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Agenda item

Access to GPs and the Impact of Covid-19 on Primary Care

Purpose: The Berkshire West Clinical Commissioning Group to provide a presentation on patient access to GPs and the impact of the Covid-19 pandemic on primary care.

Minutes:

Katie Summers was invited to give a presentation on Access to GPs (Agenda Item 8). It was noted that the report had already been presented to Health and Wellbeing Board. Key points from the presentation were as follows:

·         Due to pressures in Primary Care, the CCG had been unable to get a GP to attend the meeting.

·         Around 50% of appointments were being carried out face-to-face, which was the preferred format for GPs.

·         Most practices had moved to a hybrid model, with telephone / video consultations used to triage patients and identify those who needed a face-to-face appointment.

·         Demand for appointments had increased considerably compared with the pre-Covid situation.

·         Many people had experienced delays in elective appointments, so there was a backlog of re-referrals to secondary care services.

·         Across Berkshire West, there had been a 76% increase in consultation activity, while some Primary Care Networks had experienced increases of up to 155%.

·         Face-to-face / telephone consultations had increased in some PCNs and decreased in others, but overall, there had been a 5% increase.

·         Each GP surgery recorded its activity slightly differently, but NHS England had recently established the General Practice Data Audit, which set out standard parameters for recording all GP activity.

·         Responding to online requests was a big challenge for most GP practices.

·         Face-to-face consultations were taking longer due to Covid infection control measures (14-16 minutes vs 8-10 minutes pre-Covid).

·         Housebound patients / those with transport difficulties had better access to GPs than before, which was a benefit of the new hybrid model.

·         The Respiratory Hub arrangements had been stepped down, with all patients managed within practices – patients were given pulse oximeters to monitor the oxygen in their blood.

·         There was a local campaign to inform patients about when to contact their GP or when to call 111 or 999.

·         Plans were underway for the next phase of the Covid vaccination programme.

·         A workshop had been held in May to agree remedial actions for primary care – a key outcome was that the CCG had commissioned 170 additional appointments per day to increase capacity up to March 2022.

·         The Government had launched a new Winter Access Fund for General Practice, with £74 million allocated to Buckinghamshire, Oxfordshire and Berkshire West.

·         Workforce challenges remained – there had been a 6.8% reduction in the number of salaried GPs in the 5 years to March 2021.

·         Efforts were being made to promote General Practice as a career for new doctors.

·         The Additional Roles Reimbursement Scheme was being used to create multi-disciplinary teams to support GPs (e.g. paramedics, pharmacists, mental health specialists, nurses and care navigators).

The Chairman asked if additional roles were being used to support GPs across all GP surgeries in West Berkshire. Katie Summers explained that the clinical director and partners for each Primary Care Network (PCN) made decisions about staffing. In some cases staff would be shared across surgeries within a PCN, while in other cases each surgery might have a dedicated resource.

Councillor Alan Macro expressed concern about the emphasis on non-face-to-face consultations and suggested that GPs could tell a lot about a patient by their demeanour and how they were walking. Also, telephone conversations did not allow GPs to observe body language to confirm patients’ understanding of what they were being told. He highlighted potential issues with online consultations for patients with hearing difficulties, people without technology, poor broadband, etc. He also suggested that phone consultations were not saving time for patients who then had to book a face-to-face consultation. Katie Summers agreed about the points in relation to body language. However, GPs had received special training to listen for particular clues. She noted that the triage system was still ‘work in progress’ and that triage calls would not be appropriate for high-risk individuals with long-term conditions. She stressed that the focus was on quality of care and safety. She noted that most practices had a hearing loop system and all practices were able to automatically flag individuals with hearing difficulties.

Councillor Tony Linden raised issues around: training for receptionists; emails not being seen by GPs prior to making calls to a patient; defined time slots for a calls to avoid patients having to wait around needlessly; and ensuring that the appropriate communications tool was used for each patient (e.g. elderly patients may only have a landline). Katie Summers noted that there was a digital inclusion programme being run with Age UK aimed at patients aged 65+, providing iPads and training. She noted that patients could use Footfall to leave messages for GPs via their websites and responses were generally provided within two hours.

Cllr Linden He also indicated that he had sent a picture to his practice to clarify a previous discussion, but it had been sent to a different doctor and he had been forced to start the consultation afresh. He also observed that some people under the age of 65 had issues with IT.

Action: Katie Summers undertook to try and resolve any email issues with Cllr Linden outside the meeting.

The Chairman agreed about the need for time slots for telephone calls rather than having patients waiting for a whole morning. She also asked if enough was being done to communicate with the public and what the Committee / Council could do to help. Katie Summers agreed that Members could help to disseminate messages about the pressures and demands on GPs, and use the poster that the CCG had produced when talking to constituents. She also offered to discuss the issue of timed slots for calls with colleagues and get an audit of waiting times.

Action: Katie Summers to review the potential for timed slots for telephone calls and to undertake an audit of waiting times.

Councillor Andy Moore asked to what extent individual practices were developing their own hybrid models and whether there were any plans to achieve a consistent approach and to communicate to the public which aspect of the new approach they would be likely to encounter in particular situations. Katie Summers noted that there were 13 GP practices which were independent businesses, but there were 4 PCNs and each had a memorandum of understanding about the business models to be used. Also, the PCNs were sharing information across Berkshire West, which would help to work towards a standardised model. However, she noted that some flexibility was needed to tailor the approach to the local population.

The Chairman asked what was being done to support the mental health needs of health professionals during this challenging time. Also, she asked what the Committee could do to help. Katie Summers noted that there were national initiatives such as advice lines, counselling and support. She suggested that Members could help by promoting the poster to patients. She indicated that she would provide contact details for practice managers to allow Members to direct complaints for them to respond.

Action: Katie Summers to provide Health Scrutiny Committee Members with details of Practice Managers in West Berkshire.

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