Agenda item

Jacqui Tuffnell, Head of Co-Commissioning, Rotherham Clinical Commissioning Group, to present

Jacqui Tuffnell, Head of Co-Commissioning, Rotherham Clinical Commissioning Group (RCCG), gave a powerpoint presentation on the Primary Care update:-

 

·           From April, 2015, the RCCG had taken on delegated responsibility for GP practices but not for the whole of Primary Care.  There was the potential for conflicts of interests

 

·           The Primary Care Sub-Committee met in public on a monthly basis, the meeting papers for which were available on the website.  The Sub-Committee was Chaired by a Lay Member and was made up of members of the RCCG and 3 GPs who were elected to sit on the Sub-Committee to provide advice.  At the point of making a decision, the GPs would leave the room

 

·           A big piece of work that needed to take place was to set the GP Strategy for Rotherham.  There would only be 1 plan which would align with other strategies such as the Health and Wellbeing Strategy and the Commissioning Strategy.  There were 10 key priorities

 

-               Quality Driven Services

Services were “RAG” rated so a warning would be received as to which practice’s performance was raising concern.  This was the first time this had been seen and Rotherham was paving the way.  It enabled bench marking of practices as well as the sharing of good practice with others.  The LLP gave practices the opportunity to look at working together rather than in silos.  Work was starting on looking at new models of delivery regarding the integration of Health and Social Care and what possible models could look like

 

-               Services as local possible

There were a number of challenges associated with this priority.  Rotherham was around the national benchmark level for Doctors but new ways of managing patients were being explored including a new role of associate physician to support GPs in practice and looking at the wider health workforce including pharmacists and therapists. 

The RCCG was also looking at using IT and technology such as Skype.  The Emergency Centre would integrate urgent care and out of hours care seamlessly.

 

-               Equality of Service Provision

Dependent upon where you lived and the size of your practice, there could be real inequality in relation to the Services provided.  Encouragement was being given to having “baskets” of Services through co-operation between practices so that if a practice did not deliver a particular Service it may be that the practice down the road could do so on their behalf thereby ensuring everyone received the same service.  Some of the commissioning arrangements around Public Health were due to the way it had been divided up; the RCCG wanted to stop those barriers and all work together and avoid whose responsibility for commissioning services

 

-               Increasing Capacity and Capability

It was hoped that there would be 5,000 more GPs nationally.  Currently once trained, many Doctors opted not to go into GP practice.  It was felt that it should be made easier for those coming back into the country to start practising again as currently you had to retrain to certain degree.  There was a ten point national plan to attract and retain GPs.  Rotherham would have its own local workforce plan associated with that.  Sheffield Hallam University and Sheffield University were now running courses for associate physicians with Sheffield Hallam already having an oversubscribed allocation.  Rotherham had managed to fill its cohort for GP training as it had a really good reputation but it was hoped to secure associate physicians to support GPs.  Associate physicians would free up GPs to deal with the more complex issues and enable successful succession planning.  Work was also taking place on a Recruitment Strategy, finding out what attracted people to Rotherham, what it could do to keep them in Rotherham and improve the profile as a place to work and achieve an improved fill rate.

 

-               Primary Care Access

Questions asked at a recently held Health event had revealed:-

 

89% would be happy with telephone consultations

87% wanted an allocated appointment time and wanted to be seen very close to that appointment time

35% wanted Saturday opening

24% wanted 7.30 a.m. opening

41% wanted the surgery to be open until 8.00 p.m.

19% wanted to use technology to self-care (mainly older people)

80% supported usage of the extended workforce as they felt confident in the nurses and the advice they received from them

 

Approximately 70% of the audience were the more mature of those who attended the event.  The feedback derived from the event would be fed into the Strategy which would be subject to a number of engagement events, with the Patient Participation Groups as well as localities

 

-               New Models of Care

Currently 1 of the barriers was the contractual complexity which the formation of the GP Limited Liability Partnership would help with.  Work had started on collaboration and engaging with GPs to get the right services within a catchment area to support the whole of the population. The opportunity of the Emergency Centre would be exploited.

 

-               Self-Care

There had been significant developments in health care resulting in people living longer as their health was better, but that had led to increased demand on Services which were not seeing an increase in the same way.  There would need to be a real focus on educating the public on way services were available because for some time the message has been if you could not get in to see your GP you would be seen within 4 hours at A&E.  There was some good work being carried out on social prescribing.  The CQC on their recent visits to practices had commended the case management work – the report would be on their website soon

 

-               Robust Performance Management

Practices were far more robustly performance managed than ever before.  This gave the ability to spot where there may be a problem with a practice.  An intelligence system known as Radar had been developed by the North East which 10 practices were currently piloting which would also give information.  Satisfaction surveys were also used

 

-               Improving Medicines Management

Significant steps had been made but the Service redesign would continue.  Prescriber was also used which focused practices’ attention on ensuring patients were on the right medication and had regular medication reviews

 

-               Engaging Patients to Optimise Pathways

It was known that those that are experiencing the pathway were the ones you would get the best information from and the best routes for that were being explored.  There were Patient Participation Groups and Healthwatch Rotherham had been engaged to help with the 30% that were less successful and looking at what was right for that particular population 1 size did not fit all in how patients were engaged

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

·           Had there been any progress on matching computers between the Hospital and GPs?

It had been hoped to move to 1system but it had been agreed to move to inter-operability between the 2 systems.  Given the new Emergency Centre would be opening later in the year, everyone would be able to see the same medical record for a patient.  The governance arrangements were being worked upon so that a patient understood that their record was being shared across the Services.

 

·           Had the issue of budgets been resolved i.e. did all the Services/agencies share 1 budget?

It had not been completed resolved but steps had been made with the Better Care Fund and agencies were looking at increasing that so as to prevent silos.   Primary Care and GPs had been subject to the Equitable Funding Review so everyone would get paid the same amount for a patient.  The setting up of the GP Limited Liability Partnership would be able to help, once the contracting arrangements were in place, either to deliver it or be responsible to ensure patients received delivery of the services so the contract would be internally between the GP practices

 

·           If a GP did not provide a particular Service had any consideration been given to accessing the Service across boundary?

Work had commenced on this issue. Barnsley had opted for co-commissioning and, therefore had delegated responsibility.  It was not easy but there was a network working together as there was a similar with Sheffield.  It would not be helpful having different levels of service so plans were being shared to understand the impact of where there was an issue.  The intention was to try and work closely but it would be for Barnsley to decide what it did with its own Strategy

 

·           A number of senior GPs are retiring and we are struggling to recruit.  Was there succession planning so have part-time GPs.  Need to look at this

Work was taking place, but would be really hard to achieve, what that a patient would always see the same doctor.  However, work was taking place within the workforce plan that, instead of having locum agency staff, a bank of trainees that did not want to base themselves in a particular practice but wanted to remain in Rotherham would be developed in an attempt to reduce the need to bring in outside help and utilise our own GPs.  There were more Rotherham GPs involved in the Out of Hours facility so when doctors were away our own workforce was utilised so it was the same people seeing patients across Rotherham

 

·           How do we develop more understanding about disability including learning disability in practices?

It was difficult to achieve that a patient always saw the same doctor.  However, work was taking place within the workforce plan that; instead of having locum agency staff, a bank of trainees that did not want to base themselves in a particular practice but wanted to remain in Rotherham would be developed in an attempt to reduce the need to bring in outside help and utilise our own GPs.  There were more Rotherham GPs involved in the Out of Hours facility so when doctors were away our own workforce was utilised so it was the same people seeing patients across Rotherham.

 

·           How would you ensure patients with Mental Health issues are getting access to Services?

       1 size did not fit all.  GPs had expressed the need for additional Mental Health training for themselves and their staff or resources to support practices and it was the development around the pharmacies and how to direct patients in the right way.  1 practice was using telephone consultations but some patients did not want to feel they were being triaged by a receptionist.  1 practice was trialling triage by a GP.  That would not work in every surgery but it was working for that particular practice

 

·           With regard to the CQC Duty of Candour, would the CCG take the role of moderator?

Currently complaints and incidents were still managed by NHS England and that responsibility had not been delegated.  Work was taking place with NHS England but it was felt that it would remain with them as statutory body but issues with practices would be dealt with by the CCG.

 

·           How easy or difficult was it to keep all the GPs on side?  What were the sort of issues that came up from GPs?  Were some issues more difficult to deal with?

Some practices had been significantly affected by the Equitable Funding Review and work was taking place with them to achieve sustainability.   There were some practices that were GP-led with very little practice nursing input when it was known that some tasks could be done with a different workforce.  Practices were worried about their funding and their recruitment at the same time as wanting to deliver good services to their patients.   Work was taking place on gaining an understanding on what “extras” practices were paying for and what were the right services to provide for the whole population and not just across GMS and PMS so there was no difference

 

·           Was Rotherham working towards 7 day access to GPs?

It could be argued that Rotherham already had it due to the availability of the Walk-in Centre 7 days a week.  Barnsley did not have such a facility open 7 days.  Events had been run with health professionals who had expressed concern with regard to capacity issues as there was no additional funding associated with it.  Investigation was taking place on what access meant, what the need was rather than the want and ensure the need was addressed

 

Jacqui was thanked for her attendance and presentation.

 

Resolved:-  (1)  That the presentation be noted.

 

(2)  That the Select Commission receives further information from the Rotherham Clinical Commissioning Group on the final Strategy in September.