BHR Primary Care Commissioning Committee PART 1 Date: Wednesday, 28 November 2018 Time: 1:30pm – 3:15pm Venue: Boardrooms A/B, 2 nd Floor, Becketts House, 2-14 Ilford Hill, Ilford Essex IG1 2QX Item Time Lead Attached or verbal For Noting or Approval 1. Welcome, introductions and apologies 1.1. Declaration of conflicts of interest Types of interest: Financial Non-financial professional Non-financial personal Indirect 1:30 Chair Verbal Attached For noting 2. Minutes, actions and risks 2.1. Minutes of last meeting 2.2. Actions log 2.3. Risk register 1:35 Chair Attached Attached Attached For approval For approval For approval 3. Primary Care Budgets 2018/19 update 1:40 Tom Travers Attached For approval 4. NELCA PC Rent Review update 1:50 Gohar Choudhury Verbal For noting 5. Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee 5.1. GP Retention Scheme 5.2. GMS Contract Refresh update 5.3. GDPR Assurance process 5.4. Primary Care Strategy Refresh Approach 5.5. Discontinuance of Minor Surgery Referral Portal 1:55 2:05 2:10 2:15 2:20 Gohar Choudhury Sarah See Lucy Botting Sarah See Mary Smith Attached attached Attached Attached Attached For approval For noting For approval For approval For approval 6. Barking & Dagenham Primary Care Commissioning Committee 6.1. Barking Riverside Service Model 2:45 Sarah See Attached For noting 7. Items for information 7.1. Data quality checks on GP patient lists 7.2. BHR Christmas letter 2:55 3:00 Sarah See Sarah See Attached Attached For noting For noting 8. Questions from the public 3:05 Chair 9. Any other business 3:15 Chair 10. Date of next meeting
1. Welcome, introductions and apologies 1.1. Declaration of conflicts of interest
Types of interest: Financial Non-financial professional Non-financial personal Indirect
1:30 Chair Verbal Attached
For noting
2. Minutes, actions and risks 2.1. Minutes of last meeting 2.2. Actions log 2.3. Risk register
1:35 Chair Attached Attached Attached
For approval For approval For approval
3. Primary Care Budgets 2018/19 update 1:40 Tom Travers Attached For approval
4. NELCA PC Rent Review update 1:50 Gohar Choudhury Verbal For noting
5. Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee 5.1. GP Retention Scheme 5.2. GMS Contract Refresh update 5.3. GDPR Assurance process 5.4. Primary Care Strategy Refresh Approach 5.5. Discontinuance of Minor Surgery Referral
Portal
1:55 2:05 2:10 2:15 2:20
Gohar Choudhury Sarah See Lucy Botting Sarah See Mary Smith
Attached attached Attached Attached Attached
For approval For noting For approval For approval For approval
6. Barking & Dagenham Primary Care Commissioning Committee 6.1. Barking Riverside Service Model
2:45
Sarah See
Attached
For noting
7. Items for information 7.1. Data quality checks on GP patient lists
7.2. BHR Christmas letter
2:55 3:00
Sarah See Sarah See
Attached Attached
For noting For noting
8. Questions from the public 3:05 Chair
9. Any other business 3:15 Chair
10. Date of next meeting
Item Time Lead Attached or verbal
For Noting or Approval
20 February 2019
PCCC Minutes 3 October 2018 final draft v3 Page 1 of 6
Part 1 DRAFT
Minutes of the Primary Care Commissioning Committee (a Committee in Common) held on 3 October 2018 at Becketts House
Sarah See (SS), Director, Primary Care Transformation
Sarah See (SS), Director, Primary Care Transformation
Sarah See (SS), Director, Primary Care Transformation
Jacqui Himbury (JH), Nurse Director
Jacqui Himbury (JH), Nurse Director
Jacqui Himbury (JH), Nurse Director
Dr Arnold Fertig (AF) Independent GP
Dr Arnold Fertig (AF) Independent GP
Dr Arnold Fertig (AF) Independent GP
Dr Gurkirit Kalkat (GK), Clinical Director
Dr Shabana Ali (SA), Clinical Director
Dr David Derby (DD), GP Dr Shabnam Ali (ShA) GP In attendance: Dr Anil Mehta (AM) Chair, Redbridge CCG Dr Atul Aggarwal (AAg) Chair, Havering CCG Terilla Bernard (TB) LMC, Barking, Dagenham and Havering Alison Goodlad (AG) Head of Primary Care, NELCA Primary Care Commissioning Gohar Choudhury (GC) Assistant Head of Primary Care, NELCA Primary Care
Commissioning Tony Curtis (TC) Senior Primary Care Commissioning Manager, NELCA Primary
Care Commissioning Rob Dickenson (RD) Senior Finance Manager, BHR CCGs (for Tom Travers) Anne-Marie Dean (AMD) Chair, Havering Healthwatch Manisha Madhvadia (MM) Healthwatch Officer, Barking & Dagenham Healthwatch Dr Usman Khan (UK) Public Health, London Borough of Barking & Dagenham Mary Smith (MS) Primary Care Improvement Lead, BHR CCGs Simon Clarke (SC) Primary Care Delivery Manager, BHR CCGs Carla Morgan (CM) Strategic Delivery Project Manager Keeley Chaplin (KC) Business Manager, BHR CCGs (Minute taker) Apologies: Alex Tran (AT) Clinical Director Tom Travers (TT) Chief Finance Officer, BHR CCGs Dr Jagan John (JJ) Chair, Barking & Dagenham CCG Matthew Cole (MC) Director of Public Health, London Borough of Barking & Dagenham Gladys Xavier (GX) Interim Director, Public Health, London Borough of Redbridge Dr Ambrish Shah (AS) Redbridge LMC Dr Andrew Rixom (AR) Public Health Consultant, London Borough of Havering Elspeth Paisley (EP) Manager, Barking & Dagenham Healthwatch Cathy Turland (CT) Chief Executive, Healthwatch Redbridge Greg Cairns (GCa) Director of Primary Care Strategy, London wide LMC Dr Adedayo Adedeji (AAd) GP, Barking & Dagenham CCG
PCCC Minutes 3 October 2018 final draft v3 Page 2 of 6
Item Action 1. Welcome and apologies
The Chair welcomed those present and apologies were noted.
1.1. Declarations of conflicts of interest The Chair reminded members of their obligation to declare any interest they
may have on any issues arising at the meeting which might conflict with the business of the primary care committee and clinical commissioning group. No additional declarations of interest were declared. The register of interests held for BHR CCGs Governing Body (GB) members and staff is available from the Company Secretary.
2. Minutes, action log and risk register 2.1. Minutes of the last meeting
The minutes of the meeting held on 1 August 2018 were agreed as a correct record.
2.2. Actions log The Committee noted the actions that had been taken since the last meeting. In addition, members noted the following update: ACT97 and 105 are on the agenda and actions are now closed. ACT94: The service charges works is ongoing at a NEL level. SS to liaise
with Jason Kelder and Tom Dobrashian for an update. ACT98: Agreed to close as it will be monitored by the transformation board. ACT103: The North East London Commissioning Alliance (NELCA) primary
care commissioning team have taken over rent reviews. They are commencing a stocktake exercise and will provide an update on progress at the next meeting.
SS GC
2.3. Risk Register The Committee noted and approved the risk register with the following note: RSK22: 3 of 5 workshops on the Barking Riverside development have been
held. The service model will be presented to a future PCCC meeting.
RSK24: A primary care workshop has been held with NELCA colleagues. Risk stratification for each practice will be undertaken and will feedback at a later date.
RSK25: Assurance that all practices are following guidance on GDPR and that practices have a designated Data protection officer (DPO) is being sought and a baseline audit will be undertaken.
3. GP access hubs opening times CM presented an update on the additional activity being commissioned
within the GP access hub service in order to meet the guidance for CCGs to commission an additional 30 minutes consultation capacity, per 1000 population, per week. The federations have requested to open earlier in the day in order to spread this activity across more hours. The call centre hours will not be changed and the early slots will be pre-booked appointments from the night before and this supports redirection. The Federation have been asked to provide
CM
PCCC Minutes 3 October 2018 final draft v3 Page 3 of 6
an evaluation report. KA had read that Havering are not using weekend slots. CM advised while utilisation is good, patients are refusing the early and late appointments on Saturdays and Sundays and this is consistent across all 3 boroughs. AMD asked if there is more detail on this which CM will request the federation provide with their evaluation report on the opening hour extension. MM asked if the new opening hours could be advertised to patients. CM advised that activity this year is adjusted based on population size and throughout the year to meet seasonal demand, and so the opening times will be different on each site each month. CM to request the federations make this information available. The Committee thanked CM for the verbal update and requested a further update in 4-6 months’ time.
CM CM
4. Primary Care Budgets 2018/19 update RD presented the Committee with the summary of year to date and forecast
position for the 2018/19 financial year. The four main risks are due to demographic growth, PMS review, retrospective rent reviews and commissioning intentions. Barking & Dagenham CCG and Havering CCG PMS practices have all signed up to the review as well as the Commissioning Intentions. A new post has been agreed to help with the rent review programme, the responsibility of which has been transferred over to the NELCA Primary Care Commissioning team. They will carry out a stocktake of the current position over the next two months. A District Valuer will be evaluating practice properties as part of the review. KP asked if growth monies will be used to balance the financial position. RD clarified that the budget allows for the current level of growth. KA asked for more a detailed variance analysis of the primary care budget and how much investment contributed to reduce any pressures following agreement of the commissioning intentions. The Committee noted the content of the report and noted the level of financial risk.
RD
5. Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee
5.1. Update on Immunisation rates across Barking & Dagenham, Havering and Redbridge
SC gave the Committee an update on the practice immunisation rates. The data is extracted from practice systems however this is reliant on the practice coding correctly. Public Health England has written to CCGs advising a number of GP practices in London have not ordered adequate supplies of the flu vaccine for over 65s and issues guidance on how to deal with this. They have asked CCGs to carry out an assurance exercise in all practices to ensure sufficient stock of the vaccine. This work is ongoing. KA suggested practices engage with their PPGs to help promote the flu vaccination programme and improve immunisation coverage. KA also suggested this issue be added to the risk register.
SS
PCCC Minutes 3 October 2018 final draft v3 Page 4 of 6
SA and AA advised that their practices had ordered adequate stock however it is the supply chain that had reduced the number. SC advised that the primary care team are working with their practices to help overcome issues arising and there is a BHR-wide flu steering group that agree communications and support to practices during the flu season. SS noted that the screening and vaccination steering groups have merged and will include a Clinical Director on this group. The issue with supplies provided by the pharmaceutical companies will be reported to NHS England as they have not indicated this as an issue. The Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee noted the contents of the report and agreed to the approach to improve practice performance.
SS/SC
5.2. Special Allocation Scheme – update The current Special Allocation Scheme (SAS) service provision is due to
end on 31 December 2018. The commissioning of a new service is still being developed and will not be ready by 1 January therefore the current provision has agreed to continue for a further six months if approved. The Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee agreed to extend the current provision of the Special Allocations Service provided by Kings Park Medical Centre for a further six months, to the 30 June 2019. The Committee noted this extension will require £2,500 for the retainer fee for six months, for up to 15 patients and approximately a further £3,000, allowing for an additional 15 patients.
5.3. QOF NHS England Engagement Exercise AF presented a report on a review of QOF Engagement documentation.
The proposed principles include better aligned indicators to improve patient outcome, better recognition of personalised care and professional judgement, better support for quality improvement (QI) and to harness benefits of collaborative working. UK suggested prevention should be included which members agreed is important but QOF is not necessarily the correct tool as it is hard to measure against this as an outcome. CJ suggested that the network arrangements were helpful but that QOF was the wrong tool and that should be down to local determination through the integrated care system. Members agreed generally with the principles noting the need to localise QI as there will be variation of needs in each practice/borough and keep QOF at a practice level. Based on discussions, AF will draft a response to the consultation and noted there is no interest in piloting a network approach at this stage.
AF
5.4. Digital-First Access to Primary Care & implications for GP Payments AF presented a summary of the review of NHS England’s engagement on
Digital First Access to Primary Care. This is to encourage the use of technologies in primary care. An independent evaluation of Hammersmith and Fulham CCG on GP at Hand is being undertaken.
PCCC Minutes 3 October 2018 final draft v3 Page 5 of 6
SW voiced concern for certain cohorts of patients such as those needing mental health services that may be missed. JH added there is a safeguarding issue for vulnerable people to give them equal opportunity of access to services. The Committee agreed to all proposed principles although commenting that as an engagement piece it wasn’t obvious what the document was really about.
5.5. Resilience funding – update SC gave an update on the GP resilience scheme. The fund is to deliver
support to help practices become more stable and resilient and nominations were either by the CCG or self-nomination. The CCG worked with the LMC to review and approve the applications. Themes of applications included training in customer care, leadership, prescribing and preparation for CQC inspections. Signed Memorandum of Understanding (MOU) were requested by end September however some practices have not yet submitted these. If a signed MOU is not returned this could result in funding allocation being lost. The Committee noted the verbal update.
5.6. Personal Medical Services (PMS) update SS updated members on progress on the PMS review. Redbridge PMS
practices signed up by 20 July which is backdated to 1 July. All PMS practices in B&D and Havering all signed to go live on 1 October. The premium funding will be redistributed over the next 2.5 years and the CCG can now offer the Access LIS to all GMS practices. The Committee noted the verbal update and acknowledged the extensive amount of work that had been undertaken by the Primary Care and Finance teams in particular Sarah See, Neil Hamer and Rob Dickenson as well as from the practices themselves to reach a final resolution.
6. Havering Primary Care Commissioning Committee 6.1. Minor Surgery SI Following concerns raised by BHRUT regarding a practice undertaking
minor surgery in Havering, an independent investigation found the practice had been working safely. JH advised she has raised with BHRUT regarding the fact the GP not being invited to the MDT meetings despite requesting these, but as yet has not received a response and will pursue this (it was agreed to close this action, and that JH would escalate if the matter is not resolved). The report has been shared with the Trust. The Performers Advisory Group has now lifted the suspension on the GP to carry out minor surgery.
7. Questions from the public There were no questions from the public.
8. Any other business 8.1. Rebranding of NEL Primary Care Commissioning Team The NHS England North East London Primary Care Commissioning team
PCCC Minutes 3 October 2018 final draft v3 Page 6 of 6
have been migrated to the NEL Commissioning Alliance and are now known as the NELCA Primary Care Commissioning team.
8.2. Alternative Provider Medical Services (APMS) update Redbridge CCG, working with NHS England colleagues, recently completed
Tranche 6 of the pan-London APMS procurement programme; Aldersbrook practice was part of this. It is confirmed that Richmond Road Practice, a City & Hackney practice were awarded the contract, and they will take over the running of the practice from 1 April 2019. The CCG will be working with the incumbent provider to support them with their exit plan, whilst overseeing the mobilisation plan with Richmond Road Practice. Barking & Dagenham CCG was also part of the pan London APMS procurement programme and Concordia were awarded the contract for Porters Avenue.
9. Date of the next meeting Wednesday, 28 November 2018
Actions Log
Log owner: Sarah See, Director of Primary Care Transformation
Log manager: Mary Smith, Primary Care Team
Last Update:
URN Action Part Raised Owner Deadline Completed Status Resolution / Comments / Document RefACT 94 Property Services increase of service charges
NHS Property Services are increasing service charges at their health centres, which could increase a practice’s charge by 20%. CCG to review new guidance from NHSE on what commissioners can do to support practices
1 14/02/2018 Sarah See On-going Open Update to be provided at the meeting
ACT103 Primary Care Budgets - Rent reviewTo provide update on the impact and level of risk regarding retrospective rent review on the CCGs budgets.
1 01/08/2018 Tom Travers /
Gohar Choudhury
03/10/2018 Open NELCA Primary Care Team are undertaking a stocktake exercise.Item on agenda
ACT107A GP access hubs opening times - Havering hub utilisation is good but patients are refusing the early and late appointments. AMD asked if there is more detail on this and CM will request the Federation provide their evaluation report on the opening hours extension. A further report in 4-6 months has been requested and the Federation have been asked to provide an evaluation including hub utilisation, and overall evaluation.
1 03/10/2018 Carla Morgan
20/02/2019 Open The additional access commenced in September. The federation has been asked to provide detail on patients not taking early slots plus a full evaluation report to CM to form part of the update that will be provided to the February meeting.
ACT107B GP access hubs opening timesMM asked if the new opening hours could be advertised to patients. CM advised that activity this year is adjusted based on population size and throughout the year to meet seasonal demand, and so the opening times will be different on each site each month. CM to request the federations make this information available.
1 03/10/2018 Carla Morgan
20/02/2019 Open The federation has been asked to provide information to CM which will be shared at the February PCCC meeting
ACT108 Primary Care Budgets 2018/19 update - KA asked for more a detailed variance analysis of the primary care budget and how much investment contributed to reduce any pressures following agreement of the commissioning intentions.
1 03/10/2018 Rob Dickenson
28/11/2018 Open Item on agenda
ACT109A Immunisation rates across Barking & Dagenham, Havering and Redbridge - KA suggested practices engage with their PPGs to help promote the flu vaccination programme and improve immunisation coverage. KA also suggested this issue be added to the risk register.
1 03/10/2018 Sarah See 28/11/2018 Open Item added to the risk register
ACT109B Immunisation rates across Barking & Dagenham, Havering and Redbridge The issue with supplies provided by the pharmaceutical companies being restricted will be reported to NHS England as they have not indicated this as an issue.
1 03/10/2018 Sarah See / Simon Clarke
28/11/2018 Open Exercise regarding suffucient stock at GP practices has been completed and assurance has been given to PHE via audit return on the 12/10/18
ACT110 QOF NHS England Engagement Exercise - Based on discussions, AF will draft a response to the consultation and noted there is no interest in piloting a network approach at this stage.
1 03/10/2018 Arnold Fertig
28/11/2018 Open 26/11/2018 Letter drafted and sent out
05-Oct-18
Risk LogLast updated:
URN Impact on Risk and impact Date Opened Part Owner Mitigating Action Prob Imp Severity Category Status Next review Next action / comments
RSK6 All PMS contract review (B&D and Havering CCGs)
Significant risk that a reduction in PMS premiums (or rebasing back to GMS levels of investment) could mean that a number of PMS providers hand back their contracts, which in turn would mean loss of key clinical staff / loss of practices to a nationally reported un-doctored area and loss of currently commissioned services,. This could result in a significant gap in the provision of just over a third of the BHR CCGs population unable to access GP services and extra demand on alternative more costly providers (e.g. reduction in number of appts/per 1000 patients could meant that more patients attempt to access WIC/UCC/hub services).
30-Jan-17 1 Sarah See •NEL CCGs, via the Risk Share pool, have agreed to financial support B&D and Havering
CCGs to meet a minimum £4.30 pwp premium for PMS and GMS. B&D will require 2018/19 funding, and will payback the loan NEL CCGs. Havering require a 3 year funding arrangement but have no funding to payback NEL CCGs. Meetings have taken place with the LMC and CCG has sent offer to PMS practices for consideration
•Equality impact assessments been updated and further communications with respective LMCs and practices continue.
2 2 4 Reputational Open On-going 12/11/18 All contract signed across Barking and Dagenham, Havering and Redbridge with exception of one Barking and Dagneham contract where there is a query regarding contract holder (although company is willing to sign). GMS Commissioning Intentions - Redbridge completed Barking and Dagenham 18/22 signed Havering 12/30 signed
Item on agenda
RSK7 All PMS contract review
A reduction in the PMS premium could cause disengagement of practices on the delivery of the transformation programmes and the delivery of the financial recovery programme and (£55m 2017/18).
30-Jan-17 1 Sarah See
•Development of primary care investment schemes and delivery of GP Forward View to support delivery of financial savings challenge (e.g. advice and guidance / OD of provider at scale organisations / resilience funding)
•Practices are no longer rebasing to GMS equivalent funding and Redbridge is now assured so slight reduction in risk offset by challenging positions in remaining 2 CCG's.
2 3 6 Reputational Open On-going 12/11/18 All contract signed across Barking and Dagenham, Havering and Redbridge with exception of one Barking and Dagneham contract where there is a query regarding contract holder (although company is willing to sign). GMS Commissioning Intentions - Redbridge completed Barking and Dagenham 18/22 signed Havering 12/30 signed
Item on agenda
RSK21 All CQC VisitsHigh numbers of GP practice are being rated as ‘requires improvement’ or ‘inadequate’. There is a risk that practices may have their registration withdrawn, increased variation in the quality and safety of services provided by practices, and a reputational risk to the CCGs
01-Sep-16 1 Sarah See
1) Evaluate investment in practice education and training sessions (related to CQC inspection criteria) - completed Evaluation on the outcomes of the bespoke support commissioned to support ‘requires improvement’ practices due to be finalised shortly this will help ascertain whether a broader programme should be commissioned.2) Encourage LMCs to provide additional support.3) 2018/19 GPFV resilience programme being utiled to support practice delivery.4) CQC attending each of the PLE/PTIs to update on the new inspection regime 6)Continuing to share learning from ‘good rated’ practices at PLEs/PTIs.5) CQC inspector running IJEC session on how to become an outstanding practice (scheduled for early 2019 for when new CQC framework is published)
2 3 6 Patient care Open On-going Keep open to review outcomes of new inspection regime
RSK22 B&D Barking RiversideIf the short term provision of primary medical services in Barking Riverside utilises existing GP provision until 2020/21 (as agreed at Barking & Dagenham PCCC June 2016) this decision may not be popular with patients and local stakeholders.
Long term - new contract and premises to be commissioned from 2020/2021 as part of an integrated model. The risk is that this could cause a cost pressure for the CCG & that the CCG doesn't have the capacity to undertake a procurement with appropriate level of patient and public co-design to develop the model
01-Sep-16 1 Sarah See
1) Work closely with the Local Authority (LA) and other partners to shape the new service model within an agreed financial envelope. 2) Work with LA to access any CILs monies. 3) Explore options with LA to minimise operational commissioning (or procurement) costs by undertaking this process jointly.4) The cost of an additional practice has been built in to the latest PMS calculations and it is expected that work on this will start as part of the tranche 7 APMS contracts in November 2018.
3 3 9 Financial / Reputational
Open On-going Service model being presented at November meeting
RSK24 All Viability of Practices - risk that practices could close and we lose clinical staff to the area.
Redbridge CCG has been contacted by a number of practices about viability issues.
The CCG is working through the options with practices including mergers with neighbouring practices, joint working (economies of scale) and network support/planning
01.08.17 1 Sarah See
1) Work with practices that have expressed concern about viability around different options (merging with other practices, joint working (economies of scale) and network/federation solutions)2) Number of workforce initiatives underwayWorking with Network provider leads and CDs around network solutions3) Developing capacity plans at network level to support practices and to address sustainability issues via Network solutions 4) Hold Primary Care workshops of Primary Care, NELCA, Estates, Quality and Finance teams to review issues and agree approach
3 3 9 Patient Care Open 01-Dec-17 A primary care workshop has been held with NELCA colleagues. Risk stratification for each practice will be undertaken and will feedback at a later date
Primary Care Commissioning01-Oct-18
URN Impact on Risk and impact Date Opened Part Owner Mitigating Action Prob Imp Severity Category Status Next review Next action / comments
RSK25 ALL “The General Data Protection Regulation (GDPR) came in to effect on 25 May, the new IT operating model states that from 1st April 2018, CCGs should provide a Data Protection Officer (DPO) support function to support General Practice designated Data Protection Officers.
Currently the CCGs has not identified how this support will be provided so their is a risk that practices DPOs will not get the required support and will therefore not have the appropriate governance, procedures and policies in place.
01.08.18 1 Tom Travers Rob Meaker
1) The CCG has provided specific training around GDPR and have put guidance etc on the GP intranet.2) an options paper around practices DPOs has been shared with the federations and LMCs 3) New guidance has been shared with Information Governance lead and he is considering the way forward.4) Assurance audit tool under development.
2 2 4 Reputational Open 01-Oct-18 Funding has been sourced within the Primary Care budget, the Information Governance team will look to resource a suitable post to provide guidance and help in line with the requirements of NHS England
RSK 26 All Immunisation rates across Barking & Dagenham, Havering and Redbridge Low vaccination and immunisation rate mean that the boroughs do not achieve 'herd' immunity for the range of imms and vaccs targets - exposing residents to preventable disease / illness
03.10.18 1 Sarah See
1) CCG Primary care and quality teams to work with public health colleagues to develop action plans, which should cover all opportunities to improve vaccs and imms rates2) CCG Primary Care team to work with Comms to develop a comprehensive comms and engagement plan3) CCG Primary Care team to share coverage rates with Federations and Networks to enable peer discussions
3 3 9 Patient Care Open Ongoing The CCG is attending the bimonthly health protection forums and also engaging with Public Health England.
Comms and engagement is done via the CCG Intranet as well as regular emails to GP practices on immunisation issues.
We are working with CEG to obtain practice level information that can be shared at network meetings to enable peer discussions. The CCG has also asked PHE who hold data on practice level imms for access. There is no date for resolution at present.
Rating 1 2 3 4 5Description Rare Unlikely Possible Likely Certain
FrequencyNot expected
to occur in years
Expected to occur one a
year
Expected to occur one a
month
Expected to occur weekly
Expected to occur daily
Probability <10% 10% - 24% 25% to 45% 50% - 74% >75%
Risk grading matrix
LikelihoodRa
ting
Desc
riptio
n AObjectives/
projects
BHarm/injury to patients, staff
visitors & others
CActual/potential complaints &
claims
DService
disruption
EStaffing & competence
FFinancial
GInspection/
Audit
HAdverse media
1
Insi
gnifi
cant
Insignificant cost increase/time
slippage. Barely noticeable
reduction in scope or quality
Incident was prevented or
incident occurred and there was no
harm
Locally resolved complaint
Loss/interruption more
than 1 hour
Short term low staffing leading to reduction in quality(less than 1 day)
Small loss <£1000
Minor recommendations Rumours 1 2 3 4 5
2
Min
or Less than 5% cost
or time increase. Minor reduction in quality or scope
Individual(s) required first aid. Staff needed <3 days off work or normal duties
Justified complaint peripheral to clinical care
Loss of one whole working
day
On-going low staffing levels
reducing servicequality
Loss of 0.1% budget.
<£10,000
Recommendations given. Non-
compliance with standards
Local media column 2 4 6 8 10
3
Mod
erat
e
5-10% cost or time increase. Moderate
reduction in scope or quality
Individual(s) require moderate increase
in care. Staff needed >3 days off work or
normal duties
Below excess claim. Justified
complaint involving inappropriate care
Loss of more than one working
day
Late delivery of key objectives/service due to
lack of staff. On-going unsafe staff levels. Small error owing to insufficient
training
Loss of more than 0.25% of
budget. <£100,000
Reduced rating. Challenging
recommendations. Non-compliance with standards
Local media front page story 3 6 9 12 15
4
Maj
or
10-25% cost or time increase. Failure to meet
secondary objectives
Individual(s) appear to have suffered permanent harm.
Staff have sustained a "major injury" as defined by the HSE
Claim above excess level.
Multiple justified complaints
Loss of more than one working
week
Uncertain delivery of services due to
lack of staff. Largeerror owing to insufficient
training
Loss of more than 0.5% of
budget. <£500,000
Enforcement action. Low rating.
Critical report. Major non-
compliance with core standards
Local media short term 4 8 12 16 20
5
Seve
re
>25% cost or time increase. Failure to
meet primary objective
Individual(s) died as a result of the
incident
Multiple claims or single major
claims
Permanent loss of premises or
facility
No delivery of service. Critical error owing to
insufficient training
Loss of more than 1% of
budget. >£500,000
Prosecution. Zero rating. Severely critical report.
National media more than 3
days. MP concern
5 10 15 20 25
Seve
rity
Extreme
High
Medium
Low
Risk category
To: Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees
From: Tom Travers, Chief Financial Officer Date: 28th November 2018 Subject: Primary Care Budgets 2018/19 Executive summary This paper provides the Committee with a summary of the year-to-date and forecast position for the 2018/19 financial year. The budgets for all three CCGs are break-even at month 7, as well as forecast break-even. The main risks to the forecast position continue to be a heightened level of demographic growth, PMS Review, retrospective rent reviews and the uptake/achievement of commissioning intentions as part of the PMS Review. Recommendations The committee is asked to: • Note the content of the report and note that there is a level of financial risk which is currently
unquantifiable but will be reported on further in future months. 1.0 Purpose of the Report 1.1 The purpose of this report is to provide the Primary Care Commissioning Committee with a
summary of the month 7 financial position. 2.0 2018/19 budgets 2.1 The Co-Commissioning budgets were received from the NHS E finance team. These budgets
focussed primarily on the core elements of the Co-Commissioning obligations. The CCGs have reviewed these budgets and, where required, have used local knowledge to factor in additional requirements, whilst keeping within the notified allocations.
2.2 The budgets have been set based on known current contract values, along with assumptions for future increases and best estimates regarding new/increased costs to the system within the next 12 months.
2.3 Whilst the budgets are currently set within the nationally set allocations, there are risks to
achieving a break-even position at year-end. The four main risks at present are the rate of Demographic Growth; the outcome of the PMS Review for Barking & Dagenham and Havering CCGs; the timing and cost associated with retrospective rent reviews; and the uptake of proposed commissioning intentions as part of the PMS Review.
2.4 These risks will be constantly monitored throughout the year and will be reported to the Committee at quarterly intervals, identifying any variance, along with mitigating actions. As at Month 7 there is insufficient detail to suggest a realisation of any of the identified risks.
2.5 The current proposals of the PMS Review in Barking & Dagenham and Havering CCGs is
predicated upon STP support to enable both CCGs to offer additional access, across all of general practice, akin to what is being offered in Redbridge. This support has been factored into the budgets.
2.6 As at month 7 the year-to-date position is break-even against budget. The forecast is also
break-even.
2.7 The table below shows a high level summary of the break-even position against the 2018/19 budget, with a more detailed analysis in Appendix A.
2.8 Key notes of budgetary performance at Month 7:
2.8.1 Core contract values within GMS, PMS and APMS are seeing the impact of
both, demographic growth in list sizes, as well as the impact of the pay award of an additional £1.04 per Weighted Population. This was agreed to be backdated to 1st April 2018 with backdated payments being made to GMS practices in October and PMS/APMS practices in November.
2.8.2 PMS contractual budgets have now been adjusted to reflect anticipated growth for the year, offset by the removal of the PMS Premium value for the remainder of the year (PMS Practices transferred to the GMS Equivalent values from 1st July 2018 (Redbridge) and 1st October 2018 (Barking & Dagenham, and Havering).
2.8.3 Premises budgets are predominantly breaking even. Ongoing work by the NELCA team to confirm the revenue impact of retrospective rent reviews could well impact on this current forecast position.
2.8.4 Other Medical Services include reserve budgets for anticipated Demographic Growth, Pay Award and 0.5% Contingency. Currently these are being used to offset the cost pressures as referred to point 2.8.1 above.
2.8.5 Other Medical Services also includes budgets for the PMS Transitional Support and Commissioning Intentions, as a result of the PMS Review.
3.0 Resources/investment 3.1 There are no additional resource implications/revenue or capital costs arising from this report.
4.0 Equalities 4.1 There are no equalities implications arising from this report.
5.0 Risks and Opportunities 5.1 As mentioned in the section three, there are three main risks currently identified:
NHS England - London Region
Primary Care Services - BHR (Summary by Contract Type)
Total Primary Care Medical Services 38,149 38,149 0
BHR Total
ServiceAnnual Budget
Forecast Outturn
Forecast Variance
5.2 Demographic Growth: As mentioned in previous reports demographic growth is the most significant driver of risk within primary care contracts. However demographic trends and list size impacts are difficult to predict. Following the last PCCC report, we have since received the updated list sizes as at 1st October 2018. Across the three CCGs there has been an increase of 6,897 patients (weighted patient increase of 5,919) in the first 6 months. This is a 0.84% increase (as detailed below). Raw List Analysis
The forecast outturn has assumed that the trend above continues for the second half of the year. Analysis of trends over the last 3-4 years shows some volatility therefore these assumptions are not without risk. The growth budget (within Other Medical Services) is currently sufficient to cover this amount of growth. Any diversion from this when the December list sizes are produced will be reported back to this Committee for review.
5.3 PMS Review:
A risk to the budgets this year is the affordability of the PMS Review. Redbridge CCG agreed the outcome of the PMS Review, which was assured by NHS E. Offer letters were issued in April. The contractual changes took effect from 1st July 2018 with retrospective adjustments planned to take place in October. However, a number of contract/payment issues, within the October payments, have resulted in further adjustments being required. These issues have resulted in payments needing to be reclaimed from practices. The CCG have agreed to do this over the next 5 months to end of March 2019 to ensure that practice cash flows are not put at risk. The CCG have written to practices and the LMC, explaining the situation and setting out their payments will be adjusted in the coming months.
The Barking & Dagenham CCG and Havering CCG is also now complete and offer letters were sent out to practices at the end of June. All practices have accepted the proposals. As such we are forecasting that the full budget for transitional support and commissioning intentions will be spent. Commissioning Intentions and Transitional Support payments to PMS Practices commenced in October. The intention is that GMS/APMS practices will be able to access the Commissioning Intentions in the coming months.
5.4 Retrospective rent reviews:
As advised at the previous PCCCs, c.70% of practices are outstanding at least 1 rent review. The CCG are not yet in receipt of full information to be able to fully quantify the associated risk. NELCA Primary Care Commissioning team (formerly NHS E) have recently recruited to an additional position to focus on trying to quantify the potential impact. The CCG are yet to receive any updates to be able to further report on this matter, which therefore remains a significant risk.
5.5 Uptake and achievement of Commissioning Intentions: As part of the PMS Review Redbridge CCG offered a number of Commissioning Intentions, such as a Wound Care scheme, Additional Opening Hours, Additional Consultations, etc. Payments associated with these schemes will be related to achievement of a defined and agreed performance level. Some of these schemes have a multi-tiered payment system dependant on achieving one of a range of performance levels. The CCGs will monitor performance throughout the year and will provide mitigating actions for Committee consideration where appropriate.
6.0 Managing conflicts of interest 6.1 N/A
7.0 Recommendations 7.1 The Primary Care Commissioning Committee is asked to note the content of the report and note
that there is a level of financial risk which will be reported on further in future months.
Author: Rob Dickenson, Senior Finance Manager (Primary Care) Date: 23rd November 2018
Appendix A
NHS England - London RegionMedical ServicesFinancial Summary - 7 Months to 31st Oct 2018
Total Primary Care Medical Services 30,949,196 30,949,196 0 35,378,364 35,378,364 0 38,148,794 38,148,794 0
BARKING & DAGENHAM CCG HAVERING CCG REDBRIDGE CCG
To: Barking and Dagenham, Havering and Redbridge Primary Care Commissioning Committees From: Sarah See, Director, Primary Care Transformation Date: 28 November 2018 Subject: GP Retention Scheme Executive summary The national GP Retention Scheme has been reviewed in line with the objectives of the GP Forward View. The main objectives is to encourage GPs who may be considering leaving or have left general practice, an option to stay. The latest review and update of the Scheme was in March 2018, which has meant a number of changes to the way the scheme is processed and managed. The focus of the scheme is to support both the retained GP and the practice employing them by recognising that this role is different to a regular part-time or salaried post. It offers financial support to both the retained GP and the employing practice. A retained GP can provide up to a maximum of four clinical sessions a week for up to five years. There is an annual review that the retained GP must successfully complete each year, to continue the following year. Funding is available for the retained GP for expenses up to a maximum of £4,000 per annum and the practice is able to claim £76.92 per session up to a maximum of four sessions a week. The scheme is now jointly managed by Health Education England, NHS England and delegated CCGs who will ensure that the retained GP meets the criteria and the employing practice is of a suitable standard to be able to provide flexibility, support and supervision for the retained GP The North East London Commissioning Alliance (NELCA) Primary Care Team has developed a protocol for managing the Scheme’s application and payment process. Recommendations The Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees are asked to: • Note the GP Retention Scheme has been revised in line with the objectives of the GP Forward View • Note and agree the NELCA Primary Care Team’s protocol for processing applications, and • Note the financial costs on the primary allocations.
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1.0 Purpose of the Report 1.1 Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees are
asked to note the new GP Retention Scheme and approve the process adopted by the NELCA Primary Care Team.
2.0 Background 2.1 Section 20 of the GMS Statement of Financial Entitlements (SFE) details the “Doctors Retainer
Scheme”. This a long established scheme and was designed to keep doctors who are not in working in general practices in “touch with general practice”.
2.2 Since the establishment of NHS England and Health Education England the scheme has been reviewed and updated - in particular taking into account General Practice Forward View (GPFV) and the issues of recruiting and retaining doctors in general practice. One of the main objectives is to encourage GPs who may be considering leaving, an option to stay within general practice.
2.3 The last review of the scheme was in April 2017 and was renamed the “GP Retention Scheme”.
A further update of this scheme was published in March 2018, which has meant a number of changes to the way the scheme is processed and managed.
2.4 The focus of the scheme is to support both the retained GP and the practice employing them by
recognising that this role is different to a regular part-time or salaried post. It offers financial support to both the retained GP and the employing practice.
2.5 The scheme is now jointly managed by Health Education England, NHS England and delegated
CCGs. The GP Retention Scheme Guidance is enclosed as Appendix 1. 3.0 Summary of the GP Retention Scheme 3.1 The GP Retention Scheme is a package of financial and educational support to help doctors,
who might otherwise leave the profession, remain in clinical general practice.
3.2 The scheme is open to GPs who are seriously considering leaving or has left general practice either for personal reasons, approaching retirement or needing greater flexibility. Also the GP needs to show that a regular part-time role does not meet their requirement for flexibility and where there is a need for additional educational supervision.
3.3 GPs applying under the scheme must be in good standing with the General Medical Council,
without conditions (other than solely health matters). This scheme is not intended to support remediation.
3.4 The GP can only work in the approved practice up to the agreed maximum of four clinical
sessions per week and can only be on the scheme for up to a maximum five years. There is an annual review each year to ensure that the GP remains in need of the scheme and that the employing practice is meeting its obligations.
3.5 Practices participating in the scheme must be able to demonstrate that they can meet the
educational needs of the retained GP; there must be a named educational supervisor who is either a GP trainer, F2 supervisor or has accessed a suitable training course in supervision. The precise specification will be determined by the Health Education England Scheme lead.
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4.0 Resources 4.1 The GP Retention Scheme details the funding for approved applications. Each retained GP
qualifies for an annual professional expenses supplement which is based on the number of sessions per week. This goes towards the cost of the indemnity cover, professional expenses and CPD needs of the retained GP. Number of sessions per week
Annualised sessions* Expenses supplement payment per annum (£)
1-2 Fewer than 104 1,000
2 104 2,000
3 156 3,000
4 208 4,000
*annualised sessions include statutory holidays, annual leave and sessions used for CPD. 4.2 The expenses supplement is paid annually at the start and following successful annual review to
the employing practice and must be passed onto the retained GP. 4.3 The employing practice will be able to claim an allowance of £76.92 per clinical session up to
the maximum of four. Contracted sessions per week
Maximum financial support to practice per year (£76.92 per session)
1 £3,999.84
2 £7,999.68
3 £11,999.52
4 £15,999.36
4.4 This support is to be used by practices as an incentive to provide flexibility for the retained GP and should be used to cover salary, HR admin costs and any educational support required from the practice including any relevant course fees. The practice is eligible to claim reimbursement costs for retained GP, as a salaried GP under the SFE, e.g. sickness, maternity, parental leave.
4.5 The Committee is asked to note that each additional retained GP will incur additional costs of up to £20,000 per annum for up to five years, against the CCG’s primary care allocation. It should be noted that suitable applications should be approved as standard under the SFE.
4.6 Currently there are four retained GPs in total, two each in Barking and Dagenham and Redbridge.
5.0 Processing applications 5.1 With the new update of the scheme in March 2018, the NELCA Primary Care Team has
developed a protocol to process applications (see Appendix 2 for further detail).
5.2 In summary the process is as follows: 5.2.1 Application received by Health Education England, who will do the assessment and
suitability of the proposed retained GP and the practice.
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5.2.2 Recommendation is forwarded to the NELCA Primary Care Team who will liaise with NHS England Medical Directorate and internal records on suitability of the practice and any concerns, e.g. breaches, closed lists etc.
5.2.3 Application then passed to CCG Primary Care lead for any further information and approval (under delegation). Approval is expected to be standard under the SFE. However the CCG can now consider the impact on its primary care allocation before approving.
5.2.4 NELCA Head of Primary Care signs off application form and returned to Health Education England for final processing and informing applicant and practice.
5.2.5 NELCA Primary Care Team will process payment of expenses supplement on confirmation of start date from Health Education England.
5.2.6 The employing practice will send claims for sessions worked by retained GP to NELCA Primary Care Team for payment.
5.2.7 Health Education England will provide confirmation of the annual review and whether payment should continue.
5.3 Any application not approved will need to be referred to NHS England where the application will
be peer reviewed by another Area Team. Also NHS England central team need to be notified of any unsuccessful application.
6.0 Equalities 6.1 There are no equalities implications arising from this report. 7.0 Risk 7.1 There is potential financial risk should there be a large number of applications. However given
the historical numbers of retained GPs and small number eligible practices this should be a minimal financial risk.
8.0 Managing conflicts of interest 8.1 All Barking and Dagenham, Havering and Redbridge GP members will be conflicted and
therefore, have not been part of the development of the NELCA protocol or part of the decision-making process.
Attachments: 1. Appendix 1: GP Retention Scheme Guidance 2. Appendix 2: NELCA Primary Care Team Protocol 3. Appendix 3: GP Retention Scheme Frequently Asked Questions
Author: Gohar Choudhury, Assistant Head of Primary Care Date: 22 November 2018
GP Retention Scheme Guidance
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GP Retention Scheme Version number: 4.0 Gateway reference: 06617 First published: 1 April 2017 Last updated: 1 March 2018 Prepared by: Ed Poulter Classification: OFFICIAL Equality and Health Inequalities Statement Promoting equality and addressing health inequalities are at the heart of NHS England’s values. Throughout the development of the policies and processes cited in this document, we have:
Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and
Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities
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Table of Contents 1 Summary .................................................................................................................... 4
6.1 Professional expenses supplement ......................................................................6 6.2 Support for practices .............................................................................................7
7 Obligations of the RGP, practice, educational supervisor ........................................... 7
7.1 Obligations of the RGP ..........................................................................................7
7.2 Obligations of the practice, employing organisation ..........................................8 8 Contractual / employment issues ................................................................................ 8
8.1 Contract of employment ........................................................................................8
8.2 Hours of work .........................................................................................................9 8.3 Duration of the scheme ..........................................................................................9 8.4 Extended absence and scheme extensions .........................................................9
9 Annual review of RGPs and their placements .......................................................... 10
10 Job plan ................................................................................................................. 10
11.1 Induction ............................................................................................................ 12 11.2 Continuing Professional Development (CPD)................................................. 12
13 The role of the designated HEE RGP Scheme Lead ............................................. 13
14 Management of the scheme .................................................................................. 13
15 Review of unsuccessful applications ..................................................................... 15
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1 Summary This guidance sets out the criteria for doctors who wish to join the GP Retention Scheme. Its intended audience includes:
Doctors who are considering applying to join the scheme.
Doctors who are currently designated “retained doctors”.
Deans of Postgraduate GP Education/Heads of Primary and Community Care Education and their teams.
GP practices employing or considering employing a retained GP under this scheme.
NHS England local teams and CCGs with delegated co-commissioning responsibility.
2 Introduction The GP Retention Scheme is a package of financial and educational support to help doctors, who might otherwise leave the profession, remain in clinical general practice. The scheme supports both the retained GP (RGP) and the practice employing them by offering financial support in recognition of the fact that this role is different to a ‘regular’ part-time, salaried GP post, offering greater flexibility and educational support. RGPs may be on the scheme for a maximum of five years with an annual review each year to ensure that the RGP remains in need of the scheme and that the practice is meeting its obligations. This scheme enables a doctor to remain in clinical practice for a maximum of four clinical sessions (16 hours 40 minutes) per week – 208 sessions per year, which includes protected time for continuing professional development and with educational support. Doctors applying for the scheme must be in good standing with the General Medical Council (GMC) without GMC conditions or undertakings – except those relating solely to health matters. The scheme is not intended for the purpose of supporting a doctor’s remediation and where the relevant NHS England Responsible Officer has concerns, the doctor would not usually be eligible for the scheme. The scheme is managed jointly by Health Education England (HEE) through the designated HEE RGP Scheme Lead and NHS England.
3 Eligibility criteria for doctors The scheme is open to doctors who meet ALL of the following criteria:
1. Where a doctor is seriously considering leaving or has left general practice (but is still on the National Medical Performers List) due to:
a. Personal reasons – such as caring responsibilities for family members (children or adults) or personal health reasons
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Or
b. Approaching retirement Or
c. Require greater flexibility in order to undertake other work either within or outside of general practice.
2. And when a regular part-time role does not meet the doctor’s need for flexibility, for example the requirement for short clinics or annualised hours.
3. And where there is a need for additional educational supervision. For example a
newly qualified doctor needing to work 1-4 sessions a week due to caring responsibilities or those working only 1-2 sessions where pro-rata study leave allowance is inadequate to maintain continuing professional development and professional networks.
Doctors must hold full registration and a licence to practice with the GMC and be on the National Medical Performers List. Evidence to ascertain whether a doctor is seriously looking to leave general practice may include:
Proof from appraisal
Letter of resignation
Accessing or intention to take pension payment
Statement of intent to leave Doctors may wish to return to a more substantive role when they come to the end of the scheme, although this is not a requirement of the scheme. RGPs are not permitted to carry out other GP day time in hours locum or salaried work while on the scheme. The only exception is when a change of place of work (practice) is expected to occur (e.g. due to redundancy or resignation) or they are in the final 12 months of their scheme. Only then is limited work (limited to a maximum of 26 sessions in any 6 month period) allowed in order to aid transition to a new practice or a different variety of primary care work (e.g. walk in centre, vanguard, etc.). However RGPs may undertake GP out of hours work. They may also undertake other kinds of clinical (e.g. family planning, dermatology, occupational health etc.) or non-clinical work (education, appraisal, management etc.) which enables them to retain or extend their skills. For some doctors joining the scheme, it may allow them to retain GP skills whilst undertaking other substantive posts such as (but not limited to) senior management roles and education. Retainers must notify the designated HEE RGP Scheme Lead in advance of their wish to undertake any additional work and obtain approval before starting it. This allows RGPs to maintain a portfolio career while undertaking a GP role within the bounds of the scheme.
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Employment law states that ‘all employees have the legal right to request flexible working (not just parents and carers) and that employers must deal with requests in a reasonable manner’.
4 Possible applicants
Locums
Salaried GPs
GP Partners
Doctors within general practice on a career break of less than 24 months who remain on the National Performers List (or are expected to have been re-admitted by the time they start as an RGP) and are registered with a licence to practice with the GMC.
Where a doctor has previously been on the Retained Doctors Scheme but is not currently on the Scheme and is otherwise eligible, they may apply to re- join the scheme.
5 Eligibility criteria for GP practices The GP practice should offer the RGP work which enables them to maintain skills across the full spectrum of a general practitioner. The RGP should be embedded in one GP practice to enable peer support at work and continuity with patients. Practices must be able to demonstrate they can meet the educational needs of the RGP as appropriate and that they understand the ethos of educational supervision. The designated HEE RGP Scheme Lead will assess this based on the needs of the doctor who is applying. The practice should provide a named educational supervisor who is either a GP trainer, F2 supervisor or has recently accessed a suitable training course in supervision. The precise specification is for local determination by the designated HEE RGP Scheme Lead. Practices may employ more than one RGP where there is capacity for support and long term career opportunities with the prior approval of the designated HEE RGP Scheme Lead.
6 Funding
6.1 Professional expenses supplement
Each RGP would qualify for an annual professional expenses supplement of between £1000 and £4000 which is based on the number of sessions worked per week. It is payable to the RGP via the practice. The expenses supplement is subject to deductions for tax and national insurance contributions but is not superannuable (pensionable) by the practice. The whole of the expenses supplement payment will be passed on by the practice to the doctor to go towards the cost of indemnity cover, professional expenses and CPD needs. The practice should not automatically make any other deductions from the RGP expenses supplement except for tax and national insurance contributions. Certain expenses may be
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claimed against tax by the RGP (e.g. subscriptions to medical defence organisations and membership of the BMA and GMC annual retention fee etc). The RGP will be offered an expenses supplement payment (paid via their practice), as follows:
Number of sessions per week
Annualised sessions*
Expenses supplement payment per annum (£)
1-2 Fewer than 104 1,000
2 104 2,000
3 156 3,000
4 208 4,000
*annualised sessions include statutory holidays, annual leave and sessions used for CPD. The RGP professional expenses supplement will be paid at the commencement of employment and then each year on the anniversary following a successful annual review.
6.2 Support for practices
Each practice employing a RGP will be able to claim an allowance relating to the number of sessions for which their retained doctor is engaged. The practice will qualify for a payment of £76.92 per clinical session (up to a maximum of four) that the doctor is employed for. This allowance will be paid for all sessions including sick leave, annual leave, educational, maternity, paternity and adoptive leave where the RGP is being paid by the practice. Evidence of this payment will be required. The practice and RGP will continue to receive payments under the terms of the scheme as long as the RGP remains contracted to the practice and the practice continues to pay the RGP. Costs during these absences will need to be covered by the practice. However it may be possible to claim reimbursement costs associated with covering any absences of a RGP via the GMS (General Medical Services) SFE (Statement of Financial Entitlements) for sickness, maternity, parental and adoption leave.
Contracted sessions per week
Maximum financial support to practice per year (based on £76.92 per session)
1 £3,999.84
2 £7,999.68
3 £11,999.52
4 £15,999.36
This support is to be used by the practice as an incentive to provide flexibility for the RGP and should be used towards the RGPs salary, to cover HR admin costs and to provide funding to cover any educational support required from the practice, including course fees where relevant.
7 Obligations of the RGP, practice, educational supervisor
7.1 Obligations of the RGP
The RGP is obliged to:
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Hold full registration and a licence to practice with the General Medical Council (GMC), meet the requirements for remaining on the NHS England GP Performers List and report to NHS England any concerns that might affect their status on the National Medical Performers List.
Maintain membership of a medical defence organisation to the level required by NHS England.
Notify the designated HEE RGP Scheme Lead, in advance where possible, of any changes in working arrangements (e.g. additional work) and domestic circumstances that may affect participation in the scheme.
Notify the designated HEE RGP Scheme Lead of any long spells off work (over four weeks), e.g. maternity leave or long-term sick leave.
Submit to the designated HEE RGP Scheme Lead an annual renewal form at least one month in advance of the joining anniversary, to allow time for discussion regarding continuity of the scheme and any adjustments required.
Make every effort to attend any events organised by the designated HEE RGP Scheme Lead expressly for RGPs.
Meet appraisal and revalidation requirements and make their responsible officer aware of the fact that they are a RGP.
7.2 Obligations of the practice, employing organisation
The employing practice is obliged to:
Offer adequate and appropriate induction, both on joining and after any significant break (e.g. maternity leave). This will include for example IT systems, practice procedures and protocols, referrals systems, in-house and community services, collaborative working arrangements and referral pathways, prescribing formularies, team roles, information governance, safeguarding etc.
Nominate a clinical colleague to act as an educational supervisor, who will provide one to one support in protected time, (fortnightly or monthly as discussed and agreed with the RGP). A minimum of 2 hours a month would be recommended (additional to CPD entitlement).
Notify the designated HEE RGP Scheme Lead and RGP’s responsible officer if appropriate and in advance of any substantial changes within the practice that may impact upon the employment and educational arrangements of the RGP.
Work with the RGP to create a job plan suitable for the needs of the individual RGP to keep them in the profession. The job plan should include participation in team meetings during the RGPs normal working days.
Encourage and facilitate the appropriate use of CPD time allowance.
8 Contractual / employment issues
8.1 Contract of employment
All RGPs will be employed by the agreed practice. GMS and PMS practices should offer terms and conditions that are no less favourable than the model salaried GP contract as determined in GMS/PMS regulations. For APMS employers the Salaried Model Contract is considered as a benchmark.
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Terms and conditions of employment are a matter of negotiation between the RGP and the practice. The BMA has developed a model retainer scheme contract which is based on the Salaried GP Model Contract but specific to the Scheme. Contract checking and advice services can be accessed by BMA members by calling 0300 123 1233 or by emailing [email protected]. General advice for non-members can be obtained by emailing [email protected]. The RGP achieves full employment rights after 24 months with the same employer and the practice (employer) under employment law is obliged to continue the contract of employment after that time. Any changes in circumstance that may affect the employment of the RGP should be a matter of discussion between the RGP and the practice, and appropriate advice should be taken. The practice is expected to notify the designated HEE RGP Scheme Lead of any substantive changes that may affect employment of the RGP. Examples may include a practice merger, change to different premises, change of NHS England practice contract holder or contract type (e.g. following practice reprocurement).
8.2 Hours of work
The RGP contract is between 1- 4 sessions – a session is 4 hours 10 minutes (37.5 hrs / 9 sessions)1. The number of sessions can be annualised with the expectation that the RGP works a minimum of 30 weeks out of the 52. This will include annual leave, statutory holidays and personal development time. The pattern of sessions worked will be reviewed with the RGP each year through their annual review associated with the scheme. It is not considered good practice for an RGP to work in isolation or across more than one site. The duration of the retainer contract will be for the duration of the scheme (5 years) and reviewed annually. The number of sessions the RGP is contracted to work on the scheme may be changed following the submission of a revised suitable job plan which is subject to approval of the designated HEE RGP Scheme Lead and NHS England’s local Director of Commissioning Operations (DCO) (or nominated deputy either within NHS England or delegated CCG).
8.3 Duration of the scheme
RGPs can be on the scheme for a period of up to five years.
8.4 Extended absence and scheme extensions
The RGP, in discussion with the designated HEE RGP Scheme Lead and subject to agreement by the NHS England’s DCO (or nominated deputy either within NHS England or delegated CCG), can extend their time on the scheme in the following circumstances.
1 BMA (2017). Minimum terms and conditions [online]. Available at:
https://www.bma.org.uk/advice/employment/contracts/sessional-and-locum-gp-contracts/salaried-gp-model-contract/minimum-terms-and-conditions [Accessed 2 March 2017].
To replace time off the scheme relating to maternity, parental, adoption or sick leave.
Under special circumstances e.g. where a RGP has had to change practices due to relocation or due to break down in placement and support and would not have enough time left on the scheme to acquire employment rights in a fresh post.
In these circumstances an extension of up to 24 months would be deemed appropriate. The RGP continues to be a member of the scheme whilst on maternity, parental leave and sick leave. RGPs are strongly advised to make use of “Keeping in Touch” (KIT) days where they are available. If a RGPs annual renewal falls whilst they are on paid parental leave, they can choose to send a renewal application or defer until they return to work. The practice and RGP will continue to receive payments under the terms of the scheme as long as the RGP remains contracted to the practice and the practice continues to pay the RGP. The scheme extension form should be used for extensions in relation to maternity, parental, adoption, sick leave or special circumstances only.
9 Annual review of RGPs and their placements RGPs will be required to undergo an annual review with the designated HEE RGP Scheme Lead; this will allow careful consideration of their needs and whether they are being met by the practice, requirements for future months and whether they should remain on the scheme.
10 Job plan All GPs should have a job plan. In regards to the GP Retention Scheme the job plan is a working schedule which ensures that the RGP post delivers its aims, including provision for CPD and the requirements of the contract of employment are met by the employer and RGP. Please refer to the BMA’s guidance on job planning which is available on the BMA website. Example job plans are included in annex 2. Principles of a good job plan include: Job plans should be developed collaboratively between the employer and RGP. They should be revised only by mutual agreement as a minimum 8-12 weeks after joining the scheme, annually and when any major changes are suggested by either party. Scheduling in the job plan should include:
Clinical duties: appointments, visits, dealing with telephone queries from patients or other health care professionals.
Administrative / paperwork whether arising directly from this caseload (referrals, investigations, results) and indirectly (reports, medicals, etc.).
Meetings (whether informal or formal) essential to the delivery of team based care, discussing clinical practice standards; support significant event audit (SEA) etc. Where these occur on an ad hoc basis, adjustments to clinical workload may be required.
Personal continuing professional development (CPD) time – see CPD section.
Time for supervision.
Specific specialist roles in the practice: e.g. medical student teaching, QoF area of responsibility, other special interests, e.g. dermatology, women’s/sexual health, minor surgery.
Workload should:
Be defined in amount (number of patients) and type (clinical, paperwork, team meetings), with provisions for fluctuations in exceptional circumstances such as returning after career break.
Reflect RGP abilities.
Realistically match contracted hours as defined in the contract of employment.
Be balanced, recognising both clinical and non-clinical work. It is estimated that the ratio of clinical work to administrative work is usually in the region of 3:1 (excluding meetings).
The job plan will set out clear arrangements around how and when extra-contractual duties (where agreed) will be recognised and when time in lieu will be taken (e.g. monthly or added to annual leave). This is especially relevant where there are significant fluctuations in workload and hours of the RGP if they are helping to cover another doctors’ absence (e.g. sickness or maternity leave). RGPs on this scheme are able to work extended hours to support seven day access to primary care where appropriate and where this suits their personal circumstances. However, this must take place within the agreed pattern of work / work plan. Although a session is defined as 4 hours and 10 minutes, periods of duty do not need to be exact multiples of this. For example a contract for 16 hours 40 minutes can be divided into 2 x 6 hours days and a day of 4 hours and 40 minutes if this suits both parties and delivers the educational supervision and CPD component of the post. Breaks should be granted within worked hours in keeping with the European working time directive. Start and finish times should consider the RGPs situation and caring responsibilities if appropriate. The RGP is expected to complete medical reports that are part of GMS contractual obligations. However the RGP is not normally expected to complete medical reports for private purposes, unless there is an agreement between the RGP and the practice for additional remuneration or time within the job plan. On call commitment where applicable should be specified: e.g. 12 half days a year and no more onerous than the RGPs pro-rata share of the clinical complement of the practice. So if there are 40 clinical sessions worked by doctors in the practice and the RGP works 4 they should do no more than 1/10 of the on call over the year.
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11 Educational aspects
11.1 Induction
All RGPs, irrespective of length of service, must complete an appropriate induction programme specific to their role and the practice in which they will be based. This will include for example IT systems, practice procedures and protocols, referral systems, in house and community services and referrals pathways, prescribing formularies, team roles, collaborative working arrangements, information governance, safeguarding etc. The practice will be required to offer the RGP experience of a sufficiently wide range of general practice experience to ensure that they retain their skills. This will be mutually agreed and stated within the job plan, which will include hours of work, duties, time set aside for CPD and necessary attendance at meetings.
11.2 Continuing Professional Development (CPD)
The RGP is entitled to the pro rata full time equivalent of CPD as set out within the salaried model contract. CPD is based on:
The needs of the individual, as established at their appraisal.
Discussion with the designated HEE RGP Scheme Lead.
Discussion with the practice supervisor. This is underpinned by a robust job plan and reviewed annually by the designated HEE RGP Scheme Lead. There should be an appropriate balance of CPD sessions spent in the practice (such as in house educational meetings, SEA and prescribing meetings, quality improvement activities) and activities outside the practice (such as learning groups, e-learning, self-directed learning, talks, courses and locality protected learning events). CPD activities may fall outside the RGPs contracted time. For example, if an RGP only works on Monday, it is highly likely that they may find the course they wish to access occur on Tuesday, Wednesday Thursday or Friday. The CPD time can then be taken on an “in lieu” basis on a mutually agreed date. In line with the standard contract there are no specific contributions to CPD apart from the professional expenses supplement and financial support for practices. The practice will:
Invite the RGP as appropriate to practice based events, including practice meetings, in-house training, away-days and significant event meetings, in protected time, using the CPD allowance as appropriate and agreed.
Ensure that the workload of the doctor takes into account that this is a supported post.
Monitor sessions worked to ensure that these do not exceed those agreed in the job plan, recognising that sessions worked may be annualised.
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Ensure that all members of the practice are aware of these requirements. Development and educational input will vary according to the circumstances of the RGP and the practice in which they are working. The RGP will meet their educational supervisor annually to review the job plan and ensure CPD arrangements are in place to meet their annual Personal Development Plan (PDP) as agreed with their appraiser.
11.3 Supervision
The scheme includes a requirement for protected time for supervision by the educational supervisor. The educational supervisor will provide one to one support in protected time, (fortnightly or monthly as discussed and agreed with the RGP). A minimum of 2 hrs a month would be recommended (additional to CPD entitlement). The aim of the supervision is to provide individual support for the doctor, help facilitate their integration into the practice, ensure that their professional development needs are supported and avoid professional isolation. This support should be tailored to the individual needs of the RGP.
12 Existing retainees RGPs who have been accepted on to the Retained Doctor Scheme 2016 (where the application form has been approved by the NHS England DCO (or nominated deputy either within NHS England or delegated CCG) but who are not in post before 31 March 2017 will be accepted onto the GP Retention scheme without the need to re-apply. Those RGPs who are retained under the Retained Doctor Scheme 2016 will continue on that scheme until July 2019 when they will transfer to the GP Retention Scheme if they still have time remaining on the scheme.
13 The role of the designated HEE RGP Scheme Lead The RGPs application and proposed job plan will be reviewed by the designated HEE RGP Scheme Lead to ensure that the education and development elements are appropriate for the individual and meet the individual doctor’s skills, work-life balance requirements and career objectives. The designated HEE RGP Scheme Lead will ensure the practice has the capacity to meet the obligations of the scheme throughout its duration. The designated HEE RGP Scheme Lead will support the RGP to ensure that they are able to keep up to date with CPD and education. They will ensure that the RGP has an annual review to make sure that the practice is fulfilling its obligations and meeting the needs of the RGP and as well as the RGPs suitability to continue on the scheme.
14 Management of the scheme The designated HEE RGP Scheme Lead will manage the scheme including the review of applications and job plans of potential RGPs, monitoring educational aspects, maintaining a
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database of RGPs and practices and developing a support network for RGPs within their region. RGP application records will be retained by the HEE local team for audit purposes for six years. The retention period will be triggered by the RGP leaving the scheme, the six year retention will begin from the end of the relevant financial year2. In terms of approval of RGPs applications and payment:
Designated HEE RGP Scheme Leads process RGP applications (using the standard application form) and pass eligible applications with their recommendation to their NHS England local office – NHS England DCO (or nominated deputy either within NHS England or delegated CCG).
NHS England DCO (or nominated deputy either within NHS England or delegated CCG) makes the final decision whether the doctor can join the scheme. This will be based on the eligibility criteria to join the scheme, whether there is sufficient budget available through the primary care allocation and that there are no concerns with the doctor or practice. Where the CCG is delegated a discussion between the NHS England DCO (or nominated deputy) is recommended when considering the application. The designated HEE RGP Scheme Lead is notified of the decision who will then notify the doctor and practice.
NHS England local office finance team (or equivalent within the CCG) notifies Primary Care Support (PCS) England of the practice that will be hosting the retained doctor.
Payment authorisation – local finance team (NHS England or CCG) complete / approve retainer form and send to PCS England. Retainer to be funded through the primary care allocation budget.
PCS England sends a claim form to the practice hosting the retained doctor and then processes claims when received. Approval is sought from the relevant NHS England Contract Manager (or CCG equivalent) to enable PCS England to make payment to the practice directly.
The standard application / annual review form is to be used as part of the application and annual review process. The end of GP Retention Scheme form is to be completed by the RGP and designated HEE RGP Scheme Lead on the RGPs last day of the scheme. Data will be shared between HEE and NHS England for the purpose of approving applications and monitoring the effectiveness on the scheme.
2 Information Governance Alliance (2016). Records Management Code of Practice for Health and Social Care 2016
(p.78) [online]. Available at https://digital.nhs.uk/article/1202/Records-Management-Code-of-Practice-for-Health-and-Social-Care-2016 [Accessed 8 March 2017].
15 Review of unsuccessful applications The rationale for the decision on whether a retainer’s application is successful or not will be stated on the application form by the NHS England DCO (or nominated deputy either within NHS England or delegated CCG). Where an application to join the scheme is unsuccessful, before the decision is communicated back to the doctor the NHS England DCO (or nominated deputy either within NHS England or delegated CCG) is to peer review the application with a neighbouring NHS England DCO (or nominated deputy either within NHS England or delegated CCG). A final decision in then to be made as to whether the doctor can join the scheme. The decision will be communicated back to the doctor via the designated HEE RGP Scheme Lead. The NHS England central team must be informed on any applications being peer reviewed by copying the RGPs application and final decision to [email protected].
Details of the HEE local offices are available via the NHS England website - https://www.england.nhs.uk/gp/gpfv/workforce/retaining-the-current-medical-workforce/retained-doctors/
Annex 2 – Example job plans Example 1 Job plan – RGP with young dependents preferring to work school hours working 4 sessions (16 hours 40mins) per week To be completed jointly by RGP, Educational Supervisor and Practice Manager. Refer to job planning guidance in RGP handbook.
How many weekly sessions will the post comprise of (1-4): 4
AM surgery: Number of appointments, time of first and last appointment
Appointments from 9.30-13.30 (2 catch up slots)
Appointments from 8.00-13.00 (2 catch up slots)
Appointments from 9.30-15.10 (2 catch up slots)
Appointments from 8.40-12.30 (2 catch up slots)
PM surgery: Number of appointments, time of first and last appointment
N/A None
8.00 from 13.30 -14.50
-
Visits
- Up to 2
- 2
Time for admin
90 minutes
1 hour 50
90 minutes
90 minutes
Meetings – title, start and finish times
-
Clinical meeting 13.00–14.30
- -
Mentoring time slot
- 14.30 -15.00
- -
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Hours worked this day
4 hours
7 hours
5hr 40mins
4 hours
Comments: Ad hoc adjustments to allow for non weekly meetings or time in lieu for late finishes/extended hours
When extra visiting doctor is needed morning appointments reduced. When working Saturday extended hours this will be instead of Monday
When on call 8.00-13.00 no booked slots and duty system applies
- 8 Saturdays a year, instead of Mondays
ON CALL DUTIES - using contracted time as RGP in the practice
Start and finish time, day of week
Wed 8.00 - 13.00
Frequency (number per year)
8 times a year - reflects pro-rata share of clinical team
If extends normal day length, arrangements for time in lieu
Yes by 1 ½ hours. Time in lieu = 12 hours added to annual leave
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CPD ACTIVITY
In house education meetings: describe frequency, duration and purpose
Formal courses or protected learning events occurring on contracted retainer days
Practice development work where aligned to PDP goals and NHS appraisal
Time out of practice for self directed learning or time in lieu for CPD carried out outside of contract time where aligned to NHS appraisal PDP goals
Total
Details
Monthly 1hour, education including prescribing and SEAS
- Safeguarding, or palliative care, QOF area, etc.
-
Hours / year
Up to 42 potentially in Tuesday meeting
5 hours attending GP update course 5.40 attending safeguarding update day Time outs 2 on Tuesday = 2x90mins from 13.00 2 on Wednesday = 2x 2hr10mins Total : 16 hours
4 hours leading on safeguarding area
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81
Sessions / year approx.
10 4 1 5 20
To be completed by the Educational Supervisor - How will you support the RGP in carrying out practice development work? (e.g. IT training, admin support, etc)
Planned protected time will be given without clinical work to allow handover from previous lead, updating of protocols systems, meeting with health visitor.
To be completed by the Educational Supervisor - What are the arrangements for booking CPD time at the practice for all the above categories?
Request made via Educational Supervisor, preferably 8 weeks notice. Every effort will be made to accommodate and we ask that time in lieu is taken where possible when others are not absent.
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Example 2
Job plan – RGP is senior GP with management role working 2 sessions (8 hours 20mins) per week To be completed jointly by RGP, Educational Supervisor and Practice Manager. Refer to job planning guidance in RGP handbook.
How many weekly sessions will the post comprise of (1-4): 2
AM surgery: Number of appointments, time of first and last appointment
-
7.30-10.20 appointments. 10.20-10.50 mentoring. 10.50–13.20 appointments and admin. (2 catch up slots)
PM surgery: Number of appointments, time of first and last appointment
17.30-20.00 appointments (1 catch up slot) followed by admin
-
Visits
-
1 visit
Time for admin
-
-
Meetings – title, start and finish times
None
Monthly team meeting 8.00-9.00
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Mentoring time slot
- 10.20-10.50
Hours worked this day
2h 30
5 hr 50
Comments: Ad hoc adjustments to allow for non weekly meetings or time in lieu for late finishes/extended hours
- When on call 8.00-13.00 in which case no booked slots and duty system applies. When monthly meeting 8.00-9.00 then surgery appointments cancelled during meeting time.
ON CALL DUTIES - using contracted time as RGP in the practice
Start and finish time, day of week
Thursday 8.00-13.00
Frequency (number per year)
4 times a year reflects pro-rata share of clinical team
If extends normal day length, arrangements for time in lieu
No
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CPD ACTIVITY
In house education meetings: describe frequency, duration and purpose
Formal courses or protected learning events occurring on contracted retainer days
Practice development work where aligned to PDP goals and NHS appraisal
Time out of practice for self directed learning or time in lieu for CPD carried out outside of contract time where aligned to NHS appraisal PDP goals
Total
Details
e.g. monthly 1hour, education including prescribing and SEAS
(e.g. safeguarding, or palliative care, QOF area, etc.)
Hours / year
Monthly 8-9am =10 hours Time out events occur outside of contacted hours Practice education meetings occur outside of contacted hours on Tuesdays Possibly GP update event if occurs Thursday. Total: 7 hours
4 hours leading on QoF/ prescribing
20 hours Will attend practice education meetings on Tuesdays when outside role permits
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Sessions / year approx.
2.5 1.5 1 5 10
To be completed by the Educational Supervisor - How will you support the RGP in carrying out practice development work? (e.g. IT training, admin support, etc)
Planned time will be arranged with practice pharmacist and individually to progress prescribing lead area.
To be completed by the Educational Supervisor - What are the arrangements for booking CPD time at the practice for all the above categories?
Will be emailed routinely to be made aware of schedule of practice education meetings and have an opportunity to influence the programme. Will have protected time to attend monthly meeting 8.00-9.00 unless RGP does not find this useful and appraisal/review time would be better spent on other activities. Time out of practice for courses or for time in lieu of courses/self-directed learning will be booked via our rota manager Lesley. We ask for as much notice as possible and will endeavour to ensure requests are met whenever feasible. Authorisation will be confirmed within 7 days unless there is a more urgent request.
Appendix 2
NELCA Primary Care Commissioning Team - Protocol
GP Retention scheme
Approval process:
1. Retention scheme application processed by designated HEE scheme lead and sent to
area team (NELCA) with their recommendation.
2. Area team liaises with Medical Directorate (Trish Galloway or Anna Owen) that there
are no concerns with the doctor or practice.
3. AT check any concerns with practice e.g. breaches/remedial/premises issues?
4. AT liaise with CCG primary care contact on any concerns:
a. B&D/Havering and Redbridge – Sarah See/David Parke
This document answers some of the frequently asked questions from GPs and practices regarding the GP Retention Scheme. These should be read in conjunction with the GP Retention Scheme Guidance
General questions and answers
1. What is the GP Retention Scheme?
The GP Retention Scheme is a package of financial and educational support to help doctors, who might otherwise leave the profession, remain in clinical general practice. The scheme supports both the retained GP (RGP) and the practice employing them by offering financial support in recognition of the fact that this role is different to a ‘regular’ part-time, salaried GP post, offering greater flexibility and educational support. RGPs may be on the scheme for a maximum of five years with an annual review each year to ensure that the RGP remains in need of the scheme and that the practice is meeting its obligations.
2. Who is eligible for the scheme? The scheme is open to doctors who meet ALL of the following criteria:
1. Where a doctor is seriously considering leaving or has left general practice (but is still on the National Medical Performers List) due to:
a. Personal reasons – such as caring responsibilities for family members (children or adults) or personal health reasons Or
b. Approaching retirement Or
c. Require greater flexibility in order to undertake other work either within or outside of general practice.
2. And when a regular part-time role does not meet the doctor’s need for flexibility, for example the requirement for short clinics or annualised hours.
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3. And where there is a need for additional educational supervision. For example a newly qualified doctor needing to work 1-4 sessions a week due to caring responsibilities or those working only 1-2 sessions where pro-rata study leave allowance is inadequate to maintain continuing professional development and professional networks.
Doctors must hold full registration and a licence to practice with the GMC and be on the National Medical Performers List.
3. Why are we doing this? The General Practice Forward View (GPFV) has committed to introduce ‘a new GP retainer scheme more fit for purpose’ from 1 April 2017.
Workforce data shows that the number of GPs leaving in most ages groups particularly those aged 55–59 and 60-64, has risen over the last 10 years. Data also shows peaks in GPs leaving practice aged in their 30s and aged 55-591. This scheme is aimed at anyone intending to leave general practice at anytime in their career and when a regular part-time role does not meet the doctor’s need for flexibility and where there is a need for additional educational supervision
4. How does the GP Retention Scheme differ to that of the Retained Doctors Scheme 2016?
The GP Retention Scheme replaces the Retained Doctors Scheme 2016. The two schemes are similar in that they offer the same amount of funding – the practice still receives a payment of £76.92 per session that the RGP works, the annual expenses supplement for the RGP remains at between £1000 and £4000 and the new scheme retains much of the same approvals process as for the 2016 scheme. However the following changes have been made:
Further clarity on who can apply to the scheme.
Further clarity around what additional work can be undertaken while on the scheme.
Further clarity around extended absence and scheme extensions – for example when extensions are applicable and when payments should cease.
The introduction of a job plan to accompany the scheme to ensure that the RGP post delivers its aims including provision for CPD.
Clear guidance around the management/approval of the RGPs on to the scheme.
Introduction of a peer review process for unsuccessful applications.
A revised application form that reflects the changes made to the scheme.
1 NHS Digital (2016). General and Personal Medical Services, England 2004-2014, as at 30 September [online]. Available at
http://content.digital.nhs.uk/catalogue/PUB16934 [Accessed 1 July 2016].
5. How is this scheme different to the Induction and Refresher (I&R) Scheme?
The Induction & Refresher (I&R) Scheme (https://gprecruitment.hee.nhs.uk/Induction-Refresher) in England provides an opportunity for GPs who have previously been on the General Medical Council’s (GMC) GP Register and on the NHS England National Medical Performers List (MPL), to safely return to general practice, following a career break or time spent working abroad. It also supports the safe introduction of EU and overseas GPs who have qualified outside the UK and have no previous NHS GP experience. The GP Retention Scheme is designed to support GPs who would otherwise leave, when a regular part-time role does not meet the doctor’s need for flexibility and where there is a need for additional educational supervision. To join the scheme doctors must hold full registration and a licence to practice with the GMC and be on the National Medical Performers List.
Questions for prospective retained doctors
6. Why should I apply for the scheme? How will it benefit me? The GP Retention Scheme is designed to support GPs who would otherwise leave (or have left), when a regular part-time role does not meet the doctor’s need for flexibility and where there is a need for additional educational supervision. RGPs may be on the scheme for a maximum of five years with an annual review each year to ensure that the RGP remains in need of the scheme and that the practice is meeting its obligations. Each RGP would qualify for an annual professional expenses supplement of between £1000 and £4000 which is based on the number of sessions worked per week. It is payable to the RGP via the practice. The professional expenses supplement is subject to deductions for tax and national insurance contributions but is not pensionable by the practice. This scheme enables a doctor to remain in clinical practice for a maximum of four clinical sessions (16 hours 40 minutes) per week - 208 sessions per year, which includes protected time for continuing professional development and educational support.
7. Can I be a RGP in the practice that I already work in? Yes as long as the practice offers the RGP work which enables them to maintain their skills across the full spectrum of general practitioner work. The RGP should be embedded in one GP practice to enable peer support at work and continuity with patients.
Practices must be able to demonstrate they can meet the educational needs of the RGP and that they understand the ethos of educational supervision. The designated RGP Scheme Lead from HEE will assess this based on the needs of the doctor who is applying. The practice must provide a named educational supervisor who is either a GP trainer, F2 supervisor or has recently accessed a suitable training course in supervision. The precise specification will be determined by the designated HEE RGP Scheme Lead.
8. I am not on the National Medical Performers List but have practiced in the last 2 years, am I able to join the scheme?
To join the scheme doctors must hold full registration and a licence to practice with the GMC and be on the National Medical Performers List. It is recommended to talk to your local Responsible Officer who will be able to advise on the best route to get back onto the National Medical Performers List.
9. What evidence can be used to show that I am seriously considering leaving or have left general practice?
Evidence to ascertain whether a doctor is seriously looking to leave general practice may include:
Proof from appraisal
Letter of resignation
Accessing or intention to take pension payment
Statement of intent to leave
10. Is the money I receive through the expenses supplement taxable?
The expenses supplement is subject to deductions for tax and national insurance contributions but is not pensionable by the practice. Certain expenses may be claimed against tax (e.g. subscriptions to medical defence organisations and membership of the BMA and GMC annual retention fee etc). GPs may want to take independent financial advice.
11. What is the professional expenses supplement for?
The whole of the professional expenses supplement payment will be passed on by the practice to the doctor to go towards the cost of indemnity cover, professional expenses and CPD needs. The practice should not automatically make any other deductions from the RGP expenses supplement except for tax and national insurance contributions.
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12. Where is the scheme available? The scheme is available across England. Doctors who are intrested in applying to the scheme should in the first instance contact their designated HEE RGP Scheme Lead who will be able to advise on their eligibility for the scheme including work and educational elements and the application process.
13. Why can’t I go on the scheme if I work more than four sessions per week?
The number of sessions to be worked as a RGP is capped at four clinical sessions per week. If you want to work more than this, you are not eligible for the scheme. The scheme supports practices to provide the flexibility to doctors who for various reasons cannot undertake a regular part-time role, for example for the requirement for short clinics to work around health needs or annualised hours to allow for time off during school holidays. For annualised sessions there is the expectation that the RGP works a minimum of 30 weeks out of the 52.
14. How long can I remain on the scheme for? RGPs may be on the scheme for a maximum of five years with an annual review each year to ensure that the RGP remains in need of the scheme and that the practice is meeting its obligations.
15. What happens when the scheme ends? Doctors may wish to return to a more substantive role if they so wish when the scheme ends, although this is not a requirement of the scheme. The RGP achieves full employment rights after 24 months with the same employer and the practice (employer) under employment law is obliged to continue the contract of employment after that time. Any changes in circumstance that may affect the employment of the RGP should be a matter of discussion between the RGP and the practice, and appropriate advice should be taken. The practice is expected to notify the designated HEE RGP Scheme Lead of any substantive changes that may affect employment of the RGP. Examples may include a practice merger, change to different premises, change of NHS England practice contract holder or contract type (e.g. following practice reprocurement). Advice should be sought from the BMA on issues of continuity of service and employment rights: http://bma.org.uk/practical-support-at-work/contracts/sessional-gps
16. Can I get an extension for my time on the scheme?
The RGP in discussion with the designated HEE RGP Scheme Lead and subject to agreement by the NHS England’s DCO (or nominated deputy either within NHS England or delegated CCG), can extend their time on the scheme in the following circumstances.
• To replace time off the scheme relating to maternity, parental, adoption or sick leave.
• Under special circumstances e.g. where a RGP has had to change
practices due to relocation or due to break down in placement and support and would not have enough time left on the scheme to acquire employment rights in a fresh post.
In these circumstances an extension of up to 24 months would be deemed appropriate.
17. What is my CPD allowance as a RGP? The RGP is entitled to the pro rata full time equivalent of CPD as set out within the salaried model contract. CPD is based on:
The needs of the individual, as established at their appraisal.
Discussion with the designated HEE RGP Scheme Lead.
Discussion with the practice supervisor. This is underpinned by a robust job plan and reviewed annually by the designated HEE RGP Scheme Lead. There should be an appropriate balance of CPD sessions spent in the practice (such as in house educational meetings, SEA and prescribing meetings, quality improvement activities) and activities outside the practice (such as learning groups, e-learning, self-directed learning, talks, courses and locality protected learning events). CPD activities may fall outside the RGPs contracted time. For example, if an RGP only works on Monday, it is highly likely that they may find the course they wish to access occur on Tuesday, Wednesday Thursday or Friday. The CPD time can then be taken on an “in lieu” basis on a mutually agreed date. CPD activities may include:
• Self-directed/private study. • Developing and/or updating a personal development plan. • Practitioner or self-directed learning groups. • Local protected learning events.
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• Practice quality improvement activity. • In-house practice based educational meetings.
18. Can I work extended hours, including Saturday and Sunday working? The RGP may work extended hours during the week or at weekends by mutual agreement, provided the total number of hours worked does not exceed those in the contract, and that the extended hours sessions are incorporated into the job plan where the balance of clinical work, admin, CPD can be assessed as balanced for the post.
19. How do I go about applying to the scheme?
Doctors who are intrested in applying to the scheme should in the first instance contact their designated HEE RGP Scheme Lead who will be able to advise on their eligibility for the scheme including work and educational elements and the application process. The designated HEE RGP Scheme Lead can be contacted through the local HEE office. Details of these offices can be found on the NHS England website - https://www.england.nhs.uk/gp/gpfv/workforce/retained-doctor-scheme/
20. What happens if my application is not recommended by the designated HEE RGP Scheme Lead for approval by NHS England?
Where applications are not recommended by the designated HEE RGP Scheme Lead for approval by NHS England, RGPs should follow the local HEE office’s arrangements regarding appeals.
21. What happens if I am already on the Retained Doctor Scheme 2016? GPs who have been accepted on to the Retained Doctor Scheme 2016 (where the application form has been approved by the NHS England DCO - or nominated deputy either within NHS England or delegated CCG) but who are not in post before 31 March 2017 will be accepted onto the GP Retention Scheme without the need to re-apply. Those RGPs who are retained under the Retained Doctor Scheme 2016 will continue on that scheme until July 2019 when they will transfer to the GP Retention Scheme if they still have time remaining on the scheme.
22. Can I join the scheme and remain being a partner?
A GP partner is able to join the GP Retention Scheme but would need to step down from their partnership. The scheme is designed to support an “employed” GP in a
practice and to encourage that practice to keep / take them on but also provide educational supervision and support. All Retained GPs will be employed by the agreed practice (a condition of the Statement of Financial Entitlements on which payments are made). GMS and PMS practices should offer terms and conditions that are no less favourable than the model salaried GP contract as determined in GMS/PMS regulations. For APMS employers the Salaried Model Contract is considered as a benchmark.
Questions for GP practices
23. How will the GP practice benefit?
Each practice employing a RGP will be able to claim an allowance relating to the number of sessions for which their retained doctor is engaged. The practice will qualify for a payment of £76.92 per clinical session (up to a maximum of four clinical sessions per week) that the doctor is employed for. This allowance will be paid for all sessions including sick leave, annual leave, educational, maternity, paternity and adoptive leave where the RGP is being paid by the practice. Evidence of this payment will be required. The practice and RGP will continue to receive payments under the terms of the scheme as long as the RGP remains contracted to the practice and the practice continues to pay the RGP.
24. How many retained doctors can a practice take on at once?
Practices may employ more than one RGP where there is capacity for support and long term career opportunities with the prior approval of the designated HEE RGP Scheme Lead.
25. What constitutes as an appropriate induction for a RGP? A RGP is a qualified GP not a trainee. Any induction should take into account the specific needs of the individual RGP and so should be devised in discussion with them. It is important to ensure introduction to all key members of the primary care and allied teams and in addition ensure the RGP is informed of:
• The computer system within the practice so that consultations, prescribing, templates, protocols, mentor, BNF, word processing and internal message systems etc. can be accessed and utilised.
• Practice systems for Chronic Disease Management: adding to disease registers, care plans and patient alerts, familiarity with recall systems, targets, and team roles in their management.
• Practice procedures and protocols and where to access these. • Knowledge of local and practice prescribing policies. • Familiarity with local referral pathways used by the practice, collaborative
working arrangements and main providers together with services available.
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• Familiarity with in-house services, e.g. Phlebotomy, ECG etc. • Knowledge of any special services provided by the practice, e.g. drug
dependence, physiotherapy, counselling, chiropody etc. • Provided with relevant and necessary telephone contact numbers. • Awareness of practice appointment systems and on-call arrangements. • Location of emergency drugs. • Procedures for reporting significant events. • Panic button location and protocol for reporting violent incidents.
Questions regarding educational supervision
26. Who is the Educational Supervisor? The educational supervisor is a named doctor in the same practice, who is appropriately trained to be responsible for the overall supervision and management of the educational progress of a specified RGP whilst employed by the practice. The aim of this role is to provide individual support for the RGP, help facilitate their integration into the practice, ensure that their professional development needs are supported and avoid professional isolation. This support should be tailored to the individual needs of the RGP.
27. What support does the educational supervisor offer to the RGP?
The educational supervisor will review with the RGP their educational needs on a regular basis. The appraisal toolkits should be the route for recording learning and development for the RGP. The educational supervisor will provide regular feedback to the RGP and will oversee their professional development, including monitoring clinical and educational progress and ensuring the RGP receives appropriate career guidance and planning.
28. How can I as a RGP benefit from educational supervision? GPs on the scheme have been asked by HEE to give their views on what they found useful in their supervision, responses included:
Allows time for a wide-ranging conversation to take place which is very useful.
Allows for a greater understanding of the practice and local procedures.
The sessions provide an opportunity to discuss a mix of clinical queries and psychosocial/holistic issues.
The ability to review practice and have discussions around the management of chronic disease as well as specific cases.
Supervision sessions provide valuable time for ongoing support and discussing difficult patients.
The sessions allow for a wide range of clinical and managerial topics (funding/prescribing budgets/referral process etc.) to be discussed.
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Publications Gateway Reference: 06672
Sometimes we look at clinical skills, in areas where I have identified I struggle with (e.g. first mental health consultation).
Increases competency in key data areas so that when data / audit runs are done that they are complete from my perspective i.e. relevant information entered.
Helps to develop a mature understanding of IT- EMIS/Cerner/other.
To cover the essential practicalities of the practice that I am working in. How to manage emergencies – where and how to use emergency equipment, how the on-call works, how to work effectively with the doctor on-call, adult safeguarding and child protection.
V3.0 - last updated March 2018
To: Meeting of the BHR Primary Care Commissioning Committee From: Sarah See Director of Primary Care Transformation Date: 28 November 2018 Subject: GMS Contract Refresh Programme Executive summary Due to the passage of time and significant changes within the NHS, there is a concern that both GMS Practices and Commissioners are not in possession of up to date, accurate or complete contract documentation, including all regulatory amendments that have been issued under statutory instruments. Having engaged with LMCs including assurance that most of the work would be carried out by Commissioners, it was agreed to refresh GMS contract documents, using the latest national template, would be mutually beneficial to all concerned. BHR is vanguard on this programme, which will be rolled out Londonwide. Practices have been asked to return their questionnaires by 30 November 2018. Recommendations • That the Committees note that the GMS Refresh process is in progress. 1.0 Purpose of the Report 1.1. To update the Committees on the progress of the GMS Contract Refresh programme 2.0 Background/Introduction 2.1. It was noted that practices within NEL currently hold a range of different versions of the GMS
contract and in many cases practices are signed up to the original 2004 contract. Due to the passage of time and significant changes within the NHS, there was a concern that both GMS Practices and Commissioners were not in possession of up to date, accurate or complete contract documentation, including all regulatory amendments that have been issued under statutory instruments.
2.2. Following discussion and engagement with LMCs, who were assured that these were refreshed
contracts, not new and that the majority of the work would be carried out by Commissioners, it was agreed that it was mutually beneficial to refresh GMS contracts using the latest available national template.
2.3. BHR is acting as the vanguard on this process, which will be rolled out across London Region.
Practices have been written to regarding the process (Annex A), including a questionnaire and FAQs. Practices have been asked to return their questionnaires by 30 November.
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3.0 Benefits 3.1. The main benefit for this programme is the assurance to practices, commissioners and LMCs alike
that appropriate contractual documentation is held accordingly. 4.0 Resources/investment 4.1. No additional funding is required and human resource demand will be managed within the NELCA
Team. 5.0 Equalities 5.1. There are no known equality issues resulting from the issuing of a remedial notice. 6.0 Risk 6.1. If the programme is not carried out then all interested parties have a risk of not holding appropriate
contractual documentation. 7.0 Managing Conflicts of Interest 7.1. All GP Practices in BHR are conflicted, which will be managed through existing NELCA and PCCC
processes and guidelines Attachments Annex A – GMS Refresh Letter Questionnaire and FAQs
Author: Tony Curtis Senior Primary Care Commissioning Manager Date: 9th November 2018
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Annex A
Dear Colleague,
Re: Refresh of GMS Contract Documents in North East London
I am writing to inform you that Commissioners in North East London will be undertaking a programme to refresh GMS contract documents to move them to the most up to date version, based on the national template. This exercise is purely about ensuring that practices’ contracts are robust and fit for purpose, thus benefitting both parties.
Practices within NEL currently hold a range of different versions of the GMS contract and in many cases practices are signed up to the original 2004 contract. Due to the passage of time and significant changes within the NHS, there is a concern that both GMS Practices and Commissioners are not in possession of up to date, accurate or complete contract documentation, including all regulatory amendments that have been issued under statutory instruments. Hence, the need to undertake this exercise.
We have engaged with local stakeholders, including LMCs on this matter and have committed to undertake this exercise in such a way as to ensure that the bulk of the work is undertaken by commissioners and any workload for practices is minimal. This is also an opportunity for you to ensure that your contract accurately reflects the current position of your practice such as partnerships, opt-outs or additional service provision.
NHS England has published the 2017/18 standard contract for General Medical Services which is the template that we will use to refresh your GMS contract can be found here –
We ask that you complete the accompanying short questionnaire and we will then populate the contract document for you and then return it to you for review and signing. This is not a variation or amendment process so there is no need for a consultation period.
We would be grateful if you could return the completed questionnaire to the generic email address [email protected] by Friday 30 November 2018.
A ‘Frequently Asked Questions’ (FAQ) sheet is included with the questionnaire, but if you have any questions or concerns then please do not hesitate to contact us, via the generic email address.
3. Is the practice opted out of ‘Out Of Hours’? (please see FAQs)
Yes No
If No (practice responsible for OOH) and sub-contracted - name of provider
4. Does the Practice consider that it is opted-out of any Additional Services funded under the Global Sum (please see FAQs)
Yes No
If Yes, please tick those services you believe you have opted-out of (we will review existing contracts and records)
Additional Service Tick opted-out services
cervical screening services
contraceptive services
vaccines and immunisations
childhood vaccines and immunisations
child health surveillance services
maternity medical services
minor surgery
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5. Does your practice provide Additional Services for other practices?
Yes No
If yes, please tick those services and list the practices you deliver the additional service for? (we will review contracts and records to ensure that you are appropriately remunerated for this provision)
Additional Service Tick service provided
Practices service is provided for
cervical screening services
contraceptive services
vaccines and immunisations
childhood vaccines and immunisations
child health surveillance services
maternity medical services
minor surgery
6. Do you wish to be considered as a ‘Health Service Body’ for the purpose of the contract (If a practice opts to become a health service body, contract disputes will have to be dealt with through the NHS dispute resolution regulations. There is no alternative. If a practice holds a private law contract i.e. does not elect to become a health service body, it can choose to use either the NHS dispute procedure or use the Courts in relation to any particular dispute (source – BMA website)).
Yes No
7. Practices are required to have a nominated lead for Information Governance (IG). Could you please provide details of your nominated IG Lead? Name: Position:
To: Meeting of the NHS Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee
From: Sarah See, Director, Primary Care Transformation Date: 28 November 2018 Subject: General Data Protection Regulation & UK Data Protection Act: General Practice Assurance
Framework (2018) Executive summary The General Data Protection Regulation (GDPR) standardises data protection law across all 28 EU countries and imposes strict new rules on controlling and processing personally identifiable information (PII). GDPR replaces the 1995 EU Data Protection Directive and came into force on 25 May 2018 and coupled with a new UK Data Protection Act (DPA 20181) which received Royal Ascent on the 23 May 2018, impacts on health, including General Practice.
To date BHR CCGs have commissioned a series of workshops aimed at advising practices on the requirements of both GDPR and DPA, alongside the development of an asset register template; however, at the time of writing this paper, the CCGs remain unclear whether the practices across BHR have enacted these legal requirements. In discussion with the GP IT team, the primary care team has determined that an assurance audit (framework) of General Practice needs to be undertaken to:
1. Establish base line compliance in relation to GDPR/DPA, and 2. Set out recommendations for next steps following the collation of this information.
The purpose of the audit (assurance framework) is not to be a punitive exercise against practices, but to ascertain the level of compliance, advise practices of what other actions they need to take and agree any appropriate actions across the respective boroughs to assure ourselves of compliance by end of March 2019.
Recommendations The Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee is asked to: • Note the legal requirements set out within this report and the implications for General Practice • Approve the actions to assure General Practice in relation to the GDPR/DPA (2018), and • Receive a further report outlining recommendations and next steps in April 2019.
1 Data Protection Act (2018) http://www.legislation.gov.uk/ukpga/2018/12/contents/enacted
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1.0 Purpose of the Report 1.1 The purpose of this report is to outline the approach that Barking & Dagenham, Havering and
Redbridge CCGs (BHR CCGs) will undertake to assure General Data Protection Regulation (GDPR) and Data Protection Act (DPA) compliance in General Practices across BHR. The report will explore why the CCGs need to enact this assurance, the method by which they will do so, timeframe for delivery and next steps.
2.0 Background 2.1 The General Data Protection Regulation (GDPR) standardises data protection law across all 28 EU
countries and imposes strict new rules on controlling and processing personally identifiable information (PII). GDPR replaces the 1995 EU Data Protection Directive and came into force on 25 May 2018. This coupled with a new UK Data Protection Act (DPA 20181), which received Royal Ascent on the 23 May 2018, impacts on health, including General Practice.
2.2 Whilst the GDPR is based on the same data protection principles as before, it introduces new rights for data subjects and non-compliance can result in enforcement and penalty notices, as well as significant fines (up to 20 million euros or 4% of annual turnover – whichever is higher).
2.3 Many of the main concepts and principles set out in the GDPR are much the same as those in the previous DPA (1998). Therefore, GP practices that are already complying with current law will find that much of their approach to compliance will remain valid under the GDPR.
2.4 However, there are new elements and significant enhancements that General Practice(s) will need to be aware of and act upon to ensure compliance with the Act. • Familiarise themselves with the GDPR and the new DPA (2018) • Identify a ‘Data Protection Officer’ • Know where to find Information Governance (IG) support2 • Establish an asset register which captures what data the practice holds and with whom it is
shared. • Establish a data flow register which captures inbound/outbound data within the GP practice.
2.5 While the Care Quality Commission (CQC) will not directly assess GDPR compliance in General Practice, inspectors will be interested in how practices assure themselves that they are meeting their responsibilities to protect patient data. This comes under well-led key lines of enquiry - “Is appropriate and accurate information being effectively processed, challenged and acted on?”
2.6 Commissioners of primary care services (namely NHS England and CCGs) will also have a responsibility to assure compliance with regard to the GDPR in accordance with their commissioner- contractual responsibilities.
2 NHSE Regional Teams will ensure the provisioning of a local IG support service for primary care contractors
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3.0 Report Content 3.1 BHR CCGs - Commissioner actions to date
An options paper on the principles of GDPR and the DPA (2018) was sent to the LMCs in May 2018 (see Appendix 1). This paper set out the legal compliance requirements required from General Practice as set out within the new DPA (2018), as well as setting out a range of options for General Practice to consider in the identification of a Data Protection Officer. The LMCs are still considering this position paper and have yet to respond to the CCGs. Since May 2018 the CCGs have also provided: • GDPR (DPA 2018) one day training for General Practice across BHR CCGs; over 80
practices across BHR attended this training • Developed and piloted an asset register template for use by general practice to capture
practice-based assets and data flows, and • The CCGs GP IT team established a Data Protection Officer Support role in accordance with
recommendations made by NHS England. This practice support role and what this means for General Practice will be re-iterated to practices in December 2018.
3.2 Compliance and Assurance
3.2.1 Practices, Federations and Assurance At the current time of writing this paper the CCGs remain unclear whether practices across BHR have enacted these legal requirements as set out within the DPA (2018). The Act (having received Royal Ascent on 23 May 2018), was due to have been in place (enacted) on or before the 1st November 2018. In discussions with the three GP Federations across BHR it has come to light that they (the Federations) are also unclear about their supportive provider role in GDPR compliance across their networks and practices, but, have started to have initial conversations with networks and practices about the compulsory deliverables: namely the DPO role, practice registers and the Data Security and Protection tool (DSPT) (replacement for the IG Toolkit). At the time of writing this paper, Redbridge Federation have written out to all practices to ask if they would be interested in collaboratively signing up to a DPO assurance functionality which will be outsourced to a private company. This company will supply the DPO functionality for Redbridge practices, as well as providing the tools for delivery around data protection assurance: namely templates and the DSPT toolkit. Practices will be expected to share costs between them. To date all 38 PMS/GMS practices in Redbridge have signed up to this arrangement (thus far this has excluded APMS practices, but the Federation will discuss this with the two practices, one of whom is part of a national corporate organisation and may have this functionality/compliance supported already). Havering and Barking and Dagenham Federations with their associated practices have been asked if they would be interested in this model. However, both Federations have assured the CCGs that they are exploring options at this current time.
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3.2.2 Commissioner Assurance As the DPA became law from May 2018, some five-months hence, the CCG now wish to ensure that compliance has been enacted in General Practice and that they are compliant with the GDPR and DPA (2018). In discussion with the CCGs GP IT team, the primary care team has determined that an assurance audit of General Practice needs to be undertaken in December 2018 to:
• Establish base line compliance in relation to GDPR/DPA, and • Set out recommendations for next steps following the collation of this information.
The purpose of the audit (assurance framework) is not to be a punitive exercise against practices but to ascertain the level of compliance, advise practices of what other actions they need to take and agree any appropriate actions across the respective boroughs to assure ourselves of compliance by end of March 2019. GDPR/ DPA General Practice Assurance Framework 2018/19
GDPR General Practice Compliance Compliant Y/N
Evidence (please embed)
Remedial Action if N (attach action plan)
Workforce Compliance
1. Mandatory appointment of a Practice Data Protection Officer (DPO).
Name of DPO
2. Have all staff (clinical and non-clinical) within the practice undertaken GDPR/DPA awareness training.
Has the DPO lead (as named above) undertaken a 5-day or higher level GDPR /DPA course.
Evidence required- names of staff with dates of training.
Policy Compliance
3. Practices have all necessary GDPR policies and procedures in place, with systems in place to monitor compliance with the GDPR.
4. Practices are aware of the legal requirements to notify the regulator -the Information Commissioner’s Office (ICO) of security breaches within 72 hours.
Breaches should also be reported on the DSP Toolkit.
Outline the evidence within practice policy
5. Practices evidence within their charging policy/guidance that they
Outline the evidence
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have removed charges (in nearly all cases and except for where the request is unfounded or excessive) for providing copies of records to patients or staff who request them under Subject Access requests (SAR).
Practices indicate that written requests are turned around within one month of receipt.
within practice policy
6. Practices have policies and systems in place to consider data protection issues in all information processes.
Outline the evidence within practice policy
Compliance-Registers
7. Practices have in place a register of data processing activities (see appendix 3).
Evidence data flow template
8. Practices have in place Data Protection Impact Assessments -required for high risk processing (including the large-scale processing of health-related personal data).
Please evidence DPIA template for use
9. Practices have in place an asset register (see appendix 3). Evidence
asset register template
Data Security
10. A business continuity plan is in place to respond to threats of data security, including significant data breaches or near misses. A business continuity exercise is run
every year as a minimum, with guidance and templates available from [CareCERT Assurance]. A report will be issued to senior
managers.
Those in key roles will receive dedicated training, ensuring that planning is modelled around the needs of their own business.
Evidence of continuity plan
Evidence of Continuity Exercise report issued to senior management.
Evidence required- names of staff with dates of training.
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Patient Facing Notices
11. Privacy notices are displayed in the practice and on the practice website.
Leaflets are displayed at reception and/or leaflets given to new patients or provided with prescriptions.
Other notices: i.e. telephone messaging.
Evidence of privacy notice
Screen shot website
Evidence of leaflets used
3.3 GDPR Assurance Framework (audit) Timeframe
The approach and timeframe for undertaking the audit is outlined below: 1. Discuss the General Practice Assurance Framework approach (audit) with LMCs (BDH - 1
November 2018/ Redbridge-15 November 2018). 2. Present the General Practice Assurance Framework Report to NEL SMT for comment and
consideration (5 November 2018). 3. Present the General Practice Assurance Framework Report to the Primary Care
Commissioning Committee (PCCC) for approval (28 November 2018).
4. Present the General Practice Assurance Framework Report to the Data Protection Steering Group (DPSG) on 30 November 2018. Obtain agreement that this audit should be undertaken and that the Senior Responsible Officer (SRO) for this work should be the Director with the responsibility for the GDRP/DPA.
5. Liaise with the SRO for GDPR/DPA on the support package for primary care, ensuring that
practices are aware of the CCG data protection support offer. Flyer to be developed. To complete by December 2018.
6. General Practice Assurance Framework audit to be sent out to General Practice: Timeframe:
dispatch date 3 December 2018 - return date 14 January 2019. 7. Collate report findings by 31 January 2019. 8. Share GDPR/DPA Assurance and Recommendations Report with NEL SMT (4 February
2019). 9. Share GDPR/DPA Assurance and Recommendations Report to the DPSG (25 Jan 2019)
outlining audit results and recommendations / next steps. 10. Share GDPR/DPA Assurance and Recommendations Report to PCCC on 20 February 2019.
For approval and next steps. 11. Work with the Federations, networks and practices and, with the LMCs, to resolve
outstanding actions from the audit. To complete by April 2019.
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4.0 Resources
4.1 There are no known additional resource implications / revenue or capital costs arising from this
report. The cost of time and effort to undertake this audit has been met from within existing resources.
4.2 By undertaking this audit and applying recommendations and next steps with the providers,
namely: the three federations, ten networks and practices, the CCGs will ensure that General Practice across BHR meets its legal compliance in relation to GDPR/DPA. There may be resource implications with the recommended actions, but these will be included in the final report.
5.0 Equalities
5.1 There are no implications in relation to equality and diversity and indeed identification of GDPR
compliance will ensure a positive impact on equality and diversity (patient’s right to privacy, data sharing and patient consent).
5.2 An equalities impact assessment has not been undertaken. 6.0 Risk
6.1 There is a risk that General Practice across BHR will not be fully compliant with the GDPR/ DPA
(2018). Thus, recommendations following this audit will be critically important to inform next steps and resolve of any noncompliance issues.
6.2 The risks are not captured on the governing body assurance framework or risk register. Any risks
identified will be managed in accordance with the risk management strategy. 7.0 Managing conflicts of interest 7.1 There are no conflicts of interest in issues raised in this paper. Appendices: Appendix 1: Options Paper re DPO (May 2018) Appendix 2: Further GDPR Information (FAQ) Appendix 3: GP Toolkits: GDPR
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Appendix 1: Options Paper re DPO (May 2018) To: Barking, Dagenham, Havering LMC and Redbridge LMC From: Sarah See, Director, Primary Care Transformation Date: 24 May 2018 Subject: Options paper: General Data Protection Regulation (GDPR) requirement for ‘Data Protection
Officers’ (DPOs) Executive summary The General Data Protection Regulation (GDPR) sets out the legal requirements for how organisations must handle and process personal data. It is significant and wide-reaching in scope and expands the rights of individuals to control how their personal information is collected and processed. The GDPR places a range of new obligations on organisations to be more accountable for data protection. One immediate key issue for general practice is the need to appoint a ‘Data Protection Officer’ (DPO) who should have data protection experience, be accountable to the senior levels of an organisation’s management and fulfil the DPO tasks set out in the GDPR. The GDPR comes into effect on 25 May 2018 so is imperative that general practice is able to comply with the new legal requirements that have been put in place with minimum delay. This paper is intended to help highlight these new legal requirements to GP practices as well as provide some options on how they might deal with the administrative burden that implementation, ongoing monitoring and compliance will generate. Six potential options are presented for consideration. Recommendations
Barking, Dagenham, Havering and Redbridge LMCs are asked to:
• Note the contents of this paper; • Consider the six options presented; and • Decide on how best to ensure GP practices comply with new data protection
regulations set out in the General Data Protection Regulation (GDPR), and advise the CCG of the preferred option
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1.0 Background/introduction
1.1 European privacy rules set out in the General Data Protection Regulation (GDPR) will come
into British law and update the existing Data Protection Act (DPA 1998). It will come into full effect on Friday 25 May 2018 and coupled with a new UK Data Protection Act (DPA 20183) will impact on everyone, including GP practices, irrespective of the ‘Brexit’ process.
It is probably the most important data legislation change of recent times, it will match data privacy laws across Europe and will also apply to organisations outside the EU that offer goods or services to individuals in the EU.
Whilst the GDPR is based on the same data protection principles as before, it introduces new rights for data subjects and non-compliance can result in significant fines (up to €20m or 4% of annual turnover – however the Information Commissioner has said that issuing fines will continue to be a last resort).
2.2 Many of the main concepts and principles set out in the GDPR are much the same as those in the current DPA (1998). Therefore, GP practices that are complying with current law will find that much of their approach to compliance will remain valid under the GDPR. However, there are new elements and significant enhancements that practices will need to be aware of and act upon.4
2.3 Key initial basic requirements for GP practices are to:
• Familiarise themselves with the GDPR [and the new DPA (2018) once its provisions have been set]
• Identify a ‘Data Protection Officer’
• Know where to find Information Governance (IG) support5
• Establish an asset register which captures what data the practice holds and with whom it is shared (the CCG is developing a template for practices to adapt and forthcoming training will cover competency and utilising the asset register)
2.4 Data Protection Officers (DPOs) will need to have data protection experience or receive the appropriate level of training, be accountable to the senior levels of an organisation and fulfil the DPO tasks set out in the GDPR. A formal DPO can be a shared resource between organisations eg one individual may be the formal DPO for multiple GP practices (ref: see footnote 2). It is important to note that appointing an appropriate DPO is only the start. GDPR and data protection requires ‘buy-in’ from everyone; as meeting GDPR needs will involve changes to processes and change management.
3 The new DPA 2018 is still undergoing Parliamentary scrutiny and has not yet therefore come into effect 4 Download ‘GDPR: General Practitioner Advice Note’ - available here: https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-
governance/information-governance-alliance-iga/general-data-protection-regulation-gdpr-guidance 5 NHSE Regional Teams will ensure the provisioning of a local IG support service for primary care contractors
The CCG has developed a number of options for LMCs to consider and discuss with their members to ensure practices meet the requirements of this compulsory role: Options Benefits Negatives Funding
1. All GP practices appoint their own, practice-specific DPO
Responsibilities begin and end with individual practices
Individual practices may struggle to fully get to grips with the new requirements – multiple duplication of efforts across practices
GP practices to employ, fund and if necessary train DPO post
2. Groups of practices (e.g. networks) appoint a DPO resource
Potential for economies of scale and less duplication of efforts than Option 1
Issues around capacity - appointee likely to have other demands on their time – multiple duplication of efforts across groups of practices
Each GP practice would need to contribute towards funding DPO post; CCG may fund any necessary training
3. GP Federations appoint a DPO resource for all their member GP practices - effectively Borough-wide
Potential for economies of scale and less duplication of efforts (greater than Option 2)
Issues around capacity - appointee likely to have other demands on their time – more so than Option 2 due to covering more GP practices – multiple duplication of efforts across GP Federations
Each GP practice would need to contribute towards funding DPO post; CCG may fund any necessary training
4. Groups of practices (e.g. networks) commission a DPO resource for all GP practices within their Network
Potential for economies of scale – provider has expertise
Cost unknown – could seek indicative figure from NELCSU
Each GP practice would need to contribute towards cost; provider would do training
5. GP Federations commission a DPO resource for all their member GP practices – effectively Borough-wide
Potential for economies of scale (greater than Option 4) – provider has expertise
Cost unknown – could seek indicative figure from NELCSU
Each GP practice would need to contribute towards cost; provider would do training
6. All x3 GP Federations operating across BHR work together to commission a single DPO resource for all their member GP practices - effectively covering Barking & Dagenham, Havering and Redbridge
Potential for economies of scale (greater than Options 4 & 5) – provider has expertise
Cost unknown – could seek indicative figure from NELCSU
Each GP practice would need to contribute towards cost; provider would do training
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Appendix 2 Further GDPR Information (FAQ). A Data Protection Officer (DPO) has formal responsibility for data protection compliance within an organisation. The appointment of a DPO under the EU General Data Protection Regulation (GDPR) is mandatory in three situations: when the organisation is a public authority or body, or when the organisation’s core activities consist of either: 1. Data processing operations that require regular and systematic monitoring of data subjects on a
large scale; or 2. Large-scale processing of special categories of data (i.e. sensitive data such as health, religion,
race, sexual orientation, etc.) and personal data relating to criminal convictions and offences. GP practices and their status as independent contractors All practices which provide services commissioned through NHS England are public authorities, therefore it is mandatory that they designate under the regulation, but they do not necessarily have to employ or retain, a DPO. However, the designation must have taken place by 25th May 2018. What are the options for a GP practice to appoint a DPO? Designation is a decision to be made by the practice. The DPO is expected to monitor compliance, however, responsibility for compliance remains with the data controller and data processor. Large practices and multi-practice groups are likely to have in-house DPOs, but smaller practices may prefer to designate external DPOs that could for instance be provided by a Clinical Commissioning Group, Business Services Organisation or local/regional health board. There are several options regarding designation of a DPO: a) Employ a new member of staff with specific knowledge, qualifications and experience. b) Appoint somebody who already works in the practice with the necessary knowledge, qualifications
and experience, or who has the ability to acquire the necessary skills with suitable training. This person can add the DPO's requirements to other responsibilities, for example maintaining records of processing activities. DPOs must not be the final decision-makers regarding data processing; for example, they cannot be the data controller and must avoid any conflicts of interest.
c) Share a DPO with one or more practices. A CCG may be able to help facilitate this but is unlikely to be able to fund such a person.
Although a practice must appoint a DPO, there is no reason why they shouldn’t be supported in the role by a more experienced person, such as an information governance lead in the CCG, federation or group of practices. CCGs and/or federations could then develop a local network to support those with a DPO role in the area. What if I choose to share a DPO? In deciding upon a shared DPO you will need to consider factors such as: • the sizes of the practices • the numbers of patients • whether the DPO is genuinely going to be in a position to understand and advise each individual
practice and monitor compliance.
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Does every DPO need to be an expert in data protection law? No, Clause 97 states that in relation to the DPO; “... a person with expert knowledge of data protection law and practices should assist the controller”, it then continues in the same clause with “The necessary level of expert knowledge...” So GDPR accepts there will be different levels of “expert knowledge” needed according to the sort of processing being done, some will need more expert knowledge than others. It is recognised that they will not fully understand all the ramifications of the new legal requirements from 25 May, and they will need to keep up to date with any changes and clarifications (for example from the ICO) and understand how these changes impact the practice, as the law becomes embedded. Their knowledge can be added to through a network of practice DPOs supported by a lead with the necessary expertise in the CCG or GP Federation. What is the role of a DPO in a GP practice? The DPO is an essential role in facilitating ‘accountability’ and the practice’s ability to demonstrate compliance with the GDPR. What this means on a day to day basis is the DPO reports directly to the highest management level in the practice, normally the senior partner or partners. They don’t require line management but must have access to the senior management team of the practice. The practice must also ensure the DPO has sufficient resources to undertake the role, including financial and human resources. As noted above, the DPO will need to keep up to date with any changes and clarifications and they must be supported by the practice to do so. More specifically, the DPO will ensure that information governance and related policies address: • practice accountability • DPO reporting arrangements • timely involvement of the DPO in all data protection issues • compliance assurance: privacy by design and default • advising on where data protection impact assessment is required • the DPO’s role in incident management The practice must ensure the DPO is not told how to carry out their function and does not face any disciplinary action, dismissal or other penalties for carrying out their tasks as a DPO. They must also ensure that where the DPO performs another function within the practice, there is no conflict of interest and that the contact details of the DPO are published in the practice’s transparency information for subjects and are communicated to the ICO. The DPO must not hold a position that leads him or her to determine the purposes and the means of the processing of personal data – this requirement will vary depending on whether the DPO is an internal or external appointment. In most cases, the data controller will be the GP practice rather than an individual GP and internal practice decisions about data processing (i.e. the purpose and means of processing) will be subject to the governance arrangements of the practice partnership. This means it might be possible for GP partners to fulfil the role of DPO provided the role is defined to avoid conflict of interests and decisions are documented. In summary, the principal tasks of the DPO in a GP practice, as determined by the GDPR are: • to provide advice to the practice and its employees on compliance obligations • to advise on when data protection impact assessments are required and to monitor their
performance • to monitor compliance with the GDPR and practice policies, including staff awareness and
provisions for training
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• to co-operate with, and be the first point of contact for the Information Commissioner • to be the first point of contact within the practice(s) for all data protection matters • to be available to be contacted directly by data subjects – the contact details of the data protection
officer will be published in the practice’s privacy notice • to take into account information risk when performing the above What else do GP practices need to do to be compliant with the GDPR? The regulations require practices to identify and record what personal data has been collected from job applicants and carried through the employment lifecycle. This will cover data kept on HR information systems, in personnel files (both electronic and paper), and data saved on hard drives and emails. There isn't a prescribed format for how this data is held and it can take a variety of different forms as long as it fulfils the purpose of helping the practice to determine: What personal data is collected? Where is personal data stored? How is personal data processed? The GDPR requires a detailed record to be kept of personal data-processing activities - a data map such as outlined above can serve this purpose if it contains the necessary information. Article 6 of the General Data Protection Regulation (GDPR) states that processing of personal data will be lawful only if at least one of the following conditions applies: • The data subject has given consent to the processing of his or her personal data for one or more
specific purposes; • Processing is necessary for the performance of a contract to which the data subject is party or to
take steps at the request of the data subject prior to entering into a contract; • Processing is necessary for compliance with a legal obligation to which the data controller is
subject; • Processing is necessary to protect the vital interests of the data subject or of another person; • Processing is necessary for the performance of a task carried out in the public interest or in the
exercise of official authority vested in the data controller; or • Processing is necessary for the purposes of the legitimate interests pursued by the data controller
or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject (this condition does not apply to processing carried out by public authorities in the performance of their tasks).
Practices will need to look at the types of employee data they process and the processing activities they use and then determine which justification or justifications are relevant. If it's not possible to justify the processing activity with one of the available grounds, the practice will have to stop processing. Practices will have to take several technical and organisational measures to make sure data protection is incorporated into all procedures involving personal data. This will mean taking the following steps: • Reviewing policies and processes to ensure that only necessary data is collected, and that it is
only processed to the extent necessary; • The data must be stored securely; • Access to the data must be limited; • The data must be destroyed once it's no longer needed.
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Practices will no longer be able to charge a fee for patients to access their own information if requested under the GDPR as a SAR. However, solicitors are not permitted to seek a SAR to support an application that should be made under the Access to Medical Reports Act (AMRA), i.e., reports for employment and insurance purposes. This covers accident claims and insured negligence as well as mortgages and life insurance – anything covered by an insurance contract that requires a medical report. If a solicitor’s letter does not make the precise purpose of the request and report clear, then ask them if the report is being requested under GDPR or AMRA. If the report is to support an actual or potential insured claim, then AMRA applies. You can charge, and no additional information is needed. Where consent is used to process data (such as for research purposes or marketing to new patients) it must be explicit. Consent is not normally required for the processing of health data as Article 6(1) (e) of GDPR recognises that GPs process data on their patients because they are legally required to do so under The Medical Act, The NHS Act and contracts with the NHS.
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Appendix 3: GP Toolkits: GDPR • General Practice Data Flow register • General Practice Information Asset register • DSPT Assertions • NHS England Guidance- Privacy Notice example • Data Protection Training available from e-LFH • General Practice DSPT toolkit and Surgery Form* For a copy of the above documents please contact the Governance team on 020 3182 2913. *There are number of IT security based questions across a number of the data security standards which will be tested by BHR CCGs GP IT system within the next few months e.g. • Supported systems are kept up-to-date with the latest security patches. • All networking components have had their default passwords changed. • All organisations receive a penetration test annually, whether commercially sourced or in-house.
The scope of the pen-test is articulated to the SIRO and signed by them. • Data Security awareness training:
This has replaced the IG training tool. It is available via e-learning for health: https://nhsdigital.e-lfh.org.uk
• The Data Security & Protection Toolkit has replaced the IG toolkit. Information can be found here:
https://www.dsptoolkit.nhs.uk/ There is a version for General Practice. The new toolkit is linked to the ten data security standards, published by the National Data Guardian and CQC and link to the requirements of the GDPR. The levels of compliance in the IG toolkit have been removed and organisations are now required to comply with the assertions that relate to their organisational type and where evidence is required it is mandatory to provide it. Evidence is only asked for where it adds value. To pass the assessment an organisation must complete all of the mandatory items.
• Rather than refresh the respective BHR CCGs’ Primary Care Transformation Strategies, it is proposed to develop a programme of work in line with the national long term plan (due out in December) and the NEL Primary Care Transformation Strategy (under development) that puts primary care at the centre of the BHR Integrated Care System (ICS):
• This approach emphasises the fact that the ICS Strategy is our corporate strategy• It acknowledges the national and NEL strategy and priorities specifically set out for primary
care• It acknowledges the importance of primary care in the future model• It allows the CCGs’ resource to focus on refreshing a programme of work that delivers change
(ensuring resource is targeted on delivery) • Removes the potential confusion that having two strategies may pose, and • Utilising the plan on a page approach, building on the existing plan to set out the primary
care programme
Strategic approach that supports the BHR ICS Strategy
The programme will:
• Be clear about the role primary care plays in the integrated care system at all levels – networks, localities etc
• Demonstrate how primary care will support the development and delivery of the emerging model of care and roles
• Describe how GP Federations will be developed in the context of the Provider Alliance
• Set out how the programme will need to connect with other work streams • Align and cross reference to key projects such as Barking Riverside and frailty pilots
Strategic approach that supports the BHR ICS Strategy
Next steps:
• Agree approach with:MD and Chairs
Primary Care Clinical Directors
IJECBDH & Redbridge LMCs
BHR Primary Care Transformation Programme
Primary Care Commissioning CommitteeBHR Health & Care Cabinet
Strategic approach that supports the BHR ICS Strategy
To: Meeting of the Joint Committee of Barking and Dagenham, Havering and Redbridge CCGs From: Sarah See, Director, Primary Care Transformation Date: 28 November 2018 Subject: London-wide Minor Surgery: Cessation of Referral Portal Executive summary As part of the Minor Surgery DES, there is the ability for the provider to receive referrals from non-participating GP practices, for the provision of extended minor surgery services (excluding any services commissioned as an Additional Service). The function for managing the inter-practice referral scheme is currently provided by NHS England through an online London-wide portal. On 11 July 2018, NHS England has notified CCGs of the cessation of the inter-practice referral portal, detailing that the DES will remain available but participating CCGs/STPs will need to provide a local solution for inter-practices referrals with the below options:
1. Continue with the Minor Surgery DES by commissioning the existing portal from UKN Ltd, with cost implications in excess of £50k
2. Continue with the current DES, with local established inter-practice referral processes (claim process for GP Practices remaining the same as present)
3. Withdraw from the current DES and established a local service that meets required standards
for the provision of Extended Minor Surgery under Primary Medical Services Directions Surgery (not minor surgery under GMS/PMS additional services).
CCGs are required, by 30 November 2018, to confirm with the NHS England Minor Surgery DES Lead with what their alternative arrangements will be and assure that these will be in place by 31 March 2018 to ensure compliance with the Minor Surgery DES. A review of the current London-wide online portal has been undertaken with BHR CCGs communication team, and concluded that Option Two would be the most suitable option to take forward locally at this time, by developing a portal within the BHR CCG GP intranet. Recommendations Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee are asked to:
• Note the content of this paper • Approve Option Two (that is, continue with current Minor Surgery DES scheme and develop a
local portal) and • Agree that an engagement and communication plan needs to be developed to publicise the
above changes.
2
1.0 Purpose of the Report 1.1 The purpose of the paper is brief the Primary Care Commissioning Committee of the decision by
NHS England to decommissioning of the inter-practice referral portal (although this could still be available to CCGs, for a fee) and to approve the preferred option, option two – establishing a local CCG internal Minor Surgery portal.
2.0 Background 2.1 In 2014, NHS England developed the London model for the national Minor Surgery DES. Part of
the Minor Surgery DES was the provision of an inter-practice referral portal, which allowed non-participating practices (that is, practices choosing not to provide the minor surgery service) to refer patients requiring minor surgery to practices willing to provide the service on their behalf.
2.2 The portal was incorporated within a National IT contract between NHS England and UKN Ltd.
On the basis of value for money, NHS England have decided not to renew the contract with UKN Ltd.
2.3 NHS England managed to extend the provision of the portal for a further 12-months beyond the
main contract, however, this means that NHS England will cease to support the provision of the referral portal beyond 31 March 2019.
2.4 CCGs were notified of the cessation of the inter-practice referral portal by letter in July 2018, and
required to advise the NHS England Minor Surgery DES Lead with what alternative arrangements will be, to ensure compliance with the DES Directions, by 30 November 2018.
2.5 NHS England have also notified all GP practices that they will cease to support the service from
31 March 2019, detailing that the DES will remain available but participating CCGs/STPs will need to provide a local solution for inter-practices referrals.
3.0 Report Content 3.1 The current portal offers an ability for non-participating practices to refer minor surgery to
practices willing to provide the service on their behalf.
3.2 It also provides information for practices such as the service specification, Q&A etc. It does not have any data gathering or audit functionality in its present structures.
3.3 The use of the portal within each of the BHR CCGs has varied and the table below provides high
level detail on both activity by procedural level and details on the numbers of referred procedures carried out (based on submitted claims in 2017/18). It also provides the number of participating practices (based on the 18/19 DES sign-up)
CCG Level 1
Procedures provided*
Level 2*
Level 3*
No of participating
Practices providing
Minor Surgery DES
No of Referral
Practices
Practice Own
Activity*
Activity on behalf of
other practices*
Practice total activity
Barking & Dagenham
1344 252 0 22/35 5 1518 78 1596
Havering
2700 1715 0 29/44 8 2045 655 4415
Redbridge 1607 567 0 25/42 8 1194 413 2174
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Options Pros Cons
1) Continue with the Minor Surgery DES by
commissioning the existing portal from UKN
Ltd, with cost implications in excess of £50k
The portal is currently live with a
majority of GP practices using on a
regular basis, no amendments would
be needed.
This will incur cost implications for the CCG
and the portal only holds information not
data (no PID or activity data stored).
2) Continue with the current DES, with local
established inter-practice referral processes
(claim process for GP Practices remaining the
same as present)
Locally developed solution which is
timely as we move to a single BHR GP
intranet. Cost effective option with
same functionality as now.
Still won’t have the ability for practices to
submit activity returns – but this already
goes via NELCA team.
3) Withdraw from the current DES and
established a local service that meets required
standards for the provision of Extended Minor
Surgery under Primary Medical Services
Directions Surgery (not minor surgery under
GMS/PMS additional services).
This will enable the CCG to take full
ownership of a local service in-line with
the required standards
Withdrawing from the DES and establishing
a local service will occur cost implications
as well as establishing a claim process for
GP Practices, however this is an option that
can be scoped out during 19/20 to see if
there is potential for QIPP.
3.4 The preferred option (Option Two) – which offers the most like for like service for value for money
is for the development of a local internal Minor Surgery portal to be created within the current BHR CCGs’ GP intranet. This will enable easy access for GP Practices to obtain information required and for non-participating practices to refer minor surgery to practices willing to provide the service on their behalf.
3.5 The preferred option – which offers the most like for like service for value for money is for the
development of a local internal Minor Surgery portal to be created within the current BHR CCGs’ GP intranet. This will enable easy access for GP Practices to obtain information required and for non-participating practices to refer minor surgery to practices willing to provide the service on their behalf.
3.6 As well as an implementation plan to get the necessary information set up on the GP intranet, a
communications and engagement plan will be put in place to ensure all GP practices are aware of the new local portal and how this can be accessed, ensuring that both CCG and NHS England communications are coordinated.
3.7 A review is currently taking place of the GP intranets with the intent of combining the three GP
internets into one BHR CCG site for more easy access and navigation for GP Practices, the proposed minor surgery portal will be included within the review to ensure that functions are readily available.
3.8 It is suggested that this may be an interim step to secure the necessary offer to practices but
further work is required to review where all the non-participating practices refer their minor surgery, and how level 3 activity is managed. In the longer term – to ensure value for money and to stop unnecessary referrals going into secondary care (when these procedures can be undertaken in a primary care setting) – that a local minor surgery scheme would be more appropriate.
4.0 Resources/investment 4.1 No additional funding is required as a consequence of this report.
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5.0 Equalities 5.1 There are no equalities implications arising from this report. 6.0 Risk 6.1 There is a risk that no agreement on any option will leave a scheme un-managed and high-levels
of activity going through to secondary care, and also the risk for GP practices not managing their ongoing compliance measures.
7.0 Managing conflicts of interest 7.1 There are no conflicts of interests raised in this report.
Author: Mary Smith, Primary Care Improvement Lead Date: 16 November 2018
To: Meeting of the BHR Primary Care Committee From: Jane Gateley, Director of Strategy and Integration Date: Wednesday 28th November 2018 Subject: Barking Riverside Wellbeing Hub Executive summary Barking Riverside is a development in the south of Barking, near to Barking Town Centre. By 2037 there will be a new population of around 22,000 people, living in 10,800 new homes on what was previously brownfield site. The Developers are required to provide financial support for health and care infrastructure, and a new Wellbeing hub will be built to support the new population from 2021. In the short term (2016/17– 2020/21), the CCG is working with three existing practices in the vicinity; Dr John and Dr Kalkat’s practices at Thamesview, and the Maplestead Road GP practice to increase capacity and extend opening hours to provide primary care access to local people from 2017 to 2020/21, until the new facility is in operation. There is a deadline of November 2018 to provide a high level specification and outline of asks to Developers, in the form of a Single Client Brief and Schedule of Accommodation for the Wellbeing hub. This paper provides an outline of the key emerging principles and asks for the ‘clinical’ element of the space. Recommendations The committee is asked to: • Review and comment on the emerging principles for the clinical element of the wellbeing space
(attachment 1) • Receive a further report in 2 months 1.0 Purpose of the Report 1.1 This paper introduces the outline of the key emerging principles and asks for the ‘clinical’
element of the Wellbeing Hub (as set out in more detail in attachment 1) that is being developed in Barking Riverside to serve the 22,000 new residents coming in to the area up to 2037.
1.2 Committee members are asked to review and comment on the emerging principles for the clinical element of the wellbeing space.
2.0 Background/Introduction 2.1 To address the shortage of affordable housing in London, the Greater London Authority in
conjunction with LBBD are creating a residential neighbourhood along two miles of the Thames Estuary on the former Barking Power Station site. It is a 443-acre area close to Barking town centre, Canary Wharf and the Lower Lea Valley called Barking Riverside. The development is one of NHS England’s “Healthy New Towns” and provides us with the opportunity to design and embed innovative new approaches to health and wellbeing.
2.2 The significant re-development will accommodate 10,800 new homes and a population increase of around 22,000 residents by 2037 in 4 phases. Phase 1 is ongoing and 50% complete with c.750 out of c.1,400 new homes built and occupied together with 3 primary schools, a secondary school, a community centre, and retail space.
2.3 The developers are obliged under planning regulations to make financial contributions for new
community and health infrastructure that is required to support the development. 2.4 In the short term (2016/17– 2020/21), the CCG is working with three existing practices in the
vicinity; Dr John and Dr Kalkat’s practices at Thamesview, and the Maplestead Road GP practice to increase capacity and extend opening hours to provide primary care access to local people from 2017 to 2020/21, until the new wellbeing facility is in operation.
2.5 In the long term (2020/21 onwards), a new model of care and different type of contract for both
health and social care that meets the needs of this new population is required.
2.6 This development affords BHR Clinical Commissioning Groups the opportunity to crystallise our discussion and strategy around new models of care and integration, in an area of high deprivation; at a time when the national health and care agenda supports this approach.
2.7 The new model needs to be flexible, seamless and person orientated, with a focus on wellbeing,
getting things right first time, and improving outcomes for local people.
2.8 The Barking Riverside development is moving in to phase 2 of the four phases of the build; this is the phase during which the Wellbeing Hub will be built. The Developer has requested submission of a Single Client Brief towards the end of 2018 from Barking and Dagenham Local Authority and Barking and Dagenham Clinical Commissioning Groups, setting out the high level quantum of space in a Schedule of Accommodation, highlighting key requirements.
3.0 The emerging model of care and wellbeing 3.1 To meet the Developer’s deadline for submission of the Single Client Brief, BHR CCGs
alongside Barking and Dagenham Local Authority convened a Barking Riverside System Development Board which has overseen an initial series of five key workshops, alongside a programme of engagement with local people to feed into the development of the proposed model of care, and from this, ascertain key requirements of the physical building and wider Riverside environment.
3.2 The first workshop was linked to the Barking and Dagenham Health and Wellbeing board meeting, with additional leads invited to join the discussion, including local ward Councillors, with a focus on the type of outcomes that we would like to achieve through the new model of care for the people of Barking Riverside and wider Thames Ward area which will eventually form the fourth Locality in B&D.
3.3 The second and third workshops were independently facilitated by Mike Farrar using a ‘richly imagined futures’ technique to project the type of integrated service envisioned to be delivered from the hub in the future (to achieve the outcomes described in workshop one), and then work back to map out the requirements of the space and other key workstreams such as workforce and IT, to enable delivery of this.
3.4 The fourth and fifth workshops were facilitated by WIGs, community engagement specialists
already working with the Developer to engage local people in the emerging proposals for the site, and were focussed on firming up the key requirements of the space and enabler programmes to deliver the emerging proposed integrated model of care and wellbeing.
3.5 The workshops were well attended by a range of key stakeholders from across health, care and the community and voluntary sector. Alongside the workshops LBBD and BHR CCGs commissioned a targeted engagement programme with local people to feed in to the development of the emerging proposals for the Single Client Brief.
3.6 There will be a leisure centre and community space within the footprint of the hub, alongside the clinical space, and the emerging principles from the workshops and engagement with local people suggest that these spaces should feel integrated and seamless; there is particular opportunity to capitalise on linking health and wellbeing services with the gym/leisure facilities, and to community assets such as education campuses e.g. the nearby Riverside Campus School, and other schools in the area.
3.7 This paper specifically focusses on the clinical elements of the space, however, emerging principles for the way that the clinical space interacts with the leisure, community and education spatial elements of the Hub are referenced in the emerging proposal for the clinical space (attachment 1).
3.8 The ‘Barking Riverside; straw man for clinical space and emerging model of care/wellbeing’
document (attachment 1) sets out the emerging principles for the clinical elements of the wellbeing hub space alongside the key requirements the space must accommodate to deliver the emerging model of care, some of the key principles include:
3.8.1 The service will be jointly procured by B&D CCG and LBBD 3.8.2 The service will be delivered by a single provider alliance through a single contract; the
form of which is to be explored 3.8.3 There will not be a standard GP practice with a list size, however, General Practitioners
will be key to leading the team / model of care 3.8.4 The space will be as flexible as possible to ensure that it is able to adapt to a model of
care that will evolve over time to meet the changing needs of the local population
3.9 These proposals are being shared with a number of key forums and stakeholders; the schedule of socialisation within attachment 1 maps this out in more detail.
3.10 The ‘Barking Riverside; straw man for clinical space and emerging model of care/wellbeing’ document (attachment 1) is being used to inform the detail of the Schedule of Accommodation for the clinical space, and is feeding in to the information being submitted to the Developers at the end of November as part of the requirements of the Single Client Brief for the wellbeing hub space.
3.11 Next steps for the further development of these proposals are in discussion but will include;
3.11.1 Further engagement with local people and the community and voluntary sector 3.11.2 Further development through a clinical and professional operational group 3.11.3 Discussion and ongoing work with the Developer, designers and architects for the
wellbeing hub building and wider environment 4.0 Resources/investment 4.1 Estates and Technology Transformation Fund (ETTF) monies have been utilised to support the
Barking Riverside development programme to date.
4.2 There may be some financial investment required on an ‘invest to save’ basis (subject to development of business case) for the testing of elements of the model of care at the nearby Thamesview Healthcentre who are taking forward a ‘frailty’ project based upon the principles of integrated care.
4.3 There may also be future financial investment implications for the delivery of the required
enablers for the model of care at Barking Riverside e.g. integrated IT systems; work is already underway to take forward these enabling programmes and they will support delivery of the wider BHR Integrated Care aspirations as opposed to solely benefiting the Barking Riverside development.
4.4 A business case will shortly be developed for the new Barking Riverside wellbeing hub, taking in
to account the anticipated frontloading of prevention activity and mapping this forward in terms of developing a model of care that is sustainable. This business case will go through a due diligence process and scrutiny, both locally and through NHSE processes.
5.0 Equalities 5.1 An initial equalities impact assessment has been undertaken for the Barking Riverside wellbeing
hub. This will be reviewed and updated as the programme, and build, progresses.
6.0 Risk 6.1 There are a number of key risks identified in relation to the Barking Riverside development, the
principle risk centres on the impact of any failure to develop a suitable wellbeing hub to meet the needs of local people.
6.2 Another key risk identified with the new model of care in the context of the BHR System Financial challenge, is the need to ensure that funding for the new population coming in to the area is in line with growth, rather than retrospective. BHR CCGs finance team are aware of this key risk and have initiated discussion with the Department of Health to consider how to address this.
7.0 Managing conflicts of interest 7.1 It should be noted that all providers of health and care are potential bidders/providers of the
services that will be delivered from the hub in the future. Attachments: 1. Barking Riverside; straw man for clinical space and emerging model of care/wellbeing
This model represents a radical, integrated approach to the promotion of wellness and wellbeing
It is assumed that the following services will be provided from the hub, with the configuration and integration of these services to be further developed/modelled (this is not an exhaustive list): Primary care services including General Practice, Practice Nursing, Health Care Assistants, District Nursing, Community Nurses and other Community Care services such as podiatry, leg ulcer and catheter clinics, MSK, Long Term Conditions services, Social Care, Mental Health services, IAPT, CAMHS, Childrens Services, physiotherapy, SALT, OT, potentially some acute services and potentially some Public Health services
Care Navigators will be key to the new service, which will have a stronger focus on embedding prevention and social prescribing. Care Navigators will be dynamic and approachable, with a similar culture/background to local people to engender trust and understanding. Their role will be key to unlocking support for the wider determinants of health e.g. depression due to poor housing / debt, and supporting local people to access the services and support that they need
Other new workforce roles will also be explored
The clinical space will accommodate the following diagnostics; Ultrasound, Phlebotomy and point of care testing
Diagnostics at the site will take into account, and factor into the London Strategy over the next one and a half to two years to centralise Laboratories to achieve economics of scale
Plans for phlebotomy to be delivered at the site will be considered as part of a wider phlebotomy strategy for Barking and Dagenham and BHR over the next two years to ensure economies of scale and future proofing of provision
There is a live procurement of Ultrasound services underway in BHR. This will reference the plans for provision of ultrasound atBarking Riverside so that the new provider will be aware of the requirement to deliver ultrasound testing from the Barking Riverside site and will factor this in their bid/proposal
Standard medical care including GP input will be a point of escalation rather than the first port of call
There will be a strong focus on providing holistic support including the wider determinants of health with parity of esteem for mental health
The model of wellbeing will be an asset based one; although services and care will be delivered from the hub, the whole of Barking Riverside is considered the footprint for the model of care and the success of the model is dependant on the Developers creating an environment that promotes and supports wellbeing i.e. accessible green space, ease of walking and cycling etc. and use of all community assets such as schools and local groups
Social Workers are included in the reference to the need for community and administrative space
There will be fully digital records; paperless will be the aim
8-8 opening 7 days a week is the aspiration, although at points during this time the clinical element of the service may be nurse led
Working hours of the team TBC however it is assumed that there will be circa three day shifts to ensure cover between the hours of 8am and 8pm
Principles
Commissioning The service will be jointly commissionedby the Local Authority and CCG There will not be a traditionalprimary care contract; GPs will be employed members of the wider team but will have a strong role in leading the
service
Delivery
The service will be delivered by a single provider alliance, there will not be multiple small contracts for differentelements of the service Neutral branding will be employed (not NHS focussed) that embodies empowerment,community and friendship to promote the concept of
‘wellness’ rather than a focus on illness Access to the leisure facilities will be key to the model of wellbeing and should feel part of an integratedoffer, not a separate service Staff members of the wellbeing hub should be able, if possible, to access leisure facilitiesthemselves to support their own wellbeing for example,
before and after shifts and during their lunch break
Estates
Clinical rooms / areas will be as flexible as possible to promote the most efficientuse of all space There should be common office space that promotes health experts, leisure experts and community solutions experts sharing their knowledge in
real time, as well as other professionals working in a “hot desking” arrangement with the aim that clinical space is used for clinicalsessions/purposes, and not administrative purposes
Areas for staff should promote interdisciplinaryworking across different teams and sectors The communityspatial element of the hub will be a key feature and where possible will be owned and led by local people; e.g. they will be able to
run community yoga classes in the space / run by a Community Interest Company etc. Physio and musculo-skeletalcubicles and shared gym to be provided in leisure zone of building (i.e. not included in these requirements for the health
zone), bearing in mind that some measures may have to be employed (e.g. privacy curtains around some areas) to ensure dignity and privacy requirements are met
There will be activity space for both adults and children in the waiting areas There will be some quiet waitingspaces There will be access to outside space which will include a community run garden/allotment There will be education space to train workforce and residents about health issues The wider site will offer more integrated living options e.g. student accommodation / preferentialmarketing of shared ownership homes for
wellbeing hub staff etc. The hub will be an area that promotes wellbeing;no smoking will be permitted on site and any food sold on the site should adhere to the same Gold
Standard as ‘Food for Life’ principles IT space requirement planned as single shared area Design needs to take into account that services will need to be clustered together in final building i.e. even if requirement for a service is one
room per phase in final configurationthese will need to be located together Ensure installation of a Hard standing outside capable of taking a mobile diagnostic unit (i.e. 40 + tonne unit) and supplied with point for high
speed (fibre optic) web connection and 3 phase electrical supply to future proof diagnostic provision
Key requirements the space must accommodate
Area Key requirements the space must accommodate Spec (if known)
Open and welcoming foyer
Contemporary retail concept / aesthetic where the space is open, used purposefully,and with minimal barriers wherepeople are greetedby a ‘concierge’ type person. Also option to book in electronically
Comfortable communalspace Space for Care Navigators to welcomepeople, discuss their issues, and guide them to the right place, be it within the hub or
elsewhere;social prescribing will be a key featureof the model and links to the community and voluntary sector Care Navigatorswill need accessto ‘privacy booths’ or a similar to ensure that people are able to discuss personal issues in
private / that their dignity and privacy is respected Space for tablets/computersforpeople to electronicallyself check in if required
Developer/Architects to seek an innovative solution to maximiseuse of the available space and promote flow based on our requirements, their experience, and bestpractice
Waiting area
Waitingarea integrated with rest of facility but with clear zones for next client to be seen to reduce potential time for clientto get to room; the Developer/Architectswill seek to develop a design that promotes seamless flow
Quiet ‘mental wellbeing refuge’ zone for clients who may find chaotic/noisywaiting rooms difficult
’Universal’ clinical rooms
Thesemust be flexible to enable different disciplinesto utilise them, they should be able to accommodatemultidisciplinaryworking, and take into account that there may be clinical wastedisposal requirements (e.g. Sharps for blood testing etc.)
If possible, the clinical rooms should potentiallyhave a ‘sliding wall’ system to accommodate larger meetings/sessions as required
There will need to be easy accessto clinical supplies e.g. bandages,wipes and space for appropriate disposal facilities forsoiled materials (e.g. sharps boxes, clinical wastebins etc.)
There must be space for the storageof clinical equipment e.g. blood pressure machines, thermometersetc. The clinical space will need to accommodatethe followingdiagnostics;Phlebotomy, Point of care testing and Ultrasound
We understandthat the traditionalmodel of primary care would require working room sizes Treatment Room 16m2 (access to both sides of couch) & Consult/Exam room 16m2 Developers should seek to build clinical rooms that are as universal as possible , with the option that theycan potentially have a ‘slidingwall’ system to accommodate larger meetings/sessions asrequired
Shared administrative space
administrativespaceneeds to support clinicians to complete administrative paper work outsideof clinical areas in way thatsupports informationgovernance and data protectionrequirements to be met. Single person offices will not be the norm and will require justification
Leisure staff will also have accessto this shared space All provider staff welfarefacilities and breakout space are provided on a shared basis
Open/shared space
There will be space for the Community and VoluntarySector to come togetherfor meetings, events, to hold classes e.g. yoga There will be space for the Community and VoluntarySector (how this will work in practiceTBD) There will be space for a community run kitchen (potentiallysimilar to the Barking Community Hospital model) with space
for the community to prepare and sell food, and seatingspace for local people to eat/drink There will be joint educationspace to train workforceand residents about health issues; this will need to accommodate
some computerpoints
Outside space
Community garden/allotmentspace Potentiallyan outdoor community kitchen Seating/waiting areasoutdoors Space for physical activityoutdoors
Other requirements
High speed internet links includingN3 required, Wi-Fi required through building and into the wider environment Accessto all IT system used in building from anywhere in building All system systems web based (or capableof fully operability over the web)
Hard standingoutside capableoftaking a mobile diagnostic unit (i.e. 40 + tonne unit) and supplied with point for high speed (fibre optic) web connection and 3 phase electrical supply
Key requirements the space must accommodate
Assumptions
Provider Alliance to confirm any additional specialistrequirements that will have implications for the building at this stage The clinical spacemust be suitablydesigned to enable the taking, storing and transport of bloods and other monitoringtests as would be expected of a community
practice The Developer/Architects will seek innovative solutions to maximise use of the available space and promote flow, proposing a configurationof the rooms and
available space that takes into the account the above requirements/spec, theirexperience, and best practice Pharmacy; we understand that initial conversations have taken place between Pharmacy leads and the Developer; there is a need to ensure as we move into the next
planning stagethat these discussionsare integratedwith the discussionaround the model of wellbeing development Dental; we understand that initial conversations have taken place between Dental leads and the Developer; there is a need to ensure as we move into the next
planning stagethat these discussionsare integratedwith the discussionaround the model of wellbeing development Minor Surgery Suite; will the needs of the populationjustifya requirementfor a minor surgery suite or is the site at Barking Hospital sufficient Local Authority/CCGstodiscuss collective investment in generic space e.g. joint administrative space and educationspace Leisure and wellbeing model colleagues to discuss their assumptions around the ‘community kitchen/café’space within the building to ensure that the assumptions
align and become a single, aligned proposal around this
Schedule of socialisation for the further development of this plan
To be shared with Organisation / role By When
Barking Riversidedevelopment workshop 4
Key Stakeholders from across B&D Fiona Peskett/EmilyPlane 08.10.18
B&D GP Federation Federation/Network meetings Fiona Peskett Via email w/c 08.10.18
Shelagh Smith Chief Operating Officer Fiona Peskett Via email w/c 08.10.18
Stefan Liebrecht Social Care Lead Fiona Peskett Via email w/c 08.10.18
Melody Williams/JoeFielder NELFT Fiona Peskett Via email w/c 08.10.18
Jason SeezBHRUT, Director of Strategy & Infrastructure
Jane Gateley 22.10.18 – phone call
Tracey Welsh / Kirsty Boettcher BHR CCGs; unplanned care lead Emily Plane 22.10.18
BHR CCGS EMT Executive Management Team Emily Plane 29.10.18
BHR CCGS Informal JointExecutiveTeam
Clinical and Officer leads Emily Plane 01.11.18
Geoff Alltimes Estates lead for London Jane Gateley / FionaPeskett Meeting arranged for 01.11.18
NEL Primary Care SMG NEL Primary Care SMG Emily Plane 05.11.18
ELHCP New Models of care worksteram New Models of Care group Ceri Jacob 06.11.18
Sam Everington GP & lead for the Bromley by Bow Centre
Jane Gateley / EmilyPlane24.10.18 – phone call
05.12.18 - Bow Centre site visit
BHR Health and Care Cabinet BHR Health and Care Cabinet Emily Plane December 2018
New model of care concept; example – to be further developed
One building that connects people with one another, with the assets within the wider communityand with a broad range of services to support their aspiration and needs
VISION:
An example of the type of model we are looking to design:
OFFICIAL
Health and high quality care for all, now and for future generations
Gateway no: 08520
Dear Practice Manager
RE: Data quality checks on GP patient lists
You will be aware that GP practices need to ensure their lists of registered patients are current and accurate. The accuracy of lists is important as it ensures patients get the care they are entitled to and GP practices receive the correct funding according to their list size.
On behalf of NHS England, Primary Care Support England (PCSE) is responsible for maintaining the national patient database NHAIS, (which in turn updates some patient data on the Spine), through the information you provide from the patient registration module in your practice clinical system. Our collective maintenance of accurate patient lists.
Our collective maintenance of accurate patient lists is essential to ensure:
• the efficacy of ill-health prevention/screening programmes and total population capture
• the assessment of performance and clinical outcomes which are often compared on a ‘per patients’ denominator; and
• appropriate use of public funds, as allocations are made on a £ per patient basis.
To assist with improving the quality of information held, PCSE will be carrying out the data quality checks on your registered list of patients. This will include a three yearly rolling cycle of reconciliation between your clinical system list of registered patients and the NHAIS system held in PCSE. PCSE will also begin checks on your list by contacting patients to confirm their registration status and address.
During this process you will receive emails from PCSE which will outline the steps you need to take to submit information about certain cohorts on your patient list. You
xx November 2018
OFFICIAL
Health and high quality care for all, now and for future generations
may also receive FP69 notifications which will ask you to check the status of patients, with whom PCSE have not been able to make contact.
Practices will be advised what actions need to be taken on their clinical system to correct any differences which may be identified, or to confirm the status of a patient.
In the first instance, PCSE will contact GP practices to verify the registration details of patients aged over 100. Other patient group checks will follow, including:
• patients aged under 16 recorded as living alone • patients recorded as living in demolished properties • patients recorded as being registered at student accommodation for over four
years • addresses with apparent multiple occupancy • transient patients.
Before checks on each patient group start, more detailed information will be sent to your practice about how to proceed. You can review policies here https://www.england.nhs.uk/commissioning/primary-care/ If you have any queries about these policies, please get in touch with your regional NHSE or CCG Primary Care Commissioning contact. If you have any queries about the list quality checks process, please contact the PCSE registrations team at [email protected] (please use this email address for questions on the data quality checks process only). For all other email enquiries for PCSE please go to https://pcse.england.nhs.uk/contact-us/
Yours etc
Emily Lawson National Director – Transformation and Corporate Operations Primary Care Support Services NHS England
16th November 2018 To: All GP practices CC: CCG Primary Care leads Dear Colleague, Winter Plans and Arrangements for Primary Medical Care Services during the
Christmas and New Year Period As we know, last winter was challenging for the NHS; however with thanks to the huge efforts of frontline primary care staff, more people were seen in primary care than the previous year. As you will be aware, Local A&E Delivery Boards are responsible for developing plans to ensure that there is sufficient capacity across the system to manage the expected surge in demand over the winter period, including Christmas and New Year.
Primary Care Services play a fundamental role in managing winter demands as part of the wider health and care system which has many interdependent services. It is important that each part of the system plays its specific role in order to minimise undue pressures on any one part of the system. In order to help address winter pressures, NHS England has brought forward plans to ensure everyone has easier and more convenient access to extended general practice services, with appointments in the evenings and at weekends. CCGs will have put in place services that deliver pre bookable and same day appointments by 1st October 2018. The intention is this additional access to general practice services should help to relieve pressure in primary care as well as the wider health care system, and will be made available during peak times of demand, such as bank holidays. Services will be widely advertised and we are asking practices to help by signposting patients to the appropriate services to ensure they receive the right care, in the right place, at the right time. This will include to the local extended access service in your areas. You can find further guidance on how to promote extended access services via the following link: https://www.healthylondon.org/resource/gp-extended-access-comms/ As the commissioners of Primary Care Services, NHS England and CCGs have responsibility to ensure patients have confidence in the availability of primary care services, including Primary Medical, Dental and Community Pharmacy, over the Christmas and New Year period. The expectations of Primary Medical Care over this period are as follows: Christmas and New Year’s Eve: In the run up to Christmas and New Year’s Eve, Monday 24th and Monday 31st December 2018 are normal working days. All our partner health and social care agencies are working on this basis. The expectation is that practices will be open at
full capacity from 08:00 to 18:30 and will take telephone calls throughout this period (unless alternative arrangements, as described in Appendix A, are agreed in advance with your Primary Care Commissioning team via [email protected]. Practices are reminded that transferring calls to 111 services during normal working hours is not appropriate due to the unnecessary pressure this places on other services. Those practices that provide Extended Hours on these days under the Directed Enhanced Service (DES) may wish to request a move of these hours to another day within the Christmas and New Year period to help meet any winter surge demand. Such requests will be checked by the CCG to ensure the plans align with the broader Local A&E Delivery Board plans for this period. We would also like to remind practices of the importance to ensure there is capacity and availability to deal with same day repeat prescriptions in order to prevent patients presenting on Christmas Eve having to wait four days to collect their prescription. We would encourage practices to consider increasing the proportion of same day appointments available over the busy winter period. Weekends over Christmas and New Year: Those practices that provide Extended Hours under the DES over the weekend on the 22 and/or 23 December 2018 and 29/30 December 2018 may again wish to request a move of these hours to another day within the Christmas and New Year period. The principles as outlined for Christmas and New Year’s Eve apply. Bank Holidays: Tuesday 25 and Wednesday 26 December 2018 and Tuesday 1 January 2019 are bank holidays and normal bank holiday arrangements should be in place to ensure that patients can access primary medical care during this period. These arrangements may be supplemented by specific Local A&E Delivery Board led initiatives (e.g. GP access hub capacity is available on all bank holiday days) to help manage the expected surge in demand over this period. Again, those practices that would normally provide Extended Hours on these days of the week may wish to request a move of these hours to another day within the Christmas and New Year period to help manage demand. Sharing Information: Where Extended Hours sessions need to be changed due to falling on one of the days listed above please consider how patients will be informed in advance by the practice, by utilising patient communications and the practice website. The call centre opening times are later in this letter. It would also be beneficial for practices to hold information for signposting to other local primary care services over the holiday period, including considering links on the practice websites, such as advising patients that:
By calling NHS 111 24/7 over the holiday period, they can get urgent care
advice and if they do need to be seen, NHS 111 can book appointments at either our GP out of hours service or the GP access hubs
Dental out of hours urgent advice can be accessed by calling NHS 111 NHS 111 can provide information on community pharmacy provision Walk-In services are located at Harold Wood Polyclinic, South Hornchurch
Health Centre, Barking Community Hospital and Loxford Polyclinic Urgent Care Centres at Queen’s and King George hospitals Promoting the use of the practice’s ‘e-consult’ service (if applicable) making it
clear that this service is only available when the practice is open GP access hubs which are operational across the holiday period, with
increased activity levels and earlier opening times on some weekdays. The call centre can be accessed by calling NHS 111 or 020 3770 1888. Opening times for the access hubs call centre across the holiday period are:
DATE Call Centre Times
DEC
20th Thursday 12:00 - 21:00
21st Friday 12:00 - 21:00
22nd Saturday 09:00 - 17:00
23rd Sunday 09:00 - 16:00
24th Monday 12:00 - 21:00
25th B/H Tuesday 10:00 - 15:00
26th B/H Wednesday 09:00 - 15:00
27th Thursday 12:00 - 21:00
28th Friday 12:00 - 21:00
29th Saturday 09:00 - 17:00
30th Sunday 09:00 - 16:00
31st Monday 12:00 - 21:00
JAN
1st B/H Tuesday 09:00 - 15:00
2nd Wednesday 12:00 - 21:00
3rd Thursday 12:00 - 21:00
4th Friday 12:00 - 21:00
5th Saturday 09:00 - 17:00
6th Sunday 09:00 - 16:00
7th Monday 12:00 - 21:00
We hope that this communication provides clarity in relation to commissioner expectations of Primary Medical Care over the Christmas and New Year period. If there are any questions please contact the contracting team via [email protected] . Thank you for your continued support hard work and commitment to providing high quality and safe services to NHS patients. Yours sincerely,
Alison Goodlad Head of Primary Care, NHS North East London Commissioning Alliance (On behalf of Barking & Dagenham, Havering and Redbridge CCGs)
Appendix A: Contractual considerations for practices If you plan any changes during Core Hours (08:00-18:30 Monday to Friday, excluding Bank Holidays) over the holiday period, you will need to confirm what arrangements are in place to deliver the contractual obligations. Whilst the GMS Contract Regulations regarding the provision of essential and additional services during “core hours” is not a “doors open” requirement, these provisions do impose a contractual responsibility on the Contractor for patient care during this period. This means that the practice retains responsibility for ensuring that the care provided during core hours is appropriate to meet the reasonable needs of your patients. It is not acceptable to close the doors and rely on an answer machine message advising patients to contact another provider where no prior arrangements have been made (e.g. contact 111 or attend A&E). If the practice is planning to close during core hours, then patients need to have clarity about how to access services. As a minimum, you will need to have a system in place so that patients can access the services listed below. These services have been distilled following engagement with patient groups and patient representatives so whilst not explicit in the contract these represent in broad terms the types of services that we expect will be in place to meet the reasonable needs of your patients;
Ability to attend a pre-bookable appointment (face to face) Ability to book / cancel appointments Ability to collect/order a prescription Access urgent appointments / advice as clinically necessary Home visit (where clinically necessary) Ring for telephone advice Ability to be referred to other services where clinically urgent (including for
example suspected cancer). Ability to access urgent diagnostics and take action in relation to urgent
results These will be accessible either by ringing the surgery and:
1. Being able to talk directly to a clinician to ascertain how they can access services if they need to;
2. An answer-phone message signposting the patient to an on-call GP service for the practice.
If the on-call GP service arrangement is part of a service commissioned by the CCG (e.g. using the OOH service in-hours) then this must be with prior written agreement with both the provider and the CCG commissioner of that service.
In addition the Contract Regulations require a practice to notify their commissioner of their proposal to sub-contract. Where this is the case the commissioner will need to be assured that such an arrangement will deliver essential medical services during core hours. This notification should be made at least 28 days prior to the commencement of the sub-contract. Providers of urgent and emergency care, including GP OOHs, have previously expressed concern about early closing of general practices at Christmas and New Year and the potential impact on them. Given the pressures that the urgent and emergency care system already faces during this period, this may not be a reasonable or sustainable service option. In summary practices are expected to be open from 08:00 to 18:30, Monday to Friday excluding bank holidays, unless alternative arrangements are notified in advance. If these arrangements are not in place, or if tested they fail, this may amount to a breach of your contract.
Appendix B – preparation checklist for Christmas and New Year period
Task Responsibility Completed 1. Plans are in place to ensure the identification of
high risk community based patients and to profile their care management over the extended holiday period appropriately.
2. Email/fax is operational throughout.
3. The telephone divert arrangements are updated for holidays and a staff member is contactable/scheduled to check that the phones are still working properly over the course of the Christmas and New year weekend and bank holiday periods and can remedy any faults / issues if needed.
4. Third party call handling divert arrangements are updated – where used and are successfully operational.
5. Ensure that any changes to access times are clearly advertised on NHS Choices/practice website/in practice. If the practice uses a pre-recorded message when patients telephone, you may wish to consider using this to remind patients about changes for the holiday period.
6. In the weeks before the BH period, highlight to patients the need to plan for sufficient repeat medication to cover them for the BH period. Information to patients could include pharmacy opening times over the Christmas period.
7. Check Business Continuity Plans are up-to-date, particularly ensuring that contact details for local health organisations are correct.
8. Any changes to Extended Hours DES are advertised in practice in advance
9. Have all staff been offered flu vaccine 10. Are plans in place to cover last minute
