Agenda item

Following a request by the Performance Monitoring Panel at its meeting held on 15 November 2023, a NHS Lincolnshire Integrated Care Board contact, Sandra Williamson, will be in attendance to provide information relating to primary health care provision and patient strategy, and to answer members’ questions. 

Following a request by the Performance Monitoring Panel, Sarah-Jane Mills, Director of Primary Care and Community and Social Value for the Lincolnshire Integrated Care Board (ICB); and Sandra Williamson, Director for Health Inequalities, Prevention and Regional Collaboration for the Lincolnshire Integrated Care Board, were in attendance to provide information relating to Primary Health Care provision and Patient Strategy, and to answer members’ questions.

The Chairman confirmed the background for the attendance request which had stemmed from the desire of members to obtain a better understanding of service level provision expectations, in order to be better equipped to answer residents’ questions. The following areas were stated as being of particular interest:

A presentation which detailed the following information was delivered to members at the meeting, and appended to the minutes:

In respect of General Practice:

• Commissioning;
• Integrated Care Board Governance;
• Contracts;
• Accountability;
• Access;
• Primary Care Access Recovery Plan – Lincolnshire;
• Appointments – same day;
• Appointments – within two weeks; and
• Appointments – by type;

In respect of Dental Services:

• Access to NHS dental services;
• Lincolnshire Dental Strategy; and
• Lincolnshire Dental Strategy workstream examples.

Members considered the presentation and update from the ICB representatives and made the following comments:

• Members thanked the two ICB representatives for their attendance at the meeting and for the informative and interesting presentation.

• Members queried whether the delivery of dental services in smaller towns and villages was to be reviewed.
  • The Director for Health Inequalities, Prevention and Regional Collaboration responded that:
    • Initiatives were in place across the whole of Lincolnshire relating to the retention of dental services and access improvement; and
    • A significant procurement programme was being developed for 2024/25 to target areas of most need;
  • The Director of Primary Care and Community and Social Value added that:
    • The rural nature of Lincolnshire necessitated regular service access reviews which considered the provision of both ‘centre-based’ and ‘mobile’ services; and
    • This was an area of ongoing development.

• Members asked how the general public could provide feedback regarding the delivery of primary health care services.
  • The Director of Primary Care and Community and Social Value responded that:
    • Primary Care Service providers had mechanisms for direct feedback at the point of provision, such as at dental and GP surgeries;
    • Feedback could be sent directly to both the ICB and Healthwatch via their respective websites; relevant links would be forwarded to members after the meeting;
    • Service development feedback could be given through attendance at engagement events, such as patient participation groups, surveys, and focus groups; and
    • When applicable, direct feedback may be invited by the Care Quality Commission (CQC).

• Members were encouraged that services were not reliant solely on digital provision. Many residents cited a preference for in-person engagement and not everyone had the technical skills or facilities to access health care provision digitally.
  • The Director of Primary Care and Community and Social Value acknowledged the differing patient access needs and that a balanced approach regarding the access of services was required. In addition, those who did engage digitally, positively impacted the capacity of surgeries to provide an in-person service for those who preferred traditional engagement methods.

• Members relayed the following observations regarding the access of services:
  • During the GP appointment booking process, patients were often triaged, by front-line staff, to varying professional streams, such as paramedics and/or GPs. Members queried the level of training undertaken by surgery receptionists in order to ensure the most appropriate clinical referral, and consequently, best patient outcome;
  • Members questioned whether the recruitment, retention, and therefore the availability of professionals to service appointments for residents of South Holland, had been impacted by the wider issue of ‘finance’. Were the financial incentives sufficient to attract doctors and dentists to the area?; and
  • Regarding funding, members understood that a National Health Service dental surgery based in Spalding was in the process of transferring to private surgery status as a mitigation for insufficient NHS funding.
    • The Director of Primary Care and Community and Social Value responded that:
      • Receptionists were trained as ‘care navigators’ to signpost patients to appropriate clinicians; 
      • A greater range of clinicians worked in surgeries however a GP was always on duty should a referral beyond the expertise of the clinician be required; and
      • NHS contract funding was set at a national level within which contracts were required to operate. In areas of rurality and high health inequalities, there was acknowledgement that additional investment was often required to provide improved access.
  • The Director for Health Inequalities, Prevention and Regional Collaboration added that:
    • The current Dental Contract had been in place since 2006 and remunerated through a ‘units of activity’ system which did not contemporarily meet the needs of dental professionals. Under the Dental National Contract Reform, consideration would be given to inequalities and how a future dental contract could utilise flexible commissioning to improve access and prevention.

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• Members referred to the presentation which highlighted the importance of dental health upon overall physical health. Some dental surgeries had not initiated invitations for routine dental check-ups, however patients were subsequently removed from accessing their services due to the lapse of time between appointments. Would this approach be improved so that access to treatment was not denied?
  • The Director for Health Inequalities, Prevention and Regional Collaboration responded that:
    • Unlike GP surgeries, dental surgeries were not required to have/keep a registered patient list;
    • Most dental practices operated a recall system which was determined by the needs and circumstances of individuals; the implementation of the appropriate recall system needed to be in place; and
    • Future development may include wider health services being offered at dental surgeries.
      • The Director of Primary Care and Community and Social Value added that the GP recall service operated more proficiently due to investment in the wider use of digital technology which had been support-funded by the ICB.

• Members relayed problems experienced by residents regarding the booking of appointments:
  • When attempting to book an appointment by phone, long call-waiting times were not realistic for people with early deadline-driven commitments. Likewise, availability for ‘call-backs’, and therefore appointment opportunities, were often missed;
  • Digital appointment booking solutions were required however the NHS App functionality was poor and its data did not connect with GP systems. GP contracts needed to include a requirement for improvements in respect of the digital booking of appointments and ordering of repeat prescriptions; and
  • Members asked whether a Lincolnshire NHS App could be developed locally.
    • The Director of Primary Care and Community and Social Value responded that:
      • The ICB team was aware that the nationally developed NHS App required functionality improvements and that work in this area was ongoing;
      • The ICB priority for 2024 was the transition of GP phone systems to digital cloud-based technology, however this would be followed by a focus on improvements to digital access;
      • Through the Primary Care Access Recovery Plan, the ICB would ensure that GP surgeries had the correct linkage in place to utilise the NHS App;
      • National and local support would be available to assist surgeries with the digital transition and implementation;
      • In respect of a Lincolnshire based NHS App:

§  The ICB had funded some digital developments for Lincolnshire, such as the facility for surgeries to send mass texts, however anticipated NHS App developments would incorporate such services in due course; and

§  Many South Holland residents utilised hospitals outside of the county, such as Peterborough City Hospital, which would not be included in a specific Lincolnshire NHS App. A benefit of the development of the national NHS App included access to the wider NHS system.

• Members noted the extended services (to be) offered by surgeries however stated that a focus was required on the provision of core services, and highlighted the following issues:
  • Some surgeries prioritised telephone appointments over in-person appointments however some symptoms were not easily articulated by individuals and a professional visual diagnosis was needed. The securing of a face-to-face appointment needed to be made easier; and
  • One surgery in the district did not open for a full five days in any one week.
    • The Director of Primary Care and Community and Social Value responded that:
      • Member feedback regarding ‘access’ was not consistent with ICB expectations and information regarding the issue would be sought;
      • Telephone appointments worked well in some cases, such as routine repeat prescriptions, however the clinician was required to establish the most appropriate appointment type;
      • An increase in demand for GP appointments had challenged the types of clinical approaches taken for episodic and continuity of care needs; and
      • The Primary Care Recovery Plan aimed to improve general access.

• Members acknowledged the status of GP surgeries as ‘separate businesses’, and asked to what extent additional services provided a financial benefit to surgeries compared to the provision of core services.
  • The Director of Primary Care and Community and Social Value responded that:
    • The finance funding model was complex, for example: whilst provision of extended services fell within the national contract, others which enhanced patient experience, were commissioned by the ICB; and
    • The subject warranted a separate session if requested by members.

• Members expressed disappointment with the 24 per cent overall access to NHS dentists and queried both the national figure and associated target.
  • The Director for Health Inequalities, Prevention and Regional Collaboration stated that:
    • Dental service access within Lincolnshire at 24.26 per cent was higher than the national average however the ambition was for this to be improved;
    • No targets were in place but this would be reviewed as part of the health needs analysis; and
    • The national dental access percentage figures would be relayed to members outside of the meeting.

• Members were pleased that 14 new dentists had been recruited for Lincolnshire but relayed experiences of difficulties in the sourcing dentists for people with learning disabilities.
  • The Director for Health Inequalities, Prevention and Regional Collaboration would seek further information from the member outside of the meeting.

• Members referred to the additional services being/to be delivered by pharmacies and expressed concern that pharmacies were already overstretched. The loss of two pharmacies in Spalding had increased pressure with prescription fulfilment taking up to 10 days. Were there any plans to improve this situation?
  • The Director of Primary Care and Community and Social Value responded that:
    • The Primary Care Access Recovery Plan included the development of Community Pharmacy as part of the solution;
    • The development of Community Pharmacy represented new investment which had been welcomed by pharmacies to invigorate their services. Almost 100 per cent of pharmacies in Lincolnshire had agreed to take on the extended services; and
    • Lincolnshire planned to develop a Pharmacy Community Strategy aimed at workforce development.

• Members had been made aware of a new national NHS Health and Lifestyle survey, the results of which would be fed into the development of the cloud-based system. Could information regarding this be provided?
  • The ICB representatives would investigate and forward details to members after the meeting.

• Members referred to the housebuilding growth in the district and stated that the size of surgery facilities had fallen behind the increased need to service the population.  Some surgeries had been unable to accommodate the requisite number of GPs at surgery premises and this had led to a greater preponderance of telephone consultations. Members asked whether any capital investment was planned for surgeries to address the issue.
  • The Director of Primary Care and Community and Social Value responded that:
    • A survey of GP estates had recently been undertaken which had established both the current position and that of current and future needs;
    • Funds had previously been accessed through the Estates Transformation Technology Fund (ETTF) for Primary Care developments however this funding stream was no longer available;
    • Where surgery expansion was required as a result of housing growth, conditions could be placed upon the developer to provide funds to expand local services (Section 106) and drawndown where conditions were met; and
    • The ICB representatives would investigate whether any wider funding opportunities were available and circulate these findings to the panel.
• Members expressed concern if Section 106 funds represented the sole source of potential capital investment for surgeries. Members requested to be advised of the total value of Lincolnshire Section 106 funds that were currently held.
  • The Director of Primary Care and Community and Social Value responded that the information would be circulated to members after the meeting.

• Members relayed difficulties in securing a car park space at hospitals which had led to late arrivals or missed appointments.

• Members relayed incidents of scam calls that requested that patients attend appointments which, due to the personal health information disclosed, appeared genuine.
  • The Director of Primary Care and Community and Social Value expressed concern of this report and would investigate the issue.

AGREED:

Following consideration of the presentation by the Performance Monitoring Panel:

a)    That the ICB presentation be noted by the Panel; and

b)    That the comments of the Panel be noted by the ICB representatives.