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

3. Improving Access to Primary Medical Care Services in Portsmouth

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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?

12. 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

13. 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.”

14. 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.

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

16. 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

17. 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

18. Questions?