Agenda item

The Committee considered a report of the Integrated Care Board (ICB) which provided an oversight and summary on Primary Care services that were commissioned by the ICB and delivered by Primary Care providers (GP Practices) across Leicester, Leicestershire and Rutland (LLR). The report also provided specific information on the Melton area with regards to the current and future delivery of Primary Care services. A copy of the report, marked ‘Agenda Item 8’, is filed with these minutes, along with a separate document containing answers provided by the ICB in response to questions from the Committee about ratios of GPs to patients.

 

The report was presented by Yasmin Sidyot, Deputy Chief Operating Officer – Integration and Transformation, ICB, and Mayur Patel, Head of Integration & Transformation (Primary Care), ICB. Toby Sanders, Chief Executive, ICB was also present to answer questions.

 

The Committee welcomed to the meeting for this item Mr. A. Innes CC (Melton East division), Mr. B. Lovegrove CC (Belvoir division), and Mr. J. T. Orson CC (Melton Wolds division).

 

As part of discussions the following points were made:

 

(i)           Members expressed disappointment that the report focused on the whole of LLR and did not give sufficient detail regarding GP provision in Leicestershire, which made it difficult to scrutinise the topic. Members requested the information be broken down to electoral division or individual GP Practice level. In response the ICB stated that they would provide more detailed data to the Committee after the meeting but explained that there were limitations on what could be provided as they were reliant on how the data was collected nationally. There were also data protection concerns as patients might be identifiable if data was provided at individual GP Practice level.

 

(ii)         In response to further questions from members about the ratio of GPs to patients, it was explained that there was no national guidance on the number of GP practices per geographical area or per population size. Locally the ICB used a benchmark of 75 primary care appointments per thousand population, but this was not part of the formal contract with GP Practices. This figure was used by the ICB to identify where there was significant variation in levels of provision across LLR.  A member raised concerns that focusing on an average across a large area could mask serious access problems in some (rural) areas. The ICB agreed to provide data on GP to patient ratios in Leicestershire after the meeting.

 

(iii)        The ICB submitted that the level of access to GP Practices in Leicestershire compared well with the national and regional picture, though acknowledged that improvements could still be made locally and recognised that the public were raising complaints with elected members about access.

 

(iv)       Concerns were raised by members that because patients were not able to get appointments at GP Practices this was displacing demand elsewhere and putting pressure on other services such as the Emergency Department. It was questioned whether the capacity of primary care was genuinely being increased or whether capacity issues were being masked by displacement. In response the ICB said that the numbers of patients attending the Emergency Department was not greater than had been planned and no peaks had been seen, but work would continue to ensure that patients attended the most appropriate place for the treatment they required.

 

(v)         Members welcome the use of the NHS 111 telephone line and the increased use of digital tools by the NHS such as the NHS app and other online services. However, it was questioned how effective these services were at directing patients to the right service and whether demand was being incorrectly displaced elsewhere. In response it was explained that the NHS 111 call handlers used an algorithm set nationally and whilst they did not always provide the right advice to a patient, reviews of the calls took place to see what could be learnt and what improvements needed to be made to the process.

 

(vi)       Members raised concerns that there was unwarranted variation between GP Practices and in particular that different GP Practices were using different technology which caused confusion for patients. In response reassurance was given that there were only two booking systems being used by GP Practices in LLR. The ICB explained that although GP Practices had a large degree of independence, the ICB was sending clear messages to GP Practices about using standard procedures. The contract with GP Practices specified that patients should be able to contact the Practice by phone if their issue was urgent or episodic, and if it was non-urgent they should be able to communicate with the practice online. Therefore, these requirements should be implemented consistently across LLR.

 

(vii)      Whilst the national contract with GP Practices covered same day access, it did not specify the number of same day appointments that were required. Therefore, the ICB had commissioned the Same Day Access service. This service used an enhanced navigation and triage process to enable patients to receive same day access care in a General Practice setting, where their needs could not safely wait for the next day or a routine appointment at their registered General Practice. On average there were over 35,000 Same Day Access appointments available throughout the year offered Monday to Sunday. A member stated that patients should always be able to get a same day appointment as standard, and also submitted that whilst 35,000 sounded a large number of additional appointments, per GP Practice it was not many. The member again questioned whether capacity had genuinely increased. In response the ICB confirmed that the Same Day access appointments were in addition to the routine appointments and emphasised that this was a significant improvement on the number of appointments that had been available previously.

 

(viii)    Not all appointments at GP Practices were with a GP. There was a mixture of staff roles within GP Practices that could be utilised depending on the patient’s needs.

 

(ix)       The report set out the approximate number of GP sessions ‘saved’ by utilising Pharmacy First. In response to a question from a member as to what ‘saved’ actually meant, it was explained that the GP was not free during the time saved, they were instead carrying out other appointments. The terminology just referred to the number of extra hours that the GP would have had to work had the Pharmacy First service not been in place. The member asked if the Committee could be provided with the throughput relating to hours saved, i.e. how many more patients were then seen, that would not otherwise have been, and the ICB agreed to provide this data.

 

(x)         Did Not Attend (DNA) rates within General Practice had risen significantly across LLR within the previous 3 years.  Members raised strong concerns regarding this and questioned what the reasons for the DNAs were. The ICB explained that they were investigating the causes of DNAs and would be carrying out a full analysis and the results would be available by the end of March 2026. It was known that the reasons could vary between different GP Practices and the majority of DNAs related to appointments on the same day that they had been booked. Members emphasised that the NHS needed to be firm with patients that did not attend appointments. The ICB agreed with this but clarified that the penalties for patients that missed appointments were limited. Work was taking place to make it easier for patients to cancel appointments. The role of the ICB was to give the GP Practices the tools to tackle the issue, but the ICB could not specify exactly how the GP Practices approached it. In response to a question regarding the cost to the NHS of people not attending appointments, the ICB agreed to provide this information after the meeting.

 

(xi)       In response to a question on whether GPs working part time had an impact on patients being able to obtain appointments, it was explained that the ICB did not have the data for part time working, they only had the data for full time equivalents. However, the ICB agreed to look into this query and provide a response to the Committee after the meeting.

 

Melton

 

(xii)      Latham House Medical Practice was the largest in LLR and the only Practice in the Melton area. It was part of the Melton, Syston and Vale Primary Care Network. The next largest GP Practice in LLR was Market Harborough Medical Centre. There were only 63 practices larger than Latham House in the whole country; some of these were single-site and some were multi-group. The ICB submitted that there were advantages to having large practices such as being able to provide a greater skill mix amongst staff. The size of the Practice was not a trigger for a new Practice being required, therefore members queried what would trigger the ICB to consider the need for a new Practice.

 

(xiii)    The data in the report related to the Melton, Syston and Vale Primary Care Network but Syston was not in the Melton area. Members asked for the data to be disaggregated so it just related to Melton.

 

(xiv)    Published data from NHS Digital (from 2020 to August 2025) showed only a 3.19% increase in patient registrations at Latham House Medical Practice. In response Melton members submitted that the additional need was there and the public had a negative impression of Latham House Medical Practice which was why they were not registering. The ICB re-iterated that in their view there was no evidence, according to local and nationally published appointment data, that Melton should be prioritised above other areas across LLR for investment in additional Primary Care service provision. It had been concluded by the ICB that Latham house did not stand out in terms of level of access, or appointments available. Members therefore queried which localities in Leicestershire had a greater need than Melton.

 

(xv)     The Melton members felt let down by the ICB and pointed out that in 2022 the ICB had acknowledged that there was a need for an additional GP Practice in Melton and at that time had agreed to put together a business case, so members therefore questioned what had changed in the intervening period. It was noted that there was a different Chief Executive of the ICB in place in 2022. Members felt that the current position of the ICB was particularly surprising given the amount of new housing that was now planned in Melton. Members emphasised that conversations about demand caused by new housing needed to take place well in advance of the housing being built.

 

(xvi)    According to the ICB no issues had been raised in terms of the quality of the services provided by Latham House Medical Practice. In response Committee members pointed out that whilst the latest inspection report of Latham House Medical Practice from the Care Quality Commission (CQC) gave a ‘Good’ overall rating, the CQC had not reviewed Latham House since March 2020 therefore their assessment could be out of date. Members had received anecdotal reports regarding poor quality service at Latham House, though acknowledged the situation might be improving.

 

(xvii)  The ICB did not receive capital funding to develop new practices itself. GP Practices were funded on a per registered patient basis therefore if there were no patients there was no income stream. It was uncommon for new GP Practices to be started with no previous infrastructure. Section 106 contributions could be used for capital projects such as GP Practices, but they were unlikely to be enough for a whole new Practice. They were usually used for smaller projects such as new consulting rooms in an existing practice.

 

(xviii) A decision on a second GP Practice in Melton had been paused until 2027 and in the meantime the ICB was working with Latham House Medical Practice to improve the patient experience including the telephone and booking procedures.

 

(xix)    The ICB offered to organise a meeting between the Melton Councillors and Latham House and this offer was accepted by the Melton Councillors.

 

RESOLVED:

 

(a)        That the update on Primary Care services in Leicestershire be noted with concern;

 

(b)        That the Integrated Care Board be requested to provide a further update to a future meeting of the Committee regarding the plans for Latham House Medical Practice and primary care services in the Melton area.