Agenda item

C Stephenson, Head of Primary Care (County Durham) North East and North Cumbria Integrated Care Board provided a detailed presentation which provided Members with an update on County Durham GP Appointments (for copy see file of minutes).

The Head of Primary Care provided statistical information on the total number of GP appointments for the whole of the North East & North Cumbria (NENC) at November 2022. He explained that County Durham had the highest demand for appointments in NENC and advised that Did Not Attend appointments (DNA) appointments in County Durham had totalled 13,000. He further advised that County Durham was presently recording the highest number of face-to-face appointments in comparison to its peers across the NENC Clinical Commissioning Group system.

The Head of Primary Care explained that Acute Respiratory Response (ARI) Hubs had been commissioned to help tackle the immediate pressures on primary care created by the extraordinary increase in respiratory infections during the winter period. He explained that the hubs would provide same day/urgent respiratory appointments for all age groups (adults and children), offer point of care testing and be able to link to the respiratory consultant on call in the trust/s. Although four hubs had initially been planned, the Head of Primary Care informed the Committee that the hub at Shotley Bridge Hospital was no longer on the list. County Durham was the first ‘Place’ in the country to go live with the specialist hubs, adding up to 6,000 of additional appointments into County Durham primary care up until at least 31st March 2023.

Councillor Hovvels stressed that although the statistics looked positive, residents within her area were continuing to struggle to book GP appointments and had been waiting up to three months. She explained that her division of Trimdon and Thornley covered multiple areas and availability of appointments were problematic at all GP practices.

R Rooney, Senior Portfolio Lead, Integrated Commissioning Team, North East and North Cumbria Integrated Care Board noted that there had been a significant increase in demand for GP appointments and it was important for the demand to be managed effectively. She explained that a triage system was in place to determine whether the appointment should be face to face or via telephone and that an online option was also available for those that were IT literate, and that this helped to reduce the number of telephone calls. The Senior Portfolio Lead further advised that the workforce could be utilised differently to manage the volume of appointments stating that whilst patients requested an appointment with a GP, there were a range of health professionals that could potentially help the patient, such as a mental health professional. The Senior Portfolio Lead explained that the Additional Roles Reimbursement Scheme (ARRS) had provided an opportunity for additional roles within practices and confirmed that these had been put in place across County Durham.

In response to a question from Councillor Earley, the Senior Portfolio Lead noted that there was variation in performance across practices in County Durham and highlighted that some areas were doing well and that this needed to be shared as best practice to help standardise practice performance throughout the County. The Senior Portfolio Lead explained that workforce recruitment and retention was a significant challenge for general practices but advised that a great deal of work was currently being done to attract more GPs, including salaried GPs employed by the NHS, and offered to share this work at a future meeting of the Committee.

Councillor Freeman commented that the statistics looked positive, particularly in terms of face to face appointments, however he expressed concern regarding the length of time in obtaining an appointment and noted that this information was not reflected in the statistics. He explained that some patients required immediate attention and could at times present at A&E if they were unable to make an appointment and asked if this was due to a lack of GP’s. 

The Head of Primary Care explained that work was to be undertaken to identify the improvements that could be made at practices regarding access, and that this included the length of time in obtaining an appointment and advised that going forward, the new hubs were hoped to alleviate some of the current pressures. The Senior Portfolio Lead explained that patients attending GP practices had different needs and advised that it was important to recognise different needs and wrap primary care around these. The Senior Portfolio Lead accepted that there was a great deal of work to be done and many challenges to address but emphasised the importance of thinking differently going forward.

Councillor Quinn explained that during the Covid-19 pandemic, GP practices had to think differently, and some of the changes were evident at the practice in her area. Whilst Councillor Quinn could understand the frustration of residents who were unable to make a GP appointment, she stated that there were also positive comments from residents who were satisfied with the service they had received.

With regards to DNA appointments, Councillor Quinn asked if the reasons patients did not attend their appointments were known. The Head of Primary Care explained that although there were a variety of reasons for DNAs, in the main, patients often booked an appointment but then would start to feel better and fail to cancel it. He noted that further work was required with Healthwatch County Durham to share the message regarding DNAs to reduce the amount of wasted appointments and stated that publicity was key in doing so. He welcomed anything Members could do to get this message out to the public. 

Co-opted member, R Gott advised that in her experience, the service by GP practices had deteriorated and the length of time to obtain an appointment had significantly increased and gave an example from her own experience. She also disagreed with practices sending text messages to patients. The Senior Portfolio Lead confirmed that she was happy to discuss this further with R Gott outside of the meeting. The Head of Primary Care asked for the details of the GP practice in question and agreed to investigate this further. 

Councillor Lines expressed concern regarding the suggested charges for patients who did not attend their appointments. Although the former Health Secretary had suggested this, the Senior Portfolio Leadassured that charging patients would not be considered in addressing the issue with DNAs. She noted that there would always be reasons why people were unable to make their appointment but stated that the focus for DNAs were people that repeatedly failed to attend and the impact that this had on time and costs.

D Alexander, Healthwatch County Durham explained that anecdotal evidence highlighted a whole range of reasons for DNAs, such as mental health, caring responsibilities, family emergency, transport issues, but agreed that it would be beneficial to focus on those that repeatedly did not attend and offer them some support if required. With regards to face to face appointments, D Alexander noted that Healthwatch County Durham had done a great deal of work with the public around access and advised that although the majority of people preferred face to face appointments, there were some people that wanted the option of telephone or online appointments as this type of appointment worked better for them.

Further to comments raised by Councillor Sutton-Lloyd regarding the need for communication and education, the Senior Portfolio Lead agreed that more awareness was needed within local communities. She advised that one of the main focuses was to reduce the wait times on the telephone lines and that an e-consult was to be introduced to help with this issue so that those people who needed to telephone were able to get through to the practice successfully. Councillor Sutton-Lloyd stressed that it was important to get this message out to the public. The Head of Primary Care referred to the slide on the presentation titled ‘your GP practice is here for you’ and advised that further work was being done to improve and standardise messaging regarding access.

Councillor Andrews commented that it would be interesting to find out the reasons for the repeat DNAs. In terms of telephone consultations, she noted that these were different to telephone triage and required a specific set of skills. Councillor Andrews stated that patients and families had at times had to make multiple calls before they received the required help and hoped that this issue would be addressed. The Head of Primary Care agreed but advised that he had recently been given the opportunity to listen to some of the calls received by a practice and noted that the number of calls from people that were lonely were surprisingly high.

In terms of DNAs, Councillor Kay was confused what drove people to repeatedly miss their appointment. Councillor Earley agreed and whilst he appreciated all the issues raised by Members, he stated that he did not want people to be dissuaded from making a GP appointment. He asked the Principal Scrutiny Officer if all the comments raised at the meeting could be followed up on.

Councillor Quinn welcomed the opportunity to help publicise key messages. Councillor Sutton-Lloyd agreed and advised that he did a lot of work in the community and could help share this information.

The Senior Portfolio Lead greatly appreciated Members offers to help share this information and agreed to keep them updated on the plans going forward.

Resolved

That the presentation be noted and the additional detailed information and data regarding GP Services within County Durham requested by members be sought and a further report brought back to a future meeting of the Committee.