The report of the NHS Keeping Well Director (Document “H”) provides an overview of how General Practice, GPs and their staff have adapted to operating in the COVID-19 environment and highlights how learning to date has informed the model of care going forward.

Recommended –

1.    That the contents of Document “H” be noted as assurance of actions taken to ensure safe delivery of care by GP practices during covid-19.

2.    That the phased approach to restoring services outlined in Document ”H” be noted.

(Lynne Scrutton – 07855832612)

The report of the NHS Keeping Well Director (Document “H”) provided an overview of how General Practice and how General Practitioners (GPs) and their staff had adapted to operating in the COVID-19 environment.  The report also highlighted how learning to date had informed the model of care going forward.

Document “H” revealed that COVID -19 had an early and almost immediate impact on General Practice.  Report issues included ‘Living with COVID19’ Bradford District and Craven Strategic Approach; Maintaining Service; General Practice during COVID-19 March to August 2020; the establishment of ‘Red Hub’s for people who were COVID-19 symptomatic or living with someone who was symptomatic; Access to Care; Support to Care Home residents; The Digital Care Hub and People’s experience of General Practice during the COVID-19 Pandemic.

The report also discussed Personal Protective Equipment; Restoration Priorities from August; management of demand and impact and support for staff.

During discussions on report issues the hard work which GP’s and health care workers had undertaken was acknowledged. 

Members questioned if GP’s had continued to visit care homes as it was recognised that not all issues could be addressed digitally.   A GP from the Baildon area who was in attendance at the meeting explained that the Bradford the Airedale Digital Hub was the first point of call for care homes.  She reported that while she had undertaken fewer visits to care homes, visits had taken place when necessary and she had undertaken wider consultation and ward rounds.

The provision of the flu vaccine for the 50 to 64-year age group was questioned and it was confirmed that this was a new cohort who could access the vaccine free of charge.  It was explained that supply could be a challenge as the new cohort had been announced after supplies had been ordered.  Further details about supply were awaited. 

A Member confirmed that, in discussion with pharmacists, he had been advised that 700 vaccines had been delivered as opposed to 200 in the same period last year indicating that many more people were keen to have the vaccine.

The reliability of anti-body tests was questioned and it was reported that there were various tests available with differing accuracy.  Anecdotal reports of people with classic COVID-19 symptoms producing negative test results were reported.  It was suggested that as antibody tests were conducted at Airedale Hospital a consultant from that hospital could be invited to a future meeting.

A Member described attempts he had made for a number of years to receive a telephone consultation or communication via email with his GP without success and welcomed that the facility was available at the current time. 

He believed that the report under discussion highlighted what had gone well during the pandemic and suggested that it would be helpful to understand what hadn’t worked.  He said that he heard incidents of people who had not presented their symptoms to GPs which had resulted in serious implications.   GP’s had confirmed to him that they were not working as normal and it was believed that there was a lot of unmet need.  The inability to conduct certain tests digitally was discussed and a subsequent reduction in diagnostic services was reported.   

Incidents of residents who had called the NHS 111 telephone helpline being instructed to go to hospital Accident & Emergency Departments unnecessarily were also raised as a matter of concern.  It was stressed that an understanding of what had not worked well during the pandemic including incidents where people had received a delayed diagnosis or a diagnosis had been missed, was required.

In response the Strategic Director of Keeping Well at Home, Bradford District and Craven CCG, explained that the report focused on the impact of COVID-19 on primary care rather than hospitals.  It was recognised that there had been a reduction in access to general practice and as that was noticed the NHS had been proactive in advising people that GP’s were still available.   He acknowledged that there were lots to learn but stressed that the focus had always had been on safe systems for the whole population.

GP’s in attendance agreed with concerns about reduced access to their services and explained that they were restricted to dealing with the two week urgent referrals and routine referrals had been delayed by three to four months.

A Member, who was a retired GP, believed that a wholesale move to digital consultations would be a risk to patients and questioned if there were compelling clinical reason to do so.  He expressed concern that COVID-19 could be used as an excuse to make digital consultations normal practise.   In response it was explained that the pandemic had resulted in a massive transformation in operating models of primary care.  It was stressed that the transformation was necessary to ensure the safety of health workers and patients.  It was believed that all GPs were working at the limits of their clinical comfort zone and whilst there would not be wholesale transformation to digital consultation the measures did offer a suite of options and provided tools to help patients access their GPs.

Document “H” included an account of people’s experience of General Practice during the pandemic and, whilst acknowledging the hard work of health professions, concern was expressed that this was not universally felt with 28% reporting a poor or very poor experience of General Practice.  It was also felt that this was probably a low figure as people usually said very nice things when asked about their doctors.  Anecdotal reports of patients being told to visit Accident and Emergency Departments because face to face consultations were not available were also raised as a concern.  It was stressed that this was not only detrimental to patients but harmful to the heath economy as a whole. The variability of patients experiences was very much a concern for Members. 

The Strategic Director confirmed that the statistic of 28% of those surveyed reporting a poor experience was taken very seriously.  He also stated that if it was brought to the CCGs’ attention that people were asked to go to Accident and Emergency it did not go unchallenged.  Measures were being undertaken to drill down into the patients’ experiences and the issues arising would be addressed.  GPs in attendance confirmed that they were eager to return to face to face consultation, however, if patients wanted digital services that would also be available. 

A Member questioned the likelihood in a second lockdown period of health sites being closed and, whilst he hoped that a full service could be delivered, he recognised that staff would be impacted and whether practices closed would depend on the impact of lockdown.  He was advised that surgery closures had been for operational reasons and services had been centralised to facilitate cleaning requirements and keep people safe.  Assurances were provided that all efforts would continue to be made to prevent detrimental impacts on patients and that safety was the key factor behind all decision making.

A co-opted Member questioned the current strategic thinking in terms of timelines and whether plans were being made for three or six months ahead.  In response it was explained that the timeline could be six months or more.  The reopening of schools could impact on any key worker parent whose child had a cold or temperature as they would be unable to work until tests had been completed. 

With the approach of bad weather during the winter it was questioned if there would be arrangements for patients to wait in dry warm environments whilst visiting their doctors’ surgery.  It was explained that some practices were opening up waiting rooms whilst others were asking people to wait in their cars.  The arrangements were dependant on the size of buildings and the availability of larger rooms to facilitate social distancing.

A Member, whilst acknowledging that the health service would build on its experience of COVID-19 and learn from different models, expressed concern about the inability to read people’s mood and understand body language via digital consultation.  He explained that he had witnessed a build-up of emotional and mental health issues through his employment and believed that consultation models could appear to be technically smart but could not recognise the people element which was required.

GPs at the meeting agreed with that statement and were concerned about the trauma people had experienced over the previous six months.  It was believed that those affects would be seen over the coming months and that the right services must in place for issues which maybe health professionals were not yet aware of in terms of quantity.  

It was stressed that the operational arrangements had been implemented urgently to deal with the pandemic and it was not believed that those operating models would railroad services in one direction but open up a suite of tools for patients to access their doctors.  It was felt that rather than excluding people new models provided opportunities for people such as working age patients who had previously struggled to gain access to primary care.   GPs recognised the benefits of face to face consultations and they would still be available. Learning about the tools which had been developed overnight would be essential to ensure they were deployed in an appropriate manner.

It was acknowledged that COVID-19 had hit some of the most disadvantaged and most vulnerable communities the hardest.  Details of the Living Well programme in Bradford which focused on self-care and social prescribing were provided and it was believed that the programme would free up general practitioners to deal with more vital issues.

The Overview and Scrutiny Lead explained that there was a report on Mental Health to be considered at the meeting on 20 October 2020.  Details of the Chair’s briefing prior to that meeting were provided and all were invited to attend and shape the report which would be considered.

It was proposed that a further report be requested in 12 months’ time to include lessons learnt from the rapid introduction of digital services.  It was suggested that other Committees be advised to consider digital transformation.  The Overview and Scrutiny Lead agreed that questions as to how social care and adult social care had stayed in touch and interfaced with people could be included in performance monitoring reports and the Chair agreed that was something which could be discussed at meetings between the Overview and Scrutiny Chairs.  

Resolved –

1.    That the contents of Document “H” be welcomed as assurance of actions taken to ensure safe delivery of care by GP practices during covid-19.

2.    That the phased approach to restoring services outlined in Document ”H” be noted.

3.    That, taking account of the comments made by Members, the NHS Keeping Well Director be requested to provide a future report in 12 months time and that the report include information on lessons learnt from the rapid introduction of digital delivery of services that has taken place during the Covid-19 pandemic.

ACTION: Overview and Scrutiny Lead