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Annual General Meeting

Brighton and Hove Federation Annual Report 2023/2024

A message from our chair

Dear Colleagues in Brighton and Hove,

I am writing to you as the outgoing Chair of the Brighton and Hove Federation.

In the early days of the pandemic and the Covid -19 vaccination campaign it became very apparent that as a city we were significantly disadvantaged by not having an active and functional Federation, and that we did not have our own organisation that could support us to provide services at a city-wide level.
We did have a Federation in name, but it was a non-functioning legal entity. The PCNs agreed that we needed to reactivate this and create something that worked for our patients, practices and PCNs.

It has been a great privilege to lead and guide that process for the last four years, the last two in the formal position of Chair.

It has been wonderful to see the collaboration and co-operation that has led to us first regaining our independence and autonomy, and then growing and evolving the Federation, building a leadership team, taking on the Extended Access service and making it such a success, and using this as a platform to develop other services that support us in providing healthcare to our patients.

In 2021 we had a turnover of £17k and reserves of £15k. We are now a company with a turnover of £3.15 million with reserves of £472k, with a guiding principle that we will reinvest any surplus to provide services that benefit the people and practices of B&H. We can now start bidding for work and projects that will enable us to be more strategic and do more of this kind of work and further support the resilience of general practice in the city.

I am very grateful to the other directors of the Federation, the leadership teams of the PCNs, and the Federation for all their hard work, dedication, and effort in getting us to this position. I particularly would like to thank Nina Graham, who has been instrumental in supporting general practice and the Federation for so many years and without whom we would not be where we are today.

I have now finished in my role as Federation Chair and am stepping away from my roles as PCN Clinical Director and as a Partner in my practice at the end of June, as I have moved away from Brighton and am looking at finding a new life/work balance.

I am very proud of what we have achieved in such a short period of time and leave with the enormous satisfaction of having helped build something that is already bringing great benefit to us all and I know will do amazing things in the future.

I have handed over the position of Chair to Dr Adam Fazakerley, who will bring his ideas, energy, and enthusiasm to the role and who, with our Chief Executive, Mark Cannon, the leadership team, and the Federation Board, will help lead the Federation to work with you, as we navigate the very turbulent waters of general practice and primary care.

It has been a great honour and pleasure to have been able to do this job and thank you for your support, encouragement, and trust over the last few years.

Best wishes and take care of yourselves

Dr Craig Milne

About us

Brighton and Hove Federation (B&HF) is a member organisation, made up of 6 Primary Care Networks (PCNs) containing 31 GP practices. We are here to support practices, patients, and communities; helping people to live a good life.

We work with our local acute, community and mental health trusts: University Hospitals Sussex NHS Foundation Trust, Sussex Partnership Foundation Trust and Sussex Community NHS Foundation Trust as well as the Integrated Care Board, local authority and other stakeholders. We cover Brighton and Hove, and areas outside the city including Saltdean, Rottingdean, Portslade and Falmer (University of Sussex).

B&HF is a company limited by shares, with 28 practices as shareholders. It is your organisation. This means that we do everything with our practices and their patients in mind. We work collaboratively to provide high quality clinical and support services to NHS primary care, as well as talking to patients, listening to feedback, and being willing to adapt to constantly improve our service. In the last year we have done some focused work on our purpose and what matters to us; amended our Articles of Association to create an independent and autonomous organisation, agreed a Memorandum of Understanding with other federations in Sussex describing how we intend to work together, and continued to build our infrastructure including developing our sub-contractual arrangements, data sharing agreements, achieving CQC registration and securing NHS pensions.

Our Purpose

To help our member GP practices support people to live well at every stage of their life.

This purpose is aligned to the Fuller Review and the Integrated Care Strategy for Sussex. It is intended to help us focus on the things that will make a difference in people’s lives, in the belief that doing so will make it easier for practices to offer the support people want and need.

What Matters to Us

What matters to us as your organisation is that we do this in a way that:

Improves patient experience and outcomes (do good work);
Improves staff experience in primary care (support people to do good work);
Designs responses based on knowledge of the value demands people make (use data to experiment with the work); and
Supports the financial viability of primary care and the federation (can continue to work).

It is also important to us that, should we make a surplus, it is reinvested into primary care in ways that support the resilience of primary care and the delivery of our purpose.

Our Values

People and community first

Connecting with and understanding people, their context and what matters to them.
Designing responses that work for people and communities based on what we learn matters to people.
Working with people and supporting their strengths.

Openness and transparency

Humility and an openness to learn and experiment.
Willingness to share knowledge and lessons.
Listening and hearing deeply.
Speaking clearly – being honest, including being clear about what we can and cannot do.

Compassion and empathy

To and for each other.
Finding the time to connect when people need it most.
Doing the things, however small, that can really make a difference in people’s lives.

Sustainability

Finding ways to deliver support in environmentally friendly ways.

Bringing ideas to life

Act / adapt quickly.
Approach things experimentally – learn/fail quickly.
Developments based on knowledge and feedback from people – patients / communities / practices / staff.
Minimal bureaucracy
Support people as they learn.

Our Strategy

Our strategy is to offer practical support to practices and Primary Care Networks (PCNs) in ways that will make a difference to them and the people they support, and to work on at-scale issues that will help the system work as a whole. The services we aim to deliver better integrated services, with surpluses reinvested in primary care locally.

The board has agreed three broad strategic priorities:

to be the 'at scale' primary care provider of choice for Brighton and Hove
supporting practices in very practical ways – enhanced access / bank workforce / hypertension / protected learning time / other services
supporting the delivery of the Sussex integrated care strategy and service delivery plan including

Integrated neighbourhood teams
Data and Digital
Workforce

The Board also agreed the following principles:

B&HF should grow at a speed that reflects its ability to reliably deliver high quality services
B&HF should retain a focus on its geographical patch whilst participating in Sussex wide service delivery if appropriate
Any contracts B&HF engage in should be financially self-sufficient.

B&HF will respond to tenders for contracts (wholly or as part of a broader Alliance of Federations) that help us to deliver our purpose, that are financially sustainable.

Our Performance - 23/24

2023 / 2024 has been another successful year, building on the progress of 2022 / 2023 where the organisation began the process of building its infrastructure and securing contractual relationships with Brighton and Hove PCNs. We achieved a small surplus of £100k because of the collaboration with HERE on Enhanced Access, the delivery of respiratory hubs, the development of our practice support offer and the securing of contracts for hypertension and research.

The request for support with additional capacity to deliver respiratory hubs allowed B&HF to test our systems ahead of an earlier than planned transition to full delivery of EA services from 1st April 2023.

This has enabled B&HF to deliver on the objective of providing more, and more equitably shared, additional EA capacity across the city.

It has also helped the organisation to respond to new contractual opportunities, including administrative support for the targeted lung health check (TLHC) programme and the mobilisation of winter hub capacity for three PCNs in the city. This success has enabled the board to offer free services to PCNs and practices including:

Supporting a wellbeing offer for all staff in primary care - £16,000
Subsidising the provision of Teamnet - £18,000
Free pre-recruitment checks - £1,500
Free research support - £3,500

B&HF also secured CQC registration and has successfully signed up to NHS Pensions.

Our Services

Enhanced Access (EA)

The Enhanced Access (EA) Service was developed to ensure that patients could be offered appointments outside of the normal practice opening times of 08:00-18:30.
B&HF has been managing the EA contract on behalf of the PCNs in Brighton and Hove since October 2022.

Over 60 minutes per thousand additional capacity has been provided for every PCN in Brighton and Hove in 23/24.

EA offers a mix of face-to-face and remote (telephone) appointments; adapting to the availability of local clinic sites and allowing patients more flexibility in how they are supported. Appointments are booked by the patient’s practice via the EA Hub, which is accessed via their clinical system. Appointments are used by patients with less medically complex needs who do not require follow-up and same-GP continuity.

The EA Service core hours are Monday-Friday 18:30-20:00; Saturday 9:00-17:00 but our service runs from 4pm-10pm weekdays and also on Sunday 09.00-16.00, to reflect current patient demand. We offer appointments with GPs, ACPs, Nurses, Pharmacists and Healthcare Assistants (HCAs). There is variation between each of the 6 PCNs, and it is important for clinicians and administrators to understand the local context to ensure that the service is operated with each PCN in mind.

We are offering and developing a range of specialist services such as Menopause Clinics, Coil Clinics, Long-term Condition Management and group consultations.

EA Data (from APEX)

PCN	Q1 Minutes per '000	Q2 Minutes per '000	Q3 Minutes per '000	Q4 Minutes per '000	Cumulative minutes per '000 for year
D&C Brighton	58.7	62.9	65.4	56.3	60.8
E&C Brighton	53.9	61.1	61.8	63.8	60.2
Goldstone	57.5	61.8	59	61.8	60
N&C Brighton	58.8	59.8	59.9	61.8	60
PPC	62.5	59.4	60.4	58	60.1
West Hove	61.3	66.2	62.9	53	60.8
Citywide Total	58.1	61.7	61.3	59.9	60.3

64,689 appointments in 23/24 (average 1221pw)
11,006 unused slots (average 208pw) – 17%
2,189 DNAs (avg 41pw) - 4%
8,956 booked same day – Much higher Nov-Mar reflective of winter pressures

Practice Support

This is a programme designed to support practice resilience by developing a training hub and recruiting, training, and mobilising staff to cover practice staff absence. A workforce platform has been developed to make it easy for practices to access the bank and for staff to make themselves available. As a result, the bank has grown by over 50% with staff being onboarded all the time.

Fully Onboarded EA Workforce

Role	1st June 2023	1st August 2023	1st October 2023	1st March 2024
GP	32	36	41	52
ANP	3	3	5	7
Nurse	10	12	14	12
HCA	5	5	5	5
Pharmacist	1	2	2	1
Patient Coordinator	0	0	0	3
Total	51	58	67	80

Fill rates for shifts are also increasing. B&HF will continue to prioritise this service for practices:

February 2024: 13 shifts
March 2024: 21 shifts

Hypertension

The Federation was commissioned to provide a hypertension support service to the city from 1st April 2023 to 31st March 2024. The aim of this service was to improve access to hypertension treatment and behaviour change for cardiovascular disease prevention, and healthy lifestyles for those most at risk and already on a GP register but not being actively managed. The focus was on people living in the most deprived parts of the city.

This service was led by a prescribing pharmacist who specialises in hypertension, with an engagement officer to support patients with health and wellbeing coaching.

Dedicated hypertension clinics were established by the prescribing pharmacist at 5 GP practices across the city working with each practice individually to develop bespoke processes that worked for their practice.

998 patients whose BP was not at an age-appropriate target were reviewed by the clinic pharmacist, including those seen in the citywide clinics set up in the 3 weeks following the national Know Your Numbers campaign. This work contributed towards hypertension QoF activity

The hypertension service’s Health & Wellbeing Coach ran 8 groups of the bespoke 4-week healthy lifestyle group consult programme – 75 patients in total completed the programme as part of this service.

The hypertension project team attended over 20 community outreach events in marginalised communities across the city, offering physical BP checks and advice to patients regarding their hypertension management and healthy lifestyle/wellbeing education. We are now a key stakeholder for various community development organisations trying to embed health promotion at their community events across the city.

Feedback from service was very positive from both staff & patients:

100% of GP staff responded that their experience of the service was very good
84.9% of patients responded that their experience of the service was very good
13.2% of patients responded that their experience of the service was good

Targeted Lung Health Check

The Targeted Lung Health Check service in Brighton & Hove is a project that aims to diagnose lung cancer patients at an earlier stage, giving better outcomes by population screening for an eligible cohort of Brighton & Hove residents, aged 55-74 years old. B&HF provides the administration and review of patients from the TLHC programme for primary care patients, including onward referral as appropriate.

Data
From 1st Oct to 31st March, 3556 patients results have been recorded and coded directly into the practices medical system. Only 23% were referred back to practice.

Outcome	Total Patients	%
Contacted by B&HF	2098	59%
Referred to Practice	824	23%
None Needed	893	25%

Patients were referred to practices for the following checks:

Appointment Type	Total Patients	%
BP and/or Bloods	315	9%
NHS Health Check	449	13%
Statin Request	27	1%
Spirometery	62	2%

The Sussex Cancer Alliance has extended this service with B&HF for quarter 1 (1st April – 30th June), and we are currently supporting the service whilst it is scanning patients in the Havens. This has worked well, and processes have been put in place to share data and provide continuity for patients.

B&HF are currently in discussion with the ICB to deliver this service across the whole of Sussex.

The TLHC screening programme is due to return to Brighton in July 2024 (starting in West Hove). B&HF are planning to avoid referrals back to practices by providing dedicated clinics supporting the following services:

NHS Health Checks
Bloods/BP
Statin initiation
Smoking Cessation

Respiratory Hubs

The ICB made funds available for PCNs to set up Winter Pressures Hubs from 1st January – 31st March 2024. The hubs were intended for same-day additional capacity to support increases in Primary Care demand usually seen during the winter months, particularly from acute respiratory illness. 3 PCNs (East & Central, North & Central, Preston Park Community) asked B&HF to arrange capacity on their behalf, 1 PCN (Goldstone) utilised our SystmOne hub for appointments to enable booking across their practices.

B&HF arranged remote and face-to-face capacity up to the funding limit provided. Over the 3-month period, 2513 appointments were offered, 474 slots were unused (81% utilisation), with 23 appointment DNAs (1%).

The breakdown of appointments per clinical system across the PCNs that the Federation supported was:

S1 – 1597 appointments offered, 84% utilisation, 99% attendance
EMIS – 921 appointments offered, 77% utilisation, 99% attendance

Protected Learning Time

B&HF has provided admin and clinical cover for the 5 citywide PLTs in 2023/24. This ensured that patients could be appropriately triaged to receive necessary care while practices were closed, with both remote and face-to-face clinical capacity for patients with urgent need.

The Federation has also supported PCNs who have chosen to close on separate occasions for additional staff training, with 3 separate dates of admin cover provided.

Community Research Network

We have a unique partnership with the Kent, Surrey and Sussex Community Research Network (CRN). They wanted to grow the number of research active practices, widen the opportunity for patient involvement in research, and support the application of research outcomes in primary care.

We make it easier for practices to participate in research by providing clinical leadership, centralised searching, patient contact, and a single point of contact for contracting and treasury functions, meaning practices can participate with minimal effort.

As a direct result of our involvement, the Brighton and Hove (B&H) Health Counts survey has had a record 30,000 responses from patients in every practice in B&H. This will provide one of the most important datasets for health and wellbeing in the city for the next 10 years. We will be putting the results to good use to make quality improvements in our services. We will also continue to perform this important role with the CRN in other areas and to actively promote research.

Wellbeing Offer

The board is acutely aware of the challenges for staff working in primary care and how this can lead to burnout. We offered free, four-day, three-night retreats exclusively for Brighton & Hove primary care staff. Designed & co-coordinated by a practising GP, the unique retreat offered nature & mindfulness for self-care for 51 GPs, allied health professionals and managerial and administrative staff.

In addition, the board has commissioned eight-week online mindfulness support for primary care staff.

Feedback from the retreats has been universally positive and the board plans to continue to offer this support.

The Future

Service opportunities

B&HF is now well positioned to contribute positively to the primary care landscape in Brighton and Hove and to collaborate with partners. As a membership organisation we are uniquely positioned to provide services that are integrated well with primary care, reduce the burden of work on practices, support primary care resilience, contribute to relieving system wide pressures, and reinvest resources into primary care locally rather than support dividends for shareholders or directors of private enterprises.

Walk-in Centre and APMS tender

This is the key strategic objective of B&HF. A tender response to provide this service over the next nine years has been submitted. A successful bid will provide a great opportunity to design a service that directly supports primary care, contributes to relieving system wide pressures, and enables us to start thinking about how we might integrate services more effectively, particularly in support of urgent and same day care.

The ambition is for B&HF to use its unique position to actively support the integration of a range of other services, including virtual wards, the walk-in centre, enhanced access, and the roving GP service (should it be tendered) that will benefit patients, our practices and our system partners.

Locally Commissioned Services (LCS)

B&HF has secured an agreement with the local authority for them to directly contract for local authority LCSs with us. We will be offering NHS Health Checks, smoking cessation, and statin requests. We are actively pursuing a similar arrangement for the ICB LCS’s.

We will be offering the Out of Hours Care Home LCS on behalf of practices that want us to do it under a sub-contracting arrangement. B&HF could offer similar support for other LCS’s, such as diabetes on behalf of practices.

The principles of working on this and other ICB LCS’s are:

B&HF only work with practices that have not signed up, or do not want to deliver an LCS themselves
Practice income levels related to the specific LCS remain unchanged, assuming current activity levels are maintained by them
Any surplus made will be used by B&HF to fund additional primary care services

Virtual wards

There is a move to create GP led virtual wards, designed to avoid admissions to hospital. In collaboration with local federations, we are building an offer for SCFT to provide this for them.

Research

We are excited to build on our existing collaboration with the CRN and want to continue to develop this important aspect of our work supporting primary care.

COVID-19

We will explore the possibility of B&HF being the provider of this service for the city

Wellbeing

Following the success of the free retreats offered to staff employed in practices in Brighton and Hove, we will continue to offer wellbeing services to staff of member practices.

The offers include retreats, courses, and drop-in sessions to help staff begin or deepen a mindfulness & meditation practice. Each offer is co-led by Dr Rachel Cottam, a practising Brighton & Hove GP, along with occupational therapist & trained mindfulness teacher Patti Summerville

We will be providing the following free offers:

1-day retreats at Fintry House

Saturday 27 July
Sunday 1 September

8-week mindfulness course, online & in person, Thursday 5 September onward, 6.30pm-8.30pm

A further four 4-day retreats at The Sharpham Trust:

Friday 4 – Monday 7 October 2024
Friday 7 – Monday 10 February 2025
Friday 14 – Monday 17 March 2025
Friday 4 – Monday 7 April 2025

System wide collaboration

We want to make it easy to work in primary care; and to help patients and staff be better off because of the things we do. We also want to work with partners and build alliances on system-level issues to find effective ways of designing safe, sustainable service responses that really matter from a person’s point of view.

We will actively build relationships through formal structures, such as the Primary Care Provider Collaborative, to build a voice for primary care in the system. We will also take part in conversations that aligns with the broader strategic objectives of the Integrated Care System (ICS), including improving same day urgent care, developing integrated community teams, digital offers, and supporting workforce development. We will continue to develop our alliance with other federations in Sussex.

Internal improvements

We will enhance our internal governance arrangements to make it easy for Directors of the board to discharge their responsibilities and to assure you as members that your organisation is delivering safe, effective, and affordable services.

Monthly finance meetings with board directors will be held to provide additional oversight on financial management and planning.

An independently chaired remuneration committee will be created to support the board in making evidence-based awards to staff.

Geography

B&HF operates across the city of Brighton and Hove. This includes areas on the outskirts of the city including Saltdean, Rottingdean and Portslade, as well as a site at the University of Sussex. Many of the Practices are situated in densely populated areas of central Brighton and Hove.

The city has a mixed population, with some affluent areas but also pockets of significant deprivation. Although the geographic area is not large, public transport between some locations is not always available or convenient.

Brighton and Hove is served by University Hospitals Sussex NHS Trust (UHSx) for acute and tertiary care. The main hospital site is the Royal Sussex County Hospital. This is where the A&E department and urgent treatment centre is located. It is also the site of the children’s hospital (The Royal Alexandra Hospital). Other services are offered at the Princess Royal Hospital in Haywards Heath. Some residents of Brighton and Hove will also make use of Worthing Hospital.
Community services are provided by Sussex Community Foundation NHS Trust (SCFT). Mental Health services are provided by Sussex Partnership Foundation Trust (SPFT).

Further information

Additional information about how we work, and our services is available on our website. If you cannot find the information you need on our website, please contact us

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