NHS Salford Clinical Commissioning Group Primary Care Commissioning Committee Monday, 26th September 2016 10:30-12:00Hrs The Salford Suite, St. James’s House
AGENDA
Part I
Start of NHS Salford Clinical Commissioning Group Primary Care Commissioning Committee
10:30 Public Meeting Open Agenda for Members of the Public to raise items previously mentioned to the Senior Committee Support Officer
10:35 Start of NHS Salford Clinical Commissioning Group Primary Care Commissioning Committee
Item Time Description Lead 1 10:35 Apologies for absence Chair
2 Declaration of Interest in items on this Chair Meeting’s Agenda
3 Minutes of the meeting held on 11th July 2016 Chair
4 Matters Arising and Action Log from the Chair meeting held on 11th July 2016
For Assurance/Decision
5 10:45 Community Based Care
a. Salford Medical Practice 2 – Options Head of Service Improvement Appraisal (Paper)
b. The Height APMS Contract Update Head of Service Improvement (Paper) (Primary Care)
c. Expanding Capacity in General Practice to Head of Service Improvement Respond to the Population Growth In The (Primary Care) Ordsall Ward (Paper)
6 11:15 Primary Care Commissioning Committee Functioning
a. Primary Care Commissioning Committee Head of Service Improvement Workplan (Paper) (Primary Care)
b. Primary Care Commissioning Committee Head of Service Improvement Risk Register (paper) (Primary Care)
c. Primary Care Quality Group Review Director of Quality and Innovation
d. Primary Care Commissioning Committee Head of Service Improvement Training (Primary Care)
7 11:35 Performance
a) Financial Performance (paper) Chief Finance Officer
For Information
8 11:50 Minutes/Reports of Partnership Boards/Sub Committees
a) Primary Care Operational Group Report Head of Service Improvement (paper)
9 11:55 Reflection a) Key Decisions Chair b) Key Messages c) Benefits to the Population of Salford 10 12:00 Meeting to close
Date and Time of Next Meeting: Monday 28th November 2016, 10:30-12:30Hrs, Salford Suite, St. James’s House
Minutes of NHS Salford Clinical Commissioning Group Primary Care Commissioning Committee (PCCC) Held on 11th July 2016 12:30-14.15Hrs in the Salford Suite, St James’s House, Salford
Part I Present: Mr Brian Wroe (BW) Chair, Lay Member for Engagement, Salford CCG Mr Steve Dixon (SD) Chief Finance Officer, Salford CCG Mr Ben Squires (BS) Head of Primary Care Operations, NHSE, attending on behalf of Mrs Laura Browse Mrs Karen Proctor (KP) Director of Commissioning, Salford CCG Mr Anthony Hassall (AH) Chief Accountable Officer, Salford CCG Mrs Delana Lawson (DL) Chief Officer, Healthwatch Salford
In Attendance: Mr Harry Golby (HG) Head of Service Improvement, Salford CCG Mrs Anna Ganotis (AG) Head of Service Improvement, Salford CCG Mr David Dobson (DD) Senior Committee Support Officer, Salford CCG Mrs Sam Glynn-Atkins (SGA) Service Improvement Manager, Salford CCG Mrs Saiqa Farooq (SAF) Senior Service Improvement Officer, Salford CCG
Apologies: Mr Paul Newman (PN) Lay Member, Salford CCG Sara Roscoe (SR) NHS England Miss Siobhan Farmer (SF) Consultant in Public Health (representative for the Health and Wellbeing Board), attending on behalf of Mr David Herne – Salford City Council Dr Jenny Walton (JW) GP Neighbourhood Lead Mrs Hannah Dobrowolska (HD) Director of Corporate Services
1. Welcome and Introductions 1.1 BW introduced the remit of the Primary Care Commissioning Committee followed by introductions by members of the Committee. BW formally welcomed DL as a non-voting member of the Committee.
2. Declarations of Interest 2.1 No formal declarations of interest were made.
3. Minutes of the last meeting and Action Log of 23rd May 2016 3.1 SD advised that on Page 1 of the minutes, for accuracy SD is no longer Deputy Chair, this responsibility would be for PN. The minutes of the last meeting were agreed as a true and accurate reflection of the meeting. Action: BW to formally write to PN regarding his Deputy Chair role of the Committee as a Lay Member.
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3.2 The Action Log from the Meeting of 23rd May was considered. AH requested that the action log’s status column is completed prior to the meeting to allow for an understanding of where each item is up to. The following updates were provided against each Action Log item:
1) The Care Homes Practice Review is listed on today’s agenda (Item 7a). 2) A date is to be agreed for BS to present to the Governing Body. 3) An IT report on patients accessing online services is on today’s agenda (Item 5a). 4) The PCCC agenda has been amended to reflect the format of the Governing Body. 5) A revised Terms of Reference (TOR) is listed on today’s agenda (Item 6a). 6) KP advised that the process of deputies attending is reported in the revised TOR. 7) HG advised that the Operations Group Report is on today’s agenda (Item 9a). 8) HG advised the new clinical pharmacy service was in the process of recruiting staff and had been aware of Ellenbrook Medical Centre’s situation but no overall mobilisation plan has been agreed. BW requested the item remain on the action log to ensure Ellenbrook Medical Centre remains a priority during mobilisation. Action: HG to ensure the Ellenbrook Medical Centre is prioritised when the clinical pharmacy service is mobilised. 9) AG advised that this action was complete and is to be presented under item 6a of the agenda. 10) AG advised that Item 4 of the papers includes a suggested template for summarising recommendations put forward from the Primary Care Operations Group which will then be presented to the PCCC for decision. The PCCC approved for the use of the template. 11) HG advised that the Operations Group Report is on today’s agenda (Item 9a). 12) AG advised that ‘Primary Care Quality’ has been listed as an agenda item for today’s meeting (Item 8a), which will be listed as a standard agenda item in the future. Action: Primary Care Quality to be listed as a standard agenda item for future meetings. 13) AG advised that a formal briefing was sent to all practices via the weekly CCG Members e-bulletin in early July.
4. Matters Arising 4.1 No matters arising were discussed.
5. Community Based Case
5.1.1 Primary Care IT Strategy (a)
5.1.2 SD advised that this strategy is being presented to PCCC primarily for information purposes. Primary Care IT is the responsibility of the CCG, rather than a delegated primary care function overseen by the PCCC. However, it is important that the PCCC has visibility of the IT strategy. SD explained that the strategy outlines the CCG’s plan for ensuring that general practice IT is fit for purpose and enhances service delivery for patients.
5.1.3 SD made reference to ‘Appendix 2’ of the GMS contract negotiations summary which details what the CCG is expected to complete. He explained the process of digitalising Primary Care IT for online access. SD advised that the ‘Primary Care IT Strategy Paper’ was approved by the CCG’s Executive Team which also includes a work plan for 2016/17, such as the right IT Page 2 of 7
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infrastructure being in place. SD reported on the two clinical systems of ‘Vision’ and ‘EMIS’ which are currently used by GP practices across Salford. He explained that upgrades are required which the CCG are supporting via the Greater Manchester Shared Services (GMSS) IT Department. He added that Primary Care IT has always been the responsibility of the CCG.
5.1.4 SD reported on the electronic prescription service (EPS). It is a mandatory requirement on CCGs to ensure 100% of GP practices are live with this system by 31st March 2017. SD advised that at the start of the year, there were 28 practices using EPS with the remaining 18 GP practices to go live this year.
5.1.5 SD reported on the IT needs relating to the implementation of the extended access for seven day primary care provision which will include additional hubs for weekend GP access.
5.1.6 BW advised of how helpful the update was in relation to understanding how GPs will be able to access up to date systems, as well as the challenges for training, costs and workforce pressures.
5.1.7 KP acknowledged that this is a huge piece of work, enquiring as to any risks which exist from a staffing perspective. SD reported on the local ‘Information Management and Technology Group’ for Salford which meets on a monthly basis. He also reported on the significant amount of work which is being carried out at a Greater Manchester level, adding that Salford has purchased addition days through GMSS IT, due to the CCG prioritising this area of work. In addition to this, the GMSS contractors have agreed to allow for any necessary flexibility within their schedules to meet the requirements of the CCG’s timetable.
5.1.8 BS highlighted the compliance and delivery being important factors to consider, as well as the interdependency of GP Practices. BS advised of the volume of GP mergers and branches surgeries being established within Salford, which will also have IT consequences. SD advised that this was Caroline Rand’s report and noted her role in bringing together a complicated and fragmented area of responsibility. The PCCC formally noted their thanks to Caroline on this area of work.
5.1.9 The Primary Care Commissioning Committee noted the report and plan as detailed within the Primary Care Information Technology Plan.
5.2 Salford Standard (B)
5.2.1 HG presented the paper reporting upon current progress in implementing the Salford Standard in its first year of operation. HG advised that amendments were always envisaged as the work of the Salford Standard evolved over time. HG reported upon how the process is now established with the CCG looking at how things can be developed, which includes a clinical view and financial view of the work. HG also reported on the proposed changes to ‘Key Performance Indicators (KPIs). He added that the CCG Executive Team was in full support of this work. HG made reference to paragraph 3.2 which details of how face to face discussions with practices may be required to take place
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should the implementation plan not be approved after a second round of submissions.
5.2.2 SD referenced the finance aspect and implications attached to supporting the proposed removal of a small number of KPIs from the Salford Standard. SD advised that, rather than recalculate the finance model to spread (increase) the finances over the remaining KPIs, GPs would be paid for the KPIs that had been removed and the remaining KPIs would keep their initial financial value. In this scenario, there would be no impact on the contract value. KP stressed that assurance has been given to the Commissioning Team accordingly on areas of finance and clinical challenge. Action: SD to confirm the contract value of the removed KPIs.
5.2.3 BS enquired as to what is the impact on the clinical care for the revised KPIs. KP explained that there are no adverse impacts being made from the removal of the KPIs. AH expressed a concern for ensuring that this does not set a precedent for the future of the Salford Standard, whereby in the event of the CCG being challenged, then the KPIs would be removed. It was agreed that this should not be the case and that it would be made clear that this decision does not set a precedent.
5.2.4 The PCCC noted the contents of the report. The PCCC approved for the proposed changes upon KPIs and financial arrangements, as detailed in ‘Appendix 1’.
6 Primary Care Commissioning Committee Functions
6.1.1 Terms of Reference – TOR (A)
6.1.2 AG provided an explanation of how this was brought to May’s PCCC Meeting. She clarified that CCG’s do not cover geographical area, covering a GP registered population instead and that the TOR has been amended to reflect this. AG advised of the revised process for the use of deputies as detailed within the TOR. The PCCC noted that any proposed changes would not be approved until the autumn when NHS England will be considering the CCG’s revised changes to the constitution. The PCCC agreed to the geographical amended rewording of the TOR. The role of using deputies was agreed in principle, with an amendment to the wording suggested by AH.
6.1.3 A discussion took place regarding what is meant by ‘adhoc business’ of the PCCC. The PCCC members felt that a work plan would be of assistance to highlight what the PCCC was responsible for. AG agreed to present a work plan of PCCC business to the next meeting. Action: A PCCC work plan to be published and appended to the papers for September’s PCCC Meeting.
6.2.1 Emergency Powers (B)
6.2.2 AG introduced the item following the proposed changes in the TOR. She reported on the options that were considered as well as the governance considerations which are to be taken into account when it comes to any emergency decisions. AG advised that the recommended option is for Page 4 of 7
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emergency decisions to be made virtually and then be formally reported to the subsequent meeting. She added that such changes would need a further amendment to the TOR.
6.2.3 The PCCC approved the recommendations and additions to the TOR as part of the constitution review later this year.
6.3.1 PCCC Risk Register
6.3.2 AG advised that this matter was discussed under Part 2 of May’s PCCC Meeting. She reported on the collaborative working with other CCG colleagues in relation to developing a risk register for the PCCC and the need to link in with the review of the CCG’s strategic and programme risk registers. AG highlighted that the facilitation of a workshop is being proposed if required, to support the development of a PCCC risk register. She also reported that a risk register should be completed in preparation for the next meeting. AH requested that for an understanding and triangulation of information, she should share the risk register information with BS. Action: AG to bring the risk register to September’s PCCC Meeting. AG to share the risk register with BS prior to September’s PCCC Meeting.
7 Strategy
7.1.1 General Practice Forward View (A)
7.1.2 AG advised that the report was for noting by the PCCC which included a summary of the national ‘GP Forward View’. She reported that this information was originally provided to the CCG’s Executive Team as well as the Community Based Care Group. AG advised that on the whole, all the work streams as detailed within the ‘GP Forward View’ are already in progress in Salford, in line with the national agenda. The PCCC noted spelling changes required under Item 4.1 which AG will correct. Action: AG to amended Item 4.1 for spelling changes with the General Practice Forward View.
7.1.3 In relation to the additional £2.4 billion funding announced for Primary Care, SD advised that clarity is being sought from NHS England around what is new funding and what is funding already in the system. An initial briefing note from NHS England indicated that the majority of this funding will not be new, but already exists in baseline budgets. As such, much of this has been already allocated and spent, such as the extended access provision. The PCCC believed that the explanation was helpful in understanding the summary. BS reported on the national series of roadshows which will be delivered over the coming months, with one being held for Greater Manchester in September.
7.1.4 The PCCC noted the contents of the report.
8 Performance
8.1.1 Quality Performance – Primary Care Quality (A)
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8.1.2 KP advised that this report was provided to May’s Governing Body Meeting which detailed an overall summary of primary care quality in Salford. KP noted that the CCG also has an internal group for Primary Care Quality. She reported that the internal group is considering the revision of its terms of reference and that this would come to the September PCCC for approval. KP advised that any questions on the report can be sent directly to herself or the Director of Quality and Innovation. Action: Members of the PCCC are to provide feedback on the Quality Performance Report to the CCG’s Executive Team.
8.1.3 The PCC noted the content of the report.
8.2.1 Financial Performance (B)
8.2.2 SD provided an explanation to the finance report which was circulated later than the main papers and apologised for the delay. SD advised that the Primary Care Financial Performance Paper shows spend on those GP services such as primary care contracts which are delegated from NHS England but also includes other primary care budgets which are not within the remit of PCCC, but are included to reflect relevant funding streams such as Out of Hours (OOH) services and prescribing contracts. SD advised that the additional information is included for completeness as to what is spent on primary care services across Salford. A discussion took place regarding the large PMS forecast overspend, which the CCG is querying with NHS England. SD advised that this matter will be reported at September’s PCCC Meeting. BS believed that there was an irregularity within the data which has resulted in this forecast overspend on PMS. Action: SD to clarify upon the forecast overspend on PMS at September’s PCCC Meeting.
8.2.3 The PCCC noted the content of the report, and agreed with the format and level of detail as appropriate.
9 Minutes/Reports of Partnership Boards/Sub Committees
9.1 Primary Care Operations Group Report
9.2 HG reported on the background as to the role of the Primary Care Operations Group. HG provided an update on estates changes which included the new Refuah Centre in Broughton. He also provided an update on PMS which was detailed within the report. AH advised that the report was both informative and positive, referring to the Refuah Centre. A discussion took place as to when all of the practices will be moving into the Refuah Centre.
9.3 In relation to Item 6 ‘GP Capacity’, AH advised that a joint letter from himself and Dr Mhairi Yates was sent to Salford City Council, for their support in addressing primary care provision. AH emphasised the need for joint working in planning from a civic prospective across the city. HG advised, as listed under Item 3.1, that Limefield Medical Centre’s list remains closed. However, the Operations Group will update the PCCC as to when this status changes. KP highlighted Item 6.1 regarding the need for additional GP capacity in the
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Ordsall area. AG advised of her intentions to bring a strategic outline case to the September PCCC meeting.
9.4 The PCCC noted the content of the report.
10 Reflection
10.1.1 Key Decisions (A)
10.1.2 BW made reference to the development of the PCCC since the co- commissioning arrangements took effect. BW highlighted the context of primary care, ensuring that the PCCC uses other pieces of information and not just viewing matters in isolation. BW referred to the improving and enhancing developments of primary care across Salford.
10.2.1 Key Messages (B)
10.2.2 BW made reference to the importance of making decisions for the benefit of the population of Salford. 10.3.1 Benefits to the Population of Salford (C)
10.3.2 This item was discussed under Section 10 (B).
11 The meeting closed at 14:00Hrs.
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Primary Care Joint Commissioning Meeting 11th July 2016 – Part 1 Actions Log: Primary Care Commissioning Committee (Part 1) No Date Details of action agreed Action Lead Status Further Detail Action: HG to ensure the Ellenbrook Medical Centre is prioritised when the clinical pharmacy service is HG to provide an update during the Primary Care Commissioning Committee 2 11-Jul-16 HG Ongoing mobilised. Meeting of 26th September 2016. The PCCC agreed that rather than remove the payment for these 3 KPIs from the Salford Standard and then apportion the funding across all of the remaining KPIs, that GP practices would automatically be paid for these 3 KPIs. The 4 11-Jul-16 SD Ongoing financial value of the 3 KPIs equates to around £35,000 across Salford, assuming 100% achievement from all practices. This is around £700 for an Action: SD to confirm what is the contract value of the removed KPIs from the Salford Standard. average GP practice with a list size of £5,000 patients.
NHS SALFORD CLINICAL COMMISSIONING GROUP Primary Care Commissioning Committee AGENDA ITEM NO 5a
Item for Decision/Assurance/Information 26 September 2015
REPORT OF: Karen Proctor Director of Commissioning
DATE OF PAPER: 19 September 2016
SUBJECT: Salford Medical Practice 2 – Options appraisal
IN CASE OF QUERY Sam Glynn-Atkins PLEASE CONTACT: Service Improvement Manager [email protected] 0161 212 4129
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES: √ Quality √ Community Based Care √ Integrated Care
In Hospital Care
Long Term Conditions and Mental Health
Effective Organisation
PURPOSE OF PAPER:
To notify Primary Care Commissioning Committee (PCCC) of the options available to the CCG, in respect of the registered list, formerly of Dr Abdul Rahman, and request a decision for the future care of the registered list.
Further explanatory information required
HOW WILL THIS BENEFIT THE Provides clarity for the future care of patients on HEALTH AND WELL BEING OF the list of P87668 SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP?
WHAT RISKS MAY ARISE AS A As noted in the main document RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED?
WHAT EQUALITY-RELATED RISKS Equality Analysis completed and no equality MAY ARISE AS A RESULT OF THIS concerns were identified at this time, however PAPER? HOW WILL THESE BE this will need to be reviewed once the decision MITIGATED? has been made, to assess impact on protected groups
DOES THIS PAPER HELP ADDRESS Not applicable to organisational ‘red’ risks ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
PLEASE DESCRIBE ANY POSSIBLE Several local GPs have conflicts of interest CONFLICTS OF INTEREST associated with this paper, they have been ASSOCIATED WITH THIS PAPER. contacted to provide information, as described within the paper, but not involved in the decision making process.
PLEASE IDENTIFY ANY CURRENT GP practices SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER:
Footnote:
Members of NHS Salford Primary Care Commissioning Committee will read all papers thoroughly. Once papers are distributed no amendments are possible.
26 September 2016 Agenda Item No 5a
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement √ Patient & stakeholder letters sent Responses collated and (Please detail the method ie survey, event, consultation) (see Section 4 for details) included as Appendix 4 for consideration with this paper Clinical Engagement √ Due to potential Conflict of (Please detail the method ie survey, event, consultation) Interest Has ‘due regard’ been given to Equality EA drafted To be reviewed once a Analysis (EA) of any adverse impacts? decision is made (Please detail outcomes, including risks and how √ these will be managed) √ Hill Dickenson consulted to Advice acted upon in terms Legal Advice Sought support the Letter of Intent of the interim arrangements Presented to the Commissioning Committee √ Presented to the Health and Wellbeing Board √ Presented to the Integrated Commissioning √ Board √ Primary Care Operational Group Supported the Presented to any other groups or committees, – 8 September 2016 recommendations of the including Partnership Groups Execs – 14 September 2016 paper
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
26 September 2016 Agenda Item No 5a
Options appraisal paper – P87668 Dr Abdul Rahman
1 Executive Summary
This paper is supplied to the Primary Care Commissioning Committee, to provide an overview of the options available following the death of a single handed GMS contract holder, and to request a decision in line with recommendations.
2 Introduction and Background
2.1 On Tuesday 2 August 2016, NHS Salford Clinical Commissioning Group (CCG) became aware that Dr Rahman had sadly passed away on Monday 1 August 2016 following a short illness.
2.2 Dr Rahman was a single handed GMS contract holder at Salford Medical Practice 2 (practice code P87668).
2.3 This paper provides an overview of the options available to the CCG to commission primary medical care for the patients who were registered with the late Dr Rahman. The paper requests a decision in line with recommendations.
3 Interim arrangements
3.1 The ‘Policy Book for Primary Medical Services’, published on 12 January 2016, provides commissioners of primary medical services with the context, information and tools to safely commission and contract manage primary medical care contracts.
3.2 The policy outlines the procedure to follow in the event of the death of a contractor. Whilst this is a rare occurrence, there are certain steps to follow within agreed timescales that are laid down in legislation. The policy book stipulates that in the event of the death of a contractor holding a single handed GMS contract, the following applies:
CHAPTER 12 - Death of a Contractor
2. Individual - GMS Contract
2.1 Where a GMS contract is with an individual medical practitioner and that practitioner dies, the contract must terminate at the end of the period of 7 days after the date of the contractor’s death unless, before the end of that period:
2.1.1 the contractor's personal representatives have confirmed in writing to the Commissioner that they wish to employ or engage one or more
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general medical practitioners to assist in the continuation of the provision of clinical services under the contract; and 2.1.2 the Commissioner agrees to provide reasonable support which would enable the provision of clinical services under the contract to continue; and 2.1.3 the Commissioner and the personal representatives agree the terms upon which clinical services under the contract can continue to be provided; and 2.1.4 the Commissioner and the personal representatives agree the period during which clinical services must continue to be provided and such a period must not exceed 28 days starting on the day after the end of 7 day period following the contractor's death.
2.2 The Commissioner should issue a confirmation letter setting out the timescales of the continuation.
3.3 Members of the Service Improvement Team have been in close liaison with Greater Manchester Health & Social Care Partnership (GMHSCP) to take the necessary steps to ensure continuity of care and patient safety. A detailed record has been maintained throughout communications with all parties involved.
3.4 Dr Rahman’s personal representative chose not to continue the contract for the additional 28 day period.
3.5 Due to the contractual timescales mandated in the event of the death of a single handed contract holder, interim arrangements were put in place to ensure continuation of care for the 2,257 patients registered at Dr Rahman’s practice (list size as at 30 June 2016).
3.6 Following a desktop review of general practice quality which considered list size, GP whole time equivalents, patient age demographics and various measures of quality; Salford CCG (in liaison with GMHSCP) secured interim arrangements for patient care at the Salford Medical Practice 1 (Dr Ramzan Salim) which is co-located with Salford Medical Practice 2.
3.7 These temporary arrangements were formalised with Dr Salim firstly via a Letter of Intent (28 day arrangement from 8 August 2016), followed by a temporary APMS contract from Monday 5 September 2016 for the 3 month period to 30 November 2016, and as the CCG are not the employers, during this period the staff will be employed by Dr Salim.
3.8 The temporary APMS contract provides the CCG (in liaison with GMHSCP), a sufficient length of time to undertake an options appraisal, seek views of patients and key stakeholders and implement the chosen option for securing ongoing primary medical care for the late Dr Rahman’s patients.
3.9 The interim arrangements do not restrict patients’ right to choice and, in the CCG’s letter of 8 August 2016 (Appendix 1); patients were advised that they are free to register with any other GP practice of their choice at any point in the process.
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4 Patient and stakeholder engagement
4.1 In line with the CCG duty for public involvement and engagement, a number of letters have been circulated as follows:
• Letter to patients dated 8 August 2016 (Appendix 1) - advising of Dr Rahman’s death and providing reassurance that medical care is still available to patients and indicating how these interim arrangements could be accessed.
• Letter to key stakeholders dated 8 August 2016 (Appendix 2) – advising of Dr Rahman’s death and providing reassurance that medical care is still available to patients and indicating how these interim arrangements could be accessed. The letter was emailed to:
. the Salford City Mayor . local Councillors . local Members of Parliament . Healthwatch Salford . the Salford and Trafford Local Medical Committee . the Salford and Trafford Local Optical Committee . the Salford Local Dental Committee . the Salford and Trafford Local Pharmaceutical Committee . Patient Participation Group Chairs for Salford Medical Practice 1 & 2 . Chief Executive of Salford Royal Foundation Trust . Chief Executive of Greater Manchester West Mental Health Trust
• Letter to patients dated 22 August 2016 (Appendix 3) - outlining the options available to the CCG for the future care of patients and offering patients the opportunity to comment on these options.
4.2 A summary of the responses received from patients following the circulation of the available options are included within Appendix 4.
5 Options
5.1 The ‘Policy Book for Primary Medical Services’ – January 2016 states that GMS contracts can be held by the following:
• Individual medical practitioner; • Two or more individuals practising in partnership where; - At least one partner is a medical practitioner; and - Any other partner is either an NHS employee; or an individual eligible under s88 of the NHS Act • A company limited by shares
5.2 Therefore, since the contract at P87668 was terminated according to the regulations specified under 3.2, the following are the only 3 options available to the CCG (‘Do Nothing’ is not an option that the CCG is able to consider in this circumstance):
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1. Commission a new contract – carrying out a formal tender to find a new healthcare provider to deliver care to Dr Rahman’s patients.
2. List dispersal – This means that Dr Rahman’s patients would be asked to register at another local GP practice.
3. Managed list dispersal – This means that some local GP practices will be ready for Dr Rahman’s patients to register with them, and Dr Rahman’s patients would be told which local GP practices are waiting for their registration.
6 Considerations
6.1 Considerations taken into account by the CCG’s Primary Care Operational Group when they were considering the available options included:
6.1.1 Local strategy - All options need to be considered in line with CCG strategy. Salford CCG have a Primary Care (General Practice) Strategy which sets out the vision for a greater collaborative, federated, more robust model for general practice operating in an integrated model.
6.1.2 Value for money – A decision to disperse in preference to the procurement of a new contract would secure economies of scale for the health system. These would be derived from the consolidation of contracts, reduced rent/rate reimbursement, reduced contract and performance management costs. There would also be the savings of avoiding a full procurement exercise.
6.1.3 Access – A decision to disperse a list would reduce the choice available to patients, however there are a significant number of local GP practices – 8 within 1 mile of Salford Medical Practice 2 (P87668), 6 of these within 0.5 miles, and a further 14 that sit within 1 – 2 miles away (details contained within Appendix 5).
6.1.4 Consultation – Patient consultation has been undertaken by the CCG as described in section 4 of this paper. Should Option 1 be approved, a full patient engagement exercise would need to be undertaken as part of the formal procurement process. Of the 2,257 patients registered at the practice, the CCG received 5 responses to the consultation. Of those 5 responses, one supported Option 3 - Managed List Dispersal and the remaining four asked for a single handed practice, which was not specifically one of the options available for consideration.
6.1.5 Estates – The premises for the current provision is privately owned by 3 parties (Dr Rahman, Dr Salim and a third party), and so continue to be used within the interim arrangements for provision. Consideration would need to be given in relation to Estates issues regardless of the decision made, in terms of capacity at receiving practices in the event of dispersal, or in terms of lease arrangements if procurement were the decision.
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6.1.6 Equality Impact Assessment (EIA) – An Equality Analysis has been completed and no equality concerns were identified at this stage, however it is acknowledged that this will need to be reviewed once the decision has been made, to assess impact on protected groups. If Option 1 – Tender, were approved, a full EIA would be completed during the procurement process. Current primary care providers are contracted to provide services which are fully compliant with Equality, Diversity and Human Rights legislation.
6.1.7 Wider health economy – Impact on the wider health economy is likely to be minimal. In the event that Option 2 or 3 is approved, it is likely that registered patients will remain registered in one of the many local practices available, as described in section 6.1.3 of this paper.
6.1.8 Impact on and risks for other primary care providers – 44 of 45 Salford practices are currently operating an open list (NB. the 45th practice is not local to P87668). A paper review of performance was carried out for all of the practices geographically based within 1 mile of P87668 (Appendix 6). A letter was sent to the practices, the letter outlined the options available to the CCG and enquired as to the practice capacity, capability and appetite to register a significant number of new patients should either of the list dispersal options be approved. A summary of the responses received from the recipients of the Appendix 7 letter, is included within Appendix 8.
6.1.9 List size - It should be noted that although the list size at P87668 was 2,257 on 30 June 2016, it is likely that some patients will have already exercised patient choice and registered with another GP practice, particularly those that live a considerable distance from the practice. A view of patient distribution, as at 3 August 2016, is included as Appendix 9 and it should be noted that a number of registered patients live a significant distance from the practice. These ‘out of area’ patients would be unlikely to be eligible to register with a Salford practice, in line with individual practice boundary arrangements. The CCG are actively monitoring the list size and anticipate that this will naturally reduce in size, even before the decision required by this paper, is made, partially due to the number of ‘out of area’ patients. The viability of Option 1 - Procurement may be affected by the fact that the list size is small (and potentially reducing) and so it may not be considered attractive to any potential future providers.
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7 Options appraisal
7.1 Options criteria
The following criteria have been developed to enable the three options, as outlined in 5.2, to be compared:
Criteria Description Weighting
C1 A permanent solution is quickly implemented 35
C2 Commission high quality general practice in line with 15 the CCG strategy
C3 Commission general practice ‘at scale’ in line with the 15 CCG strategy
C4 Local practices are not adversely impacted meaning 20 they would be unable to safely deliver services to patients
C5 General practice to work as part of a federated 15 neighbourhood model
Total 100
7.2 Options appraisal
The Primary Care Operations Group assessed each option against the above criteria. The table below shows the scoring for each of the criteria.
Options appraisal scoring
Option1 Option 2 Option 3 Criteria Weight Score Weighted Score Weighted Score Weighted score score score C1 35 2 80 10 400 10 400
C2 15 5 75 6 90 6 90
C3 15 1 15 5 75 5 75
C4 20 8 160 4 80 7 140
C5 15 5 75 9 135 9 135
Total 100 405 780 840
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26 September 2016 Agenda Item No 5a
A brief summary of the rationale used in scoring each option, is included below.
7.2.1 C1 - A permanent solution is quickly implemented
Scoring for this criterion was highly weighted as the CCG felt it important to quickly provide stability for patients, and to promptly confirm arrangements to patients for their continued access to medical care. The timescale for an effective procurement process is around 12 months; this would include pre engagement, service specification development, tendering processes and effective mobilisation of services. For this reason, Option 1 did not score highly. Options 2 and 3 would both be able to be implemented before the expiry of the APMS contract (30 November 2016).
7.2.2 C2 - Commission high quality general practice in line with the CCG strategy
In the New Contract option the procurement process could be used to ensure only providers with a track record of delivery of high quality care were commissioned, however the quality of the new provision would be uncertain until they were up and running. The two dispersal options would potentially maintain the existing level of quality. This currently varies between other local practices that the list would be most likely to disperse to, however none of these practices have been highlighted as having quality concerns associated with them, and practices within this neighbourhood are already working together on a variety of schemes to reduce the variation in the quality of care.
7.2.3 C3 - Commission general practice ‘at scale’ in line with the CCG strategy
The ambition set out in the CCG’s Five Year Strategic Commissioning Plan is to embed ‘Primary care, provided at scale’. The tender option would go against this ambition given that it would result in another small contract being established. For this reason, Options 2 and 3 scored higher.
7.2.4 C4 - Local practice are not adversely impacted
In a climate of increasing pressure in general practice, the CCG are mindful of the potential additional workload associated with Option 2 – List Dispersal. Option 3 scores higher as this would potentially reduce the number of patients seeking to register with practices that are already struggling with capacity. Option 1 would have the least impact upon local practices.
7.2.5 C5 - General practice to work as part of a federated neighbourhood model
CCG primary care strategy sets out the vision for a greater collaborative, federated, more robust model for general practice operating in an integrated model. In Option 2 and Option 3, the list would be dispersed amongst existing practices, who are already working together as part of a neighbourhood model and as part of the developing Salford Primary Care Together. If Option 1 resulted in a new provider being established in Salford it is less certain whether they would immediately be able to work within this arrangement.
7
26 September 2016 Agenda Item No 5a
7.2.6 Options Appraisal summary
Of the options assessed, Option 3 – Managed list dispersal scores the highest and balances speed of implementation with maintaining the CCG’s strategic direction around scale and collaborative working.
8 Recommendation
8.1 The Primary Care Commissioning Committee is asked to:
• note the contents of the paper
and
• approve the recommendation to implement Option 3 – Managed List Dispersal, in line with the outcome of the options appraisal
Sam Glynn-Atkins Service Improvement Manager
19 September 2016
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26 September 2016 Agenda Item No 5a
Appendix 1 – Letter to patients (8 August 2016)
7th Floor, St James’s House Pendleton Way Salford M6 5FW
8th August 2016 Dear Patient,
PLEASE READ CAREFULLY
RE: Dr A Rahman, Salford Medical Practice, 194-198 Langworthy Road, Salford M6 5PP
We are writing to inform you of the very sad news that unfortunately your GP, Dr Abdul Rahman, who practiced at Salford Medical Practice, sadly passed away on the 1st August 2016. Our thoughts are with his family and friends during this difficult time.
We understand that this news may be upsetting and may cause concern, but please do not worry, as we have tried and tested systems in place to support patients who are affected. We would like to assure you that we are committed to making sure that all of Dr Rahman’s patients have access to alternative high quality GP services.
We have been working hard to put temporary measures in place so that you and members of your family currently registered at Salford Medical Practice can continue to receive medical care. We have arranged for another local GP practice to see Dr Rahman’s patients in the short term. So, from today, if you need to see a GP and were previously registered with Dr Rahman, you can now go to Dr Salim, whose practice is located within the same building as Dr Rahman’s practice at Salford Medical Practice, 194 -198 Langworthy Road, Salford M6 5PP.
If you would prefer to register with another GP instead, you need to contact the local GP practice of your choice and ask if you can register with them. The new practice will let you know what to do. The NHS England customer contact centre can also help you to find local GP practices – just contact them via the website at www.england.nhs.uk or call on 0300 311 22 33.
We are working towards making sure long term arrangements are put in place for patients and we will write to you again as soon as we have more information.
How does this affect me?
From 8 August 2016, if you need to see a GP or practice nurse, continue to use the same contact details for Salford Medical Practice detailed below:
26 September 2016 Agenda Item No 5a
Appendix 1 – Letter to patients (8 August 2016)
Dr Salim Salford Medical Practice 194-198 Langworthy Road Salford, M6 5PP
Tel: 0161 745 8341
Website: http://www.salfordmedicalcentre.nhs.uk Email: [email protected]
Salford Medical Practice telephone lines are open from 8am - 6pm daily (excluding weekends, Bank Holidays & Training Closures), outside of these hours the phones will be diverted to the Out Of Hours provider.
What do you need to do now?
If you are happy to see Dr Salim at the Salford Medical Practice, then you do not need to do anything.
If you would like to register at a different GP practice, please follow the instructions above.
We are very sorry for any upset or worry that this situation may cause you. If you have any further questions or concerns, please contact Patient Services at Salford CCG on 0161 212 4960.
Yours sincerely,
Anthony Hassall Chief Accountable Officer
26 September 2016 Agenda Item No 5a
Appendix 1 – Letter to patients (8 August 2016)
Frequently Asked Questions (FAQs):
Q: How do I make an appointment to see Dr Salim as I do not want to register with another practice? A: All practice details remain the same so please continue to use Dr Rahman’s practice telephone number 0161 745 8341 to make an appointment or if you have any queries or questions
Q: I want to register with another practice how do I do that? A: You would need to contact one of your other local practices and ask if you can register with them. The new practice will let you know what you need to do.
The NHS England customer contact centre can also help you to find local GP practices – just contact them via the website at www.england.nhs.uk or call on 0300 311 22 33
Q: Will the temporary GP practice know what medicines I’m taking and what treatment I’m getting? A: Yes, Dr Salim’s practice will have access to your medical records so that they can manage your care and treatment.
Q: I am waiting for the results of tests … where will they be sent now? I am worried they are going to be lost. A: Normal procedures are still in place and your test results will come to your GP practice as they would normally do. If you move to a new practice now or in the future, standard procedures include making sure that test results are sent to the new practice.
Q: I want to make a complaint – how do I do this? A: To make a complaint please contact NHS England on 0300 311 22 33 or email [email protected] To find out more about the complaints process please visit the NHS England website at www.england.nhs.uk
26 September 2016 Agenda Item No 5a
Appendix 2 – Letter to stakeholders (8 August 2016)
7th Floor, St James’s House Pendleton Way Salford M6 5FW
8th August 2016 Dear
RE: Dr A Rahman, Salford Medical Practice, 194-198 Langworthy Road, Salford M6 5PP
We are writing to inform you of the very sad news that unfortunately Dr Abdul Rahman, who practiced at Salford Medical Practice, sadly passed away on the 1st August 2016. Our thoughts are with his family and friends during this difficult time.
We understand this news may be upsetting for patients but we want to reassure you that the CCG has tried and tested systems in place to offer support and we are committed to making sure that Dr Rahman’s patients have access to alternative high quality GP services.
We have arranged for another local GP practice to see Dr Rahman’s patients in the short term. So, from today, patients who were registered with Dr Rahman can now go to Dr Salim, whose practice is located within the same building as Dr Rahman’s practice at Salford Medical Practice, 194 -198 Langworthy Road, Salford M6 5PP.
If a patient would prefer to register with another GP instead, they can contact the local GP practice of their choice and ask to register with them.
We are working towards making sure long term arrangements are put in place for patients and we will write to you again as soon as we have more information.
Yours sincerely,
Anthony Hassall Chief Accountable Officer
26 September 2016 Agenda Item No 5a
Appendix 3 – Letter to patients about the options (22 August 2016) (actual font 14pt)
7th Floor, St James’s House Pendleton Way Salford M6 5FW
22 August 2016 Dear Patient
Dr A Rahman - Salford Medical Practice
We wrote to you recently to share the sad news of Dr Rahman’s death. In that letter we told you that we would write to you again to give you more information about the longer term arrangements for your medical care.
NHS Salford Clinical Commissioning Group (CCG) needs to make a decision about the future arrangements for the medical care of Dr Rahman’s patients and the following are the only 3 options available to us:
1. Tender – carrying out a formal tender to find a new healthcare provider to deliver care to Dr Rahman’s patients. 2. List dispersal – This means that Dr Rahman’s patients would be asked to register at another local GP practice. 3. Managed list dispersal – This means that some local GP practices will be ready for Dr Rahman’s patients to register with them, and Dr Rahman’s patients would be told which local GP practices are waiting for their registration.
If you have any comments or questions about these 3 options, please contact Patient Services at Salford CCG on 0161 212 4960 or [email protected]
When the CCG has made a decision, we will write to you again to tell you what will be done.
Yours sincerely,
Anthony Hassall Chief Accountable Officer
26 September 2016 Agenda Item No 5a
Appendix 3 – Letter to patients about the options (22 August 2016) (actual font 14pt)
Frequently Asked Questions (FAQs):
Q: Do I need to do anything now? A: No, you do not need to do anything. This letter is to give you a chance to tell us what you think. If you are not sure, or do not want to tell us, then that is okay.
Q: Why do things have to change, why can’t I keep seeing a doctor in Dr Rahman’s practice? A: Dr Rahman was a ‘single handed GP’ so when he passed away, the NHS contract with his practice ended. Arrangements have to be put in place to make sure that his patients can continue to receive medical care, and this letter describes the different options available to the CCG to do this.
Q: I want to continue to go to a doctor in the same building as Dr Rahman’s practice, can I do this? A: Yes, if you need to see a GP or practice nurse you can go to Dr Salim’s practice, which is in the same building as Dr Rahman’s practice. This option will be available to you until a decision has been made on the options described within this letter. When the CCG has made a decision, we will write to you again to tell you what will be done.
Dr Salim Salford Medical Practice 194-198 Langworthy Road Salford, M6 5PP Tel: 0161 745 8341 http://www.salfordmedicalcentre.nhs.uk Website: Email: [email protected]
Salford Medical Practice telephone lines are open
from 8am - 6pm daily (excluding weekends, Bank Holidays & Training Closures), outside of these hours the phones will be diverted to the Out Of Hours provider.
26 September 2016 Agenda Item No 5a
Appendix 3 – Letter to patients about the options (22 August 2016) (actual font 14pt)
Q: I don’t want to go to Dr Salim’s practice, can I change my GP practice? A: Yes. Any patient can register at a GP practice of their choice at any time. You would need to contact the local practices of your choice and ask if you can register with them. The new practice will let you know what you need to do. Alternatively, you can go to NHS Choices at www.nhs.uk and search for ‘Find GP services’ or contact the NHS England Customer Contact Centre on 0300 311 22 33. They will be able to help you to find local GP practices.
Q: I am worried about all this change. A: Please try not to worry, the temporary arrangements we have put in place will ensure that you continue to receive all the health care you need whilst longer term arrangements are being made. We will continue to keep you informed.
Q: I want to make a complaint – how do I do this? A: To make a complaint please contact NHS England on 0300 311 22 33 or email [email protected] . To find out more about the complaints process, please visit the NHS England website at www.england.nhs.uk
26 September 2016 Agenda Item No 5a
Appendix 4 – Responses from patients
The following responses were received from patients:
No. 1: Preference – single handed practice Telephone call
No. 2: Email Preference - managed list dispersal No. 3: Preference – single handed practice Telephone No. 4: Preference – single handed practice Telephone No. 5: Email Preference – single handed practice
26 September 2016 Agenda Item No 5a
Appendix 5 – GP practices located within 1 – 2 miles of P87668
Practices within 1 mile of P87668
Salford Medical Centre 1 - Dr Ramzan 194 - 198 Langworthy Road 0.0 miles Salim Salford Tel: 0161 736 1166 Manchester M6 5PP
Langworthy Medical Practice 250 Langworthy Road 0.2 miles Lancashire Tel: 01617379244 Salford Lancashire M6 5WW Cornerstone Medical Practice Langworthy Cornerstone 0.3 miles Tel: 0161 212 4445 451 Liverpool Street Salford M6 5QQ Sorrel Bank Medical Practice 23 Bolton Road 0.4 miles Tel: 0161 736 1616 Salford Lancs M6 7HL
Clarendon Medical Practice Pendleton Gateway 0.4 miles Tel: 0161 211 7373 Pendleton Gateway 1 The Broadwalk Salford M6 5FX
Pendleton Medical Practice Pendleton Gateway 0.4 miles Tel: 0161 211 7420/1 1 Broadwalk (1st Floor) Salford
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Appendix 5 – GP practices located within 1 – 2 miles of P87668
Manchester M6 5FX
Dr J Y Amin The Willows Medical Practice 0.6 miles Tel: 0161 7362356 Lords Avenue Salford M5 5JR The Energise Healthy Living Centre Energise Healthy Living Centre 0.9 miles Tel: 0161 212 6540 3 Douglas Green Salford M6 6ES
Practices 1 - 2 miles away from P87668
Ordsall Health Surgery Ordsall Health 1.1 miles 118 Phoebe Street Tel: 0161 212 6600 Salford M5 3PH
The Height Medical Practice 355 Bolton Road 1.1 miles Irlams O'Th'Height Tel: 0161 736 5282 Salford M6 7NJ
Salford Health Matters (Salford) Willow Tree Healthy Living Centre 1.3 miles 94 Littleton Road Tel: 0161 212 5815 Salford England - Uk M7 3SE
Orient Road Medical Practice 37 Orient Road 1.4 miles Salford
26 September 2016 Agenda Item No 5a
Appendix 5 – GP practices located within 1 – 2 miles of P87668
Tel: 0161 789 3029 Lancs M6 8LE
Dr N Kassam & Dr A Pira 4 - 5 Mocha Parade 1.4 miles Salford Tel: 0161 839 2721 M7 1QE
Dr Choudhury And Dr Sultan Lower Broughton Health Centre 1.5 miles Great Clowes Street Tel: 0161 212 6530 Salford M7 1RD
Lower Broughton HC Dr K H Buch Great Clowes Street 1.5 miles Salford Tel: 0161 212 6525 Lancs M7 1RD
Lower Broughton HC Dr I Jeet Great Clowes Street 1.5 miles Salford Tel: 0161 212 6520 Lancashire M7 1RD
Blackfriars 138 Chapel Street 1.7 miles Salford Tel: 0161 819 4790 England - Uk M3 6AF
Dr M S Yates, Dr A W Fletcher, Dr C 30 Russell Street 1.9 miles Mafunga & Dr M Mafunga Eccles Manchester Tel: 0161 707 5500 Lancs M30 0NU
26 September 2016 Agenda Item No 5a
Appendix 5 – GP practices located within 1 – 2 miles of P87668
Drs Budden, Sutherland,Tasker & Tyrrell 30 Russell Street 1.9 miles Eccles Tel: 0161 707 5500 Manchester M30 0NU
Dr J Behardien, Dr A Walker & Dr T Regan 30 Russell Street 1.9 miles Eccles Tel: 0161 707 5500 Manchester M30 0NU
Eccles Gateway Medical Centre - Dr H 28 Barton Lane 1.9 miles Singh Eccles M30 0TU Tel: 0161 211 7039
Salford Health Matters (Eccles) 1st floor, Eccles Gateway 1.9 miles 28 Barton Lane Tel: 0161 212 5815 Eccles Greater Manchester M30 0TU
Source: NHS Choices website www.nhs.uk
26 September 2016 Agenda Item No 5a
Appendix 6 – Paper review of GP practices located within 1 mile of P87668
P code Practice name Type List size Distance GP GP CQC Practice performance Patient survey (as at 30 from WTE* WTE rating Indicators* (key below)* June P87668 per 2016) 1,000* Flu 15/16 QOF P87004 Salford Medical Practice 1 Single 3,125 0.0 miles Good handed (co-located) (02/2015) P87027 Langworthy Medical Partnership 14,671 0.2 miles Good Practice (04/2016)
P87639 Salford Care Centre Single 1,928 0.3 miles Good handed (10/2014) P87040 Sorrel Bank Partnership 8,857 0.4 miles Good (04/2016) P87634 Clarendon Medical Practice Partnership 9,287 0.4 miles Good (09/2015) P87015 Pendleton Medical Practice Partnership 3,413 0.4 miles Good (10/2014) P87658 The Willows Single 2,737 0.6 miles Good handed (05/2016)
*This information is not publicly accessible so has been removed for the purposes of the Primary Care Commissioning Committee meeting
Patient survey data has been counted as the number of indicators of the 23 that are ranked as Dark Green, Green, Amber and Red respectively, as at July 2016.
Greater than 105% of CCG average 100% – 105% of CCG average 95% - 100% of CCG average Less than 95% of CCG average
26 September 2016 Agenda Item No 5a
Appendix 6 – Paper review of GP practices located within 1 mile of P87668
Performance data for Flu has been counted as the number of indicators of the 3 that are ranked as Green, Amber and Red respectively, as at Quarter 4 15/16 (31 March 2016).
Greater than CCG average 95% - 100% of CCG average Less than 95% of CCG average
Performance data for QOF has been counted as the number of indicators of the 17 that are ranked as Green, Amber and Red respectively, as at Quarter 1 16/17 (30 June 2016).
Greater than CCG average 95% - 100% of CCG average Less than 95% of CCG average
26 September 2016 Agenda Item No 5a
Appendix 7 – Letter to GP practices located within 1 mile of P87668
25 August 2016
Dear Colleagues
RE: Primary Care Commissioning Committee decision - Dr A Rahman, Salford Medical Practice
You will be aware that Dr Rahman sadly passed away earlier this month.
An options paper regarding the future arrangements for Dr Rahman’s patient list is currently being prepared for consideration at the Primary Care Commissioning Committee meeting on 26 September 2016.
The following are the only 3 options available to the CCG:
1. Tender – carrying out a formal tender to find a new healthcare provider to deliver care to Dr Rahman’s patients. 2. List dispersal – This means that Dr Rahman’s patients would be asked to register at another local GP practice. 3. Managed list dispersal – This means that some local GP practices will be ready for Dr Rahman’s patients to register with them, and Dr Rahman’s patients would be told which local GP practices are waiting for their registration.
Your practice is located within 1 mile of the Salford Medical Centre. Therefore, you are likely to be directly affected if either option 2 or 3 is approved.
Following the decision on 26 September 2016, the CCG will need to be prepared to quickly implement the agreed option and so we are preparing for each scenario.
If option 3 (Managed List Dispersal) was to be selected, we need to know which practices we could signpost patients to, as described above. I should be grateful if you would contact Sam Glynn-Atkins ([email protected]) by email to indicate whether or not your practice would like to be included in option 3. If we do not hear from you by Friday 16 September 2016, any letter to Dr Rahman’s patients would not include your practice details.
If you have any queries about this matter, then please do not hesitate to contact Sam Glynn Atkins as above.
Yours sincerely
Anthony Hassall Chief Accountable Officer
26 September 2016 Agenda Item No 5a
Appendix 8 – Summary of responses from GP practices located within 1 mile of P87668
P code Practice name Wishes to be included in Option 3, if selected
P87004 Salford Medical Practice 1 Yes
P87027 Langworthy Medical Practice Yes
P87639 Salford Care Centre (Cornerstone) Yes
P87040 Sorrel Bank Yes
P87634 Clarendon Medical Practice Yes
P87015 Pendleton Medical Practice Currently considering their position P87658 The Willows Yes
26 September 2016 Agenda Item No 5a
Appendix 9 – Current patient list distribution (SHAPE tool – 3 August 2016)
NHS SALFORD CLINICAL COMMISSIONING GROUP Primary Care Commissioning Committee AGENDA ITEM NO 5b
Item for Decision/Assurance/Information 26 September 2015
REPORT OF: Karen Proctor Director of Commissioning
DATE OF PAPER: 19 September 2016
SUBJECT: The Height General Practice – Procurement briefing paper
IN CASE OF QUERY Sam Glynn-Atkins PLEASE CONTACT: Service Improvement Manager [email protected] 0161 212 4129
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES: √ Quality √ Community Based Care
Integrated Care
In Hospital Care
Long Term Conditions and Mental Health
Effective Organisation
PURPOSE OF PAPER:
This paper is supplied to the Primary Care Commissioning Committee, to provide an update on progress made following the decision to re-procure the Alternative Provider of Medical Services (APMS) contract at The Height General Practice and to request confirmation of the decision made on 15 July 2015 by the Primary Care Joint Commissioning Committee, to re-procure the contract.
Further explanatory information required
HOW WILL THIS BENEFIT THE Provides clarity for the future care of patients on HEALTH AND WELL BEING OF the list of Y02767 SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP?
WHAT RISKS MAY ARISE AS A As noted in the main document RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED?
WHAT EQUALITY-RELATED RISKS Equality Analysis to be completed during the MAY ARISE AS A RESULT OF THIS procurement process to identify any equality PAPER? HOW WILL THESE BE concerns and to assess impact on protected MITIGATED? groups, if any
DOES THIS PAPER HELP ADDRESS Not applicable to organisational ‘red’ risks ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
PLEASE DESCRIBE ANY POSSIBLE Several local GPs would have conflicts of CONFLICTS OF INTEREST interest associated with this paper, none have ASSOCIATED WITH THIS PAPER. been contacted in relation to this paper, and none are involved in the decision making process.
PLEASE IDENTIFY ANY CURRENT GP practices SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER:
Footnote:
Members of NHS Salford Primary Care Commissioning Committee will read all papers thoroughly. Once papers are distributed no amendments are possible.
26 September 2016 Agenda Item No 5b
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement √ Carried out in 2015 Appetite to procure (see (Please detail the method ie survey, event, consultation) Appendix 1) Clinical Engagement √ Clinical Lead assigned Dr Elaine Tamkin is part of (Please detail the method ie survey, event, consultation) the Project Group Has ‘due regard’ been given to Equality Noted the need to undertake an EIA will feature in the Analysis (EA) of any adverse impacts? Equality Impact Assessment (EIA) procurement process (Please detail outcomes, including risks and how √ these will be managed) √ Legal Advice Sought
Presented to the Commissioning Committee √
Presented to the Health and Wellbeing Board √
Presented to the Integrated Commissioning √ Board √ Primary Care Operational Group Paper approved to go to Presented to any other groups or committees, – 8 Sept 2016 PCCC including Partnership Groups
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
26 September 2016 Agenda Item No 5b
The Height – Procurement update
1 Executive Summary
This paper gives an overview of the background to the decision made by the Primary Care Joint Commissioning Committee in July 2015 to re-procure the Alternative Provider of Medical Services (APMS) contract at The Height General Practice. It summarises progress to date, sets out some commissioning considerations for note and outlines the next steps for the project group.
The Primary Care Commissioning Committee is asked to: - note the contents of the paper - consider whether or not the decision made on 15 July 2015 by the Primary Care Joint Commissioning Committee to re-procure the APMS contract is still the correct one in light of the CCG’s clearer strategic direction for primary care.
And if so, - approve the proposal to extend the current APMS contract to end on 31 March 2018 (subject to provider agreement) - note the planned commissioning approaches
2 Introduction and Background
2.1 The Alternative Provider of Medical Services (APMS) contract currently held with The Height General Practice (Y02767) is due to expire at the end of March 2017.
2.2 Some preliminary work was undertaken in May 2015 to consider whether the contract would be re-procured or whether the practice would be closed and the patient list dispersed.
2.3 This preliminary work included consultation with patients and stakeholders. Comments were received from: • 21 patients/local residents • 2 GP practices • the Salford and Trafford Local Medical Committee • the Salford and Trafford Local Pharmaceutical Committee • the Local Authority A summary of the comments received at that time is included as Appendix 1.
2.4 On 15 July 2015, the Primary Care Joint Commissioning Committee made a decision to re-procure the contract. However, work stalled once it was recognised that NHS Salford Clinical Commissioning Group (CCG) was not able to identify the significant amount of management resource that was required to undertake a full procurement.
26 September 2016 Agenda Item No 5b
2.5 It should be noted that subsequent to the Primary Care Joint Commissioning Committee’s decision to re-procure, the CCG has done much work to set a strategic direction for primary care. This includes:
- The Primary Care (General Practice) Strategy (January 2016), which sets out the vision for a greater collaborative, federated, more robust model for general practice operating in an integrated model - The CCG’s Five Year Strategic Commissioning Plan, which sets an ambition to embed ‘primary care, provided at scale’
2.6 Background information about The Height General Practice
2.6.1 The APMS contract for The Height General Practice was due to expire in May 2015 following a 5 year term. A further extension was offered to support the review due to the reasons outlined under 2.4.
2.6.2 The list size of The Height, as at 30 June 2016, was 4,009 patients. The distribution of patients is shown in Appendix 2.
2.6.3 There are 3 practices geographically located within 1 mile of The Height General Practice as shown in the table below. A further 19 practices are located within 2 miles of the practice.
Practice name Distance from The Height General Practice
Sorrel Bank 0.8 miles P87040 Orient Road 0.8 miles P87032 Langworthy Medical Practice 1.0 miles P87027
3 Actions taken
3.1 Following the recruitment of a number of members of the CCG’s Service Improvement Team with a remit around primary care, a member of staff was identified to manage the project to re-procure The Height General Practice. A preliminary scoping meeting took place with the Greater Manchester Health and Social Care Partnership (GMHSCP) lead for APMS contracts on 7 July 2016.
3.2 A re-established project team met for the first time on 13 September 2016. The project team includes a representative from the GMHSCP and representatives from CCG teams including Finance, Information Governance, Engagement, Medicines Optimisation, Service Improvement and IT. An external clinical lead has also been identified.
3.3 It is acknowledged that this work will require dedicated CCG resource in order to meet the prescriptive timeframe that procurement of services demand. GMHSCP has
26 September 2016 Agenda Item No 5b
provided a generic procurement timeline which is to form the basis of the project plan for this reprocurement. The generic document indicates a reasonable timescale is approximately 12 months to new service mobilisation. The current contract expires on 31 March 2017 and will therefore need to be extended to allow the procurement to go ahead (subject to provider agreement).
3.4 Commissioning considerations
To support the design of the procurement evaluation questions and weightings, there are some commissioning considerations for note by the Primary Care Commissioning Committee (PCCC).
3.4.1 Premises – there is no expected risk associated with the current premises and it is therefore expected to be available for future services.
3.4.2 Contract tariff – GMS tariff will apply to the future contract to ensure equity amongst primary care commissioning in Salford.
3.4.3 Local quality schemes – The service specification will clarify the core contractual requirements. In addition, there are various national and local enhanced services. The commissioner’s expectation is that the new provider will sign up to deliver these. In particular at the moment the practice is commissioned to open Monday to Friday 08.00 – 20.00 and Saturday 09.30 – 11.00. The new specification will detail GMS core hours (Monday to Friday 08.00 – 18.30), and will clarify the commissioner’s expectation in terms of patient access.
3.4.4 Contract term – NHS England GM obtained approval in March 2016, to offer contracts on a 10 year basis with the option to extend up to 5 years, pending performance.
3.4.5 Engagement with the market – It is possible for commissioners to engage with the market to gather soft market intelligence in to better understand the level of interest within the external market. Market engagement is not mandated and, as other Greater Manchester CCG’s have completed this exercise, consideration will be given to the findings of this exercise.
4 Extension of the current contract
4.1 Due to the time needed to undertake a full procurement process, it will not be possible to have a newly procured APMS contract in place by 1 April 2017. With this in mind and to sustain provision whilst the procurement exercise is undertaken, the it will be necessary to extend the current contract for a further 12 months until 31 March 2018 (subject to provider agreement).
26 September 2016 Agenda Item No 5b
5 Next steps
5.1 Once the above intentions within 3.4 have been confirmed, the project group will oversee the commencement of work to:
5.1.1 Update the service specification.
5.1.2 Develop the procurement questions to be responded to by potential providers.
5.1.3 Develop a specific procurement timeline and project plan, in liaison with North of England Commissioning Support (NECS) and GMHSCP, to link in with the extended contract dates, as described in 4.1.
5 Conclusions and Recommendations
5.1 The Primary Care Commissioning Committee is asked to:
• note the contents of the paper
• consider whether or not the decision made on 15 July 2015 by the Primary Care Joint Commissioning Committee to re-procure the APMS contract is still the correct one in light of the CCG’s clearer strategic direction for primary care
and if so,
• approve the proposal to extend the current APMS contract to end on 31 March 2018 (subject to provider agreement)
• note the planned commissioning approaches
Sam Glynn-Atkins Service Improvement Manager
19 September 2016
26 September 2016 Agenda Item No 5b Appendix 1 – Summary of comments received from patients & stakeholders (May 2015)
Excerpt taken from the Report to Joint Committee on 20 June 2015 (Author: Kerry Porter)
3.1.1 Registered patients and their carers
Both online and paper surveys were available to both patients and the wider population of Salford, however only patients registered at The Heights took the opportunity to share their views. In summary surveys were completed by 34 of the registered population (identified on the survey as patients and carers), 0.9% of the total population.
All respondents supported a service remaining at The Heights.
The majority of respondents left additional comments. There were many positive comments making reference to the current provider, service provided, and location of the site, access, friendly staff and a wish for the service to remain. Equally there were a number of constructive comments relating to the problems ‘open’ morning access can present and the need for a regular GP instead of locums. It should be noted time limited contracts are inherent of the risk of retaining staff which is further compounded by a service review: a longer-term contract in the future may mitigate this.
The Patient Participation Group were consulted directly and whilst no formal response was received, during the meeting the PPG did support a procurement of services echoing the patient survey.
3.1.2 Local Authority
The local authority supported procurement of service on the basis this reduced variation in services, provide continuity for patients whilst ensuring value for money in an environment which has changed since the original service was commissioned.
3.1.3 Local LMC
The LMC indicated support for a procurement.
3.1.4 Other Salford GP Practices
13 practices were identified as being directly affected by any service consideration being within 1.30miles of the Heights of which 2 provided a formal response supporting a service review and procurement.
3.1.5 Local Pharmaceutical Council (LPC)
Again LPC supported procurement of services
26 September 2016 Agenda Item No 5b Appendix 2 – Distribution of patients
NHS SALFORD CLINICAL COMMISSIONING GROUP Primary Care Commissioning Committee AGENDA ITEM NO 5 (c)
Item for Decision/Assurance/Information 26 September 2015
REPORT OF: Karen Proctor Director of Commissioning
DATE OF PAPER: September 2016
SUBJECT: Strategic Outline Case and Options Appraisal - Expanding Capacity in General Practice To Respond To Population Growth In Ordsall
IN CASE OF QUERY Anna Ganotis PLEASE CONTACT: Head of Service Improvement (Primary Care) [email protected] 0161 212 4912
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES: √ Quality √ Community Based Care √ Integrated Care
In Hospital Care
Long Term Conditions and Mental Health
Effective Organisation
PURPOSE OF PAPER:
This Strategic Outline Case seeks to set out the strategic case for expanding capacity in general practice in the Ordsall ward of the city and to identify the most appropriate commissioning option to address it.
Further explanatory information required
HOW WILL THIS BENEFIT THE Will ensure that there is adequate access to HEALTH AND WELL BEING OF general practice for patients living in Ordsall. SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP?
WHAT RISKS MAY ARISE AS A Noted in section 3.9 RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED?
WHAT EQUALITY-RELATED RISKS An Equality Analysis has been undertaken and MAY ARISE AS A RESULT OF THIS no equality concerns were identified at this PAPER? HOW WILL THESE BE stage. MITIGATED?
DOES THIS PAPER HELP ADDRESS Not applicable ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
PLEASE DESCRIBE ANY POSSIBLE GPs have no role in commissioning decisions CONFLICTS OF INTEREST relating to general practice in order to avoid ASSOCIATED WITH THIS PAPER. possible conflicts of interest.
PLEASE IDENTIFY ANY CURRENT GP practices that currently provide services to SERVICES OR ROLES THAT MAY BE Ordsall residents. AFFECTED BY ISSUES WITHIN THIS PAPER:
Footnote:
Members of NHS Salford Primary Care Commissioning Committee will read all papers thoroughly. Once papers are distributed no amendments are possible.
26 September 2016 Agenda Item No 5 (c)
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement √ Attendance at the Ordsall and There was complete support (Please detail the method ie survey, event, consultation) Langworthy Patient Participation for the objectives of this Group strategic outline case. Clinical Engagement √ Due to potential Conflict of (Please detail the method ie survey, event, consultation) Interest Has ‘due regard’ been given to Equality EA drafted To be reviewed once a Analysis (EA) of any adverse impacts? decision is made (Please detail outcomes, including risks and how √ these will be managed) Legal Advice Sought √ Presented to the Commissioning Committee √ Presented to the Health and Wellbeing Board √ Presented to the Integrated Commissioning √ Board √ Primary Care Operational Group Supported the Presented to any other groups or committees, – 8 Sept 2016 recommendations of the including Partnership Groups strategic outline case
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work
Salford Clinical Commissioning Group
Strategic Outline Case and Options Appraisal
Expanding Capacity in General Practice To Respond To Population Growth In Ordsall
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Section 1 Summary
There is projected to be significant population growth in the Ordsall area of Salford in the next 20 years. Therefore, as commissioners of primary medical care services, NHS Salford Clinical Commissioning Group (CCG) needs to ensure that plans are in place to be able to meet the additional demand that population growth will present.
As things stand, it seems as if the two Salford practices which predominantly serve Ordsall North would have the estate capacity and willingness to expand to meet the additional demand, subject to ability to recruit additional workforce (although this of course would continue to be monitored). However, there is less scope to be able to expand the practice that predominantly serves the south of Ordsall. Therefore, this project focuses upon ensuring that there is adequate capacity in Ordsall South to meet the needs of the potential circa 15,000 new residents moving in to the area over the next 20 years.
The objective of this Strategic Outline Case is to identify a commissioning option to address the identified general practice capacity issues in Ordsall South that will:
• Secure sufficient capacity in general practice to meet increased demand arising from longer term population growth • Have the ability to be implemented quickly in order to meet the already increasing demand for primary medical care • Provide value for the tax payer and be affordable to the NHS • Support the CCG’s aspiration to commission high quality general practice • Support the CCG’s aspiration to commission primary care ‘at-scale’ • Support the CCG’s strategy for general practice to work as part of a federated neighbourhood model
Following an options appraisal, the recommendations of this Strategic Outline Case are that:
- Option 2 – Expand Current Local Provision – is approved (with the expectation that it will provide at least a 5 – 10 year solution) and passed to the Salford Strategic Estates Group for implementation
- The scale and impact of population growth in Ordsall is reviewed in two years’ time and the need for a branch surgery is re-considered at that point
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Section 2 Strategic Context … ……
2.1 Problem / Opportunity
2.1.1 Ordsall Population Growth
Ordsall is situated chiefly to the south of the A57 road and close to the River Irwell, the main boundary with the city of Manchester. Ordsall is bound to the south by Salford Quays and the Manchester Ship Canal, which divides it from Stretford and the Metropolitan Borough of Trafford.
Figure 1: Map of Ordsall Ward
In 2006, Salford City Council and Legendary Property Company Living (LPC) signed up to the Ordsall Development Framework (produced in 2004), securing a partnership commitment to regenerating an area totalling almost 73 hectares. So far, more than 500 homes have been created, along with a children’s centre and a new primary school. The initial phase of a £50 million mixed use scheme at Radclyffe Park was completed in 2012 providing a new local centre for the area. The development to date includes: • a new 4,500m2 retail space • a 156 Travel Lodge hotel • 14 retail units • a mix of 29 town houses and apartments
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• Ordsall Health building including a GP practice, chemist, NHS and private dentist along with community services
This regeneration has contributed to Ordsall being the fastest growing neighbourhood in Salford. The population of the Ordsall ward increased by 111 % between 2001 and 2011 (2011 National Census Data).
Despite this already significant population growth since 2001, the population of Ordsall is predicted to grow further. The table below shows that projections in 2015 anticipated that Ordsall’s total population will increase from 16,000 residents in 2016 to 22,000 residents in 2021; an increase of over 6,000.
Table 1 - Forecast Total Population, Salford Wards: 2015-21
Change Ward 2015 2016 2017 2018 2019 2020 2021 2016-19 2016-21 Barton 12,590 12,651 12,715 12,733 12,838 12,941 13,040 187 389 Boothstown & Ellenbrook 9,840 9,999 10,059 10,088 10,136 10,183 10,227 138 228 Broughton 15,357 16,031 16,177 16,478 16,518 16,555 16,588 486 557 Cadishead 11,088 11,107 11,050 11,033 11,081 11,127 11,171 -26 64 Claremont 10,686 10,679 10,606 10,544 10,496 10,447 10,396 -183 -283 Eccles 11,522 11,712 12,053 12,407 12,433 12,456 12,477 720 765 Irlam 10,029 10,036 9,967 9,909 9,866 9,821 9,775 -170 -260 Irwell Riverside 13,154 13,146 13,580 13,874 14,377 14,873 15,362 1,231 2,216 Kersal 13,335 13,333 13,268 13,326 13,279 13,231 13,180 -54 -153 Langworthy 13,382 13,531 13,410 13,600 13,871 14,137 14,397 340 866 Little Hulton 13,439 13,717 13,740 13,795 13,869 13,941 14,010 152 293 Ordsall 15,666 16,026 17,627 18,746 19,893 21,027 22,145 3,867 6,119 Pendlebury 13,364 13,361 13,269 13,193 13,198 13,201 13,202 -163 -159 Swinton North 11,426 11,419 11,343 11,278 11,246 11,212 11,177 -174 -242 Swinton South 11,606 11,612 11,568 11,501 11,577 11,650 11,721 -35 109 Walkden North 12,275 12,649 12,916 12,998 13,080 13,160 13,237 431 587 Walkden South 10,579 10,866 11,130 11,470 11,578 11,685 11,788 712 921 Weaste & Seedley 12,429 12,421 12,336 12,328 12,394 12,457 12,517 -28 96 Winton 12,528 12,610 12,611 12,626 12,578 12,529 12,478 -31 -132 Worsley 10,419 10,430 10,393 10,333 10,302 10,271 10,237 -128 -192 Salford 244,716 247,339 249,817 252,259 254,609 256,903 259,126 7,270 11,787 Source: Salford City Council 2015
The forecasted scale of population growth in Ordsall compared to other wards in the city is starkly demonstrated in Figure 2.
Figure 2: Forecast Salford Population Changes 2015 - 2021
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Table 2 below shows the estimated net additional housing for each ward in Salford over the next 20 years. It should be noted that these figures have subsequently been updated as part of the 2016 Housing and Economic Land Availability Assessment (see tables 3 and 4) and indeed increased, however, this data is included here to demonstrate the rate of building growth in comparison to the other wards in the city. It should also be noted that the CCG has only had access to data regarding housing developments within the Salford City Council border. It is possible that there will be developments across the Manchester and Trafford borders that could also impact upon GP practices in Salford. The CCG’s Service Improvement Team is liaising with colleagues in Manchester and Trafford to try to quantify this.
Table 2 – Estimated net additional housing by ward, 2015 - 2035
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Net additional dwellings Phasing (1 April to 31 March) Dwelling type Total Ward / Spatial 2015 to 2020 to 2025 to 2015 to Total Framework 2020 2025 2035 2035 houses Total apts Barton 245 480 354 1079 830 249 Boothstown & Ellenbrook 121 70 32 223 190 33 Broughton 503 409 992 1904 364 1,540 Cadishead 73 66 307 446 279 167 Claremont 15 5 142 162 144 18 Eccles 365 235 148 748 257 491 Irlam 6 8 22 36 25 11 Irwell Riverside 1,694 1,844 1,502 5,040 1,543 3,497 Kersal 62 131 123 316 133 183 Langworthy 72 1,007 227 1306 981 325 Little Hulton 29 641 177 847 751 96 Ordsall 5,868 6,029 4,851 16,748 410 16,338 Pendlebury 11 219 172 402 290 112 Swinton North 36 29 113 178 120 58 Swinton South 17 353 117 487 335 152 Walkden North 430 207 299 936 777 159 Walkden South 492 95 143 730 608 122 Weaste And Seedley 322 98 22 442 388 54 Winton 97 41 83 221 112 109 Worsley 19 42 82 143 84 59 Total 10,477 12,010 9,907 32,394 8,621 23,773
Regional Centre 6,775 6,838 5,301 18,914 164 18,750 Central Salford (excluding the Regional Centre) 1,726 2,686 2,425 6,837 3,644 3,193 Salford West 1,976 2,486 2,181 6,643 4,813 1,830
Source: Salford City Council Housing and Economic Land Availability Assessment (August 2015)
It can be seen that by a significant margin, Ordsall is anticipated to be the ward seeing the most development, with an additional 16,748 dwellings between 2015 and 2035. The vast majority of these dwellings will be apartments (16,338). Representatives from the City Council have pointed out that bearing in mind the nature of the accommodation (98% apartments), it is anticipated that the household sizes will be small; using the most up to date census data gives an average household size of approximately 1.5 people per household. Therefore council officers have estimated that the Ordsall population might increase by approximately 9000 people between 2015-2020, based upon the following assumptions: • An average household size of 1.5 people; • The predicted number of additional homes being delivered;
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• No household change in all homes; • All homes (including existing stock) are occupied.
Although the figures are different, the predictions based on August 2015 housing plans and the December 2015 population forecasts both indicate substantial population growth in Ordsall. The population forecasts are due to be refreshed in December 2016 and so those figures are likely to increase in line with recent housing projections.
2.1.2 Geography of Ordsall Population Growth
Figure 3 shows the planned housing developments on a map of Ordsall.
Figure 3 – Housing Sites In Ordsall Ward 2016 – 2036
Due to the geography of this area, this Strategic Outline Case will consider the impact of housing development in Ordsall in terms of two distinct areas (as marked by the green line on figure 3): 1) all housing development south of Regent Road (Ordsall South), 2) all housing development north of Regent Road (Ordsall North).
Figures that Salford City Council have provided to support Figure 3 (taken from the draft 2016 Housing and Economic Land Availability Assessment) have been used to create the tables below which show the potential number of new houses and apartments to be built in Ordsall in the next 20 years. It should be noted that for
Business Case document suite Page 7 19/09/2016 many of these schemes, no work has started and no planning application has been started. Construction has only started on 34% of the 9925 new dwellings estimated for 2016 – 2021 and of course there is no guarantee that once the new homes have been built that they will sell (although this is considered to be a low risk given current market conditions). Full planning permission has been granted for an additional 21% of the new homes. However, even where planning permission has been granted, there is no guarantee that the housing will progress to being built.
The housing projections supplied have been used to estimate population figures based on an average household size of 1.5 for apartments and 2.3 for houses (based upon average census figures). It can be seen that there is a fairly even split between north and south of Regent Road.
Table 3 – Estimated Population Growth South of Regent Road
No. New House No. Apt. Total Total New Houses Population New Population New Population Apts Dwellings 2016- 125 288 4307 6461 4432 6749 2021 2021- 184 423 3097 4646 3281 8878 2026 2026- 0 0 1974 2961 1974 2961 2036 Total 309 711 9378 14,067 9687 14,778 2016- 2021
Table 4 – Estimated Population Growth North of Regent Road
No. New House No. New Apt. Total Total New Houses Population Apts Population New Population Dwellings 2016- 33 76 5460 8190 5493 8266 2021 2021- 50 115 2444 3666 2494 3781 2026 2026- 25 58 2114 3171 2139 3229 2036 Total 108 248 10,018 15,027 10,126 15,276 2016- 2021
Summary
Given the projections of population growth in the Ordsall area, there is a need to ensure that primary medical services are able to meet this additional level of
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demand. Therefore, this strategic case aims to look at the options for ensuring that there will be sufficient provision to service this new population coming to live in the Ordsall area.
2.1.3 Population Demographics
Council housing officers expect that a significant proportion of the homes to be built will be for private rent. As a result of the accommodation size, tenure and proximity to Manchester City Centre / Media City, it is anticipated that the occupants will likely be: • Young single adults and some young couples; • Professionals working in the service sector; • Economically active; • Without children; • Mainly transitional (i.e. will only stay in the area for a short period before moving on).
Public health colleagues from the City Council have concurred with this view. They cite that the housing development that has taken place over the last decade has attracted mainly childless singles aged 21-30, most of whom are recent graduates and have the same Mosaic Code - J41 (or people like ‘Holly and Tom’):
Figure 4 – Typical Profile of new Ordsall Residents
Public health colleagues point out that while these housing developments have and will continue to dramatically increase the population in Ordsall, the people who live in these households are less than half as likely to regularly visit their GP compared to more deprived household types of a similar age. This is probably a result of them also being:
• Half as likely to consider themselves in bad health
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• Half as likely to be unemployed or have an income of less than £10,000 per year • More than 50% less likely to smoke, or go out drinking and/or eat takeaways more than once a week • Around 50% more likely to eat 5 a day, exercise for 4 or more hours a week, or take other steps to improve health • Around 50% less likely to have asthma, depression or a heart condition • More likely to have private health insurance or visit health websites such as NHS Choices
This indicates that the needs of this new patient population are likely to be different from a typical practice profile of an aging population with one or more long term conditions. Prevalence of long term conditions in this population will be well below the Salford average. It will be important for this to be considered when implementing the chosen option from this Strategic Outline Case.
Given that most new residents are coming from surrounding student areas in Irwell Riverside and Central Manchester, there is also the question of whether many of them will actually register with a local GP practice in the next 5 years at all. Recent public health analysis of registered populations suggests that most of this demographic are not currently registered locally, having either never registered with any GP or still being registered close to their previous student accommodation, or in some cases closer to their previous homes, such as their parents.
2.2 Current Ordsall Primary Medical Care Provision
Figure 5 shows that there are currently two practices located within the Ordsall ward: Ordsall Health Surgery (P87035) and the Blackfriars Medical Practice (Y02622). In addition to this, the Trinity Medical Centre (which is a branch of P87634 – Clarendon Surgery) and the University of Salford Health Centre (which is a branch of P87027 – Langworthy Medical Centre) sit just over the Ordsall border in Irwell Riverside and there are several practices that are located further away in the Langworthy district of the city.
Figure 5 – GP Practices In The Ordsall Ward
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Analysis of postcode data has shown the top 4 GP practices where Ordsall residents are registered (table 5).
Table 5 – Top 4 GP Practices where Ordsall Residents Are Registered
Practice Code Practice Name Number of Ordsall Residents P87035 Ordsall Health Surgery 8259 Y02622 Blackfriars Medical Practice 2899 P87634 Clarendon Medical Practice 1486 P87027 Langworthy Medical Practice 1119 Total 13,763
It is perhaps to be expected that these four practices are top given their geographical location. It is likely that a significant proportion of the Ordsall patients registered with the Clarendon Medical Practice and Langworthy Medical Practice are likely to attend the branch surgeries given their proximity to the Ordsall border.
Figure 6 shows how the registered population at the two Ordsall practices has grown in the last four years. It can be seen that they have seen significant increases in the number of registered patients.
Figure 6 – Ordsall Practice Population Changes
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2.3 National / Local Context
This project will need to be considered in the context of the broader strategic direction for the NHS both locally and nationally. Key considerations will need to include:
• Salford Together (Vanguard Programme for an integrated primary and acute care system) • NHS Salford CCG Five Year Strategic Commissioning Plan 2014/15 – 2018/19 • NHS Salford CCG Primary Care (General Practice) Strategy • NHS Salford CCG Estates Review 2014/15 • NHS Salford CCG Primary Care Information Technology Plan 2016/17 – 2019/20 • Greater Manchester ‘Commissioning for Reform’ • Greater Manchester Primary Care Strategy • NHS England, The GP Forward View • NHS England, The Five Year Forward View
Of particular relevance are:
• The vision set out in the Salford Primary Care Strategy for ‘general practices in Salford to deliver high quality, safe, accessible and efficient primary care services that are clinically effective and put the patient at the centre’ • The vision set out in the Salford Primary Care Strategy ‘to create a sustainable primary care service that works collaboratively with other stakeholders / federated working between practices’ • The ambition set out in the CCG’s Five Year Strategic Commissioning Plan to embed ‘Primary care, provided at scale’
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The project will also need to be considered in the context of the Greater Manchester Spatial Framework which is a joint plan to manage the supply of land for jobs and homes and Salford City Council’s local plan to address this. Both documents are due to go out for public consultation later in 2016.
Section 3 Project Proposal ………………………
3.1 Brief Project Description
As commissioners of primary medical services, NHS Salford CCG will need to put plans in place to ensure that there is enough capacity to meet the needs of the growing population in the Ordsall area of the city. This Strategic Outline Case sets out and assesses the commissioning options that have been identified to address the additional need in Ordsall. Once an option has been approved, work will then need to commence to implement the agreed option, including the consideration of any financial implications.
3.2 Objectives
The objective of this Strategic Outline Case is to identify a commissioning option to address the identified general practice capacity issues in Ordsall that will:
• Secure sufficient capacity in general practice to meet increased demand arising from longer term population growth • Have the ability to be implemented quickly in order to meet the already increasing demand for primary medical care • Provide value for the tax payer and be affordable to the NHS • Support the CCG’s aspiration to commission high quality general practice • Support the CCG’s aspiration to commission primary care ‘at-scale’ • Support the CCG’s strategy for general practice to work as part of a federated neighbourhood model
3.3 Scope of the Project Proposal
The project aims to ensure sufficient capacity in general practice to meet the needs of a rising population in Ordsall. The following factors will be out of scope: • Population growth in other areas of the city • Capacity in wider primary care services • Capacity in other health and social care services
Initial discussions have taken place with colleagues from Manchester and Trafford CCGs given the proximity of Ordsall to their borders. It will be important to continue to liaise to ensure that the impact of any developments taking place across the border are taken in to account.
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3.4 Timeframe
Following the decision on the most appropriate commissioning route for expanding capacity in general practice, a project group will be established to take the project forward. The timeframe to implement the project will be dependent upon the commissioning option selected. Additional homes have already been built in Ordsall and the number of new homes is set to continue rising for the foreseeable future. Therefore, the CCG will need to work closely with the identified provider to ensure that the chosen option is implemented as quickly as is feasible.
3.5 Implications of Failure to Proceed
If the project to expand general practice capacity in Ordsall does not proceed, there is a high risk that the practices in the area will continue to come under pressure. This would mean that the practices would need to reach agreement on how to manage the additional demands with commissioners and they may apply to close their patient lists. This could result in patients living in Ordsall being forced to travel further for care as they would only be able to register with a GP further away from home. This would create pressures elsewhere in the system and would not provide Salford residents with accessible, high quality, safe and sustainable primary medical services. The CCG would not be fulfilling its delegated duties in respect of the commissioning of primary medical services.
3.6 Outline Project Plan
A detailed project plan will be developed following the decision regarding the most appropriate commissioning option and upon inception of the project group. However, key workstreams may include (depending upon the option selected): - Finance - Estates - Communications - Patient Engagement - IM&T - Procurement
3.7 Critical Time Issues
There are no critical time issues other than the need to implement a solution as quickly as possible to meet the needs of the already rising population in the Ordsall area.
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3.8 Anticipated Cost Implications
Given that general practice is largely funded on a capitation basis, the funding for a growing population will follow the patient. However, it is worth noting that there will be a time lag between the real population increase and the recognition of this within allocations, particularly as the population is projected to rise fairly rapidly.
Investments in locally commissioned services such as the Salford Standard are outwith core primary care contract funding and will compete with acute and community funding pressures for this population.
There will inevitably be costs from an estates and IM&T perspective that will need to be considered once a decision has been made on the most appropriate commissioning route for this project. There may also be non-recurrent costs for patient engagement, communication and procurement (depending upon the chosen commissioning option) during the project.
3.9 Project Risks
A full risk register will be created for the project. However, initial project risks that have been identified are:
- If CCG staff have insufficient capacity to manage the project, then the CCG may be unable to deliver the project on time and local practices may come under increased pressure and patients may struggle to access primary medical services - If CCG staff don’t have access to primary care commissioning knowledge and expertise, then the project may not be successful and local practices may come under increased pressure and patients may struggle to access primary medical services - If Greater Manchester Health and Social Care Partnership staff have insufficient capacity to be able to support the project, then the CCG may be unable to deliver the project on time and local practices may come under increased pressure and patients may struggle to access primary medical services - If there is insufficient funding, then the CCG may be unable to implement the project and local practices may come under increased pressure and patients may struggle to access primary medical services - If no GP providers are willing to provide services in this area, then the CCG may be unable to implement the project and local practices may come under increased pressure and patients may struggle to access primary medical services - If GP providers are unable to recruit new workforce to provide services in this area, then the CCG may be unable to implement the project and local
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practices may come under increased pressure and patients may struggle to access primary medical services - If the rate of population growth does not materialise as projected, then the CCG’s plans will not be fit for purpose and it may be that there is under or over supply of primary medical care capacity in the Ordsall area - If the identified solution doesn’t meet the needs of patients living in the Ordsall area, then the project may not deliver its intended outcomes and local practices may continue to come under increased pressure and the health needs of this population group may not be met - If local residents don’t conform with the assumptions made in the Strategic Outline Case (e.g. they choose to register elsewhere), then the project may not deliver its intended outcomes and local practices may continue to come under increased pressure and the health needs of this population group may not be met
Section 4 Capacity In Existing Practices
The figures in Table 4 demonstrated that it is estimated that an additional circa 15,000 residents might move in to the part of Ordsall that is north of Regent Road over the next 20 years and an additional 15,000 residents might move in to the part of Ordsall that is south of Regent Road.
Although patients are free to register with the GP practice of their choice, we have assumed that as things currently stand, new residents in Ordsall South might look to register with the Ordsall Health Surgery, whilst the new residents in Ordsall North might be more likely to look to the Blackfriars Medical Practice, the Trinity Medical Centre or one of the Manchester City Centre GP practices. We have not included the University of Salford Health Centre as only students are eligible to register there.
Therefore, the first step in the options appraisal process was for the Primary Care Operational Group to assure itself whether or not the three GP practices most impacted by Ordsall population growth would have the capacity (in terms of workforce and estates) and willingness to take on significant number of additional patients to meet the needs of the new residents moving in to the Ordsall area.
4.1 Capacity in Ordsall South
In November 2015, the Ordsall Health Surgery made an application to reduce the size of their practice boundary. The practice moved into new premises in 2012. In their business case for the new build, the practice described the pressures on the practice due to population growth. The business case indicated a willingness to grow to a list size of 10,000 and the building was designed to cope with that. However, in their practice boundary application, the Ordsall Health Surgery cited that given the pressures of a rising list and new local enhanced services, they were struggling with space in the building at their current list size of just under 9000 patients. The application to change the practice boundary was accepted and has subsequently been implemented.
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Separately, representatives from the Ordsall Health Surgery have contacted the CCG to highlight concerns regarding population growth in Ordsall. They expressed anxieties regarding the ability of the practice to take on significant numbers of new patients given the lack of space within the surgery.
The Ordsall Health Surgery also reported that they experience a high patient turnover, largely created through a young, transient population. CCG analysis has confirmed the practice’s assertion – in 2015/16, 3.64% of the Ordsall Health Surgery patients left the list as compared to 1.87% of the rest of Salford. The practice reports that this creates a lot of work as patients register when they have a problem (e.g. knee pain) or require contraception etc. So the practice has to deal with this presentation as well as other work relating to the new registration: summarising their medical records; undertaking smears; immunisations etc; only for the patient to move away and leave the list a year or two later.
The practice has reported other challenges including: - A high prevalence of mild mental health conditions - A high need for interpreters (requiring double appointments) - Demanding patients with high expectations for referral and prescribing - A high birth rate putting pressure on maternity services, baby clinics and need for immunisations
Members of the CCG’s Service Improvement Team attended the Ordsall and Langworthy Neighbourhood Patient Participation Group in July 2016 to start the process of engaging with members of the public about the CCG’s plans. Group members (predominantly from the Ordsall Health Surgery) echoed many of the issues highlighted by the practice and they expressed concerns about the impact that population growth was having on accessing services at the practice.
Therefore, the Primary Care Operational Group concluded that as it stands, the Ordsall Health Surgery will not have the estates or workforce capacity to be able to meet the needs of the circa 15,000 residents predicted to move in to Ordsall South over the next 20 years.
Subsequent to work on this Strategic Outline Case starting, the Ordsall Health Surgery have identified that there are some clinical rooms in their health centre currently leased to Salford Royal Foundation Trust for the delivery of community services. The practice have suggested that if these services could be moved, that would provide enough space for an additional 2 – 3 whole time equivalent GPs, thus enabling the practice to increase their list by 3400 – 5100 patients (subject to being able to recruit additional GPs). Based upon the population growth estimates for Ordsall South, this could provide enough additional capacity for at least the next five years, but potentially longer if the public health assumption that many new residents will not seek to register with a local GP are borne out. Therefore, this would present a viable option for consideration as part of this Strategic Outline Case.
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4.2 Capacity in Ordsall North Blackfriars Medical Practice
As a relatively new GP practice, the Blackfriars Medical Practice has been growing significantly year on year. The practice reports that they are willing and able to continue to grow the practice list and estimate that they could take on an additional 7000 – 8000 patients. They have confirmed that they would have the estates and workforce capacity to enable this growth.
Trinity Medical Centre
The Trinity Medical Centre is a branch surgery of The Clarendon Surgery. The practice reports that they do have the estates capacity to absorb more patients. They would need to do more analysis, but estimate that they could take on an additional 2000 patients, subject to being able to recruit another GP.
4.3 Summary
As things stand, it seems as if the two Salford practices which predominantly serve Ordsall North would have the estate capacity and willingness to expand to meet the additional demand, subject to ability to recruit additional workforce (although this of course would continue to be monitored). Therefore, the Primary Care Operational Group did not deem it necessary to progress to an options appraisal for this area of the city at this stage.
However, with the current number of clinical rooms available to them, the Ordsall Health Surgery would be unable to absorb the potential circa 15,000 new residents moving to Ordsall South over the next 20 years. Therefore, the Primary Care Operational Group agreed to progress to an options appraisal to assess the commissioning options that would ensure that there is adequate primary medical services provision in this area of the city.
Section 5 Options Appraisal
5.1 Options
Four commissioning options have been identified for addressing the primary medical needs of the growing population in Ordsall South:
1) Do Nothing: Continue as now with new residents free to choose an existing local GP practice to register with.
2) Expand Current Local Provision: Expand the Ordsall Health Surgery (as the only existing provider in the South of Ordsall).
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3) Expand Local Provision – Branch Practice: Run a process to identify an existing local GP practice to open a branch surgery on a new site in the south of Ordsall.
4) Commission a New Contract: Run a procurement process to identify a new provider to establish a new GP practice in the south of Ordsall.
5.2 Options Criteria
The following criteria have been developed from the Strategic Outline Case objectives to enable the four options to be compared:
CRITERIA DESCRIPTION WEIGHTING (%) C1 Will the option secure sufficient capacity in general 30 practice to meet increased demand arising from longer term population growth? C2 Will the option be able to be implemented quickly in 20 order to meet the already increasing demand for primary medical care? C3 Will the option provide value for the tax payer and be 20 affordable to the NHS? C4 Will the option support the CCG’s aspiration to 10 commission high quality general practice? C5 Will the option support the CCG’s aspiration to 10 commission primary care ‘at-scale’? C6 Will the option support the CCG’s strategy for general 10 practice to work as part of a federated neighbourhood model?
TOTAL 100
5.3 Options Appraisal
Table 6 below shows the scoring for each option which was undertaken by members of the Primary Care Operational Group. A brief summary of the rationale used in scoring each option has also been included.
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Table 6 – Options Appraisal Scoring
Option1 Option 2 Option 3 Option 4 Criteria Weight Score Weighted Score Weighted Score Weighted Score Weighted score score score score C1 30 1 30 6 180 9 270 9 270 C2 20 10 200 8 160 6 120 2 40 C3 20 10 200 7 140 4 80 2 40 C4 10 4 40 6 60 6 60 5 50 C5 10 5 50 5 50 5 50 1 10 C6 10 9 90 9 90 9 90 5 50 Total 100 610 680 670 460
5.3.1 C1 - Will the option secure sufficient capacity in general practice to meet increased demand arising from longer term population growth?
Option 1 (Do Nothing) was not perceived to be a long term solution given the significant anticipated population growth projected in the Ordsall area. Option 2 would provide at least a short term solution, but possibly not a longer term solution depending upon the proportion of new residents who seek to register with a local GP practice. Options 3 and 4 both provide an opportunity to ensure that there is adequate capacity for the future.
5.3.2 C2 - Will the option be able to be implemented quickly in order to meet the already increasing demand for primary medical care?
The ‘Do Nothing’ option would clearly be the quickest option to implement and Option 2 (Expand Current Local Provision) potentially could happen reasonably quickly. Option 4 (New Contract) would be the most time consuming as a full procurement would need to be undertaken. Whilst the ‘Branch Surgery’ option would require some sort of selection process, it is anticipated that this could happen more quickly than going out to open tender.
5.3.3 C3 – Will the option provide value for the tax payer and be affordable to the NHS?
No additional costs would arise from the ‘Do Nothing’ option. The ‘New Contract’ option would be the most costly as there would potentially be the costs of new premises, equipment and the costs of staff time and procurement. A branch surgery would also incur premises and equipment costs, but would be less costly in terms of staff time and procurement. It is thought that apart from doing nothing, the option that would be most affordable would be Option 2 – expansion – as there would only be costs of new equipment and possibly some refurbishment costs.
5.3.4 C4 – Will the option support the CCG’s aspiration to commission high quality general practice?
The branch surgery and expansion options would potentially maintain the existing level of quality, although there is potential for quality to be affected as the chosen
Business Case document suite Page 20 19/09/2016 practice(s) may ‘take their eye off the ball’ if they are concerned with the implications of expansion. In the ‘Do Nothing’ option, it is thought that quality could take a hit as practices become increasingly stretched and as there is the potential for practice lists to be closed. In the ‘New Contract’ option, the procurement process could be used to ensure only providers with a track record of delivery of high quality care were commissioned; however, the quality of the new provision would be uncertain until they were up and running.
5.3.5 C5 – Will the option support the CCG’s aspiration to commission primary care ‘at-scale’?
The ‘New Contract’ option would go against the CCG’s ambition to commission general practice at scale given that another small contract would be established. The remaining three options would maintain the existing levels of scale.
5.3.6 C6 - Will the option Support the CCG’s strategy for general practice to work as part of a federated neighbourhood model?
In options 1, 2 and 3, there would not be a change of provider and therefore the existing practices would continue to work within the Ordsall and Claremont neighbourhood group and as part of the developing Salford Primary Care Together. If option 4 resulted in a new provider being established in Salford, it is less certain whether they would immediately be able to work within these arrangements; thus Option 4 received a lower score.
5.3.5 Options Appraisal Summary
Of the four options assessed, Option 2 - Expand Current Local Provision scores the highest and balances costs and speed of implementation with maintaining some of the CCG’s priorities around quality, scale and collaborative working.
However, it is acknowledged that this option may not provide a long-term solution if the projected population growth materialises as planned (or above projections) and if the public health assumption that many residents may not register with a local GP is not borne out. Therefore it is recommended that scale and impact of population growth in Ordsall is reviewed in two years’ time and the second most viable option - the commissioning of a branch surgery – is reconsidered at that point. The branch surgery option may also need re-considering if access to the identified community rooms at the Ordsall Health Surgery cannot be secured.
Section 6 Conclusions and Recommendation …………
6.1 Conclusions & Recommendations
This Strategic Outline Case has demonstrated that there is projected to be significant population growth in the Ordsall area of Salford in the next 20 years.
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It is concluded that the practices that are most likely to be impacted by population growth in the north of the ward have the capacity and ability to be able to absorb at least the majority of this growth, however, this will continue to be monitored.
The Ordsall Health Surgery is currently the only practice located in the south of the ward and as things stand, they have little capacity to be able to further grow the patient list. Therefore, as commissioners of primary medical care services, NHS Salford CCG needs to ensure that plans are in place to be able to meet the additional demand that population growth will present in this part of the city.
Of the four identified commissioning options for ensuring that there is sufficient primary medical service provision for the new population coming to live in the Ordsall South area, Option 2 - ‘Expand Current Local Provision’ was assessed as the preferred option. Implementation of this option would be led by the Strategic Estates Group and would involve freeing up rooms in the Ordsall Health Surgery currently used for the provision of community services. However, it was highlighted that this option may not provide a long-term solution if the projected population growth materialises as planned (or above projections) and if the public health assumption that many residents may not register with a local GP is not borne out. The second most viable option was the commissioning of a branch surgery which would provide additional GP capacity in new premises in the south of Ordsall.
Therefore, the recommendations of this Strategic Outline Case are that:
- Option 2 – Expand Current Local Provision – is approved (with the expectation that it will provide at least a 5 – 10 year solution) and passed to the Salford Strategic Estates Group for implementation
- The scale and impact of population growth in Ordsall is reviewed in two years’ time and the need for a branch surgery is re-considered at that point
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Meeting of 26th September 2016 Item 6A Primary Care Commissioning Committee Work Plan
According to the terms of reference, the role of the Primary Care Commissioning Committee is to carry out the functions relating to the commissioning of primary medical services.
Committee Function Current CCG Work Plan Provisional Meeting Date GMS, PMS and APMS contracts (including the design of - Re-commissioning of the Care Homes Practice July 2016 PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial - Re-procurement of The Heights Medical September 2016 notices, and removing a contract) Practice
- Commissioning of a new practice in Ordsall TBA once business case approved
- Update reports from the Primary Care At each meeting Operational Group
- Update reports from the Primary Care Quality At each meeting from Group November 2016
- Contractual actions will be taken as necessary As required
Newly designed enhanced services (“Local Enhanced - Monitoring and reviewing the implementation of At each meeting from Services” and “Directed Enhanced Services”) the Salford Standard via the Primary Care November 2016 Quality Group Reports
- Monitoring and reviewing the implementation of January 2017 the Extended Access business case
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Meeting of 26th September 2016 Item 6A Design of local incentive schemes as an alternative to the Nothing currently planned although the Salford NA Quality Outcomes Framework (QOF) Standard does incentivise quality over and above the requirements of QOF Decision making on whether to establish new GP - Strategic Outline Case for expanding GP September 2016 practices in an area capacity in Ordsall
- Review of GP capacity in Ordsall September 2018
Approving practice mergers This will be undertaken as necessary along with As required decisions regarding other contract variations, e.g. practice boundary changes and list closures. Making decisions on ‘discretionary’ payment (e.g., - A policy to be developed TBA returner/retainer schemes) - Decisions to be made by PCCC on a case by As required case basis To plan, including needs assessment, primary medical - A business case for the re-current funding of November 2018 care services in Salford the Salford Standard
- Undertake an assessment of primary care TBA capacity by neighbourhood and use this to prioritise future capacity expansion plans To undertake reviews of primary medical care services in - As required dependent upon the outcome of As required Salford the monitoring and review of primary medical services.
- Review and update of the Salford Standard for November 2016 2017/18
- Annual review report for the Salford Standard July each year
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Meeting of 26th September 2016 Item 6A - Monitoring and reviewing the Care of the May each year Homeless Local Commissioned Service via the Primary Care Operational Group Reports
- Monitoring and reviewing the Directed July each year Enhanced Services
To co-ordinate a common approach to the commissioning Keep abreast of local and national strategy and Via an annual strategy of primary care services generally consider the implications for the CCG and the update from March commissioning of primary medical services 2017 To manage the budget for commissioning of primary - Monthly budget monitoring reports At each meeting medical care services in Salford
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NHS SALFORD CLINICAL COMMISSIONING GROUP Primary Care Commissioning Committee AGENDA ITEM NO 6 (b)
Item for Decision/Assurance/Information 26 September 2015
REPORT OF: Karen Proctor Director of Commissioning
DATE OF PAPER: September 2016
SUBJECT: Primary Care Commissioning Committee Risk Register
IN CASE OF QUERY Anna Ganotis PLEASE CONTACT: Head of Service Improvement (Primary Care) [email protected] 0161 212 4912
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES:
Quality √ Community Based Care
Integrated Care
In Hospital Care
Long Term Conditions and Mental Health √ Effective Organisation
PURPOSE OF PAPER:
This report gives an overview of the work that has been undertaken to create a Primary Care Commissioning Committee Risk Register and presents the draft register for comment.
Further explanatory information required
HOW WILL THIS BENEFIT THE Identifying and managing the risks to HEALTH AND WELL BEING OF commissioning primary care services will help SALFORD RESIDENTS OR THE to ensure that the population of Salford has CLINICAL COMMISSIONING GROUP? access to high quality and stable provision of care.
WHAT RISKS MAY ARISE AS A NA RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED?
WHAT EQUALITY-RELATED RISKS NA MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED?
DOES THIS PAPER HELP ADDRESS NA ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
PLEASE DESCRIBE ANY POSSIBLE NA CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER.
PLEASE IDENTIFY ANY CURRENT All primary care providers delivering services in SERVICES OR ROLES THAT MAY BE Salford. AFFECTED BY ISSUES WITHIN THIS PAPER:
Footnote:
Members of NHS Salford Primary Care Commissioning Committee will read all papers thoroughly. Once papers are distributed no amendments are possible.
26 September 2016 Agenda Item No 6 (b)
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement √ There was complete support (Please detail the method ie survey, event, consultation) for the objectives of this strategic outline case. Clinical Engagement √ (Please detail the method ie survey, event, consultation) Has ‘due regard’ been given to Equality To be reviewed once a Analysis (EA) of any adverse impacts? decision is made (Please detail outcomes, including risks and how √ these will be managed) Legal Advice Sought √ Presented to the Commissioning Committee √ Presented to the Health and Wellbeing Board √ Presented to the Integrated Commissioning √ Board √ Supported the Presented to any other groups or committees, recommendations of the including Partnership Groups strategic outline case
Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work
26 September 2016 Agenda Item No 6 (b)
Primary Care Commissioning Committee Risk Register
1 Executive Summary
This report gives an overview of the work that has been undertaken to create a Primary Care Commissioning Committee Risk Register as requested at the May 2016 committee meeting.
The members of the PCCC are asked to: - Review the draft PCCC risk register and provide any suggestions for amendments or additions - Consider the frequency of which they would wish to receive the risk register (for oversight and scrutiny) at committee meetings
2 Introduction and Background
2.1 At the May 2016 Primary Care Commissioning Committee (PCCC) meeting, it was agreed that there was a need to develop a PCCC risk register for the reporting of risks relating to primary care services.
2.2 On 31 August 2016, NHS Salford Clinical Commissioning Group’s (CCG’s) planning and performance manager facilitated a risk workshop to review the CCG’s objectives in relation to primary care services and identify risks to those objectives.
2.3 Attendees included representatives from: the Primary Care Operational Group, CCG Finance and Estates, CCG Service Improvement, the Greater Manchester Health and Social Care Partnership and CCG Planning and Performance.
3 Risks Identified
3.1 An overview of the risk workshop is provided below and the resulting risk register can be found in Appendix 1.
3.2 The group agreed that the overall primary care objective for the CCG is: “To commission high quality, stable provision of primary care services for the population of Salford” and proposed that a new overarching risk was added to the CCG’s Strategic Risk Register to articulate the potential impacts of failure to meet this objective.
3.3 Once the group had assessed the strategic risk, it began to look at potential programme risks using PESTLE and SWOT (risk identification models) to help focus the discussions.
3.4 The group identified 11 new risks and proposed that 2 existing strategic risks in relation to primary care should be moved in to Community Based Care and Integrated Care programme risk registers.
26 September 2016 Agenda Item No 6 (b)
4 Actions Taken To Date
4.1 The identified primary care related risks have now been added to Covalent (the CCG’s planning and performance system).
4.2 Each identified risk has been added to the appropriate programme risk register (Quality, Integrated Care, In Hospital Care, Community Based Care, Effective Organisation, Long Term Conditions or Mental Health) and will be reported to relevant governance groups as part of regular programme reports.
4.3 The group members attending the risk workshop felt that it was important for the PCCC to retain oversight of these risks and so a bespoke risk report was created by categorising the primary care risks and pulling them together in one report (Appendix 1). This approach allows the risks to be monitored and managed by the appropriate governance groups across the CCG, but allows the opportunity for risks to be regularly reported to PCCC without duplicating effort.
5 Next Steps
5.1 The planning and performance team is currently in the process of reviewing its programme risk registers and the work of this task and finish group will contribute to the final programme risk registers and PCCC risk report.
6 Recommendations
6.1 The members of the PCCC are asked to: • Review the draft PCCC risk register and provide any suggestions for amendments or additions • Consider the frequency of which they would wish to receive the risk register (for oversight and scrutiny) at committee meetings
Anna Ganotis Emma Reid Head of Service Improvement Planning and Performance Manager
September 2016
Primary Care Commissioning Committee (PCCC) Risk Register
Generated on: 15 September 2016
Current Last Target Risk ID Risk Title Existing Controls Assurances Gaps I L Latest Position I L Risk Owner Risk Sponsor Score Reviewed Score The final structure of the provider organisation is still unknown, so there Relationships have been may be limited capacity There is a draft established with the workforce lead and capability to deliver implementation plan Primary care workforce within SPCT and there are ongoing the objectives within the Failure to deliver the within the strategy to group provides regular discussions around the transition of strategy. A governance 01-Sep- PR.CBC.04 objectives within the primary describe how the updates to the 4 3 12 some aspects of the 4 2 8 Sue Louth Francine Thorpe group has not yet been 2016 care workforce strategy objectives will be Community Based Care implementation to this entity. A identified for the ongoing delivered. Commissioning Group. number of risks to implementation performance of the have been identified within the implementation plan. strategy. Final strategy and delivery plan has not yet been agreed. The work to develop the model is not expected to Rapid changes in population NHS Salford CCG is in commence until October demographic may lead to discussions with Salford 2016. pressures in demand which City Council to develop The new model will not 01-Sep- PR.CBC.06 primary care services may a model to match None identified. address impacts on 3 4 12 3 3 9 Anna Ganotis Harry Golby 2016 not be able to respond to changes in population to other primary care (Salford is an increasingly capacity within General delivery units diverse, growing city) Practice. (Optometrists, community pharmacists, dentists) Salix Health (a GP
provider company for GP Design Group Salford) is established effectively informing and ready to accept commissioning Risk reviewed and scores remains contracts for some work. intentions. MoU agreed the same. Making good progress in Lack of an effective primary Various plans for greater between General Salix Health not developing Salford Primary Care care provider organisation joint working within Practice & SRFT. effectively representing Together as a GPPO but the 25-Aug- PR.IC.02 working across Salford to neighbourhoods, 4 3 12 3 1 3 Marie Clayton Francine Thorpe Regular meetings with Salford General organisation is not yet established 2016 provide collaborative primary particularly linked to 7 Salix Health directors to Practices city-wide and practices have not yet formally care services day opening. GP Design discuss potential CCG signed up therefore the risk score Group Neighbourhood work. Plans from remains the same Collaborative Model neighbourhoods for accepted at CCG greater federated Members event in working November. Support functions to primary Contracts in place with Relationships with A number of contracts Risk raised at primary care 01-Sep- PR.EO.25 care services fail to deliver all providers with member practices, are not held by Salford 3 3 9 commissioning committee (PCCC) 3 3 9 Harry Golby Karen Proctor 2016 contracted responsibilities contract management especially via CCG and we have risk workshop 31/08/16. Former
1 Current Last Target Risk ID Risk Title Existing Controls Assurances Gaps I L Latest Position I L Risk Owner Risk Sponsor Score Reviewed Score (primary care support arrangements in place. Neighbourhood Leads, limited ability to affect primary care risks moved to England, NHS property There is currently a GM provide feedback on the them community based care programme services, clinical waste review of clinical waste services. risk register as part of work to management, GMSS IM&T)) services ongoing. review programme risks and give more focus to overarching strategic risks. If primary care estates Lack of knowledge provision cannot meet regarding the GP owned service requirements then we Oversight by the 01-Sep- Elaine PR.EO.30 None identified. estate regarding 3 3 9 2 2 4 Steve Dixon may not be able to deliver Strategic Estates Group 2016 Vermeulen condition and capacity. integrated provision across
the system We currently have Collaborative working limited collaborative through GM Health and working arrangements Risk raised at primary care Social Care partnership NHS Salford CCG has for primary medical care. commissioning committee (PCCC) for assurances around established a Primary This has been identified risk workshop 31/08/16. Former Failure to commission high wider primary care. Care Commissioning as a Programme Risk primary care risks moved to quality, stable provision of Primary Care 01-Sep- SRR.10 Committee (PCCC) that and is being managed 4 2 8 community based care programme 4 1 4 Karen Proctor Anthony Hassall Primary Care services for the Operational Group and 2016 focuses on delivery of as such. Limited risk register as part of work to population of Salford Primary Care Quality primary medical coordination of wider review programme risks and give Group currently monitor services. primary care services more focus to overarching strategic and manage primary which are managed risks. medical practice across multiple delivery. organisations. Various plans for greater We currently have Plans from Risk raised at primary care joint working between limited collaborative Individual primary care neighbourhoods for commissioning committee (PCCC) GP practices within working arrangements delivery units (GP, greater federated risk workshop 31/08/16. Former neighbourhoods. GP for primary medical care. Optometrists, community working Collaborative primary care risks moved to Design Group Responsibility for other 01-Sep- PR.CBC.05 pharmacists, dentists) may working through GM 3 2 6 community based care programme 3 2 6 Harry Golby Karen Proctor Neighbourhood primary care services 2016 not have sufficient short term Health and Social Care risk register as part of work to Collaborative Model (e.g. optometrists, resilience which may affect partnership for review programme risks and give accepted at CCG dentists, community their long term viability assurances around more focus to overarching strategic Members event in pharmacists) does not wider primary care. risks. November. sit with the CCG. NHS Salford CCG's Service Improvement Team supports quarterly neighbourhood If we do not maintain strong commissioning meetings The CCG has developed The practices have a The strategy has been approved relationships with member Weekly member practice a new communications very high workload and since May 2016. We are still in the practices, partner e-bulletins and engagement do not always have the process of recruiting to the 01-Sep- Hannah PR.EO.28 organisations and the public Public engagement 3 2 6 3 2 6 Claire Connor strategy and is working opportunity to engage positions that were highlighted as 2016 Dobrowolska we may be unable to activities detailed in towards implementing with the CCG as much necessary if the strategy is to be implement strategic plans for communications and the agreed approach. as we would like. delivered effectively. primary care effectively engagement strategy NHS Salford CCG is a member of multiple GM groups and networks across the system
2 Current Last Target Risk ID Risk Title Existing Controls Assurances Gaps I L Latest Position I L Risk Owner Risk Sponsor Score Reviewed Score Risk raised at primary care commissioning committee (PCCC) If primary care funding does risk workshop 31/08/16. Former not match our ongoing 5 year financial plan and Currently achieving all primary care risks moved to commissioning intentions commissioning 01-Sep- PR.EO.29 relevant financial None identified. 3 2 6 community based care programme 3 2 6 Harry Golby Steve Dixon then the CCG may need to intentions reviewed 2016 measures. risk register as part of work to reprioritise short term and annually. review programme risks and give long term commitments more focus to overarching strategic risks. Risk raised at primary care If we fail to translate external commissioning committee (PCCC) policy changes or anticipate Business planning risk workshop 31/08/16. Former emerging opportunities and process and governance CCG Operational Plan We do not have an primary care risks moved to communicate these in a local structure within the CCG identifies need for 01-Sep- PR.CBC.07 agreed Community 2 2 4 community based care programme 2 2 4 Harry Golby Karen Proctor community based care provides mechanism to Community Based Care 2016 Based Care Strategy risk register as part of work to strategy then we may fail to identify and act on Strategy review programme risks and give develop services in the most opportunities. more focus to overarching strategic effective and efficient way. risks. Various initiatives within the Service Improvement Team to equip staff with skills to work across a range of different areas. Memorandum of Risk raised at primary care understanding is in commissioning committee (PCCC) place between NHS Commissioning capacity and Membership of GM risk workshop 31/08/16. Former Salford CCG and the capability to manage the Primary Care Co- primary care risks moved to GM Health and Social 01-Sep- PR.EO.27 delegated primary care co- Commissioning to None identified. 2 2 4 community based care programme 2 2 4 Harry Golby Karen Proctor Care Partnership to 2016 commissioning work monitor and review risk register as part of work to provide support from a programme is limited arrangements. review programme risks and give core team of primary more focus to overarching strategic care commissioners risks. GM Contract for the provision of support from Primary Care Commissioning (PCC) GM Network of primary care leads meets monthly
3
Date of meeting 26/09/2016 Agenda Item No 6 (c)
NHS SALFORD CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE AGENDA ITEM NO 6 (c)
Item for Information and Decision
26 September 2016
REPORT OF: Francine Thorpe, Director of Quality & Innovation
DATE OF PAPER: September 2016
SUBJECT: Primary Care Quality Group Review
IN CASE OF QUERY Natalie McInerney, Service Improvement PLEASE CONTACT: Manager (Primary Care) [email protected] 0161 212 4913
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES: √ Quality √ Community Based Care
Integrated Care
In Hospital Care
Long Term Conditions and Mental Health √ Effective Organisation
PURPOSE OF PAPER: This paper summarises the outcomes of the review of the role and remit of the Primary Care Quality Group.
The Primary Care Commissioning Committee is asked to note the content of this report and to approve the recommendations.
Page 1 of 13
Date of meeting 26/09/2016 Agenda Item No 6 (c)
Further explanatory information required
HOW WILL THIS BENEFIT THE The Primary Care Quality Group is working to HEALTH AND WELL BEING OF improve and assess the quality of care in SALFORD RESIDENTS OR THE primary care across Salford. CLINICAL COMMISSIONING GROUP?
WHAT RISKS MAY ARISE AS A NA – update paper. Risks will be managed RESULT OF THIS PAPER? HOW CAN within each individual programme of work. THEY BE MITIGATED?
WHAT EQUALITY-RELATED RISKS NA – update paper. Risks will be managed MAY ARISE AS A RESULT OF THIS within each individual programme of work. PAPER? HOW WILL THESE BE MITIGATED?
DOES THIS PAPER HELP ADDRESS NA ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
PLEASE DESCRIBE ANY POSSIBLE The membership of the PCQG includes local CONFLICTS OF INTEREST general practices and the group is chaired by a ASSOCIATED WITH THIS PAPER. clinical lead. Conflicts of interest may therefore arise given the group’s role to advise on the quality of primary medical care. These will be managed in line with the CCG’s policy.
PLEASE IDENTIFY ANY CURRENT Primary care services. SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER:
Page 2 of 13
Date of Meeting 26/09/2016 Agenda Item No 6 (c)
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement (Please detail in the Comments and Date column the method i.e. survey, event, consultation) Clinical Engagement (Please detail in the Comments and Date column the method i.e. survey, event, consultation) Has ‘due regard’ been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes) Legal Advice Sought Presented to Quality and Safety Presented to the Commissioning Committee Commissioning Committee 12 Group October 2016 Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, Presented to Primary Care Quality including Partnership Groups Group 23 June 2016 (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
Page 3 of 13
Primary Care Quality Group Review
1 Executive Summary
This paper summarises the outcomes of the review of the role and remit of the Primary Care Quality Group. The paper provides a summary of key changes to CCG responsibilities and governance arrangements arising from the CCG assuming delegated authority for the commissioning of primary medical services.
The key recommendations are as follows:
• General principles for the group will be that it acts as a scrutiny group, reviewing performance metrics and quality indicators in order to continue to support practices with quality improvement, but to also oversee the implementation of mitigating actions where a quality concern is identified • The Primary Care Quality Group will become a sub-group of the Primary Care Commissioning Committee in order to inform the committee on any issues pertaining to practice quality and escalate any concerns.
A summary paper and the approved recommendations from Primary Care Commissioning Committee will be presented to the Quality and Safety Commissioning Committee at their October meeting for final ratification.
If agreed, it is anticipated that the new arrangements will be introduced in shadow form pending the CCG’s next review of its constitution in November when the changes would be made formal.
2.0 Background & Context 2.1 Since being established in 2013, Clinical Commissioning Groups (CCGs) have had a statutory duty to assist and support NHS England to monitor the quality of primary medical services. However, initially, CCGs had no contractual leverage in terms of performance management and under performance of practices and therefore NHS Salford CCG’s approach was very much a supportive role around driving quality improvement.
2.2 In April 2016, Salford CCG received delegated authority from NHS England for commissioning primary medical services for the Salford population. This includes responsibility for quality monitoring and responding to quality concerns arising from general practice. This means that the CCG now has a more robust role in managing both contractual and quality matters. As part of this change in responsibility, the CCG has reviewed and changed its governance structure. The Primary Care Commissioning Committee was established to function as a corporate decision-making body for the management of the delegated functions associated with commissioning of primary medical services.
2.3 The Primary Care Commissioning Committee is informed by the Primary Care Operational Group which acts as an operational forum to determine the appropriate actions, follow due process and to submit recommendations for decision making / ratification on all contractual matters to the Primary Care Commissioning Committee.
2.4 To support this statutory duty, the CCG established a Primary Care Quality Group (PCQG), reporting to the Primary Care Commissioning Committee, with a remit to assist in the delivery of the CCG’s Quality and Safety Strategy and to be assured on the quality of primary medical services, supporting member practices around quality improvement to reduce unwarranted variation.
2.5 It is recognised that prior to the CCG’s new responsibilities and accountability for primary medical services, the PCQG group’s powers have been limited. The CCG has had no real means to performance manage, other than to support practices to improve and escalating issues to NHS England as appropriate.
2.6 It is also worth noting that during the period April 2015 to March 2016, 5 of the 12 scheduled meetings were cancelled. This was due to either lack of agenda items for discussion or a high number of apologies.
2.7 However, it has been recognised that there are new opportunities for the remit of the PCQG now that responsibilities for the commissioning of primary medical services have been assumed by the CCG.
2.8 Alongside the change in commissioning arrangements, NHS Salford CCG launched ‘The Salford Standard’ in April 2015 which aims to:
• Reduce unwarranted variation in quality of care; • Improve access and experience of care; • Improve health outcomes; • Ensure future stability, sustainability and growth; • Reduce the number of avoidable hospital admissions; • Target resources at areas of greatest need.
This newly commissioned service will require significant monitoring and performance management which would sit within the existing remit of the PCQG.
2.9 Given the new governance arrangements and CCG responsibilities, it was agreed at the May meeting of the Primary Care Quality Group to undertake a review of the role and terms of reference of the group. The aim was to make the functioning of the group as effective as possible and to ensure clear separation between the Primary Care Operational Group and the Primary Care Quality Group. It was agreed that both groups have roles to inform the decisions of the Primary Care Commissioning Committee.
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3.0 Links to the Quality and safety Strategy
3.1 The Quality and Safety Strategy (2014-2017) clearly outlined a quality assurance framework that we have implemented for commissioned services. This has provided the CCG with a high level of assurance in relation to the quality and safety of services commissioned from our major providers.
3.2 The commissioning arrangements for Primary Care when the strategy was developed meant that a different approach was required for GP practices with an emphasis on supporting quality improvement. NHSE had the responsibility for monitoring quality and performance; however the links between their role and the CCG were sometimes difficult to navigate. The move to level 3 co-commissioning provides the CCG with the opportunity to implement the quality assurance framework for GP practices and the PCQG will be the forum to scrutinise relevant data.
4.0 Summary of the Review of the Primary Care Quality Group
4.1 In order to inform a review of the Primary Care Quality Group, feedback was sought from the core members of the group at their June meeting. Members were provided with a table of proposed areas of review along with the following questions: • What, in your view should be the scope and purpose of this group? • Do you feel that the group membership is correct, if not who is missing? • What topics / agenda items would you like to see covered at the meeting? • In your opinion, what can we do differently at future meetings to improve the meeting effectiveness? • General Comments/feedback on the meeting
The findings of the review were used to draw up the recommendations that are reported below.
4.2 It is proposed that the general principles for the group will be that it acts as a scrutiny group, reviewing performance metrics and quality indicators in order to continue to support practices with quality improvement, but to also oversee the implementation of mitigating actions where a quality concern is identified.
4.3 It is proposed that the Primary Care Quality Group will become a sub-group of the Primary Care Commissioning Committee in order to inform the committee on any issues pertaining to practice quality and escalate any concerns. It is suggested that the Primary Care Quality Group provide the Primary Care Commissioning Committee with: - an assurance report at every meeting (once every two months) - information and recommendations on any formal sanctions that are deemed necessary
4.4 It is recommended that an annual schedule of agenda items is developed so that each meeting has a focus on one of the three quality domains (Clinical Effectiveness, Patient Safety and Patient Experience) in order to facilitate a more comprehensive review of the different areas of quality.
4.5 It is proposed that at each meeting, the group will review and assess data to seek assurance on the delivery of the Salford Standard. The group will oversee and manage the Salford Standard Escalation Process, which will be used to performance manage practices who are not delivering the Salford Standards. Formal application of the escalation process will not come into effect
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until April 2017; however it is proposed that throughout 16/17, this is administered in shadow form.
4.6 It is proposed that the PCQG would undertake multidisciplinary reviews of the data that is collated and triangulated as part of the CCG’s Quality Assurance Framework.
4.7 It is proposed that the PCQG will oversee the implementation of the CCG Primary Care Dispute & Appeals Policy.
4.8 Suggested amendments to the PCQG’s terms of reference have been made and are included as Appendix 1.
5.0 Next Steps
5.1 A summary paper and the approved recommendations from Primary Care Commissioning Committee will be presented to the Quality and Safety Commissioning Committee at their October meeting for final ratification.
5.2 If agreed, it is anticipated that the new arrangements will be introduced in shadow form, pending the CCG’s next review of its constitution in November when the changes would be made formal.
6.0 Recommendations
6.1 The Primary Care Commissioning Committee is asked to note the contents of this paper and support the recommendations made in section 6. Namely the changes to the terms of reference and the change to move the PCQG to become accountable to the Primary Care Commissioning Committee.
Natalie McInerney Service Improvement Manager (Primary Care)
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
Appendix 1 – Revised Primary Care Quality Group Terms of Reference
Primary Care Quality Group Terms of Reference
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
1 Introduction & Background
1.1 Since the transfer of Primary Care Trust’s to Clinical Commissioning Group’s in 2013, CCG’s have had a statutory duty to assist and support NHS England to monitor the quality of Primary Care Medical Services. However during this period, the CCG had no contractual leverage in terms of performance management and under performance of practices and therefore the CCG’s approach was very much a supportive role around driving quality improvement.
1.2 In April 2016, Salford CCG received delegated authority from NHS England for contracting Primary Care Medical Services for the Salford population. This includes responsibility for quality monitoring and responding to quality concerns arising from general practice. This means that the CCG now has a more robust role about management of both contractual and quality matters.
2 Scope
2.1 These terms of reference have been developed to outline the responsibilities of the Primary Care Quality Group in respect of its role:
- To assist in the delivery of the CCG Quality and Safety Strategy to ensure excellence in Salford Primary medical care provision. - To seek quality assurance and encourage practices to aspire for quality improvement using the Quality Assurance Framework. - To act as a scrutiny group to inform and make recommendations to the Primary Care Commissioning Committee for quality monitoring and responding to quality concerns arising from general practice.
2.2 The group will assess and monitor member practices to deliver primary care that is safe, effective, minimises variation and secures continuous improvement.
2.3 The group will offer support to member practices with the assistance of partners.
2.4 The Primary Care Quality Group is established as a sub-committee of the NHS Salford CCG’s Primary Care Commissioning Committee.
2.5 The group has a role to provide Primary Care Commissioning Committee with assurance, but also around escalation where necessary, in line with contractual matters.
3 Purpose
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
3.1 The Primary Care Quality group has delegated authority from NHS Salford CCG’s Primary Care Commissioning Committee to:
3.1.1 monitor progress against the actions outlined in NHS Salford CCG’s Quality & Safety Strategy that relate to primary care quality
3.1.2 Ensure timely measurement and monitoring of quantitative and qualitative information pertaining to Salford general practice which may impact on the quality and safety of care provision.
3.1.3 To utilise the data held in the GP Dashboard and the Salford Standards Primary Care Dashboard to assess the Quality of Primary Care Medical Services in Salford. (These dashboards will also enable practices to monitor and benchmark their own performance across a range of indicators).
3.1.4 Monitor practice progress and achievement of the Salford Standard.
3.1.5 Oversee and administer the Salford Standard Escalation Process to seek quality assurance and to escalate areas of concern to the Primary Care Commissioning Committee in line with the process.
3.1.6 To reduce unwarranted variation in primary care general practices, the group will create opportunities and ensure that Salford general practice has access to quality improvement initiatives:
• Making Safety Visible • PrISMS – Medication Safety Collaborative • Productive General Practice
3.1.7 Oversee the CCG Primary Care Dispute & Appeals Policy.
4 Membership and Quorum
4.1 The core voting membership shall comprise:
• Clinical Lead for Quality and Safety – Chair • Two other medical qualified professionals (one of whom should be Neighbourhood Quality Lead) • Practice manager, annual rotation (with Deputy Practice Manager if required) • Practice nurse representative (with Deputy Practice Nurse if required) • Quality Team • Innovation • Finance • Contracting • Business Intelligence • Service Improvement (Primary Care)
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
• Medicines Management • Safeguarding • GP Provider Support Team
Other non-voting members in attendance may include members of the Service Improvement Team, the Quality & Innovation directorate and a note taker.
4.2 The Chair will be the Quality and Safety Clinical Lead. The position of Vice Chair will be agreed by the group.
4.3 Co-opted members will attend meetings as required. Co-opted members could include: • Local Medical Council • Public Health
4.4 Task groups may be established to oversee specific pieces of work; however, these will be disbanded once the work is complete.
4.5 The quorum will be: • 1 Clinical Lead • 1 other clinician • 2 other members
4.6 Decisions shall be made by consensus or, in its absence within the time allotted by the Chair, by simple majority. The Chair will have the casting vote.
5 Accountability
5.1 The Primary Care Quality Group is accountable to the Primary Care Commissioning Committee in ensuring that any concerns with regard to the quality effectiveness of member practices are escalated.
5.2 The group will have a duty to escalate any such matters which may have implication or influence to the strategic intentions to the Community Based Care Strategy Group.
6 Conflicts of Interest
6.1 To ensure that members are aware of what may constitute a Conflict of Interest, that Conflicts of Interest are formally disclosed, and subsequently managed in adherence with the CCG’s Conflict of Interest Policy, the Nolan Principles for Standards for Public Life and in favour of the commissioning and delivery of high quality, safe and cost effective services.
6.2 To formally record within the relevant minutes the mechanism for making members aware of what may constitute a conflict of interest, any disclosure of conflicts of interest and the actions taken in the management thereof. Any failures to disclose, or other breaches of policy, must be reported to the CCG’s Chair or Accountable Officer, in the first instance.
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
6.3 Conflicts of interest may arise where a member of the Primary Care Quality Group is required to consider CCG payments to practices or to take decisions with regard to improvement actions and referral to Primary Care Commissioning Committee where necessary and:-
• Is a partner/lead/practising GP in a particular practice that has been identified through the Salford Standard escalation process/or CCG Primary Care Dispute and Appeals Process/or identified as requiring discussion pertaining to an identified quality concern • Is a Practice Manager in a particular practice that has been identified through the Salford Standard escalation process or CCG Primary Care Dispute and Appeals Process/or identified as requiring discussion pertaining to an identified quality concern • Has a close personal or professional connection with any individuals that may be directly affected by Salford Standard escalation process or CCG Primary Care Dispute and Appeals Process/or identified as requiring discussion pertaining to an identified quality concern
6.4 Depending on the topic under discussion and the nature of the conflict of interest, the member may be:-
• Allowed to remain in the meeting and contribute to the discussion. • Allowed to remain in the meeting but asked to refrain from participating in the discussion, voting or attempting to influence any vote (deputising arrangements shall be instigated if appropriate). • Asked to leave the meeting for the duration of the item under consideration.
6.5 Information obtained during the course of the Primary Care Quality Group must only be used for the purpose it is intended in relation to the monitoring of member practices. In particular, sensitivity should be applied when considering any financial, activity and performance data associated with individual practices and services.
6.6 Where items are deemed to be privileged or particularly sensitive in nature, these should be identified and agreed by the Chair. Such items should not be disclosed until such time as it has been agreed that this information can be released.
7 Term of Delegated Powers
7.1 Ongoing.
8 Frequency of meetings
8.1 Meetings will be held on a monthly basis (normally on the last Thursday of the month).
8.2 The Chair of the Primary Care Quality Group may call extraordinary meetings at his / her discretion.
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Date of Meeting 26/09/2016 Agenda Item No 6 (c)
9 Reporting
9.1 The Primary Care Quality Group will report once every two months to the Primary Care Commissioning Committee.
10 Review Date
10.1 These terms of reference will be reviewed in February 2016.
Natalie McInerney Service Improvement Manager (Primary Care)
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Primary Care Commissioning Committee (PCCC) training Date Location
13.00 Introduction and context
Overview of the contracts
Who can hold what type of contract?
Contract variations
Contract management
Scenarios
16.00 Close
NHS SALFORD CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE AGENDA ITEM NO 7 (a)
Item for: Decision/Assurance/Information
REPORT OF: Chief Finance Officer
DATE OF PAPER: 15 September 2016
SUBJECT: Primary Care Finance Report Month 5
IN CASE OF QUERY Elaine Vermeulen PLEASE CONTACT: 0161 212 4874
Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES:
Quality Community Based Care
Integrated Care
In Hospital Care
Long Term Conditions and Mental Health Effective Organisation
PURPOSE OF PAPER:
The purpose of this paper is to provide the Primary Care Commissioning Committee with information on the primary care budgets and finances. The report is based on information that was available at the end of August 2016.
Primary Care Finance Report
1.0 Executive Summary
This paper has been developed to provide the Primary Care Commissioning Committee (PCCC) with a view of the primary care budgets and finances. This includes budgets for locally commissioned services and prescribing which have historically been managed by the CCG, and co-commissioning budgets for primary medical services, delegated to the CCG from 1 April 2016.
The paper provides PCCC members with information on:
• GP services (including Primary Care contracts - GMS PMS and APMS) • Locally Commissioned Services, including the Salford Standard contracts • Prescribing and other budgets
2.0 Primary Medical services
Last Reported Annual Forecast Forecast Change in YTD YTD YTD Financial Summary Table budget Forecast Variance Variance Variance Budget Actual Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
CCG Allocation 35,626
GP Services General Practice - GMS 15,075 14,968 -107 -107 0 6,281 6,222 -59 General Practice - PMS 6,758 6,758 0 0 0 2,816 2,817 1 General Practice - APMS 1,727 1,728 0 0 0 720 713 -7 QOF 3,162 3,148 -14 -14 0 1,317 1,312 -6 Enhanced services 1,497 1,475 -22 -22 0 623 615 -9 Premises Cost Reimbursement 4,325 4,305 -20 6 -26 1,805 1,793 -12 Other Premises Cost 1 1 0 0 0 0 0 0 Dispensing/Prescribing Drs (PA Drugs) 166 166 0 0 0 69 69 0 Other GP Services 904 904 0 0 0 377 377 0
Void & Subsidy 1,617 1,617 0 0 0 587 587 0
Primary Care Investments 0 0 0 0 0 0 0 0
Total PRC Cost Centre 35,232 35,070 -162 -136 -26 14,595 14,504 -91
0.5% Contingency (Not budgeted for within PRC Cost Centre) 176 176 176 1.0% NR (Not budgeted for within PRC Cost Centre) 351 351 351
Balance -133 365
2.1 Financial Summary
The table details the CCG allocation, 2016-17 GP services budgets and the total forecast operating costs for 2016-17. The overall reported year to date position for primary care services at month 5 is an underspend of £91k.
The current annual budget is £35.23m and the forecast outturn is £35.07m. The year-end forecast outturn underspend is therefore £162k. The main
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reason for this position relates to the forecast underspend on GMS services (£107k), Enhanced services (£22k), Premises cost (£20k) and QOF (£14k). However this excludes the 0.5% contingency and the 1% non recurrent commitments. Including these commitments changes the position to a forecast year-end overspend of £365k. NHS England is considering refreshing the allocations made to CCGs to ensure that no CCG has a budgeted deficit for 2016/17.
2.2 Primary Care Contracts (GMS, PMS and APMS)
GMS - The annual budget for GMS is £15m and comprises of the global sum payment, MPIG payment and also includes deductions for opt outs.
The current forecast is based on the revised GMS rate for 2016/17 and the weighted list size for Q2. This area is reporting a year to date underspend of £59k and the forecast underspend is £107k. As list sizes are adjusted quarterly, this forecast outturn position will change accordingly. Prudently built into the position is an allowance for a 0.4% growth in list size for the remaining two quarters of this year.
PMS - The annual budget for PMS is £6.8m. PMS is showing a year to date £1k overspend and a year-end forecast breakeven position based on current payments.
APMS - The annual budget for APMS is £1.7m. APMS is showing a year to date underspend of £7k with a forecast breakeven position. Both APMS practices’ payments are based on April 2016 list sizes and include the uplifted DDRB Rates for 2016/17. The Heights contract is due a financial reconciliation for the contract year end date June 2016. The Care Homes contract is reconciled to date based on the contract year end date of March 2016.
2.3 QOF
The budgets were originally based on the projected achievement for 2015/16. The QOF sign off process is now complete for 2015/16 apart from one practice in Salford (Dr Finnegan). The revised forecasts are based on the actual 2015/16 achievement by practice (or 2015/16 budget if not available) with applied list size growth for 2016/17. The forecast represents an average of total points achieved by Salford CCG of 90%.
For 2016/17 the total QOF points available are 559 and this has remained unchanged from 2015/16. The indicators have also remained unchanged. The average £ per point has increased nationally by 3.16% to £165.18, however the list size used for the CPI adjustment has also increased by 3.14% to 7,460, and assumes a net cost impact.
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2.4 Enhanced Services
The annual budget for enhanced services totals £1.5m and comprises of services for minor surgery, learning disabilities, extended hours, avoiding unplanned admissions and violent patients. Enhanced services has a year to date underspend of £9k and forecast underspend of £22k based on the current number of practices signed up. Where a practice has not notified their intentions, it has prudently been assumed that the practice may still do so.
• Extended hours access is currently breaking even as only 70% of practices have confirmed sign up of the DES for 2016/17
• Learning disabilities has a small year to date and full year forecast underspend of £4k and £10k respectively
• Unplanned admissions has a small year to date and full year forecast underspend of £5k and £12k respectively
2.5 Premises Costs - reimbursement
The annual budget for premises cost reimbursement is £4.3m. Premises costs comprise of rent, rates, water and clinical waste costs.
Health Centre Rent and Rates (Community Health Partnerships CHP) - The CHP billing model has been received for all GP Practices. The year to date and forecast outturn positions now reflects this information.
The budgets and forecasts for the Newbury Place premises development have been included and revised, the associated non recurrent underspends for the existing three premises have also been included within the forecast.
Health Centre Rent and Rates (NHS Property Services) – In the absence of verifiable invoices, it has been anticipated that year to date spend and forecast will be in line with budget. The provider has indicated a change in their billing methodology, to reflect the cost of freehold properties at a market rent. The NHSE Central team have notified that a provision has been made centrally to offset any budget pressures for 2016/17 only.
As part of a national recalculation of GP premises rateable values, NHS England has appointed GL Hearn Property Consultants to collate and verify all business rate refunds. Revised invoices have been issued to practices for 2016/17 business rates and any recurrent savings have been forecast for month 5 where practices have submitted the invoices for reimbursement. For any practices which have yet to submit rates invoices for reimbursement, the 2015/16 values have been forecast to ensure a prudent approach.
Other services are showing a nil year to date variance and the forecast year- end position is in line with budget. Page 3 of 6
2.6 Premises Costs - Building Void, Subsidy and Bookable costs
Building void, subsidy and bookable costs for CHP and NHS Property Services have been split out to enable clear reporting. The combined budget for these services is £1.6m.
CHP - A detailed billing model for building void, subsidy and bookable costs has been received from CHP. Although an underspend is likely, forecasts have been held at breakeven until there is more clarity on the NHS Property Services costs.
NHS Property Services - No invoices have been received to date and so anticipating that year to date spend and forecast will be in line with budget. The year-end forecast is being held at breakeven until the NHS Property Services billing model has been received and agreed.
2.7 Dispensing\Prescribing Drs (PA Drugs)
The annual budget for PA Drugs is £166k and relates to professional fee payments. The year to date position is in line with budget and the forecast year-end position is in line with budget.
2.8 Other GP Services
The annual budget for other GP Services is £904k and includes seniority payments, costs for suspended GPs and locum costs in relation to maternity, paternity and sickness. Locum costs in relation to maternity, paternity and sickness are in line with the budget year to date and a break-even year-end position has been forecast. This is to account for any future commitments.
3.0 Locally Commissioned Services
3.1 Financial summary
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The recurrent annual budget requirement for the Salford Standard is £7,340k but this has been reduced to £6,325k in 2016/17 to reflect the anticipated uptake in this first year of operation. The financial plan includes an additional investment of £1,015k in 2017/18. The budget comprises of a fixed payment amount of 75% for signing the contract and submission of an acceptable implementation plan and 25% for achievement of the KPIs associated with the standards.
The year to date position is in line with budget and the CCG is forecasting a break-even position until information is received later in the year regarding achievement.
3.2 Salford Standard
The first upfront payment (37.5% of the contract value) has been released for all practices.
The payment for the initially approved implementation plans was made in July 2016. Practices whose plans were approved following resubmission have received payment in August and September. Due to the circumstances of Dr Rahman’s passing, a revised payment has been made to Dr Salim who is undertaking a caretaker contract until a decision has been made on the future management of Dr Rahman’s patient list.
The year to date budget and actual as at the end of month 5 is £5,481k.
After the last payment for the implementation plans, the budget remaining in the Salford Standard will be £843k and relates to the KPI element. Recurrently, this funding requirement is £1,862k and therefore there is sufficient funding in 2016/17 budgets for achievement of 45% of the KPIs across all practices. There is therefore a financial risk that practices will achieve in excess of 45% of KPIs. The CCG will monitor this over the next two quarters to assess the level of risk. The table below illustrates the financial risk for 2016/17 at various levels of achievement:
KPI achievement 40% 45% 50% 60% 75% 100% across all practices Cost of KPI £744,656 £843,266 £930,820 £1,116,983 £1,396,229 £1,861,639 achievement Potential -£98,610 -£0 £87,554 £273,717 £552,963 £1,018,373 over/underspend
3.3 Other Locally Commissioned Services
Other locally commissioned services are those which were not appropriate to include within the Salford Standard. The year to date variances total a £6k underspend and the forecast positions total a £15k underspend.
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4.0 Prescribing and Other
4.1 Financial summary
The annual budget for prescribing is £39,438k. Prescribing is showing a £286k over spend year to date with a forecast over spend of £685k. The forecast includes the potential Category M savings for prescriptions issued between June and September (as provided by NHS Business Services), after which the position will be further reviewed. The overspend is mainly attributable to the Care Homes practice, where a number of frequently used generic drugs for this population have had significant price increases. In addition, there has been an increase in the use of the newer and more expensive direct oral anticoagulants, as recommended by NICE.
The out of hours service is provided by Salford Royal and is part of the Integrated Care pooled budget. Home Oxygen and central drugs expenditure and forecast are also provided by NHS Business Services.
5.0 Recommendation
5.1 Recommendation
The Committee is asked to note the report.
Steve Dixon Chief Finance Officer
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Date of meeting 26 September 2016 Agenda Item No 8 (a)
NHS SALFORD CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE AGENDA ITEM NO 8 (a)
Item for Information
26 September 2016
REPORT OF: Karen Proctor, Director of Commissioning
DATE OF PAPER: September 2016
SUBJECT: Primary Care Operational Group Report
Anna Ganotis, Head of Service Improvement IN CASE OF QUERY (Primary Care) PLEASE CONTACT: [email protected] 0161 212 4912 Please tick which strategic priorities the paper relates to: STRATEGIC PRIORITIES:
Quality √ Community Based Care
Integrated Care
In Hospital Care
Long Term Conditions and Mental Health √ Effective Organisation
PURPOSE OF PAPER: The Primary Care Operational Group (PCOG) is responsible for overseeing and managing the delivery of the Medical and Task Functions as specified by NHS England. The group is required to submit recommendations for decision making / ratification to the Primary Care Commissioning Committee (PCCC). Therefore, this paper provides an update on the work that is overseen by the PCOG.
The PCCC is asked to note the content of this report.
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Date of meeting 26 September 2016 Agenda Item No 8 (a)
Further explanatory information required
The Primary Care Operational Group is working HOW WILL THIS BENEFIT THE to improve the quality of care in primary care HEALTH AND WELL BEING OF across Salford. SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP?
NA – update paper. Risks will be managed WHAT RISKS MAY ARISE AS A within each individual programme of work. RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED?
NA – update paper. Risks will be managed WHAT EQUALITY-RELATED RISKS within each individual programme of work. MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED?
NA DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM?
NA PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER.
Primary care services PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER:
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Date of Meeting 26 September 2016 Agenda Item No 8 (a)
Document Development
Not Comments and Date Process Yes No Outcome Applicable (i.e. presentation, verbal, actual report) Public Engagement (Please detail in the Comments and Date column the method ie survey, event, consultation) Clinical Engagement (Please detail in the Comments and Date column the method ie survey, event, consultation) Has ‘due regard’ been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.
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Date of Meeting 26th September 2016 Agenda Item No 8 (a)
Primary Care Operational Group Report
1 Executive Summary
This paper provides an update on the work that is overseen by the Primary Care Operational Group (PCOG). This includes updates on: practice specific contractual issues; estates projects, core contractual requirements, enhanced services and general practice capacity.
The Primary Care Commissioning Committee is asked to note the content of this report.
2 Introduction and Background
2.1 The Primary Care Operational Group (PCOG) provides an update report to every Primary Care Commissioning Committee (PCCC) meeting.
2.2 This report covers the PCOG meetings held in July, August and September 2016.
3 Practice Issues
Broughton Neighbourhood
3.1 Limefield Medical Centre – the list remains closed at Limefield Medical Centre. The PCOG continues to monitor the practice’s action plan and recruitment difficulties.
The practice submitted an expression of interest in participating in NHS England’s Targeted Investment in Recruiting Returning Doctors Pilot Scheme and this was supported. The scheme will provide the practice with marketing and recruitment support and a financial support package.
It has been agreed that the situation will be reviewed with the practice in October 2016.
3.2 Leicester Road Medical Centre – The PCOG received an update on Leicester Road Medical Centre’s progress against contractual compliance issues highlighted at their CQC inspection. It was highlighted that some information is still outstanding and the practice has been given a deadline of 23 September for submission.
3.3 Mocha Parade Medical Practice – It has come to the attention of the PCOG that a doctor on the contract at the practice has retired and is no longer working there. This means that Dr Kassam is now working as a single-handed GP. The practice has submitted the necessary paperwork to change to a single handed contract and this will be actioned within a 28 day timeframe. The submission included an action plan to provide assurance that quality and patient safety would not be adversely affected. This action plan was reviewed, alongside information from the CCG’s GP Quality Dashboard by the Primary Care Commissioning Committee in August 2016.
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Date of Meeting 26th September 2016 Agenda Item No 8 (a)
3.4 The Energise Healthy Living Centre – The Energise Healthy Living Centre is a branch practice of Lower Broughton Health Centre 3 and they have recently received a CQC inspection. The overall outcome of the inspection was ‘good’, however, the inspection highlighted some areas where the practice was not compliant in respect of the GMS contractual requirements. Upon request, the practice submitted the necessary policies and processes and the Primary Care Operations Group was assured that this was satisfactory.
Eccles and Irlam Neighbourhood
3.5 Chapel Medical Centre – It was reported to the group that the practice manager (who had been convicted of fraud) has now been removed from the contract and a new doctor has been added. Therefore, this matter is now closed.
3.6 The Primary Care Operations Group has been formally notified of a concern regarding the use of faxed prescriptions by one of the practices in the neighbourhood. The group noted some potential issues relating to patient safety. It was agreed a letter should be sent to the practice to request information and a meeting arranged between the practice, commissioning managers and a CCG clinical lead to discuss the matter further.
Ordsall and Claremont Neighbourhood
3.7 Salford Medical Practice 2 – The PCOG have been overseeing the arrangements that have been necessary following the sad news of the death of Dr Rahman on 1st August 2016. In accordance with contractual regulations, the contract was terminated on 7th August 2016 and temporary arrangements have been put in place with Salford Medical Practice 1 (which is co-located) until 30th November 2016. The PCCC has been asked to make a decision on the long-term arrangements for the provision of services for Dr Rahman’s practice list and then the implementation of the approved option will be overseen by the PCOG.
Walkden and Little Hulton Neighbourhood
3.8 The Gill Medical Practice – The Gill Medical practice has recently undergone a CQC inspection. The overall outcome of the inspection was ‘good’, however, the inspection highlighted some areas where the practice was not compliant in respect of the GMS contractual requirements. The practice will be asked to submit the necessary assurances and their submission will be considered at the October 2016 PCOG meeting.
4 Estates Update
4.1 The group received an update on the three major primary care estates projects: Little Hulton, Lower Broughton and Irlam. It was noted that progress is being made on these schemes.
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Date of Meeting 26th September 2016 Agenda Item No 8 (a)
5 Core Contractual Requirements
5.1 Following the decision at part 2 of the July 2016 PCCC meeting to continue to re- commission the Care Homes Medical Practice from Salford Royal Foundation Trust; the PCOG is now overseeing the implementation of the recommendations of the review. A new contract will be in place for April 2017.
5.2 The work to re-procure The Height Medical Practice has now resumed. A full update is on the agenda for the September PCCC meeting.
5.3 The PCOG reviewed data showing current performance against the contractual requirement for all practices to have at least 10% of their patients signed-up for online services (booking appointments, ordering prescriptions etc.) by the end of 2016/17. Only 11 of the 46 practices in Salford are currently meeting the target and Salford practices are the worst performing in the North of England. The group discussed and agreed ways in which practices could be supported to increase their performance.
6 Enhanced Services
6.1 Colleagues from the Greater Manchester Health and Social Care Partnership shared the latest position regarding the enhanced services that Salford practices have signed-up for in 2016/17. CCG officers have been contacting practices to ensure they were aware of the deadlines. As of 12 September 2016, 2 practices have not signed up to any enhanced services and 3 practices have not signed up to any of the public health enhanced services. Of those practices who have already signed-up: - 1 practice has not signed-up to the Avoiding Unplanned Admissions Enhanced Service - 13 practices have not signed-up to the Extended Hours Access Enhanced Service - All practices have signed-up to the Learning Disabilities Health Check Enhanced Service - 1 practice has not signed up to deliver childhood immunisations; however, arrangements are in place with another practice to provide these on their behalf - The Care Homes Medical Practice has not signed-up to a number of public health enhanced services because they are not applicable to their patient demographic
6.2 It was noted by the group that the PCCC approved the Salford Wide Extended Access Business Case in part 2 of the July 2016 meeting. An update has been scheduled to come to PCCC in January 2017.
6.3 Colleagues from the Greater Manchester Health and Social Care Partnership updated the group that there are some issues regarding the Violent and Vexatious Patient Scheme. It was agreed that this enhanced service may require a review in the future.
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Date of Meeting 26th September 2016 Agenda Item No 8 (a)
7 General Practice Capacity
7.1 The PCOG considered a strategic outline case to agree the commissioning approach to expanding general practice capacity in Ordsall and this is on the agenda for decision by the PCCC.
7.2 The group acknowledged that it will be necessary to do a wider piece of work to benchmark capacity in general practice in order to prioritise other parts of the city where there may be a need to expand primary medical service provision. A project group has met to discuss a methodology for undertaking this and it has been agreed that this work can begin in October 2016 once all of the necessary data is available.
7.3 PCOG noted some practices appear unclear regarding their responsibilities if they are closing the practice for training. The group agreed to draft a communication to go out to practices via the email bulletin in order to clarify responsibilities.
8 Recommendations
8.1 The PCCC is asked to note the contents of this report.
Anna Ganotis Head of Service Improvement (Primary Care)
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