Meeting documents

To receive this report. 

The Committee received a report from the Director of Clinical and Collaborative Commissioning which outlined the commissioning process of the improved access service for the population of Somerset.

In October 2016 it was announced that Somerset CCG was identified as a transformation area for improved access to GP services. In January 2017 Somerset CCG Governing Body approved a proposed commissioning, financial and service framework for the delivery of Improved Access to the Somerset population.

The foundation of the Somerset CCG improved access service is based on four primary objectives that are coherent with the Somerset Primary Care Plan and supported by key enablers;

•      Commission a sustainable and effective model of care that enhances the availability of primary medical services across the county whilst maintaining high quality services, increasing patient satisfaction, managing demand and reducing duplication

•      To deliver joined up, collaborative and responsive out of hospital care for patients across 7 days, meeting population needs and reducing unnecessary demand through the use of patient education and awareness

•      Increase the capacity of primary medical services through the delivery of at scale services, sharing of resources and utilisation of IT innovations

•      Deliver an integrated and responsive primary medical service that is clinically led and supported by a multi-disciplinary team, providing care to population groups in collaboration with multiple provider organisations

It is the ambition of the CCG to deliver the national requirements from April 2017, with the model for delivery being developed over the course of the contractual period. The intention is to learn from potentially different delivery models across Somerset and allow for the collaboration and integration between providers to take place.

A phased model has been developed to allow movement towards an integrated same day service across seven days, joining up service provision to deliver better care for patients and enhance the sustainability of services. Some federations were already considering or moving towards different ways of managing demand for primary care services. Having a phased approach prevents the CCG from unintentionally restricting any local innovations.

The following points were raised during discussion:

·        I am cynical about this being achieved.  In wellington, I can’t see a GOP for any reason because they use a phone triage system and the surgery doesn’t have any evening or weekend opening.  I don’t think this service is deliverable.

-        I understand the frustration and anxiety if patients can’t access their GP.  There is quite a wide variation in the spectrum of practices and what they can deliver.  Workforce challenges are also an issue and we need a skill-mix model.

·        There seems to be a wide range of accessibility.  Best practise will need to be recognised and rolled out across the county.

-        We would definitely want to learn and roll out best practise but we also want to be better integrated and this is part of what the STP is developing. 

·        There are issues around communication too.  Patients need to know what services are available.

·        There has been a move to nurse practitioner practices in other areas of the county.  This seems to be a logical model. 

-        There is a practice in Exeter that runs this way.  There is a challenge with the nursing workforce too - they have the same age profiles. We need to increase the number of nurses and the level of training.  I think that nursing is an important part of the system and this will increase in future. 

·        Is the extended hours voluntary for GP practices?

-        It is a government manifesto commitment but it is not negotiated in the national GP contract.  Instead CCG’s have been given this mandate.  Surgeries could opt-out but it would be difficult as they cannot access the extra funding without committing to extended hours.

·        I think we should introduce ratings for GP surgeries, in a similar way to restaurants.

-        The Care Quality Commission inspects all health care providers and rates them.  Patients can see this on the NHS choices website. 

·        Did the CCG apply to be a transformation area?

-        It was an opportunity that was given to us rather than applied for. 

·        It seems to have brought a number of surgeries to the brink of collapse.

-        Some are significantly challenged but it is also an opportunity for practices to work together and share resources.  So collaboration may help with some of the issues that surgeries are facing. 

·        Are there opportunities to encourage career changes and returners to health services?

-        Yes we are pursuing all of these avenues with some rigour. 

The Committee noted the report and requested an update early in the new quadrennium.