1 Primary Care Co-Commissioning Committee Held in Public Wednesday 4 th October 2017 2.00-3.30pm Public Gallery West, Bexley Civic Centre, DA6 7AT AGENDA Item No Times Description Enc.s Lead 1 Standing items 16/17 2.00 Welcome and introductions Neil Ross 17/17 2.02 Declarations of Interest A Neil Ross 18/17 2.05 Review of minutes from the previous meeting on 28 th June 2017 B Neil Ross 19/17 2.07 Review of action log C Neil Ross 2 Items for Decision 20/17 2.10 Welling Road Surgery – Business Case D1 – D2 SEL PCT 3 Items for Discussion 21/17 2.20 Reducing Inequalities in access to general practice E1-E2 Pauline Wortman 4 Items for Information 22/17 2.30 Primary Care Digital Update F1-F2 Nisha Wheeler 23/17 2.40 Patient Survey Report To note: All GPs are conflicted on this item G1-G2 Nisha Wheeler 24/17 2.50 PMS Commissioning Intentions Update Verbal SEL PCT / NW 25/17 2.55 Westwood Surgery Update Verbal SEL PCT 26/17 3.05 Mill Road Surgery Update Verbal SEL PCT 27/17 3.15 Primary Care Finance Report To note: All GPs are conflicted on this item H1-H2 Theresa Osborne
Transcript
1
Primary Care Co-Commissioning Committee Held in Public
Wednesday 4th October 2017
2.00-3.30pm Public Gallery West, Bexley Civic Centre, DA6 7AT
AGENDA
Item No
Times Description Enc.s Lead
1 Standing items
16/17 2.00 Welcome and introductions
Neil Ross
17/17 2.02 Declarations of Interest A Neil Ross
18/17 2.05 Review of minutes from the previous meeting on 28th June 2017
B Neil Ross
19/17 2.07 Review of action log C Neil Ross
2 Items for Decision
20/17 2.10 Welling Road Surgery – Business Case D1 – D2 SEL PCT
3 Items for Discussion
21/17 2.20 Reducing Inequalities in access to general practice
E1-E2 Pauline Wortman
4 Items for Information
22/17 2.30 Primary Care Digital Update F1-F2 Nisha Wheeler
23/17 2.40 Patient Survey Report To note: All GPs are conflicted on this item
NHS Bexley CCG Declaration of Interest – Primary Care Committee meeting in public
Name Role Description of relevant Interests Comments Updates Signature
Sid Deshmukh Bexley CCG Chair and Frognal Locality Lead
1. Senior Partner Sidcup Medical Centre PMS Contract - Personal Interest - Materiality 50% 2. Shareholder Bexley Health Limited 3. Shareholder Frognal Limited - Personal Interest 4. Shareholder Blossoms Care Home Ltd - Personal Interest 15%. 5. Clinical Lead - Referral Management and Booking Service (RMBS) - Personal Interest 6. Shareholder, Bexley Health Neighbourhood Care 7. Wife (Dr Sonia Khanna-Deshmukh) is a locality representative for Frognal and on the CCG governing body 8. Non-financial personal interest in Inspire Community Trust; a) Wheelchair service b) Joint Equipment Store c) Personal Health Budgets d) Information and service support for people with physical and sensory impairment.
1. Attends various locality/clinical meetings which could be sponsored by drug companies where sandwiches/meal is provided (from £5.00 to £30.00) 2. Received £200 form Astra Zenica for chairing educational meeting on Diabetes Management on 10/05/2017
Nikita Kanani Chief Clinical Officer
1. Sessional GP, Bellegrove Surgery 2. Council Member, National Association of Primary Care 3. General Advisory Council member, The Kings Fund 4. Husband is a director of Lewisham GP Federation
Attends various locality/clinical meetings which could be sponsored by drug companies where refreshments are provided (from £5.00 to £30.00)
Varun Bhalla North Bexley GP Locality Lead
1. Partner in Belvedere Medical Practice which holds NHS (PMS) contract Value - Materiality 45% 2. Director of RSVS Ltd a non NHS company - wife is also a Director 3. Bexley Healthcare Services Ltd (wife is also a director) 4. GPCC (Greenwich) Value - Nil so far 5. Shareholder, Bexley Heath Neighbourhood Care 6. Shareholder, Bexley Health Ltd
Attends various locality/clinical meetings which could be sponsored by drug companies where refreshments are provided (from £5.00 to £30.00)
Enc A Item 19/17
Name Role Description of relevant Interests Comments Updates Signature
Jhumur Moir Clocktower GP Locality Lead
1. GP Partner, Westwood Surgery 2. Shareholder, Bexley Health Ltd 3. Shareholder, Bexley Health Neighbourhood Care 4. Clinical Lead, Diabetes 5. GP Appraiser, NHS England 6. GP Trainer, Bexley VTS, HESL
Attends various locality/clinical meetings which could be sponsored by drug companies where refreshments are provided (from £5.00 to £30.00)
Keith Wood Lay Member for Audit and Governance
None None
Paul Cutler Lay Member for Patients Participation and Involvement (PPI)
1. Director, Paul Cutler Consultancy 2. Associate for the National Children's Bureau, Centre for Public Scrutiny, CAN-Invest, Participation Works 3. Consultant / Advisor to a variety of charities, social enterprises and local authorities across England (None in SE London) 4. Extended family member works for the Alzheimer’s Society
None
Neil Ross Lay Member for Legal and Procurement
None None
Mary Currie Registered Nurse
1. Director, Quality for Health Ltd - company offering consultancy service in healthcare sector. 2. Interim Director of Transformation, NHS Bromley CCG 3. Partner is a Director of Physiological Measurements Ltd who deliver NHS clinical services
None
Theresa Osborne
Chief Operating Officer and Chief Financial Officer
None None
Enc A Item 19/17
Name Role Description of relevant Interests Comments Updates Signature
Michael Boyce
Director of Quality, Governance and Performance
None None
Nisha Wheeler
Director of Primary Care None None
Richard Money
1. Medicines Management Committee Member 2. LMC Representative, Primary Care Commissioning Committee
1. GP Partner, Station Road Surgery 2. Director, Bexley Health Ltd 3. Director, Bexley Neighbourhood Care
None
Jill Webb
1. Member, Estates Strategy Working Group 2. NHS England Representative, Primary Care Commissioning Committee
Head of Primary Care, SE London Primary Care team, NHS England
None
Sarbpal Bansal
1. Member, Estates Strategy Working Group 2. NHS England Representative, Primary Care Commissioning Committee
Essentia UK
Stuart Rowbothom
Primary Care Commissioning Committee
Bexley Health and Wellbeing Board
Lotta Hackett Primary Care Commissioning Committee
Healthwatch Bexley
Mark Burgess Primary Care Commissioning Committee
1. Practice Manager, Plas Meddyg Surgery 2. PCDWG Member
Enc B Item: 18/17
1
PRIMARY CARE CO-COMMISSIONING COMMITTEE Public meeting
Wednesday 28th June 2017 2.00pm - 3.30pm
G04/G05 Room, Bexley Civic Centre Voting Members Present Neil Ross (NR) Chair Lay member, legal & procurement Paul Cutler (PC) Lay member, patient and public involvement Dr Nikita Kanani (NK) Chief Clinical Officer Theresa Osborne (TO) Chief Operating Officer & Chief Financial Officer Michael Boyce (MB) Director of Quality, Governance & Performance Dr Sid Deshmukh (SD) Chair & Frognal locality lead Mary Currie (MC) Governing Body Nurse Dr Varun Bhalla (VB) Bexley Clinical Commissioning Group, Clocktower locality Non-voting members Nisha Wheeler (NW) Interim Director of Primary Care Stuart Rowbotham (SR) Director of Adult Social Care & Health, representative of Health &
Wellbeing Board, LBB Jill Webb (JB) Head of Primary Care, SEL, NHS England, Sarb Bansal (SB) Assistant Head of Primary Care, NHS England Lotta Hackett (LH) Bexley Manager, Healthwatch Dr Richard Money (RM) LMC Chair In attendance Lindsey Coeur-Belle (LCB) Deputy Director of Commissioning for Item 03/17 Sukh Singh (SS) Interim Head of Primary Care & ICT Service Delivery for Item 09/17 Lisa Luxford (LL) Primary Care Support Officer (notes) Apologies Keith Wood (KW) Lay Member, governance Dr Jhumur Moir Clocktower locality lead
Item No
Standing Items
01/17 01.17.1
Welcome and introductions NR welcomed everyone to the first Bexley Primary Care Co-Commissioning Committee (PCCC) meeting in public. Introductions were made and absences noted.
02/17 02.17.1 02.17.2
Declarations of Conflicts of Interest Declarations were noted and recorded. It was noted that GPs are conflicted on the following agenda items:
2
03/17 PCIF 2017/18
04/17 report on PCCC extraordinary meeting on 18/05/2017 to discuss PMS review
10/17 Primary Care 2017/18 budgets
Items for Decision
03/17 03.17.1
03.17.2
Primary Care Improvement Fund (PCIF) 2017/18; Cancer and End of Life and Integrated Case Management LCB presented the PCIF 2017/18 and 2018/19 report which detailed the proposed scheme for the next 2 years. The paper was agreed by the Governing Body in March 2017 and following subsequent negotiation with the LMC and locality groups has been slightly amended. All practices are offered the opportunity to participate in the scheme, the total value of which is £768,000. Payments are made for the delivery of quality, audit and education deliverables The Committee approved the PCIF LIS negotiated and approved with the LMC.
Items for Discussion
04/17 04.17.1 04.17.2 04.17.3 04.17.04
Report on PCCC extraordinary meeting held on 18/05/2017 regarding Personal Medical Services (PMS) review and subsequent Pan Bexley PMS Event The Committee was asked to note the
o Contents of the minutes from the extraordinary meeting of the PCCC on 18/05/2017
o PMS commissioning intentions o Completed assurance and financial template submitted to the NHS
England (NHSE) NW presented the paper and referred to the main points detailed on the summary page. National guidance was received by NHSE area teams in February 2014 advising of a review of all PMS contracts to be completed by March 2016 with the intention of ensuring equalisation of funding for all practices. After a breakdown in the initial negotiations, all London CCGs assumed responsibility for the local negotiation directly with the Local Medical Council (LMC) supported by NHSE. At £6.54, Bexley has the lowest PMS premium in London. The actual average Bexley PMS premium is £6.29 with one practice receiving £6.54. Consequently, the CCG has committed to making this sum available to all practices. Following a series of meetings between Bexley CCG and the LMC, PMS premium commissioning intentions have been agreed which it is hoped will commence on 01/10/2017. KPIs are being introduced, and performance will be assessed using a stepped model approach. Practices will have to demonstrate performance in each area of quality service provision to be eligible for full payment. However, the first six months will be paid as a preparatory period to allow practices the
3
04.17.5 04.176
necessary time to introduce new systems for delivery which will begin on 01/04/2018. NK thanked colleagues in the LMC, SEL NHSE and the CCG for the work undertaken to reach this point in the PMS premium review negotiations and emphasised that the aim of the CCG is to equalise funding across Bexley practices and ensure a standardisation of service provision to Bexley patients. JW advised that the Bexley CCG commissioning intentions had been assured by NHSE and await London Wide LMC assurance. Until this has been received, the offer cannot be sent to practices for their review.
05/17 05.17.1 05.17.2 05.17.3 05.17.4
Update on education Events for PCCC members The SEL Primary Care Executive Board recognises the Primary Care Co-Commissioning Committee as a new committee and supports the need for training provision. JW advised that 2 of the 6 SEL CCGs had identified training needs. There are a set of slides available to support the training of PCCCs that she will arrange to be distributed Action: Jill Web to arrange for Tom Bunting to distribute training slides to members of the committee. NK made the suggestion that as a new committee, consideration should be given to arranging an opportunity for members to come together to examine what training is required and what should be the direction of future meetings Quoracy was confirmed as 50% of the non-GP voting members. It was requested that at future meetings voting and non-voting members of the committee were identified by the use of different coloured name plates Action; Lisa Luxford to arrange for voting members to be identified by coloured names plates to ensure clarity in future meetings.
06/17 06.17.1
Quality and Performance Report JW advised the committee that the Quality and Performance report is a standard report previously used by the Primary Care Joint Committee. Currently the report is produced quarterly, although not all supporting data is refreshed quarterly and some of the data in the report covers different time periods. The operating model is under review by the NHSE SEL Primary Care Team to consider if any value can be added. The expectation is that the CCG and NHSE SEL Primary Care Team colleagues will have further discussions to work out how best to triangulate quality information so that it can provide value to the PCCC members.
4
06.17.2 06.17.3 06.17.4 06.17.5 06.17.6
The results of the next GP patient survey will be published in July 2017. Nationally, Ipsos MORI have moved to the patient survey data being published annually, rather than 6 monthly. Patient satisfaction was a focus of discussion during the recent PMS premium review The Friends and Family Test (FFT) data in the report is as at March 2017. All Bexley practices are submitting their data to NHSE. Bexley patient satisfaction figures are slightly lower than previously reported but still in line with the national average. 92.9% of inspected Bexley practices were rated as “Good or Outstanding” by the Care Quality Commission (CQC) in their inspection regime that commenced in October 2014. This places Bexley above both the London benchmark of 76.9 % and the National benchmark of 84.7%. As at 22nd May 2017 212 GP practices in SE London had been inspected The Committee discussed the current format of the report that is produced for use across the 6 CCGs of the south-east London area. Views were expressed that the report needed to be developed to include more CCG specific information that would enable quality issues to be identified and scrutinized more easily Action: Jill Webb to arrange for the inaccuracies in the Bexley data within the Quality & Performance report noted by Theresa Osborne, to be checked by the SEL reporting team The Committee considered and noted the contents of the Quality and Performance report
07/17 07.17.1 07.17.2 07.17.3
Primary Care Finance Report TO presented the report provided by the NHSE SEL finance team, which details the primary care budgetary position for months 1 & 2 of 2017/18 It was reported that no narrative had been provided with the finance report as would normally be expected. It is anticipated that a more comprehensive report will be produced by the NHSE finance team from month 4. There is a predicted overspend of £100k that is not included in the report as a result of the budgets delegated being higher than the resource limit. The Committee noted the contents of the NHSE Primary Care Finance report
08/17 08.17.1 08.17.2
Clinical Workforce reporting – GPs and Nursing, Bexley CCG SB presented the paper and provided a summary of the clinical workforce analysis carried out at London wide level by Health Education England (HEE) in November 2016 and the Bexley CCG workforce modelling project completed in February 2017. The reports identify that Bexley has the second lowest GP staffing ratio in
5
08.17.3 08.17.4 08.17.5
London and the second highest ratio of nursing staff to patients. Bexley’s workforce age profile is in line with the London average. The modelling has shown that with the current workforce initiatives underway within, Bexley may have adequate nurse provision by 2021 to meet the growing demand. However, the modelling identifies a GP shortfall of 10-11 even with the current programmes in place such as the GP Fellowship, Pharmacists in general practice and the Care Navigator Pilot. The committee was assured by the number of programmes currently in place, working to support the increasing demand and prevent a workforce deficit in future years, in addition to recognizing the size of the challenge faced. The committee acknowledged that further work is required to understand what can be done to attract key staff to working in Bexley and encourage existing staff to remain The committee noted the contents of the workforce modelling paper.
09/17 09.17.1 09.17.2 09.17.3 09.17.4
GP hub 8-8 Service SS provided a verbal update to the committee on the GP hub 8-8 service. The 8-8 service provided by Bexley Health Neighbourhood Care (BHNC) CIC went live at Queen Mary’s Hospital on Monday 8th May and Erith Hospital on 5th June 2017. The service is available 6.30-8pm Monday-Friday and 8am-8pm Saturday, Sunday and public holidays. To date the service has provided 1000 appointments, booked by 24 Bexley practices. Patient feedback has been positive. The service is currently staffed by Bexley GPs, although this may not be sustainable The service model of the 8-8 hubs will be reviewed once the service has run for a number of months to address issues such as under-utilisation on Sunday afternoons and slightly higher than normal levels of patients not attending their appointment. It is anticipated that the service will offer nurse appointments in the future. NK expressed thanks on behalf of the committee for the work that has been undertaken to get the service up and running.
Items for information
10/17 10.17.1 10.17.2
Primary Care 2017/18 budgets The Committee noted the primary care budgets 2017/8 report presented by TO. The budgets were previously presented to the Governing Body for approval in May 2017. The report is reflective of current list sizes, 2017/18 contractual changes and updated premises costs. An overspend of £103K on the overall budget of
6
£28.5m is predicted. It is considered that this amount is manageable.
11/17 11.17.01
Primary Care Co-Commissioning Committee (PCCC) Terms of Reference, ratified The Committee noted the terms of reference for the primary care commissioning committee ratified by the Governing Body in March 2017.
12/17 12.17.01 12.17.02 12.17.03
South East London (SEL) Primary Care Executive Board Terms of Reference The committee noted the terms of reference for the SEL primary care executive board. The board is the principle coordinating forum for general practice commissioning and contracting matters across south east London and is accountable to the PCCC in each borough. The committee reflected that there is no clinical representation on the SEL primary care executive board. It is an organisational meeting and has no decision making authority. It was agreed that the minutes from the SEL Primary Care Executive Board should be brought to the PCCC Action: Nisha Wheeler to arrange for the minutes from the SEL Primary Care Executive Board to be included as an agenda item at future PCCC meetings held in private
Other agenda items
13/17 13.17.1 13.17.2
Questions from members of the public An employee of Alere (manufacturer of point-of-care diagnostics) asked if there was potential for companies in point of care diagnostics to contribute at CCG level? NK commented that the CCG is open to new ways of working. There are many NHSE programmes involving technology and suggested contact is made via the Bexley CCG comms e-mail address.
14/17 14.17.1
Any other business There was no other business
Date of next meeting
15/17 Date of next meeting Wednesday 30th August 2017 Public (part 1) 2-3.30pm - Council Chamber, Bexley Civic Centre
Enc C
Item: 19/17
Action Meeting
Date
Action Agreed Lead Action Taken Date for
completion
Status
05.17.2 28/06/2017 Jill Web to arrange for Tom Bunting to distribute PCCC training
slides to members of the Committee
Jill Webb Slide pack received from
Tom Buntiing and
distributed by Lisa
Luxford via e-mail on
12/09/2017
30/08/2017 close
05.17.4 28/06/2017Lisa Luxford to arrange for voting members to be identified by
coloured names plates to ensure clarity in future meetings
Lisa Luxford completed 30/08/2017 close
06.17.5 28/06/2017 Jill Webb to arrange for the inaccuracies in the Bexley data
within the Quality & Performance report noted by Theresa
Osborne, to be checked by the SEL reporting team
Jill Webb 30/08/2017 open
12.17.03 28/06/2017 Nisha Wheeler to arrange for the minutes from the SEL Primary
Care Executive Board to be included as an agenda item at
future PCCC meetings held in private
Nisha
Wheeler
Completed, agenda item 30/08/2017 close
Primary Care Co-Commissioning Committee (public) Action log updated 28.06.2017
DATE: 4th October 2017
Title
Welling Medical Practice – Proposed Partnership Changes
This paper is for Decision
Recommended action for the Primary Care Commissioning Committee
The Primary Care Commissioning Committee is asked to:
1. AGREE to vary the PMS contract to remove Dr Masi 2. AGREE to add Kay Wood (Practice Manager) to the PMS contract
as a non-clinical signatory 3. CONFIRM it strongly supports the future proposals to take on new
partners after an initial probationary period 4. Commend Welling Medical Practice for the work it has done to
stabilise and develop new partnership arrangements over the last year
Potential areas for Conflicts of interest
No conflicts are known
Executive summary
Welling Medical Practice is a long established 2 site PMS practice, serving the local areas of Welling and New Eltham. The main practice is located in Bexley and the branch surgery located in Greenwich, on the Bexley border. The practice currently consists of 3 partners, Dr Kailey, Dr Masi and Dr Wahla (joined as of 1 August 2017). The practice has struggled with prolonged sickness of partners and their subsequent retirement/resignation from the practice, firstly Dr Balaji and more recently Dr Oxford (retired 1 August 2017). Although Dr Masi resigned on 31 July 2017 and has subsequently moved away from the area, she has not yet been removed from the contract as at the time this would have left Dr Kailey as the sole holder of the PMS contract with a considerable list size of 12,422 which commissioners could not approve, without destabilising the practice. Dr Wahla, a former salaried partner, who knows the practice and patients well, has recently joined as a partner, and a full time Nurse Practitioner joined in the Summer. The practice enjoys regular locum GPs who are
ENCLOSURE: D1 Agenda Item: 20/17
Primary Care Commissioning Committee (held in public)
known to the practice and its patients, which enables continuity of care to be provided for registered patients. One of the regular locum GPs who works 3 full days and another who works 10 sessions per week have expressed an interest in becoming partners at the practice after a period of time. The attached business case details the practice’s reasons for requesting the commissioner’s agreement to immediately action the following:
- Removal of Dr Masi from the PMS Contract - Addition of Kay Wood, the Practice Manager, as a non-clinical
partner to the PMS Contract The business case notes that Dr Masi, although still a partner on the contract, has since moved out of the area and is working elsewhere. The business case highlights the importance of the good working relationship between Dr Kailey and Kay Wood which has been integral in terms of supporting the practice through its recent challenges. Kay has worked at the practice for over 20 years and has the knowledge, experience and commitment to enhance the practice for the benefit of its patients. The view of officers is that the inclusion of this very committed practice manager as a partner to the PMS contract will free up Dr Kailey to attend to clinical governance and other appropriate matters that require clinical input and this can only support and enhance the organisational development journey that the practice is progressing. Finally, the business case outlines the proposal to stabilise the practice over the next 6 to 12 months, to have a period of working together with the prospective new partners with a view to adding them as partners at a later date in order to ensure their suitability and future sustainability of the practice. In parallel with considering the practice’s business case, officers have requested assurance that there is sufficient clinical workforce to meet the reasonable needs of patients across the practice’s two sites. Based on rotas provided for the weeks of August and September, the following information can be verified:
There are clearly regular doctors and nurses working on both practice sites
The average WTE for September was 6.175 WTE clinical staff, made up of 2 WTE partners; 1.6 WTE regular locums with a view to partnership; 1.4 WTE nurse practitioners; and other regular locums
The ratio of clinical staff to patients is slightly better than the Bexley average of 2328 (though this excludes nurse practictioner) – at 1 WTE clinician (inc. nurse practitioner): 2008 patients – which is very encouraging that this practice has managed to stabilise to the extent
it has, taking into account the significant challenges it has faced over the last two years.
Further assurance has been requested in respect of sight of the rotas over the next few months to ensure that the clinical services currently on offer will be maintained. It is also important to take into account the wider well reported challenges that Bexley CCGs practices have had in attracting GPs into Bexley, which makes the practice’s turnaround even more encouraging. The Primary Care Commissioning Committee is asked to agree the above recommendations which have already been endorsed by the LMC, which has been actively supporting the practice in its rebuilding endeavours.
How does this paper support the CCGs objectives?**
Patients: The practice’s actions should improve the health and wellbeing of registered patients in partnership with our key stakeholders.
People: Enacting the paper’s recommendations should enable the CCG to continue to demonstrate the success of their general practice constituents.
Pounds: There are no cost pressures associated with the recommendations.
Process: The proposals in this paper should enable safe, sustainable and equitable services which improve outcomes and improvements in patient experience to be demonstrated.
What are the Organisational implications
Key risks
That no further partners are added to the PMS contract, which would leave a high patient/doctor ratio across 3 partners, one of which is non clinical. However, not agreeing to the changes proposed in the practice’s business case are viewed as more retrograde and higher risk by officers
Equality
Proposal likely to maintain and potentially improve equality of access for registered patients.
Financial
No cost implications.
Data
n/a
Legal issues
Consideration of contract variations such as this is core business of the PCCC, so this is n/a.
NHS constitution
Proposal in line with the principles of the NHS constitution.
Engagement LMC fully involved.
Audit trail Available on request
Comms plan n/a
Author: Jill Webb Head of SEL Primary Care
Clinical lead Dr Nikita Kanani Chief Clinical Officer:
Executive sponsor: Nisha Wheeler Director of Primary Care
Date 25th September 2017
Enc D2
Item 20/17
BUSINESS CASE
Project Name:
WELLING MEDICAL PRACTICE
Author: Dr Lakhbir Kailey
22/08/2017
Practice Name:
Welling Medical Practice 2 Danson Crescent, Welling, Kent DA16 2AT
& 12 Avery Hill Road, SE9 2BD
Enc D2
Item 20/17
EXECUTIVE SUMMARY Welling Medical Practice is a long established 2 site PMS practice consisting originally of 4 partners (all on PMS contract originally) and when fully staffed 2 full time salaried doctors – stable until the last 2 years, over which time the practice has struggled with prolonged sickness of partners and subsequent retirement from the practice of firstly Dr Balaji 31/8/16, then Dr Oxford 31/3/17 and then Dr Masi 31/7/17. Partners left the practice earlier than planned due to discord within the practice and an inadequate partnership agreement which did not serve the needs of the practice within the current climate of recruitment crisis for doctors (both partners and salaried partners). Also, an important consideration is the increased costs of employing locums to cover doctor absence which has had a severe financial impact on the practice due to lack of full reimbursement from the practice locum insurance policy. The partners on the PMS contract currently would be Drs Kailey, Masi and Wahla if as suggested by Jill Webb Dr Oxford is removed as he retired before Dr Masi. Despite seeking to recruit new GP partners by all means available over the last 18 months or so we have only been partly successful and so far, we have taken on as a partner Dr Wahla – commenced partnership 1/8/17 with a standard 6 months mutual probationary period. She was previously our salaried partner and knows the practice and its patients well. In addition, we have taken on one full time nurse practitioner and one who works 2 full days (17 hours) who are seeing patients who would otherwise be making appointments with GPs. As well, we have regular locum GPs who are known to the practice and its patients, so providing continuity of care, including Dr Oxford who recently retired. In addition, we have recently taken on as regular locums, one GP who commenced with us on 7/8/17 working 3 full days and another fulltime GP has joined this week working 10 sessions per week. Both these doctors are well qualified and at interview expressed desire to become partners. However, Dr Wahla and I are acutely aware, in view of the previous history that we should have a period of working together with any prospective new partners as they have not previously worked in practice with us, though Dr Wahla has previously worked with one in an urgent care setting. We need to assess them and their suitability for the practice over a mutually agreed 6 -12 month period. We are keen to improve the ethos, partnership spirit and working environment within the practice and have outlined our vision when interviewing for the clinical posts. The new clinicians who have joined us understand that we are moving forward from the difficulties and that we have a plan for the future and are keen to be part of this. In large part, this vision has been driven by me as a senior partner and Kay Wood, our Practice Manager. We also have well trained and loyal staff who have supported us through all the problems and we feel now we will emerge stronger. As you are aware, I, Dr Kailey, have been sole working partner in this practice since the middle of January 2017 and we have made great progress as a practice. A key factor in the progress has been the good working relationship between Kay Wood and myself. We share the vision for the practiced outlined in previous emails: ideas such as skill mix with a range of clinicians, taking on more administrative staff,
Enc D2
Item 20/17
working in new ways to reduce the burden on clinical staff hence freeing them up for work which needs their clinical skills, thereby improving patient care. I note you require details of the regular clinical capacity from August, but this is quite a transitional month as the new doctors have joined part way through the month. As you may be aware Kay Wood, Practice Manager, is currently away on annual leave returning 29/8/17 and she says she will do as a priority that day. Unfortunately, prior to her leave she had been unable to work due to sickness. PROPOSAL
1. Remove Dr Masi from the PMS contract The practice would be best served by removing Dr Masi from the contract as she has now moved and is working elsewhere
Time scale: Immediate
2. Kay Wood, Practice Manager, to be entered as a named partner on the PMS contract
A key proposal, bearing in mind that Kay has an excellent knowledge of all aspects of the practice (having worked here for over 20 years), is loyal and committed to improving the practice and the patient care, and we have a shared vision for the future. We propose that Kay would be entered as a named partner on the PMS contract. Kay has been an integral part of ensuring the practice continued to function as well as it could through all the challenges. She and myself, Dr Kailey work well together and are both optimistic and keen to ensure the practice goes forward to provide an excellent service for our patients, including exploring additional new services as well as continuing to maintain the current ones. We will be working with Modality using the resilience funding with initial meeting planned for September. This proposal has been discussed verbally with Kay, Dr Wahla and Dr Kailey with Nora Breen from the LMC in attendance. Kay is in agreement with this proposal and understands her role .The necessary documentation would be drafted with the help of Nora Breen, LMC, prior to this change occurring. Time scale: Immediate
3. In the future, as and when the current partners and Kay feel that the new GPs
are able to be taken on as partners after initial probationary period we would then ask NHS England for their support in adding them to the PMS contract. Time scale: 12 – 18 months
CASE FOR CHANGE
Enc D2
Item 20/17
The proposals outlined above will provide the necessary structure for the practice with loyal and committed PMS partners who are keen to progress the practice forward into the future and are passionate about having good working relationships and partnership spirit, providing a dynamic interactive and pleasant place to work, which would inspire everyone to improve the care of or patients. The partners we are proposing have demonstrated, particularly since January, that we are making good progress, both in provision of services to our patients but also successfully recruiting new clinicians who are keen to join and share our vision in moving the practice forward. CONCLUSION The three key individuals within the practice, Partners Drs Kailey and Wahla and Practice Manager Kay Wood have all discussed these three proposals with Nora Breen in a face to face meeting and feel that these changes are both necessary for the practice and beneficial for its patients. We very much hope that NHS England and Bexley CCG will support us and agree the proposals which we have carefully considered. Thank you. Dr Lakhbir Kailey on behalf of Welling Medical Practice
DATE: 4th October 2017
Title
Reducing Inequalities of Access for all in General Practice services
This paper is for Information
Recommended action for the Primary Care Commissioning Committee
That the Primary Care Commissioning Committee: Note the requirement for the CCG to review, assess and publish an Equality Impact Assessment and plan to address inequalities in access to General Practice services
Potential areas for Conflicts of interest
None
Executive summary
Bexley CCG as commissioners of general practice services need to understand the challenges faced by the local population in accessing General Practice Services. One of the seven core requirements for implementing improved access, as set out in the NHS Operational Planning and Contracting Guidance 2017-19, is to address issues of inequalities in patients’ experience of accessing general practice, identified by local evidence, and put actions in place to resolve this. To support this, the CCG will be required to:
Complete, approve and publish an Equality Impact Assessment, planned for completion by March 2018
Develop a plan, to address any inequalities of access issues identified
Engage and work with PPG’s to build better participation
Support GP practices in addressing barriers to access for all patient groups
Review how effective communication of enhanced access initiatives to individuals or groups sharing one or more protected characteristics are to ensure that all patients have equal access to and awareness of NHS services
ENCLOSURE: E1 Agenda Item: 21/17
Primary Care Commissioning Committee (held in public)
How does this paper support the CCGs objectives?**
Patients: Ensuring inequalities in access is identified and addressed
People: Ensuring general practice staff understand their roles and responsibilities to improve access for their patients
Pounds: Ensuring that communication and information is accessible for all patients will ensure patients are better aware and able to access services that are most appropriate to their needs
Process: Ensuring that access to services is equitable, and the patient experience and health outcomes are consistent for all
What are the Organisational implications
Key risks
Access to general practice services across Bexley is not equitable for all.
Equality
Aims to improve access for all by identifying access inequalities and addressing them
Financial
The outcome of the Equality Impact Assessment and associated plan may require additional resources or funding to support it.
Data
Data to support understanding of inequalities is key, including Health watch surveys and patient survey/feedback results
Legal issues
N/A
NHS constitution
N/A
Engagement Will require close working and engagement with Healthwatch, PPG’s and GP Practices.
Audit trail Progress with the plan will be monitored via the Primary Care Development Working Group meetings with regular updates provided to the Primary Care Commissioning Committee.
Comms plan Communications plans will be developed as part of action plan.
Author: Sukh Singh Interim Head of Primary Care and ICT Service Delivery
Clinical lead: Dr Nikki Kanani Chief Clinical Officer
Executive sponsor: Nisha Wheeler Interim Director of Primary Care
Date 26th September 2017
Enc E2 Item 21/17
1
Reducing Inequalities of Access for all in General Practice
services
Background Ensuring everyone can access services on an equal footing is a key priority for the NHS. One of the seven core requirements for implementing improved access, as set out in the NHS Operational Planning and Contracting Guidance 2017-19, is to address issues of inequalities in patients’ experience of accessing general practice, identified by local evidence, and put actions in place to resolve this. Understanding our local population
Bexley CCG as commissioners of general practice services need to understand the challenges faced by the local population. Individuals and groups sharing one or more protected characteristics may not currently experience easy access to general practice services, and subsequently do not experience the same health outcomes as the rest of the population. This may include those insecurely housed, Gypsy, Traveller, and Roma groups, refugees, asylum-seekers, migrants, sex workers and faith groups. Additionally, people with mental health problems, learning disabilities, low health literacy, and drug and alcohol problems may be similarly challenged. Those not registered with practices may also be subsequently ‘invisible’ in the primary care system.
We should also understand the perspectives of children and young people, carers, and patients and service users with disabilities and long-term conditions. Due to the diversity of those who may share one or more protected characteristics, it is crucial that commissioners of general practice acknowledge that ‘one size doesn’t fit all’. Patient pathway
As well as the pathway to accessing general practice services there are other pathways including self-care and community pharmacy. It’s important to consider whether health materials published are easy to understand and available in other languages to ensure patients are aware of these pathways and know how to access them.
2
NHS England Patient Registration Standard Operating Principles for Primary Medical Care (General Practice) states that a lack of identification documents should not be a barrier. It is important for practices to ensure they have adopted these principles.
Improving access: core requirements There has been a lot of work already undertaken to support improved access, outlined in the follow sections are details of how the seven core requirements for improving access have already been met or on-going actions being undertaken to address any gaps. Timing of appointments:
The CCG has commissioned a weekday provision of access to pre-bookable and same day appointments to general practice services every weekday evening (after 6.30pm) – to provide an additional 1.5 hours
The CCG has commissioned weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays (8am-8pm) to meet local population needs
The CCG has access to robust evidence, based on utilisation rates to enable continual review of the GP extended access service provision to ensure it is fit for purpose and meets the needs of our population.
Capacity
There is a requirement for the CCG to Commission a minimum additional 30 minutes consultation capacity per 1000 population per week, rising to 45 minutes per 1000 population. At this stage with the provision of the 8-8 extended access service, the CCG provide 26 additional minutes. Once nursing provision is in place, this will increase and move towards the target of 45 minutes additional capacity per 1000 population
Telephone and online consultations are increasingly being used to expand access, some of these provide additional functionality to help patients manage their care. Additional support for addressing capacity is provided with eConsult allowing patients to consult with their GP practice online.
Enhancing the skill mix with Prescribing nurses, physicians associates, clinical pharmacists, paramedics and other roles are increasingly complementing the primary care workforce and offer unique skills that benefit patients.
Measurement
The CCG are ensuring usage of a nationally commissioned GP workload tool introduced during 2017/18 to automatically measure appointment activity by all participating practices, both in-hours and in extended hours. This will enable improvements in matching capacity to times of great demand.
Advertising and ease of access
The CCG will provide a rounded communications on services available (Pharmacy, 111, self-help, GP, UCC, A&E, etc. and when to use them). This includes notification on practice websites, notices in local urgent care services and publicity into the community, so that it is clear to patients how they can access local NHS services.
The CCG monitors practice utilisation of 8-8 service to ensure it is offered consistently. All practice receptionists are able to direct patients to the service and
3
offer appointments to extended hours service on the same basis as appointments to non-extended hours services. Patients should be offered a choice of evening or weekend appointments on an equal footing to core hour’s appointments.
Digital
The CCG and GP practices are supporting the use of digital approaches to support new models of care in general practice including eConsult and patient online access. Next steps are to enable 111 direct booking into GP extended access appointments and work towards the provision of patient online access to these appointments.
Inequalities
Issues of inequalities in patients’ experience of accessing general practice have been identified by local evidence via the Healthwatch Snap shot study into GP Access & Quality of Experience for People with Learning Disabilities http://www.healthwatchbexley.co.uk/sites/default/files/snap_shot_study_big_health_check_-_final.pdf The key recommendations of which are:
o Provide the opportunity for people with a learning disability to book a longer appointment.
o Provide accessible information. o Increase the uptake of routine health checks. o Re-assess the black book so as it works to provide the information
necessary for healthcare professionals. o Collect patients from waiting room to assess mobility. o Healthcare staff training for understanding the wide range of learning
disabilities and explain the dangers of delaying or deferring action on symptoms.
Following on from this work Healthwatch are now planning a number of Enter and View visits into GP practices to see how learning disability friendly they are. The Enter and View will commence around middle to late September 2017 and will be ongoing until Christmas 2017 at least.
Healthwatch are also conducting some engagement with BME groups in the Thamesmead area in relation to GP services.
There is an interpreter provision available via Language Connect. Inspire are contracted to provide sign language support to Bexley residents, in the main this is the service practices should use if they need to book a BSL interpreter. The CCG also have a contract with SignVideo. This service should only be used for those situations where it has not been possible to book a signer in advance e.g. a walk in or emergency appointment.
Accessible Information Standard needs should be flagged and recorded within the patient’s clinical record, to ensure patients are appropriately supported. The CCG has produced an AIS GP practice guide, and directory of information and useful contacts booklet available for all GP practices in Bexley.
Effective access to wider whole system services
eConsult, signposting, and rounded communications on services available (Pharmacy, 111, self-help, GP, UCC, A&E, etc. and when to use them) ensures effective connection to other system services enabling patients to receive the right care.
Develop a plan to deliver compliance with all seven core access requirements.
Complete, approve and publish an Equality Impact Assessment by March 2018, this includes close working with Healthwatch to inform and develop a plan, to address any issues identified as a result of completing the Equality Impact Assessment. CCGs will be monitored on the requirement to publish an equality impact assessment linked to improving general practice access and their associated action plan to address inequalities.
The CCG and GP practices should be engaged with their PPG networks. The National Association for Patient Participation (N.A.P.P.) are producing ‘Building better participation’ (http://www.napp.org.uk/bbp.html) a resource to support PPGs, whether long-standing or recently formed, large or very small, a single practice or as part of a federation of practices, to reflect on what they do. This is a useful tool for GP practices and CCGs seeking to support effective PPGs.
The CCG will work closely with PPG’s to review their functions and support them as necessary to ensure they are effective in their role throughout 2018.
GP practices should review their NHS Choices website, link with health watch, CQC reports, feedback websites such as patient opinion, complaints, NHS FFT, social media, feedback via PPG and develop focus groups for patients with disabilities or language barriers.
GP Practices should focus on improving access for specific groups based on their needs including those with complex needs, children & young people, or the frail elderly. In some cases this has included providing consultations outside of traditional care settings.
Review how effective communication of enhanced access initiatives to individuals or groups sharing one or more protected characteristics are to ensure that all patients have equal access to and awareness of NHS services
Progress with the plan will be monitored via the Primary Care Development Working Group meetings with regular updates provided to the Primary Care Commissioning Committee.
Recommended action for the Primary Care Commissioning Committee
That the Primary Care Commissioning Committee: Note the progress of programmes being implemented within the Primary Care Digital agenda
Potential areas for Conflicts of interest
None
Executive summary
The ‘NHS Five Year Forward View’ and ‘Personalised Health and Care 2020’ describe the commitment to make full use of information and technology to support the integration of the health and social care system. This includes ensuring patient records are digital and interoperable by 2020. IT has a significant role to play in transformation and enabling new care models. This includes delivering primary care at scale and supporting 7 day out-of-hospital services. It is a vital part of the infrastructure to support improved operational performance in a number of areas, including reducing unnecessary non elective admissions and supporting timely discharge. Over the course of the last year, there has been a number of digital programmes implemented within Bexley to further progress the Primary Care Digital agenda. This paper outlines developments and progress made to date in respect of the requirements laid out in the GPFV with respect to digital enhancements of primary care services. In summary, these cover the following areas:
Universal Capabilities – a range of 10 core digital capabilities identified for health and care settings to deliver as standard
Integrated Care Records – shared access of patient records across key local stakeholders
ENCLOSURE: F1 Agenda Item: 22/17
Primary Care Commissioning Committee (held in public)
Virtual Training Hubs – implementation of the successful ETTF bid to deliver virtual training to the primary care workforce across Bexley
Implementation of free Wi-Fi across the primary care estate
Upgrade and implementation of the N3 network to the Health and Social Care Network (HSCN)
Online Consultations
NHS 111 Digital Services
How does this paper support the CCGs objectives?**
Patients: Ensuring that technology implemented enhances patients care
People: Ensuring that the NHS workforce is supported in implementing new technologies
Pounds: Ensuring that technology implemented improves efficiency
Process: Ensuring that technology implemented is encompassing of wider NHS services and providers to improve health outcomes across the NHS.
What are the Organisational implications
Key risks
Organisations and services ability to adapt to change technology brings.
Equality
Aims to improve access for all
Financial
Funding to support implementation of all initiatives have either been committed or received.
Data
Supports data sharing as agreed via data sharing agreements and consent models.
Legal issues
N/A
NHS constitution
N/A
Engagement A number of initiatives, particularly around data sharing have involved wide reaching communications and engagement. On-going communications and engagement key to each initiative.
Audit trail ICT Steering Group and Primary Care Development Working Group are kept abreast of all Primary Care Digital updates
Comms plan Communications plans available at either STP or local level.
Author: Sukh Singh Interim Head of Primary Care and ICT Service Delivery
Clinical lead: Dr Nikki Kanani Chief Clinical Officer
Executive sponsor: Nisha Wheeler Interim Director Primary Care
Date 26th September 2017
Enc F2 Item 22/17
1
Primary Care Digital update
Background The ‘NHS Five Year Forward View’ and ‘Personalised Health and Care 2020’ describe the commitment to make full use of information and technology to support the integration of the health and social care system. This includes ensuring patient records are digital and interoperable by 2020. We recognise that IT has a significant role to play in transformation and enabling new care models. This includes delivering primary care at scale and supporting 7 day out-of-hospital services. It is a vital part of the infrastructure to support improved operational performance in a number of areas, including reducing unnecessary non elective admissions and supporting timely discharge. Over the course of the last year, there has been further progress. This has included the publication of the South East London Local Digital Roadmap, which is aligned to our STP footprint. At a high level the SEL LDR focuses on:
Being paper-free at the point of care by 2020;
Digitally enabled self-care empowering patients in the management of their own
care;
Real-time data analytics at the point of care;
Whole systems intelligence to support population health and effective
Universal Capabilities NHS England has identified ten Universal Capabilities that are mandatory for inclusion in LDR footprint planning. The Universal Capabilities are:
• Professionals across care settings can access GP-held information on GP-
prescribed medications, patient allergies and adverse reactions.
o South East London have developed two interoperable systems sharing GP-
held records across care settings. NHS Bexley CCG has also already
established its linked care programme which provides access to GP-held
data to GP out of hours, urgent care centre and GP extended access
service. The CCG are also linking into the Darent Valley Hospital's Vision
360 solution.
• Clinicians in U&EC settings can access key GP-held information for those patients
previously identified by GPs as most likely to present (in U&EC)
o Risk stratification tools available to Bexley GP practices with patient
information accessible via Connect Care (Lewisham and Greenwich), and
Bexley Linked Care (UCC and soon to be Dartford & Gravesham NHS
Trust).
• Patients can access their GP record.
o Access to detailed coded records available to all Bexley residents via either
Vision or EMIS patient online services
• GPs can refer electronically to secondary care.
o Referrals should no longer be sent by paper or fax. Referrals are generally
sent via email or the e-Referrals system. By October 2018, there is a
requirement that all referrals are sent via e-referrals. The CCG are working
with providers and GP practices to support the transition.
• GPs receive timely electronic discharge summaries from secondary care.
o The target for delivery of eDischarge summaries is within 24 hours of a
patient’s discharge, secondary care will need to transform its processes for
creation of discharge summaries, supported with the use of Docman Hub.
• Social care receives timely electronic Assessment, Discharge and Withdrawal
Notices from acute care.
o Bexley Local Authority receive notifications electronically from all three main
acute partners. Connect Care will enable Social Care to receive timely
access to this information.
• Clinicians in unscheduled care settings can access the child protection information
systems (CP-IS) with social care professionals notified accordingly.
o CP-IS is accessed by all three main acute trust providers for Bexley
residents and the requirement is included in standard contracts with these
providers.
o UCC are working with their clinical system supplier to implement CP-IS.
3
• Professionals across care settings made aware of end-of-life preference
information
o Co-ordinate My Care (CMC) is the national solution for recording the end-of-
life preferences of patients. Co-ordinate My Care is in use across all CCGs
in the South East London Digital Footprint.
• GPs and community pharmacists can utilise electronic prescriptions.
o All practices and pharmacies in Bexley have implemented the Electronic
Prescriptions Service (EPS). Utilisation is monitored and support offered by
the CCG to improve upon this.
• Patients can book appointments and order repeat prescriptions from their GP
practice.
o Online access to book appointments and order repeat prescriptions is
available to all Bexley residents via either Vision or EMIS patient online
services
In addition the CCG is working with the SEL STP to:
Integrate Care Records - work across SEL to share information between the Local
Care Record and Connect Care systems
Support Virtual collaboration via increased use of technology – Video Conferencing
Provide Free Wi-Fi in all NHS buildings to support digital and paperless activity
Implement Health and Social Care Network (HSCN), replacement for N3 network
Provide Online Consultations as part of the GPFV
Provide NHS 111 digital services by December 2017
Implement 8-8 extended access GP hubs with read-write access to patients GP
records
Integrated Care records We have been actively pursuing integrated digital record sharing with key stakeholders and suppliers through the Bexley Linked Care programme using the Vision 360 system. Bexley Linked Care is already live in the urgent and out of hours settings and allows for the electronic record to be shared for direct care purposes and with consent from the patient. As part of Phase 2, Bexley Linked Care has been extended to encompass GP-to-GP sharing, which supports the 7 day access agenda and enables Bexley GPs to provide extended hours GP services from 6pm-8pm Monday to Friday and 8am-8pm Saturdays and Sundays from 2 access hubs located in the North (Erith Hospital) and South (Queen Mary’s Hospital) of the borough. Access to electronic patient records is now being extended to enable sharing with Darent Valley Hospital. In addition, we have joined the Connect Care collaboration programme using the Cerner system. Connect Care has now been rolled out across all Bexley practices, and Oxleas NHS Foundation Trust, enabling electronic records to be shared at the point of direct
4
contact across Lewisham and Greenwich Trust. Access for Social Services planned for late 2017. Running alongside the Connect Care programme is an integration work stream which has been established through the initiatives of the local digital roadmap and seeks to enable data sharing of both portals in South East London, i.e. the Connect Care portal and the Local Care Record (LCR) portal run by the Kings Health Partnership. The LCR portal captures health and care data for Bexley patients and residents that are seen in Guys & St Thomas’, Kings College Hospital Trust and South London and Maudsley NHS Trust.
Support Virtual collaboration via increased use of technology – Video Conferencing The CCG have provided a video-conferencing infrastructure to support virtual consultations, communications, remote access and virtual training. This will enable:
• delivery of various models of training and activities with virtual attendance,
• holding virtual MDT meetings aimed at avoiding admissions by inviting District
Nurses and Social Workers remotely
• strengthening of communication links with care homes without the GP physically
needing to attend
• video consultations with patients
• virtual team meetings where practices operate across a number of sites
• closer working between practices as federated working evolves over forthcoming
years.
Provide Free Wi-Fi in all NHS buildings to support digital and paperless activity NHS Digital is working to make sure that everyone can access free WiFi in NHS sites in England, as set out in the NHS England General Practice Forward View. NHS WiFi will provide a secure, stable, and reliable WiFi capability, consistent across all NHS settings. It will allow patients and the public to download health apps, browse the internet and access health and care information. Bexley CCG are responsible for choosing a supplier that can provide an NHS WiFi compliant system which suits their needs, and working with them to implement it across their local GP sites by the December 2017. The chosen system will be based on a set of policies and guidance defined by NHS Digital.
Health and Social Care Network (HSCN) The HSCN is the replacement for the current N3 network. The current N3 contract ends on 31st March 2017 although an 18 month extension has been put in place for a ‘Transition Network’.
5
There are three strategic drivers for the HSCN Programme which includes the following: • the requirement to prepare for the pending implementation of N3 replacement
services for health partners to maintain business continuity
• the need for core infrastructure and services to deliver against Sustainability
Transformation Plans, Digital Roadmaps and Digital Maturity in support of major
service reconfigurations.
• the need for greater inter-operability going forward across organisations, including
other public, voluntary and private providers to closely integrate services for the
benefit of citizens
Ultimately, it provides the underlying network arrangements to help integrate and transform health and social care services by enabling them to access and share information more reliably, flexibly and efficiently.
Online Consultations as part of the GPFV The rollout of eConsult across all Bexley GP practices which will enable patients to interact electronically using their practice website for self-help, advice and guidance on symptoms presented and will also enable them to consult with their practice electronically for non-urgent conditions. The urgent care settings in Bexley are also being transformed from September and will be piloting a new digital concept where service users will be directed to a digital health pod to take details of their symptoms which will then triage them appropriately in advance of the patient being seen by a clinician which will reduce the time that the patient is waiting to be seen and enables the clinician to provide enhanced care as they are given access to information relating to the patient’s condition prior to the patient being seen.
Provide NHS 111 digital services by December 2017 The NHS 5YFV Next Steps sets out the requirement to provide an NHS 111 Online solution by December 2017. London STPs were recommended to mobilise one of the vendors which have already been tested under the national pilot framework. Given the timing / funding constraints, coupled with the due diligence that has taken place since 31st July 2017, NHS Digital Pathway is the recommended 111 online solution for SEL. NHS 111 Digital Pathways is a new digital service provided by NHS Digital. It's based upon NHS Pathways clinical algorithms and complements the existing national 111 online telephone service. The 111 online service uses the suite of NHS Pathways algorithms to allow users to go through an online triage and be referred on to the most appropriate NHS care service or to self-treat at home. The clinical content on the service follows all the same rigorous clinical governance and clinical assurance as the 111 telephone service.
DATE: 4th October 2017
Title
GP Patient Survey results July 2017 publication
This paper is for Discussion
Recommended action for the Governing Body
That the Governing Body: DISCUSS and NOTE the patient survey results.
Potential areas for Conflicts of interest
All GPs are conflicted as the results directly relate to GP practices. However, no practice level information is included in the report.
Executive summary
The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. Ipsos MORI administers the survey on behalf of NHS England. This report highlights the key results for NHS Bexley CCG based on a response rate of 39%, 2,911 returned questionnaires. Participants are sent a postal questionnaire with the additional option of completing the survey online or via telephone. The GP Patient Survey measures patients’ experiences across a range of topics. It provides data at practice level using a consistent methodology, which means it is comparable across organisations and over time. However, the survey does have limitations and all comparisons are indicative only. Differences may not be statistically significant, particularly when comparing practices due to low numbers of responses. The survey cannot therefore be used in isolation to judge performance but can be used as one element of evidence. It can be triangulated with other sources of feedback, such as feedback from Patient Participation Groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient experience and in order to identify potential improvements and highlight best practice.
ENCLOSURE: G1 Agenda Item: 23/17
Governing Body meeting (held in public)
Bexley CCG took on delegated commissioning responsibilities from April 2017, prior to this it held joint commissioning responsibility with NHS England from April 2015. Since taking on its delegated commissioning responsibilities, the CCG has established a robust primary care commissioning committee which is responsible for overseeing the work required in commissioning primary care services within Bexley. In addition to this, there is a strong and proactive primary care development working group which comprises a vast range of stakeholders, including CCG primary care representatives (both GP and practice managers), CCG primary care managers, Healthwatch Bexley, voluntary services, the local authority, the local pharmaceutical committee (LPC) and community education provider network (CEPN) who meet monthly to discuss and work through primary care initiatives to support enhanced patient care and patient experience in Bexley. Despite Bexley’s performance being below the national average in all areas, it is possibly not surprising given the challenges and difficulties that practices in Bexley face with recruitment and retention in the area. Notwithstanding this, some small scale improvements have been achieved and many areas have demonstrated a constant performance with only a small percentage gain required to meet the national average. This in itself may be seen as quite an achievement given the workforce pressures that Bexley practices have endured. Access to GPs and recruitment and retention of the workforce are two areas of significant focus for the CCG going forwards and will be reflected in the growing demand for GP services and increasing expectations of the population. The CCG will be working with patient groups to understand these demands further. A number of initiatives have been implemented over the last year to help improve the availability of GP appointments and the primary care development team will continue to work with practices to improve performance.
How does this paper support the CCGs objectives?
Patients:
The patient survey gives one indication of practice performance which can be triangulated with other sources of feedback, such as feedback from patient participation groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient experience and in order to identify potential improvements and highlight best practice.
People: N/A
Pounds: There is likelihood that investment will be required to transform primary care, which is not available within existing
resources.
Process: N/A
What are the Organisational implications
Key risks
That patients do not get the required service from primary care.
Equality
All patients should expect the same service from Bexley practices.
Financial
N/A
Data
N/A
Legal issues
N/A
NHS constitution
N/A
Engagement Monthly PCDWG meetings are held which includes Healthwatch and the lay member for Patient and Public Engagement as well as other stakeholders.
Audit trail This paper has not been to any other committee. The results will be discussed at future locality and primary care development working group meetings.
Comms plan None
Author: Nisha Wheeler Interim Director of Primary Care
Clinical lead: Dr Nikki Kanani Chief Clinical Officer
Executive sponsor: Nisha Wheeler Interim Director of Primary Care
Date 26th September 2017
Enc G2 Item 23/17
GP Patient Survey results July 2017 publication
Introduction The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. Ipsos MORI administers the
survey on behalf of NHS England.
This report highlights the key results for NHS Bexley CCG. Results are based on aggregated data collected from a single wave of fieldwork. In previous years, questionnaires were sent out bi-annually and data for two waves were combined for publication. In 2017 a similar number of surveys were distributed in a single wave as the combined number of surveys that were distributed across two waves in previous years. It is considered that this presents sufficiently large sample sizes to publish statistically robust results at GP practice level. Results are also published at national and Clinical Commissioning Group level. The results presented for 2017, are based on one wave of fieldwork which took place in January-March 2017 which aligns with the fieldwork dates for wave 2 in earlier years. For Bexley, 7,498 questionnaires were sent out, and 2,911 were returned completed. This represents a response rate of 39% which is a slight decrease in the response rate received in 2016 where 41% was achieved for a similar number of questionnaires, 7,173, being sent out. This is in line with the national average for overall response rate to the survey which is 37.5%. Participants are sent a postal questionnaire, also with the option of completing the survey online or via telephone. The GP Patient Survey measures patients’ experiences across a range of topics, including:
Making appointments
Waiting times
Perceptions of care at appointments (overall experience)
Practice opening hours
Out-of-hours services It provides data at practice level using a consistent methodology, which means it is comparable across organisations and over time. However, the survey does have limitations:
• Sample sizes at practice level are relatively small • The survey does not include qualitative data which limits the detail provided
by the results • the survey will run annually only from 2017 and data provided is for January-
March 2017rather than in real time. All comparisons are indicative only. Differences may not be statistically significant –
particularly when comparing practices due to low numbers of responses.
Enc G2 Item 23/17
The survey cannot therefore be used in isolation to judge performance but can be used as one element of evidence. It can be triangulated with other sources of feedback, such as feedback from Patient Participation Groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient experience and in order to identify potential improvements and highlight best practice.
Enc G2 Item 23/17
July 2017 Survey Results The table below analyses the July 2017 survey results and compares them to the survey from the previous year.
June 2013
July 2014
July 2015
July 2016
July 2017
Movement since last survey
National results
Number of practices on or above national average
Bexley range
National range
Overall experience of GP surgeries
Overall experience of GP surgeries – Good
82% 80% 78% 80% 79%
85% 10/27 59%-96%
73%-87%
Overall experience of GP surgeries – Poor
6% 7% 9% 7% 9%
5%
Access to GP services
Ease of getting through to GP surgery on the phone – Easy
69% 65% 59% 61% 58%
68% 11/27 31% -91%
49%-79% Ease of getting through to GP surgery
on the phone – Not easy 27% 32% 38% 36% 38%
28%
Helpfulness of receptionists at GP surgery – Helpful
85% 85% 81% 85% 83%
87% 12/27 68%-96%
78%-89% Helpfulness of receptionists at GP
surgery – Not helpful 12% 13% 18% 13% 15%
11%
Percentage aware of online services available – Booking appointments online
32% 37%
36% 8%-78%
Percentage aware of online services available – Ordering repeat prescriptions online
28% 29%
34% 7%-57%
Percentage aware of online services 4% 5% 9% 0%-
Enc G2 Item 23/17
available – accessing medical records online
14%
Online services used in the last 6 months – Booking appointments online
8% 8%
= 9% 1%-
23%
Online services used in the last 6 months – Ordering repeat prescriptions online
9% 9%
=
12% 2%-26%
Online services used in the last 6 months – accessing medical records online
0% 0%
=
2% 0%
June 2013
July 2014
July 2015
July 2016
July 2017
Movement since last survey
National results
Number of practices on or above national average
Bexley range
National range
Making an appointment
Ability to make an appointment or to see someone last time it was required - Yes
85% 81% 79% 78% 79%
84% 8/27 65%-93%
73%-88%
Ability to make an appointment or to see someone last time it was required – No
11% 16% 17% 17% 17%
=
11%
How convenient was the appointment you were able to get - Convenient
91% 90% 89% 90% 90%
= 92% 12/27 80%-
98% 85%-92%
How convenient was the appointment you were able to get – Not convenient
9% 10% 11% 10% 10%
= 8%
Enc G2 Item 23/17
June 2013
July 2014
July 2015
July 2016
July 2017
Movement since last survey
National results
Number of practices on or above national average
Bexley range
National range
What did patient do when unable to get appointment / offered inconvenient appointment:
Went to the appointment offered 36% 36%
= 35%
Got an appointment for a
different day
23% 19%
20%
Had a consultation over the
phone
4% 5%
6%
Went to A&E 6% 8%
5%
Saw a pharmacist 2% 3%
3%
Used another NHS service 7% 5%
6%
Contacted surgery at another
time
11% 15%
13%
Didn’t see or speak to anyone 14% 12%
15%
Overall experience of making an appointment - Good
72% 66% 64% 65% 64%
73% 10/27 36%-93%
58%-77%
Overall experience of making an appointment - Poor
12% 15% 18% 17% 18%
13%
Waiting times at the GP surgery
Enc G2 Item 23/17
How do you feel about how long you normally have to wait to be seen – Don’t wait too long
53% 51% 51% 51% 51%
=
58% 10/27 31%-83%
41%-63%
How do you feel about how long you normally have to wait to be seen – Wait too long
41% 43% 42% 41% 39%
33%
Perceptions of care at patients’ last GP appointment
Last time you saw or spoke to a GP from your GP surgery, how good was that GP at each of the following?
Very Good
Good Neither good not poor
Poor Very Poor National results – Poor / Very Poor
Giving you enough time 39% 43% 13% 4% 1% 4%
Listening to you 43% 40% 12% 3% 1% 4%
Explaining tests and treatments 39% 43% 14% 2% 1% 3%
Involved in decisions about your
care
35% 43% 17% 4% 1% 4%
Treating you with care and
concern
39% 41% 14% 4% 1% 4%
Enc G2 Item 23/17
June 2013
July 2014
July 2015
July 2016
July 2017
Movement since last survey
National results
Number of practices on or above national average
Bexley range
National range
Did you have confidence and trust in the GP you saw or spoke to – Yes
94% 93% 93% 95% 95%
= 95% 15/27 83%-
99% 91%-96%
Did you have confidence and trust in the GP you saw or spoke to – No
6% 7% 7% 5% 5%
= 5%
Perceptions of care at patients’ last nurse appointment
Last time you saw or spoke to a Nurse from your GP surgery, how good was that Nurse at each of the following?
Very Good
Good Neither good not poor
Poor Very Poor National results – Poor / Very Poor
Giving you enough time 49% 39% 10% 2% 0% 2%
Listening to you 48% 40% 10% 2% 1% 2%
Explaining tests and treatments 46% 41% 15% 2% 1% 2%
Involving you in decisions about
your care
41% 41% 15% 2% 1% 2%
Treating you with care and
concern
46% 40% 10% 2% 2% 2%
Enc G2 Item 23/17
June 2013
July 2014
July 2015
July 2016
July 2017
Movement since last survey
National results
Number of practices on or above national average
Bexley range
National range
Did you have confidence and trust in the Nurse you saw or spoke to – Yes
96% 96% 97% 96% 96%
= 97% 17/27 85%-
100% 92%-98%
Did you have confidence and trust in the Nurse you saw or spoke to – No
4% 4% 3% 4% 4%
= 3%
Satisfaction with the practice’s opening hours
Satisfaction with the hours that the GP surgery is open - Satisfied
76% 72% 70% 70% 71%
76% 8/27 58%-90%
70%-81%
Satisfaction with the hours that the GP surgery is open - Dissatisfied
9% 13% 13% 12% 13%
9%
Out-of-hours services
Considering all of the services you contacted, which of the following happened on that occasion?
I contacted an NHS service by
telephone
47% 45%
61%
A health professional called me
back
19% 17%
26%
A health professional visited me
at home
2% 2%
=
6%
I went to A&E 39% 43%
34%
I saw a pharmacist 8% 10%
11%
Enc G2 Item 23/17
I went to another NHS service 30% 27%
23%
Can’t remember 5% 4%
4%
How do you feel about how
quickly you received care or
advice on that occasion – About
right
58% 59%
61%
How do you feel about how
quickly you received care or
advice on that occasion – Took
too long
34% 35%
33%
The full survey is available at https://gp-patient.co.uk/surveys-and-reports#july-2017
Bexley CCG took on delegated commissioning responsibilities from April 2017, prior to this it held joint commissioning responsibility with NHS England from April 2015. Since taking on its delegated commissioning responsibilities, the CCG has established a robust Primary Care Commissioning Committee which is responsible for overseeing the work required in commissioning primary care services within Bexley. In addition to this, there is a strong and proactive primary care development working group which comprises a vast range of stakeholders, including CCG primary care representatives (both GP and practice managers), CCG primary care managers, Healthwatch Bexley, voluntary services, local authority, local pharmaceutical committee (LPC) and community education provider network (CEPN) who meet monthly to discuss and work through primary care initiatives to support enhanced patient care and patient experience in Bexley. The July 2017 results illustrate that Bexley remains below the national average in all areas, with some notable minor improvements in performance in a few areas A number of indicators have remained static, potentially illustrating the efforts that practices have gone to, despite the challenges they have faced with respect to workforce::
Overall experience of GP surgeries has declined marginally from 80% to 79%
Access to GP surgeries on the telephone has remained difficult with only 58% of patients in 2017 reporting they can get through easily, previously 61%
An increase in online services has been reported for booking appointments, ordering repeat prescriptions and accessing medical records. This can be attributed to the intensive work undertaken by practices and the CCG earlier in the year between January – April 2017.
Patients experience of making an appointment in July 2017 has remained largely static with only a 1% increase, to 79% of patients having the ability to make an appointment or see someone last time it was required.
Confidence and trust in their GP remained static at 95% which is in line with the national average and confidence and trust in their nurse also remained static at 96%. The latter being 1% below the national average of 97%.
Satisfaction with GP opening hours has seen a marginal increase for patients in Bexley to 71% from 70% in 2016 whilst out of hours services have had a mixed response with 43% visiting A&E, an increase of 4% from 2016 and an increase of 2% visiting their pharmacist from 8% to 10%. It is anticipated that the results for out of hours services will be improved by the CCG communications campaign to help patients to ‘choose services well’ over the autumn and winter months.
Since the last report in July 2016, the CCG has been aware of the need to focus attention onthe growing demands for GP services and increasing expectations of the population.
Enc G2 Item 23/17
With respect to managing access and waiting times for appointments, the CCG’s Primary
Care team has been working with practices to offer a range of enhanced services as follows:
Patient online – This service enables patients to book appointments, order repeat prescriptions and view their medical records securely using online services.
eConsult – Patients will have the opportunity to access GP services online using their practice website from the end of October 2017. This service will enable patients to check their symptoms at any time and receive on the spot medical advice
and treatment guidance. It will provide them with advice on how to self-manage their symptoms at home and signpost them to the most suitable services that can provide
effective treatment solutions. It will also enable them to have an online consultation with their GP. In addition, access to the UCCs at Queen Mary’s and Erith Health Centre will also be available.
Enhanced Access – Since May 2017, patients have been able to access the enhanced access hub services that have been established in Erith Hospital and at Queen Mary’s. These services are an extension of the GP practice service and enables patients to be seen from 6.30-8.00pm on a Monday – Friday and 8am-8pm on Saturdays, Sundays and bank holidays.
There has also been extensive work taking place within Bexley to introduce new roles within the GP practices to support the additional demands on GP time. Roles such as medical assistants, clinical pharmacist and GP fellows have been introduced within some of our practices to provide additional support with respect to access and continuity of care.
According to the Healthy London Partnership GP Workforce modelling undertaken in January 2017, Bexley remains the borough with the lowest number of GPs per 1000 patients in England. This goes some way towards explaining the difficulty that patients have at getting a GP appointment, however to help address the challenges that practices have in recruiting and retaining GPs, a number of initiatives have been implemented by Bexley Community Education Provider Network (CEPN) which seek to up-skill, diversify and attract new clinical staff to work in Bexley practices. These schemes are summarised below:
GP Fellows scheme - a new role of GP Fellow was introduced during 2016 to offer training and experience opportunities in primary Care, community and CCG management. The role will be based in General Practice, but will also include placements in Bexley CCG, Greenwich and Bexley Hospice and Oxleas Trust (community care provider) to gain experience and develop well rounded future GPs.
Bexley CEPN in collaboration with Bexley Health Neighbourhood Care (Bexley CIC) won the NHS England bid for Pharmacists in General Practice Pilot. This pilot involves 6 non-prescribing pharmacists training within 11 practices, under a senior pharmacist's tuition. The aim of this being to redirect
Enc G2 Item 23/17
some of the workload from GPs (eg. medication reviews etc) who can then deal with more clinical issues. Due to the success of this pilot, BHNC, CEPN and lead Clinical Pharmacist are putting together a bid for a third wave of Clinical Pharmacists with support from the CCG.
Securing multi-professional undergraduate placements in primary care for nursing, medical, allied health professionals and physician associates students to help expose these clinicians to working in the primary care environment.
In addition to the workforce and access initiatives outlined above, the following schemes are at various levels of implementation to help improve the availability of GP appointments:
Telephone triage – some practices operate a triage model where patients with urgent on-the day medical issues are all called back by a GP. This helps determine whether the patient actually needs a face-to-face appointment or whether the issue is resolvable with just advice from the GP, a prescription or other community services. This helps retain GP appointments for those with the most complex needs where assessment is required. This model has been promoted and showcased by practices who use it.
Social prescribing – practices across Bexley can make a non-medical referral to the social prescribing service where patients are linked with sources of community support that improve health and wellbeing. This helps navigate patients to services which are best placed to support their non-medical needs, helping to release GPs’ time to focus on medical, complex cases.
Resilience and Retention Planning – A series of externally facilitated, half day development workshops, have been agreed for Bexley practices to enable them to plan their resilience and sustainability strategies.
A further workshop has been agreed for Bexley Health Neighbourhood Care (NHBC) to them to plan and develop services that will support member practices as required to remain resilient and continue to provide essential primary care services to the Bexley population.
Virtual Training Hubs - the delivery of the virtual infrastructure ETTF bid will be completed by the end of September 2017 and will help to increase the number of training practices in Bexley and support the primary care workforce in obtaining relevant training at a time that is convenient to them.
International GP Recruitment - Bexley has recently been successful in a joint bid with Greenwich, Lewisham and Bromley CCGs for the International GP programme which will deliver an additional 45 much needed GPs to these boroughs.
Enc G2 Item 23/17
Conclusion and Recommendations
Although the July 2017 survey results show that performance of Bexley practices is below the national average, it is possibly not surprising given the challenges and difficulties that practices in Bexley face with recruitment and retention in the area. Notwithstanding this, some small scale improvements have been achieved and many areas have demonstrated a constant performance with only a small percentage gain required to meet the national average. As stated earlier in the report, the survey results cannot be used in isolation to judge performance but needs to be triangulated with other sources of feedback to understand practice performance and as outlined above, there is significant work taking place in Bexley to implement initiatives and provide support with respect to improving the access and workforce challenges it faces. The Primary Care Development team will continue to work with practices to implement services that assist with access and provide continued support with respect to the retention and recruitment plans for Bexley practices. Members are asked to DISCUSS and NOTE the patient survey results.
DATE: 4th October 2017
Title
Month 5 2017/18 Primary Care Finance report
This paper is for Discussion
Recommended action for the Primary Care Commissioning Committee
That the Primary Care Commissioning Committee:
1. NOTES the month 5 2017/18 primary care budgetary position.
Potential areas for Conflicts of interest
All GPs will be conflicted as these budgets relate to their main PMS/APMS/GMS contracts.
Executive summary
Attached at Appendix 1 is the month 5 primary care finance information provided by the NHS England finance team. The budget of £28,549k shown is in line with the primary medical services revenue resource limit, previously submitted to this committee as part of the 2017/18 budgets. This allocation increased by 2.7% from 2016/17. The primary care medical budget calculated for the CCG leaves a net deficit position of £103k against this allocation as previously reported. This is after utilising the contingency and non-recurrent reserve. It is expected that this deficit will be managed within the population growth reserve following low levels of list increase in quarter 2. The CCG’s weighted practice list size has increased by 1.9% year on year from April 2016 to April 2017 and only a further 0.06% to July 17. The reported year to date position is an overspend of £28k (0.2%), the majority relating to seniority. However, it is not expected that this overspend position will continue to year end. A number of practices are awaiting retrospective rent reviews and this poses a risk to the budgetary position in this and future years. However, NHS England is confident that sufficient accruals are held for previous years’ costs. Additional void costs will also be payable on both Lakeside
ENCLOSURE: H1 Agenda Item: 27/17
Primary Care Commissioning Committee Meeting
and Erith Health Centres following the withdrawal of Oxleas, following the loss of a health visitors contract, and the resultant increase of void space. The CCG’s finance department has organised a meeting to review all primary care budgets, with NHS England, to obtain a thorough understanding of what has been included and to undertake a review as to whether any can be release to assist with the CCG’s financial position. The CCG is also still awaiting the reversal of accruals, and associated cash, for 2016/17 expenditure processed in 2017/18. There may also be additional accruals no longer required that could potentially be released to support the financial position. Members are asked to note the financial position in respect of delegated primary care.
How does this paper support the CCGs objectives?
Patients: Payment of the PMS/GMS and APMS contracts will ensure that all Bexley residents have access to a Bexley GP.
People: These budgets are required for the CCG to be able to fund the PMS/GMS and APMS contracts for Bexley GPs.
Pounds:
The committee need to be aware of the potential cost pressures around this budget. This budget will need to be further updated to include agreements around the PMS premium and equalisation across Bexley.
Process: These budgets have been approved by the Governing Body and uploaded to the financial systems. The NHS England STP team provide the financial information to the CCGs.
What are the Organisational implications
Key risks
That the allocation is insufficient to cover the costs incurred by the CCG on primary care including increased rent from rent reviews and void costs.
Equality
Not applicable
Financial
That the allocation is insufficient to cover the costs incurred by the CCG on primary care. There are no QIPP plans as mitigation to cover any potential shortfall.
Data
Not applicable
Legal issues
Not applicable
NHS constitution
Not applicable
Engagement Not applicable
Audit trail Not applicable
Comms plan Not applicable
Author: Theresa Osborne Chief Operating Officer and Chief Financial Officer
