Agenda item

The Board received a presentation, previously circulated within the agenda pack, from Sarah Barron, Interim Manager, Primary Care at NHS England on behalf of the Task & Finish Group Following the presentation the Board discussed the group’s findings.

Ms Barron noted that she had asked Ms Williams to help present this item in order to show that NHS England and the CCGs had been working closely on this to allay the perception that the two organisations tend to work in isolation. It was also noted that Nicky Hopkins of North London Estate Partnerships had also been asked to help present part of this item. Ms Hopkins would be presenting what North London Estate Partnerships would be doing as part of the strategic plan that was being developed.

Ms Barron commented that although she was on a short term interim posting, she was fully aware of the level of concern around primary care access around east Haringey and Tottenham Hale in particularly. At the last meeting in September 2014 a mapping of need was called for and proposals were requested from NHS England on how that need for primary care would be met. As part of this process a Task and Finish group was established and it was noted that it had now had three meetings. In addition an officer sub-group and an access taskforce was also set up as a sub group to look at the immediate issues that were arising. The idea was that the Task &Finish group would look at the strategic concerns that have been raised.

Ms Barron noted that since that last meeting of the HWB a PID document was submitted to the NHS Finance Investment Committee to get funding to undertake a full strategic plan. This included what needs to happen around primary care as part of the regeneration of east Haringey, but also what quick wins could be achieved to tackle immediate concerns around primary care. It was commented that the process of commissioning primary care was a statutory process and that it required clear evidence of strategic need; this was what the strategic plan was intended to give. Ms Barron noted that the plan would hopefully provide evidence of the strategic case for investment. The plan was envisaged to be completed by April but a draft would be brought to the next meeting of this Board.

Ms Barron advised there seemed to be some disconnection between known capacity and what patients were experiencing. The presentation tabled in the agenda pack contained a graph showing the GP Full Time Equivalent rate (FTE) across London of which Haringey sat in the middle. When the figures were broken down to show individual practices that were experiencing problems with access, these practices did not necessarily have the fewest doctors.  In addition, it was noted that one particular practice that concerns were raised with in the past regarding access was actually towards the upper end of GP FTE rate scores.MS Barron commented that this showed that GP access was a multi faceted problem that was not just about capacity. However, it was commented that, the strategic plan would examine the capacity problems and attempt to fill those gaps.

In addition, Ms Barron commented that one of the key things she wanted to highlight was what they could do in the short term to address some of the issues identified.  Some of the key access issues in this respect were; the management of appointment systems, utilisation of nurse capacity, using alternative methods of consultation and a poor level of patient experience of access in areas of east Haringey.

The GPs Survey had recently been released and it was noted that a number of improvements had come about in supporting some of the practices that were at the bottom end of the curve on the aforementioned GP FTE rate graph. Including one example where patient satisfaction levels with being able to see or speak to a GP went from 41% to 76 %. Showing that a commitment from those practices where improvements were needed was taking place. NHS England was working with those practices to bring about these improvements to accessibility and the ability to see or speak to a GP.

Ms Barron noted that in cases where GP practices were not engaging with current processes to improve performance levels around accessibility NHS England were able to take contractual compliance measures where necessary, including serving breach and/or remedial notices. It was commented that some of the practices were in the process of being taken through the contractual compliance route. 

Ms Barron noted that work has been undertaken with the CCG to understand if there were any short term fixes in the Tottenham / east Haringey area that can be undertaken to tackle these accessibility problems. There were no solutions that NHS England could get funding for through their Finances & Investment Committee without demonstrating clear evidence as part of the strategic plan. Initial conversations had taken place with the developer at Tottenham Hale around finding an on-site solution but again this funding would have to be fully evidenced and again would have to go through the Finances & Investment Committee. Ms Hopkins would continue to explore this as part of the process of bringing together the strategic plan.

Ms Hopkins spoke to the Board and outlined that her organisation was a public-private partnership that was established to address premises needs in Health and Social Care in the Barnet, Haringey and Enfield area. They have developed two health centres in the area at Hornsey and Lordship Lane. They were tasked by NHS England to develop a Primary Care Premises Plan or a Strategic Premises Development Plan for east Haringey and to support the decision making processes. In order to do this the short, medium and long term primary care needs were to be determined and a clear picture of existing capacity to deliver services developed. As part of this process Ms Hopkins commented that they hoped to identify some quick wins such as a potential temporary solution at Tottenham Hale. The timescales for completion of this project were noted as usually taking 3-4 months; however it was hoped that it would be done sooner in this instance. An update on the project will be brought back to this Board at its next meeting.

Beverly Tarka, Interim Director for Adult Social Care, asked for a little further clarification about the short term routes that were available to tackle poor performance from individual practices. Ms Barron noted that the routes available ranged from the more severe contractual processes that were outlined above, to the CCG providing support to ensure that a practice was able to provide everything that they should provide. Examples of this included liaising with them to determine whether their operating system is operating as smoothly as it can or working to see if a practice provided access through other forms of consultations.

Ms Tarka noted that these routes would take some time before a resolution was found and questioned whether the integrated collaborative GP system provided any opportunities for residents to access appointments quicker. Ms Williams responded that this was currently being looked at by the CCG. In addition to actively going in and supporting a particular practice, the working at scale project was highlighted as having enabled some practices to open up their appointment processes. However it was commented that in the north east the pilot project focused on enabling telephone appointments with doctors, as opposed to making more appointments available. Any future roll-out of the working at scale pilot would also need to be funded.

Ms Barron noted that the current pilots could not provide an immediate solution as the federation of practices was at a very embryonic stage and asking them to undertake any additional tasks could destabilise them. It was further commented that, any additional funding for primary care capacity had to be agreed through the NHS Finances and Investment Committee and this required evidence of strategic need.

The Chair noted that she still did not have a clear sense of where the problem was in Haringey following the last session when a number of residents and Councillors recounted their difficulties of getting an appointment. Ms Barron responded that the charts were provided to illustrate that there was not necessarily a correlation between a lack of capacity and an inability of residents to access services. Ms Price commented that this was not necessarily an issue of just GP numbers. Instead the issue was less straightforward and was more about; how these services were run, the quality of individual GPs or how practices organised themselves. Ms Herman commented that instead of this being a capacity issue it seemed that this was more about the capability of particular primary care providers.

Cllr Waters, the Cabinet Member for Children and Families asked Ms Hopkins to give the board an estimation of how long this process would take.  Ms Hopkins responded that for some of the issues around organisational practices and the re-development alterations, the next step would be to go back to the NHS England governing bodies to see how the projects could be taken forward. It was commented that a key consideration in taking any projects forward would be how they fitted into the strategic plan. It was commented that it would take at least 12 months to build a new building and 6 months to secure planning permission. A range of options would likely be required and that was why a short, medium and long term plan was being developed.

The Chair asked for clarification on what the timescales were for resolution if there were contractual issues. Ms Barron responded that a remedial route involved serving a notice and giving a timescale for improvement; a timescale of two months was suggested.  In the case of a breach notice the practice would be informed that they were in breach of contract and NHS England would continue to monitor the practice to ensure that this did not happen again. Both of these courses of action would ordinarily happen at the same time. 

Ms Grant expressed concern that the representatives from NHS England and the CCG were unable to give any assurances of remedying the situation in the short term. Ms Grant commented that Healthwatch had previously demonstrated that a severe lack of access to primary care existed around Tottenham Hale. It was also commented that the graph showing the GP FTE was based on averages and did not necessarily do much to help those people who were struggling to access GP services. Ms Barron commented that a key practice in the area was within the top quartile of GP FTE and the correlation wasn’t necessarily about lack of capacity and an inability of residents to access services.  Health inequalities existed in a number of areas of the borough not just around Tottenham Hale. In the short term NHS England’s role was around contract management.

Ms Herman commented that consideration should be given to providing solutions to the primary care shortage that do not necessarily involve providing new facilities i.e. ones that looked into other models of primary care provision.

Ms Etheridge thanked colleagues from NHS England, the CCG and North London Estate Partnerships for their levels of engagement in this process.

It was:

RESOLVED:

1. That progress of the Primary Care Task And Finish Group, be noted;

2. That the next steps given as part of the presentation be noted; and

3. That an update on the progress of the Primary Care Task And Finish Group be brought back to the Health and Wellbeing Board on 24^th March 2015.