Agenda item

To receive a report on GP Services.

Dr Katie Coleman, GP and NCL Clinical Lead for Primary Care Network Development, and Dr Peter Christian, GP and NCL CCG Board Member, introduced the report which provided an update on GP Services. Dr Peter Christian noted that the report provided an overview of primary care in North Central London. He explained that the report provided detail about the different types of contracts, including General Medical Services (GMS), Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS), and about which services were commissioned from general practice.

It was explained that all contracts with GP practices were delegated from NHS England to Clinical Commissioning Groups (CCGs). It was noted that, in North Central London, the contracts were managed by the CCG contracts team and the Primary Care Commissioning Committee. Performance and monitoring was routinely conducted on the contracts through various mechanisms and any issues were referred to the Committee.

Dr Katie Coleman noted that primary care had worked exceptionally hard throughout the Covid-19 pandemic, including significant achievements with the vaccination programme. It was acknowledged that there had been a reduction in face-to-face provision at the beginning of the pandemic but that over 50% of appointments were now provided face-to-face. It was added that face-to-face appointments were provided if required.

It was explained that GP practices were working together with local health and voluntary services in groups, known as Primary Care Networks, and that alliances of practices were working together to deliver primary care services, known as GP Federations. It was noted that, under the developing Integrated Care System (ICS), it was envisioned that GP Provider Alliances would ensure a strong, unified voice for primary care to influence and challenge ICS decision-making. In North Central London, it was stated that a GP Alliance reference group had been formed and was establishing its structure.

Jo Sauvage, NCL CCG Chair and Primary Care Lead, stated that the demand on primary care was immense and that some of this could be managed through digital options. It was accepted that the traditional model was still important but that the system needed to consider how it could modernise effectively to deal with demand and ensure high standards for patients and staff. It was commented that Healthwatch was very helpful in providing engagement and reports on these issues, and particularly on access. The Chair added that the recent Healthwatch report on digital exclusion was included in the Committee’s agenda papers for information.

It was noted that some changes to the way NHS Digital would access and use GP data had recently been announced. It was explained that the new way to use data was called the General Practice Data for Planning and Research (GPDPR). GPs would provide data which would be pseudonymised; this meant that the data would not be directly identifiable but could be used to identify patients if needed. It was added that the data would be used to plan future services and monitor health service delivery. Dr Katie Coleman noted that the changes were due to be implemented on 21 June 2021 but had been delayed and it was acknowledged that there was a need to better engage with communities and explain the implications of the changes. Dr Peter Christian welcomed improved communications and highlighted that the changes had significant potential to improve research and patient care.

Cllr Tricia Clarke accepted that the data would be valuable for research purposes but expressed concerns about the commercial value and commercialisation of this data. She stated that it was difficult to opt out of the data sharing, that the process might need to be simplified, and that the deadline might need to be further delayed. The Chair enquired about the implications of opting out; specifically, whether this would allow data sharing for direct health purposes to continue. She added that it would be useful to clarify and provide this information to GPs and residents. Dr Katie Coleman noted that she could feed back these points to the officer who was leading on this work. She acknowledged that this was a difficult issue which was not within the control of the CCG and it was understood that the mechanisms for opting out were being considered. It was explained that there were two types of data opt outs: a Type 1 Opt Out would mean that data was not shared with NHS Digital and a Type 2 Opt Out would mean that patient data was not shared for any purposes beyond the patient’s care.

The Committee noted that there were concerns about the General Practice Data for Planning and Research (GPDPR) proposals. It was considered that the governance arrangements and safeguards for patient data needed to be clearer. It was accepted that many patients were likely to consent to the use of their data for purely research-based use but would not want this data to be commercialised. The Committee considered that more action should be taken to explain the arrangements for patient data and suggested that an opt in arrangement might be more appropriate.

The Chair noted that there had been significant pressure on health and care staff, including within primary care, and enquired whether the workload was expected to reduce towards the end of 2021. Dr Katie Coleman believed that Covid-19 vaccinations would be provided for the long term and that, although the vaccinations were likely to become easier to store and process, there would still be pressure on primary care. Jo Sauvage added that there was also a backlog in elective procedures and it was anticipated that, due to some suspended services and patient lack of confidence during the pandemic, there would be a backlog for those with long term health conditions and for missing cancer patients. It was predicted that there would be increases in respiratory issues as an impact from Covid-19. It was also stated that demand was not expected to reduce in the foreseeable future.

The Chair noted the stresses on the workforce and the greater complexities faced by a number of patients, in some cases, in accessing services. She stated that how GPs communicated changes with patients was key. It was noted that the Healthwatch report, Locked Out: Digitally excluded people’s experiences of remote GP appointments, was included in the agenda pack and set out the following principles of post-Covid digital healthcare:

-       Maintain traditional models of care alongside remote methods and support patients to choose the most appropriate appointment type to meet their needs;

-       Invest in support programmes to give as many people as possible the skills to access remote care;

-       Clarify patients’ rights regarding remote care, ensuring people with support or access needs are not disadvantaged when accessing care remotely;

-       Enable practices to be proactive about inclusion by recording people’s support needs;

-       Commit to digital inclusion by treating the internet as a universal right.

It was noted that the Committee supported these principles.

RESOLVED

1.    To note the report.

2.    To submit the following statement to the North Central London Clinical Commissioning Group to pass on as appropriate:

The Committee noted that there were concerns about the General Practice Data for Planning and Research (GPDPR) proposals. It was considered that the governance arrangements and safeguards for patient data needed to be clearer. It was accepted that many patients were likely to consent to the use of their data for purely research-based use but would not want this data to be commercialised. The Committee considered that more action should be taken to explain the arrangements for patient data and suggested that an opt in arrangement might be more appropriate.

3.    To support the Healthwatch principles for post-Covid digital healthcare.