Agenda item

To note the draft Southwark primary and community care strategy.

Andrew Bland introduced the item, noting the context of enormous national and local changes, including the national Call to Action and local learning from the joint strategic needs assessment (JSNA) and the need to address inequalities. He noted that Southwark appeared to be the first CCG to produce this kind of plan, which highlighted our potential to shape future developments.

Tamsin Hooton, Director of Service Redesign, outlined how the strategy was developed. She highlighted that the drivers for change included the increasing demand and financial pressures on primary care and the variability in outcomes and quality evident across local primary provision. She noted that the developments would also support the integration of services in line with local and national requirements. She outlined how the strategy was developed within a framework of local strategies including the JHWS, and involved consultation with all partners as well as a benchmarking review and JSNA analysis. Key messages from stakeholders included acceptance of the rationale for change but also the need for workforce development and locality support to facilitate change, alongside consideration of how resources including premises and renegotiation of the community contract would support this. Tamsin added that the benchmarking review reinforced that the wide variability between practices in patient outcomes was not explained by demographic variation. She noted that although the review found sufficient overall capacity, this was not reflected in the patient experience, with an imbalance across days of the week and practices. The review also found inequity in the distribution of extended services across Southwark and that outcomes and performance were significantly below national average, for example immunisations, health checks, management of long term conditions and mental health reviews. Tamsin concluded by outlining the actions flowing from the strategy’s priorities. These focus on developing services in localities, ensuring primary and community care services are at the core of a population health approach, working with other agencies to address health improvement and health inequalities, and developing community hubs, including integrated services. She asked the board to consider three questions:

-  How does this strategy support the aims of the Health and Wellbeing Strategy?

-  How can locality based services help us to deliver better outcomes for Southwark residents?

-  How do locality based primary and community care services support the further integration of services in the borough?

Romi Bowen, Strategic Director of Children’s and Adults’ Services noted that the strategy was helpful in setting out what needs to happen, and asked how the CCG would ensure a breakthrough with GPs, particularly in areas where there had been significant resistance such as ensuring capacity on Mondays or Fridays. Tamsin highlighted the development of tools to support GPs to better manage demand and output as well as the commissioning of pathways such as phone triage. She also pointed to the development of locality pilots in which seven-day provision is established across a cluster of practices, and ongoing work with GPs to combine better with A+E and walk-in centres. Jane Friar noted that the current financial and demand pressures on GPs provided an impetus to change as the system and many organisations are unsustainable. In response to a question from Councillor Peter John, Leader of the Council, Dr Amr Zeineldine said the LMC agreed with the impact of these pressures, adding that it recognised the need for workforce development. Andrew Bland added that the Southwark and London LMCs were supportive, including providing a letter of support. He stressed that the strategy’s key messages were addressing access, variation and inequity of provision, and that delivery at scale on a population basis was critical. He urged the board to use population-based delivery models to improve consistency and access. He added that if GPs do not collaborate across localities, commissioning choices would provide additional pressure to conform. Jane Fryer confirmed NHS England action to remove the very poorest quality practices, with three dispersed since April and action continuing against the very few now left.

Dr Ruth Wallis noted that the strategy fitted with the JHWS, with better access, treatment and outcomes key to both. She noted that place-based planning provided bigger opportunities, with work still to do on some cohorts, citing how young people and men do not like visiting GPs, as well as the borough’s transient and unregistered populations causing issues for all services. She confirmed that these issues are being addressed through the JSNA which will support work to define issues and identify solutions. In agreeing that there was close correlation between the JHWS and the CCG primary and community care strategy, Eleanor Kelly, Chief Executive of the council highlighted the need to integrate actions across both strategies, to prevent a twin-track approach developing.

Alvin Kinch added that Healthwatch was on the CCG steering group, and welcomed the importance of continued consultation. She noted that Healthwatch had a role in monitoring strategy implementation and that it would continue its workshop programmes, particularly with particular cohorts including Latin women, deaf patients and African forums. Councillor McDonald highlighted the need to ensure buy-in from GPs to deliver JHWS priorities, with slower than wished-for engagement in some key areas, for example health checks or holistic health assessment through Southwark and Lambeth Integrated Care (SLIC). Tamsin reiterated the CCG intention that locality commissioning and the bundling of specifications would address these performance and service issues. Cllr McDonald also asked how we would support those residents who currently have poor quality provision while the strategy is implemented. Dr Amr Zeineldine and Andrew Bland reiterated that a population based approach to reducing variation was the strongest response. Andrew also noted that the model was being implemented in Dulwich first and that the CCG would continue to look for opportunities elsewhere in the borough to develop community hubs.

RESOLVED:

That the content of the draft Primary and Community Strategy, attached as appendix 1 of the report, be noted.