The Joint Health Overview and Scrutiny Committee met to discuss improvements to GP access, and to receive updates from the North East London (NEL) Integrated Care Board (ICB), Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), and North East London Foundation Trust (NELFT). The committee heard about initiatives to improve patient access and satisfaction, manage demand, and address financial challenges within the local healthcare system.

Improving GP Access

The committee heard a presentation from Dr Atul Aggarwal, a GP partner, on how Maylands Healthcare, a surgery on the boundaries of Elm Park and Raynham, has transformed primary care access. Dr Aggarwal explained that the surgery had implemented two key systems to improve access and patient experience:

• Exxon Health phone system: A cloud-based system designed for GP surgeries, which uses smart call management to reduce patient waiting times and integrate with the clinical system.
• Clinic AI-based triage tool: An online system where patients input data about their condition, which is then reviewed by a senior clinician to determine the urgency and appropriate pathway for their care.

Dr Aggarwal reported significant improvements since implementing the systems, including:

• Reduction in workload by 20%
• Improved patient satisfaction, with 68% of patients satisfied with waiting times in the 2025 survey, compared to 28% the previous year.
• Reduction in missed calls and improved staff morale.
• Fewer patients waiting outside the surgery in the mornings.

Councillor Fong asked how the model met the new contractual obligations for GP practices to offer always-on digital access with triage systems by October 2025. Dr Aggarwal confirmed that the model already complies and that they are happy to help other practices struggling with implementation.

When asked about how the system directs patients, Dr Aggarwal clarified that patients are only asked about their symptoms, and the AI grades the urgency of the case, but a clinician always makes the final decision.

Ian Buckmaster from Healthwatch Havering added that Healthwatch had conducted an interim visit to Maylands and found that both staff and patients were happy with the new systems.

Councillor Rizio asked what safety net is in place for patients who re-present because they feel fobbed off by non-GP clinicians. Dr Aggarwal clarified that the system does not send patients to other clinicians, but instead gives the GP the information to decide confidently what the patient needs.

Provider Updates

BHRUT Update

Professor Andrew Diener, Chief Medical Officer of BHRUT, provided an update on the trust's performance. He reported that the trust was close to the 80% target for patients being seen within four hours in A&E, and had been the top performing trust in London the previous week. However, he noted that the trust was still incredibly busy, with the Tuesday of that week being the busiest day ever since opening at Queen's Hospital.

Other key points from the BHRUT update included:

• Over 70% of patients were seen for their first treatment within 18 weeks of referral.
• The trust met the target of a 28-day fast diagnostic standard for cancer in June, reaching 79.1%.
• The trust's deficit was greater than hoped, and there was a challenging target to save money this year.
• BHRUT was one of the trusts chosen for the Baroness Amos Maternity Services inquiry, despite recent improvements noted by the Care Quality Commission (CQC).
• The trust was introducing an electronic patient record system on 8 November, which is expected to improve patient safety and data collection.

Professor Diener noted that mental health patients arriving in A&E were an issue, with an average length of stay of 20 hours. He explained that the lack of mental health beds in the area was a significant challenge, and that the trust was working with NELFT to address this.

Councillor Pongo asked about the high number of mental health referrals from A&E and the actions being taken to reduce prolonged stays. Professor Diener explained that the main issue was the lack of capacity for mental health admissions, and that they were working with NELFT to make the most of available capacity.

Councillor Sweden asked about the electronic patient record system and whether social care professionals would have the same authority to make notes on the system as they do currently. Professor Diener said he did not know the answer to that question. Councillor Sweden also asked whether the records would be shared with GPs and other trusts. Professor Diener said that the system would be shared with Barts, and GPs would be able to access x-ray and blood results, as well as receive electronic patient discharge summaries.

Councillor Vance raised concerns about maternity provision, and asked what was being done to improve it. Professor Diener responded that the service had improved hugely, and that they were hoping for an upgrade in their CQC rating.

NELFT Update

Carol White, Deputy Chief Operating Officer at NELFT, provided an update on the North East London Mental Health, Learning Disability and Autism (MHLDA) Collaborative and the Community Healthcare Collaborative.

Key points from the NELFT update included:

• A 200% increase in referrals across all mental health pathways since pre-Covid.
• The opening of the Integrated Crisis Assessment (ICA) hub (mental health A&E) in March, which has seen just under 800 patients, with only 20% requiring admission to a hospital bed.
• Plans to build 30 new beds for adult and mental health admissions.
• Ongoing work to develop neighbourhood mental health centres.
• The mental health in schools teams have been very successful in rolling out.

White also addressed a letter that was sent to the ICB from the Mental Health Action group, raising concerns about the quality of talking therapy services. She said that the letter raised concerns about dropout rates, but that the data quoted misinterpreted drop-outs and that services redirect people to other appropriate help when talking therapies are not suitable.

Councillor Pongo asked about plans to establish a local crisis house in Barking and Dagenham, and to expand local inpatient capacity. White responded that B&D residents can use the ICA hub and the well house in Redbridge, and that they are working on securing recurrent funding for a crisis house in B&D.

Councillor Ofolue asked why mental health patients need a bed, and what kind of mental health issues drive the need for admission. White explained that NELFT works with serious and enduring mental illness, such as depression, psychosis, and schizophrenia, and that they admit patients mainly under the Mental Health Act when they are a danger to themselves or others.

White also updated the committee on the charges that NELFT had faced in relation to an incident in 2015, stating that the jury found the trust guilty of a health and safety breach, but not guilty of corporate manslaughter.

ICB Health Update

Zina Etheridge, Chief Executive of the NEL ICB, provided an update on the ICB's work. She noted that the ICB was expected to make savings equivalent to about half of its budget, and was expecting to go through a significant organisational change to move to a different operating model to focus on strategic commissioning¹. However, she explained that the restructure had not yet started because they were waiting for confirmation from NHS England on how the redundancies would be funded.

Etheridge also discussed the ICB's system strategy, highlighting the good care framework and the outcomes and equity framework. She noted that the ICB was working to implement the three shifts outlined in the NHS 10 Year Plan:

• Moving care from hospital to community
• Shifting from treatment to prevention
• Transitioning from analogue to digital

Councillor Rizvi expressed sadness at Etheridge's departure and asked about the number of redundancies forecasted. Etheridge responded that it was difficult to estimate, but that the budget was being cut by about half, and they currently employ around 900 people. Councillor Rizvi also asked what strategic commissioning actually means. Etheridge explained that it means ensuring that the ICB is contracting and paying for the care which delivers the most effective results for residents.

Councillor Sweden asked about the nature of the investment envisaged in order to bring about the laudable aims of community and end of life and palliative care, and reducing mental health placements through out of area. Etheridge responded that one of the purposes of having a set of commissioning intentions is to start to describe what the direction of travel in terms of that investment is.

Councillor Pongo asked how the mandated 50% reduction in ICB running costs would not compromise frontline services. Etheridge responded that her job was to ensure that they understand any quality or equality risks arising from the reduction in the size of the ICB and put mitigations in place.

Finance Overview

Samuel Thacker, Director of Finance and Partnership Services at NEL ICB, presented a finance overview. He reported that the ICS operating plan expects a system breakeven position by year-end, but that the actual delivery against this was a deficit of £59.5m, which is an adverse variance to plan of £30.2m. He noted that the main driver of this was cost improvement plan slippage.

Councillor Pongo asked what specific cost improvement strategies were being implemented to meet national targets. Thacker responded that the ICS has committed to delivering a breakeven position, and that this is monitored on a monthly basis.

Councillor Rizvi asked how the ICB could justify carrying a surplus while the major acute provider is being forced to ration its care. Thacker responded that the ICB surplus was set in stone when the operating plan was signed off in April, and was a commitment to deliver a surplus to offset the consolidated deficit position across the five providers.