The Inner North East London Joint Health Overview and Scrutiny Committee (INEL JHOSC) met to discuss a range of healthcare issues affecting the region. The agenda included health and finance updates, LGBTQ+ health services, improvements to GP access, and a review of the committee's scrutiny report. Councillors were also scheduled to elect a chair and vice-chair for the committee.

Improving GP Access in North East London

The committee was scheduled to receive a report on improving access to primary care in North East London, with a case study from Addison Road Medical Practice (ARMP). The report, authored by Alison Goodlad, Deputy Director of Primary Care Commissioning for NEL, included a presentation from Dr Janakan Crofton, GP Clinical Lead for Waltham Forest and GP/Medical Director at ARMP, and Sindhu Balakrishnan, Chief Operating Officer at ARMP.

The presentation was expected to cover ARMP's approach to providing accessible, equitable, and patient-centred care across its seven GP practices in North East London, serving 75,000 residents across four Primary Care Networks (PCNs) in Waltham Forest and Havering. Their mission is:

Changing lives, creating equity, leading with compassion.

The report noted that over the past two and a half years, a programme of work has been undertaken across North East London to improve access to primary care and the patient experience. It stated that this is part of a national drive to move away from the 8am phone call queue and 'first come, first served' process for allocating appointments to a system where patients' needs are assessed and triaged.

ARMP's key success ingredients were listed as:

• 'Digital Hubs and Call Centres' Multiprofessional co-located spaces
• Cloud Based Telephony (CBT) and GP led AI powered triage
• 100% digitised access through single point of access virtual front door
• Data-led
• Continuous improvement culture embracing modern general practice access
• Outreach access models
• Continuity of care
• Equitable access

The presentation was also expected to cover the challenges ARMP faced in 2017, including rising demand, unmet needs, the 8am rush, increased use of 111, long call wait times, rising patient dissatisfaction, widening health inequalities, a shortage of GPs, suboptimal workforce skills mix, a lack of physical space, a tired workforce, and dwindling continuity of care.

ARMP's journey to better access involved several stages, including:

• Contact: Phone, online, or walk-in access during core hours, with support for safe surgeries, veterans, LGBTQ+ individuals, and cultural awareness.
• Understand need: Structured forms and AI-powered triage, open for urgent problems from 07:30 to 16:30 and until 18:30 for non-urgent routine queries.
• Filter: Separating administrative from clinical demand, with reception teams trained as Care Navigators .
• Assess, prioritise, and allocate: GP-led total triage, utilising in-hours and out-of-hours appointments, and balancing same-day demand with continuity of care.

The presentation was expected to conclude with a summary of the outcomes achieved through ARMP's Modern General Practice (MGP) model, including 100% response to online consultations within three hours, call wait times of less than 1 minute 30 seconds, missed calls down from 33% to 9%, 92% staff satisfaction scores, an outstanding rating from the Care Quality Commission (CQC) in well-led domains, the lowest utilisation of in-hours 111 use in the borough, and high patient satisfaction scores.

Health Update

The committee was scheduled to receive a health update, including reports from:

• Dr Paul Gilluley, Chief Medical Officer, on LGBTQ+ Health Services
• Henry Black, Chief Finance Officer, on the financial overview
• Lorraine Sunduza, Chief Executive Officer (ELFT), on NEL Collaborative updates
• Ann Hepworth, Director of Strategy and Partnerships, on Barts Health NHS Trust

The health update included discussion of organisational changes, including a national decision to reduce Integrated Care Boards' (ICBs) running costs by 50% and a restructure of the senior team. The new executive management team comprises:

• Chief Clinical and Quality Commissioning Officer (CQCO) Dr Paul Gilluley
• Chief Finance Officer (CFO) Henry Black
• Chief Strategic Commissioning Officer (CSCO) Charlotte Pomery
• Chief Strategy officer (CSO) Ralph Coulbeck

Dame Marie Gabriel was confirmed as continuing to lead the ICB as chair. It was also noted that Zina Etheridge would be standing down as CEO, with recruitment underway for an interim CEO.

The update also covered strategic commissioning plans, referencing the recently published NHS 10-year health plan¹ and a draft NHS Planning Framework. The NHS 10-year plan confirms that ICBs will be the strategic commissioner for the system they serve, leading the delivery of improvement in population health through allocation of the financial resources available, working to redesign pathways and ensuring that improved health outcomes and reduced inequalities are delivered. The plan also sets out three shifts, hospital to community; analogue to digital; and sickness to prevention.

The committee was also scheduled to discuss the Integrated Care Partnership's ambition to Work with and for all the people of north east London to create meaningful improvements in health, wellbeing and equity, and the NEL Outcomes and Equity Framework, which takes a life course approach.

The update also included discussion of the three shifts outlined in the NHS 10 Year Plan:

• Shift 1: Hospital to community Moving healthcare services from traditional hospitals into local communities to provide care closer to people's homes
• Shift 2: Treatment to prevention Shifting the focus from treating illnesses to preventing them in the first place, with an emphasis on public health and well-being
• Shift 3: Analogue to digital Transforming the health and social care system from a traditional, paper-based model to a modern, digital one

Examples of work underway to support the delivery of these three shifts were provided, including integrated neighbourhood working, commissioning an integrated pathway for women's health, and implementing an electronic patient record at BHRUT.

The update also covered managing winter pressures, with a focus on collaboration, system coordination, and supporting those most at risk. Key priorities for Winter 2025/26 include faster ambulance handovers, same-day emergency care, quicker supported discharges, vaccinations, out-of-hours GP appointments, and mental health and local authority partnership.

The update also included discussion of the North East London Collaborative updates, including the Mental Health, Learning Disability and Autism Collaborative and the Community Healthcare Collaborative.

An open letter on NHS Talking Therapies in North East London from the Mental Health Action (MHA) group, part of Socialist Health Association, was also scheduled to be discussed, with responses from NEL and ELFT colleagues.

Finance Overview

The committee was scheduled to receive a finance overview from Henry Black, Chief Finance Officer. The report covered the ICS's month 4 (July) 25/26 reported position, which expected a system breakeven position by year-end (£2.5m surplus for the ICB and £2.5m deficit for providers). To deliver this, there is an expectation that efficiencies of £367.7m will be delivered (£37.8m ICB and £329.9m providers).

The report also outlined the NEL ICS efficiencies, risks, and mitigations, noting that the risk to the delivery of the ICS breakeven position is reported as part of the run rate return to NHSE.

LGBTQ+ Health Services

The committee was scheduled to receive a report on LGBTQ+ Health Services from Dr Paul Gilluley, Chief Medical Officer. The report provided information on gender dysphoria, gender identity, and gender services in the NHS.

The report also covered the Cass Report² (Independent Review for Gender Identity Services for Children and Young People), noting that the final report was published 10 April 2024, gender services for children at the Tavistock and Portman closed in April 2024, and two new services (London and Manchester) opened.

The report also provided information on North East London Gender Services for Children and Young People, treatment of children with gender dysphoria/incongruence, and inclusion health.

The Scrutiny Report

The committee was scheduled to discuss the Scrutiny Report, which included a review of the Forward Plan, Action Tracker, and Recommendations Tracker from the previous meeting. The INEL JHOSC Scrutiny Forward Plan 25/26 Cycle: Rationale included items on primary care, an update on the Cass Review/Sexual Health, a Health Update, and a Finance Update.

The INEL Action Tracker captured all actions required of officers by the committee at the previous scrutiny meeting and provided an update on progress.

The INEL Rec Tracker captured all recommendations made by the committee at the previous scrutiny meeting.

Other items

The agenda also included the election of a chair and vice-chair, apologies for absence, declarations of interest, public participation, and the minutes of the previous meeting.