Venue: Ground Floor Meeting Room G02A - 160 Tooley Street, London SE1 2QH. View directions
Contact: Julie Timbrell, Project Manager (scrutiny)
To receive any apologies for absence.
Councillor Maria Linforth – Hall gave apologies.
Notification of any items of business which the chair deems urgent
In special circumstances, an item of business may be added to an agenda within five clear working days of the meeting.
There were none.
Disclosure of Interests and Dispensations
To approve as a correct record the Minutes of the meeting held on 11 July 2022.
There were none.
The Minutes of the meeting held on 11 July 2022 were agreed as an accurate record.
Access to Medical Appointments Review: Healthwatch
Shamsur Choudhury , Healthwatch Southwark Manager will present the enclosed ‘GP Access Project- A report on post-lockdown experiences of GP access in Southwark’ and subsequent follow up work.
The South East London NHS Southwark Borough Board minutes of the 3 March 2022 are also enclosed, when the Healthwatch report was discussed; see point 5, pages 4-6.
The chair explained that this item is part of the review into Access to Medical Appointments. This review has arisen because of Councillors concern at delays and problems that our constituents have experienced in accessing Emergency services and GPs surgeries, in particular, as was discussed in depth at the last meeting with the NHS and GP leads.
Healthwatch Southwark have been invited here this evening as they also identified patient problems with accessing GPs surgeries last year and undertook outreach work with patients to understand this further, and subsequently produced a report . The intention is to continue to work with Healthwatch on this area as they have unique powers to visit health settings, which are complementary to our health scrutiny powers, and both organisations have a joint mission to represent and advocate for Southwark residents to improve local health services.
Shamsur Choudhury , Healthwatch Southwark Manager then gave a presentation summarising the ‘GP Access Project- A report on post-lockdown experiences of GP access in Southwark’ and subsequent follow up work.
The chair then invited members to ask questions and the following points were made:
· The survey was sent out to Healthwatch responders – these are local people who have expressed an interest in engaging with Healthwatch to give the patient voice.
· Members asked about the range of survey participant ages, ethnicities, disability, etc.The Healthwatch manager said that information on equality and diversity of respondents is available at end of report. He highlighted the limitations of online access and explained that follow up work with focus groups to address gaps was not possible due to the pandemic and staff capacity.
· Healthwatch now have an ongoing an outreach programme and calendar, with events in libraries, women’s groups, hospitals and other community venues twice a week. A health ambassador programme also supplements this community engagement programme.
· There was a discussion on the use of frontline practitioners and satisfaction with telephone and online appointments . The Healthwatch Manager commented that Pharmacies can work as a good source of advice , and both telephone and online appointment can work well on occasions, whereas other times they are not so suitable . It was noted that sometimes the sex of the health-worker matters
· Members saluted the health ambassador programme and welcomed the potential for Healthwatch and the Commission to collaborate further on the review .
Access to Medical Appointments Review: NHS update
Follow up briefing arising from the last session on GP workforce and appointments covering :
· Updated Workforce data where available comparing Southwark to others
· GP appointment data, with comparisons
The chair introduced this item by explaining that this presentation is also part of the review into Access to Medical Appointments. She recapped that at the last meeting the Commission had a discussion with NHS Southwark Primary Care Network leads, and Martin Wilkinson, on improving access to GPs and frontline practitioners. At the end of that session the commission asked for some more information fromthe NHS on:
-Workforce data comparing Southwark to inner city peers, the wider South East London area and rural provision
- GP appointment data, with comparisons.
In order to address the above a briefing has been provided in advance and following NHS leads will present:
• Martin Wilkinson full time chief operating officer for Partnership Southwark, who will be leading the local team
• Dr Nancy Kuchemann, co-chair for Partnership Southwark
A presentation followed and then members were invited to ask questions. The following points were made:
· Different surgeries vary in their use of telephone, online and face to face appointments and there are variations in practice and patient satisfaction . The NHS leads said this is a new system which is difficult to evaluate as certain types of data are not captured. The national GP Patient survey was mooted to address this as would give some comparison information and subjective experience.
· NHS leads said that the early recruitment of social prescribing practitioners is working well and the they are making links with housing, employment and financial support, as these areas do negatively impact on people’s health and wellbeing . The fits in with the aim of better utilisation frontline practitioners. In other areas there are limitations in the ability to recruit , such as pharmacists.
· The number of people registered with a borough GP is different to the population as people can cross borders and to choose a GP.
· The differences in in recruitment of care coordinators, who assist with providing wrap around care for people with long term conditions. The NHS leads will get back with more on this .
· There are two GP hubs in Southwark serving the north and south : Tessa Jowell and Bermondsey Spa, who offer out of hours services . There is an expansion of use of these hubs for more appointments, booked via local GPs. The 111 service can also now do this . Expanding access to this for more routine appointment, not just urgent is learning from a recent review and use of 111 during the pandemic.
· GP retention rates and the population of Lambeth are very similar , and there are initiatives to retain and train done at a South East London level.
· There are no rules about numbers on the patient registers.
· NHS leads are small business and that can be destabilises by staff capacity issues; for example a good GP goes on long term leave . This can make the workload difficult and precipitate a downward spiral . The federations seek to support and offset these risks by ... view the full minutes text for item 6.
Partnership Southwark Review
A presentation introducing Partnership Southwark is enclosed. This was supplemented by slide shown on the night illustrating the Partnership Southwark structure.
A ‘Trigger Template’, used by the NHS and commissioners to communicate changes to scrutiny, is enclosed to inform the discussion on developing a protocol.
The chair introduced this item by explaining that Partnership Southwark and the Integrated Care System is a review topic this year. As well as the presentation introducing Partnership Southwark there is also a ‘Trigger Template’ enclosed with the papers. The ‘Trigger Template’ document used by scrutiny to gather information from the NHS and commissioners on changes to health services that might impact on the local population. This is enclosed to inform the discussion on developing a protocol – which is a proposed outcome for this topic.
Dr Nancy Kuchmann and Martin Wilkinson presented and then the chair invited questions from members and the following points were made:
· NHS leads confirmed that the aim of devising a protocol and revisiting the Trigger Template is to agree ways of working together. The NHS said that this would set out roles and clarity on communication with a draft being devised by officers, with input sought from members on approach and principles, and the commission agreeing the final version. Members supported this approach.
· A member asked about FGM, and referred to national research on safeguarding and asked about local initiatives, particularly as Southwark was identified as having the highest prevalence across the UK several years ago. Specific concerns were raised about responses when FGM survivors go for smear tests. The NHS leads said that the Safeguarding Executive take a lead on this as FGM is a cross cutting issue involving health, police and social care. They undertook to get back about, provide an update on current plans, and suggested that the annual Safeguarding interview may be a good point to add this to the work programme.
· A member spoke about the importance of voluntary sector and their vital role in keeping populations such as pensioners and older people active and well, and the importance of providing sufficient resources . NHS agreed and the leads were asked how Partnership Southwark support this. They responded that the voluntary sector is vital and they are a key part of Partnership Southwark. The focus tends to be on objectives where the partnership can make an impact.
· NHS leads were asked about the work streams and if ‘start well’ , ‘care well’ and ‘age well’ link up with housing. They confirmed that housing is involved and relevant officers will attend, with a view to addressing specific issues, and that this is one of the key purposes of the partnership.
· They were also asked if a project in Lambeth, where older people and a nursery were co-located, could be replicated and if there was a value to bringing different populations together. NHS leads said that this was the kind of initiative that would be supported through the Think Family approach, and types of co-location do take place currently in services such as Cambridge House. Partnership Southwark can further cultural change, as well as adding value to existing relationships, and tackling specific objectives that can best be delivered by a partnership.
There will be an update on FGM provided, with ... view the full minutes text for item 7.
A cover report, work programme, and review scopes are enclosed.
The work programme was discussed and the following points were made:
· The chair and project manager updated the Commission regarding a meeting held with Healthwatch prior to this evening on the potential to collaborate on the Access to Health Appointments review. At this meeting there was a discussion on consulting the public further using a survey, by door to door or other through other methods of outreach. Healthwatch also indicated a willingness to undertake some Enter and View visits to complement the review. The possibility of visiting GP surgeries and Hospital Accident and Emergency was discussed and this will be followed up.
· A member proposed requesting a report on uptake of Covid and Flu vaccination from different cohorts, given the winter will soon be upon us.
· The chair invited members to send in comments on the review scopes and work programme by email.
A briefing and presentation on flu and Covid vaccination take up will be requested for a subsequent meeting.
Further discussions will take place with Healthwatch on obtaining the patient voice, outreach and visiting providers.