Agenda item

Briefing Note

The Board considered a Briefing Note and presentation of the Chief Integration Officer, Director of Primary Care and Head of Communications, Coventry and Warwickshire ICB, regarding an overview of the Primary Care Strategy, including an overview of general practice in Coventry and Warwickshire, an introduction to the Primary Care Strategy and an overview of the Primary Care Access Recovery Plan.

Within Coventry and Warwickshire’s Primary Care Landscape, there were 119 GP contracts and 20 Primary Care networks. The way general practices were contracted and funded was complex and very different from other parts of the health and care system.  General practices were small to medium sized businesses whose services were contracted by NHS commissioners to provide generalist medical services in a geographical or population area.  Most GPs in England were run by a GP partnership involving 2 or more GP’s owning a stake in the business. GP partners were jointly responsible for meeting the requirements set out in the contract for their practice and share the income it provided.

Responsibility for commissioning primary care services including general practice sits formally with NHS England. However, Integrated Care Boards (ICBs) had taken on full delegation of these commissioning powers for General Practice. ICB’s had responsibility for commissioning general practice in their local area, while keeping to national guidelines to ensure consistency.

Core GP services were contracted through a nationally agreed contract which the ICB could not make changes to. Payment for the core element of the contract was based on an annual per capita payment. In addition, a GP contract also contained a number of optional agreements for services that a practice might enter into, usually in return for additional payment. GP Out of Hours Services (6.30pm – 8am) were commissioned by the ICB separately and currently provided by Practice Plus Group Ltd.

Primary Care Networks (PCNs) were groups of practices working together to focus local patient care. Since April 2019, individual GP practices could establish or join PCNs covering populations of between 30,000 to 50,000. 

Within the Primary Care Network funding, each PCN provided:

• A Clinical Director role
• Extended hours – to provide core general practice on a PCN footprint.
• Provision of Care Home Support
• Additional roles to work across the network including e.g. physiotherapists, paramedics, pharmacists, occupational therapists and social prescribers.
• Population Health Management
• Online consultants

The Primary Care Strategy included general practice, pharmacy, optometry and dentistry with a large focus on general practice. The Primary Care Group held multiple primary care engagement and clinical leadership events to listen to key messages and understand the key issues from over 300 primary care clinicians and staff.

Consultation had taken place across the system to capture the views of Primary Care in Coventry and Warwickshire, with 6 key areas impacting on primary care providers identified as follows:

• System Integration,
• The Voice of Primary Care
• Resource Allocation
• Activity and Demand
• Workforce
• IT and digital

Operating model key ambitions were urgent non-complex care, urgent complex care, non-urgent planned care and non-urgent proactive care.

The members of the Primary Care Collaborative (PCC) came together in a strategic role to represent the views of primary care and provide leadership on behalf of primary care. The Strategy set out bold ambitions for the Primary Care sector, grouped into 4 sections:

• For the public
• For our staff
• For our NHS system partners
• For the Coventry and Warwickshire system

During 2023, NHS England and the Department of Health & Social Care published a Primary Care Access Recovery Plan (PCARP) for recovering access to primary care while taking pressure off General Practice. PCARP encompassed 4 domains as follows:

• Empowering patients
• Implementing Modern GP Access
• Building capacity
• Cutting bureaucracy

The Cabinet Member for Adult Services, Councillor L Bigham welcomed the item and requested clarification on whether single-handed GP practices since the Dr Shipman case were permitted and if so, how single-handed practices coped with increased numbers.

Members of the Scrutiny Board, having considered the verbal report and presentation, asked questions and received information from officers on the following matters:

• Single GP practices were able to hold contracts (since the Dr Shipman case).  Most single GP practices had additional roles in place as well as locum GPs.  The same governance and oversight of safety was employed whether the practice was a single GP or multiple.
• An improvement in GP waiting times across all practices had been noted and were providing excellent services however, a small number of practices were being supported to improve their services.
• Waiting times were dependent upon clinical need and surgeries were monitored against this on a 48 hour, 1 week and 2 weekly basis.
• Primary care estates and buildings were a significant issue in Coventry and Warwickshire and high risk for the ICB, especially as the population was growing.
• Section 106 funding from developers allowed the ICB to support a build in a new housing estate however, this was not usually enough to fully deliver the service and the practice often had to provide and manage the building.
• Private GP practices were not an issue in Coventry and Warwickshire. They could be accessed online and were required to hold an NHS contract.
• GPs, pharmacists and opticians all held separate nationally agreed contracts.
• Flu and covid vaccinations could be provided by GPs or by pharmacies – both entities were paid the same per vaccine and it was patient choice where they received their vaccine. 
• Prescription funding was provided via the NHS to the ICB who identified and allocated practice level budgets to the GP practices and monitored usage of the budget.
• None of the GP out of hours service was contracted back to GPs.  The out of hours service was monitored by the ICB on activity and performance.
• The Primary Care Strategy was a sector strategy, aimed towards practices improving and collaborating and significant engagement with GP practices had taken place regarding how the ICB could work with them.
• As the strategy had only been approved in November 2024, metrics relating to its success would be visible in 12 months-time.
• Discussions took place at a national level regarding funding of GP practices.
• Referrals from GP to hospital or eg. audiology, are paid for by the ICB.
• Pharmacies and GP practices were both private businesses with NHS contracts.  Pharmacies also had a national contract.
• The Primary Care Collaborative started with GP representation but now had representation from pharmacy, optometry and dentists.  A quarterly primary care forum met where all 4 providers came together.
• Communications to relay the changes coming through in Pharmacy First was being managed by the Communications Team.
• Most GP practices referred to pharmacists however, some did not and vice versa.
• Steps towards improving ways to contact GPs via the telephone were being taken. It was hoped figures would show improvement in the next national survey.
• Data from the patient survey at practice level highlighted those patients that had not had a good experience. Poor patient experience was mainly due to being unable to contact the GP first thing in the morning. GP practices engaged with patient participation groups to improve.
• Integrated teams – GPs and wider primary care teams worked with the community services to support patients however, improvements were always welcomed.
• Governance arrangements were in place where officers from the Local Authority officers and the ICB, worked collaboratively with representatives of primary care, the voluntary and community sectors and other representatives to make progress eg. Coventry Care Collaborative, Geographic Care Collaborative Forum.
• Different ways of working would be required to streamline and make the NHS more efficient and effective however, integrated GP and wider primary care teams worked in partnership with community services to support patients and keep them out of hospital.  If these teams could be more proactive it would make a difference.

RESOLVED that the Health and Social Care Scrutiny Board (5):

1)  Note the information provided in Appendix 1.

2)  Coventry City Council to use its resources to work as a conduit with community organisations to improve knowledge of and access to the NHS for all residents of Coventry.