Agenda item

To receive an update from Betsi Cadwaladr University Health Board on Primary Care and Community Services and Mold Hospital.

(a)          That the update be noted; and

(b)       That the Senior Manager Children and Workforce provide information on the contact number for all services.

The Chair welcomed and introduced Mr. Rob Smith, Area Director East, Nikki Palin, Team Leader RN, and Dr. Gareth Bowdler, Area Medical Director East, , to the meeting.

The Senior Manager Children and Workforce provided background information and invited the BCUHB representatives to give an update on Primary Care and Community Services. 

Mr Rob Smith and Nikki Palin gave a joint presentation on the East Area Community Resource Team – supporting patients closer to home.  Mr. Smith explained that patients and families were at the heart of all plans and  developments and that BCUHB was working in  collaboration  with the Authority to provide treatment and care for  people at home.  The main points of the presentation were as follows:

·         introduction and background – where we were

·         the vision – East Area Community Resources Team

·         project work – Community Resource Team

·         work to date

·         next steps 

The Chair thanked Mr Smith and Ms Palin for their presentation and invited Members to raise questions.

Councillor David Healey asked who residents would contact for assistance concerning Adult Social Care and Children’s Social Care services, child protection and mental health issues. The Senior Manager Integrated Services explained there was a single contact number for all services and  the Emergency Duty Team provided an out of hours service.  The Senior Manager Children and Workforce agreed to provide information on the contact number for all services.

In response to a question from Councillor Ian Smith concerning treatment for ear syringing, Dr. Gareth Bowdler advised that the process had changed  and the patient was now assessed by the ear syringing services team and was not necessarily referred to a GP for treatment.

Councillor Hilary McGuill questioned how  the emergency or GP out of hours services, which may  result in an hospital admission, link up with single point of access services.  Mr. Smith responded that the aim was to work more collaboratively with the emergency services, however he acknowledged that it was currently work in process. 

Dr.Bowdler advised that the appropriate action was to call the GP out of hours service and link up into Community Resource  services.  Councillor  McGuill responded that this was difficult because the GPs out of hours service was operated by different GPs to BCUHB GPs.

Mr. Smith explained that  the vast majority of illness prevention and Ambulance service referrals took place during the day.  He said that the service had improved when the majority of people required the service which is during the day.

The Chair commented that more reassurance was needed that out of hours GPs have a strong link with the out of hours service to relieve the pressure on A&E rather than the ambulance being called and services deployed which may not be required in itself.

Mr. Smith responded that the majority of people are referred to the ambulance service in the middle of the day.  In general, what happens is that people call their GP  in the morning and then arrive in hospital in the evening.

In response to a question from Councillor Gladys Healey around care in the home and the need to avoid patients being admitted to hospital. Nikki  Palin explained that care was provided for individuals when a carer was no longer able to care for a loved one.  She said ongoing support for physio was provided  and the service also educated and supported  family members on providing care from a nursing perspective. 

Regarding questions and concerns on the recruitment of GPs, Dr. Gareth Bowdler advised that this was proving extremely difficult both nationally and locally.  He explained that discussions were currently being held to develop a strategy to improve the situation and commented on the  initiatives being considered to encourage GPs to work in North Wales, citing financial incentives, flexible contracts,  and optimising workforce skills to ease workload, as some examples.  He expressed the view that the issue was also due in part to a lack of recruitment in the past.

Responding to the further questions around management of GP practices, Dr. Bowdler commented on the risk assessments undertaken by BCUHB and the sub matrix recommended by the Welsh Government, which was used to identify practices at high risk.  He also commented on the support and initiatives provided to improve services and on the need to maintain provision. 

During discussion the representatives referred to the intention to build on community resources so that provision was available 24/7 to treat  patients when most vulnerable and also to provide urgent care clinics so people can seek treatment and advice on the day they feel unwell.

The Chair asked if some form of medical teaching/training  could be provided in North Wales which would encourage GP trainees to settle in the area as it appeared North Wales was disadvantaged in not having a medical teaching hospital/facility.  Dr. Bowdler advised that there was no opportunity in the near future for under graduate training in North Wales, however, Chester College would be providing  a pilot scheme in the future for post graduate medical training for GPs which would probably influence general practice in North Wales.

Responding to the further comments made by Councillor Mackie around the requirements for a  Welsh preference list, Dr. Bowdler explained that 3 months grace was being given to enable GPs to compile the necessary documentation.  He said that nationally consideration was being given to making the process as easy as possible to move from one area to another.

Members expressed concern that as BCUHB was in special measures and that GPs  may be discouraged from moving to the area. Dr. Bowdler said that he did not believe this was the cause and that the perceived workload may be a more significant factor in the decision making process.

The Senior Manager Children and Workforce referred to the development of the Authority’s housing stock and suggested that consideration be given to the opportunities that could be utilised through new housing development to attract GPs into the area.

Councillor Gladys Healey expressed concerns that physiotherapy services were no longer provided in her local  surgery.  Dr. Bowdler responded that  GP practices were given a fund to deal with as  they thought necessary.  Physiopherapy funding was different.  This was the first point of contact for physiopherapy and the patient was not necessarily referred to the GP for physio.  Examination, information and advice was provided. 

Councillor Cindy Hinds commented on the waiting time to get a GP appointment at some large local practices which she said was unacceptable and that in some instances residents had to wait 6 or 7 weeks to see their GP.  She referred to the new housing development in Flintshire and asked how the medical services would cope with the extra demand in the future. 

Councillor Carol Ellis reiterated the concerns expressed by Councillor Hinds regarding a lack of GP provision and the impact on medical services of new and planned housing development in Flintshire.  She asked what planning was in place to address the additional demand on GP patient lists and medical services.

The Senior Cluster Co-ordinator & Partnership Lead acknowledged the concerns raised and said that consultation took place between the Authority and the  Health Board.  She advised that the Health Board was keen to work with local developers to make a stronger contribution to the planning and infrastructure around new housing development in Flintshire.  In response to the further concerns raised by Councillor David Healey on the impact of new housing development in Flintshire, Mr. Rob Smith gave an assurance that liaison was taking place between the Authority and BCUHB to address the challenges raised.

Councillor Hilary McGuill asked what work was being undertaken to promote the North Wales area in medical schools.  Mr. Rob Smith said  BCUHB proactively marketed North  Wales to encourage both medical students and practising GPs to move to the area and reiterated the initiatives which were being considered to encourage recruitment.

Councillor Kevin Hughes asked what impact BREXIT had on the recruitment of medical staff.  Mr. Rob Smith advised that there was an issue recruiting sufficient nursing staff in one local hospital, however, there had been no problem with the recruitment of staff  in the Community Team.

Responding to a question from Councillor Hilary McGuill regarding whether GP patient lists were still ‘open’, Mr Gareth Bowdler confirmed that most GP surgeries in Flintshire had ‘open’ lists and this information could be forwarded to the Committee.  Dr. Bowdler outlined the stringent process applied should  a medical practice wish to ‘close’ patient lists.

On the subject of GPs pay, Dr. Bowdler explained that the income from BCUHB to general practices in North Wales was not much different to that in England.

Councillor Hilary McGuill asked if Patient Groups were being maintained.  Mr. Rob Smith confirmed that the Groups were in operation and encouraged and said he could provide a list for information.

Councillor Marion Bateman also expressed concerns around the unacceptable waiting times for GP appointments.   Dr. Bowdler acknowledged the concerns which he said was a national problem.  Mr. Rob Smith advised that if there were any specific concerns about a general practice BCUHB could provide support to address the issue.

Councillor Gladys Healey suggested that the bursary for training should be increased to encourage more people to train as nurses.

The Chair thanked Mr. Smith, Ms Palin and Dr. Bowdler for their attendance and responses to Members questions.

RESOLVED:

(a)       That the update be noted; and

(b)       That the Senior Manager Children and Workforce provide information on the contact number for all services.