Agenda item

Presentation by the Deputy Place Director and the Head of Primary Care, NHS Humber and North Yorkshire Integrated Care Board.

Charlotte Liddle, Head of Primary Care, NHS Humber and North Yorkshire Integrated Care Board (ICB) gave a detailed presentation on the operation of and pressures facing general practice (GP) across the Thirsk and Malton area.

Business model.

·       Independent businesses, not part of the NHS.

·       Three types of GP contracts and most local practices held a GMS contract with no end date.

The current essential service obligations, core opening hours and the national funding formula, which has not kept pace with the complexity or cost pressures modern practices face, were summarised.

GP funding streams.

·       Core GMS income remained the majority of practice funding, supplemented by voluntary Quality and Outcomes Framework (QOF) participation, national and local enhanced services and primary care network (PCN) funding.

·       Additional Roles Reimbursement Scheme (ARRS), which financed a range of staff such as physiotherapists, mental health practitioners and dieticians to reduce GP workload.

·       Rising running costs, including energy, estates and staffing, had outstripped income increases, contributing to recent collective action by practices.

The range of PCN workforce roles available and the importance of directing patients to the most appropriate clinician were highlighted. Members were reassured that physiotherapists and other ARRS‑funded clinicians could refer patients for diagnostic imaging and support those cases traditionally seen by GPs. The high proportion of over‑65 residents in North Yorkshire increased demand for continuity rather than urgent same‑day appointments. Preferences of telephone versus face‑to‑face appointments and ongoing concerns about the volume of “did not attend” (DNA) appointments were also reported.

National workload trends showed a sharp rise in appointment numbers post‑COVID and changes in patient expectations, with many seeking repeat appointments sooner than clinically necessary. NHS budgets have increased overall but growth had not been proportionate in community and primary care. The number of fully qualified GPs had fallen nationally, despite higher numbers entering training. The UK currently has record numbers of unemployed qualified GPs due to insufficient practice funding for recruitment.

There were ongoing pressures including persistent staff sickness linked to stress, high DNA rates, unexpected public health outbreaks and significant estates challenges. Many practices were officially undersized for their patient populations and lacked capital funding to expand. Even where capital funding existed, ICBs may lack the revenue budget to reimburse future rent, creating an ongoing bottleneck.

A comprehensive explanation was provided on Section 106 developer contributions, including eligibility, trigger points, time limits and restrictions on use. S106 funds could only be drawn down once housing developments reached specific build or occupancy stages and funds were strictly for capital projects rather than staffing. It was noted that extensions to S106 time limits could sometimes be negotiated where developments were delayed. The Committee discussed the need for better communication with practices regarding available S106 funds. It was confirmed that annual estates planning was undertaken and that additional funds such as the Utilisation and Modernisation Fund had been made available this year.

It was explained that historical planning applications predating the current ICB had sometimes not included S106 requests and that such contributions could not be retrospectively applied. Members raised the impact of significant new developments and institutional settings such as care homes and prisons, which created substantial additional GP workload with no dedicated funding stream.

The Committee explored wider system issues including care home development, workforce pressures, and mental health demand. Practices often received no advance notification of new care homes because registration was managed by the Care Quality Commission and the ICB could not prevent new developments even where pressure on local practices was significant due to the complexity of supporting care homes, the need to build relationships with providers and the mismatch between funding levels and the intensity of GP work required.

Ms Liddle explained the challenges in mental health provision, particularly for adults under Tees, Esk and Wear Valleys NHS Trust (TEWV) and noted that while ARRS mental health workers were available, their deployment depended on 50/50 funding between PCNs and TEWV, making recruitment difficult. There was rising demand for mental health support, increasing requests for fit notes and limited clinical tools available to GPs. Further discussion covered the Mayor’s emerging interest in health hubs and high‑street models. The ICB is engaged in early discussions but had highlighted that single‑site hubs were impractical for rural PCNs covering hundreds of square miles. There was ongoing work on neighbourhood models, integrated frailty services and potential mobile or market‑day hubs to deliver flexible local support.

It was explained that GP practices almost universally use one IT system, while hospital trusts used varied and sometimes internally inconsistent IT systems, limiting interoperability. National procurement constraints, historical system differences and safety considerations had prevented adoption of a single NHS‑wide system. The ICB was focused on expanding shared care records and enabling information exchange between systems even where platforms differ. Improvements would take time but remained a national priority.

Members were interested in receiving a further update later in the year once they had digested the material and considered next steps. Ms. Liddle confirmed she would be happy to attend future meetings.

The Chair thanked Ms. Liddle for her exceptionally comprehensive presentation. The Committee requested follow‑up information and suggested a referral to the Council’s Scrutiny of Health Committee.

Useful link

Appointments in General Practice - NHS England Digital select the month then select Annex 1 – Appointments recorded in General Practice MM YY: Practice Level Summary.