Minutes:
Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners (HHCP), advised that HHCP was not really an organisation but was a place-based partnership comprising The Hillingdon Hospitals NHS Foundation Trust (THH), Central and North West London NHS Foundation Trust (CNWL), H4All, and the Hillingdon GP Confederation. HHCP worked with the local authority and North West London Integrated Care System (NWL ICS) to get all parts of the system working together and holding each other to account to improve population health and join up care in the Borough.
It was noted that HHCP and the Council had a Joint Health and Wellbeing Strategy with six priorities which included support for the mental health of children and young people. The delivery model included three big moving parts:
1. six integrated neighbourhoods – population health, proactive and anticipatory care and same day urgent primary care. These services aimed to move to local preventative interventions;
2. joined up Borough-based services – urgent same day unplanned community response. Currently, about 5,000 residents used 70% of Hillingdon's health and adult social care resource and this needed to be managed carefully; and
3. Hillingdon Hospital – hospital services.
In terms of performance, Mr Spencer advised that NWL measured place based metrics, comparing each of the constituent local authorities and benchmarking against England / London. To ensure that any action taken really made a difference, the Borough had focussed on three key strategic priorities:
1. developing Hillingdon 'place';
2. building 'Team Hillingdon'; and
3. delivering transformation programmes.
Dr Ritu Prasad, Co-Chair of the Hillingdon GP Confederation, advised that the national demand on GP appointments had increased by 35 million between 2019 and 2022 which had put massive pressure on the system, especially when trying to care for people with long term conditions. During the pandemic, systems had been rapidly digitised over a very short space of time and the choice for patients to have virtual consultations rather than face-to-face had been retained. Overall, there were more appointments available now than there had been before the pandemic. Although virtual appointments tended to be more convenient for individuals that worked, there were conditions that needed to be dealt with face-to-face and it often was better to see children in person.
The move to digital services had meant that data could be gathered to identify how many telephone / virtual (decreased from 39% to 30%) and face-to-face (increased from 61% to 70%) appointments had been booked and the number of patients that had not attended their appointment had reduced to around 9% in December 2022. It was thought likely that the percentage of virtual appointments would remain around 20-30%.
In between appointments, GPs undertook other tasks such as sorting out prescriptions, writing hospital letters, etc. It was anticipated that the move to digital services would help keep patients out of A&E but there were challenges with delays for elective surgery. In addition, GPs had continued to use the messaging services where appropriate.
With regard to GP appointments, Dr Prasad advised that PATCHS / eConsult (online consultation software) had been introduced for non-urgent appointments and GP Connect telephone system had been introduced across all practices. It was noted that the telephone calls to GP surgeries were incessant and each practice had a maximum capacity for dealing with these calls. Mr Spencer recognised that people with complex needs needed a continuity of care which was one of the drivers for simplifying access.
Members expressed concern that A&E had been facing huge demand which increased when patients were unable to get an appointment with their GP. Mr Spencer advised that around 30% of the patients in A&E had gone there as they felt they were unable to get a GP appointment and could get a complete treatment in hospital (with diagnostics, etc). It was anticipated that the new hubs, which would be able to provide diagnostics, would be up and running in the next few months to provide a proof of concept.
Concern was expressed that the GP surgeries in the Heathrow Villages had all closed and Members asked whether the new hubs would be located closer to this area. Dr Prasad advised that there had been a commissioning issue with regard to provision in the Heathrow Villages but that the hubs could potentially be located closer and help resolve the issue faced by residents. Mr Spencer advised that he had met with residents of Harmondsworth and Sipson and that investigations would be undertaken as part of neighbourhood working and he would be meeting with them again to see what action could be taken. It was noted that, as well as not having access to a GP practice or pharmacy, these residents were not even able to get prescriptions delivered. Mr Richard Ellis, Joint Lead Borough Director at North West London Integrated Care System (NWL ICS), advised that discussions were underway with Hounslow about cross-Borough working and the need for virtual GP consultations.
Dr Prasad advised that pharmacies were providing a lot more services than they had previously and advanced services were being investigated such as the provision of part time GPs. Since 2022, GPs were also able to refer patients to pharmacies for minor ailments. Lead pharmacies were attached to neighbourhoods on the Primary Care Networks (PCNs) which were able to do things such as blood pressure monitoring but the IT systems were not yet integrated.
Dr Prasad advised that GP recruitment continued to be a challenge that would take some time to address and that Hillingdon was considered to be a high risk area. There were a number trainees in Hillingdon and interventions had been put in place to try to retain them after their training whilst avoiding them getting burnt out. Capacity was being built into the system by removing reliance on GPs and shifting some responsibilities to paramedics, pharmacists, etc.
RESOLVED: That the discussion be noted.