NHS North Central London CCG Primary Care Commissioning Committee Thursday 17 June 2021 2:30pm to 4pm Virtual Meeting via MS Team Live
Item Title Lead Action Page Time
Pre-meet to be held for committee members between 2pm & 2:25pm
AGENDA Part 1 1.0 INTRODUCTION
1.1 Welcome and Apologies Ian Bretman Note Oral
1.2 Declarations of Interest Register Ian Bretman Note 4
1.3 Declarations of Interest relating to the All Note Oral items on the Agenda 1.4 Declarations of Gifts and Hospitality Ian Bretman Note Oral
1.5 Draft Minutes of the NCL Primary Ian Bretman Approve 9 2:30pm Care Commissioning Committee to Meeting on 22 April 2021 2:40am 1.6 Action Log Ian Bretman Approve 19
1.7 GPDPR Ian Bretman Note Oral
1.8 Matters Arising All Note Oral
1.9 Questions from the public relating to items on the agenda received prior to the meeting
Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.
2.0 BUSINESS 2.1 Primary Care Finance update Tracey Lewis Note 23
2.2 Quality & Performance Report Paul Sinden Note 33 2:40pm to 2.3 NCL Online Consultation in Primary Jessica Note 63 3:10pm Care Ratner & Nikki Hookins
1 / 113 3.0 ITEMS FOR DECISION
Contract Variations
3.1 All Boroughs
PMS Changes
Haringey
The Alexandra Surgery – To note the death of a provider Vanessa Approve 81 Piper / Enfield Borough Rep 157 Medical Practice – the removal of one provider
3.2 Camden Vanessa Primary Care Networks – Piper / Approve 86 3:10pm Proposals for Organisational Borough Rep to and Membership Changes 3:40pm 3.3 Islington
Barnsbury – caretaking Vanessa Approve 89 APMS contract extension Piper / decision, and case for re- Borough Rep procurement to note 3.4 Haringey
Vale Practice – landlord Vanessa Approve 94 improvement works and a new Piper / lease leading to an increase in Borough Rep rent reimbursement 3.5 Haringey Vanessa 97 St Ann’s Road Surgery – Piper / Approve taking void space in the laurels Borough Rep 4.0 ITEMS TO NOTE – URGENT DECISION TAKEN SINCE 22 APRIL 2021
4.1 None
5.0 GOVERNANCE AND COMMITTEE ADMINISTRATION
5.1 PCCC Risk Register Paul Sinden Note 102 3:40pm to 5.2 PCCC Forward Planner Ian Bretman Note 112 3:55pm
6.0 ANY OTHER BUSINESS 3.55pm
6.1 Any other Business
7.0 DATES OF 2021/22 MEETINGS - all between 2:30pm & 4pm Thursday 19 August 2021
Thursday 21 October 2021 Thursday 16 December 2021 Thursday 17 February 2022
2 / 113 Resolution to exclude observers, the public and members of the press from the remainder of the meeting. By reason of the confidential nature of the business to be transacted in accordance with Section 1, Subsection 2 of the Public Bodies (Admissions to Meetings) Act 1960 and clause 22 of the Terms of Reference of this Committee and clauses 9 and 10 of the Standing Orders of this Committee.
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North Central London CCG Primary Care Commissioning Committee Meeting 17 June 2021
Report Title Declaration of Interests Register – Agenda Item: 1.3 Primary Care Commissioning Committee Meeting
Governing Body Mr Ian Bretman Tel/Email [email protected] Sponsor Committee Chair and Governing Body member Lead Director / Mr Ian Porter Tel/Email [email protected] Manager Executive Director for Corporate Services Report Author Vivienne Ahmad Tel/Email [email protected] Board Secretary
Name of Not Applicable Summary of Not Applicable Authorising Public Financial and Patient Implications Engagement and Equalities Lead Report Summary Members and attendees of the Primary Care Commissioning Committee Meeting are asked to review the agenda and consider whether any of the topics might present a conflict of interest, whether those interests are already included within the Register of Interest, or need to be considered for the first time due to the specific subject matter of the agenda item.
A conflict of interest would arise if decisions or recommendations made by the Governing Body or its Committees could be perceived to advantage the individual holding the interest, their family, or their workplace or business interests. Such advantage might be financial or in another form, such as the ability to exert undue influence.
Any such interests should be declared either before or during the meeting so that they can be managed appropriately. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money.
If attendees are unsure of whether or not individual interests represent a conflict, they should be declared anyway.
Recommendation To NOTE the Declaration of Interests Register and invite members to inspect their entry and advise the meeting / Board Secretary of any changes.
Identified Risks The risk of failing to declare an interest may affect the validity of a decision / and Risk discussion made at this meeting and could potentially result in reputational and Management financial costs against the CCG. Actions
4 / 113 Conflicts of The purpose of the Register is to list interests, perceived and actual, of members Interest that may relate to the meeting.
Resource Not Applicable Implications Engagement Not Applicable
Equality Impact Not Applicable Analysis
Report History and The Declaration of Interests Register is a standing item presented to every Key Decisions meeting of the Primary Care Commissioning Committee Meeting.
Next Steps The Declaration of Interests Register is presented to every meeting of the Primary Care Commissioning Committee Meeting and regularly monitored.
Appendices The Declaration of Interests Register.
5 / 113 NCL CCG Primary Care Committee Declaration of Interest Register - April 2021
Date of Interest
Type of Interest From Updated To Date declared Actions to be taken to mitigate risk (to Current Position (s) held- Declared Interest - (Name of the organisation and nature of business) Is the interest Nature of Interest be agreed with line a manager of a i.e. Governing Body, Member practice, Employee or other Name direct or senior CCG manager) Indirect?
Interests
Non-Financial Non-Financial
Financial Interests Financial
Professional Interests Professional
Non-Financial Personal Non-Financial Members
Ian Bretman Lay Member of NCL CCG Governing Body Citizens Advice Bureau, Barnet No Yes No Direct Trustee 01/04/2017 14/08/2019 11/05/2020 Member of Covid Response Oversight Committee Member of NCL CCG Governing Body Biomedical Healthcare Ltd No No Yes Indirect Son is a senior technical manager in a company offering an 01/04/2017 14/08/2019 11/05/2020 Chair of Patient and Public Engagement Committee App for people to manage prescription requests and long- Chair of Primary Care Procurement Committee term medication programmes Member of Audit Committee Member of Remuneration Committee Provides occasional consultancy services for this social Attend other committee meetings as and when required Timewise Foundation CIC No No No Direct enterprise that helps organisations make better use of flexible 17/10/2018 14/08/2019 11/05/2020 working. No No 01/10/2019 no Direct 15/05/2019 11/05/2020 Timewise Jobs Ltd No Direct 01/10/2019 No no 15/05/2019 11/05/2020 Timewise Solutions Ltd
Simon Goodwin Chief Finance Officer of NCL CCG East London NHS Foundation Trust Yes No No Indirect Wife is a senior manager at the Trust 14/06/2017 current 11/05/2020 Member of NCL CCG Governing Body NCL Finance Committee Attendee, NCL Audit committee NCL Strategy and Commissioning Committee NCL Primary Care Commissioning in Common Attend other meetings as and when required. 12/10/2018 Claire Johnston Registered Nurse of NCL CCG Governing Body Our Time No Yes No Direct Chair of Trustees . A charity which provides interventions 12/09/2019 31/03/2021 Member of Primary Care Committee and campaigns for children and young people with a mentally Member of Quality Committee ill parent. Member of Medicines Management Committee Member of Public and Patient Engagement Committee Nursing and Midwifery Council No Yes No Direct Registrant Member 12/09/2019 31/03/2021 Member of Covid Reponse Oversight Committee Member of IFR Panel The Guardian No No No Indirect Spouse is Public Services Editor 12/09/2019 12/05/2020
Jenny Goodridge Director of Quality and Chief Nurse Joseph Rowntree Foundation (JRF) No no yes direct Member of Care sub-committee. This is a voluntary role with N/A N/A 13/02/2018 09/09/2020 no financial incentive for myself.
Dr Subir Mukherjee Secondary Care Clinician, NCL CCG Health Education England, KSS yes no yes direct Associate post graduate Dean 2003 current Member of Covid Reponse Oversight Committee Member of Primary Care Commissioning Committee Member of Quality and Safety Committee Member of Individual Funding Request Appeals Panel Member of Medicines Management Committee Member of Strategy and Commissioning Committee 05/09/2020 Arnold Palmer Lay Member of NCL CCG Governing Body A & C Palmer Associates Yes No No Direct Director and Owner of private LTD company, providing 01/01/2006 current 16/04/2020 Chair of Remuneration Committee training, executive coaching and consultancy services Member of IFR Appeals Panel (including coaching and consultancy services to the NHS but Member of Strategy and Commissioning Committee excluding NCLCCG) Member of Primary Care Commissioning Committee Spouse is also a shareholder and company secretary. Member of Finance Committee Member of Audit Committee Mental Health & Community Service Review, led by Carnell Farrar No Yes Yes Direct Member of the Programme Board - from May 2021 to March 05/05/2021 current 11/05/2021 Member of Public and Patient Engagement Committee 2022. An acquaitance of a partner at Carnell Farrar, known of since 1995, as professional colleagues at the same NHS Trust.
Dr Dominic Roberts Independent GP Clinical Lead, Strategic Commissioning, NCL CCG n n n none 07/11/2018 current 10/05/2020 02/08/2019 Clinical Director, Islington Borough, NCL CCG y y n direct member 07/11/2018 current 10/05/2020 02/08/2019 Conflict of interest issues for the Governing Body and CCG. n y n direct Lead 07/11/2018 current 10/05/2020 02/08/2019 Caldicott Guardian for Islington & Haringey n y n direct Caldicott Guardian 07/11/2018 current 02/08/2019 10/05/2020 Freedom to Speak up Guardian forNCL GP Practices n y n direct Guardian 07/11/2018 current 02/08/2019 10/05/2020 Freedom to Speak up Guardian for Islington Federation n y n direct Guardian 07/11/2018 current 02/08/2019 10/05/2020 Individual Funding Request Panel direct Chair 07/11/2018 current 10/05/2020 02/08/2019 Locally Commissioned Services Working Group direct Chair 07/11/2018 current 02/08/2019 10/05/2020 Member of NCL Primary Care Commissioning Committee direct Clinical representative 07/11/2018 current 02/08/2019 10/05/2020 Supporting and managing the Clinical Leads (including Darzi fellow) - direct Support and manage 07/11/2018 current 10/05/2020 recruitment, bi-monthly network meetings, appraisals, finance. 02/08/2019 direct Safety Officer 07/11/2018 current 10/05/2020 Medicines and devices Safety Officer (MSO & MDSO) 02/08/2019 MSO/MDSO network for local CCGs and Providers direct Chair 07/11/2018 current 02/08/2019 10/05/2020 Controlled drugs safety lead and Antimicrobial stewardship lead. direct Lead 07/11/2018 current 02/08/2019 10/05/2020 Whittington Care Quality Review Group direct member 07/11/2018 current 02/08/2019 10/05/2020 Islington Transformation Group direct member 07/11/2018 current 02/08/2019 10/05/2020
6 / 113 Dr Dominic Roberts
NCL CCG Primary Care Committee Declaration of Interest Register - April 2021
QIPP Delivery Group direct member 10/05/2020 current 10/05/2020 ICCG Website direct Provide clinical leadership 10/05/2020 current 10/05/2020 Serious incident reviews & patient safety direct Provide clinical leadership 07/11/2018 current 02/08/2019 10/05/2020 direct Provide clinical leadership 07/11/2018 current 10/05/2020 GP Practice Quality 02/08/2019 Federation Working Group direct Provide clinical leadership 07/11/2018 current 10/05/2020 02/08/2019 Federation Contracts and Quality Group direct Co Chair 10/05/2020 current 10/05/2020 Care Homes Working Group direct Chair 10/05/2020 current 10/05/2020 NLP IG Working Group direct Chair 07/11/2018 current 02/08/2019 10/05/2020 Locum GP y y n direct Homerton Hospital OOH care, Paradoc emergency home 07/11/2018 current 10/05/2020 visiting service , Tower Hamlets, SELDOC GP OOH services and Croydon (including Brigstock surgery, Thornton Heath (ad hoc sessions in various GP surgeries across London, excluding Islington) 02/08/2019 Greenland Passage residential association n y y direct Board Director 07/11/2018 current 02/08/2019 10/05/2020 1-12 Royal Court Ltd n y y direct Secretary & director 07/11/2018 current 02/08/2019 10/05/2020 Novo Nordisk pharmaceutical company. n n n Indirect My Sister is a Medical Advisor 07/11/2018 current 02/08/2019 10/05/2020 St Helier Hospital in Sutton. n n n Indirect Partner is an ITU Consultant 07/11/2018 current 02/08/2019 10/05/2020 BMA y y n direct member 07/11/2018 current 02/08/2019 10/05/2020 City and Hackney Local Medical Committee n y n direct member 07/11/2018 current 02/08/2019 10/05/2020 City & Hackney Urgent Healthcare Social Enterprise -providing out of hours care y y n direct I am a GP - I do shifts for the Paradoc emergency home 07/11/2018 current 10/05/2020 for City & Hackney CCG residents. visiting service. 02/08/2019 Communitas, a private provider seeing NHS patients, y y n direct I undertake clinical sessions in my role as a GP with a 07/11/2018 current 10/05/2020 Special interest in ENT. 02/08/2019 Haringey CCG as an external GP y y n direct as an external GP on their transformation group and 07/11/2018 current 10/05/2020 investment committee. I also support some of their procurement work streams and other CCG duties as required as an external GP. 02/08/2019 Hackney VTS GP training scheme y y n direct Programme director, employed by the London Specialty 07/11/2018 current 10/05/2020 School of General Practice, Health Education England. 02/08/2019 I am a GP Appraiser for the London area. y y n direct GP Appraiser 07/11/2018 current 02/08/2019 10/05/2020 I am a mentor for GPs under GMC sanctions. y y n direct GP Mentor 07/11/2018 current 02/08/2019 10/05/2020 I am currently mentoring a salaried GP at a practice in Haringey. y y n direct Salaried GP 07/11/2018 current 10/05/2020 02/08/2019 Paul Sinden Chief Operating Officer No interests declared No No No No Nil Return 30/04/2018 current 16/08/2019 15/05/2020 Exec Lead for Primary Care Committee Member of NCL CCG Executive Management Team attend Quality and Safety Committee and other committees as and when required
Karen Trew Deputy Lay Chair of NCL CCG Governing Body Broxbourne School Hertfordshire No No Yes direct Chair of the Governing Body (previously Governing Body 01/07/2015 current 15/07/2015 25/05/2020 Member of Covid Response Oversight Committee members since Nov. 2004) Member of Finance Committee Chair of the Governing Body Member of Primary Care Committee Wormley C of E Primary School, Hertfordshire No No Yes direct 28/06/2005 current 15/07/2015 25/05/2020 Member of Remuneration Committee Member of IFR Appeals Panel Member of Strategy and Commissioning Committee Chair of Audit Committee
Attendees Vivienne Ahmad Board Secretary No interests declared No No No No Nil Return 25/10/2018 current 16/10/2019 03/09/2020 Director of Public Health Camden and Islington Yes Yes No Direct Salaried Employee 01/02/2013 current 08/08/2019 Dr Julie Billett Public Health Representative London Association of Directors of Public Health No Yes No Direct Chair of 15/11/2016 current 08/08/2019 Dr Peter Christian Haringey Clinical Representative, NCL CCG Governing Body Muswell Hill Practice No No No Direct Salaried GP 15/03/2018 current 07/11/2018 31/12/2020 member of Audit Committee Chair of IFR Panel Muswell Hill Practice is a member of Federation4Health, the pan- Haringey No No No Direct Salaried GP 15/03/2018 current 07/11/2018 31/12/2020 Member of Primary Care Committee Federation of GP Practices `
Salaried GP 15/03/2018 current 07/11/2018 31/12/2020 Muswell Hill Practice provides anitcoagulant care to Haringey residents under a No No No Direct contract with the CCG Member 15/03/2018 current 07/11/2018 11/05/2020 The Hospital Saturday Fund - a charity which gives money to health related No No Yes Direct issues Patron 15/03/2018 current 07/11/2018 11/05/2020 The Hospital Saturday Fund - a charity which gives money to health related No No Yes Indirect (Wife) issues Patron 15/03/2018 current 07/11/2018 11/05/2020 The Lost Chord Charity - organises interactive musical sessions for people with No No No Indirect (Wife) dementia in residential homes. Direct Practice is a member 01/07/2019 current 04/09/2019 11/05/2020 North West Primary Care Nework No No No ` Haringey Health Connected, the federation of West Haringey GP Practices. No No Yes Indirect Pactice Manager is Finance Manager 15/03/2018 current 07/11/2018 11/05/2020
Dr Louise Jones Healthwatch Representative Camden Healthwatch No Yes No Direct Chair 01/11/2020 current 04/11/2020 St George’s School, Weybridge, Surrey No Yes No Direct Governor current 04/11/2020 Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL No Yes No Direct Honorary Clinical Senior Lecturer current 04/11/2020
Covid Evidence Service, Nuffield Department of Primary Care, Oxford and No Yes No Direct Member of Palliative Care interest group under umbrella current 04/11/2020 Hospice UK
30/08/2018 Dr Will Maimaris Interim Director of Public Health, Haringey Council No n/a n/a n/a n/a n/a current 09/08/2019 Rev Kostakis Christodoulou Community Member, Primary Care Commissioning Committee Church of England Yes Yes Yes Direct Priest, accountable to Robert Wickham, Bishop of Edmonton, current 16/10/2020 responsible for four north London Boroughs of Barnet, Camden, Enfield and Haringey. Medical ethics, health and social care Mark Agathangelou Community Member N/A N/A N/A N/A N/A N/A N/A N/A 13/10/2020
7 / 113 NCL CCG Primary Care Committee Declaration of Interest Register - April 2021
Jane Betts LMC Representative Director of Primary Care, Local Medical Committee, NC, NW and SW London N/A N/A N/A N/A N/A 13/08/2020 current 13/08/2020 Member of Primary Care Commissioning Committee Attend other committee meetings as and when required Officer at Londonwide LMC- not elected member
Anthony Marks Senior Primary Care Commissioning Manager N/A N/A N/A N/A N/A N/A N/A N/A 30.10.2018 30/08/2019 Su Nayee Assistant Head of Primary Care, NHS England N/A N/A N/A N/A N/A N/A N/A N/A 20.10.2018 14/07/2020 Vanessa Piper Head of Primary Care, NC London, NHS England, London Region Sarah McDonnell-Davies Executive Director, Borough Partnerships None no no no Direct n/a 20/06/2018 19/11/2020 Positions held in relation to CCG business Attend Governing Body Attend NCL Committee Meetings as required e.g. Strategy and Commissioning Committee Primary Care Commissioning Committee Borough Commissioning Committee NCL CCG Executive Management Team
Deborah McBeal Director of Integration, Enfield Borough We are Pareto no no no N/A director of company, dormant, non-trading 2013 current 28.03.2018 13/07/2020 Tracey Lewis Head of Finance – Primary Care Attends Primary Care Commissioning Committee N/A N/A N/A N/A N/A N/A 29/07/2020 Owen Sloman Assistant Director of Primary Care, Haringey Borough St Ann’s church, South Tottenham. N/A N/A X direct Churchwarden 01/04/2020 31/03/2020 03/10/2019 26/07/2020 Attends Primary Care Commissioning Committee Fowler Newsam Hall in South Tottenham and the Emily Mary Robbins Trust. N/A N/A X direct Trustee 01/04/2020 31/03/2020 26/07/2020 Rebecca Kingsnorth Assistant Director of Primary Care, Islington Borough Yes No No Yes Indirect My sister-in-law is a salaried GP in City Road Medical Centre. Dec-17 current 18/10/2018 22/07/2020 I will declare this in any meetings Part of my role is the support of the CCG’s delegated where decisions are being taken Member of Primary Care Transformation Board responsibility for commissioning core primary care services about either services commissioned and the commissioning of Locally Commissioned Services, from or performance of City Road. which can result in changes to funding to Islington practices This might include decisions taken including City Road. about LCSs. I would be able to participate in any decision that relates to Islington-wide commissioning of which City Road may be one of many beneficiaries, but not decisions that relate singly to City Road.
Dr Vicky Weeks Medical Director, Local Medical Committee, North Central London None no no no N/A N/A N/A N/A 30/11/2020 Dr Sue Dickie LMC Haringey Borough Representative Highgate Group Practice yes yes yes direct GP Partner Have done 3 triage sessions for LCW ooh over the Christmas period in the yes yes yes direct pandemic Haringey Federation no yes yes direct Practice is a member 2016 Haringey North West PCN No yes yes direct Practice is a member 2019
Daniel Glasgow Deputy Director of Primary Care Transformation, Barnet Borough None no no no N/A N/A N/A N/A 15/12/2017 27/08/2020
Colette Wood Director of Primary Care Transformation, Barnet Borough None no no no N/A N/A N/A N/A 27/10/2017 27/07/2020 Simon Wheatley Director of Primary and Community Commissioning, Camden Borough (interim) None no no no N/A N/A N/A N/A 28/05/2019 04/08/2020 Riyad Karim Interim Head of Primary Care Commissioning - Attends variety of committee meetings & The Lordship Lane Surgery, East Dulwich no no no direct unpaid practice management advisor at surgery. current 13/07/2019 29/07/2020 NCL committee meetings.
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PRIMARY CARE COMMISSIONING COMMITTEE
Draft Minutes of Meeting held on Thursday 22 April 2021 between 2:30pm and 4pm
Online Meeting via MS Teams Live
Voting Members Present: Mr Ian Bretman (Chair) Governing Body Lay Member, Patient & Public Engagement and Committee Chair Mr Simon Goodwin Chief Finance Officer Dr Dominic Roberts Independent GP Ms Claire Johnston Governing Body Member, Registered Nurse Dr Subir Mukherjee Governing Body Member, Secondary Care Clinician Mr Arnold Palmer Governing Lay Member, General Portfolio Mr Paul Sinden Chief Operating Officer Ms Karen Trew Governing Body Lay Member for Audit & Governance
In Attendance Dr Peter Christian Governing Body Member, Clinical Representative Ms Tracey Lewis Head of Finance, NCL STP Primary Care Ms Vanessa Piper Head of Primary Care, NCL Primary Care Commissioning & Contracting Team Ms Deborah McBeal Director of Integration, Enfield Mr Simon Wheatley Director of Primary & Community Commissioning (Interim), Camden Ms Colette Wood Director of Primary Care Transformation, Barnet Ms Rebecca Kingsnorth Assistant Director of Primary Care, Islington Mr Owen Sloman Assistant Director of Primary Care, Haringey Ms Noelle Skivington Healthwatch Representative, Enfield Ms Jane Betts Deputy Director of Primary Care, London Wide LMCs Dr Sue Dickie Chair of Haringey LMC, London Wide LMCs Mr Mark Agathangelou Community Representative, Camden Ms Nicola Theron Director of Estates, NCL Cllr Patrician Callaghan London Borough of Camden Cllr Alev Cazimoglu London Borough of Enfield Cllr Nurullah Turan London Borough of Islington Vivienne Ahmad (Minutes) Board Secretary , NCL
Public Attendance Mr Malcolm Souch Healthy Urban Development Unit Mr Ismail Ihahir Practice Manager at Phoenix Practice Mr Kostakis Christodoulou Community Representative, Enfield Dr Louise Jones Healthwatch Representative, Camden Ms Karla Damba Estates Strategic Delivery Lead, NCL Ms Sally Mackinnon Director of Integration, NCL
Apologies: Ms Sarah McDonnell- Executive Director of Borough Partnerships, NCL Davies Page 1 of 10
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Ms Jenny Goodridge Director of Quality & Chief Nurse, NCL Cllr Sarah James London Borough of Haringey Cllr Caroline Stock London Borough of Barnet Mr Stuart Lines Director of Public Health, Enfield
1.0 INTRODUCTION
1.1 Welcome & Apologies
1.1.1 The Chair welcomed members and attendees to the meeting.
Apologies were recorded as above.
1.2 Declarations of Interests Register
1.2.1 The Register was noted by the Committee.
The Committee NOTED the Register
1.3 Declarations of Interest Relating to Items on the Agenda
1.3.1 The Chair invited members of the Committee to declare any interests in respect to the items on the agenda. There were no declarations declared.
1.4 Declarations of Gifts and Hospitality
1.4.1 There were no declarations declared.
1.6 Minutes of the NCL Primary Care Commissioning Committee Meeting on 18 February 2021 1.6.1 Prior to approving the minutes, the Chair suggested that an additional sentence be added to the penultimate paragraph in item 1.6.1 on page 13 in regards to AT Medics.
This currently reads – “Councillor James advised that the decision had caused anger and risked trust at a time that the NCL integrated care system was being developed. Although the decision to agree the change of control may have been conducted within due process, it still raised a wider question about ownership of health services in England and Wales. The CCG was urged not to sign this and refer the matter to the Secretary of State and NHS England.”
The suggested additional sentence to be added was – “Councillors Callaghan, Cazimoglu, Turan and Stock all spoke in support of these comments and reiterated the deep concerns among patients and residents about the CCG’s decision and their dissatisfaction with the process by which it was reached”.
The Committee agreed to the additional sentence.
A further point was raised about rephrasing the action of the finance report on page 14 of the papers: Instead of stating ‘to bring back an outturn report to the next meeting’, that it could change to: - ‘Prior year comparatives to be shown on the finance report and a more detailed analysis of the other medical services line’.
The Committee agreed to the action being rephrased.
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Subject to the above amendments, the minutes of the NCL Primary Care Commissioning Committee Meeting on 18 February 2021 were agreed as a true record of the meeting.
Subject to the above amendments, the Committee APPROVED the minutes of the meeting dated 18 February 2021.
1.6 Action Log
1.6.1 The Action Log was reviewed and updated.
The Committee NOTED the updates to the action log
1.7 Matters Arising
1.7.1 There were no matters arising.
1.9 Questions from the public relating to items on the agenda received prior to the meeting 1.9.1 No questions from the public had been received.
2.0 BUSINESS
2.1 Primary Care Finance Update
2.1.1 The Committee was asked to note: The month 11 report was presented and the out-turn position for 2020/21 would be available at the next meeting in June 2021; The forecast for the year remained as break even against plan; The budget for Other Medical Services was currently fully shown against Barnet resulting in an under spend in Barnet and a corresponding over spend in the other four localities. The budget would be redistributed for the year-end report to show the correct values against the individual Boroughs respectively.
2.1.2 The Committee NOTED the report.
2.2 Quality & Performance Report
2.2.1 The following was highlighted to the Committee: The Quality report covered all practices in NCL and the metrics included the Care Quality Commission (CQC) ratings, patient experience data, complaints, the quality outcomes framework and the demographic data; Section 3 of the report set out how the data was used to improve performance including formal contract notices where the practices receive an inadequate or requires improvement CQC, quality improvement support from borough teams where practices were getting lower quality outcome framework results than their peers; Deprivation - practices were segmented into five categories with the highest level of deprivation in NCL recorded in Enfield, Haringey and Islington, although all boroughs have areas of deprivation; Care Quality ratings – most practices in NCL had a good rating with a single practice rated as inadequate with the rating relating to the previous contract holders. Three practices recording an inadequate rating at the last meeting had moved up to requiring improvement, but these practices would still need to continue with remedial action plans until they receive a good rating;
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The Quality Outcomes Framework for 2021 – had a new focus on early diagnosis for cancer and also physical health checks for people with severe mental illness and learning disabilities; Patient Experience measures were drawn from the GP Patient Survey and the Friends and Family Test. These indicators would be used in the forthcoming access review including for the impact to a total triage model for access introduced as a response to the covid pandemic; Practice Appointments – fell in January 2021 due to the second peak of Covid but they fell by about 5 to 6% which was a lot less that 30% reduction seen in the first wave of the pandemic in April / May 2020. The switch to virtual appointments was still apparent and this would also be picked up in the access review; Early Warning System – identifies struggling practices as summarised in section 6. A primary care recovery plan was being prepared as we moved out of the second wave of Covid. This will be developed during April / May 2021 focussing on: practice workforce and resilience; access and patient experience; clinical prioritisation (how to remove the planned care backlogs and how to support people with long term conditions including long term Covid); and the development of networks and neighbourhoods.
2.2.2 In consideration, the Committee noted: When e-consult was introduced at the start of the pandemic there was more uptake in Enfield compared to other boroughs. This would be investigated through the access review; The impact of Medicus Health Partners merger on the uptake of on-line appointment bookings and repeat prescriptions in Enfield should be investigated, as well as included in the access review; Patient Participation Groups (PPG) would make a valuable contribution to the access review, in Enfield and across NCL, building on work on access agreed to be undertaken at the April 2021 Voluntary and Community Stakeholder Reference Group meetings in Enfield; Digital – work was being done on telephony systems as some practices had older systems which required improving to support access; At the peak of the pandemic, practices provided weekly reports on capacity, picking up on the ability to see people with Covid, access to personal protective equipment (PPE) and ability carry out face to face appointments. The frequency of the reports has been stood down but could be brought back at points of peak demand; Practice capacity had been supported locally with the resilience package and supporting funds, and there had also been national capacity funding for practices to maintain business as usual as well as undertake the covid vaccination programme; Workforce capacity was being addressed through skill mix in practices via the additional roles reimbursement scheme augmenting the traditional clinical mix of GPs and nurses. The specifics on nursing capacity would be included in the next report. Training hubs were supporting the work on workforce development in primary care. It was agreed that a slide would be useful to circulate about the priorities in NCL around workforce, training and nursing; Information on the role of patient participation groups (PPGs) in Care Quality Commission (CQC) inspections was requested.
2.2.3 Action: To circulate a slide about the priorities in NCL around workforce, training and nursing. (Sarah Mcilwaine)
The Committee NOTED the report.
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2.3 Primary Care in Planning Guidance for 2021/22
2.3.1 The following was highlighted to the Committee: The guidance for 2021/22 was set in the context of the need to continued recovery from the impact of Covid on services, managing future transmission of Covid, addressing the inequalities impact of Covid, and returning to the delivery of the NHS Long Term Plan priorities; Guidance had a focus on the health and wellbeing for staff in the context of the demands of recovery following the impact of addressing the covid pandemic. Many primary care staff working hard in Covid services and the vaccination programmes, would also be asked to support primary care recovery; For the delivery of the Covid vaccination programme, 900,000 vaccinations had been delivered in NCL to date with over half a million of these delivered from the primary care network sites; Restoration of planned care services (Cancer, Electives, Mental Health and Primary Care) would need to be prioritised for return in order of clinical need; The guidance prioritised expanding primary care capacity to support access and address health inequalities, and expanding community and urgent care capacity to support hospital flow including introducing a two-hour community rapid response service and maintaining integrated discharge teams; Maintaining the collaborative work developed during the pandemic and the development of integrated care systems; Priorities for primary care were: (a) improving access; (b) getting appointments back to pre-pandemic levels; (c) population health management to address poor health outcomes; (d) continued delivery of the vaccination programme including the potential booster programme in the Autumn; (e) the renewed focus on early cancer diagnosis; (e) physical health checks for people with learning disabilities and serious mental illness; and finally (f) further development of primary care networks and their alignment to health and care services in neighbourhoods; Appointments in primary care had fallen less than elsewhere in the system. At the height of the second wave in January, appointments were 5 to 6% below where they were in the previous year; Nationally there had been 1 million fewer referrals in the last 12 months compared to the previous year and within that about 37,000 less cancer referrals.
2.3.2 In consideration, the Committee made the following comments: The low uptake of the vaccine by staff in Enfield care homes and some population groups was being addressed by the CCG and the London Borough of Enfield working with stakeholders. GP surgeries had been working alongside the Council, Public Health and community groups to provide advice to patients to help overcome vaccine hesitancy. The GP led PCN sites remained ready to vaccinate health and social care workers. There was also access via the national booking system for eligible patients to book into the vaccination site at the Dugdale Centre and approved local pharmacy sites. When vaccinating registered care home patients GPs and partners had also encouraged care home staff to have their vaccination at the same time. Outside of these care home visits, staff were still able to access the numerous local options for the vaccination; Similar work was underway across all of the Boroughs in NCL to improve vaccine uptake, and it would be useful for future Committee meetings to receive an update on progress. This would be added to the forward planner and recovery plan; A System Inequalities Fund was being developed to target resource and investment in the most deprived parts of the population to support both access and population health management. Proposals for the fund would be developed through integrated borough partnerships.
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2.3.3 Action: To provide an update on how the Primary Care in Planning Guidance for 2021/22 is being implemented at a future meeting. (Paul Sinden) The Committee NOTED the paper.
2.4 NCL Improvement Grant Process
2.4.1 The following was highlighted to the Committee: The improvement grant process was designed to ensure that the CCG was supporting local strategic priorities including Primary Care Network (PCN) development in a consistent manner across NCL, and that premises directives were followed; Funding for improvement grants was held by London Region and NCL would bid for the funds according to local priorities and estates strategies; Improvement Grants were not there for major new capital developments, with these sourced through Estates and Technology Transformation Funds (ETTF) or through Section 106 monies held by Local Authorities; Practices would submit expressions of interest for estates improvement to Borough Primary Care teams, the proposals were then prioritised by the Local Estates Forum. The prioritised list would then go to London Region for approval; The Committee was asked to approve the standardised NCL Improvement Grant Process but noting the process had already been presented and signed off by the NCL Local Care infrastructure Board and the NCL Estates Board.
2.4.2 In consideration, the Committee noted: The CCG Estates team worked very closely with the borough primary care teams to ensure that expression of interest were received from practices with the greatest need, and proposals were aligned to longer-term primary care development needs; The Improvement Grants process, and supporting premises directions, needed to support the recruitment of Primary Care Network (PCN) additional roles as an integral part of primary care development and delivery of the core contract; The need for priorities for funding ICS strategic priorities to align with population health need and the strategic priorities of the Borough or PCN; Estates development and improvement grants should balance the needs of physical requirements (including face-to-face appointments being given where required) and digital requirements, the need for covid compliance, PCN development, and the impact of the strategic reviews for community and mental health services; Patient Engagement would be developed by borough primary care proposals being part of borough partnership delivery plans; The consolidated NCL estates team provided the strategic oversight team to support the development of borough plans, and align plans into common themes across Boroughs.
The Committee APPROVED the process, with further work requested on the incorporation of Primary Care Network additional roles reimbursement scheme into the process in the future.
3.0 ITEMS FOR DECISION
Contract Variations 3.1 All Boroughs – Personal Medical Services (PMS) Changes
3.1.1 The Committee was asked to note that all contract variations and change requests were subject to review by the NCL Primary Care Commissioning Team to ensure that all clinical staffing levels were in line with the British Medical Association (BMA) guidance, and that GP and nursing appointment levels were in line with benchmark levels.
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Capacity was also monitored after agreed changes were made to contracts to ensure capacity was retained.
Barnet – The Speedwell Practice The Committee was asked to approve the addition of a new partner to the Personal Medical Services (PMS) agreement from 1 April 2021. The practice was providing above the recommended level of GP and nurse appointments.
The Committee APPROVED the recommendation.
Barnet – Millway Medical Practice The Committee was asked to approve the resignation of a GP from the PMS agreement with effect from 26 April 2021. The practice was providing above the recommended level of GP and nurse appointments.
The Committee APPROVED the recommendation.
Barnet – Ravenscroft Medical Centre The Committee was asked to approve the addition of a partner to the PMS agreement with effect from 27 April 2021. The appointment would support delivery of the benchmark level of GP appointments.
The Committee APPROVED the recommendation.
Barnet – Torrington Park Group Practice The Committee was asked to approve the addition of a partner to the PMS agreement with effect from 1 April 2021. There was a shortfall of 46 GP appointments and 124 nurse appointments per week. The practice has been advised that there was a requirement to improve patient access, and that their progress towards minimum target appointments will be supported and monitored.
The Committee APPROVED the recommendation.
Barnet – Langstone Way Surgery The Committee was asked to approve the 24-hour retirement of a partner from the PMS agreement with effect from 30 March 2021, re-joining 5 May 2021. A locum would be engaged to cover the partner’s sessions in his absence. Otherwise, the practice was providing above the recommended level of appointments.
The Committee APPROVED the recommendation.
Barnet – Hodford Road Surgery The Committee was asked to approve the addition of a partner to the PMS agreement with effect from 1 July 2021. The practice has been advised there was a requirement to improve patient access and their progress towards minimum target appointments will be supported and monitored.
The Committee APPROVED the recommendation.
Camden – Daleham Gardens Surgery The Committee was asked to approve the addition of a partner to the PMS agreement and at the same time the removal of a partner both with effect from 17 May 2021. The practice was aware of the shortfall in appointments and planned to increase appointments to meet the recommendation by adding 1 additional GP session and 2 nursing sessions.
The Committee APPROVED the recommendation.
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Enfield – Arnos Grove Medical Centre The Committee was asked to approve the removal of a partner from the PMS agreement with effect from 20 March 2021. There was a shortfall of 228 GP appointments, 7 GP sessions, 108 nurse appointments and 6 nurse sessions per week. The practice had stated that from 4 April 2021, a new salaried GP would offer one session per week increasing to 4-6 sessions per week over the course of the year. The practice also had a healthcare assistant working three hours per week, but longer-term nursing solutions were required.
The Committee APPROVED the recommendation.
Haringey – Rutland House Surgery The Committee was asked to approve the addition of partner to the PMS agreement with effect from 1 May 2021. There was a shortfall of 49 GP appointments, 2 GP sessions, 44 nurse appointments and 3 nurse sessions per week. The practice was aware of the shortfall and is reviewing ways to increase provision.
The Committee APPROVED the recommendation.
Haringey – Tynemouth Medical Practice The Committee was asked to approve the retrospective removal of a partner from the PMS agreement with effect from 1 August 2019. The practice was providing above the recommended guide in both GP and nursing provision.
The Committee noted that the retrospective request was required due to a delay in the forms being completed by the practice accruing from historic performance problems and previous GP resignations from the contract.
The Committee APPROVED the recommendation.
3.1.2 The Committee APPROVED the contract variations requested in 3.1.1 above.
3.2 Barnet - Ravenscroft Medical Centre - Request for relocation and increase in rent
3.2.1 The Committee was asked to approve the relocation and increase in rent on the following basis; a) Relocation of the practice to Olympia House on the basis of using 6 clinical rooms in line with calculated estates requirements and allowing for population growth; b) The contract holder has evidenced that a lease will be in place; c) That the District Valuer confirms the new rent and plans; d) The landlord will meet the costs of capital work, as currently indicated; e) A relocation plan was developed and implemented with relocation likely in quarter two of 2021.
3.2.2 In Consideration, the Committee noted: The revised case addressed the fit of clinical rooms with estates calculators raised by the Committee in February 2021, with the increase in rent (£12,654 per annum) based on the use of six clinical rooms; The patient survey showed that the practice had received 374 responses from patients with 93% in favour of re-location; The new site was across the road (0.2 miles) from the existing one; A second GP was being added as a partner improving practice resilience.
The Committee APPROVED the recommendation subject to the timeline of the build.
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3.3 Enfield – Winchmore Hill Practice and Park Lodge Medical Centre – Request to merge contracts 3.3.1 The Committee was asked to approve the following: a) The merger by varying the Winchmore Hill Practice PMS contract and terminating the Park Lodge Medical Centre GMS Contract. b) Existing remedial notices were retained and transferred to the merged contract and evidence that both practices sign this agreement; c) Retain the existing practice catchment areas for Park Lodge Medical Centre to ensure that no patients were de-registered following the merger.
The practices already shared premises, partners and IT systems, and the merger would address IT issues accruing from a common system being used for two separate contracts. There was no change in service provision.
The Committee APPROVED the recommendation.
3.4 Enfield – Brick Lane Surgery & East Enfield Medical Practice – Merger & Relocation 3.4.1 The Committee was asked to approve the following: a) The merger of the two contracts by varying the East Enfield Medical Practice PMS contract and terminating the Brick Lane Surgery GMS contract; b) Relocation of merged practiced into new premises – the Electric Quarter building in Ponders End, with an increase in rent of £42k per annum.
The request for the merger was made in the following context: The new premises would provide capacity to meet population growth and remove the risk of the 12-month rolling lease for Brick Lane Surgery; The merger would take effect from July 2021 and the relocation by the end of the year; The new premises would also house a pharmacy and dental practice and was 0.2 miles from East Enfield Medical Practice and 0.9 miles from Brick Lane Surgery; The two practices already shared joint contract holders; The practices had already commenced engagement with 90% of patients in favour of the merger and relocation.
The Committee APPROVED the recommendation.
3.5 NCL – Direct Payments for practices for reimbursable premises costs
3.5.1 The Committee was asked to approve the setup of direct payments from the CCG to community health partnerships (CHP) for reimbursable premises costs for the following four practices: a) Hanley Road Primary Care Centre – Islington b) The Partnership Practice – Islington c) Queens Medical Centre – Haringey d) The Morris House Group Practice – Haringey
3.5.2 In Consideration, the Committee noted: Currently 12 practices in NCL were tenants in the community health partnerships (CHP) buildings. Direct payments could only be considered under premises directions for those practices that did not hold any premises debt and had signed a lease. The four practices above had agreed a switch to direct payments form the CCG to CHP;
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Negotiation was underway with a fifth practice (in Camden) with resolution of negotiations on non-reimbursable costs required before direct payment of reimbursable costs could be considered; The CCG could revoke direct payments if a practice did not comply or agree to a new lease, and if a practice was taken over the new practice would have to sign a new lease with CHP. At the point of the change, the payments would stop and it would come back for re-approval.
The Committee APPROVED the recommendation in principal subject to the above conditions.
4.0 ITEM TO NOTE – URGENT DECISION TAKEN SINCE 18 FEBRUARY 2021
4.1 Primary Care Networks – Proposals for Organisational and Membership Changes 4.1.1 The Committee was asked to note that the urgent decision-making process had been used to confirm the proposed changes to Primary Care Network (PCN) configurations in Camden and Islington with effect from 1 May 2021.
The Committee NOTED the report.
5.0 GOVERNANCE AND COMMITTEE ADMINISTRATION
5.1 PCCC Risk Register
5.1.1 The Committee was asked to note: The risk register picks up many of the issues discussed today including support for struggling practices, addressing variation in performance through the development of Primary Care Networks, the quality improvement Focus through the Quality Outcomes Framework, pressures accruing from the response to Covid and the mitigating resilience package put in place for General Practices, and workforce development The highest risk score on the register is with Capita (Perf 9) which had been undertaking the list cleansing programme. The Committee asked the risk to be reviewed to see whether the risk rating could be reduced; Primary Care Workforce Development (Perf 18) – The Committee asked the risk to be reviewed and to include actions to address nurse development.
5.1.2 Action: To review two risks: Perf 9 (Inadequate support from primary care support England – Capita contract) and Perf 18 (Primary Care Workforce development) to see whether their risk ratings could be reduced. (Paul Sinden & Vanessa Piper) The Committee NOTED the risk report.
5.2 PCCC Forward Planner
The Committee NOTED the forward planner.
6.0 ANY OTHER BUSINESS
7.1 None. 7.0 DATE OF NEXT MEETING
Thursday 17 June 2021 – 2:30pm to 4pm
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NCL CCG Primary Care Commissioning Committee - Action Log June 2021 ITEM 1.6
Meeting Action Minutes Action Action Deadline Status update Date Date No. Ref lead closed 22.04.21 1 2.2.3 Quality & Performance Report – To Sarah June 7 June 21 – This was circulated to the circulate a slide about the priorities in NCL Mcilwaine 2021 members. around workforce, training and nursing. Recommend to close the action.
22.04.21 2 2.3.3 Primary Care in Planning Guidance for Paul August 7 June 21 - Operating Plan for 2021/22 2021/22 – To provide an update on how the Sinden 2021 to be submitted in June 2021. Update to Guidance is being implemented at a future Committee in August 2021. meeting. 22.04.21 3 5.1.2 PCCC Risk Register – To review two risks Paul June 7 June 21 - Updated in the risk register Perf 9 (Inadequate support from Primary Sinden & 2021 for June 2021. Care England – Capita contract) and Perf 18 Vanessa Recommend to close the action. (Primary Care Workforce Development) and Piper see whether their risk ratings could be reduced. 18.02.21 4 3.7.3 Haringey – Rutland House / Queens Owen TBC 8 June 21 – A meeting is taking with the Avenue – Approval of relocation of Sloman practice on 9 June and an update will be practice linked to the previously agreed provided to the Committee on 17 June merger – To submit a further paper to a 2021. future PCCC meeting in considering the 22 April 21 – The Committee agreed to costs for the stamp duty Land tax as well as keep the action open. legal and surveyor fees. 17 March 21 – Paper scheduled for the June meeting.
22.10.20 4 To add to a future seminar: June 6 May 21 – 2nd Seminar scheduled for 3.5.3 2021 15 July 2021. A demonstration on using the Vanessa
Department of Health (DH) Health Piper Recommend to close the action. Building Notes Estimator (HBN), tool
19 / 113 and how it assesses additional space 22 April 21 – Action noted. for practices. Paul 3.5.3 Sinden A discussion on additional workforce 17 March 21 – The 1st seminar is now in Primary Care and where practices scheduled for 20 May between 12pm and 1pm. would place the additional workforce
A discussion on the pros and cons of 18 February 21 – Seminar will be 3.7.3 Vanessa practices merging together into a rescheduled, in line with reduction in Piper single contract as opposed to covid pandemic, for May 2021. separate contracts. Also noting the risks and benefits for the CCG in allowing these contracts to go 18 Jan 21 – PCCC was informed the forward. seminar scheduled for 28 Jan was postponed until further notice due to the Future of Procurement and the new current covid challenges. white paper legislation 8 Dec 20 – Seminar to be scheduled for 28 January 2021.
Closed Actions
18.02.21 1 1.6.2 Draft Minutes of the NCL PCCC meeting Vivienne March 22 April 21 – The Committee agreed 22.04.21 on 17 Dec 2021 – To add the Councillor Ahmad 2021 to close the action. leads of the five north central boroughs to 8 March 21 – The Councillors were the circulation list for PCCC papers. added to the circulation list. Recommend to close the action.
18.02.21 2 2.1.3 Primary Care Finance Update – To bring Tracey April 22 April 21 – A point was raised at the 22.04.21 an outturn report to the next meeting. Lewis 2021 meeting to rephrase the action overleaf to ‘Prior year comparatives to be shown on the Finance report and a more detailed analysis of the other medical services line’. The Committee agreed to close the action.
Page 2 of 4 20 / 113 17 March 21 – Verbal update will be provided at the April meeting with an outturn paper for the June meeting.
18.02.21 3 3.1.3 All Boroughs – Personal Medical Vanessa April 22 April 21 – The Committee agreed 22.04.21 Services (PMS) Changes – To explain, Piper to 2021 to close the action. outside of the meeting, what the requirement Karen 9 April 21 - This action is related to was on branches supplying data. Trew Medicus Health Partnership, who have one patient list size on Exeter across 14 sites and whether branch sites can provide list size and other data. Branch sites are required to provide data, specifically from the EMIS clinical system and Commissioners are exploring how data can be extracted from PCSE regarding list sizes by branch. Recommend to close the action.
17.12.20 1 1.2.2 Resolution to exclude members of the Paul April 22 April 21 – Today’s meeting was the 22.04.21 public from the meeting for the Sinden 2021 first MS Teams LIVE meeting, in which protection of public health - To clarify the members of the public could join in and Committee format for February 2021. this type of meeting would continue from now on. The Committee agreed to close the action.
17 March 21 – The PCCC meetings will now be on MS Teams ‘Live’ with the first live meeting on 22 April 2021. Recommend to close the action.
18 Feb 21 – As a result of the pandemic, the NCL CCG Executive Leadership agreed to streamline and simplify committee meetings wherever possible during January and February recognising the ongoing challenges. As Page 3 of 4 21 / 113 ‘Live’ meetings require significant preparation and additional resource the February PCCC meeting will be held using MS Teams although it is anticipated ‘Live’ will be utilised in April. PCCC will have MS Teams ‘live’ by 22 April 2021. Recommend to close the action.
17.12.20 2 2.2.3 Quality & Performance Report - Paul April 22 April 21 – The Committee agreed 22.04.21 The next Quality & Performance Report to Sinden 2021 to close the action. include an update on the early warning 17 March 21 – This has been included system, the work with volunteers in in the Quality report for April. Haringey, and specification for the access review. Recommend to close the action. 18 Feb 21 – This will be Included in Quality report for April 2021.
23.07.20 4 3.3.3 To check and verify the engagement Vanessa April 22 April 21 – The Committee agreed 22.04.21 processes GP Practices were undertaking Piper 2021 to close the action. with regard to merger / relocation. 10 Feb 21 - An update will be provided at the April 2021 meeting. Recommend to close the action. 7 Dec 20 – Will be sending out the methods to Healthwatch, week commencing 7 December 2020. 22 Oct 2020 – The Committee agreed to carry the action forward to December’s PCCC meeting.
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North Central London CCG Primary Care Commissioning Committee Thursday 17 June 2021
Report Title M12 NCL Primary Care Date of 8 June 2021 Agenda 2.1 Delegated report Item Commissioning Finance Report Lead Director / Paul Sinden, Chief Email / Tel [email protected] Manager Operating Officer
GB Member Sponsor Report Author Tracey Lewis, Head of Email / Tel [email protected] Finance Primary Care Name of Becky Booker, Summary of Financial Implications Authorising Director of Financial To inform the Committee of any financial risks Finance Lead Management associated with the Primary Care Delegated Commissioning budget.
Report Summary This report details the 2021/22 M1-6 draft budget. The total Primary Care Delegated Allocation for 2021/22 M1-6 is £123.4m and the CCG expects to breakeven against this allocation.
The report also presents the 2020/21 Month 12 Delegated Primary Care financial outturn position across the five North Central London (NCL) localities (Barnet, Camden, Enfield, Haringey and Islington).
The CCG reported a £1.1m underspend against its allocation of £239.9m for Primary Care Delegated Commissioning in 20/21.
Recommendation The Committee is requested to:
NOTE the Primary Care Delegated Commissioning 21/22 Budget and the 20/21 Month 12 outturn position.
Identified Risks The Committee will provide oversight and scrutiny of the CCG’s key risks within and Risk the area of its remit. Management Actions Conflicts of This report was written in accordance with the CCG’s Conflicts of Interest Policy. Interest Resource This report supports the CCG by providing oversight and scrutiny of delegated Implications primary care commissioning and in making effective and efficient use of its resources.
Engagement The Committee includes Lay Members and clinicians. Patient Representatives are also invited to Committee meetings as Standing Attendees.
23 / 113 Equality Impact The report was written in accordance with the provisions of the Equality Act Analysis 2010. Report History For noting by the Committee. and Key Decisions Next Steps None. Appendices None.
24 / 113 Primary Care Delegated Commissioning Finance Report
251 / 113 Executive Summary
This report details the 2021/22 M1-6 draft budget. And 20/21 final outturn position.
For 21/22 the CCG allocation has been uplifted to fund growth between 2020/21 and 2021/22. Additional allocations have been issued to fund;
• Practice contract funding (to fund the impact of the 2020/21 GP contract), • New QOF indicator for Mental Health, • New QOF indicator for vaccines and immunisations.
This draft budget is being presented to June Governing Body for approval. This report also presents the 2020/21 Month 12 Delegated Primary Care financial outturn position across the five North Central London (NCL) localities (Barnet, Camden, Enfield, Haringey and Islington).
The CCG reported a £1.1m underspend against it’s allocation of £239.9m for Primary Care Delegated Commissioning in 20/21.
262 / 113 2021/22 M1-6 NCL Primary Care Delegated Commissioning Budget Summary
• The table below summarises the 2021/22 M1-6 NCL draft Primary Care Delegated Commissioning Budget. • The total Primary Care Delegated Allocation for 2021/22 M1-6 is £123.4m. • The CCG expects to breakeven against this allocation.
273 / 113 2021/22 NCL Primary Care Delegated Commissioning Budget Detail . The table below summarise the 2021/22 Month 1-6 NCL Primary Care Delegated Commissioning budget by locality.
284 / 113 2020/21 NCL Primary Care Delegated Commissioning as at Month 12
Financial Summary - 12 Months to 31st March 2021
NCL Total
YTD Actual YTD Variance Annual Budget YTD Budget Service Expenditure Fav/(Adv)
£000's £000's £000's £000's PMS 98,208 98,208 98,315 (107) GMS 100,680 100,680 99,324 1,356 APMS 14,057 14,057 14,377 (321) Other Medical Services 26,927 26,927 26,756 171 Total Primary Care Medical Services 239,872 239,872 238,772 1,100
The NCL Delegated Commissioning budget reported a £1.1m underspend against the final annual allocation of £239.9m.
295 / 113 2020/21 Primary Care Delegated Commissioning Expenditure by Locality as at Month 12
YTD Actual YTD Variance Annual Budget YTD Budget Expenditure Fav/(Adv)
Barnet £000's £000's £000's £000's PMS 23,644 23,644 23,501 143 GMS 27,134 27,134 26,635 499 APMS 558 558 582 (24) Other Medical Services 10,596 10,596 6,213 4,382 Total Primary Care Medical Services 61,932 61,932 56,931 5,001
YTD Actual YTD Variance Annual Budget YTD Budget Expenditure Fav/(Adv)
Camden £000's £000's £000's £000's PMS 21,398 21,398 21,057 341 GMS 17,011 17,011 16,959 52 APMS 3,672 3,672 3,806 (134) Other Medical Services 4,207 4,207 5,335 (1,128) Total Primary Care Medical Services 46,288 46,288 47,158 (870)
306 / 113 2020/21 Primary Care Delegated Commissioning Expenditure by Locality as at Month 12
YTD Actual YTD Variance Annual Budget YTD Budget Expenditure Fav/(Adv)
Enfield £000's £000's £000's £000's PMS 27,950 27,950 28,504 (554) GMS 12,935 12,935 12,255 680 APMS 2,696 2,696 2,672 24 Other Medical Services 4,567 4,567 5,348 (781) Total Primary Care Medical Services 48,148 48,148 48,779 (632)
YTD Actual YTD Variance Annual Budget YTD Budget Expenditure Fav/(Adv)
Haringey £000's £000's £000's £000's PMS 23,225 23,225 23,158 66 GMS 13,514 13,514 13,646 (132) APMS 4,916 4,916 5,055 (139) Other Medical Services 4,295 4,295 6,022 (1,727) Total Primary Care Medical Services 45,950 45,950 47,881 (1,931)
317 / 113 2020/21 Primary Care Delegated Commissioning Expenditure by Locality as at Month 12
YTD Actual YTD Variance Annual Budget YTD Budget Expenditure Fav/(Adv)
Islington £000's £000's £000's £000's PMS 1,992 1,992 2,095 (103) GMS 30,086 30,086 29,829 257 APMS 2,214 2,214 2,262 (48) Other Medical Services 3,263 3,263 3,837 (574) Total Primary Care Medical Services 37,555 37,555 38,023 (468)
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North Central London CCG Primary Care Commissioning Committee Meeting 17 June 2021
Report Title Primary Care Date of 10 June Agenda 2.2 Quality and Performance report 2021 Item Report Lead Director / Paul Sinden, Email / Tel [email protected] Manager Chief Operating Officer
GB Member Not Applicable Sponsor Report Author Paul Sinden, Email / Tel [email protected] Chief Operating Officer
Name of Not Applicable Summary of Financial Implications Authorising Finance Lead Not Applicable Report Summary 1. Introduction This report sets out: The latest Quality and Performance Report for comment; A summary of actions accruing from the quality report; An update on our primary care recovery plan following the second wave of the pandemic including a review of access; An update on the coronavirus vaccination programme.
Recommendation The Committee is asked to:
COMMENT ON future development of the quality and performance report to support onward quality and performance improvement; COMMENT ON the identified actions to carry forward into NCL CCG governance structures.
Identified Risks The report outlines areas where support to practices is required, and where formal and Risk action requiring remedial actions plans are required.
Management Actions Conflicts of Conflicts of interest are managed robustly and in accordance with the CCG’s Interest conflict of interest policy.
Resource The report helps to identify practices in need of resilience funding. Implications Local primary care development plans, including the GP Forward View and developing primary care at scale seek to address variations in care and access described in the report. Engagement The report includes patient experience measures from the Friends and Family Test and GP Patient Survey carried out by Ipsos MORI.
33 / 113 Equality Impact This report was written in accordance with the provisions of the Equality Act Analysis 2010.
Report History The Quality Report provides an overview of primary medical services contracts and Key delegated to the CCG from NHS England.
Decisions Next Steps Local reporting will be further extended through work to develop reporting to support the development of Primary Care Networks in NCL.
Appendices 1. Quality and Performance Report to the NCL Primary Care Committee-in- Common; 2. Quality dashboard for each Borough 3. Overview of workforce development 4. Overview of primary care recovery programme
34 / 113 NCL CCG Primary Care Committee-in-Common Quality and Performance Report – Appendix 1
1. Introduction This report sets out: The latest Quality and Performance Report for comment; A summary of actions accruing from the quality report; An extract from the NCL urgent and emergency care report that sets out measures of primary care capacity.
2. Quality Report The report is a consolidation of publicly available information on individual practice performance, and is therefore included in Part I of the Committee (a meeting in public).
This report aims to highlight practice sustainability through an aggregation of national indicators and local knowledge. The table draws together a multitude of indicators from an array of sources, including data from Care Quality Commission (CQC) ratings, GP Patient Survey (GPPS) results and practice demographics.
The metrics in this report have been used to identify and support practices in difficulty through the resilience programme. Local teams were asked to identify those practices which were considered in difficulty and those which would benefit from Resilience Programme support.
National criteria in this report were created for use as a screening tool by local commissioners to guide their assessment with local stakeholders on offers of support to improve sustainability and resilience.
3. Actions accruing from the report This section summarises how the report is used to make commissioning decisions and apply primary care medical contracts where applicable. The table below summarises commissioning actions undertaken against the performance domains in the report:
Domain Indicator Description of action taken
Quality Care Quality 1. Informal remedial action - Number of practices under Commission (CQC) improvement plan review ratings; 2. Formal remedial action - number of practices issued a Complaints remedial notice 3. Practice mergers 4. Infection control audits Efficiency Quality Outcomes 1. Performance improvement plans Framework (QOF); 2. Quality Improvement Support Teams (QISTs) to List size changes; reduce unwarranted variations Friends and Family 3. Care Closer to Home Integrated Networks (CHINs) / Test (FFT) Neighbourhoods development 4. Resilience funding 5. Financial assistance (Section 96) Workforce Age profile; 1. Pharmacists in Practice Full-time 2. GP retention scheme equivalents (FTE) 3. Medical Assistance Programme for GPs and Nurses 4. Training programmes
Patient GP Patient Survey 1. National access programme Experience 2. GP access Hubs 3. Performance improvement plans Patient Online 1. Differential access linked to deprivation levels in some Online appointments; CCGs – ensure digital inclusion part of roll-out. Repeat Prescriptions Extended Extended access 1. GP Hubs Access days; 2. DES sign up 3. National access programme
35 / 113 Direct Enhanced Service (DES) sign up Premises New schemes; 1. Improvement grant awards Relocation into 2. Capital funding awards compliant buildings; 3. Service charge financial assistance applications Void space
The report will also be used to provide as a source of information to help develop and early warning system to identify struggling practices and enhance current levels of support prior to any regulatory action being taken. The early warning system will be developed across North Central London.
The report has enabled the following actions to be undertaken: Remedial notices have been issued to practices receiving Care Quality Commission (CQC) ratings of inadequate or requires improvement, with practices developing action plans to address CQC findings. This has in turn prompted the following work by CCGs: Establishing the workforce and resilience workstream as per of the primary care recovery plan from the covid pandemic. Within this an early warning system to identify struggling practices will be developed; Practice Caretaking arrangements put in place where required to secure service continuity; Practice resilience support programme; CCG have facilitated practice mergers to support struggling practices and reduce variations in care; Practices with low Quality Outcomes Framework (QOF) scores receive a performance report with a series of actions agreed with NHS England Medical Directorate to improve delivery; Actions to address workforce gaps includes participation in international recruitment, focus on workforce in general practice strategy for NCL, employment of greater skill-mix in practices (this will now be supported by the new GP contract and extended definition of core staff that will attract funding); CCG teams have been working with practices in response to the results of the patient survey; The identification of differential access to patient on-line initiatives according to deprivation; Access developments include action to ensure all practices have adequate cover arrangements for any half-day closures in operation. Full population coverage for extended access schemes is in place across NCL; Development of NCL-wide process to identify both major capital schemes for general practices and the award of minor improvement grants. Estates and Technology Transformation Funds (ETTF) received for general practice strategic developments, and consideration of amendments to premises directions to ensure premises are used effectively and support primary care development.
4. Overview of performance This section sets out an overview of performance for practices across each Borough including an overview of practice outliers in performance compared to Borough averages.
Performance for practices, and across Boroughs, should be assessed against the range of indicators provided (Care Quality Commission ratings, patient experience responses, Quality Outcomes Framework achievement, and written complaints received) to arrive at a rounded view of performance rather than using single measures of performance. Demographic, finance, and workforce information is then provided as context.
4.1 Demographics This section provides a summary of population profiles for practices including: Deprivation in a range of 1-5, with 1 being the most deprived and 5 the least deprived, percentage of patients aged over 75, and proportion of the practice list made up of people from lack and ethnic minorities; Average list size per practice and list size change over the 12 months to March 2021.
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Barnet Camden Enfield Haringey Islington Contract type GMS 28/51 GMS 14/33 GMS 19/32 GMS 15/35 GMS 28/32 PMS 23/51 PMS 14/33 PMS 10/32 PMS 19/35 PMS 2/32 APMS 1/51 APMS 5/33 APMS 3/32 APMS 2/35 APMS 2/32 Deprivation: 1 = most deprived 0 0 17 10 1 2 3 10 9 16 26 3 11 12 10 5 5 4 27 6 7 3 0 5 = least deprived 10 4 3 1 0 Null 0 1 0 0 0 Patients aged > 75 on list 7% 4% 6% 4% 4% % list black & ethnic minority 37% 35% 40% 42% 33% Average list size 8,532 9,950 10,526 9,269 8,619 Annual list size change +1% +3% +1% +1% +2%
To note: The relatively high rates of deprivation in Enfield, Haringey and Islington; The higher rate of over 75s in Barnet and Enfield; The April 2021 report reported the number of practices in Enfield reducing from 47 to 33 following the merger of 15 practices to create Medicus Health Partnership which was approved by the Committee in December 2020. Forest Road Group Practice is the host for the partnership with a list size of circa 90,000 for the merged practice. The number of practices has now reduced to 32 with the merger of Park Lodge Medical Centre and Winchmore Hill Practice from 1st May 2021. Average list size in Enfield has therefore increased from 7,445 to 10,526 per practice; Following the creation of Medicus Health Partnership for Enfield some indicators are still reported on the previous practice baseline. This includes deprivation indices, patient feedback and Quality Outcomes Framework delivery; The number of practices in Haringey has reduced from 36 to 35 to reflect merger of Queens Avenue Practice and Rutland House Surgery; List sizes, and annual changes, are based on the movement from May 2020 to May 2021, with an overall list increase of 1% year-on-year. List size growth recorded across the five Boroughs compared to the last report (based on March 2021 lists) is 0.7%
4.2 Care Quality Commission The Care Quality Commission (CQC) rates general practices to give an overall judgement of the quality of care. The CQC applies four ratings to practices, as is the case for other health and social care services. Practices are assessed across five key areas for quality of care (caring, effectiveness, responsiveness, safety, being well-led). The table below summarises Care Quality Commission (CQC) overall ratings for practices within each Borough as at March 2020:
CQC ratings Barnet Camden Enfield Haringey Islington Overall rating: Outstanding 0 0 0 1 0 Good 49 33 43 31 31 Requires Improvement 2 0 3 2 1 Inadequate 0 0 0 1 0 Yet to be rated 0 0 0 0 0 Total 51 33 46 35 32
To note from the above: The majority of practices assessed to date have received a good rating, with this including all practices in Camden. All practices in NCL have now received a CQC inspection and rating; The first practice in North Central London has received an overall “outstanding” rating – West Green Road Surgery in Haringey; There remains a single practice in NCL with an inadequate rating from the Care Quality Commission. Staunton Group Practice remains on an inadequate rating, with the rating relating to the previous partnership and not the current caretaking arrangements; The number of practices with a “requires improvement” rating from the CQC has reduced from nine to eight reflecting the merger of Park Lodge Medical Centre and Winchmore Hill Practice from 1 May 2021;
37 / 113 Practices with an inadequate or requires improvement rating are subject to formal remedial action through the primary care medical services contract, as well as being required to complete an action plan to address concerns raised by the CQC.
4.3 Quality Outcomes Framework The Quality Outcomes Framework (QOF) was introduced as part of the new General Medical Services contract in April 2014, with the intention to improve the quality of care patients are given by rewarding practices for the quality of care they provide to patients.
The table below summarises performance for practices in each Borough in 2019/20 compared to the range for previous years:
Quality Outcomes Framework Barnet Camden Enfield Haringey Islington % achievement in 2019/20 94.5% 94.4% 95.8% 95.8% 96.1% % achievement in prior years 95.8%-96.8% 96.3% 95.2%-95.3% 95.8%-96.1% 96.4% Practices with less than 70% 0 0 0 0 0 Practices with less than 80% 2 0 0 0 1 Practices with 80% to 90% 6 2 4 2 1
The table reports by exception the number of practices in each Borough with achievement materially below CCG average scores. Quality Outcomes Framework (QOF) outcomes for those practices achieving less than 90%.
When cross-referenced to Care Quality Commission ratings, all the practices across the five Boroughs achieving less than 90% QOF scores currently have a Good rating from the Care Quality Commission.
At the end of 2019/20 and in 2020/21 practice delivery against QOF indicators has been materially reduced by the covid pandemic. The financial resilience support package for practices therefore includes payment protection for practices based on prior year performance.
NHS England has invested an additional £10m nationally into the Quality Outcomes Framework (QOF) in 2020/21, supported by a number of changes to the QOF Domains for Asthma, COPD, Heart Failure, Diabetes, Early Cancer Diagnosis, and Learning Disabilities.
4.4 Patient experience The GP patient survey is an independent survey run by Ipsos MORI on behalf of NHS England, with the survey being sent to over one million people nationally. The survey results presented were published in July 2020 and cover the period from January to March 2020.
The Friends and Family Test asks patients how likely they are to recommend their GP service to friends and family based on their most recent experience of service use, with the results showing those likely or extremely likely to recommend their practice. Results are from February 2020.
Patient Experience Barnet Camden Enfield Haringey Islington GP patient survey – good overall 78% 85% 76% 77% 82% experience of the practice GP patient survey – easy getting 64% 80% 60% 69% 77% through by phone GP patient survey – satisfied with 68% 73% 66% 70% 74% type of appointment offered Friends and family test: Average recommendation % 85% 89% 86% 87% 90% Practices with results 19/51 12/33 25/46 21/35 15/32 Range of recommendation % 69% - 100% 76% - 100% 50% - 100% 54% - 100% 70% - 100%
The friends and family test does not provide an outcome for each practice, so the average is shown for those practice with a patient response recorded. A broad range of recommendation across practices is shown within each CCG area.
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4.5 Complaints The NHS Complaints procedure is the statutorily based mechanism for dealing with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure.
The table shows the number of written complaints made by patients and/or their carers during 2018/19, 2017/18 and 2016/17 in total, and then per practice and per 1,000 people on practice lists.
Written complaints received Barnet Camden Enfield Haringey Islington Number of complaints received in: 2018/19 568 406 498 394 280 2017/18 582 430 530 411 346 2016/17 610 416 527 394 377 Complaints escalated to NHSE in 2018/19 34/568 19/406 44/498 34/394 15/280 Average received per practice in 2018/19 12 12 11 11 9 Average per 1000 people on list in 2018/19 1.3 1.3 1.4 1.2 1.0
The number of complaints received by per head of population, and by practice, is broadly consistent across practices in the five Boroughs. Within each Borough there is a broad range of complaints received across practices.
This report adds in the complaints escalated to NHS England as they have not been resolved locally by practices.
In response to the Committee request to have a view of complaints themes and trends – the national team at NHS England have been asked to check the granularity of the information available through reporting on the governance portal.
4.6 Access and Digital Access The table below shows that all practice lists have extended access to general practice services seven days per week through primary care hubs. The table also shows coverage of digital access for on-line booking of appointments and ordering of repeat prescriptions.
Access to general practice Barnet Camden Enfield Haringey Islington Seven-day extended access to general 100% 100% 100% 100% 100% practice though primary care hubs % of population with on-line booking of 38% 36% 19% 31% 27% appointments enabled % of population with on-line ordering of 35% 31% 23% 34% 29% repeat prescriptions enabled
Coverage in Enfield has been adjusted to reflect the establishment of Medicus Health Partnership, with coverage increasing from 19% to 23% of the population.
4.7 Workforce The table below provides on overview of workforce information for each CCG. The information is sourced from the workforce minimum data set collected by NHS Digital. The information is for Quarter One 2020/21 (April to June 2020).
Workforce Barnet Camden Enfield Haringey Islington % of GPs aged over 55 30% 15% 32% 37% 28% % locum GPs 5% 6% 9% 7% 6% % of nurses aged 55 and over 47% 21% 56% 53% 50% Number of patients per full-time GP 2,478 1,622 2,647 2,471 2,295 Number of patients per full-time nurse 8,772 10,014 7,659 12,631 7,891
The information shows the need for succession planning for the GP and nurse workforce, some of which will be provided through the use of new skill-mix in general practice accruing from the Primary Care Network Additional Roles Reimbursement Scheme. Additional roles now funded include pharmacists, physicians, physiotherapists, social prescribers and mental health professionals.
39 / 113 In April 2021 the Committee requested further information on the workforce priorities. The slides appended to the report provide an overview including the alignment of our local plans to London priorities, and priorities in the national People Plan.
5. Primary care recovery programme The primary care recovery plan has been refreshed following the second wave of the covid pandemic. The plan focuses on three key areas: The interface between primary and secondary care; Reviewing access and managing demand; Reviewing locally commissioned services with an initial focus on those covering long term conditions (proactive care), with a view to introducing from April 2022.
These priorities are part of a larger programme of work for primary care programme, and have been developed as part of an overall plan, an outline of which was described in the last report to the Committee. The plan has been developed with input from Borough teams, working with local GPs, Primary Care Network Clinical Directors, GP federations, Integrated Care Partnerships and LMC, and has been refined through the CCG’s Primary Care workstreams. The plan focuses on the areas which were flagged during a period of engagement. The outline plan and three priorities received broad support from recent discussions at Primary Care Commissioning Committee and Governing Body seminars, and at the NCL System Recovery Executive. The pack presented to the System Recovery Executive in May is included as an appendix.
National GP appointment data shows that across NCL, GP appointment levels are already exceeding pre-pandemic levels. This is excluding online consultation activity (for e-Consult in April, these ranged from circa 8,000 per month in Camden to circa 17,000 per month in Barnet).
The plan also includes a snapshot of primary care achievements during the pandemic, during which the majority of NCL practices have continued to offer face to face appointments for those patients who needed them, and where it has been clinically necessary.
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The CCG is now progressing work in the three priority areas, including development of a dedicated project management approach to focus on the interface between primary and secondary care.
6. Coronavirus vaccinations Primary care-led sites (local vaccination services) in North Central London have delivered 746,847 of 1,248,181 total doses (60%) since the start of the programme in December. For all adults in NCL, 49% have had their first dose and 29% have also received their second dose As of Tuesday 8 June, all sites are inviting everyone 25-29yrs old (from cohort 12) To combat the increasing prevalence of the Delta (B1.617.2) variant, second doses for people in cohorts 1-9 have been brought forward to eight weeks o Second dose coverage in NCL for those over 70 is over 80% All sectors of the vaccine programme are also increasing capacity for first doses. In preparation for any surge vaccination requirements, all PCN sites are also looking to maximise their capacity. This includes the PCN sites who, in April, decided to opt out of vaccinating cohorts 10-12. Should it be required, they have also agreed to put on additional capacity for new first doses through to the end of June. Pop up and mobile vaccination clinics continue across all boroughs to ensure community in-reach. This includes: o Vaccine bus in Camden o 7 week pop up programme in schools, community & faith venues in Islington o Continued series of pop up vaccination clinics in Barnet, Enfield and Haringey, including working closely with faith venues across NCL More vaccination centres and pharmacy sites are switching over to Pfizer to increase capacity for people under 40 years old, who are advised to have an alternative vaccine to Astra Zeneca/ Oxford. NCL has submitted requests for more community pharmacy sites in wave 20. Assurance visits for these potential new sites took place in the week of 7 June.
41 / 113 Barnet Directorate Practice Practice Demographics Quality Workforce Efficiency Patient Experience Finance Patients Online Extended Access JUNE 2021
Practice
Practice Name 21)
2020) Code phone
Enabled
2018/19
2018/19
(Mar21)
Category
CQCSafe -
GPpractice
CQCCaring -
Practice Size Practice
% LocumGPs %
Contract Type Contract CQCWell - led
CQCEffective -
patient 2019/20 patient
Full / Partial / No PartialFull / /
May 20 - May 21 - May20
List size - May 21 - size List
CQCResponsive -
(Based on FTE GPs)(Based FTE on
DispensingPractice
(National Quintiles) (National
CQC Rating - Overall - Rating CQC
% Patients Aged 75+ Aged Patients %
% Patients Non-BME Patients %
appointment offered appointment
appointment enabled appointment
QOF Personalised Care PersonalisedCare QOF
Adjustment Rate 19/20 Rate Adjustment 0.5%) < = * <10; nos = ~
Annual List Size Change Size List Annual
( 0.5%) < = * <10; nos = ~ (
Co-commissioning model Co-commissioning online Popwith OfReg %
Practice Linked IMD2019 Linked Practice
Written complaints (Total) complaints Written
Directed Enhanced ServicesEnhanced Directed
(Extended Access payment) Access (Extended
No. of extended accessdays extended of No.
QOF Achievement 19/20 (%) 19/20 Achievement QOF
online appointments service appointments online
prescriptions online enabled online prescriptions
% GPs aged 55 years andover GPs aged 55 %
GPPS – Easy to get throughby get GPPS to Easy –
Online Appointments Enabled Appointments Online
Total no. pt transactions usingtransactions pt no. Total
Written complaints (via complaints NHSE) Written
FFT: % likely to recommend to GP likely FFT:%
service to friends & family(Feb & friends to service
Number of patients per FTE GP FTE per Numberpatients of
Average payment per weighted Averagepaymentweighted per
* = nos <6; no data = zero return) zero = data no <6; nos = * order repeat Popwith OfReg %
GPPS - Satisfied with the type of type the with GPPSSatisfied -
% Nurses aged 55 years andover Nursesaged55 %
(
online pt transaction service (Marservice transaction pt online
GPPS - Good overall experience of GPPSexperience Goodoverall -
Order Repeat Prescriptions Online Online Prescriptions OrderRepeat
Number of patients per FTE Nurse FTE per Numberpatients of orderedvia prescriptions no. Total 1 E83003 Oakleigh Road Health Centre Del GMS 4 7.4% 70% 11 0 Large 20% 0% 100% 1,347 6,735 93.6 3.3 9144 0.2% 93% 99% 92% 78% £136 33% 0 32% 371 FULL 7 ✔ 2 E83005 Lichfield Grove Surgery Del PMS 5 - Least Deprived 4.8% 64% 8 1 Small-medium 15% 3% 100% 2,315 19,778 98.5 7.6 6343 -0.3% no data 82% 58% 70% £135 58% 115 58% 228 FULL 7 ✔ 3 E83006 Greenfield Medical Centre Del PMS 3 5.6% 58% 5 0 Medium-large 17% 0% 58% 2,857 ND 97.5 4.4 7003 2.9% no data 70% 56% 67% £153 38% 0 38% 267 FULL 7 ✔ 4 E83007 Squires Lane Medical Practice Del GMS 3 6.6% 59% 7 2 Single-handed 0% 100% 6,050 17,800 99.0 6.2 5669 -3.0% 71% 54% 39% 56% £129 37% 0 37% 148 FULL 7 ✔ 5 E83008 Heathfielde Medical Centre Del PMS 5 - Least Deprived 7.6% 78% 9 0 Medium-large 50% 4% 15% 3,659 5,449 95.0 2.8 8853 2.1% no data 77% 87% 65% £142 49% 0 49% 407 FULL 7 ✔ 6 E83009 PHGH Doctors Del PMS 5 - Least Deprived 8.4% 75% 24 2 Medium-large 25% 4% 100% 3,280 11,474 95.6 5.2 11567 3.2% 87% 80% 60% 62% £146 43% 0 43% 820 FULL 7 ✔ 7 E83010 The Speedwell Practice Del PMS 4 6.7% 63% 38 0 Medium-large 13% 0% 36% 2,096 4,539 97.3 4.4 10959 -3.2% 77% 69% 48% 57% £144 39% 149 39% 470 FULL 7 8 E83011 The Everglade Medical Practice Del GMS 2 2.9% 42% 1 1 Medium-large 21% 0% 0% 2,170 8,080 96.9 9.2 9234 5.3% 74% 80% 59% 50% £129 19% 0 19% 228 FULL 7 ✔ 9 E83012 The Old Courthouse Surgery Del GMS 4 8.7% 77% 0 0 Medium-large 0% 0% 0% 1,478 8,624 99.7 7.0 8380 -0.8% 85% 82% 55% 69% £130 no data 0 33% 178 PARTIAL 6 ✔ 10 E83013 Cornwall House Surgery Del GMS 5 - Least Deprived 8.2% 63% 0 0 Medium-large 33% 0% 0% 1,215 19,885 94.7 6.2 5820 -3.6% 86% 69% 54% 53% £133 30% 0 29% 168 FULL 7 ✔ 11 E83016 Millway Medical Practice Del PMS 4 7.3% 65% 64 0 Large 2% 1% 12% 1,851 6,026 99.9 6.7 18831 1.5% no data 82% 48% 68% £159 94% 44 94% 1001 FULL 7 ✔ 12 E83017 Longrove Surgery Del PMS 4 8.6% 79% 17 2 Large 29% 0% 53% 1,992 9,886 96.0 4.3 17380 51.9% no data 77% 64% 60% £145 32% 0 32% 1119 FULL 7 ✔ 13 E83018 Watling Medical Centre Del GMS 3 6.1% 51% 20 0 Large 7% 0% 0% 1,362 7,535 97.7 7.3 16648 1.0% 85% 90% 68% 70% £128 35% 1 34% 943 FULL 7 ✔ 14 E83020 St George’s Medical Centre Del PMS 4 5.9% 60% 1 1 Medium-large 0% 13% 0% 1,872 5,942 97.1 4.7 11764 -0.4% no data 82% 46% 70% £142 22% 0 47% 832 FULL 7 ✔ 15 E83021 Torrington Park Group Practice Del PMS 4 9.1% 63% 9 0 Medium-large 27% 0% 55% 2,210 10,497 93.7 8.6 12358 0.4% 100% 78% 42% 67% £133 no data 0 45% 509 FULL 7 ✔ 16 E83024 St Andrews Medical Practice Del PMS 5 - Least Deprived 9.4% 72% 2 2 Large 15% 0% 48% 1,312 4,269 98.4 4.8 11245 0.9% no data 75% 63% 58% £160 57% 10 56% 763 FULL 7 ✔ 17 E83025 Pennine Drive Practice Del GMS 3 5.8% 55% 9 2 Small-medium 24% 0% 0% 2,283 7,742 94.7 6.7 8712 -2.6% no data 65% 61% 59% £136 13% 0 13% 217 FULL 7 ✔ 18 E83026 Supreme Medical Centre Del GMS 5 - Least Deprived 8.3% 65% 2 0 Small-medium 76% 0% 0% 2,184 5,533 92.0 4.4 4401 0.4% no data 77% 68% 70% £136 36% 0 36% 178 FULL 7 ✔ 19 E83027 The Practice @ 188 Del PMS 4 8.9% 69% 10 1 Small-medium 7% 39% 0% 3,503 ND 96.7 6.2 8742 6.1% no data 80% 78% 73% £135 24% 62 24% 227 FULL 7 ✔ 20 E83028 Parkview Surgery Del PMS 2 3.1% 47% 6 0 Small-medium 40% 17% 100% 2,744 11,038 87.2 4.1 6620 -0.3% no data 68% 68% 67% £135 22% 20 22% 145 FULL 7 ✔ 21 E83030 Penshurst Gardens Surgery Del GMS 4 9.9% 61% 33 0 Medium-large 0% 0% 0% 1,684 7,455 97.4 5.6 6745 -0.1% no data 79% 21% 56% £131 67% 14 66% 495 no data - ✔ 22 E83031 The Village Surgery Del PMS 4 8.9% 76% 1 0 Small-medium 42% 3% 100% 2,972 7,633 94.6 3.7 5294 0.6% no data 92% 89% 77% £133 no data 0 24% 246 FULL 7 23 E83032 Oak Lodge Medical Centre Del GMS 3 4.1% 43% 32 0 Large 0% 0% 11% 1,504 5,819 99.3 10.4 17953 -0.8% no data 80% 40% 72% £137 52% 0 52% 456 FULL 7 ✔ 24 E83034 Mulkis Hb-The Surgery Del GMS 3 6.5% 69% 0 0 Single-handed 100% 0% 100% 5,272 7,322 96.6 4.5 5257 -1.7% no data 83% 79% 73% £127 36% 146 36% 275 FULL 7 ✔ 25 E83035 Wentworth Medical Practice Del PMS 4 6.8% 59% 24 2 Medium-large 0% 0% 2,018 5,168 94.2 2.6 12638 6.3% 86% 71% 65% 66% £150 35% 0 35% 393 FULL 7 ✔ 26 E83037 Derwent Crescent Medical Centre Del PMS 5 - Least Deprived 8.6% 68% 4 0 Small-medium 41% 15% 52% 1,744 4,996 99.8 5.3 5592 0.8% no data 82% 82% 71% £133 87% 0 87% 326 FULL 7 ✔ 27 E83038 Jai Medical Centre Del GMS 3 8.1% 50% 8 0 Small-medium 31% 0% 76% 4,902 3,327 94.9 5.0 8704 3.0% no data 80% 74% 71% £128 20% 0 20% 122 FULL 7 ✔ 28 E83039 Ravenscroft Medical Centre Del PMS 4 4.4% 62% 2 0 Small-medium 0% 100% 2,321 4,748 92.3 2.9 5481 -9.3% no data 89% 76% 77% £161 no data 0 12% 84 FULL 7 ✔ 29 E83041 Wakeman’s Hill Surgery Del GMS 3 5.3% 40% 8 1 Small-medium 0% 34% 0% 3,661 7,029 93.7 5.8 4338 -4.0% no data 80% 75% 76% £131 17% 20 17% 34 FULL 7 ✔ 30 E83044 Addington Medical Centre Del GMS 4 8.2% 76% 8 0 Medium-large 50% 0% 76% 2,693 ND 96.8 4.2 9464 0.1% 90% 87% 72% 77% £120 33% 151 33% 87 FULL 7 ✔ 31 E83045 Friern Barnet Medical Centre Del GMS 4 6.0% 63% 2 2 Medium-large 42% 0% 100% 2,175 6,584 98.6 5.8 9577 0.7% no data 77% 41% 66% £129 27% 0 27% 302 PARTIAL 5 ✔ 32 E83046 Mulberry Medical Practice Del GMS 3 5.2% 53% 31 1 Medium-large 23% 0% 26% 2,462 6,232 93.2 11.2 9453 -2.0% no data 60% 40% 58% £131 26% 0 26% 278 no data - ✔ 33 E83049 Langstone Way Surgery Del PMS 4 5.4% 59% 48 2 Medium-large 30% 0% 34% 2,315 2,197 93.3 8.2 8635 2.7% no data 70% 40% 66% £157 no data 0 23% 312 FULL 7 ✔ 34 E83050 East Finchley Medical Centre Del GMS 5 - Least Deprived 6.4% 77% 12 0 Medium-large 0% 0% 0% 2,586 9,375 88.3 3.0 7974 -0.6% no data 73% 49% 73% £118 24% 0 25% 285 no data - ✔ 35 E83053 Lane End Medical Group Del GMS 4 7.7% 60% 15 1 Large 18% 0% 1,352 9,373 96.5 6.8 13439 1.0% 93% 74% 42% 60% £146 49% 0 42% 651 FULL 7 ✔ 36 E83600 Adler Js-The Surgery Del GMS 4 4.4% 73% Small-medium 50% 24% 0% 2,296 6,051 78.7 1.7 6423 2.6% 100% 99% 91% 88% £135 no data 0 26% 232 FULL 7 ✔ 37 E83613 East Barnet Health Centre Del PMS 4 7.5% 76% 6 0 Large 0% 40% 1,261 11,914 96.7 2.9 11450 -1.3% no data 77% 77% 80% £152 25% 165 24% 357 FULL 7 ✔ 38 E83621 Brunswick Park Medical Centre Del GMS 4 8.9% 68% 14 1 Large 0% 100% 977 4,310 98.7 3.2 8526 0.1% 75% 70% 55% 65% £150 41% 0 41% 557 FULL 7 ✔ 39 E83622 Temple Fortune Medical Group Del GMS 5 - Least Deprived 7.6% 74% Medium-large 51% 0% 55% 2,802 12,975 98.1 6.9 8002 4.6% no data 87% 76% 79% £121 33% 0 33% 307 no data - ✔ 40 E83637 Colindale Practice (Dr Lamba) Del PMS 3 2.9% 41% 5 0 Medium-large 47% 0% 65% 3,262 13,512 97.1 4.2 10131 5.2% 80% 68% 58% 63% £131 29% 2 28% 226 FULL 7 ✔ 41 E83638 The Mountfield Surgery Del PMS 5 - Least Deprived 7.8% 66% 1 0 Small-medium 93% 0% 100% 4,467 4,169 95.8 2.9 4989 -2.2% 80% 94% 96% 88% £149 19% 0 18% 116 FULL 7 ✔ 42 E83639 Rosemary Surgery Del GMS 4 3.5% 62% 0 0 Medium-large 15% 0% 1,488 ND 98.8 3.8 6222 4.0% 99% 77% 72% 58% £132 49% 0 49% 244 FULL 7 ✔ 43 E83649 The Hodford Road Surgery Del PMS 4 5.4% 67% 1 0 Small-medium 100% 0% 0% 1,898 10,058 91.5 3.3 4014 1.0% no data 86% 88% 76% £139 83% 0 83% 181 FULL 7 ✔ 44 E83650 Gloucester Road Surgery Del GMS 4 12.2% 75% 0 0 Single-handed 100% 0% 100% 1,970 4,648 87.2 2.1 1859 -1.2% no data 86% 92% 81% £122 28% 0 27% 47 FULL 7 45 E83653 The Phoenix Practice Del GMS 4 6.1% 61% 11 1 Medium-large 13% 0% 42% 2,729 8,162 78.8 2.5 10348 0.5% no data 73% 64% 60% £136 39% 225 38% 416 FULL 7 ✔ 46 E83657 The Hillview Surgery Del GMS 4 6.7% 62% 1 0 Small-medium 100% 0% 100% 1,875 7,917 81.7 4.7 1911 2.9% no data 84% 91% 67% £146 10% 0 10% 12 NO 0 ✔ 47 E83668 Medical Centre (Deans Lane) Del GMS 4 3.5% 52% 4 0 Single-handed 0% 0% 100% 4,620 8,085 99.3 6.1 4300 1.1% no data 85% 90% 68% £140 19% 0 19% 57 FULL 7 ✔ 48 Y00316 Woodlands Medical Practice Del PMS 4 6.1% 68% 14 0 Medium-large 0% 0% 0% 1,605 11,125 98.4 4.9 4469 1.3% 69% 67% 47% 52% £135 52% 0 52% 220 FULL 7 ✔ 49 Y02986 Cricklewood Health Centre Del APMS 2 0.5% 54% 8 3 Small-medium 0% 0% 100% 2,416 25,880 86.1 5.1 4735 -8.6% no data 87% 75% 70% £132 28% 0 28% 121 no data - 50 Y03663 Hendon Way Surgery Del GMS 3 3.3% 53% 4 4 Medium-large 10% 2,865 14,578 97.5 5.0 8761 -1.5% 92% 70% 37% 58% £120 30% 0 30% 163 no data - ✔ 51 Y03664 Dr Azim & Partners Del GMS 4 3.7% 55% 28 2 Medium-large 0% 2,453 10,817 83.9 5.3 8,787 -5% no data 62% 36% 62% £129 63% 0 63% 260 FULL 7 ✔
Comments: No. 38 - E83613 East Barnet Health Centre list size increase reflects merger of Monkman (E83613), Weston (E83629) and Peskin (E83632) practices now under East Barnet Health Centre (E83613) 01.01.21 - E83036 Vale Drive Medical Practice merged with E83017 Longrove Surgery
42 / 113 Camden Directorate Practice Practice Demographics Quality Workforce Efficiency Patient Experience Finance Patients Online Extended Access JUNE 2021
Practice
Practice Name 21)
2020) Code phone
Enabled
2018/19
2018/19
(Mar21)
Category
CQCSafe -
GPpractice
CQCCaring -
Practice Size Practice
% LocumGPs %
Contract Type Contract CQCWell - led
CQCEffective -
patient 2019/20 patient
Full / Partial / No PartialFull / /
May 20 - May 21 - May20
List size - May 21 - size List
CQCResponsive -
(Based on FTE GPs)(Based FTE on
DispensingPractice
(National Quintiles) (National
CQC Rating - Overall - Rating CQC
% Patients Aged 75+ Aged Patients %
% Patients Non-BME Patients %
appointment offered appointment
appointment enabled appointment
QOF Personalised Care PersonalisedCare QOF
Adjustment Rate 19/20 Rate Adjustment 0.5%) < = * <10; nos = ~
Annual List Size Change Size List Annual
( 0.5%) < = * <10; nos = ~ (
Co-commissioning model Co-commissioning online Popwith OfReg %
Practice Linked IMD2019 Linked Practice
Written complaints (Total) complaints Written
Directed Enhanced ServicesEnhanced Directed
(Extended Access payment) Access (Extended
No. of extended accessdays extended of No.
QOF Achievement 19/20 (%) 19/20 Achievement QOF
online appointments service appointments online
prescriptions online enabled online prescriptions
% GPs aged 55 years andover GPs aged 55 %
GPPS – Easy to get throughby get GPPS to Easy –
Online Appointments Enabled Appointments Online
Total no. pt transactions usingtransactions pt no. Total
Written complaints (via complaints NHSE) Written
FFT: % likely to recommend to GP likely FFT:%
service to friends & family(Feb & friends to service
Number of patients per FTE GP FTE per Numberpatients of
Average payment per weighted Averagepaymentweighted per
* = nos <6; no data = zero return) zero = data no <6; nos = * order repeat Popwith OfReg %
GPPS - Satisfied with the type of type the with GPPSSatisfied -
% Nurses aged 55 years andover Nursesaged55 %
(
online pt transaction service (Marservice transaction pt online
GPPS - Good overall experience of GPPSexperience Goodoverall -
Order Repeat Prescriptions Online Online Prescriptions OrderRepeat
Number of patients per FTE Nurse FTE per Numberpatients of orderedvia prescriptions no. Total 1 F83003 Park End Surgery Del PMS 5 - Least Deprived 9.3% 79% 5 0 Large 14% 0% 0% 884 14,627 98.1 3.1 7,254 0.9% no data 94% 94% 88% £146 68% 0 68% 359 FULL 7 ✔ 2 F83005 Gower Street Practice Del GMS 3 1.3% 61% 7 2 Medium-large 55% 0% 0% 2,439 ND 94.1 4.3 7,500 -12.8% * 85% 89% 88% £122 22% 81 22% 87 FULL 7 3 F83006 Ampthill Practice Del GMS 2 4.5% 55% 1 1 Medium-large 25% 0% 0% 1,200 7,573 94.8 3.1 7,558 -3.5% no data 81% 80% 78% £151 22% 11 19% 340 FULL 7 ✔ 4 F83011 Primrose Hill Surgery Del GMS 4 6.6% 79% 14 1 Medium-large 0% 7% 1,575 ND 95.5 2.3 6,934 3.3% NA 90% 80% 72% £130 31% 1 31% 292 FULL 7 ✔ 5 F83017 Hampstead Group Practice Del PMS 4 5.3% 73% 27 0 Large 7% 0% 0% 1,040 6,830 92.7 3.0 17,592 10.7% 96% 92% 93% 71% £164 34% 0 34% 521 FULL 7 ✔ 6 F83018 Prince Of Wales Group Surgery Del PMS 2 5.0% 63% Large 22% 10% 55% 981 4,729 93.6 5.5 9,010 1.6% no data 83% 69% 53% £166 33% 0 33% 151 FULL 7 ✔ 7 F83019 Abbey Medical Centre Del GMS 3 5.2% 62% 19 0 Large 11% 0% 0% 1,423 ND 98.6 3.3 12,130 1.1% 88% 88% 58% 74% £147 34% 0 34% 245 PARTIAL 1 ✔ 8 F83020 Adelaide Medical Centre Del GMS 4 6.8% 71% 14 0 Large 12% 1% 60% 1,529 6,831 99.5 8.2 11,945 1.1% * 89% 75% 81% £137 no data 0 50% 268 FULL 7 ✔ 9 F83022 Caversham Group Practice Del GMS 3 4.8% 70% 38 0 Large 46% 0% 0% 1,001 5,905 94.5 3.1 16,146 2.4% no data 87% 77% 73% £145 27% 5 27% 555 PARTIAL 2 ✔ 10 F83023 James Wigg Practice Del PMS 2 4.0% 67% 91 3 Large 13% 3% 17% 1,151 5,350 91.9 5.0 21,975 0.3% 100% 77% 58% 55% £196 no data 0 27% 610 FULL 7 ✔ 11 F83025 The Regents Park Practice Del PMS 2 4.9% 52% 8 0 Medium-large 0% 0% 35% 854 6,069 92.9 3.4 6,070 0.0% no data 89% 78% 62% £160 17% 9 16% 276 FULL 7 12 F83042 Grays Inn Road Medical Centre Del PMS 3 2.1% 58% 13 0 Medium-large 30% 0% 100% 1,294 ND 98.4 10.3 7,120 -1.3% 86% 71% 87% 73% £136 23% 31 23% 80 FULL 7 ✔ 13 F83043 Ridgmount Practice Del GMS 3 0.4% 59% 8 0 Large 29% 0% 2,128 5,675 99.4 9.3 17,593 -6.5% 76% 81% 89% 71% £144 49% 106 49% 37 FULL 7 14 F83044 The Bloomsbury Surgery Del GMS 2 3.8% 52% 1 1 Medium-large 0% 3% 0% 1,093 ND 94.6 3.2 4,417 3.0% 100% 82% 93% 80% £131 no data 0 43% 73 PARTIAL 6 ✔ 15 F83048 Brunswick Medical Centre Uhpc Del APMS 3 2.9% 56% 6 0 Medium-large 0% 43% 0% 4,542 ND 98.9 11.3 6,999 2.1% 87% 85% 83% 76% £161 40% 0 40% 86 FULL 7 16 F83050 Fortune Green Road Surgery Del GMS 4 6.1% 69% 1 0 Small-medium 0% 31% 0% 2,092 24,383 98.0 7.7 2,917 1.6% * 91% 94% 81% £136 24% 0 24% 66 FULL 7 17 F83052 Brookfield Park Surgery Del GMS 3 5.8% 77% 8 2 Small-medium 35% 0% 0% 1,301 ND 99.3 4.7 3,601 0.7% no data 83% 80% 75% £138 33% 0 33% 96 FULL 7 ✔ 18 F83055 West Hampstead Medical Centre Del PMS 4 2.9% 72% 30 1 Large 13% 0% 53% 2,022 14,274 96.4 4.8 18,864 8.2% 100% 73% 50% 67% £145 88% 4 84% 527 FULL 7 ✔ 19 F83057 Parliament Hill Surgery Del PMS 3 4.3% 78% 7 1 Large 3% 0% 100% 934 20,279 98.7 3.0 7,653 -0.9% no data 97% 95% 82% £141 50% 0 50% 208 FULL 7 ✔ 20 F83058 Holborn Medical Centre Del PMS 3 2.1% 57% 14 0 Large 24% 12% 0% 1,256 19,813 97.3 3.8 11,912 -2.7% 89% 93% 85% 75% £154 24% 71 24% 126 FULL 7 ✔ 21 F83059 Brondesbury Medical Centre Del PMS 2 3.0% 63% 35 0 Large 10% 0% 31% 1,764 ND 93.5 7.0 19,833 4.8% no data 78% 71% 67% £154 41% 0 38% 411 FULL 7 ✔ 22 F83061 Museum Practice Del PMS 3 4.2% 63% 1 1 Medium-large 0% 10% 962 12,825 97.1 3.3 5,150 -1.8% * 97% 98% 91% £133 41% 131 41% 63 FULL 7 ✔ 23 F83615 Cholmley Gardens Surgery Del PMS 5 - Least Deprived 4.5% 73% 3 0 Medium-large 40% 0% 0% 1,735 18,640 95.8 2.2 7,973 -0.5% * 92% 82% 69% £134 21% 0 21% 169 FULL 7 ✔ 24 F83623 Keats Group Practice Del PMS 5 - Least Deprived 5.9% 79% 9 1 Large 12% 0% 0% 1,414 10,677 96.7 2.1 13,344 6.1% no data 89% 72% 72% £165 44% 72 44% 555 FULL 7 ✔ 25 F83632 Queens Crescent Practice Del GMS 2 4.1% 61% Medium-large 5% 0% 0% 1,494 6,443 94.8 6.6 6,757 20.5% 83% 82% 81% 65% £137 no data 0 14% 158 FULL 7 ✔ 26 F83633 Daleham Gardens Health Centre Del PMS 5 - Least Deprived 4.8% 73% 3 0 Small-medium 0% 0% 0% 1,381 ND 96.1 4.8 4,184 18.7% * 79% 86% 77% £131 33% 66 33% 58 FULL 7 27 F83635 Kings Cross Surgery Del APMS 2 1.2% 51% 7 1 Small-medium 6% 15% 0% 3,183 ND 100.0 7.6 8,273 22.4% 78% 76% 49% 59% £118 33% 0 33% 161 FULL 7 28 F83658 Belsize Priory Medical Practice (Group) Del GMS 3 4.6% 62% 1 1 Small-medium 76% 19% 1,704 ND 97.7 4.5 4,514 3.3% no data 76% 78% 75% £130 33% 46 33% 55 FULL 7 ✔ 29 F83665 Swiss Cottage Surgery Del GMS 4 2.7% 66% 21 2 Large 0% 0% 40% 1,479 4,865 98.3 2.8 15,155 3.1% * 87% 86% 72% £164 52% 438 52% 215 FULL 7 ✔ 30 F83672 St Philips Medical Centre Del GMS 3 0.4% 63% 3 0 Large 0% 9% 1,593 7,008 97.8 4.8 12,572 5.9% no data 85% 94% 84% £106 45% 0 45% 165 PARTIAL 6 31 F83683 Somers Town Medical Centre Del APMS 2 2.4% 48% 6 1 Single-handed 0% 33% 4,114 6,748 100.0 7.2 5512 14.8% 83% 80% 77% 66% £153 20% 0 20% 67 FULL 7 32 Y02674 Camden Health Improvement Practice Del APMS 2 0.7% 5 0 Small-medium 0% 4% 50% 353 757 84.4 10.1 554 -21% no data 89% 84% ~ £1,052 3% 0 3% 0 no data - 33 Y03103 Medicus Select Care (SAS) APMS 0.0% 36.9 43.2 155 0% no data ~ ~ ~ £3,121 0% 0 0% 0 NO 0
Comments: F83677 The Matthewman Practice now merged with F83632 Queens Crescent Practice as of 01 May 2020. F83682 Rosslyn Hill Surgery now merged with F83017 Hampstead Group Practice as 01 July 2020.
43 / 113 Enfield Directorate Practice Practice Demographics Quality Workforce Efficiency Patient Experience Finance Patients Online Extended Access JUNE 2021
Practice
Practice Name 21)
2020) Code phone
Enabled
2018/19
2018/19
(Mar21)
Category
CQCSafe -
GPpractice
CQCCaring -
Practice Size Practice
% LocumGPs %
Contract Type Contract CQCWell - led
CQCEffective -
patient 2019/20 patient
Full / Partial / No PartialFull / /
May 20 - May 21 - May20
List size - May 21 - size List
CQCResponsive -
(Based on FTE GPs)(Based FTE on
DispensingPractice
(National Quintiles) (National
CQC Rating - Overall - Rating CQC
% Patients Aged 75+ Aged Patients %
% Patients Non-BME Patients %
appointment offered appointment
appointment enabled appointment
QOF Personalised Care PersonalisedCare QOF
Adjustment Rate 19/20 Rate Adjustment 0.5%) < = * <10; nos = ~
Annual List Size Change Size List Annual
( 0.5%) < = * <10; nos = ~ (
Co-commissioning model Co-commissioning online Popwith OfReg %
Practice Linked IMD2019 Linked Practice
Written complaints (Total) complaints Written
Directed Enhanced ServicesEnhanced Directed
(Extended Access payment) Access (Extended
No. of extended accessdays extended of No.
QOF Achievement 19/20 (%) 19/20 Achievement QOF
online appointments service appointments online
prescriptions online enabled online prescriptions
% GPs aged 55 years andover GPs aged 55 %
GPPS – Easy to get throughby get GPPS to Easy –
Online Appointments Enabled Appointments Online
Total no. pt transactions usingtransactions pt no. Total
Written complaints (via complaints NHSE) Written
FFT: % likely to recommend to GP likely FFT:%
service to friends & family(Feb & friends to service
Number of patients per FTE GP FTE per Numberpatients of
Average payment per weighted Averagepaymentweighted per
* = nos <6; no data = zero return) zero = data no <6; nos = * order repeat Popwith OfReg %
GPPS - Satisfied with the type of type the with GPPSSatisfied -
% Nurses aged 55 years andover Nursesaged55 %
(
online pt transaction service (Marservice transaction pt online
GPPS - Good overall experience of GPPSexperience Goodoverall -
Order Repeat Prescriptions Online Online Prescriptions OrderRepeat
Number of patients per FTE Nurse FTE per Numberpatients of orderedvia prescriptions no. Total 1 F85002 Forest Rd Group Practice Del PMS 1 - Most deprived 5.1% 44% 27 0 Large 21% 0% 23% 2,053 7,413 97.7 3.8 91,066 585.7% 83% 70% 36% 57% £183 14% 0 14% 1272 FULL 7 ✔ 2 F85003 Riley House Surgery Del PMS 1 - Most deprived 6.5% 60% 34 1 Medium-large 55% #N/A 27% #N/A #N/A 96.4 0.0 #N/A #N/A no data 63% 47% 51% £150 PARTIAL 1 ✔ 3 F85004 Eagle House Surgery Del PMS 1 - Most deprived 6.0% 53% 3 3 Medium-large 29% 0% 100% 1,979 3,651 94.9 4.3 13,138 -1.4% 79% 62% 25% 61% £148 28% 0 28% 383 PARTIAL 4 ✔ 4 F85010 Keats Surgery Del GMS 2 6.7% 52% 1 1 Small-medium 100% 0% 100% 2,584 3,864 93.4 4.1 5,083 -1.4% 93% 91% 86% 81% £107 18% 0 18% 102 PARTIAL 6 ✔ 5 F85016 Cockfosters Medical Centre Del GMS 5 - Least Deprived 10.8% 76% 10 0 Medium-large 67% 6% 100% 1,797 10,782 91.5 1.6 6,783 1.0% no data 85% 70% 86% £123 19% 4 19% 109 FULL 7 ✔ 6 F85020 The Woodberry Practice Del PMS 4 7.7% 74% 13 1 Medium-large 3% 0% 50% 2,633 6,811 98.0 6.1 9,093 1.1% no data 82% 77% 77% £145 31% 0 31% 351 FULL 7 ✔ 7 F85023 The Ordnance Unity Centre For Health Del APMS 1 - Most deprived 2.8% 57% 45 3 Small-medium 0% ND 0% ND ND 100.0 8.9 11,175 8.4% 98% 59% 31% 52% £177 21% 197 21% 179 no data - 8 F85024 Dean House Surgery Del PMS 2 5.8% 51% 5 1 Single-handed 100% #N/A #N/A #N/A 98.2 7.0 #N/A #N/A no data 74% 91% 74% £152 NO 0 ✔ 9 F85025 White Lodge Medical Practice Del PMS 4 8.4% 78% 18 1 Large 18% 0% 13% 1,318 8,223 97.2 3.3 11,464 1.6% 90% 80% 71% 70% £150 40% 0 40% 752 FULL 7 ✔ 10 F85027 Carlton House Surgery Del GMS 3 8.5% 80% 34 0 Large 11% #N/A 0% #N/A #N/A 99.0 0.0 #N/A #N/A no data 76% 52% 58% £144 PARTIAL 4 ✔ 11 F85029 Abernethy House Surgery Del PMS 4 10.1% 79% 10 0 Large 27% 0% 51% 1,477 5,068 99.6 4.8 12,930 -1.7% 94% 89% 61% 70% £143 36% 32 35% 1000 FULL 7 ✔ 12 F85032 Southgate Surgery Del PMS 4 7.6% 69% 19 0 Large 44% 0% 0% 2,182 13,247 83.3 3.8 10,093 0.8% 87% 80% 67% 72% £133 23% 146 23% 405 no data - ✔ 13 F85033 Winchmore Hill Practice Del PMS 5 - Least Deprived 9.2% 76% 47 3 Large 0% 0% 58% 2,179 9,778 94.4 : 16,804 -1.6% 79% 70% 46% 59% £158 55% 321 54% 1096 FULL 7 ✔ 14 F85035 Highlands Practice Del GMS 5 - Least Deprived 9.4% 73% 1 1 Large 0% 1,421 7,583 83.6 2.4 11,152 2.3% no data 84% 58% 77% £131 10% 131 10% 313 PARTIAL 5 15 F85036 Willow House Surgery Del GMS 3 6.0% 74% 6 1 Small-medium 38% #N/A 0% #N/A #N/A 98.1 0.0 #N/A #N/A 100% 78% 93% 69% £124 FULL 7 ✔ 16 F85039 Rainbow Practice Del PMS 1 - Most deprived 4.1% 43% 2 0 Small-medium 29% 29% 0% 3,529 8,522 97.1 6.1 6,076 5.0% 82% 82% 65% 53% £180 23% 28 23% 127 PARTIAL 6 ✔ 17 F85043 Boundary Court Surgery Del APMS 1 - Most deprived 3.4% 42% 2 0 Small-medium 0% 30% 0% 2,781 7,679 97.3 3.4 3,988 -3.8% no data 84% 62% 70% £148 20% 145 19% 67 FULL 7 ✔ 18 F85044 The Bounces Road Surgery Del GMS 1 - Most deprived 4.4% 44% 4 0 Medium-large 0% 0% 0% 2,875 5,258 96.9 3.0 5,762 1.5% 100% 84% 79% 80% £145 21% 2 21% 45 FULL 7 ✔ 19 F85048 Moorfield Road Health Centre Del GMS 1 - Most deprived 4.7% 59% 0 0 Small-medium 70% #N/A 0% #N/A #N/A 90.3 0.0 #N/A #N/A no data 77% 65% 51% £125 PARTIAL 2 ✔ 21 F85055 Connaught Surgery Del GMS 3 8.8% 63% 11 0 Small-medium 0% #N/A 0% #N/A #N/A 96.1 0.0 #N/A #N/A no data 80% 79% 61% £124 PARTIAL 6 ✔ 22 F85058 Nightingale House Surgery Del PMS 2 5.7% 49% 25 0 Small-medium 20% 0% 100% 2,257 3,082 97.1 4.3 6,759 0.9% 83% 80% 64% 74% £143 19% 36 18% 91 PARTIAL 4 ✔ 23 F85072 Grovelands Medical Centre Del PMS 3 7.3% 64% 2 0 Small-medium 40% 41% 100% 3,677 10,067 88.8 4.2 10,758 0.8% no data 83% 89% 59% £138 15% 0 15% 165 FULL 7 ✔ 24 F85076 Freezywater Primary Care Centre Del PMS 2 5.7% 62% 20 8 Medium-large 16% #N/A 58% #N/A #N/A 92.9 0.0 #N/A #N/A 80% 50% 19% 52% £136 PARTIAL 2 ✔ 25 F85625 Bincote Surgery Del PMS 4 8.2% 77% 0 0 Medium-large 69% 8% 0% 2,076 12,248 88.3 3.2 6,535 1.7% 93% 90% 73% 85% £133 38% 0 37% 365 PARTIAL 2 ✔ 26 F85634 East Enfield Practice Del PMS 1 - Most deprived 2.3% 51% 3 1 Small-medium 0% 0% 100% 2,205 6,285 99.4 4.8 3,371 4.1% no data 82% 65% 73% £145 32% 0 33% 70 PARTIAL 1 ✔ 27 F85642 The North London Health Centre Del GMS 4 7.0% 67% 6 0 Medium-large 0% 0% 35% 2,275 6,756 95.9 3.9 8,832 -0.1% 90% 80% 55% 72% £121 28% 9 28% 425 no data - ✔ 28 F85650 Morecambe Surgery Del GMS 2 6.3% 51% 8 0 Small-medium 10% 100% 2,424 7,182 98.6 4.9 5,186 2.4% 96% 69% 44% 52% £124 25% 1 25% 215 FULL 7 ✔ 29 F85652 Southbury Surgery Del PMS 3 5.5% 73% 5 0 Small-medium 100% #N/A 100% #N/A #N/A 99.7 0.0 #N/A #N/A no data 80% 80% 70% £140 FULL 7 ✔ 30 F85654 Brick Lane Surgery Del GMS 2 6.5% 59% 4 2 Single-handed 30% 0% 100% 7,739 8,840 99.3 3.4 4,250 2.6% no data 62% 50% 60% £121 42% 64 41% 76 PARTIAL 1 ✔ 31 F85656 Bush Hill Park Med Centre Del GMS 3 6.3% 68% 3 0 Small-medium 50% #N/A #N/A #N/A 99.8 0.0 #N/A #N/A no data 81% 87% 70% £127 FULL 7 ✔ 32 F85663 Latymer Road Surgery Del GMS 2 7.3% 47% 2 2 Small-medium 34% 0% 0% 2,029 4,261 95.7 2.4 4,547 0.3% no data 71% 32% 56% £134 20% 0 20% 182 FULL 7 33 F85666 Edmonton Medical Centre Del PMS 1 - Most deprived 5.6% 43% 4 0 Small-medium 0% 47% 100% 1,623 5,814 98.5 6.4 3,711 0.1% 93% 96% 60% 79% £149 21% 33 21% 54 FULL 7 34 F85676 Boundary House Surgery Del PMS 1 - Most deprived 4.7% 46% 7 0 Small-medium 19% 0% 100% 6,606 1,312 98.1 3.8 5,307 3.1% 91% 70% 54% 59% £162 21% 0 20% 55 PARTIAL 2 ✔ 35 F85678 Town Surgery Del PMS 3 3.1% 71% 4 0 Small-medium 31% 0% 100% 1,726 20,822 95.4 5.3 4,487 2.4% no data 86% 87% 71% £138 25% 0 24% 98 FULL 7 ✔ 36 F85681 Green Street Surgery Del PMS 1 - Most deprived 6.1% 57% 2 0 Single-handed 100% #N/A 100% #N/A #N/A 97.4 0.0 #N/A #N/A 50% 80% 61% 80% £136 PARTIAL 1 ✔ 37 F85682 Chalfont Road Surgery Del APMS 1 - Most deprived 3.6% 46% 9 1 Small-medium 0% 100% 100% 2,206 8,633 97.8 5.5 4,332 -5.7% no data 68% 53% 59% £160 24% 108 23% 86 FULL 7 38 F85684 Curzon Avenue Surgery Del GMS 1 - Most deprived 3.9% 50% 14 1 Medium-large 40% #N/A 0% #N/A #N/A 96.2 0.0 #N/A #N/A no data 68% 22% 53% £126 PARTIAL 3 ✔ 39 F85686 Trinity Avenue Surgery Del PMS 3 6.7% 66% 3 0 Small-medium 0% #N/A #N/A #N/A 94.2 3.7 #N/A #N/A 71% 75% 75% 67% £128 PARTIAL 4 ✔ 40 F85687 Oakwood Medical Centre Del PMS 4 7.3% 71% 19 1 Medium-large 19% 0% 0% 1,864 6,632 94.7 3.7 7,703 2.9% 83% 86% 55% 57% £147 18% 0 18% 193 FULL 7 ✔ 41 F85700 Arnos Grove Medical Centre Del PMS 3 3.9% 61% 4 1 Small-medium 43% 50% 100% 4,061 5,529 96.7 12.5 6,969 7.6% no data 53% 52% 65% £123 no data 0 21% 108 FULL 7 ✔ 42 F85701 Gillan House Surgery Del GMS 3 4.9% 66% 5 1 Medium-large 41% 0% 100% 2,291 11,703 97.6 3.1 11,629 3.2% 84% 85% 73% 76% £128 26% 0 26% 329 FULL 7 ✔ 43 F85703 Lincoln Road Med Practice Del PMS 2 3.2% 61% 2 2 Medium-large 23% #N/A 100% #N/A #N/A 98.9 0.0 #N/A #N/A 88% 60% 33% 67% £138 PARTIAL 2 ✔ 44 F85707 Enfield Island Surgery Del PMS 2 1.7% 49% 3 1 Small-medium 50% #N/A 100% #N/A #N/A 94.5 0.0 #N/A #N/A no data 68% 66% 64% £146 FULL 7 ✔ 45 Y00057 Angel Surgery Del PMS 1 - Most deprived 3.3% 42% 10 2 Medium-large 57% 0% 100% 4,104 5,075 98.5 6.9 12,692 6.5% 80% 82% 63% 62% £122 14% 8 14% 102 FULL 7 ✔ 46 Y00612 Green Cedars Medical Centre Del GMS 1 - Most deprived 3.3% 44% 12 3 Small-medium 16% 22% 100% 2,732 9,069 97.1 5.7 5,990 -4.6% 71% 63% 44% 61% £120 no data 0 13% 36 FULL 7 47 Y03402 Evergreen Primary Care Centre Del PMS 1 - Most deprived 3.1% 42% 19 2 Large 9% 8% 58% 2,358 9,811 98.3 8.7 19,692 2.1% no data 65% 29% 59% £153 40% 793 40% 424 FULL 7 ✔
Comments: 01/05/2021 F85053 Park Lodge Medical Centre merged with F85033 Winchmore Hill Practice No.45 - List size reflects merger with Dover House (F85015) in October 2018 Figures for 'Patient Online' section relating to MHP practices all recorded under F85002 Forest Road Group Practice.
PLEASE NOTE - As of 01.01.21, all MHP practices merged under F85002 Medicus Health Partners. As some data reflects the pre-merger structure, MHP practices will remain split on the dashboard until data is able to be presented accurately under F85002.
44 / 113 Haringey Directorate Practice Practice Demographics Quality Workforce Efficiency Patient Experience Finance Patients Online Extended Access JUNE 2021
Practice
Practice Name 21)
2020) Code phone
Enabled
2018/19
2018/19
(Mar21)
Category
CQCSafe -
GPpractice
CQCCaring -
Practice Size Practice
% LocumGPs %
Contract Type Contract CQCWell - led
CQCEffective -
patient 2019/20 patient
Full / Partial / No PartialFull / /
May 20 - May 21 - May20
List size - May 21 - size List
CQCResponsive -
(Based on FTE GPs)(Based FTE on
DispensingPractice
(National Quintiles) (National
CQC Rating - Overall - Rating CQC
% Patients Aged 75+ Aged Patients %
% Patients Non-BME Patients %
appointment offered appointment
appointment enabled appointment
QOF Personalised Care PersonalisedCare QOF
Adjustment Rate 19/20 Rate Adjustment 0.5%) < = * <10; nos = ~
Annual List Size Change Size List Annual
( 0.5%) < = * <10; nos = ~ (
Co-commissioning model Co-commissioning online Popwith OfReg %
Practice Linked IMD2019 Linked Practice
Written complaints (Total) complaints Written
Directed Enhanced ServicesEnhanced Directed
(Extended Access payment) Access (Extended
No. of extended accessdays extended of No.
QOF Achievement 19/20 (%) 19/20 Achievement QOF
online appointments service appointments online
prescriptions online enabled online prescriptions
% GPs aged 55 years andover GPs aged 55 %
GPPS – Easy to get throughby get GPPS to Easy –
Online Appointments Enabled Appointments Online
Total no. pt transactions usingtransactions pt no. Total
Written complaints (via complaints NHSE) Written
FFT: % likely to recommend to GP likely FFT:%
service to friends & family(Feb & friends to service
Number of patients per FTE GP FTE per Numberpatients of
Average payment per weighted Averagepaymentweighted per
* = nos <6; no data = zero return) zero = data no <6; nos = * order repeat Popwith OfReg %
GPPS - Satisfied with the type of type the with GPPSSatisfied -
% Nurses aged 55 years andover Nursesaged55 %
(
online pt transaction service (Marservice transaction pt online
GPPS - Good overall experience of GPPSexperience Goodoverall -
Order Repeat Prescriptions Online Online Prescriptions OrderRepeat
Number of patients per FTE Nurse FTE per Numberpatients of orderedvia prescriptions no. Total 1 F85007 Lawrence House Surgery Del PMS 1 - Most deprived 3.4% 49% 34 1 Large 25% 6% 82% 1,215 6,404 95.6 6.0 15,825 -3.3% 82% 79% 67% 66% £135 no data 0 57% 465 FULL 7 ✔ 2 F85008 Staunton Group Practice Del GMS 2 4.1% 57% 82 6 Medium-large 39% 59% 27% 3,040 6,580 97.1 5.2 13,156 -8.5% 70% 53% 37% 46% No data no data 0 15% 378 no data - ✔ 3 F85013 Tynemouth Medical Practice Del PMS 1 - Most deprived 3.7% 44% 16 1 Medium-large 8% 0% 26% 1,642 2,655 97.1 5.7 9,065 -5.1% 75% 64% 44% 64% £140 no data - ✔ 4 F85014 Highgate Group Practice Del PMS 4 7.4% 81% 13 1 Large 0% 0% 0% 1,704 6,632 92.8 4.2 16,451 2.1% 78% 90% 81% 84% £136 75% 9 75% 937 FULL 7 ✔ 5 F85017 Charlton House Medical Centre Del GMS 1 - Most deprived 4.5% 43% 1 1 Small-medium 50% 0% 76% 4,042 8,212 89.4 5.5 6,848 -4.8% no data 63% 48% 60% £115 38% 0 38% 200 PARTIAL 1 ✔ 6 F85019 Morris House Group Practice Del GMS 1 - Most deprived 4.1% 47% 15 2 Large 15% 0% 0% 1,380 15,685 97.8 13.7 13,208 -0.5% 78% 67% 33% 60% £140 no data 0 39% 496 FULL 7 ✔ 7 F85028 Bruce Grove Primary Health Care Ctr Del GMS 1 - Most deprived 4.8% 0 0 Small-medium 65% 0% 100% 2,677 14,458 96.9 5.1 7,672 -2.5% no data 65% 83% 69% £106 11% 0 11% 82 no data - ✔ 8 F85030 Somerset Gardens Family Health Centre Del PMS 1 - Most deprived 5.0% 42% 5 5 Medium-large 0% 42% 2,254 32,850 94.9 8.0 13,188 -1.7% no data 56% 26% 70% £137 14% 22 14% 273 FULL 7 ✔ 9 F85031 Westbury Medical Centre Del PMS 2 4.1% 54% 25 1 Small-medium 0% 0% 100% 3,668 12,083 100.0 9.1 10,915 -2.0% 92% 81% 73% 62% £148 38% 0 38% 266 FULL 7 ✔ 10 F85034 Arcadian Gardens Surgery Del GMS 2 5.2% 60% 5 1 Small-medium 7% 0% 100% 2,632 5,001 93.1 4.2 5,419 14.4% no data 79% 80% 73% £124 27% 3 27% 167 FULL 7 ✔ 12 F85046 Hornsey Park Surgery Del GMS 2 2.9% 59% Small-medium 100% 44% 0% 3,102 5,584 97.3 3.1 6,160 40.9% no data 77% 75% 73% £131 17% 0 17% 78 FULL 7 ✔ 13 F85052 Spur Road Surgery Del GMS 2 6.4% 50% 2 0 Small-medium 87% 0% 100% 1,073 12,694 99.4 7.8 2,058 6.6% 77% 84% 92% 81% £148 30% 2 30% 34 FULL 7 14 F85060 Havergal Surgery Del PMS 2 5.0% 58% 18 0 Small-medium 10% 24% 90% 2,241 5,467 97.5 4.3 5,918 -4.8% no data 70% 59% 64% £140 39% 0 36% 124 FULL 7 ✔ 15 F85061 Christchurch Hall Surgery Del GMS 3 4.6% 73% 6 1 Small-medium 92% 30% 0% 1,802 7,795 3,298 -5.5% 98% 89% 88% 67% £127 7% 4 7% 20 FULL 7 ✔ 16 F85063 The Muswell Hill Practice Del PMS 5 - Least Deprived 5.5% 82% 5 0 Large 21% 0% 0% 1,683 9,137 90.4 3.3 14,618 0.2% no data 89% 54% 75% £130 51% 0 51% 655 FULL 7 ✔ 17 F85064 Stuart Crescent Health Centre Del PMS 2 5.1% 57% 4 1 Small-medium 0% 0% 4,238 10,317 98.2 5.2 6,417 13.6% 100% 70% 75% 77% £131 26% 123 26% 89 FULL 7 ✔ 18 F85065 Stuart Crescent Medical Practice Del GMS 2 5.2% 56% 8 1 Small-medium 50% 0% 0% 1,319 7,913 98.0 5.8 3,141 -4.0% 84% 68% 71% 76% £124 24% 0 24% 34 FULL 7 ✔ 19 F85066 Bounds Green Group Practice Del PMS 3 4.4% 65% 22 3 Large 12% 13% 37% 1,245 9,347 95.3 3.7 18,536 1.8% 96% 77% 50% 67% £140 48% 573 49% 1143 PARTIAL 6 ✔ 20 F85067 The 157 Medical Practice Del PMS 2 6.5% 65% 1 1 Small-medium 60% 19% 100% 3,212 5,675 92.1 7.9 4,530 2.9% no data 77% 66% 62% £45 no data 0 14% 99 NO 0 ✔ 21 F85069 Crouch Hall Road Surgery Del PMS 4 4.4% 77% 8 0 Medium-large 73% 8% 54% 3,027 5,735 99.9 4.0 8,416 -0.6% 94% 95% 95% 91% £140 96% 0 96% 296 FULL 7 ✔ 22 F85071 Fernlea Surgery Del PMS 2 3.0% 57% 19 0 Medium-large 32% 0% 100% 3,577 50,081 95.8 5.0 10,660 2.6% 81% 81% 74% 64% £137 24% 33 24% 134 FULL 7 ✔ 23 F85615 Tottenham Health Centre Del PMS 1 - Most deprived 3.4% 43% 2 0 Small-medium 98% 4% 0% 2,082 10,305 95.9 2.9 5,514 0.5% no data 70% 66% 76% £147 27% 10 26% 66 FULL 7 ✔ 24 F85623 Grove Road Surgery Del PMS 1 - Most deprived 3.3% 48% 0 0 Small-medium 44% 0% 100% 1,910 21,488 94.3 5.4 4,580 -2.8% 100% 97% 90% 84% £131 14% 0 14% 36 FULL 7 ✔ 25 F85628 Dowsett Road Surgery Del GMS 1 - Most deprived 4.3% 44% 4 0 Medium-large 0% 0% 100% 1,794 4,026 98.2 5.8 4,838 -0.6% 82% 72% 65% 72% £115 no data 0 25% 78 FULL 7 ✔ 26 F85640 Cheshire Road Surgery Del PMS 2 4.4% 61% 1 0 Small-medium 0% 0% 0% 2,226 8,125 90.8 2.8 6,464 -3.7% no data 87% 68% 75% £133 50% 63 49% 102 FULL 7 ✔ 27 F85669 West Green Road Surgery Del GMS 2 1.1% 54% 17 3 Large 19% 13% 100% 2,146 62,420 96.5 5.1 18,438 10.8% 99% 83% 85% 69% £113 8% 0 8% 93 FULL 7 ✔ 28 F85675 The Alexandra Surgery Del PMS 3 6.8% 70% Small-medium 58% 39% 2,151 8,539 87.5 3.5 5,618 0.2% 95% 82% 69% 72% £137 49% 0 49% 322 no data - ✔ 29 F85688 Rutland House Surgery Del PMS 4 4.5% 74% 10 1 Medium-large 24% 0% 100% 2,277 8,804 98.6 5.5 7,063 0.3% no data 89% 85% 74% £135 33% 39 31% 217 FULL 7 ✔ 30 F85697 The Old Surgery Del GMS 2 6.9% 61% 0 0 Small-medium 43% 0% 100% 1,607 9,966 95.0 6.7 2,104 1.0% no data 84% 90% 77% £121 8% 0 8% 7 FULL 7 ✔ 31 F85705 JS Medical Practice Del PMS 1 - Most deprived 3.4% 49% 3 0 Small-medium 50% 0% 40% 3,323 8,678 99.0 5.3 12,476 -2.8% no data 80% 67% 72% £136 55% 2 55% 252 FULL 7 ✔ 32 Y01655 The Vale Practice Del GMS 3 1.6% 74% 0 0 Large 55% 3% 66% 1,331 7,494 96.6 3.1 10,867 -2.7% 100% 83% 89% 75% £135 no data 0 42% 247 FULL 7 ✔ 33 Y02117 The Laurels Medical Practice Del APMS 2 3.3% 50% 2 2 Small-medium 19% 0% 0% 6,585 10,092 100.0 6.1 15,445 9.5% 96% 77% 60% 68% £146 no data 0 no data 0 FULL 7 ✔ 34 Y03035 Queenswood Medical Practice Del GMS 3 4.4% 75% 39 0 Large 6% 0% 0% 1,495 17,103 100.0 5.6 22,381 -0.7% 54% 91% 83% 78% £145 46% 713 46% 711 FULL 7 ✔ 35 Y03135 Bridge House Medical Practice Del PMS 2 4.1% 64% 16 1 Small-medium 50% 0% 0% 4,142 9,720 92.6 4.7 9,757 -5.5% no data 57% 29% 53% £145 20% 188 20% 275 FULL 7 ✔ 36 Y05330 Tottenham Hale Medical Practice Del APMS 2 0.5% 0% 6 0 Small-medium 40% 0% 100% 3,118 12,472 91.6 7.4 3,368 -1.4% 89% 75% 87% 70% £141 no data 0 27% 79 FULL 7
Comments: 01/05/21 F85045 Queens Avenue Practice merged with F85688 Rutland House Surgery
45 / 113 Islington Directorate Practice Practice Demographics Quality Workforce Efficiency Patient Experience Finance Patients Online Extended Access JUNE 2021
Practice
Practice Name 21)
2020) Code phone
Enabled
2018/19
2018/19
(Mar 21)
Category
CQC -CQC Safe
GP practice
CQC -CQC Caring
Practice Practice Size
% % Locum GPs
Contract Type Contract
CQC -CQC Well led
CQC -CQC Effective
patient 2019/20
Full / /Partial No
May 20 - May 21
CQC -CQC Responsive List size - May 21
(Based on FTE GPs) FTE (Based on
Dispensing Practice Dispensing
(National Quintiles)
CQC Rating - Overall
% % Patients Aged 75+
% % Patients Non-BME
appointment offered appointment
appointment enabled appointment
QOF Personalised Care QOF Personalised
Adjustment Adjustment Rate 19/20
Annual ListAnnual Size Change ~ = nos <10; * = < 0.5%)
( ~ = nos( <10; * = < 0.5%)
Co-commissioning model Co-commissioning (
% % Of Regwith Pop online
Practice Practice Linked IMD 2019
Written (Total) complaints
Directed Enhanced Services Directed Enhanced payment) Access (Extended
No. of extended access days No. access extended of
online appointments service online appointments
QOF Achievement 19/20 (%) online enabled prescriptions
% % GPs over 55aged and years
GPPS – Easy to get through by GPPS by to – Easy get through
Online Enabled Appointments
Total no. pt transactions using using Total pt no. transactions
Written (viacomplaints NHSE)
FFT: % likelyFFT: to recommend GP
service & to friends family (Feb
Number patients of per GPFTE
Average payment per weighted
% % Of Regwith repeat Pop order
* * = nos <6; no = zero return)data
GPPS - Satisfied with the type of
% Nurses aged 55 years and over % 55aged Nurses and years
(
online pt transaction service (Maronline pt transaction
GPPS -overall Good experience of
Order RepeatOnline Prescriptions
Number patients of per Nurse FTE via ordered Total prescriptions no. 1 F83002 River Place Health Centre Del GMS 2 3.9% 72% 8 0 Large 0% 4% 83% 1,067 6,688 99.7 7.6 10,063 0.6% 92% 94% 80% 76% £147 25% 0 24% 325 FULL 7 ✔ 2 F83004 Archway Medical Centre Del PMS 2 2.9% 66% 6 0 Small-medium 44% 0% 73% 6,607 10,969 95.1 10.6 15,374 52.7% 87% 77% 74% 53% £148 no data 0 17% 136 FULL 7 ✔ 3 F83007 Roman Way Medical Centre Del GMS 2 6.3% 66% Small-medium 35% 47% 0% 1,724 8,618 98.6 3.5 3,455 1.0% no data 89% 85% 74% £131 22% 0 21% 38 FULL 7 4 F83008 The Goodinge Group Practice Del GMS 2 4.1% 66% 8 4 Large 21% 0% 0% 1,296 18,313 91.0 4.7 11,772 -3.7% no data 88% 63% 79% £134 39% 351 39% 490 FULL 7 ✔ 5 F83010 Islington Central Medical Centre Del GMS 3 3.3% 73% Large 41% 0% 100% 3,775 24,537 96.4 3.7 20,362 4.0% no data 80% 53% 77% £144 57% 0 57% 421 FULL 7 ✔ 6 F83012 Elizabeth Avenue Group Practice Del GMS 2 5.5% 73% 11 1 Large 0% 0% 0% 1,102 7,466 98.8 7.9 7,477 -2.1% 100% 83% 84% 78% £159 41% 0 41% 242 FULL 7 ✔ 7 F83015 St Johns Way Medical Centre Del GMS 2 4.9% 67% 16 1 Large 22% 0% 27% 1,152 4,916 98.5 10.2 12,267 -2.6% 80% 82% 78% 70% £140 no data 0 29% 441 FULL 7 ✔ 8 F83021 Ritchie Street Group Practice Del GMS 2 3.1% 73% 33 0 Large 25% 11% 31% 1,906 9,190 98.2 8.3 18,456 -0.1% no data 75% 70% 69% £135 45% 0 43% 498 FULL 7 ✔ 9 F83027 Drs Bowry & Bowry's Practice Del GMS 2 4.9% 66% 3 0 Small-medium 47% 0% 2,286 ND 97.0 8.9 5,179 -2.6% no data 87% 60% 60% £136 14% 0 14% 66 FULL 7 ✔ 10 F83032 St Peter's Street Medical Practice Del GMS 2 3.2% 74% 17 0 Large 49% 6% 0% 1,243 14,079 98.7 5.2 12,067 0.2% 70% 81% 85% 66% £135 23% 1 9% 91 FULL 7 ✔ 11 F83033 Dr Haffiz Del GMS 2 6.5% 61% 3 0 Small-medium 0% 23% 100% 2,513 4,506 97.0 13.7 3,497 8.1% no data 74% 84% 80% £167 10% 0 10% 45 no data - 12 F83034 New North Health Centre Del GMS 2 9.1% 70% 0 0 Single-handed 100% 0% 1,627 ND 83.5 2.1 1,605 -2.8% no data 81% 99% 96% £156 14% 0 14% 12 FULL 7 ✔ 13 F83039 The Rise Group Practice Del GMS 2 5.2% 64% 5 0 Small-medium 54% 0% 100% 1,887 5,231 94.8 5.1 4,840 -4.9% 70% 73% 79% 69% £149 23% 0 23% 120 FULL 7 ✔ 14 F83045 The Miller Practice Del GMS 3 4.1% 73% 14 1 Medium-large 33% 0% 100% 1,968 7,995 98.7 4.7 10,194 -3.8% 100% 98% 90% 87% £137 46% 0 46% 429 FULL 7 ✔ 15 F83053 Mildmay Medical Practice Del GMS 2 3.8% 65% 15 0 Medium-large 32% 15% 100% 1,492 3,929 97.4 5.0 6,306 0.3% 90% 82% 72% 70% £179 31% 0 31% 118 FULL 7 ✔ 16 F83056 The Mitchison Road Surgery Del APMS 2 2.5% 67% 3 0 Small-medium 44% 0% 0% 4,643 8,744 100.0 6.4 7,149 19.3% * 82% 82% 71% £154 no data 0 36% 131 FULL 7 17 F83060 The Northern Medical Centre Del GMS 2 4.1% 67% 1 1 Medium-large 17% 0% 59% 1,975 6,662 98.9 6.2 9,075 -0.5% no data 74% 70% 67% £143 28% 0 28% 79 FULL 7 ✔ 18 F83063 Killick Street Health Centre Del GMS 2 2.8% 62% 22 1 Large 20% 0% 21% 1,269 4,611 99.5 5.3 12,115 -1.5% 97% 88% 76% 76% £164 24% 0 24% 290 FULL 7 ✔ 19 F83064 City Road Medical Centre Del GMS 2 4.1% 64% 9 0 Medium-large 0% 0% 1,347 ND 90.8 6.6 8,201 2.9% 90% 76% 55% 81% £164 34% 116 34% 125 FULL 7 ✔ 20 F83624 Clerkenwell Medical Practice Del GMS 3 1.3% 68% 20 0 Large 13% 13% 7% 1,927 5,368 98.0 6.1 15,177 7.7% 95% 86% 91% 89% £136 37% 0 37% 267 FULL 7 21 F83652 Amwell Group Practice Del GMS 2 2.2% 69% 10 0 Large 0% 0% 52% 1,064 10,928 98.4 7.5 10,209 -3.6% NA 80% 83% 64% £178 37% 0 37% 237 FULL 7 ✔ 22 F83660 Highbury Grange Medical Practice Del GMS 3 3.8% 72% 8 0 Medium-large 59% 4% 0% 2,997 5,503 93.1 4.1 9,382 0.9% no data 64% 67% 58% £128 23% 8 23% 185 FULL 7 ✔ 23 F83664 The Village Practice Del GMS 1 - Most deprived 1.8% 57% 9 1 Medium-large 0% 0% 0% 2,060 6,737 94.7 4.2 9,719 6.6% no data 72% 73% 65% £159 40% 0 40% 207 FULL 7 ✔ 24 F83666 Andover Medical Centre Del GMS 2 4.9% 58% 8 1 Medium-large 0% 0% 30% 1,088 4,853 94.6 8.2 5,951 -9.0% no data 93% 78% 71% £161 no data 0 26% 161 FULL 7 ✔ 25 F83671 The Beaumont Practice Del GMS 2 3.3% 63% Small-medium 80% 0% 100% 1,520 ND 95.5 6.4 3,190 5.7% no data 82% 81% 72% £149 34% 0 35% 62 FULL 7 ✔ 26 F83673 The Medical Centre Del PMS 2 3.2% 65% 8 0 Small-medium 100% 0% 16% 2,168 4,950 99.5 4.1 5,706 0.6% no data 91% 91% 94% £161 29% 0 29% 108 FULL 7 ✔ 27 F83674 The Junction Medical Practice Del GMS 3 5.0% 71% 16 0 Medium-large 0% 57% 100% 2,124 5,242 98.9 4.4 9,618 -0.1% no data 77% 83% 74% £162 24% 99 24% 285 FULL 7 ✔ 28 F83678 The Pine Street Medical Practice Del GMS 2 6.8% 67% Small-medium 0% 0% 0% 995 4,774 95.1 10.4 2,373 -2.9% no data 92% 75% 82% £121 21% 28 21% 27 no data - ✔ 29 F83680 Sobell Medical Centre Del GMS 2 3.5% 63% 4 0 Small-medium 57% 11% 100% 2,859 5,250 76.8 5.2 4,256 -1.4% 87% 78% 74% 76% £127 20% 0 20% 49 FULL 7 ✔ 30 F83681 Partnership Primary Care Centre Del GMS 2 4.4% 68% 6 1 Small-medium 10% 0% 100% 2,576 3,978 99.0 10.6 3,961 -2.2% 100% 83% 77% 73% £151 16% 1 16% 107 FULL 7 31 F83686 Stroud Green Medical Centre Del GMS 2 2.2% 67% 3 0 Single-handed 0% 0% 100% 7,020 8,472 97.5 5.8 6,530 -4.4% 88% 88% 91% 77% £127 34% 106 34% 129 FULL 7 ✔ 32 Y01066 Hanley Primary Care Centre Del APMS 2 2.1% 61% 14 3 Small-medium 0% 0% 4,168 ND 100.0 6.5 10,290 16.7% 96% 68% 73% 69% £172 34% 0 33% 214 FULL 7
Comments: No. 27 - List size change reflects merger with Dr. Ko and partner (F83051) in October 2018.
46 / 113 General Practice Sustainability and Resilience References
Purpose of document, and source data
This report aims to highlight practice sustainability through an aggregation of national indicators and local knowledge. The table draws together a multitude of indicators from an array of sources, such as the General Practice Indicators, along with data from CQC ratings, GPPS and practice demographics. In January 2016, £10m was allocated for a pilot programme to support practices in difficulty, and a further £40m was made available over four years (to 2020) under the General Practice Resilience Programme. Local teams were asked to identify those practices which are considered vulnerable* and those which would benefit from Resilience Programme support. These practices have been highlighted in the regional and DCO tables.
Brief Description Source Time period Published Data for GPs and GP Surgeries is supplied by the NHS Prescription Service of the Total Practices Main practices NHS Business Services Authority. Medical Practices classed as Active and with a NHS Digital Jan-19 Feb-19 Summary GP Practice prescribing setting are included. Number of Patients Registered Data extracted as a quarterly snapshot in time from the GP Payments system Registered Population NHS Digital Feb-19 Feb-19 at a GP Practice maintained by NHS Digital.
Primary care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View. Co-commissioning aims to support the development of Delegated commissioning integrated out-of-hospital services based around the needs of local people. It is Primary Care part of a wider strategy to join up care in and out of hospital. Delegated commissioning: CCGs assume full responsibility for the Greater involvement NHS England Apr-18 Apr-18 Co- commissioning of general practice services. Commissioning Greater involvement: an invitation to CCGs to collaborate more closely with their Joint commissioning local NHS England teams in decisions about primary care services. Joint commissioning: enables one or more CCGs to jointly commission general practice services with NHS England through a joint committee.
Contract Type Displays the contract type and if the practice is authorised to dispense drugs. Sourced from NHS Payments to General Practices in England for 2017/18 by NHS Digital 2017-18 Dec-18 Dispensing Practice individual General Practice
Patient level IMD has been calculated from IMD 2015 data. For each practice, NHS Digital gives the number of registered patients in each LLSOA (based on their Kings College Deprivation Practice patient level London, Department registered address). Kings College London then calculate a weighted mean based 2015 Sep-16 deprivation for Communities and Practice on the mean IMD-2015 scores for all patients (in turn, based on LLSOA residency) Local Government Information & registered at the practice. Demographics % Aged 75+ Data extracted from the NHS Digital's GP Payments system. NHS Digital Feb-19 Feb-19
English Indices of Estimated proportion of non-BME ethnic groups in the practice population Deprivation, % Non-BME Department for 2015 Jul-16 (weighted average over the contributing LSOAs). Communities and Local Government
Outstanding The CQC rates General Practices to give an overall judgement of the quality of Good care. There are four ratings that we give to health and social care services. The CQC Rating Requires improvement rating examines five key areas for the quality of care: Caring, Effective, CQC Feb-19 Feb-19 Inadequate Responsive, Safe, Well-led. When no rating is shown, no published rating is available. No published rating The NHS complaints procedure is the statutorily based mechanism for dealing Quality with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure. This shows the counts of the Written Complaints (total for practice) number of written complaints made by (or on behalf of) patients, received NHS Digital 2017-18 Sep-18 between 1 April 2017 and 31 March 2018. Data are collected via two forms, the Written Complaints (directed to NHS England) KO41a (NHS Hospital and Community Health Service (HCHS)) and KO41b (Family Health Service (GP including Dental) (FHS)). Please note this is experimental information.
Single-handed (=<1 FTE GP) The primary data source for General and Personal Medical statistics is the Practice Size Small-medium (>1 and =<3) workforce Minimum Data Set (wMDS) collected via the Primary Care Web Tool (PCWT) Workforce Census module and the workforce Minimum Data Set (Based on FTE GPs) Medium-large (>3 and =<6) Collection Vehicle (wMDSCV). These statistics are labelled Experimental so care Large (>6 FTE GPs) needs to be taken when interpreting the figures. Workforce % FTE GPs aged 55 and over NHS Digital Mar-18 Sep-18 % FTE Locum GPs Note that all indicators are based on Full Time Equivalent (FTE) staffing and not numbers of staff. % FTE Nurses aged 55 and over Number of patients per FTE GP The number of patients registered at the GP practice is also taken from the https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/final-30-september-2019 wMDS return. Number of patients per FTE Nurse
The QOF was introduced as part of the new General Medical Services (GMS) QOF Achievement contract on 1 April 2004. The objective of the QOF is to improve the quality of care patients are given by rewarding practices for the quality of care they provide NHS Digital 2017-18 Oct-18 QOF Exception Rate to their patients. Participation in QOF is voluntary, though participation rates are very high (94.8% in 17/18). Efficiency Number of patients registered to the GP Practice. Data extracted as a monthly List size NHS Digital Feb-19 Feb-19 snapshot in time from the GP Payments system.
Available quarterly, the annual percentage change of list size of all practices in List Size Change +/- 5-10% NHS Digital Jan-19 Jan-19 England.
The Friends and Family Test asks patients how likely they are to recommend % likely to recommend the GP service to friends and their GP service to friends and family based on their most recent experience of NHS England Dec-18 Feb-19 family service use. This indicator presents the percentage of those 'Likely' or 'Extremely likely' to recommend their practice.
The GP Patient Survey, an independent survey run by Ipsos MORI on behalf of Good overall experience of GP practice NHS England, is sent to over a million people across the UK. The results Patient (weighted) show how people feel about their GP practice. The survey was Experience extensively redesigned for 2018. Due to this, and the inclusion of 16-17 year olds, comparisons cannot be made with previous years' results even where Easy to get through on the phone NHS England Jan - Mar 18 Aug-18 question wording remains similar. Note that two of the questions reported have changed in 2018: - Good overall experience of GP practice (% very or fairly good) Satisfied with the type of appointment offered - Ease of getting through by phone (% very or fairly easy) - Satisfied with the type of appointment offered (% yes)
This figure is taken from the NHS Digital report 'NHS Payments to General Practice, England'. It represents the total payments figure divided by the number of weighted patients. Values are included only where a full year of data Finance Average payment per weighted patient is available. The number of weighted patients is calculated by the Global Sum NHS Digital 2017-18 Dec-18 process. Global Sum Payments are a contribution towards the contractor’s costs in delivering essential and additional services, including its staff costs. For more information, please visit NHS Digital's website.
GP practices provide functionality for patients to book/cancel appointments Online Appointments Enabled electronically % Of Reg Population with online appointment Number of patients enabled to electronically book or cancel an appointment enabled divided by the practice list size Total no. pt transactions using online appointments Total number of appointment scheduling or cancelling transactions using an service Online Patient Transaction Service. Patients Online NHS Digital Jan-19 Feb-19 GP practices provide functionality for patients to view/order repeat Order Repeat Prescriptions Online Enabled prescriptions electronically. % Of Reg Population with order repeat prescriptions Number of patients enabled to electronically view/order repeat prescriptions online enabled divided by the practice list size Total number of prescriptions ordered using an Online Patient Transaction Total no. prescriptions ordered via online pt Service. (Note that ordering several items at once to be counted as one transaction service prescription).
Bi-annual data collection monitors availability of pre-bookable appointments in Category practices at evenings and weekends. Launched in Oct 2016 in response to the Full/Partial/No extended access government’s mandate to NHS England “to ensure everyone has easier and more NHS England Sep-18 Nov-18 convenient access to GP services, including appointments at evenings and No. of extended access days weekends”, data are published as experimental statistics as they are new and Extended Access undergoing evaluation.
Directed Enhanced Services Whether or not a practice received a Directed Enhanced Services payment for NHS Digital 2016-17 Sep-17 (Extended Access payment) Extended Hours Access in 2016/17
Feb-19 References
* National criteria has been created to be used as a screening tool by local commissioners to guide their assessment with local stakeholders on offers of support to improve sustainability and resilience. This criteria includes 9 data indicators out of the 16 identified examining areas such as Safety, Workforce, Efficiency and Patient Experience/Access.
Sustainability and Resilience Reports - Conditions on Forward Use
Sustainability and Resilience reports provide NHS England Management Information at an individual practice level, including potentially sensitive information relating to practices status in the Vulnerable Practice Programme, GP Resilience Programme and Personal Medical Services Reviews.
This information therefore needs to be managed accordingly and should be held in strict confidence, not for onward transmission to any other individual or organisation (other than CCGs), or the details of any practice disclosed publicly. Measures should therefore be taken locally to guard against unauthorised access or sharing of the data.
NHS England local teams will need to be satisfied these conditions and controls are equally understood and applied by CCGs when sharing any reports under co- commissioning arrangements.
47 / 113 London Workforce Delivery Group April ‘21
NCL Primary Care Workforce Priorities 21/22
DRAFT
Keziah Insaidoo, Programme Manager, NCL CCG Michael Fox, Programme Manager, NCL Training Hub
48 / 113 Governance
49 / 1132 50 / 1133 Primary Care Workforce Priorities 2021-22
Develop Faculty & Expand Workforce Planning & Approved Learning System Change Recruitment & Retention Environments
- Expand training capacity for - Embed new roles - Respond to rising burnout & offer range of professional groups - Ensure PCNs planning whole Health & Wellbeing Support workforce - Engage and expand ALE‘s - Deliver London WRES & EDI Plans (de-bias recruitment, representation, - Model future workforce needs - Develop Faculty of Allies programme) - Connect to ICP plans Educators to underpin - Deliver recruitment initiatives - Develop cross sector (Fellowships/SPIN, Apprenticeships, - Identify workforce dev Recruitment platforms needed to align to service models for clinical placements (e.g. NCL TNA) - Deliver retention initiatives ( redevelopment & health flexible working, talent management, inequalities leadership development)
514 / 113 General Practice Deep Dive – System Recovery Executive May 2021
52 / 113 Introduction
Significant pressure on general practice, as with all other parts of the health and care system. Appointments already back to higher than pre-pandemic appointments, and online consultations on top (eConsults at c8,000/ month in Camden to c17,000 Barnet, April 2021). Focus on resilient General Practice to ensure minimal detrimental system impact
Key pressure points include: • Primary / secondary care interface; increased workload and flow to GP from secondary care; more advice and guidance managed in primary care; • Significant volume of online consultations; • New workload /managing chronic and complex conditions, pent-up demand; • Limited access to diagnostics; • Tired workforce; • Limitations of IT infrastructure (GP IT, telephony) and estates (no room to increase physical workforce); • How to shift resources to follow activity e.g. increased advice and guidance delivered in general practice; • Further development of Primary Care Networks, as foundation of integrated care
These slides set out the four recovery programme priorities for General Practice in NCL in 2021/22, with areas for discussion:
1. Address identified challenges in primary/ secondary care interface (aligned with system recovery and Elective Accelerator, with primary care input). Scope to include: reverse referral support, integrated care coordinators. (slide 6) 2. Access and demand management – review (slide 7) 3. Review of Locally Commissioned Services, with an initial focus on long term conditions, for introduction from 2022 (slide 8) 4. Reinvest Personal Medical Services (PMS) funding within boroughs (slide 9)
53 2/ 113 How we got here: General Practice
Primary care is the foundation of the NHS; accounting for 90% of all consultations for less than 10% of the national budget and embedded in local communities; delivers a life course so fundamental to population health. Journey to the current offer of primary care at scale in NCL. Expert generalist care of the whole patient, advocacy and confidentiality, taking into account socio-economic and psychological determinants of disease. Pandemic has enhanced at GP contract 2019 scale working The core offer of general practice is prevention at all endorsed our and levels; admission avoidance; gatekeepers to approach and demonstrated other services, providing over 300 million Quality PCNs were then opportunities it contracted entity consultations a year – ensuring right care, first time improvement brings support teams (only 23 million ED visits/year). (QISTS) - ensured Care & Health QI and use of Integrated data to inform care. • 200 practices: single-handed Networks (CHINS) – practices to super-partnerships clinical case for e.g. Medicus (Enfield) - super- changing, Social prescribing partnership of 13 practices Borough link workers - level bringing GP, • Strong history of practices community and Linking people working together practice / with local locality mental health • CCG clinical leadership: Jo communities. collaboration together to Sauvage, Katie Coleman deliver care at locality
54 3/ 113 Delivering Care: GP Achievements during Covid NCL GP annual appointments 6.7m Annual referrals to secondary care 339,086 Enfield Annual LD health checks 3,000+ % of NCL 2016-20 mortality Barnet 11% Preventable 52.5% via telephone Haringey 6% Treatable 1.6m residents (<75) 7% Both 47.5% face to face 203 practices Avoidable mortality Avoidable 91% attendance rate Camden Islington 32 PCNs (Oct-Dec 2020) 6 federations 5 extended access services 50,000 online consultations (Oct-Dec 2020, avg/ month)
1,301 GPs 559,811 covid vaccines delivered 345 practice nurses 62% of all covid vaccines in NCL 200+ multidisciplinary roles £237m annual delegated primary care 13,071 referrals to social prescribing budget and £261m primary care services of 12,500 personalised care and support plans (target) c£2.9bn CCG budget
55 4/ 113 Workforce
• General practice workforce are exhausted. Practices habe changed their operating and access model, adapted to new ways of working, and continued to deliver face to face care. The last 14 months have been exceptionally difficult for staff across general practice, some of whom may have experienced personal loss as a result of covid-19, or are finding it generally difficult to cope with the rapid changes to how they work.
• Total triage (telephone, video, online consultation) model in place for many months. Has kept patients and practices safe but is an intensive way of working; some reporting professionally feeling isolated e.g. where working from home. What GP providers have told us through recent local engagement (April 21) • Significant volume of covid-vaccination telephone queries to GP - particularly in response to media spotlights e.g. on AZ/bloodclotting, or from national messaging (NBS “staff are and 119). “I’m more having stressed than meltdowns” • Practices have seen a recent surge from pent up demand in both online consultations I’ve ever been” and in phone queries e.g. one practice (12,000 list size) recently recorded 7000 phone calls, in and out, in one week in April 21. “the workload is becoming • GP workforce pressures which existed pre-covid continue to provide challenge e.g. “I’m working the longest unsustainable” shortages of GPs and practice nurses, high numbers of GPs who are retiring / close to days I’ve ever worked” retiring. Recent workforce survey by Londonwide LMC indicated that of the 74 NCL practices that completed the survey 41% reported having a GP planning to retire in the next three years. “one of the main issues is…how an exhausted workforce manages increased GP work whilst also managing Covid vacs etc.”
56 5/ 113 Priority 1. Primary care/ secondary care interface Current significant levels of pent-up demand exacerbated by workload that primary care is now managing on behalf of secondary care.
Issues raised by practices include: Sense-check the emerging • Requests of primary care to complete tests/ diagnostics; leads to patients using GP appointments to principles; how do we ask for access / information on other care; communicate these across the • Primary care (GP) providing increasing care coordination role; system? • Requests for increased management of and communication with patients on secondary care waiting lists; NCL-wide clinical summit – • No easy / consistent way to contact secondary care; formative conversation on a • Patients discharged after 1 DNA, but not having received appointment details prior; cross system strategy? • GPs now more experienced at using advice and guidance (but resourcing has not followed); • Primary /secondary interface groups are in place for each acute Trust – largely managing strategic Rapid programme to address issues. Need responsive and agile way to rapidly work through issues as they arise. key interface issues (with PMO support), e.g. reverse referral Emerging principles: support, integrated care • Make every contact count; coordinators (system • Tests to be carried out by the person requesting the test; accelerator funding?) • Make better use of electronic solutions e.g. NHS App, electronic prescribing – links to nominated pharmacies, electronic prescription-checking service • Direct test ordering by secondary care – direct booking into community based diagnostics • Reviewing secondary care patient access policy • Avoid referrals back to primary care to progress treatment / management unless clear patient benefit
57 6/ 113 Priority 2. Access and demand management
Access to and management of primary care appointments presents challenges for practices and patients. Significant change in primary care model to Total Triage; virtual appointments where possible, and face to face where clinically safe and beneficial. No parallel information or education for patients about changes to model. Planned national access review, and national access improvement programme – imminent changes to funding.
Current and immediate access-focused work includes: Other areas/ factors to • Segment access: urgent/ complex/ planned; reduce volume of low level requests (identification of cohort for consider as priority to improved self-management/ redirection to e.g. social prescribing); include in access work? • Understand current appointment demographic: face to face/ other (including online consults) quantitative and qualitative, and development of dashboard to track improvement What are the priority • Engage with National Access Improvement Programme and support improvement at practice level (16 NCL areas for the next two practices identified to participate – efficiency/ QI approach), ahead of funding transferring to PCNs in April 2022; months/ six months? • Temporary increase of extended access capacity to support primary care and 111; • Use of clinical advice and guidance and Consultant Connect – review of savings from increased use; explore How best to engage our redirect into primary care communities on the new • Develop clear road map for GPIT – improvement and joining up of GP IT systems, including improved comms normal / ways of infrastructure (telephony and websites) working and how to • Progress digital inclusion; NHSE-funded pilot of PCN digital health coordinator roles – ensuring that patients access care? who want to can have equitable access to digital / virtual offers • Patient-facing communications and engagement/ education – how to use the new Total Triage system; incorporating ‘be kind’ message • Scope potential increased roll out of Community Pharmacy Consultation Scheme (July)
58 7/ 113 Priority 3. Locally Commissioned Services
LCS commissioned in addition to core GP services. Variation in LCS across NCL. LCS largely commissioned pre-pandemic/ different context. Proposal to review; initial focus on long term conditions. How best to take a system The NCL-wide Enhanced Services Review Group (multi-stakeholder) developed draft principles for approach to development of developing NCL wide enhanced services specification (pre-Covid): long term conditions: • Build on best practice and shared learning • Keep it simple to support sign up and delivery • Make sure services are person-centred and support an equitable offer for patients across NCL How do we set outcomes • Support sustainability and resilience for practices (data driven)? • Support activity shift from secondary care to primary care Creation of engine rooms to • Develop payment methods to support outcomes based commissioning drive population health at • Support delivery of short term, medium term and long term outcomes PCN/ borough-level, to • Work with practices to develop sustainable, long term approaches and facilitate primary care working at scale across NCL improve outcomes? • Deliver value for money (with fair pricing) and properly trained and skilled staff How do primary, secondary • Move towards longer term contracts (3-5 years) but with flexibility to adjust along the way and community services • Co-production; ensure GPs and practices are on board. best collaborate to deliver on outcomes? Other considerations: • LTC LCS to enable GP to deliver proactive, personalised care for patients with complex care needs. • Key interface between LTC LCS and acute, community and MH services, to ensure integrated patient Development of a potential pathways; menu-based approach for LTC LCS? • Educational requirements required to enable practices to deliver enhanced services; • Impact of LCS-related appointments (e.g. extended care planning appointments) on GP access
59 8/ 113 Priority 4. Personal Medical Services Funding
• Personal Medical Services (PMS) agreements are locally agreed contracts between NHS England and a GP practice. They have historically offered local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range and funding of services provided by the practice Develop overview analysis of primary care budgets (income • A nationally mandated (locally-led) review of PMS contracts was carried out to deliver and expenditure) at borough greater equity of funding between PMS and GMS practices (2016-17). In most cases level PMS practices had higher levels of funding, and arrangements were put in place in North Central London to equalize funding across GMS/ PMS practices over a 4 year Develop NCL-wide principles for period (5 years in Camden). PMS funding reinvestment across primary care contracts? • By April 2022 the final PMS payments will have been completed in all NCL boroughs except Camden. Once available, the funding (c£11m across NCL) will need to be Confirm mobilisation of a task reinvested across all GP (PMS and GMS) practices. PMS is core contract, so funding and finish group to take forward would remain in boroughs. the development of a NCL wide LTC LCS. • With the 21/22 Contract changes, some of the APMS contract key performance indicators have transitioned into the core contracts and Quality and Outcomes Undertake review of APMS Framework (QoF). It is therefore proposed that a review of the APMS KPIs is KPIs? undertaken (indicators and value) to assess whether to retain or revise.
60 9/ 113 Primary Care: NCL Governance
NCL System Recovery Executive
Key GP interfaces/ relationships include:
Primary Care Commissioning Emerging NCL GP Alliance Committee NCL People Board
Digital First Board Primary Care Silver (provider and commissioner) Estates
Primary Care Clinical PCN DES Contract group GP Recovery Leads (inc finance)
Primary / secondary care Enhanced Services Access PMS Reinvestment Project specific interface Review Group (LCS) (not yet in place)
Reflects NCL-wide governance/ groups only (does not include borough-based primary care governance) Requires review to support ICS development
6110 / 113 Access & Patient experience: immediate recovery challenge
• National GP appointment data shows that across NCL, GP appointment levels are already exceeding pre-pandemic levels. • We note the shift in appointment modalities: pre-Covid approximately 16% of GP appointments were conducted via telephone/video/online. Following the introduction of the Total Triage model in mid-March 2020, the proportion of non-face-to-face appointments increased to 66% in April. • The proportion has decreased since but remains at least 45% of total appointments as of December 2020. • The charts here show rolling appointment capacity (overall and split by modality).
6211 / 113
North Central London CCG Primary Care Commissioning Committee Meeting 17 June 2021
Report Title QIA and EQIA for NCL Date of 28 May Agenda 2.3 Digital First (Online report 2021 Item Consultations) Lead Director / Paul Sinden, Chief Email / Tel [email protected] Manager Operating officer
GB Member Not Applicable Sponsor Report Author Ruth Evans Email / Tel [email protected]
Name of Not Applicable Summary of Financial Implications Authorising Finance Lead Not Applicable Report Summary As NCL Digital First relates to Primary Care, clinical oversight of the online consultation product contracts are through the Primary Care Committee.
NCL has just completed a re-procurement of online/video consultation services in April 2021 which has resulted in some changes to the online consultation contracts. Therefore, An EQIA and QIA has been conducted by the NCL Digital First team to form part of the Clinical Governance Framework underpinning the recent re-procurement.
These papers take account of patient experience, monitoring of quality and patient safety.
They also include clear processes for dealing with complaints, clinical incidents and describe mitigations in place to support patient groups with protected characteristics.
Recommendation To NOTE
Identified Risks The purpose of these reports is to identify quality/equality risks associated with and Risk use of online consultations services.
Management Mitigations of quality risks and the risks associated with groups of patients with Actions protected characteristics are outlined in these documents.
Conflicts of We are not aware of any conflicts of interest at this point. Interest
Resource These reports support the CCG by providing an underpinning Clinical Implications Governance Framework to support the provision of online consultation services in primary care.
63 / 113 Engagement Engagement with patients and stakeholders has been carried out in the following ways: Suppliers provide monthly qualitative patient feedback to commissioners. Consultation with Healthwatch and findings from other regions NCL digital clinical leads, primary care leads, the LMC and patient representatives were involved in the procurement planning processes During the product rollouts extensive comms and guidance was provided to practices and project managers were available to answer practices’ questions. Online training was also provided for all practices signing up for online consultations. Resources for patients were also supplied to practices in the form of from suppliers on how they can use their products
Equality Impact EQIA report provides detailed overview on the equality and diversity impact of Analysis the online consultation services on patient groups. Report History Not Applicable and Key Decisions Next Steps Ongoing contract monitoring and clinical assurance meetings with suppliers to monitor quality/equality issues/concerns
Appendices Not Applicable
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EQUALITY ANALYSIS (Equality Impact Assessment)
Service/Policy title Online consultations Service/Policy type IT Author Ruth Evans Lead Director Nina Paul Email [email protected] Date approved Review date
Before completing the Equality Analysis (EQIA) please read the guidance on the intranet.
For further help and advice please contact Emdad Haque at [email protected] Tel: 07753836900
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65 / 113 Brief description of the policy/service Please provide only a brief description covering what this policy/service aims to achieve and which groups it will benefit.
In response to Covid-19, it has been important to protect patients and staff and minimise the risk of infection. It was therefore important to rapidly implement digital solutions to support clinicians to triage and consult with patients remotely, and to also support clinicians and other staff to work remotely. This required rapid acceleration of the aims of the Digital First programme to deliver key capabilities to all GP practices in England where they did not already have them. Mobilisation at pace and at scale to support the introduction of ‘total triage’ or ‘triage first’ across all practices was necessary to support the response to Covid-19.
In April 2020, NHSE advised rapid implementation of online consultation (OC) services across primary care in response to COVID-19. As a result, NCL deployed eConsult across the STP and the other 4 STPs across London also commissioned similar online consultation technologies.
Following the expiry of NCL’s contract with eConsult in April 2021, and NHSE’s new OC/VC procurement framework was completed in January/February 2021. NCL CCG re-procured online/video consultation services from a range of providers, these were: eConsult, Patchs, accuRx, EMIS Health/Egton, and Footfall.
The rollout of online consultations will benefit patients who are able to access their GP practice online, it is hoped that it will improve access for patients by offering another route to communicate with their practice and increased flexibility as they will be able to complete online consultations outside of core practice hours. It is hoped that it will also reduce the workload for practices as it will signpost patients to other services as appropriate and free up staff time to manage patients who contact the practice in other ways, e.g. over the phone.
Engagement with patients and stakeholders Please provide a brief summary about engagement with patients, clinical leads, voluntary organisations Healthwatch- and the outcomes. If no engagement has been carried out then please explain why.
Engagement with patients and stakeholders has been carried out in the following ways: eConsult provide(d/s) monthly qualitative patient feedback to commissioners. However project team needed qualitative data to provide a fuller picture of the patient experience. Consultation with Healthwatch and findings from other regions Overall Clinical Lead for OC in NCL and clinical borough leads were brought on board during the eConsult implementation During the OC rollout extensive comms and guidance was provided to practices regarding the rollout of online consultations and project managers were available to answer practices’ questions. Online training was also mandatory for all practices wanting to sign up for online consultations. Resources for patients were also supplied to practices on how to use OC
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Impact analysis This section should be used to analyse the likely impact of the policy/service on protected and disadvantaged groups. It should be noted that the CCG’s default policy intent is to maximise opportunity (positive impact) for all groups by removing barriers so that they can access the service they need and enjoy good outcomes.
Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
Age Online consultations enables practices to better manage demand, with the Positive/Unknown 1 majority of contacts entering into a single workflow and clinicians therefore able to prioritise care based on need rather than on a ‘first come, first served’ basis. This benefits all patients regardless of the mode that they use to access the practice. Those patients that cannot or choose not to use digital modes can be supported by practice staff who record information on their behalf when they telephone or walk-in.
Within each age group there would be people who would be positively affected by the availability of online and video consultations; however, these benefits would not be shared by others in their age group. Each age group is heterogenous: patients’ digital skills, attitudes or circumstances may vary, and this would impact on whether they are able to experience the benefits.
Older age group: some older people have good digital skills and are confident accessing services using online tools and therefore stand to benefit from increased flexibility. Those who cannot (or prefer not to) utilise online consultation can still access care via telephone or in person. While they would not directly experience the benefits of increased convenience and flexibility enabled by online consultation, they would still benefit from the introduction of digitally supported total triage.
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67 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
We are aware of some work taking place at a national level on clinical safety. There is currently variation across supplier systems in terms of who can access the systems, dependent upon age. Some don’t allow under 18s or under 16s without a parent or guardian completing the consultation on their behalf. There is a large cohort of young people that would prefer to use the systems themselves and the pandemic has highlighted the impact on them from not being able to easily access services. The national team has sought medico-legal advice and there is broad agreement that access for young people should be enabled and to align the minimum age with other parts of the system, i.e. 13 years old upwards. By opening up the systems, it does require additional safeguarding to be in place. A co-design workshop was run in April by the national team to discuss how this might move forward with enabling access for these young people in a safe way. A task and finish group is being set up to help co-design screening questions that could be used to enhance safeguards, particularly for this patient cohort but also other vulnerable groups.
Specific sub-groups that are likely to benefit from the introduction of online consultations:
University students may be able to continue to get support from the same practice and benefit from continuity of care.
Working population or those with caring responsibilities unable to access care/make calls/walk in during practice opening hours.
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68 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
Patients with unplanned pregnancies seeking advice and support of their options to make informed choices for themselves, such as interventions to end their current pregnancy.
Patients with carers who can access on their behalf Non English speaking patients or those with English as a second language that may find a face to face of telephone conversation difficult.
Disability These specific groups are likely to benefit from the availability of online and video Positive 2 consultations if digital support is introduced across all modalities (e.g. walk in, phone and online), access should be equal through any modality the patient chooses, ensuring equality of access to appointment based upon need, taking into account patient choice and however care is accessed:
People with physical disability that have mobility difficulties. if they have the capacity to utilise digital tools they would be able to access care more easily without needing to access premises. While the proportion of internet non-users is higher among disabled than among non-disabled1there are still many who do use the internet and would be able to utilise online and remote consultations.
People with dementia or vulnerable patients who have carers with the skills and tools needed for online and video consultations. The ability to access care remotely offers increased convenience and a reduction in the risks associated with attending the practice.
1 1(Oxford Internet Survey, Oxford Internet Institute, University of Oxford, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3522083, accessed 18/3/2021), ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
69 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
Patients with a learning disability may be able to benefit from accessing care remotely if they are in an environment where they can be supported by a carer to utilise digital access modes. Some people with autistic spectrum disorders may find communicating via online consultations easier and this would make their experience of accessing care better. However, others would find this more challenging and would therefore need to utilise other modes of access.
The increased flexibility is likely to positively impact the experience of care reported by people with learning disability and autistic spectrum disorder. Findings from the GP Patient Survey undertaken by NHS England in 2017 highlight that only 53% of people with a learning disability or autism rated the service they get from their GP positively, compared to 85% of the general population.
Some patients with severe mental illness may benefit from online and video consultations due to the reduced likelihood of experiencing negative stigmas when accessing service.2 It may also benefit those who struggle with attending appointments at the practice due to feeling uncomfortable with the interactions this involves.
Similarly, for some partially sighted or D/deaf people digital access may be possible and this would have a positive impact on their experience. However, other people with sensory impairment may not be able to utilise digital tools and their ability to do so could depend on the built-in functionality of a solution. These patients would still benefit from the improved demand management enabled by digitally supported total triage.
2 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–639 ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
70 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
People with long term conditions such as asthma or diabetes may benefit from digitally enabled remote access. Their long-term condition means that they require regular monitoring. The ability to access care remotely would reduce the time burden associated with their condition, for example through having to take time off work. Gender N/R -
Gender People who are transgender or have undergone gender reassignment may benefit Unknown 3 reassignment from the ability to use digital tools to access care remotely. This would help reduce the likelihood of experiencing negative interactions with staff or patients associated with stigma.3
This potential for positive impact may be undermined if the online consultation solutions do not allow users to record their gender identity in a way that reflects their own experience. For example, if the solution only has male/female as gender categories.
Male/Female option – data capture guidance around protected characteristics (non-binary – two step – m/f/non-binary/other and Is gender ID same as birth certificate) Marriage and N/R - civil partnership
Pregnancy and eConsult is the only one with templates, others are free-text. Positive maternity
3 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–639 ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
71 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
An additional non urgent servicefor Women who are pregnant or parents with young babies may benefit from digitally enabled remote access. During the perinatal period, women (and their babies) require regular monitoring. The ability to access care remotely would enable them to receive prompt advice and would reduce the time burden associated with attending appointments in practice.
Race/ethnicity Patients from BME backgrounds who have the skills and means to access care Unknown 4 remotely using digital solutions stand to benefit from increased flexibility and convenience in access to care.
This is particularly important as findings from the GP Patient Survey 2019 suggest that patients from BME background were more likely to decline an appointment because there were not any appointments for the day or time wanted compared to White British patients. This may be the result of difference in employment arrangement and the flexibility level afforded.
In the context of online consultation, identification of patients’ race or ethnicity is not captured on the online consultation solutions or questions (whether used by practice staff over the phone/in person with a patient or used by patients online) therefore identification of high risk patients e.g. Covid-19, may not be identified immediately due to the question format/content.
Non-English-speaking patients or those unfamiliar with NHS care may find the questions challenging or not understand the reason for the questions. However, research suggests that online written consultations offered advantages for
------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
72 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
patients who required an interpreter and who had had a previous stigmatising reaction. 4
Religion/belief People from minority religions or beliefs may benefit from the utilisation of online Unknown 5 consultations if their religious beliefs involve a distinct dress identifying them as part of a religious minority. Online written consultations were found to offer advantages for patients who had had a previous stigmatising reaction.5
Some ultra-orthodox / devout communities do not allow the use of computers and the internet so this might be a blocker for accessing online consultations. However, patients from these communities will still be able to access GP services through other methods.
Unless specific questions are built-in locally, generally OC solutions don’t capture religion or belief of patients, however some questions do ask for patient preference of access or contact but this is not standard.
Sexual LGBT people may benefit from the ability to use digital tools to access care Positive 6 orientation remotely. This would help reduce the likelihood of experiencing negative 6 interactions with staff associated with stigma.
4 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–63 5 Ibid 6 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–63 ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
73 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
The availability of remote access may improve the experience of care for this group. The GP Patient Survey (2019) found that gay or lesbian patients were less likely to report a positive experience of making an appointment, especially in younger age groups.
Disadvantaged Homeless people are likely to be positively impacted by digitally supported online Unknown 7 groups consultations. [homeless, People who are sleeping on the street are often only engaged by the outreach unemployed, team. The ability of outreach workers to remotely consult GPs would improve the single parents, health care received by rough sleepers who are not likely to seek care for their medical problems themselves. asylum seekers, Digitally supported access can also help homeless people overcome practical victim of domestic barriers to access and also avoid any potential negative stigmatising interactions violence] with staff.7 Young people experiencing homelessness were found to have maintained the use of internet and digital tools and therefore digital access would support their ability to access care. 8
Homeless people who are temporarily living with friends or in a hostel would benefit from digital access to care, if they have the skills and means to utilise this. They may be more distant from their GP practice as a result of living in temporary accommodation and digital access would make it easier to receive care.
7 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–63 8 VonHoltz L A H, Frasso R, Golinkoff J M, Lozano A J, Hanlon A, Dowshen N (2018). Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study. Journal of medical Internet research, vol 20, no 5, pp e184. ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
74 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
Refugees and asylum seekers who have good digital skills and have the means to access care remotely using digital solutions stand to benefit from increased flexibility and convenience in access to care.
Refugees and asylum speakers who are non-English speaking and unfamiliar with NHS care may find the questions challenging or not understand the reason for the questions. However, research suggest that online written consultations offered advantages for patients who required an interpreter and who had had a previous stigmatising reaction.9
Those experiencing modern slavery are likely to struggle to access care. They would therefore benefit from accessing care using digital tools (where they have the capacity to do so).[ seeking help- reaching out/safeguarding ?]
Access to a computer/phone with wifi or internet access? However, limited evidence to show that online consultations are freeing up phone lines for those without access to OC to contact the practice and be seen by a GP.
Need to be able to read English (none so far have comprehensive translation services).
Human Rights [how the policy/service will
9 Huxley C J, Atherton H, Anstey Watkins J (2015). Digital communication between clinician and patient and the impact on marginalised groups : a realist review in general practice. British Journal of General Practice, vol 65, no (641):, pp 638–63 ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
75 / 113 Recommendation Protected Level of impact Likely impact /mitigating action Describe how the policy/service will impact the protected and See the keys at the Group/Strands Please reference by disadvantaged groups based on the data available from local/NHS/national end of the form entering the number sources + the latest COVID 19 information. It’s important that the relevant from the list on the data is used in the analysis and referenced for robustness and relevance. If next page. the policy/service is not relevant to a group/strand then say ‘N/R’.
impact Human Rights of patients] Commented [RE1]: Need Emdad’s support to answer this one
Recommendations/mitigating actions
No Recommendation/mitigating action Which protected group/ Lead Person and Deadline/ strand does this cover Organisation Review date 1 We are aware of some work taking place at a national level on Young people NHSE/I national team Sept 2021 clinical safety to support young people (13 years old and above) to access online consultations without the need for a parent or guardian to complete on their behalf. This would bring systems in line with the minimum age used in other parts of the system, i.e. 13 years old upwards. By opening up the systems, it does require ------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
76 / 113 additional safeguarding to be in place. A co-design workshop was run in April by the national team to discuss how this might move forward with enabling access for these young people in a safe way. A task and finish group is being set up at a national level to help co- design screening questions that could be used to enhance safeguards, particularly for this patient cohort but also other vulnerable groups. The NCL team will keep in touch with the national team to keep updated
2 The national team is working on the following and NCL will remain Disability NHSE/I national team Sept 2021 in contact with them to incorporate any findings into the local approach. New framework support WCAG and considering going through testing using named testers from a list for consistent accessibility standards – NHSD/DFPC. To utilise working in partnership with other organisation for example voluntary sector and charities who support people with disability. Helping patients gain access to services they require, within a timely manner. Accessibility & usability evaluation work started in DFPC – outcome - clear guidance on what good/bad tech looks like The results of GPPS 2021 to be monitored in order to evaluate the impact of digitally supported total triage on the experience of care reported by different patient groups. Carry out patient survey to understand impact and potential mitigations for this group of patients.
3 Link with national team to understand work happening on Gender reassignment NHSE/I national team July 2021 inequalities. and NCL OC team
Establish a requirement for OC solutions to offer users an appropriate range options to describe their gender.
------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
77 / 113 Monitor the results of GPPS 2021 in order to evaluate the impact of digitally supported total triage on the experience of care reported by people who are transgender or have had gender reassignment.
4 Explore use of language tools Race/ethnicity NHSE/I national team Sept 2021 Explore processes for utilising interpreters to support remote and NCL OC team consultation Explore communication methods/channels to reach groups, to promote use and reason for triage in a way that’s meaningful and reassuring. Monitor the results of GPPS 2021 in order to evaluate the impact of digitally supported total triage on the experience of care reported by people from BAME backgrounds. Carry out patient survey to understand impact and potential mitigations for this group of patients.
5 Explore ability to capture this information at triage and explore Religion/belief NHSE/I national team Sept 2021 approach with patient groups and NCL OC team
Understand barriers to using digital/accessing healthcare and promotion of the use of digital tools to minority groups, including religious minorities.
6 The national team is working on the following and NCL will remain Sexual orientation NHSE/I national team Sept 2021 in contact with them to incorporate any findings into the local approach. Monitor the results of GPPS 2021 in order to evaluate the impact of digitally supported total triage on the experience of care reported by LGBT people. Carry out patient survey to understand impact and potential mitigations for this group of patients.
------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
78 / 113 7 The national team is working on the following and NCL will remain Disadvantaged groups NHSE/I national team Sept 2021 in contact with them to incorporate any findings into the local and NCL OC team approach. Explore development of OC supplier solutions to include remote new patient registration online. Liaise with regional homeless health programme to support promotion of digital access to primary care by homeless people or those in temporary accommodation. Engage key stakeholders in the field (main charities) to highlight the opportunities for supporting homeless people’s health using digital access to primary care. DFPC evaluation for usability & accessibility findings due in Summer 2021 Gain additional support for those where language barriers are preventing patients from accessing services. Working with local organisations to enable the support required to reduce access barriers.
Please send a copy of the EqIA with the original business case or policy for review to Emdad Haque at [email protected]
Keys explaining the impact- Positive- Evidence including the policy/service objectives indicate that this protected group/strand will benefit equally like their counterparts. It should be noted that the default policy intent of the CCG is to maximise opportunity for all groups. Negative- Evidence including the policy/service objectives indicate that this protected group/strand may not benefit and experience disadvantage compared to their counterparts. Positive/unknown- The policy/service intent is clear about the equality in access and outcomes in its objectives/goals – and evidence is required to demonstrate the actual positive impact. Negative/unknown- There is no hard evidence of likely negative impact but anecdotes and engagement outcomes suggest the likelihood of negative impact. Not relevant- The policy/service is not relevant to equality or this protected group/strand. The general rule of thumb is that all patient facing services are equality relevant.
------NCL CCG Equality Analysis (Equality Impact Assessment) Template, June 2020
79 / 113 Quality Impact Assessment
* Mandatory Fields Initiative Name* NCL Online Consultations Initiative Reference (Verto)
Ruth Evans, Jess Ratner, and Nikki Hookins Project Lead (Author)*
Impact question: 'Could the proposal have a *Positive/ NCL CCG Governing Body Risk Appetite Escalation Area of Quality positive impact (opportunity) or negative impact Neutral / *Score (Risk Management Policy) required?
Impact
(risk) on any of the following' Negative *
Likelihood
*
Compliance with the NHS Constitution, partnership working with others e.g. third sector and voluntary organisations, local councils, Information Governance Legislation, Safer We will ensure equitable, high quality services for all the people of Camden and Duty of Quality Positive 1 1 1 No Recruitment processes, Safeguarding (children or adults), will only rarely accept risks which threaten that goal. Mental Capacity Act, and other locally defined quality indicators.
Results from national and local patient experience surveys. Patient Choice, personalised and compassionate care, CMMC, Patient Experience Positive 1 1 1 No waiting times, complaints etc.
Are there systems in place to identify those who may be at risk We hold patient and staff safety as the highest priority and will not accept any risk Patient Safety of harm e.g. risk assessments, incident reporting systems, Positive 1 1 1 No that threatens either. processes to escalate concerns, clear governance processes
Evidence-based practice, clinical leadership, clinical Clinical Effectiveness Positive 1 1 1 No engagement and/or high quality standards?
Promotion of self-care, through appropriate education and Prevention Netural 1 1 1 No support, reduce variation and reduce health inequalities.
We aim to foster, and will encourage, a culture of innovation and efficiency; in so The best setting to deliver best clinical and cost-effective care; doing we are prepared to accept the concomitant risks. However, when doing so Productivity and innovation eliminating any resource inefficiencies or improving care Positive 1 1 1 No we will work within the risk appetite levels for each Service Area set out in the Risk pathways? Management Policy and will not exceed them. Vacancy - Result of staffing posts lost? Resource - Estates, IT resource, community equipment or Vacancy / Resource impact Negative 5 1 5 No other agencies or providers, e.g. social care, voluntary sector or district nursing?
Area of Quality What existing evidence (either presumed or otherwise) do you have to support positive impacts? Duty of Quality Providers offer links to local services. Patient Experience For more detailed information on the impact on protected characteristics see the completed EQIA template. 66% of patient using eConsult were satisfied with their experience (Nov 2020 report). A limited Health Watch report published in spring 2021 concluded that patients were fairly confident using technology to access GP services, however this must be only one area of a much wider and imrpved access offer for patients. Evidence that phone line burden has been reduced as new access route so potentially offers more access for people who can't access a computer and increases the number of choices for patients accessing GP services. Patient and service user experiences will be taken into account as part of the contract monitoring processes for each provider. Currently awaiting feedack from the national team on East of England questionnaire on impact of OC.
Patient Safety All suppliers are procured through frameworks and are required to provide clinical safety docs - DCB125 or DCB 60 which are available. Access to timely consultation is intended to increase patient safety, as patients are able to get quicker response to their health queries. However requests submitted over the weekend are not responded to during the weekend - there is clear signposting on product websites to explain this. There is clear information on the OC websites/practice websites to explain the response times for requests submitted over weekends to manage patient expectations. Patients don’t receive responses over weekends because practices are closed, unless the eConsults are being dealt with by extended access hubs. Furthermore, some practices have opted to switch off their OC system out of hours, which includes weekends. Patients know that they can't access the OC service during these because of information they see when they click on the product link (i.e. they are informed they cannot submit a request, and they are signposted to 111/other local services). Practices have also been advised to include clear comms on their websites explaining this too to help manage patient expectations around when these services are availalbe, and when they can expect to receive responses. GPs and practice staff have been given training and support to implement and use the OC system. There is also a process for practices to raise concerns or issues with their OC provider. There should not be an impact on the organisation's duty to protect children, young people nad adults. The system should reduce the risk of healthcare-acquired infections as it reduces the need for patients to attend the practice. It also should not impact on clinical workforce capability and skills.
Clinical Effectiveness Clinical leads were appointed across NCL and at borough level to promote and support practices/PCNs to implement online consultations. Patches, Accurx and eConsult all have clinical leads. All providers are on the procurement framework. The OC platforms differ in terms of their form structure and the ability to switch the OC services on/off easily so there may be some variation in patient experience of filling out forms and patient access to the platforms too. There is an NCL Clinical Lead appointed to oversee OC. OC supports people to stay well and encourages self-care by re-directing patients to relevant information and services outside of primary care if appropriate. OC means that more patients can be treated virtually or online and so reduces the necessity for patients to come into the practice. Care pathways have been created by providers in order to ensure patients are being appropriately triaged and treated.
Prevention Promotes self-care as not automatically offered an appointment and signposted to other supports as necessary e.g. health education and other providers. Can access links to self-care and local services when out of hours. There isn't any evidence yet that it's reducing self-referrals, however evidence shows that it's reducing the admin burden e.g. sick notes. Potentially does not reduce inequalities for some groups of patients as relies on patients to have access to a computer and being able to read English. It is thought to be better for people who are working, can't get to the GP surgery etc. Productivity and innovation Potentially reduces the workload for GPs as referrals are triaged and carried out online, fewer people offered face to face appointments and improve pathways also signposts people to other services so minimises inappropriate appointments. Providers review of the pathways and templates regularly and are continuously updated. All platforms are relatively new and are adaptable and flexible to meet needs of the ICS/practices.
Area of Quality What actions will you take to mitigate negative impacts? Vacancy / Resource impact No impact on staffing. Implications on IT resources to download relevant OC software onto GP practices' computers. Resource to manage roll out and contract management
Signed-off: Senior Responsible Officer (normally Director level)*
Signed-off: Clinically Responsible Officer (normally GB member)
N:\IslingtonCCG\NCLCorporateServices\NCL CCG\NCL CCG Meetings\PCCC Meetings\2021\11. 17 June 21\part 1\word\; 2.3c - Completed OC QIA template v0.5 280521; Quality Impact Assessment 80 / 113
OFFICIAL
North Central London CCG Primary Care Commissioning Committee Thursday 17 June 2021
Report Title Commissioning Date of 7 June 2021 Agenda 3.1 Decisions on PMS report Item Agreement Changes
Lead Director / Paul Sinden, NCL Chief Email / Tel [email protected] Manager Operating Officer
GB Member Not Applicable Sponsor Report Author GP Commissioning & Email / Tel [email protected] Contracting Team Name of Not Applicable Summary of Financial Implications Authorising Finance Lead Not Applicable Report Summary Detail of the request to vary PMS Agreements and any conditions to be applied Recommendation The Committee is asked to NOTE one change and where indicated to APPROVE the proposed changes outlined below and any conditions
Identified Risks Not maintaining the stability of the agreement. The risk can be mitigated by and Risk approving the variations with appropriate conditions. Management Actions Conflicts of Not Applicable Interest Resource Not Applicable Implications Engagement Not Applicable
Equality Impact Not Applicable Analysis Report History Not Applicable and Key Decisions Next Steps Issue appropriate variations with conditions where applicable
Appendices Not Applicable
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OFFICIAL
Contents
Contents ...... 2 1 Executive summary ...... 3 2 Background ...... 3 3 Appointment benchmarking ...... 3 4 Table of requested PMS Agreement Changes ...... 4
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OFFICIAL
1 Executive summary
The below table summarises the Agreement Changes requested by PMS Practices in NCL. Committee members are asked to make determination for the PMS Agreement Changes in their area.
2 Background
PMS practices are required to submit agreement change requests with 28 days’ notice to allow the commissioner to consider the appropriateness of the request. The Commissioner should be satisfied that the arrangements for continuity of service provision to the registered population covered within the agreement are robust and may wish to seek written assurances of the post-variation individuals ability and capacity to fulfil the obligations of the agreement and their proposals for the future of the service.
3 Appointment benchmarking
As a part of the due diligence undertaken when assessing PMS Practices’ requests to vary the PMS Agreement, the number of GP appointments offered by the Practice is assessed. All weekly GP appointments (face to face, telephone, home visit) are totalled and compared to the benchmark of 72 appointments per 1000 patients per week. This figure is a requirement in all new Standard London APMS contracts and is described in the BMA document Safe working in general practice1 as developed by NHS England via McKinsey but widely accepted.
Where Practices do not meet the 72 GP appointments per 1000 patients Commissioners will seek to work with the provider to increase access.
1 https://www.bma.org.uk/- /media/files/pdfs/working%20for%20change/negotiating%20for%20the%20profession/general%20prac titioners/20160684-gp-safe%20working-and-locality-hubs.pdf
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OFFICIAL
4 Table of requested PMS Agreement Changes
Practice Borough List Size PCN Agreement Comment Recommendati location 01/04/21 membership Change Recommended guide based on: on to 72 GP appointments per 1000 patients committee Apps x 10 min (app) / 180 (3 hour session) F85675 Haringey 5620 Practice is a Removal of Dr N To note to the committee of the sad passing of To note Alexandra member of Sinvananthan Dr Nalliah Sivananthan on 20 April 21 leaving Dr Surgery Haringey – West Atheetha Sinvananthan as a single-hander on Central the PMS agreement. comprising of: 4 Practice with a PCC team is currently working with the practice combined list size to support and advise as required. of 29,461 as of 01/04/2021
F85002 Medicus Enfield 90949 Practice is a Removal of Dr Dr Arundeep Hansi has requested to be To approve Health Partners (14 sites) member of Arundeep Hansi removed from the PMS Agreement held by (MHP) Enfield Unity from PMS Medicus Health Partners with effect from PCN, Agreement 19/06/21. Thirty five partners remain on the comprising: agreement. 10 Practices 158428 patients Clinical sessions/Appointments provided at 01/04/21 6910 GP appointments per week 3152 nurse appointments per week
GP and nurse sessions not listed but practice inform that they will deliver the same configuration of appointments and services currently offered to registered patients with Partners and Salaried GPs covering Dr Hansi’s sessions until a new post is in place (post already advertised).
Recommended Guide (for all sites) 6549 GP appointments per week 345 GP sessions per week
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OFFICIAL
Practice Borough List Size PCN Agreement Comment Recommendati location 01/04/21 membership Change Recommended guide based on: on to 72 GP appointments per 1000 patients committee Apps x 10 min (app) / 180 (3 hour session) 2911 nurse appointments per week 154 nurse sessions per week
Provision of GP and nurse appointments meets requirements.
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North Central London CCG Primary Care Commissioning Committee 17 June 2021
Report Title Primary Care Networks – Date of 7 June 2021 Agenda 3.2 Proposals for report Item Organisational and Membership Changes
Lead Director / Paul Sinden Email / Tel [email protected] Manager
GB Member Sponsor Report Author Anthony Marks Email / Tel [email protected]
Name of Summary of Financial Implications Authorising Finance Lead The overall budgets allocated to PCNs will not be affected, but as PCN funding is allocated on the basis of practice list sizes. However, any changes to PCN composition approved by the commissioner will result in changes to financial allocations to the respective PCNs.
Report Summary This paper summarises proposals put forward by NCL’s primary care networks (PCNs) as part of the annual process for PCNs and commissioners to confirm any proposed changes. The proposals put forward in NCL are: 1. Proposed changes to practice and PCN membership: Four proposed changes to core membership in Camden;
Context Proposed changes to PCN membership are expected to be confirmed as part of the annual process for practices confirming participation in the Network Contract DES. The guidance for 2021/22 has been updated with the new DES Directions coming into force from 1 April 2021.
All NCL PCNs were previously approved via borough-based panels, at the time of their formation, and confirmed by NCL’s Primary Care Committee in Common (May 2019).
Where a PCN has been previously approved and one of the following scenarios, applies: a. a Core Network Practice from another PCN joining; and/or b. a non-participating practice joining; and/or c. a New Practice joining; and/or d. a Core Network Practice opting out of participating,
86 / 113 practices are required to seek approval of the proposed changes, completing the Network Contract DES Participation and Notification Form, submitting it to the commissioner. Commissioners will consider all the information provided and confirm to the PCN as soon as possible (at the latest, within one month of receipt of the notification) whether or not the practices’ participation in the Network Contract DES is confirmed. Commissioners are not required to wait for 100 per cent geographical coverage in order to approve Core Network Practice participation and PCN continuation or formation.
Commissioners are required to maintain accurate records of all PCN Core Network Practice membership approvals and rejections and will be required to demonstrate if requested, the rationale for their decision.
The Core Network Practice membership of a PCN must cover a Network Area that aligns with a footprint that would best support delivery of services to patients in the context of the relevant Integrated Care System (ICS) strategy. The Network Area is expected to: a. cover a boundary that makes sense to: i. the Core Network Practices of the PCN; ii. other community-based providers which configure their teams accordingly; and iii. the local community; b. cover a geographically contiguous area; c. not cross Clinical Commissioning Group (CCG), STP or ICS boundaries except where: i. a Core Network Practice’s boundary or branch surgery crosses the relevant boundaries; or ii. the Core Network Practices are situated in different CCGs.
NCL Proposals Camden: summary of proposed change a) West Camden PCN (list size increases from 28,956 to 30,144) - Abbey Medical Centre join - Cholmley Gardens Medical Practice exit - Fortune Green Practice exit
b) Central Hampstead (list size decreases from 33,927 to 32,739) - Abbey Medical Centre exit - Cholmley Gardens Medical Practice join - Fortune Green Practice join
c) South Camden (PCN list size drops from 36,828 to 29,895) - Brunswick Medical Centre exit
d) Central Camden (list size increases from 63,002 to 69,935) - Brunswick Medical Centre join
All changes above keep PCN formations geographically aligned.
Recommendation The Committee is asked to consider the proposals and CONFIRM the proposed changes to PCNs in North Central London.
Identified Risks Commissioners are not required to approve proposed changes to PCNs, but are and Risk asked to confirm any proposed changes. The key risks associated with changes to PCNs are: Management - Risk of reduced integration with other services, including with other Actions PCNs - Financial risk e.g. use of PCN funding for additional workforce - Risk to existing services e.g. vaccination programme
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While commissioners are asked to confirm the proposed changes, rather than approve, the CCG may want to continue to monitor these risks through: - PCN and Investment and Infrastructure Dashboard (national) and delivery of the PCN DES specifications - Recruitment to PCN additional roles (via workforce returns and planning) - Progress in first and second covid vaccination doses
Conflicts of Not Applicable Interest Resource Not Applicable Implications Engagement Where PCNs have proposed changes, the specifics in local engagement are described in their individual proposals. Equality Impact Not Applicable Analysis Report History Not Applicable and Key Decisions Next Steps Confirm proposals and communicate to respective PCNs Report for information to PCCC
Appendices None
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North Central London CCG Primary Care Commissioning Committee 17 June 2021
Report Title Islington GP Group – Date of 7 June 2021 Agenda 3.3 caretaking contract report Item extension
Lead Director / Clare Henderson Email / Tel [email protected] Manager
GB Member Sponsor Report Author Anthony Marks Email / Tel [email protected]
Name of Tracey Lewis, Summary of Financial Implications Authorising Head of Finance Contract continues to funded at the current rate Finance Lead Rebecca Booker, Director of Finance Report Summary The report sets out the case for the extension of the current caretaking arrangements until 31 January 2022. The current contract expires on 31 October 2021. The report also provides Committee with requested assurance regarding the Practice list growth and potential for growth over 15 years (from 2018).
With the continued pressures on Primary Care and the COVID response, it is thought that a full and open procurement is not feasible by 31 October 2021. Commissioners are therefore recommending that the contract be extended until 31 January 2022 with provision for further 3 month extensions should there be a requirement to delay until such time that a procurement can successfully conclude.
The Practice is in a purpose built health centre in an area with significant deprivation. It has historically had void space and the borough team are working with local partners and the South Islington PCN to maximise the use of the space. It is a Community Health Partnerships building and so a fixed point within the system with the CCG bearing the cost of voids. There is a focus across NCL on maximising the use of CHP buildings.
Barnsbury Medical Practice is the nearest GP practice in Islington to the Kings Cross Development in Camden. Whilst patients have historically stayed in borough boundaries significant investment has been made in the development to open up new or more pleasant routes through this area which may have led to more residents willing to cross the Camden/Islington border to access primary care.
Camden and Islington Public Health surmise that population growth in the Kings Cross and Barnsbury Medical Practice area is projected at 11,400 over 15 years. Most patients are likely to register in this area with a smaller number registering with practices outside the area. The land between Barnsbury Medical Practice
89 / 113 and Kings Cross Surgery was until recently largely disused railway lands which is now high density housing. Improved access routes in the area suggest that patients will exercise greater choice in local practices which will likely see growth in the Barnsbury Medical Practice list size.
There are 12 practices within 1 mile of the Kings Cross development site (based on the N1C postcode), whilst it is unlikely that they would receive an even spread of patients registering, each practice list size could increase by 950 patients.
The list sizes in the same Primary Care Network declined during 2020 however Barnsbury Medical Practice list grew over the same period. It is currently at a 5 year high of 3,488 growing 246 or 7%. At this rate the list would reach 6,000 in 8 years however this is without the anticipated growth from the Kings Cross development or nearby Caledonian Road development which could see the practice register an additional 1,800 patients across both developments.
Recommendation The Committee is asked to APPROVE the:
Extension of the caretaking contract provided by Islington GP Group Limited at Barnsbury Medical Practice until 31 January 2022
The Committee is also asked to NOTE the projected list growth for the practice
Identified Risks Failure to extend the contract will result in lack of Primary Care access for 3,488 and Risk patients which would have a significant impact on local practices if patients re- Management registered.
Actions Risk can be avoided by extension of the current contract.
Conflicts of Not Applicable Interest
Resource Contract continues to funded at current rate Implications
Engagement Not Applicable
Equality Impact Not Applicable Analysis Report History and October 2019 Key Decisions Termination of the GMS contract approved by PCCC Procurement of an APMS contract approved by PCCC
December 2019 Approval by PCCC to procure a caretaking contract until 30 June 2020 whilst a full APMS procurement is undertaken
February 2021 Commencement of caretaking and extension until 31 October 2021. Use of two additional rooms to increase clinical capacity
Next Steps Issue contract variation notice
Appendices Not Applicable
90 / 113 1.0 Recommendation
The Committee members are asked to approve the extension of the caretaking contract provided by Islington GP Group Limited at Barnsbury Medical Practice until 31 January 2022
Further assurance is provide on the potential for list growth for Barnsbury Medical Practice.
2.0 Background
Following enactment of the termination of the GMS contract at Barnsbury Medical Practice, Islington GP Group limited commence a caretaking APMS contract at the practice on 19 January 2021. The initial term of 6 months was extended until 31 October 2021. It is now though unlikely that a procurement can be successfully completed by this time and Commissioners are seeking to extend for a further 3 months as permitted under the contract.
In December 2019 Committee approved the recommendation to procure an APMS contract for the patient list at Barnsbury Medical Practice. This was held in abeyance whilst the legal dispute was resolved over the termination of the GMS contract.
The Practice is in a purpose built health centre in an area with significant deprivation. It has historically had void space and the borough team are working with local partners and the South Islington PCN to maximise the use of the space. It is a Community Health Partnerships building and so a fixed point within the system with the CCG bearing the cost of voids. There is a focus across NCL on maximising the use of CHP buildings.
3.0 List growth at the Practice
The patient list at Barnsbury Medical Practice has grown over the past five years and currently is at its highest point. The list has grown throughout 2020 when there was a decline in the overall list size of the South Network PCN of which the practice is a member. The PCN has subsequently grown again and the tables below show the comparison.
Table 1 Barnsbury Medical Practice List Size
Year Apr Jul Oct Jan 2016 3027 3036 3051 3102 2017 3083 3076 3082 3073 2018 3041 3050 3040 3070 2019 3109 3124 3188 3195 2020 3242 3267 3352 3414 2021 3488 - - -
91 / 113 Figure 1 Barnsbury Medical Practice list graph Practice List Size 4500
4000
3500
3000
2500 Weighted 2000 List Sizes
1500 Raw List 1000 Sizes
500
0
Figure 2 South Network PCN list graph PCN List Size 70000
69500
69000
68500 Raw List 68000 Size 67500
67000 Weighted List Size 66500
66000
65500
Near to the Practice, two large residential developments are starting on the nearby Caledonian Road. One development is on the site of the former HS1 yard immediately south of the North London Line where it crosses Caledonian Road (351 Caledonian Road; 156 homes, approximately 310 residents), and another across two sites to the north and south of Brewery Road at the junction with Caledonian Road (423-425 Caledonian Road; 252 homes,
92 / 113 approximately 500 residents). These developments are in addition to the larger development at Kings Cross.
Figure 3 shows a map of Camden and Islington with the King’s Cross and Barnsbury practices’ area outlined in red. Population growth using the GLA 2018 housing-led population projections at middle super output area level (MSOA, which is a geographical area with an average population of 7,200). New potential housing developments identified after the Strategic Housing Land Availability Assessment (which informs the GLA population projections) was last updated are shown with black markers. Note that population projections describe people whilst housing developments describe homes. This is because the latter are further behind in the development process and housing size is more uncertain.
Overall population growth from the GLA projections in the King’s Cross Surgery and Barnsbury Medical Practices’ area suggest that over the next 15 years there will be a further 8,400 residents, although as shown above, not all residents register at the nearest practice.
Additionally, two other practices (Somers Town Medical Centre and Killick Street Health Centre) are located within the same area.
Figure 3: Population growth and new housing development to 2036
Source: GLA 2018 housing-led population projections, Camden Council Planning Department, Islington Council Planning Department. Contains OS data © Crown copyright and database right 2018
4.0 Next steps
Issue contract extension
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North Central London CCG Primary Care Commissioning Committee 17 June 2021
Report Title Vale Practice – increase Date of 7 June 2021 Agenda 3.4 in rent reimbursement report Item
Lead Director / Owen Sloman Email / Tel [email protected] Manager
GB Member Sponsor Report Author Anthony Marks Email / Tel [email protected]
Name of Tracey Lewis, Head of Summary of Financial Implications Authorising Finance The current rent will increase from £223,000 to Finance Lead Rebecca Booker, £242,250 Director of Finance
Report Summary This report sets out the case for the approval of a number of works at the Practice to take place which improve the premises and result in an increase rent reimbursement once the new lease begins on October 2021.
The Vale Practice is in purpose built premises in Crouch End, Haringey. The GMS contract is held by three partners with a list size of 10,870 (April 2021). The current Practice lease is for another 2 years and is being reimbursed at £223,000 per annum. The lease is fully repairing insurance (FRI) lease requiring that the tenants hold responsibility for the cost of all the repairs and upkeep of the property and also the cost of buildings insurance.
The private landlord has agreed a list of works to be undertaken at the Practice with a completion date of 1 October 2021. The works are Staff toilets – to fix issue of poor run off and occasional flooding. Install new WC’s and wash hand basins. Patient toilets – WCs to be provided with new ventilation to corridor and WC’s. Ceiling Leaks – water egress from residential apartments above Ceiling tiles replaced. All Clinical Rooms – Update all clinical rooms with new vinyl flooring, HTM64 Compliant wall mounted basins on IPS panelling with lever taps, new LED lighting throughout and new ash veneer fire doors and ironmongery throughout. Staff and Circulation Space – Refurbished areas with new carpeting, LEDs throughout and new signage wayfinding system. Heating/Circulation – Package of works including recommissioning all thermostats to the wet system and new air source heating system to 2 consulting rooms.
94 / 113 The landlord has proposed a new lease for 25 years to commence once the works are completed in October 2021. The new rental reimbursement value agreed by the District Valuer (DV) is £242,250 (including FRI):
CURRENT NEW
CMR £188,000.00 £204,250.00
Lease Rent £175.000.00 £190.000.00
VAT £35,000.00 £38,000.00
FRI £13,000.00 £14,250.00
Total reimbursable £223,000.00 £242,250.00
The lease will have three yearly rent reviews.
Commissioners will write to the Practice to confirm FRI responsibility and seek assurance on the yearly actions taken by the Practice to repair and insure the building.
Recommendation The Committee is asked to APPROVE the:
List of proposed works and the new rent reimbursement of £242,250 per annum
Identified Risks Failure to agree the list of works and new rent value will leave the Practice with a and Risk number of areas requiring timely remedial work. Management Risk can be avoided by agreeing the works and commencing the new lease Actions once they are complete
Conflicts of Not Applicable Interest
Resource The current rent will increase from £223,000 to £242,250 Implications
Engagement Not Applicable
Equality Impact Not Applicable Analysis Report History and Not Applicable Key Decisions
Next Steps Confirm the Committee approval to the Practice and seek assurances on FRI responsibilities
Appendices Not Applicable
95 / 113 1.0 Recommendation
The Committee is asked to approve the list of works that the landlord has proposed and the new rent reimbursement value of £242,250 which the District Valuer (DV) has approved. The new 25 year lease will start when the improvement works are complete in October 2021.
2.0 Background
The Vale Practice is in purpose built premises in Crouch End, Haringey. The GMS contract is held by three partners with a list size of 10,870 (April 2021).
The current Practice lease is is due to expire in June 2023 and is being reimbursed at £223,000 per annum. The lease is fully repairing insurance (FRI) lease requiring that the tenants hold responsibility for the cost of all the repairs and upkeep of the property and also the cost of buildings insurance.
The building has a number of issues that the landlord will address through the works listed below.
• Staff toilets – to fix issue of poor run off and occasional flooding. Install new WC’s and wash hand basins. • Patient toilets – WCs to be provided with new ventilation to corridor and WC’s. • Ceiling Leaks – water egress from residential apartments above Ceiling tiles replaced. • All Clinical Rooms – Update all clinical rooms with new vinyl flooring, HTM64 Compliant wall mounted basins on IPS panelling with lever taps, new LED lighting throughout and new ash veneer fire doors and ironmongery throughout. • Staff and Circulation Space – Refurbished areas with new carpeting, LEDs throughout and new signage wayfinding system. • Heating/Circulation – Package of works including recommissioning all thermostats to the wet system and new air source heating system to 2 consulting rooms.
Upon completion of the works anew 25 year lease will be signed with an initial reimbursable value of £242,250 per annum. The lease will continue to be FRI and the Commissioners will seek annual assurance from the Practice regarding their responsibilities undertaken as tenants.
3.0 Next steps
Confirm the Committee approval to the Practice and seek assurances on FRI responsibilities
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North Central London CCG Primary Care Commissioning Committee 17 June 2021
Report Title St Ann’s Road Surgery - Date of 7 June Agenda 3.5 taking void space in the report 2021 Item Laurels
Lead Director / Rachel Lissauer Email / Tel [email protected] Manager
GB Member Sponsor Report Author Angela Kindrat Email / Tel [email protected]
Name of Rebecca Booker, Summary of Financial Implications Authorising Director of Financial Finance Lead Management The estimated increase in the current market rent to the delegated budget is £26,371
Report Summary Committee members are asked to consider the request from St Ann’s Road Surgery for additional space within the Laurels Healthy Living Centre.
The APMS contract is held by AT Medics Ltd and the Practice has a list size of 15,178 patients (1st April 2021)
Negotiations with the landlord and the Practice by the CCG have meant that there is only one void room left in the Laurels Healthy Living Centre.
St Ann’s Road Surgery is based in the building and its administrative offices are on the same corridor and has agreed to take the space. The Practice will use the room for telephone and digital appointments, freeing up clinical rooms for more face to face appointments for the Practice. The Practice will also make the facility open to PCN additional roles staff.
Currently the Practice occupies 443m2 space at the Laurels Healthy Living Centre, which includes 10 consultation rooms and 2 treatment rooms at current market rent (CMR) of £200,751. The proposed new space is 63.64m2.
Revenue change
The estimated increase in the CMR to the delegated budget is £26,371 of which will need to be verified by the district valuer if approved by PCCC members.
Current rent of existing space £200,751 Rent for the proposed new space £26,371 Total new rent from the existing and additional space £227,122
97 / 113
Triggers for the request from the Practice for the additional space:
1. To expand workforce to include a teaching hub
2. To accommodate the digital operational team as the Practice has uncapped access on the patient app. DrIQ
3. To enable processing of administration and clinical work load to free up staff to take calls and patient focussed at the front desk
4. The Practice has an open catchment area
5. Requirement for space for 2 admin staff and 3-4 clinical staff to manage DrIQ appointments.
6. Accommodation for PCN staff appointed via ARRS funding –and at least 3 additional dedicated workstations for PCN staff.
7. To enable the Practice to meet population growth
Using the DH HBN estimator, the calculation indicates that the Practice requires 11 clinical rooms with a room ratio of 1 room: 1379 patients. This is based on providing 1821 GP & Nurse appointments per week (1,457 GP appointments and 364 Nurse appointments).
Currently the Practice occupies 10 consultation rooms and 2 treatment rooms, and provides a ratio of 1 room: 1264. Committee members have approved lower ratios for previous schemes at 1 room: 1000 patients.
The Practice has not confirmed the number of GP appointments provided at this time. Currently the Practice provide 400 nurse appointments.
The Practice has 5 GP’s, 2 nurses, 3 pharmacists, 1 physician associate and 1 HCA working from the current premises.
Committee members are asked to note that the Practice has experienced significant list size growth of 15.5% over the past three years.
Recommendation Commissioners are requesting committee members to APPROVE;
1. Occupation of the vacant space (1 room) at the Laurels
2. Increase in the rent to the delegated budget of £26,371
The approval is on condition that, commissioners will instruct the DV to verify the cost per square metre and increase in rent
Identified Risks Not Applicable and Risk Management Actions Conflicts of Not Applicable Interest Resource Increase in rent of £26,371 but this will offset the void space cost the CCG is Implications currently paying
98 / 113 Engagement Commissioners do not anticipate disruption to patient’s services and therefore engagement is not required Equality Impact There is no change to service provision and where it is delivered from therefore Analysis an equality impact assessment was not carried out Report History and This case has not been considered by PCCC members Key Decisions Next Steps If approved by committee members the District Valuer will be instructed to verify the increase in rent Appendices None.
99 / 113 Background
The Laurels Healthy Living Centre building in south Tottenham is managed by NHS Property Services. The building has had void space for some time. The CCG Borough teams have been working with the landlord and Practice to fill the void space and this was a key priority. St Ann’s Road Surgery has agreed to take the remaining room and to increase clinical capacity and appointments for the Practice.
Space requested
The space requested would be the remaining one large room available, (63.64m2) which is on the same corridor at St Ann’s Road Surgery’s administration are currently accommodated.
For consistency, Commissioners have assessed practice space requirements using the Department of Health (DH) Health Building Notes Estimator (HBN). This tool calculates (1) 80% utilisation of the patient list, (2) 6 contacts per annum, (3) 15 minute consultations and (4) number of appointments per week, which exceeds the BMA guidance of 72 GP and 32 nursing appointments per week, which allows for a wider workforce operating in the Practice.
The Practice currently occupies 12 clinical rooms at a ratio of 1 room: 1264 and the DH HBN estimator calculates the Practice requires 11 clinical rooms (1 room: 1379 patients).
Commissioners deem the Practice have a need for the additional space due to the continued growth in the registered list size by 15% over three years.
Financial Year List Size (April) % increase
18-19 13,144
19-20 14, 108 7.33%
20-21 15,178 7.58%
Increase in 20-21 compared to 15.47% 18-19
The CCG is also already paying void space cost for the room therefore the increase in rent will offset this cost.
Benefits
St Ann’s Road Surgery has had historically high rates of A&E attendances per head. Improving access is therefore critical. The new space would allow clinicians to make calls and carry out video consultations, and would also free up clinical rooms for face to face appointments.
PCN staff would also use the additional room. This would be helpful to smaller practices in the PCN who may not have the facilities to accommodate the staff.
Financial implications
The proposed new space is 63.64 m2, which will increase the rent by £26,371 per annum.
Currently the Practice occupies 443m2 space at the Laurels, at a current market rent (CMR) of £200,751per annum.
The total new rent from the existing and additional space would increase to £227,122 per annum.
100 / 113 The change and the increase in rent would need to be assessed by the district valuer.
Patient Engagement and Equality Impact assessment
Patient and Stakeholder views, including an equality impact assessment was not carried out because the Practice will continue to operate from the same premises and there will be no change to service delivery.
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North Central London CCG Primary Care Commissioning Committee Meeting 17 June 2021
Report Title Primary Care Date of 7 June 2021 Agenda 5.1 Commissioning report Item Committee Risk Register Lead Director / Paul Sinden, Email / Tel [email protected] Manager NCL Chief Operating Officer GB Member Not Applicable Sponsor Report Author Chipo Kazoka Email / Tel [email protected] Governance and Risk Lead
Name of Not Applicable Summary of Financial Implications Authorising Finance Lead This report assists the CCG in managing its most significant financial risks.
Report Summary This report provides an overview of material risks falling within the remit of the Primary Care Commissioning Committee (‘Committee’) of North Central London CCG.
There are 5 risks on the Committee Risk Register. Since the last meeting 2 risks have closed and the risk rating of the remaining 5 have not changed. 1 risk is below the threshold but, due to its significance to the COVID-19 pandemic response, it is included in the Risk Register for information purposes.
Key Highlights:
PERF4: Opportunities to support struggling practices are sometimes delayed by the absence of a systematic early warning system (Threat): This risk is a response to regulatory action that has been taken with a series of practices recently following “inadequate” or “requires improvement” ratings following Care Quality Commission (CQC) inspections. Action in some cases has included having to put in place caretaking arrangements at practices at very short notice.
The aim of the risk mitigation is to promote earlier recognition of struggling practices, and ensure that support is provided before regulatory action is required. The workforce and resilience workstream for primary care recovery has a focus on supporting, and early identification of, struggling practices.
The NCL financial resilience package for practices to cover the impact of the COVID-19 pandemic, in place since April 2020, is in line with national guidance published in August 2020. The resilience package aims to mitigate the impact of the COVID-19 pandemic, and had been extended to cover all of 2020/21. Support is based on income protection where practices are unable to complete income generating work due to the pandemic (Quality Outcomes Framework, Locally
102 / 113 Commissioned Services) and to offset additional costs incurred including cover for staff absence and personal protective equipment.
The financial resilience package forms part of the local support offer to practices with other aspects including a central clinical triage and home visiting service to treat COVID-19 positive patients separately, training for infection prevention control, and weekly practice webinars.
The package for 2021/22 has been developed in line with planning guidance, and initially will be in place for Quarters one and two.
The Primary Care SITREP reporting, in place since November 2020, has been paused based on a low level of reporting of concerns from practices. Practices are still being supported with funding via the Capacity Expansion Fund. The North Central London allocation of the funding is £4.11million. This equates to £2.58 per patient across NCL. NCL CCG will release this funding to practices in two tranches, with the first being released in January 2021.
This risk is rated 12.
PERF15: Failure to address variation in Primary Care Quality and Performance across NCL (Threat): Mitigations in place to help reduce unwarranted variation in quality and performance across general practices include: Plans to further develop Primary Care Networks (PCNs) through the introduction of the service specifications in the Direct Enhanced Service (DES) for 2020/21 and 2021/22. These are available to provide development support for Clinical Directors; The use of GP Forward View monies from NHS England to support the development of primary care networks and GP Federations, and to develop a resilience programme for general practice; The introduction, via the new GP contract, of a greater quality improvement focus in the practice level Quality Outcomes Framework incentive scheme and under the new Investment and Impact Fund incentive scheme - introduced to reward PCNs for delivering against the NHS Long Term Plan; The establishment of models for mutual aid across practices during COVID-19, including hot site and home visiting service and training for practices in managing COVID-19 patients; Ongoing work to develop the GP Provider Alliance and a unified primary care provider voice within the NCL integrated care system.
This risk is rated 12.
PERF18: Primary care workforce development (Threat): The updated GP contract for 2021/22 continues to emphasise the importance of funding and flexibility for workforce development and includes: An increase in the national funding for the Additional Roles Reimbursement Scheme to help secure 15,500 whole time equivalent (WTE) roles to be deployed by end of 2021/22; More roles added to the Scheme (which now includes paramedics, and mental health practitioners as well as pharmacy technicians, dieticians, care coordinators, health coaches, podiatrists, occupational therapists and nursing associates/trainee nursing associates); Every PCN becoming entitled to a fully embedded WTE mental health practitioner, employed and provided as a service by the PCN's local provider of community mental health services; Introduction of an inner and outer London maximum reimbursement rate;
103 / 113 Further flexibility in the Scheme’s rules, including the ability to employ staff at an advanced practitioner designation (clinical pharmacist, physio, occupational therapist, dietician, podiatrist and paramedic); The extension of the window to transfer any clinical pharmacists funded under the previous NHSE scheme to move to the PCN scheme; The expectation that CCGs and systems will explore different ways of supporting PCNs to recruit; PCNs’ continuing to recruit to these roles and supported by Training Hubs with induction and professional development; Further funding for the PCN Clinical Director support up to June 2021 in addition to the COVID capacity expansion fund; Measures to support GP training, recruitment and retention, to help deliver 6,000 more doctors in primary care (£94m to address recruitment and retention issues, including Partnership Premium of £20,000; greater proportion of GP training time spent in general practice) NCL Training Hub is developing a Primary care nursing strategy and have engaged with relevant stakeholders as part of this.
Given the high demand on the Primary Care workforce during the pandemic, the CCG will have to monitor the impact on wellbeing and fatigue.
This risk is rated 12.
COVID11: Trust and Confidence of Member Practices (Threat): This risk has been mitigated to date through the use of weekly webinars with practices, the use of twice weekly GP Bulletins to distil national guidance, and updates to the GP Website. A Primary Care COVID-19 meeting has also been established with clinical commissioning leads to agree service models and resilience support to address the COVID-19 pandemic.
A primary care vaccination steering group has been established with providers as part of the general practice COVID-19 vaccination programme, and a weekly call is held with commissioning leads.
A new single GP website has been launched to replace the individual borough websites. This provides information to practices, such as clinical guidelines/ pathways, education and training events etc.
This risk is rated 8. This risk is below the threshold but, due to its significance to the COVID-19 pandemic response it is included.
COVID12: Capacity in General Practice (Threat): Actions to ensure that there is sufficient capacity in general practice to manage demand include: Increasing availability of staff testing for General Practice in order to reduce absences due to suspected COVID-19; GP practices using the "telephone first" model where the majority of consultations will be carried out on the phone – with face to face being offered where it is clinically appropriate. GP Federations leading in providing GPs with equipment and remote access to the Egton Medical Information Systems (EMIS) in order to allow them to work remotely to provide these consultations; The returning of staff (retirees) to General Practice; NCL-wide acute Covid support service being put in place - provided by the 6 NCL GP federations. The offering of senior clinician triage, advice and guidance on management of Covid patients and supporting step down of patients who are on the oximetry at home pathway; The development of service triggers to scale COVID-19 services up and down in line with symptom levels; Practice 'buddying' arrangements via their Primary Care Networks;
104 / 113 The receipt of the £4.1m capacity fund for general practice to maintain capacity during delivery of the COVID-19 vaccination programme, with all funds to go to general practice to support service priorities, including: supporting patients with Long COVID-19; establishment of systems for remote monitoring of patients, including pulse oximetry; supporting clinically extremely vulnerable patients and maintaining the shielding list; addressing the backlog of appointments, including those for chronic disease management and routine vaccinations and immunisations; making progress (in addressing inequalities) on learning disability health checks and actions to improve ethnicity data recording in GP records and; potentially offering backfill for staff absences where this is agreed by the CCG, is required to meet demand, and the individuals concerned are not able to work remotely. The national announcement that the GP Covid capacity fund will be extended up to September 2021.
However, GP capacity is being impacted by workforce burnout / tiredness, pent up demand for general practice services, and due to demands of system recovery.
This risk is rated 12.
Closed Risks: The following risks have been closed since the last Committee meeting.
PERF9: Inadequate support from Primary Care Support England (Capita contract) for general practices (Threat): The 3 year list cleansing programme commenced in January 2019. The cohorts are listed below and preliminary commencement dates for NCL Boroughs were between June 2020 and June 2021. Primary Care Support England (‘PCSE’) had been instructed by NHSE/I to pause the list cleansing programme in March 2020, due to the COVID-19 Pandemic response, and it restarted in July 2020.
The 6 patient cohort lists are:
Patients registered over 100 years of age. Under 16 and sole occupant at address following the removal of an adult. Houses of multiple occupancy (10 or more registered residents). Transient Patients. Patients living at an address flagged as demolished on the Post Office Address File. Students who have been registered for four or more years.
Capita have provided an up to date position for NCL CCG on 4th June 2021, as follows:
There is a national list cleansing programme for patients aged over 100 and patients registered living at a demolished address. As such, all boroughs are being targeted in this area based on the following schedule: List cleansing for patients aged over 100 was run in November 2020. Due to a request from NHS England to pause list cleaning activities, due to the Covid response, list cleansing was not run for this cohort in May 2020 and May 2021; Demolished properties list cleansing was run in January, July and Oct 2020. Due to Covid, it was not run in April 2020, January 2021 or April 2021.
In relation to the Multiple Occupancy cohort: Barnet was due to be run in January 2021 but due to Covid the list cleansing was paused at the request of NHSE and was not run;
105 / 113 In Camden, list cleansing was run in September 2020; In Haringey list cleansing was run in January 2020; For the Enfield and Islington Multiple Occupancy cohorts no run has yet been scheduled.
In relation to the Transient’s populations cohort: Camden & Haringey list cleansing was run in January to March 2020 and July to December 2020. It was paused from April to June 2020 due to Covid. In 2021, it was commenced again and ran from January to April before being paused again. Enfield, Barnet and Islington Transient Population list cleansing is not scheduled to be run yet.
In relation to the Transient’s populations cohort: Camden & Haringey list cleansing was run in January to March 2020 and July to December 2020. It was paused from April to June 2020 due to Covid. In 2021, it was commenced again and ran from January to April before being paused again. Enfield, Barnet and Islington Transient Population list cleansing is not scheduled to be run yet.
List cleansing has commenced in NCL and is well underway. No negative consequences have been identified for GP practices. The contract is held by NHS England, and therefore should this risk re-emerge we have contractual levers to continue to manage the risk. As such this risk has been mitigated and is therefore closed.
COVID14: Lack of Personal Protective Equipment in General Practice (Threat): The lack of PPE is no longer deemed to be a risk for general practice. As such, this risk is now closed. Recommendation The Committee is asked to NOTE the report and the risk register, provide feedback on the risks included, and, identify if there are any new or additional strategic risks.
Identified Risks The risk register will be a standing item for each meeting of the Committee. and Risk Management Actions Conflicts of Conflicts of interest are managed robustly and in accordance with the CCG’s Interest conflict of interest policy. Resource This report supports the CCG in making effective and efficient use of its Implications resources. Engagement This report is presented to each Committee meeting. The Committee includes clinicians and lay members. Equality Impact This report was written in accordance with the provisions of the Equality Act Analysis 2010. Report History The Primary Care Commissioning Committee Risk Register is presented at each and Key Committee meeting. Decisions Next Steps To continue to manage risk in a robust way. Appendices Appendices are: 1. Primary Care Commissioning Committee Risk Register; 2. The Committee Risk Tracker; and, 3. Risk scoring key.
106 / 113 Status Open Open Open Open Open
04.06.2021 07.06.2021 04.06.2021 o4.06.2021 07.06.2021 Date of of Date Last Update 107 / 113 This risk has been mitigated to date through the use of weekly webinars with practices, the use of twice weekly GP Bulletins to distil national guidance, guidance, national distil to Bulletins GP weekly twice of use the practices, with webinars weekly of use the through date to service agree mitigated to been riskleads has This commissioning clinical with established been also has meeting COVID-19 Care Primary A Website. GP the to updates and pandemic. COVID-19 the address to support resilience and models and programme, vaccination COVID-19 practice general the of part as providers with established been has group steering vaccination care primary A leads. commissioning with held is call weekly a clinical such as practices, to information provides This websites. borough individual the replace to launched been has website GP single new A etc. events training and education pathways, guidelines/ include: demand manage to practice general in capacity sufficient is there that ensure to Actions COVID-19; suspected to due absences reduce to order in Practice General for testing staff of offered being face to availability face with – • Increasing phone the on out carried be will consultations of majority the where first" model Information Medical Egton "telephone the the to access using practices • GP remote and equipment GPs with providing in leading Federations GP appropriate. clinically is it where consultations; these provide to remotely work to them allow to order in (EMIS) Systems Practice; and General advice to triage, (retirees) staff of clinician returning • The senior of offering The federations. GP NCL 6 the by - provided place in put being service support pathway; Covid home at acute • NCL-wide oximetry the on are who patients of down step supporting and patients Covid of management on guidance levels; symptom with line in down and up services COVID-19 scale to triggers service of development • The Networks; Care Primary their via all with arrangements programme, 'buddying' • Practice vaccination COVID-19 the of delivery during capacity maintain to practice general for fund capacity £4.1m the of receipt remote for systems • The of establishment COVID-19; Long with patients supporting the including: addressing list; priorities, service shielding support to the practice maintaining general to and go to funds patients vulnerable extremely clinically supporting oximetry; pulse (in including progress making patients, of immunisations; monitoring and vaccinations routine and management disease chronic offering for those including potentially and; records GP in appointments, of recording backlog data ethnicity improve to actions checks and health disability learning on remotely. work to able inequalities) not are addressing concerned individuals the and demand, meet to required is CCG, the by agreed is this where absences staff for 2021. backfill September to up extended be will fund capacity Covid GP the that announcement national • The of demands to due and services, practice general for demand up pent / tiredness, burnout workforce by impacted being is capacity GP However, recovery. system Strategic Update for Committee for Update Strategic improvement” “requires or “inadequate” following recently practices of series a with taken been has that action at regulatory arrangements to response caretaking risk a is This place in put to having included has cases some in Action (CQC) inspections. 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August the in to due work published guidance generating income complete to unable are practices where protection income on based is Support personal 2020/21. of and all absence staff for cover including costs incurred additional offset to and Services) Commissioned Locally Framework, Outcomes equipment. protective visiting home and triage clinical central a including aspects other with practices to offer support local the of part forms package resilience webinars. practice financial The weekly and control, prevention infection for training separately, patients positive COVID-19 treat to service two. and one Quarters for place in be will initially and guidance, planning with line in developed been has 2021/22 for package The practices. from concerns of reporting of level low a on based paused been has 2020, November since place in £4.11million. is funding reporting, the of SITREP Care Primary allocation The London Central North The Fund. 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Committee Primary Care Commissioning Committee Primary Care Commissioning Committee Primary Care Commissioning Committee Primary Care Commissioning Committee Primary Care Commissioning Committee
Rating (Target) 6 12 6 6 9
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March in published this. from 5 with established group working Recovery A5. of end by place in be to Plan workstreams. supporting 2021 May completed plan Action A1. financial practice in included DES Network A2. Completed. package. support resilience Draft established. report Performance and Quality A3. at presented be to update and developed report PCN meeting. PCCC 2021 August March in published 2021/22 for guidance National A4. July of end by place in be to plan Recovery 2021. 2021. work reset and planning recovery Re-establishing A5. as access in variation removing with care primary in priority key with line in ongoing ARRS of Recruitment A1. subject to and submissions planning workforce supply and federations -staff, GP CCG WorkA2. ongoing practices support to together working hubs training PCNs and A1. 31.03.2022 A1. 30.04.2020 A1. 31.08.2020 A2 01.06.2021 A3. 01.08.2021 A4. Action Action Deadline 31.08.2020 A1. 31.03.2021 A2. 31.07.2020 A3. 31.04.2021 A4. 31.05.2021 A5. 31.08.2020 A1. 31.07.2020 A2. 31.08.2021 A3. 30.07.2021 A4. 30.06.2021 A5. 31.03.2022 A1. 31.03.2022 A2. A1. Continue as per Controls in in Controls per as Continue A1. Place Support COVID-19 NCL A1. live now Service buddying practice Confirm A2. practice - via arrangements plans continuity business general for model new Develop A3. general NCL the through practice group recovery practice programmes for funding Secure A4. wellbeing staff ensure to Actions framework of Development A1. resilience and workforce the through care primary in workstream programme recovery and quality the Update A2. 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There are no further Controls Controls further no are There the at implemented be to identified time current Primary with calls Bi-weekly CN1. clinician and Leads Covid Care will plan action associated and further plan to need the identify controls and fatigue prevent to Need CN2. staff care primary in burn-out Controls Needed Controls NCL of Development CN1. warning early for framework system of development Further CN2. to report quality and performance of view triangulated provide performance practice practice of Development CN3. the through programme resilience programme recovery care primary financial of Determination CN4. for coved for package support planning with line in 2021/22 guidance for plan recovery Redevelop CN5. of 2 wave of light in care primary planning and pandemic the guidance early of Development CN1. primary through system warning and workforce Covid care workstream resilience Directed Implement CN2. for (DES) Service Enhanced PCNs of development Further CN3. report quality and performance guidance national Reflect CN4. addressing on 2021/22 for in coved by bare laid inequalities plans local experience patient Develop CN5. in workstream access and include to plan recovery updated access differential on learning vaccination coved from programme with line in recruitment PCN CN1. requirements DES development the Supporting CN2. to able are they so PCNs the of Clinical e.g. roles, new develop prescribers, social Directors, current of baseline the on building workforce Rating (Current) 8 12 12 12 12 Likelihood (Current) 2 3 4 4 3 Consequence (Current) 4 4 3 3 4 successfully successfully the controlling risk STRONG: STRONG: controls The 80%+ a have or chance of higher successfully the controlling risk AVERAGE: controls The – 61 a have chance 79% of successfully the controlling risk AVERAGE: controls The – 61 a have chance 79% of AVERAGE: controls The – 61 a have chance 79% of successfully the controlling risk AVERAGE: controls The – 61 a have chance 79% of successfully the controlling risk Overall Overall of Strength in Controls place C6. 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Committee reports Committee C1. notes Meeting C2. practice and notes Meeting C3. correspondence papers Committee CCG C4. papers Common in Committee C5. practice and notes Meeting C6. correspondence plan recovery and notes Meeting C7. support and notes Meeting C8. package 2021/22 for guidance Planning C9. 2020/21 for papers PCCC and Report C1. papers Committee C2. papers CCG C3. Strategy CCG C4. STP and papers CCG C5. papers workstream and papers Covid Care Primary C6. minutes papers CCG C7. 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Borough each in (QISTs) Teams focusing workstream a has Plan Recovery Care Primary C6. resilience and workforce on address to workplan inequalities of Development C7. services NHS and care primary to access differential Controls in place in Controls Rating (Initial) 12 8 16 20 16 Likelihood (Initial) 3 2 4 4 4 Consequence (Initial) 4 4 4 5 4 There is a risk that practices across NCL will will NCL across practices risk that a is There There is a risk that greater number of practices practices of number greater risk that a is There This may result in more practices receiving receiving practices more in result may This There is a risk that practices will be forced to to forced be will practices risk that a is There There is a risk that it will not deliver the primary primary the deliver not will it risk that a is There This may result in greater pressure being put put being pressure greater in result may This This could mean that, for example, patients with with patients example, for that, mean could This This may result in plans to reduce health health reduce to plans in result may This If the CCG is ineffective in developing the primary primary the developing in ineffective is CCG the If If NCL CCG fails to identify and address address and identify to fails CCG NCL If If there are delays in identifying struggling struggling identifying in delays are there If If GP practices experience an increase in the the in increase an experience practices GP If Capacity in General Practice (Threat) Practice General in Capacity CAUSE: with self-isolating are or unwell are who staff of number covid-19 suspected EFFECT: close IMPACT: be also may which open, remain which practices onto demand. increased manage to short-staffed, Trust and Confidence of Member Practices (Threat) Practices of Member Confidence and Trust CCG the feel not do practice CCG’s member the If Cause: the through them supported and engaged properly has pandemic COVID-19 trust lose practices member the risk that a is There Effect: Body Governing the of leadership the in confidence and directors and become practices member in result may This Impact: to challenge potential a and co-operative less disengaged, CCG’s leadership. the inequalities and move more care closer to home to be less less be to home to closer care more move and inequalities experience patient inferior risking planned than effective effectiveness cost poor and (Threat) workforce care development Primary CAUSE: workforce care EFFECT: strategy care IMPACT: care primary in supported fully not are conditions term long care. hospital frequent more require and formal contract remedies for completion, more caretaking caretaking more completion, for remedies contract formal / dispersals list more place, in being arrangements being not practices and undertaken, being procurements networks care primary with aligned Quality Care Primary in variation to address Failure (Threat) NCL across Performance and CAUSE: Quality and Performance in variations EFFECT: residents NCL for services and access differential offer IMPACT: Risk are practices struggling to support Opportunities systematic of a absence by the delayed sometimes (Threat) system warning early CAUSE: practices EFFECT: Care poor receive and processes regulatory through go will ratings Commission Quality IMPACT:
Objective Support the ongoing ongoing the Support Covid- to response and pandemic 19 vaccination programme Support the ongoing ongoing the Support Covid- to response and pandemic 19 vaccination programme change Provide robust robust Provide and to, support our of, development - workforce through including system approach to to approach system / place- population and health based management care Tackle health health Tackle and inequalities the strengthen Care Support system system Support and recovery both strengthen & Care Urgent Urgent Integrated
Risk Manager Sarah Mcilwaine, Mcilwaine, Sarah of Director - Transformation Care Primary Sarah Mcilwaine, Mcilwaine, Sarah of Director - Transformation Care Primary Keziah Bowers, Bowers, Keziah Care Primary Programme Manager Primary Care Primary Sarah Mcilwaine, Mcilwaine, Sarah of Director - Transformation Vanessa Piper - Piper Vanessa Care Primary Head
Risk Owner Chief Operating Operating Chief Officer Paul Sinden Paul Paul Sinden Paul Operating Chief Officer Executive Director Director Executive & Performance of Assurance Paul Sinden - Sinden Paul Paul Sinden Paul Operating Chief Officer Chief Operating Operating Chief Officer Paul Sinden Paul
ID COVID 12 COVID COVID 11 COVID PERF18 PERF15 PERF 4 PERF NCL CCG Primary Care Commissioning Risk Register - June 2021 - June Register Risk Commissioning Care Primary CCG NCL 2021/22 North Central London CCG PCCC Risk Register - Highlight Report Movement From Target Risk Current Risk Score Last Report Score Risk ID Risk Title Risk Owner Key Updates DEC FEB APR JUN
PERF4 Opportunities to Paul Sinden This risk is a response to regulatory action that has been taken with a series of practices recently following “inadequate” or “requires improvement” ratings support struggling Chief Operating Officer following Care Quality Commission (CQC) inspections. Action in some cases has included having to put in place caretaking arrangements at practices at practices are very short notice. sometimes delayed by the absence of a The aim of the risk mitigation is to promote earlier recognition of struggling practices, and ensure that support is provided before regulatory action is systematic early required. The workforce and resilience workstream for primary care recovery has a focus on supporting, and early identification of, struggling practices. warning system (Threat) The NCL financial resilience package for practices to cover the impact of the COVID-19 pandemic, in place since April 2020, is in line with national guidance published in August 2020. The resilience package aims to mitigate the impact of the COVID-19 pandemic, and had been extended to cover all of 2020/21. Support is based on income protection where practices are unable to complete income generating work due to the pandemic (Quality Outcomes Framework, Locally Commissioned Services) and to offset additional costs incurred including cover for staff absence and personal protective equipment. 12 12 12 6 The financial resilience package forms part of the local support offer to practices with other aspects including a central clinical triage and home visiting service to treat COVID-19 positive patients separately, training for infection prevention control, and weekly practice webinars.
The package for 2021/22 has been developed in line with planning guidance, and initially will be in place for Quarters one and two.
The Primary Care SITREP reporting, in place since November 2020, has been paused based on a low level of reporting of concerns from practices. Practices are still being supported with funding via the Capacity Expansion Fund. The North Central London allocation of the funding is £4.11million. This equates to £2.58 per patient across NCL. NCL CCG will release this funding to practices in two tranches, with the first being released in January 2021.
PERF15 Failure to address Paul Sinden Mitigations in place to help reduce unwarranted variation in quality and performance across general practices include: variation in Primary Chief Operating Officer • Plans to further develop Primary Care Networks (PCNs) through the introduction of the service specifications in the Direct Enhanced Service (DES) for Care Quality and 2020/21 and 2021/22 are available to provide development support for Clinical Directors; Performance across • The use of GP Forward View monies from NHS England to support the development of primary care networks and GP Federations, and to develop a NCL (Threat) resilience programme for general practice; • The introduction, via the new GP contract, of a greater quality improvement focus in the practice level Quality Outcomes Framework incentive scheme and under the new Investment and Impact Fund incentive scheme - introduced to reward PCNs for delivering against the NHS Long Term Plan; 12 12 12 • The establishment of models for mutual aid across practices during COVID-19, including hot site and home visiting service and training for practices in 6 managing COVID-19 patients; • Ongoing work to develop the GP Provider Alliance and a unified primary care provider voice within the NCL integrated care system.
PERF18 Primary care Paul Sinden The updated GP contract for 2021/22 continues to emphasise the importance of funding and flexibility for workforce development and includes: workforce Chief Operating Officer • An increase in the national funding for the Additional Roles Reimbursement Scheme to help secure 15,500 whole time equivalent (WTE) roles to be development (Threat) deployed by end of 2021/22; • More roles added to the Scheme (which now includes paramedics, and mental health practitioners as well as pharmacy technicians, dieticians, care coordinators, health coaches, podiatrists, occupational therapists and nursing associates/trainee nursing associates); • Every PCN becoming entitled to a fully embedded WTE mental health practitioner, employed and provided as a service by the PCN's local provider of community mental health services; • Introduction of an inner and outer London maximum reimbursement rate; • Further flexibility in the Scheme’s rules, including the ability to employ staff at an advanced practitioner designation (clinical pharmacist, physio, occupational therapist, dietician, podiatrist and paramedic); 12 12 12 9 • The extension of the window to transfer any clinical pharmacists funded under the previous NHSE scheme to move to the PCN scheme; • The expectation that CCGs and systems will explore different ways of supporting PCNs to recruit; • PCNs’ continuing to recruit to these roles and supported by Training Hubs with induction and professional development; • Further funding for the PCN Clinical Director support up to June 2021 in addition to the COVID capacity expansion fund; • Measures to support GP training, recruitment and retention, to help deliver 6,000 more doctors in primary care (£94m to address recruitment and retention issues, including Partnership Premium of £20,000; greater proportion of GP training time spent in general practice) • NCL Training Hub is developing a Primary care nursing strategy and have engaged with relevant stakeholders as part of this.
Given the high demand on the Primary Care workforce during the pandemic, the CCG will have to monitor the impact on wellbeing and fatigue.
108 / 113 COVID11 Trust and Confidence Paul Sinden This risk has been mitigated to date through the use of weekly webinars with practices, the use of twice weekly GP Bulletins to distil national guidance, and of Member Practices Chief Operating Officer updates to the GP Website. A Primary Care COVID-19 meeting has also been established with clinical commissioning leads to agree service models and (Threat) resilience support to address the COVID-19 pandemic.
A primary care vaccination steering group has been established with providers as part of the general practice COVID-19 vaccination programme, and a weekly call is held with commissioning leads.
A new single GP website has been launched to replace the individual borough websites. This provides information to practices, such as clinical guidelines/ pathways, education and training events etc. 8 8 8 8 6
COVID12 Capacity in General Paul Sinden Actions to ensure that there is sufficient capacity in general practice to manage demand include: Practice (Threat) Chief Operating Officer • Increasing availability of staff testing for General Practice in order to reduce absences due to suspected COVID-19; • GP practices using the "telephone first" model where the majority of consultations will be carried out on the phone – with face to face being offered where it is clinically appropriate. GP Federations leading in providing GPs with equipment and remote access to the Egton Medical Information Systems (EMIS) in order to allow them to work remotely to provide these consultations; • The returning of staff (retirees) to General Practice; • NCL-wide acute Covid support service being put in place - provided by the 6 NCL GP federations. The offering of senior clinician triage, advice and guidance on management of Covid patients and supporting step down of patients who are on the oximetry at home pathway; • The development of service triggers to scale COVID-19 services up and down in line with symptom levels; • Practice 'buddying' arrangements via their Primary Care Networks; • The receipt of the £4.1m capacity fund for general practice to maintain capacity during delivery of the COVID-19 vaccination programme, with all funds to 12 12 12 12 12 go to general practice to support service priorities, including: supporting patients with Long COVID-19; establishment of systems for remote monitoring of patients, including pulse oximetry; supporting clinically extremely vulnerable patients and maintaining the shielding list; addressing the backlog of appointments, including those for chronic disease management and routine vaccinations and immunisations; making progress (in addressing inequalities) on learning disability health checks and actions to improve ethnicity data recording in GP records and; potentially offering backfill for staff absences where this is agreed by the CCG, is required to meet demand, and the individuals concerned are not able to work remotely. • The national announcement that the GP Covid capacity fund will be extended up to September 2021.
However, GP capacity is being impacted by workforce burnout / tiredness, pent up demand for general practice services, and due to demands of system recovery.
Risk Key
Risk Improving
Risk Worsening
Risk neither improving nor worsening but working towards target
109 / 113 Risk Scoring Key
This document sets out the key scoring methodology for risks and risk management.
1. Overall Strength of Controls in Place There are four levels of effectiveness: Level Criteria Zero The controls have no effect on controlling the risk. Weak The controls have a 1- 60% chance of successfully controlling the risk. Average The controls have a 61 – 79% chance of successfully controlling the risk Strong The controls have a 80%+ chance or higher of successfully controlling the risk
2. Risk Scoring This is separated into Consequence and Likelihood.
Consequence Scale:
Level of Impact on the Descriptor of Level Consequence for Consequence Objective of Impact on the the Objective Score Objective 0 - 5% Very low impact Very Low 1 6 - 25% Low impact Low 2 26-50% Moderate impact Medium 3 51 – 75% High impact High 4 76%+ Very high impact Very High 5
Likelihood Scale:
Level of Likelihood Descriptor of Level Likelihood the Risk Likelihood Score the Risk will Occur of Likelihood the will Occur Risk will Occur 0 - 5% Highly unlikely to Very Low 1 occur 6 - 25% Unlikely to occur Low 2 26-50% Fairly likely to occur Medium 3 51 – 75% More likely to occur High 4 than not 76%+ Almost certainly will Very High 5 occur
110 / 113 3. Level of Risk and Priority Chart
This chart shows the level of risk a risk represents and sets out the priority which should be given to each risk:
LIKELIHOOD CONSEQUENCE
Very Low Low (2) Medium (3) High (4) Very High (1) (5)
1 2 3 4 5
Very Low (1)
2 4 6 8 10
Low (2)
3 6 9 12 15
Medium (3)
4 8 12 16 20
High (4)
5 10 15 20 25
Very High (5)
1-3 4-6 8-12 15-25
Low Priority Moderate Priority High Priority Very High Priority
111 / 113 NCL PRIMARY CARE COMMISSIONING COMMITTEE
FORWARD PLANNER 2021 / 22
Area 22 Apr 20 May 17 June 15 July 19 21 16 17 2021 2021 2021 2021 August October December February 2021 2021 2021 2022 Seminar Seminar Governance Review of Risk Register X X X X X X
Review of Terms of X Reference (TOR) Review of Committee X X Effectiveness Contracting Decisions relating to GMS, X X X X X X PMS and APMS contracts eg: practice mergers Local Commissioned X Services Procurements As and when required
Demonstration of DH X Health Building Notes Estimator (HBN) Pros & Cons of practices X merging together Quality & Performance
112 / 113 Quality and Performance X X X X X X Report
Finance Report
Finance Report X X X X X X
Strategy
Primary Care Strategic X X X Review NHS Long Term Plan and X X X Operating Plan Other papers
Developing Primary Care X X workforce GP Patient Survey learning X
NCL Finance Resilience X X Package for Primary Care Extended Access scheme to X PCNs by 1 April 2022 New GP Contract Update X
PCN Development X X
Covid report X X
Primary Care Estates X X
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