ICB Board Meeting 14th April 2024: a report
Meeting in-person-only in outer Hillingdon with a reduced invitation-list of partners, the NWL ICB Board initially planned not to webcast its first Board Meeting since the Same Day Access plans became public, held on 17th April.
A few hours before the meeting was due to begin, the ICB did post up a webcast link. This link reported itself “unsafe” in many web browsers; the webcast itself lacked roving camera technology to make the conversation comprehensible to remote viewers; and the ICB afterwards claimed the audio was so poor that no recording can be provided.
Nevertheless, Save Our Family Doctors have been given a TRANSCRIPT of the Same Day Access part of this meeting!
In this the ICB make clear that they are pushing ahead with their plans for Same Day Access hubs with triage-at-scale that will radically break up General Practice and end continuity of GP Surgery care for most patients.
Bafflingly, rattled CEO Rob Hurd repeatedly told the meeting that “nothing is changing on the 1st April”, despite speaking to a meeting held on the 17th April. Otherwise, with just one exception (see the bottom of the page), there was no critical questioning of the Board by supine invited partners.
Much of the Same Day Access discussion at the meeting was taken up with increasingly futile attempts by Board Chair Penny Dash to glean from partners evidence – any evidence – that the ICB possesses data or understanding of what she admitted are huge variations in patients’ experiences of GP access across North West London.
ICB CEO Rob Hurd said:
“We have a national policy as outlined in the Fuller [Stocktake] around same day access. We are not here to reconsult on those matters. We do not consult on policy that is national.”
“We’re going to spend the next year working with our Primary Care Networks … to provide a different – potentially different – same day access model … case by case.”
“We are not deviating from this path, and we will appropriately consult at a local level if necessary.”
SOFD says:
Alongside minister Andrea Leadsom, senior figures at NHSE insist that NWL’s hub triage-at-scale model is NOT nationally mandated.
Potentially different? The ICB is mandating Same Day Access hubs from April 2025 on all GP Surgeries who don’t want to lose up to 20% of their funds or have their patients barred from wider services.
Meaning: “we’ll let you tweak a few details locally, but basically you’ll have to like it or lump it”.
ICS Medical Director, Genevieve Small said:
“The July board meeting would be a completely appropriate time for us to be able to clarify where we have got to in co-design with the Local Medical Committee … I think that being able to have conversations in depth with our community will really only make our proposal stronger.”
“Some of our Practices offer exemplary access and others really struggle.”
Save Our Family Doctors say:
“Co-design” or attempted financial coercion, Genevieve?
Then why aren’t you working to spread that good practice, rather than leveling everything down and destroying the continuity-of-care models of your better GP Surgeries?
A member of the public had submitted a good question about whether the ICB has any data on variations in GP access in North West London and what those variations might signify…
ICS Chair, Penny Dash said:
“We have loads and loads and loads of data on what’s actually happening … captured at the Borough-Based Partnership level and I think at PCN level.”
“There are very different models out there. We know that, out of our 400 – 360, whatever – GP Practices, in North West London, people work in very, very different ways, and part of this is about trying to take the best practices and replicate those.”
Save Our Family Doctors says:
“Loads and loads and loads of data?” Really? Where?
Then why don’t you try actually to do that, Penny, instead of ripping up good practice for a one-size-fits-all break-up of General Practice in your area?
An unidentified partner at the Board meeting said:
“Brent Scrutiny in May2022 received a really interesting report on GP access. I would refer the whole ICB to look at that, because there’s some really interesting learning.”
Save Our Family Doctors says:
We agree. This Report ‘No One Left Behind’ recommends developing – with Patient Participation Groups and Primary Care Networks – a baseline ‘Access and Treatment Standard’ for all GP practices to sign up to. Such a Standard should (a) include emergency and urgent needs being triaged within four hours, (b) draw otherwise on best practice elsewhere in NWL, and (c) be aligned towards the upper end of a very variable picture of patient GP access and experience.
Of course, none of this would require reducing GP Surgeries to refer-in services solely for those coded as complex long-term sick.
Another unidentified partner at the meeting said:
“The message that’s gone out … has been that it’s a communication issue, and we’ve used the word: that people have ‘misunderstood’. And I think we probably need to think really carefully about that. I think it’s an engagement issue. The suggestion with it being a communications issue is that we’ll just get communications right and we’ll do the same thing again. And I think that is the message that people are getting … I would try to avoid using the word ‘misunderstanding’.”
“In the end, it doesn’t matter particularly what the delivery mechanism is, provided that the outcomes that they deliver are of a comparable quality.”
Save Our Family Doctors says:
Indeed.
Exactly. The ICB is attempting to mandate a delivery mechanism instead of working with General Practice and Patient Participation Groups in North West London to identify and mandate high outcomes and quality.