Agenda item

[To receive a presentation from the Black Country and West Birmingham CCG on Primary Care Access.  There will also be an opportunity for Panel Members to ask general questions on the matter of Primary Care in Wolverhampton]. 

The Managing Director of the Wolverhampton area of the Black Country and West Birmingham CCG introduced the item.  He explained that they had been asked to focus on the issue of Primary Care Access.  He commented that during the pandemic lockdown demand for GP services had been reduced due to anxiety from patients about contacting their GP.  This meant there would now be people presenting with issues to their GP that they ordinarily would have brought earlier.  They had heard the concerns raised by the public regarding Primary Care Access, this was through direct contact, Healthwatch, Councillors and Members of Parliament.  The CCG understood the frustration of patients who wanted an appointment with their GP but were unable to obtain one when they needed.  Demand for services was at a heightened level. 

The Managing Director of the Wolverhampton area of the Black Country and West Birmingham CCG commented that GP practices also faced additional pressures of delivering the vaccine programme.  As Covid was still prevalent practices were having to continue to deliver services in a Covid safe environment.  This did change their operating procedures including how they managed access to their surgeries and the telephone triage model. 

The Managing Director of the Wolverhampton area of the Black Country and West Birmingham CCG displayed a graph which showed that from April 2020 there was a significant reduction in appointment numbers.  Appointments had then built back up again slowly over the course of the year.  Levels of activity in Primary Care were now at the same level or above that prior to the pandemic.  Before the pandemic the vast majority of appointments were face to face at approximately 86%.  In June 2020 the overall levels of GP activity had reduced and there was a much smaller ratio of face to face appointments and a higher level of telephone consultation.  In June 2021, levels of activity had significantly increased.  The proportion of face to face appointments had increased but had not returned to the same levels as in January 2020.  They did not necessarily expect face to face appointments to return to the level they were pre-pandemic because of the different ways services could now be offered.    In August of 2021, 57% of appointments were being seen face to face.  This local figure was also the same as the national figure.   Even at the height of the pandemic GPs were still seeing some people face to face. 

The Managing Director of the Wolverhampton area of the Black Country and West Birmingham CCG showed a slide from the national LMC (Local Medical Committees) snapshot survey from March 2021.  69% of patients accessing GP services were now considered complex.  Consequently over 50% of GPs had advised of increasing consultation times.  The CCG did not receive routine data of the number of calls being received by GP practices.  However, at Dr Reehana’s practice, Health and Beyond group, call volumes were up 165% in June, 80% in July and 30% in August, compared to the same months last year.  One of the positive changes from having more telephone appointments was that more people had received a consultation on the same day as booking the appointment.

Whilst they were receiving information from the general public on GP Services, they also wanted their own data.  They were therefore focusing on three area of intelligence.  They had conducted a snap shot review.  This review had focused on websites to ensure they were as user friendly as possible.  They were also developing a dashboard to give the CCG real time information on the level of activity at GP practices.  The CCG were analysing the GP Satisfaction Surveys, which were undertaken at each practice.

The Director of Primary Care remarked that the CCG’s approach had focused on four areas.  These were:-

·       Local Improvement Plans

·       Consolidate national must dos

·       Centralised oversight of all system wide programmes

·       New emerging projects

With regard to the Local Improvement Plan they had shared feedback from the snapshot audit with the Place Commissioning Board.  Quick wins had been identified such as improvements to the website and other online channels.  They had worked with each Place team in developing a local approach.  As part of the restoration and recovery plans they had put together a package of resources.  They were in the process of recruiting a Primary Care Access and Engagement Co-ordinator for each place.  Three out of five had been recruited to date.  They had also recruited a Covid vaccination co-ordinator for each of the five places.  A one hundred thousand pounds restoration and recovery fund had been provided for each local Place Board to support their restoration and recovery.  They were developing a practice resilience resource programme.

The Director of Primary Care commented that they had allocated an access and engagement resources budget of over a quarter of a million pounds.  They were also developing an empowering and enabling patient engagement programme.  This was focusing on four areas:-

·       Patient champions for access

·       Key message toolkit / briefing and support

·       Myth busters – alternative options

·       Patient Leadership Development Programme

The CCG had supported Practices and PCNs by:-

·       Working Together: A guide to involving patients, carers and their communities in general practice/PCNs

·       Developing strong and inclusive PPGs (Patient Participation Groups)

·       Practicing support to train and support staff to implement guide

·       Asset Mapping social support systems / networks/orgs link to Social Prescribers

The CCG were working with Healthwatch, the voluntary, community and faith based sector to engage and support access improvements for vulnerable individuals and communities from the protected characteristic groups.  In terms of overall system planning they were trying to advance on line / video consultations, GP Connect which linked 111 to practice appointments, and progressing the community pharmacy consultation scheme.  They were mindful of ensuring digital opportunities and not increasing inequality in the health system.  He highlighted the work the CCG were completing on improving communications, this included work on the call infrastructure. 

The Director of Primary Care requested the support of the Health Scrutiny Panel to enable co-production and links with user and community groups.  He offered Councillors the opportunity to shadow GPs to gain an insight into the changes in practices.  The CCG would continue to work with the Place teams to co-produce plans to improve Primary Care access.  This would help inform the longer term plans to transform the delivery of Primary Care. 

The Chair reiterated her desire for Healthwatch to collect data on access to Primary Care. She then suggested a special meeting on Primary Care later in December. 

The Panel spoke in favour of some Members of the Panel shadowing a GP.  A Panel Member asked if someone had a telephone consultation and as a consequence a face-to-face appointment was also required, was this counted as two appointments or one.  They also highlighted the importance of patients having a good understanding of how the medical system worked, such as dentistry issues being seen by a dentist and not a GP and eye issues being seen by an optician.  

A Panel Member commented that any graphs in the future on slides from the CCG on Primary Care should show percentages and numbers to make the data clearer.  He spoke of the disparity in how well Patient Participation groups operated.

The Chair asked for some information on how the CCG worked with the vertically integrated primary care practices and whether proposals would also apply to them.  The Managing Director of the Wolverhampton area of the Black Country and West Birmingham CCG responded that the vertically integrated practices were one of the six Primary Care networks in Wolverhampton.  They would be soon meeting each of the six Primary Care networks about their plans and they treated each of them the same.  

Resolved:

a)    That a Special Health Scrutiny Panel meeting on Primary Care take place in December 2021     

b)    That some Members of the Health Scrutiny Panel shadow a GP before the Special meeting is held in later December.