Who is responsible for what? - NHS England Area Team and Wokingham Clinical Commissioning Group (CCG)
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- Teresa Arnold
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1 Introduction In April 2014 the MP Rob Wilson called a public meeting following concerns raised by residents to him via his surgeries, s and letters about access to GP services in Woodley. The meeting took place on 10 th April at Beechwood School. Below is set out the Area Team response to the issues raised at the recent public meeting in regards GP services in Woodley, Wokingham. Who is responsible for what? - NHS England Area Team and Wokingham Clinical Commissioning Group (CCG) NHS England holds the GP contracts by which practices are contracted to the NHS to provide primary care medical services. Area Teams are the means by which NHS England monitors the local contract. The contract specifies that GP practices must provide access to GP services within core hours 08:00 18:30 Monday to Friday, but often practices offer appointments outside of these core hours. Clinical Commissioning Groups (CCG) have a statutory responsibility for improving the quality of primary care. Thames Valley Area Team and Wokingham CCG are the local bodies which currently hold these responsibilities for the practices in Woodley Issues highlighted at the 10 th April Meeting The 10 th April meeting took place at Beechwood School, Woodley. In attendance were: Dr. David Buckle (GP Woodley Centre) Katie Summers and Cathy Winfield (Wokingham CCG) Helen Edwards (Practice Manager, Parkside Practice) Matthew Tait and Ginny Hope (NHS England) Darrell Gale (Consultant in Public Health for Wokingham Borough Council) Issues raised included: Identifying who is responsible for monitoring the quality of access to GP Surgeries Poor continuity of care Difficulty in contacting the surgeries by telephone Waiting times for appointments At the meeting on 10 th April the main issues were summarised by Rob Wilson as: The main points to take away tonight are that the access issues must be addressed; the number of GPs in the Woodley area needs to be re-assessed, with the rising population being taken into account. I m concerned that the figures NHS England have are not accurate and that not enough has been done yet to tackle these issues. It is essential that swift action is
2 taken, as it s clear that things aren t right and this needs to change. (Extract from Rob Wilson News website) It was agreed that the CCG and the Area team would make a short and long term plan. This report summarises the initial work undertaken by the CCG and Area Team with practices in Woodley. Actions by Woodley Practices The CCG and Area Team have worked with the three Woodley Practices on the following areas: Telephone Access Number of GPs On line Booking Working with patients Telephone access All practices have looked to improve telephone access by looking at how their telephone systems are used by patients. A key issue is the number of telephone lines that patients are able to access the surgery. The following actions have been implemented by the practices: Increased number of phone lines into the practice (Woodley) Woodley practice placed an order in May for an increase in phone lines. This will increase the number of phone lines by 50% and install call queue numbering. The practice recruited an extra member of staff for Monday mornings and is looking to reorganise reception staff to increase number of call handlers during busy periods. Increase number of receptionists (Parkside) Parkside practice has employed two more receptionists to help with access to the surgery and services to patients. Undertaken a review of telephone systems to ensure that the telephone system meets the needs of the patients Loddon Vale have been working with patients and the Loddon Vale patient group to review how the telephone system works in the practice.
3 Number of GPs The number of GPs is key to patient s satisfaction with service. At the time of the public meeting each of the practices had GP vacancies. There is a national shortage of GPs which in areas such as Woodley is due to the high cost of housing. Each practice has been successful in recruiting new GPs to the practice. Woodley Practice Have recruited a GP who is due to start in September. The practice is also planning to develop one of the practice nurses into a nurse practitioner. Parkside Practice From August 2014 Parkside will be recruiting another three salaried GPs to work across the practice. Loddon Vale Have recruited another GP and are looking to recruit further GPs. The new GP starts in September. On line booking All practices now offer on line booking. This has been a new development for GP practices. There have been issues with patients accessing on line appointments due to software problems. These have been resolved and practices are looking to how on line booking can be used further. For example Parkside are piloting the booking of online blood clinics. This was a result of working with the practice patient group. Working with Patients All practices are keen to work with patients to learn what works well for patients and what could be improved at the practice. All three practices joined together to commission a mystery shopper exercise to ascertain patient views. This was undertaken by an outside independent organization and the practices had no involvement in the running of it. All Woodley practices run patient participation groups and are looking at ways to improve communicating with patients.
4 How do Woodley practices perform against other practices? There are a number of ways in which the NHS monitors how practices perform. Outlined below are various ways in which performance is measured. Number of weighted patients registered by WTE GP This measure compares the number of GPs against the population. For Wokingham CCG the average is 1 full time GP per 2058 patients. The practices compare as below: Loddon Vale Woodley Practice Parkside Practice 1 full time GP per 2215 patients 1 full time GP per 2072 patients 1 full time GP per 2002 patients These figures were before the recruitment of new GPs. Number of GP appointments per 1000 GP The number of GP appointments offered per 1000 patients is a good indicator of the capacity of the GP practice. By looking at it by per 1000 patients it is possible to compare practices with different list sizes. For Wokingham CCG the average is appointments per 1000 patients. The practices compare as below: Loddon Vale Woodley Practice Parkside Practice 70.6 appts. per 1000 patients 74.1 appts. per 1000 patients 78.3 appts. per 1000 patients At the time of the surveys each of the practices had GP vacancies. By recruiting more GPs more appointments can be offered and increase these number. A &E Attendances Per 1000 weighted population Recent newspaper reports suggested that increased A&E activity was due to the difficult of accessing GP appointments. This may be particularly the case with A&E attendances when GP practices were contracted to open (Monday to Friday 8.00 am to 6.30 pm). For this period of time the average for Wokingham CCG was 8 attendances per 1000 weighted population. All the Woodley practices were below both of these figures at 6 attendances per 1000 for Parkside, 7 attendances per 1000 for Woodley and Loddon Vale. Other sources of data General Practice Outcome Standards (GPOS) - GPOS is a national tool which ranks all GP practices in England against a variety of factors and identifies whether they are approaching a need for formal contract review. For Wokingham CCG no practices were identified as a needing formal review. Of
5 the three Woodley practice, two were identified as achieving practices and only one as approaching review (the stage before needing a formal review). NHS Choices On the NHS choices website patients can leave comments on their experience of the practice and star rate the practice. Woodley was rated 3 out of 5 stars based on 7 rating, Parkside was rated 1.5 out of 5 stars based on 9 patients views and Loddon Vale was rated 3 out of 5 stars based on 16 patient views GP National Patient Survey The GP National Patient Survey is a survey carried out by MORI and involves postal questionnaires being sent out to patients of all practices in England. The 2013 results for the practices in Woodley show variances to the Wokingham CCG and England Average. For example in relation to patient satisfaction with telephone access, the England average was 75%. For Loddon Vale 63% of respondents were satisfied, for Woodley Practice it was 61%, and for Parkside Practice it was 47%. In relation to satisfaction with opening hours, Wokingham CCG average is 72% (i.e. 72% of respondents satisfied). For Loddon Vale it was 66%, for Woodley practice it was 68%, and for Parkside Practice it was 61%, Care Quality Commission (CQC) - CQC is a separate body which regulates Health and Social Care. Since April 2013 it has been responsible for regulating GP Practices since April Their aim is to visit all practices by Of the three Woodley practices, Loddon Vale has been visited by the CQC. This was in October The practice met all the CQC standards. No dates have been given as yet for the other two practices. Concluding Comments The three practices which serve the population of Woodley, offer a choice of primary care for the residents. This report has outlined various actions the Woodley practices have taken to address the issue of access to GP appointments: Put in means to improve telephone access by recruiting additional staff and improving telephone systems Recruited additional GPs Improved online booking including widening the type of clinics available to book online The CCG is working on a number of initiatives to improve access to primary care. These will benefit the patients in Woodley and we will provide a further update on this wider work in September. The Woodley Practices, the CCG and the Area Team are all committed to improve primary care for the patients of Woodley. Patient views are key to improving services and it is hoped the engagement will continue.
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