Decision details

The Chairman invited the following to the table:

Dr Debbie Frost – Chairman, Barnet CCG

Ms Kay Matthews – Director of Commissioning, Barnet CCG

Ms Lisa Robbins – Manager, Barnet Healthwatch

Ms Colette Wood – Director, Care Closer to Home

Dr Steve Shaw – CEO of Barnet Hospital, Royal Free London NHS Foundation Trust

A report from Barnet CCG on waiting times for GP appointments in Barnet and utilisation of extended access (8am-8pm) services was received. Dr Debbie Frost spoke to the report. She noted that various mechanisms were being used to cope with the increased demand on Primary Care. She explained that it was difficult to offer appointments to such high volumes of patients in the traditional way. The pressure was being relieved by input from skilled nurses, pharmacists and others. ‘Patient First’ was a triage system which ensured that every patient phoning in received a response the same day. Dr Frost added that Barnet was fortunate in terms of Primary Care, with good services in place and good access to patient records. The nine GP Hubs were open either 7.30am-6pm or 8am-8pm. Most of the GP practices also offered extended hours appointments and electronic prescribing was also helpful.

Barnet has 55 GP Practices and a GP-registered population of 424,000. There is good continuity of care and all Practices use the same IT system. The Hubs are currently being used to 80% capacity and feedback from patients is positive. However there is a 10% Did Not Attend (DNA) rate. The Committee discussed the possibility of implementing ways to improve the DNA rate and also to increase usage of the Hubs.

The Chairman noted that the British Medical Association had previously voted against charging for missed appointments. Cllr Don would forward a transcript of a NHS reminder text message she had received, which the Governance Officer would include in the minutes (see below):

We hope to see you at Royal Free Hospital, Clinic 1, on (insert date) at (insert time) for an outpatient appointment. Each missed appointment loses the NHS £160. If you are unable to attend, please reply ‘RE-BOOK 9909’ or ‘CANCEL 9909’ if appointment is no longer needed. Reply STOP to opt out.

The Committee agreed it would be worth using similar messages in Barnet to remind the public of the value of the service and cost to the NHS when appointments are missed.

A Member enquired about progress on the GP Workload Collection Tool. Ms Wood noted that this was being developed by NHS Digital and that data would be available soon. The CCG would bring details back to a future meeting. This would include details such as the total number of appointments offered and scheduled, times of these appointments, modes of appointments, healthcare professional types, number of appointments cancelled and demographic details. This would enable the CCG to support GP Practices to reduce unwarranted variation in waiting times. The Vice Chairman noted that Councillors received many complaints from residents about inaccessibility of GP appointments.

Action: Barnet CCG

A Member enquired about the Brent Cross South development and the likely increase in population and how this might impact on the Cricklewood Walk-In Centre. Ms Matthews noted that the Walk-In Centres had been set up prior to the GP Hubs. There was no plan to grow the Cricklewood Walk-In Centre as it was not anticipated that this would be needed, given the presence of GP Hubs. The CCG was currently working through its commissioning strategy for the Walk-In Centres.

Ms Wood added that Barnet CCG and the Council were jointly leading the CHINs programme and working with community partners to wrap community services around GP Practices, as well as harnessing the voluntary sector. In addition, services were being tailored according to the patient; for example some people were happier with online consultations whereas others preferred to see a GP in the traditional way. The CCG was committed to continuing to improve access to Primary Care.

A Member asked how Barnet compared to other CCGs in terms of GPs per capita. Ms Matthews noted that Barnet was the largest CCG in London and was lucky to have a good GP to patient ratio. The CQC ratings had all been positive, with only two Practices being given improvement plans, which was low for a London CCG.

A Member enquired whether patients who turned up at BH and RFH were asked to prove eligibility to use the services. Dr Shaw responded that there was a registration process and patients who were not entitled to use the NHS were sent invoices. The Chairman stated that a significant amount of money had been written off in the last year by the RFH, as many invoices had not been paid. 

Ms Robbins commented that a lot of patients reported being confused about the purpose of the Walk-In Centres and where they could access a routine GP appointment. Many thought that the Walk-In Centres were for urgent appointments, so it would be helpful to communicate with the public about this. The Chairman suggested including an article in Barnet First with details of the location of the nine Hubs. Other suggestions from the Committee were:  leaflet drops through every house, bus stop posters, GP notice boards, Finchley Memorial Hospital Walk-In Centre’s and Barnet Hospital A&E’s notice boards and Facebook. Ms Wakeling agreed to discuss further with Dr Djuretic and coordinate a plan.

Action: Ms Wakeling, Dr Djuretic

The Chairman asked Ms Matthews and Dr Frost also to consider where it might be appropriate to inform the public about the Hubs.

Action: Ms Matthews

Ms Robbins explained that one of the roles of Healthwatch was to help different groups, especially people new to the UK, to understand how the health system works. It was funded by the Department of Health (DH) but managed by the Local Authority. Ms Robbins also represented Healthwatch at the Health and Wellbeing Board (HWBB).

Ms Robbins reported that Healthwatch had found, through a piece of work with Middlesex University, that many young people did not understand the health system and some were therefore attending A&E unnecessarily. Healthwatch had put together a list of current services: Ms Robbins suggested using this as a starting point to inform people of GP Hubs. Ms Robbins would liaise with the CCG on this and also share it with Dr Shaw and Dr Djuretic.

Action: Ms Robbins

Ms Robbins noted that a useful way to disseminate this information was through community groups, refugee groups and schools/sixth form. 

A Member asked how the problems regarding GP recruitment could be alleviated. Dr Frost agreed that it was harder to recruit GPs than before and this was partly due to long hours and heavy workload as well as other factors. Systems such as electronic prescribing would alleviate the burden, as well as input from other Healthcare professionals. She added that Barnet attracted sufficient numbers of GPs at present.

RESOLVED that the Committee noted the written and verbal reports.