- Meeting of Health & Adult Social Care Select Committee, Thursday, 10th September, 2020 10.00 am (Item 8.)
Primary Care Networks (PCNs) were launched in June 2019 and ambitious plans were put in place to deliver a number of projects across the networks over the coming years, including recruiting to a number of newly created roles.
As part of the Time for Care Programme, NHSE&I is providing support to practices, PCNs and the Clinical Commissioning Groups to capture the learning and improvements that have arisen through the Covid-19 pandemic.
This item will provide the Committee with the opportunity to hear more about the work of the PCNs, as well as examining how GPs and patients have coped with the changes in how primary care has been delivered in light of Covid-19 and the recovery plans.
Ms Louise Smith, Director of Primary Care
Dr Rashmi Sawhney, representative from the Primary Care Networks in Buckinghamshire
Mr Mike Etkind, representative from a Patient Participation Group
· Power point slides - attached
· Scoping report from the work with Primary Care representatives and the Time for Care team, NHS England (June 2020) - attached
The Chairman welcomed Ms L Smith, Interim Director Primary Care and Transformation, Clinical Commissioning Group (CCG), Dr R Sawhney, GP at Riverside Surgery and CCG Clinical Director, Dr S Jinah, GP at Hughenden Vale Surgery and Mid Chiltern Primary Care Network (PCN) Clinical Director and Mr M Etkind, representative from John Hampden Surgery Patient Participation Group.
During their presentations, the following main points were made:
· The Covid pandemic had halted the development plans for the Primary Care Networks, although some recruitment had taken place during the last few months (with interviews taking place via Zoom).
· Remote working for GPs had been set-up very quickly, prioritising those that had to shield or look after their families. Hubs were set-up to deal with symptomatic Covid patients, who were filtered through the 111 number.
· The CCG had worked with the Time to Care team and Patient Participation Groups (PPGs) to identify the benefits and challenges through lockdown and this feedback would be used to discuss what would continue in the recovery stage.
· The CCG was working closely with Buckinghamshire Healthcare NHS Trust to see the backlog of patients as part of the recovery plan.
· Phase 2 and 3 of the recovery action plan had been mandated by NHS England.
· There was general consensus by GPs that online consultations had worked well and there were plans to maintain these in the recovery phase as well as face-to-face consultations, where necessary.
· Primary Care Networks had submitted their 20/21 workforce plans which included identifying which additional roles they needed within their networks, including social prescribers, pharmacists, dieticians and podiatrists. A second plan to take them up to 2023/24 needed to be submitted by the end of October.
· A group had been set-up to define clinical harm, quantify and monitor this issue and the learning from this group would be shared across the system.
· Health checks would be promoted to vulnerable groups with the aim of picking up underlying issues.
· There was a pilot study with care home staff to assist with recognising clinical deterioration (RESTORE 2). A Primary Care Network Care Homes page was being developed to bring all the relevant information together in one place.
· It was acknowledged that a co-ordinated approach would be required to improve housing conditions, particularly the impact of poor housing on health conditions such as asthma and COPD.
· The new contract with NHSE included an increase in the use of digital technology to around 50% of patients so the Covid pandemic had accelerated the introduction of this.
· During the lockdown, General Practice and pharmacy was still open – calling patients to reassure them, sending out shielding letters, dealing with prescriptions, emergency blood tests and delivering medications, etc. Appointments were held by phone and/or video-consultation.
· Personal Protective Equipment had been an issue in the early days of the pandemic with poor quality PPE. A number of volunteer groups made visors for those working in primary care.
· It was acknowledged that there would be an unprecedented demand on flu jabs this year. As yet, there were no real plans on how to resource this and deliver it in a Covid safe way.
· Mr Etkind provided feedback on the work of the Patient Participation Group he is a member of. The surgery had carried out a survey of 400 patients to find out about their experiences of accessing primary care during the lockdown – 49 out of the 114 respondents said that they had received a telephone consultation during lockdown and 80% of those patients said it had been successful/very successful. 58% of all the respondents said they would be happy to have telephone consultations instead of face-to-face in future with 11% not happy and 26% unsure – with comments from all three groups to the effect that it would depend on what they were consulting about..
· Four recommendations had been made to the surgery about remote consultations – flexibility around patient preferences and clinical judgements, maintaining much valued relationships with patients, supporting people who did not have access to digital technology or had privacy issues and providing clear communication about patient expectations.
· The strength of local communities during lockdown was acknowledged and GPs should try to harness this when thinking about how to provide services in the future.
· Whilst the benefits of holding telephone consultations had been recognised (spending more time with patients with complex needs), it was also recognised that this way of working, with GPs seeing more patients in a day, can be very tiring.
During discussion, Members made the following points and asked the following questions:
· Whilst acknowledging that the PPGs were all working differently and were at different stages of development, a Member felt that there needed to be an overall drive to have active PPGs across Buckinghamshire and that good practice needed to be shared. Ms Smith explained that the CCG was responsible for the development of the PPGs and Healthwatch had helped with this in the past. Mr Etkind added that there was no contractual agreement for Primary Care Networks to have a PPG but there could be a role for PPGs to join together to provide a patient perspective to how PCNs chose to develop local services for patients.
· A Member expressed concern about the over-reliance on technology as some patients will not have access to this and mentioned, in particular, patients with dementia. The Member suggested that receptionists need to be trained to assist people who might experience problems.
· In response to a question about flu vaccinations this year, Ms Smith explained that the CCG was working closely with the Hospital Trust and Public Health in terms of developing different models of delivery – for example, possibly using mobile testing units to get people through the vaccine programme. Good communications and signposting for GPs and patients was acknowledged as being critical to its success. Dr Jinah confirmed that there were enough flu vaccines for the patients at her surgery for the time being and there was a balance to be struck between demand and wastage.
· A Member asked whether there was data relating to the number of BAME residents in Buckinghamshire affected by Covid-19 and evidence to show why the numbers were higher in this group. Dr Sawhney clarified that overall deprivation across Buckinghamshire was not just within the BAME community but affected all groups. A national report was currently being produced which recorded ethnicity both nationally and locally. Public Health had provided local data for this report. As soon as this report was available, it would be shared with the Committee.
ACTION: Dr Sawhney to send report to the Committee & Governance Adviser
· A Member asked a specific question around GP provision and how any future plans for expanding a surgery were considered. The Member referred to Wycombe and the proposed plans for a feasibility study in the area. Ms Smith said she would speak to her colleague, Jessica Newman, in the CCG to find out more and to report back to the Committee.
ACTION: Ms Smith to speak to Jessica Newman
· In response to a question about the lack of outpatient appointments, Ms Smith explained that Hospital appointments were starting up again but the majority had been undertaken over the telephone during the past few months.
The Chairman explained that Members who were unable to attend the meeting had sent in a number of questions. These questions would be sent to Ms Smith after the meeting for a written response.
ACTION: Ms Smith to respond to written questions