Agenda item

Presentation from representatives of the North East North Cumbria Integrated Care Board

The Committee received a presentation from representatives of the NENC ICB giving a workforce update.

An overview of the Primary Care Network (PCN) structure was provided. In Gateshead there are 5 PCN’s, with the largest in Central South which has 10 practices. The smallest PCN is Birtley and Central Gateshead, which has 3 practices.  Central South PCN has 31.8% of Gateshead’s patients and the lowest is East PCN which has 14%.

The last survey results to be published around patient data was in January 2022, 2023 results are due to be published next month. The results show that 10 practices in Gateshead do not have enough GPs, this is based on 1,800 patients per GP.  It was noted that, despite high numbers in the GP training programme, many are moving abroad or into another part of the system upon completion of their training programme. It was acknowledged that this is a national issue. It was also recognised that the workforce is young and has different needs, many of them do not want to join partnerships but prefer to be a salaried GP or Locum which enables them to move between roles and build a portfolio of experience. 

In order to support the issues raised a number of initiatives have been introduced. NHS England has made funding available to PCNS to grow capacity through Additional Roles Reimbursement Scheme (ARRS), in order to enhance a multi-disciplinary community offer. ARRS supports recruitment in roles including of Clinical Pharmacists, Social Prescribing Link Workers, Physician Associates, Physiotherapists, Paramedics and Mental Health Practitioners.  Each PCN analysed their need and created ARRS roles, which eased the pressure on GP appointments. In Gateshead 136 ARRS staff were in place as of May 2023.

In terms of GP appointments a snapshot of data from October 2022 was provided which showed that the majority of appointments were held face to face. PCNs will also provide extended access appointments for all patients between 6-8pm Monday – Friday and 8am – 5pm on a Saturday. It was noted that between October and March there were an additional 12749 appointments.  A national framework from NHSE has just been published in relation to PCN Access Recovery, and health colleagues are working through it.

It was reported that recruitment issues continue to be a national problem, with a shortage of staff in all parts of the health and social care system. Gateshead Cares Workforce Partnership has identified issues impacting locally on the workforce and ways to overcome them;

-        Recruitment from local community

-        Training and career pathways

-        Making Gateshead an attractive place to work

-        Staff benefits and rates of pay

An analysis will also be conducted to identify where the biggest gaps in the workforce are.

It was reported that Health Education England (HEE) has commissioned a national programme for adults aged over 19 receiving work related benefits to support them into health and social care roles. So far 150 residents in Gateshead have engaged. In the first cohort, 6 gained employment across the sector, the second cohort is ready for placement. The programme is funded for 3 years but will continue after that as the funding received goes back into the programme.

In terms of career pathways, a Practice Development Nurse has been recruited to support work-based assessment, deliver training and promote Primary Care careers. The Gateshead Care Academy has been developed to offer in-house training for new employees and existing staff and looking at engaging those wanting a career change.

Gateshead Cares Summer School is continuing to be developed to engage pupils in year 9 and above into system-based careers. This may be with young people at risk of disengagement and inspire them through non-traditional routes into the sector.  The GP Fellowships programme is due to relaunch for newly qualified GPs to primary care jobs.  A Level 2 Medical Administrator apprenticeship has been developed with the Council’s Learning and Skills.

A Flexible Workforce Hub is due to be launched this month which will offer flexible hub workers practice support to fill any workforce gaps and ensure there are no missed appointments. It is hoped this will be extended wider to support other parts of the system.

It was queried whether Government had delivered on its promise of more medical schools. It was confirmed that there are new schools, Sunderland is doing PCN work for example, however, it is too early to see the impact on GP numbers as it takes 10 years to train a GP. It was also acknowledged that retention is the major issue in terms of GPs, however locally a lot of work is underway to retain GPs for example through fellowships programme.

It was questioned what the uptake is like in relation to the summer school offer. It was confirmed that there are 60 places and so far 25 have been filled. Work has taken place to link with schools in Gateshead and the Virtual School to identify those at risk of disengagement.  The programme will focus on project-based work throughout the week, with visits to the QE, social prescribers as well as first aid work and mental health work. It is hoped this will open up those careers to young people and introduce fundamental skills, for example communication and teamwork. It was noted that in the future it is hoped that a separate summer school could be held for those young people with additional needs.

It was queried whether the PCN extended access appointments have taken away from the 9am-5pm appointments. It was confirmed that there has been no decrease in the 9-5 demand for appointments.

It was questioned whether there is any information in terms of health inequalities which relates to the PCN make up and size of practices. It was confirmed that these were set up on a geographical basis, it was recommended that each PCN should have between 30-50,000 patients, although Gateshead South has more than that. The health colleagues in attendance were not aware of specific health inequalities work in relation to the size of PCNs. However, it was acknowledged that a lot of the work undertaken by the PCNs outside contractual work will identify the needs of their community in order to tackle inequalities.

Committee requested timescales for the roll out of digital telephony in all practices.

It was questioned whether housing developments have been considered in relation to the increased population in certain areas and the impact on local practices. It was confirmed that two estate strategies have been undertaken which identifies all practices and what space they have to identify where the pressures are. New developments have been mapped out and potential pressures identified where there may be a shortage of provision in the future. Work is ongoing and discussions with the Council to look at other estates and utilise empty properties.

It was questioned whether there is any way of having named GPs for those people with complex needs in order to provide them with confidence in the system. It was acknowledged that it is very important to have a touchpoint and that this is around care planning and the need to develop continuity through for example nurse practitioners. The Care Home system has named GPs for example. It was recognised that it is important to build relationships and although the role of GPs is evolving there should always be that oversight and continuity in different ways.

RESOLVED    -           That the information presented be noted.