Agenda item

Lynne Selman, Director of Citizen Engagement and Communications, Eastern and Coastal Primary Care Trust, and Julia Ross, Director of Civic Engagement and Bill Millar, Assistant Director of Primary Care, West Kent Primary Care Trust, will be in attendance for this item.

(Item 6 – Report by Research Officer, Health Overview and Scrutiny Committee)

(Lynne Selman, Director of Citizen Engagement and Communications, Eastern and Coastal Primary Care Trust; Julia Ross, Director of Primary Care, and Bill Millar, Assistant Director of Primary Care West Kent Primary Care Trust were in attendance for this item.  They were accompanied by Paul O’Brien and Michelle Ford, Dr R Hart, Maidstone Division of the British Medical Association, Dr Jenny Gill and David Barr, (Secretary) and Dr A Doyle, representatives of the Kent Local Medical Committee)

(1)       Dr Robinson said that as a believer in the NHS which was free at the point of delivery, he was concerned at the prospect of private companies entering into health care.  He added that there was widespread confusion over whether there was a difference between GP-led Health Centres and polyclinics.  He asked whether there was any truth to the suggestion that GPs would lose their jobs as a result of the implementation of this initiative.  He had recently attended an open meeting in Sittingbourne and discovered that there were several single-handed GP practices on the Isle of Sheppey, that no less than 6 GPs in the area were shortly due to retire, whilst 26% of the local population were not registered.  The establishment of a GP-led Health Centre in the Swale District would be an excellent idea.

(2)       Lynne Selman and Julia Ross said that the purpose of setting up GP-led Health Centres was to target under-doctored areas and provide equitable access to primary medical services. It would involve investment in bolt-on services. Surgeries would be open from 8 am to 8 pm seven days per week and would be able to treat unregistered patients.  There would be one such Centre per PCT, requiring an additional 600 new GP posts in the UK (3 or 4 per PCT).  As a result, there would be no redundancies resulting from this initiative.

(3)       Ms Harrison welcomed the initiative, saying that the population of the Isle of Sheppey tended to double during the summer months as a result of tourism.  There was a considerable number of single-GP practices on Sheppey which were open at times which did not necessarily suit all concerned. 

(4)       Lynne Selman said that the location of the Centre on the Isle of Sheppey was still being considered.  A number of consultation meetings had been arranged with the aim of gathering the views of as many members of the public as possible. Members of the Committee were most welcome to attend.  She noted Ms Harrison’s view that all HOSC Members should automatically receive invitations.

(5)       Dr Gill said that as a Swale GP she was well aware of the problems faced in the District.  This initiative represented a new model of a general practice with additional services included.  It was nevertheless very important to ensure the maintenance of continuity of care which was valued by older patients in particular.  The question was whether the current holistic, generalist approach to primary care would be jeopardised by the new centres.  The creation of 2 or 3 new GP posts in Swale would not address the problems of the District where there was a shortage of up to 20 GPs.

(6)       Mr Millar said that the service in West Kent was being developed within the community by expanding the service offered to a significantly increasing population.  They were looking to build on the current pattern of general practices locally and identifying the needs of continuity.

(7)       Dr Hart said that the BMA had identified a threat to doctor – patient relationships.  GPs got to know the families they treated very well and became responsible for their welfare.  This was a priceless asset.  There was also a threat arising out of privatisation.  It was quite possible that private companies could run a chain of polyclinics and seek to make profits, thereby taking away money that should be spent on improving healthcare.

(8)       Mr Barr, the Clerk of the Gravesend Medical Committee said that Gravesend had a walk-in centre, an A & E and a co-operative of GPs. The addition of another centre could result in confusion and problems of providing continuity of care.   To this day, there was no electronic communication system to enable the transfer of records.   In West Kent, 75% of medical practices already offered extended hours.  One of the consequences of this was that when blood tests were taken at 8 pm, the samples were not collected until the next morning.  Gravesend wanted to extend the model of general practice to provide long term continuity. This had not proved possible as the PCT had not been able to provide the necessary finance.   Now it was funding an untested initiative.  A further problem lay in the fact that the Government set the bidding rules. As a result, it was possible that private companies could be successful, putting long term care in jeopardy.

(9)       Mr O’Brien from the West Kent Primary Care Trust said that local practices had been successful in the notional bidding process.  In GP-led Health Centres, local Members would be part of the Evaluation Panels, whilst the focus of Scrutiny would be on quality rather than price.  The PCT Board had approved a three year investment programme of improvements for 31 practices.  This would be complemented by the extended hours brought in by the Centres.  This was an opportunity to address the health needs of the community through additional investment. The major issue was accommodation. It was possible that temporary accommodation would need to be used to provide an interim solution.

(10)     Mrs Tweed noted that funding of £790,000 was being made available per Health Centre.  She asked whether there was a danger of a private company setting up a walk-in clinic and then withdrawing from the project.  Were there sufficient GPs available to put the plan into practice and was it really possible for the new GP-led practices to come on line by March 2009?

(11)     Mr O’Brien replied that a detailed analysis had been undertaken which had led the West Kent PCT to the conclusion that resources would reflect the cost.  Companies who put in bids would be subjected to a vigorous validation process.   It was never easy for the Health Service to match the requirements of the Service to the needs of the population. It involved identifying local needs and gaps in order to improve access and outcomes and reduce health inequalities.  A key factor in this process was local integration.  An example of this was outside hours local diagnostic testing.  As a result of technological advances, it was now possible to make this available on site.

(12)     Mr Chell said that funding for GPs was based on population density at a rate of 10 Doctors per 1000 patients. The danger of providing GP-led Health Centres was that if they resulted in the optimum rate being exceeded, the local community would become “over-doctored” thereby jeopardising local surgeries.  Lynne Selman replied that the locations for the Centres were chosen in those areas where there was a demonstrable lack of GPs.

(13)     RESOLVED that the report be noted.