Item for:- Decision Recommendation Information X AGENDA ITEM NO: 8.0. Meeting Title/Date: Primary Care Commissioning Committee - 2 April 2020 Report Title: Askam-in-Furness List Dispersal Update Kay Wilson/ Date of Paper Prepared By: March 2020 Kate Hudson Paper: Responsible Executive Sponsor: Hilary Fordham Kate Hudson Manager: Committees where Paper 18 February 2020. Previously Presented: 3 October 2019. Background Paper(s): Summary of Report: At the meeting on 18 February, Committee members considered how services should be provided to patients registered at the Askam in Furness practice following the retirement of Dr Jain. This report provides an update on the situation and actions that have been taken since that meeting. Recommendation(s): Members are asked to note the contents of this report. Please Select Y/N Identified Risks: (Record Risks were identified in the paper Y related, Assurance presented to the Committee on 18 Framework or Risk Register February 2020. reference number) Due to the current public health crisis, there is a risk that patients may have difficulties with registering, or fail to register with, an alternative GP before the surgery closes. The impact of this is discussed in this paper. Impact Assessment: An Impact Assessment was included with Y the papers presented to the Committee on (Including Health, Equality, 18 February 2020. Diversity and Human Rights) Strategic Objective(s) Please Supported by this Paper: Select (X) Better Health - improve population health and wellbeing and reduce X health inequalities Better Care - improve individual outcomes, quality and experience of care X Delivered Sustainably - create an environment for motivated, happy staff X and achieve our control total Please Contact: Kate Hudson Head of Primary Care [email protected] AGENDA ITEM NO 4 – ASKAM IN FURNESS: UPDATE _________________________________________________________________________________ MORECAMBE BAY CCG PRIMARY CARE COMMISSIONING COMMITTEE ASKAM IN FURNESS: UPDATE REPORT (DISPERSAL OF PATIENT LIST) (A82621) 1. INTRODUCTION 1.1 Dr Jain (sole GP at Askam in Furness) confirmed to NHS Morecambe Bay CCG that he intended to resign from the General Medical Services (GMS) contract he held with effect from 30 March 2020. 1.2 The Committee considered the appropriate way in which primary medical services should be provided to patients registered at the practice, following Dr Jains’ retirement, at its meeting on 18 February 2020. It was agreed that the list should be dispersed subject to two specific actions being taken: 1.2.1 the LMC and CCG to work with local practices to explore the potential for an existing practice to open a branch surgery at Askam; and 1.2.2 the CCG to discuss with local practices the option of extending existing practice boundaries to include Askam in Furness and the surrounding areas. 1.3 The Committee also noted that, in advance of the Committee meeting, Dr Jain had made an offer to delay his leaving date for a period of 3 months and wished this to be pursued also. 1.4 This report provides an update on the current situation in relation to the dispersal of the patient list. 2. ACTIONS TAKEN TO DATE Contractual Position with Dr Jain 2.1 Following the Committee meeting on 18 February, the CCG’s Head of Primary Care, met with Dr Jain to discuss the potential extension to the contract until 30 June 2020. 2.2 Dr Jain agreed that the contract could be extended for a 3 month period to allow the dispersal of the list to be undertaken. However, Dr Jain asked that the CCG ensured he was not financially penalised for this and that the total cost of Locums was reimbursed. The CCG agreed that Dr Jain should not bear any financial cost personally during the period of extension and confirmed to Dr Jain that the current payments made to the practice would continue for a three month period and that, in addition, the CCG would fund any gap in the reimbursement he received for Locum costs compared to the actual cost. _________________________________________________________________________ Page 1 of 7 AGENDA ITEM NO 4 – ASKAM IN FURNESS: UPDATE _________________________________________________________________________________ 2.3 Dr Jain did stress, however, that he would not be willing to extend the contract beyond 30 June 2020 as he was keen to retire and asked for reassurance that the CCG would not delay the dispersal process so that the GMS contract could be terminated at the end of June. Communication with patients 2.4 The CCG wrote to all patients on 21 February 2020 outlining the decision made by the Committee and setting out the steps patients needed to take in order to be registered with an alternative practice by the end of June 2020 (attached as Appendix 1). 2.5 Whilst the majority of patients have remained registered with the practice a number of patients have registered with an alternative GP and as at 01 March 2020, the list size was 1,386 patients. This represents a decrease of 104 patients since the figures presented to the Committee in mid-February. 3. UPDATE ON CURRENT SITUATION Branch Surgery / Expansion of current practice boundaries 3.1 Whilst initial discussions were held between the Local Medical Committee (LMC) and neighbouring practices in respect of the branch surgery, these discussions stalled due to the impact of COVID-19 on general practice. Consequently, and also due to ongoing premises constraints, it has not been possible to identify an existing practice able to open a branch surgery at this point in time. 3.2 The setting-up of a branch surgery would not only require a significant amount of administrative work but would also need staff, both practice staff and other NHS staff / contractors, to physically attend the surgery premises to install such items as a new telephony system (the current system is owned by Dr Jain) as well as new / additional IT equipment. In line with the Government’s advice in relation to social distancing and self isolation, this would not be appropriate or possible at this time. 3.3. In respect of the expansion of practice boundaries, the CCG does not believe that it would be appropriate during the current operational difficulties which are impacting upon practices workloads to enter into discussions about changes to contractual boundaries which may further increase the pressure upon an increased number of practices at this difficult time. 3.4 The Primary Care Commissioning team undertook to write out to all patients with an update at the end of March 2020; that letter is being prepared and will be sent to patients by 31st March 2020. 4. NEXT STEPS 4.1 In view of the current advice from the Government relating to the need to limit social contact, patients will not be able to attend practices to complete the usual registration process. To that end, the CCG is working with NHS England / NHS Improvement to discuss how to safely achieve a full dispersal of the patient list prior to the deadline of 30th June 2020. _________________________________________________________________________ Page 2 of 7 AGENDA ITEM NO 4 – ASKAM IN FURNESS: UPDATE _________________________________________________________________________________ 4,2 The paper presented to the Committee in February 2020 said that should the Committee choose to disperse the list, the process would involve writing to patients requesting that they make a choice about which practice they would like to register with and approach that practice direct. The only time the CCG planned to intervene was, firstly to ensure that vulnerable patients remained registered with a practice and, secondly, if individual patients had difficulties registering. However, following discussions with colleagues within NHS England / NHS Improvement, it has been agreed that the safest approach in the current circumstances would be to undertake a managed dispersal of the patient list, therefore allocating patients to a practice. 4.3 The CCG and NHS England / NHS Improvement are mindful of the need to promote patient choice and the letter to patients confirmed that if they do not wish to remain registered with the allocated practice, then they are free to register with the GP of their choosing. 4.4 Discussions with neighbouring practices about how best to allocate patients were on- going at the time of writing this report. The final arrangements for patients being allocated to a practice will be included in a future patient letter. 4.5 Practices that receive allocated patients from Askam will be provided with appropriate support and resource to enable them to safely accept and provide care for both their existing and newly registered patients. 4.7 The CCG anticipates that the majority of patients will be disappointed that the option of a branch surgery opening in the village has not proved successful. The letter has informed patients that any practice can apply to open a branch surgery at any point in time and that the CCG’s Primary Care Commissioning Committee would consider all applications should any be received later in the year. 4.8 The CCG has also been in contact with Cumbria County Council and is exploring the options of extending the current voluntary transport services that operate around Cumbria and how these could be extended to include Askam in Furness and the surrounding areas. 5. SUMMARY / RECOMMENDATION 5.1 Members are asked to note the contents of this report. A further update will be provided to the Committee in July 2020. _________________________________________________________________________ Page 3 of 7 AGENDA ITEM NO 4 – ASKAM IN FURNESS: UPDATE _________________________________________________________________________________ APPENDIX 1 COPY OF LETTER SENT TO PATIENTS FOLLOWING COMMITTEE MEETING ON 18 FEBRUARY 2020 Moor Lane Mills Moor Lane Lancaster LA1 1QD Tel: 01524 519470 [email protected] www.morecambebayccg.nhs.uk 21 February 2020 Dear Sir/Madam Re: Important information for patients of Dr Jain – Askam GP Surgery As you are a patient registered with Askam GP Surgery, we are writing to inform you of the decision made by the Primary Care Commissioning Committee on 18 February 2020 in relation to the future of the practice.