Agenda item

13.1     Garry Money, Director of Primary Care NHS Sussex, presented the report, which provided an update to prior reports regarding primary care performance and the services that Primary Care Networks (PCNs) provide across East Sussex, including access to GP appointments. The report existed in the context of national policy changes in the NHS, including changes to Integrated Care Boards (ICBs), NHS England, and the 10-year Health Plan, which would likely change the way general practice is contracted in the future. When compared to other counties, East Sussex had been performing well in terms of volume of appointments, but patient experience, service variation and connection between services remained areas to monitor for improvement.

13.2     The Committee asked what the long-term issues are for the recruitment and retention of staff.

13.3     Garry Money responded that recruitment decisions in general practice were made individually across the 156 practices, which were sometimes in competition with each other for staff. The Additional Roles Reimbursement Scheme (ARRS) enables specialists to work flexibly across practices within PCNs, but there was room for further integration in the local workforce, which may be achieved in the development of neighbourhood health teams. Difficulties with capacity have also stemmed from the segregation of roles and a lack of flexibility in the workforce, which has led to pressures on doctors and nurses in practices. This amounts to a loss of flexibility for patients too.

13.4     Dr Binodh Bhaskaran added that a training hub had been established that provided support to apprentices and students to use resources effectively to retain staff. He raised complications regarding finding training areas and having sufficient estates to host trainees and recently qualified staff, has become difficult, but the PCNs were working collaboratively to address this. He added that the Levelling Up Partnerships in Rother and Hastings was being used to support the expansion of necessary infrastructure, which aids the retention of staff in the area, and that these efforts should also be inclusive of non-clinical staff that support practices.

13.5     The Committee asked for an update on the development of the Seaford Health Hub, which had been in development for 6 years, as residents in Seaford have been allocated GP appointments in Eastbourne.

13.6     Garry Money confirmed that NHS Sussex would provide a response to this question outside of the meeting.

13.7     The Committee noted from the report that the clinical workforce shrank by 15FTE, whereas the non-clinical workforce increased by 23FTE, and asked what is being done to increase the clinical workforce.

13.8     Garry Money responded that there was no fixed level of staffing within GP practices, and an increase in non-clinical workforce could, for instance, be to correct a deficit in the workforce. The goal was for clinical staff in practices to spend as much time as possible with patients, but there were other practical issues for recruiting and retaining a workforce which are beyond the control of GP practices, such as affordable housing and local facilities. Recruitment and retention of staff in practices was a challenge, especially when practices were in competition with each other and other healthcare providers such as hospital trusts, and it was important for NHS organisations to collaborate on workforce planning.

13.9     The Committee asked when and where in the County enhanced access hours appointments were being offered by GP practices.

13.10   Garry Money confirmed that the ICB were unable to provide data for all 12 PCNs, as the totality of minutes offered varied across PCNs and practices, the data does show a sustained level of service over time.

13.11   The Committee asked what work is being undertaken to encourage the workforce to get vaccinated, as the uptake figures were low in the report.

13.12   Kate Symons responded that frontline health and social care workers were not included in the eligible groups for COVID-19 vaccination for winter 2025-26, so a drop in uptake was expected. Frontline health and social care workers remained eligible for the flu vaccination, and the ICB was working with each healthcare trust to increase flu vaccination uptake for frontline staff, with an aim for a 5% increase on the previous year.

13.13   Simon Dowse, Director of Transformation, Strategy & Improvement, added that work was being undertaken to frame messaging around vaccinations, including reassuring staff, and ensuring that vaccinations remain accessible. He stated that it was not easy to encourage people to get vaccinated, and that often data is skewed by staff receiving vaccinations outside of the trust (e.g. through their GP), which was often missed in data. He explained that extensive communications are sent out to staff in the lead-up to winter to ensure questions about vaccinations are answered in the messaging.

13.14   The Committee asked how NHS Sussex are delivering the 10-year Health Plan through access to general practice, and what key issues they face.

13.15   Garry Money responded that access to general practice, and same-day or urgent care were key areas for delivering the 10-year Health Plan. Neighbourhood health and continuity of care were key focuses of the plan, which is something practices have been trying to deliver. There were changes anticipated in PCNs, due to the expiration of the initial 5-year PCN contract, however these had become fundamental to delivering primary care through the ARRS roles. The plan advanced the idea of neighbourhood working, which would be built around larger and more coherent geographies than PCNs currently were. In the context of cuts to non-clinical costs in the ICB though, there remained a key question of how to deliver this with fewer non-clinical staff.

13.16   Dr Binodh Bhaskaran added that key issues experienced across Sussex include managing frailty, as many of the population needing care are frail and vulnerable. Bringing care closer to home, as in the 10-year plan, could improve support for those people, but would need to involve working with community trusts and the VCSE sector. Hastings and Rother had been announced as areas that would be part of a national programme to support neighbourhood working.

13.17   The Committee asked if, in circumstances where patients experience adverse reactions to vaccines, this is kept in patients’ records.

13.18   Garry Money responded that record keeping is a basic requirement of all GP practices, and Binodh Bhaskaran added that this is part of the duty of care that practices have for their patients, regardless of vaccination status. Dr Bhaskaran noted that self-limited adverse reactions to the COVID-19 vaccine have been observed in approximately 5% of the total people who received it, due to their immune system reaction. The decision to receive the vaccine remained an individual one, and the risks should be assessed between individuals and their healthcare professionals where patients do have certain risk factors.

13.19   The Committee asked what work the ICB is undertaking to mitigate health inequalities in end of life care in Hastings, and whether health data in future reports can be broken down by area in East Sussex.

13.20   Garry Money confirmed the ICB maintained an active programme with the hospice alliance, to enable access to palliative and specialist care for East Sussex residents. He confirmed that data is collected from the five ICTs in East Sussex, and future data can be presented at that level. Hastings and Rother were set up as a single neighbourhood, for the establishment of neighbourhood health teams in the area, which would be undertaking work to address health inequalities.

13.21   The Committee commented that the VCSE sector had found engagement with GP practices to be irregular, and asked what the ICB and the VCSE sector could do to support further engagement by GPs in neighbourhood working.

13.22   Garry Money replied that practices work with Healthwatch and the voluntary sector to deliver improvements and acknowledged there was some variation in delivery between practices, due to resource capacity. GPs conduct assurance but, despite constraints on resources, often have delivered improvements that they have not been asked to. The task of the ICB was to therefore ensure that these improvements become more wide-spread. Part of the reason for this variation in service stemmed from PCNs grouping practices into silos, whereas previously practices would group together naturally to form co-working arrangements and share good practice. He expressed hope that neighbourhood health working would reinvigorate co-working between practices, as well as working with VCSEs to make improvements. Further information could be shared with the Committee when the programme was launched.

13.23   The Committee asked how patient voice contributed to the quality improvement programme.

13.24   Kate Symons responded that patient experience surveys and collecting data were important to deliver improvements. Metrics used in the report came from patient experience surveys, including a survey of over 10,000 residents, and this was being used to facilitate conversations about service improvements. Receiving further feedback from patients was key to identify and address variation in services, as part of quality improvement. Garry Money added that the ICB were due to launch a new programme for patient engagement and experience, working with Healthwatch and the VCSE sector.

13.25   The Committee asked what system is used by GP practices to triage same-day appointments.

13.26   Garry Money responded that every practice operated a triage process, but the appearance of this process may be different in different areas. In some cases, GP practices encouraged patients to complete a form which would be triaged, or patients would receive a call back with appointment information, and the ICB was monitoring how practices triaged patients. Part of practices’ contractual agreements specifies that patients should not be told to call back for an appointment, so practices would always follow up with patients after triage.

13.27   BinodhBhaskaran outlined how a practice in Bexhill operated a triage system whereby the reception team were trained in care navigation and supported by a paramedic to direct patients to the correct support; they received approximately 350 online questions per week which would then be triaged to a pharmacist, nurse, GP or other services as appropriate. How the triage process operated was dependent on the workforce and the skills available, so this system may not be applicable to all practices. Practices receive calls from patients, but also from healthcare professionals and carers, so triage systems were encouraged to manage the demand.

13.28   The Committee asked what will be done to ensure access to the NHS for patients that are digitally excluded, given that East Sussex has one of the highest proportions of over-85s nationally.

13.29   Garry Money responded that the development of the NHS app was a key priority for the government; the app was intended to be the primary route of usage for the majority of people, and most people would be able to access the NHS through this route, but this did not mean it was the only route. The ICB have been working with Healthwatch, the VSCE sector and patients to ensure that patients can still access services without the app, to mitigate digital exclusion.

13.30   Binodh Bhaskaran added that many older people are digitally literate and can use the app to access their medical records. Practices in East Sussex have set up hubs in town centres to upskill people in using the NHS app, but this work was ongoing.

13.31   The Committee asked what future planning is being undertaken to build new GP practices, to cope with new people moving into the area if new housing is built under the direction of a Mayor.

13.32   Garry Money responded that housing remained a constant topic of discussion, but that ultimately what decisions on new health facilities were considered on the unique circumstances of each development, and the ICB worked closely with district and borough councils on this. He confirmed that there were practices in East Sussex undergoing reviews to improve capacity or facilities, but this is dependent on resources available and staffing needs. He added that the role of the ICB is to be a strategic commissioner, meaning that they would need to consider what health facilities would be needed for any new housing developments.

13.33   The Committee expressed a view that developers should be responsible for the building of new health facilities around large developments. In areas like Telscombe Cliffs, the number of GP practices has reduced in recent years from four to one, for an area of 23,000 people, so the Committee stressed that the ICB must ensure that infrastructure is in place for new developments.

13.34   The Committee asked what the impacts the rural/urban split in East Sussex has on unwarranted variation in access to GPs, and what the areas for improvement are, including through neighbourhood working.

13.35   Garry Money responded that GP practices in rural areas are a lot more knowledgeable about their area and patients than the ICB, but there have been difficulties, with rural practices sometimes unable to keep up with wider developments in practice. This has previously included changes to dispensing practices, for example. He stated that the aim for incoming neighbourhood health changes should create support for rural areas, by enabling feedback from rural areas and co-working for the wider population.

13.36   Ashley Scarff added that integrated community teams (ICTs) are coterminous with the areas for district and borough councils, who are directly engaged in their operation. This is partially due to housing needs and developments and their role as a local planning authority, which means the ICB will find it useful to be involved with the mayoral authority at a strategic level in the future. The ICB have been investigating inequalities and unwarranted variations in services, through actions like working with Healthwatch and considering the role of the wider determinants of health, including housing. The 10-year plan set out the new role of the ICB as that of a strategic commissioner, so health inequalities and variation in services would be considered as part of that role.

13.37   The Committee asked what the variation is in digital access across the county, how digital access is spreading between practices and what initiatives the ICB has for improving digital access.

13.38   Garry Money clarified that there are public reports available to see digital access in the county. He stated that GP practices aim to focus on outcomes: for example, calling you back to follow-up, rather than telling you to call the practice back. He noted that while technology can help to an extent, there is a limit to its benefits, as this was dependent on developments being joined up, to streamline working.

13.39   The Committee RESOLVED to:

1)    note the report; and

2)    request a focused update report on general practice issues at an appropriate date.