Agenda item

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.

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.