Agenda item

Primary Care Update

Minutes:

The Committee considered a report presented by Juliet Carling, Commissioning and Delivery Manager, NHS County Durham Clinical Commissioning Group which provided an overview of the primary care     Covid-19 response and subsequent stakeholder engagement.  The report also provided information on the national ‘Talk Before You Walk’ pilot, an update on primary care strategy development, and, information on Peterlee Urgent Treatment Centre (for copy see file of minutes).

 

Prior to presenting the report, the Commissioning and Delivery Manager explained that the NHS long term plan was for organisations to have integrated care systems in place by 2021.  Members were informed that the north east integrated care system has three integrated care partnerships which focus mainly on acute services. The County Durham Care partnership includes health and social care organisations which work collaboratively to ensure joined-up services where possible.  Thirteen primary care networks are in place  throughout County Durham which are groups of practices that work together on matters such as staffing, finance and estates and they promote easier integration with the wider health and care system. 

 

The Commissioning and Delivery Manager then outlined the report and the response from the primary care service during Covid-19.  She provided information on the ways in which primary care had transformed the way it works, including the introduction of ‘total triage’ and moving to deliver consultations via telephone, online and through e-consult.  Work with care homes had been brought forward including GP practice alignment to every care home in County Durham, with the facility to undertake online consultations with a named GP, and, the introduction of NHS emails to ensure the safe transfer of confidential information.  There was now a refocus on commissioning priorities in order to incorporate these improvements.  Areas of focus for the future include, where appropriate, supporting patients to self-manage, the increase in the use of digital technology, and  the possibility of widening the range of health care professionals working within primary care.  In conclusion, the Commissioning and Delivery Manager advised that the primary care strategy will be discussed at the January meeting of the Adults, Wellbeing and Health Overview and Scrutiny Committee. She responded to comments and questions from members as follows.

Referring to total triage Councillor Temple spoke of a resident in his ward who had approached him for assistance as she had been unable to access medical advice.  She had telephoned her consultant’s secretary who had advised her to ring her GP.  She had then spent two days repeatedly telephoning the GP surgery to speak her doctor only to be told no telephone slots were available and to ring back the following day.  Councillor Temple advised her to call 111, however, the advice from 111 had been to continue calling the GP.  Councillor Temple remarked that this effectively reduced the ability to access medical advice to a lottery of telephone connectivity.  He requested that total triage be given careful thought prior to its adoption.  The Head of Integrated Commissioning, Sarah Burns, requested that Councillor Temple share the details of the case, to enable the service to follow it up.  Councillor Temple confirmed he had permission to share the information, that he would do so, and, that he would like two matters to be investigated, triage, and the appointment system.

 

Councillor Quinn, local member for Shildon, commented that her GP surgery is based in Bishop Auckland however she understood the surgery’s health visitors are based in Tees and Esk and travel from as far as Ripon and she queried the practicalities of this.  The Commissioning and Delivery Manager responded that she understood the service provider is Tees and Esk, however, she understood the teams were local adding that she would feed Councillor Quinn’s comment back.

 

Rosemary Hassoon expressed concern at the lack of detail regarding mental health in the report and spoke of the importance of continuity of care for those with mental health issues adding that many people suffering with their mental health are unable to work and therefore may not be able to afford equipment to be able to access online services.  In addition, she pointed out that although she is a member of the Mental Health Strategic Partnership Board, she had not been invited to a meeting of the Board for a year.  The  Commissioning and Delivery Manager agreed to pass these concerns to the primary care team to be followed up.

 

Councillor Jopling pointed out that there are occasions when telephone consultations are not appropriate, for example, she had been contacted by a resident who was suffering from an ear condition who had been offered a consultation, by phone, by the audiology department at her hospital.  Councillor Jopling stressed that the method of delivery must be fit for purpose and there are some instances where a physical examination is the most appropriate method.

 

Councillor Bell agreed swaying although modern technology has its place it also has limitations and he reported that a GP he had spoken to said remote appointments can lead to duplication of work as some patients cannot be diagnosed remotely and ultimately are asked present themselves at the surgery for a face-to-face appointment.  He also pointed out that members of the public can be apprehensive about using technology for medical and health matters and whilst technology can be a solution, it is not the only solution.

Councillor E Huntington agreed that telephone consultations can be limited, for example where patients have multiple conditions, it may lead to confusion and a delay in getting the correct diagnosis.

 

The Commissioning and Delivery Manager clarified that total triage involves an initial telephone contact and the patient may be offered a face to face appointment which is a clinical decision taken by a GP or a nurse.  She confirmed the service was aware that telephone and video consultations have their limitations and she agreed to feedback members’ comments, to ensure all the points discussed are taken into account. 

 

The Head of Integrated Commissioning agreed that telephone consultations do have their place, however, in some cases they are appropriate, especially at the current time with the need to reduce footfall.  She added that GPs are reporting similar themes, in that there are times when telephone consultations are appropriate and at other times physical examinations are required.  She assured the Committee that the service is carefully working through these new principles and ways of working.

 

Resolved:

 

That the report be noted.

 

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