Agenda item

To receive an update on access to primary care services in NCL.

The report was introduced by Katie Coleman which is summarised below:

·         Primary care or GP Services made up more than 90% of all NHS activity in North Central London, and 95% of all activity in the NHS.

·         GP services in North Central London carried out more than 800,000 appointments and of those 740,000 were ‘in- hours’ appointments. 50% of targets were dealt with on the day.

·         In North Central London, GPs were responding to an increase in demand, however it was noted that GP services were attaining pre- pandemic levels of service.

·         Patient satisfaction with GPs services were declining across the country.

·         It was noted that adequate recruitment and retention of GPs, as well as consistent funding of the service must be focused on, if not, GPs would not be able to keep up with demand.

The Committee was then asked for comments and questions on the report.

Cllr Connor stated that the report was extensive and needed some focus. It would be useful to include a summary of points for the Committee to consider.

Cllr Clarke also pointed out that there was no mention of the GP Federation in the paper. Katie Coleman responded that GP Federations were vital for GPs to have a consistent approach to healthcare. The GP Federations have a strong voice in North Central London in working collaborations. This is being developed further by the ICB.

Residents in Cllr Revah’s ward had difficulty seeing their GPs - sometimes waiting 3-4 weeks for an appointment. Cllr Revah also stated that there are issues with patient confidence in the ability of GPs to diagnose illness over the phone. Face-to-face appointments are preferred. Katie Coleman responded that over 69% of GP appointments are face to face. And although there are still some issues with seeing patients within a suitable period, levels are returning to pre- pandemic levels.

Cllr Chowdhury reiterated that the residents in his ward also had issues with getting appointments. His own experience was that patients would give up waiting in the telephone queue for an appointment. He stated that also the online consultation forms are not easy to access or use. Not all people have access to digital channels and therefore access to emergency appointments for all, was questioned. He also raised that his feeling was that some GP surgeries are taking more patients than their capacity allows. Ms Coleman responded that it is a requirement that GP practices respond to patients on the day with information, signposting to other services or an appointment. She also stated that GPs are not allowed to deny locals access to their services, so were unable to limit patient numbers.  She, however, admitted that the system was not perfect. The ICB was working with GP practices to decrease variances in how patients experienced the service across the locality. It was pointed out that funding was at the lowest level, but the service was experiencing an increase in demand.  Regarding online consultations, she acknowledged the challenges patients experienced, and suggested that work may be done around training receptionists to support patients.

Discussion then turned to access for those who found digital access hard or not possible. Cllr Chowdhury suggested there may be some role for Voluntary sector organisations to help. Ms Coleman affirmed that work was already being done with some organisations to include older people.  More details on the voluntary organisations working with the ICB were requested by the Committee.ACTION  

Cllr Cohen then questioned the Pharmacy First approach, as he understood it certain pharmacies had hit back at this approach – as seeing a pharmacist was not a substitute for seeing a GP. Ms Coleman responded that the Pharmacy First approach was supported by over 96% of pharmacists across the nation. All have undergone training to treat seven acute presentations in patients. Some pharmacies will have the ability to prescribe in the future. Cllr Cohen stated that perhaps the ICB should sponsor a communications campaign to increase uptake in the Pharmacy First service.

The discussion then turned to the availability of patient records. Cllr Atolagbe recounted her own experience of the out-of-hours service. She related that access to GP records was not given to the out-of-hours service, making a diagnosis impossible. Ms Coleman then responded that the London Care Records will give access to patient records to all providers. It was also noted that all patients will be given access to their own file digitally as of October 1^st, 2024.

Cllr Chakraborty then questioned the ‘digital first’ approach. He asked whether access to apps and online consultations actually help more patients get an appointment sooner, or whether it was just the timeliness of responses to the patient that was recorded. He also asked what recent technology had been implemented for primary care staff and whether this had improved outcomes for patients. Ms. Coleman responded that digital inclusion was something the ICB was aiming for. Technology in primary healthcare settings is used to track capacity and understand demand – this was being used as evidence.

As time was short, Cllr Connor then asked for written responses to Committee comments and questions as set out below.

·         More details were needed from the IBC around improving the patient experience and decreasing long waiting times. Also, details about patients who remain under primary care because of long waiting lists for secondary care. (ACTION)

·         It was stated that better consistency with the same doctor was needed for those with chronic medical conditions. (ACTION)

·         It was affirmed that from experience, councillors hear patients do not easily access apps or online forms. Training and support are needed to increase uptake amongst residents. Also, the right level of training should be delivered for practice receptionists to become information-givers and gatekeepers. (ACTION)

·         More details were requested on Physicians Associates. How supervision was being enforced and what the pressures were on GPs. (ACTION)

·         A communications plan for pharmacies was then suggested to increase uptake in the expanded services they offer and reduce pressure on GPs. (ACTION)

·         Details were requested as to how the ICB is responding to a recent report into the safety of online consultations. (ACTION)

·         More research was needed into how many residents do not have access to a smart phone. Details were also needed was to the work being done to ensure their inclusion.  (ACTION)