Agenda item

A presentation will be given at the meeting.

 

The Chairman welcomed representatives from Surrey Heartlands Clinical Commissioning Group (SHCCG) to the meeting: namely, Rhian Warner, Head of Primary Care Commissioning & Development, Guildford and Waverley Integrated Care Partnership (ICP), SHCCG; Jane Williams, Deputy Director of Guildford and Waverley ICP, SHCCG; Helen Snelling, Head of Primary Care Contracting, SHCCG; and Jules Wilmshurst-Smith, Head of Estates, SHCCG.

 

The Chairman invited the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, to give a presentation and advised the meeting that the slides for this were included at pages 5-26 of the agenda papers.

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the meeting about ICPs and the establishment of SHCCG in April 2020.  The Committee was informed that each of the four ICPs across SHCCG was responsible for planning and delivery of services at a local level and for developing its own priorities, and each had a Board with representation from local partners.

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, presented the meeting with details of developments and events in Primary Care; namely, the response to the COVID pandemic, the flu programme, the Primary Care Network (PCN) development, and PCN Estates. 

 

With reference to the Primary Care response to COVID, the meeting was informed of the activities undertaken by SHCCG.  The Committee heard these activities included support for shielded and vulnerable patients, more than 28k video consultations between April and September 2020, and three quarters of GP practices introducing home working for staff who were shielding.  The meeting was advised that the pandemic had accelerated the delivery of digital modes of contact for patients and that these services would complement the existing traditional modes rather than replace them completely.  The Committee was informed that patient feedback about both practice websites and improved digital access was positive.

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, stated that primary care appointments had dropped significantly at the start of the pandemic and increased noticeably in August and September.  She indicated that primary care appointments were back to pre-pandemic levels.  The meeting was informed that SHCCG ensured practices offered a COVID risk assessment to all staff to protect the workforce, particularly black and ethnic minority staff.

 

With reference to the COVID vaccination programme, the Committee was advised that many of the details were classed as Official Sensitive and unable to be shared.  The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, indicated that local sites were being prepared to deliver vaccinations from 15 December, although this date was subject to the approval and supply of the vaccine.  In addition, the Committee heard that vaccination sites in each Primary Care Network area were pending approval.

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the Committee about the flu programme.  She indicated that the cumulative uptake had increased in 2020/21 compared to 2019/20 in the over 65s, under 65s at clinical risk, and 2- and 3-year olds; the meeting heard that the only cohort not to show an increased uptake was pregnant women.  The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, confirmed that the 50-64 year-old group would be eligible for flu vaccination from 1 December as part of an expansion of the programme.  She outlined to the Committee the timeframe for ordering supplies of the vaccine and the increased uptake due to the COVID pandemic and indicated that additional stock was available from a Department of Health and Social Care national store. 

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the meeting of an issue with the national call and recall service that had meant some people not eligible had mistakenly been contacted and encouraged to get a flu vaccine.  In addition, she informed the Committee of two drive-through flu vaccination clinics held in the Borough.

 

Continuing her presentation and moving on to PCN development, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the meeting of the four PCN groupings of GP practices within the Guildford and Waverley area and their respective patient list sizes.  She highlighted the achievements of each PCN, including participation by West of Waverley PCN in a population health management NHS England pilot, GPiMHS (General Practise integrated Mental Health Service) in both North Guildford and East Guildford PCNs, and enabling GP Connect for the direct booking of GP appointments through the NHS 111 service. 

 

The Committee was informed about the Enhanced Health in Care Homes Direct Enhanced Service introduced in October 2020 to ensure NHS support to people living in care homes.  In addition, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the meeting on the Additional Roles Reimbursement Scheme (ARRS) and the roles that PCNs could choose from for the recruitment of additional staff to deliver health services.  In relation to ARRS and supporting Direct Enhanced Service specifications, the meeting was advised of the recruitment intentions of PCNs in Guildford and Waverley ICP for the next four years.

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, advised the Committee of the GPiMHS pilots in the Guildford PCNs. She indicated that the majority of GPiMHS requests had been from women aged from 24 to 64 years old. 

 

In addition, the meeting was advised of the digital-first primary care requirements and the move within the ICP towards such an approach.  The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, indicated that such an advance would complement and not replace existing methods available for people to access Primary Care.

 

In relation to Guildford and Waverley PCN estates, the Committee was advised of premises issues, including the Chiddingfold Surgery fire, North Guildford Estates plans, Wisley / Ockham development, the closure of New Inn Surgery, and the closure of Buryfields branch of the Guildford Rivers GP practice.  The meeting heard how SHCCG had supported GP practices in North Guildford PCN with university student registrations in 2020 and the difficulties of the previous year had been avoided. 

 

The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, outlined the highest quality and performance risks across primary care and the mitigations proposed.  The meeting heard that the top risk was a COVID-19 surge in winter; other risks identified by the ICP related to delivery of the flu programme for 2020/21, ARRS workforce recruitment, a NHS submission deadline for digital first primary care, high demand and limited capacity, moving from PCNs to community networks, and primary care estates issues.

 

At the conclusion of her presentation, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, noted the value of the Council’s support to help ensure the success of primary care community networks.

 

During the ensuing discussion and question session a number of points and clarifications were made, including:

 

·        In response to a question about the possible difficulties that residents reliant on public transport might experience accessing the COVID-19 vaccination locations, particularly in rural areas, the Deputy Director of the Guildford and Waverley ICP referred to the different models employed to deliver the vaccination.  She indicated that a roving model of delivery would enable people designated as housebound and all those in care homes and in residential homes to access the vaccine.  The meeting was informed that vaccination sites for the PCN model of delivery would be relatively small-scale and use voluntary sector transport networks, such as car driver schemes.  She confirmed that discussions were continuing concerning transport links within both the roving and PCN models.  The Deputy Director of the Guildford and Waverley ICP confirmed that the accessibility of public transport would be a factor in the location of any large-scale vaccination site within Guildford.

 

·        A member of the Committee questioned the difference in attitude between young and old people toward compliance with COVID restrictions. The Deputy Director of Guildford and Waverley ICP, SHCCG, indicated that compliance with guidance was a matter for individuals.

 

·        In response to a question about the learning from the handling of the pandemic, the Deputy Director of Guildford and Waverley ICP, SHCCG, advised the meeting that virtual working, partnership working, and speed of delivery had been successful. 

 

·        In response to a question, the Deputy Director of Guildford and Waverley ICP, SHCCG, advised the meeting of the plans for the staged delivery of COVID vaccinations. 

 

·        The Deputy Director of Guildford and Waverley ICP, SHCCG, indicated that in terms of any COVID-related backlog of non-urgent treatment, as measured by Referral to Treatment (RTT) rates, the CCG was faring well compared to national figures.  She advised that the RTT statistics could be provided to the Committee.  The meeting was informed that a potential concern was the number of late referrals or those patients who had not delayed presenting to primary care due to the pandemic.

 

·        The Committee heard that the number of people eligible to receive a COVID vaccination in their homes had not been quantified at this stage.

 

·        The Deputy Director of Guildford and Waverley ICP, SHCCG, informed the meeting that public information and reassurance relating to the safety of the COVID vaccination was controlled nationally.  She indicated that while the scale and newness of the COVID vaccines were unusual, the delivery of vaccination programmes by the NHS was not.

 

·        With reference to GPiMHS and measures such as basic cognitive behaviour therapy, a member of the Committee asked if the NHS would be able to support the increase in mental illness caused by the pandemic.  In reply, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, requested the member of the Committee contact her for a full discussion so she could liaise with Surrey and Borders Partnership NHS Foundation Trust to progress the query.  The Deputy Director of Guildford and Waverley ICP, SHCCG, indicated that the impact from COVID would continue for some time yet and she confirmed the value in obtaining further details about mental health services for the Committee members. 

 

·        The Deputy Director of Guildford and Waverley ICP, SHCCG, stated that a query from a Committee member about why the majority of GPiMHS requests had been from women aged from 24 to 64 years old would be shared with Surrey and Borders Partnership NHS Foundation Trust for an update.

 

·        In response to a question from a member of the Committee about referral thresholds for physical disabilities associated with mental illness, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, asked that the Committee member contact her for a further discussion.

 

·        The Head of Primary Care Contracting, SHCCG, confirmed that registration with a GP practice had been problematic for university students the previous year.  She informed the Committee that arrangements were now more resilient and more practices that covered the area were willing to accept new patients.  The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, suggested the development of PCNs had led to GP practices working better together and created additional resilience.

 

·        The Committee questioned why it seemed difficult to persuade GPs to accept the opportunities offered by new health facilities, such as those sometimes proposed as part of a new housing development.  In reply, the Head of Estates, SHCCG, indicated that there could be several factors: availability of the workforce; efficient use of any new estate by GPs responsible for the cost of its ownership; historical lack of co-ordinated planning of GP practices’ estate, with GP practices run as individual businesses; a previous shortage of capital within SHCCG; and the benefits to patients of fewer sites with a multi-disciplinary team of specialists.

 

·        In reply to questions, the Head of Estates, SHCCG, updated the meeting on the progress of proposals to address longstanding issues at two GP practices, over five sites, in North Guildford.  He indicated that the COVID pandemic had delayed the process and the aim was to achieve approval of a business case for change by December 2021, with full public consultation following.  He indicated a likely completion date of late 2023 for the North Guildford Estates plans.

 

·        The Head of Estates, SHCCG, indicated that the Council had been involved in considerations of the North Guildford Estates plan and new housing developments.

 

·        In response to a member of the Committee asked about the retention of GPs, the Head of Estates, SHCCG, and the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, referred to the benefits of a healthy workplace and workforce.  The Head of Estates, SHCCG, suggested that the quality of working environment and property ownership issues were factors in GP retention.  The Deputy Director of Guildford and Waverley ICP, SHCCG, indicated the need to plan for an upcoming spike in the number of GPs retiring.

 

·        The Head of Primary Care Contracting, SHCCG, advised the Committee that she was not aware of any application for the closure of Wodeland Surgery in the Guildowns Group Practice.  The Head of Estates, SHCCG, indicated that the options and proposals for North Guildford were yet to be defined.

 

·        In response to a question, the Deputy Director of the Guildford and Waverley ICP, SHCCG, advised that digital poverty was recognised as an issue and that online service delivery would not replace face to face communication with patients.  The Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, confirmed that some GPs were exploring how to do annual health checks  She indicated that annual health checks were a priority for the CCG and additional funding had been made available to incentivise their delivery by GPs.

 

·        In reply to questions about the accessibility of services to members of the public unable or unwilling to use digital services, the Head of Primary Care Commissioning & Development, Guildford and Waverley ICP, confirmed that the approach would not be digital by default.  The meeting was informed that existing approaches to service delivery would be maintained and the introduction of online services would be additional.  The Head of Primary Care Contracting, SHCCG, informed the meeting of work undertaken with Healthwatch Surrey to encourage communication with those patients not engaging with digital services.

 

·        In response to a question about the accessibility of a super-surgery model of provision, the Deputy Director of Guildford and Waverley ICP, SHCCG, indicated that the process was still at the scoping stage and patients’ need would be paramount.  The Head of Estates, SHCCG, indicated that the CCG recognised the possible significance of transport as an element in any proposed model.

 

·        The Head of Primary Care Contracting, SHCCG, advised the Committee that patient feedback suggested maintaining continuity of care could be a concern for some patients while for others the advantages from a bigger GP practice was more significant.  In addition, she advised that registered patients could request to see a particular GP of their choice.

 

·        The Deputy Director of Guildford and Waverley ICP, SHCCG, informed the meeting that normal winter pressures were expected to cause an increase in non-elective emergency care in January. 

 

·        In reply to a question, the Committee was advised that the uptake of flu vaccination by pregnant women was lower than the previous year and, while data issues might be partly responsible, there would be a communications campaign to help address this. 

 

·        The Head of Estates, SHCCG, confirmed to the meeting that proposed housing developments were included in the planning of primary care delivery for central Guildford and North Guildford. 

 

The Chairman thanked the representatives of SHCCG for attending the meeting to present the Primary Care update to the Committee and answer questions.  Summarising, he indicated continuing support from Councillors for both the transformation of primary care by the NHS in the Borough and for the NHS generally.