Agenda item

Joint Report of the Sefton Clinical Commissioning Groups and NHS England (Cheshire and Merseyside).

 

Further to Minute No. 55 (2) of 3 April 2018, Fiona Taylor, Chief Officer for NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group; and Anthony Leo, Director of Commissioning; NHS England (Cheshire and Merseyside), will be in attendance at the meeting to present the report to the Committee and respond to questions put by Members.

Further to Minute No. 55 (2) of 3 April 2018, the Committee considered the joint report on Primary Care in Sefton, submitted by the Sefton Clinical Commissioning Groups and NHS England (Cheshire and Merseyside), describing the National and Local landscape for primary medical care across NHS South Sefton and NHS Southport and Formby Clinical Commissioning Groups (CCGs).

 

The report set out the background to the matter; the national summary that included five key areas for support, namely investment, workforce, workload, practice infrastructure, and care re-design; and the local summary for both NHS Southport and Formby CCG and NHS South Sefton CCG.

 

The Committee also considered a presentation submitted by NHS Southport and Formby CCG and NHS South Sefton CCG.

 

The presentation provided a General Practice update that included the following information:-

 

·         Local Context 2018/19;

·         Delegated commissioning;

·         Contracting for primary care;

·         Local Quality Contract (LQC);

·         An overview of NHS South Sefton CCG;

·         An overview of NHS Southport and Formby CCG;

·         General Practice Forward View (GPFV);

·         GPFV Progress to date;

·         Enhanced Access – GPFV;

·         Primary care work-streams;

·         Southport and Formby workforce;

·         South Sefton workforce;

·         Care Quality Commission (CQC) visits - Southport and Formby;

·         CQC visits - South Sefton;

·         Patient survey results to July 2017 - Southport and Formby;

·         Patient survey results to July 2017 - South Sefton;

·         Challenges;

·         Role of General Practice;

·         Aims;

·         Strategy;

·         How will we get there?;

·         Integrated care; and

·         Targeted care.

 

Fiona Taylor, Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG; Anthony Leo, Director of Commissioning; NHS England (Cheshire and Merseyside); and Dr. Rob Cauldwell, Chair of NHS Southport and Formby CCG; were in attendance at the meeting to present the report and presentation to the Committee and respond to questions put by Members.

 

Fiona Taylor explained aspects of the presentation that was included within the Committee agenda.

 

Members of the Committee asked questions/raised matters on the following issues:-

 

·         How could sufficient numbers of GPs be attracted from overseas to work in the NHS?

Some 5,000 additional doctors would be required to work in general practice by 2020 and there were issues around international recruitment. Lobbying of relevant Government Departments was currently taking place concerning the decision to refuse doctors whose first language was not English.

 

·         Where was the detail on the Enhanced Access Service, with regard to the General Practice Forward View (GPFV)?

This was in the process of procurement. Patients would have access to primary care services delivered from a primary care hub in each CCG area. Services were anticipated to be provided up to 8.00 p.m./8.30 p.m. on week days, plus weekend access, although there would be some flexibility permitted by the Provider regarding precise details.

 

·         Would consultation on Enhanced Access Service take place beforehand?

Engagement was key although a Provider was required to be procured first in order to carry it out.

 

·         Was the delivery of an Enhanced Access Service dictated by national directive?

Attempts were being made to take national policy and shape it for Sefton requirements. Feedback would be sought from users as to what capacity was actually required at a local level.

 

·         What finance would be available for the Enhanced Access Service?

£6.00 per head of population, per annum had been allocated.

 

·         Concerns were raised that there were only two primary care hubs planned for Sefton, as access/transport around the Borough was an issue. There were currently transport issues in travelling from Maghull to the Litherland Walk-in Centre by public transport. Members considered that all too often patients tended to be referred to A&E.

 

·         Why were GPs not approached in order to ascertain the number likely to retire in the next few years?

Some data had been acquired on the workforce and huge numbers of GPs were anticipated to retire within the next 5 years. International recruitment would not provide the numbers of GPs required and there was a need to think differently with regard to GP provision, possibly by the retention of GPs on part-time hours; the expansion of the role of nursing staff, other healthcare assistants and pharmacists; and an increase to community service provision. This was a major risk area.

 

·         Concerns were raised that there was a lack of public engagement regarding the future of primary care provision.

Engagement took place at Shaping Sefton events. GPs were becoming more engaged with the process out of necessity, with increased networking and working with other practices. Assistance could be required from the Council regarding the promotion of healthy living and engagement with local communities.

 

·         When would the strategy for Sefton on primary care be available?

It was considered that the model of care the CCGs wished to commission was clear and that this had formed part of the Shaping Sefton Strategy for some time. Once the strategy had been developed it would be considered by the Committee.

 

·         Would the proposed solutions to addressing the future lack of GP provision be sufficient and had a risk analysis been undertaken?

Significant changes had occurred in nursing in recent years, particularly following the removal of nursing bursaries. Some areas were seeing an over-supply of pharmacists. The engagement of GPs as Providers remained a major challenge.

 

·         Other than GPs, the public was not really aware of other aspects of primary care and was this part of the problem?

The CCGs and NHS England wanted an integrated approach in primary care provision within local communities and attempts were being made to target efforts in those areas that would make the biggest differences.

 

There were a number of questions outstanding that Committee Members did not have time to raise and these would be forwarded to the Chief Officer for NHS South Sefton CCG and NHS Southport and Formby CCG, with a view to obtaining responses in the near future.

 

Although Committee Members understood that the CCGs and NHS England had a broad vision of a GP Primary Care Strategy in Sefton, concerns remained regarding risks and assurances; and also consultation and engagement, involving communities. It was considered that the Committee would wish to see an assurance framework of risks associated with the Primary Care Strategy; together with a consultation and engagement strategy setting out details of how the high level strategy would be delivered to local communities.

 

RESOLVED: That

 

(1)       the report and presentation on Primary Care in Sefton, describing the National and Local landscape for primary medical care across NHS South Sefton and NHS Southport and Formby Clinical Commissioning Groups, be noted;

 

(2)       the questions outstanding be forwarded to the Chief Officer for NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group for an early response; and

 

(3)       the Chief Officer for NHS South Sefton Clinical Commissioning Group and NHS Southport and Formby Clinical Commissioning Group; be requested to submit a further document to a future meeting of the Committee, on a date to be agreed, setting out detailed information on the following:-

 

·         The Primary Care Strategy, together with its associated delivery plans;

 

·         A full risk assessment of the Primary Care Strategy, together with associated assurances for the Committee regarding any impact of the Strategy on Sefton communities; and

 

·         An associated consultation and engagement strategy, offering Sefton communities the opportunity to be involved in the design and co-production of the approach to be adopted.