PCCC Item 9 Sands End and South

Paper: 9

Date Tuesday, 12 December 2017

Title of paper Sands End Health Clinic and South Fulham Clinic Merger Proposal

Presenter Atilade Adeoye – Senior Commissioning Manager – NHS England Author Atilade Adeoye – Senior Commissioning Manager – NHS England

Responsible Julie Sands - Head of Primary Care North West London – NHS England Director

Approved report Yes  Clinical Lead Items are only confidential if it is in the Confidential Yes ☐ No  public interest for them to be so Assurance Level Agreed Good Adequate Limited Unsatisfactory by Responsible YES Director

The Committee is asked to: Ratify the decision made by Primary Care Committee in Private (November 2017) to merge the two practices effective from 1st January 2018 subject to confirmation of the completion of patients and stakeholder engagement to commissioners.

Summary of purpose and scope of report

1. Summary:

Sands End Health Clinic is a GMS Practice with services provided by Dr Caroline Jewels, Dr Gemma Crittenden and Dr Simon Edwards in partnership.

South Fulham Clinic is a GMS Practice with services provided by Dr Caroline Jewels, Dr Gemma Crittenden and Dr Simon Edwards in partnership.

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An application has been made to NHS England requesting for the approval of a merger of the above two practices. The proposed contract merge date is 1st January 2018.

Both practices currently occupy the same premises including a shared reception area, waiting rooms and office space and are part of Hammersmith and Fulham CCG

In November 2017, The PCCC agreed to the merger from 1st January 2018 subject to confirmation of completion of patient and stakeholder engagement.

The delegated Committee is asked to note the decision made in November 2017 in private.

2. Clinical Provision:

Sands End and South Fulham currently have the same opening hours (NHS Choices) : 07:00- 19:00 Monday to Friday 08:00-10:00 Saturday

Current South Fulham Clinic provides 10 sessions per week, with Sands End Health Clinic providing 42 sessions. Additional provision is available at Sands End through extended hours.

Proposal from the newly merged practices is to provide 60 sessions per week during core hours. This will be facilitated through the recruitment of additional staff. This will result in an additional 8 sessions per week.

Sands end Health Clinic is a teaching practice with 4 x admin staff, 4 x receptionists, 2 x apprentices, 2 x nurses, 1 x HCA, 1 x physicians associate and 8 x GPs.

South Fulham currently has 2x GPs, 1x part time nurse, and 1 x HCA, 2 x receptionists, 1 x administrator and 1 x practice manager.

The merged practice will continue to operate under Sands End Health Clinic Contract and will employ all staff. The South Fulham Clinic contract will terminate.

3. Distance between sites:

As above, the practices occupy the same premises. Therefore there will be no geographical change for patients.

The current two practice catchment areas will be continued but merged into one. From the catchment maps below Sands End Practice already covers all areas covered by South Fulham.

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Sands End South Fulham

There is no reduction in patient choice. The practice have also confirmed that as a merged practice there will be no restrictions on new patient registrations, that the merged practice will have capacity to take on new patients and will adjust capacity appropriately. They have confirmed that accordingly they will recruit more staff as the need arises and review workforce needs regularly.

4. Benefits:

The practice has proposed the following strategic benefits: - Patients will not experience a change to telephone access or arrangements. - Better access for patients, particularly for South Fulham Clinic registered patients who currently do not receive the full range of services and access provided at Sands End. Sands End patients will also see more availability of GPs and more clinical sessions. - More GPs will enable development and special interests to up skill. - Economies of scale. Practices have already been working collaboratively, this will formalise. - Plan to use the existing rooms which South Fulham and Sands End currently occupy. Currently South Fulham Clinic has unused rooms for large proportions of the week, plan to use the rooms more effectively. - All patients will access a single service consistency across provisions, home visits, booking appointments, opening hours, single IT and phone systems.

5. Performance:

Sands End Health Centre- E85128

- QOF 2016/17- 540.92 points achieved out of 559 (96.8%) - NHS Choices- 86% would recommend, 2 star rating (14 ratings) - Sands End was rated GOOD in published report dated 19th June 2017

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South Fulham Clinic- E85110 - QOF 2016/17- 503.52 points achieved out of 559 (90%) - NHS Choices- 87% would recommend, 2star rating (9ratings) - South Fulham Clinic was rated as GOOD in published report dated 27th June 2017

Infection control:

- No infection control concerns for either practice

6. Finance:

Rental Costs will remain as per the current costs. Rental distribution is split, South Fulham Health Clinic share is 20.41% and Sands End Health Clinic share is 39.84%. There will be no reduction in premises and no rent or rates saving.

7. Patient Engagement:

Practices have confirmed that they have informally engaged with respective PPGs and there has been no resistance. Patient have expressed that they feel that the building would better service one practice than the existing two practices. Formal discussions are to be planned. After proposing a bulk mail out to registered patients, the PPG is understood to have felt that this was unnecessary and expressed concern with regards to the time and cost associated with sending a bulk mail out. They were satisfied that the practice had engaged with patients in many other ways.

Initial patient engagement information presented to NHS England in the form of a patient survey required NHS England to seek further clarification from the practices. The results initially suggested that patients were unsure of the impact a merger of practices would have and what it would subsequently meant for them. The practice confirmed that they intend to compile a list of FAQs for patients to provide clarification and reassurance, especially with regards to access if approval is granted.

8. Recommendation:

In November 2017, the PCCC agreed to the merger from 1st January 2018 subject to confirmation of completion of patient and stakeholder engagement.

The delegated Committee in Public is asked to ratify the decision made in November 2017 committee meeting.

Quality & Safety/ Patient Engagement/ Impact on patient services: Quality & Safety:

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None identified. Patient Engagement: Already covered above. Impact on patient services: No reduction in patient services identified. The provider has expressed commitment to offer increase access and a range of other services to patients.

Finance, resources and QIPP The merged contract will be remunerated in line with the national General Medical Services Contract and policy guidelines.

Equality / Human Rights / Privacy impact analysis None

Risk Mitigating actions Not identified N/A

Supporting documents

Governance and reporting (list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper) Committee name Date discussed Outcome