Purpose of the item: For the Select Committee to receive updates from Surrey Heartlands Integrated Care System and Frimley Integrated Care System.
Minutes:
Witnesses:
Mark Nuti – Cabinet Member for Adults and Health
Liz Uliasz - Chief Operating Officer, Adult Social Care
Nikki Mallinder – Director of Primary Care, Surrey Heartlands
Pramit Patel – Primary Care Clinical Leader, Surrey Heartlands
Katrina Watson - The Associate Director for Primary Care and Primary Care Network (PCN) Development for Surrey Heath, Frimley
Key points raised during the discussion:
1. The Vice Chairman asked if plans existed to enable GP surgeries to return calls during times suitable for patients, particularly given that some patients may be working full-time, on zero hours contracts or caring for someone. The Primary Care Clinical Leader, Surrey Heartlands explained that work to manage the demand of unscheduled inbound calls was progressing, communication with patients was required to advise when they would receive a response as the urgency of need was dependant on the clinical query in question. Outbound planned appointment calls would continue in the same way as face to face appointment requests.
2. The Vice Chairman queried what provision was in place for weekend calls. The Primary Care Clinical Leader, Surrey Heartlands confirmed that extended access for routine appointments was available outside of the general practice contracted hours of 8.00am until 6.30pm, Monday to Friday adding that out of hours calls backs had been subcontracted to 111 resulting in urgent need callers receiving a call back from the out of hours provider following their initial call to 111.
3. The Chairman said that despite the report noting that 98 per cent of practices had moved to the new telephony system, barriers remained for some when contacting practices by telephone and queried how could be addressed. The Director of Primary Care, Surrey Heartlands said that whilst 98 per cent of practices in Surrey Heartlands had moved to the new increased functionality cloud based telephony system, providing the system alone was not enough and in partnership with Redmoor Health, a change programme was being rolled out to help each of the 104 practices to determine a set of standards for patients to address those that still faced barriers.
4. The Chairman asked if training packages had been purchased with the new telephony systems and queried who had been trained and how. The Director of Primary Care, Surrey Heartlands explained that telephony systems purchased by each practice were sourced from an NHS England procurement framework with each provider required to confirm a required set of purchase standards. Training differed between providers and Redmoor Health had been contracted regionally to provide any required additional learning.
5. The Chairman asked if the basic training on any new telephony system was provided by the technology provider. The Primary Care Clinical Leader, Surrey Heartlands confirmed that a basic hardware support package was provided by the technology provider and there was confidence that the technology procured across 98 per cent of practices could now achieve the expectations within the development toolkit.
6. The Chairman said that the paper did not reflect the experiences of people that had not been able to use the telephone system successfully and asked what were the health implications of patients that drop out whilst waiting in a telephone queue. The Director of Primary Care, Surrey Heartlands said that each practice was required to provide telephone data, these numbers did reflect drop out numbers and could be shared with Committee Members following a sensible period of reporting. Action - The Director of Primary Care, Surrey Heartlands
7. A Member asked if the language line services noted in paragraph 10, page 27 of the Frimley report were centralised or geographically based and queried how patients were made aware of these services, was there evidence to indicate the extent to which these services were being utilised and what were the clinical and mental health ramifications of not being able to access these services. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley summarised the successful use of language line and BSL services in Surrey Heath noting that the system had been used 628 times over the last year covering 34 languages. The service was promoted through the carers network, various events and by practice staff who have had or would receive training. The Member noted concerns at the feedback he had received, particularly from Ukrainian visitors that they had experienced difficulties in connecting and engaging with services. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley agreed that more could be done to make these cohorts of patients aware of the services available and undertook to investigate this further. Action - The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley
8. The Mental Health Lead, Surrey Coalition of Disabled Peoplequeried the accessibility features of the new telephony systems, in particular SMS reminders and the accessibility for people who were deaf or hard of hearing. The Mental Health Lead, Surrey Coalition of Disabled Peoplealso ask if any consideration had been given to people with home care needs who may not be able to access appointments in the morning. The Primary Care Clinical Leader, Surrey Heartlands explained that work with the Surrey Coalition of Disabled People following the procurement of the Surrey Heartlands online portal would result in all interfaces having a more simplistic feel. The Chairman queried the consequences of failure to implement these aspects. The Director of Primary Care, Surrey Heartlands confirmed that Surrey Heartlands would help practices comply to the contractual requirements.
9. A Member queried current Surrey Heartlands & Frimley access for patients that may struggle to book appointments by telephone such as non – verbal residents or those with mental health issues. The Primary Care Clinical Leader, Surrey Heartlands confirmed that consideration of how to work with such patients would be undertaken and the help of local councillors to share the message with communities would be needed.
10. A Member asked if there were targeted efforts to overcome challenges around digital exclusion. The Director of Primary Care, Surrey Heartlands confirmed that a Surrey Heartlands workstream under the digital portfolio had focused on bringing together a program to support those that did not have access to services digitally and this would help to free up resources for other patients that would access services in a more traditional way. The Primary Care Clinical Leader, Surrey Heartlands added that a partnership with Barclays Tech Angels had resulted in a patients champion which meant that people could be signposted to a location set up to provide digital support and guidance. The Member said that it was important to know who was not accessing services so their needs could be identified and addressed.
11. The Chairman said that additional information and detail about the figures included in the report tables was required so that the Committee could fully understand the approach being taken.
12. The Cabinet Member for Adults and Healthchampioned the actions taken by Surrey Heartlands and Frimley in recognising demand and identifying solutions to educate people to access the right services for their needs.
13. A Member, in referencing a recent personal experience where a receptionist was not able to book an appointment, queried how digitally excluded residents could access appointments. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley said that this should not have been the case and requested further information for investigation. The Chairman noted that this was not a one off occurrence and as such, it was essential that those being turned away with no further offer were recorded and included in the data. The Primary Care Clinical Leader, Surrey Heartlands said that practices would be supported to implement the contractual changes to address the specific inclusion of on the day assessment of need included in the new contract.
14. The Vice Chair asked to what extent patients were being made aware of how to decide if they should approach their GP or attend Accident and Emergency (A&E) in the event of becoming unwell and did reception staff receive training around this. The Director of Primary Care, Surrey Heartlands said that national communication around this had restarted and would run alongside communications about how to access available services. The Director of Primary Care, Surrey Heartlands added that there was work was underway with practice receptionists and care coordinators to focus on responding to and directing people to the appropriate service.
15. The Vice Chairman asked if it would be possible to record and monitor when patients are advised to attend A&E rather than being offered General Practice (GP) appointments. The Director of Primary Care, Surrey Heartlands confirmed that all A&E demand was captured.
16. A Member questioned what was being done to ensure that mental health patients were directed to safe havens as opposed to A&E. The Primary Care Clinical Leader, Surrey Heartlandsagreed that it was important that patients were seen by the right service the first time around and said that the appointment of new mental health practitioners as part of the additional roles reimbursements scheme would work closely to ensure services work effectively.
17.A Member asked how continuity of care was being optimised to improve clinical outcomes as well as patient experience and how could any barriers to achieving effective continuity of care be overcome. The Primary Care Clinical Leader, Surrey Heartlands said that there were 64,000 high users of healthcare of which 1 per cent (624) were 'very' high users. This 624 cohort had 1900 A&E attendances, 500 in patient stays, 500 outpatient appointments and 54000 GP contacts. This cohort now has a PCN multidisciplinary team wrapped around them and early reports suggest the number of hospital attendances had started to significantly drop.
18.A Member asked what prevention measures were being taken to ensure a proactive, rather than reactive approach to providing care and asked for more detail about national and localised prevention measures. The Primary Care Clinical Leader, Surrey Heartlands noted the focus on prevention within the Fuller Stocktake report and explained that work was underway within Surrey Heartlands to make every contact count and to reach out and create simple pathways. An example of this was encouraging patients to have blood pressure and weight monitoring checks to prevent chronic cardiovascular disease. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley explained that Frimley ICB had been focusing on developing multi-disciplinary core models of care to make every contact count. Health on the High Street work through the spring booster campaign had been used to help to boost blood and weight tests to identify patients as they presented alongside the management of long term conditions to improve targets and help the patient recover in a more holistic way.
19. A Member asked what was being done within primary care to address the issue of elective treatment waiting lists. The Primary Care Clinical Leader, Surrey Heartlands said that the demand for general practice had increased and the development of an interface between primary and secondary care was being progressed. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley agreed that the elective care backlogs had resulted in an increased demand in primary care and multi-disciplinary teams were being utilised to support patients whilst they waited for surgery on certain pathways.
20. The Local Healthwatch Contract Manager, Healthwatch Surrey asked if all sources of patient experience were being considered together to consider themes and ensure system developments could be implemented to achieve better outcomes for all and how was the information being captured and measured. The Director of Primary Care, Surrey Heartlands said that it had been difficult to pull together the entire picture to date because general practice complaints had originally been retained by NHS England and not delegated down to Integrated Care Systems (ICS). This data was now being brought over and combined with the other data, would allow an understanding of all the issues faced by patients. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley said that regular meetings with Healthwatch representatives and direct access to practice managers helped to consistently address any patient experiences and complaints.
21. A Member queried what processes in place to identify if individual learning and training of practice staff was adequate. The Director of Primary Care, Surrey Heartlands noted that each practice was an independent contractor and as such, the human resources (HR) function of staff would fall directly with the practice. Support to train and educate from Surrey Heartlands would be provided and the Care Commissioning Committee in Surrey Heartlands continued to have the responsibility for overseeing the delivery of general practice in Surrey.
22. A Member asked if practitioners would continue to routinely receive mental health training, and would such training be mandatory. The Primary Care Clinical Leader, Surrey Heartlands explained that a the locally commissioned Severe Mental Illness service provided specific training requirements for administrators and clinicians with performance measured through the Primary Care Commissioning Committee.
23. The Chairman queried how monies were allocated in the Additional Roles Reimbursement Scheme (AARS). The Director of Primary Care, Surrey Heartlands confirmed that the national Carr-Hill formula was used for the entirety of the contract and considered various demographics of the population being served. The Primary Care Clinical Leader, Surrey Heartlands added that whilst the funding had been provided for the additional roles, they would still require training and supervision to be undertaken by GPs and their practices as this had not been taken into account within the multiyear deal. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley confirmed that systems were in place to train to the AARS roles within Frimley which were PCN led to support the needs within the communities.
24. The Vice Chairman asked what was the process for monitoring GP surgery performance and would additional and special assistance be offered to practices performing poorly. The Director of Primary Care, Surrey Heartlands noted the responsibility of the Primary Care Committee in the commissioning and delivery of general practice with practice performance considered monthly to ensure targets were met. Targets would be measured against metrics, access visits and Quality Care Commission (QCQ) inspections. Any poorly performing practices were referred for assistance to the delivery team in Surrey. Any issues would be identified by The Director of Primary Care, Surrey Heartlands; each area has a team of people looking after Practice, on top we have metrics and measurement. Access visits annually with specific questions and the CQC had its own standard for measurement. The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley confirmed the same processes for Frimley including quality and resilience monthly meetings to address any upcoming issues, weekly practice meetings regular practice visits to ensure issues were flagged as quickly as possible.
25. The Primary Care Clinical Leader, Surrey Heartlands welcomed Members to a further session outside of the Committee to discuss the Development Toolkit in more detail and address some of the issues that have been discussed.
Recommendations:
Primary Care Leads at Surrey Heartlands & Frimley Integrated Care Systems:
Actions/ requests for further information:
Further investigation to be undertaken around how cohorts can be made more aware of services such as language line availability and access. Action - The Associate Director for Primary Care and PCN Development for Surrey Heath, Frimley