Agenda item

To receive a report from the Head of Democratic Services which presents a further update provided by the ICB Accountable Officer (Leeds Place).

The Head of Democratic Services submitted a report which presented further updates provided by the ICB Accountable Officer (Leeds Place).

The following were in attendance for this item:

·  Cllr Fiona Venner, Executive Member for Adult and Children’s Social Care and Health Partnerships

·  Cllr Salma Arif, Executive Member for Public Health and Active Lifestyles

·  Tim Fielding, Deputy Director of Public Health

·  Tony Cooke, Chief Officer Health Partnerships

·  Jenny Cooke, Director of Population Health Planning, Leeds ICB

·  Gaynor Connor, Director of Primary Care and Same Day Response, Leeds ICB

The Chair explained that since July 2021, the Scrutiny Board has been actively monitoring the ongoing development of the new local Integrated Care System.  During the Board’s last update in October 2022, it was agreed that this next update would be more focused on the key priority work areas of the ICB in Leeds linked to the Healthy Leeds Plan.

The Chair invited the Director of Population Health Planning and the Director of Primary Care and Same Day Response to provide a brief introduction to the report provided by the ICB Accountable Officer (Leeds Place).  In doing so, the following areas were highlighted:

Ø  The refresh of the Healthy Leeds Plan had been undertaken between October 2022 and March 2023 to coincide with the refresh of the Health and Wellbeing Strategy.

Ø  Funding secured through the Core20PLUS5 framework resulted in £3million being allocated to the health inequalities programme in Leeds. This programme is made up of 44 individual projects across the system alongside funding to the eight local care partnerships (LCP) with the highest levels of deprivation.

Ø  The 44 individual projects were selected from a list of over 90 proposed projects in varying states of maturity, from ongoing projects that were coming to the end of their funding to new projects.

Ø  The funding for next year has been secured and discussions are underway to determine how best to deploy this funding.

Ø  The Intermediate Care Redesign Programme aims to deliver a bold and innovative programme to achieve the vision of having a sustainable, person-centred, home-first model of intermediate care across Leeds that is joined up and promotes independence.  This 18-month programme has been constructed over three phases and is being led by Dr Phil Wood, the Chief Executive for Leeds Teaching Hospitals Trust (LTHT).  The programme is transitioning from Phase 2 to Phase 3 and it was therefore suggested that that Scrutiny Board maintains a watching brief of progress.

Ø  Improving access to General Practice is recognised as a key priority for the ICB due to unprecedented demand for services.  Recent data shows delivery of 20,000 appointments on average per day across the 92 practices in Leeds.  Currently 43% of all appointments are booked on the same day with a total of 70% being booked within 7 days.  Over 71% of all appointments were conducted face to face and just under 50% are with a GP.  A further 20,000 enhanced access service appointments (evening and weekends in PCN based hubs across the city) are also delivered per month.  A further 3,300 are also delivered through the Same Day Response Service.

Ø  The Additional Roles Reimbursement Scheme has provided funding to Primary Care Networks to allow practices to collectively employ more staff with different skills to complement the existing workforce.  However, this Scheme is set to end in 2024.  In Leeds, there is around 300 whole time equivalent staff with the aim of this rising to over 500 by the end of 2024.

Ø  Engagement with Healthwatch Leeds and other organisations has helped increase understanding of service accessibility with optional modules regarding quality and patient outcome co-designed.

Ø  The new GP contract renewal for 2024 will make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice. Requirement for improved online access to GP records will be provided and telephone systems to become cloud based, including functionality for call queuing or call back to provide a better patient experience when the lines are busy as well as management information and data so that practices have better insight around improving their responsiveness further.

Ø  At the end of March 2023, a nationally produced recovery plan for general practice is also expected.

Ø  As from July 2023, West Yorkshire ICB will take responsibility for the co-commission of pharmacy, dentistry and optometry NHS services.

The following key points were also raised during the Board’s consideration of the report:

·  In response to a question regarding the provision of community funding, particularly focused on the Chapel Allerton Ward, it was outlined that two-thirds of the £3million funding was allocated to Third Sector organisations, working collaboratively with forums, communities of interest groups and Local Care Partnerships to best allocate funds to tackle health inequalities. The specifics for Chapel Allerton were to be followed up after the meeting.

·  The value of informing Ward Members of community and third sector projects in terms of improving awareness and accessibility for the public.

·  The variable levels of access experienced across GP surgeries, largely due to them being independent organisations with different systems and practises.

·  Expectations for the quality improvement module and GP contract changes, which are to be more patient centred and provide an outcome at the first point of contact, including seeing people on the same day when required and where possible.

·  Service recovery was not at full pre-pandemic capacity contributed to by long term condition reviews, routine health check backlogs, an increasing demand for same day services and for mental health and frailty service provision.

·  The increase in demand and people’s frustration experiencing service access issues equates into staff working under extreme pressure and leading to exhaustion.  Threatening behaviour towards GP staff was also noted to be increasing.  The Board recognised the importance of having effective communication with the public in terms of helping them to better understand the existing service pressures as well as being offered other pathways to primary care.

·  Members discussed the comparative GP access data across West Yorkshire, which was set out within the report. In doing so, it was noted that national GP access data had only recently been made available and that further analysis work is therefore still required.

·  Reference was made to the value of social prescribing and Board Members suggested that the successor Scrutiny Board considers this in more detail.

·  The intermediate care redesign will be a fundamental shift to strip the complexity for patients and staff trying to navigate the various institutions and layers of the health and care system and will also have positive economic implications across the entire system.

·  The importance of ensuring that the various plans and strategies, including the Healthy Leeds Plan and the Health and Wellbeing Plan, are aligned and aim to maximise opportunities while avoiding duplication.

·  Patient Participation Groups (PPG) were noted to have not been re-established in some GP practices. It was outlined all GPs are required to have some form of PPG, however some stood down during the pandemic and had struggled to re-emerge. A recent event involving PPGs resolved to refresh the approach of the network through the ICB and offer support where needed. 

·  Members were assured that the end of the 5-year Additional Roles Reimbursement Scheme will not be abrupt as there will be some guaranteed income once concluded. During the final year of the programme, recruitment will also be maximised as much as possible.

·  Same day GP service provision is proposed in all possible cases including supported capacity through 23 hubs and virtual appointments. However, some challenges regarding travel to the designated hubs from outer areas, particularly for less able people, were noted.

·  Mitigation for missed appointments, which had unfortunately slightly increased, was discussed and it was noted that best practice initiatives were also being shared through PPG communication.

·  It was highlighted that the ratio of GPs per 100,000 of the population had increased in Leeds since 2018 which is largely the opposite case for other areas of the UK.

·  Regular zero tolerance and ‘leaving a gap’ campaigns run in attempt to raise awareness on the repercussions of abusive behaviour towards GP practise staff and there are processes for dealing with abusive patients with the ultimate sanction being removed from the register.

RESOLVED – That the contents of the report, along with Members comments, be noted.