Agenda item

The Committee considered a joint report of the Corporate Director of Resources, and Director of Commissioning Strategy and Development (Primary Care), NHS County Durham and Darlington which provided an update of progress made against the recommendations of the review of GP Services in County Durham and an overview of NHS England guidance issued on 14th October 2021 entitled Improving Access for Patients to Primary Care and Supporting General Practice and the associated Winter Access Fund (for copies see file of minutes).

The Principal Overview and Scrutiny Officer advised that the report was in three parts, there was an update on recommendations of a review presented to Cabinet in November 2020 in respect of GP services in County Durham after concerns had been expressed by Members regarding the cumulative impact of several applications to review, merge or close GP services across County Durham.

He referred to recommendation 3 with regards to the use of Section 106 resources for the development of health care services and reported that the policy of which section 106 contributions were allocated was within the CDP and there was a proposal and recommendations to Cabinet in December on how contributions for health would be calculated and spent.  This was money as a result of housing development and one of the key was the number of new housing estates that needed access to infrastructure and primary care.

J Chandy, the Director of Commissioning Strategy and Development (Primary Care), NHS County Durham and Darlington advised that there were challenges on staff and patients in accessing services.  He referred to the key points in the report and advised that the Joint Committee which was made up of number of Councilllors and CCG and had continued to work through pandemic on supporting the recommendations of the Committee.

Councillor Hovvels advised that she had been the first to raise concerns about the Trimdon area as there had been section 106 agreements in place yet no services to go with it.  A lot of work had been done and she wanted to thank the Director of Commissioning Strategy and Development (Primary Care) on behalf of the community in Wheatley Hill, for the work done with them to improve services.

The Director of Commissioning Strategy and Development (Primary Care) advised that the second report provided an overview of NHSE guidance issued on 14th October 2021 entitled Improving Access for Patients to Primary Care and Supporting General Practice and the associated Winter Access Fund.

The current government recognised that patients were having difficulty getting face to face appointments with their GP post COVID-19 and this had been highlighted in the media. The government were concerned that if nothing was done, the normal rise in respiratory viruses and escalating cases of COVID-19 would worsen.

The Director of Commissioning Strategy and Development (Primary Care) advised that this guidance had not been expected so timely and this was the first time being reported.

Paul Clitheroe, Primary Care Commissioning and Delivery Manager, NHS County Durham CCG advised that the report  should reassure Members that despite the move to ICS there was action being taken due to this policy initiative to plan and deliver local services.

A task group had been set up with partners from NHS, LA and outside of the public sector.  He highlighted some key issues that the policy was intended to respond to, which were issues that were raised by patients about being unable to get face to face appointments.

He confirmed that primary care was changing, which had already been alluded to by the  Director of Commissioning Strategy and Development (Primary Care).  Telephone and walk in was once the only way that patients could access services, but additional doorways had been opened up which allowed more people access in different ways.

Practice call volume had been steadily increasing prior to the pandemic and calls were increasing not only to book appointments, but requiring  advice or requesting sign posting.  There was an increase in the number of calls being made and £0.5m had been invested into GP telephone systems in County Durham.

In addition to the volume of calls, there was also issues with self-care and he acknowledged that not everybody would be able to, however there were a number who with support, could self-care and assist with a more sustainable service.

The Director of Commissioning Strategy and Development (Primary Care) added that there were a number of issues preventing good access to services including lack of workforce, organisation, COVID-19 isolations and sickness were having an impact and despite having strict rules, there were sudden episodes of staff sickness, which were compounded with the increase in demand.

The Director of Commissioning Strategy and Development (Primary Care) advised that £1m had been invested in County Durham to combat the strain of an anticipated bad winter.  A general practice overflow service had been set up at the A&E department which was able to redivert patients who were otherwise unable to get treatment from their practice.

The task group were aware that access to services was not perfect but were listening to the feedback from patients.  There were additional pressures in supporting the vaccine roll out and this was exhausting for staff but they were determined to support it.

The Chair advised that she had experienced the hub at UHND after being sent there by the GP, but there was a concern regarding wait times for 111 and she asked for information on how appointments were allocated.

The Director of Commissioning Strategy and Development (Primary Care) advised that the 60 available appointments were ring fenced for 111, GP’s and A&E who were able to alleviate pressures.  Each practice had been allocated a number based on their size.  If a practice exhausted those appointments and still had demand it would

The Chair asked whether this was being rolled out across the County and The Director of Commissioning Strategy and Development (Primary Care) advised that there were three hubs operating in Peterlee, Sedgefield and Bishop Auckland and similarly North Durham had evening and weekend hubs.  In South Durham, it had been recognised that there was a problem in the ED with patients attending to get GP advice and this had had led to creating this hub as a pilot.

Councillor Gunn commended all of the work done by the task group, which had occurred during a really challenging time and in particular wanted to mention the importance of the 111 service as most people would have used it and experienced being held in a queue.  There were many pressures on general practitioners, which were exacerbated by the pandemic and the roll out of vaccines was highly commendable.

With regards to the Winter Access Fund, Councillor Gunn asked what £820k could do for County Durham, as in her opinion it was insufficient.  The Director of Commissioning Strategy and Development (Primary Care) advised that the government had announced £240m and when split ICS system, the largest areas were North East and North Cumbria with £8m.  Each CCG had to be allocated and this was approximately £800k,  so prior to allocating, a bid for an additional £450k had been submitted which been approved and was predicted to amount to in excess of £1m.  The Director of Commissioning Strategy and Development (Primary Care) advised that the cost to fund a year of the ED PCS hub, based on the current level of service, was £650k so acknowledged that this would not go very far, but he had advised primary care to submit bids at scale  and where there were already overflow hubs, they could try and upscale with additional Nurse Practitioners and Doctors.

Councillor Hovvels had concerns regarding telephone services which were unable to give repeat prescriptions and patients were having to sometimes travel to other villages which was costly for some and contributed to poverty and ill health.  The Director of Commissioning Strategy and Development (Primary Care) confirmed that advice given was that a significant number of minor pharmacy and medication issues were disruptive to the telephone service so patients were being encouraged to use repeat prescription request slip or the web portal.  There was also an issue with accuracy which was reduced by ordering non-verbally over telephone.  He recognised that there were a number of people that were unable to post and that general practice needed to have exceptions for those house bound.  There was a demand on telephones, which had been exacerbated by the pandemic and some practices were like call centres, but unlike experienced call centres who were equipped for high call volumes and had systems to cope, general practice had outgrown their service and needed adapting.  The only way to cope was to reduce the amount of activity that could be done in other ways.

Councillor Hovvels’ other concern was the pressures on post office because some NHS appointments were arriving a week out of date which was contributing to missed appointments.  The Director of Commissioning Strategy and Development (Primary Care) advised that in secondary care, hospitals had a telephone back up system which sent automated calls to press one if attending and 2 if not.  Primary care had changed a lot and the amount of letters that were sent had significantly  decreased.  To book vaccinations, links were sent out to book flu jabs, or clinical appointments and this had reduced the amount of letters sent. Patients were able to now have more choice in the time of their appointments.

In response to a question from Councillor Earley regarding North Durham, the Director of Commissioning Strategy and Development (Primary Care) advised that the Shotley Bridge hub provided minor injury and Bishop Auckland,

In addition GP’s Derwentside Federation, provided additional appointements 6-8 Monday – Friday and Saturday and Sunday mornings.  If felt demand was such that those were not sufficient, they would be reviewed.  With regards to whether Casualty would be extended, R Stray,  CDDFT confirmed that she would ask for a response from Sue Jacques.

The Director of Commissioning Strategy and Development (Primary Care) advised that having a well-designed A&E with space to co-locate a hub with someone to navigate them would avoid patients sitting for hours to be told that they can access other services.

The Principal Overview and Scrutiny Officer advised that reference had been made to the 111 service and suggested that should Members require further information on the pressures and demand, they could consider an additional recommendation to invite NEAS to a future meeting of the Committee and consider the specific details.  

Councillor Howey appreciated the hard work but there were complaints daily that patients were unable to see a Doctor and children having to go to A&E for treatment, there was also information given by staff that pre-bookable appointments were unable to be made due to COVID-19 measures.  The Director of Commissioning Strategy and Development (Primary Care) advised that he had experienced similar complaints from patients where it was assumed by default that the practice had done something wrong but when it was investigated, people had refused to wear a face covering to enter the premises, including mothers who had children that needed to be seen.  Those that would not adhere to that policy, despite being there to protect more vulnerable, had to be treated a suspected COVID-19 patient, brought through a fire exit and into covid hot room.  Typically a child presenting, would be asked for a PCR test before arriving and these were seen to be reasonable procedures but there were some being reported different.

The Director of Commissioning Strategy and Development (Primary Care) advised that the issue of whether  primary care was increasing the demand by means of only offering appointments on the same day would be considered by the task group.  The COVID-19 protocols still applied, staff isolations were causing massive challenges but he acknowledged that advance bookings should be considered in more detail.

Councilllor Savory asked whether the information that the Committee had received could be communicated to the general public through either social media or newspaper as it was important that patients were kept up to date.  The Director of Commissioning Strategy and Development (Primary Care) advised that he had asked the communications team how to convey the information and agreed that it was important when heading towards a bad winter.

Resolved

That the report and presentation be noted.