GP Access Report - Spring 2008democraticservices.hounslow.gov.uk/documents/s47592... · primary care services. This is the starting point for this piece of work – it seeks to establish

ADULTS HEALTH & SOCIAL CARESCRUTINY PANEL & EALING,HAMMERSMITH & HOUNSLOWLOCAL MEDICAL COMMITTEE

GP ACCESS PROJECT - SPRING 200817 February 2009

Contents Foreword..........................................................................................................2

Introduction ......................................................................................................4

Membership of the Panel .................................................................................6

1.0 LOCAL BACKGROUND AND CONTEXT 7

2.0 NATIONAL DEVELOPMENTS: HEALTHCARE FOR LONDON

AND THE EQUITABLE ACCESS TO PRIMARY MEDICAL

CARE PROGRAMME 7

3.0 PURPOSE OF THE SURVEY 9

4.0 LIMITATIONS IN ANALYSIS OF SURVEY RESULTS 10

5.0 SURVEY RESULTS AND ANALYSIS 12

APPENDIX 1 - BRENTFORD AREA DEVELOPMENT HEALTH IMPACT

ASSESSMENT ..............................................................................................29

APPENDIX 2 - CASE STUDY: ARBOUR WAY DEVELOPMENT, TOWER

HAMLETS......................................................................................................35

APPENDIX 3 - PHAST REPORT EXECUTIVE SUMMARY ..........................37

APPENDIX 4 - GP LOCALITY BOUNDARIES ..............................................41

APPENDIX 5 - DISTRIBUTION OF PATIENTS REGISTERED TO A

PRACTICE BY RESIDENT POSTCODE.......................................................42

1

Foreword Cllr Jon Hardy Chair of the Adults Health & Social Care Scrutiny Panel Access to high quality primary care services is something that matters to all our residents. For many of them, GPs are a gateway to other health services and are the first port of call when they want to see and talk to a health professional. Members of the Adults Health & Social Care Scrutiny Panel and other Councillors through their knowledge and experience of the Borough and from talking to residents are aware of the acute inconsistencies there are in access to GP services in different parts of Hounslow. A key contributory factor to these inconsistencies in access has been the rapid population growth seen in particular parts of the Borough over the last few years. Notwithstanding such external factors, I do not believe that where you live in Hounslow should dictate the ease by which you are able to access primary care services when you need them. In order to effectively address any such inconsistencies in service provision, our health colleagues in the PCT who have responsibility for commissioning primary care services need to have an accurate picture of current access to primary care services. This is the starting point for this piece of work – it seeks to establish some robust baseline data on the Full Time Equivalent (FTE) hours worked by GPs in the Borough and the knock-on implications this has for residents in terms of their access to primary care services. The environment in which residents receive health services continues to change at a rapid pace. Since this survey was conducted, the Department of Health’s requirements for Practices to offer extended opening hours will obviously have had a significant impact on the level of access residents have to GP services going forward. The PCT has also received additional funding from the Department of Health for 3 new Practices in the Borough. The PCT is also currently working with Practices to address the variability in quality of primary care services and ensure that all Practices are able to deliver a high standard of care to their patients. This survey is therefore only one part of a much bigger picture. The changing landscape of primary care services will require us to continue working closely with health colleagues to understand the primary care health needs of our residents and ensure that any changes to services contribute to closing the gap that currently exists between the best and worst in terms of access to and quality of primary care services. The Panel through its work will endeavour to continue to raise these issues with health colleagues and work with them to ensure all our residents receive the services they are entitled to.

2

I would like to take this opportunity to express my thanks to the Londonwide Medical Committees (LMC) and in particular Dr Fay Wilson (who was LMC Secretary for the North West London region at the time the survey was carried out). Dr Wilson was instrumental in designing this survey and also working closely with GPs to encourage them to respond. I would also like to thank Cllr Andrew Dakers who recognised that this was an important piece of work from the outset and gave up his time to support this project from start to finish. Finally I would like to thank all those GPs and Practice Managers who took the time to complete this survey. Your efforts are greatly appreciated.

3

Introduction Cllr Andrew Dakers Brentford Ward Councillor & Overview and Scrutiny Member

As a ward Councillor, I have been acutely aware of the concerns that many local residents have raised in relation to the significant and large scale housing developments in the Brentford area over recent years. Understandably residents are worried about the impact of the increase in population from these developments on the provision of public services and in particular what it means in terms of them accessing their local GP. In responding to these concerns the Adults Health & Social Care Scrutiny Panel in January 2006 commissioned a health impact assessment on the Brentford Area Development. This piece of work recognised that it was likely there would be a need for increasing local health facilities in line with the rising population. Although concerns around population growth are particularly acute for residents in Brentford, I see the provision of primary care services and infrastructure as a Borough wide issue. Establishing some baseline data on actual GP hours, not just the number of GPs we have in Hounslow is key to understanding the level of provision that is available to our residents and what is needed going forward. I am pleased that the Adults Health & Social Care Scrutiny Panel were able to take forward this piece of work and glad that they recognised the value of what we were trying to achieve in collecting this data. There have been some frustrations along the way, including the lower than expected response rate and the time taken to turn this piece of work around. However it must be noted that this is the first time that GPs have been asked to provide this sensitive data. I recognise that we do not yet have a complete picture as to current levels of primary care provision but I am confident that we are moving in the right direction in terms of better understanding the primary care health needs of our residents. It is my hope that moving forward Hounslow PCT will now start to gather this data – with the support of GPs – as part of their contractual relationship on an annual cycle. This is already the norm in many other PCT areas and without this data Councillors and the wider community cannot be confident in the adequacy of local health care provision. The pie charts in appendix 5 extracted by the PCT from the Exeter computer system and National Strategic Tracing Service (NSTS) show the distribution of patients registered to a practice by resident postcode. It would be extremely useful if the PCT provided this data annually to councillors to help us better understand changing trends in local service usage.

4

The evidence we have gathered confirms that most people go to relatively local GPs. That is why having this information on GP service provision and capacity in the public domain, and collected annually by the PCT, would help people determine which GP practice in their local area is most suited to their needs as a retired person or a full time worker, for example. Only then will people really have meaningful choice of service. I welcome the news that one of the 3 new GP Practices Hounslow PCT has received Department of Health funding for, will be situated in the Brentford area. I will continue to take an interest in monitoring how quickly these new services come on stream and how other developments in primary care address the needs of our increasing population across the Borough.

5

Membership of the Panel

Chair

Cllr Jon Hardy Cllr Felicity Barwood Cllr Ruth Cadbury Cllr Ajmer Grewal

Cllr Barbara Harris Cllr John Howliston

Cllr Paul Jabbal Cllr Peta Vaught

Co-optees Rea Mattock .

6

1.0 LOCAL BACKGROUND AND CONTEXT 1.1 For some time now, local Councillors and residents have been raising

concerns in relation to the capacity of primary care services for residents in the Borough. These concerns have been raised in the context of the pace and size in growth of residential developments that are taking place particularly in the Isleworth and Brentford areas - because health infrastructure has not developed at the same rate as new residential developments, existing primary care capacity, has had to stretch to cope with an influx of new patients. These concerns are further supported by the Health Impact Assessment on development plans in Brentford that was commissioned by the Adults health and Social Care Scrutiny Panel in 2005. Key findings and recommendations from this assessment are attached at Appendix 1.

1.2 Councillors continue to have acute concerns on the implications that an

increasing population will have for a patient’s access to primary care services as well as the quality of care they receive.

1.3 These concerns have been further compounded by the Council’s

historical difficulty in securing what Members feel are adequate S106 contributions for health and health infrastructure from developers.1 There is strong evidence which indicates that where there is insufficient detail on existing health need/capacity a local authority may be unable to secure health contributions from a residential developer. For further details on this please refer to Appendix 2 which provides a summary of the judgement in the Arbour Way development in Tower Hamlets.

1.4 Councillors are also aware that Department of Health funding to

Hounslow NHS, is population based and that the Office of National Statistic figures used to help determine the funding allocation the PCT receives, undercounts the population by approximately 17,7002 people and therefore does not represent the true number of people in the Borough. Again, Councillors are concerned of the impact this will have on access to and quality of primary healthcare services as well as the knock on implications for hospital and other secondary care services.

2.0 NATIONAL DEVELOPMENTS: HEALTHCARE FOR LONDON AND

THE EQUITABLE ACCESS TO PRIMARY MEDICAL CARE PROGRAMME

2.1 In December 2006, NHS London (the Strategic Health Authority for

London) asked Professor Lord Darzi to develop a strategy to meet Londoners' health needs over the next five to ten years. The strategy,

1Note that developers are required to minimise the negative impact of a development on a local community and carry out tasks which will provide community benefits as set out in Section 106 of the Town and Country Planning Act 1990. 2 The Greater London Assembly (GLA) contend that the ONS figures not only under-count the population of most London boroughs but also under-estimate the rate at which numbers are growing.

7

known as Healthcare for London: A Framework for Action was published in July 2007 and sets out NHS London’s vision for future healthcare in the capital.

2.2 The vision for primary care services in Healthcare for London, is based

around the model of a polyclinic (the future base for most GP services, diagnostic services and outpatient activity). Polyclinics can either be co-located at hospital sites or can be free standing in the community. Three options for how they may be organised is presented in the diagram below:

2.3 Implementing this model of primary care services will inevitably impact

on the way in which primary care services are currently delivered. In Hounslow, the Heart of Hounslow (in the Central Hounslow area) is being developed as a polyclinic site, and an Urgent Care Centre will deliver primary care services at the front door of the West Middlesex University Hospital site in Isleworth. Both these centres will provide much needed additional primary care capacity and help divert patients from A&E. It is envisaged that the smaller Practices in the Borough will need to move to a networked polyclinic model in order to provide the range of services primary care needs to be able to deliver in the community as opposed to a hospital based setting.

2.4 The NHS Next Stage Review Interim Report (October 2007) carried out

by Lord Darzi recognised that currently access to primary medical care services and the quality of those services, continues to vary significantly across the country. In order to address this inequality in provision, the Government has made new investment available to allow the

8

commissioning of at least 100 new General in Practices in the 25% of PCTs with the poorest provision.

2.5 As part of this programme, Hounslow NHS has been selected to receive

investment to allow it to commission 3 new Practices in the Borough. 2.6 In order to help determine the location of the new Practices, the PCT

commissioned the Public Health Action Support Team (PHAST) to write a report which considered geographic variation of healthcare need and current provision of primary care services. The executive summary from the PHAST report is attached at Appendix 3. Findings from the report support the PCTs decision of locating the new Practices in the following localities: Hounslow (Heart of Hounslow), Feltham, (Feltham Health Centre) and Brentford (location to be determined).

2.7 It is hoped that these 3 additional Practices will go some way to

improving access to primary care services for local residents. 3.0 PURPOSE OF THE SURVEY 3.1 Councillors were aware that at the time the survey was conducted, data

on current capacity of primary care services in the Borough was not as robust as it could be and in particular, there was a concern that the PCT did not hold information on the Full Time Equivalent (FTE) hours worked by staff at GP Practices, which in turn meant that it was difficult to get an accurate picture of capacity.

3.2 In order to develop more robust data on GP capacity, this survey was

carried out in partnership with the London-Wide Local Medical Committees (LMC) 3 in the spring of 2008, with the purpose of providing an accurate snap shot in time of GP capacity across the Borough. The collection of this data would then be used to:

(a) To inform the PCT and Borough Council’s planning of

healthcare provision services and infrastructure in the Borough. 3.3 In 2008, West London Health Estates Facilities Management (WLHEFM)

were in the process of putting together an up-to-date estates strategy of health facilities/infrastructure in the Borough. The intention was that data collected from this survey, would help inform and identify existing capacity issues which would be reflected in the final version of the estates strategy.

3.4 This strategy will feed into the process of planning health services across

the Borough within available resources.

3 London wide LMC is the representative body for London’s 6,000+ GPs and their Practice Teams.

9

(b) To inform the Council’s negotiations with developers to justify funding contributions required for health facilities/infrastructure.

3.5 As mentioned already, there is strong evidence which indicates that

where there is insufficient detail on existing health need/capacity a local authority may be unable to secure health contributions from a residential developer. The intention was that the data collected would be used to inform the negotiations the Council’s planning department enters into with developers in order to justify and secure an appropriate level of funding towards health facilities and infrastructure in the Borough.

(c) Inform the LMC’s responses to consultations in respect of

proposed changes in general practice and other local services 3.6 The LMC is aware that the NHS interim review has determined that

Hounslow is an under-doctored area but that this assessment is based on out-of-date figures and may not take account of sessional GPs. It also takes no account of nursing or other healthcare staff.

3.7 The data collected will enable the LMC to respond in a more informed

manner to proposals for development of practices or for alternative or additional practices from whatever source.

4.0 LIMITATIONS IN ANALYSIS OF SURVEY RESULTS 4.1 A full analysis of survey results is presented in the remainder of this

document. As a precursor, it is important to keep the following factors in mind when drawing conclusions from the responses received:

• Low response rate overall: The overall response rate (45%) means

that it is difficult to form an accurate picture of GP capacity in the Borough.

• Inconsistent number of returns from different ward areas: This

has meant a like for like comparison between localities is difficult and data for some areas where response rate is low cannot be used as indicative of a general pattern, but rather only tells us about capacity at a particular practice.

• Inconsistencies in the way in which surveys were completed:

Not all GPs completed all questions and some responses given, indicated that the same questions had been interpreted in a different way.

4.2 Further to the points made above, a big caveat is that since this survey

was conducted there have been substantial changes to the opening hours of Practices, because of the new enhanced service for extended hours which requires Practices to have weekday opening of 45 hours

10

and additionally, evening or weekend opening hours. This inevitably will improve access for patients overall.

4.3 A new contract is also in the process of being negotiated for the 15

practices on local (PMS) contracts and in anticipation some practices are extending their opening hours. This contract will go through in the next few months and will result in quite substantial changes to these practices.

4.4 Notwithstanding the above limitations, headline findings are as follow:

• There is an overall increase in Patient list sizes across all localities with the most significant increase in the Isleworth and Syon locality.

• There is considerable variability between and within localities as

regards staff numbers, average time for each appointment and time to next urgent appointment.

• A number of responses to different questions (i.e. length of GP/nurse

appointment and time to next routine appointment) indicate that there is an access issue in the Isleworth & Syon locality (note only one Practice responded from this locality).

11

5.0 SURVEY RESULTS AND ANALYSIS Surveys were sent out by email to the 51 independent practices in Hounslow, to practice managers. A list of practices by locality was emailed to LMC members so they could promote the survey to colleagues. By the end of June, 25 survey forms had been returned. Of these two were duplicates > total useable responses = 23 (45%) QUESTION ONE: YOUR PRACTICE (1A) PERSON COMPLETING THE SURVEY Those completing forms were asked to indicate whether they were a GP or a practice manager. 7 surveys indicated completed by general practitioners, 11 by practice managers and five by both. (1B) LOCALITY WHERE MOST PATIENTS LIVE Practices were asked to identify the locality in which most of their patients lived. Appendix 4 shows the GP locality boundaries used for this survey. All but three practices did so. One did not identify a locality; one identified two localities and one identified three. Where more than one locality was selected, subsequent responses have been split equally between localities for analysis. Locality Number of

practices Registered list

Chiswick 7 + ½ + 1/3 35,386 Brentford 2 + ½ + 1/3 20,726 Isleworth and Syon 1 6,197 Osterley 0 Heston 0 Hounslow 7 33,396 Bedfont 0 Feltham 2 9,709 Hanworth 1 5,703 Gunnersbury 1/3 2,069 Not specified 1 3,450

(1C) LIST SIZE CHANGES BETWEEN 31ST DECEMBER 2003 – 31ST

DECEMBER 2007 Practices were asked to report their list size at annual intervals from 31.12.2003 to 31.12.2007. The date of 31.12.07 was chosen to avoid the effect of PCT list cleansing registration removals, predominantly in 2008, confounding trends on practice list size. Three Practices were unable to report from 2003. Two of these reported from 2004 onwards whilst the third reported from 2005 onwards.

12

In order to reduce the impact of the difference on analysis, where Practices have not reported from 2003, the figure for the closet available year has been used.

Locality Average % change in each locality

Change by individual practice

Average practice size 31.12.2007

Chiswick + 4.7% 5 falling 2.9-8.2% 4 rising 1.9-66.7%

4,518

Brentford +9.6% 4 falling 0.6-8.1% 1 rising 61%

7,316

Isleworth & Syon +39% 1 rising 39% 6,197 Hounslow +2.4% 2 falling 5.5-13%

5 rising 2.3-10.1% 4,771

Feltham +2.3% 1 static 1 rising 4%

4,855

Hanworth +3.3% 1 rising 3.3% 5,703 Gunnersbury -8.1% 1 falling 8.1% 6,209 Note: split lists x 5 affecting three localities (Gunnersbury, Brentford, Chiswick) The overall trend for all areas (except Gunnersbury) is an increase in patient list size between December 2003 to December 2007. It should be noted however, that there was only one Practice which identified registered patients as resident in the Gunnersbury locality. The same Practice also identified Chiswick and Brentford as localities where patients were resident. This means the % change for Gunnersbury can only be read as reflecting what is happening in one Practice, which also serves residents from two other localities i.e. the data relates to only a small number of patients in the Gunnersbury area. Furthermore when looking at the data relating to the Isleworth and Syon and Hanworth localities, it must be remembered that only one response was received from both these wards, so again data shown will relate to an individual Practice rather than identifying a trend in that locality. The figures in the column which show a breakdown of percentage change in patient list size between December 2003 and December 2007 reflect that there is an acute variation between Practices within and across wards as regards changes to patient list size. The table also shows us that although the biggest average increase is shown in the Isleworth and Syon locality (note this data relates only to one Practice), there are two other localities which have a greater increase in patient list size at an individual Practice i.e. Chiswick 66.7% and Brentford 61%. PERCENTAGE INCREASE IN PATIENT LIST SIZE BETWEEN DEC 03-07 FOR EACH INDIVIDUAL PRACTICE Change in patient list size between December 2003 and December 2007 by each individual Practice is shown in the list below. The list has been ranked in order of greatest to smallest increase. Ranking number 6 relates to one

13

Practice which identified patients resident in 3 localities and ranking number 19 relates to one Practice which identified patients resident in 2 localities. Ranking number 14 is for two separate Practices which both reported that there had been no change in patient list size. Each locality in the table has been shaded a different colour. The mix of colours indicates that it is difficult to draw any conclusions about overall trends in changes in patient list size in any locality, because there is so much variation within localities between individual Practices. Locality Practice List

Size in Dec 2007 Percentage Increase between 2003 & 2007

Rank

Chiswick 2500 66.7 1 Brentford 6250 61 2 Isleworth 6197 39 3 Chiswick 6477 26.7 4 Hounslow 4112 10 5 Chiswick 2069 8.1 6 Brentford 2069 8.1 6 Gunnersbury 2069 8.1 6 Hounslow 5603 7.7 7 Hounslow 3196 7.3 8 Hounslow 5300 4.5 9 Chiswick 4241 4.4 10 Feltham 5609 4 11 Hanworth 5703 3.3 12 Chiswick 6485 1.9 13 Not given 3450 - 14 Feltham 4100 - 14 Hounslow 7880 -0.3 15 Brentford 7158 -0.6 16 Chiswick 2412 -2.9 17 Hounslow 5155 -5.5 18 Chiswick 5248 -6 19 Brentford 5248 -6 19 Chiswick 2262 -7 20 Chiswick 3693 -8.2 21 Hounslow 2150 -13.1 22 QUESTION 2: NUMBERS OF STAFF Practices were asked to identify the Full Time Equivalent (FTE) of number of staff in each Practice, categorised by GP, nurses and non-clinical staff. Number of GPs were further categorised by if the were partners, salaried doctors, or trainee/F2 GPs. Numbers of weekly hours provided by trainee GPs and locum GPs was also requested.

14

The graph below shows a breakdown of total number of staff categorised by GP (partners and salaried doctors), nurse and non-clinical staff in each locality. F2/Trainee GPs are not reflected in the analysis as posts are usually temporary and locums are not reflected in the analysis as in almost all Practices, the number hours they worked were extremely low or nil. There was only one exception to this – the GP surgery with patients resident in the Hanworth locality reported using 15 hours of GP locum time a week. This has been reflected in the graph as 0.4 (FTE) member of staff.

0

10

20

30

40

50

60

Num

ber o

f Sta

ff

Houns

low

Chiswick

Islew

orth

Brentfo

rd

Feltha

m

Gunne

rsbury

Hanwort

h

Not Spe

cified

GP Practice Locality

Number of Total Staff Per Locality

Partners & salarieddoctors Qualified nurses

Non-clinical staff

In order to avoid double counting staff in Practices which have identified more than one locality in which patients were resident, numbers of staff indicated have been split equally amongst all localities given. One Practice with patients resident in the Hounslow locality identified that its nurses were part time and two other practices with patients resident in the Hounslow locality identified it nurses were a shared resource. As no further information was provided, these nurses have been reflected in the graph as the equivalent of a 0.5 FTE member of staff. One Practice in Chiswick had a nurse vacancy. This vacancy has been counted in the graph when showing the number of nurses in the Chiswick locality as it is assumed that this post will at some point be filled. Two Practices (one with patients resident in the Hanworth locality and one with patients resident in the Chiswick, Brentford and Gunnersbury localities) indicated the number of nurses and health care assistants when responding to the question on number of qualified nurses. For the purposes of analysis health care assistants have been counted as nursing staff in the graph as healthcare assistants by definition are classified as “nursing staff” in the NHS. Localities in which a higher number of Practices responded will inevitably show higher totals in the graph. The graph highlights the relationship between

15

different types of staff at each practice – in all surgeries number of non-clinical staff far outnumbered the number of GPs or nurses. To allow more meaningful comparison of numbers of staff in each locality, the average numbers of doctors, nurses and non-clinical staff in each practice was calculated and is shown in the graph below.

0

1

2

3

4

5

6

7

8

9

10

Ave

rage

Num

ber o

f St

aff

Houns

low

Chiswick

Islew

orth

Brentfo

rd

Feltha

m

Gunne

rsbury

Hanwort

h

Not Spe

cified


Average Number of Staff in Each Practice Per Locality

Partners & salaried doctors Qualified nursesNon-clinical staff

The graph indicates there is variability between localities in the average number of GPs nurses and non clinical staff in Practices. Gunnersbury had the most GPs on average per Practice however it must be remembered that data shown relates to one Practice only which indicated patients resident in two other localities i.e. a third of primary care services available at this Practice were dedicated to Gunnersbury residents. For the purposes of determining number of staff at one Practice in the above graph, data for the Gunnersbury Practice has been calculated as if totals received were for the provision of primary care services to Gunnersbury residents only i.e. other two stated localities relating to this Practice have been ignored. Practices with residents in the Hounslow locality had the least number of staff in all categories. Variations in Practice size will inevitably affect the numbers shown on the graph. In order to refine analysis, the tables below shows the relationship between patient list size and GP/nurse hours worked in ratio format:

16

Table 1

Locality Total patient list size

Total GP hours

worked

One GP hour to patients list size

ratio Chiswick 35387.5 811.25 1: 44 Brentford 20725.5 456.25 1:45 Isleworth and Syon 6197 112 1: 55 Hounslow 33396 585 1: 57 Feltham 9709 220 1:44 Hanworth 5703 150 1:38 Gunnersbury 2069 41.75 1:50 Not Specified 3450 60 1:57

Table 2

Locality Total patient list size

Total nurse hours

worked

One nurse hour to patient list

size ratio Chiswick 35387.5 268.3 1: 132 Brentford 20725.5 142.8 1: 145 Isleworth and Syon 6197 36 1: 172 Hounslow 33396 192 1: 174 Feltham 9709 104 1: 93 Hanworth 5703 74.5 1: 76 Gunnersbury 2069 18.8 1: 110 Not Specified 3450 20 1: 172.5

The first table shows that there is most demand on GP time relative patient list size in the Hounslow area where there is one GP hour worked for every 57 patients. The second table shows that there is also most demand on nurse time relative to patient list size in the Hounslow area where there is one nurse hour worked for every 174 patients. Hanworth has the best access for patients in terms of GP and nurse hours worked relative to patient list size with one GP hour worked for every 38 patients and one nurse hour worked for every 76 patients. Because only one response was received from a Practice which indicated Patients were resident in the Hanworth locality, we do not know if there are similar levels of access for patients in other Practices in this locality. There is a greater degree of variability overall in patient list size to nurse ratios across localities than patient list size to GP ratios. QUESTION 3: WEEKLY WORKLOAD This question asked Practices to identify the total number of GP hours, nurse hours and non clinical staff hours worked in each Practice. Total hours include patient facing appointments and administrative/organisational work.

17

There were a number of inconsistencies in the way in which Practices responded to this question. Two Practices (one with patients resident in Chiswick and the other with patients resident in Hounslow) were unable to indicate the exact number of hours worked by GPs so reported back 60+ and 80+. As there is no way of knowing how many additional hours this refers to over and above the figure given, only the stated number of hours has been reflected in the analysis. Another Practice in Hounslow reported GPs undertook 26 sessions. In presenting this data, an assumption has been made that one session is the equivalent to morning/afternoon surgery hours, which in this case was 5 hours as indicated by the Practices’ opening times. The graph below shows the total actual hours worked in Practices in each locality. Although we know from the graph on page 8 (Number of Total Staff per Locality) that there was an acute difference between number of GPs and non-clinical staff at Practices, there is not the corresponding acute difference you might expect to see in the hours worked by these two categories of staff. As identified previously because of the variation in the number of responses received from different localities it is difficult to use this data to make comparisons across localities.

0

200

400

600

800

1000

1200

Tota

l Num

ber o

f Hou

rs

Houns

low

Chiswick

Brentfo

rd

Gunne

rsbury

Feltha

m

Hanwort

h

Islew

orth

Not Spe

cified

GP Practice Per Locality

Total Weekly Hours worked in Each Locality

Total GP hours worked (alldoctors added together)

Total nursing hours

Total non-clinical staff hours

To allow more meaningful comparison across localities, the graph below shows the average percentage of hours in Practices worked by doctors, nurses and non-clinical staff in each locality. Where Practices identified they served more than one locality, percentages were calculated after divided hours between each of the localities indicated.

18

0

10

20

30

40

50

60

70

Wor

kloa

d Pe

rcen

tage

Houns

low

Chiswick

Brentfo

rd

Gunne

rsbury

Feltha

m

Hanwort

h

Islew

orth

Not Spe

cified

GP Practice Per Locality

Percentage Weekly WorkloadTotal GP hoursworked (all doctorsadded together)Total nursing hours

Total non-clinicalstaff hours

The graph shows that there is some variability in terms of the percentages of hours different categories of staff work in different localities in which patients are resident. Chiswick shows the highest percentage of hours worked by GPs in Practices, Isleworth showed the lowest, for both GPs and nurses (note only one Practice indicated patients resident in the Isleworth locality). The Hanworth locality had the greatest percentage of nurse hours worked in a Practice by locality (note only one Practice indicated patients resident in the Hanworth locality). QUESTION FOUR: PATIENT ACCESS This questions asked Practices a number of questions around patient access as set out in further details below. (4A) PRACTICE OPENING HOURS This question asked Practices to identify the number of hours they were open before and after one. Practices were also given the opportunity to make any other comments regarding opening hours when responding. One Practice (Chiswick/Brentford localities), stated that it was open before and after official opening hours. It is assumed that this was to meet patient need. Responses received relate to advertised opening hours only and do not include hours for any specialist clinics providing services at Practices. The graph below shows the total number of hours Practices are open in each locality per week. Again it is important to remember that because of a varying response rate from different localities, it is difficult to draw any meaningful comparison from this data.

19

0

20

40

60

80

100

120

140

160

180

Hours Open

Chiswick

Brentfo

rd

Islew

orth &

Syo

n

Houns

low

Feltha

m

Hanwort

h

Gunne

rsbury

Locality

Total Weekly Opening Hours in Practices Before and After One in Each Locality

Before One

After One

To enable more meaningful comparison of data between localities, the graph below shows the average opening hours of Practices in each locality. Where Practices have indicated residents located in more than one locality, hours have been split between all localities indicated.

0

5

10

1520

25

3035

Hou

rs O

pen

Chiswick

Brentfo

rd

Islew

orth &

Syo

n

Houns

low

Feltha

m

Hanwort

h

Gunne

rsbury

Locality

Average Hours per Week Practices in Each Locality are Open Before and After One

Before One After One

The graph above shows there is some variation between localities in terms of patient access. Gunnersbury overall has the most extensive patient access (note that only one Practice from the Gunnersbury locality responded and this Practice also identified two other localities in which patients were resident). Hounslow has the least patient access by hours overall and this is particularly the case after one. This may be a more true representation of access in a locality as 7 Practices in the Hounslow area responded. Hanworth has the second least patient access by hours overall. Because there was only one

20

Practice which responded, there is no way of knowing whether this is indicative of a wider access issue in the Hanworth area or simply reflects what happens at one Practice. The graph shows that before one, there is the least access for Patients resident in the Chiswick locality. Practices before one in Chiswick are open an average of 20 hours per week (8 Practices which responded indicated residents from this locality). Going forward, we would expect to see better access for patients across the Borough in all localities, as the PCT implements the new enhanced service for extended hours, which requires weekday opening of 45 hours and evening and weekend opening as well. QUESTION 4B&4C: NUMBER OF DOCTOR AND NURSE APPOINTMENTS LAST WEEK These two questions asked Practices to identify the number of (face to face and over the telephone) GP and nurse appointments in the last week. To allow some comparison across localities, the graph below shows the average number of (face to face and over the telephone) GP and nurse appointments in Practices by locality, over the course of one week.

050

100150200250300350400450500

Num

ber o

f A

ppoi

ntm

ents

Chiswick

Brentfo

rd

Islew

orth &

Syo

n

Houns

low

Feltha

m

Hanwort

h

Gunne

rsbury

Locality

Average Number of GP and Nurse Appointments in Each Locality per Week

GPNurse

From the graph it appears that on average, the Isleworth and Syon followed by the Brentford locality, has the highest number of GP appointments in Practices. Because of the low response rates from Practices in these localities, it is difficult to know if there is a similar level of activity across all or most of the Practices in these two localities. If such a level of activity is replicated in the other Practices in these two localities, then it would point to a

21

high demand rate on the part of patients for primary care services in these areas. Although Gunnersbury is shown as having no nurse appointments, it must be noted that this data relates to one Practice only so is not reflective of what happens in that locality. To gain an understanding of how different levels of activity at Practices affected the average length of appointment time in each locality, the total number of hours a Practice was open was divided by the total number of GP and nurse appointments in each locality. (Note, two Practices did not complete the questions relating to number of nurse appointments – one in the Hounslow locality and the other in a Practice which stated patients resident in three localities, Chiswick, Brentford and Gunnersbury in which patients were resident). Data from these two Practices could therefore not be included in the analysis below.

0

5

10

15

20

25

30

35

Num

ber o

f App

oint

men

ts

Chiswick

Brentfo

rd

Islew

orth &

Syon

Houns

low

Feltha

m

Hanwort

h

Gunne

rsbury


Average Length of GP and Nurse Appointments

GPNurse

As the graph above shows, there is considerable variation between different localities in terms of length of GP and nurse appointment times. Feltham had the longest time per appointment with a GP at approximately 13 minutes, with Chiswick coming second at 11 minutes. Isleworth and Syon has the shortest length of time per appointment with a GP, at just 6 minutes for the average appointment, with Hanworth coming second at 6.75minutes. As mentioned previously, as only one Practice in both these localities responded, there is no way of knowing if this is indicative of a wider trend across Practices in these two localities. Length of appointment times for nurses showed that Chiswick has the longest length of appointments at 31 minutes, with Brentford and Hounslow coming

22

second. The shortest time spent per appointment was in Feltham at 15.7minutes. Information for length of nurse appointments in the Gunnersbury locality is not available as the one Practice that identified this as a locality, did not enter data for nurse appointments in the last week. It is recognised that the variation in length of appointment times can be affected by the purpose of the patient’s visit. However, length of appointment time can also provide an indication of the demand on individual Practices and the capacity of staff at the Practice to meet patient demand. A variation in length of appointment times shows a corresponding variation in capacity i.e. staff resources available to meet patient demand. This variability will inevitably impact on the quality of care the patient receives and therefore the above analysis raises questions about levels of consistency in the quality of primary care services that are provided in different localities in the Borough. QUESTION 4D: TIME TO THIRD ROUTINE APPOINTMENT This question sought to check availability of appointments at each Practice and therefore draw some further conclusions about what access was like in each locality. Time to the third routine appointment is agreed within the NHS as being a good indication as to when the next available appointment is as the first available appointment may be down luck or a cancellation. The third is therefore seen as being a more reliable indicator. In responding to this question, one Practice (with patients resident in the Hounslow locality) stated it was unable to specify time to next third routine appointment as it was dependent on the doctors leave. One Practice (with patients resident in the Chiswick locality) indicated 24hours/same day in its response. This has been recorded on the graph as same day. Another Practice (with patients resident in the Chiswick locality) reported time as being “each session” - it is unclear what this meant. This response has been recorded under 24hours.

23

0

0.5

1

1.5

2

2.5

3

Tim

e to

App

oint

men

t

Houns

low

Chiswick

Islew

orth

Brentfo

rd

Feltha

m

Gunne

rsbury

Hanwort

h

Not sp

ecifie

d


Time to Third Next Routine Appointment From Now

Same DayNext Day12 hours16 hours24 hours48 hours72 hours96 hours

The graph above shows responses received from each Practice in the various localities. Where Practices have indicated they treat patients from more than one locality, the response has been recorded separately for each locality. Looking at the graph, the most common response was 48 hours to next third routine appointment. The graph also shows us that there is significant variability within the same localities i.e. in Chiswick, time to third routine appointment ranges from same day to 72 hours. The locality with the longest time to third routine appointment was Isleworth with 96 hours. Again it must be remembered that only one Practice responded from this locality and given the variability of responses received in other localities where a more significant number of Practices responded i.e. Chiswick and Hounslow, we are not able to draw any conclusions as to what time to third routine appointment for other Practices in this locality may be. QUESTION 4E: TIME TO NEXT URGENT APPOINTMENT This question asked Practices to indicate time to next urgent appointment. Again this question sought to give some indication of patient access in different localities. The responses are considered to provide some indication of capacity in different localities with shorter waiting times indicating better capacity to meet demand. In responding to the question one Practice (with patients resident in the Chiswick locality) indicated within 24 hours/same day. This has been recorded on the graph as same day. Another Practice (with patients resident in the Chiswick & Brentford localities) stated next surgery. This too has been recorded as within 24 hours.

24

Where Practices identified they were treating patients from more than one locality, the graph shows the response for each locality separately.

0

1

2

3

4

5

6

7

Num

ber o

f pra

ctic

es

Houns

low

Chiswick

Islew

orth

Brentfo

rd

Feltha

m

Gunne

rsbury

Hanwort

h

Not sp

ecifie

d


Time to Next Urgent Appointment From Now

Same Day

Within 24 hours

4 hours

3 hours

1 hour

14 out of 23 Practices (or 61%) indicated same day to next urgent appointment. The graph shows that there is a much greater degree of consistency in responses received from Practices in Hounslow (where all 7 indicated same day for next urgent appointment) than Chiswick (where time to next urgent appointment varied from within 24 hours to one hour) and Brentford (which varied from within 24 hours to one hour). QUESTION 4F: NUMBER OF APPOINTMENTS OUTSIDE CORE HOURS This question asked Practices to indicate number of appointments made outside core Practice hours. The graph shows the total number of appointments in each locality. Three localities (and a fourth unnamed one) offered no outside core hours appointments. As responses in all localities (apart from Hounslow and Chiswick) was fairly low, it is difficult to know if responses from other localities are representative of what happens in all/most Practices in those localities. Chiswick had the best access for patients outside core hours. As stated already, there will be better access to primary care services outside core hours for patients in all localities, as a result of the new enhanced service for extended hours.

25

0102030405060708090

100

Num

ber o

f App

oint

men

ts

Houns

low

Chiswick

Brentfo

rd

Gunne

rsbury

Feltha

m

Hanwort

h

Islew

orth

Not Spe

cified


Number of Appointments Outside Core Hours

QUESTION 5: POTENTIAL OF YOUR PRACTICE TO EXPAND This question asked Practices the extent to which they were able to increase the number of clinical (medical and nursing) appointments in their current premises if they were enabled to recruit more clinical staff. The table below shows the way in which Practices responded. Chiswick Brentford Isleworth

& Syon Hounslow Feltham Hanworth Gunnersbury

Not at all 1 1 Yes by up to 10%

- - - - - - -

Yes by 10 – 25%

4.8 2.8 - 4 - 1 0.3

Yes by 25 – 50%

1 - 1 3 - - -

Yes by 50 – 75%

1 - - - - - -

Yes by 75 – 100%

- - - - - - -

Yes by over 100%

- - - - - - -

As shown, all but two Practices were are able to increase the number of clinical appointments if given more staff which indicates that an increase in provision of services, in the majority of cases, is not being constrained by physical space. One Practice indicated that it was able to increase appointments but could not quantify by how much. 14 Practices felt able to increase clinical capacity

26

between 10-25%, 5 by 25-50% and 1 by 50-75%. Where a Practice had indicated it covers more than one locality, this has been reflected in the numbers given by splitting that Practice between the relevant localities. The responses received do not indicate any clear patterns in terms of ability to increase in localities across the Borough rather it seems to be the case that there is variability amongst individual practices within localities. This question also asked Practices about their ability to increase the number of clinical (medical and nursing) appointments in the current premises if they were enabled to recruit more clinical and non-clinical staff. Responses were the same bar two exceptions. The Isleworth Practice which could increase appointments by 25-50% with additional clinical staff indicated that with additional clinical and non clinical staff it could not increase appointments. This response is interpreted to mean that an increase in non clinical staff do not impact on the Practice’s ability to expand. The Practice which did not state the locality its patients are resident in indicated an increase in ability to expand if it had more clinical and non-clinical staff from 10-25% to 50-75%. QUESTION SIX (A): HAVE YOU DONE A PES SURVEY AS PART OF QOF This question asked Practices if they had completed a Patient Experience Survey (PES) as part of their Quality Outcomes Framework (QOF). Only 5 Practices out of 23 indicated that they had completed a PES survey as part of their QOF. QUESTION SIX (B) HAS ACCESS FEATURED IN YOUR PES SURVEY This question asked Practices access had featured in their PES. 3 out of 5 Practices who has completed a PES indicated that access had featured in their survey. It should be noted that PES was part of the quality and outcomes framework until April 2008 but this local survey is now being replaced by a national survey which will be going out to all Practices shortly. The new national survey is being delivered by Ipsos MORI on behalf of the Department of Health and should give a much more comprehensive picture of patient experience as the range of question included is broader. 7. CONCLUSIONS The purpose of carrying out this survey has been outlined at the start of this report. Unfortunately, due to the factors which have been highlighted and referred to throughout, in presenting an analysis of the responses received, it will be difficult to use this data for the purposes originally intended. In addition to this there have been significant developments since this survey was conducted; changes to the opening hours of Practices, because of the new enhanced service for extended hours and the new contract that has been

27

negotiated for the 15 practices on local (PMS) contracts. Both these developments will impact on patients access to primary care services. In addition to the above, it is important to mention that the PCT recognises the variability of primary care services in the Borough, as relates to the quality of services that Practices currently provide. The PCT further recognises that it is important to address this variability in standards and with this in mind, in November 2008, the PCT began a piece of work to establish what standards of primary care were like across different Practices in the Borough. This work included developing a matrix to judge the way in which Practices perform against a number of identified standards. Going forward, it is envisaged that data collected from the application of this matrix will be used to identify those Practices that are performing well and those Practices that could be performing better. The PCT will support Practices were there are performance issues to improve the primary care services delivered to patients. This should help introduce more consistent standards of primary care across the Borough. Notwithstanding the above changes and work currently in progress, there are a number of headline messages (page 4) that are reflected in the analysis of the data and in particular it is worth reiterating that the issue of variation in terms of capacity of Practices across the Borough (relating to time to next routine and urgent appointment and average length of nurse/GP appointment) does need to be reflected and addressed in any work undertaken, to ensure that the PCT does not contribute to widening health inequalities in the Borough through the way in which primary care is provided in different localities. 8. NEXT STEPS Given the above developments referred to, it is suggested that the Adults Health & Social Care Scrutiny Panel:

• Receive an update on the impact the new enhanced service for extended hours has made in terms of accessibility of primary care services.

• Receive an update on the impact of the new contract for the 15 practices on local (PMS) contract on accessibility of primary care services.

• Receive an update on the work the PCT is undertaking to introduce a greater consistency in primary care standards across the Borough.

• Determine the extent to which the differences in time to next routine or urgent appointment and length of appointment time have been satisfactorily addressed through all of the above work.

• The Panel recommend that the PCT as part of their contractual relationship with GPs will begin to gather this data on an annual cycle.

28

Brentford Area Development

Health Impact Assessment

FINAL REPORT

Maggie McNab

Assistant Director of Public Health

Hounslow Primary Care

Trust

January 2006

APPENDIX 1APPENDIX 1

29

Executive Summary Brentford is an area towards the east of the London Borough of Hounslow (LBH). It lies on the western edge of London, north of the river Thames and to the east of Heathrow airport. It is currently undergoing a large programme of development guided by the existing Urban Development Plan (UDP). There have been a number of plans for Brentford over recent years. The London Borough of Hounslow is currently developing a Brentford Area Action Plan (BAAP) to co-ordinate the activities, incorporate strategic planning guidance as set out in the Mayor’s strategy and review the parts of the UDP that relate specifically to the Brentford Area. It is due to be adopted in October 2007. There are several key policies relating to the development, they include the Brentford Regeneration Area (policy IMP 3.1) that lists broad objectives for the area as:

• To maintain and support existing businesses whilst creating new jobs and investment;

• Implement environmental improvements, with special attention to the town centre, the Thames and canal side and conservation areas;

• To reduce crime and increase community safety; • To improve the housing stock including affordable housing; • To provide a range of community, cultural and leisure facilities; and • To provide a high quality built environment.

In February 2005 the London Borough of Hounslow Scrutiny Committee decided to commission a Health Impact Assessment (HIA) of the overall development plans for Brentford. This followed concerns expressed by some of the local residents. The Public Health Directorate of Hounslow Primary Care Trust (HPCT) agreed to lead the assessment. The initial process began in May 2005 and involved numerous processes that are detailed in the main report. These include reading through a range of local plans and policies, requesting additional local information, reviewing research from similar urban developments, interviewing key organisations and individuals (see Appendix 2), presenting to a Scrutiny meeting, facilitating a stakeholder consultation event, collating responses, analysing the findings, drafting an interim report in October 2005 for circulation and discussion. The process was completed in January 2006 with this report and recommendations being presented to the Scrutiny committee. The whole exercise has been time consuming and costly. The direct costs to the PCT are calculated at approximately £10,000. This does not include any additional time spent by employees of the PCT, Local Authority or community organisations who kindly gave information to inform the consultation. It is an estimate of the costs of the Public Health team expertise.


30

The HIA report is well placed to provide a formal and supportive contribution to the forthcoming Brentford Area Action Plan. Indeed some of the processes have been duplicated and many of the recommendations are mirrored in the preferred options of the BAAP and could help to strengthen the emerging Area Plan. It has shown that it would be beneficial to strengthen partnerships to utilise available mechanisms for maximising health gain in any future development. The key findings A social model of health (see Appendix 1) was used to determine the impact on the health of the community. It is recognised that health is influenced by a broad range of factors, such as educational attainment, housing, employment, family background and is not just reliant on health services. The key findings include: 1. Communication

A lack of adequate communication and overall co-ordination of the area developments

2. Co-ordination

A range of different people complained that they are often not aware of what others are doing or planning for the area.

3. Capital development focus There is a perceived focus on capital development and less attention to the needs of the community. There is insufficient reference to the development of healthier communities in the Brentford Regeneration Area policy.

4. Planning and Vision There is a perceived lack of vision and insufficient long-term planning for the area. Some suggest concerns about the legacy that future generations will inherit. The use of the term “we are fast becoming the ‘Manhattan’ of west London” is entering into the local vocabulary.

5. Poverty

Ground rentals for community organisations are rising and resulting in a loss of local voluntary and community group support

6. Funding

Funding opportunities for additional health service developments and facilities have been missed.

7. Social inclusion

There is much interest from local residents in ensuring good inclusion and involvement with those who live in local estates and the new arrivals to the area.


31

8. Employment There is keen interest in retaining a good mix of residential and employment sites, providing local employment opportunities and maximising options for working closer to home, thus reducing the need to travel out of area to work.

9. Air quality and pollution

There is a high level of concern about current levels of pollution and management of traffic congestion. There is much interest in working to ensure the best use of mechanisms to protect people from hazards and dangers.

10. Housing There is a predominance of one and two-bedroom accommodation. There is a high level of interest in developments including a greater mix of housing size in order to enable growing families to remain in the locality.

11. Social Environment Any improvements to the social environment are generally seen as real opportunities for the local community to contribute to and benefit from the improvements. There is a widely felt anxiety about providing a poor environment for the next generation.

12. Crime and Community Safety

There is a potential for an increase in theft, anti-social behaviour due to alcohol and road traffic accidents in vulnerable groups.

13. Community services and health facilities

There are mixed feelings about current local facilities and keen anticipation that the new developments will support the overall improvement and expansion of health and social services, a better range of shops, social venues and support agencies. There are an increasing number of families with young children being supported by community and voluntary sector agencies due to low levels of formal community health care support. There is likely to be pressure on existing transportation systems, including public transport.

14. Individuals and community groups The evolving community of Brentford will be broad and have diverse strengths and needs. It is important to the positive development of the area to ensure that people are enabled to contribute to the growth of a supportive and welcoming environment.


32

Recommendations include: 1. Communication

A need to ensure good a high level of communication with residents, community groups, service providers, other local government departments and interested parties. The responsibility, accountability and mechanisms for this are important considerations

2. Co-ordination

Greater consultation and interagency engagement with respect to the area development and the longer-term community needs.

3. Capital development focus

Introduction of mechanisms to ensure a shift towards community development, inclusion and local capacity building rather than maintaining the focus on capital development. This should include formal policy inclusion to promote healthier environments. It is currently missing from the Brentford Regeneration Area broad objectives.

4. Planning and Vision Improved mechanisms for engaging with a broader local community about the plans and vision for the area, including residents to the north of the M4.

5. Poverty Consideration of community needs and affordable rental space to be included as a dimension in the overall planning of the area

6. Funding The Local Authority and Hounslow Primary Care Trust to ensure a full engagement in regular formal discussions about planning application and participation in section 106 contributions.

7. Social inclusion A shift towards greater community development, inclusion and local capacity building. A Review of current mechanisms to reduce the potential for new developments to become isolated or self-contained communities.

8. Employment

Encouragement of greater support for a good variety of local jobs for local people

9. Air quality and pollution Greater support for traffic management schemes, green transport plans and public transport, improved reporting arrangements for the public to report pollution and noise concerns and encouragement of local retailers to reduce local journeys to shop.


33

10. Housing Greater development of larger unit accommodation to encourage local movement of residents rather than transient families Ensure enforcement of policies and systems and utilisation of modern technology to reduce negative effects of pollution and noise

11. Social Environment Encouragement of systems for contributing to a sustainable and greener community environment within all new developments

12. Crime and Community Safety

Support for more community policing and road traffic management schemes to assist the more vulnerable members of the community

13. Community services and health facilities Increased level of communication with planners and developers in order to plan, fund and provide for future services, shops and services Pre-emptive investment in capacity and facilities for primary care, community and hospital support with greater application and use of appropriate funding, namely section 106. Review the level of support needed from the statutory sector by community organisations engaged in voluntary, informal activities with maternal and child-care. Review existing transport and parking services in line with anticipated growth in population and need

14. Individuals and community groups

Ensure planning to include appropriate services for the needs of the broader community including: infants, children, young people, adults, older people, and families. Encourage good community networks and affordable facilities for meetings and social events Ensure adequate assistance for voluntary sector and community organisations to continue to provide networks, support and advocacy for individuals and groups.

Further Discussion The above recommendations should be further supported by an agreement between agencies to work in closer partnership to:

• Nominate lead agencies or departments • Identify specific mechanisms for achievement, • Undertake robust review and evaluation processes with set timescales

and • Ensure formal evaluation and monitoring procedures.


34

Case Study: Arbour Way Development, Tower Hamlets Summary The proposed development in the Arbour Way case included a residential development of 67 units. One of the main issues for consideration by the Inspector was the affect of the proposals on the provision of healthcare in the Tower Hamlets area allowed S106 funding for health to be secured. Background Planning Policy relating to S106 in Tower Hamlet’s Tower Hamlets Development Plan Document (DPD): This incorporates the Unitary Development Plan (UDP) and the London Plan. The DPD contains a policy entitled “Health Living” and refers to working in partnership with Tower Hamlets PCT to ensure that appropriate new healthcare facilities are provided to support the current and future population. This is to be implemented by seeking planning obligations through the HUDU model. The DPD also states that there will be Supplementary Planning Documents (SPD) to follow that provides the detail on planning obligations. The London Plan includes policies on “negotiations on development proposals”, including amongst other things health facilities. Circular 05/05 “Planning Obligations” (issues by the Department of Communities and Local Government): This provides justification for planning obligations to address the impacts of development on health services. It supports "pump-priming" revenue contributions where "there is a time lag between the provision of the new facility and its inclusion in public sector funding streams" Inspectors ruling on whether the new development could be shown to have an adverse impact on health in the area and therefore secure s106 funding The Inspector decided that the developer would not have to make a financial contribution to health. There were two main reasons given for this: Policy backing for requirement was weak There was no SPD or Guidance on health planning obligations. The requirement was only identified at borough level in the council’s emerging Core Strategy, which had not yet been subject to examination or discussion.

APPENDIX 2

33

APPENDIX 2

35

Insufficient detail on current capacity of health facilities Whilst in principle the Inspector considered that the new development could have an adverse affect on the provision of healthcare in an area, in order to determine what this adverse affect was, it was necessary to have details on the level of pre-existing service provision and the numbers, ages and well-being of the new population which would be living in the borough. Details on the capacity, need or slack in the system were unavailable. The exact nature and location of the improvement had also not been specified. The Inspector concluded that it could not be shown that an obligation relating to health funding was applicable, to make the proposed development acceptable in planning terms.

APPENDIX 2

34

APPENDIX 2

36

Community Interest Company: a Social Enterprise Organisation

Project Report

Equitable Access to Primary Medical Care Services in Hounslow

Authors: David Murray – Operational Director & Consultant in Public Health

Helen Atherton – Associate Analyst Steve Hajioff – GP, Operational Director, & Consultant in Public Health Medicine

Version: Final Date: 25th June 2008 Client: Hounslow Primary Care Trust PHAST Ref: P103

APPENDIX 3

37

Final Report: 25th June 2008

Hounslow PCT

EXECUTIVE SUMMARY Introduction This report was commissioned by Hounslow Primary Care Trust (HPCT), and was delivered by the Public Health Action Support Team (PHAST), a Social Enterprise trading as a Community Interest Company (CIC), run by a group of experienced public health professionals. Inequalities in health and access to health services are well documented in England, with more deprived social groups consistently experiencing poorer health outcomes. Such variations have persisted despite policy initiatives, and recently the gap between the life expectancy in the most and least deprived has widened. The Department of Health Fair Access to Equitable Care Programme aims to contribute to tackling this problem, by providing new investment to deliver at least 100 new GP practices to the 25% of PCTs with worst provision. Hounslow PCT has been selected to receive investment funding as part of the national initiative, and commissioned this report to inform their decision making on the location of new primary care medical services. Aims & objectives The aim of the project is: • To provide rapid advice on the optimal location of new primary care medical

services in Hounslow, based on systematic assessment of geographic variation in health care need, and current provision of primary care medical services, using immediately accessible and available sources of data.

The objectives of the project are, where appropriate data (i.e. ward level) is available, to assess geographic variations in: • Current population; • Population projections; • Deprivation; • Health needs (e.g. mortality, life expectancy, chronic ill-health/long-term illness,

disability); • Current supply of GP services (i.e. list size); • Quality of GP services (i.e. QOF); • Primary care patient experience survey findings (e.g. GP access).

Data & methods Data for each Hounslow ward, Hounslow Borough, London, and England were compiled on the above. Averages on data for individual GP practices were calculated for the wards in which they are located. Wards were then ranked according to results for each indicator, with higher rank (i.e. rank 1 = high) indicating greater health need or the less good current GP services.

APPENDIX 3

38


Hounslow PCT

3.5.2 ward aggregate indicator scores & ranks – health need & primary medical care supply

Ward Need rank

score Need rank Supply rank

score Supply rank Brentford 48 1 26 8 Syon 50 2 0 0 Hounslow West 51 3 12 1 Heston West 54 4 16 3 Feltham North 58 5 29 10 Cranford 62 6 13 2 Bedfont 63 7 26 8 Isleworth 68 8 23 6 Hounslow Heath 69 9 47 18 Hounslow Central 71 10 18 5 Hanworth 72 11 40 14 Heston Central 74 12 23 6 Feltham West 78 13 17 4 Heston East 79 14 44 17 Hanworth Park 84 15 32 12 Turnham Green 86 16 42 15 Chiswick Homefields 91 17 0 0 Osterley and Spring Grove 99 18 30 11 Hounslow South 101 19 43 16 Chiswick Riverside 102 20 32 12 Conclusions & recommendations Wards identified as having both low aggregate scores for health need and primary care supply should be the priority locations. This interpretation would suggest that Brentford, Syon, Hounslow West, Heston West, and Bedfont were priorities; given their relatively low scores in both dimensions. However, it is important that this conclusion is considered in full light of the limitations of the methods employed, in particular that: • The ward level analysis of primary care supply is a simplification of the actual

picture, with GP practice catchments likely to serve populations beyond the ward in which they are located, especially in regard to the two wards with no GP practices, and thus assigned a zero supply score in this analysis.

• Given that some wards have greater health needs than others, irrespective of their current supply of primary care, that they should receive priority based on need alone.

• Other important factors, beyond the scope of this report, require full consideration.

That said, the methods do provide an adequately systematic, open, and explicit basis for consideration and discussion, appropriate to the requirements of the decisions facing the PCT, if supplemented as suggested.

APPENDIX 3

39


Hounslow PCT

Consequently it is recommended that the PCT:

1. Consider the above findings with relevant stakeholders and partners. 2. Consider information on a range of other factors/influences on the optimal

location of new primary care medical services, including: 3. More detailed information and local intelligence on the current pattern of supply

of primary care medical services, below ward level, including other primary and immediate care services (e.g. walk-in centres, minor injury units, A&E).

4. Geographical and transport accessibility of alternative locations. 5. Local and national primary care strategies. 6. Local land-use and planning policies and strategies. 7. Community views on the need for, nature of, and access to GP services. 8. Availability and cost of additional accommodation for new GP facilities.

APPENDIX 3

40

© Crown copyright.All rights reserved. London Borough of Hounslow 100019263 2008.

Hounslow

Feltham

Brentford

Isleworth & Syon

Heston

OsterleyChiswick

Hanworth

Bedfont

LMC Localities Map for GP's

APPENDIX 4

41

Dr Hefferman 0%

0%

13%

0%

2%

0%

85%

TW13 TW14 TW3 TW4 TW5 TW7 TW8

TW7

TW3

Distribution of Patients Registered to a Practice by Resident Postcode

Dr Crowe

88%

0%

11%

0%

0%0%

0%1%

0%

0%

TW1 TW13 TW3 TW4 TW7 TW8 W13 W4 W5 W7

TW8

TW7

APPENDIX 5

42

Dr Badgett

33%

0%

58%

0%0%

0%0%

0%

0%0%

5%

0%0%

0%

2%0%

0% 0%0%0%

0%0%0%

HP12 KT10 RG18 RH2 SW14 SW6 TW1 TW10 TW11 TW12 TW13 TW14 TW19 TW2 TW3 TW4 TW5 TW7 TW8 TW9 W14 W4 W5

TW1

TW7

TW2

Dr Kooner0%0%

13%0%

0%

0%

1%

5%

5%

2%

1%

71%

1%0%

0%0%

0%

0%

KT2 SW14 TW1 TW10 TW11 TW12 TW13 TW14 TW2 TW3 TW4 TW5 TW7 TW8 TW9 UB1 UB2 W4

TW1

TW7

TW2

TW3

TW7TW7

APPENDIX 5

43

Dr Lane

12%3%

0%0%

0%0%

0%1%0%

0%0%

0%

84%

TW 13 TW 14 TW 3 TW 4 TW 5 TW 7 TW 8 UB2 W 13 W 3 W 4 W 5 W 7

TW8

TW7

Dr Ho

1%

2%

0%

8%

0% 0%0%

0%

0%

0%0%0%

0%

0%0%

0%

87%

GU15 TW1 TW13 TW14 TW16 TW3 TW4 TW5 TW7 TW8 UB5 UB6 W13 W3 W4 W5 W6

TW7

TW3

APPENDIX 5

44

Dr Hunt

0%

0%

0%

0% 2%0%0%

0%

1%

0%

0%

1%

96%

TW 14 TW 3 TW 5 TW 7 TW 8 W 12 W 13 W 3 W 4 W 5 W 6 W 7 W 9

W4

Dr Burbidge

0%0%0%0% 3% 0%0% 1%

0%1%1%

0%

94%

HA8 RG8 SW 6 TW 3 TW 5 TW 7 TW 8 W 12 W 13 W 3 W 4 W 5 W 6

W4

TW8

APPENDIX 5

45

The Manor Practice

0%

0%0%

2%

0%

0%

94%

4%

GU14 TW3 TW7 TW8 UB1 W3 W5 W7

TW8

TW7

Dr Yasin

18%

0% 0%

0%

0%0%

0%

0%0%1%2%

79%

GL55 TW13 TW3 TW5 TW7 TW8 UB2 W13 W3 W4 W5 W7

TW7

TW8

APPENDIX 5

46

Isleworth Centre Practice0% 0%0%

0% 0%1%0%

99%

KT5 RG29 SW6 TQ12 TW1 TW3 TW7 W13

TW7

Dr Williams

0%4%

0%

0%

0%0%

0%

1%

0%0% 0% 0%

0%

1%

0% 0% 0%0%

0%0%1%0%

90%

KT1 SW13 SW14 SW6 TW10 TW11 TW13 TW2 TW3 TW4 TW5 TW7 TW8 TW9 UB6 W12 W13 W14 W3 W4 W5 W6 W7

W4

TW8

APPENDIX 5

47

Dr Lu th r a

0%

0%

0%

31%

44%

0%

0%

0%

0% 0%

1%

0%

1%

1%0%

1%

8%

12%

A L10 CR0 TW1 TW12 TW13 TW14 TW2 TW3 TW4 TW5 TW7 TW8 UB1 UB2 UB6 W12 W4 W7

TW 7TW 3

TW 5TW 4

Dr. Kuk uls k i

7%

0%

0%

2%

2%

1%

8%

2%3% 0%

1%0%

1% 0%

2%

0%

5%

66%

NW10 TW14 TW3 TW4 TW5 TW7 TW8 UB2 UB5 UB6 W12 W13 W14 W3 W4 W5 W6 W7

W4

TW8

W3

W5

APPENDIX 5

48

Sunita Sharma Head of Scrutiny & PerformanceLondon Borough of HounslowCivic Centre, Lampton Road, Hounslow TW3 4DN.Telephone: 020 8583 2462Fax: 020 8583 2526Email: [email protected]

Alan Weaver Scrutiny OfficerJonathan Hill-Brown Scrutiny OfficerDeepa Patel Scrutiny OfficerBen Osifo Scrutiny OfficerNadia Awan PA to Head of Scrutiny & Performance

www.hounslow.gov.uk

Translations & Accessible Formats:

020 8583 2298

Communications Feb 2009