To receive a verbal update. .

A verbal update on the General Practice Workforce Plan was received from Tim Sacks, Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG); and presentation on the Leicester, Leicestershire and Rutland (LLR) End of Life Service Redesign Work was given Dr Cassy Rowe-Haynes, LOROS/CCG, Palliative Medicine Consultant.

Mr Sacks informed the Board that the Partnership was in the process of putting together a clear and detailed plan which would cover all elements of health and care services for Rutland including the Hub and One Public Estate.  This would be brought to the next meeting.

General Practice Five Year Forward View

During discussion the following points were noted:

a)    The Workforce Plan provided a clear understanding of the current workforce.

b)    NHS England was committed to increasing the number of General Practitioners (GPs) by 5,000 including overseas doctors; and Clinical and Advance Care Practitioners.

c)    Concerns that there had been a 5% drop in sessions done by GPs in the last two years.  The number of the GPs had remained static.

d)    NHS England target of 0.58 GP per 1,000 population.  East Leicestershire and Rutland much closer to this target than Leicester City.

e)    East Leicestershire and Rutland had more nursing and clinical staff than any other part of Leicester, Leicestershire and Rutland.

f)     Need to consider what could be done to enable and support GPs.

g)    NHS England had a clear drive to look at other models of care: Clinical Pharmacists, Advanced Nurse Practitioners to allow GPs to deal with complex cases.

h)   Consideration needed to be given to joint working with Primary Care Home given the geographical area and Practice locations within Rutland.

i)     NHS England proposing to spend £100m on GPs from Europe to England.  22 practices (out of 139) in the LLR area were interested in this proposal.  There were sustainability issues: with additional training and support it could be up to two years before these GPs are fully trained.

j)      The Modelling of Supply and Demand within the Plan would not meet the need due to an increase in the number of GPs retiring or reducing hours or becoming Locum doctors.

k)    70% of Health Care funding was spent on staffing in Leicester, Leicestershire and Rutland.

l)     Need to ensure an increase in funding GP service, both national funding and existing funding received.

m)  Need HNS England to support rather than just set targets.

n)   Make sure the whole of the system responds, with appropriate skills to see patients.

o)    That the Plan was aspirational not many new people were coming through the system so needed to make LLR an attractive area to work.

p)    The Plan focused on practices within the Leicester, Leicestershire and Rutland area rather than the population; with 15% of the population registered outside the area.

q)    That if looking at new models of care there was an assumption that the area did not have the level of GPs and clinical staff that it aspired to.

r)     The future delivery of clinical care would require GPs to have the capacity to look after very ill patients therefore there was a need to co-educate/co-design the way delivered.

s)    The engagement from Rutland County Council to support Primary Care Home; moving towards a level of integration to have an impact.

End of Life Service

(Presentation attached)

During discussion the following points were noted:

a)    ‘Hospice at Home’ offered a minimum of two calls a day.  To be provided by already commissioned services.

b)    Work being undertaken by the End of Life Programme Board on how to improve End of Life care generally not just palliative care.

c)    It was important to recognise that patients dying required palliative care.

d)    LOROS Outreach Clinics offering specialist palliative care outpatient services were held in Rutland.

e)    That resources were small in terms of investment.  Current resources were being used inefficiently; with integration there were possible efficiencies to be made.

f)     Evaluating and testing of carers giving injections, etc. at the end of life was being undertaken.

g)    Looking to reduce inappropriate admission.

h)   It was envisaged that Domiciliary Care would have to alter.  Better Care together was looking at more highly trained assistance for carers, offering greater opportunity to fit into model, giving more flexibility for approaching.

i)     Trialling a holistic home care pilot until March.

j)      Full integration of operational service: March 2019