Agenda item

7.1          The Committee considered a report providing an overview of access to GP surgeries and appointments following the Covid-19 pandemic, including the challenges Practices are facing in returning services to pre-Covid levels and changes in working practices.

7.2          The Committee asked when the number of available appointments will recover to pre-pandemic levels.

7.3          Amy Galea explained that the data showed the number of available appointments has now returned to pre-pandemic levels. What has changed, however, is that individual practices are now operating virtual appointments alongside face-to-face appointments. This has advantages to some parts of population, but others still prefer face to face appointments. The CCG is working with Practices to understand what the right balance and mix of appointments could be for their practice list, which varies from practice to practice due to the demographic makeup of their lists.

7.4          Amy Galea added that the CCG is trying to understand the reasons why people are making GP appointments. The data shows half the appointments patients make are for the same day they contact the GP practice. This suggests there is unmet demand, if half the patients have to wait longer. It is also necessary to understand whether people who have a same day appointment need to have it on the same day, or whether it is less urgent. The healthcare needs of callers are being assessed as part of a piece of work being undertaken with some practices in Sussex. In addition, the CCG is working with ESHT to understand why some people are using the ED on the same day they have a GP appointment later in the day.

7.5          In addition to this work, Amy Galea said a pilot has begun in Brighton & Hove involving a team of healthcare workers either going to people’s homes or locations like a town hall to offer primary care services. This is designed to benefit people who may not want or be able to access a GP practice. If successful, it may be rolled out across Sussex.

7.6          The Committee asked for clarification how the needs of the 50% of patients who do not receive a same day appointment can be served.

7.7          Amy Galea clarified that whilst half of patients who call the practices are not getting a same day appointment, it is not necessarily the case that they all wanted to have one that day. Similarly, patients who did receive a same day appointment may not have needed one but were able to get through and book one. Furthermore, not all practices have the facility to book patients ahead and require patients to call up each day until they get an appointment for that day, which is unproductive for both the individual and practice.

7.8          Amy Galea said there is currently no way of measuring the telephony systems to understand in a systemic way why people requested an appointment on the day and whether the reason they did was appropriate or not.  The CCGs are working to understand these issues across the 161 practices in Sussex and will produce a multi-year improvement strategy called “Next Steps on Integrating Primary Care” that will be agreed by the successor organisation, NHS Sussex, in September. Amy Galea added that the CCGs are already working with those GP practices that are known to have acute issues with same day appointments and their service offer generally and these will be resolved quicker than less acute practices. The Executive Director of Primary Care clarified that four of these are in East Sussex.

7.9          The Committee asked how people who are hard of hearing can receive virtual appointments, for example through Teams using subtitles, when practices only offer over the phone or face-to-face appointments.

7.10       Amy Galea said the technology does exist to provide this service and some practices do offer it. The CCG is focussed on reducing the variation of the virtual offer available to patients that exists across practices. This includes establishing the eHub that offers video call facilities to GP practices that sign up to it. The CCG is also working with Healthwatch on how the service offer could be more sensitive to people with differing needs, such as the neuro-diverse and hard of hearing, and those who struggle with using technology.

7.11       The Committee asked whether there are alternatives to booking appointments over the phone, for example, online bookings.

7.12       Amy Galea said the work to improve the virtual offer to patients includes exploring the more widespread use of online booking, which currently does not happen across all practices in Sussex and forms part of the eHub offer.

7.13       The Committee asked whether continuity of care with the same GP could be improved.

7.14       Amy Galea explained that continuity of care needs to be considered within the context of the increasing number of patients with complex needs and the development of the GP workforce into multi-disciplinary teams of healthcare professionals. This means patients will no longer solely rely on seeing a GP and will instead increasingly being seen by the right kind of healthcare professional based on their need, for example, seeing mental health practitioners when presenting with anxiety or depression. This is not just because lack of growth of GP numbers, but also in recognition that the type and complexity of cases coming to GP practices could be better served by other parts of the GP team.

7.15       The Committee asked for more details of the eHubs, including where they were situated, how they were staffed, why take up was not at 100%, how GP practices would be made to sign up to it, and how GP practices would advertise them to patients.

7.16       Amy Galea explained eHubs work across a cluster of GP practices within a geographic area. The eHub integrates the back office functions of these practices virtually to provide a unified offer for patients, so that they are able to call up or book online using the eHub systems rather than the ad hoc systems used by the individual practices. The eHubs will require an additional new workforce to staff. They have been adopted by 30 practices in East Sussex rather than the whole of the county in order to pilot different ways of running them over the next six months.  Once the data from this period has been collected and reviewed, they should be rolled out across Sussex during the next financial year 23/24. From the perspective of patients, eHubs will result in better opportunities to book online and carry out video consultations; whilst for GP practices, it will enable them to manage demand on any single day in a different and more robust way.

7.17       Amy Galea said the CCG cannot require GP practices to adopt video consultations or online bookings, however, some may not offer these services as they have not recognised the benefits they have delivered elsewhere – both to patients and to the practices themselves – for example, they may not recognise that the online and telephone lists are not separate lists of patients that require further resources to meet the needs of, but are the same list trying to access services in different ways and offering both can increase the practice’s capacity.

7.18       The Committee asked where GP practices are offering screening services such as Health Checks again, and whether eHubs might benefit health checks.

7.19       Amy Galea explained that in order to meet the demands of the pandemic, deliver virtual appointments and then deliver the vaccine programme, national guidance required GP practices to deprioritise routine health checks.  GP practices are now restoring health checks using national incentives and they should be back to pre-COVID-19 activity levels soon. As part of the future work around Primary Care Networks (PCNs), NHS Sussex will expand on the work some practices – such as the Hastings PCN – have done with Public Health Teams and the voluntary and community sector to offer more comprehensive, early health checks, such as monitoring different vital statistics in people who might be at risk of developing conditions later in life.

7.20       The Executive Director of Primary Care said it is hoped the eHubs will improve all services, as it is a way of better managing the demand a practice receives on any single day and allows the practice to plan for activities in a more managed way.

7.21       The Committee asked what the effect recruiting additional roles such as paramedics has on other areas of healthcare, particularly the ambulance trusts.

7.22       Amy Galea agreed there is a risk that creating new roles moves people around the NHS without increasing workforce numbers. In response, once established, NHS Sussex will review the workforce across the whole of Sussex to help ensure that when one area puts in place an initiative such as this it does not move healthcare workers away from another area and put it at risk.

7.23       The Committee asked what reasonable adjustments would be made for people who struggle with technology to access online or video consultations.

7.24       Amy Galea agreed a one size fits all approach to accessing GP practices will not work and that GP practices will need to have an offer that responds to different people’s needs and preferences, however, this offer needs to be realistic and deliver a service that meets these different needs whilst operating within the resource restrictions that are in place.

7.25       The Committee asked what could be done to reduce the length of time people spend on the phone.

7.26       Amy Galea agreed waiting on the phone is a frustrating process and GP practices need to be sensitive to the concerns people have about waiting. It is, however, a common phenomenon in many industries where people often make contact via phone. In GP practices it is also often due in part to the limitations of the software package they purchased to handle calls.

7.27       The Committee asked whether the start time of 8am could be amended particularly help single parents, and whether any feedback from these groups has been sought.

7.28       Amy Galea said the CCG regularly uses feedback from communities to help shape its work. The Next Steps on Integrating Primary Care strategy will set out how NHS Sussex plans to help improve the 8am call up process and improve the offer to patients generally, including those such as single parents who work parttime or fulltime and may struggle to call at 8am.

7.29       The Committee RESOLVED to:

36.          1) agree to consider a future report on primary care access at the 15^th December meeting; and

2) agree to consider the Next Steps on Integrating Primary Care strategy at the 15^th December meeting.