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From YouTube: Leeds City Council - Adults, Health and Active Lifestyles Scrutiny Board - 12 September 2023
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A
Now,
good
afternoon,
everyone
I'm
because
they're
not
quite
a
shelf
as
I
thought.
I
was
this
this
afternoon
good
afternoon.
Everyone
this
is
today's
security
board
for
adults,
health
and
active
lifestyles.
I
hope
you
all
enjoy
this
screening
board
meeting.
We've
got
some
really
important
topics
on
the
agenda
today,
as
as
always
in
terms
of
this,
just
to
remind
everyone
that
this
is
webcast
live,
so
my
little
photo
earlier
will
be
a
public
public
information
soon
enough.
A
My
name
is
Andrew
Scott
I'm,
a
council
for
Beeson,
holbeck
and
I'm.
Chair
of
this
board,
we're
going
to
start
with
introductions
we'll
go
around
the
table
and
then
we'll
get
into
the
meat
of
the
meeting.
Okay,
so
we'll
go
this
way.
Thank
you.
D
H
K
L
M
N
Q
That's
knowing
everybody
councilor
Conrad,
hartbrook
I've,
been
a
member
of
this
committee,
come
up
to
three
years
and
I'm,
a
council
representing
Rothwell
world.
A
Thank
you
very
much
everyone
and
welcome
I'd,
just
like
to
say
that
councilor
James
Goodson
he's
he's
the
chair
of
the
licensing
committee
and
I.
Think
that
means
when
an
overseas
is
going
to
join
us
once
that
meeting
finishes
and
also
councilor
Sam
Arif.
It's
a
wedding
so
I'd
like
to
wish
her
all
the
best
for
Friday
in
particular,
okay.
So,
let's
move
on
to
the
first
items
and
I'm
going
to
pass
over
to
Angela
to
run
through
the
first
items.
Thank
you
thank.
S
You
so
under
item
one.
There
are
no
appeals
against
the
refusal
of
inspection
and
documents
under
item
two.
There
are
no
items
for
exclusion
in
relation
to
item
three.
There
are
no
late
items
and
under
item
four,
please
may
I
ask
if
both
members
have
any
Declarations
of
Interest
and
I
shall
take
silences.
No
thank
you
and
under
item
five.
S
We've
had
no
apologies,
led
by
bar
members
enough
to
chair,
explained
cancer
Gibson's
indicated
that
he
may
be
a
bit
late
and
also
apologies
from
Council,
Arif
and
and
also
from
Caroline
barrier
as
the
interim
director
of
adults
and
health.
Thank
you.
A
A
S
Thank
you
chair.
There's
a
number
from
the
last
meeting
minute
number
21,
the
chairs
being
advised
by
the
director
of
Public
Health,
but
a
briefing
paper
from
the
drug
and
alcohol
team
regarding
the
issue
of
cannabis
use,
particularly
amongst
young
people,
will
be
made
available
in
October
sticking
with
minute
21
the
children
family
scrutiny
board
will
be
holding
its
working
group
meeting
on
the
issue
of
vaping
amongst
children
and
young
people
on
the
27th
of
September
at
2,
30
and
Council
Scopes
and
councilor
Anderson
have
volunteered
to
attend
this
meeting.
S
To
represent
this
particular
scrutiny
board
minute
22,
as
requested
members,
have
now
received
information
on
the
evaluation
framework
that
was
linked
to
the
Community
Mental
Health
Grant
allocations.
While
members
also
requested
further
information
surrounding
neurodiversity
assessments
for
children,
it
is
now
proposed
that
this
matter
be
considered
as
part
of
a
working
group
approach,
as
opposed
to
just
receiving
a
briefing
paper.
So,
arrangements
for
this
will
be
confirmed
shortly
and
finally,
in
relation
to
minute
23
link
to
the
healthy
leads
plan.
Members
have
been
sent
details
of
these
existing
outcome.
S
Frameworks,
that's
associated
with
each
of
the
population
boards
we've
been
advised
that
these
are
currently
under
review,
so
we're
expecting
update
versions
to
be
available
by
November.
Thank
you.
A
Thank
you
very
much
Angeline
just
going
back
to
the
The
Vaping
one
because
we're
looking
particularly
at
younger
people
using
them,
it
feels
like
it's
probably
is
a
children.
Family
screening
board
item
to
lead
on,
but
they're
letting
us
be
part
of
the
discussion.
So
I
think
that's
really
important.
F
Yeah
sorry
to
take
up
a
bit
of
time,
but
I
just
want
to
record
my
thanks
around
the
drug
issue,
because
I
know
that
a
shout
out
has
been
put
out
through
the
local
care
partnership
digest
so
for
sort
of
gathering
intelligence.
So
I
do
appreciate
that.
So
thank
you.
Victoria
I
think,
particularly
for
instigating
that.
A
It's
great
okay,
anything
else.
Okay,
so
now
we
can
move
on
to
our
first
substantive
item,
which
is
access
to
GP
practice,
which
obviously
affects
everyone
in
the
city
I'm
going
to
hand
over
to
Council
of
energy
to
start
just
as
always,
you
can
always
assume
that
we've
read
the
papers,
but
obviously
it's
key
points.
Please
drop
them
out
thanks
cancer
winner.
H
Yeah
so
I'll
introduce
the
report
and
then
am
I
handing
over
to
you
again
yeah,
so
I'm
introducing
this
in
the
health
Partnerships
part
of
my
role
where
I
chair
the
health
and
well-being
board.
So
this
support
is
in
the
context
of
access
to
GPS
being
the
top
health
issue
that
is
raised
by
the
public.
So
with
things
like
the
big
leads
chat,
all
the
work
works
at
healthwatch
undertake.
This
is
the
issue.
H
That's
that's
raised
the
most,
so
it's
frequently
discussed
at
the
health
and
well-being
board,
and
we
know
both
that
people
are
struggling
sometimes
to
access
GPS
and
that
GPS
are
working
incredibly
hard.
So
both
both
those
things
are
true.
So
GPS
are
now
as
the
report
States,
offering
more
appointments
and
more
face-to-face
appointments
and
they
were
pre-pandemic,
but
demand
has
swords.
H
So
in
the
health
and
well-being
board.
We've
also
discussed
campaigns
to
promote
people's
understanding
of
the
range
of
services
that
are
provided
at
GPS
practice
that
people
don't
always
need
to
see
a
doctor.
You
know
there's
Pharmacists
and
there's
social
prescribers,
who
personally
I'm
a
big
fan
of
so
social
prescribers
who
work
across
the
city
are
there
to
support
GP
practices
where
people
are
presenting,
but
the
underlying
courses
are
around
the
wider
determinants
of
health.
H
So,
for
example,
if
someone's
underlying
issue
is
housing
or
loneliness,
a
social
prescriber
can
support
by
directing
them
to
services
that
we're
able
to
be
able
to
support
them,
and
this
is
reflected
in
the
paper
where
it
talks
about
the
modern
general
practice
of
multidisciplinary
working.
So
we're
really
Keen
to
promote
that
that
there's
a
huge
range
of
expertise
and
support
available
through
primary
care.
It's
not
only
seeing
a
doctor.
H
The
report
also
refers
to
accessible
information
standard,
which
is
about
people's
communication
needs
and
again
we
picked
that
up
as
a
really
important
issue,
and
we
did
a
workshop
on
that
also
in
the
last
year
in
the
health
and
wellbeing
board,
where
we
heard
from
a
deaf
person,
we
heard
from
someone
with
learning
disabilities
about
their
challenges
in
being
communicated
with
by
the
health
system
and
Jim
Barwick
from
the
GP
Confederation
took
away
actions
to
look
at
how
we
can
improve
that
and
we'll
get
a
report
back
in
the
next
couple
of
months
on
that
so
overall,
as
you'll
have
seen
in
the
report,
the
picture
in
Leeds
is
more
positive
than
it
is
across
the
country,
but
we
we
also
do
need
to
continue
to
support
Primary
Care
in
their
continued
aspiration
for
improved
access.
O
Thank
you
for
that
introduction.
Council
of
Anna
I'm
conscious
in
presenting
this
report
to
the
to
scrutiny
committee
that
there's
a
vast
amount
of
information
in
there
and
I
know
that
councilors
will
want
to
ask
specific
questions
so,
just
by
way
of
introduction,
I'd
just
like
to
just
bring
out
a
couple
of
points,
some
of
which
emphasize
or
both
of
which
emphasize
or
Echo
things
that
councilor
Vena
has
said
by
way
of
her
introduction.
O
And
then
what
I'd
like
to
do
is
invite
my
general
practice,
colleagues
to
share
their
experiences
of
sort
of
you
know
a
day
in
the
a
day
in
the
real
life
of
the
of
them
general
practice
if
you
like,
and
they
want
to
draw
out
further
items
for
discussion
if
that's
okay
with
with
committee
members.
So
first
thing
I'd
like
to
say
and
again
say:
I
know
this
as
a
has
already
been
picked
up
by
council.
Venner
is
just
that.
O
The
the
total
Quantum
of
appointments
that
we
now
offer
across
general
practice
is
significant
and
and
is
above
pre-pandemic
levels
and
within
the
paper.
I
did
include
a
comparison,
I
think
which
just
helps
to
to
show
the
the
context.
O
So
for
comparison,
an
average
day
around
900
people
are
seen
in
our
City's
emergency
departments,
and
you
can
contrast
that
with
19
000
appointments
been
delivered
in
general
practice
every
day
the
total
number
of
appointments
now,
as
I
said,
exceeds
and
pre-pandemic
levels,
with
40
of
those
being
delivered
on
the
same
day
and
74
of
those
being
face
to
face,
which
is
something
we
know
that
patients
really
highly
value
nationally,
there's
been
a
requirement
to
continue
to
recruit
to
the
national
number
of
26
000
additional
roles
by
the
end
of
March,
and
we
continue
to
commit
to
that
in
Leeds,
as
councilor
Vena
says,
our
Workforce
has
grown
in
general
Practice
in
recent
years,
due
to
the
number
of
the
additional
roles
that
are
funded
through
that
National
scheme.
O
The
additional
roles
reimbursement
scheme
are
the
hours
scheme.
For
short,
so
these
rules
are
employed
to
work
with
groups
of
practices
in
their
Primary
Care
networks
and
by
the
end
of
this
financial
year,
which
is
the
end
of
the
five-year
scheme.
We
will
have
implied
an
additional
400
whole
time
equivalents
within
general
practice
across
the
city,
so
the
roles
include
pharmacists
care,
coordinators,
physios,
social
prescribers
and
mental
health
workers,
as
well
as
others,
and
people
can
be
care
navigated.
O
To
see
one
of
these
professionals
when
it's
preferable
to
be
them
being
seen
by
a
doctor.
So,
for
example,
somebody
with
back
pain
being
able
to
see
a
physio
directly
rather
than
going
through
a
GP
or
seeing
a
pharmacist
where
there
might
be
a
medication
issue
and
again
as
councilman
referred
to.
This
is
part
of
that
vision
for
modern
general
practice,
which
I
think
is
still
not
not
well
understood
nationally
and
locally
by
by
some
members
of
the
public.
So
I
think
we've
still
got
work
to
do
there
together.
O
So
general
practice
continues
to
be
a
really
busy
and
dynamic
part
of
our
Health
and
Care
system,
and
that's
probably
as
much
as
I
was
going
to
say
by
way
of
introduction
keeping
it
brief.
Knowing
that
you'll
have
all
read,
the
report
and
you'll
have
questions
but
I'd
just
like
to
bring
in
at
this
point
Dr
George
Winder,
who,
as
he
said,
is
the
is
both
a
GP
and
chair
of
the
Leeds
GP
com
fed
just
to
to
share
some
of
his
Reflections
and
to
further
our
discussion
this
afternoon.
Thank
you.
M
Thanks
Gainer
and
thanks
Council
of
Anna
for
the
summary
and
introduction
and
hope
it's
a
lovely
opportunity
for
us
all
to
give
you
a
flavor
of
what
is
happening
in
general
practice
at
the
moment
and
it's
a
real
welcome
opportunity.
So
thank
you.
M
We
know,
for
example,
that
lots
of
people
value
continuity
more
than
access,
but
currently
we
describe
access
by
the
number
of
appointments
that
we
offer
not
by
the
community
that
we
offer.
We
also
know
that
there
is
no
direct
correlation
between
the
number
of
appointments
that
you
offer
as
a
GP
surgery,
to
the
satisfaction
that
patients
feel
in
the
service
that
you
provide.
M
A
recent
study
showed
that
there
is
as
much
correlation
between
the
name
of
the
practice
and
its
rate
of
satisfaction
as
the
amount
of
appointments
it
offers
and
the
satisfaction.
So
that's
to
say,
the
more
appointments
we
offer
does
not
increase,
satisfaction
or
patient
satisfaction
in
a
global
sum,
but
what
we
know
is
that
continuity
across
staff
groups
within
Primary
Care,
increases,
satisfaction
and
decreases.
Healthcare
utilization
I
think
it's
really
important
to
remember
that.
M
I.
Think
it's
also
important
to
know
that
the
staff
that
work
within
Primary
Care
are
also
citizens
of
leads.
I
am
foremost
not
a
GP
I'm
foremost
a
dad,
a
brother,
a
son
to
people
who
are
growing
up
and
getting
older
in
this
city.
My
mum
can't
get
appointments,
she's
got
dementia.
She
can't
get
appointments.
My
sister
with
her
kids
can't
get
appointments.
It
is
incredibly
difficult
for
everyone.
M
What
that
looks
like
so
that
we
can
ensure
that
we
promote
continuity
so
that
we
promote
good
access,
but
we
get
that
balance
right
and
so
I
think
there
is,
whilst
currently
the
situation
for
patients
and
for
staff
in
Primary
Care
is
in
Leeds
is
fairly
awful.
I
know
if
you
use
that
word
deliberately
it's
fairly
awful,
that's
how
our
staff
would
describe
it
and
that's
how
some
of
my
family
members
would
describe
it
I
think
there
is
hope.
M
I
think
gainers
alluded
to
that
and
I'm
going
to
hand
over
to
Andrea
to
talk
a
little
bit
about
the
roles
and
the
RS
roles,
and
then
we'll
talk
a
little
bit
more
about
the
challenges
around
the
states
and
the
brexit.
So
I'm
going
to
hand
over
to
Andrea.
N
Thank
you,
George.
Thank
you
for
inviting
us
today,
I
think
it's
a
really
useful
opportunity
to
kind
of
discuss
the
different
roles
that
we've
got,
that
we
are
all
hoping
are
going
to
make
a
difference
in
terms
of
access
in
general
practice.
I
just
wanted
to
kind
of
draw
the
attention
to
section
far
on
the
on
the
report
in
terms
of
the
different
roles
and
give
you
a
little
bit
of
context
as
to
how
far
we've
come
and
where
we
are
at
the
moment.
N
So,
over
the
past
four
years,
when
the
hours
rules
started
to
get
introduced
into
Primary
Care
networks,
we
had
zero
of
these
roles
and
we've
built
them
up
as
as
again
as
mentioned
to
over
400
at
the
moment,
whole
time
equivalents-
and
these
are
a
range
of
health
professionals
from
unregistered
unregistered
roles
and
some
of
these
and
well
many
of
these
are
very
new
to
primary
care.
N
So
a
very
familiar
around
patients
are
with
GPS
practice:
nurses,
Advanced,
practitioners
and
over
the
past
few
years,
pharmacists,
but
many
of
the
other
roles
are
usually
working
in
secondary
care
or
Community
settings.
So
it's
not.
You
know
a
patient's
First
Choice
to
ring
up
and
ask
to
be
booked
in
with
some
of
these
roles.
So
there's
a
huge
amount
of
patient
education
around
what
different
roles
are
in
primary
care
and
what
types
of
services
and
clinics
that
they
can
book
into.
N
Colleagues,
that
you
know
we're
not
really
sure
also
what
to
do
with
some
of
the
roles
and
there's
not
a
Amanda
as
to
what
lift
to
offer
specifically-
and
it
is
around
your
own
population,
needs
and
and
sort
of
different
diversities
and
kind
of
what
types
of
appointments
and
services
that
a
Primary
Care
Network
needs
to
offer.
So
you'll
you'll
notice
that
there
is
a
variation
on
the
numbers
of
full-time
equivalents
across
different
Primary
Care
networks
and
we've
all
got
different
budgets
in
terms
of
what
what
agiles
we
can
recruit.
N
But
it
will
also
have
an
impact
in
terms
of
the
area
that
they
can
recruit
into.
So
some
more
deprived
areas
will
really
struggle
with
any
Workforce
and
recruitment,
but
specifically
the
new
rules
and
what
we
noticed
at
the
start
sort
of
a
couple
of
years
ago
was.
You
know.
Other
health
professionals
didn't
really
know
what
primary
care
networks
were
to
be
looking
for
these
jobs
and
actually
a
bit
careful
about
taking
on
a
position
in
primary
care.
But
we've
seen
this
past
year
or
two
that's
definitely
increased.
As
the
teams
have
increased.
N
N
So
there's
not
the
funding
within
Primary
Care
to
grow
and
develop
our
Estates
strategy,
so
we're
actually
faced
with
some
Primary
Care
networks
actually
stuck
in
terms
of
recruiting
more
posts
because
they
have
nowhere
to
put
them
so
to
be
able
to
offer
appointments
to
patients
the
need
to
have
a
clinical
room
so
that
they
can
see
patients
face
to
face
because
the
majority
of
patients
still
want
face-to-face
contact,
but
we
have
very
limited
space
within
primary
care.
N
So
you
know
we
are
looking
at
new
ways
of
working
and
now
we
can
offer
that.
But
that
is
a
real
real
challenge
and
I.
Think
a
lot
of
primary
care
networks
have
stopped
recruiting
to
a
point
that
they've
just
got
no
access
for
them,
so
I
think
just
finally,
on
my
point
before
I
undo
over
to
my
colleague
for
sort
of
another
area
is
just
you
know
within
the
teams.
Part
of
the
challenge
we've
got
is
really
communicating
to
patients.
What
the
new
roles
are,
why
we've
got
them
in
practice?
N
That
is
an
ongoing,
updated
training
for
them,
so
real
challenges
around
getting
the
new
roles
into
practice,
keeping
them
and
returning
them,
but
also
sort
of
making
sure
they're
embedded
within
the
teams
in
Primary
Care.
So
I'm
going
to
want
you
over
to
my
colleague
Sarah
and
just
to
follow
up
on
that.
But
thank
you
happy
to
take
some
more
questions
later.
A
T
Hi,
thank
you.
Dr
Sarah,
mcsorry,
Vice,
chair
of
Leeds,
LMC
I'm,
also
a
local
GP
in
the
city
I'm
currently,
and
having
been
a
salary
GP
in
chapeltown
previously
for
about
four
years
to
that.
T
T
T
You
sorry,
okay,
just
make
the
point
as
well
that
about
the
funding
limitations.
T
Just
to
reiterate
that
point
really
so
having
been
only
two
percent
uplift
over
the
last
five
years,
which
is
obviously
not
in
line
with
inflation,
that's
had
an
effect
on
practices
being
able
to
retain
and
recruit
stuff,
and
in
addition
to
that,
just
the
additional
work
from
left
shift
from
secondary
care
having
an
impact
on
waiting
times
in
Primary
Care,
and
also
a
lot
of
the
appointments
are
still
remote
about
patient
appointments
which
isn't
always
too
satisfaction
of
patients,
so
that
can
end
up
having
an
effect
on
wanting
to
see
GPS
additionally,
which
wouldn't
always
be
necessary.
T
Oh
sorry,
sorry,
that's
a
bit
of
a
technical
term
in
our
world,
so
basically
the
workload
from
second
UK,
which
was
really
been
moved
down
to
Primary
Care.
It's
been
happening
for
quite
a
long
time
and
it
sort
of
it
isn't
always
appropriate.
We
feel
is
from
GPS
and
it
does
have
a
massive
impact
really
on
the
workload
to
all
the
stuff
in
general
practice,
including
the
admin
team,
so
that
I
think
that
has
a
huge
impact
on
access.
A
Thank
you
so
I'm
going
to
open
up
to
questions
from
Members.
If
anyone
wants
to
ask
a
question,
please
indicate
in
use
your
way.
Otherwise,
I'll
start
with
my
questions
and
we'll
see
how
we
get
on
okay.
So
thank
you
very
much,
but
I
found
this
report
really
really
interesting.
A
Just
just
a
couple
to
start
with,
so
the
first
one
is
around
I
thought:
it's
really
really
impressive
statistic:
80,
but
within
14
days
I
had
a
question
around
the
sort
of
this
other
20
sort
of
the
tale
of
that
and
whether
that
was
like
how
how
far
it
goes
out
and
then
sort
of
link
to
that
which
is
still
appointments
is
I
really
appreciated.
The
map
that
you
put
in
on
on
page
on
page
35
of
the
pack
I
thought.
That's
really
helpful
to
see
where
the
practices
are.
A
I
was
wondering
in
terms
of
the
pitch
points,
so
just
because
it's
too
close
to
each
other,
it
I
guess
the
population
can
be
more
dense
in
different
areas.
So
I
was
wondering
if
there's
any
really
particular
picture
points
in
terms
of
where
waiting
time
is
longer
than
other
places.
So
two
questions
about
appointment
times.
Thank
you.
O
Thank
you
so,
in
terms
of
in
terms
of
the
the
report
containing
the
data
around
appointments
booked
within
14
days,
the
reason
for
including
that
is
one
of
the
national
measures
that
we
are
that
we
are
monitored
against
I
did
then
do
a
subsequent
piece
of
work
to
look
at
that
remaining
20
Council
Scopes.
So
we
can
track
that
per
practice
and
per
PCN.
O
If
I
look
at
the
the
the
Primary
Care
Network,
where
there's
the
the
largest
disparity
in
terms
of
appointments
booked
within
14
days,
our
appointments
booked
Beyond
14
days,
the
the
data
tells
me
that
most
of
those
most
of
the
appointments
that
are
booked
beyond
the
14-day
cut
off
point
are
those
are
for
those
types
of
procedures
that
are
booked
are
pre-planned
or
you
know,
booked
in
advance
for
a
reason
not
because
there
isn't
any
any
availability
within
that
14-day
period.
O
Our
data
very
clearly
shows
us
that,
like
I
said
that
that
longer
term
tale
is
where,
like
I
say,
appointments
need
to
be
and
can
be
and
should
be
booked
further
in
advance
for
the
for
the
purposes
of,
say,
monitoring,
a
a
chronic
condition.
O
We
expect
all
all
practices
to
respond
to
patients
based
on
clinical
need,
so
offering
both
that
you
know.
Somebody
needs
to
be
seen
clinically
on
the
day
and
being
able
to
do
that
and
then
like
I
said,
then
that
then,
that
other
National
measure
of
of
appointments
being
booked
within
within
that
next
two
week
period,
And,
so
that
that
data
is
available
and
I
can
share.
Is
it
as
a
subsequent
piece
of
data?
Should
you
want
it.
O
I,
don't
I
don't
have
specific
data
set
in
terms
of
in
terms
of
pinch
points
other
than
like
I
said
the
data
that
we
use,
which
shows
both
the
Quantum
of
appointments
and
the
time
within
which
they're
booked
and
the
type
of
appointments,
which
does
show
a
spread
across
the
city
and
each
practice
uses
their
own
sort
of
operational
model.
O
If
you
like,
so
we
might
not
necessarily
be
comparing
apples
with
apples
in
terms
of
that
direct
value
of
this
percentage
of
patients
are
booked
within
this
percentage
of
time
and
from
one
practice
to
another.
O
But
as
I
say
it,
you
know,
we,
we
use
our
data
alongside
the
Insight
that
we
get
from
from
patients
and
also
the
information
that
we
get
in
terms
of
the
national
GP
service.
So
if
we
feel
there's
an
area
where
there's
an
issue,
then
obviously
we
would
be
looking
at
any
unwarranted
variation
in
those
areas.
But
I
haven't
got
anything
here
now
that
says,
we've
got
a
particular
pinch
point
in
X
practice
or
or
why
PCM.
A
Okay,
so
I
guess
I,
guess
you're
going
back
to
your
your
point,
I
think
it's
Andrew's
point
about
the
Estates.
I
guess
is
that
the
data
you
you
need
before
you
decided
where
you
would
build
increased
capacity.
O
Capacity
Works
slightly
differently
in
terms
of
in
terms
of
the
general
practice
contract,
so
a
contract
is
paid
per
capita
per
head
of
population
and
it
and
the
payment
follows
the
registration
of
a
patient.
So
we
don't
have
so
I
think,
unlike
schools,
for
example,
so
you
can,
in
a
in
a
council
sense
can't
you
plan
for
a
new
school
knowing
that
there's
going
to
be
new
housing
and
therefore
there'll
be
numbers
of
children,
one
in
that
school.
O
We
can't
do
the
same
in
anticipation
because
of
the
way
that
the
GP
contract
and
the
the
national
funding
floors
funding
follows
once
patients
have
been
have
been
have
been
registered
so
again,
we've
got
that
balance
of
understanding
where
we
think
they
might
be
projected
population
growths
or
where
we
think
there
might
be
practices
that
have
outgrown
their
their
their
building
size.
Because
again,
there
are
calculations
between
the
square
meter
Ridge
that
a
practice
can
claim
reimbursement
of
the
rent
for
versus
their
registered
population.
O
So
there's
some
quite
complex
things.
Things
within
that
yeah
I
think
George
wants
to
come
in.
M
Is
that
okay,
just
a
number
of
people
in
this
room
are
also
involved
in
the
workaround
East
Leeds
extension
and
the
development
that
that
will
the
Housing
Development
and
the
pressure
that
will
put
on
not
just
GP
services
but
the
wider
Health
economy.
M
That
said,
it's
an
absolutely
great
opportunity
and
I
think
I
should
probably
share
a
few
people's
frustrations
that
we've
yet
managed
to
grasp
that
nettle.
It's
both
a
challenge
but
a
real
opportunity
and,
as
Gaynor
said,
the
part
of
The
Challenge
from
primary
Care's
perspective
is
that
the
the
money
will
only
flow
once
patients
are
registered
and
there
is
a
huge
challenge
around
who's,
going
to
again
bridge
that
gap
of
risk.
Currently
there
is
no
obvious
large
partner
within
the
city,
who
is
Keen
to
do
that.
M
Understandably,
there
is
a
challenge
about
the
rate
of
housing
growth
which
we're
at
the
whim.
It
would
appear
to
be
of
a
number
of
developers
and
other
people
and
in
terms
of
pinch
points,
while
that
may
not
currently
exist,
it's
certainly
one
that
we
would
project
to
the
future,
I
suspect
and
I.
Think
as
a
as
a
collective.
M
There
is
something
that
we
should
be
doing
to
ensure
that
that
doesn't
happen
because
currently,
at
the
moment,
it's
waiting
to
happen
and
we're
at
not
an
impasse,
but
certainly
significant
challenging
time,
where
we
can't
pass
that
so
one
of
our
asks
would
be.
How
is
a
city?
Can
we
really
do
something
Innovative?
How
can
we
share
that
risk?
How
can
we
take
those
steps
forward,
because
otherwise,
that
area
we
will
waste
the
opportunity
and
we
will
create
further
pinch
points.
L
So
there's
lots
of
creative
ways
that
we
are
doing
some
joint
working
sharing
spaces
third
sector,
if
I
could
call
that
a
voluntary
sector
and
so
I
think
we
should
thank
those
people
who
have
partnered
with
general
practice,
Primary
Care,
to
give
us
that
resilience.
Thanks.
D
No
thank
you
chair.
There
were
two
things
I
wanted
to
pick
up,
but
can
I
just
make
a
comment
on
one
other
point
which
Sarah
has
has
already
mentioned.
In
paragraph
four,
three
within
the
national
GP
contract,
there
has
been
a
two
percent
staff
pay
uplift
to
practice
funding
in
each
of
the
last
five
years.
D
I
couldn't
believe
that
when
I
read
it
in
fact,
I've
marked
it
down
with
three
exclamation
marks,
because
I'm
sure
that
there
is
no
one
in
the
government.
There
is
no
one
in
NHS
England
who
got
a
two
percent
pay
rise
for
each
of
the
last
five
years
and
I
think
that
is
just
absolutely
appalling
and
just
wanted
to
say
I'm
speaking
here
personally,
not
not
on
behalf
of
healthwatch
leads,
but
I
was
really
amazed
at
that
comment.
D
In
there
the
two
things
I
wanted
to
pick
up
chair
were,
first
of
all
in
2.9
to
enable
patients
in
over
90
of
practice,
that
is
to
see
their
records
and,
and
that
clearly
includes
being
able
to
book
appointments.
D
Healthwatch
leads
has
recently
been
undertaking
a
an
investigation
of
access
to
GP
services
and
it's
it's
not
published.
Yet
it's
in
a
draft
form
at
the
moment,
but
I
know
that
wonderful
things
which
people
have
said,
or
at
least
some
of
the
respondents
have
said,
was
difficulty
in
using
the
electronic
appointment
system
and
it's
not
always
clear.
Actually
what
you
do.
I
I
got
a
probably
a
year
or
so
ago.
D
Now
a
text
from
my
practice
saying
that
from
such
and
such
a
date
they
would
be
using
patches,
didn't
describe
what
patches
were
didn't
describe,
how
I
got
hold
of
patches
didn't
describe
what
it
did
didn't
describe
how
to
use
it.
We
really
do
need
to
make
sure
that
we
let
people
know
how
to
use
these
electronic
digital
systems
and
particularly
for
older
people,
maybe
for
people
with
a
whole
range
of
different
disabilities.
D
We
need
to
accept
that
some
of
them
are
never
ever
going
to
be
able
to
use
it
anyhow,
but
some
of
them
can
use
it
if
they
have
the
training
and
the
explanation
about
how
to
use
it.
So
I
do
think
we
need
to
be
much
wiser
about
how
we
actually
communicate
with
people
and
provide
training,
whether
that
could
be
done
within
practices
or
local
libraries
or
community
centers
or
whatever.
D
But
there
are
people
who
will
struggle
to
use
it
unless
someone
shows
them
how
to
do
it
and
and
the
other
thing
I
was
going
to
raise
and
I
I
do
like
bar
charts
and
I
do
like
Lee
tables,
especially
I,
have
to
say,
when
Arsenal
at
the
top,
but
and
and
I'm
also
slightly
disappointed
when
I
see
that
Bradford
is
doing
better
than
Leeds.
D
So
on
page
28,
we've
got
the
average
number
of
appointments
per
thousand
population
and
Bradford
does
much
better
than
Leeds
in
fact
leads
his
bottom
of
of
the
league
on
this,
and
even
when
you
look
at
it
by
the
IMD
deciles
for
all,
except
for
one
decile
Bradford
is
way
out
now.
Is
that
because
they
have
more
GPS
per
thousand
or
the
GPS
have
more
appointments
per
GP
compared
with
leads?
D
O
O
Think
you
made
some
really
really
really
good
points
and
I
think
there
is
more
that
we
we
could
do
and
should
be
doing
and
we'll
be
doing
in
relation
to
comms
with
Communications
with
with
patients,
but
we've
been
as
part
of
the
work
that
we've
been
doing
to
improve
that
we've
been
doing
work
with
the
with
the
100
digital
leads
team
who
have
been
working
with
practices
in
the
in
the
local
care
partnership
area.
O
So,
having
start
excuse
me,
style
set
up
at
various
places
locally
and
having
open
days,
in
particular,
GP
practices
where
patients
are
able
to
come
and
and
learn
and
see
and
and
how
to
use
those
and
devices
and
how
to
load
the
app
on
the
phone.
So
we're
really
pleased
with
the
with
the
support.
100
digital
leads
team,
and
we
want
to
continue
to
to
do
that.
Work
and
recognizing
that
there
is
still
still
more
to
do.
O
I
think,
in
terms
of
the
the
information
on
page
28,
there
is
a
comment
just
at
3.7,
saying
that,
as
part
of
our
work
across
West
Georgia
to
understand
variation,
we
are
wanting
to
look
at
what
data
is
being
submitted
and
how
appointments
are
being
categorized
and
I
do
think
there
is
an
element
of
some
of
our
data
is
missing,
so
I
think
that,
hopefully,
the
next
time
that
this
data
is
updated
and
presented,
we
may
have
a
different
position
in
terms
of
leads
versus
versus
Bradford
I.
O
Don't
believe
that
they've
got
more
access
in
terms
of
in
terms
of
quantum
to
the
level
that's
reflected
here.
I
think
some
of
our
appointment
data
is
missing,
particularly
those
appointments
that
are
provided
on
the
evening
and
a
weekend.
So
we
need
to
get
much
better
at
the
way
that
we
collect
and
Report
our
data
as
part
of
the
West
Yorkshire
set
of
data.
G
Thank
you
chair,
so
I've
just
got
a
few
questions
about
Workforce
and
then
a
little
bit
about
integration.
So.
Currently
you
know,
as
you
know,
with
with
the
launch
of
the
NHS
long-term
Workforce
plan
a
few
months
ago.
A
lot
of
the
conversations
now
moved
to
kind
of
how
are
we
how's
the
system
actively
looking
to
kind
of
recruit
people
from
right
across
communities?
G
What
what
does
that
Citywide
Workforce
plan?
Look
like
specifically,
if
there
is
such
a
thing
for
for
Primary
Care,
and
it
is
primary
care
in
the
city.
You
know
actively
working
working
together,
I
assume
through
the
GP
Confederation
to
recruit
and
then
look
to
the
Future
Okay.
Where
are
our
future
general
practice?
Clinicians
coming
from
yeah
I'll
leave
that
I'll
leave
that
there
and
I've
got
some
more
Workforce
questions.
O
Thank
you,
councilor
I'll,
just
pick
up
the
beginning
of
that
I.
Think
primary
care
plays
a
really
prominent
role
in
the
Leeds
one
work
fast
group
we've
been
doing
some
work
with
the
Leeds
Health
and
Care
Academy
around
hyper
local
recruitment,
which
Builds
on
some
work
that
they
did
very
successfully
with
lch
and
the
recruitment
for
red
kite
view.
O
So
there
was
when
that
new
children's
and
Adolescent
mental
health
unit
opened
in
armley.
They
did
some
very
targeted
approaches
with
that
local
community,
and
there
was
a
lot
of
learning
from
that.
O
So
we
are
now
ruling
out
that
approach
in
bermantoff's,
hair,
Hills
and
Richmond
Hill
PCN,
where,
where
we're
off,
where
we're
offering
the
chance
for
the
local
community
to
be
to
come
forward
with
an
interest
in
roles
in
general
practice
and
they'll,
do
some
pre-employment
work
that
gives
them
a
basic
level
qualification
and
then
we're
able
to
match
them
with
them
with
vacancies
and
practices
in
the
city
and
say
we'll
take
the
learning
from
that
work
in
that
PCN
and
then
and
then
move
that
across
in
terms
of
the
other
Primary
Care
networks,
as
a
different
initiative
to
recruit
locally
and
I,
went
with
some
colleagues
and
here
and
heard
at
the
forum
for
race
equality
in
Health
and
Social
care
very
loudly
that
people
want
to
see
a
Workforce
that
represents
the
local
community.
O
We've
also
done
work
with
lch,
so
Leeds
Community,
Healthcare
trust
where
they've
offered
pcns
the
opportunity
to
employ
and
then
deploy
staff.
So
we've
tried
to
do
that
at
scale
across
Primary
Care
networks
with
a
number
of
those
additional
roles,
and
so
that
people
are
not
working
in
isolation
but
also
have
some
of
the
advantages
of
working
for
an
NHS
trust
whilst
being
deployed
to
work
in
general
practice.
O
So
there's
a
number
of
Workforce
initiatives
that
we
are
trying
to
take
forward
as
well
as
creating
you
know,
networks
of
people
as
Andrea
was
saying
before
you
know.
Some
of
these
roles
are
new
to
general
practice,
so
we're
creating
some
of
those
networks
within
primary
care.
So
that's
opportunities
for
training,
learning
and
and
supervision.
I'll
I'll
pass
there.
A
G
You
chair,
thank
you
just
just
just
with
regards
to
the
the
RS
roles.
Are
they
are
they
coming
from
outside
of
general
practice
that
they
sit
with
with
the
trusts
and
then
are
deployed
into
into
the
community?
Is
that
correct.
N
I
think
we're
all
fishing
from
the
same.
Pond
is
a
big
challenge.
You
know,
we've
got
a
lot
of
experience
out
there
within
different
organizations
and
some
of
them
are
Keen
to
work
in
Primary
Care
networks.
N
You
know
to
provide
extra
appointments,
but
yet
you
you,
then
destabilizing
some
other
areas,
I
think
what
again
is
saying
in
terms
of
we've
done
some
try
to
look
at
some
parts
where
we
can
do
some
joint
sharing
across
different
organizations
to
retain
them
within
each
organization
and
not
do
stabilized
areas,
but
there
are
some
new
ones
and
they're
the
ones
that
need
that
support
and
training
and
but
we've
also
got
other
Workforce
training
schemes
across
West
Yorkshire.
N
So
one
example
of
vocational
training
scheme
for
new
to
practice,
nurses,
but
I
think
there
was
only
about
three
in
Leeds
positions.
So
there
wasn't
that
many,
and
there
was
probably
about
150
that
applied
so
there's
a
lot
of
interest
out
there
to
come
and
work
in
primary
care,
but
then
there's
not
the
opportunities
necessarily
and
to
take
them
all
so
combination
of
new
ones
that
need
a
lot
of
training
support
and
then
there's
the
other
ones
that
are
in
the
system
and
you're
risking
destabilized
in
other
areas.
M
Yeah
I
part
of
the
workforce
plan
is
not
just
recruitment.
It's
retention.
If
I
was
going
to
describe
the
main
problem
in
Prime,
Primary
Care.
At
the
moment,
it's
retention,
it's
pretty
awful
working
in
any
role
in
Primary
Care
at
the
moment,
from
front
reception
to
GPS
to
practice
managers.
There
is
a
retention
crisis
in
primary
care.
M
If
you
look
at
the
data
around
number
of
trainees
coming
in
through
GP
vocational
training
schemes
and
the
amount
of
those
that
choose
to
work
full-time,
there's
a
significant
variation
between
that
I
used
to
when
I
started,
doing
this
job
work
10
sessions
that
was
10
half
days.
M
Quite
frankly,
that
is
impossible
these
days
and
for
a
number
of
reasons,
including
the
complexity,
the
the
time
commitment
everything
around
it,
but
we
have
a
real
challenge:
general
practice
as
become
a
role
in
which
nobody
wants
to
pursue
a
five-day
week,
and
that
lends
a
challenge
to
continuity.
How
would
you
maintain
continuity
when
most
people
working
with
primary
care
now
do
not
want
to
work
I'm,
not
saying
full-time
hours,
because
studying,
but
certainly
you
know,
spread
across
every
day
and
most
people
are
choosing
portfolio
careers
now,
so
retention
becomes
the
biggest
problem.
T
I
just
want
to
add
to
the
points
that
George
has
made,
so
we're
lucky
to
have
a
good
network
of
GP
registrars
and
leads
that,
but
often
do
stay
and
could
work
in
the
city
as
solo,
GPS
or
Partners
solocoms.
T
But
we
just
these
I,
wouldn't
see
a
survey
meltedly
recently
and
of
the
GP
registrars,
and
a
lot
of
them
were
planning
to
not
stay
on
even
in
the
country,
never
mind
leads
and
to
move
abroad.
So
that's
obviously
very
concerning
for
the
future
of
cheapest
of
our
city.
We
do
we
have
members
of.
We
have
LMC
committee
members
who
are
GP
registrars
and
we
you
know
we
try
and
keep
them
in
touch
with
as
much
as
possible
and
involve
them.
T
I
just
wanted
to
just
add
to
George's
Point
further
about
the
work-life
balance
for
GPS.
It's
I
think
it's
not
often
recognized
by
the
public,
how
much
work
stuff
to
you
in
their
own
time
weekends
evenings.
T
If
it's
not
doing
good
results
and
things
or
letters,
it's
sort
of
emails
and
WhatsApp
messages
constantly
so
I.
Just
that
obviously
I
need
to
burn
out,
which
is
a
significant
cause
of
the
loss
of
lots
of
GPS
in
the
city
and
then
finally,
just
about
the
Estates
as
well.
T
Like
Andrea
said,
people
are
being
stolen
by
other
trusts,
not
just
you
know
locally,
but
even
further
towards
the
Northeast,
because
they've
got
better
Estates
they're,
offering
people
to
have
their
their
cars
charged
for
free,
the
electronic
cars,
and
things
like
that.
So
we're
not
anywhere
near
that
in
Leeds.
So
that's
you
know.
People
are
obviously
concerned
about
their
carbon
footprint
as
well
in
this.
So
just
all
those
points
to
be
taken
forward,
please.
L
It's
the
best
job
in
the
world,
I
just
thought
to
report
that
I
asked
the
colleagues
I
qualified
as
a
GP
in
2016
I've
been
adopted
for
much
longer
than
that,
but
when
I
posted
on
our
WhatsApp
group
to
the
colleagues
that
I
sort
of
qualified
with
as
GPS
and
what
would
make
you
take
up
a
salary
or
a
partnership
role
in
a
GP
surgery,
they
gave
me
three
things
and
those
three
things
were:
a
good
coffee
shop,
a
waitrose
nearby
and
a
car
park.
A
Thanks
for
that
look,
do
you
have
a
constipology
of
a
follow-up?
Yes,.
G
Thank
you.
Well,
it's
obviously
positive
and
used
to
hear
that
we're
at
least
sending
one
GP
in
the
city.
I
mean
I,
I,
I
suppose,
just
just
on
on
the
back
of
that.
G
You
know.
I
I
should
have
said
asked
this
with
two
practicing
GPS
in
in
the
room
but
can
I.
Obviously
you
know
in
primary
care.
We
are
asking
people
to
work
to
the
top
of
their
register
like
day
in
day
out
and
I.
Suppose
the
question
is
coming
out
and
it's
difficult
with
general
practice,
because
it
is
the
triage
service
for
a
lot
of
people
and
the
contact
that
they
have.
G
Is
you
know
10
minutes
with
you
guys
can
I
go
in
in
clinic
but
I
suppose
the
question
is
like?
Are
we
always
directing
people
to
the
right
place
and
is
there
more
that
can
be
done
to
to
make
the
public
aware
of
kind
of
alternative
provision?
You
know
Pharmacy
First
Services,
you
know.
Perhaps
it's
it's
the
case
that
we've
got.
G
You
know
you
know
almost
like
social
care
or
alternative
provision.
Perhaps
you
could
talk
a
little
bit
more
about
that.
Thank
you.
N
I
think
I'll
come
in
on
that,
so
part
of
my
I've
got
dual
heart,
so
I'm
managing
partner
with
a
practice.
So
one
of
my
challenges
is
around
the
communication
and
upskilling
our
Frontline
staff
in
terms
of
that
sign
posting.
So,
first
of
all
to
be
able
to
do
that
effectively,
we
need
to
have
enough
on
the
front
line,
taking
the
calls
to
be
able
to
signpost
into
these
services
and
that's
a
challenge
in
itself.
N
Our
reception
team
who
are
navigating
patients,
the
ones
that
have
been
in
primary
care
for
a
long
time,
are
still
with
us
generally,
unless
they've,
retired
and
but
the
new
ones
coming
in.
It's
it's
extremely
difficult
to
recruit
receptionists
because
of
the
the
nature
of
the
role
and
the
public
perception
of
what
what
a
receptionist
is,
and
they
they
take
a
huge
amount
of
abuse
and
a
lot
of
the
new
ones
are
quite
Keen
to
come
into
the
role.
N
But
you
know
they
leave
quite
quickly
because
not
because
they've
got
the
support-
and
it's
just
you
know
not
what
the
world
is
expecting
and
they
don't
have
appointments
in
their
pocket
to
be
able
to
give
out
and
a
lot
of
patients
do
think
that
they're
holding
appointment's
back
so
they
they
are
constantly
getting
that
abuse
around
appointments
and
when
they're
starting
to
sign
past
patients,
because
they
don't
have
enough
GP
appointments
on
that
day
to
offer
them
and
there's,
as
you
can
see,
from
the
list
of
the
different
roles,
the
amount
of
different
types
of
roles,
experience
and
services
to
be
able
to
explain
that
appropriately
to
different
patients
for
the
triage
and
it's
really
quite
difficult.
N
In
Leeds,
we've
got
well
with
our
PCM.
We've
got
three
platforms
for
appointments,
so
one
is
our
practice
clinical
system
and
patients
can
book
online
for
that
we've
got
the
GP
Confederation
platform,
so
for
the
extended
hours
the
weekends
evenings
they
have,
they
can't
book
online
for
those
ones.
And
then
we
have
a
different
system
for
the
PCN
as
roles
staff
and
again
the
Cat
book
online.
N
For
that,
so
our
reception
front
line
when
the
sign
posting
is
first
establish
pushing
what
the
patient's
needs
are
in
that
triage,
then,
where
where
they
can
see
them
booking
into
a
different
system
every
time
and
also
trying
to
get
through
the
call
very
very
quickly
because
the
biggest
challenge
patients
feedback
has
been
is
getting
through
to
their
GP
surgery
and
it's
constantly
either
engaged
or
they're
just
queuing
a
long
time,
and
part
of
that
is
the
length
of
time
to
sign.
Post
patients
is
creating
a
huge
amount
of
backlog
on
the
funds.
N
So
plus
you
need
the
body's
answering
the
phones
and
that's
the
difficulty
that
we've
got.
L
I
would
say
that
there
is
a
lot
more
that
we
can
do.
We
need
to
empower
the
public
I
think
we
have
lost
the
public
health
message
about
self-care,
so
signposting
is
absolutely
important,
but
you
know
we
really
need
to
invest
in
empowering
people.
People
can
take
care
of
themselves
most
of
the
time
and
we
have
absolutely
lost
that,
but
it
is
a
confusing
system
that
we've
got
in
terms
of
Health
and
Social
care.
So
a
survey
said
48
of
working
age.
L
People
found
it
difficult
to
navigate
the
system,
although,
having
said
that,
you
will
see
the
art
roles
and
Social
prescribers
and
Health
and
well-being.
Coaches
are
playing
a
vital
role
in
sign
posting
people
to
the
right
place.
T
Can
I
just
I
agree
with
Andrea's
point.
I
also
want
to
say
it
is
the
same
goes
for
Recruitment
and
Retention
of
the
GP
staff
and
the
nursing
staff,
not
just
the
admin
teams
again
for
the
same
reasons,
you
know
there's
a
lot
of
GP
particular
bashing
that
goes
on,
particularly
in
the
media
and
I.
Think
majority
of
people
actually
really
happy
with
their
GPS.
T
To
be
honest,
if
you
actually
spoke
to
them
in
the
street,
especially
if
they've
had
them
in
them
for
a
long
time,
but
I
think
the
media
is
is
disproportionately
negative
and
that
has
a
huge
impact
and
I
think
it
just
takes
a
couple
of
people
to
whip
up
something
locally
and
that
can
have
a
real
effect
on
people's
mental,
the
staff's
mental
health
and
perhaps
the
final
straw,
sometimes
so,
yeah
I
think
there's
a
lot
of
positive
things
that
people
say
about
their
GPS
and
their
and
their
practice.
T
Staff
and
I
think
that
needs
to
be
celebrated
and
published
and
supported
by
the
city
really
as
a
whole
and
I
think
that's
the
way.
You
know
it's
a
great
City
I've
chosen
to
work
here.
Having
trained
down
south
I
worked
in
Bradford
I've
worked
in
Harrogate,
but
Leeds
is
where
I
want
to
be
a
GP
for
various
reasons.
So
I
think
we
need
to
sort
of
promote
that
really
to
everybody
and
so
getting
the
media
message
out.
T
Really
everyone
positive
one,
because
we
do
get
those
reports,
it
just
needs
to
be
sold
to
the
public
really.
H
Thank
you
on
the
back
of
that
and
the
comments
about
GPU
research.
This
I
just
wanted
to
say
a
little
bit
about
why
we
did
the
workshop
that
I
referred
to
earlier
around
supporting
staff
and
staff
retention.
H
It
came
out
of
I
I'm,
a
government
lead
to
New
York
partnership,
Foundation
trust,
and
we
have
obviously
an
annual
staff
survey
and
I
was
quite
shocked
by
the
percentage
of
Staff
who
Rick
said
that
they
they'd
faced
abuse
from
patients
or
their
families
or
the
public
in
the
last
year,
I
was
shocked,
but
I
wasn't
surprised
because
I'm
also
in
a
Frontline
role
and
I,
think
it's
well
known
how
much
abuse
politicians
get
in
public
life,
and
we've
talked
here
about
the
amount
of
abuse,
gp's
taken
specific,
the
receptionist
and
I
think
that's
really
striking
that
it's
the
people
that
sometimes
place
the
worst
abuse
are
the
low
status,
Lower
status,
less
financially
recompense
staff
and
I
felt.
H
We
really
needed
to
look
at
this
because
and
I'm
I
am
saying
it's
probably
for
my
own
experience
of
having
a
public
role
as
well.
It
just
feels
sometimes
like
there's
a
culture
where
it's
acceptable
and
I,
don't
think
it's
only
people
in
Health
and
Social
care,
I
think
people
work
in
call
centers
people
working
in
shops.
Anyone
really
in
a
public-facing
role
is
is
facing
an
increase
in
abuse,
I
think
some
of
that's
because
the
public
are
at
the
end
of
their
tether.
H
You
know:
we've
had
a
really
challenging
few
years
with
the
pandemic
cost
of
living
crisis.
I
think
people
are
really
struggling
and
that's
coming
out
in
the
way
people
behave
towards
people
in
public
facing
roles,
but
obviously
the
part
of
the
system
where
we've
got
some
influence
is
the
Health
and
Care
sector,
and
one
of
the
benefits
of
the
health
and
well-being
bud
is
you've
got
the
most
senior
people
in
the
system.
H
You
know
who
can
affect
change,
so
we
did
a
workshop
looking
at
you
know,
issues
around
staff,
support
and
Welfare
and
how
we
can
create
a
culture
of
zero
tolerance
of
abuse.
We
also
talked
about
some
of
the
nuances
of
that
because,
for
example,
in
a
psychiatric
ward,
you
may
get
abused
from
people
because
they're
not
capacitors
or
because
you
know
they're
against
their
will.
H
So
we
talked
about
what
happens
in
environments
where
you
know
you're
going
to
face
some
challenges,
how
you
support
each
other
with
that.
We
also
have
from
the
freedom
to
speak
up
Guardian
at
lch,
and
we
are
the
only
Authority
in
the
country
to
also
have
a
freedom
speak
up
guardian
and
one
of
the
actions
we
took
forward
is
that
we're
going
to
in
six
months
have
another
workshop
and
look
at
themes
coming
out
from
the
freedom
to
speak
up,
Guardians
work
and
what's
been
brought
to
them
things.
H
You
know
to
support
staff
working
in
Health
and
Care
and
also
to
I
know
the
hospital
West
Yorkshire
campaign
about
the
unacceptability
of
abuse,
but
I
do
feel
like
we
need
to
do
more
work
in
that
area,
really
because
it
is
one
of
the
reasons
that
we're
not
retaining
staff
is
that
it's
hard
working
in
a
front
line
job.
Thank
you.
A
Thank
you
very
much
councilman
I'm,
going
to
move
on
to
councilor
Richie
now.
Thank
you.
F
Thank
you
chat
and
first
thing,
I
want
to
say
thank
you
actually
for
working
in
being
committed
to
the
NHS
throughout
whatever
the
rules
that
you're
in
and
your
colleagues
I,
think
I,
certainly
value
I'm.
Sure
everybody
in
this
room
does
as
well
so
I'll
start
with
a
a
thank
you
and
I.
Think
Dr
Winder
made
the
point
that
as
a
double
stakeholder,
that
is
family
and
your
families,
usually
HS
NHS,
well
you're
triple
stakeholders,
because
you
also
pay
for
it
through
your
taxes
and
I
trust.
F
So
thank
you
again
also
thank
you
for
the
context
around
the
how
that
starts
to
work
in
and
the
loss
of
appointments.
F
While
the
training,
that's
really
helpful,
to
know
I
just
wanted
to
talk
a
couple
of
things
around
the
booking
system
really
page
33
5.6
talks
about
the
race
to
get
through
and
so
on
and
so
forth,
and
there's
been
some
discussion
around
triage
in
and
signposting
I
just
wondered,
obviously,
I
don't
know
what
systems
every
GP
service
has
got,
but
if
there
was
a
way
to
self
refer
to
the
Physiotherapy,
and
so
when
you
ring
up
instead
of
it
all
go
into
that
receptionist
and
putting
them
under
pressure
that
actually
you
can
think
about
it.
F
I've
sprained,
my
ankle
I
want
to
ring
the
number
for
the
physiotherapist
I'm,
not
saying
the
council's
telephone
Center
is
perfect,
but
you
get
a
range
of
options
and
you
know
Dial
X
for
this,
so
I'm
guessing
that
goes
to
different
stuff.
So
I
don't
know
if,
if
that's
something
you
can
do
and
then
also
expanding
the
online
bookings
for
those
extra
Services
as
well.
So
that's
the
first
point.
F
The
second
one
is
around
planning
issues
now:
I
wonder
it's
a
while,
since
I've
been
on
planning
committees,
but
every
time
there's
a
new
development
members
on
the
panel
would
ask
about
Health
provision,
so
your
Insight
as
to
the
issues
that
it
has
to
come
after
is
really
interesting.
I,
wonder
if
we
need
you
know:
Collective
sit
in
the
room
with
our
chief
planners
around
a
strategy
towards
towards
this,
because
we've
got
the
site
allocation
plan.
We
know
where
the
housing
growth
is
going
to
be
so
some
kind
of
a
mechanism
of
planning
ahead.
F
I
realize
you
mentioned
the
funding
is
an
issue.
So
that's
one
element
of
it,
but
the
other
element
is
increasing
capacity
quickly
again.
Do
we
need
to
sit
down
with
the
planners
and
look
at
we've
got
screw
up
to
do
supplementary
planning
documents
so
that
we
can
Fast
Track,
perhaps
temporary
accommodation
I
know
that's
been
an
issue
for
GP
surgeries
in
my
patch
when
they've
wanted
to
get
maybe
part
of
cabins
or
something
in,
but
the
time
it
takes
to
get
through
planning.
F
N
Like
I'll
just
pick
up
the
first
question:
if
that's
okay,
thank
you,
Council
Richard
in
terms
of
the
self-referrals,
so
there
are
a
number
of
services.
Patients
can
already
refer
into
self-refair.
They
are
limited
at
the
moment
and
I
think
a
lot
of
it
is
because
patients
don't
know
where
the
services
are
so
I.
Think
we've
mentioned
about
social
prescribers
and
kind
of
their
support
with
that
navigation
and
the
phone
system.
N
So
some
of
the
practices
do
already
have
the
cloud-based
fund
systems
and
you
can
have
different
options
for
press
one
press
two
for
this
Etc
we've
got
our
practice,
it's
the
same
team
that
are
answering
the
phones.
N
It's
just
that
we
can
report
on
the
different
numbers
in
terms
of
whether
it's
gone
to
prescriptions,
but
obviously
we
can
expand
on
some
of
that
service
in
terms
of
putting
the
options
on
the
phone
line
for
when
patients
are
ringing
so
that
we
can
also
be
thinking
about
kind
of
actually
I
can
maybe
ask
Corona
Physio
and
appointment.
So
some
practices
probably
already
doing
that
really
well
a
lot
of
patients
don't
realize
which
role
they
can
book
into
for
different
conditions.
N
So
again,
that's
self-referral
can
be
a
bit
of
a
challenge
because,
ordinarily,
they
want
to
see
the
GP.
So
again,
it's
that
communication
across
you
know
not
just
the
practice,
but
it
needs
to
be
a
large
scale,
comes
around
the
different
roles
and
and
ask
empowering
patients
to
be
able
to
ask
for
these
different
roles
and
kind
of
have
an
appointment
with
a
particular
practitioner.
But
again,
we've
not
got
that
consistency
across
every
single
practice
and
we
all
have
different
roles
in
the
practices
in
a
PCN.
N
So
it's
not
consistent
message
that
you
could
say
ask
to
book
in
with
a
physio
across
one
area.
Might
not
have
them
for
different
reasons.
I'll
pass
you
once
again
for
the
other
two
points.
Thank
you.
O
And
thanks
Andrea,
so
we're
trying
to
get
better
and
I
think
we
have
got
better
in
terms
of
working
with
colleagues
in
the
council
from
a
planning
perspective.
So
we
look
to
things
like
you
know
how
the
the
community
infrastructure
Levy
can
work
in
terms
of
new
new
developments
and
whether
there
can
be
provision
for
Health
premises
within
that.
O
We
also
I
think
had
the
opportunity
to
do
quite
a
lot
around
the
East
Leeds
extension.
So
again
we
see
we.
We
have
met
with
them
with
planners
in
relation
to
that
and
we
primary
care
is
a
member
of
the
city's
strategic
Estates
group.
O
So
again,
I
think
some
of
those
positive
things
that
Moore
mentioned.
You
know
like
the
work
in
terms
of
the
libraries.
Some
of
those
opportunities
have
come
out
through
some
the
connections
at
the
strategic
Estates
group
and
how
we
can
have
a
sense
of
one
public
estate
in
the
city,
and
you
know
how
do
we
maximize
a
state
that
that
is
there
for
the
benefit
of
our
of
our
populations?
O
It's
not
like
I
was
saying
that
it's
quite
complex,
it's
not
an
easy
one
to
to
crack,
but
I
think
we
are
trying
to
and
have
been
doing
like
say
to
work
much
more
closely
with
them
planning.
Colleagues
in
in
the
council,
understanding
and
anticipating,
where
we're
going
to
have
growth.
Our
pinch
points
going
forward.
L
And
I
think
it's
great
to
give
patients
the
autonomy
to
be
able
to
book
in
with
who
they
think
may
be
the
best
person
to
solve
their
problem
and
I.
Think
I
would
Advocate
that,
although
or
the
other
side
to
that
would
be,
we
don't
want
to
miss
something,
and
so
I
guess
there's
a
risk
that
we
need
to
consider
in
terms
of
uncertainty.
But
we
would
hope
that
if
there
was
a
back
pain,
for
example,
that
was
Sinister
and
they'd
seen
the
physio.
L
That
would
then
quickly
make
its
way
to
me
and
often
does
the
second
thing
in
terms
of
Estates,
it's
great
having
more
rooms
where
doctors
and
physios
and
pharmacists
can
sit
in
them,
but
I
think
we
need
to
think
about
this
differently.
If
we
want
to
be
the
healthiest
City
in
the
UK,
then
we
need
to
think
about
a
GP
practice
buildings
being
different,
so
we're
using
our
buildings
differently.
Health
and
well-being
teams
are
doing
as
sort
of
as
Healthy
Living
exercise
a
patient
education
session.
L
So
we
need
spaces
so
that
people
can
do
that
in
and
also
feel
comfortable
in
so
light
and
Airy
plants.
You
know
we
need
to
think
about
all
these
things.
When
you
look
at
hospitals
and
they're
built,
you
look
outside
and
you're
looking
onto
a
car
park
that
is
not
going
to
heal
people
thanks.
O
And
just
just
a
final
Point,
really
the
table
at
2.9.
Just
again
is
just
a
summary
of
the
things
that
we
are
nationally
required
to
do
in
the
GP
access
recovery
plan,
and
there
is
reference
in
there
to
expanding
self-referral
opportunities
for
for
patients,
as
well
as
expanding
the
role
of
Community
Pharmacy.
For
example,.
A
T
I
welcome
your
ideas
about
the
thinking
quickly
about
Estates,
particularly
the
port
cabin
ideas.
I
mean
the
pandemic
showed
how
quickly
things
could
be
moved
and
changed
and
I'm
proud
of
the
work
that
GPS
and
the
team
around
the
table,
the
lead
that
they
did
so
quickly
and
to
you
know,
support
patients.
T
I've
watched
a
practice,
that's
had
a
podcasting
for
years,
and
it
works.
To
be
honest,
it's
easy
to
clean
and
yeah
so
that
why
not?
You
know
if
it
needs
to
be
happening
quickly.
That's
a
great
idea!
One
more
point,
though:
we
do
need
to
try
and
have
some
influence
on
trying
to
get
skilled
nurses
up
and
running
again,
because
that's
a
huge
impact
on
general
practice.
T
The
work
that
they
used
to
do
has
been
pushed
again.
The
left
shift
to
general
practice
and
also
to
increase
the
number
of
Health
visitors
again
for
this.
For
the
same
reason,.
E
Thanks
chair
most
of
my
question
comments
already
being
asked
because
I
was
going
to
talk
about
navigation,
but
I've
read
the
truly
reports,
and
this
report
is
much
better
than
the
last
one
that
came
to
us.
Thank
you
for
all
the
work
that
you
are
doing.
It
and
GPS
have
challenges
just
like
any
other
organization
and
I
feel
that
we
are
doing
the
best
they
can
with
whatever
resources
they
have
today.
E
I'm
only
going
for
my
doctor's
perception,
I've
seen
Improvement
in
appointments
and
face
to
face,
and
so
on,
and
it's
not
underway,
it's
not
fully
under
track,
but
is
on
the
track
since
the
pandemic,
which
I
think
is
good.
But
my
main
concern
is
the
communication
bits.
We
have
navigation
everywhere
to
go,
there
go
there,
but
please
take
the
elderly
with
you.
We've
got
apps
I'm
UPS
freak
with
maybe
my
grandma.
E
My
disability
won't
be
so
I'm
asking
you
when
you
do
communicate,
communicate
for
everyone
to
understand
at
each
levels,
different
languages
and
so
on,
and
so
someone
I've
met
this
gentleman
who's
coming
from
the
chemist
a
few
weeks
ago,
and
he
says
the
receptionist
sent
him
to
the
chemist
for
some
Illness,
but
the
chemist
says
he
doesn't
deal
with
that.
They
can't
prescribe
certain
things.
That's
something
that
you
need
to
lay
out
to
the
patient.
A
Thank
you
very
much.
I
was
going
to
take
that
as
a
comment
unless
it
because
I
think
we've
talked
about
some
of
those
issues,
but
you
know
it's
really
important,
though
the
communication
and
particularly
making
so
we
talk
about
digital,
leads
but
alternative.
If,
if
you're
not
ready,
so
I,
think
that's.
E
Q
Thank
you
chair.
First
of
all,
I'd
like
to
start
off
by
thanking
everybody
that
works
in
the
GP
practice,
both
the
receptionists,
the
nurses,
the
GPS.
Anybody
else.
That's
involved
it's.
It
is
a
very
valuable
service
and
we
know
you.
We
know
you
work
hard
and
we
want
to
support
you
in
working.
Better
I've
got
a
couple
of
points
that
I'd
like
to
sort
of
pick
up.
Q
One
building
on
what
George
was
saying
around
access
is
more
important
than
appointments
and
we're
also
kind
of
building
on
what
Andrea
was
saying
around
patients
needing
to
know
the
roles
better
and
I've
been
in
a
situation
from
a
personal
perspective
where
I've
absolutely
looking
after
family
members
dealt
with
a
number
of
different
GP
practices
in
the
East
Leeds
area
in
recent
years,
and
the
one
thing
I've
experienced
is
that
the
quality
of
the
reception
team
and
their
ability
to
triage
is
absolutely
vital.
Q
I
think
that
Andrea
says
around
patients
need
to
know
the
role
that
they
want
to
speak
to
I'm,
not
sure
I
agree
with
that.
I
think
patients
need
to
articulate
what
they
need
help
with,
but
I
I
think
you
know
it
shouldn't
be
for
them
to
say,
I
need
a
physiotherapist
or
I
need
XYZ.
It
should
be
actually
from
what
you're
telling
me.
This
is
what
you
need
and
to
direct
them.
Q
I'm,
curious
and
I'd
might
just
be
a
point
of
clarification
around
access
being
more.
You
know
the
correlation
between
accessing
it
and
appointments,
because,
from
my
own
perspective
and
I'd
be
curious.
If
this
is
correct,
an
appointment
is
something
where
I
I
thought
or
I
get
in
touch
somewhere
and
I
get
an
outcome.
Q
Q
It's
a
I
have
contact
I,
get
a
result
and
that
that,
for
me,
is
what
I
class
an
appointment
I'd
be
curious
as
to
how
that
how
that's
how
it's
defined,
there's
two
bits
that
I'd
like
to
comment
on
one
and
Dr
Bill
mentioned
it
first
patches
again,
I've
seen
I've
got
one
of
my
family
members
as
learning
difficulties
and
his
practice,
which
is
brilliant
in
many.
Many
ways
tried
to
push
him
down
the
can
you
just
do
it?
Online
solution
was
like
well,
no.
Q
You
can
and
I'm
also
making
my
experience
with
patches.
It
feels
a
bit
like
the
kind
of
John
Cleese
meaning
of
life
sketch.
You
know
if
you've
got
hemorrhoids
between
before
three
o'clock
and
it's
a
Thursday.
Please
use
this
system,
and
it
just
feels
as
though
you
you've
got
to
kind
of
it's
very
time
related.
Q
Q
Welcome
to
any
sort
of
comments
on
patches
as
to
whether
the
way
it's
been
because
it
feels
a
bit
clumsy
and
that
does
build
on
the
feeling
of
it
being
impersonal,
because
it's
like
I've
experienced
it
I
know.
Family
members
have
you've
Fallen
up
and
if
they're
just
going
to
use
this
system.
Well,
actually
no
I'd
like
to
speak
to
somebody
about
it
and
not
necessarily
speak
to
a
GP,
but
I
just
like
to
articulate
what
I
need,
verbally
rather
than
having
to
log
on
go
down
that
route.
The
other
area
I'd
welcome.
Q
Some
comments
on
is
the
ecosystem
of
healthcare.
You
know
you
have
pharmacies,
you
have
hospitals,
a
e.
You
have
Community
out
of
hours,
services
like
the
one
in
Middleton
and
others
plotted
around
Leeds
and
GPS,
and
your
people
will
get.
People
are
ill
if
they,
if
they're
cut
themselves
or
their
kids
ill
at
a
certain
time,
they
will
go
to
wherever
they
feel
is
the
most
likelihood
of
getting
an
outcome
and
I.
Q
Q
Q
N
Thank
you,
Council
Harbor,
Brock,
yeah
I
think
we
were
a
pilot
for
the
patches
at
the
beginning
of
the
year.
N
So
I'll
give
you
a
little
bit
of
background
in
terms
of
how
it's
set
up
in
terms
of
some
of
those
challenges
that
you've
mentioned,
and
so
it's
an
online
consultation
tool
and
that
can
allow
video
consultations,
messages
and
online
requests
from
patients
that
have
the
capability
and
systems
to
be
able
to
do
that.
So
it
was
recommissioned
across
West
Yorkshire
for
patches.
N
It's
a
funded
program
for
practices
to
pick
up
some
of
chills
to
go
with
a
different
package,
but
majority
have
gone
with
patches
and
within
our
PCM
we
set
up
an
online
service
in
the
extended
access
using
that
across
the
whole
of
the
PCN
and
piloted
that
and
some
of
the
hours
rules
that
we've
got
the
care
coordinators
are
the
ones
that
our
daily
filtering
all
those
requests
through
triaging
them,
making
them
an
appointment
with
either
a
GP
where
it's
appropriate
booking
them
in
with
the
physio
Etc.
N
So,
coming
back
to
your
point
about
patients,
not
knowing
who
to
book
into
our
care
coordinates,
would
would
navigate
that
and
it's
not
suitable
for
everybody.
So
some
still
want
that.
You
know
phone
call
or
actually
at
the
front
desk
that
they
will
come
and
speak
to
a
receptionist
face
to
face
to
book,
and
that's
I
think
it's
really
important
that
we
give
patients
those
choices
so
we're
not
expecting
our
patients
to
go
down
the
online
route.
N
Our
first
patient
that
ever
used
online
consultations
was
somebody
who
was
90
years
old
and
I
actually
rang
them
up
after
they
completed
it,
to
ask
how
they
found
using
it,
and
it
was
you
know.
Oh,
it
was
absolutely
fine
easy.
So
we
we
shouldn't
underestimate,
there's
actually
a
lot
of
older
patients
that
are
actually
using
them
more
than
the
younger
ones.
N
In
terms
of
the
capacity
for
cutoff
points,
it's
a
bit
of
an
open
stream
for
online
consultation,
so
where
we
would
normally
have
our
appointment
book,
you
have
so
many
appointments
to
offer
each
day,
if
you
add
an
open-ended
online
system,
you
have
to
have
the
resources
to
be
able
to
triage
those
requests
appropriately,
and
there
are
some
systems
within
protocols
within
it
so
that
we
shouldn't
be
getting
patients
that
are
sending
requests
through
that
are
Urgent.
N
So
that's
why
some
practices
are
able
to
switch
that
on
and
off,
and
the
alternative,
if
that's
closed,
is
that
we
still
have
the
phone
lines
up
and
other
can
come
through.
So
we're
not
stopping
access.
It's
just
managing
that
safely.
Really
the
true
I
think
patches
that
you
absolutely
right
around
patients,
knowing
what
it
is
I,
don't
think
we
were
great
when
we
started
using
it,
sending
the
messages
out
and
partly
for
that.
It
was
because
it
was
a
new
system
and
they've
been
trialling
lots
of
problems
and
amending
them.
N
So
we're
feeding
back
constantly
as
to
what
patient
feedback
is
to
to
make
those
changes,
but
they
do
have
to
log
into
the
system
and
set
it
up.
So
we've
definitely
noticed
in
patients.
Saying
I've
not
received
that
message.
You've
sent
me,
they
will
have
received
a
text
but
they've,
maybe
not
thought
it
was
related
to
the
medication
inquiry
or
something
at
the
GP
surgery.
So
I've
just
left
it
so
yeah.
We
do
have
to
train
patients
and
and
communicate.
N
Q
A
Q
One
I
think
that
the
the
fact
that
you
say
it's
actually
a
dedicated
team
that
responds
for
patches
is
quite
interesting,
so
I
haven't
appreciated
that
I
assumed
it
was
one
of
the
GPS
that
would
have
been
taking
regular
appointments
that
were
seconded
onto
patches.
So
that's
that's,
probably
an
important
communication
point,
because
what
we're
saying
is
effectively
it's
additional
resource
and
the
other
thing
I
would
say
regarding
tax
sent
out
identifying
person
who
is
to
because
I
know.
Q
For
example,
at
one
point,
I
had
three
people
that
I
was
the
primary
contact
for
myself
and
took
two
relatives,
and
sometimes
when
text
came,
it's
like
I
think
that's
for
me
or
I.
Think
it's
for
my
brother
or
I
think
it's
somebody
else
and
knowing
who
it's
for
you
kind
of,
have
to
try
and
get
try
and
guess.
No,
it
did
help.
There
were
different
practices,
but
it's
you
know
from
just
from
a
small
admin
perspective.
Thank
you.
O
I
think
you
were,
you
were
very
so
articulate
in
your
description
of
general
practice
being
part
of
an
ecosystem.
So
we
are
a
Health
and
Care
system
and,
like
I,
said
general
practice.
Primary
Care
is
is
one
part
of
that.
O
So
one
of
the
fundamental
roles
of
the
integrated
care
board
is
that
in
integration
of
the
the
Health
and
Care
partnership,
so
recognizing
all
of
the
all
of
the
partner
organizations
on
of
the
third
sectoral
organizations
all
of
the
communities
that
we
that
we
work
with
having
a
you
know
having
a
part
to
play
in
in
delivering
on
behalf
of
Health
and
Care
partnership,
and
we
we
align
behind
the
the
goals
and
Ambitions
of
the
of
the
healthy
leads
plan,
and
in
doing
that
we
have
a
series
of
population
and
Care
delivery
boards
in
the
city
that
are
made
up
of
Representatives
of
every
every
part
of
the
Health
and
Care
and
partnership.
O
The
role
of
those
population
boards
is
to
really
understand
the
the
health
needs
of
that
population
and,
to
then
understand
the
resources
that
are
being
that
are
being
directed
and
spent
on
the
on
achieving
the
outcomes
for
the
for
the
health
of
those
particular
populations
and
then
to
increasingly
start
to
have
those
conversations
around.
Are
we
spending
the
right
amount
of
money
in
the
right
place?
Are
we
getting
the
right
outcomes
for
the
value
of
the
money
that
we're
that
we're
spending
would
actually
spending
this
pound
here?
O
Result
in
a
better
outcome
for
more
people
than
spending
this
pound
over
there,
and
that's
that's
quite
a
new
way
of
working
that
say
as
a
Health
and
Care
partnership.
We've
been
we've
been
developing
over
the
last
few
years
and
we're
starting
to
see
that
more
now
as
an
approach,
that's
reflected
through
the
creation
of
integrated
care
boards
and
then
work
that
we're
doing
particularly
in
needs
as
a
place
within
West
Yorkshire
learning
from
other
systems
elsewhere.
O
So
people
might
have
heard
of
the
work
of
people
in
Staten
Island
in
New,
York
and
again
the
way
that
those
organizations
work
together
as
a
as
a
partnership
and
a
line
behind
you
know
stated:
Ambitions
and
contracts
are
aligned,
spending
is
aligned.
O
So
again,
you
know
we're
trying
to
develop
those
ways
of
working
but
you're
right,
we're
very
much
an
in
interdependent
system
and
if
one
part
of
the
system
is
experiencing
an
issue
around,
you
know
capacity,
our
demand,
it's
often
reflected
in
another
part
of
the
of
the
Health
and
Care
System.
M
Sorry
Council,
you
made
some
comments
at
the
beginning
about
the
difference
between
I
think,
your
appointments
and
access
and
I
think
the
point
I
was
trying
to
get
across,
probably
poorly
right
at
the
beginning,
when
I
had
a
frog
in
my
throat
was
that
there's
a
difference
between
accessibility
and
the
the
availability
of
the
number
of
appointments
and
continuity
and
quality,
and
that's
the
problem
that
I
personally
feel
and
there's
evidence
to
say
that
satisfaction
does
not
come
from
the
more
appointments
that
you
offer.
M
It's
the
quality
in
which
you
receive
that
and
that
largely
lends
itself
to
continuity.
So
there's
a
risk
with
this.
You
also
asked
about
how
appointments
are
measured.
There
is
a
recognition
in
the
system
from
NHS,
England
and
part
of
the
plans
that
we
have
across
the
city
is
for
a
better
use
of
coding
and
data
into.
So
with
those
appointments.
Are
it's
better
clarity
about
what
is
done
within
those
appointments?
So
we
currently
code
into
one
of
four
different
places,
so
it
describes
what
the
type
of
clinical
contact
was
or
whether
it's
administrative.
M
So
none
of
this
counts
for
administrative
stuff.
So
if
you
send
something
through
saying,
can
I
have
a
letter
for
something
that
doesn't
count
as
an
appointment
unless
that
GP
practice
makes
it
into
an
appointment
because
then
they're
doing
it
and
as
Sarah
is
describing
the
amount
of
non-gp
appointment.
Work
is
escalating
day
by
day
by
day,
when
we
lose
a
GP,
we
don't
worry
about
the
appointments
we
offer.
We
worry
about
the
amount
of
admin
that
we
will
then
have
to
manage,
because
you
can't
get
a
local
to
do
that
admin.
M
You
can't
do
those
things
so
again,
I
think
there's
a
focus
on
appointment,
numbers,
appointment,
access,
appointment,
those
things
really
the
struggle
that
we
have
is
maintaining
high
quality
staff,
who
patients
have
a
good
relationship
with
where
we
know
that
better
outcomes
for
patients
come
patients
rate
that
better
in
terms
of
satisfaction
and,
in
fact,
staff
rate
that
better,
because
we
we
like
the
relationships
that
we
have
with
patients
and
whatever
we
can
do
to
do.
That
is
better
the
online
consultation
models
and
use
the
word
capacity.
We
haven't
talked
much
about
capacity.
M
Online
consultation
models
are
good
for
some
people,
they're
good.
If
you're
a
working
age,
adult
they're
good,
if
you're
you
know
needing
an
administrative
procedure
or
all
those
other
things,
they
might
be
good
if
you
have
something
simple,
but
fundamentally
the
rest
of
the
time,
their
capacity
management
systems,
that's
what
they're
doing
they're
trying
to
manage
that
and
you,
you
I,
think
it's
unfair.
Just
to
point
of
order.
I
think
it's
unfair
to
characterize
how
each
GP
practice
uses
patches
or
uses
any
of
the
online
consultation
models.
We
will
do
it
differently.
M
Looking
for
the
same
answer
and
the
same
answer
is:
how
do
we
find
appointments
for
people
when
we
don't
have
enough
appointments
and
that's
that
is
an
absolute
fundamental.
So
everything
else
about
it
is
trying
to
speak
expediate
or
manage
simple,
simple
problems,
and
we
talked
about
people
working
at
the
top
of
their
license
and
I.
Think
that's
absolutely
important
and
those
online
consultation
models
assist
with
that
and
they
help
us
to
do
that.
A
Thanks
for
that,
I
think
that's
really
articulate
well
articulated
in
terms
of
in
terms
of
the
challenge.
So
thank
you
for
that.
Okay,
I'm
gonna,
have
you
got
an
additional
point
on
this
serum.
T
Just
wanted
to
say
it's
a
double-edged
sword
really
things
like
patches
knee
consult,
initially
it's
difficult
for
everyone.
It
took
a
lot
of
time
out
for
the
staff
to
have
to
retrain,
to
learn
another
sister
as
well.
But,
of
course,
it's
courses
really.
T
We
want
to
make
sure
that
it's
it's
for
the
right
people
and
when
we,
you
know
our
Forefront
of
our
minds,
is
reducing
Health
inequalities,
and
you
know
people
who
want
to
still
access
traditionally
we're
not
good
at
it's,
not
anyone's
intention
to
replace
the
receptionist,
they're,
absolutely
valued
part
of
the
the
workforce,
so
that,
and
also
it
will
save
time
in
the
long
run,
because
medical
equally
things
get
document
illustrations
to
the
patients
records,
and
that
saves
a
lot
of
time
on
the
the
clinician's
part.
L
Sorry
I
just
wanted
to
say
that
if
we
did
want
to
take
advantage
of
the
front
door
being
an
online
option,
then
now
really
is
the
time,
because
over
covered,
what
we
saw
is
everybody
downloaded
the
NHS
app.
It
was
the
most
downloaded
app
in
the
UK,
and
so
we
have
to
take
that
forwards.
If
we're
going
to
do
it.
L
The
the
second
thing
I
wanted
to
say
was
my
practice
does
not
use
patches,
it
uses
accurx
actually,
and
we
took
that
as
a
conscious
decision
and
there's
lots
of
complexities
around
patches
and
accuracs.
We
debate
it
a
lot
weekly
as
colleagues
about
the
pros
and
cons
around
that
and
the
process
that
that's
been
rolled
out.
So
I'm,
a
fan
of
iqrx
and
the
the
final
thing
I
just
wanted
to
say
is
that
a
patient
should
be
able
to
contact
the
practice
in
the
way
that
they
choose.
So
that
could
be
by
email.
L
It
could
be
via
patches,
it
could
be
coming
to
us
front
door
or
it
could
be
via
telephone
about
three
weeks
ago,
I
met
a
patient
who
was
deaf,
whose
English
was
not
their
first
language
and
and
also
they
were
not
digitally
literate.
They
put
in
a
request
that
they
wanted
to
contact
the
practice
to
make
the
appointment
via
a
text
messaging
service.
L
Although
we
do
interact
with
text
messages,
patches
doesn't
allow
you
to
sort
of
go
in
and
say,
I
would
like
an
appointment
in
the
same
way
that
you
can
call
the
practice
or
turn
up,
and
so
why
should
this
one
patient
after,
if
they're
poorly,
come
into
the
practice
or
ask
their
younger
child
to
call
because
they're,
not
deaf
and
or
hard
of
hearing?
So
what
we
did
was
a
medical
student
was
sitting
with
really
he
saw
the
light
and
he
said
I'm
going
to
use
this
as
a
quality
improvement
project.
L
This
is
a
health
inequality
problem,
so
he
met
with
stakeholders.
He
spoke
with
patients
who
are
from
the
deaf
community
and
he
also
looked
at
the
current
standards
in
terms
of
what
the
NHS
says.
In
terms
of
accessibility
and
getting
to
the
practice,
and
so
we
have
implemented
a
WhatsApp
business
and
so
that
that
patient
can
now
interact
with
us
in
the
way
that
they
choose,
so
they
want
to
get
an
appointment.
Obviously
we
can't
we
have
to
manage
the
risk
of
that
so
they're
having
a
cardiac
arrest.
L
We
don't
want
them
to
be
Texas
saying
we
want
an
appointment.
So
there
needs
to
be
a
caveat
to
that.
A
warning
that
this
is
not
an
emergency
text
messaging
service
and
you
might
not
get
a
response
straight
away
in
the
same
way
that
you
get
a
message
via
online
and
we've
also
invited
that
person
to
join
our
patient
participation
group
where
they're
able
to
actively
influence
change
from
a
health
perspective.
Delivery
perspective.
L
I
just
want
to
share
that
as
a
good
practice,
and
it
shows
how
fast
and
versatile
and
responsive
general
practice
actually
is.
A
Nice
thanks
for
that,
it's
really
good
example
and
I
think
the
reality
is.
We
do
need
to
engage
with
technology
where
it
can
make
things
better,
but
we
need
to
recognize
the
weaknesses
and
the
challenges
techno.
It's
not
like
a
universal
solution,
but
we
shouldn't
see
it
as
a
necessarily
as
a
problem.
Either
it's
got
to
be
both
okay
I'm,
going
to
move
on
to
councilor
mayor
France,.
C
Hello
good
afternoon,
thank
you
for
coming
and
person
wants
to
say
thank
you
for
your
hard
work
and
also
especially
to
my
own
GP
surgery.
They
do
fantastic
work.
C
We've
touched
upon
it
lightly,
but
it
was
something
that
that
I
I
wanted
to
ask
I,
don't
know
if
it
could
be
a
written
report
later
on
that.
Could
that
could
give
us
an
update
on
this,
but
as
more
and
more
GP
surgeries
are
moving
towards
the
modern
general
practice
access
models
which,
which
is
fantastic.
A
lot
of
people
from
the
older
generation
do
prefer
the
traditional
model,
and
we
do
have
that.
And
yes,
we've
spoken
about
how
the
1990
or
90
odd
year
old
and
you.
U
C
Elderly
people
being
able
to
get
used
to
the
technology
because
they've
been
passed
to
do
so,
but
because
of
the
pandemic,
but
we've
also
got
a
younger
generation
that
that
are
wanting
to
get
in
touch
with
their
GPS
and
or
their
GP
surgery
and
so
on,
and
they
could
do
that
via
online.
But
we've
also
got
digital
poverty
in
this
city
that
we
have
to
really
really
look
at
and
with
digital
poverty
comes
with
health
inequalities,
and
it's
those
hard.
C
You
know
those
those
it's
those
vulnerable
people
within
societies
that
that
are
getting
missed.
So
I
would
like
to
know
if
you've
got
any
information
right
now,
what's
been
done
about
that
or
if
not
I'm
happy
to,
if
chairs
willing
to
have
a
report
on
that
really.
But
yes,
that's
what
I
wanted
to
go
with
that.
O
We
know
currently
we've
got
54
of
our
Leeds
population
that
have
registered
to
use
the
NHS
app.
So
that's,
that's.
That's
one
indication
in
terms
of
people
using
using
a
digital
tool
like
so
we've
also
got
the
work
that
I
described
earlier
in
terms
of
the
100
digital
leads
team
and
the
the
work
that
we're
doing
to
work
local
care
partnership
by
local
care
partnership
and
engaging
in
local
populations.
O
L
I
mean
you
might
be
aware
that
there
is
a
tablet
learning
scheme
from
the
library,
so
you
can
get
a
tablet
if,
if
you
don't
have
one
just
want
to
make
that
point,
if
members
were
not
aware
but
you're,
absolutely
right.
Counseling.
Thank
you
for
your
acknowledgment
in
terms
of
the
work
that
GP
practices
do,
but
the
people
that
are
most
need
care
are
least
likely
to
get
it.
So
you
that
is
what
you
are
referring
to
I
think
again.
L
100
digital
leads
I've
known
for
a
long
time
and
I've
done
some
fantastic
work.
One
of
the
things
that
they've
done
in
our
surgery
actually
is
to
digitally
enable
and
create
Champions
and
who
volunteer
in
our
coffee
mornings,
and
so
patients
that
come
in
on
a
Wednesday
morning
then
can
sit
with
one
of
the
volunteers
who
have
actually
had
that
training
and
condensed
to
enable
people
so
yep
there
is
that
having
the
device
but
then
also
knowing
how
to
use
that
device
as
well.
A
Thank
you
for
that
and
I
think
I
think
what
we've
you've
said
already
around
making
sure
the
front
door
remains
open
is
a
key
part
of
solving
the
problem
that
councilman
Francis
question
there:
good
okay,
I'm
gonna,
move
on
to
councilor
Iqbal,
please
thank
you.
B
Thank
you,
chair
I,
wanted
to
speak
on
retention,
but
there
was
a
long
wait
in
the
queue
so
can
I.
Thank
the
team
for
coming
in,
and
thank
you
for
the
report.
Just
you
mentioned
GP
bashing,
there's
a
counselor
bashing
as
well.
B
You
know
it's
quite
normal,
but
it's
a
culture
of
people
getting
agitated,
but
it
is
frustrating
when
somebody
wants
to
see
GP
undering
some
ring
the
surgery
at
eight
o'clock
and
half
past
eight
answer
saying
sorry:
all
the
appointments
are
gone
and
I
do
understand
that
there's
immense
immense
pressure
on
GP
practices,
but
then
equally
I
must
say
the
walk-in
walk-in
centers
are
doing
an
excellent
job.
People
do
have
access
to
GPS
on
the
same
day,
which
is
fantastic,
and
some
of
my
family
members
are
to
go
to
the
walk-in
centers.
B
What
I
wanted
to
say
is
it's
a
comment
or
just
what's
your
thoughts,
I've
been
with
the
practice
for
40
years,
and
people
have
loyalty
to
the
practices
which
they've
been
with,
maybe
not
the
new
generation
but
the
middle
days
and
the
earlier
generation.
You
know
we
have
loyalties
and
even
though
doctors
keep
changing
I
was
speaking
to
our
practice,
whom
I've
been
with
for
40
years,
and
they
are
very
good
practice.
I
mean
they've
extended.
B
You
know
some
GPS
I've
opted
to
provide
that
service
for
their
patients,
which
is
really
greatly
appreciated
because
to
help
the
Jewish
faith,
the
Muslim
faith,
some
Catholics
and
other
Faith
groups
who
want
body
else
as
soon
as
possible,
while
the
cemeteries
colonist
service
registrars
are
available
seven
days
a
week,
it's
not
part
of
gp's
contract
for
Saturdays
and
Sundays,
but
some
practices
have
been
very
supportive,
which
is
really
appreciative
and
I've
been
leading
so
on.
Some
work
on
that.
B
So
there's
been
huge
improvements
in
that,
but
I
was
speaking
to
one
of
the
practice.
Managers
and
he's
left
friend
of
mine
can
ring
on
weekends
and
they
used
to
come
out
to
issue
the
mccds
to
the
bereaved
families
and
he
said
I'm.
Sorry
I
don't
want
to
go
in
details,
but
it's
not
same
anymore.
You
know:
I
became
a
GP
and
I
have
the
passion
to
help
people,
but
there's
something
wrong
somewhere.
So
it's
about
retention,
a
lot
of
practice.
B
A
lot
of
GP
doctors
are
not
willing
to
take
practices
on
too
much
pressure
too
much
work,
and
you
know
your
commitment.
We
Salute,
your
commitment
you're
still
happy
to
do
your
work.
So
what's
wrong,
how
can
we
detain
these
doctors?
People
doctors
are
not
taking
over
becoming
GP
practice
partner
practice,
Partners
I've,
seen
in
that
practice,
so
many
partners
have
left
other.
The
other
comment
from
GP,
a
friend
of
mine
about
mentioned
name
and
I,
won't
mentioned
the
surgery,
but
he's
saying
there's
something
wrong.
B
You
know
I
I
decided
to
opt
out
I'm,
not
not
stay
as
a
partner
anymore.
So
what
can
we
do?
What's
the
reason
for
this,
how
can
we
retain
doctors,
our
doctors?
Thank
you.
L
Thanks
man,
as
I
said,
I
love
my
job
so
but
I
think.
The
point
that
you
raise
is
really
complex,
there's
loads
of
reasons
why
GPS
may
be
bent
out,
but
I
I
think
there
is
a
lot
of
investment
at
the
moment
in
terms
of
giving
people
another
hobby,
enthusiasm
and
interest
alongside
their
core
general
practice,
works
or
sort
of
upskilling
them
leadership
skills.
L
You
know
GPS
with
special
interests
and
so
so
that
the
opportunities
are
are
wide
and
varied,
but
it
it
is
tough.
We
are
working
in
a
broken
system
and
I
tell
our
staff
that
they
can
only
do
their
best,
they
need
to
lead
and
they
need
to
be
on
the
side
of
the
patient.
L
So
it's
a
very
difficult
question
to
answer
and
as
I
alluded
to
before,
my
colleagues
of
2016
that
I
I
qualified
with
said
that
they
wanted
a
weight,
Rose
nearby,
a
coffee
shop
and
a
car
park.
It's
as
simple
as
that
you
know.
If
you
you
know,
I
I've
had
my
car
lifted
away.
Whilst
I
was
visiting
a
patient,
you
know
so
it
is.
It
is
difficult,
but
lots
of
different
reasons
and
I
think
the
world
has
changed
as
well
and
I
think
we
have
to
think
as
GP
practice
and
partners.
L
You
know
working
nine
to
six
is
no
longer.
You
know
how
people
wanna
want
to
do
things.
You
know
and
we've
got
a
GP
in
Scotland,
that's
doing
telephone
consultations
for
us
remotely.
You
know
I've
had
a
GP
who
was
sitting
in
Spain
and
able
to
do
telephone
consultations
as
well.
That
brings
the
challenges
because
it
means
that
I'm
good
to
have
to
see
the
patient
if
they
need
to
come
in,
but
I
think
we
need
to
be
open
to
all
options
and
be
able
to
do
that
and
then
the
other
thing
is.
L
We
should
support
things
like
I,
don't
know
cycle
to
work
schemes,
you
know
as
little
businesses.
We
don't
have
access
to
that
sort
of
stuff.
So
if
you
can
offer
these
additional
things
to
your
staff,
then
they're
going
to
be
happier
and
that
lots
and
lots
of
different
reasons
and
and
pay
again
is
a
really
really
big
thing.
You
know:
we've
got
a
GP,
that's
going
off
to
Bermuda
and
gonna
get
to
three
times
the
salary
that
we
could
pay.
L
You
know
I'm
hearing
of
colleagues
going
over
to
Qatar
to
Doha,
because
they've
got
a
better
work-life
balance.
You
know
an
example:
I
will
give
you
is
in
Ramadan.
You
know
it
is
very
fasting
period.
It's
really
difficult
to
get
up
and
go
to
work
for
nine
o'clock
if
you're
in
Doha,
you
can
start
later
and
finish
later
and
then
you're
home
for
opening
your
fast.
L
The
adjustments
like
that
culturally
competence
and
you
know
all
sorts
of
things
so
and
people
in
our
lives
are
so
complex
now
and
we
have
to
be
open-minded
about
that,
and
that
is
difficult
if
you're,
a
small
business
so
I
think
there's
lots
of
lots
of
different
reasons.
Expeditions
are
high
and
people
are
more
complex,
but
it's
still
a
very
rewarding
job.
Every
week.
Something
amazing
happens.
You
know,
I
have
a
letter
from
a
patient.
A
T
Just
said
that
sorry,
we
I
think
we
could
spend
all
day
answering
your
question
and
cancel
it
well,
this
multi-factorial
the
the
GPS
and
tied
more
and
more
so
medic,
legally
and
obviously
having
to
adhere
to
rightly
so,
the
appraisal
process,
which
is
an
arduous
taxes
in
itself,
keeping
up
to
date,
again
rightly
so,
having
to
do
50
hours
learning
every
year
and
reflecting
on
that.
T
So
it's
that's
just
in
addition
to
what
Rose
said,
I
think
majority
of
GPS
if
they
are
leaving
or
saddened
by
that
it's
a
profession
that
they've
you
know,
worked
hard
to
come
into.
It's
not
taken
easily
I
know
GPS
who've,
Young
gp's
have
trained
in
in
the
city
and
then
changed
to
that
to
become
a
lawyer.
Because
of
you
know
the
pays
there's
like
three
times
as
much
then
they'll
they
wanted.
So
it's
multi-factorial
as
I
said.
Thank
you.
N
Yeah
I
was
just
going
to
kind
of
add
from
a
patient's
perspective
around
some
of
the
challenges
for
GPS
is
around
the
managing
the
complexity
of
Patients
health
problems,
and
you
know
we've
mentioned
about
the
system's
broken.
You
know.
N
You
know
ringing
the
surgery,
but
that
frustration
in
accessing
Services,
getting
the
pain,
controlled
and
managing
all
the
conditions,
sometimes
is
what
offsets
when
they
come
back
to
the
surgery
and
we've
got
a
10
minute.
Consultation
model,
you
know
and
and
patients
are
coming
in
with
multiple
problems
which
we
can't
you
either
address
them
all.
And
then
you
leave
all
your
patients
waiting
the
waiting
room
and
then
that
results
in
complaints
or
you
you,
a
patient,
goes
away
and
they've
not
got
all
their
medical
problems
addressed.
N
So
we
are
seeing
a
huge
increase
in
compliance
from
patients,
apparently
because
of
the
frustration
within
the
system,
partly
because
when
they
do
get
seen,
they're
not
getting
everything
dealt
with
appropriately,
but
also
their
demands
and
expectations
are
sometimes
unreasonable,
and
you
know
within
the
NHS
that
you
know,
we've
only
got
a
finite
amount
of
resource
which
just
doesn't
manage
their
needs
and
wants,
and
so
that
does
our
lead
on
to
that
kind
of
burnout
and
frustration
for
clinicians
working
in
Primary
Care
and
as
part
of
that
job
satisfaction.
N
But
I
do
agree
a
lot
of
of
them
that
do
leave.
They
are
very
saddened
to
leave.
It's
not
the
first
choice.
It's
it's
down
to
multiple,
multiple
factors
and
I'm,
not
sure
how
we'll
resolve
all
those.
M
Thanks
Jack
I
again
agree:
it's
multifactorials,
you
ask
ask
one
GP
one
thing:
I'll
give
you
another
reason
a
bit
of
leeway
as
you
will
I.
M
As
I
said,
a
group
of
leads
and
I've
always
I
had
it
before
I
went
to
school
I
used
to
work
in
a
green
grocers
on
street
lane
and
left
the
bags
of
heavy
potatoes
out
and
then
get
up
to
school,
plus
eight
o'clock
and
I
used
to
go
to
the
Boston
Chapel
out
and
and
be
a
pot
washing
Mamma
Mia's
restaurant
in
Chapel
Florida
I
had
two
jobs
whilst
I
was
at
University
I
had
a
summer
job
when
I
came
home
with
Randy
Fox
and
worked
in
the
popular,
rounded
Fox
I've,
never
not
had
a
job
I
used
to
deal
with
the
Louise
Willy's
Weekly
News
in
the
sky
rack
when
I
was
13
as
well
doing
those
things
I've
never
not
had
a
job.
M
I've
worked
in
I've
been
working.
Obstetrics
I've
worked
in
general
surgery.
I've
worked
in
the
busiest
a
e
Department
in
the
City
in
Leicester
in
in
the
country
in
Leicester,
I've
worked
in
numerous
different
areas.
I
promise
you
I've.
Never
ever
worked
as
hard
as
I
do
now,
one
in
my
day
job
when
I'm
at
work
on
a
Thursday
on
call
from
I'm
afraid
it's
nowhere
near
nine
o'clock,
it's
well
before
nine
o'clock
to
well
after
seven
o'clock
to
missing
the
kids
bedtime
to
all
those
things.
It
is
painful
painfully
hard
painfully
hard
work.
M
Andrew's
hit
a
big
thing
for
be
honest,
the
mismatch
between
what
we
can
provide
What
patients
need
and
what
patients
want
is
vast,
and
that
creates
a
really
unhappy
unsatisfactory
day.
We
can't
provide
what
people
want
can't
provide
work
when
people
need,
and
then,
when
you
get
home,
you
hear
that
actually
you're
really
bad
at
your
job
and
you're
not
doing
enough
for
people,
and
that
is
quite
frankly
depressing.
It
is
not
a.
M
It
is
not
a
great
place
and
I'm
with
my
I'm
slightly
longer
in
the
tooth
than
most
slightly
gray
in
the
hair,
I
have
been
a
passionate
advocate
for
Primary,
Care
and
GP.
When
I
applied
to
general
practice,
there
were
20
people
for
one
job
within
Leeds.
There's
no
way
near
that
now
you
are
lucky
if
you're
in
the
South.
As
this
city
to
find
a
GP
to
to
go
into
those
roles,
because
quite
frankly,
no
one
wants
to
do
it,
but
I
also
like
to
make
the
point:
it's
not
just
GPS.
M
We
keep
going
back
to
GPS
I'm,
not
actually
worried
about
GPS
in
the
city,
I'm
worried
about
the
practice,
managers
and
Andrea
coach
very
well,
but
you
know
practice.
Management
retention
is
probably
the
bigger
threat
to
the
stability
of
primary
care
in
the
city.
We've
talked
a
lot
about
the
you
know.
The
challenges
that
reception
teams
have.
We
also
got
a
problem
with
practice:
nurses,
there's
no
the
training
platform
for
practice.
Nurses
coming
through
is
absolutely
you
know
you.
M
You
know
my
wife's
got
so
you
know
it's
really
struggle
to
get
a
nurse
just
to
work
in
the
practice.
The
challenges
are
huge
and,
unfortunately,
like
any
problem
when
you've
got
retention,
the
worse,
the
retention
is
the
worse.
The
problem
is,
and
it
just
multiplies
and
and
gets
worse
and
so
again,
I
think
for
me:
if
we're
looking
for
ways
and
solutions
of
working
together,
there
is
absolutely
something
that
we
can
do.
M
Working
with
the
public
about
expectation
about
expectation
of
what
the
service
can
provide,
what
it
should
provide
and
where
they
can
get
additional
and
I
often
say
better
support.
I
think
one
of
the
conversations
we've
had
is
talk.
Talk
about
alternative
ways
of
getting
General
GP
shouldn't
be
an
alternative
way.
I
always
say
to
my
friends:
if
you've
got
a
problem,
you
need
you,
don't
want
a
GP,
you
don't
want
an
orthopedic
surgeon.
M
You
want
a
physio,
you
know
why'd,
you
do
that,
but
currently
we
sell
physios
as
a
poor
excuse
for
a
GP
for
a
problem
with
your
knee
pain.
There
needs
to
be
a
whole
conversation
around
that
we've
got
a
multi-disciplinary
team
who
are
better
at
some
bits:
social
subscribers,
all
those
other
things
that
we've
got
that
are
amazing
and
currently
what
we're
describing
is
a
system
in
which
we
don't
have
enough
EPS.
So
we
tell
people.
M
M
So
for
me,
there's
there's
an
absolutely
the
word
communication
started
to
to
emerge
in
the
conversations
that
we're
having
communication
communication
communication
help
patients
to
understand
the
next
Expect
While
that
is
pre-messaging,
not
just
sending
things
out,
saying,
use
patches
really
helping
people
to
do
that.
Looking
at
digital
inclusion,
looking
all
those
things,
but
it's
more
than
that,
it's
more!
It's
more
submissive!
It's
more!
You
know
what
does
look
North
say:
what
do
the
papers
say?
What
do
all
those
other
people
say?
M
Who
could
be
helping
and
being
part
of
a
solution
for
this
city
around
a
better
conversation
about
what
primary
care
looks
like
it
doesn't
have
to
be
the
new
model
of
primary
careers,
of
the
people
who
said
old,
Primary
Care.
Still
there
was
12
years
ago.
There
was
nothing
wrong
with
primary
care.
12
years
ago
the
Commonwealth
report
said
that
Primary
Care
in
the
UK
is
the
Jewel
of
the
crown
the
jewel
in
the
crown
of
the
NHS.
M
It
ranks
as
what
I
think,
apart
from
one
parameter
top
out
of
all
11
Commonwealth
Nations,
the
primary
care
model
hasn't
changed,
the
partnership
model
hasn't
changed.
Something
else
has
12
years
ago
and
I
think
you
know
there
is
there's
something
absolute
in
that
I
know.
There
is
something
that
we
can
do
about
that.
We
keep
looking
for
model
changes
around
this.
You
know
12
years
ago.
A
Thank
you
very
much
for
that.
I
think
one
of
the
things
you
I
think
you're,
probably
inference,
is
sort
of
non-medical
issues
and
I.
Imagine
those
present
more
than
I
can
imagine
in
you
know
your
10
minute
slots,
whether
that's
debt,
whether
that's
heating,
whether
that's
housing,
whether
that's
schooling,
whether
that's
whatever
else
it
is,
and
ultimately
there's
not
a
medical
solution
to
that,
and
so,
when
you're
talking
about
system
challenges,
it's
widened
to
just
the
NHS.
A
It's
the
it's
the
I'd
say
it's
the
public
sector
system
I'm
going
to
bring
in
councilor
Firth
next
thank.
R
You
very
much
Sharon.
Thank
you
very
much
for
this
wider
debate.
That's
been
taking
place,
it's
been
fascinating
to
hear
and
listen
to
some
of
the
complex
points
that
have
been
raised.
I
just
wanted
to
raise
a
couple
of
points
before
I
ask
my
question.
First
of
all,
on
6.6.2
with
the
map,
it
shows
Jessamine
Cottage
Branch
surgery
in
abbaford,
which
was
closed
as
of
way
before
July
2023,
so
that
should
be
removed.
R
Unfortunately,
in
terms
of
also
one
thing
that
has
been
raised
quite
significantly
in
this
meeting
is
the
East
Leeds
extension
and
we
do
welcome
the
work.
That's
been
done
on
that
as
one
side
of
the
ECS
extension
within
my
ward
and
really
certainly,
although
there
is
a
lot
of
fear
with
the
E6
extension,
particularly
with
regards
to
having
lost
the
abbaford
surgery,
that
we
may
then
lose
the
surgery
in
schools,
and
we
want
to
do
everything
we
can
to
stop
that.
R
I
really
do
appreciate
the
fact
that
it
got
a
specific
mention
in
this
report
and
has
been
repeatedly
covered
throughout
I.
Just
wanted
to
ask
two
things:
to
start
off
with
the
patient.
Journey
there's
been
a
lot
of
mention
today
about
the
abuse
that
are
received
by
GPS
and
staff
within
the
surgeries
and
I.
Think
that,
as
it
said
before,
communication
is
absolutely
key
to
that
and
as
a
result,
it
I
think
it
was
quite
interesting
within
this
report.
I
think
it's
something
to
reflect
on
that.
R
There
hasn't
been
very
much
mention
of
of
what
the
projections
would
look
like
in
terms
of
the
number
of
patients,
whether
it's
just
actually
that
we're
having
a
particular
problem
after
the
largest
and
most
unprecedented
shock
to
the
NHS
since
its
Creation
in
the
pandemic,
or
actually,
whether
there's
general
population
rise.
R
The
second
thing
I
also
wanted
to
ask,
was
the
fact
that
it
mentions
that,
roughly
by
the
end
of
this
financial
year,
two-thirds
of
GP
practices
throughout
Leeds
54,
already
using
cloud-based,
Solutions
and
12
identified
for
the
next
transition
over
the
next
year
to
expand
their
telephony
and
I
just
wanted
to
ask
in
terms
of
those
particular
12
how
they've
been
identified,
and
also
more
generally,
what
the
plans
are
for
the
future
to
make
that
as
close
as
we
can
as
soon
as
possible.
I
appreciate
within
the
financial
envelope.
O
So
the
reason
that
the
next
12
have
been
chosen
will
be
a
mixture
of
practices
who
are
have
themselves
indicated
their
willingness
to
move
to
cloud-based
telephony
in
the
in
a
shorter
period
of
time.
That
will
be
linked
to
things
like
their
current
telephony
contracts
and
how
long
they've
got
to
run
on
that
contract
and
whether
there's
any
financial
implications
of
them
ending
a
contract
early
and
starting
with
a
new
telephony
provider.
It
will
link
to
their
what
they
would
assess
their
capacity
be
to
Implement
and
then
roll
out.
O
A
new
telephony
system
in
respect
of
staff
training
comes
to
patients
so
again
an
assessment
of
their
their
their
Readiness
to
undergo
that
that
change
and
there'll
also
be
an
assessment
of
the
capacity
and
how
we
deploy
that
capacity
in
supporting
practices
in
a
in
a
phased
program.
So
there
would
be
external
support
required
for
practices
or
undergoing
that
change,
and
again
the
resources
would
be.
O
You
know
the
assessment
of
the
resources
in
terms
of
how
many
practices
can
we
can
we
move
at
a
certain
period
of
time,
and
how
long
is
that
say,
and
how
many
waves
do
we
do
we
need
to
have
so
all
of
those
factors
will
be
will
be
taken
into
consideration.
A
Okay,
so
I've
got
the
end
of
the
questions.
I
I
think
it's
quite
just
sober
in
conversation.
We've
just
had,
but
also
it's
worth
noting
some
of
the
positive
comments
made
as
well,
particularly
from
Dr
May.
So
thank
you
very
much
for
that.
I
really
think.
We've
had
a
helpful
conversation,
really
appreciate
you
coming
and
and
I
think
it's
been
really
helpful
to
have
outside
voices
today
at
today's
community
meeting
and
that's
something
that
I
certainly
really
appreciate
and
I.
A
Think
it's
really
important
for
us
as
a
city
to
hear.
So.
Thank
you
for
coming
and
thank
you
Gainer
for
writing.
The
report
I
I
thought
it
was
very,
very
helpful,
very
useful
report,
so
I'm
going
to
draw
this
sort
of
section
of
the
meeting
to
to
an
end.
We've
been
going
for
sort
of
two
hours
since
the
start
so
I'm
going
to
propose.
We
have
a
10
minute
break
before
we
have
our
second
substantive
item.
A
If
that's
okay
with
everyone
and
we'll
give
everyone
a
chance
to
change
their
suits
around.
So
thank
you
again
for
coming
and
everyone
else
come
back
in
10
minutes,
I'll
start
actually
at
22..
Thank
you.
A
Okay,
welcome
back
everyone,
we're
back
at
adults,
health
and
actual
lifetime
screening
board
for
those
who've
missed
the
first
bit.
We've
heard
of
a
lot
long
and
good
debate
about
access
to
General
practice,
GPS,
which
I
think
was
really
helpful.
We're
now
going
to
move
on
to
item
number
eight,
which
is
the
report
from
the
director
of
the
public
health
and
her
annual
report,
which
I
think
is
also
very
interesting,
read
you
can
find
the
papers
really
easily.
A
If
you
put
into
Google
adults,
health
and
active
lifestyle,
scrutiny
board
leads,
and
it's
usually
the
first
link
when
I
when
I
do
it
many
times.
Okay,
we've
got
a
few
people
new
people
on
the
table
since
the
last
session,
so
I'll
start
with
councilor
Cohen
and
then
the
people
at
the
other
end
of
the
table.
Please
can
you
introduce
yourself
as
well
and
then
we'll
move
into
the
item.
Thank
you.
X
P
Y
A
Super
thank
you,
I
think.
That's
everyone,
who's
joined
during
the
break,
so
I'm
going
to
pass
over
to
councilor
Jenkins
to
introduce
his
paper.
Thank
you.
Thank.
I
You
chair,
so
the
director
of
Public
Health
has
a
statutory
Duty
to
produce
an
under
report
describing
the
health
of
the
population
and
recommendations
to
improve
this
following
a
break
in
producing
the
under
reports
during
the
covert
pandemic.
These
have
now
been
reinstated
and
it's
great
that
Victoria
has
chosen
to
focus
on
children
for
this
year's
report
as
her
first
as
director
of
Public
Health
for
leads,
children
are
much
less
likely
to
become
ill
with
covid-19
than
adults,
and
they
were
not
the
main
focus
of
protective
measures
during
the
pandemic.
I
However,
this
report
highlights
how
the
pandemic
has
affected
the
health
and
well-being
of
children
profoundly
and
unequally
as
Deputy
exec
member
for
public
health.
I'm
pleased
to
add
my
support
to
this
report
and
Shining
a
light
on
the
health
and
well-being
of
the
children
and
young
people
in
our
city
and
the
report's
recommendations
on
what
we
can
do
together
for
all
children
in
Leeds
to
thrive
on
page
75.
We
note
especially
the
importance
of
Access
to
Health
Care
in
the
areas
of
Dentistry
speech
and
language
therapies
and
Mental
Health
Services.
I
This
report
is
particularly
strong
because
the
voices
of
children,
young
people
and
families
and
partners
who
work
with
them
are
Central
I
would
recommend,
sharing
in
schools
and
youth
centers,
the
U2
four
minute
film
and
the
children's
summer
report
report,
as
they
both
shed
light
on
the
effects
of
covert
on
young
people's
lives
in
the
city.
I
should
also
recommend
the
black
boys
Joy
work
of
Marina,
Newton
and
karmana
school
in
Synergy,
which
is
also
on
YouTube
hot
off
the
press.
I
Today
it
has
been
announced
under
government
proposals,
disposable
Vapes
will
be
banned,
stop
children
becoming
addicted
to
these
devices.
Leeds
has
become,
has
been
nationally
recognized
by
the
Association
of
directors
of
Public
Health,
as
one
of
four
reports
highlighted
as
best
practice.
This
is
because
Jordan's
voices
are
at
the
heart
of
the
report,
coupled
with
a
rigorous
academic
approach,
which,
together,
strengthens
the
power
of
the
recommendations.
I
The
association
has
also
just
issued
a
statement
on
air
pollution
which
may
be
of
interest.
The
annual
report
adds
to
the
momentum
of
other
important
work
we
are
leading
in
the
city,
including
the
program
we
have
committed
to
to
be
a
marmot
City
and
our
drive
to
reduce
Health
inequalities.
Our
mama
mission
is
nothing
less
than
a
fairer,
healthier
Society,
reducing
Health
inequities
by
tackling
the
social
determinants
of
Health
women
living
in
Leeds,
Dock,
huntslet
and
sturton
have
the
lowest
life
expectancy
in
all
of
England.
I
I
J
J
Okay,
so
I'm
very
mindful
of
time
and
I'm
going
to
keep
this
presentation
very
brief,
and
so
we
can
get
into
the
conversation
about
the
report.
We
will
also
attempt
to
show
the
four
minute
film
just
because,
as
part
of
this
slide
set
technology
willing
Angela.
So
if
you
wouldn't
mind
going
back
to
the
first
slide,
I'll
just
say
a
couple
of
points
and
to
build
them.
What
councilor
Jenkins
has
said
in
these
opening
comments?
J
Thank
you.
So
I'm
really
pleased
to
have
the
opportunity
to
bring
this
here
today.
It
is
the
first
director
of
Public
Health
annual
report
we've
had
since
the
pandemic,
and
it's
great
to
be
here
and
have
the
conversation
you
will
have
received
a
full
copy
of
the
annual
report
and
also
a
four-page
summary
that
we've
done
for
children
and
young
people.
So
it's
always
quite
a
handy
summary
if,
if
we
need
a
briefer
report
to
refer
to
so
you've
got
both
of
those
just
a
couple
of
points.
J
Before
we
start,
we
did
take
this
paper
through
the
health
and
wellbeing
board
in
a
session
chaired
by
councilor
Bennett
in
July,
and
it's
also
been
to
the
council's
executive
board
again
in
July.
J
We,
it
is
part
of
an
annual
cycle
of
reports
which
we'll
now
follow
so
the
routine
will
be
that
we
make
recommendations
in
each
of
the
director
of
Public,
Health
annual
reports
and
then
subsequent
reports
report
back
on
the
progress
of
last
year's
recommendations,
so
just
to
kind
of
acknowledge
that
that
will
be
the
the
process
we're
now
in,
and
you
will
see
that
we
have
reported
back
on
the
progress
with
the
recommendations
of
the
last
report,
even
though
that
last
report
was
produced
in
2018
just
to
keep
that
kind
of
continuity.
J
The
other
thing
just
to
mention
front
because
it
may
come
into
the
conversation,
is
that
the
the
performance
measures
of
progress
on
the
recommendations
of
this
report
will
be
linked
with
the
existing
surveillance.
We
do
around
Public
Health
measures
for
children,
young
people
routinely
in
in
our
Public
Health
work
in
the
in
the
council.
So
there's
not
a
different
process
to
to
Monitor
and
measure
performance.
It
will
be
it's
built
into
ongoing
surveillance.
J
So,
just
of
like
those
two
things,
I
put
the
beginning,
the
us
counselor
Jenkins
has
said
we.
It
wasn't
really
a
hard
decision
to
decide
to
make
this
report
around
really
shining
a
light
on
the
children,
the
health
of
children
and
young
people,
because
we
were
so
mindful
that
the
they
were
never
at
the
top
of
the
list
in
terms
of
the
risk
from
covid
itself.
J
But
we
know
that
the
pandemic
has
had
significant
impact
on
the
mental
and
physical
health
of
children
and
young
people,
and
we
wanted
to
understand
this
better
and
for
our
city
and
start
to
build
the
Collective
response
to
that
next
slide.
J
Please
Angela
and
you'll
see
from
the
report
that
what
we
did
is
bring
together
a
review
of
the
available
literature
around
the
impact
of
of
the
pandemic
on
children
and
young
people's
health
and
our
local
data
on
health
outcomes,
but
essentially
with
what
children
and
young
people
told
us
about
their
own
experiences
of
their
health
and
well-being
over
over
those
years
and
now,
and
also
very
much
listening
to
what
professionals
who
work
with
children
and
young
people
and
partners
were
telling
us
so
the
all
of
the
content.
J
Next
slide,
Angela
and
I
think
this
is
the
slide
that
we
should
be
able
to
see
just
the
brief
film.
U
AB
Z
I
J
So
I
hope
you
enjoy
that
it's
very
much
a
kind
of
a
trail
for
the
report
and
after
we
launched
the
report
at
the
health
and
wellbeing
board,
and
it
became
very,
it
became
searchable
on
YouTube
in
the
public
domain.
So
if
you
put
it
in,
you
can
share
that
with
colleagues
and
and
families
widely
one
of
the
most
rewarding
parts
of
the
process
that
we
we
committed
to
actually
sharing
the
film
first
with
the
families
that
had
actually
been
part
of
helping
us
make
it.
J
And
then
we
had
a
very
impactful
evening
just
upstairs
in
the
library
with
with
all
of
the
people
and
others
on
the
on
the
film
and
yeah.
It
was
very
powerful
there.
Just
in
terms
of
the
stories
that
came
out
and
so
yeah,
we
wanted
to
bring
some
of
that
to
life
as
well
as
the
report
just
being
about
data.
J
We
through
the
work
of
the
report,
the
the
analysis
of
the
data,
came
down
to
these
11
key
themes,
so
you'll
see
in
the
report.
There
is
a
section
on
each
of
those.
Each
of
these
11
key
areas-
and
there
are
findings
for
all
of
these
areas
in
terms
of
what
we
found
in
terms
of
the
the
health
and
well-being
impact
of
the
city
and
there's
also
a
a
kind
of
a
headline
Showcase
of
of
everything.
We
do
in
Leeds
around
this
particular
theme.
J
So
what
we
wanted
to
do
was
present
lots
of
the
really
good
work
that
we
provide
that
we're
really
proud
of
across
the
city
across
Partners,
as
well
as
describing
the
needs
in
these
areas,
so
that
that
they're
in
much
more
detail
in
the
report
itself
and
again,
there's
no
time
to
go
into
this
now.
But
one
of
the
things
that
you'll
see
through
the
report
is
that
we
wanted
to
very
visually
present
kind
of
key
data
and
headlines
in
a
really
kind
of
graphic
way.
J
So
it
it
was
easy
for
people
to
kind
of
see
some
of
those
kind
of
very
clear
findings
of
the
report
and,
where
possible,
we've
looked
at
the
the
difference
with
communities
across
the
city,
and
here
we've
been
able
to
pull
out
quite
a
lot
of
data
in
terms
of
leads
as
a
whole
and
deprived
leads.
Oh
sorry,
I've
moved
on
to
the
next
slide.
J
The
this
is
the
data
you'll
have
seen
from
the
report,
but
it's
just
an
example
of
the
way
that
we
wanted
to
present
some
of
those
headlines
headline
findings
within
the
report
and
then
the
next
slide.
Angela
is
just
an
example
of
one
of
the
pages
that
shows
some
of
the
fabulous
work
across
the
city
that
is
happening
and
for
each
of
the
themes
we've.
We've
we've
captured
this
next
slide.
J
Angela,
the
each
of
the
themes
has
headline
findings,
so
particular
partners
and
particular
boards
will
be
interested
in
in
in
in
different
parts
of
the
report.
What
we've
done-
and
this
is
from
page
74
of
the
report-
is
pulled
together.
All
of
those
together
to
to
give
us
some
findings
throughout
the
whole
work.
So
these
are
the
themes
that
that
kind
of
came
through
all
of
all
of
all
of
the
report
and
again
it's
worthwhile
I'm
sure.
J
Hopefully,
you've
had
a
chance
to
have
a
look
at
these
in
detail,
but
but
there's
two
key
messages
that
I'll
just
pull
out
now
for
for
this
board
today
that
overall
we
found
that
most
measures
of
children
and
young
people's
physical
and
mental
health
and
had
worsened
from
the
time
since
the
last
report,
which
includes
the
time
of
the
pandemic,
and
although
that
that
pattern
is
very
complex
and
plays
out
differently
for
different
indicators.
J
But
there
was
a
overall
worsening
in
both
physical
and
mental
health
and
the
second
key
finding
across
all
of
these
is
that
we
that
that
impact
has
not
been
equal
across
the
city,
and
we
know
we
have
more
negative
impact
in
our
most
disadvantaged
families
and
communities
across
most
of
the
measures
of
health
and
well-being,
and
that
we
know
that
the
most
vulnerable
children
are
experienced
are
experiencing
multiple
effects
from
from
that
kind
of
hit
from
different
indicators
around
their
health
and
well-being.
So
there's
a
kind
of
a
compounding
effect.
J
That
happens
with
our
most
disadvantaged
families
and
communities.
There
is
good
news.
There
is
good
news
in
the
report
that
that
we
are
doing
some
excellent
work
across
the
city
we
should
be
incredibly
proud
of,
and
there
was
some
positive
impacts
of
the
pandemic
in
terms
of
time
with
family
members
which
came
out
in
the
film,
some
of
which
has
sustained
beyond
the
pandemic.
J
So
the
last
slide
points
to
the
recommendations
of
the
report
again
no
time
to
go
into
these
in
depth
here,
hopefully,
you've
had
a
chance
to
read
them,
and
but
these
10
recommendations
have
come
through
from
the
findings
which
have
come
through
from
the
evidence,
and
these
these
provide
a
way
forward
to
how
we
continue
to
respond
to
this
changing
pattern
of
needs
for
children
in
young
People's
Health
across
the
city.
Building
on
the
good
work.
J
We
do,
but
very
mindful
we're
in
a
financially
challenged
position
and
where
we're
having
to
make
some
really
difficult
decisions
around
services,
and
so
we
very
much
want
the
recommendations
to
be
at
the
heart
of
some
of
those
very
difficult
conversations.
We're
having
at
the
moment
so
I
shall
leave
it
there
chair.
Thank
you.
A
Yeah,
thank
you
very
much
for
that.
Victoria
really
helpful.
It's
great
to
see
you
at
Beeston
village,
community
center
in
the
video,
while
I'm
waiting
for
whether
members
want
to
indicate
to
speak.
A
It's
interesting,
the
impact
of
Chill
on
children
and
young
people,
my
daughter's
13,
but
13th
birthday
was
during
the
pandemic
and
what
she
wanted
was
to
be
allowed
to
go
back
to
school,
which
is
a
she's,
a
sort
of
a
change
from
the
sort
of
other
Generations
I
think
so,
if
you
want
to
come
in
I'll
start
with
counselor
Cohen,
please.
Thank
you.
A
V
You
chair
and
thank
you
for
this
report,
I
suppose
not
trying
to
simplify
anything
I
think
most
most
people,
particularly
those
involved
with
young
people
in
in
any
way
shape
or
form,
would
recognize
pretty
much.
Everything
within
the
report
I
think
it's
always
reassuring
when
research
confirms
what
we
probably
knew.
I'm
involved
in
as
a
governor
in
five
different
schools
and
the
impact
of
the
the
the
lockdowns
and
the
impacts
on
taking
young
people
out
of
educational
settings
is
going
to
be
something
that
we're
going
to
see.
V
I
suspect
until
those
young
people
come
out
we'll
see
within
schools.
Until
those
young
people
come
out
of
formal
education
in
in
varying
ways
as
a
city,
we
have
a
a
real
Focus,
an
obsession
with
attendance
for
good
reason
and,
of
course,
therefore,
where
we
enforce
non-attendance
that
the
impacts
aren't
a
surprise.
The
impact
on,
as
we
saw
in
the
in
the
film
on
the
youngest
people,
people
born
during
the
pandemic
and
preschool
not
being
able
to
socialize
with
young
people
other
young
people.
V
It
is
going
to
be
significant
and
that's
going
to
present
different
kinds
of
challenges
as
young
people
move
through
the
move,
through
their
educational
and
social
life
over
the
years
to
come.
I
think
this
is
a
superb
report
and
really
really
grateful
that
you
made
young
people
the
focus
of
this
first
report
and
thank
you.
D
Thank
you.
Jen
can
I
reiterate
my
thanks
to
Victoria
as
well,
for
a
very
comprehensive
and
detailed
Report,
with
all
sorts
of
very
useful
information,
I'm
not
going
to
ask
her
questions
about
what's
happening.
Some
of
those
are
actually
addressed
in
the
report
itself,
but
some
of
them
remain
to
be
addressed,
but
I
just
want
to
link
it
with
two
of
the
things
which
are
on
our
agenda
over
the
next
few
months.
D
One
is
one
of
the
three
issues
that
she
has
mentioned
was
access
to
dental
services
and
I
hope
that
we'll
be
able
to,
as
well
as
the
wider
access
to
to
Dentistry
pick
up
access
and
the
effects
of
lack
of
access
to
dental
services.
When
we
do
our
workshop
on
on
Dentistry,
the
other
one
is
about
mental
health
and
looking
on
page
50
54
of
the
report.
Talking
about
referrals.
D
Mind
made
single
point
of
access
up
by
50,
Eating
Disorders
up
by
329
and
the
mind
boggles
at
that,
and
and
then
referrals
for
autism
assessments
up
by
70
percent,
and
you
mentioned
at
the
very
beginning
of
our
meeting
today
that
we're
going
to
be
looking
at
autism
at
some
time
in
in
the
in
their
future.
I
I,
I.
Think
with
what
you
said
so
I
I
just
wondered
whether
we
could
make
a
note
of
some
things
which
we
hope
will
be
addressed
in
that
meeting.
D
Secondly,
we've
been
told
before
that
one
in
eight
children
in
this
city
are
referred
for
an
assessment
of
neurodiversity
or
Autism.
What
I
don't
know
is
what
happens,
how
many
of
those
get
some
sort
of
diagnosis,
what
what
diagnosis
comes
out
of
it?
What
what
is
the
result
of
the
the
assessment
and
then
what
is
done
about
it
and
what
is
done
about
it?
Not
only
in
the
NHS
and
I,
don't
know
quite
what
the
NHS
can
do
and
what
it
does
do.
D
What
about
education,
because
part
of
the
what
should
happen
as
a
result
of
the
assessment
I
believe
is
that,
should
there
should
be
additional
support
in
the
children's
education?
So
what
actually
does
happen?
Is
there
enough
Finance
to
make
sure
that
it
can
happen?
And
what
is
the
result
of
those
assessments?
So
not
looking
to
Victoria
to
tell
us
today,
but
highlighting
things
I
hope
we
can
have
presented
to
us
when
we
actually
have
that
meeting
on
on
autism.
A
Thank
you
for
that
doctor
I,
think
yeah
I
think
some
of
those
things
would
be
fun:
children,
families,
remit
and
I.
Guess
if
you're
talking
about
mental
health,
one
of
the
things
that
stood
out
to
me
and
in
the
report
more
than
anything
else,
was
on
page
21
of
the
of
Victoria's
report,
which
was
nearly
40
percent
of
young
people,
feel
stressed
or
anxious
every
on
those
days
and
that's
like
deeply
concerning
sort
of
numbers
and
I
I
do
hope.
It's
something.
A
J
Thank
you
chair
and
thanks
for
those
comments,
Dr
Beale
I
know,
Emily
wants
to
come
in
as
well,
so
I'll
make
some
just
an
opening
comment.
J
We
have
it
feels
that
the
three
areas
of
Access
to
Health
Services
were
the
ones
that
particularly
stood
out
through
all
of
the
the
data
and
the
conversations
and
the
processes
around
the
report,
so
not
to
say,
there's
not
many
more,
but
these
were
the
ones
that
were
that
were
the
most
significant
and
and
I
think
it's
fair
to
say
that
around
the
mental
health,
the
Mental
Health
Service
access
question
we're
having
one
of
the
the
positive
things
that
the
I
think
the
report
has
helped
with
is
to
to
have
a
wider
conversation
about
how
we,
how
we
respond
to
this
level
of
need
so
and
I
think,
with
with
a
sort
of
a
baseline
working
assumption
that
there's
no
way
that
NHS
Services
can
can
respond
entirely
on
their
own
to
this.
J
This
level
of
need,
that
is,
that
is
being
expressed
through
through
through
the
city
at
the
moment.
So
we're
having
really
helpful
conversations
around
you
know
what
can
we
do
for
children
who
really
need
you
know
clinical
Mental,
Health
Services
now
and
in
the
future,
but
how?
How
can
we
as
a
city-
and
it
goes
back
to
the
school
survey-
counselor
Scopes
around?
J
How
do
we
actually
look
at
mental
health
in
in
a
much
more
holistic
way,
with
all
Partners
across
across
the
city,
because
we
know
80
of
mental
health
is
created
outside
the
NHS
through
communities
and
everything
we
all
do.
So
you
know
we're
never
going
to
resolve
this
just
by
more
access
to
more
services,
and
we
don't
have
the
funding
to
do
that
anyway.
J
So
it
feels
like
we
need
much
more
of
a
fundamental
conversation
about
supporting
our
young
people
to
be
mentally
healthy
and
for
those
that
need
it
get
the
right
access
to
services,
but
for
all
of
this
to
tip
into
NHS
Services
is
absolutely
you
know
just
just
as
something
that
that
we're
not
in
a
position
as
a
system
to
do
so.
J
They're
the
they're
some
of
the
live
conversations
that
have
been
fed
into
conversations
with
health
colleagues
at
the
moment
about
how
we
prioritize
need
and
also
support,
much
more
prevention
and
support
around
you
know,
working
with
children
more
more
generally
I'll.
Let
Emily
come
in
I,
don't
know
if
you're
going
to
comment
on
the
the
waiting
lists
around
mental
health,
Emily
might
have
something
different
to
say:
there's
no
evidence
I've
seen
of
them
coming
down.
This
is
why
we
need
a
different
solution.
Thank
you.
Y
Thank
you,
Victoria,
and
thank
you
chair
for
making
the
time
on
this
agenda
for
this
discussion.
It's
it's
so
fantastic
to
have
this
space
to
discuss
these
really
important
issues,
I'd,
absolutely
Echo.
The
position
that
Victoria
has
described
to
pick
up
some
of
the
specific
questions
from
Dr
Beale
that
you've
gone
right
to
the
heart
of
the
matter
there
on
this
issue.
Y
However,
we
are
working
together
to
understand
what
we
can
do
to
enable
children
to
access
the
support
they
need
without
the
need
for
a
diagnosis,
because
the
partnership
model
that
we
have
in
place
with
children
and
families
and
with
schools
in
this
city
is
that
you
should
have
the
support
that
you
need
in
school
for
the
needs
that
you
are
presenting
with
whether
or
not
that's
accompanied
with
a
formal
diagnosis.
Y
So
whilst
as
Victoria's
described,
you've
got
a
very
challenged
service
trying
to
cope
with
is
actually
approaching
100
increase
in
referrals
across
the
neurodiversity
pathway.
We
can
still
make
sure
those
children
are
getting
what
they
need,
either
in
a
school
environment
or
in
that
wraparound
environment
from
the
community
and
family
that
they
live
in.
Y
Further
from
that,
there
was
a
question
around
our
mental
health
referrals
stabilizing
and
going
down
on
the
side
of
the
pathway
that
relates
to
emotional
and
social
and
mental
health
rather
than
neurodiversity.
Y
This
is
a
significant
challenge,
as
Victoria's
described
and
in
the
present
climate,
not
one
which
we
can
meet
with
ease,
but
I
can
report
that
we've
invested
an
additional
400
000
pounds
this
year
into
doing
neurodiversity
assessments
for
the
most
urgent
children,
and
that
funding
also
includes
some
pilot
work
to
see
how
we
can
improve
between
ourselves
and
the
local
Authority.
Some
of
the
working
schools
that
supports
those
children.
F
Thank
you,
chair,
yeah
I.
Second,
everything
that's
been
said
about
the
report.
It's
really
important
piece
of
work,
an
excellent
piece
of
work
and
I.
Think
actually
the
video
really
sums
up.
Doesn't
it
better
than
words?
You
know
a
written
word,
I
think
at
the
first
time,
I
saw
it
even
then
it's
kind
of
emotional.
Isn't
it
watching
some
of
those
stories.
If
you
think
too
deeply
about
them,
I
tried
not
to
so
I
didn't
start
blooming,
but
but
yeah.
F
What
I
want
to
focus
on
is,
and
it
was
touched
on
there
and
it's
people
who
aren't
engaging,
who
aren't
picking
up
the
vast
types
of
support
and
activities
that
are
available,
and
many
are
highlighted
in
this
report.
F
I'm
thinking,
particularly
things
like
the
Henry
scheme,
which
I
know,
is
fantastic,
and
certainly
in
West,
we've
had
some
funded
through
Health,
in
addition
to
previously
by
the
council
and
one
particular
scheme
had
a
very
low
take
up,
and
it's
just
things
like
that:
getting
those
people
onto
those
schemes
now
the
last
Labor
government
had
a
scheme
called
Emma.
Didn't
therefore,
encouraging
people
to
attend
college
for
60
and
I
think
where
they
got
a
small,
well,
a
weekly
allowance,
I
believe
and
that
I
think
was
successful.
F
So
should
we
look
at
things
like
that
when
we're
putting
the
funding
bids
up
that
there
is
an
incentive
to
attend
these
courses
and
what
have
you
because
I
think
they
can
make
a
whole
world
of
difference
and
then
the
other
groups
that-
and
it
may
be
I'm
sure
it
is
a
result
of
not
engaging
mental
health
issues
and
so
on.
But
that
makes
a
minority
of
people
vulnerable
to
criminal
exploitation.
And
then
we
see
you
know
some
destruction
within
our
communities.
F
You
know
if
people
are
offering
an
e-bike
worth
four
thousand
pounds
and
then
you're
going
around
perhaps
drug
dealing,
which
we've
seen
a
lot
of
that's
that's,
probably
more
attractive
than
to
them
than
maybe
attending
one
of
the
youth
Provisions
that
were
going
on.
So
it's
how
we
get
to
that
cohort,
get
them
engaged,
get
them
and
join
all
the
things
that
the
majority,
thankfully
of
young
people
do.
It
is
only
a
minority,
but
it's
quite
a
destructive
minority.
F
W
So
I
think
there
was
a
really
significant
challenges
in
relation
to
people
that
prey
on
children
that
are
vulnerable
and
in
the
context
of
post-covered.
Those
vulnerabilities
have
increased,
but
we're
we're
fortunate
in
Leeds.
But
despite
the
challenges,
we
have
a
strong
partnership.
We
have
investment
in
locality
working
through
our
clusters
through
our
early
help
provision
through
our
commitment
to
those
Investments,
our
youth,
for
example.
W
Our
youth
offer
our
youth
workers
working
in
those
communities
doing
some
really
proactive
work
with
young
people
who
are
at
risk
of
exploitation
to
to
really
engage
them
in
positive
activities
and
and
have
some
real
success
stories
around
that.
You
know.
W
We
often
only
hear
the
the
negatives
in
the
way
there
are
concerns,
but
some
real
success
stories
around
working
with
exploitation,
and
we
were
part
of
a
pilot
with
Professor
Carlene
Furman,
who
is
an
expert
in
contextual,
safeguarding
and
that's
looking
at
risk
outside
of
the
home
and
how
we
support
young
people
and
families
and
professionals
around
understanding
risk
outside
of
the
home.
W
So
that's
people
who
will
pray
on
young
people
and
as
a
result
of
that
and
some
real
Innovative
work
in
the
east
of
the
city,
in
partnership
with
police
colleagues
with
third
sector
colleagues
and
our
colleagues
in
safer,
leads
aware
expanding
that
to
Across
the
three
areas
of
the
city,
so
we're
looking
at
youth
violence
having
that
locality
model
where
a
partner's
meet.
Where
will
they
talk
about
emerging
issues?
They
will
discuss
young
people
that
are
a
particular
risk
that
we've
got
concerns
about.
W
They
will
also
look
at
emerging
themes,
so
that's
about
space
and
places.
For
example,
you
mentioned
parks.
There
are
lots
of
places
that
those
who
exploit
children
will
Target.
So
we
look
at
a
partnership
approach
in
tackling
that
and
breaking
the
cycle
and-
and
so
the
challenge
continues
in
the
context
of
of
the
current
Financial
challenge,
also
in
Social
care
in
health.
W
There
is
a
Workforce
challenge
as
well
and
and
and
stability
in
the
workforce,
but
we're
fortunate
we've
got
early
help
investment
and
this
report
really
captures
why
we
continue
with
that
localized
model
of
support
investment
in
family,
valued
and
early
help
and
those
most
deprived
areas.
The
gaps
between
those
and
other
areas
is
quite
prevalent,
but
that's
where
we
invest
more
of
our
services.
We've
got
our
fantastic
children's
centers.
There
are
some
examples
in
in
here,
but
also
the
work
in
Leeds.
W
We,
we
also
have
a
poverty
strategy,
tackling
child
poverty
strategy
and
we
have
a
thrive
driving,
which
is
a
board
that
that
oversees
the
work
of
the
child
poverty
strategy,
because,
obviously
all
these
factors
are
linked
and
wherever
we
have
deprived
areas,
children
will
be
most
vulnerable
more
vulnerable.
So
it's
that
joint
up
approach,
that
Emily
mentioned
and
with
our
Public
Health
colleagues
and
with
our
third
sector,
and
that
really
we
look
at
pooling
our
resources.
W
W
So
in
leads
that
cluster
work
in
where
we
have
clusters
of
schools
of
third
sector
organizations,
funding
from
the
local
Authority
from
the
ICD,
bringing
local
Services
together
and
building
on
that
is
the
right
way
forward
and
we'll
continue
to
do
that.
This,
like
councilor
Cohen,
mentioned
earlier.
These
challenges
are
going
to
continue
for
this
cohort
of
young
people
for
a
long
time
and
for
their
families.
W
Mental
health
in
particular
not
just
child
mental
health
but
adult
mental
health
as
well,
and
so
that
cross-directorate
working
with
Adult,
Services
and
third
sector
looking
about
I,
think
family
approach
and
and
how
we,
how
we
support
the
whole
family
to
tackle
those
issues,
is
where
we're
investing
our
services
in.
P
Thanks
for
I'd
really
like
to
add
to
that
as
well,
I
think
you've
answered
the
question
really
well,
but
also
in
public
health,
always
trying
to
look
upstream
and
look
at
prevention,
and
so
you'll
probably
know
that
we
commissioned
the
Public
Health
Integrated
nursing
service
and
which
delivers
and
the
five
mandated
checks
to
Children
before
the
age
of
five,
and
there
are
different
levels
of
service
provided
depending
on
need,
so
all
families
and
will
get
the
five
contacts.
P
But
there's
a
universal
plus
and
a
universal
partnership
plus
offer
for
families
that
have
greater
needs.
So
the
the
children
living
in
the
families
that
you're
talking
about
would
get
more
support
and
then,
if
a
need
is
identified,
there
are
Pathways
to
follow
so
domestic
violence,
economic
well-being,
mental
health,
and
we
we
link
with
the
system
of
the
service
into
the
system
to
access
and
further
support
and
leaders
recently
been
evaluated
by
University
College
London,
which
showed
that
compared
to
other
local
authorities.
P
We
do
really
well
and
delivering
these
service
to
families
living
in
the
most
deprived
areas
of
Leeds.
That's
something
we
proud
of
what
we
think
makes
a
difference,
and
the
data
that
Victoria
included
in
her
presentation
is
always
at
the
Forefront
of
our
minds.
The
if
we
compare
the
leads
average
outcomes
of
children
and
comparing
the
leads
that
average
to
Children
a
third
of
our
children
lived
in
most
deprived
communities.
P
The
outcomes
are
worse,
so
everything
we
do
and
it
tries
to
focus
on
that
from
services
that
we
directly
commission
to
serves
as
we
influenced
partnership
work
and
the
moments
the
Imam
at
City
work.
That
has
already
been
mentioned.
We're
really
delighted,
that's
focusing
on
not
to
five
year
olds,
and
we
think
that
will
make
a
difference
and
we're
looking
forward
to
delivering
evidence-based
programs
and
tweaking
how
we
work
to
make
a
bigger
impact.
P
The
financial
incentives,
an
interesting
idea.
We
could
think
about
that.
We
have
looked
at
that
in
the
past
for
things
like
but
breastfeeding
uptake
I
mean
our
current
approach
is
Pharaoh
has
mentioned.
The
children's
centers,
as
you'll
probably
know
leads,
were
really
pleased
that
we
kept
investment
in
children,
centers
that
that
we've
got
coverage
across
Leeds.
So
there
are
from
push
away
and
the
notes
19
service
we
a
mandated
to
co-deliver
services
with
Children's
Center
Partners,
so
we
try
and
make
it
as
accessible
as
possible
and
Target.
P
The
Henry
courses
are
targeted
on
the
areas
of
leads
where
there
are
more
children
living
and
with
obesity.
So
we
do.
We
do
try
to
reach
out,
but
that's
a
really
interesting
point
about
financial
incentives
which
we'll
look
into.
Thank
you.
A
R
Thank
you
very
much
indeed,
chair
I
wanted
to
cover
male
suicide,
because
there's
two
there's
a
lot
of
recommendations
in
this
report
and
there's
a
lot
of
progress
provided.
But
in
my
opinion,
there
are
two
recommendations
on
men's
suicide
that
appear
to
have
had
much
blur
provided
in
terms
of
how
they've
progressed
and
appreciate
some
meat
on
the
bone.
R
R
But
there
doesn't
seem
to
have
been
any
information
provided
what
has
actually
happened
and
taken
place
and
also
to
take
forward
work
in
terms
of
actually
looking
at
men
who
are
at
high
risk
and
looking
at
how
we
can
Target
them
for,
as
it
mentions
in
the
report,
the
new
mentally
healthy
leads
plan,
but
there's
not
much
on.
What's
actually
happened
since
2017
seen
in
the
last
report
and
the
recommendation
made
and
I'd
appreciate
some
more
detail.
Thank
you.
J
Thank
you
councilor.
First
for
that
question,
the
the
the
work
of
the
Suicide
Prevention
partnership
group
and
and
network,
and
the
the
action
plan
that
we
have
as
a
city
wasn't
covered
in
the
overall
scope
of
this
report.
Obviously
this
is
about
children
and
young
people,
whereas
obviously
the
suicide
work
is
is
all
age.
J
So,
even
though
we
do
have
sadly
some
deaths
by
suicide
in
children
and
young
people,
thankfully
they
are
very
low
and
but
but
still
incredibly
important
to
prevent
that
they
they
will
be
part
of
the
the
work
of
well.
They
are
part
of
the
work
of
that
broader
all
age
group
and
I
am
really
happy
to
bring
back
a
separate
report
on
that.
The
the
audit
that
you
mentioned
is
being
finalized.
J
As
we
speak,
it's
a
report
that
we
do
on
a
rolling
program
every
few
years
and
our
kind
of
nationally
recognized
for
our
approach
on
our
suicide
audit
in
Leeds
and
this
time
we've
done
it
jointly
with
Wakefield,
actually
as
a
joint
bank,
because
we
share
a
coroner
and
that
report
will
launch
with
a
workshop
event
this
in
the
Autumn
I'm
more
than
happy
to
share
the
details
and
dates
of
that.
J
If
people
are
interested
and
and
the
the
workshop
will
be
very
much
involving
Partners
in
really
looking
at
the
findings
of
this
last
audit
and
how
we
actually
refresh
our
city
Suicide
Prevention
plan
to
to
to
meet
the
the
findings
of
the
audit,
because
what
we,
what
we
do
know
from
that
audit,
is
that
there
are
particular
parts
of
the
city
and
groups
of
people
who
are
most
at
risk.
And
we
can.
We
have
a
lot
of
granular
detail
around
that
have
a
very
targeted
plan.
A
Thank
you,
I
think
that
would
be
helpful
and
I
think
it's
something
that
would
obviously
be
of
interest
to
board
members.
A
Okay,
are
there
any
other
questions?
I
can't
see
anyone
else
in
the
cane
I.
Think
I.
Think
the
lack
of
questions
is
a
is
a
reflection
of
the
sort
of
the
detailing
report.
A
So
thank
you
very
much
for
that
and
I
think
I
think
this
Focus
has
been
really
important
and
we
look
forward
to
next
year's
report,
but
also
how
progress
on
this
has
happened
or
has
progressed.
So.
Thank
you
very
much
for
that.
Okay,
so
I'm
gonna
close
this
item.
Thank
you.
So
much
for
coming.
I
really
appreciate
it
and
move
on
to
the
next
item
on
the
agenda,
which
is
item,
number
nine,
which
starts
on
page
97.
A
This
item
members
will
call
we
had
a
a
working
group
on
tier
three
weight
management
and
wrote
to
Peg
and
we've
had
a
response
from
Tom,
Reardon
and
Tim
Reilly
I.
Think
it's
self-explanatory,
I
think
one
of
the
things
action
from
this,
for
me
is
the
Workshop
we're
gonna
have
with
Tim
and
Tom,
maybe
not
those
specifically
about
the.
How
the
NHS
funding
works,
but
are
there
any
other
comments,
questions
that
members
want
to
make
or
should
we
just
take
it
as
record?
A
Take
it
as
record
great
okay.
Thank
you
very
much
and
thanks
for
everyone
supporting
that
item,
I
thought
we
made
some
good
points
which
have
been
heard
by
those
two
okay.
So
now
just
moving
on
to
item
number
10.,
which
is
the
work
schedule
so
I
think.
The
first
thing
to
note
is
around
we've
been
asked
to
put
two
people
on
a
Community
Committee
working
group
I'm
in
the
pre-meeting
we
discussed
having
a
counselor
win
kid
year
and
councilor
Mahalia,
France
Mir,
so
I.
A
No
great!
Take
it
as
very
happy
happy
Christmas.
So
with
that,
thank
you
very
much
for
coming
today.
I
think
it's
been
a
really
important
meeting.
Sorry,
it's
been
a
long
one.
Now
I'm,
not
sorry,
it's
been
a
long.
One
I
recognize
it's
been
a
long
one,
but
it's
been
really
important
topic.
So
thanks
for
coming,
okay,
goodbye.