Agenda item

25.1     The Committee received a report which provided an update on access to Primary Care services in East Sussex, including GP appointments and surgeries, and access to NHS Dentistry.

25.2     The Committee asked what is going to change to increase access to regular NHS Dentistry appointments.

25.3     Amy Galea, Chief Primary Care Officer NHS Sussex, outlined that there two elements in the report that address this question. One is the number of units of NHS Dentistry activity commissioned across East Sussex and the other is an increase units of activity post pandemic at two dental practices, one in Hastings and the other in St. Leonards who have capacity to offer more NHS appointments. In the longer term the hope is that the reforms announced by Government will increase access. NHS Sussex is also exploring with dental practices what flexibility there is locally across East Sussex to increase access and what NHS Sussex can do to support this. NHS Dentistry has previously been commissioned through a national contract before it was delegated to NHS Sussex and NHS Sussex is working with colleagues in NHS England to see what can be done to improve access. NHS Dentistry is facing some of the same workforce challenges and pressures that the rest of the NHS is facing.

25.4     In terms of access to GP appointments, the Committee asked if online booking and e-consult services are widely available across East Sussex.

25.5     Amy Galea responded that although GP appointment levels are at the same level or higher than before the pandemic, there is some variability across East Sussex in the offer from GP practices and the tools they use. Although online booking and e-consult can be incredibly helpful, some practices have taken the decision not to use them and ‘switch them off’. All practices across East Sussex have the ability to use these facilities and NHS Sussex is trying to ensure that all GP practices are offering them to their patients by the end of January 2023. NHS Sussex is working with practices to improve the publicity of these facilities by including information on their web sites and include them within the literature and leaflets they give out within their practices. The other way of accessing GP services is through the NHS App and around 60% of people in East Sussex are using the app, which allows you to book an appointment at your GP practice.

25.6     The Committee asked if booking GP appointments by telephone will be restricted to particular times (e.g. 8.00am to 9.00am as some practices do) or will can people ring anytime.

25.7     Amy Galea outlined that NHS Sussex is aware that some practices only make e-consult available at some times of the day and are trying to make sure this additional functionality is available at all times of the day. The reason for this is that practices need time to think through how they are going to manage the different forms of access and communication channels with the resources they have available. Practices may need time to change their operating model and ensure all the systems are talking to one another so they do not exceed their capacity to respond to all the requests. In terms of telephone bookings all practices will have access to the cloud telephone service described in the report by the end of January 2023. This has the facility to tell people where they are in the call queue and allows them to request someone calls them back rather than waiting in the queue. The system also provides information on the number of abandoned calls so practices can monitor this.

25.8     The Committee welcomed the allocation of additional funding to support GP practices over winter period and asked how many bids had been approved and if NHS Sussex could give some examples of the types of bids.

25.9     Amy Galea outlined that the funding to increase GP capacity had been ring-fenced from existing funding and conversations about its use are taking place. At present around one third of the additional funding has been allocated in Sussex, and panel meetings to allocate funds are being held daily rather then weekly to speed up the process. There have been around 80 bids so far and the type of bids that have been received have been to increase staffing capacity and to extend opening hours during the evening and at weekends.

25.10   The Committee asked if GPs could refer patients to different provider Trusts.

25.11   Amy Galea responded that GPs have autonomy to refer to different NHS services and other organisations, but sometimes there are issues with certain pathways. NHS Sussex is discussing these pathways and reviewing muscular skeletal services in East Sussex.

25.12   Joe Chadwick-Bell added that all referrals for assessment services are usually to the local Trust. Once investigations have been done patients can be referred to different secondary care providers. GPs can also refer to emergency pathways (e.g. for spinal compression). It was clarified that patient choice comes in when patients are referred into secondary care and where there is a choice of service provider.

25.13   The Committee asked if it was possible to make GP practices take up the phone service and highlighted the estates pressure on buildings where larger practices may be needed in areas where the population is growing (e.g. Seaford).

25.14   Amy Galea acknowledged the estates constraints in Seaford and NHS Sussex is taking short term measures to provide additional space for administration functions in a former pub building. NHS Sussex is pursuing new developments with GP practices and partners in health and local government. NHS Sussex does have the ability to encourage practices to take up the new telephone facilities and is working with practices to help them with their thinking around the new channels of communication and how this can improve workflow for them. Practices have seen a spike in call volumes over the last three weeks due to Strep A infections and 1,000 calls a day is not uncommon. Amy Galea agreed to follow up engagement with Lewes District Council after the meeting, who may be able to offer a site to help address estates constraints in Seaford.

25.15   The Committee asked how GP referrals to community Pharmacist consultation services would work given the pressures with large telephone call volumes.

25.16   Amy Galea outlined that there are several referral routes for community Pharmacists services including through NHS111 and direct self-referral.

Healthwatch East Sussex

25.17 John Routledge, Healthwatch East Sussex, gave an overview of the work Healthwatch has undertaken over the last two years on access to GPs and NHS Dentistry. Access to GPs and dentistry are the top two enquiries that Healthwatch receives and in public feedback. For dentistry, once people are able to get through and are registered with a dentist, they are generally happy with the service. However, there does not appear to be a plan for how to address dentist shortages locally.

25.18   For GP services it is about getting through to GP practices to book an appointment. In regard to new telephone services and digital access, it would appear that GP practices do not share learning about implementing new telephone systems and some practices have closed e-consult services. Many people are happy to have telephone or video consultations, but there are some situations where a face to face appointment is needed. With the digital divide becoming wider it is important to ensure people can still access services. As appointments become shorter it may be leading to more appointments being made overall as issues are not resolved first time. People will also access A&E services because they are open and easy to access.

25.19   Simon Kiley, Healthwatch East Sussex outlined the issues relating to NHS Dentistry. Access to NHS Dentistry was problematic pre-pandemic but the pandemic has shone a light on the issue. The shortages in the supply of a skilled workforce coupled with an increase in demand post pandemic has caused particular problems for access. The top question Healthwatch gets asked locally, regionally, and nationally is “how do I get an NHS dentist?”. This is not an issue specific to East Sussex and there may be some learning nationally that can be gained to solve the problem.

25.20   People are not only concerned about getting access to urgent and emergency care, but also routine and preventative care. There seems to be particular issues for children and young people and children in care accessing dental care, orthodontic work and denture maintenance services. Where people are unable to get an appointment with an NHS dentist there are examples of people accessing other services to get dental care such as going to Emergency Departments or having to use private services. The cost of living crisis has also affected people’s ability to pay for dental care. The recent change in commissioning responsibilities provides an opportunity to positively look at these issues.

25.21   The Committee asked if there are any dental practices in Eastbourne taking on NHS patients and can NHS Sussex expand the number of hours like in Hastings and St. Leonards.

25.22   Charlotte Keeble, NHS Sussex outlined that the offer of additional hours has be extended to all dental practices where they have the capacity to safely expand services. So far the uptake has been limited to an additional 14 hours in Hastings and 7 hours in St. Leonards. Some dental outreach services are being provided via Dent Aid to people in the homeless and other communities. There are some procurements in progress, but these are mainly in West Sussex. The main constraint on increasing capacity is the limited workforce.

25.23   Nick Hanmore, NHS England explained that the planned improvements in services may help people not just where they live, but by increasing capacity overall (e.g. this may reduce people travelling to other areas in order to get treatment). The dental system reforms that are already taking place will also have some impact. For example, being able to reduce the frequency of routine check-up appointments in line with patient needs may increase capacity, as well as looking at the staff mix in dental practices. There are also a number of other initiatives on the horizon.

25.24 Amy Galea added that changes need to be made to make NHS Dentistry an attractive proposition for dentists and NHS Sussex is having conversations with dentists locally to see what more can be done.

25.25   The Committee noted that the report outlines the challenges for NHS Dentistry and asked if there is enough capacity to meet demand (NHS and private) or is it an issue about meeting demand for NHS Dentistry.

25.26   Amy Galea outlined that an understanding of need comes from the Public Health work on the oral health needs of the population and further work is planned over the next twelve months. This will explore the public/private dentistry mix and capacity as well as issues such as deprivation.

25.27   The Committee asked if it is just an issue of lack of capacity and appointments, and whether there is a way the NHS could directly provide GP and Dentistry services in order to have more control over them.

25.28   Amy Galea responded that the fact that GP and dental practices are independent businesses means they have a clear stake in being engaged and efficient in providing services. There are things that commissioners can do to make practices work in way to meet patient needs through commissioning. There are models and pilots to bring GP services into direct NHS control. In Scotland there is an initiative to convert GP practices to directly provided services by buying them out.

25.29   The Committee commented that the suggested solutions did not appear to be solving the problems and that something major may need to be done.

25.30   Amy Galea outlined that workforce supply is a key issue and this is being tackled nationally. The media coverage is not helping staff morale or the recruitment and retention of GPs, and there has been an increased turnover of practice managers locally.

25.31   The Chair commented that the Committee may need to look at dentistry in more detail to examine the issues and there may be a transfer of private to NHS patients if NHS Dentistry capacity increases.

25.32   The Committee RESOLVED to:

1)         Note the report outlining the updated position regarding access to Primary Care in East Sussex, including access to GPs and NHS Dentistry; and

2)         Agree to add a report on access to NHS Dentistry to the Committee’s work programme in 2023 and receive further update report an access to GP services in 2023.