Agenda item

In attendance for this item: Sukh Singh, Director of Primary Care, NHS Kent and Medway, Dr Ash Peshen, Deputy Medical Director, NHS Kent and Medway and Dr Jack Jacobs from the Local Medical Committee.

1.    The Chair welcomed the guests, who confirmed there were no updates to provide since publication of the report. 

2.    The Chair welcomed that GP appointments were up 7% compared to pre-pandemic levels along with the continued recruitment drive within GP practices. Mr Singh explained that the increased workforce numbers reflected the appointment to new roles within general practices and across the wider workforce. The Chair asked if the numbers on the entire workforce cohort across Kent and Medway were available, Mr Singh said this could be shared after the meeting. 

3.    A Member raised a point on the accessibility of GP appointments, especially face-to-face appointments. Concern was expressed that e-consult and digital offerings were too difficult for many to access leaving them no option but to try A&E or other avenues. The Member asked if the nature of GP contracts (i.e. private suppliers as opposed to employed by the NHS) was a reason for the inaccessibility of primary care services for many, and would further integration with the NHS help to resolve this and make GPs more customer focussed. Dr Peshen responded that GPs must move from their traditional model and take advantage of the opportunities presented by technological advances. There were three aspirations:

3.1. Good, consistent access to services - recognising the different needs of patients requiring ‘transactional’ or continued care. Dr Peshan cited the widening role of pharmacists in treating patients as well as the potential for ‘access hubs’ to reduce the burden of transactional care on GPs.

3.2. Proactive care, including social prescribing.

3.3. Prevention

4.    Addressing a question around poorly performing surgeries, Mr Singh explained that action plans were developed alongside the ICB teams when the Care Quality Commission (CQC) rated a surgery as inadequate or requiring improvement. There was also a proactive GP Support Improvement Programme which helped prevent GPs from getting to the stage of CQC intervention. There was a need to better understand demand so that plans could be put in place to address that demand. 

5.    Concern was expressed over the difficulty to recruit salaried GPs, could more be encouraged to join a partnership rather than on locum contracts.

6.    Responding to a concern about the apparent difficulty in contacting GP surgeries over the phone, Mr Singh said that work was ongoing with practices to implement a call-back functionality. Members were also concerned about the role of receptionists in determining whether a patient saw their GP. Dr Jacobs noted that receptionists were hard working professionals who  operated in a challenging environment and often faced verbal abuse from patients. Mr Singh noted that the ICB offered a training programme for receptionists. It was important to provide them with support so that they have what they need to fully provide their service to patients. 

7.    Members commented on the process of receptionists seeking personal details in front of others at the surgery. Mr Singh said that the estates were a limiting factor, as many practices did not have the capacity to offer private cubicles for discussions. It was noted that privacy concerns were very important, but they needed to understand where their problems were arising before putting in place a resolution.  

8.    Addressing a concern about the recruitment and retention of GPs, especially in coastal areas, Mr Singh noted that the issues had been recognised and areas such as Thanet had recently received targeted recruitment support. 

9.    A Member asked about the lack of NHS dentistry and the long waits for care that children were experiencing. Mr Singh said that dentistry had been delegated to the ICB, the challenges seen in this area reflected a national contract issue. Conversations were ongoing with the Kent Local Dental Committee to get their insights into how to resolve the current challenges and recruit more dentists. 

10. A Member asked about the consistency of GP opening hours with several closing or offering limited services over lunch. Dr Jacobs said that GPs work very long hours, including evenings and weekends, but system-wide challenges made the job very difficult. Further investment in the workforce, specifically training and recruitment, was required to increase capacity. It was noted that more doctors were training to be GPs than ever before, and training was being provided to pharmacists and medical students to give additional support across the system. The training required considerable supervision which left less time for qualified GPs to see patients.         

11. Dr Jacobs provided a GP’s perspective, noting the following: 

11.1.            Access difficulties reflected demand and capacity issues which were symptomatic of a system-wide NHS crisis. The workload of GPs had increased substantially since the start of the pandemic because of increased demand and additional responsibilities.       

11.2.            According to a survey of local GPs, a third of the responsibilities being placed on GPs were unsuited for general practice, yet GPs were having complaints filed against them for not performing the tasks that were both time-consuming and detracted from their core responsibilities. Meetings with hospital Trusts remained ongoing to resolve the questions around responsibility for the tasks being performed by GPs.

11.3.            Additional bureaucratic and regulatory burdens were being placed on GPs, further adding to the huge demand for their services.   

11.4.            Local Practices were not receiving adequate resource allocation from the NHS. 

11.5.            A lack of physical space had been a constant unresolved issue.

12. Mr Singh thanked Members for their input and for raising awareness of the challenges that residents were facing. A strategy to improve the GP offer to their patients was needed and this must be developed as a partnership with all stakeholders, including local authorities. 

13. Dr Peshen said that improvements were starting to be seen. Digital innovations were very important - if those who were comfortable with technology increased their use of digital pathways then phone lines would be available for those less able to use technology. He accepted that e-consult needed to be more user-friendly. 

14. The Chair summarised the discussion and thanked Members and the guests for their time and contributions. The Chair noted the Council’s role in advocating for change along with ensuring adequate S106 monies were secured for new housing developments (thus ensuring adequate provision of services).

RESOLVED that

i)             the committee note the report and thank for three guests for their contribution. 

ii)            An update paper be presented to the Committee in Spring 2024.