Agenda item

15.1     The Committee considered a report on primary care services and access to General Practice across the county, following on from a report on Primary Care Networks (PCN) the Committee had considered in September 2023. The report covered a number of areas that the Committee had previously asked about when it had considered earlier reports.

15.2     The Committee asked what the average wait time was for patients to have a GP appointment.

15.3     Garry Money, Director of Primary Care Commissioning and Transformation, noted that at 5.3 in the paper there were average figures for waiting times. The NHS only monitored the number of appointments booked on the same day and the number of appointments given within two weeks. Currently just under 80% of patients in East Sussex who tried to book a GP appointment got one within 2 weeks, which was a couple of percentage points below the England average. Some GP practices’ ways of working skewed these figures slightly, such as by booking recurring appointments for long term conditions in advance, which gave the impression that a patient was waiting much longer than the 2-week target. NHS Sussex was working to address issues of variation between individual practices, to identify where GPs had issues that they needed support to reduce waiting times.

15.4     The Committee noted that workforce absences in East Sussex due to mental health problems was double the national average and asked how access to the Emotional Wellbeing Service would be improved.

15.5     Garry Money explained that NHS Sussex was working closely with Sussex Partnership Foundation Trust (SPFT) and with High Weald and Seaford PCNs to provide the Emotional Wellbeing Support Service in all PCNs in the county. This included exploring how to fund it and simplify employment arrangements. Garry agreed to provide the Committee with an update on the service in these two PCNs, as well as data on current performance, activity and impact of the service broken down by other areas.

15.6     The Committee noted that in some cases GP appointments available to book online were much further in the future than those available to book on the phone, and asked if this was a common issue.

15.7     Garry Money accepted that there was variation between practices in this issue, and that often appointments offered online were with a nurse rather than GP. Different practices varied in how they used online consultation systems, sometimes turning them off in the morning once capacity had been reached. There were other known communication issues and NHS Sussex was working to reduce the level of variation between practices. There was a programme of unwarranted variation quality improvements that it would be possible to provide an update on the next time the issue was discussed by the Committee.

15.8     The Committee commented that patients had a right to choose when being referred to secondary care by GPs and asked how the NHS ensured this right was being upheld.

15.9     Garry Money commented that GPs worked according to clinical pathways, and that when they referred patients to specific specialist services, patients should be offered the right to choose which hospital they were referred to. Some services were intermediary, sitting between GP practices and hospitals, such as musculoskeletal, and were a triaging service. If intermediary services then offered a referral to secondary care, then they should also offer the patient choice about where they were referred to. He added monitoring of GPs offering patient choice was done by sample as there was no data monitoring of it. GPs had systems for comparing waiting times for services at different hospitals and this should be part of the conversation with the patient. Richard Milner, ESHT Chief of Staff, commented that ESHT was not forcing patients to particular services, but agreed to discuss the issue with colleagues outside of the meeting.

15.10   Some members of the Committee commented that they did not believe patient choice was being routinely offered in GP consultations. Garry Money noted the Committee’s concerns and agreed to follow up with any specific examples that members had outside of the meeting.

15.11   The Committee welcomed that Richmond Road car park in Seaford was being considered for estates developments, and asked what assessments were being undertaken and for a timeline update.

15.12   Garry Money explained that Value for Money assessments would be required as part of any development, and the NHS worked with local authorities on these assessments. He agreed to provide more detail on this specific development ahead of the next scheduled update.

15.13   The Committee commented that one GP (SDHC) operated across many PCN geographies asked why this practice was not able to provide the Emotional Wellbeing Service in all the PCNs it was part of.

15.14   Garry Money agreed to provide more information about the Emotional Wellbeing Service outside of the meeting. The first priority was provide an equivalent service as soon as possible in Seaford and High Weald that was available in the rest of the county. There were many more locations than the 50 GP practices listed, as some were collaborations of individual surgeries under a single provider. Where a provider was across many geographies then it would be providing in the PCN areas where the Emotional Wellbeing Service was currently in place.

15.15   The Committee asked what cloud-based telephony was.

15.16   Garry Money explained that cloud-based telephony was a means by which telephone calls could be securely answered without staff being present in a building. This reflected the pandemic where not all staff worked permanently in one place and meant that a GP could take a telephone consultation in a secure location that was not a surgery, increasing the number of phone lines available.

15.17   The Committee asked how it was possible to mitigate digital exclusion through training if people did not have digital devices.

15.18   Garry Money noted that digital inclusion included several different elements, so the report only covered a high-level update on some of the work involved in it. There was a general trend to have more of a ‘digital front door’ in general practice, so it would be more important to understand whether all patients trying to access healthcare were able to. He agreed to provide a more detailed update in a future report, as the ICB was doing a lot of work in the area of digital exclusion.

15.19   The Committee asked how many extended hours appointments were taken up at each individual practice.

15.20   Garry Money noted that for the whole of East Sussex 606 hours of enhanced access was provided per week, but did not have the did not attend (DNA) figure for the enhanced access sites. He agreed to explore whether that data was available and provide it to the Committee if possible, as well as a breakdown of the number of enhanced hours appointments available at each practice.

15.21   The Committee noted a recent news piece where a patient had died due to symptoms being missed despite having repeatedly being seen a physician associate, and asked whether physician associates had sufficient training.

15.22   Garry Money commented that he was not aware of the level of training required or what the clinical governance around the physician associate role were specifically, but was aware of the national news. NHS Sussex was positive about the role of physician associates and other ARRS roles and agreed to provide further detail on training outside of the meeting.

15.23   The Committee asked for further detail on the distribution of specific roles between PCNs under the Additional Roles Reimbursement Scheme (ARRS), and how PCNs were able to access funding for those roles.

15.24   Garry Money explained that all the ARRS roles were available to PCNs to choose from. Every PCN had a notional allocation of the national funding it would receive for the recruitment of ARRS roles, and there was then a bidding process to receive the funding. The role of NHS Sussex was to maximise the number of roles employed in the area based on its notional allocation, which it had to draw down from to receive. It engaged PCNs throughout the year to encourage and support the uptake of ARRS roles. Garry agreed to provide a breakdown of which PCNs recruited to which roles.

15.25   The Committee noted that some GP practices no longer offered online appointments which they did during the pandemic, and asked which surgeries offered online appointments currently, and whether NHS Sussex could encourage an increase in the number offering it.

15.26   Gary Money explained that GPs were contractually required to offer a live online consultation tool, and NHS Sussex followed up with surgeries where there were reports that this was not available. However, the GP contract did not specify at what hours these tools needed to be available, and there was a potential safety issue associated with online tools where the level of need being presented was not able to actively be met. NHS Sussex was actively exploring how to improve access to online consultation and reduce the level of variation seen across the county

15.27   The Committee asked where Pharmacy First services were available.

15.28   Gary Money explained that there was a paper on Pharmacy First going to a future meeting of the Integrated Care Board, and agreed to come back on the detail of which pharmacies were offering Pharmacy First services. There were seven specific pathways that allowed patients to avoid having to go through general practice for certain common issues. Where it was in place it was working well and NHS Sussex was supporting pharmacies with it, as well as communicating to GPs how it operated.

15.29   The Committee commented that the availability of COVID-19 vaccinations in Eastbourne had been limited when people were trying to book online and asked how this was being addressed.

15.30   Gary Money confirmed there were vaccination sites available in Eastbourne and agreed to quickly investigate this issue.

15.31   The Committed commented that there were often delays in GPs signing off repeat prescriptions sent by pharmacies, which presented issues for patients and prevented pharmacies from offering the service.

15.32   Garry Money commented that a focus of the development of Integrated Community Teams was to improve join up between GPs and pharmacies. Pharmacists were not contracted to provide a repeat prescription ordering service, but it was a very valuable one for patients. NHS Sussex was able to facilitate discussions between GPs and pharmacies to improve working relationships and address this issue. There was communication activity on Pharmacy First and more targeted work to explain to the public what the offer was would be explored ahead of winter.

15.33   The Committee commented that there was not a GP surgery in Baird ward in Hastings despite previous site allocations, and asked for an update.

15.34   Gary Money agreed to provide an update outside of the meeting.

15.35   The Committee RESOLVED to:

1)    Note the report; and

2)    schedule an update report on primary care for its meeting in June 2025.