Agenda item

Jessica Newman, Head of Primary Care, Buckinghamshire Clinical Commissioning Group.

The Chairman advised that she had requested this agenda item due to the amount of correspondence, which she, and other local members, had received regarding difficulties in accessing not only face to face appointments, but also access over the telephone.  The Chairman stated that she wanted to explore the current situation and the actions being taken to address concerns.  The Chairman welcomed Jessica Newman, Head of Primary Care, Buckinghamshire CCG and Debbie Breen, Primary Care Director, Berkshire, Buckinghamshire and Oxfordshire Local Medical Council (LMC) to the meeting.

J Newman provided an update on the figures in the agenda pack. The activity figures had continued to improve in terms of total appointments of all types being offered in primary care both nationally and in Buckinghamshire.  56.3% of the appointments in Buckinghamshire in September 2021 were face to face; the total number offered in September 2021 was higher than in September 2019 and was a promising outcome.  J Newman stressed that the activity was not equal to face to face appointments and some appointments needed to be remote for many reasons.  The ‘Improving Access and Supporting General Practice’ document had been published recently and was being referred to as the Winter Access Fund.  The process, in conjunction with the Primary Care Network (PCN), the LMC, the urgent care teams at the CCG and BHT, had started the process to decide on how the funding of £7.4m would be distributed to the BOB ICS until March 2022.  There were three main areas of work:

• Supporting all practices to increase their capacity and resilience.
• To increase capacity using a primary care hub model, particularly in the evening.
• Acceleration of national initiatives, particularly telephony solutions and the community pharmacy access service.

Dr Raj Bajwa, Clinical GP Chair, CCG, stressed the importance of the topic and that there had been significant discussions in the NHS, media and government in recent months.  Dr Bajwa advised that practice activity had returned to pre-pandemic levels; the number of same day appointments had increased.  Approximately 350,000 Covid-19 vaccinations had been delivered, mainly off site, and the largest flu vaccination programme, working with the pharmacies, in NHS history.  The service had continued to deliver the majority of long-term condition care including mental health conditions which have been especially prevalent.  It had also provided the ongoing management of patients waiting for specialist appointments and procedures whilst dealing with the pandemic.  Every patient contact took longer due to the need to use personal protective equipment (PPE) and decontaminate equipment and rooms.  Staffing pressures had existed due to absence with Covid-19 and the isolation requirements for those who had been in contact with Covid-19.  The level and range of activity had only been possible by following NHS England’s triage model which ensured every case was clinically assessed and signposted appropriately.  There had been a long standing mandate from NHS England to increase the use of technology and recognition that primary care needed to be updated and become more flexible.  Before the pandemic, progress was slow as primary care was working to capacity on face to face appointments but, at the start of the pandemic almost overnight, there was the rapid deployment of desktop systems to enable remote video consultations.  Before the pandemic, more than 80% of contacts were face to face which did not always meet all GP patients’ needs and the request to return to that proportion did not accommodate patients’ preferences.  It is not known what the correct proportion of face to face appointments should be or how it be determined who would suit a face to face appointment.  Work was required with organisations, such as Healthwatch Bucks, in order to balance want with need and supply; the HWB would also have a key role in these discussions.  Primary care recognised the challenges and Dr Bajwa pointed out that staff had experienced the same disruption.  The issues mentioned by Dr Bajwa were rarely covered in the media and affected the morale of the workforce.  Dr Bajwa emphasised that primary care would welcome elected members if they wished to visit a local practice.

The Chairman thanked Dr Bajwa for his considered and sensitive response and stated that no one would dispute the pressures and how agile the service had been.  The Chairman agreed that the need to work with patient groups and councillors would be key.  The issue was around perception and the variation from practice to practice needed to be understood.

The following key points were raised in discussion:

• It was emphasised that the meaning of ‘access’ needed to be explored.  Life was returning to normal but face to face consultations might not always be possible and were not always best.  Access had increased and improved and it needed to be recognised that pre-pandemic there was a concern.  In reality, the length of time in obtaining an appointment to speak to primary care had reduced.  Morale had had an impact in primary care; people were burning out and others were leaving the profession.
• One of the GPs stated she had never known it so tough.  GPs did their jobs because they cared but the way it had been portrayed in the media had been demoralising.  An appeal was made for people to think about the responsibility to their primary care colleagues.  Social media attacks on practices and people were damaging and thought should be given before making comments.  There were issues with getting through on the telephone, this was being worked on, however once patients had got through good quality care was provided.
• The Chairman stated that the HWB was the forum for the public to hear the facts around the situation.  The Chair agreed that not all the reports were bad but there did seem to be differences in access and service across the county and that more needed to be understood around this, particularly how contact could be made easier for people.  These were the things which could be worked on together and the Chairman asked how councillors could help and offered to cascade the correct messages to other councillors. 
• N Macdonald emphasised the challenges and agreed that primary care access needed to be redefined and articulated in a different way.  The data in the paper related to Buckinghamshire and possibly provided limited assurance as there would be variances; a breakdown of the geographical distribution was required. 
• J Newman advised that resources from the Winter Access Fund would be distributed according to patient need and priority given to areas where patients were struggling to access primary care; it was not about identifying individual practices and castigating them when they were under pressure. 
• Communications were key to share the story and cascade key messages.   Suggestions would be considered by the HWB and Communications and Engagement Officer. 
• J Newman added that there were some great examples of positive communications on social media on what it was like to work in general practice and offered to share the link with the HWB to enable something similar to be produced for Buckinghamshire.

Action: J Newman

• D Breen advised that the LMC represented the interests of GP practices across the county and heard of the pressures daily and stressed that work needed to be carried out to provide geographical and demographical data.
• J Newman emphasised that the NHS complaints procedure stated that the first point of contact for patient concerns was the practice itself as it gave the practice a chance to respond and make improvements.  If the patient then wished to raise it further the next port of call was the NHS England Contact Centre.  The CCG needed to understand and know the concerns but were unable to answer questions. 

The Chairman requested an update be brought back to the HWB after the winter period.

Action:  J Boosey

The Chairman thanked everyone for their contributions and stated that the HWB had heard the reality of the situation; work needed to be undertaken and there were areas where improvements could be made but the intense amount of work carried out during the pandemic should be celebrated.

Resolved:  The Health and Wellbeing Board noted the content of the report.