Primary Care

Hounslow has 46 GP Practices located across the borough, grouped into five Primary Care Networks (PCNs).  Hounslow’s Primary Care Networks cover the full breadth of the borough and every person living in Hounslow can register with a GP, regardless of immigration status or fixed abode. 

PCNs were established in 2019 and were designed to support Primary Care to work at scale to improve the care offered to patients. They work closely with community, mental health, social care and acute care partners and cover population footprints (neighbourhoods) of approximately 30,000-50,000 patients. 

Each Primary Care Network has a Clinical Director (CD) who is the leader of the PCN and accountable to their member practices. 

All PCNs in England must provide the following under the PCN Enhanced Services contract: 

• Social Prescribing 
• Early Cancer Diagnosis 
• CVD and Hypertension 
• Enhanced Health in Care Homes
• Personalised Care
• Anticipatory Care
• Enhanced Access (Weekend and evening access to GP appointments)

Under this contract, there is additional funding for GPs to employ additional roles into General Practice under the Additional Roles Reimbursement Scheme (ARRS). These roles are reimbursed by NHS England, the cost of which is more than £7 million in Hounslow in 2023/24. As of April 2023, Hounslow has more than 150 Additional Roles staff, spanning:

• Digital and Transformation Managers
• Social Prescribers
• Pharmacists
• First Contact Physiotherapists
• Paramedics
• Care Coordinators
• Mental Health Practitioners 
• Health and Wellbeing Coaches 

In 2023, more and more contracting routes and funding sources are coming down to Network/ Neighbourhood level rather than at practice level, to maximise at-scale solutions to serve a PCN geography, and to reduce inequalities in patient experience across a given patch. One such example of this is in the new NW London Standard Enhanced Services contract, which was rolled out in April 2023. This is a single suite of services that all GP practices in NW London will offer.

This means that whether you have a GP in Brent or Hounslow, you would have access to the same suite of services. 

The services commissioned are:

• Ambulatory Blood Pressure Monitoring (ABPM)
• Anticoagulation- Warfarin 
• Diabetes 
• ECG 
• Latent TB (LBTI)
• Medicines Management (Prescribing Incentive Scheme)
• Mental Health 
• Near Patient Testing 
• Phlebotomy
• Ring Pessary 
• Spirometry
• Wound Care 

There is also some local nuance to this on the basis of historical services that we have commissioned locally to address inequalities in healthcare experiences. They are:

• Homelessness
• Asylum Seekers
• Care Homes 
• Additional Weekend Access (was Saturday mornings)
• Public Health Outcomes Framework

The current significant challenges facing General Practice, like many elements of the NHS are:

• Demand and Capacity: despite a national increase in appointments of 11% since 2020 to 2023, demand continues to outstrip capacity and patient access to general practice continues to be a significant challenge for patients across the borough, echoed by a general decrease in patient satisfaction with general practice in the 2022 GP Patient Survey, which is a strategic focus for 2023/24. 
• Workforce: Hounslow has an ageing GP workforce, and a large number of Hounslow GPs will be of retirement age in the next five years. This is an ongoing challenge for all areas in the NHS but particularly acute in Primary Care. The new NW London Workforce Strategy is designed to address a number of these workforce challenges.  
• Estates: many GP practices are operating from premises that are not fit for purpose, nor sustainable in the long run. Many sites are overcrowded and require an increase in consultation rooms to be able to see more patients and meet the demands of the population in 2023. The absence of capital and revenue investment in Primary Care Estate has posed a continued challenge for both practices and the Primary Care Teams to seek to deliver high quality care for patients in Hounslow. 
• Working at scale: historically, many practices were small (under 2000 list size) and were run by single-handed GPs. This model is not sustainable with the demands of the new GP Contract. 

Within Primary Care, the majority of the strategic decision-making comes in directives and contacts negotiated by NHS England, and some from the ICB within NW London. It is the role of the Borough Primary Care Team to work on how to operationalise the national strategy. The Hounslow Borough Primary Care Team therefore have the following plans for 2023/24:

Primary Care also relies heavily on enabling functions from accompanying workstreams, both locally and at system-level. 

There are multiple ways to engage: 

• Fortnightly strategic meetings with PCN CDs and managers in the Hounslow Integrated Primary Care Group
• Fortnightly GP webinars for all Hounslow GPs 
• Bi-monthly Practice Manager forums for Hounslow Practice Managers 
• Weekly GP bulletins which are circulated to all GPs and Practice Managers on a Friday afternoon. Please note that the content deadline is 12pm on Fridays submitted to the Primary Care inbox: houccg.primarycare@nhs.net 

The Primary Care Team are also mapped against the PCNs so can advise on specific projects and issues, please contact The Hounslow Primary Care Team: houccg.primarycare@nhs.net for further information.