Agenda item

Witnesses:

•      Nikki Mallinder – Director of Primary Care, Surrey Heartlands

•      Giselle Rothwell – Associate Director of Communications and Engagement, Surrey Heartlands

•      Nina Crump – Communications and Engagement Lead, Surrey Heartlands

•      Rich Stockley – Head of Research, Surrey County Council & Surrey Heartlands

•      Dr Charlotte Canniff – Clinical Chair, Surrey Heartlands

•      Dr Pramit Patel – Primary Care Network Lead, Surrey Heartlands

•      Maria Millwood – Board Director, Healthwatch Surrey

•      Clare Burgess – CEO, Surrey Coalition of Disabled People

Key points raised during the discussion:

1.    The Clinical Chair introduced the Surrey Heartlands report. It was noted how primary care access had changed since the pandemic and in some ways, it had changed for the better. The changes that were already planned pre-pandemic were accelerated. Many service users liked the digital form of access, and many conditions could be managed in this way. It was important to recognise now that some conditions were better dealt with face to face, therefore, primary care needed to be flexible about the types of access for conditions and patient preferences, especially for vulnerable communities. There was continued work with the 104 GP surgeries in Surrey Heartlands to address the issues from residents. 

2.    The Chairman asked about the use of KPIs to monitor progress in practices. The Director of Primary Care explained that KPIs measured the impact and delivery of GP surgeries. Surgeries were registered with the Care Quality Commission and the Primary Care Commissioning Committee oversaw the delegated authority for Primary Care, including the performance. A demand and capacity tool was used locally to monitor the delivery of services, such as face to face or digitally.Support was provided to surgeries by visiting each surgery and talking to them about best practice and how to improve inconsistencies. The Access Improvement Programme was a national piece of work and 23 of Surrey Heartlands’ GP surgeries were part of this programme, with 17 already completed. The programme helped to improve quality of access.

3.     A Member enquired about the number of hours a doctor provided to each surgery. The Director explained that a contract was held by the partners in the surgery, and there was a workforce tool which showed the totality of the workforce. There were around 530 FTE GPs, which meant that they provided eight or more sessions into the surgery. The Clinical Chair added that contractually the surgery had to offer a service from 8am to 6.30pm. The Primary Care Network Lead clarified that a session was 4 hours and 10 minutes, but between sessions there would be other work to complete due to the complexity of the role. The Member asked for any information about hours worked to be shared with the Select Committee. The Clinical Chair responded that they should be able to share the number of FTEs and their contractual hours. 

4.     A Member raised concerns about the waiting times on the phone to contact a GP surgery. The Director explained that telephony had never been invested in in general practice. The NHS had just started to invest in cloud-based telephony. There had only recently been enough money to upgrade all PCNs’ telephony system. There had been some issues in how this was done in multiple occupancy buildings. The Clinical Chair added that the hope was that digital access had opened up the phones for those unable to use digital services. The issues were usually due to the number of calls and a lack of space within a surgery to hire more staff. The Primary Care Network Lead added that a cloud system would open up access and reduce congestion. The Director shared that it would take around a year to get all providers onto the new framework. 

5.    In response to a question on issues regarding the availability of GPs, the Director shared that over 6.5 million appointments were delivered in a year, of which 3.1 million of those were face to face. Surrey Heartlands were the first to engage with the community about co-design. The system had been under a lot of pressure, especially due to delivery of the vaccination programme. 

6.    A Member thanked those involved for their hard work over the pandemic. The Member asked about the impact of the pandemic on health inequalities and the work being done to ensure consistency and avoid a ‘postcode lottery’.  The Clinical Chair responded that they were aware that the pandemic had affected the most vulnerable communities more and they had learnt from the vaccination programme that they needed to approach these communities in different ways. This work would continue into practice more generally. The Communications and Engagement Lead added that they were engaging with these communities in ways that had not been done before. There were contacts within some of the groups who had been impacted by health inequalities with which they would continue to work and co-design. This was a new and evolving process. The Clinical Chair highlighted the challenge of recruitment of GPs which had been ongoing for at least five years and continued to get worse. The Primary Care Network Lead explained that in 2019 there was a target to deliver 50 million more appointments nationally and to increase the workforce. The target to recruit allied healthcare workers was likely to be met, however, the challenge was to recruit 6,000 new GPs nationally. Many GPs were in the final few years of their career and due to the complexity of the job, it became difficult and unsustainable. Due to the long waiting times in general practice and hospitals, patients were more unwell by the time they would get an appointment with a GP. There needed to be multi-disciplinary teams to support patients with complex needs and to create a more resilient and sustainable workforce. 

7.      A Member asked whether there had been consideration of extending opening hours for GPs. The Clinical Chair explained that the new contract had been introduced which meant that a service had to be offered until 8pm from Monday to Friday and from 9am to 5pm on Saturday. Surrey Heartlands had already been providing this offer. The Primary Care Network Lead added that from 6.30pm to 8pm not all 104 surgeries remained open, instead appointments were offered collectively during that time. The Clinical Chair explained that there was a shared record between surgeries. 

8.      The Board Director of Healthwatch Surrey acknowledged the positive approach taken by Surrey Heartlands in understanding the impact of primary care access on the public but noted that there were still issues around navigating the total triage system. Receptionists were often seen as a barrier and having a lack of understanding. Healthwatch were working closely with Surrey Heartlands and the co-production was positive.

9.    The CEO of Surrey Coalition of Disabled People queried whether there was two-way SMS contact for community members who were hard of hearing and/or had speech and language difficulties. The CEO noted that when the digital system would get ‘turned off’ it could make it inaccessible. The CEO also shared an experience of a resident with sensory issues who had huge difficulties accessing a GP. The Clinical Chair stated that the experience of the resident was not acceptable and noted that there was no surgery that was not trying to see as many patients as possible. 

Ernest Mallett left at 12:57.

10.   A Member asked about plans in place to help to recruit new staff. The Member noted that the public needed to understand that the GP might not always be the appropriate person to deal with their issue. The Primary Care Network Lead explained that they had been set a target to recruit 540 additional roles, but recruiting GPs was difficult. Surrey was in competition with other areas, including London, however, the headcount per population was higher than in other parts of the south east. The outcomes for patients were better when they could see the most appropriate colleague for their issue, and it allowed GPs to focus on high complex patients. The Clinical Chair agreed with the Member that this was a communications exercise. It was relatively recent that the workforce in GP surgeries had become so diversified. It would be useful if Councillors could have that conversation with their residents. 

11.   A Member asked about training for staff to support those with accessibility needs. The Director explained that as a commissioner, they had to ensure that services met accessibility standards. The first phase was focused on accessibility for those with sensory difficulties. The next phase was directed at those with sensory difficulties and those with learning difficulties. The Associate Director of Communications and Engagement highlighted that they needed to ensure training was conducted regularly and there needed to be a cultural piece of work across the system to understand accessibility issues. The Communications and Engagement Lead added that there was a tool available for surgeries to use, which allowed them to review best practice. The Member also asked how Surrey Heartlands were working with Frimley Health Foundation Trust. The Director shared that there was a good peer network across the south east who shared best practice. 

12.   A Member raised concern around issues with receptionists and a lack of continuity between 111 and GP surgery telephone services. The Director acknowledged that receptionists had a difficult job. The individual GP surgery provided some training to their own receptionist staff. Surrey Heartlands were planning to conduct a refresh of customer service training for receptionists. The 111 Service had the ability to pass a patient directly from their system into the GP telephone system. The Clinical Chair added that the correct use of language by the 111 operator and understanding by the patient was crucial.

13.   Speaking about plans for citizen co-design and the involvement of a wide variety of residents, the Communications and Engagement Lead explained that there had been engagement with groups to understand their access needs, and they would come back to them afterwards to ensure those needs had now been met. There needed to be a focus on the service users that had experienced challenges. The Member also asked whether GP surgeries had reached out to patients that they had not heard from for a while. The Primary Care Network Lead explained that the vaccination programme highlighted the need for outreach to those communities. Surgeries had started to develop relationships with those communities that they did not have before. 

14.   A Member asked whether there were any plans to introduce advance booking. The Director explained that advance booking was paused during the pandemic. From April, advance booking would be reintroduced for appointments that did not need to be triaged first. 

15.   A Member thanked the witnesses for their hard work over the pandemic. The Primary Care Network Lead thanked the Member for their comments and invited Select Committee Members to visit a GP surgery in the future if they would like to. 

Recommendations:

1.    The Select Committee urges Surrey Heartlands to:

•      Ensure that the total triage model and investment in cloud telephony is delivered concurrently across all of Surrey Heartlands to ensure all citizens can access an equal level of care and avoid a “postcode lottery” in service availability

•      Work closely with the Surrey Coalition of Disabled People, Sight for Surrey and the Surrey Minority Ethnic Forum to ensure the new cloud telephony system is accessible for all

•      Regularly deliver training to all members of staff to ensure they are able to fully support people with accessibility needs

•      Provide the Select Committee with an update report on the above recommendations later in the year

2.    The Select Committee agrees to explore how it can best share information about this work with citizens as and when relevant, helping to promote the associated engagement and co-design activity. The Surrey Heartlands team will link in with the Surrey County Council Communications team to help facilitate this.

Actions/request for further information:

1.    Surrey Heartlands Primary Care team to provide an updated infographic on the delivery of services.

2.    Surrey Heartlands Primary Care team to provide further information on the contractual hours worked by GPs across Surrey.

3.    Arrange a visit for Select Committee Members to a GP Surgery,