Agenda item - Primary Care Networks

Presentation on Primary Care Networks from NHS Sussex (papers attached)

16.1    This item was presented by Liz Davis, Director of Primary Care Operations, East Sussex & Brighton & Hove, NHS Sussex; and by Hugo Luck, Associate Director of Primary Care, NHS Sussex (Brighton & Hove).

16.2    In response to a question from Cllr Shanks on city GP numbers, Mr Luck responded that the numbers have plateaued in recent months, but Brighton & Hove still has a poor GP to patient ratio. There is no ready solution to the national shortage of GPs, and local focus is on recruiting more allied health professionals. Mr Luck offered to circulate more information on this issue.

16.3    Cllr Asaduzzaman asked why city Primary Care Networks (PCNs) were of such differing sizes. Ms Davis replied that GP practices had been asked to come together in PCNs representing populations of 30 to 50,000 patients, but that there was no absolute bar on PCNs being smaller or larger than this.

16.4    Cllr Evans noted that the local GP to patient ratio had been one of the worst in the country and asked whether this was still the case. Mr Luck responded that the local ratio remains poor. The long term aim is to make Brighton & Hove a more attractive place for GPs to work, but there are no short term fixes. More needed to be done to attract more GP trainees, to improve the working environment, and to recruit more allied health professionals.

16.5    In response to questions from Cllr Evans on physician’s assistants, Mr Luck told the committee that there were currently 1.8 physician’s assistant posts in the city. It should be stressed that physician’s assistants have useful roles to play in healthcare, but that clinical responsibility for patients will remain with GPs.

16.6    Cllr Wilkinson asked whether there had been sufficient communication with patients on the role of PCNs. Ms Davis responded that lots of work has been done already, and that all practices are asked to display materials about PCNs. However, commissioners would welcome ideas on how to communicate better.

16.7    Nora Mzaoui asked about support to help people in financial difficulties access additional/enhanced services that might be hosted in a PCN GP surgery distant to the patient’s own surgery. Ms Davis responded that patients should contact their patient participation group to see if there was some volunteer transport support available. However, there is no NHS Sussex funding for this. Ms Mzaoui noted that there was realistically very little funding available in practices to support patient travel, and that this was a serious problem as it is leading to people not engaging with services they need. Mr Luck acknowledged the point and noted that it was important that there was meaningful engagement with patients to identify where there were access problems. NHS Sussex are talking with Healthwatch Brighton & Hove about this.

16.8    In response to a question from Ms Mzaoui about training for GP receptionists, Mr Luck told members that there was no specific funding for this, but that every GP practice is expected to appropriately support its reception staff. There may also be relevant training which reception staff can access.

16.9    Cllr Hill asked whether the very large PCNs in the city might function better if they were split in two. Ms Davis responded that this is not for NHS Sussex to determine as it is up to GP practices how they constitute themselves as PCNs, provided that they are geographically aligned and are not too difficult to access. Mr Luck added that a PCN operating in an urban area might well have a patient population of more than 50,000 whilst covering a relatively small geographical area, so larger PCNs are not necessarily harder to access.

16.10  Cllr Shanks enquired about PCN impacts on continuity of care and on prevention. Mr Luck responded that assessing continuity of care can be complex, as patients differ in whether they need or value continuity of care over ease of access. Limited GP numbers mean that patients have to be triaged, with those who really need continuity of care being prioritised. In terms of prevention there are good practice examples from local PCNs. For instance, diabetes clinics have been delivered in community centres rather than GP surgeries in Hangleton & Knoll, improving access for local prevention services.

16.11  Theresa Mackey noted that people have been contacting the Older People’s Council with concerns about access to GP services. In particular, people have complained that they have been advised to self-refer online to physio and other services, and have struggled to do this. Mr Luck acknowledged that there are issues around self-referral. Self-referral is intended to make it easier for people to book appointments and to relieve pressure on GP services, but this is still in its infancy and it is clear that there are issues with patients who are digitally excluded. NHS Sussex is working with Healthwatch on this.

16.12  Cllr Robins noted that some of the figures quoted in the report (e.g. at 5.32)  regarding the proportion of the city’s over 65 population who are frail seem far too high. Mr Luck agreed to look at the definitions of frailty being used.        

16.13  The Chair thanked the presenters for their contributions.