Agenda item

Report of Andrea Green, Coventry and Rugby Clinical Commissioning Group

(CCG) who has been invited to the meeting for the consideration of this item  

The Board considered a report of Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) which set out the current position of primary care within Coventry and outlined the future primary care planning arrangements. Andrea Green and Jenni Northcote, Coventry and Rugby CCG, and Justine Richards, Coventry and Warwickshire Partnership Trust (CWPT) attended the meeting for the consideration of this item. Councillor Abbott, Cabinet Member for Adult Services was also in attendance.

The report set out the background to Coventry and Rugby CCG which was formed in 2013 and whose membership was derived from local General Practice provider contract holders. The CCG had 59 member practices located in Coventry. These made up the general practice provider market for providing primary care medical services for registered patients across Coventry. The practice membership included 9 single handed practices as well as practices with multiple partners. The Board were informed that the smallest practice, Anchor Centre, had a registered population of 582 patients with the largest being Engleton House Surgery with a population of 23,020, this included Coventry University branch. Providers of general practice services were independent contractors within the NHS family and their responsibilities included delivery of a nationally prescribed Core Contract for specified primary care services. The main challenges and top 5 workforce priorities were detailed.

The Board were provided with a definition of primary care noting that it encompassed a wide range of contractors and services included pharmacists, opticians, dentists and General Practice. It encompassed all health care taking place outside acute and mental health trusts.

The report informed that the CCG had been accepted on a national primary care development programme led by the National Association of Primary Care called Primary Care Home. The programme supported primary care collaboration and delivery around registered patients lists of around 30,000 to 50,000 to deliver 4 core objectives.

Reference was made to the quality and performance management of General Practice. There were two types of contracts for primary general medical services in Coventry: General Medical Service contracts (GMS) which were not time limited and Alternative Provider Medical Services contracts (APMS) which had a contract life cycle of typically 5 years. In Coventry there were 52 GMS contract holders, 6 APMS contracts and I practice with a PMS agreement.  Details about the contract specifications were outlined. Under delegation the CCG was responsible for the overall performance management and quality assurance of general provider contracts. Individual GP Performance standards and clinical competence assurance was retained by NHSE. The CCG monitored a range of indicators to assure the quality of general practice which were outlined in the report. The CCG worked with practices on action plans to address any areas identified as requiring improvements.

The Board were informed that in Coventry 2 practices were rated overall outstanding; 49 practices were rate good; 3 practices had an overall requires improvement rating; 1 practice was rated overall inadequate; and 3 practices were still awaiting inspection.

Detailed information was included on the key pressures on General Practice, with the following local pressures reflecting the pressures recognised nationally in the General Practice Forward View:

·  Workforce and work load

·  Patient expectations and national requirements for improved access (including evenings and weekends).

Reference was made to the 2 GP surgeries in Longford and Hillfields that had closed in the current financial year. The Board noted that the register patient lists had been dispersed to other local practices and to the support that had been provided by the CCG. 

The report provided an update on planning for the future of Primary Care highlighting that the CCG had submitted a local General Practice Forward View Plan to NHSE which had been fully assured and supported the delivery of the Primary Care Strategy. The CCG was also a key partner within the STP and was working with partners on the key workstreams including urgent care, out of hospital and proactive prevention. Reference was made to the estates strategy; the Local Estates Forum; engagement with the planning process; and workforce strategy.

The report concluded with detailed information on the financial position of primary care and financial trends over time. The Board were informed that hospital funding had been growing at twice the rate of the investment in local doctors’ services. Details of the indicative budget allocations for the CCG’S primary care medical services to 2020/21 were set out. Additional information was provided on the current interface between primary care and other partners.

The Board questioned the officers on a number of issues and responses were provided, maters raised included:

·  How was best practice from the 2 outstanding General Practices shared with other practices

·  The measures being put in place to improve the General Practice rated as inadequate

·  Was it possible to introduce the required changes needed to address workforce issues

·  An explanation of what the General Practice ratings actually meant, particularly ’inadequate’

·  Concerns about the issues relating to GP recruitment, in particular the current shortage of GPs

·  A comparison of the levels of primary care in Coventry with primary care in other areas of the country

·  Further information about the 9 single handed practices; the availability of support ensuring they didn’t operate in isolation; and what happened when these GPs decided to retire

·  An explanation about the GP Alliance/ Federation

·  The implications for GPs of increasing hospital waiting lists

·  Further information about the use of digital technology to free up GP time

·  Further details about what was included in the GMS and APMS contracts

·  Additional information about plans for future GP recruitment

RESOLVED that:

(1) The content of the report setting out the current position of primary care within Coventry and the future primary care planning arrangements be noted.

(2) Further reports on the following be submitted to appropriate future meetings of the Board:

(i) Workforce issues including GP recruitment

(ii) Primary Care Digital Strategy

(iii) Supporting self-care.

(3) Members be provided with a dash board informing of the availability and quality of GP Practices across the city, to be updated on a regular basis.

(4) Members to be provided with a map detailing the GP Practices not signed up to improved access (including evenings and weekends and access to same day urgent appointments).