Agenda item

To review and discuss with representatives of Bracknell Forest General Practitioners and NHS England (the commissioners of most General Practitioner (GP) services): the latest GP Patient survey results; the Care Quality Commission’s ‘Intelligent Monitoring’ ratings for Bracknell Forest GP practices; and national concerns regarding the capacity of GP Practices and the ease of obtaining GP appointments.

The Chairman welcomed, Sarah Bellars, Nursing Director Berkshire East Clinical Commissioning Group, Dr William Tong, Bracknell and Ascot Clinical Commissioning Group and Binfield GP Practice, Dr Martin Kittell, Bracknell and Ascot Clinical Commissioning Group and Forest End GP Practice and Helen Clanchy, Director of Commissioning NHS England, to the meeting to speak about the primary care service provided in Bracknell Forest.

Care Quality Commission Inspection of GP Surgeries

It was reported that to date 10 GP practices in the Borough had been subject to an inspection by the Care Quality Commission (CQC).  Four practices had received a grading of Good, four had been graded as Requiring Improvement.  The outcomes of two inspections were still awaited.

Analysis of the inspection reports had found that GP surgeries were failing inspections in the following areas:

·         Record storage

·         Staffing requirements e.g. Had DBS checks and references been obtained

·         Monitoring of infection control standards

·         Quality of service

·         Supporting staff e.g. One to ones and appraisals

·         Medicine dispensing had been raised as an issue in one surgery

It was stressed that further investigation had found that surgeries were complying with standards however evidence trails and records were not always being properly maintained and this had impacted on inspection outcomes.  The Berkshire East Clinical Commissioning Group was working with practices to resolve the issues that had been identified by the inspections.  All those practices which had been classified as requiring improvement had developed action plans and were working to deliver identified actions.

It was reported that the action plans and associated evidence would be submitted to the CQC for examination.  It was hoped that the CQC would be able to carry out a desktop review or inspection visit within the next six months.  The Clinical Commissioning Group was confident that all the surgeries would on re-examination be regarded as being good.

GP Satisfaction Surveys

The Panel considered the outcomes of the recent NHS GP Patient Survey and the CQC Intelligent Monitoring ratings of GP practices in the Borough. 

It was stressed that caution must be exercised when using the GP Patient Survey to make inferences about the quality of GP service provision due to the small sample sizes used and the fact that the survey did not take the socio-economic profile of patients or clinical outcomes into account.

Dr Kittell expressed disappointment with the outcomes of both the CQC inspection and the GP Patient Survey satisfaction ratings that Forest Park GP Surgery had received.  The Panel was informed that the practice’s designated area covered a high proportion of young people and a high proportion of patients with mental health problems both factors which impacted on satisfaction levels. 

Initial plans to expand the building occupied by Forest End Surgery had fallen through however the available space had been re-organised and the surgery now had access to an additional consulting room.  The surgery had also been approved to become a GP Training Practice and two trainee GPs had now been employed.  It was stressed that surgeries had to pass stringent assessments before they were allowed to become GP Training Surgeries and a recent report from the training providers, which looked at similar areas to the NHS Patient Survey, had been very positive.

Work had also taken place to better manage demand so that patients were able to see a doctor more promptly if necessary.

Expansion of Primary Care

Helen Clanchy gave the Panel an overview of the way that expansion of primary care provision was managed and commissioned by the NHS in England.  

It was acknowledged that recruitment of doctors into primary care settings was a national problem and whilst the Thames Valley was not currently experiencing a significant recruitment problem the age profile of the Thames Valley’s GP population was a concern.  Work was taking place within the NHS to raise the profile of GP practice as an option amongst student doctors and to increase the flexibility of doctors’ careers to make it a more attractive option.

When planning the future provision of primary care services, including any decision over whether to expand existing practices or build a new surgery, a range of factors was examined including whether any planned development in an area was a larger development in a single area or if it was smaller numbers across a wide area

The provision of new GP surgeries was complex and required the involvement of multiple parties.  Whilst NHS England ran the procurement exercises required to physically build premises, the funding for building was obtained through the Section 106/Community Infrastructure Levy process and the Clinical Commissioning Group took responsibility for commissioning the service that would run the surgery.  The NHS also had to work closely with Local Planning Authorities to not only ensure that sufficient appropriate provision for primary care facilities was made in planning policy documents but also that any planning applications submitted had the best chance possible of being approved.

The Panel was informed that clarification would be sought over plans for the development of a health centre in Jennetts Park however it was stressed that Jennetts Park did not currently feature on the NHS Commissioners plans.  If the NHS was to prioritise health facilities in Jennetts Park then this would be at the expense of expansion in another area.

Arising from the Panel’s subsequent questions and comments the following points were noted:

• Greater use could be made of pharmacies to relieve pressure on GP surgeries
• There were anecdotal reports of GPs and pharmacies refusing to accept for disposal full sharps boxes that had been issued by hospitals.  A situation that might encourage the inappropriate disposal of used needles.  It was acknowledged that hospitals and primary care providers had separate contracts for waste disposal however this should not matter when it came to the disposal of used sharps and surgeries ought to accept full boxes issued by other agencies.  It was agreed that the matter would be followed up with surgeries
• The maternity tariff was complex due to the way that the service was split between hospitals and the community.  GPs only received funding for the elements of the maternity service that were included in the GP Core Contract.  There was no funding available from the Quality and Outcomes Framework
• It was agreed that a suggestion to label medicines with their cost as a method of raising people’s awareness and to reduce wastage would be explored by the Bracknell and Ascot Clinical Commissioning Group
• It was acknowledged that whilst there was space at the Urgent Care Centre to provide preventative services it was not necessarily the most appropriate location for these services
• A programme was underway to recruit 200 volunteer Health Makers who would learn about a range of chronic illnesses and then pass this knowledge on to others.  This work would initially focus on diabetes, muscular-skeletal problems and chronic lung diseases
• The Panel requested that its frustration over the provision of GP capacity to meet the demands of an expanding population in Bracknell Forest be conveyed to NHS England.  Members would return to this topic at a future meeting

The Panel thanked their guests for their time.