Presentation by Jacqui Tuffnell, Rotherham CCG
Jacqui Tuffnell, Rotherham Clinical Commissioning Group, gave an update following the Scrutiny Review carried out in 2014/15. The powerpoint presentation illustrated:-
Improving Access to General Practice
- We would bid to improve telephony systems across Rotherham
- Bid unsuccessful to date so Primary Care Committee has approved utilising Primary Care funding to enable the upgrades and also to enable call recording to support telephone consultation
- Appendix A details completed practice upgrades and those which will be completed before 31st March, 2017
- We would introduce telehealth across Rotherham
- Piloted and now rolled out telehealth to 19 practices (as at the end of January) and will complete full rollout before 31st March, 2017
- Appendix B details the benefits already being seen from implementing the telehealth system
- Access would be a significant element of our Quality Contract
- Access improvement will be a requirement of all 31 practices from 1st April 2017. Practices have all confirmed that they will meet the requirements of the quality contract by this date
- Appendix C - confirms the requirements of practices by 1st April 2017
- All practices undertaking a resilience programme ‘Productive General Practice’ to support their ongoing sustainability by the end of March, 2017
- It provides essential tools for practices to support for example skill mix, front and back office functions, planning and scheduling
The Village - care navigators
Woodstock Bower - telephone consultation for Advance Nurse Practitioners
Rationalisation of back office functions such as clinical documentation
- We would work with practices to provide more flexibility in appointments
- We have audited the number of appointments in practices to understand if more or less capacity is being provided.
- Appendix D - report and papers associated with the access audit
– Commenced a pilot of Saturday routine appointment availability to complement our urgent appointment offer in January
– Publicising appointments in practices
– Text messages regarding Saturday appointments to all patients with mobile phones
– Article in Rotherham Advertiser (Appendix F)
- Appendix E - initial report of the uptake and patient feedback regarding the Saturday service
- Patient online numbers have significantly improved over the last year. The CCG and NHS England are working with practices who are struggling with their uptake of patient online
- Appendix G - current information regarding uptake of patient online
- We continue to look at ways of raising the profile of the availability
- We would implement our interim strategy for general practice
- The Strategy has now been superseded by ‘the Rotherham response to the GP Forward View’
- Appendix H – our response to the GP Forward View
- Appendix I – NHS England’s February assessment of our progress in relation to implementation
- We would consider health implications of building schemes impacting on Rotherham
- We are now at the design stage with the developers and are advised that subject to planning, the build of the new health centre will commence in September 2017
- In the interim, an improvement project for Treeton medical centre has commenced to improve capacity
- Reviewed medical capacity for the proposed increased housing to other sites and there is capacity in the practices surrounding the area:
- Bassingthorpe Farm development – Rawmarsh, High Street, Bellows Road and Parkgate
- York Road development - York Road, Shakespeare Road and The Gate
- Forge Island development
- We are reviewing the medical capacity as urban capacity is more limited.
Discussion ensued on the presentation and accompanying papers with the following issues raised/clarified:-
· Had the advent of Saturday appointments reduced the numbers attending A&E? – It was not believed that the offer of a Saturday GP service had significantly affected the position. Significant numbers of patients had not been identified that needed a routine appointments with their GP as opposed to those identified that required self-care i.e. pharmacy
· What was the overall aim for improving access to GPs? The main aim was in terms of the 24 hour (urgent) and the five day (routine) access and also ensuring if it had been indicated that someone needed to go back to the practice, that they could get in contact with the practice by telephone/online and make an appointment. 2 practices were providing Physio First where a patient saw the Muscular Skeletal practitioner in the practice rather than the GP and waiting for a referral. Work was taking place on improving the offer of interpreting as well as ensuring that those people that were hard to reach were reached in different ways. The Limited Liability Partnership (consisting of the 31 practices) was converting to a Community Interest Company and had employed a Federation Manager and advertising for a Lead Development Nurse. The two postholders would independently support the practices to improve their standards across the board and share the learning.
· What about those people who could not read or did not have very good eyesight? If they were sent text messages/emails they would struggle as well as the need for easy read letters – The use of text messages was another vehicle to improve communication with patients and was only done so with those patients that had given permission. Letter notification and telephoning the patient directly would continue. The CCG agreed to a follow up discussion with Speak Up.
· How confident was the CCG that the improvement journey could continue given the shortage of GPs and Practice Nurses nationally? Technically Rotherham was “overdoctored”. The journey being taken with productive general practice was to evidence to the GPs that they needed to change how they worked and that there was another workforce that could be employed to do the “everything”. Bands 1-4 staff could be utilised to carry out the basic level skills that were currently conducted at a higher level i.e. GPs. It was also about the GP workforce adjusting to that change of working practice. A bid had been submitted to the CIC for 8.5 fte pharmacists who were a different workforce and carry out medication reviews that were currently done by GPs. It was already being seen in a number of practices where there were less GPs and more Advanced Nurse Practitioners taking over the roles traditionally carried out by GPs. The feedback from patients was that they had more time with the individuals than the GPs. Patients also needed to understand the different workforce.
· Concern with regard to reducing access to GPs on the basis that in many cases patients booked an appointment for an issue but it was not actually the issue they wanted to discuss. Removing that option may have implications/unintended consequences - This was not the intention; it was the capacity/demand and the actual identification of patients that did not necessarily need to see a GP. It was still expected that soft intelligence would be picked up by practitioners and then brought to the attention of the GP.
· Members of the public valued their relationship with the GP and may share something with them that they would not with a practice nurse – This would be monitored as it progressed. There was a GP recruitment crisis so the resources had to be used correctly but it should not cause a barrier.
There was work taking place nationally in improving the offer to GPs with a supporting infrastructure to attract more to the profession. A number of GPs in Rotherham were aged 55+ with 16% in the 55-59 years category. There was also the new role of physician associate with 40 students on courses in Sheffield, who would be able to work in both Primary and Secondary Care.
· What kind of contract management performance would there be? Peer review visits were carried out to all the practices and would also incorporate the contract review. On the CCG website under the Primary Care Committee a dashboard of is published showing information for each individual GP practice.
Resolved:- (1) That the presentation be noted.
(2) That a further update be received in 12 months’ time.