Our first annual meeting, held in September 2023, looked back at the performance of NHS Kent and Medway during its first nine months as an organisation.
A quesiton and answer session took place at the end of the AGM. The questions and answers can be found below.
We fully endorse and work closely with the Kent and Medway Medical School. Now, people who want to train locally as doctors can do so. We have also supported recruiting additional roles into general practice, such as physiotherapist, pharmacist, counselling staff – there are now more than 700 additional roles in practices across Kent and Medway. We have also provided guidance to GP colleagues to help them retain team members, especially in some of the most challenged geographical areas.
As part of the Primary Care Access Recovery Plan, We are committed to addressing the interface difficulties highlighted in the recovery plan (onward referrals, fit notes, discharge letters, call and recall and clear points of contact). We are leading a primary and secondary care Interface forum and updates will be provided to our Board in November.
We work very closely with primary care looking at the areas of most need.
Our Board is considering development of healthy living centres across all parts of Kent and Medway, which will allow GPs to come together with other health and care providers. We’re involved in the business case around Chatham Healthy Living Centre; and in the work in Edenbridge, pulling together the plans for a multi-use space. Those are buildings which GP practices will occupy as part of our estates strategy, looking at how we make best use of our estate across health and care.
A lot of GP practices are privately owned and the ICB is working with primary care to support and make sure the investments they might want to put in their own buildings are value for money.
We receive an allocation delegated by NHSE to cover the costs of general practice. The main purpose of this allocation is to fund contractual costs associated with general practice, including primary care networks. The contract payments made by the ICB to practices and primary care networks are in accordance with national contracts or directions.
The ICB has an allocation of £341million for delegated GP medical services for 2023/24 and has set a balanced budget for this year. It is expected that £337million (98.8 percent) is required to cover recurrent costs of general practice. The balance of £4million (1.2 per cent has been set aside to create an investment reserve and a contingency to mitigate financial risk during the year.
NHS Kent and Medway is committed to supporting primary care, and as such, while the ICB is now able to remove the ringfence from primary care budgets, it has not done so and assumes this funding within primary care in its annual plan.
Hearing loss can occur for a number of reasons which include the accumulation of wax blocking the ear as well as other rarer conditions such as acoustic neuroma.
Ear wax removal is available from GPs using ear irrigation (but not ear syringing) which is funded by the ICB through a primary care quality standard, if self-care using ear wax softeners has not worked. Ear wax softeners can be brought over the counter. Microsuction to remove ear wax is funded by the ICB if ear irrigation is not successful after two attempts or if there is a medical reason why ear irrigation is not appropriate.
You can also speak to a pharmacist about ear wax build-up and they can give advice and suggest treatments. Find further information on the NHS website.
Care navigators and reception teams attend a two-day course that teaches them to recognise and allocate patients with urgent health needs and when to seek advice and guidance from registered practitioners.
The course also enables them to allocate patients safely into face-to-face or phone appointments, with an appropriate practitioner or service.
The focus of the course is safety of the patient journey, but does not deter from the need to liaise with a registered clinician for advice and guidance. This is reliant on three core principles, however, as the training is just one part of it:
- Robust agreed protocols are implemented in practices to support the initiative.
- A full commitment from the whole team to support the reception staff is implemented.
- Continuing audit of activity and outcomes to identify best practice and areas of improvement.
The Community Pharmacy Consultation Service (CPCS) where GP practices can refer patients to be seen or contacted by phone by community pharmacies for same-day minor illness consultations has been in place in Kent and Medway since June 2021 with 27,351 consultations completed to date.
Both the CPCS and Pharmacy First schemes allow community pharmacies to sign up to deliver them. They are not mandatory for community pharmacies, which receive additional funding when they participate.
Most community pharmacies in Kent and Medway are signed up to CPCS. The schemes provide improved same-day access to patients for minor illness conditions and free up capacity in GP practices so they can manage more complex patient issues and long-term conditions.
Community pharmacies do not currently have access to patient records and this is not considered a requirement when consulting on minor illness presentations.
There isn’t a statutory requirement for medication review to take place, but best practice is for PCNs to carry out structured medication reviews (SMR) for people:
- in care homes
- with complex and problematic polypharmacy, specifically those on 10 or more medications
- on medicines commonly associated with medication errors
- with severe frailty, who are particularly isolated or housebound or who have had recent hospital admissions and/or falls
- using potentially addictive pain management medication.
Where PCN clinical pharmacist capacity allows, and where patients are not covered by the criteria above, PCNs should also consider offering a SMR to any other patients they think would benefit from one, including those prescribed multiple but fewer than10 medications.
We agree the voluntary sector is essential to delivering the right services in the right places and will be critical to the delivery of the integrated care strategy. We recognise funding is important for this sector and are looking at how we can make sure that is done on a longer term basis, as we recognise the difficulty in funding short-term pieces of work.
Part of our role is to bring all parts of the system together and to have open and respectful dialogue. We are reviewing our governance structure to reflect the range of voices that need to come together to drive these changes. Three of our four health and care partnerships have now appointed a medical director from the primary care community to be a key voice for primary care and to link with the medical director inside the hospital to allow professional dialogue.
We, along with our trusts, are collectively committed to this agenda and the ICB’s EDI improvement plan is part of that. We’re sharing good practice across all our organisations in Kent and Medway, and there are joint talent programmes where colleagues, who may have previously faced challenges are being lifted up. We are working with colleagues to understand their lived experiences and what needs to change to make things better for them.
As an integrated care partnership, working with Kent County Council and Medway Council and other partners, the ICB is working to maximize Section 106 benefits. Section 106 benefits are where developers contribute towards public services, including schools, hospitals, parks, sporting and healthcare facilities. As an Integrated Care Partnership (ICP), we will make sure economic development is considered so the infrastructure is there for any new developments.
In Kent and Medway, PCNs are an important part of the future. The ICB will continue to develop these positive partnerships as part of the primary care strategy.
There is a clear, well publicised two-stage process for NHS complaints – local resolution and then the Parliamentary and Health Service Ombudsman if a person is unhappy with the outcome or handling of their complaint once local resolution is concluded.
It is helpful for practices to see the complaints as it gives them a chance to respond and to address concerns. If people do not wish to complain direct to their practice, they can complain to the South East Complaints Hub about any primary care services. All NHS services should publicise their complaints procedure on their websites.
Organisations, which provide NHS services,should also have the opportunity to respond and address concerns raised.
Free advocacy is available for people wishing to complain about the NHS if support is needed.
As NHS Kent and Medway is just over 12-months-old, we recognise it will take time for people to understand the organisation and what it does.
We work closely with Healthwatch and other organisations to make sure we are listening to all concerns, including those outside of complaints processes.
We have been working hard to hear the views of the people across Kent and Medway for much of this year. We want people to help us design how health and care services will work for them into the future. We have heard from thousands of people through events, social media, survey responses, meeting attendance and ideas boards. These views are vital to creating our final integrated care strategy.
We are always keen to hear the views of people living and working in Kent and Medway and consider them alongside data around population needs. In Deal, this has resulted in a plan to add some blood testing capacity for specific conditions into the local area. Find further information on our website.
Decisions on what services to place where are taken by looking at local needs and the local population and designing services to meet those needs.