Agenda item

Stephen Ingram (Head of Primary Care, Kent & Medway Area Team, NHS England), Dr Mike Parks (Medical Secretary, Kent LMC) and Dr John Allingham (Medical Secretary, Kent LMC) were in attendance for this item.

(1)       The meeting reconvened at 13.30. The Chairman welcomed the guests to the Committee. Members of the Committee then proceeded to ask a number of questions and made a number of comments.

(2)       A Member enquired about the challenges of general practice. Mr Ingram explained that the role of the GP had changed with multi factorial challenges which included running a business; maintaining professional accreditation; complying with regulations; involvement with CCGs in addition to providing services to patients.

(3)       A question was asked about succession planning. Mr Ingram stated it was extremely difficult to replace GPs on a like-for-like basis. Health Education England had set a target for 50% of all medical students to become GPs but this was not producing GPs as quickly as they were required. Dr Parks stated that the Kent LMC was actively discussing the fragility of the service and the importance of succession planning with practices.

(4)       Mr Ingram and Dr Parks stressed the importance of the wider primary care team in managing GP workload. The use of nurse practitioners to deliver care for long term conditions; accreditation for community pharmacists and nurse practitioners to independently prescribe; and the introduction of physician associates, science graduates who complete two years of intense training, to support GPs in the diagnosis and management of patients were discussed.

(5)       Dr Parks explained that Health Education Kent, Surrey and Sussex had identified recruitment to primary care as a key issue for the Deanery in particular the shortage of nurses in primary care. Dr Parks acknowledged that nurses in training had little experience of primary care. The Deanery was establishing community networks to provide mentoring and training for nurses in order to make it easier for them to move from acute to community roles.

(6)       A number of comments were made about holistic care and GPs directly employed by the NHS. Dr Parks explained that GPs were generalists and closest to providing holistic care. He stated that the average consultation time had increased to 12 minutes. The Royal College of General Practitioners was campaigning for 15 – 20 minutes consultations as patients were attending with multiple problems. As part of a holistic approach, multiple problems could be assessed over a number of consultations with the most important being dealt with first. Mr Ingram stated than in his experience GPs directly employed by the NHS had not worked well.

(7)       In response to a specific question about sustainability, Mr Ingram explained that the current model of general practice was not sustainable. Proposals for a new model of general practice included the introduction of place based services whereby an integrated team including GPs could provide health and social care for their local populations. He stated that CCGs were developing community hubs, based around a clustering of GP practices and a local population, which could provide a wide range of services. He explained that there was a move away from single-handed GPs holding contracts as the challenges were more significant than those in a partnership or a company. Mr Ingram expressed concerns about the overinvestment in buildings rather than services. In Kent there were 260 practices which operated out of 400 buildings. The Local Area Team had concerns about the state and condition of 30 – 50 buildings in Kent and Medway.

(8)       A question was asked about the attractiveness of being a GP. Dr Parks explained that General Practice was no longer attractive to medical students. A number of reasons were highlighted including long working hours, rising patient expectations, workforce pressures, partnership working, funding and increased regulation. This was leading to stress and burnout of experienced GPs. Dr Allingham added that with the feminisation of the workforce, many female GPs wanted to be salaried and work child friendly hours rather than take on the responsibility of a partnership. The average age for GPs to leave the profession was 35 – 39 for women and 55 – 59 for men, it was explained that many female GPs did not return to work after having children. Dr Allingham stated that he had recently met with 30 – 40 trainee GPs in Kent; only one trainee GP wanted to become a partner, 7 – 8 trainee GPs were leaving general practice and the remainder were going to practice abroad, become a salaried or locum GP.  He stressed the importance of highlighting the interesting nature of the job to medical students such as unexpected and challenging problems brought by patients and new developments such as the Prime Minister’s Challenge Fund.

(9)       In response to a specific question about the difficulties faced by GPs returning to practice after a period of absence, it was explained that GPs had to undertake a refresher examination and scheme in which they worked full time in a training practice under the supervision of a trainer. GPs had to pay for the examination and often had to pay the training practice for supervision. Once a GP had completed the scheme, the trainer can write to NHS England Local Area Team to say the GP can rejoin the local performers’ list. A Member requested examples of difficulties faced by GPs returning to practice. Representatives from the Kent LMC stated that they would be able to provide this.

(10)     Mr Inett informed the Committee about a project, being undertaken by Healthwatch Kent, to look at patients’ experiences of primary care in Kent. He explained that the CCGs had been approached and enquired if NHS England could input into the project. Mr Ingram stated that he would be happy to discuss the project with Healthwatch Kent.

(11)     The Chairman asked the Committee for expressions of interest to join a working group, led by Mr Angell, to meet with Professor Tavabie (Interim Dean Director, Health Education Kent, Surrey & Sussex). Dr Eddy and Mr Chard indicated their interest. It was suggested that Mr Ingram, Dr Allingham and Dr Parks be given the option to attend.

(12)     A Member thanked Mr Ingram for the paper which gave a national overview of general practice. The Member requested a Kent focused paper when the item returned to the Committee in six months. Mr Ingram stated that he would be happy to provide more detailed information on Kent which could be broken down by CCG area. He suggested that the Committee could look at one or two CCGs in detail and ask CCG representatives to also attend in six months.

(13)     Mr Ingram gave an example of a unique feature of Kent; the county had the highest percentage of nationally negotiated General Medical Services (GMS) contracts in the UK. It was explained that the Local Area Team had little power over this type of contract. NHS England’s preference for new contracts was Alternative Provider of Medical Services (APMS) contract as it was the only contract which met the requirements of procurement law. Kent LMC representatives stated their preference for nationally negotiated GMS contracts.

(14)     RESOLVED that the report be noted and that NHS England (Kent and Medway Area Team) take note of the comments made by Members during the meeting and be invited to attend a meeting of the committee in six months.