For the Committee to consider and comment on the measures being taken to improve patients’ access to GP services.

The committee received a report regarding GP Access within Herefordshire, which was presented by Charmaine Hawker (Herefordshire & Worcestershire Clinical Commissioning Group Associate Director, Primary Care), Dr Jonathan Leach (OBE, NHS England Medical Director for COVID-19 Immunisation, NHS England Associate Medical Director for Armed Forces & Veterans Health and General Practitioner Davenal House Surgery Bromsgrove) and Dr Mike Hearne (Managing Director of Taurus Healthcare representing Herefordshire General Practice).

An outline of changes to how primary care during the Covid-19 period was restructured and delivered was given to the committee along with an overview of the data and information contained within the report. A number of key points were expanded on including: workforce issues (especially in terms frontline recruitment), the pros and cons of face-to-face and remote appointments and the increased use of wider healthcare professionals. It was suggested that people needed to consider whether it was the GP or GP team that couldn’t be accessed and that there was a need for greater awareness about the wider GP team and the changing role of GPs. The presentation also highlighted the desire among GPs and the GP teams for greater flexibility in the hours they were expected to work

The committee congratulated those involved in the vaccine rollout within the county, for being efficient and quick. The vital role volunteers played was also noted. The teams in Herefordshire had achieved the second highest level of Covid vaccination in the country.

The committee made a number of comments:

·       It questioned whether public opinions on GP access were based on perception or reality?

·       It noted that there was a multiplicity of ways to access the service and that changes within the service were happening at pace.

·       It questioned how successfully changes to the service were being communicated to the public.

·       It noted the need to raise public awareness in relation to the different ways of accessing services.

·       The committee welcomed the idea of GP teams with a wide range of skills and expertise, but questioned who ultimately makes the decisions about which GP team member should deal with certain individuals and cases?

It was explained to the committee by the report presenters that the GPs along with trained care navigators make those decisions. The role of the GP was likened to a conductor of an orchestra.

The committee noted that within the county rural areas sometimes benefitted from better access than those in the city, call waiting times in city practices were cited as being notably lengthy and problematic.

The committee gave a number of examples (from both personal experience and constituents) of instances where the time taken to get through (via telephone) to the merged practice in Hereford HMG (Hereford Medical Group) was unacceptably long. People had reported waiting in a queue of 50 and in some instances, having endured a lengthy wait, they were cut off before being able to speak with anybody. It was suggested by the committee that some of the fears of people who had been sceptical about the merging of the practices had been fulfilled.

The committee felt there shouldn’t be a two-tier standard between city and rural. It was noted that the City and South Wye felt disenfranchised and that the loss of the drop in centre near ASDA had been profoundly felt and the committee felt that the service which had replaced it was viewed by residents as a 2^nd class option.

The Clinical Commissioning Group Associate Director, informed the committee that the HMG acknowledged the problem of long telephone waiting times and was concerned that receptionists were leaving the sector because of the pressure and abuse they receiving from irate patients. It was noted that the HMG had made a pledge, that by the end of March 2022, no patient would wait longer than 10 minutes on the phone before being spoken with.

It was pointed out that the City and South Wye areas felt disenfranchised and the loss of the drop in centre located by ASDA was profoundly felt. The committee asked the report presenters about how the virtual hub worked?

It was explained that the virtual hub was being run in conjunction with the winter access funding and was intended to support access to general practice. It was currently being trialled in three locations within the county. A care navigator asks the patient if it would be suitable/acceptable to have their care delivered by phone or video and then takes them down that path. One advantage of the hub is that it provides general practice with greater resilience to cover sickness and other absence. GPs from remote national and international locations know the local area and have access to the system and records so that they can provide an informed consultation. It was noted that sustaining and expanding this service would be key to building additional resilience and supporting 111.

The committee heard about the Covid management service and how community teams and social care were providing a two-hour response, which was designed to keep people out of hospital and support urgent needs in the community.

The committee enquired if it was possible to triage telephone calls during heavy use time and redirect towards email/online contact?

It was explained that in addition to the expanded peripheral general practice website a new internet based telephone system would allow for online consultation using a triage set of questions to determine the urgency of a case.

The committee welcomed these new approaches, but felt there was a real need to promote and raise awareness of the virtual hub and other means of access as a legitimate alternative to main surgeries. It was suggested that Talk Community might be a good platform to communicate the new mixed model of access. It was noted that society is accepting that doing things online can be quicker, easier and more efficient than doing them by phone and in person, but good communications would be needed to turn around the 75-year-old culture of physically going to see your doctor. 

The committee noted that it was important that feedback from patient engagement continued to be monitored and that Healthwatch supported and challenged these new systems.

As a closing comment the report presenters suggested that if the committee was going to return to the issue of access to general practice, looking at access to health and social care services as a collective might prove more informative than just focusing on individual providers, as that only gave one part of the story.

The committee agreed that focusing on the various points of interface would be sensible approach for future discussion.

The recommendations below were proposed and seconded and carried unanimously.

RESOLVED:

The Committee recommended that:

a)    The measures being taken to improve patient access to GP services be noted.

b)    Information be shared with the Committee on how avenues for contacting healthcare providers are communicated to the public, and the Executive consider the role of Talk Community in promoting these avenues.