Future Primary Care in the Black Country

12 August 2024 – 20 September 2024

Background

Primary care plays a central role in our communities, offering care, support and guidance to people at all stages of life. As the NHS Black Country Integrated Care Board (ICB), we are responsible for planning health services for the 1.26 million people in the Black Country. A key part of that responsibility is to make sure there is access to safe, timely and effective primary care services.

Primary care includes general practice, community pharmacy, dental and optometry services. These services are often the first places people go to for help with their health.

Right now, we are focusing on improving general practice and community pharmacy, while we also start to understand the issues facing dental and optometry services.

The NHS is facing increasing demand. We know that access to primary care is a challenge and that despite the hard work of those in primary care, the current way of working is not meeting the demand. There are a number of things that are creating the challenges now for general practice:

  • high demand for services
  • people are living longer and often with more complex and long-term health conditions
  • locally there are significant challenges that contribute to health and social problems
  • it is hard to recruit into some roles in primary care, the workforce is getting older, and we are losing doctors to more attractive roles.

Overview of Primary Care

Primary care is an essential and invaluable part of the NHS:

  • 95% of activity is delivered in primary care
  • 12% of ICB budget flowed into Primary Care FY23/24
  • £369 million spent on Primary Care in the Black Country FY23/24
  • 95% return on every £1 invested in primary care

Within the black country there are currently:

  • 27 Primary Care networks
  • 172 GP practices
  • 270 community pharmacies
  • 135 dental practices
  • 166 opticians

Providing care for 1.26 million residents.

Black Country Primary care is facing challenging times. There are fewer GPs per 10,000 patients and our patient satisfaction levels are lower than the national average.

How primary care is currently working

Primary care in the Black Country has been experiencing increasing demand for some time. We have increased the number of appointments provided in general practice every year for the last five years, despite patient lists growing and having fewer qualified GPs.

With this we have also seen an increased demand for same day appointments in a daily 8am rush. Same day appointments are important for patients who have urgent health problems and are made available each day so that people can see a health professional quickly when they need to. For less urgent needs, other appointments are available to be booked in advance. All appointments allocated are 10-minute slots regardless of whether they are same day or advance bookings. This allows practices to manage and provide an efficient and timely appointment service with a high standard of care, however for some patients with multiple health needs, 10 minutes is not enough time to discuss multiple health needs.

Currently, there are 172 GP practices within the Black Country who are working together through 27 Primary Care Networks (PCNs) groups to improve services.

PCNs bring together groups of connected local GP practices in Dudley, Sandwell, Walsall and Wolverhampton alongside community, mental health, social care, pharmacy, hospital and voluntary services to improve access, availability, and quality of primary care services. You can see a list of all GP practices, divided by Place and then by PCN (Primary Care Network). They also work together as the Black Country Primary Care Collaborative who are at the heart of transforming primary care services for the future.

Working alongside GP practices there are 271 community pharmacies. Patients can now get treatment for seven common conditions directly from their local pharmacy as part of the Pharmacy First scheme. This includes prescription-only medicines, including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions without the need to visit a GP.

The Pharmacy First scheme was launched by the government and NHS England on 31 January 2024 to give patients quick and accessible care and ease pressure on GP services. You can find out more about your local pharmacy and the service they offer here.

How we are already making improvements

We have already started to make improvements to the way primary care services work. These include:

  • Extended healthcare teams: We have introduced new roles into primary care that include advanced nurse practitioners, physician associate, healthcare assistant, first contact physiotherapy practitioner, practice- based pharmacist, mental health practitioner and health and wellbeing coach. These extended healthcare teams are highly skilled and knowledgeable in the areas they specialise in and can diagnose and treat a variety of health conditions. This means patients are seen by the most appropriate professional within the primary care setting, and GPs can focus on those patients who most urgently require their care.
  • Digital tools and data use: We have introduced new improved telephone systems and ways to access advice, appointments and services using technology. Added to this, we have developed ways to track and monitor health conditions away from the practice. Having this information enables better understanding of patient needs and streamlined services.
  • Enhanced access: Appointments are available on evenings and weekends. The enhanced access service provides patients with access to pre-bookable appointments between 6.30pm and 8.00pm Monday to Friday, and between 9.00am and 5.00pm on Saturdays, to ensure that people can receive care when it’s convenient for them.
  • Triage and navigation: Practice staff working at the reception desk are trained to ask patients a series of questions when they contact the practice. Using the information obtained, the person taking the call ensures patients have a timely appointment with the most appropriate health professional or service depending on needs. This is called triage.

Future primary care transformation programme

We have been listening to what you have told us as patients and carers as well as talking to staff working in primary care. Combining this feedback with the priorities for action recommended by the NHS nationally and other authoritative sources such as the Kings Fund, we are working to find solutions to the problems we are facing.

Looking to the future, we know that primary care needs to improve to make it work better for us all. The traditional way of providing and accessing primary care is not able to manage the increasing number of requests for care. By transforming our approach, we can create a more joined up, efficient and effective primary care system that meets the needs of our people and communities.

We have set out our ambition to improve primary care in an outline 5-year strategy which is available on our website and summarised in this document.

Priorities of the strategy

Our strategy focuses on the following key priorities:

  1. Enhancing and streamlining unplanned care: Improve access to unplanned care in general practice joined up better with community pharmacy making it easier for people to access the right support first time.
  2. Managing complex care needs better: Address the care needs of those in the Black Country living with one or more long term health conditions or disabilities by enhancing personalised care, ensuring continuity, and improving integration and collaboration among care partners.
  3. Patient and community activation for prevention: Equip patients with the knowledge, skills and confidence to manage their own health and care.
    Prevent local people from becoming unwell and those with diagnosed conditions getting worse, by working with health and care partners using shared data to provide the right services and resources for better health education and support.
  4. Skill and capability development: Enable primary care colleagues to perform at their best, with dedicated time to learn and innovate, as well as access to consistent education, training and development opportunities.

Our strategy is aligned with the ICB’s Five-Year Joint Forward Plan published earlier this year and the national direction of travel set out in the Fuller Stocktake report.

The goal is to do all we can to help local people stay well and to improve care, whether it is needed urgently or on an ongoing basis to manage long term conditions. We want to increase the time primary care staff spend on planned and preventative care, and by doing this reduce the amount of care that needs to be responded
to urgently. We also want to focus on building local primary care teams (not just GPs) working together more closely with other services to support people when their needs require urgent care. This will not only make it easier for people to get the help they need but also have a better experience.

Different types of care:

Urgent or unplanned care is care that is delivered when the person seeking care, and their health-care providers, did not anticipate that care would be required. Urgent care services provide immediate attention for unexpected illnesses or injuries that are not life-threatening but need quick medical intervention.

Planned care is care that is planned in advance, such as regular check-ups, ongoing treatment for long-term conditions and medical procedures or operations that do not need to be provided straight away.

Preventative care is about helping people stay healthy, happy and independent for as long as possible. This means reducing the chances of problems from arising in the first place and when they do, supporting people to manage them as effectively as possible. Preventative care includes vaccinations, screenings and lifestyle advice.

The strategy also describes how the ICB will develop other elements of primary care to support its vision, including:
  • promote wider use of the NHS app so patients can view their medical records, order repeat prescriptions, and manage routine appointments
  • provide more training to pharmacists to allow them to assess patients and make prescribing decisions without the need to involve a GP
  • further the roll-out of the minor eye conditions service across the ICB
  • working with local communities to design health initiatives that meet their specific needs, ensuring that care is both effective and culturally appropriate.
The starting point for developing the strategy was listening. We wanted to hear and understand the views, experiences and opportunities for improvement shared by local people, staff within primary care and representatives from a range of health and care organisations. During our listening stage we have:
  • talked with more than 800 people involved in primary care and the health system
  • used feedback and information from past plans and used insights from the latest GP survey in 2023
  • collected views and experiences from patients and the public through local People Panels and Community Conversations
  • collated insights gathered by partners like Healthwatch, and earlier involvement work.

You can view a summary of this listening work.

We heard:
  • People find it difficult to get through to their local GP Practice: we need to develop multi-channel approaches that make it easier for patients to contact their practice.
  • Longer appointments are needed: People with complex needs and lives need more time with their doctors.
  • Better communication is required: We need to improve how we communicate with patients about their care.
  • Access for all: Making sure everyone, including those with disabilities and whose first language isn’t English, can easily access quality care.

Key conversation areas

Our approach so far has been driven by involvement with the people who provide and receive primary care. We all agree that to continue to improve primary care, we need to develop the strategy further with ideas that come from our local community and that are supported by the health system.

We now want to understand local people’s views on areas in this strategy so that together with GPs and health leaders, we can start to improve things further.

It’s important that we continue to create ways for people whose voices all too often go unheard, to share their experiences of accessing or receiving planned, unplanned and preventative primary care services.

Some of the initiatives described in the strategy are already being put into practice throughout the Black Country but it’s crucial that we explore a range of different approaches to developing, raising awareness and improving confidence in new initiatives.

We would like to invite new ideas, and test people’s comfort, with how we might navigate patients towards other suitable services such as Pharmacy First, social prescribers and other community services to free up GP appointment availability.

We also want to hear what more could be done to help you stay well for longer and what other service providers, agencies and organisations you’d expect to see involved in co-designing the future of primary care as well as your care.

How you can have your say

We have launched the ‘Future Primary Care Conversation.’ This is your chance to help us shape the future of primary care.

You can take part in a survey if you live in Dudley, Sandwell, Walsall or Wolverhampton. The survey is open until 20 September 2024 and can be found online.

Call us on 0121 612 1447 and a member of the team will help you to complete the survey (this will take around 20 minutes). If English isn’t your first language and you’d like help completing the survey over the telephone with the assistance of an interpreter, call us on 0121 661 7501.

To sign up for a People Panel please visit our events page:

  • Dudley – 16 September 2024, Brierley Hill Methodist Church
  • Sandwell - 11 September 2024, Jubilee Park Community Centre
  • Walsall – 5 September 2024, Darlaston Town Hall
  • Wolverhampton – 18 September 2024, Graiseley Family Hub

If you’d prefer, you can contact your local HealthWatch:

If you are a member of or lead a community group or Patient Participation Group in the Black Country and would like to share the invitation to have your say with your network or members, please email involve.blackcountry@nhs.net to find out what support and resources we can help you with.

If you require this in another language or format such as large print, braille or easy read please contact the involvement team on 0121 612 1447 or email involve.blackcountry@nhs.net.

What happens next?

Your feedback will be collated and shared with primary care and community partners.

There will then be opportunities for you to continue influencing and co-design how the ambition and initiatives in the strategy are put in place at more local and practice level, in partnership with health and care leaders.

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