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Meeting name: Primary Care Commissioning Committee Date Wednesday, 22 May 2019

Title of paper Primary Care Networks in

Presenter Neha Unadkat, Deputy Managing Director Author/s Neha Unadkat, Deputy Managing Director Responsible Tessa Sandall, Managing Director Director Clinical Lead Dr Mohini Parmar, Chair Items are only confidential if it is in the public Confidential Yes ☐ No  interest for them to be so

The Committee is asked to: 1. Note the submissions from each of the Primary Care Networks across Ealing o North o South Southall o South Central Ealing o The Ealing Network o Acton o Northolt o Greenwell o NGP 2. Considering all practices have agreed to be a part of the PCN and there is geographical coverage of the borough of Ealing under this DES, that all PCN submissions are approved by the PCCC and as per the process outlined submit to the Health and Care Partnership (ICS) for NWL for assurance 3. Note the requirement to establish how the Nursing Home List is covered under the PCN Configuration. 4. Note the progress made to link up the branch practices with their neighbouring PCNs and the on-going role in ensuring that the Branch practices work closely with the neighbouring boroughs Networks to ensure patients benefit from the services provided in that area 5. Note the requirement of PCNs (where practices are within the same building, but different PCNs), to work closely together to ensure community service provision is not duplicated and is seamless. 6. Note the requirement for commissioners to ensure PCNs understand their role in

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managing conflicts of interest and how this can be managed.

Strategic Objectives and Board Assurance Framework Aim: To support people closer to home in order to maximise and prevent deterioration in their health and wellbeing.

Outcome: Increase the proportions of people with long term conditions who are fully supported in the community and place of work and home, and who make informed decisions about their health and care

Summary of purpose and scope of report

The publication of Investment and Evolution: A five year framework for GP contract reform to implement the NHS Long Term Plan was published in January 2019 with an intention for primary care networks (PCNs) to cover 100% of the population by 1st July 2019 with the ability to hold a new Directed Enhanced Service (DES) – the Network Contract DES. A primary care network will typically serve a population of at least 30,000 and will tend not to exceed 50,000. Networks need to operate at a level that provides sustainability for the member practices and small enough to make relationships work. Whilst no network should be smaller than 30,000 the 50,000 is a suggested upper level rather than a strict requirement. Each PCN must have a boundary area that makes sense to its constituent practices, to other community based providers and to its local community. It is expected that on application to be registered as a PCN the member practices in the PCN are geographically aligned. In the event that a practice does not wish to join a PCN the CCG will add the patient list into one of its local PCNs and the PCN will take on responsibility to deliver the servicers in the Network Contract DES on behalf of the patients of the non-participating practice. The five year framework focuses on general practice but the concept of the PCN is wider. The PCN is seen as an essential building block of every Integrated Care System (ICS). Using a Network Contract Directed Enhanced Service format (DES) it is expected that by 1st July 100% of the population will be covered by a Network Contract DES. In order to be eligible to hold a Network contract DES a Primary Care Network will had to submit a completed registration form to its CCG by the 15th May 2019 and all member practices were to be signed up to the DES. There are six requirements; 1. the names and code numbers of the practices in the PCN, 2. the networks size as related to the registered list size on 1st January 2019, 3. a map outlining the network area, 4. a network agreement signed by all member practices,

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5. a single practice or provider that will receive funding on behalf of the PCN and 6. a named accountable clinical director. The CCG is responsible for confirming that the PCN has met the eligibility requirements by 31st May 2019 and is responsible for ensuring that the ICS/STP partnership has confirmed a pledge of support for the PCN. The CCG must also: • Assure itself that the PCN has conducted a process to appoint their clinical lead • Assure itself that each PCN is geographically aligned • There is geographical coverage across the borough • Assure itself that the population size coverage for each is above 30,000 A summary of each network submission is below: North Southall (NSN) The practices that make up the North Southall Network are: • Chepstow Gardens Medical Centre • Medical Centre • Lady Margaret Road Surgery • KS Medical Centre • Saluja Clinic • Somerset Family Health Practice • Southall Medical Centre • St Georges Medical Centre • The MWH Practice • The Town Surgery • Woodbridge Medical Centre

The list size of the Network as at 1st July 2019, is: • CCG Source Validated - 58,940 • Declared by Network (NHS Digital) – 58,933

The Clinical Directors appointed are: • Dr Kamini Gautam from KS Medical Centre and • Dr Mark Mikhail from Chepstow Gardens Medical Centre

The process to nominate the clinical directors is set out in the section 6 of Schedule 1. The appointed Clinical Directors will work as a Job share.

The nominated practice to receive the funds is: • The Saluja Clinic

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. MWH

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practice has a branch practice within . The branch practice has been put into contact with the PCN in Hounslow to establish links and create a working relationship as services develop within the PCN. The Map is largely geographically aligned apart from the patients registered at the Branch surgery.

The committee is asked to note that Woodbridge Medical Centre operates from within the same building as Jubilee Gardens Medical Centre which is a part of the Northolt Network. Community Services alignment will need to be carefully considered so that two teams are not having to serve the population who’s GPs are within the same building but part of two separate networks.

South Southall The practices that make up the South Southall Network are: • Waterside Medical Centre • Belmont Medical Centre • Welcome Practice • Hammond Road • Medical Centre • Guru Nanak • Sunrise Medical Centre • Featherstone Road

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 51,824 • Declared by Network (NHS Digital) – 51,822

The Clinical Director appointed is: • Dr Eva Clemente from Waterside Medical Centre

The process to nominate the clinical director is set out in the section 6 of Schedule 1. Information is limited in the submission.

The nominated practice to receive the funds is:

• Welcome Practice

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The Medical Centre has a branch practice within Hounslow. The Guru Nanak practice has a branch practice in . The branch practices have been put into contact with the PCN in Hounslow to establish links and create a working relationship as services develop within the PCN. The Map is largely geographically aligned apart from the patients registered at the Branch surgeries.

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South Central Ealing The practices that make up the South Central Ealing are: • Florence Road Surgery • Park Surgery • Grosvenor House Surgery • Northfields Surgery • Ealing Park Health Centre

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 50,662 • Declared by Network (NHS Digital) – 50,840

The Clinical Director appointed is: • Dr Patricia Barbour at Florence Road Surgery

The process to nominate the clinical director is set out in the section 6 of Schedule 1. Information is limited in the submission.

The nominated practice to receive the funds is: • Florence Road Surgery

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

Gap in submission: The Bank Account details have not been provided as yet.

The Ealing Network The practices that make up the Ealing Network are: • Gordon House Surgery • Queens Walk Practice • Brunswick Road (St Marks) Medical Centre • The Avenue Surgery • The Cuckoo Lane practice • The Argyle Surgery • The Corfton Road Surgery • The Lane Surgery • Mattock Lane Health Centre • The Lynwood Surgery

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 59,605 • Declared by Network (NHS Digital) – 59,593

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The Clinical Directors appointed are: • Dr Ravi Ramanathan from Gordon House Surgery and • Dr Susru Sukumaran from The Corfton Road Surgery

The process to nominate the clinical directors is set out in the section 5 of Schedule 1. The appointed Clinical Directors will work as a Job share.

The nominated practice to receive the funds is: • Gordon House Surgery

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

The committee is asked to note that The Cuckoo Lane Practice operates from within the same building as WestSeven GP and Health Centre which is a part of the Greenwell Network. Community Services alignment will need to be carefully considered so that two teams are not having to serve the population who’s GPs are within the same building but part of two separate networks.

Acton The practices that make up the Acton Network are: • Crown Street Surgery • Hillcrest Surgery • The Bedford park Surgery • Family Practice (Dr O’Connell & Bennett) • Surgery • Acton Health Centre • Chiswick Family Practice (Dr Bhatt & Syzcko) • Acton Town Medical Centre • Western Avenue Surgery • The Vale Surgery • Churchfield Surgery • Horn Lane Surgery • Cloister Road Surgery • Acton Lane Medical Centre • Boileau Road Surgery

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 77,731 • Declared by Network (NHS Digital) – 77,703

The Clinical Directors appointed are:

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• Dr Sid Datta from Churchfield Surgery and • Dr Supriya Sukumaran from Cloister Road Surgery

The process to nominate the clinical directors is set out in the section 5a of Schedule 1. The appointed Clinical Directors will work as a Job share.

The nominated practice to receive the funds is: • Hillcrest Surgery

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

Northolt The practices that make up the Northolt Network are: • Goodcare • Somerset Road Medical Centre • Northolt Family Practice • Allenby • Medical Centre • Jubilee Gardens Medical Centre • Broadmead • West End Surgery

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 38,420 • Declared by Network (NHS Digital) – 38,417

The Clinical Director appointed is: • Dr James Swain at Broadmead Surgery

The process to nominate the clinical director is set out in the section 6 of Schedule 1.

The nominated practice to receive the funds is: • Yeading Medical Centre

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

Gap in submission:

The Bank Account details have not been provided as yet.

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The committee is asked to note that Jubilee Gardens Medical Centre operates from within the same building as Woodbridge Medical Centre which is a part of the North Southall Network. Community Services alignment will need to be carefully considered so that two teams are not having to serve the population who’s GPs are within the same building but part of two separate networks.

Greenwell The practices that make up the Greenwell Network are: • Oldfield Family Practice • Mansell Road Practice • Eastmead Avenue Surgery • Elmbank Surgery • Avenue Family Health Practice • Hanwell Health Centre • Westseven GP

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 36,272 • Declared by Network (NHS Digital) – 36,661

The Clinical Directors appointed are: • Dr Beena Gohil at Oldfield Family Practice • Dr Vic Sivanesan at Mansell Road Practice

The process to nominate the clinical directors is set out in the section 5 of Schedule 1. The appointed Clinical Directors will work as a Job share.

The nominated practice to receive the funds is: • WestSeven GP

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

The committee is asked to note that WestSeven GP and Hanwell Health Centre operate from within the same building as The Cuckoo Lane Practice which is a part of the Central Ealing Network. Community Services alignment will need to be carefully considered so that two teams are not having to serve the population who’s GPs are within the same building but part of two separate networks.

NGP The practices that make up the NGP Network are:

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• Allendale Road Surgery • Greenford Road Medical Centre • The Medical Centre • Hillview Surgery • Islip Manor Medical Centre • Mandeville Medical Centre • Medical Centre • Elm Trees Surgery • Barnabus Medical Centre • Meadow View Surgery • The Grove Medical Practice

The list size of the Network as at 1st July 2019, is: • CCG Source Validated – 68,229 • Declared by Network (NHS Digital) – 68,217

The Clinical Directors appointed are: • Dr Suk Shergill from Hillview Surgery and • Dr Inderpreet Bagga from Allendale Road Surgery

The process to nominate the clinical directors is set out in the section 6 of Schedule 1. The appointed Clinical Directors will work as a Job share.

The nominated practice to receive the funds is: • The Grove Medical Centre

Geographical alignment: The map submitted covers the registered patients at the practices within this PCN. The map is geographically aligned.

Geographical coverage across the borough All 75 practices have opted to participate in the PCN DES. The only list (840 patients) which is not as yet a part of a PCN is the list associated with the Nursing Home Contract. Up until the end of June, the list is registered under The Argyle Care Home Service, however, this list will move to West NHS Trust as of 1st July following a successful procurement.

The map below shows the population across Ealing:

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Managing Conflicts of Interest Ealing GP Ltd is a membership organisation where all practices are a Shareholder. With the appointment of Clinical Directors, there is an obvious question about the role these appointed clinical directors of the PCNs perform versus the role of the clinical directors within the Federation. There is an overlap of 3 of the clinical directors who are Federation Board members, but are also in a Job share position in their PCN. The roles and functions of any clinical director will need to be clearly demarcated and any conflicts of interest will need to be managed by the PCN taking into account what is in the best interests of the PCN and their collective patients. As per the Network Contract DES, section 4.4.2, the clinical director will take a lead role in developing a PCNs conflict of interest arrangements. In order for the PCN to be able to manage these Conflicts of Interest, each clinical director will need to declare any other roles they hold or organisations they are affiliated with or work for. The CCG would be required to assure itself that the PCN has systems and processes in place to manage these conflicts of interest

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Recommendation It is recommended that: 1. Considering all practices have agreed to be a part of the PCN and therefore there is geographical coverage of the borough of Ealing under this DES, that all PCN submissions are approved. 2. Commissioners agree how the Nursing Home List is covered under the PCN Configuration. 3. Commissioners ensure that the Branch practices work closely with the neighbouring boroughs Networks to ensure patients benefit from the services provided in that area 4. The PCNs where practices are within the same building, but different PCNs, work closely together to ensure community service provision is not duplicated and is seamless. 5. Commissioners ensure PCNs understand their role in managing conflicts of interest and how this can be managed.

Next Steps If there is are any issues or full coverage is not achieved, between 16th May and 31st May 2019, the CCG and LMC will work with practices during this time to ensure full population coverage. Once full population coverage for the DES is confirmed by the CCG, networks will need to complete a formal network agreement by Friday 28 June 2019. This is a legal agreement between all of the network practices confirming which practices are in the network and how they will work together. In addition, each GP practice in a PCN will sign-up to the network contract DES through the Calculating Quality Reporting Service (CQRS) when available. If CQRS is not available by the 30th June 2019, GP practices must sill ensure they have confirmed their sign-up in writing to the commissioner and agree to subsequently participate in the service through CQRS. What are the benefits of this project? General Practice is the bedrock of the NHS and this national programme to establish PCNs is seen as a key component of the wider system changes to improve care for patients. PCNs will form the building blocks as local operational units of the borough based Integrated Care Partnerships, which will include Local Authority colleagues, Community Service providers, Voluntary Sector organisations and other community based service providers. These partnerships will work very closely with the hospitals to ensure that the pathways of care for patients and clear and support for clinicians and patients is available in the community. Patient, staff and stakeholder engagement Patient involvement and engagement will be core to the successful delivery of the PCNs and

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the Long Term Plan. PCNs will be required to engage their registered patients as services evolve, and a route to this may be via the PPGs. This will form part of the next stage of PCN development as the PCNs start to work together to deliver services. Jargon buster PCN – Primary Care Network DES – Directed Enhanced Service CCG – Clinical Commissioning Group

Quality & Safety The PCN DES includes a number of additional service specifications which will have a positive impact on quality of care. As of April 2020 there are 5 new specifications namely: i. Structured Medications Review and Optimisation ii. Enhanced Health in Care Homes iii. Anticipatory Care requirements iv. Personalised Care v. Supporting Early Cancer Diagnosis Two further specifications will be released as of April 2021: vi. CVD Prevention and Diagnosis vii. Tackling Neighbourhood Inequalities In 2019, PCNs will be recruiting Social Prescribers and Clinical pharmacists to support PCNs to develop their workforce and support infrastructure as a network. PCNs will also be required to establish links with their local community services providers and social care teams as well as the Voluntary Sector. Equality analysis Population coverage of PCNs has been achieved in Ealing.

Finance and resources The funding associated with the PCNs is nationally defined. The allocations to CCGs for Delegated primary care services, include this funding, however, a potential shortfall of £600k has been identified. Mitigations to this risk are being developed with the finance team and further clarity and guidance is being sought from NHSE.

Risk Mitigating actions Financial Shortfall in delegated budget Further clarity is being sought from NHSE. Mitigations are being explored with the finance team

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Supporting documents Appendix 1 – Maps of PCN Coverage

Conflict of interests Following the review of the paper by the main co-ordinating team (secretary; committee chair and executive lead), have any potential conflicts affecting the membership been identified?

Yes  No 

If yes, please identify conflicted individual(s) and confirm what action is being taken, ticking all the actions that apply. If actions differ for more than one conflicted individual, please record this clearly by further naming each individual alongside each action that applies to them.

Name and nature of conflict (describe): • Dr Mohini Parmar, Chair Ealing CCG, Member of NGP Network • Dr Vijay Tailor, Deputy Chair Ealing CCG, Member of Acton Network • Dr Shanker Vijayadeva, GB Member, employed by member of Acton Network • Dr Adam Jenkins, LMC Chair, Member of Greenwell Network • Dr Maria Waters, GB Member, Member of South Central Ealing Network .…………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… Please Action taken: tick one The paper has been withheld from the individual(s) ☐ 1. concerned. The individual(s) will not attend the meeting where the paper ☐ 2. will be discussed. The paper is being shared; however, the individual(s) will not ☒ 3. participate in discussion. The paper is being shared for discussion purposes; however ☐ 4. the individual(s) will not participate in, or be present for the final decision For the avoidance of doubt, the use of the above chosen handling strategy will also be formally recorded by the secretary in the minutes of the meeting to confirm the action that was taken, which shall further be added to the CCG’s COI management actions log and made available online alongside the CCG’s register of decisions taken.

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Governance, reporting and engagement Provide a brief overview of where this paper – or work in developing it – has been discussed. Signpost to where in the paper more detail on this can be found. Name Date Outcome and where in the report can you find out more

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01/05/2019 All Networks Interactive NHS Ealing CCG Networks: Number of Patients by Output Area Jan 2019 (small numbers aggressively suppressed) Name BELMONT MEDICAL … FEATHERSTONE ROA… GURU NANAK MEDIC… HAMMOND ROAD S… MEDICAL CENTRE SUNRISE MEDICAL C… WATERSIDE MEDICAL… WELCOME PRACTICE

Esri UK, Esri, HERE, Garmin, METI/NASA, USGS

1/1 01/05/2019 Population Practice Code Name Network Number of Registered Patients  E85006 WATERSIDE MEDICAL CENTRE South Southall 4,749 E85049 BELMONT MEDICAL CENTRE South Southall 7,232 E85061 WELCOME PRACTICE South Southall 3,543 E85090 HAMMOND ROAD SURGERY South Southall 4,089 E85096 MEDICAL CENTRE South Southall 8,407 E85121 GURU NANAK MEDICAL CENTRE South Southall 11,793 E85656 SUNRISE MEDICAL CENTRE South Southall 3,890 Y02342 FEATHERSTONE ROAD HEALTH CENTRE South Southall 8,119 Total 51,822

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Map of Network Area

01/05/2019 All Networks Interactive NHS Ealing CCG Networks: Number of Patients by Output Area Jan 2019 (small numbers aggressively suppressed) Practices (Multiple)

Acton And Chiswick E85019 CROWN STREET SURGERY E85028 HILLCREST SURGERY E85066 THE BEDFORD PARK SURGERY E85075 CHISWICK FAMILY PRACTICE E85107 THE MILL HILL SURGERY E85109 THE ACTON HEALTH CENTRE E85130 CHISWICK FAMILY PRACTICE E85617 ACTON TOWN MEDICAL CENTRE E85630 WESTERN AVENUE SURGERY E85635 THE VALE SURGERY E85640 THE CHURCHFIELD ROAD SURGERY E85677 THE HORN LANE SURGERY E85680 CLOISTER ROAD SURGERY E85687 ACTON LANE MEDICAL CENTRE E85694 THE BOILEAU ROAD SURGERY

Esri UK, Esri, HERE, Garmin, METI/NASA, USGS 1/1 01/05/2019 Population Practice Code Name Network Number of Registered Patients  E85019 CROWN STREET SURGERY Acton And Chiswick 8,667 E85028 HILLCREST SURGERY Acton And Chiswick 8,858 E85066 THE BEDFORD PARK SURGERY Acton And Chiswick 3,570 E85075 CHISWICK FAMILY PRACTICE Acton And Chiswick 4,497 E85107 THE MILL HILL SURGERY Acton And Chiswick 7,623 E85109 THE ACTON HEALTH CENTRE Acton And Chiswick 3,416 E85130 CHISWICK FAMILY PRACTICE Acton And Chiswick 4,429 E85617 ACTON TOWN MEDICAL CENTRE Acton And Chiswick 3,316 E85630 WESTERN AVENUE SURGERY Acton And Chiswick 3,133 E85635 THE VALE SURGERY Acton And Chiswick 5,846 E85640 THE CHURCHFIELD ROAD SURGERY Acton And Chiswick 3,384 E85677 THE HORN LANE SURGERY Acton And Chiswick 4,768 E85680 CLOISTER ROAD SURGERY Acton And Chiswick 11,063 E85687 ACTON LANE MEDICAL CENTRE Acton And Chiswick 1,570 E85694 THE BOILEAU ROAD SURGERY Acton And Chiswick 3,563 Total 77,703

1/1 18/04/2019 All Networks Interactive NHS Ealing CCG Networks: Number of Patients by Output Area Jan 2019 (small numbers aggressively suppressed) PracticeName  ALLENBY CLINIC BROADMEAD SURGE… DR PERINPANAYAGA… DR SA QURESHI GOODCARE PRACTICE JUBILEE GARDENS M… NORTHOLT FAMILY P… WEST END SURGERY

Esri UK, Esri, HERE, Garmin, METI/NASA, USGS

1/1 18/04/2019 Population Practice Code PracticeName Network Number of Registered Patients Practices (Multiple)  E85021 DR PERINPANAYAGAM & PARTNERS South North 7,102 Select All E85064 WEST END SURGERY South North 4,412 Acton And Chiswick E85105 ALLENBY CLINIC South North 1,852 Central Ealing E85623 DR SA QURESHI North Southall 2,088 E85712 GOODCARE PRACTICE South North 7,408 North North E85715 BROADMEAD SURGERY South North 4,524 North Southall E85723 NORTHOLT FAMILY PRACTICE South North 4,274 E85012 E85745 JUBILEE GARDENS MEDICAL CENTRE North Southall 6,757 E85023 Total 38,417 E85051 E85083 E85103 E85119 E85623 E85633 E85663

1/1 26/04/2019 All Networks Interactive NHS Ealing CCG Networks: Number of Patients by Output Area Jan 2019 (small numbers aggressively suppressed) PracticeName DR B GOHIL DR DA JENKINS DR RC STEWART DR SK GILL DRS BASSI & KAMBOJ ELMBANK SURGERY GREENFORD AVENUE…

Esri UK, Esri, HERE, Garmin, METI/NASA, USGS

1/1 26/04/2019 Population Practice Code PracticeName Network Number of Registered Patients  E85013 DR RC STEWART South North 4,075 E85041 DRS BASSI & KAMBOJ South North 5,495 E85046 DR SK GILL South North 5,867 E85051 GREENFORD AVENUE FHP North Southall 6,362 E85069 DR B GOHIL South North 4,297 E85088 ELMBANK SURGERY South North 4,134 E85129 DR DA JENKINS South North 6,017 Total 36,247

1/1 25/04/2019 All Networks Interactive NHS Ealing CCG Networks: Number of Patients by Output Area Jan 2019 (small numbers aggressively suppressed) PracticeName DR G BALACHANDRAN DR G SIVARAJAH DR MG PARMAR DR N KOYE DR RC MOORE DR RK BHATT DR SS GORAYA DR SS SHERGILL ELM TREES SURGERY ISLIP MANOR MEDIC… MANDEVILLE MEDIC…

Esri UK, Esri, HERE, Garmin, METI/NASA, USGS

1/1 25/04/2019 Population Practice Code PracticeName Network Number of Registered Patients  E84059 DR SS GORAYA North North 4,237 E85050 DR RC MOORE North North 7,944 E85053 DR G BALACHANDRAN North North 3,948 E85054 DR SS SHERGILL North North 10,638 E85098 ISLIP MANOR MEDICAL CENTRE North North 4,202 E85108 MANDEVILLE MEDICAL CENTRE North North 4,910 E85111 DR N KOYE North North 4,869 E85112 ELM TREES SURGERY North North 5,178 E85127 DR MG PARMAR North North 9,501 E85643 DR G SIVARAJAH North North 5,716 E85725 DR RK BHATT North North 7,074 Total 68,217

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