To receive a report from the Head of Democratic Services which presents an update from the Leeds Health and Care Partnership surrounding access to General Practice in Leeds.
The Head of Democratic Services submitted a report which presented a briefing paper from the Leeds Health and Care Partnership on access to General Practice in Leeds.
The following were in attendance:
· Councillor Fiona Venner, Executive Member for Children’s Social Care and Health Partnerships
· Councillor David Jenkins, Deputy Executive Member
· Victoria Eaton, Director of Public Health
· Shona McFarlane, Deputy Director Social Work and Social Care Service
· Dr George Winder, Chair of the Leeds GP Confederation and Clinical Director of Seacroft Primary Care Network
· Dr Mo Sattar, Clinical Director of Chapeltown Primary Care Network
· Andrea Mann, Clinical Director of Cross Gates Primary Care Network
· Dr Sarah McSorley, Vice Chair of Leeds Local Medical Committee
The Chair invited the Executive Member for Children’s Social Care and Health Partnerships to provide some introductory comments and then invited the Director of Primary Care and Same Day Response, along with representatives from the GP Confederation and Leeds Local Medical Committee, to give a brief overview of the key points set out within the appended briefing paper.
In summary, the following key points were highlighted:
· Leeds has 90 practices that collaborate in an operating model of 19 Primary Care Networks (PCNs) and Local Care Partnerships (LCPs).
· Levels of appointments are now back to pre-pandemic levels and continue to grow, with 417,704 appointments carried out in June 2023, which is an increase of 28,000 appointments when compared to June 2022.
· For Leeds, it was reported that the overall experience of the GP practice was slightly better than the national and West Yorkshire average at 73%. However, it was acknowledged that the consensus view from both patients and staff is that more work still needs to be done to reduce the barriers some patients face when accessing services.
· Patients particularly value quality and continuity of care and so the balance between increasing access, using the range of professional expertise in a practice and maintaining continuity of care is one that continues to be developed.
· The reception team has a vital role to play in triaging patient calls. Care navigation is a process done by care coordinators, appropriately trained reception or other practice staff, to signpost to the most appropriate clinician or elsewhere outside of the practice.
· The impact of secondary care waiting times and changes in outpatient arrangements to more remote consultations have contributed to an increasing workload and appointment requests in general practice as people seek assurance, advice or information as they wait for hospital care.
· Core general practice is funded through a national GP contract. There is no specific standard within the contract which determines what workforce a practice should have in place other than it is sufficient and safe to deliver a core service as outlined in the contract.
· Within the national GP contract there has been a 2% staff pay uplift to practice funding in each of the last 5 years, which has impacted on the ability to recruit and retain staff.
· One of the key objectives for general practice nationally includes the recruitment of 26,000 Additional Roles Reimbursement Scheme (ARRS) roles by the end of March 2024.
· In Leeds, much of the growth of the workforce can be accounted for through the ARRS workforce with approximately 417 FTE in post and a further 490 FTE by April 2024.
· It was noted that a summary of the number and type of ARRS roles was set out within the paper. It was also highlighted that many of these staff can be new to primary care and as such would require support, training and supervision from GPs, which then impacts on their capacity demands.
The following areas were also discussed during the Board’s consideration of the briefing paper:
· Accessing appointments within two weeks – it was noted that patients being able to access an appointment within two weeks is a national measure. It was reported that currently 80% of patients in Leeds have an appointment booked within 14 days or less and that the remaining 20% were generally associated with pre-planned future appointments. It was agreed that the latest appointment data, which is tracked by practice and PCN, would be provided to Board Members.
· The use of comparative data – while acknowledging the value of collating data to be able to compare Leeds performance against other West Yorkshire places, the Board was advised that work was ongoing in terms of ensuring the accuracy of the data and looking at ways of also trying to compare “like with like”.
· Primary care estates – it was noted that there is limited capital available for primary care estate improvements and limited revenue budget. Members were informed that GP practices receive funding once a patient has registered. As such, responding pro-actively to increases in population growth can be challenging. However, the ICB continues to seek opportunities for improvement in this area. It was noted that there are good examples of practices working together to share estates as well as exploring opportunities to build further resilience by working closely with local community hubs and libraries. The Board also discussed potential opportunities to increase capacity quickly using temporary accommodation options, such as portacabins.
· Links between planning and health provision – it was highlighted that links between planning and health provision can be challenging but have improved. It was noted that discussions regarding the East Leeds Extension have been a particular recent focus, with the ICB undertaking an options appraisal on the appropriate response to the increased population attributed to the East Leeds Extension, which has identified a particular impact on 3 PCNs across the city.
· Digital tools – it was acknowledged that increasing the use of digital tools to support patient access is a key feature within the access recovery plan. Linked to this, importance was placed on improving public communications particularly around the use of PATCHS, a technology developed to book a GP appointment recently implemented across West Yorkshire. It was noted that the ICB is also continuing to engage with the council and other partners on programmes such as 100% Digital Leeds to address issues around digital exclusion. However, it was recognised that a non-digital option should also be kept available for those who either express this as a preference or who are without access to digital tools and technologies.
· Helping people to understand and embrace the new model of general practice – it was acknowledged that the vision of modern general practice is not as well known to most patients. Many will therefore still prefer and expect the traditional model of seeing a familiar GP rather than being seen directly by another professional in the general practice team. Importance was placed on working with the public to better understand and manage their expectations linked to the new model of general practice.
· Recruitment and retention challenges – the Board discussed some of the key challenges faced by GP practices and particularly the role of practice managers in terms of recruiting and retaining staff, which were reflective of the challenges nationally too. This included GPs themselves in terms of striving for a better work/life balance when often faced with demanding workloads. Linked to the new model of general practice, it was highlighted that trained reception or other practice staff were particularly hard to retain given their difficult role in trying to signpost patients appropriately and having to also deal with complaints and abusive behaviour from patients when their expectations are not being met.
· Self-referral pathways – it was noted that one of the main national objectives is to expand self-referral pathways to enable patients to access services directly and prevent the need for contacting the practice. Linked to this, the Board discussed some of the potential pitfalls of this approach and that many patients will need support to determine the most appropriate referral pathway for them.
· Telephony systems – it was reported that 54% of Leeds practices are already on cloud-based telephony with a further 12 practices identified as part of the next transition.
· Continuing to improve access and experience of general practice – it was highlighted that the national and local media would often paint a negative picture of general practice despite more appointments being made than ever before, alongside an increasing number of ways to access those appointments. However, there was also a consensus view that the system does still require much improvement, which includes the need to address staff burnout. It was reported that the ICB continues to seek and hear the views of people using general practice services in order to use this insight to help shape approaches and plans in improving the access and experience of general practice in the city.
The Chair thanked everyone for their valuable contribution to the Board’s discussion.
RESOLVED - That the report, along with Members comments and information requests, be noted.