The Committee received an update and
presentation from Liz Gaulton and Rose Uwins of the Coventry and
Warwickshire Integrated Care Board (C&WICB). Initially,
background was provided on the Integrated Care System (ICS), a
partnership of organisations that came together to
plan and deliver joined up health and care services. It explained
the role of the C&WICB and the IC Partnership, those which
rested with local authorities, care collaboratives and
The report set out the requirements to develop
an Integrated Care Strategy, to meet the assessed needs, from the
previously developed Joint Strategic Needs Assessments (JSNAs). In
Coventry and Warwickshire considerable work on integration had
already taken place. The Integrated Care Strategy would build on
this to further the required transformative change to tackle the
significant challenges facing health and care. The strategy
presented an opportunity to do things differently.
The ICP had agreed a work programme to develop
the strategy, led by a working group and with input from key
stakeholders. The draft strategy needed to be submitted to NHS
England for review on 14th December. The report outlined
the planned approach and format for developing the strategy,
signposting to existing strategies, the mapping which had taken
place and identification of proposed priority or ‘strategic
focus’ areas. The draft priorities had been discussed at the
Integrated Health and Wellbeing Forum, resulting in a series of
commitments that would run through the strategy.
Details were provided on engagement activity,
to ensure that development of the strategy and the Integrated Care
5-year Plan were done in an aligned and connected way. A separate engagement task and finish group had
been established for this purpose which
included broad representation from stakeholders. Wide public
engagement was also planned with over 30 scheduled events, planning
for more events and an online survey. Stakeholder engagement would
continue with regular updates, including with this committee.
The requirements to
produce a five-year Integrated Health and Care
Delivery Plan were reported. The delivery plan would be
refreshed before the start of each financial year and meet the
reported statutory requirements from the Health and Care Act 2022.
Further guidance was expected shortly from NHS England, which would
be provided to members via a stakeholder briefing.
The report concluded by referring to the
strategy content and next steps, as well as providing the national
timeline for producing the strategy and the five
year delivery plan.
The presentation included
- Integrated Care - a huge opportunity.
- ICS aims – improve outcomes, tackle inequalities,
enhance productivity and value for money and support broader social
and economic development.
- The ICS vision.
- Planning for the future –
development of the Integrated Care Strategy and 5-year Joint
- The vision for integration and collaboration
across the system to achieve the four key aims.
- Grounded in the reality of now. The strategy would
be built from local assessments, include consultation with
Healthwatch and statutory components of national guidance. It would
set out how assessed needs would be met, show regard to the
Secretary of State’s mandate and any guidance and set out
views on how health and care services could be more closely
- Engagement and involvement through a
phased approach. Additional information was provided on the
processes, the engagement undertaken or planned, and the feedback
received to date, which showed a number of consistent key themes.
These included access to GP services, trust in services and digital
services. Some patients could not access digital services and
others did not want to use them, preferring face-to-face
appointments. This was an area for further consideration on how to
approach digital services and working with patients.
- Through engagement and involvement the ICS had
iteratively developed the priorities for the strategy.
- The priorities:
- Improving access to health and care
services and increasing trust and confidence
- Prioritising prevention and
improving future health outcomes
- Tackling immediate system pressures
and improving resilience.
- The commitments:
- Improve outcomes
- Tackle inequalities
- Enhance productivity and value for
- Support social and economic
Questions and comments were invited with
responses provided as indicated:
- Several members thanked the ICB
representatives for the presentation.
- A question on the response from
rural parts of north Warwickshire and whether feedback had been
sought from organisations like the Citizens Advice Bureau (CAB) in
Atherstone. There had been a dialogue with the CAB, and it would be
checked if this included the Atherstone branch specifically.
Rurality was a recognised theme within the feedback on access to
services. It was questioned whether a mobile GP service could be
provided to rural areas similar to the mobile libraries. This
suggestion would be researched.
- A comment that some people did not
like to use digital services. Problems could be experienced using
online services if the options available didn’t meet the
customer’s needs. An example was given using a financial
institution to demonstrate this. There was a need to consider
service delivery options for those who could not access services
digitally. Liz Gaulton replied that the aim was to make best use of
digital services. This was the same for health and the County
Council’s services and there may be merit in working
collaboratively to give confidence to communities to access
services digitally. The councillor said that nationally the digital
service provision was the default and there should be more
consideration for those who could not access services in this
- On face-to-face appointments and
trust, patients also valued a relationship with their GP. It was
known that GP practices were, in the main, private businesses and
was questioned how the ICB was able to influence practices to
undertake more face-to-face appointments.
- Liz Gaulton explained the
ICB’s role to give assurance on the quality of GP services,
working in a collaborative way. Generally, this worked well but
this may be an area for more detailed focus with the appropriate
senior ICB officer at a subsequent meeting. Overall, patient
satisfaction was good.
- Rose Uwins added that the feedback
regarding GP access was much wider than just face-to-face
appointments. It included access to appointments and seeing the
right person first time, rather than having a GP appointment before
accessing the specific service needed. The member pursued this
change from the traditional route of a GP referral and it was
questioned how this would work. Rose
replied that this was a work in progress and options were being
considered. There were known workforce challenges. An example being
piloted in Coventry was the use of first contact practitioners,
linked to GP practices who would make the referral instead of the
patient seeing a GP. As pathways changed, these would be
- Dr Shade Agboola spoke of the duty
for GPs to engage with the system and its quality assurance
processes. She gave an outline of the better reporting arrangements
under the ICB structures, including regular performance management
reports. She attended the ICB committee and the recent report
showed an increase in the number of face-to-face GP appointments,
compared to the same period last year. These processes enabled
challenge and constructive feedback to be provided. For the first
time, it gave a clear line of sight for primary care services.
- Councillor Holland commented that
many people saw the move to the ICB as positive. Previously he had
asked how this change would be measured, or whether it might be
seen as another layer of bureaucracy, but he had not received a
clear response. He referred to the public question earlier in the
meeting and access issues for people in new housing developments.
The key issue was the shortage of GPs and he asked how the ICB
would address this. Liz Gaulton responded on the wider strategy and
the feedback received from stakeholders that improving access to
primary care services and building trust/confidence were key. It
had been suggested to have a dedicated session on primary care at a
future committee meeting.
- Reference was made by Councillor
Holland to the JSNAs. It was suggested that the boundaries selected
for these areas could have been more customer focused. He then
spoke about the ‘place-based’ approach. The primary
care networks (PCNs, groups of GP practices) had been based on the
JSNA areas and he asked if these could be changed to be more
cohesive. Liz Gaulton confirmed that the work on JSNAs had been
undertaken by the County Council. It was understood the methodology
used for grouping PCNs was more complex than just basing them on
JSNA areas. This could be covered in the subsequent session, or a
written briefing be provided on the methodology used.
- A point that having a consistent GP
meant they knew the patient’s medical history.
- A question about the progress made
in achieving needs identified through the JSNAs for each of the
places. Shade Agboola responded that the findings from the JSNAs
were used in formulating the Health and Wellbeing Strategy (HWBS),
for both Coventry and Warwickshire. In Warwickshire the place-based
programme had been completed for 22 areas. She explained that this
had been replaced with a thematic approach, giving examples of some
focus areas. The JSNA had influenced both the HWBS and the ICS
Strategy for the local system. She then advised how the JSNA
priorities were translated into actions through the three place
partnerships, drawn from the HWBS and with a series of local
priorities and strategies. This work was supported by the
Council’s Public Health and Strategic Commissioning teams.
Examples could be provided to the committee to show how identified
priorities had been implemented.
- Councillor Holland referred to the
background information circulated to the Committee, from a Health
and Wellbeing Board (HWBB) development session. Reference was made
to the linkages between this committee and the local system. This
document included a statement on shared accountability between the
local organisations. The councillor viewed that accountability
could not be shared, suggesting that the HWBB should revisit this
- Councillor Bell, as Chair of the
HWBB advised that an update from each of the place partnerships
would be provided to the January board meeting. Having met with
them recently, she gave a brief outline and example of how JSNA
priorities were being implemented. She confirmed that the HWBB was
accountable to this scrutiny committee.
- Further reference to digital
services with an example of the challenges faced by some elderly
people. A resident was moving to another GP as they were unable to
gain access to the surgery car park which required use of a mobile
- There would need to be follow up
reports to the committee with data on what had been achieved. It
was questioned how the ICB would collect data to show the direction
of travel and achievements. Liz Gaulton gave an outline of the
performance reporting arrangements. A meeting of the ICB would be
held in public later in the day and its agenda included a
performance update. She gave examples of the service performance
monitored, including that set by NHS England and which had
continued from the earlier clinical commissioning group
arrangements. There would also be locally set measures, to monitor
areas within the strategy, to assess what success looked like.
Examples were given around reducing waiting times, better outcomes,
service access and reducing inequalities. A report back could be
provided to the committee.
- On digital services, further
discussion about supporting communities on how to access services
in this way. This would include identifying barriers, seeing if
they could be addressed, but also recognising that some people may
not be able to use them and ensuring services were inclusive. It
was viewed that the emphasis was on people needing to learn and
change, rather than designing a service to meet their needs. It was
more about assessing the challenges, to see if these could be
overcome, but not relying solely on digital services. There were
many benefits from digital services, especially with the workforce
challenges and service delivery in rural areas. It was made clear
that no-one would be left without access to services.
- Chris Bain of HWW commented that the
greatest challenges for the ICS were workforce, culture and
unnecessary complexity. An example was the care collaboratives. He
referred to the key aims and would have added putting patients at
heart of everything you do. He drew comparison to the supermarket
Tesco which considered itself to be customer
‘obsessed’, with the customer benefit being the core
focus for every action.
- Chris Bain of HWW confirmed the need
for trust in services, but also in decision makers and the system.
There was a need for continual dialogue to build trust, to
‘sense check’ and to get early warning messages. The
voluntary sector was well placed to do this but needed support and
resources to do it effectively. On digital services, the aim should
be for a digital service which is part of the NHS, which works for
people who access it.
- On digital services, a further
aspect was the messaging. On most occasions, people were encouraged
to use an application or website. This shouldn’t be the first
option or indeed the only option. Also, the length of pre-recorded
telephone message options was frustrating.
- Examples of good practice were
provided by a member for their local practice which had effective
triage and offered rural home visits. Some people would never
access digital services and should not feel excluded.
- An important aspect was face-to-face
access for patients with dementia and their carers. Dementia cafes
were providing great community support and were often run by
volunteers. An example was provided in one member’s division.
However, when people were in crisis they were being signposted to
these voluntary services. This was a significant gap in the system
which needed resourcing and replicating in other parts of the
county. Dementia cases were not going to decrease. There was a need
to ensure this cohort had speedy face-to-face access to GPs and
specialist support. The member sought reassurance that this would
be taken on board. Councillor Bell asked if GPs received extra
funding to monitor dementia patients and undertake periodic
reviews. This would be researched but could also be raised at the
- Liz Gaulton thanked members for the
examples provided which demonstrated some issues in the local
- The Chair reminded of previous
comments she had made about GPs and the critical responses
she’d received from GPs. She was glad that the issue had been
recognised and stood by her earlier statements, expecting further
feedback. She was also pleased that GPs should not be seen as the
gatekeepers for accessing healthcare and this had led to backlogs.
The self-referral piece was a good start. She then stated the
immeasurable improvements at her local GP practice over the last
year, referring to the effective triage. This meant her health
needs had been resolved by seeing a nurse without needing a GP
appointment. Triage at the point of contact was a good idea but was
not necessarily provided by all surgeries. She was heartened by the
update. The lack of GP access was a significant issue for
residents, and she was supportive of a further specialist
conversation on this area.
- Rose Uwins confirmed that the
engagement work had highlighted the importance of access to GPs,
and it needed to be reflected in the strategy. It was about how to
support GPs to deliver what they could, given the workforce
challenges, to build trust and ensure that people could access the
healthcare system. Liz Gaulton added that this had been a useful
and honest discussion.
The Chair thanked the speakers for their
That the Committee notes the
presentation and adds to the forward plan for a specialised session
on GP services and access to primary healthcare.