessing their records remotely (which would be interesting to compare with any available regional / national figures).  Members were informed that, from 31 October 2023, there was a new contract requirement that all people should have access to future (not past) records, though this had created some nervousness amongst practices with regards potential safeguarding issues – the ICB continued to work with providers on this.  In terms of the different levels of online bookings / cancellations and repeat prescription ordering, variances in relation to the level of awareness / promotion of remote options may explain data fluctuations, and there was not an ambition to get this close or up to 100% – this was merely just a way of expanding patient choice.

A query was raised as to whether a register of the different services offered by each practice was kept (reported confusion as to which services offered flu and / or COVID vaccinations was relayed by Members).  Members were reminded about the difficulty within the GP contract in articulating what 'essential services' included – as such, practice websites and patient leaflets were the main source of information.

Thanking the NENC ICB representative for their detailed submission, attention turned to the second evidence-gathering session scheduled for the next Committee meeting in November 2023.  It was subsequently agreed that contributions would be sought from both the Cleveland Local Medical Committee, and Hartlepool and Stockton Health GP Federation.

AGREED that the information be noted.