Agenda item

To provide an update on NCL primary care and an overview of community pharmacy integration in NCL.

Clare Henderson, Director of Integration (Islington), provided an update on the primary care response to winter 2022/23. She explained that:

·         Comprehensive plans had been developed but there had been additional challenges such as Strep A. There was always a lot of focus on primary care access and demand for face-to-face appointments which needed to be balanced against protecting capacity for proactive care and long-term condition management.

·         Rates for face-to-face appointments in NCL were slightly lower than the national average but NCL was one of the best performers in terms of same day appointments. In Camden there had been a focus on high intensity users, while in Islington there had been an approach based on speaking to a PCN reception rather than an individual practice for triaging purposes.

·         A shift in focus to same day access was anticipated and NHS England were expected to publish a document on this shortly.

·         Primary care services still had a range of telephony systems which was a currently a significant topic of conversation.

Cllr Chowdhury raised the difficulties for patients in obtaining GP appointment by calling at 8am. Cllr Connor noted that there was often availability at GP hubs at evenings and weekends but that this was not widely known or communicated by GP practice reception staff. Clare Henderson acknowledged that there was scope for better communications about how people can access GP hubs. She added that the recruitment and retention of reception staff was an area where many practices struggled and this added to the challenges of primary care access.

Kristina Petrou, NCL Community Pharmacy Clinical Lead, provided an overview of community pharmacies, noting that there were just over 300 community pharmacies in the NCL area, 80% of which were independently owned with 20% provided by chains such as Boots or Superdrug. She also explained that:

• The Pharmacy Integration Programme was a drive from NHS England to improve services in community pharmacies. The aim was to increase the presence of pharmacists in primary care and to make pharmacists the first point of call in many situations to help people to self-care and to free up primary care capacity. This would also better utilise the clinical skills in community pharmacies that were currently underused.
• The table on page 56 of the agenda pack provided a list of community pharmacy services. From March/April the Community Pharmacy Consultation Service (CPCS) would be accepting referrals from Urgent or Emergency care settings which meant that a large amount of presentations could be managed through community pharmacies rather than GP practices or A&E.
• A hypertension case-finding service was being expanded to identify risk of strokes, heart attacks and cardiovascular disease. 204 pharmacies in NCL had signed up to this, of which 142 (as of Dec 2022) were actively providing appointments so far. They could also accept referrals from GP practices that did not have the capacity to monitor blood pressure which could help to identify long-term conditions at an earlier stage.
• Another service was the Discharge Medicine Service (DMS) which must be offered by all pharmacies. This was to ensure better communications of changes to a patient’s medication when they leave hospital. It was estimated that 60% of patients had three or more changes to their medicines during a hospital stay which increased the risk of errors during the discharge process.
• A Smoking Cessation Service (SCS) was provided from Chase Farm hospital in Enfield to patients identified in hospital and then directed to a pharmacy of their choice.

Kristina Petrou then responded to questions from the Committee:

• Cllr Cohen asked whether the pharmacies that had signed up to new services had been supported with additional training and financial resources. Kristina Petrou explained that the central services must be offered by all pharmacies so this was part of their core payment. The advanced services (which included the CPCS, smoking cessation and hypertension services) were designed nationally but pharmacies could choose whether or not to opt into these. Pharmacies that opted in received a set-up payment based on the staff training requirements as well as the fees for services provided. While funding had been cut for dispensing prescriptions, pharmacies were being paid more for consultations and other services ‘on the shop floor’.
• Members raised various concerns about communications issues: 

o   Cllr Anolue expressed the view that public awareness about the new services needed to be raised and also expressed concern about the availability of pharmacies in some parts of the local community.

o   Cllr Revah said that communications from GP practices about these services may need to be improved.

o   Cllr Connor asked how GPs would know about patient interactions with pharmacists.

Kristina Petrou agreed that there was untapped potential of the clinical skills of pharmacists but said that the public view of pharmacy services, in terms of awareness of the services that were available, was improving according to surveys that were carried out each year. The provision of services across population areas was typically addressed through the Pharmaceutical Needs Assessment which was published every four years by the Health & Well Board and assessed any gaps in need across the population in the Borough. 

Kristina Petrou added that the communications on the pharmacy services included a national approach as well as communications from individual GP practices through their websites, posters and display boards. GP practices were encouraged to work with pharmacies within individual primary care networks.

Kristina Petrou agreed that the sharing of data between GP practices and pharmacies was the top stumbling block to rolling out services across pharmacies for IT and GDPR reasons. Pharmacies did not have the ability to add entries to GP records and so the system relied on them sending messages to GP practices.

Cllr Connor addressed a matter arising from a previous meeting (raised by Cllr Bevan) which related to the improvement of the external condition of the premises of GP practices. A response had been provided to the Committee setting out the expenditure required to make the buildings fully compliant and Cllr Connor requested further details about the expected timescales for the completion of this work. Clare Henderson said that the improvement grants came from NHS England to improve GP practice premises, including disabled access but that she would provide a further update on the expected timeline. (ACTION)

Due to time constraints, Cllr Connor suggested that Committee Members submit any additional questions that they may have by email.