Emma Prokopiuk gave the Committee an update on the primary care response to the COVID 19 pandemic to maintain and deliver key services and then provided details on the opportunities for April 2021 and beyond.
All practices in Derbyshire were open and seeing patients face to face. Following national guidance, GPs had adopted a ‘total triage’ system, treating patients over the phone or online where appropriate. Appointments had risen since the same time last year and access had improved. Some surgeries temporarily closed due to difficulties ensuring COVID security or the need to rationalise staffing but all were now open and advertising this on websites, in reception and on phone messages alongside CCG and Local Medical Committee (LMC) communications advising patients that their surgeries were open. The CCG had investigated all patient concerns raised about practices being closed, or refusing face to face appointments; none of these concerns had been upheld.
On the 25th February 2021, 5.7% absence levels were reported which was relatively low compared to other parts of the NHS and social care system and low compared to the height of the first wave (15-20%). None of the 112 Derbyshire practices were currently experiencing outbreaks. Practices had updated their business continuity plans to address this risk and the CCG was working with the GP Task Force to establish a clinical and non-clinical staff bank.
Primary Care Network Clinical Directors had worked with the CCG to establish a RAG rating system to assess pressure on General Practice. This asked practices to assess themselves as green, amber or red in terms of pressure on practice, balancing demand on services against capacity to deliver.
As of the week commencing 24th November General Practice was on ‘amber’ alert (the definition and consequences were detailed in the report).
General Practice had focussed on a number of areas to catch up and restore services and, overall, were on track to deliver all the national targets linked to recovery and restoration. Progress was being monitored in light of the increasing pressure on services from COVID and normal winter demands.
The pandemic had forced a transformation in the way practices and patients use IT to provide virtual, telephone and online service by issuing hundreds of laptops and working away from their surgeries using online consultation tools. Practices were rapidly moving back to face to face contact however there had been some benefits in remote working in terms of improved patient choice and experience, more rapid access and more efficient use of time. It was hoped to make those improvements permanent; the CCG was surveying practices for their views.
The CCG had also been working on consolidating and developing its local commissioning approach and had already delivered the first two phases. The next phase was urgent response in the community and would look at new services to improve care, focusing on those who need support the most, including the intention to establish a service for people who are ‘housebound’ and cannot get to their practice but need care quickly. This would link to the Directed Enhanced Service for Care Homes started in October 2020 and the national ‘Ageing Well’ programme of work which focused on improving care for older people both proactively and reactively.
Access to General Practice had improved however delivering good access for patients with finite capacity and increasing demand was a big challenge for General Practice. Triage people was one of the ways to improve this and to channel them to the right service or person.
There was also evidence that showed patients could be broadly differentiated into ‘hot’ patients who needed on the day and ‘cold’ patients who needed care for more complex long term conditions. This could be developed at a network level, where ‘hot hubs’ be established for on the day care and freeing practices to focus on patients with more complex problems with specialist ‘cold hubs’. Some places in Derbyshire were already doing a version of this.
Committee members asked questions predominantly around the security of patient data and around the ‘hot’ and ‘cold’ hubs.
RESOLVED – that the report be noted.