Report for the Royal Borough of Kingston Health Overview Panel (HOP) on GP Provision in Kingston.

Author: Kathryn MacDermott, Director Primary Care & Planning, Kingston & Richmond CCGs

Contact: [email protected]

Contributions from and thank you to:

 KCCG Primary Care Team  KCCG Performance & Information Team  SWL Primary Care Contacting Team

1 Contents 1. GP Provision in Kingston - background...... 4 2. Kingston Medical Services – the local primary care strategy ...... 4 2.1 Quality in Primary Care – local engagement in Kingston Medical Services ...... 5 3. The GP Forward View ...... 6 3.1 Investment...... 7 3.2 Workforce...... 7 3.3 Work load ...... 7 3.4 Infrastructure...... 8 3.5 Care redesign...... 8 4. The South West London STP...... 9 5. Services provided by GP Practices in Kingston ...... 9 5.1 Contract by contract type...... 10 5.2 Core primary care medical services...... 11 5.3 Locally Commissioned Services ...... 11 5.4 National Directed Enhanced services ...... 12 5.5 Kingston Medical Services – local KPIs...... 13 5.6 GPs with Specialist Interest ...... 14 6. Access to general practices...... 15 7. Extended Primary Care Services ...... 17 7.1 Weekend additional capacity ...... 17 7.2 National DES extended hours ...... 17 8. Urgent Primary Care services ...... 21 8.1 Urgent Treatment Centres...... 21 8.2 GP Out of Hours Services...... 22 8.3 NHS 111 ...... 22 9. Primary Care data...... 23 9.1 Numbers and ages of registered patients ...... 23 9.2 Deprivation by practice ...... 25 9.3 Ethnicity by practice ...... 26 9.4 Usage of GP appointments ...... 27 10. General practice workforce ...... 29 10.1 Kingston primary care workforce as of March 2016: ...... 29

2 10.2 Patient to GP Ratio ...... 30 10.3 Total Health Care professionals per practice FTE ...... 31 10.4 GPs by Age Band...... 32 11. The GP Patient Survey ...... 33 11.1 Overall experience of GP surgeries...... 33 11.2 Patient experience of telephone access...... 34 11.3 Success in getting an appointment...... 34 11.4 Waiting time at the GP surgery ...... 35 11.5 Patient perception of care...... 36 11.6 Patient satisfaction with opening hours...... 36 12. Care Quality Commission (CQC) ratings ...... 37 13. Primary Care Governance...... 39

3 1. GP Provision in Kingston - background

There are currently 22 practices listed as members of Kingston CCG. One practice whilst a member of Kingston CCG is geographically located in the borough of Merton. At this point in time three practices also have branch surgeries. This means that in Kingston there are 26 locations at which patients can see a GP. In addition to the individual GP practices Kingston also provides three extended primary care services that offer 8 to 8, 7 day a week access to a GP and/or nurse appointment.

2. Kingston Medical Services – the local primary care strategy

The local primary care strategy covers delivery of the GP Forward View transformation of primary care whilst aiming to provide the same services across all practices in Kingston. To achieve this KCCG is investing additional money into Kingston general practices through a range of locally developed services known as KPIs. In 2016/17 the additional investment was £1m. In 2017/18 the additional investment is £1.5m. The intent is to be able to invest an additional £2m in 2018/19 to achieve the transformation and equalisation of services. However, this level of additional investment is only sustainable if we can change the flow of patients into hospitals, change patient behaviours and move money around the local healthcare system.

The local Kingston Medical Services strategy invests in a range of additional services including extended primary care services, primary care mental health, paediatric same day appointments, supports practices to make informed referral decisions, supports practices identify vulnerable patients that require additional care and/or referral to Kingston Coordinated Care, audiology services, respiratory services, and supports practices set a minimum number of GP appointments based on list size (not currently stipulated in the GMS contract). The local strategy is in the middle of being rolled out and the GMS practices are already delivering a range of the local KPIs. The PMS practices will be moving from their existing PMS KPIs to the new Kingston Medical Services local KPIs for the 1st April 2018. The table below sets out the current pattern of delivery for the new KPIs:

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n A y i a p G a k l k e s d t M r s e m i e e i S a e M r R a R E P P W Berrylands Surgery Brunswick Surgery Canbury Medical Centre Central Surgery Chessington Park Surgery (Merrick Centre) Churchill Medical Centre Claremont Medical Centre Fairhill Medical Practice Groves Medical Centre Holmwood Corner Surgery Hook Surgery (Merrick centre) Kingston Health Centre Langley Medical Practice Manor Drive Medical Centre Orchard Practice Red Lion Surgery (Mediventure Ltd) Roselawn Surgery St Alban’s Medical Centre Sunray Surgery Village Surgery West Barnes Surgery

2.1 Quality in Primary Care – local engagement in Kingston Medical Services

Kingston CCG launched a public engagement programme at its AGM in September. The aim is to have a public conversation about the quality of locally provided general practice and community pharmacy across Kingston & Richmond CCGs. It has been 18 months since Kingston CCG took on the responsibility for commissioning primary care medical services and we included a commitment in our commissioning intentions to actively engage the local population in the design of local services.

Kingston CCG completed an engagement programme in primary care in 2015. The feedback from this programme helped inform the primary care strategy – Kingston Medical Services. We wish to build on what local people have already told us about local GP practices and pharmacies, and develop a set of quality pledges for primary care. To do this we will be

5 talking to patients, carers, local people, clinicians and staff, to understand what good quality looks like. Over the next four months KCCG will be talking to people across Kingston and asking ‘what matters most to you when visiting your GP and/or local pharmacy?

We also want the perspective of clinicians and staff working in local GP practices and pharmacies about what good quality primary care looks like and what matters most to them about the services they deliver.

3. The GP Forward View

Kingston Medical Services sits alongside the General Practice Forward View (GPFV) published in April 2016 by NHS England, with support from Royal College of GPs (RCGP) and Health Education England. The GPFV sets out a substantial 5 year package of investment and transformation that aim to support practices respond to the changing environment. It sets out a plan to stabilise and transform general practice, improving services for patients and investing in new ways of providing primary care. The key actions set out in the plan include: accelerated funding of primary care; expanding and supporting GP and wider primary care staffing; reducing the burden on practices to help release time for patient care; develop the primary care estate and invest in better technology and a major programme of improvement support to practices.

The illustration below attempts to illustrate how the delivery of the GP Forward View intends to impact on general practice, patients and the wider healthcare system.

Strengthening General

Practice Community Collective Services Working

Access Hub

Demand Management Standard • Self-help e.g. nhs.uk Contract • Better sign posting • Stabilise practices o Minor Ailments • Support for stressed GPs o Social prescribing • Resilience programme • Enhanced remote care • Development programme • Care Planning Approach • Workforce expansion • Reformed 111/Urgent Care Greater • Streamlined processes Specialist Support

Proportionate regulation Streamlined payment systems Review of requirements e.g. QOF/AUA

6 The GP Forward View is structured into five sections:

1) Investment 2) Workforce 3) Workload 4) Practice infrastructure 5) Care redesign

3.1 Investment

The GP Forward View states “by 2020/21 recurrent funding to be increased by an estimated £2.4 billion a year, decisively growing the share of spend on general practice services”. This is clearly positive news and taken with Kingston CCGs strategy to invest in Kingston Medical Services represents a unique opportunity in Kingston to general practices to support the significant redesign of care pathways and patient flows.

The new funding formulae for general practices (to replace the existing Carr-Hill formulae) is proposed and being worked by up NHSE with the BMA and is designed to take into account ‘atypical’ population lists, i.e. practice lists with significant older populations, high rates of students, black and minority ethnic communities etc. This work is expected to be completed in the summer of next year.

3.2 Workforce

The GP Forward View recognises that there is a significant workforce challenge for primary care and refers to new incentives for training, recruitment, retention and return to practice. The ambition is to double the workforce and ongoing work across London to understand how this could be achieved.

There are a number of positive initiatives proposed including the health & wellbeing of GPs, training ‘hubs’, practice nurse development, leadership development, and piloting clinical pharmacists in general practice. Across SWL the CCGs are collaborating on the development and delivery of a shared workforce strategy.

3.3 Work load

“Releasing Time for Patients” is a development programme to support general practice ‘release time’ by enabling the care of patients to be provided by the appropriate professional, at the right time, in the right place. This refers predominantly to the care and self-management of people living with long term conditions.

7 The GP Forward View suggests that CCGs look to local community pharmacy to help with patients with long term conditions and minor ailments. This is a key element within the Kingston plan, included in the extended primary care services communications materials and a key question in the current quality in primary care engagement programme.

3.4 Infrastructure

The infrastructure section covers both estates and technology. The GPFV signalled a change in the way CCGs could apply for capital funding for estates bids, establishing the Estates and Technology Transformation Fund (ETTF). Kingston CCG currently has a proposal in the ETTF ‘round; for a new primary care centre on the Kingston Hospital site.

Most of the focus on infrastructure within the GPFV focusses on changing the way people can access general practice through technology. This includes:

 Technology that enables self-care and self-management for patients  Helps to reduce workload in practices  Helps practices who want to work together to operate at scale  Supports greater efficiency across the whole system  Support uptake of online consultation systems  Digital Primary Care Maturity Index – sets out the support general practice can expect from IT services

3.5 Care redesign

Care redesign focusses on enhanced primary care access (8 to 8, 7 days a week), and the integration of core general practice with out of hours and urgent care services. This element has been recently expanded on in the Urgent Care Guidance, and is informing the extended primary care services commissioning intentions for 2018/19 onwards.

The GPFV lists 10 high impact actions supporting care redesign and releasing capacity for practices. These include:

 Active signposting  New consultation types  Reduce DNAs (did not attends)  Develop the team  Productive workflows  Personal productivity  Partnership working  Social prescribing  Support self-care  Develop Quality Improvement expertise (QI)

8 4. The South West London STP

The South West London (SWL) Sustainability & Transformation plan includes a chapter on general practice and sets out the plan to integrate primary care and community services. However primary care is threaded throughout the strategy and is the bedrock of the out of hospital transformation of care.

The framework of the SWL STP chapter on general practice is currently structured around the 17 London specifications (Access, Coordinated & Proactive). This framework overlaps in a number of ways with the delivery of Kingston Coordinated Care.

5. Services provided by GP Practices in Kingston

Nationally there are three types of contracts that a general practice can sign up to. There are two contract types in place for general practices in Kingston, GMS & PMS.

The GMS contract covers the delivery of general medical services (GMS). It is the nationally set NHS contract between NHSE and a practice, not the individual GP. This came into force on 1st April 2004. Services in the GMS contract are split into three groups: essential, additional and enhanced.

Essential services are mandatory. Practices must provide essential services for people who are sick or perceive themselves to be sick with conditions from which recovery is expected, chronic disease management and general management of terminally ill patients.

Additional services are ‘expected’ under the GMS contract but Practices have the option to opt out. Additional services include cervical screening, contraceptive services, vaccination and immunisation, child health surveillance, maternity services (including intra partum care) and some minor surgery procedures.

Enhanced services can be either essential or additional services that are delivered to a higher standard, or extra/additional, specialised services, such as minor surgery or extended hours. These are known as Directed Enhanced Services (DES). Directed Enhanced Services are voluntary and NHSE commissions the national Directed Enhanced Services (on behalf of the CCGs).

Directed Enhanced Services are NHSE defined and funded services that practices can opt to provide. An example is the extended hours DES which a number of Kingston practices provide. Additionally, Kingston CCG commissions Locally Commissioned Services (LCS) that are designed and funded locally to meet local population needs.

9 PMS contracts build on the GMS contract. A practice with a PMS contract has contractually agreed to provide additional services as part of their core contract.

GMS and PMS contracts were introduced in 2004 as part of The NHS Plan. The intention was to move away from simply paying practices on the number of registered patients by introducing a number of quality indicators. The basic principle is that high quality practices receive additional resources to support continuation of quality services.

5.1 Contract by contract type

Kingston CCG is made up of a number of practices, some of which include branch surgeries. These are listed below by contract type as requested:

Practice Branch GMS Brunswick Surgery GMS Canbury Medical Centre Berrylands GMS Claremont Medical Centre GMS Groves Medical Centre GMS Hook Surgery (Merrick centre) GMS Kingston Health Centre GMS Manor Drive Medical Centre GMS Orchard Practice Part of Churchill Medical GMS St Alban’s Medical Centre GMS West Barnes Surgery GMS

Practice PMS Central Surgery PMS Chessington Park Surgery (Merrick Centre) PMS Churchill Medical Centre Surbiton & Tudor Drive PMS Fairhill Medical Practice Fairfield & University PMS Holmwood Corner Surgery PMS Langley Medical Practice PMS Red Lion Surgery (Mediventure Ltd) PMS Roselawn Surgery PMS Sunray Surgery PMS Village Surgery PMS

10 5.2 Core primary care medical services

All Kingston general practices provide the essential GMS services. In addition half of Kingston practices also provide additional services as part of the PMS contract. The additional services provided by a PMS practices includes:

1) A stretch target (i.e. higher than the GMS target) for childhood immunisation target. PMS practices are expected to achieve 95% coverage of all childhood immunisations DTP, MMR, Hib, Men C, PCV, etc. 2) Stretch target on QOF (Quality Outcomes Framework). PMS practices are expected to achieve greater than 950 QOF points. 3) Stretch target on cervical cytology (screening). PMS practices are expected to achieve 85% or more coverage of women aged between25-64 years of age. 4) Stretch target on flu & pneumococcal vaccination for patients aged 65 and over. PMS practices are expected to achieve 75% coverage of flu vaccination cover for patients who meet the DH criteria for flu immunisation. 5) Mental Health: PMS practices are expected to achieve 65% of patients diagnosed with dementia provided with an annual physical check-up including a regular review of any antipsychotic medication prescribed. 6) Obesity: The practice will offer a health check for 95% of new registrations over age 18 to include waist, weight and height measurements and offer referral to local weight management and exercise referral schemes where higher risks are identified and schemes are available e.g. Weigh-to-Go, Rosemary Conley, Get Active, Walk-4- Life and Cyle-4-Life. 7) Choose and Book: PMS practices are required to continue to deliver Choose and Book. 8) Carers: Have a carer’s register, routinely identify carer’s, have a ‘carer’s liaison officer’. 9) PMS practices are required to provide data on the delivery of any of the DH Vital Signs Targets (limit up to 3). The data is fed back to child health for reporting coverage to the DH for public health information

5.3 Locally Commissioned Services

Kingston CCG also invests in locally commissioned services, which all practices can opt into delivering. These local services are designed to meet the needs of the local population and can be different across different boroughs. The range of locally commissioned services provided by Kingston practices are illustrated in the table below:

11 Kingston Locally Commissioned Services

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P p o ( u r n u p V D x g h i o h S s B P m e i c m S e P R l A S o L M A C Berrylands Surgery Brunswick Surgery Canbury Medical Centre Central Surgery Chessington Park Surgery (Merrick Centre) Churchill Medical Centre Claremont Medical Centre Fairhill Medical Practice Groves Medical Centre Holmwood Corner Surgery Hook Surgery (Merrick centre) Kingston Health Centre Langley Medical Practice Manor Drive Medical Centre Orchard Practice Red Lion Surgery (Mediventure Ltd) Roselawn Surgery St Alban’s Medical Centre Sunray Surgery Village Surgery West Barnes Surgery

5.4 National Directed Enhanced services

In addition to locally commissioned services, that are developed and paid for locally, there are a range of nationally developed enhanced services that are managed by NHSE. Kingston practices also deliver a range of the nationally directed enhanced services illustrated below. Further detail on directed enhanced services can be found in section 6.2:

12 National Directed Enhanced Services

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t y e i d o g t r i y l e s r n t r w A r i u d o a e t c f u n r n n g i r t i n o o r f e s Practice a e f i t u H t i i M e g x S t u L D E e a O R P With Berrylands Surgery Canbury Brunswick Surgery Canbury Medical Centre Central Surgery Chessington Park Surgery (Merrick Centre) Churchill Medical Centre Claremont Medical Centre Fairhill Medical Practice Groves Medical Centre Holmwood Corner Surgery Hook Surgery (Merrick centre) Kingston Health Centre Langley Medical Practice Manor Drive Medical Centre Orchard Practice Red Lion Surgery (Mediventure Ltd) Roselawn Surgery St Alban’s Medical Centre Sunray Surgery Village Surgery West Barnes Surgery

5.5 Kingston Medical Services – local KPIs

Unique to Kingston is the investment that KCCG is putting into primary care through Kingston Medical Services. This new investment is enabling the roll out a suite of new services to all practices. Kingston Medical Services will ensure that all practices are able to offer the same range of services to their patients regardless of the type of national contract the practice holds with NHSE (i.e. GMS or PMS).

Kingston Medical Services has to demonstrate that it can achieve a shift in patient activity to enable the non-recurrent investment currently underpinning Kingston Medical Services to become recurrent.

13 GMS PMS Practice Essential Additional LCS KPIs Services Services Berrylands Surgery Brunswick Surgery Canbury Medical Centre Central Surgery Chessington Park Surgery (Merrick Centre) Churchill Medical Centre Claremont Medical Centre Fairhill Medical Practice Groves Medical Centre Holmwood Corner Surgery Hook Surgery (Merrick centre) Kingston Health Centre Langley Medical Practice Manor Drive Medical Centre Orchard Practice Red Lion Surgery (Mediventure Ltd) Roselawn Surgery St Alban’s Medical Centre Sunray Surgery Village Surgery West Barnes Surgery

5.6 GPs with Specialist Interest

Kingston has a number of GPs trained in specialised areas. These are known as GPs with a specialist interest (GPwSI). We currently have eight GPwSI and a number of them are specialist in more than one area.

Specialist GP advice is available on:

 Dermatology  Dementia  Neurology  Urology  Vasectomy  Minor Surgery

14 GPs with a specialist interest provide this additional service through a number of clinics that a patients GP can refer a patient to.

6. Access to general practices

The GMS contract describes core general practice hours as 8am to 6.30pm. However the GMS contract does not stipulate that the practice must be open for all core hours only that practices must provide essential services to meet the 'reasonable needs' of their patients.

The table below illustrates the current opening hours of practices in Kingston and illustrates the range of hours available. This range is due to a number of factors:

 The extended hours provided under the national extended hours enhanced service  If the practice has chosen to deliver the Kingston Weekend Additional Capacity KPI that provides for Saturday morning appointments.  If a practice closes for lunch  If a practices closes to allow for staff training time

There has been recent national attention paid to the contractual requirement to be open for the full core hours and future revisions to the GMS contract may clarify this point.

15 Kingston GP Hours

Practice provides cover outside of core opening Practice Hours (core hours are 8.00 to 18.30) GP practices open on Saturdays Online services times (8am - 18.30pm)

Berrylands Surgery Extended hours Mon & Fri only Yes. Extended hours Mon & Fri only Yes Yes Brunswick Surgery 7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed Yes. 7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed No Yes Canbury Medical Centre Extended hours Mon & Tues only Extended hours Mon & Tues only Yes Yes Central Surgery 7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri Yes. 7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri No Yes Chessington Park S8uargme r-y 13.00 Mon to Fri, 14.00 to 18.30 Mon, Tues, Fri, 14.00 to 20.00 Wed 7 Thur No Every 2nd Sat am No Churchill Medical Centre, 8.00am - 20.00 Mon to Fri 8.00am - 20.00 Mon to Fri 8.30am - 11.10 Yes Kingston Churchill Medical Centre, 8.30am - 12.00, 16.00 - 18.00 Mon, Tues, Thur, Fri. Wed Wed eve to 20.00 No Repeat Prescribtions only Surbiton 8.30am - 12.00, 15.00 - 17.00, 18.00 - 20.00 Churchill Medical Centre, Tudor 8.30am - 12.00 Mon to Fri. 16.00 - 18.00 Mon to Thur. No No Repeat Prescribtions only Br 8.30am to 13.00 Mon, Tues, Thur, Fri. Wed 8.30 am to Claremont Medical Centre Wed eve to 19.50. Thur eve to 19.20. Fri eve to 18.50 Yes Yes 19.50. Thur 14.10 - 19.20. Fri 14.10 - 18.50 Fairhill Medical Practice 8.00am - 18.30 Mon to Fri No No Yes Fairhill Branch 8.00am - 18.30 Mon to Fri No No Yes Fairhill University Branch 8.00am - 17.30 Mon to Fri No No Yes Groves Medical Centre 8.30am - 13.00, 14.00 - 18.30 Mon to Fri 7.00am on Tues & Thurs. 20.00 on Wed eve Yes Repeat Prescribtions only 8.50am to 11.30, Mon, Thur & Fri, 8.30am to 11.30 Tues & Holmwood Corner Surgery wed. 16.00 - 18.00 Mon. 15.00 - 19.30 Tues & Thur. 14.00 - Tues & Thurs eve to 19.30. 9.00 - 10.30 Yes 17.30 Wed eve. 15.00 - 18.00 Fri eve. Hook Surgery 8.00am - 13.00, 14.00 - 19.00 Mon to Fri Eves to 19.00 Every 2nd Sat am 8.30 - 10.30 Yes Kingston Health Centre 8.00am - 18.30 Tues to Thur, 7.15am - 18.30 Mon & Fri. Mon & Fri 7.15 am start Yes Yes Langley Medical Practice 8.00am to 18.30 Mon to Fri No No Yes 9.00 - 11.00 Mon to Fri, 15.30 - 18.00 Mon, Tues, Thur & Manor Drive Medical Centre Mon eve to 20.00 Yes Yes Fri, 17.00 on Wed, 18.30 - 20.00 Mon eve. 8.30 - 11.30 Mon & Thur, 9.00 - 11.30 Tues, 9.30 - 11.30 Red Lion Surgery (Mediventure Wed, 8.30 - 10.30 Fri, 16.30 - 18.30 Mon & Wed, 16.30 - Tues eve, 18.30 - 19.30, Fri eve 18.30 - 19.00 No Repeat Prescribtions only Ltd) 19.30 Tues, 16.30 - 19.00 Fri. Orchard Practice 7.30 - 18.30 Mon, Wed & Fri, 7.30 - 20.00 Tues & Thur 7.30 am, Tues & Thur eve to 20.00 Yes Yes 8.30 - 13.00 Mon to Fri, 14.00 - 19.30 Mon, 14.00 - 19.00 Roselawn Surgery Mon, Tues, wed & Fri extended eve hours. No Yes Tues, Wed & Fri. St Alban’s Medical Centre 7.30 - 18.00 Mon to Fri, closed 12.00 - 13.30. No No Yes Sunray Surgery 8.00 - 13.00, 15.00 to 18.30 Mon - Fri Mon eve 20.00 No No Village Surgery 8.30 - 18.30 Mon to Fri, 19.30 Wed & Thur. Wed & Thur eve to 19.30. No Repeat Prescribtions only To 19.00 Mon to Fri, Wed am 7.30 to 8.00, Fri eve West Barnes Surgery 8.00 - 19.00 Mon - fri Yes Yes 18.30 to 19.40.

16 7. Extended Primary Care Services

Kingston has three extended primary care services across Kingston that provides access to GP and/or Nurse Appointments, 8 to 8, 7 days a week.

The three services are based at:

 Surbiton Health Centre  Kingston Health Centre  Merritt Health Centre

Access to the weekday appointments are made by the patients GP through their clinical system. The appointments for each week (Monday to Friday) are available to be booked from Monday morning.

For access to weekend appointments patients can book via a single shared phone number. All callers will have access to the appointment available in all three extended primary care services, providing an element of patient choice. The weekend extended services is not advertised as a walk-in service. Where patients do walk-in they are allocated the next free appointment slot.

The extended primary care services and all Kingston practices are on the same clinical system (EMIS). This ensures that no matter where a patient is seen the clinician will be able to access their clinical records.

7.1 Weekend additional capacity

Weekend Additional Capacity is the name given to one of the local KPIs in the Kingston Medical Services contract. This KPI requires a practice to be open on a Saturday morning with a minimum number of appointments available (based on list size). There are two options for delivery of the Weekend Additional Capacity KPI. One requires that practices offers booked appointments, up to 5 days in advance. The second option requires practices to offer both booked in advance and same day appointments. Practices can choose which option best meets the needs of their local population.

7.2 National DES extended hours

The national DES (directed enhanced services) extended hours is commissioned and managed by NHSE. For Kingston CCG as a level 3 commissioners we would want to ensure that the extended provision provided through the national DES, local KPIs and the extended primary care services formed a holistic and seamless approach to extended hours that did not duplicate or create gaps in service provision for Kingston residents.

17 The next two tables are drawn from NHSE information on Kingston practices that have signed up to provide DES extended services. The detail provides a clear illustration of the extended hours provided and the clinical professional providing the services:

18 Monday - Tuesday - Tuesday - Monday - Monday Monday Tuesday Tuesday Extended Extended Extended Extended Extended Extended Extended Extended Hours Hours Hours Practice Name Hours Hours 1 GP 2 GPs 3 GPs 1 Nurse 2 Nurses HCA Hours 1 GP 2 GPs 3 GPs 1 Nurse HCA Hours 1 GP 2 GPs 1 Nurse HCA Other Hours 1 GP 2 GPs 1 Nurse Evening - Morning - Evening - Morning - Morning - Evening - Morning - Evening - start start start start time end time end time end time end time time time time Canbury Medical Centre 07:00 08:00 1 GP HCA Advanced Nurse Practitioner Brunswick Surgery 07:00 08:00 3 GPs 1 Nurse 18:30 19:00 1 GP The Groves Medical Centre 07:00 08:00 1 GP 1 Nurse HCA 18:30 19:30 1 GP Fairhill Medical Practice 18:30 20:00 2 GPs 18:30 20:00 2 GPs Hook Surgery 18:30 19:00 2 GPs Churchill Medical Centre 18:30 20:00 2 GPs 18:30 20:00 1 GP St Alban's Medical Centre 07:30 08:00 2 GPs 2 Nurses HCA 07:30 08:00 2 GPs 1 Nurse The Orchard Practice 07:30 08:00 1 GP 18:30 20:00 1 GP Holmwood Corner Surgery 18:30 20:15 1 GP Chessington Park Surgery Roselawn Surgery 18:30 19:30 2 GPs 18:30 19:00 2 GPs Berrylands Surgery 07:30 08:00 2 GPs Red Lion Road Surgery (Mediventure Ltd) 06:30 07:30 1 GP 18:30 19:30 1 GP Kingston Health Centre 07:00 08:00 1 GP 1 Nurse HCA Langley Medical Practice 07:00 08:00 1 GP 1 Nurse 07:30 08:00 1 Nurse 18:30 20:00 1 GP Sunray Surgery 07:30 08:00 1 GP HCA 18:30 20:00 1 GP 1 Nurse Claremont Medical Centre 18:30 20:00 3 GPs 18:30 19:00 1 Nurse The Village Surgery Manor Drive Medical Centre 18:30 20:30 2 GPs 1 Nurse HCA West Barnes Surgery 18:30 19:00 1 GP 1 Nurse 18:30 19:00 2 GPs

19 Wednes Wednes Wednes Wednes Thursday - Thursday - Friday - Friday - Saturday - day - day - Thursday Thursday Friday Friday Saturday day day Extended Extended Extended Extended Extended Extended Extended Extended Extended Extended Extended Extended Extended Extended Hours Hours Hours Hours Hours Practice Name Hours 1 GP 2 GPs 1 Nurse 2 Nurses HCA Other Hours 1 GP 2 GPs 1 Nurse Hours 1 GP 2 GPs 1 Nurse HCA Hours 1 GP 2 GPs 1 Nurse Hours 1 GP 1 Nurse 2 Nurses HCA Hours 1 GP Hours 1 GP 1 Nurse Hours Hours Morning - Evening - Morning - Evening - Morning - Morning - Evening - Morning - Evening - Morning - Evening - Morning - Morning - Evening - start start start start start start start end time end time end time end time end time end time end time time time time time time time time Canbury Medical Centre 07:00 08:00 2 GPs HCA Brunswick Surgery 18:30 19:45 1 GP 07:30 08:00 1 GP The Groves Medical Centre 07:30 08:00 1 Nurse 18:30 20:00 2 GPs 07:00 08:00 2 GPs Fairhill Medical Practice 18:30 20:00 1 GP 18:30 20:00 1 GP 07:30 08:00 1 GP 08:00 11:30 1 GP Hook Surgery 07:30 08:00 Nurse Practitioner 18:30 19:30 2 GPs Churchill Medical Centre 18:30 20:00 1 GP 18:30 20:00 1 GP 18:30 20:00 1 GP St Alban's Medical Centre 07:30 08:00 2 GPs 1 Nurse HCA 07:15 08:00 2 GPs 1 Nurse HCA 07:30 08:00 1 GP 1 Nurse The Orchard Practice 18:30 20:00 1 GP 07:30 08:00 1 GP 18:30 20:00 1 GP Holmwood Corner Surgery 18:30 20:15 1 GP 09:00 11:45 1 GP Chessington Park Surgery 18:30 20:00 1 GP 1 Nurse 18:30 20:00 1 GP Roselawn Surgery Berrylands Surgery 07:00 08:00 1 GP Red Lion Road Surgery (Mediventure Ltd) 18:30 19:00 1 GP Kingston Health Centre 07:00 08:00 1 GP 1 Nurse HCA 07:00 08:00 1 GP 1 Nurse HCA 07:00 08:00 1 Nurse HCA Langley Medical Practice 07:00 08:00 1 GP 1 Nurse Sunray Surgery Claremont Medical Centre 18:30 19:30 2 GPs 1 Nurse 08:30 11:30 1 GP The Village Surgery 18:30 19:45 1 GP 18:30 19:45 1 GP Manor Drive Medical Centre West Barnes Surgery 07:30 08:00 1 GP 1 Nurse HCA 18:30 18:45 1 Nurse 18:30 19:00 1 GP 08:30 11:15 1 Nurse

20 8. Urgent Primary Care services

8.1 Urgent Treatment Centres

National guidance on Urgent Treatment Centres was published recently. It includes the definition of an Urgent Treatment Centres (UTC) as:

“Urgent treatment centres (UTCs) are community and primary care facilities providing access to urgent care for a local population. They encompass current Walk-in Centres, Minor Injuries Units, GP-led Health Centres and all other similar facilities, including the majority of those currently designated as “Type 3 and Type 4 A&E Departments”. Urgent treatment centres will usually be led by general practitioners, and are ideally co-located with primary care facilities, including GP extended hours / GP Access Hubs or Integrated Urgent Care Clinical Assessment Services (formerly known as “GP out of hours” services)”.

The guidance sets out clear ‘minimum standards by which UTCs should operate. These include:

• Urgent treatment centres should be open for at least 12 hours a day seven days a week, including bank holidays. Typically this will be an 8-8 service • Urgent treatment centres must include minor illness and injury in adults and children of any age: • including wound closure, removal of superficial foreign bodies and the management of minor head and eye injuries. • Access to investigations including: • swabs, pregnancy tests and urine dipstick and culture. Near patient blood testing, such as glucose, haemoglobin, d-dimer and electrolytes should be available. Electrocardiograms (ECG) should be available, and in some urgent treatment centres near-patient troponin testing could also be considered. • Bedside diagnostics and plain x-ray facilities, particularly of the chest and limbs, are desirable and considerably increase the assessment capability of an urgent treatment centre, particularly where not co-located with A&E. • Where these facilities are not available on site, clear access protocols should be in place. • Provide both pre-booked, same day and “walk-in” appointments • Apply an effective and consistent approach to the primary prioritisation (triage) of pre-booked appointments and “walk-in” appointments, and the allocation of pre- booked routine and same day appointment slots (ratio) • Ability to book an appointment in the urgent treatment centre by a single phone call to NHS 111; patients should be encouraged to use NHS 111 as the primary route to access an appointment at an urgent treatment centre. • Patients who have a pre-booked appointment made by NHS 111 should be seen and treated within 30 minutes of their appointment time

21 • Patients who have a pre-booked appointment made by their GP should be seen and treated within 30 minutes of their appointment time • Patients who “walk-in” to an urgent treatment centre should be clinically assessed within 15 minutes of arrival • but should only be prioritised for treatment, over pre-booked appointments, where this is clinically necessary. • Following clinical assessment, walk in patients will be given an appointment slot, which will not be more than two hours after the time of arrival. • Be able to issue prescriptions, including repeat prescriptions and e-prescriptions • Access to the electronic (up to date) patient care record • Ability for other services (e.g. NHS 111) to electronically book appointments directly

Kingston Hospital is currently developing a UTC for the front end of Kingston A&E. The current KHFT plans include the triage of patients, and could include redirection of patients to the extended primary care services. The current contract with Kingston GP Chambers for extended primary care services includes the provision for the extended primary care service to be able to provide appointments for redirected patients. The contract for the Teddington walk in centre that many Kingston residents use is being updated for 2018/19 to include the ability to provide appointments for Richmond patients that are redirected.

8.2 GP Out of Hours Services

GP out of hours services are provided from 6.30pm to 8am on weekdays and all day at weekends and on bank holidays. For Kingston residents this service is provided by a partnership of Vocare and SELDOC. Sutton CCG manages this contract on behalf of Kingston CCG and four of the other five SWL CCGs.

8.3 NHS 111

NHS 111 is a national telephone based service that helps callers identify the most appropriate service for them to use. The intention is to integrate NHS 111 with the GP OOH services and enable 111 to book directly into the extended primary care services/hubs, enabling a seamless transfer for a patient calling the service.

22 9. Primary Care data

9.1 Numbers and ages of registered patients

As of 1st April 2017 there were 204,821 patients registered with a Kingston CCG practice. The number of patients registered per practice as of 1st April 2017 is set out below, by age band:

e e d m o a C N e e 9 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 ic ic 4 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 t t 0 o o o o o o o o o o o o o o o o o o l c c o t t t t t t t t t t t t t t t t t t ta ra ra t 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5+ P P P 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 To W H84053 Berrylands Surgery 263 247 211 159 231 298 304 361 302 315 273 255 216 215 177 124 102 71 36 8 4,168 4,013 H84015 Brunswick Surgery 554 501 410 345 362 530 729 756 648 619 545 419 331 286 215 151 114 81 38 22 7,656 6,725 H84010 Canbury Medical Centre 598 707 619 550 489 598 671 817 807 841 726 664 536 478 343 209 150 98 49 24 9,974 8,821 H84030 Central Surgery 788 783 687 564 533 789 1,033 1,135 1,113 980 903 696 580 580 490 361 272 198 102 44 12,631 11,588 H84050 Chessington Park Surgery 480 459 389 447 422 481 457 469 478 475 537 421 392 339 303 168 156 90 41 13 7,017 6,647 H84027 Churchill Medical Centre 1,471 1,460 1,044 743 922 1,426 1,795 1,881 1,800 1,449 1,121 905 680 600 531 331 226 149 63 25 18,622 16,137 H84619 Claremont Medical Centre 860 626 462 356 400 875 1,338 1,505 1,213 946 626 463 301 247 214 143 100 63 24 8 10,770 8,624 H84020 Fairhill Medical Practice 892 920 751 1,406 6,559 3,043 1,653 1,409 1,262 1,014 872 637 524 455 398 254 170 121 59 17 22,416 18,772 H84042 Holmwood Corner Surgery 818 824 709 688 730 851 992 1,078 1,049 968 883 682 549 546 415 323 277 198 83 30 12,693 11,192 H84025 Hook Surgery 518 509 414 355 401 491 604 582 539 534 446 385 313 274 252 178 139 90 42 15 7,081 6,693 H84058 Kingsdowne Surgery 172 168 179 205 209 280 309 296 283 272 278 225 242 228 188 143 109 64 29 11 3,890 3,786 H84062 Langley Medical Practice 511 458 378 316 381 567 642 678 635 623 556 455 346 336 301 195 159 105 29 12 7,683 7,091 H84635 Manor Drive Surgery 966 866 719 646 613 808 985 1,164 1,132 927 902 791 665 600 551 367 277 162 76 22 13,239 11,755 H84054 Red Lion Road Surgery 146 172 163 179 174 216 259 254 240 239 192 164 128 125 98 76 69 33 16 14 2,957 2,610 H84061 Kingston Health Centre 746 707 630 501 735 945 1,064 1,109 976 870 688 385 302 290 189 102 81 48 27 6 10,401 8,513 H84051 Roselawn 352 345 404 374 368 477 487 451 508 482 457 323 238 219 180 111 95 64 26 11 5,972 5,087 H84033 St Albans Medical Centre 410 508 498 434 313 341 345 480 560 582 615 504 387 362 311 218 166 103 54 16 7,207 6,624 H84618 Sunray Surgery 236 330 308 272 242 289 348 360 315 290 307 256 202 152 115 59 48 26 8 2 4,165 3,379 H84016 The Groves Medical Centre 780 1,071 1,093 962 742 912 929 1,185 1,204 1,254 1,166 972 784 704 529 415 315 267 149 52 15,485 13,916 H84034 The Orchard Practice 450 519 520 479 485 571 577 639 566 594 665 534 422 427 345 244 166 141 45 19 8,408 8,286 H84629 Village Surgery 217 296 304 288 307 478 462 385 442 413 344 301 221 170 167 102 56 34 8 1 4,996 4,090 H85055 West Barnes Surgery 331 424 409 431 436 473 475 600 566 582 546 509 415 376 292 222 142 93 48 20 7,390 6,247 KCCG 12,559 12,900 11,301 10,700 16,054 15,739 16,458 17,594 16,638 15,269 13,648 10,946 8,774 8,009 6,604 4,496 3,389 2,299 1,052 392 204,821 180,598

23 The illustrations below allow you to see how the age bands by sex are spread across the Kingston registered population.

Age Band Male Female Male Female Kingston CCG Practice List Size Apr 2017 0 to 04 6,433 6,126 -6433 6,126 05 to 09 6,506 6,394 -9655+06 6,394 10 to 14 5,657 5,644 90 to-5 96457 5,644 15 to 19 5,115 5,585 85 to-5 81915 5,585 20 to 24 6,965 9,089 80 to-6 89465 9,089 25 to 29 7,605 8,134 75 to-7 76905 8,134 30 to 34 8,111 8,347 70 to-8 71411 8,347 35 to 39 9,053 8,541 65 to-9 60953 8,541 40 to 44 8,744 7,894 -8744 7,894 60 to 64 45 to 49 8,219 7,050 -8219 7,050 55 to 59 50 to 54 7,219 6,429 -7219 6,429 50 to 54 55 to 59 5,691 5,255 -5691 5,255 60 to 64 4,386 4,388 45 to-4 43986 4,388 65 to 69 3,946 4,063 40 to-3 49446 4,063 70 to 74 3,226 3,378 35 to-3 32926 3,378 75 to 79 2,050 2,446 30 to-2 30450 2,446 80 to 84 1,505 1,884 25 to-1 25905 1,884 85 to 89 881 1,418 20 to -28481 1,418 90 to 94 335 717 15 to -13935 717 95+ 102 290 10 to -11402 290 101,749 103,072 05 to 09 0 to 04

10000 8000 6000 4000 2000 0 2000 4000 6000 8000 10000

Male Female

24 9.2 Deprivation by practice

Kingston is a relatively affluent borough with deprivation scores well below the England average. There is however variation across Kingston with all of the practices in the two localities of Chessington and New Malden with a score over the CCG average.

25 9.3 Ethnicity by practice

The population in Kingston, like most London boroughs, is made up of a range of people from differing ethnic backgrounds. The practices in New Malden have the greatest mix of ethnicity with Chessington the least.

26 9.4 Usage of GP appointments

In the last year in Kingston there have been over 800,000 GP appointments. That roughly equates to an average of 4 appointments per patient. 27% of these GP appointments could have been seen by a community pharmacist or nurse. Each and every GP in Kingston has more than 8 appointments a week missed. This does not include appointments where a patient has contacted the practice and cancelled, this is where a patient simply does not turn up for a booked appointment. This adds to the pressure on appointments that could be avoided.

Appointments Not Attended Column Labels Row Labels 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Grand Total 2 - Appointment Cancelled By, Or On Behalf Of, The Patient 7,449 13,194 26,900 14,103 16,169 31,590 31,146 34,072 38,369 13,276 226,268 3 - Did Not Attend - No Advance Warning Given 15,799 18,251 20,786 18,688 19,333 16,915 19,098 20,061 20,863 6,031 175,825 4 - Appointment Cancelled Or Postponed By The Health Care Provider 4,421 14,140 27,123 13,984 12,634 30,832 37,187 41,563 45,317 15,376 242,577 Grand Total 27,669 45,585 74,809 46,775 48,136 79,337 87,431 95,696 104,549 34,683 644,670

In Kingston we have three extended primary care services that also offer GP appointments. The take-up of these appointments during the week is high and the service is well used. However the weekday appointments also have a high level of ‘did not attend’ (averaging over 10%).

The weekend appointments have a low utilisation with only 50% of available appointments booked on a Saturday and even less on a Sunday. Saturday and Sunday also have high levels of ‘did not attend’. Kingston CCG is currently working with the provider Kingston GP Chambers to maximise the use of the service / redesign to better meet patient’s needs.

27 28 10. General practice workforce

The general primary care workforce is made up of GPs (as partners and salaried members of the practice), Registrars, Nurses, Allied Health Professionals, Medical Secretaries, Trainee Nurses, Health Care Assistants, and Practice Managers. General practices can also employ therapists, pharmacists, pharmacy support staff, and physician associates amongst other roles.

10.1 Kingston primary care workforce as of March 2016:

GPs N= fte Male / female Over / under 55 years Partners 65 54.57 42 Male 23 Female 19 over 55 Salaried GP 1 0.32 Male Over Registrar (ST3/4) 3 1.81 1 Male 2 Female Under GP Registrar 1 0.8 Male Under

Nursing staff N= fte Male / female Over / under 55 years Advanced Nurse 12 8.43 All female 5 aged 55 and over Practitioner Health Care Assistants 22 14.41 All female 7 aged 55 and over Nurse specialist 1 0.15 Female Over Practice Nurse 49 27.23 All female 16 aged 55 and over

Admin/non-clinical N= fte Male / female Over / under 55 years Practice Manager / 32 25.43 28 Female 4 Male 7 aged 55 and over management Receptionist 138 82.18 133 Female 5 Male 44 aged 55 and over Medical Secretary 28 18.53 All female 14 aged 55 and over Admin / estates / 30 21.41 28 Female 2 Male 12 ged 55 and over ancillary

29 10.2 Patient to GP Ratio

Patient to GP Practice Name Patients GP FTE Note Ratio BERRYLANDS SURGERY 4139 4.67 887 BRUNSWICK SURGERY 7538 3.85 1956 CANBURY MEDICAL CENTRE 9937 4.89 2033 CENTRAL SURGERY 12561 0.00 0 Data not available CHESSINGTON PARK SURGERY 6849 4.56 1502 CHURCHILL MEDICAL CENTRE 18440 11.37 1621 CLAREMONT MEDICAL CENTRE 10994 4.50 2444 FAIRHILL MEDICAL PRACTICE 21920 0.00 0 Data not available GOSBURY HILL GP CLINIC 801 0.00 0 Data not available GRAY'S MEDICAL CENTRE 766 0.00 0 Data not available HOLMWOOD CORNER SURGERY 12522 7.09 1767 HOOK SURGERY 6813 3.61 1888 KINGSDOWNE SURGERY 3794 0.00 0 Data not available KINGSTON HEALTH CENTRE 9842 0.00 0 Data not available LANGLEY MEDICAL PRACTICE 7432 4.16 1787 MANOR DRIVE MEDICAL CENTRE 13066 5.73 2279 RED LION ROAD SURGERY 2925 0.00 0 Data not available ROSELAWN 5867 3.56 1648 ST ALBANS MEDICAL CENTRE 7149 4.27 1676 SUNRAY SURGERY 3926 2.53 1550 THE GROVES MEDICAL CENTRE 15544 0.00 0 Data not available THE ORCHARD PRACTICE 8080 4.53 1782 VILLAGE SURGERY 4848 2.93 1653 WEST BARNES SURGERY 7397 3.12 2371

203150 75.38 2695

30 10.3 Total Health Care professionals per practice FTE

Practice Name GPS Other Doctors Senior Partners Provisional Partners Nurses Dental Practitioners Total Health Professionals BERRYLANDS SURGERY 4.67 4.67 0.89 2.22 1.23 0 13.68 BRUNSWICK SURGERY 3.85 3.85 1 2.43 1.61 0 12.74 CANBURY MEDICAL CENTRE 4.89 4.89 0.89 1.56 3.03 0.91 16.17 CENTRAL SURGERY 0 0 0 0 4.27 1.77 6.04 CHESSINGTON PARK SURGERY 4.56 4.56 1.07 1.07 1.68 0.51 13.45 CHURCHILL MEDICAL CENTRE 11.37 11.37 0.87 1.13 3.25 2.17 30.16 CLAREMONT MEDICAL CENTRE 4.5 4.5 0.67 2.13 1.08 0 12.88 FAIRHILL MEDICAL PRACTICE 0 0 0 0 1.65 1 2.65 GOSBURY HILL GP CLINIC 0 0 0 0 0 0 0 GRAY'S MEDICAL CENTRE 0 0 0 0 0 0 0 HOLMWOOD CORNER SURGERY 7.09 7.09 0.7 5.8 3.03 1.4 25.11 HOOK SURGERY 3.61 3.61 1.09 1.09 1.37 0.8 11.57 KINGSDOWNE SURGERY 0 0 0 0 0.48 0.32 0.8 KINGSTON HEALTH CENTRE 0 0 0 0 1.27 1.81 3.08 LANGLEY MEDICAL PRACTICE 4.16 4.16 0.53 2.13 1.29 0 12.27 MANOR DRIVE MEDICAL CENTRE 5.73 5.73 1.2 2.4 1.71 0.53 17.3 RED LION ROAD SURGERY 0 0 0 0 0.32 0 0.32 ROSELAWN 3.56 3.56 1 2 1.01 0.83 11.96 ST ALBANS MEDICAL CENTRE 4.27 4.27 0.67 2.13 1.76 1 14.1 SUNRAY SURGERY 2.53 2.4 0.8 1.6 0.45 0 7.78 THE GROVES MEDICAL CENTRE 0 0 0 0 4.81 3.55 8.36 THE ORCHARD PRACTICE 4.53 4.53 0.13 0.88 1 1.21 12.28 VILLAGE SURGERY 2.93 2.93 1.2 1.2 0.96 0 9.22 WEST BARNES SURGERY 3.12 3.12 0.53 2.59 0.91 0.93 11.2 0 75.37 75.24 13.24 32.36 38.17 18.74 253.12

31 10.4 GPs by Age Band

GPs GPs GPs GPs 60 And GPs Between GPs Between GPs Between GPs Between GPs Between GPs Between 65 GPs 70 and UNDER Between 30 Between 35 Above 40 AND 44 45 AND 49 50 AND 54 55 AND 59 60 AND 64 AND 69 Above Practice Name 30 AND 34 AND 39 (overall) BERRYLANDS SURGERY 0 1 1 2 2 0 0 0 0 0 0 BRUNSWICK SURGERY 0 0 0 5 0 0 0 0 0 0 0 CANBURY MEDICAL CENTRE 0 2 1 2 1 0 0 0 0 0 0 CENTRAL SURGERY 0 0 0 0 0 0 0 0 0 0 0 CHESSINGTON PARK SURGERY 0 0 1 2 1 1 1 0 0 0 0 CHURCHILL MEDICAL CENTRE 0 3 5 3 1 3 1 0 0 0 0 CLAREMONT MEDICAL CENTRE 0 1 1 2 3 0 0 0 1 0 1 FAIRHILL MEDICAL PRACTICE 0 0 0 0 0 0 0 0 0 0 0 GOSBURY HILL GP CLINIC 0 0 0 0 0 0 0 0 0 0 0 GRAY'S MEDICAL CENTRE 0 0 0 0 0 0 0 0 0 0 0 HOLMWOOD CORNER SURGERY 0 3 1 1 1 0 2 0 0 0 0 HOOK SURGERY 0 0 1 2 1 0 1 0 0 0 0 KINGSDOWNE SURGERY 0 0 0 0 0 0 0 0 0 0 0 KINGSTON HEALTH CENTRE 0 0 0 0 0 0 0 0 0 0 0 LANGLEY MEDICAL PRACTICE 0 2 1 1 0 1 0 0 0 0 0 MANOR DRIVE MEDICAL CENTRE 0 0 3 0 1 1 0 0 0 0 0 RED LION ROAD SURGERY 0 0 0 0 0 0 0 0 0 0 0 ROSELAWN 0 0 1 0 1 0 0 1 1 0 2 ST ALBANS MEDICAL CENTRE 1 0 0 0 0 0 2 0 1 1 2 SUNRAY SURGERY 0 0 2 1 0 1 0 0 1 0 1 THE GROVES MEDICAL CENTRE 0 0 0 0 0 0 0 0 0 0 0 THE ORCHARD PRACTICE 0 2 2 1 1 2 1 0 0 0 0 VILLAGE SURGERY 0 0 0 0 1 0 0 1 0 1 2 WEST BARNES SURGERY 0 0 1 0 0 3 0 0 0 0 0

1 14 21 22 14 12 8 2 4 2 8

32 11. The GP Patient Survey

The GP Patient Survey is an England wide survey commissioned by NHSE provided by ipsos MORI. The information below is taken from the July 2017 Patient Survey.

The results published are based on 2,491 responses to the 7,112 questionnaires were sent out; a response rate of 35%. ipsos MORI acknowledge that the survey has 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 data are provided once a year rather than in real time

However Kingston CCG through its Primary Care Commissioning Committee and Primary Care Patient Forum recognises the feedback on telephone access to practices and has collaborated with Kingston GP Chambers to secure investment to roll out a new, pan practice integrated telephone system that we believe will address the telephony issues currently being experience by Kingston patients.

11.1 Overall experience of GP surgeries

Kingston practices score 83% ‘Good’ against a national average of 85%. The ‘Good’ experience across practices ranged from 73% to 87%.

Results from the GP Patient Survey on overall experience are illustrated below:

Very good 4% 12% Fairly good 38% Neither good nor poor

Fairly poor

45% Very poor

33 11.2 Patient experience of telephone access

Kingston practices achieve a score of 63% on the ease of getting through to the surgery on the phone, against a national average of 68%.

Results from the GP Patient Survey on telephone access are illustrated below:

4% Very easy 11% 16% Fairly easy

Not very easy 22% Not at all easy

Haven't tried 47%

Kingston CCG in partnership with Kingston GP Chambers submitted a bid to the Estates & Technology Transformation Fund (ETTF) to provide investment to introduce a new, integrated across practices telephony system. Kingston GP Chambers is in the process of rolling VOIP out across the Kingston practices.

11.3 Success in getting an appointment

Kingston practices score 85% ‘Yes’ against a national average of 84% on the question ‘Last time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to get an appointment to see or speak to someone?.

Results from the GP Patient Survey on getting an appointment are illustrated below:

34 Yes 4% 11% Yes, but I had to call back closer to or on the 17% day No 68%

Can't remember

11.4 Waiting time at the GP surgery

Kingston practices score 61% ‘Don’t wait too long’ against a national average of 58% on the question ‘How do you feel about how long you normally have to wait to be seen?

Results from the GP Patient Survey on waiting times are illustrated below:

8% I don't normally have to wait 7% too long I have to wait a bit too long

I have to wait far too long 25% 61% No opinion/doesn't apply

35 11.5 Patient perception of care

 Kingston practices score 95% on the question ‘Did you have confidence and trust in the GP you saw or spoke to?’ in line with the national average of 95%.  Kingston practices score 97% on the question ‘Did you have confidence and trust in the nurse you saw or spoke to?’ in line with the national average of 97%.

11.6 Patient satisfaction with opening hours

Kingston practices score 75% on the question ‘How satisfied are you with the hours that your GP surgery is open?’ against a national average of 76%.

Results from the GP Patient Survey on opening hours are illustrated below:

Very satisfied 3%4% 7% Fairly satisfied 34% 11% Neither satisfied nor dissatisfied Fairly dissatisfied

41% Very dissatisfied

I'm not sure when my GP surgery is open

36 12. Care Quality Commission (CQC) ratings

The CQC inspects and regulates health and social care services. The role of the CQC is to regulate through registration and continuously monitor the quality of the services provided through inspections. The inspection of a GP service covers five key areas:

Safe Is the patient protected from abuse and avoidable harm Effective Does the care, treatment and support achieve good outcomes, helping patients to maintain quality of life and is based on the best available evidence Caring Do the staff involve and treat patients with compassion, kindness, dignity and respect Responsive Are services organised so that they meet patients’ needs Well led Is the leadership, management and governance of the organisation making sure that it is providing high-quality care that's based around patient individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture

A summary of the CQC findings for Kingston practices is below:

• Overall quality of care in Kingston is good • All of the 22 practices in Kingston have been inspected and had reports

Practices that have received ‘requires improvement’ or ‘inadequate’ ratings work towards addressing the issues within a set timeframe. This is overseen by KCCG Primary Care Quality & Development Group (PCQDG) which reports to the Primary Care Commissioning Committee.

37 A summary of the Kingston practice CQC ratings is provided below:

Overall Practice Caring Effective Responsive Safe Well-led Rating Berrylands Surgery Good Good Good Good Good Good Canbury Medical Centre Good Good Good Good Good Good Central Surgery Good Good Good Good Good Good Chessington Park Surgery Good Good Good Good Good Good Churchill Medical Centre Good Good Good Good Good Good Claremont Medical Centre Good Good Good Good Good Good Fairhill Medical Practice Good Good Good Good Good Good Groves Medical Centre Good Good Good Good Good Good Hook Surgery Good Good Good Good Good Good Holmwood Corner Surgery Good Good Good Good Good Good Kingston Health Centre Good Good Good Good Good Good Langley Medical Practice Good Good Good Good Good Good Manor Drive Medical Centre Good Good Good Good Good Good Orchard Practice Good Good Good Good Good Good Requires Requires Requires Requires Requires Red Lion Road Surgery Good Improvement Improvement Improvement Improvement Improvement Roselawn Surgery Good Good Good Good Good Good Requires Requires Requires St Albans Good Good Inadequate Improvement Improvement Improvement Sunray Good Good Good Good Good Good Village Surgery Good Good Good Good Good Good West Barnes Surgery Good Good Good Good Good Good

38 13. Primary Care Governance

The first illustration below sets out the governance structure for primary care commissioning within KCCG. KCCG is a level 3 commissioner of primary care medical services. This means that KCCG has taken on the responsibility of directly commissioning primary care medical services. This responsibility was delegated to KCCG in April 2016. The Primary Care Commissioning Committee is the subcommittee of the Governing Body who has responsibility for ensuring this duty is carried out. RBK are represented on the PCCC through councillor representation and the Director of Public Health.

The Primary Care Commissioning reports to the Governing Body and the Council of Members. It meets monthly and is a meeting held in public.

Primary Care Governance Structure

Council of Members

Kingston CCG Governing Body

Primary Care Commissioning Committee

Primary Care Quality & Locally Commissioned GP IT Steering Group Development Group Services Steering Group

Primary Care Patient Forum

The second illustration sets out the place of the primary care governance within the totality of the CCG governance structure.

39 KCCG Governance Structure

Council of Members

Kingston CCG Governing Body

Joint Executive Management Team

Primary Care Integrated Governance Finance Committee Commissioning Committee Committee

Quality, Safety & Audit Committee Performance

The CCG has a range of stakeholders that can be broadly described in three groups:  Delivery partners  Strategic partners  Assurance

The SWL Primary Care Contracting team is the NHSE primary care team that have been seconded to the SWL area to support delivery of primary care commissioning at a local level. The Primary Care Contracting team are responsible for contract management and performance. The contracting team have a representative on the Primary Care Commissioning Committee and provide regular updates to that meeting.

GP Chambers if the federation of all GP providers in Kingston and is commissioned to provide the three extended primary care services at Surbiton Health Centre, Merritt Health Centre and Kingston Health Centre.

Kingston and Richmond CCGs are now working together in one Local Delivery Unit (LDU). This has had no impact of the way primary care services are commissioned and the two CCGs continue to operate separate governance arrangements for the commissioning of primary care services. The benefit of operating in a LDU has included the development of a primary care team that works across both Kingston and Richmond enabling best practice to be shared across both boroughs.

40 Stakeholders

Delivery partners Strategic partners SWL Primary SWL Transforming Health & Care contracting Primary Care Delivery Wellbeing Board Team Group K&R Local Pan London GPFV Richmond CCG Transformation Delivery Oversight Board Group

GP Chambers

NHSE / Healthy London Assurance Partnership

CQC LMC Healthwatch

Strategic partners include RBK Health & Wellbeing board, the Kingston & Richmond Local transformation Board and SWL and London level partnerships. These are important is ensuring that primary care is included in local commissioning and transformation plans.

There are a range of national, regional and local stakeholders that monitor general practices and provide assurance on the quality of services provided. The GP contracts continue to be monitored by NHSE, through the team that is now seconded to SWL. The CCG is responsible for monitoring performance against any locally commissioned services. The Locally Commissioning Services Steering Group is responsible for the monitoring of performance against the locally commissioned services (listed below). In addition Kingston CCG has invested significantly in general practices locally to equalise the services offered by general practices to enable all practices to be able to provide the ‘additional’ services that previously only PMS practices were able to offer.

41