Agenda item

16.1     The Committee considered a report on Primary Care Networks (PCNs), which are groups of GP practices in East Sussex, following on from a report the Committee considered in March. There are twelve PCNs in East Sussex which include all GP practices, with the largest covering around 100,000 registered patients and the smallest covering around 28,000 patients.

16.2     The Committee asked what progress had been made in the recruitment of mental health clinicians and support staff, and the development of Emotional Wellbeing Services in Eastbourne.

16.3     Liz Davis, NHS Sussex Director of Primary Care, answered that some initiatives were locally led and PCNs were not specifically contracted to provide mental health services. PCNs were expected to work with local partners and stakeholders to develop appropriate mental health pathways and services. There was a primary care workforce hub that was working with all PCNs in East Sussex to encourage uptake of additional mental health staff under the Additional Roles Reimbursement Scheme (ARRS). Jessica Britton, NHS Sussex Executive Managing Director, East Sussex, added that the staff to support the Emotional Wellbeing Services were being trained through the ARRS and developed in partnership with Sussex Partnership Foundation Trust (SPFT), with the intention of introducing those services across all GP practices in East Sussex. The intention was for 90% of practices in Sussex to offer Emotional Wellbeing Services by the end of the financial year. Jessica agreed to provide further details on the rollout of these services in Eastbourne outside of the meeting.

16.4     The Committee asked how mental health ARRS staff connected to other local support services such as youth services and mental health support teams (MHSTs) in schools.

16.5     Jessica Britton answered that across Sussex there was the Mental Health Community Transformation Programme which took a strategic approach to expand the mental health support offer within communities, which included linking between MHSTs and access to talking therapies. As part of the Community Transformation Programme there was ongoing work in East Sussex to identify the totality of services that were available in a given locality to further join up support more comprehensively. Both physical and mental health support would be enhanced further around neighbourhoods in coming months and into next year as Integrated Community Teams were developed, and this would include links between schools and young people’s services that would improve integration between services.

16.6     The Committee asked whether any talking therapies would be delivered by non-clinical staff.

16.7     Jessica Britton confirmed that talking therapies would be delivered by trained mental health practitioners. The Emotional Wellbeing Services was a partnership with SPFT to oversee trained clinical professionals, but also a wider support from non-trained staff and voluntary and community sector to provide a more comprehensive offer. People would always be referred to the right service for them which offered support relative to their need.

16.8     The Committee asked about access to GPs where PCNs covered a large geographical footprint, noting that residents were being offered GP appointments in places far from where there lived and which had few public transport routes available.

16.9     Liz Davis confirmed that PCNs were an amalgamation of local groups of GP practices, and they had the autonomy to design their services based on their populations’ needs. While PCNs aimed to work together at scale offering Enhanced Access (EA) services across their practices to provide resilience to general practice, the PCN contract does not stipulate where Enhanced Hours services should be held, such that EA services may operate from only one site and not at all practices in the PCN. The Integrated Care Board (ICB) was working closely with all PCNs across Sussex to drive increased access and understand what barriers there are to why patients cannot always be seen at certain locations. A System Level Access Plan was being developed to tackle issues with access across Sussex, which would be published in late January 2024. Liz offered to bring a report on this to a future HOSC meeting.

16.10   Cllr Mike Turner raised a long-running estates issue of there being a lack of GP surgery in Baird ward in Hastings, and asked how the ICB were addressing the situation.

16.11   Liz Davis confirmed that she was happy to discuss that particular issue outside of the meeting. She also confirmed that the ICB were running a programme called the Clinical Estates Toolkit Strategy which was available to all PCNs to support them with estates issues. This programme was due to end in the next few months, and a full evaluation of the programme would take place to identify necessary actions to address estates issues across the system.

6.12     Cllr Turner noted that a temporary structure on the land to increase access in the interim would help.

16.13   The Committee asked whether patient choice still existed for GP referrals  as set out in the Patient Charter.

16.14   Jessica Britton confirmed that GPs did discuss with patients their right to choose and that remained a right for patients.

16.15   The Committee asked for more detail on which and how many of each ARRS roles available to PCNs had been taken up, and how they were distributed across PCNs.

16.16   Liz Davis confirmed that each PCN had agreed set of collective terms and conditions which set out how they intended to use their ARRS and where they would be based. From a contractual standpoint, the ICB could not mandate how PCNs utilised and operationalised their ARRS staff. There was work currently taking place to develop a primary care workforce strategy and a report on this could be brought to a future HOSC meeting.

16.17   The Committee asked what work was going on to increase GP recruitment.

16.18   Liz Davis answered that the ICB run a number of programmes to increase GP recruitment across the system, including programmes to bring in and help develop newly qualified GPs and nurses. PCN education leads worked with PCNs to provide education on how they can promote patient care and resilience through ARRS roles to make best use of GP resources, and Liz offered to bring a further report on plans to increase GP recruitment if requested.

16.19   Cllr Abul Azad highlighted difficulty for patients in accessing GP appointments in his division, and asked for more information on the roll out of the out of hours service.

16.20   Liz Davis answered that PCNs were contracted to provide enhanced access service which offered appointments on weekday evenings between 18:30 – 20:00 and Saturdays from 09:00 – 17:00. The ICB would investigate if PCNs were not offering these services and Liz offered to have a discussion on the issue with Cllr Azad outside of the meeting.

16.21 The Committee asked for clarification and confirmation on whether all GP practices should be offering enhanced hours services, and when GPs on the New To Practice programme would be fully operational, and how many more GPs were needed in East Sussex.

16.22   Liz Davis confirmed that every PCN, regardless of how many practices it had, was contractually obliged to provide the enhanced access service. However, this did not mean that it had to be offered at every GP practice within the PCN. As part of their Mandatory Network Agreement, each PCN had to set out where their enhanced access services are operated from. Liz offered to bring a report on how each individual PCN offered the service together with GP and ARRS workforce information if requested. The Chair responded that report for information providing this information would be helpful, and Jessica Britton agreed to coordinate such a report on an appropriate timeframe.

16.23   The Committee asked whether the use of digital platforms, such as Livi, could be used to provide greater access to GP appointments.

16.24   Liz Davis answered that there were programmes to increase online access and that a System Level Access Plan would be published in November 2023, part of which would include plans to encourage PCNs to provide digital alternatives. Individual PCNs had the choice of whether to adopt specific digital capabilities, however the ICB did not commission all of these services across the system at present.

16.25   The Committee asked how soon all GP practices in East Sussex would be accredited as Veteran Friendly.     

16.26   Jessica Britton agreed to provide this information outside of the meeting.

16.27   The Committee asked for more information on work PCNs were doing on health inequalities and what the expected long-term impact of this work was.

16.28   Liz Davis answered that PCNs were contractually obliged to support tackling neighbourhood health inequalities, and all PCNs were engaged in projects focused on the CORE20. The majority of PCNs in East Sussex were working on projects to tackle serious mental illnesses in particular age groups and cohorts, and other key areas for some PCNs were learning disabilities, hypertension, vaccination inequalities. The new Integrated Community Teams (ICTs) would be a key mechanism to longer-term work on health inequalities, as they would work with PCNs, health and social care authorities and VCSEs to deliver for the health needs of defined populations. Work with Public Health authorities was underway to develop population level health profiles, and there would be 5 ICTs across East Sussex, which would use all available data to better understand and tackle health inequalities at a more localised level.

16.29   Cllr Mike Turner asked for reassurance that funding from the former Clinical Commissioning Group for health inequalities in Hastings would be ringfenced for that area.

16.30   Jessica Britton confirmed she was happy to have a discussion on this with Cllr Turner outside of the meeting.

16.31   The Committee RESOLVED to:

1) note the report; and

2) request a future update report on PCNs to come a future meeting.