Members were provided with a copy of the Briefing Note prior to the meeting. Mark Tebbs provided members with an overview of the Briefing Note that had detailed some of the current issues facing General Practice and the particular actions being taken in Thurrock to address this. The national Standard Operation Procedure had been developed by NHS England which had set out requirements for general practitioners to reduce face to face contact with patients and adopt total triage to limit the spread of COVID at the outset of the pandemic. The Standard Operation Procedure had since been relaxed and NHS England had made clear that practices should continue to offer a blended approach of face to face and remote appointments. The challenges and frustrations across primary care were summarised for members with one of the areas of frustration being the difficulty of getting through on the telephone. Members were briefed on the actions being taken and were referred to a HealthWatch Facebook live session that had been held to help with communication and to help residents understand the current pressures.
Councillor Ralph referred to the national General Practitioner Patient Survey results which had showed Thurrock had the lowest overall experience rating in Mid and South Essex and stated the main concerns were telephones not being answered and residents being passed about and questioned when were residents of Thurrock going to see some improvements. Mark Tebbs stated there was no quick solution to the current situation that primary care were facing and NHS generally. There were long term impacts that COVID had on operational delivery and delivering of the vaccination program. There were extensive waiting lists in secondary care which had meant burden on primary care had been much greater to provide COVID safe services which had meant additional burdens on telephone lines. That work was being undertaken on the action plan, recruiting to additional roles but as members knew it was very difficult to attract new general practitioners into the area. Plans to improve the estate for a better environment for practitioners and the public but reiterated there was not a quick solution. A comprehensive response would be presented at the next Health and Wellbeing Board and further updates would be provided to this committee.
Councillor Ralph stated there were some brilliant general practitioners in Thurrock but there were some surgeries in need of improvement and questioned had those surgeries been identified and targeted for help. Mark Tebbs stated the vast majority of surgeries in Thurrock were rated good with only one practice in Thurrock rated inadequate. That scorecards, quality visits and work would continue with support and investment of project management support to help primary care network development and how practices could work together in localities.
Councillor Holloway thanked Mark Tebbs for the update and stated this was fundamentally a workforce issue not just amongst general practitioners but all teams. That the recruitment of general practitioners was not just a concern in Thurrock but everywhere in the country were facing the same recruitment problem and would need to be escalated to government. Councillor Holloway referred to additional roles mentioned in the briefing note and questioned how this type of recruitment would help general practitioner and patients. Also how was a picture of a good general practitioner surgery pulled together and questioned was this based on performance, complaints, patient feedback. Mark Tebbs stated there was a national shortage of general practitioners especially in Thurrock which were experiencing lower levels than elsewhere. As part of the new model of care the number of frontline clinicians had been increased in developing a mixed skill workforce and noted this had taken some time to be communicated to the public. Mark Tebbs confirmed that inspections of surgeries were undertaken by CQC and that scorecards were used to summarise a number of indicators. That practices were encouraged to have a patient participation group and that a number of different routes were used to monitor the effectiveness of primary care as one size did not fit all.
Councillor Fish questioned the kind of challenges that were being faced by surgeries to which Mark Tebbs stated that the majority of surgeries were rated good with only one rated inadequate. The CQC rating system scores were used for practices on safe care, effective care and leadership. As part of the challengers a number of different kinds of criteria would be followed to look for good performing practices.
Councillor Fish questioned what new roles would be undertaken by general practitioner surgeries to which Mark Tebbs stated that would be recruitment but would hand over to Kim James from HealthWatch to touch on social prescribing. Kim James stated that social prescribing offer was ran by the voluntary services and community resources with recruitment being managed by HealthWatch. That social prescribing was a social model to support people to access services that were within the community rather than within a clinical setting. Kim James referred to the live Facebook event that had taken place with over 130 members of public attending with concerns mainly around the access to surgeries and that communication was vital as residents were unsure how the new system was working. Members of the public were encouraged to join a patient participation group so that issues could then be challenged and shared with the CQC. HealthWatch would continue to work independently and monitor with future events to be held and to update this committee.
Councillor Polley questioned the estate issues mentioned in the briefing note and for an explanation on the increase of appointments as to whether these were face to face or telephone appointments. Councillor Polley also questioned how effective the offered triage service was and stated that the current telephone system was ineffective and could be made more simplified and inexpensive to implement. Mark Tebbs stated that the capacity modelling that was being undertaken was delivering more appointments than it was this time last year but agreed with Councillor Polley how these appointments were being delivered had changed. It had also been recognised that the telephone access had been a problem and that residents were waiting longer than normal to get an appointment. Mark Tebbs reassured Members that some of the solutions would be to find the right way of communicating with residents and the 111 website offered a good source of information around the kinds of complaints. General practitioners were encouraging residents to use the e-consult, use of the NHS app for repeat prescriptions, hold more Facebook events, that there was not just one solution there had to be multiple actions. In regards to Councillor Polley’s question re estates this was addressing those older properties which were not purpose built and harder to make COVID safe. That some properties presented more challenges than others.
Councillor Ralph stated that more complex issues were being recorded as patients had not seen their general practitioner and that face to face appointments with general practitioners was what residents wanted. Councillor Ralph thanked Mark Tebbs and asked that an update be provided following the presentation of the report to the Health and Wellbeing Board.