Improving access to GP services in South East London

Who is working together?

Six local Healthwatch organisations in South East London are working with Our Healthier South East London Integrated Care System (ICS), including:

• Healthwatch Greenwich
• Healthwatch Lewisham
• Healthwatch Southwark
• Healthwatch Lambeth
• Healthwatch Bexley
• Healthwatch Bromley

What's the population like?

The ICS serves a diverse population of approximately two million people with pockets of deprivation sitting side by side with significant pockets of wealth. Age profiles vary widely across the six boroughs - Bromley has the oldest population in London, and Lambeth and Southwark are the most diverse and youngest boroughs. In Greenwich, with a population of 280,000 people, 47.9% are from an ethnically diverse background with a seven-year range in life expectancy from poorest to wealthiest parts of the borough.

How are they working together?

• Six local Clinical Commissioning Groups (CCGs) formally merged in 2020. This provided the impetus for six local Healthwatch who were already working together to consider how best to organise their collective approach and relationship with the new South East London CCG.
• The six local Healthwatch are now represented by a single South East London Healthwatch Director, who has a dedicated leadership role in ensuring that patient voice across South East London is central to decision making within the ICS.
• The South East London CCG currently funds the director role. System partners are confident about continued funding of this role with the formation of the ICS Partnership.
• Local Healthwatch meet every two weeks with a set agenda, including developments within the ICS and other relevant committees shared by the South East London Healthwatch Director. This forum also provides an opportunity for local Healthwatch to feedback on significant concerns collectively.
• Communication and engagement specialists across local Healthwatch meet regularly with the South East London Healthwatch Director. The Director works with the ICS communications and engagement leads to contribute to developing an ICS engagement strategy.
• Local Healthwatch have a joint working agreement and pool resources for relevant projects. They have developed an approach to team working and allocate tasks based on the issue being addressed and area targeted. For example:
  • Southwark and Lambeth partner together to work on local initiatives which involve Guy's and St Thomas’ and King's hospitals.
  • Lewisham and Greenwich work together to support and progress improvements and developments at the Lewisham and Greenwich NHS Trust, for example policy and process on charges for patients not eligible to access free NHS services. o Lewisham have been active members of a GP task and finish group. This is helping to provide input from local users into fast-moving issues like the development of digital tools and proposed GP mergers. 
  • Greenwich took a key role on the mutual aid governance board during the COVID pandemic.

What are the enablers of working together?

• Local Healthwatch have prior experience of working in partnership at a place-based level with local providers, smaller provider collaboratives, and the previous South East London Sustainability and Transformation Partnership.
• The Healthwatch Director has previously worked as a Healthwatch Chief Executive and has a specific leadership and coordination role for local Healthwatch within the ICS.
• The Healthwatch Director is a member of various governance bodies in the CCG/ICS. This includes the Primary Care Commissioning Committee, the Engagement Assurance Committee, the Equality Committee, the Equalities Task Force (which was set up specifically to look at vaccine distribution and COVID inequalities, and is expanding its remit), the Quality and Safety Subcommittee, the Data Usage Committee, the Information Governance Steering Group of the ICS, and the South London COVID-19 Preventing Mental Ill-Health Taskforce.
• Local Healthwatch perceive their work with the ICS to be an extension of their statutory duties. Joint reports are shared and published on all six local Healthwatch websites.
• Following the local Healthwatch joint working protocol, the Healthwatch Director delivers a progress update to the six local Healthwatch and the ICS. This reports activity against the domains set out in the Quality Framework but also captures impact, for example, where the ICS has accepted evidence or recommendations presented by the Healthwatch and agreed an action plan. This means it can be followed up to ensure the ICS is responding appropriately to feedback from users.

Working together to improve access to GP services

Local Healthwatch are working collaboratively, with support from the ICS, to assess access to GP services in South East London. The purpose of this work is to help the ICS dig beneath the surface satisfaction figures provided by the annual GP Patient Survey, and to properly contextualise the current media stories around problems with access to primary care. This means the ICS has an accurate local picture of current experience and an understanding of why people are having these problems.

To provide this insight, each of the six local Healthwatch is responsible for assessing (with agreed parameters) the quality of information regarding access on GP websites. A website audit tool has been developed and shared across the six boroughs to support this task. In addition. each Healthwatch is tailoring a base survey, that was developed in collaboration, to collect people’s experience of accessing GP services. For example, Lambeth is gathering insight at GP practices; Bexley and Southwark are carrying out qualitative research, in addition to the survey; and Lewisham, Bexley and Bromley have added questions to their survey. To date 1,145 people have participated in the survey.

Developing and administering the survey in collaboration has reduced the administrative burden and allowed for the identification of cross cutting emergent themes that are common across the six boroughs. For example, a key theme that has emerged is that online triage and waiting for telephone calls from GPs causes patients to experience confusion and anxiety. The ICS has committed to using the findings from local Healthwatch to inform local plans to improve patient experience of accessing GP services.

This case study was produced by the Strategy Unit for Healthwatch England.