Agenda item

The Board received a verbal update from Neil Roberts, Head of Primary Care at NHS England, on the provision of GP services in Haringey and particularly in Tottenham Hale. Mr Roberts also responded on points made as part of the deputation and formal questions submitted under Item 6 in relation to the lack of GP services in Tottenham Hale.

Mr Roberts began by noting that the issue of access to GP services was of concern to many people across the UK and that this was not particular to Haringey. He noted that the Healthwatch report on the capacity of GPs in Tottenham Hale was alarming and he accepted that the position appeared to be worsening based on the Healthwatch report and the experiences that had been shared by residents with the Board that evening. Mr Roberts advised that GP’s could not be compelled to establish practices and noted that the funding arrangements in place for GP practices were based on population rather than an analysis of the needs of an area. As a consequence establishing a practice in an area of significant need was likely to be less ‘profitable’ and more demanding and therefore was less attractive to GPs.

With regard to specific criticism of the Tynemouth Road Practice Mr Roberts noted that NHS England had been working with the practice to improve the quality of the services it offered and the systems in place there. Though it was disappointing that the impact of this improvement work did not appear to have taken full affect NHS England would continue to work with the practice to improve standards.

In terms of the regeneration work being undertaken in Tottenham Hale and the impact of additional population of Hale Village, Mr Roberts noted that NHS England had only been in place since April 2013 and that discussion around Hale Village and the regeneration of Tottenham Hale pre dated its existence. Therefore work was required to assess how the regeneration work and needs of a growing population would be addressed and it was proposed that this could be done in part by a Task and Finish group chaired by Mr Roberts and including representatives from the CCG, Council and Healthwatch.

In relation to the twelve to fifteen month period referred to in terms of procuring a new GP practice Mr Roberts noted that there were procurement rules that NHS England were required to follow and that this timescale was based on the need to adhere to these. Therefore ‘growing’ existing practices was an important alternative and NHS England was working closely with practices in the area to achieve more capacity and improve the quality of services. Mr Roberts also made reference to the average number of patients on a GP practice list and the importance of having sufficient nursing capacity and skills mix within a practice.

The Chair thanked Mr Roberts for attending and responding to the points made earlier. She opened discussion by noting that the average number of patients on a GP’s list was a misleading measure of their capacity; for example there may be a larger than average population of elderly people or high levels of social deprivation meaning that there were likely to be more demanding health needs and this would not be detected by looking at the average number of patients on a GPs list.  The Chair also noted that if the provision of GP services were to be discussed using private sector terminology then the lack of adequate GP services in Tottenham Hale could be seen as market failure on the part of NHS England.

In response to a question with regard to what action NHS England intended to take as a matter of urgency, in order to respond to the acute problems residents were experiencing in registering with GPs and obtaining GP appointments; Mr Roberts advised that NHS England was putting measures in place to address the immediate problems. These included discussion with the CCG around solutions that would provide quick action; however, simply providing cash injection to address the problems in the short term was not a viable option and would set a precedent that could not be met.

The Board was in agreement that new and innovative approaches had to be adopted in order to address the acute need that was evident in the area. There was a general consensus that as a matter of urgency examples elsewhere in the country where this type of scenario had been successfully addressed should be identified and looked at. It was also noted that it would be important that the proposed Task and Finish Group considered and quickly identified measures that could be quickly put in place as well as considering the long term healthcare needs of the area over the next twenty years. 

In response to concerns expressed with regard to the need to plan for the wider healthcare needs in the north east of Haringey, as these were likely to significantly increase over the next decade; Mr Roberts agreed that a clear strategy for recruiting GPs in the medium to long term was required and that improving the viability of existing practices and planning with GPs would form an important part of this.

At the conclusion of discussion there was a general consensus that the Board should escalate this issue and formally write to NHS England outlining its concerns with regard to GP services in Tottenham Hale and the Tynemouth Road clinic. There was agreement that the letter should call for immediate action to be taken by NHS England and for the proposed Task and Finish group to commence as soon as possible.

RESOLVED:

1. That the information and proposed actions presented by NHS England be noted;

2. That a Task and Finish Group be established as soon as possible to look at how the immediate and long term health care needs of Tottenham should be met.

3. That a letter should be sent by the Chair, on behalf of the Board, to NHS England formally setting out its concerns with regard to the provision and quality of GP services in Tottenham Hale and the Tynemouth Road practice, calling for immediate action to be taken and for it to outline how it intended to do this.