Healthwatch Portsmouth Board meeting 17 October 2018 Presentation by Dr Linda Collie, Chief Clinical Officer, Portsmouth Clinical Commissioning Group  

Improving Access to Primary Medical Care Services in Portsmouth

Improve the quality and sustainability of General Practice Context Improve the quality and sustainability of General Practice Demonstrate how: Access to general practice will be improved Ring-fenced funding will be deployed Primary care Transformation will progress locally Investment Workload Workforce Practice infrastructure New Models of Care

Overall experience of GP practice Q31. Overall, how would you describe your experience of your GP practice? CCG’s results Comparison of results CCG National 81% 84% Good Good 6% 6% Poor Poor Practice range in CCG – % Good Local CCG range – % Good Lowest Performing Highest 55% 93% Lowest Performing Highest 78% 89% Practice bases range from 20 to 119; CCG bases range from 876 to 7,543 %Good = %Very good + %Fairly good %Poor = %Very poor + %Fairly poor

Ease of getting through to GP practice on the phone Q1. Generally, how easy is it to get through to someone at your GP practice on the phone?* CCG’s results Comparison of results CCG National 67% 70% Easy Easy 33% 30% Not easy Not easy Practice range in CCG - % Easy Local CCG range - % Easy Lowest Performing Highest 35% 92% Lowest Performing Highest 57% 83% *Those who say ‘Haven't tried’ have been excluded from these results. Practice bases range from 19 to 114; CCG bases range from 853 to 7,306 %Easy = %Very easy + %Fairly easy %Not easy = %Not very easy + %Not at all easy

Overall experience of making an appointment Q22. Overall, how would you describe your experience of making an appointment? CCG’s results Comparison of results CCG National 63% 69% Good Good 17% 15% Poor Poor Practice range in CCG - % Good Local CCG range - % Good Lowest Performing Highest 39% 84% Lowest Performing Highest 57% 77% Practice bases range from 19 to 112; CCG bases range from 814 to 7,105 %Good = %Very good + %Fairly good %Poor = %Fairly poor + %Very poor

Treating you with care and concern Perceptions of care at patients’ last appointment with a healthcare professional Q26. Last time you had a general practice appointment, how good was the healthcare professional at each of the following* CCG’s results Nationl results % Poor (total) National results % ‘Poor’ (total) 4% 3% CCG results % Poor (total) CCG results % ‘Poor’ (total) 4% 5% Giving you enough time Listening to you Treating you with care and concern Very poor Very good *Those who say ‘Doesn’t apply’ have been excluded from these results. Base: All had an appointment since being registered with current GP practice excluding 'Doesn't apply’: National (706,895; 705,167; 706,882); CCG (1,524; 1,521; 1,523) %Poor (total) = %Very poor + %Poor

Satisfaction with appointment times Q8. How satisfied are you with the general practice appointment times that are available to you?* CCG’s results Comparison of results CCG National 59% 66% Satisfied Satisfied 21% 17% Dissatisfied Dissatisfied Practice range in CCG - % Satisfied Local CCG range - % Satisfied Lowest Performing Highest 27% 82% Lowest Performing Highest 53% 71% *Those who say ‘I’m not sure when I can get an appointment’ have been excluded from these results. Practice bases range from 20 to 108; CCG bases range from 824 to 7,043 %Satisfied = %Very satisfied + %Fairly satisfied %Dissatisfied = %Very dissatisfied + %Fairly dissatisfied

Own Surgery/Given Number Improved Access GPFV Plan commitment: By the end of 18/19 commissioned a robust integrated OOH, 111 and Primary Care service for the city Portsmouth CCG has: Commissioned an Integrated Primary Care Service which offers 24/7 Primary Care to Portsmouth residents including an Acute Visiting Service, Extended Access Service, and Out of Hours Service Exceeded local and national expectations (connected to 111) Managed services within the existing budget  Extended Access Patient feedback Strongly agree Agree Uncertain Disagree Strongly Disagree I received a call back quickly 60.76% 30.38% 6.33% 0.00% 2.53% When I arrived the staff where helpful and courteous 76.40% 22.47% 1.12% I was seen quickly after arriving for my appointment 48.19% 27.71% 13.25% 9.64% 1.20% I was very happy with the outcome of my consultation 60.87% 34.78% 2.90% 1.45%  Extended Access Ease of Access Own Surgery Own Surgery/Given Number Called 111 By Friend/Family Other How did you access EAS? 34.57% 0.00% 64.20% 1.23% Current challenge: Increasing the utilisation of Routine Extended Access appointments. Patients need reassurance that they will receive the same level of service through a routine Extended Access appointment, although this may not be with their registered practice doctor.

Primary Care at scale Secondary Care LTC Hub Primary Care Long-term Condition Hub Pilot(LTC Hub): The focus of the LTC hubs integrated workforce will be to assess the patient’s overall health and wellbeing through the delivery of personalised clinical assessment, in the form of a conversation and development of a care plan. The care plan will determine any onward treatment for patients including medication, self-management, social prescribing etc. The Provision of an LTC Hub offers many patient benefits including Improved menu of support more tailored to individual patient needs Increased appointment availability and choice Improved patient activation Reduced variation in care received – agreed gold standard care Improved care of housebound patients Improved diagnostic accuracy Increased number of patients achieving treatment targets Primary Care Initial Diagnosis Ongoing Management (Low / Med Risk) Palliative Care LTC Hub Confirmation of Diagnosis Wellbeing and self-management Specialist Services Case Load Management (Post Diagnosis & Med/ High Risk) Secondary Care Specialist Diagnostics Elective Procedures / Operations Emergency Admissions What can we do to improve patient participation and how should we evaluate patient experience during the 12 month pilot?

Ten high impact actions GPFV Plan commitment: Implement initiatives around all of the ten high impact actions Portsmouth CCG has: Supported practices to engage in all of the ten high impact actions in a planned and manageable way Invested in support over and above national allocations 10HIA Developments 1 – Active signposting Training / Directory of Services / Evaluation 3 – Reduce DNAs MJOG purchased for all practices in the city 5 – Productive workflows 13/16 practices trained and 3 to complete in 2019 6 – Personal productivity Ardens templates for Clinicians 7 – Partnership working Portsmouth Primary Care Alliance Services 8 – Social Prescribing Linked to Active signposting work / Time for Care 9 – Support self-care Self Care week activities / eConsult 10 – Develop QI expertise Primary Care CQUIN / Quality Framework

Ten high impact actions “Good caring service. Working in the NHS, know how busy it is but econsult a good idea as doctors can prioritise.” 2 -New consultation types eConsult - East Shore Partnership “It was easy, quick and convenient.” “I would just like to be able to request an appointment and see a doctor like you are able to in other NHS practices.”

Ten high impact actions 4 –Develop the team MSK (Musculoskeletal pilot) Triage Pilot: Summary of Benefits to Patients Empowering patients to self-manage their MSK symptoms, by ensuring they can access to specialist MSK advice and sign-posting at their first point of contact Earlier access to the MSK service, with patients being offered an appointment for a physiotherapy assessment (often same-day) or clinical physiotherapy specialists when clinically indicated Improved patient experience within the Solent MSK pathway, with high levels of patient satisfaction from preliminary data.

Ten high impact actions MSK (Musculoskeletal) Triage Outcomes: Challenges Managing patient expectations and instilling Trust Changing behaviours and patients actively choosing to self-care

Other developments Workforce strategy in development (Jan 2019) Engaging widely with practices through QI framework, practice visits and the Portsmouth Primary Care Alliance Sharing best practice and providing the full range of support required to adopt innovations Development of communications strategies for patients and the public

Challenges No system that enables us to truly understand demand and capacity in General Practice Capacity to make changes (within General Practice and the CCG/PPCA) Make take time to fully realise impact of all initiatives in all practices Need to maximise utilisation to realise benefits (particularly online and at scale services) Managing patient expectations and understanding of the system – language! Resources and resilience Finding solutions – help to explore opportunities

Questions?