Agenda item - Developing Enhanced Health & Wellbeing GP Services

1)              It is noted that the paper presents the plans for developing a new way of commissioning enhanced services from GPs for discussion and feedback. The new commissioning approach will be about developing more proactive and integrated primary care organised around clusters of practices to start in all areas by April 2016.  It is agreed that an update on the progress of the new contract will be brought back to the Health and Wellbeing Board in July 2015. 

2)              It is noted that the new commissioning approach will require a new contractual relationship with GP’s, the details of which are currently being developed.  It is agreed that contract management will be carried out jointly between the CCG and BHCC.

Introduction

68.1    The Board considered a report of the Public Health Principal, the Interim Primary Care Transformation Lead, and the GP Lead for Primary Care Quality and Public Health, which briefed members on the work to develop and enhance primary care in the city.  Members were invited to provide feedback and were asked to support the overall process.  The report was presented by Nicola Rosenberg, Public Health Principal and Suzanne Novak, Interim Primary Care Transformation Lead.    

68.2   The Interim Primary Care Transformation Lead stated that the objective with the transformation was to improve health outcomes.  General practices were being asked to work very differently.  Contracts were being aligned with GPs to achieve universal coverage and equal access to all patients.  There was a need to expand GP capacity.  Not having enough doctors impacted on the health of patients.  There were ambitious plans to attract high quality GPs and there would be an emphasis on prevention of premature mortality.  There was a desire for doctors to be able to have dedicated time with children and young people.  The result would be an improved patient experience in primary care.  

68.3   The Public Health Principal stated that the contract was based on GPs working in clusters as set out in Appendix 1 of the report. This was a five year contract. 

68.4   The Interim Primary Care Transformation Lead explained that there would be six clusters across the City.  They would each have shared values and objectives.  There would be a transition year from April 2015

          Questions and Discussion

68.5    The Chair stated that the report was clear and the audit on mortality was very useful. 

68.6    Pinaki Ghoshal considered that having GP clusters was the right approach.  However, he stressed that over the last couple of years a great deal of work had been carried out with schools across the city to develop a cluster based approach.  The clusters in the current report were not geographically based and did not bear much relationship to other clusters arrangements across the City.  He asked if there would be an opportunity to look at the proposed clusters to see whether there were other ways for these groups to come together that fit in with other arrangements.  The Interim Primary Care Transformation Lead agreed that this was a valid point.  She stressed that the priority was for GP practices to deliver services in groups.  They were being asked to find people they could work with.  It was hoped that eventually they would develop relationships with schools and other services and realise it would make sense to be more geographically coherent.  In the meantime it had to be recognised that GPs had patients registered with them from all round the city.    

68.7    Councillor Morgan stated that he thought a patient could only register with a GP surgery in their locality.  He referred to the GP Clusters map on page 42 of the agenda and noted that there were huge gaps city wide.  For example, when Eaton Place surgery was taken out there was an enormous geographical separation between the GP surgeries in an area where there was high deprivation.  Councillor Morgan asked how practically did the strategy impact on that area and how these concerns would be addressed.  The Interim Primary Care Transformation Lead explained that although GPs covered their geographical area, patients sometimes moved out of the boundaries.  Any patient could register with any practice if this was agreeable to both parties.  Populations overlapped quite significantly.  There were concerns about practices closing and officers were hoping to carry out assessments of health outcomes and were trying to identify problems.  GPs were working at cluster level to address gaps.  There was a desire to attract more GPs into the area and address the problems Councillor Morgan highlighted. 

68.8    Denise D’Souza also expressed concern that the boundaries of the GP clusters did not align with other clusters in the city.  She asked if the funding for this work was different from the Better Care Fund funding.  This was confirmed to be the case. 

68.9    Geraldine Hoban stressed the importance of having a skill mix in terms of clusters.  Clinical leadership was essential to deliver change.  Additional GP capacity was essential. There were also other skill mixes that were needed in the clusters.   With regard to boundaries Ms Hoban stressed the importance of starting work on looking how to sensibly align other community services with the emerging clusters.  There could then be a sensible configuration for integrated services in the city.  In the meantime, the willingness of GPs to work together was a huge step forward.     

 68.10 Councillor Jarrett stressed that the hardest thing to alter was the GP practice locations and where their core patients lived.  Altering local authority provider services might be simpler than rearranging where GP surgeries were sited.  It was inevitable that some boundaries did not match but there was a need to be clear about procedures.   

68.11  Frances McCabe raised the issue of the variability of the service.  As there were so many discrepancies already she asked how officers were going to make sure that there was a fair service provided for everybody in the city.  The Interim Primary Care Transformation Lead replied that this question had been discussed at the CCG.  She explained that the City was not in an ideal situation regarding inequalities of health, provision and capacity.  There was a need to make inequalities more explicit through baseline assessments and through asking the clusters to self assess with regard to their structures and outcomes.  Clusters would develop action plans to address this.  The CCG would test action plans to see if value for money was being achieved and to see if it was a good return for the taxpayer.  The CCG wanted to see transparency at every step of the process and wanted to see Clusters addressing some of these inequalities.      

68.12  Tom Scanlon stated that GP practices working together was a step forward and a big change in primary care.  

68.13  RESOLVED:

1)              That it is noted that the paper presents the plans for developing a new way of commissioning enhanced services from GPs for discussion and feedback. The new commissioning approach will be about developing more proactive and integrated primary care organised around clusters of practices to start in all areas by April 2016.  It is agreed that an update on the progress of the new contract will be brought back to the Health and Wellbeing Board in July 2015. 

2)              That it is noted that the new commissioning approach will require a new contractual relationship with GP’s, the details of which are currently being developed.  It is agreed that contract management will be carried out jointly between the CCG and BHCC.