Agenda item

Purpose: To present North and West Reading CCG’s Primary Care Strategy to the Board and to provide an update on Newbury and District CCG’s Primary Care Strategy.

(Councillor Mollie Lock joined the meeting at 9.25am)

Cathy Winfield introduced the report (Agenda Item 9) which presented the Berkshire West Primary Care Strategy for 2015-2019.

An engagement report would also be published which would describe how the strategy had been informed by extensive discussion with patients through public meetings, dissemination of information about its vision and an 18 week online consultation.

The Clinical Commissioning Groups (CCGs) also wanted to highlight that they had applied to move to a fully delegated co-commissioning arrangement with effect from 1st April 2016. It was believed that this would have a positive impact on the development of local primary care services, and put CCGs in a stronger position to implement the vision described in the strategy.

The Berkshire West CCGs’ 5 Year Strategic Plan described how, by 2019, enhanced primary, community and social care services in Berkshire West would work together to prevent ill-health within the local populations and support patients with complex needs to receive the care they needed in the community, only being admitted to hospital where this was absolutely necessary.

There was an emerging consensus locally that a clinically and financially sustainable health economy could best be delivered through the creation of an Accountable Care System (ACS), ultimately functioning on the basis of a place-based capitated budget incorporating all aspects of healthcare including primary medical services with providers and commissioners jointly incentivised to deliver specified outcomes in a cost-effective way.

The strategic context mirrored the national picture, essentially being an ageing population and an increase in consultation rates.

Other key pressures related to General Practitioner (GP) recruitment and retention. Although training places were full, Primary Care was struggling to retain GPs as they increasingly applied to work abroad or move to a part of the country where living cots were lower. There were also trends for increased part-time working among female members of staff and trainees, in addition to an ageing workforce who would be reaching retirement age in five to ten years.

Patients had been consulted on their views and they had contributed that they would welcome online services and would like Saturday morning appointments.

The strategic objectives were to address pressures in the system, work with specialists usually in the secondary sector (such as with diabetes), taking a more preventative role, using technology to allow information sharing and mobile working and finally, consistently referring to other services where required.

Angus Tallini echoed the positive approach to resolving some of the issues that had been identified and outlined four strands of action being taken locally.

(Rachael Wardell joined the meeting at 9.32am)

Firstly, motivated patients with long-term health conditions would be enabled to mange their own care. Patients with such conditions often had a better understanding of their needs than their GP so lessons would be learnt from the approach to diabetes and ownership of care would be shifted onto patients. The result would be that GPs had more time for undiagnosed and acute issues.

Secondly, a wider workforce would be developed to support primary care staff. It had been identified that other healthcare professionals were not utilised as much as they could be .For example, a pilot had been undertaken where a pharmacist had been utilised in a GP surgery to handle enquiries about medication, explain side effects and monitor those on high risk medications. It was also thought that physiotherapists could be integrated into the practice.

Thirdly, collaboration among smaller clusters of practices would link into the Accountable Care System.

Finally, a Training Hub was proposed to Health Education England to address local recruitment and retention problems across many areas of health care. A new Healthcare Coordinator Level 3 NVQ would be developed to ensure clerical staff had organisational and healthcare knowledge. Steps would also need to be taken to raise the profile of the area.

Councillor Jones thanked Cathy Winfield and Angus Tallini for clear data presentation in the report. He agreed that for too long there had been an emphasis on giving care but not explaining care. Councillor Jones added that he would be pleased to see the involvement of the pharmacist in a GP practice be developed and welcomed the proposals regarding the training hub.

Councillor Cole advised that she would like to see West Berkshire’s social work academies be involved in the training hub as social workers had a role in healthcare and she would not want to see duplication. She added that the CCGs should engage with the Director of Communities to see whether there was any synergy between the two and whether economies of scale could be achieved.

Councillor Cole expressed the view that the proposed Level 3 NVQ should include an element of customer care because patients expected a level of service and in order to get patients out of the habit of seeing their GP, that service had to be consistently high across the practice.

Additionally, Councillor Cole asked if there was any scope to contractually oblige GPs to remain in service for a period of time following the completion of their training. Cathy Winfield advised that Health Education England funded the training so such a requirement would not be legally enforceable. Dr Barbara Barrie commented that there was a national problem of second and third year doctors leaving the NHS, with 600 applications per week to work abroad, although she noted that this was in part due to the national debate regarding junior doctors’ contracts. Dr Bal Bahia observed that in order to achieve a happy and motivated workforce, there needed to be incentive rather than deterrent. Lise Llewellyn concurred that doctors were trained under a national process and budget and they could not be ‘tied in’ under Human Resources law.

Andrew Sharp noted that the workforce retention issue was reminiscent of the teacher recruitment and retention problem, and asked whether giving doctors key worker status might assist with their costs of living. He also outlined that the communication to the public of the different way of work would need to be clear as they might not understand the role, for example, or the pharmacist other than dispensing medication. Councillor Lynne Doherty agreed that a communications exercise on the integration of health and social care would be required to support the strategy.

Cathy Winfield informed the Board that while face-to-face communication would be the richest way to communicate the message, a short film was in production which would include interviews with different healthcare professionals explaining their roles. Councillor Doherty proposed that these films be played in GP surgeries.

Dr Bahia expressed his excitement in the idea of a training hub which extended to back office roles because it would enrich understanding of the roles of other healthcare professionals.

Dr Barrie offered a perspective from the North and West Reading CCG. She reported that there were similar problems with training and recruitment, drawing particular attention to Physician’s Assistants which was not well funded and required a large time commitment. There had been successful programmes such as the Living Well project and Beat the Street which has achieved positive outcomes including sustained levels of exercise. There was a concern that many GPs would be retiring over the next five to ten years so alongside measures to persuade them to keep working, GP surgeries would be asked to alert the Lead Commissioner in order for remedial action to be taken.

Dr Barrie continued that a GP in Reading had spent some time in Newcastle to gain an understanding of their new transformed care model which included patients receiving longer appointments. A generic model for care plans had been developed and the project had seen increased job satisfaction among GPs.

Rachael Wardell identified that a connection between this work and the frail and elderly pathway was essential in order to combat increasing consultation rates from the older population. 

RESOLVED that the report be noted.