The following are responses to questions answered by Laura Trott MP for Sevenoaks
1. The Kent and Medway ICB My Care Project and concerns relating to numbers of medical staff
I have raised both the project, and also the concerns relating to the numbers of medical staff with the Acting Chief Executive of Kent and Medway NHS Integrated Care Board (ICB). Please see below his response:
“Thank you for your email with the request for information from the Sevenoaks District Seniors’ Action Forum regarding the medical workforce in Sevenoaks and the ‘My Care’ Record project.
In order to ensure I answer each of the questions, I have put the responses against each of the numbered questions below.
6. What are the plans for increasing the numbers of medical staff in Sevenoaks to cope with the forecast population increase.
7. What are the plans for increasing the numbers of medical staff in Sevenoaks to cope with the current shortages of staff and existing high demand?
NHS Kent and Medway supports the requirement for additional staff to meet a significantly growing population. You are aware that there is a national shortage of General Practitioners and this is why the government have made it a key target to grow the number of people trained in, and staying in, this profession. In Kent the establishment of the first Medical School is a significant step forward in growing a future workforce but this is of course a longer term strategy.
It is equally important to consider the whole of the General Practice workforce in consideration of the needs of the population. It is becoming more broadly acknowledged that for many patients, the best person for them to see is not always a general practitioner and the range of primary care professionals working in general practice with their specialist skills may be better placed to meet their needs. In supporting the development of the wider primary care team, the ICB has supported practices to appoint over 967 additional whole time equivalent staff in practice as part of the general practice workforce. These include staff such as advanced care professional, physiotherapists, practice nurses and counsellors.
There are several programmes of work provided by the ICB to support recruitment and retention of both GPs and the wider multi professional workforce. These include the following:
• Development and accreditation of all Primary Care Networks to become quality assured clinical learning environments. This means that these practices can host GP trainees as well as Foundation year and Medical Students.
An increase in the number of GP Trainee places.
Individual support to practices to increase the number with Skilled Workers licences. Practices with this licence are able to recruit newly qualified GPs on a skilled worker visa
• Provision of a range of portfolio working initiatives such as academic fellowships, educator roles and GPs with extended Roles to support retention and job satisfaction
• GP Coaching and support for established GPs
• “New to Practice Programme” for all newly qualified GPs to support their induction into general practice
• “New to Partnership” peer support group
• Peer Mentor programme for general practice staff
• Workforce planning support provided to individual practices. This assists practices to recruit according to population need and includes the support of the multi professional workforce
• A communication campaign to raise the profile of a variety of specialist roles within primary care and explain their particular skills and expertise.
In addition to the above, we have launched “Pharmacy first”. This new service will enable community pharmacists to fully meet the care needs of patients without the need for the patient to visit their general practice. This, alongside expansions to the pharmacy blood pressure checking and contraception services, will save up to 10 million general practice team appointments (nationally) a year and help patients access quicker and more convenient care, including the supply of appropriate medicines for minor illness.
8. Who is responsible for implementing the plans?
The national general practice contract sets out that practices are responsible for recruiting their own workforce. The ICB will continue to support practices through the various initiatives mentioned above and continue to work together to identify other ways we can help.
9. Will there be a medical centre for the proposed Tarmac site development or 10. Will existing GP Practices be expected to cope?
The ICB recently responded to the Sevenoaks District Council Regulation 18 (Part 2) consultation which included three growth options to meet housing need, which could see the District accommodate between 9,500 homes and 12,000 homes. The full extent of proposed housebuilding across the District is not yet known, however, the Council Infrastructure Delivery Plan (IDP) statement recognised that many infrastructure providers are not in a position to identify specific needs until the local plan has been confirmed. We can provide assurance that the ICB and the Health and Care Partnership (HCPs) will continue to engage with the council as the local plan progresses in order to refine infrastructure requirements and ensure new developments can be supported by the appropriate infrastructure. HCPs are partnership of local health and social care organisations which come together to plan services. The NHS will also ensure that we bid against any money made available through the developers contribution to support the wider community infrastructure. These are often int eh form of section 106 or community infrastructure levy (CIL) funds.
In order to properly quantify the need an initial high-level infrastructure assessment, informed by the potential healthcare demand, has been undertaken. We in the ICB have stated that in the Sevenoaks urban area there will be a requirement for both additional general practice and community health services capacity. We will undertake more in depth assessments as we have more information and this will include the infrastructure requirements for the Sevenoaks Hospital site. In most cases, infrastructure requirement to meet healthcare need will arise from the cumulative impact of the development rather than a specific site so our assessments need to look strategically at the whole of area.
An Interim NHS Kent and Medway Estates and Infrastructure Strategy was approved by the Integrated Care Board in November 2023 and this will be further informed by place based clinical and estates strategies that are currently being developed by HCPs. These strategies will inform estates plans and the IDP as part of an iterative process.
At this point in time, as far as we are aware, a new medical facility is not included in the Sevenoaks Quarry development site (Tarmac site). However, the ICB is aware from previous discussions that space for a building could be provided within the permission process if required. We are keeping this under review with primary and community care colleagues.
16. What is the current exact status of the Kent and Medway My Care Record?
17. Is/was the Kent and Medway My Care Record a duplication of costs?
18. Will this project be yet another write off?
The Kent and Medway Care Record is live and in use across Kent and Medway. Patients can also access their medical records through the NHS app.
In addition to presenting data that is held in health and social care systems, the KMCR is increasingly used to enable colleagues from multiple organisations to work in a much more integrated way by creating and storing documents like the ReSPECT form in the KMCR which gives clinicians information on what is important to a patient, their values and beliefs. This enables multiple professionals to undertake assessments and make plans with citizens using a single document source.
New developments include the deployment of the KMCR to community pharmacies and a data feed from pharmacies into the KMCR – this is currently scheduled for April. You can see how this links into the support to General Practice I described above.
My Care Record is a Kent and Medway development that enables citizens to view a summary of the confidential health and social care records that are held in the Kent and Medway Care Record (KMCR). My Care Record will no longer be deployed as a standalone app but the work that has gone into it will be integrated into the NHS App which has been launched nationally. This has meant that we are able to develop the NHS app for the residents of Kent and Medway more quickly. The Kent and Medway Care Record (KMCR) is a single shared care record for each patient who is cared for by the health and social care services in Kent and Medway. Relevant information will be viewable by all relevant health and care professionals, and citizens will be empowered to manage their own data as they will be able to access and input to their records and care plans. KMCR forms a key part of the ICS’s digital strategy.
2. Local Government Funding
The Government has set out plans for a funding package worth more than £64 billion to support councils in England to deliver frontline services in 2024-25. This is an increase of almost £4 billion (7.5%) from the 2023-2024 settlement.
On top of this, last month an additional support package of £600m was announced – with £500m of that being added to the Social Care Grant
The Government is also committed to simplifying the funding landscape for local authorities, to ensure the funding system is fairer, more transparent, and accountable.
3. Free rail travel for 100 days
This is a matter which has been raised with me previously, and one that I raised with the relevant minister. The Minister responded to say that free schemes, such as those in London, are beyond the statutory duties, and have to be funded by the relevant authority (such as the Greater London Authority) through local resources such as business rates and council tax. Therefore, it is not possible for the Government to remove money from the London scheme (and other such metropolitan areas that carry out similar schemes) and reallocate to the counties. It would therefore be for Kent County Council to fund such a scheme.
4. Housing targets
I, and other MP’s campaigned for changes to the NPPF so that Green Belt restrictions could be taken into account when setting a housing target for a local area. This led to a consultation over the NPPF, and the changes following that consultation were announced on 19 December 2023.
Under the previous version of the NPPF, all local planning authorities were required to build a buffer of 5% (by default) following a consultation, this (and a higher figure of 10%) has now been removed in all circumstances. A higher buffer will be in place for councils who do not have an up to date plan and have delivered less than 85% of the housing requirement over the previous three years.
The announcement of 19 December also for the first time made it clear that the standard method for calculating housing need is now considered as an “an advisory starting point” At the same time, clearer protection for the Green Belt has been given with the updated NPPF stating that authorities are not required to alter Green Belt boundaries.
New paragraph 130 of the revised NPPF provides that a significant increase in the average density of residential development in an existing urban area may be inappropriate if it will result in developments which are “wholly out of character with the existing area” – this is a further protection.
The Secretary of State in his 19 December announcement also made it clear that “Where a local authority considers the number unachievable, it must provide robust evidence for that judgement. The revised NPPF provides clarity on what may constitute such exceptional circumstances for using an alternative method to assess housing need, including the particular demographic characteristics of an area” It will therefore be incumbent upon authorities who propose a lower figure to produce evidence to back up the constraints that prevent the higher figure being achieved. The Planning Inspector must then take this evidence into account. The route to challenge a Planning Inspectors decision over a Local Plan remains, as far as I am aware, via judicial review.
5. Downsizing
I absolutely agree about the importance of ensuring that everyone has access to a suitable home, and I understand that downsizing is an option many older people wish to take. And, the Government is committed to improving the supply and diversity of housing options available for people in the places they want to live. While it is for local planning authorities to plan for new homes in their area, national planning guidance is clear that the “size, type and tenure of housing needed for different groups in the community should be assessed and reflected in planning policies”.
You may be interested to know that the Government has created a taskforce to help improve housing options for older people, chaired by Professor Julienne Meyer. The taskforce is looking ways to provide greater choice, quality and security of housing for older people and is expected to make recommendations to the Government on ways to increase the volume and range of housing options. You can find details here: https://www.gov.uk/government/news/government-unveils-taskforce-chair-to-boost-older-peoples-housing
With regard to stamp duty, the Government has increased the nil-rate threshold of Stamp Duty Land Tax from £125,000 to £250,000 for all purchasers of residential property in England and Northern Ireland. This applies until 31 March 2025. While I am not aware of any current plans to introduce a new stamp duty exemption for people looking to downsize, I will ensure I raise with my ministerial colleagues the suggestion made in relation to exempting “last home” purchases from stamp duty.
6. Accessible Information in Healthcare and Education
The issue of accessibility is vital and it is important implement the Accessible Information Service (AIS). I will make sure that I feed this into wider discussions about accessibility with my ministerial colleagues. Additionally, I welcome the work of the Kent and Medway Medical School to implement AIS, it is a positive step and I hope institutions of higher education follow in their footsteps.
More generally, reducing digital exclusion is a crucial component of increasing accessibility and I can assure you the Government is working to increase accessibility across public sector websites. This includes both the health service and education. Accessibility regulations are in place to ensure that websites as many people as possible can use them, with websites designed to be perceivable, operable, understandable and robust. This, combined with similar standards for mobile apps, which are increasingly important in supporting ease of access to public services, are measures that I will continue to support to help increase accessibility.
Although we live in an increasingly online world, clearly parts of the population remain digitally excluded. I welcome the Government’s commitment to helping elderly people in particular acquire basic digital skills, as part of its broader strategy to reduce digital exclusion. These assisted digital support services aim to increase digital inclusion for those online users who lack digital confidence, digital skills or access to the internet. I know this is very important to SDSAF, and that you do a lot of brilliant work in this field, both advocating the case on behalf of those who are not comfortable using digital means of communication, and for helping those who wish to learn – so thank you!
Finally, concerning potential attempt to confirm the legal status of AIS through the courts, I would be happy to be contacted should a court case be mounted.
I do hope this email is helpful. Once again, it was a pleasure to catch up, and thank you to all those who attended for making the time to come and see me.
Laura