Agenda item

The Chairman introduced the report which had arisen as a result of a Member’s Item raised by Councillor Barry Rawlings at the meeting of the Committee on 6 July 2015.  The report provided an outline on the management of GP Provision in the London Borough of Barnet within the context of:

·         The number of GPs expected to retire

·         Regeneration programmes

·         The management of future seven day GP services. 

The Chairman invited Ms. Jill Webb, the Head of Primary Care Commissioning at NHSE, Ms.Su Nayee, Senior Contracts Manage at NHS England, and Dr. Debbie Frost, Chair of Barnet CCG to the table.

Ms. Webb informed the Committee that London was considered over target by 2.29% based on recurrent revenue budgets, which meant that the current budget was considered too high compared to the size of our population. It was noted that this had led to only a 1.8% recurring increase in Primary Care allocations in 15/16 against a national average recurrent increase of 2.3%. Taking into account the Inflation uplift of 1.1% 15/16 and London’s increase in population of 1.3% as a result of regeneration programmes, London had a cost pressure.

Ms. Webb also informed the Committee of the need for more key/priority worker schemes.  There was now more focus on skill mix for general practice, with the development of the role of physician assistant and pharmacist in general practice.

The Committee noted that there was a Government policy to create 5000 new GPs by 2020 and that GP training places within London were always fully subscribed.  Ms. Webb advised the Committee that whilst GPs often want to work in London because of partnerships, it wasn’t always feasible.  Ms. Webb also informed the Committee of the need for more key worker schemes and an increased focus on working.

The Committee noted that Barnet has one of the highest numbers of Practices in London and that smaller Practices are well scattered in meeting the needs of the population.  Ms. Webb advised that it was difficult to provide information on future retirements because there is no retirement age, and that there was no bar to when a GP must stop working, as long as they are competent.  The Committee noted that 3% of GPs in Barnet are locums, which is comparatively low to the national average.

The Committee noted that in 2014, the Office for National Statistics had estimated the population size of Barnet to be 367,265 whereas the current registered list size is around 400,000.

Ms. Webb informed the Committee that the Clinical Workforce within Barnet was 0.72 nurses per 1000, which is below national clinical the ratio which is 0.84 per 1000. 

The Committee noted the following in relation to Patients Access to GPs:

·         Only 13% (8) of Practices across Barnet are open 100% of Core Hours (8am to 6.30pm)

·         48% (30) are open between 80-100% of core hours

·         8 / 30 Practices are delivering 80% (+/- 2%) of core hours per week. They are closed for 10.5 hours per week (equates to 2 hours closure per day)

·         4 Practices are delivering less than 60% of core hours. They are closed for more than 21 hours per week (equates to 4 hours closure per day)

The Committee noted that Barnet is lower than average for patient satisfaction but also noted that London always performs lower than the national average.

The Committee noted that NHSE had recently launched the “Friends and Family Test” which asked patients if they would be likely to recommend a service to family and friends.  The Committee were informed that the latest survey position as of July is based on 41 practices submissions and that 88.39% of patients would recommend their practice. 

Ms. Webb advised the Committee that it had been calculated that there would need to be a growth approximately an extra  15 full time GP equivalents over next 7 years in order to meet demand and that the population demographics is reflected in practices budgets.

Ms. Webb commented on the priorities to address capacity and access in the development area of Central Colindale and that NHSE wanted to work with existing practices.  The Committee noted that because of the population increase in Barnet, there would be a need for a new practice.  Ms. Webb also informed the Committee of the following:

Primary Medical Services Contract Review 2015/16: that “Premium Services” and renegotiated Key Performance Indicators (KPIs) would aim to deliver improvements in clinical services, access and clinical capacity through increased appointments to meet patient need and access.

Primary Care Infrastructure fund (PCIF): That nationally, 721 practices’ PCIF applications had been approved in principle.

Primary Care Co- Commissioning: That from 1 October 2015, NHS England and North Central London CCGs would be “co-commissioning” GP services.

The Vice Chairman referred to a statistic in the report which said that there are 284 GP Performers across Barnet of which 3 % (8) are locums and 17% (48) are more than 60 years and questioned how many people were performing those roles full or part time.  Ms. Webb advised the Committee that the figure of 284 was an equivalent number.

The Vice Chairman thanked NHS England for the report, and notedthat it has responded very well to the request made by the Committee.

A Member commented that she was pleased that NHSE were looking at capacity for the regeneration areas of the Borough and noted that the Joint Strategic Needs Assessment has anticipated an increase in need expected for the Mill Hill Ward.

A Member commented on the statistic outlined in the report of FT per head 0.56 for GPs (excluding Registrars and Retainers) per 1,000 Patients, and questioned if the primary concern should be that there were a large number of single-person GP Practises within the Borough, which was not in line with modern requirements.  The Member commented on the need to change the culture so that GP Practices because more open to combining.  The Member noted that when Practices combined, it might be across different Ward boundaries, but this is something that Practices would need to get used to.  Ms. Webb commented that she would be able to provide Members with a map showing the catchment area of GP practices.  Responding to the point made by the Member, Ms. Webb noted that the analysis was helpful, but there was also a need to layer with the needs of the elderly population as well as the younger population in order the make an attractive offer for General Practices. 

Ms. Webb advised the Committee that they wished to have an item on the agenda for a forthcoming meeting of the Committee on primary care in Colindale.  The Chairman advised that the Committee would be happy to receive this item. 

A Member questioned if there were currently enough GPs in the country to allow for GPs to be open seven days a week.  Ms. Webb advised that she didn’t believe that there were currently enough GPs in the country to allow every GP practice to be open.  The Member commented that he had further questions for NHSE on this, and noted that he would send further questions for response through the Governance Officer servicing the Committee.

RESOLVED that the Committee note the update from NHS England and ask appropriate questions.