Agenda item

To update the panel on progress towards improving primary care in Haringey in the context of the North Central London Strategy for General Practice and other developments including provisional funding to open three new GP practice buildings.

Dr Peter Christian, Chair of Haringey CCG, introduced this item noting that the Panel had read the paper supplied with agenda pack and that the key themes that should be highlighted included the workforce, the estate and the escalating demand for primary care. Clare Henderson, Director of Commissioning at Haringey CCG, highlighted the long term plan which included developing more services and skills around primary care such as primary care mental health services for example.

In response to questions from the Panel, Dr Peter Christian and Clare Henderson said:

• That with regards to online booking systems and patients with limited internet access or computer skills, what is needed is systems that can operate in parallel. There had been huge demand from people who wish to interact with primary care in new ways including telephone consultations, which are popular, and online bookings. The development of systems that use new technology can’t just move at the slowest pace but it is important to pay regard to people who find that the new systems don’t work for them. There are never going to be enough appointments to meet demand in primary care and so meeting demand for need and ensuring that people who are acutely ill are seen promptly is the priority. Each practice therefore needs to design its own appointments system built around achieving this.
• That with regards to whether the rating by patients of GP practices as outlined in the report had been affected by difficulties in getting an appointment, it is likely that this had been a factor. The NHS 10-year Plan refers to drafting more staff into primary care who are not doctors and there is a challenge to communicate to the public in the coming years the concept of a primary care team, that the GP may not always be the right person to see and that it could sometimes be, for example, a pharmacist or nurse.
• On what action commissioners can take to ensure good performance from GP practices, firstly performance is managed through the contractual route via the contracts team at NHS England. Secondly, at a CCG there are primary care facilitators who engage with the GP practices and there are also annual board link visits. Practices work together in networks to learn from one another and there are practice manager forums.
• On patient satisfaction surveys, there can often be huge variations in the feedback on the same GP practice due to the subjective nature of the answers and because those you are dissatisfied can sometimes be more vocal than people who are satisfied. Cllr da Costa commented that it might be useful to cross-reference the patient satisfaction results with the CQC ratings. (ACTION)
• On whether the improvement plan focused mainly too heavily on the east of the Borough, there are also significant plans in the west including a business plan for the merger of three GP practices which aimed to improve the quality of services, a wider range of services and longer opening hours.
• On the accessibility of new practices after the various mergers, given that this leaves some wards without a GP practice, there is a balance to be struck between the benefits of larger practices which is increasingly becoming the preferred model, particularly by the younger GPs coming through who often prefer to be salaried GPs rather than operating a practice as a small business, and the practical arrangement such as the transport links available in the area. There are also challenges involved with smaller practices closing down when GPs retire. The CCG works with public health on future population forecasts when developing proposals for sites. There had also been engagement with patient groups regarding the proposals. Cllr Connor commented that the point of transport links need to be flagged up as an important issue when these proposals go through Planning and also that Healthwatch are ideally placed to have further conversations with residents about transport.
• With regards to ongoing technological developments and new ways of working the use of unified electronic patient records could help to deliver significant improvements in patient care, and the increased use of Skype/video-based consultations may be beneficial for some patients but it is important to bear in mind that this does not necessarily enable GPs to do more in the limited time they have available. With all new ways of working need to mitigate against digital exclusion of patients who find it difficult to use technology.

Cllr Connor commented that some residents felt that the communications with them on what to expect from the process when their GP practice has received a poor CQC rating could be improved as the wording of the letters was unclear in parts.