Agenda item - GP Sustainability: December HOSC Update

Report from Brighton & Hove CCG on plans to improve the sustainability of city GP services (copy attached)

31.1    This item was introduced by Dr David Supple, Chair of Brighton & Hove CCG. Dr Supple outlined the state of local GP services, noting that there were issues with workforce, estates, the partnership model, and patient-mix in terms of the increasing prevalence of Long Term Conditions (LTC).

31.2    However, it is not the case that all city GP practices are struggling. At a rough estimate, approximately 10 practices are reasonably comfortable/stable, another 10 are struggling, and the remainder are somewhere in the middle.

31.3    The CCG is working hard to support struggling practices, with a variety if interventions. In general, problems concern working conditions rather than practice income.

31.4    Dr Supple explained the graph on GP/patient ratios which were included in the papers, noting that there is some uncertainty about the figures as not all practices necessarily report this date and there is ambiguity about how the figure of whole time equivalent (wte) workers is calculated. Also, the graph does not take into account clinician skills-mix: a practice that has a relatively high GP/patient ratio may also have practice nurses, pharmacists etc. delivering high quality and timely services to patients. However, notwithstanding this, the figures are a clear cause for concern. Brighton & Hove Caring Together (Cato) will seek to address this problem, creating a more attractive environment for primary care, for example by instituting an emergency/LTC split which could see specific GPs providing continuity of care by working consistently with patients with LTCs whilst urgent calls are diverted to a more generic GP service.

31.5    The CCG is also beginning to amass better quality data about GPs – for example, around likely GP retirement dates. In addition, a local federation of GPs is being formed and this will be able to provide support to prospective GPs. For instance, the federation may be able to hold the leases to GP practices, reducing the risk to partners and allowing more GPs to opt for salaried employment. A federation may also be able to directly employ and support some staff (e.g. practice nurses) to work across several practices. It can be difficult for small practices to recruit to these roles since workers tend to prefer larger practices because they provide more opportunities for career progress. A federation could potentially also be in a position to step in and take over a practice in an emergency.

31.6    Cllr Greenbaum welcomed the report, but expressed concerns about CCG capacity to manage GP services, particularly in light of the CCG alliance plans. Dr Supple responded that the alliance should not result in there being fewer staff to commission services, but that the CCG is aware of this risk.

31.7    Fran McCabe also welcomed the paper, but wondered whether there was an issue of patient expectations exceeding the capacity of services. Dr Supple replied that patient expectations need to be taken seriously. For instance, if there is a genuine desire for extended opening times then this needs to be picked up.

31.8    RESOLVED – that the report be noted.