Agenda item

Resolved: to note the update.

5.1      Martin Wilkinson (Chief Officer, Lewisham CCG) and Gemma Gilbert (Programme Director, Primary Care, NHS England) introduced the report; the following key points were noted:

• The CCG was working to improve the delivery of primary care in the borough and had developed a Primary Care Strategy.
• NHS England, in partnership with patients and clinicians, had developed a framework for transforming GP services in London.
• The CCG along with SEL CCGs were submitting proposals for co-commissioning GP services, which would support the work happening in primary care.
• NHS England was currently the commissioner of GP services but the CCG was responsible for improving the quality of services.
• The national patient surveys on GP services were helping to highlight issues with access. There were still concerns from patients about getting through to GP practices over the phone- and awareness of who to contact out of hours.
• The CCG are developing communications for the public about out of hours services.
• CQC risk ratings for GP surgeries – had shown that few (3) were high risk.
• NHS England was working to develop a new vision for GP services over five years, building on the best practice in London.
• The local strategy would link with London strategy.

5.2      Martin Wilkinson (Chief Officer, Lewisham CCG); Gemma Gilbert (Programme Director, Primary Care, NHS England) and Jackie McLeod (Clinical Director and Primary Care Lead, Lewisham CCG) and Diana Braithwaite (Commissioning Director, Lewisham CCG) responded to questions from the Committee, the following key points were noted:

• The CCG Procurement Policy had been approved by the CCG Governing Body and each procurement activity would include public engagement activity.

Strategic Commissioning Framework for Primary Care Transformation in London

• A transformation framework has been developed deliver improvements to primary care, building on existing best practice and working to ensure consistency across providers.
• The model of general practice had not changed for a number of years
• NHS England intended to invest in the delivery of general practice including the development of systems; workforce development and facilities.
• In future, GP practices would likely work in groupings to share and deliver services and provide patients with choice as well as access to specialist services that could not be delivered by a single practice.
• Partners in London healthcare had been working closely together to determine what the future of healthcare in the city might look like.
• Increased population, demographic changes along with increasingly complex health problems and co-morbidities meant that more people were looking to see their GPs; however, GPs needed more time to deal with complex health problems not afforded in the current model.
• Practices in Lewisham recognised that the current service was unsustainable and different approaches would be required.
• There were examples of excellent practice in London. Where practices worked collaboratively, they were able to achieve a great deal.
• The changes being proposed would not just be about general practice – but would include all parts of primary care, preventative care and self-care.
• They would also have to build on existing services and provision to find new solutions for demand and capacity.
• There had to be consistency between local and regional strategies.
• There had previously been a focus on APMS (Alternative Provider Medial Services) through health centres – but this was no longer the case.
• Most GP services contracts in Lewisham were PMS (personal medical services) contracts.
• Providers might choose alternative contracting arrangements in order to develop new or innovative services.
• In order for a private provider to take over a GPs partnership – all of the partners would need to be in agreement.

Access

• GP practices were not able to close their lists to new patients
• It was recognised that further work needed to take place to ensure that the balance was right between pre-bookable appointments and those that were available on the same day.
• Current issues with access to A&E were a symptom of wider issues. A&E departments across the whole country were facing significant pressure.
• The development of new models of primary care could help avoid admissions to hospital through the provision of community services
• Prevention was a key focus of the CCG Primary Care Strategy.
• The CCG worked with NHS111 providers to ensure that the full range of treatment options was made available.
• Sicker people were going to A&E; work was also taking place to develop preventative activity and treatment options.
• Information was provided through surgeries about how to access out of hours services.
• SELDOC (South East London Doctors Cooperative), which provides the local GP out of hours service also provided services at Lewisham Hospital in the Urgent Care Centre; consideration would be given to promoting and advertising the out of hours service.
• Lewisham CCG and the Council were developing a coordinated structure of strong neighbourhood community teams; which would have the capacity to manage long term conditions in community settings.
• Community neighbourhood teams would also be able to identify and support people at risk of deterioration before they required admission to hospital.
• A ‘care navigation’ role was being developed as part of future proposals for multi-disciplinary community teams.
• Evidence from across London was that a named physician could help to ensure continuity of care and could work across a range of settings to advocate for patients. This person did not necessarily need to be a doctor – as long as they were able to coordinate care on behalf of their patients.
• In case conferences this person could act as a single point of contact.

Resolved: to note the update.