The Secretary
of the Cleveland Local Medical Committee (Dr. Rachel McMahon) will be in attendance
to provide information about health inequalities from a Primary Care
perspective.
Minutes:
The Chair welcomed
the Secretary of the Cleveland Local Medical Committee (LMC)
who provided Members with information relating to how GP Practices could contribute
to the Health Inequalities agenda.
Members were advised
the LMC was the statutory body representing GPs and
GP Practices. The LMC, by extension, also represented
Primary Care Networks (PCN) and worked closely with
Clinical Directors as part of the primary care collaborative.
One of the primary
aims of GPs was to provide cradle to grave care for all. GPs also provided services
that overlapped with Urgent Care services as well as undertaking roles to
monitor long term illnesses and administer the appropriate medication to manage
those conditions.
It was commented
that GPs strived to offer better services, and in some cases diversified their
service offer, such as Foundations Practice. However it was recognised there
were pressures on GP Practices that were not present in the past.
Members were made
aware that GPs were essentially individual businesses that received a relatively
small amount of the larger NHS budget which equated to £15.9 billion out of
£176.5 billion respectively. There were additional funding streams available including
weighted funding for age and gender as well as disease prevalence.
There were several
challenges facing GP Practices including a reduced number of staff with 1,139
fewer GPs than in the previous years as well a 24% increase in appointments
delivered versus 2019. These pressures often led to media stories which could
exacerbate the issue.
In light of such
longstanding issues Primary Care Networks (PCN) were
introduced to try and alleviate them. PCNs were a
group of practices working together although additional resource allocation was
limited. There were three main PCNs in Middlesbrough
with some crossing over with networks in Redcar and Cleveland.
One of the aims of PCNs was an increased focus on population health which included
engaging with seldom heard patients and increasing collaboration with community
providers. While PCNs were able to secure additional
staff and funding to assist with the Covid-19 vaccination programme, it was
recognised this affected the main objectives of the PCNs.
It was noted that any under spent budgets could be prioritised for deprived
areas.
One of the most
significant successes of PCNs was the alignment of
care home patients to one Practice, as previously this was quite nebulous.
Further positives
from the creation of PCNs was the ability for GPs to
contribute to complex medical reviews, cancer treatments and social
prescribing. It was commented that social determinants of health were more
likely to have an impact on health inequalities.
Members were also
made aware that 75% of Covid-19 vaccinations had been administered via the PCN model. Similar social trends relating to vaccination
take-up had been observed by GPs; namely that lower take-up rates tended to be
in more deprived areas.
With regards to
Health Inequalities; there was a new requirement for GPs to work with their communities
to try and reduce inequalities and this was planned for a 2021 implementation.
However, this was delayed by Covid-19. It was commented that current work
pressures were preventing work on this requirement.
However, there were
several factors known to GPs that contributed to health inequalities. For
example, 10% of service users consumed 40% of practice resource. This was
partly explained by the pressures of modern society and the ability for
patients to look up symptoms online. There was also a decline in community
support that was present previously.
It was commented
that screening services, such as heart checks and smear tests, tended to be
lower in more deprived communities and it was here that GPs could work to
engage more closely with their communities to try and understand those issues
better. It was recognised that initiatives that took care into the community
such as Heart Checks taken to places of work, had more success than centralised
services.
It was commented
that some members of the community preferred walk-in facilities rather than making
appointments, such as contraceptive access. Members were advised that this
service, especially fitting long term contraceptives, had recently been
reduced. With family planning clinics no longer offering repeat prescriptions
for the contraceptive pill it was commented the impact of this was still to be
understood.
While digitisation of
services was seen as a benefit, this did not create additional resource for Practices
to see patients. Digitisation also negatively impacted patients who did not
know how to use or afford the required technology.
There was also a
significant number of patients who did not qualify for free prescriptions but
who could not afford to pay for repeat prescriptions.
The CCG’s Director
of Commissioning, Strategy and Delivery (Primary & Community Care) advised
the Panel it would be helpful for the CCG to return to the Panel and provide an
overview of how the challenges and constraints identified were being addressed
by commissioners.
It was noted that
while the Covid-19 Pandemic had affected initiatives associated with health
inequalities a great deal of work was being undertaken by the CCG, PCNs and the Local Authority.
A Member commented
that current funding levels for GP Practices was insufficient to meet demand
and that more should be available as social inequalities would only exacerbate
health inequalities. The Member also queried what initiatives were in place to
recruit more staff to GP practices.
It was clarified
that while staff shortages were currently acute there had always been a
shortage of GPs locally.
A Member commented
that health inequalities was a complex topic and while financial investment
would help, social responsibly was also an important factor.
A Member queried if
a replacement sexual health service had been installed to replace a previously
closed one. The Member also raised
concern over recent plans to change prescription services to the over 60s.
A Member queried if
the improvements needed for local health services would be realised post
Covid-19. While it would require significant discussion and planning, several initiatives
had been proposed. For example, hospital speciality doctors working in GP hubs
which would enable health services to be taken to communities. However, this
would require investment in infrastructure such as premises.
A Member commented
on the current messaging used to demonstrate welfare rights and how Primary
Care could contribute to that agenda. It was confirmed that an update on this
would be brought back to a future meeting of the Panel.
A Member queried if
there was data was available to compare funding streams across health and local
government areas to make further understand the links between poverty and
health inequalities in different parts of the country. A discussion took place
regarding the national funding formula, and funding for Health and Social Care
more generally, and how increased funding could actively contribute to the
health inequalities agenda.
Members were advised
that a key challenge for the health sector was the corollary of an ageing
population and the increased prevalence of complex medical needs and manage
quality of life effectively.
The Chair thanked
the representatives from the LMC and the CCG for
their attendance.
ORDERED that:
1. The CCG attend a
future meeting of the Panel to discuss how the challenges identified were being
addressed from a commissioner’s perspective.
2. To understand if
a replacement sexual health service was installed to replace the previously
closed town centre service.
3. That the
information presented be noted.
Supporting documents: