Meeting documents

Purpose:

This item is for Committee Members to hear from representatives from the Clinical Commissioning Group and the two GP Federations in Buckinghamshire in relation to GP services across the County.

Attendees:

Ms L Patten, Chief Officer, Clinical Commissioning Group

Mr R Majilton, Deputy Chief Officer, Clinical Commissioning Group

Dr P Macdonald, Chair of FedBucks

Dr G Gavriel, Clinical Director of Medicas

Papers:

Briefing paper attached

Intended outcome:

For Members to have a greater understanding of the priorities and challenges facing GP services across the County and also to receive reassurances around some specific issues affecting GP provision locally.

The Chairman welcomed Mr Majilton, Deputy Chief Officer (Clinical Commissioning Group), Dr Macdonald, Chair of FedBucks and Dr Gavriel, Clinical Director of Medicas.

The following main points were made as part of the introduction.

·         FedBucks comprised of 44 practices across the County and by federating it offered a level of sustainability for GP practices.

·         Medicas had 4 practices which looked after around 50,000 patients in the North of the County (including Buckingham, Whitchurch and Wing).

·         Access to and quality of GPs in Bucks was above the national average.  All practices were rated as either "Good" or "Outstanding".

1.    Plans for Buckingham GP Practice

·         In response to a question about whether an Equality Impact Assessment (EIA) had been undertaken to identify whether there were groups who would be significantly disadvantaged as a result of the proposed changes, Mr Majilton explained that an EIA would be undertaken once the scope had been finalised.  The risks had not yet been identified.

·         The proposals were still in the early stages and have not yet formally been considered by the Clinical Commissioning Group’s Primary Care Commissioning Committee (a meeting held in public).

·         Liaison with Patient Groups and Carers Groups was part of the process in developing the plans.  Any significant change to services would have to be undertaken using the national framework for Patient Engagement and Consultation.  The Clinical Commissioning Group was aware that this would have to be undertaken once the plans were properly developed.

·         A planning application had been submitted to the District Council in June 2017 and a decision was still pending.

·         In response to a question about who was on the Stakeholder Engagement Group and what the remit of the Group was, Dr Gavriel agreed to send the terms of reference for the group and the most recent minutes of the meetings.

ACTION: Dr Gavriel

2.    Proposal for the new Primary Care hubs

·         Mr Majilton stated that in Wycombe, there were plans to bring together the GP led Minor Injuries and Illness Unit with general primary care provision, as part of the CCG’s commitment to developing services on the Wycombe Hospital site.

·         Any planning for future provision needed to be linked to the Local Plan.

·         There was a general feeling that the word "hub" was being over-used and this should be looked at in order to reduce public misunderstanding.

·         Mr Majilton recognised that, in terms of estates work, the planning can appear to be piecemeal.  Funding opportunities were adhoc and this could also make it appear un-coordinated but lots of work had been undertaken around the One Public Estate.

·         A Member commented that the new hubs provided an ideal opportunity to improve access to mental health services and a chance to profile mental health alongside health services.  Dr Macdonald added that mental health was part of the Provider Collaborative and integrated teams were being piloted across the County which would also reduce duplication.

3.    Update on Chiltern House Medical Centre, High Wycombe

·         In response to a question about how many patients had been affected, Mr Majilton confirmed that 7,500 patients were registered across both surgeries belonging to the practice.

·         It was a very unusual set of circumstances which led to the closure of Dragon Cottage.  The Clinical Commissioning Group would normally receive at least 6 months’ notice of a practice dissolving which would allow for a systematic planning process to commence, including planned communications.

·         The Patient Participation Group was acknowledged as being incredibly helpful in getting messages out to patients.

·         It was acknowledged that collective working exists amongst the GP practices and they learn and support each other.

4.    Ghost Patients

·         The issue around "Ghost patients" was not considered an issue in Bucks.

·         Care Co-ordinators were currently in place which provided more ability to identify and cleanse patient lists.

·         A Member commented on the changing nature of GP practices with an increase use of locums which results in them not knowing the patient.  Dr Macdonald explained that there was a drive towards training more doctors and encouraging them to stay with their practice.  Dr Macdonald went on to say that a locum organisation was proposed in order to keep the knowledge in Buckinghamshire.  

5.    Changes to repeat ordering of medication across Buckinghamshire

·         The changes to over the counter medicines were also discussed as these came into effect on 1 October 2018.

·         A Member expressed concern about the lack of communication around the changes to repeat ordering and also over the counter services and asked that the Select Committee be informed at an early stage in future.  Mr Majilton agreed to speak to the Communications team.

ACTION: Mr Majilton

·         A Member expressed concern for carers who may find the proposed changes harder for them to access what they need.  It was confirmed that any proposed changes were discussed with Carers Bucks and Adult Social Care.

6.    Improved Access to General Practice

·         Dr Macdonald explained that an extra 30 minutes per 1,000 patients had been made available for each GP surgery.

·         GP surgeries were looking at innovative ways to deliver the additional appointments.

·         Very few GP practices had not opted in.

·         The improved access would be reviewed over the coming months to ensure it was successful.

The Committee AGREED to send a letter to the Clinical Commissioning Group requesting that the Select Committee be included as a key stakeholder in future discussions and decisions.  The Committee requires early sight of any proposed changes.

ACTION: Chairman/Committee & Governance Adviser

The Chairman thanked Mr Majilton, Dr Macdonald and Dr Gavriel for attending.