Agenda item

Dr Marc Rowland (Chair, Lewisham CCG) and colleagues introduced the report. The following key points were noted:

·         The officer report provides an overview of the situation in primary care following the refresh of the primary care strategy – Developing GP Services (2016-2021). The four priorities of the strategy are: proactive care, accessible care, coordinated care, and continuity of care.

·         GPs in Lewisham are under increasing pressure from population growth, widening health inequalities, and an ageing population with increasingly complex conditions.

·         GPs have been working together around neighbourhoods since 2008, to try to shift activity and resources from secondary to primary care. The CCG’s vision is for sustainable development of primary and community care, which is embedded within, and working together with, local communities and neighbourhood networks.

·         Primary care will be increasingly delivered at scale and make better use of technology. It will also make better use of the buildings at its use and support the development of the local workforce to address shortages. Primary care in Lewisham is on the verge of a great improvement. 

·         The CCG has recently applied to move from the existing arrangement of co-commissioning of primary care services with NHS England to delegated commissioning, giving the CCG full responsibility for commissioning GP services. The new arrangement will start in April this year if the application is successful. 

·         The CCG has also recently started a primary care assessment pilot at the urgent care centre at Lewisham Hospital. This means that the first point of contact for patients arriving at the hospital will be a GP. Since October 2016, 60% of those seen under the pilot were treated by the GP they saw or redirected to an appropriate alternative service.

·         Five practices towards the north of the borough are planning to merge to become a partnership. It will be a gradual, “evolutionary” merger focused on back-office functions, allowing for economies of scale. Patients will see very little change in service. The partnership is also looking to work with the council to take on apprentices to build its own workforce to address shortages.

·         The partnership’s business plan will involve looking at the buildings it has to use. Some current practices are not fit for purpose, but there may be opportunities for some other practices to expand. This is high on the agenda and sites are currently being looked at.

·         One Health Lewisham is the overall federation of all 40 General Practices in Lewisham. It is a limited company, wholly owned by the GP surgeries of Lewisham. It aims to working collaboratively to ensure high quality, equitable, and sustainable primary care across Lewisham.

·         Many GP practices are struggling to remain financially viable, and GPs are becoming increasingly reluctant to become partners – including in Lewisham. This situation was exacerbated by the way the recent Department Health service charge request was handled.

·         GPs in the borough are also looking at ways GP services are delivered. Traditional GP consultation slots may not be right for the future. May have to consider different ways of working, different consultation lengths, other forms of consultation (including phone and email), and how we use pharmacists. Technology could also be used to help reduce in-surgery waiting times.

·         The national requirement to provide GP services from 8am to 8pm is being met in Lewisham by setting up a hub site at Lewisham hospital staffed by GPs from across the borough. The CCG is also looking for another, separate hub site.

·         Meeting the extended hours requirement will be challenging, but the CCG and partners will monitor feedback on the central hub approach and review as necessary. It is not yet clear if the extended GP hours will improve outcomes. Communicating the availability of this service to the public will be key.

Resolved: the committee noted the report.