Agenda item

The BOB ICB draft Primary Care Strategy is being presented to Members as part of the ICB’s commitment to ensuring the contribution and engagement of system partners and the public in the development of its Primary Care Strategy.  The document, in draft form, sets out details of the ambition for a new model of primary and community-based care.  It builds on the Integrated Care Strategy (published in March 2023) and the Five Year Joint Forward Plan (published in July 2023).

Presenters:

Louise Smith, BOB ICB Deputy Director Primary Care

Papers:

Cover report

BOB Draft Primary Care Strategy

BOB Draft Primary Care Executive Summary

The Chairman welcomed colleagues from the Integrated Care Board - Dr Rachael De Caux, Deputy Chief Executive and Chief Medical Officer, Dr Abid Irfan, Director of Primary Care and Louise Smith, Deputy Director of Primary Care. 

Dr De Caux provided an outline of the ICB’s draft primary care strategy which had been published on 10^th January 2024 and was currently out for public engagement (deadline end of February).  Key stakeholders were encouraged to provide feedback on the draft strategy within the engagement period so that comments could be considered before the final strategy was presented to the Board in the summer.

During her presentation, she made the following main points.

·       Primary Care includes General Practice, Community Pharmacy, Optometry and Dentistry services.  These services provide the first point of contact, have an ongoing connection with local communities, and lead on improving the “whole person” health of the population.

·       Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) had a population of nearly 2 million, approximately 253 pharmacies, 203 dental practices, 51 Primary Care Networks and 156 GP practices.

·       The draft strategy had been developed using national guidance alongside local plans.

·       Demand for primary care outstrips current capacity and inefficiencies were created where parts of the system were not working well together.  The challenges required a system response and could not be solved by primary care alone.

·       The vision for primary care centres on people being directed to the right health and care support to meet their needs first time.  This does not necessarily mean a GP but the right health care professional and in the right place.

·       The strategy outlines four key enablers – workforce, digital and data, estates and resourcing.

·       The introduction of Integrated Neighbourhood Teams (INT) would be a key part of delivering the strategy.  INTs would be made up of professionals from a range of disciplines, operating at the appropriate scale to support people with more complex needs to stay well in their communities.

·       Pharmacy First would be launched on 31^st January 2024 and enabling pharmacists to treat a number of common minor illnesses.

·       Local authorities were thanked for their help in contacting residents who were harder to reach.

Primary Care challenges were outlined and included the following key points.

·       Year on year, since 2021, patients had increasingly reported difficulties in making an appointment with a GP or a dentist.

·       There were significant challenges in the workforce, both in terms of recruitment and retention of staff.  There were also challenges around staff wellbeing across the system.

·       Demand for services was rising with capacity unable to keep pace and with an ageing population and people living with more complex health needs, this situation would not improve unless significant changes were made in the way services were delivered.

·       Whilst estates were a key enabler in delivering future primary care services, it was acknowledged that the ICB had no capital funding for primary care estates so more creative solutions needed to be found, involving greater collaboration with key system partners.

·       Currently 10% of patients present at A&E as they cannot access a GP with this rising to around 30% when the surgeries were closed.  This situation also put additional pressure on the Ambulance service and the NHS 111 service.

·       At the heart of the draft strategy was the creation of INTs which put the patient at the heart of the health system, with the aim of providing personalised care so people could access the health and care professionals they needed to at the right time.

During the discussion, Members asked the following questions and made the following comments.

·       A Member felt that the INTs were a positive development in providing multi-disciplinary care for patients.

·       The Deputy Chief Executive stressed the importance of partner working to ensure the vulnerable and lower-income groups were supported in all aspects of health and the wider determinants of health, including housing, education and transport.  She provided the example of COPD patients living in poor housing and the need to work together to make improvements, in partnership.

·       The Director of Primary Care explained that in a “typical” day, he would see around 50 patients but the new model of primary care would mean that his time would be spent focussing on fewer patients with more complex needs.

·       A Member asked why Cardio-Vascular Disease (CVD) had been made a prevention priority in the draft strategy rather than other conditions, such as dementia or obesity.  The Deputy Chief Executive explained that, whilst CVD was a key priority in the strategy, the other prevention measures and interventions were just as important.

·       The Director of Primary Care explained that primary care estates were the biggest concern for all primary care providers.  The fact that GP practices were individual businesses added to the challenges around estates and planning for future provision.

·       The ICB’s Digital and Data strategy was mentioned and the need for patients to feel confident in using the NHS App for repeat prescriptions and test results would help deliver better solutions and improve access for patients to certain health services.

·        A Member pointed out the low response rates to the engagement process, particularly referring to the 52 responses from Berkshire West.  The Deputy Chief Executive  explained that there had been a soft launch of the draft strategy in November 2023 and since then, she had received significantly more responses from members of the public and also from Patient Participation Groups.  There had also been a significant amount of work to reach all part of the BOB population.

·       The Deputy Chief Executive explained that there needed to be a shift in funding between acute and primary care to rebalance the current 80:20 funding.  She went on to stress that this did not mean de-stablising the acute services but there needed to be more focus on primary care to ensure better outcomes for patients.

·       A Member expressed concern about the lack of NHS dentists but commended the introduction of flexible commissioning for dentists and asked for further information on how this would be sustained.  Over 30 dental practices across BOB had taken up this flexible commissioning approach.  It was hoped to set-up mobile dentistry units in 2025.  It was acknowledged that poor dental health was one of the main causes of hospital admissions for children.

·       A Member commented that the introduction of INTs would help co-ordinate services and make it easier for patients to access the services they needed within their local communities, particularly mental health services.  The Chief Executive Officer explained that mental health practitioners were key members of the INTs.

·       The Deputy Chief Executive Officer explained that the draft primary care strategy was meant to be ambitious but at the same time, pragmatic.  INT’s would provide ongoing care for patients and include a range of partners, include community health professionals and social workers.  She went on to say that the strategy provided an opportunity to integrate services which were currently quite fragmented.

The Chairman thanked all ICB colleagues for attending the meeting and explained that the BOB JHOSC would be preparing a formal response to the draft primary care strategy.  It was agreed that the primary care strategy would be discussed at a future JHOSC meeting once it had been ratified by the ICB and delivery plans had started to be developed.