Agenda item

This report sets out the role and responsibilities of NHS England (NHSE) and others in primary care commissioning and asks the Health and Wellbeing Board to consider how they should seek to support and influence primary care commissioning to ensure that it reflects current and future local need.

This report also includes information on the quality of primary care within the London Borough of Hammersmith and Fulham

The HWB received a presentation, which set out the role and responsibilities of NHS England (NHSE) in primary care commissioning. In addition, the report provided information on the quality of primary care within the London Borough of Hammersmith & Fulham..

Julie Sands, representing Karen Clinton, Head of Primary Care, North West London, NHSE (London Region) responded to members’ queries.

In respect of the GP practices which had recently closed their contracts with the NHS,  one would be going out to procurement shortly, one was under consideration and the others had been closed.

It was difficult to forward plan as GPs were required to give only  three months’ notice and partnerships six months. This was a tight timescale,  but it might be possible to plan the transition though caretaking arrangements or disbursing the list.

In respect of practices identified for review, performance tools indicated those practices which needed to be reviewed, on the basis of the data. This might be because the data was incomplete. Alternatively, it might indicate that a full practice review was necessary and advice should be sought from the Local Medical Committee.

The achievement categories could be equated to a traffic light system, with the 14 practices approaching review categorised as amber and the 12 practices where a review had been identified as red.

Mr Mallinson stated that Healthwatch had identified patient transfer issues, particularly in unscheduled care and that a seamless transfer was essential. Ms Sands responded that NHSE was interested to know of any issues and noted the importance of patient tracking, especially vulnerable patients, and clear communication. NHSE intended to again meet with Healthwatch.

Members queried progress in respect of the transformation of GP practices to support Out of Hospital Care and the Prime Minister’s Challenge Fund.

Ms Sands responded that progress had been made with: GP Outcome Standards setting out expectations in respect of, for example, access, waiting times and referral;  practice networks; and changes in the delivery of patient services. In addition, feedback from the independent GP Patient Survey was monitored.

GPs in North West London, including in Hammersmith and Fulham, had been awarded £5m from the Prime Minister’s Challenge Fund to support schemes to make it easier for patients to see their GP. The money was being used to provide extended opening hours, weekend opening and better use of technology. Ms Jones noted the importance of the front desk experience and stated that the CCG had recently recruited someone to work with practices to obtain direct patient feedback.

Members noted  the poor performance in respect of diabetes indicators and queried whether this was related to the number of nurses and practices undertaking health checks, and the support provided. Ms Sands responded that there were likely to be a combination of factors and these would be included when preparing for reviews of practices with issues.  

Ms Jones responded that diabetes care was a priority for the CCG and that support was being provided by a GP working within the CCG three days a week. Ms Jones noted that the data was now over a year out of date.

Ms Sands stated that the reason for the lower level of patients with confidence and trust in their nurse In Hammersmith & Fulham was not known. However, the 2013/14 data analysis would be by practice, making it possible to identify themes. Dr Spicer  noted the recruitment and retention issues in Hammersmith & Fulham. The satisfaction levels were partly a reflection of the isolation of practice nurses, although some networks were now beginning to share practice nurses.

Members queried how the prevention of avoidable emergency admissions and A&E attendances would be monitored. Ms Sands responded that the data would reflect only A&E attendances. There were a number of targets for practices in respect of frequent attendances.

Members queried the adequacy of GPs locally and how GPs would work with NHSE to ensure that the level of primary care services was adequate to meet the additional demands of out of hospital care.  Ms Sands responded that the indications were not a measure of changing demand. There was a need to change how primary care was accessed and to work in different ways, with different forms of contract and funding being used more flexibly to benefit patients.

Members queried how the performance of individual practices would be presented, in order for patients to make an informed choice, and how good practice would be shared. Ms Sands responded that NHS Choices published healthcare data including satisfaction surveys and some quality indicators and My Health London published data to compare practices. In addition, practices worked in networks to discuss data and opportunities, facilitated by the CCG. Ms Jones confirmed that each practice should have a lay-person forum.

Dr Spicer referred to the national plans to increase GP places at medical schools, towards ensuring that 50% of medical students became GPs, over the next few years. GPs tended to move out of the central zone and therefore Hammersmith & Fulham needed to retain as many as possible. 

Councillor Lukey concluded the discussion by commending the report for the good points of improving services locally and as a direction on which to focus.

RESOLVED THAT:

The report be noted.