Agenda item

Report of the Divisional Director, Strategic Commissioning.

The Sub-Committee considered a report on the implementation of recommendations arising from a review of Access to Primary Care with a particular focus on those recommendations which involved the NHS Harrow CCG.   Javina Seghal, Chief Operating Officer of the CCG, addressed each of the relevant recommendations of the scrutiny review as follows: 

Recommendation 1:  In total, there had been 1,455 visits to the Harrow CCG website and Health Help Now app in May 2018 by 739 users. Of the 739 users, 385 users were new to the app and website.  Since its launch in  December 2016, the app and website had been used almost 36,000 times by nearly 22,000 users.  There had been 2,596 downloads of the Health Help Now app in that period. 70 users had come direct to the Harrow Health Help Now website and 106 had been referred by other websites.  Ms Seghal asked councillors to help increase awareness of the website and app in local communities. 

Recommendation 2:  A data sharing agreement had been put in place in April  2017 for all three walk-in centres. 

Recommendation 3:  not for the CCG.

Recommendation 4:  The reconfiguration of the first floor at Belmont Health Centre remained a priority scheme for the NHS.  There had been some delay due to the funding route changing from NHS England to NHS Property Services.  However, tenders had now been returned and adjudicated for the approved scheme, lease terms with the practices were being negotiated and, once these were agreed construction contract would be awarded.  The work to reconfigure the first floor of the Belmont centre, estimated to take 5 months, would bring all of the void space back into use, creating additional clinical capacity for each of the GP practices and the Walk-in Centre.

Recommendation 5:  There were a number of different engagement forums  organised by the CCG; these included monthly peer group meetings where GP practices convened on a geographical basis to discuss topics such as patient experience, access and quality of services.  There were also regular respective GP, Practice Manager and Practice Nurse forums which reinforced the collaborative environment.  These offered an effective medium through which practices were able to share best practice with a particular focus on improving the patient experience.

Recommendation 6:  All Harrow GP practice websites were being refreshed, and the new design of websites would not only contain a ‘Self-Help’ section, but also a signposting service for patients on conditions that they may have or services that they may require.  The new websites would link to the Harrow Help Now website and app download pages.  In addition, further designs were being explored, to be implemented within the Health Help Now app, to allow patients to self-refer to services.  The CCG would centrally manage the information displayed on GP screens in Harrow and regularly populate it with information about services such as GP extended access, as well as local events in the community and information about public health campaigns. 

The Health Help Now app had been widely promoted on the CCG's social media channel, website and through local engagement events.

A Member commended the CCG on progress in these areas; in particular, he considered that the work at the Belmont Centre would take the burden off other services. 

Another Member referred to some concerns among residents both about the signposting to the Belmont facility and the need for some cosmetic changes to the premises.  Ms Seghal agreed to take these up with NHS Property Services and then update the Sub-Committee.  Adam Macintosh, Programme Director, Integrated Urgent Care & Transformation at the CCG, added that the centre was well used with the highest proportion of Harrow residents of the three centres in the Borough.  He reported that the common IT platform used across these facilities allowed for availability capacity to be checked online; this would assist in directing patients to the quickest option for an appointment.

In response to a Member’s query about public transport access to the Alexandra Avenue Centre, Ms Seghal replied that the CCG would fully support the Council’s representations to TfL.  Another Member suggested Mr Anthony Wood, Chairman of the Harrow Public Transport Users Association, would also be a useful contact.

Dr Merali asked about the cost-benefit assessment of the walk-in centres in terms of the lowering of pressures on Accident and Emergency units and any financial savings.  Ms Seghal advised that this was a very complex assessment given the number of variables involved.  It was clear that the centres were helping to manage care outside the hospital environment, with an estimated 7% transfer of cases from A&E.  Dr Dilip Patel, Clinical Director, Mental Health at the CCG, underlined that the original objective of establishing the centres was about improved patient access rather than financial savings, because waiting lists for GP appointments were getting longer.  The data and patient experience was being assessed, and it was hoped that the centres could, in future, see patients by appointment.  In effect, they could develop into local “hubs” for primary care in addition to GP practices.

Ash Verma, Chair of Healthwatch Harrow (Enterprise Wellness Ltd.) confirmed that his organisation supported the hub concept and looked forward to research into how it could work to meet patients’ needs more effectively. 

Dr Merali asked whether the GP practices nearest the walk-in centres were being disadvantaged and also whether the location of those centres were a matter of pragmatic opportunism rather than planning.  Ms Seghal agreed that there may have been some element of practicality, for example, by linking to PFI bids.  Dr Patel reminded the Sub-Committee of the Darzai review and the introduction of the “polyclinics” concept.  This had not been particularly relevant to Harrow Borough which already had the Pinn and Alexandra Avenue centres; also the concept had its limitations in the sense that a very elderly patient should continue to have access to a GP close by rather than being expected to travel further to receive treatment.  Adam Macintosh added that the Pinn and Alexandra Avenue centres had developed more as part of an estate-based initiative, but in the case of Belmont, there had been relevant research and examination of the case for its location.  He reported that the Alexandra Avenue centre received more than 30,000 visits per year and that there was now an opportunity to direct patients more effectively to appropriate facilities, eg. through triaging patients from A&E into Urgent Treatment Centres and walk-in centres.

Dr Merali pointed to the impact on GP practices of the development of these new options for care.  He considered that this was promoting the trend towards mergers of practices such that he envisaged two large groupings providing primary care services in the Borough within a year or two.   Dr Patel referred to the fact that up to 70% of GPs were salaried NHS staff rather than practice partners and that there was no equity of resources across practices.  He agreed that groupings were emerging, one as a result of formal mergers and the other developing out of collaborative working between the other services.  There was already a formal federation of services in the Harrow Health CIC and there were a number of federations across the country delivering primary care services. 

Ms Seghal made it clear that the CCG did not propose mergers to GP practices and there were at present no formal proposals to restructure primary care; if any were forthcoming, there would be a number of steps before they could be implemented.  However, practices were perfectly entitled to consider and pursue mergers if they wished.  While contracts for walk-in centres were being extended, there was no certainty as to how they would develop in future, and she anticipated that it would take a year or so for plans to take shape.

In response to a Member’s question about the governance arrangements in the Federation, Ms Seghal explained that the CCG was solely a commissioning body, not a provider; it was therefore not part of the Harrow Health CIC which was owned by all 33 GP practices in the Borough with each having an equal share.  She confirmed that it had a board of management.  Dr Patel added that Harrow Health CIC had some 7 years experience of delivering services; he referred to the need for the federation to address the issues of patient access and capacity in the discussions on the future configuration of primary care services in the Borough. 

The Chair thanked the CCG representatives and Members for their contributions to this item.

RESOLVED:  That the report and the contributions from Members and the representatives of the NHS Harrow CCG be noted.