Agenda item

An overview of the role of  SCCG and NHS England in commissioning, providing and promoting good access to local GPs with reference to the review on “Access to Health Services in Southwark”, and comment on the below questions:

• What service pressures are local GPs facing?

• How easy is it for patients to access GP surgeries?

• What are the waiting times for appointments?

• How easy is it for new patents to register with a GP surgery?

• What could be better done by the Health and Adult Social Care system to reduce service pressures and better direct people to the right services?

9.1  The chair welcomed the health commissioners to the meeting and Jill Webb Deputy Head of Primary Care (South London) NHS England and Tamsin Hooton, Director of Service Redesign, NHS Southwark Clinical Commissioning Group (CCG Primary and Community Care strategy) introduced themselves. They both did a short verbal presentation based on the papers circulated and the project manager promised to forward a slide presentation.

9.2  A member commented on the evidence that people are presenting later in the day and at A & E. He asked if doctors will be providing services later in the day to meet some of this need. Tamsin Hooton commented that the Call for Action may provide more of an indication that expectations are changing, however she cautioned that places with later access might not have patient records or offer continuity of care. Jill Webb agreed and noted that provision risks being too expensive and also risks duplication. 8am to 8pm opening will be considered in 2014.

9.3  Andrew Bland, Chief Officer, CCG, commented that the focus is on changes that will make the most difference to patients and the biggest issue is still acuity in A & E. Dr Amr Zeineldine, Chair of the CCG, added that the quality, appropriateness and value of the services are also important, and concerns about continuity and patient records particularly apply to walk-in centers. A & E offer excellent diagnostic services but GPs and community care are better placed to manage long term conditions effectively.

9.4  A member referred to constituency concerns and his own experience. He reported that he had to wait between 7-9 days or even 2 -3 weeks for an appointment. He said long waits mean that people use the walk - in centre and commented that he did not think patients should have to wait longer than 5 days. Members added that it is very difficult to get an appointment after 4pm or on Saturday, when there is the biggest demand. Jill Webb commented that some practices are offering extended hours - but this is a quite marginal, rather than uniform, offer. She added that Southwark is comparable for access to other inner city areas.

9.5  There was a discussion on advance -booking and immediate access. It was reported that the former targets that used to monitor 48 hour urgent access and two weeks for a scheduled appointment have been abolished. .Members commented that nowadays people want different types of access and there is more of an orientation towards walk-in. Dr Amr Zeineldine commented that some practices are better at moving resources to meet demand - but this is often a crude process as there are not many resources. He explained that there is an emphasis on managing immediate access for acuity. Jill Webb commented when the evidence for long waits is unpicked there are often other issues which make accessing a doctor harder,  for example some patients want to see a  preferred doctor within two weeks, rather than the doctor at the practice who is first available.

9.6   A member asked about future planning for surgery buildings and referred to the regeneration of Heygate. He asked if there is a process to get developers and planners to work together. Andrew Bland reported that there is a strategy to get more practices to work together and that the CCG do try to ensure good use of section 106 money. The member asked if there was a plan to make best use in the coming years of the regeneration opportunities and Andrew Bland responded that sometimes the approach has been rather piecemeal, partly because it has been difficult to make forward plans because of uncertainty around phasing. The member assured Andrew Bland that these problems have now been resolved and encouraged the development of a homogeneous plan. Jill Webb commented that given the price of renting property section 106 money is very important for GP practices and Andrew Bland concurred, and agreed to pick up on this.