Executive Medical Director Blog: March 2024 – Dr Frankie Swords

18th March 2024

Spring is finally here – the sun is shining and the daffodils are up and in bloom.

This month, we received formal notification that Norfolk and Waveney has been removed from “special measures” (national oversight framework 4) which is a huge cause for celebration and testament to hard work from all of our teams . We have also completed our ICB restructure consultation and so it is a good time to reflect on what is working well and what else we want to focus on as a system.

In this month’s blog, I will touch on that restructure, focus on primary care, national changes around death certification exploring how that plays into our local work on learning from deaths, and discuss our plans to improve women’s health.

In terms of the ICB restructure, nationally all ICBs have been required by NHS England (NHSE) to reduce running costs by 30%. Following a comprehensive consultation process within our ICB, the outcomes of the restructure have now been communicated to all staff members. Appeals are currently underway, but we anticipate they will be finalised by 29 March, allowing us to proceed with the filling of posts in alignment with our organisational objectives.

Unfortunately, due to funding limitations and as the ICB will no longer be a direct provider of services, we have had to make the difficult decision to discontinue the Prescription Ordering Direct (POD) service. The service will close at the end of June 2024. We are actively supporting patients who already use digital means for prescription ordering away from the POD, and we’re working with local practices to gradually transition other patients to alternative methods of ordering their repeat prescriptions over the next four months. We will continue to provide support through a call handling service from July to September to assist those facing challenges with “offboarding” from the POD, and at the same time, we are working to develop a long-term solution with local partners for those who are most vulnerable and digitally excluded.

Recognising the pivotal role of primary care in our healthcare system, and the unique pressures in this sector, we are strengthening the ICB Primary Care team as part of our organisational change programme. We are also bolstering the teams focused on primary / secondary care interface, health inequalities, and collaboration with Voluntary, Community, and Social Enterprise (VCSE) organisations.

With the five-year GP contract coming to an end, we have recently received information on a new national one-year GP contract. This aims to streamline processes, enhance financial flexibilities, and support practices and Primary Care Networks (PCNs) in improving outcomes and patient access. I think we all acknowledge that the funding uplifts are disappointing. However, as an ICB we remain committed to mitigating the strains on our practices and we will continue to do all we can to ensure equitable support across the board.

General practice remains incredibly busy across Norfolk and Waveney – we provided over 647,000 appointments in the last reported month! 77% were face to face, 42% were on the same day or within 24 hours, over 250,000 were delivered by GPs, and the remainder were delivered by other members of the Primary Care team.  However, we do still see variations in appointment rates across different demographic groups, underscoring the importance of our focus on equitable access and on the continued transformation of Primary Care. As I mentioned last month, the new GPAS reporting is also helping to really demonstrate the pressure points with more than 50% practices reporting last week. It only takes 5 minutes and is incredibly useful at system level to ensure that Primary Care has the same profile and support as our other providers. Recent reports have highlighted the increased demand for phlebotomy, extended waits for people requiring routine appointments (due to such high demand for urgent appointments) and ongoing shifts of work from Secondary to Primary Care which we are determined to address.

There has been a huge national debate on the role of physician associates working across Primary Care as well as secondary care over recent months, so I hope the recent publication of guidance from the Academy of Royal Colleges helps bring some clarity in this area: do take a look here.

On a separate note, I’d like to highlight the work of our Learning from Deaths (LFD) forum. This started last February and brings together a wide range of partners to review and share all sources of learning from deaths that occur across our system. We cannot prevent deaths of course, but too many people still die earlier than they might have, and there are still gaps in the life expectancy between different areas of Norfolk and Waveney. We are determined to tackle those “modifiable” risks factors, as well as improve the experience for people known to be at, or nearing, end of life, as well as the bereaved.

All deaths that occur in hospital are already subject to independent scrutiny by medical examiners (MEs) and the LFD forum has also supported the roll out of ME scrutiny to all deaths in community and mental health hospitals, hospices and some care homes. We are on track to review all deaths occurring across our whole population as soon as this becomes statutory (expected any day).

That expected change in legislation will also bring with it some key changes to medical certification of the cause of death (MCCDs) including:

  • Removal of the requirement for the attending doctor to have seen the deceased within 28 days – any doctor who attended the deceased during their lifetime and knows the cause of death will be able to complete the MCCD.
  • Changes to the MCCD including adding information about whether it’s a maternal death, the ethnicity of the deceased, and whether they had any medical devices.
  • The statutory time frame in which families must register the death remains 5 days but this won’t start until the Registrar receives the MCCD from the ME or Coroner.
  • There should be a fall in coroner referrals as the attending doctor and ME will agree the cause of death.
  • Cremation form 4 will no longer be required.

Overall, I think these changes will speed up the process of issuing death certificates, and together with the ME roll out, these changes should improve the experience for grieving families. The changes will also improve our ability to accurately code and therefore learn from some deaths.

Finally, as a woman and mother of two daughters, I have quite a vested interest in women’s health! So, I welcome the recent national drive for the NHS to do more to adequately address the health needs of women: to improve access to support, improve experiences of care, improve health outcomes for women, and to reduce health inequalities.

Norfolk and Waveney ICB has been allocated non-recurrent, ring-fenced funding for women’s health initiatives to be spread over 2 years. We held a workshop with key stakeholders including those who commission, manage, deliver or work clinically across women’s health services as well as local women themselves. We looked at local data, to identify areas of greatest need to determine how to make the best use of this short-term funding for long term benefits.

Together we have decided to focus primarily on training and supporting our existing workforce. We want them to be better equipped to provide the high-quality care women need such as long-acting reversible contraception and menopause support, close to home and as quickly as possible. We will also be working to upskill trusted communicators in some of our local communities where we know that inequalities remain. We want to improve women’s understanding of their health, improve access to appropriate support and to break down barriers to care so that we enhance women’s health outcomes and reduce health inequalities across the whole lifespan.

Please note that the monthly medical director meeting for medical staff (MDMS) scheduled for the 9 April has been cancelled. The next meeting will be on the 14 May at 1pm.

Thank you as ever, for all that you do, working together to improve the health and care of our population.