Agenda item

Purpose of the report: Scrutiny of Services

Following the investigation of the Board’s GP Access Task Group NHS Commissioners, including NHS England South, NHS Guildford & Waverley CCG and NHS Surrey Heath CCG, will be asked to discuss with the Board how the situation can be improved in the future.

Declarations of interest:

None

Witnesses:

Dr David Eyre-Brooke, Clinical Chair, NHS Guildford & Waverley CCG

Dr Claire Fuller, Acting Clinical Chief Officer, NHS Surrey Downs CCG

Rose Hopkins, Head of Primary Care, NHS Surrey Heath CCG

Matthew Parris, Engagement and Insight Manager, Health watch Surrey

Key points raised during the discussion:

1.    The Clinical Chair of Guildford & Waverley CCG stated the main issues related to access to primary care in Surrey. Principally, caring for the frail/ elderly was said to be one of the main financial costs as patients were getting older and had higher expectations. The Board queried the likelihood of NHS England recruiting 5,000 new GPs they were advised the probability of achieving this was quite low. Surrey’s recruitment problem was deemed to be less severe than elsewhere in the country allowing the NHS to learn from others experiences. Instead, the challenge was to offer services in a new way for example, urgent care was being integrated across hospitals and general practices.

2.    The Head of Primary Care informed the Board that general practices in Surrey Heath had extended opening hours to 8am-8pm to increase GP appointment availability. This would reduce the number of patients going straight to A&E. Patients would be able to call up on the day and make an appointment for the same day. Surgeries will stay closed on weekend and patients will be urged to use the out of hour’s system.  It was expressed that by working together, practices could control wasted appointments.

3.    It was highlighted by the Board that communication is a key aspect of making the system work to its best ability. There was agreement that the public could be better informed of the extended surgery opening hours and accessible walk-in centres. It was noted that the main funding was also spent on extendable hours being applied to Nurses and Health care assistants, as well as GPs. The Board were given the example in this area of the Community Assessment and Diagnostics Unit on the Epsom Hospital site which had received good feedback from patients had prompted a meeting with the local press to publicise the services more broadly across the Mole Valley district.

4.    It was reported that Healthwatch Surrey’s understanding of current patient experience of general practice is one of deterioration. It was suggested that part of the solution would require partners working together to agree and communicate what patients can expect when accessing their GP. It was stated that some GP practices are very successful in managing appointments in a way which suits patient’s needs, whilst others are not. This remains a priority for Healthwatch Surrey and it will be undertaking further work in this area. It was agreed by the Board that communication is vital when looking at ways to strengthen GP services in Surrey.

5.    The Board asked what could be done by CCGs, by working together with the NHS and general practices to create a new model sharing practices in federations and by developing the NHS workforce. The Board were advised that the traditional list system and consistent, personal contact can be diluted by a more federated system but for G&W CCG this was a tolerable change. CCGs do have levers they can use to influence primary care in Surrey for example, they can encourage federation and the new capital funding available for practices required CCG sanction to approve plans.

6.    Further to these points, the numbers of doctors in hospitals have been increasing while the numbers of GPs have been declining so there is a role for the Royal Colleges in addressing this. CCGs are working with Health Education England to develop a Community Geriatrician role – merging GP and Geriatrician roles.  The Board asked about an increase role for Pharmacists in the future and were advised that there is a national surplus of Pharmacists with the Government supporting moves into General Practice beginning in areas of highest need first.

7.    The Board asked about the lack of equality in funding in different practices in Surrey. The Acting Clinical Chief Officer stated that she was very well aware of the inadequate funding of different practices and were currently coming up with ways to solve this issue, including integration of two practices. The CCG leaders discussed the limitation of the Carr-Hill resource allocation formula which is based on deprivation. For example, Surrey Downs CCG is the second most affluent area in England so their funding is affected despite an elderly population and high prevalence of learning disabilities. However, caution was added when it was suggested this was raised with NHS England as it would be a tough sell for Surrey CCGs when their situation was compared with an area of high deprivation such as NHS Tower Hamlets.

Recommendations:

·         The Board recognises the need for effective communications with patients and the public and recommends that the Surrey Health and Wellbeing Board works with the NHS England Communications Team to explore publicity relating to expectation of delivery of primary care services.

·         The Scrutiny Board will schedule further scrutiny on new models of local delivery of primary care.