Agenda item

The committee considered the report of the Director of Commissioning Strategy and Deliver – Primary Care, NHS County Durham Clinical Commissioning Group that presented the Draft County Durham Primary Care Commissioning and Investment Strategy 2020-22 before ratification was sought by the County Durham CCG Governing Body on 16 March 2021 (for copy of report, see file of minutes).

Joseph Chandy, Director of Commissioning Strategy and Delivery was attendance to present the report and deliver a presentation that set out their Vision; Key Achievements from the last Primary Care Strategy; Strategic Themes; Priorities; How they intended to deliver their priorities; Local Incentive Scheme; Investment; Measuring Success and Engagement Timeline (for copy of presentation, see file of minutes).

The Chair asked the Officer what the Committee could do to protect the Durham Pound. He also had a question from a Member who asked what the process was for patients who could not get a face-to-face appointment with their GP, was there any escalation processes in place.

Councillor R Bell thanked the Officer for the report and the reason why he was very defensive of the Clinical Commissioning Groups (CCGs) and the excellent work that they had done particularly in primary care that had been outlined in the presentation. He asked what the committee could do to ensure that the legacy bodies that closely resemble the CCGs and all the plans that they had for investment and protection of services going forward.

Councillor Crathorne agreed with Councillor R Bell and they should look at ways where they could move forward to try and protect what was currently in County Durham. She indicated with COVID doctors were under great pressures and patients could not access them as easily and asked if enough had been done to utilise pharmacies as an alternative to GPs to take the pressure off doctors.

The Director of Commissioning Strategy and Delivery responded with regard to face-to-face appointments and indicated that every practice in County Durham had moved to total triage where every patient request for a consultation was triaged. This was usually a one step process where the doctor or nurse practitioner triaged the patients need and treats at the same time. This wasn’t done in the past commonly but had proved from a clinical evidence point of view as effective as a face-to-face appointment. Clinically there were times where a GP needed to see the patient and was the clinical judgement of the clinician who was triaging to decide if they needed to be seen face-to-face. COVID screening was important but they did not want patients coming out of their home unnecessarily, the clinicians overriding factor was the need to see the patient on a face-to-face basis that overrides the COVID imperative so there should be no barriers. There were demands placed by the COVID vaccination programme and a number of staff from GP practices were manning that vaccination programme that was putting pressure on GP practices but this should not be a determining factor for determining whether a face-to-face appointment was required over and above the first telephone triage appointment. If a patient found that they did require a face-to-face appointment and they did not agree with the clinical decision to be treated remotely they should take this up with the practice manager in the first instance.

In terms of what the Committee could do to support the Durham Pound lobbying through the transition process. There were a number of officers attending today who would join him and had an input into shaping the arrangements that were going to come forward. A lot of the decision making would be done nationally or at ICS level but these plans would be brought forward and shared with the committee on how they believed place based arrangements should work for patients including financial and decision making and budget setting. He would ask the committee to look through those plans and give it the appropriate scrutiny and stand by them in fighting for what they believe was best for patients.

With regard to pharmacies, pre COVID they were working hand in hand with pharmacies promoting patients receiving care from pharmacies and all pharmacies with exception developed consulting rooms and that may have been pushed back due to COVID as the footfall into pharmacies had reduced. In addition, if GPs felt under pressure there were a number of staff attached to a collective of GP practices called the primary care network that they did not have before.

Councillor Crathorne referred to the private consultation rooms in pharmacies and the wait was deterring people, so could an appointment system be introduced that could be advertised through the NHS.

Councillor Huntington referred to bringing all the health services into the local communities and she remembered going around factories organising basic health checks and these people had not sought help before and it was wonderful to see how far the health service had come on. She shared some of the concerns that had been expressed and would hate to think they had lost all the work that they had achieved.

Michael Laing, Director of Integrated Community Services, responded that there were three things that the committee could do to support the officers to protect health funding and decision making. The first was to give advice on integrating more closely health and social care in the county. They were part way down the journey and there was still much more to do that included acute services that were currently delivered in the hospital that could be delivered closer to home in the community. The second was to exercise scrutiny on any changes to local partnership arrangements that they would bring forward and would strengthen those partnership arrangements so that it inspired confidence in the regional bodies to delegate finance and decision making to them. The third was have a consistent message to the region and to the NHS nationally so that there was a consistent message coming out from this committee, Health and Wellbeing Board, Trust Executive Board and the CCG that had a tremendous track record in County Durham with integrated working that needed to be preserved and built on and not dispensed with and that they were more than capable of manging their own affairs and making decisions and spending money together and had done for the past five years. If this message was consistently given this would be a tremendous advantage in making sure this committee got what it thinks was right for the people of the county. He advised that he would take up Councillor Crathorne’s point in relation to pharmacies with Joseph Chandy outside of the meeting.

The Principal Overview and Scrutiny Officer indicated that it was important that the committee’s views were fed back to the primary care commissioning committee when they meet to formally agree the strategy. On behalf of the committee if members were agreeable he would formally respond to the strategy and send a letter on behalf of the committee into that primary care commissioning committee expressing the views of the committee and the support for the excellent integrated work being achieved in County Durham in partnership with the CCG with providers with the County Council and the community and voluntary sector.

Resolved: (i) That the report be noted.

(ii) That a formal response be sent to the Primary Care Commissioning Committee expressing the views of the Committee.