Agenda item

5.1  The Chair stated that in the context of the ongoing successes of Richmond Rd Medical Centre in the National GP Awards they had invited the lead Partner, Dr Mehta, to discuss the current challenges in primary care as we emerge from the pandemic and explore how they are overcoming these challenges as well as the innovative approaches they have adopted.  He added that Healthwatch Hackney had also provided two very helpful research reports to inform the discussion. He added that the broader issues here would be expanded upon further at the 16 March meeting but the aim of this item was to focus on Richmond Rd.  Dr Mehta gave a tabled presentation.

5.2  Members gave consideration to:

  (a) Tabled presentation titled Richmond Road Medical Centre

  (b) Two press reports on their success in the National GP Awards

  (c) Research report from Healthwatch Hackney Improving online information about GP services in Hackney - saving times for patients and surgery staff, Oct 2021

(d) Research report from Healthwatch Hackney GP registration in Hackney the right to access health care, Jan 2022

5.3  The Chair welcomed for this item:

Dr Gopal Mehta (GM), GP Partner, Richmond Road Medical Centre/Sandringham Practice/Aldersbrook Medical Centre; Clinical Director, London Fields Primary Care Network

Dr Suresh Tibrewal, GP Partner at Richmond Rd Medical Centre

Dr Vinay Patel, GP Partner at Stamford Hill Group Practice, Joint Clinical Director for Springfield Park PCN and Woodberry Wetlands PCN Chair of City & Hackney LMC

Dr Mark Rickets, Co Chair of HWB and CoChair of ICPB

Dr Kirsten Brown GP Partner at Spring Hill Practice and The Lawson Practice Primary Care Clinical Lead for City and Hackney

Richard Bull (RB), Programme Director Primary Care NEL CCG

Kirit Shah (KS), Member of Local Pharmaceutical Committee

Malcolm Alexander (MA), Chair, Healthwatch Hackney

Jon Williams (JW), Executive Director, Healthwatch Hackney

5.4  GM took Members through his presentation which covered their access system, how they promoted health and wellbeing, on preventing disease and long-term conditions, their patient engagement, on staff wellbeing, on becoming part of the community and their patient feedback.

5.5  Members asked detailed questions and in the responses the following was noted:

(a) The Chair asked how easy it had been to embed their model in the other GP Practices they ran. GM explained how they went all in on the other practices they took on and rolled out their Richmond Rd model there.

(b) The Chair asked if they were seeing the metrics improving for Sandringham Practice since taking over in 2019. GM replied that they were.  The order of focus was’ access’ first and then ‘health and wellbeing outcomes’. He described how for example they worked with the local Black African Churches to talk to them about blood pressure and diabetes.

(c) Members asked about the challenge of funding these special initiatives.  GM replied that they funded everything from within their GP Practice and these services (yoga and ante-natal) are completely free for patients and he added that the investment in their patients had generated positive results in the long run.

(d) A Member recalled concerns in the past about Sandringham Practice and stated that the focus now needed to be on sharing the best practice with the minority who are still outliers.  He also asked why the next door Dalston Practice remained separate.  GM replied that they were on two separate GP contracts - Sandringham on APMS and Dalston on GMS, and they were two totally separate organisations.

(f) The Chair asked how they were able to make their Access model work when others had struggled and how they managed demand when they were a staff member down. GM described how they planned well in advance for all eventualities that would impact on loss of cover. He also described their approach to appointments and acknowledged that some will always have to be face to face. The Chair asked why other Practices couldn’t match this. GM replied that the model could be used across City and Hackney but it took a lot of work and required a whole team effort.

(g) Members questioned how they overcame the barriers in setting up their Access model GM replied that a strong associated communications plan and regular tweaking of the model was key to it.

5.6  The Chair welcomed the Chair of Healthwatch and the LMC Chair to the meeting. MA took Members through the two survey reports on websites and on access (registration).  He also reflected on the recent closure of Southgate Rd/Whiston Rd Practice and the need to re-allocate 6000 patients from there.  He added that 3 Practices had now been lost over the past few years and there was a need for greater succession planning. On the Registration report, he stated that it had highlighted how a few Practices had really fallen short and how this had impacted on vulnerable residents and stressed that it needed to be tackled.  He added that ongoing staff training was key here but he also added that the collaborative work with the CCG on this issue had led to a change in requirements for ID.

5.7  The Chair asked Richard Bull (NEL CCG) how 7 GP Practices were still outliers on the issue of wrongly requesting ID from patients attempting to register. RB replied that it was being addressed and he thanked Healthwatch for their reports.  The  CCG was in fact asking Healthwatch to re-run the registration research report as it had been so useful.  He went on to explain how in some situations there had been a disconnect between management policy and what was happening on the front line and this needed to be sorted.  The Chair asked how enforcement action could be taken against the outliers here and was it the CCG or the GP Confed.  RB replied that it was the CCG and they were acting on it but attempting other approaches first rather than a breach notice e.g  the Confed were putting on additional training and there was support material from NHSE to assist. The Greenhouse Practice was also there for all vulnerably housed and homeless patients.

5.8  Kirit Shah (LPC) raised the issue of reductions in funding to the Minor Ailments Scheme which had taken pressure off GP Practices.  He also raised concerns about the imminent loss of the Medicines Optimisation Scheme which helped elderly and vulnerable people practically manage a large number of prescribed medications. The Chair asked KS to provide the details on this to the O&S officer for further consideration by the Commission.

5.9  Cllr Adams stated that the previous week at De Beauvoir Surgery had insisted that he provide photo ID in order to register, after he’d been displaced from Whiston Rd and had not accepted his councillor ID badge as valid ID.  A Member added that it was totally unacceptable for GP Practices to continue to demand photo ID and he asked the Chair to formally complain in writing on behalf of the Commission to the 7 outliers and/or the CCG. Another commented that there must be a structural reason why receptionists continue to request photo ID and asked if there was a financial issue underlying the process. 

5.10  The Chair asked the GPs present if there was a payment motivation here and Dr Mehta replied that there wasn’t and it was purely an issue of staff training and staff turnover.

5.11  The Chair thanked Dr Mehta and Dr Tibrewal for their report and attendance. Members asked the Chair to congratulate the Practice in writing on behalf of the Commission.

ACTION:

Chair to write to Programme Director Primary Care NEL CCG expressing concern about the 7 Practices still demanding photo ID from patients and highlighting the issues with registration experienced at De Beauvoir Practice by a Commission Member.

ACTION:

Chair to write to Richmond Rd Medical Centre congratulating them on their success in the National GP Awards.

RESOLVED:

That the report and discussion be noted.