Primary Care Hub Derbyshire and

EXECUTIVE SUMMARY SHEET NHS North and East CCG Primary Care Commissioning Committee

Date of 2 February 2017 Agenda Item: PCCC 17-029 b meeting: and 6 April 2017 Title: Torkard Hill Surgery, Practice Boundary Application Supporting Paper

Presented by: Kerrie Woods

Written by: Jayne Bouch, Primary Care Support Officer, NHS

Purpose of paper:

Torkard Hill Medical Centre applied to NHS Nottingham North and East, Clinical Commissioning Group (NNE CCG) to reduce their current practice boundary to exclude the Bestwood Village area. (Appendix 1)

The practice boundary forms part of the contract for Primary Medical Services and any changes are considered within contract variations. (Appendix 2)

This supporting paper provides the Primary Care Commissioning Committee (PCCC) with requested additional information and the opportunity to consider this application and subsequently accept or decline the application on behalf of NNE CCG.

Key Issues and Recommendations:

 Torkard Hill Medical Centre wishes to reduce their practice boundary to exclude Bestwood Village.

 All reductions to boundaries to be considered carefully in order to ensure the patient population have adequate GP coverage.

Action required by the NHS Nottingham North and East CCG Primary Care Commissioning Committee:

Primary Care Commissioning Committee:  Consider the application for the boundary change. Primary Care Hub Derbyshire and Nottinghamshire

Introduction

In July 2016 Torkard Hill Medical Centre applied to NHS Nottingham North and East, Clinical Commissioning Group (NNE CCG) to reduce their current practice boundary to exclude the Bestwood Village area. (Appendix 1)

The application was discussed at the December 2016 NNE CCG, Primary Care Commissioning Panel. A decision on the application was deferred following a request by the panel to provide additional information on the application before a final decision could be made. (Appendix 3)

Additional contracting information:

It is important to note that the current contractual arrangements do not prevent practices accepting patients onto their list, even if they live outside the practice boundary area. It is at the practice’s discretion entirely if they choose to register patients from outside of its boundary area.

In particular, primary medical services contracts (GMS, PMS, APMS) contain provisions that practices are required to use in considering an application from a patient to join the practice list.

The contract states that the practice:

“…shall only refuse an application … if it has reasonable grounds for doing so which do not relate to the applicant’s race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition”.

The reasonable grounds referred to include the ground that the applicant does not live in the practice boundary area.

It is a contractual requirement for a practice that declines a registration for a patient who is resident within the practice boundary, to have an alternative reason to do so which does not relate to the any of the characteristics (included those protected by the Equality Act 2010). Refusals for alternative reasons are generally very limited.

Where practices are routinely registering patients from outside of their agreed practice boundary it is recommended that they increase the boundary area. This is in order to ensure there is greater transparency in the practice decision making, particularly in relation to applications that are refused, which can then be monitored more robustly under the terms of the contract.

Primary Care Hub Derbyshire and Nottinghamshire

Additional information requested:

The additional information requested by the PCCC is as follows:

1) Number of patients registered at practices within the Bestwood Village area

Name of practice CCG Number of patients

Torkard Hill Medical NNE CCG 419 Practice Leen View Surgery Nottingham City CCG 249 Om Surgery NNE CCG 43 Oakenhall Medical Practice NNE CCG 246 Parkside Medical Practice NNE CCG 143 Rise Park Surgery Nottingham City CCG 641 Riverlyn Medical Centre Nottingham City CCG 82 Springfield Medical Centre Nottingham City CCG 70 St Albans Medical Centre Nottingham City CCG 242 Medical Practice NNE CCG 91

The above patient numbers have been reported by the individual practices as of December 2016 and January 2017.

2) By practice over a 12 month period patient capitation list sizes

As you can see in the table below the patient capitation flow between all the practices has been stable over the past twelve months.

This shows a 1% average for the increase and decrease of the patient list sizes generally for all practices concerned.

Total patient Q4 Q1 Q2 Q3 12 month list size forecast

31/03/16 30/06/16 30/09/16 31/12/16 (Yr (Yr (Yr (Yr 2015-16) 2016-17) 2016-17) 2016-17) Practice Patient Patient Patient Patient Increase/de 12 mth period Name List size List size List size List size crease % increase/decre ase

Torkard Hill 14572 14567 14611 14628 56 0% Medical Practice Leen View 8696 8801 8833 8853 157 2% Surgery Oakenhall 7154 7172 7215 7218 64 1% Medical Practice Primary Care Hub Derbyshire and Nottinghamshire

Om Surgery 2005 1987 1995 2013 8 0% Parkside 6806 6863 6948 7007 201 3% Medical Practice Rise Park 6973 7096 7187 7242 269 4% Surgery Riverlyn 3021 3021 3068 3077 56 2% Medical Practice Springfield 2698 2707 2681 2676 -22 -1% Medical Practice ST Albans 7567 7533 7502 7495 -72 -1% Medical Practice Whyburn 11892 11963 11963 12012 120 1% Medical Practice TOTAL 71384 71710 72003 72221 837 1%

Section 106 Funding

- NNE CCG confirmed with regards to Local Authority ‘Section 106’ funding available in the Bestwood Village; there is currently funding available to the practices. This is a total of £105,600 for the Bestwood Village and £55,651 for a West Farm development.

- Currently, patient flow to the Nottingham City CCG is approximately 52%. Therefore, the amount available to NNE CCG would be £77,000. This amount is negotiable with Nottingham City CCG depending if Nottingham City CCG requires any funding to increase capacity.

- If Torkard Hill Medical Centre’s application to reduce the practice boundary is approved the patient flow will change and the money available for developments and any future developments in that area will be reduced.

- The proposed boundary change border would depend on where it is as there may be other developments that need to be looked into.

- As reported by NNE CCG with regards to ‘Section 106’ funding; the patient list size growth over a three year period for the Hucknall practices has seen marginal growth which is slightly less than the CCG average. (Appendix 4)

Primary Care Hub Derbyshire and Nottinghamshire

Public Health patient registration information

In January 2017 the Patient Registration team provided patient postcode details for total patients registered at Torkard Hill Medical Practice and all the individual surrounding practices detailed within the practice boundary change application and both NNE PCCC panel reports.

This information has been plotted by Public Health onto individual scatter graphs for each practice concerned. The graphs highlight where the registered patients live and which practice patients are registered with. (Appendix 5).

For further historic area knowledge please see the most recent Public Health, Hucknall and Bestwood Local Health demographic population report up to 2014. (Appendix 6)

Recommendations

The panel is asked to consider this boundary reduction application and additional information detailed within this report before making an informed decision:

- The practice inner boundary will reduce as described with immediate effect.

- Bestwood Village area patients currently registered with the practice living outside the new boundary will remain registered with Torkard Hill Medical Centre

- Currently Torkard Hill Medical Centre has registered patients within two residential homes within the Bestwood Village area.

- There are significant GP access practice issues generally within Nottingham City and NNE CCG areas; especially bordering with the Bestwood Village.

Primary Care Hub Derbyshire and Nottinghamshire

Appendices:

1 Torkard Hill Medical Practice boundary change application

2 Appendix 2 NHS England Policy Book web link https://www.england.nhs.uk/commissioning/wp-content/.../sites/.../policy-book-pms.p

3 Original PCCC panel report NNE CCG Torkard Hill Medical Practice Boundary Change Application

4 NNE CCG quarterly practice population list sizes

5 Public Health data postcode scatter graph mapping

6 Public Health local health report to 2014