Agenda item

To consider an update on Westminster’s Primary Care Strategy.

8.1       Chris Neill (Interim Deputy Managing Director, NHS Central London Clinical Commissioning Group) presented this item and began by referring to NHS England delegation of primary care commissioning to local CCGs in April 2017. He stated that there had been a lot of support from GPs in developing primary care commissioning and the strategy would address an area wider than primary care, such as accountable care.  During the presentation, Chris Neill advised that the vision of the Primary Care Strategy was to improve the quality of care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community. Both national and local NHS priorities would be used to deliver the vision. NHS England’s national priorities were set out in its’ Five Year Forward View, whilst the North West London STP set out the local priorities. A person perspective approach had been taken to transform primary care, focusing on the patient’s expectation of care. In respect of the workforce perspective, there would be more emphasis on technology and digital tools to ensure staff could undertake their work more effectively. Chris Neill stated that the transformation needed to ensure that there were improved patient outcomes, including reduced premature mortality and morbidity and improving the experience of care. Care would also be coordinated around individuals, targeting their specific needs.

8.2       Chris Neill advised that there were three stages to transforming primary care built on village working, these being:

·         Stage 1: Embedding effective village working

·         Stage 2: Forming primary care homes

·         Stage 3: Forming a multi-speciality community provider and accountable care.

8.3       Chris Neill stated that having larger groups of GPs working more closely together to provide primary care homes provided more structure and the transformation, which NHS England wanted completed by 2020, would provide greater flexibility to move more resources around. In terms of the commissioning approach, there will be more community focus and populations, services and budgets will be viewed together. Chris Neill advised that there was a three year delivery plan in place to ensure that NHS England’s deadline was met and that the proposals to develop the strategy were currently subject to consultation with NHS Central London CCGs’ partners, including the Council.

8.4       During Members’ discussions, Dr Neville Purssell stated that GPs could not continue to work in the same way they currently did because of change in demographics, patient demand and lack of staff. GPs had recognised this and were focusing more on ensuring that they could undertake and meet specific purposes. There was considerable variation in the quality of delivering care and greater equality of care and better outcomes would be achieved by more GPs working closely together. In terms of governance, Dr Neville Purssell advised that this was being consulted on and GPs were also subject to the national General Medical Services Contract. Some new GPs were not keen on becoming partners and further consideration needed to be given in how to provide continuity of care. Looked after elderly patients also provided a considerable challenge, particularly where there were mental health issues involved and pharmacies would play a key role in addressing this. Dr Neville Purssell stated that primary care homes sought to focus on outcomes and more details on how these would operate would be made available soon as this matter was currently being discussed by the CCGs’ governing bodies. A key aim of the strategy was not a new alignment of services, but rather an alignment of outcomes and the challenge would be in obtaining good data to demonstrate that this was being achieved.

8.5       Members commented that there should be a focus on explaining to GPs that the changes will benefit them and the village model offered the opportunity to start mapping what voluntary and community organisations could be involved in working with the CCGs and partner organisations as a parallel workstream. There also needed to be more public and patient consultation to ensure they understood the purpose of transforming primary care and developing a strategy and what outcomes it intended to deliver. Members asked when public consultation was due to take place. One Member suggested that the approach taken to primary care transformation needed to be altered as at the moment it was suggesting services being provided and seeking responses to these. He felt this was the wrong emphasis as patients felt that they owned the condition they had and had their own ways of dealing with it. As such, the Member suggested that the emphasis should be on professionals working constructively with patients to achieve outcomes and the dialogue used should be positive.

8.6       The Chairman felt there was scope for the strategy to take a more ambitious approach and that highlighting customer journey stories and the role of health visitors and pharmacists should also be highlighted. It was important to impress upon GPs the case for transforming primary care and the benefits it would bring.

8.7       Dr Joanne Medhurst suggested that care needed to be taken in respect of the wording used in the strategy, including defining primary care and primary care homes as those involved was broader than just GPs. She stated that the voluntary sector had wide involvement in some areas of primary care, whilst acute services also played a role. It was also important to provide transparency and sound data to demonstrate to what extent the outcomes were being achieved.

8.8       In response to issues raised, Holly Manktelow (Head of Unscheduled and Primary Care, NHS Central London Clinical Commissioning Group) advised that stage 1 of the primary care transformation was being taken from a GP perspective and involved a significant piece of work. She acknowledged the need for an ambitious approach to be taken and step changes would be made during the transformation, with changes to commissioning being the next step. Holly Manktelow advised that formal public consultation was due to take place, however the intention was for patients to be fully involved in developing the strategy throughout the process and she also welcomed involvement from Healthwatch and the voluntary and community sector. She added that a clearer focus in respect of outcomes could be provided in September or October.

8.9       The Chairman welcomed the positive start to developing the strategy and emphasised the need for CCGs, providers, GPs, the voluntary and community sector and the Council to work closely together and share information to help develop the strategy.