Chorley and South Ribble CCG Primary Care Commissioning Committee

4 September 2019 Garden Room - St. Catherine's Hospice, Lostock Lane, Lostock Hall, Preston PR5 5XU 3.30 pm

Item Agenda Item Presented By Time No 1 Welcome and apologies for absence Mrs Tricia Hamilton 3.30 pm Verbal 2 Declarations and Register of Interests (Pages 3 Mrs Tricia Hamilton 3.35 pm - 10) Information

3 Minutes of previous meeting (Pages 11 - 16) Mrs Tricia Hamilton 3.40 pm Ratification 4 Matters arising Mrs Tricia Hamilton 3.45 pm Verbal

Strategy 5 Quarterly Contractual Changes (Pages 17 - 20) Ms Lysa Hasler 4.00 pm Information 6 GP Quality Contract: Performance 2018/19 Mr Andy McAllister 4.10 pm (Pages 21 - 54) Decision

Operational 7 Station Surgery (Pages 55 - 120) Mrs Donna Roberts 4.20 pm Decision 8 Merger Document Adlington Medical Centre Ms Lysa Hasler 4.40 pm (Pages 121 - 130) Decision

Any other business 9 Any Other Business Mrs Tricia Hamilton 4.50 pm Verbal

Agenda Chorley and South Ribble CCG Primary Care Commissioning Committee Meeting Wednesday, 4 September 2019 1

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Primary Care Commissioning Committee

Date of Meeting 4 September 2019 Title of paper Declarations and Register of Interests Presented by Primary Care Commissioning Committee Chair Author Mrs Joanne Croasdale, Corporate Affairs and Governance Administrator Clinical Lead N/A Confidential No

Purpose of the paper This register is a standing item on all statutory Committee agendas. The register is for information purposes and allows members to challenge any potential conflicts against agenda items. This item also allows members and attendees to declare any additional interests against agenda items prior to the main body of the meeting.

Executive Summary The Clinical Commissioning Group (CCG) has a statutory requirement to keep and maintain a Register of Interests for the organisation with regard to actual or potential interests declared by; Governing Body members, Membership Council members, members of Sub Committees of the Governing Body, and employees of the CCG.

This report presents the flowchart for declaring and managing Conflicts of Interest, as outlined in the Managing Conflicts of Interest Policy.

The Committee should note the information contained within the registers is based on the information provided in the 2019/20 financial year. The registers will be updated in due course as declarations of interest are made and published on the CCG website. The interests are as recorded on the Pentana system at the time of producing this paper, if a new proforma has been submitted in the intervening time this will be captured at the next meeting.

The Committee should note that Members who are Governing Body Members have recently completed their annual request for Declarations of Interest and those submissions received have been included within this latest register.

All conflicts or potential conflicts should be declared, and where a conflict of interest has required specific management arrangements during the course of the meeting, this should be recorded in the minutes, along with the action taken by the committee Chair in managing the conflict. Recommendations The committee is asked to note the register of interest and to make any additional declarations as appropriate against any agenda items.

Declarations of Interest NHS Chorley and South Ribble CCG Page 3 Primary Care Commissioning Committee 4 September 2019 Links to CCG Strategic Objectives SO1 Improve Quality through more efficient, safer services which deliver a ☐ better patient experience SO2 Commission care so that it is integrated and ensures an appropriate ☐ balance between in-hospital and out of hospital provision SO3 Be an integral part of a financially sustainable health economy ☐ SO4 Ensure patients are at the centre of the planning and management of ☐ their own care and their voices are heard SO5 Be seen as a well-run clinical commissioning group and the system ☒ leader

Governance and reporting (list committees, groups or other bodies that have discussed this paper) Meeting Date Outcome Delegated Commissioning 5 June 2019 This paper was last reported to the Committee committee on 05.06.2019 Were any conflicts of interest identified at previous meetings (mark X in the correct box below) Yes No X If conflicts of interest were identified what were these: N/A

Implications Quality/patient Experience Yes ☐ No ☐ N/A ☒ implications (Potential) Conflicts of Interest Yes ☐ No ☐ N/A ☒ Equality Impact Assessment Yes ☐ No ☐ N/A ☒ Privacy Impact Assessment Yes ☐ No ☐ N/A ☒ Are there any associated risks? Yes ☐ No ☐ N/A ☒ Are the risks on the CCG’s risk ☐ ☐ ☒ register Yes No N/A

Assurance Assurances will continue to be provided to the Governing Body from the CCG’s Audit Committee.

Declarations of Interest NHS Chorley and South Ribble CCG Page 4 Primary Care Commissioning Committee 4 September 2019

NHS Chorley and South Ribble CCG Primary Care Commissioning Committee - Declarations of Interest Declarations of Interest are recorded on the Register when specifically declared by a member of the meeting. This Register was accurate at the time meeting papers were submitted; therefore, any changes received after submission will be included on the Register for the next statutory meeting.

Codes for the types of interests declared are (2018 proforma): DP=Direct Pecuniary, IP=Indirect Pecuniary, NP=Non Pecuniary Personal Interest, CL=Conflict of Loyalty, PR=Professional or Personal Relationship. (2019 proforma): FI=Financial Interest, NFProI=Non Financial Professional Interest, NFPI=Non Financial Personal Interests, II=Indirect Interests. Interests declared in 'bold' are pending confirmation of the type of interest.

Name Role Declaration Date Mitigating Actions Mrs Helen Curtis Director of Quality and NFPI - Daughter is Specialty Business 14.12.2018 This will be declared separately in any Performance, NHS Manager for Surgery at Lancashire meetings whereby this presents a conflict Chorley and South Teaching Hospitals NHS Foundation Trust to my decision making Ribble and NHS Greater - December 2018 Preston CCG NFPI - Son is a Social Worker in central Preston - Current Mrs Patricia Governing Body Nurse, No Interests Declared 19.12.2018 Not applicable - no interests declared Hamilton NHS Chorley and South Ribble and NHS Greater Preston CCG Dr Eamonn Secondary Care Doctor, NFProI - Retired Consultant Anaesthetist 18.12.2018 Interest noted. Will be reviewed in line McKiernan NHS Chorley and South who worked at Lancashire Teaching with agenda items at committee meetings Ribble and NHS Greater Hospitals NHS Foundation Trust for 31 and procurement involvement. Where a Preston CCG years conflict emerges the individual will be NFPI - Oldest daughter is a social worker excluded from decision making. in Newcastle Upon Tyne - Current Page 5 Page

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Name Role Declaration Date Mitigating Actions NFPI - Second daughter is a Psychiatrist researching and practicing in Cambridge - Current NFPI - Third daughter is Children's nurse in Stockport - Current NFPI - Son in Law training in Cardiology in Cambridge and Norwich - Current Mr Paul Vice Chair and Lay NFProI - Lancashire Joint Police Audit & 12.06.2019 Interest to be managed as and when Richardson Member for Governance, Ethics Committee - Updated conflict arises NHS Greater Preston NFPI - Son is employed by NHS Blackpool CCG & NHS Chorley & Teaching Hospitals Trust - Current South Ribble CCG NFPI - Daughter employed by Public Health England - from 2013 Dr Lindsey GP Director, NHS NFPI - Sister in law works for LCFT as 12.12.2018 No direct involvement in commissioning Dickinson Chorley and South Team Manager for Mental Health - from contracts from LCFT Ribble CCG Dec 2018 Interest noted, will be reviewed in line with FI - GP Partner in The Chorley Surgery - agenda items at committee meetings and from 2016 procurement involvement. Where a FI - Shareholder in the Primary Care Prime conflict emerges the individual will be Vendor company - from Nov 2018 excluded from decision. FI – GP working for The Chorley Surgery providing primary medical care services for residents of NHS Chorley and South Ribble/Greater Preston CCG Mr Denis Gizzi Chief Accountable FI - The Electric Church Recording Studio 14.08.2019 Interest noted, will be reviewed in line with Officer, Chorley & South FI - Smart Sight Coaching - Current Updated agenda items at committee meetings and Ribble & Greater Preston FI - Procorre Consulting - Current procurement involvement. Where a CCG’s NFII - Dr Alan Nye is a long-time conflict emerges the individual will be acquaintance from my time in Oldham - excluded from decision making Page 6 Page

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Name Role Declaration Date Mitigating Actions Current NFII - My partner is owner and MD for C&I Consulting - Current Dr Gora Bangi Chair, NHS Chorley and FI - GP Principal - Leyland Surgery and the 20.03.2019 Interest noted, will be reviewed in line with South Ribble CCG Surgery Chorley - Current agenda items at committee meetings and FI - Director of BAS group limited - Current procurement involvement. Where a FI - Son employee of BAS Group Ltd conflict emerges the individual will be FI - Leyland Surgery - Member of Leyland excluded from decision making Network - Current FI - The Surgery Chorley - Member of Chorley Central Network - Current FI - Lancashire Care NHS Foundation Trust - is a Tenant - Current NF ProI- NHS Clinical Commissioners Board Member - Current II - Wife is a nurse at Lancashire Teaching Hospitals Trust - Current II - Son is an Accountant at Deloitte UK - Current Mrs Linda Chivers Lay Member, Chair of FI - Non-executive Director Bridgewater 18.12.2018 Interest noted, will be reviewed in line with Audit, NHS Chorley & Community Healthcare Foundation Trust agenda items at committee meetings and South Ribble CCG (Audit Chair) - 01.06.2018 procurement involvement. Where a NF ProI - Chorley and South Ribble CCG conflict emerges the individual will be Conflicts of Interest Guardian - Current excluded from decision making. if deemed appropriate member would also be excluded from any discussion prior to a decision. Mr Matt Gaunt Chief Finance & No Interest Declared 11.12.2018 No risk to decision making as no potential Contracting conflicts identified

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Name Role Declaration Date Mitigating Actions Officer,Deputy Accountable Officer, Chorley & South Ribble & Greater Preston CCG’s Mr Geoffrey Lay Member - NF PI - Co-opted Governor at Parklands 21.12.2018 Interest noted, will be reviewed in line with O'Donoghue Public,Patient Academy, Chorley - 17.12.2018 to Present agenda items at committee meetings and Engagement NF PI - Secretary to Chorley Sheds, procurement involvement. Where a Chorley South Ribble community group set up to alleviate conflict emerges the individual will be CCG isolation and improve individuals mental excluded from decision making. if deemed health and wellbeing - August 2018 to appropriate member would also be Present excluded from any discussion prior to a decision. Mrs Jayne Mellor Director of No Interest Declared 14.02.2019 No risk to decision making as no potential Transformation and conflicts identified Delivery

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Declarations of Interest Flowchart

Annual Declarations In Year Changes In a Meeting

Are you aware You should complete a I have a I need to I have just I have an You need to of the potential Declaration of Interest new change my been interest in an N declare in the conflict before Pro-Forma Annually interest declaration appointed agenda item meeting the meeting?

Do you know what to include? You must provide details in Y writing, as soon as you You should become aware and no later complete a Declaration than 28 days after becoming Is this on the You need to update of interest N aware to the Governing Body Y Register of N your declaration of Y Pro-Forma Secretary Interests? Interest Form

Refer to You should declare when requested, and Pro-Forma before the agenda item

Declarations are collated and What type of Interest do you have? the register of Interests Direct Pecuniary updated: Could YOU (or a close relation, partner or friend) financially benefit? • Membership Council Interest • Governing Body Are YOU (or a close relation, partner or friend) a partner / member / Indirect Pecuniary • Statutory Committees and shareholder in an organisation that would financially benefit? Interest Sub Committees Do YOU (or a close relation, partner or friend) hold a non-remunerative or Non-Pecuniary • Employees not for profit interest in an organisation that would benefit? Interest Could YOU (or a close relation, partner or friend) enjoy a qualitative Non-Pecuniary benefit, which cannot be given a monetary value? Personal benefit

Review by Head of Strategy Review by Head of Strategy The Chair of the meeting will determine if there is a conflict of interest and the course of action to & Corporate Services and & Corporate Services and take (YOU should advise of the arrangements already agreed for managing the conflict) Lay Member for Finance, Lay Member for Finance, Audit and Conflicts of Interest audit and Conflicts of Interest to determine arrangements to determine arrangements for managing conflicts for managing conflicts Are more than 50% of members affected?

The type and details of the interest and the course The Register will be amended and the change Y N of action taken to be recorded in the minutes Reported to Audit Committee reflected in the next quarterly refresh

Page 9 Page Chair to refer to CCG Constitution Written notification of declarations made and P31 Clause 8.4.9-8.4.12 to course of action taken (using template) to be PUBLISH REGISTERS determine next steps submitted to Governing Body via GBS

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Chorley and South Ribble CCG Primary Care Commissioning Committee Minutes Wednesday, 5 June 2019, Board Room - Chorley House, Lancashire Business Park, Centurion Way, Leyland PR26 6TT at 2.30 pm

Present Mr Paul Richardson, Lay Member Governance (Chair) Dr Eamonn McKiernan, Secondary Care Doctor Mrs Tricia Hamilton, Governing Body Nurse Mrs Linda Chivers, Lay Member, Chorley and South Ribble CCG Mr Matt Gaunt, Chief Finance and Contracting Officer Mr Denis Gizzi, Chief Officer

In Attendance Dr Gora Bangi, Chair of NHS Chorley and South RIbble CCG Dr LIndsey Dickinson, GP Director Dr Sumantra Mukerji, Chair of NHS Greater Preston CCG Dr Hari Nair, GP Director Mrs Debbi Corcoran, Lay Member, Greater Presotn (arrived 2:45 pm) Mrs Jayne Mellor, Director of Transformation Planning and Delivery Mrs Donna Roberts, Head of Primary and Elective Care Ms Lysa Hasler, NHS England Mrs Jill Truby, Committee Secretary

Members of the Public There were 4 members of the public present

1 Welcome and apologies for absence As Chairman of the meeting, Mr Paul Richardson welcomed everyone to the meeting in common of the Primary Care Commissioning Committees of Chorley and South Ribble CCG and Greater Preston CCG.

Apologies for absence were received from Mr Ian Cherry, Mr Geoffrey O’Donoghue and Ms Helen Curtis.

Quorum The meeting was quorate.

2 Declarations and Register of Interests Mr Richardson reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of the CCGs.

Declarations made by members of the Primary Care Commissioning Committee are listed in the CCGs’ Register of Interests. The Register is available either via the secretary

Minutes of Chorley and South Ribble CCG Primary Care Commissioning Committee 5 June 2019 Page 11 to the governing body or the CCGs’ websites at the following link: http://chorleysouthribbleccg.nhs.uk/about-chorleysouthribbleccg/who-we-are/our- governing-body/

GP directors made the usual GP declaration as providers of services.

Chorley and South Ribble CCG Primary Care Commissioning Committee resolved: • Declarations of Interests were noted

3 Minutes of previous meeting The minutes of the meeting held on 3 April 2019 were agreed as an accurate record subject to the following amendment:

Item 9 Primary Care Financial Budget 2019/20 – paragraph 6 should read……… “A question was raised in regards to the care home model and how this supports practices with specialised care homes where patients with complex medical issues live such as a hostel served by the Berry Lane practice.”

The minutes of the meeting held on 16 May 2019 were agreed as an accurate record.

4 Matters arising April minutes – Item 5 Memorandum of Understanding Helen Curtis to confirm the mechanism to report and review complaints.

5 Network DES Registration confirmation

Mrs Donna Roberts presented the report which summarised the Networks across both CCGs and detailed the next steps which are being taken by the Networks to ensure their registration is confirmed.

A Primary Care Network consists of groups of general practices working together with a range of local providers, including across primary care, community services, social care and the voluntary sector, to offer more personalised, co-ordinated health and social care to their local populations.

Primary Care Networks were required to submit an initial Network Agreement by 15 May 2019, as part of the registration process for the Network Contract Directed Enhanced Service. By the specified date the CCGs received initial registration from nine Primary Care networks which cover 100% of practices across both CCGs.

Mrs Roberts explained that the geographic coverage of the Primary Care Network is up to the member practices to decide through discussions with their colleagues and neighbours. The only involvement of the CCG in this process should be when there are gaps in the total Primary Care Network coverage of their area. The Network area must cover a boundary that makes sense to its: (a) constituent members (b) other community based providers who configure their teams accordingly and (c) the local community, and would normally cover a geographically contiguous area.

In response to a question Mrs Roberts confirmed that patients would normally expect to travel for specialised services.

A question was raised as to the process of engaging with patients on how services were developed and was there a mechanism in place to ensure networks were delivering a quality of service. Mrs Roberts confirmed that feedback would be sought through activity

Minutes of Chorley and South Ribble CCG Primary Care Commissioning Committee 5 June 2019 Page 12 reports and via the practices Patient Participation Groups.

Chorley and South Ribble CCG Primary Care Commissioning Committee: • Noted the report and the CCG’s decision to approve the Primary Care Networks.

6 Quarterly Contractual Changes Ms Lysa Hasler presented the paper which provided the committee with a summary of the contractual changes that were effective during the previous quarter January – March 2019.

Chorley and South Ribble CCG Primary Care Commissioning Committee: • Noted the contractual changes

7 Summary of the Changes to the Policy Guidance Manual 2019/2020 Mrs Donna Roberts presented the changes which NHS England have made to the Primary Medical Care Policy and Guidance Manual for 2019/20.

The Policy Book was published in January 2016 to provide commissioners with guidance on the process of primary care contractual management and changes.

In 2017, NHS England released the Primary Medical Care Policy and Guidance Manual (PGM) which expanded the Policy Book guidance and included templates for commissioners to use when considering a range of contractual changes.

NHS England committed to review the Primary Medical Care Policy and Guidance Manual each year to include its use, application and taking into account any feedback received.

Chorley and South Ribble CCG Primary Care Commissioning Committee: • Noted the changes.

8 Proposals to develop a Lancashire & South Cumbria wide approach to Practice Relocations Ms Lysa Hasler presented to the committee a proposed template business case for use in all future GP practice relocation applications for all CCG areas across Lancashire and South Cumbria.

The template has been developed with the intention of ensuring commissioners are provided with the robust information required in considering the implications of a proposed relocation and to ensure a standard approach across Lancashire and South Cumbria.

Chorley and South Ribble CCG Primary Care Commissioning Committee: • Approved the final draft template business case for use in all future GP practice relocation applications.

9 Template Business Case for Practice Merger applications Ms Lysa Hasler presented the final version of the template business case for use in all future GP practice merger applications for all CCG areas across Lancashire and South Cumbria.

The initial version was presented at the February 2019 Primary Care Commissioning

Minutes of Chorley and South Ribble CCG Primary Care Commissioning Committee 5 June 2019 Page 13 Committee and has been revised following the recommendations made by the Committee.

Chorley and South Ribble CCG Primary Care Commissioning Committee resolved: • Approved the final draft template business case for use in all future GP practice merger applications.

10 Whittle surgery portakabin Mrs Donna Roberts presented the paper which informed the Committee of the request by Whittle Surgery to continue to use their temporary portakabin premises which provide additional clinical space and to also request the required notional rent for the portakabin.

The Committee was also advised that the surgery originally applied for permission for alternative premises as a contingency should planning permission for the portakabin not be extended by Chorley Borough Council. At the Delegated Commissioning Committee in December 2018, the practice received permission for alternative / contingency premises should planning permission for their temporary portakabin not be extended by Chorley Borough Council. The premises identified as the contingency were the former Chorley Medics building at 114 Wigan Road, Euxton.

The Committee also approved the associated notional rental contributions for the Chorley Medics Building; this meant that the notional rent contributions payable to the practice for both buildings would increase from £29,100pa (current surgery rent) to £50,850pa (an increase of £21,750pa).

Planning permission has now been extended for the portakabin. The current rental value of the portacabin is £33,696 per annum (£40,435 inclusive of VAT). The supplier has also quoted for reduced price of £26,957 per annum (£32,348 inclusive of VAT) effective after signing a 12 month lease.

The Committee was also advised that the development of the practices new premises had been delayed due to land acquisition issues and clarification on the use of ETTF funding for new premises under the new Premises Cost Directions (PCD). The practice supported by the CCG has worked directly with Chorley Council who have now purchased the land, removing any land issues and Chorley Council will now lease the land to the practice for a nominal sum, supporting progress with the build. Clarification on the use of ETTF under PCD is still awaited.

Dr Bangi also gave a brief summary of the background to this application. He confirmed that the surgery was looking at the longer term plan and that the portakabin was part of an interim solution that would also require the administration functions of the practice to be moved off site to create further space at the main practice premises.

Following further discussion it was agreed that approval be given to the practice to continue to operate from their temporary portakabin premises and to utilise the former Chorley Medics building to facilitate the practices administrative functions moving off site.

'It was agreed that, in order to avoid any unnecessary delay in facilitating this move, Chair's action would be taken, in consultation with CO & CFO, in respect of approving the move of the administration services to the former Chorley Medics building. Any such Chair's action taken would be reported at the first subsequent PCCC meeting.

Mr Gaunt requested that any future funding was taken into consideration for inclusion in the 2020/21 budget.

Minutes of Chorley and South Ribble CCG Primary Care Commissioning Committee 5 June 2019 Page 14

Chorley and South Ribble CCG Primary Care Commissioning Committee agreed: • To support the request from the practice to continue to operate from their temporary portakabin premises until their new premises were completed and to support the request for the additional notional rent contributions for the portakabin. • Chairs action to be taken for the practices administration functions to move off site to the former Chorley Medics building.

11 Vice Chair arrangements Mr Paul Richardson raised the issue of vice chair arrangements for the PCC committee. It was agreed that in the absence of the Chair, then either the Secondary Care Doctor or Governing Body Nurse as lay members would take on the role.

12 Any other business There was no further business.

Signed as an accurate record ………..……………………. Date ……………………...

Minutes of Chorley and South Ribble CCG Primary Care Commissioning Committee 5 June 2019 Page 15

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Primary Care Commissioning Committee

Date of Meeting 4 September 2019 Title of paper Quarterly contractual changes report Presented by Sarah Danson – NHS England and NHS Improvement Author Steven Harris – NHS England and NHS Improvement Clinical Lead Confidential

Executive Summary This report is a summary of any Contractual Changes to GMS and PMS contracts effective in the previous quarter (April – June 2019) where Contract Variations have been processed to reflect a change to a practice’s existing contract.

Recommendations The Delegated Commissioning Committee is asked to Receive the contents of this report

1 | P a g e Quarterly contractual changes report Primary Care Commissioning Committee 4 September 2019 Page 17

Links to CCG Strategic Objectives SO1 Improve Quality through more efficient, safer services which deliver a ☐ better patient experience SO2 Commission care so that it is integrated and ensures an appropriate ☐ balance between in-hospital and out of hospital provision SO3 Be an integral part of a financially sustainable health economy ☐ SO4 Ensure patients are at the centre of the planning and management of ☐ their own care and their voices are heard SO5 Be seen as a well-run clinical commissioning group and the system ☐ leader

Governance & Reporting (list committees, groups or other bodies that have discussed this paper) Meeting Date Outcome

Implications Quality/patient Experience ☐ ☐ ☐ implications Yes No N/A (Potential) Conflicts of Interest Yes ☐ No ☐ N/A ☐ Equality Impact Assessment Yes ☐ No ☐ N/A ☐ Privacy Impact Assessment Yes ☐ No ☐ N/A ☐ Are there any associated risks? Yes ☐ No ☐ N/A ☐ Are the risks on the CCG’s risk Yes ☐ No ☐ N/A ☐ register

Assurance Explain where assurances will be provided on delivery Q&P Audit Programme Boards

2 | P a g e Quarterly contractual changes report Primary Care Commissioning Committee 4 September 2019 Page 18

Chorley and South Ribble Clinical Commissioning Group

Primary Care Commissioning Committee

Quarterly Contractual Changes Summary

4 September 2019

Overview

Detailed within this report is a summary of any Contractual Changes effective in the previous quarter (April – June 2019) where Contract Variations have been processed to reflect a change to a practice’s existing contract.

Partnership Changes

• P81769 Village Surgery - Dr Muttucumaru joined the practice with effect from 24 April 2019. • P81769 Village Surgery - Dr Mashayekhy took 24 hour retirement from the practice with effect from 25 April 2019. • P81741 Station Surgery – Park View Surgery (P81046) commenced a Caretaker Contract at the surgery with effect from 25 May 2019

PMS to GMS

• P81076 Sandy Lane Surgery – the practice exercised their right to revert from a PMS Agreement to a GMS Contract with effect from 1 April 2019.

Practice Mergers

No partnership changes were effective during this quarter.

Open and Closed Lists

No applications to open or close lists were effective during this quarter.

Boundary Changes

No boundary changed applications were effective during this quarter.

Premises (Relocations)

No premises relocations were effective during this quarter.

Recommendation

Members of the Primary Care Commissioning Committee are asked to note the content of this report.

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Primary Care Commissioning Committee

Date of meeting 4 September 2019 Title of paper GP Quality Contract: Performance for 2018/19 Presented by Andy McAllister Author Andy McAllister Clinical lead Lindsey Dickinson / Hari Nair Confidential Yes

Purpose of the paper To present the end of year performance data for the 2018/19 GP Quality Contract, highlighting where improvements have been made at both CCG and practice level, showing what variation still exists and identifying outlying practise that require extra support.

Executive summary In 2018/19 the GP Quality Contract included financial consequences for the non- achievement of KPIs, based on an equal weighting for every KPI in the contract. This, as well as the core aims of the quality contract to improve quality and reduce variation in care across general practice, means that assessing, measuring and benchmarking the quality measures within the contract is essential for quality assurance purposes. This report aims to assess both the achievement of individual practices and overall CCG level achievement against the KPIs, as well as highlight the variation across practices.

The following KPIs showed significant improvement at CCG level across one or both CCGs since they were introduced into the quality contract over the last 12-18 months: • Over 65s receiving a pulse screening • Carers registers • Dementia prevalence • End of Life records completed • COPD inhaler technique checked • Learning Disability Registers • Cancer annual reviews However, performance against some KPIs showed little or no improvement over this period at CCG level (although some improvements were noted at individual practices), these are below: • End of Life registers • Asthma peak flow • LVSD: Heart Failure registers

There was, in general, a high achievement rate at practice level against the KPIs, with

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee Page 21 4 September 2019 only two practices in Chorley & South Ribble and one in Greater Preston failing to achieve over 60% of KPIs, i.e. 94.5% of practices achieved over 60% of KPIs. Seven practices in Chorley & South Ribble and six in Greater Preston achieved over 90% of KPIs. The lowest achievement rate across both CCGs was 52.5%.

The three outliers i.e. those achieving less than 60% of KPIs are:

Chorley & South Ribble CCG: • P81173 • P81689 Greater Preston CCG: • P81750

Those KPIs where a) the data is not extracted from EMIS, and b) are not measured in a manner best presented in a graph, are represented in this report in a separate table. Within this set of KPIs there was strong achievement across the high majority of practices in: • 70% of high risk patients prescribed anti-coagulants • No secondary care referrals for Ambulatory Blood Pressure Monitoring • Make 70% of changes recommended by the Medicines Optimisation team • Ensure there is a National Diabetes Audit completed by the practice Conversely, a low number of practices achieved the following KPIs: • Evidence how information from Membership Council and Peer Groups are disseminated to practice staff. • Completion of 3 core aspects in End of Life records • Antibiotic items prescribed

Recommendations

To note the contents of the paper and make recommendations regarding the improvement process.

Links to CCG Strategic Objectives SO1 Improve quality through more efficient, safer services which deliver a ☒ better patient experience SO2 Commission care so that it is integrated and ensures an appropriate ☒ balance between in-hospital and out of hospital provision SO3 Be an integral part of a financially sustainable health economy ☒ SO4 Ensure patients are at the centre of the planning and management of ☒ their own care and their voices are heard SO5 Be seen as a well-run clinical commissioning group and the system ☐ leader

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee 4 September 2019 Page 22 Governance and reporting (list committees, groups or other bodies that have discussed this paper) Meeting Date Outcome

N/A

Were any conflicts of interest identified at previous meetings (mark X in the correct box below) Yes No X If conflicts of interest were identified what were these:

Implications Quality/patient experience Yes ☒ No ☐ N/A ☐ implications? (Potential) conflicts of interest? Yes ☐ No ☒ N/A ☐ Equality Impact Assessment? Yes ☐ No ☒ N/A ☐ Privacy Impact Assessment? Yes ☐ No ☒ N/A ☐ Are there any associated risks? Yes ☐ No ☒ N/A ☐ Are the risks on the CCG’s risk ☐ ☐ ☒ register? Yes No N/A If yes, please include risk description and reference number

Assurance

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee 4 September 2019 Page 23

GP Quality Contract: Performance for 2018/19

Introduction

The GP Quality Contract for Chorley & South Ribble and Greater Preston CCGs was introduced in 2016/17 and included a number of KPIs in key areas, designed to improve quality and reduce variation right across the CCG area. In 2018/19 the GP Quality Contract included financial consequences for the non-achievement of KPIs, based on an equal weighting for every KPI in the contract. This, as well as the core aims of the quality contract to improve quality and reduce variation in care across general practice, means that assessing, measuring and benchmarking the quality measures within the contract is essential for quality assurance purposes. This report aims to assess both the achievement of individual practices and overall CCG level achievement against the KPIs, as well as highlighting the variation across practices. Therefore, each KPI slide has a graph showing all practices’ performance at year end benchmarked against each other, and a graph showing the CCG level (i.e. all practices combined) trend over time.

Quality Improvement

The following KPIs showed significant improvement at CCG level across one or both CCGs since they were introduced into the quality contract over the last 12-18 months:

• Over 65s receiving a pulse screening • Carers registers • Dementia prevalence • End of Life records completed • COPD inhaler technique checked • Learning Disability Registers • Cancer annual reviews

However, performance against some KPIs showed little or no improvement over this period at CCG level (although some improvements were noted at individual practices), these are below:

• End of Life registers • Asthma peak flow • LVSD: Heart Failure registers

Practice achievement

There was, in general, a high achievement rate at practice level against the KPIs, with only two practices in Chorley & South Ribble and one in Greater Preston failing to achieve over 60% of KPIs, i.e. 94.5% of practices achieved over 60% of KPIs. Seven practices in Chorley & South Ribble and six in Greater Preston achieved over 90% of KPIs. The lowest achievement rate across both CCGs was 52.5%.

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee 4 September 2019 Page 24

The three outliers i.e. those achieving less than 60% of KPIs are:

Chorley & South Ribble CCG: • P81173 • P81689

Greater Preston CCG:

• P81750

Other KPIs

Monitoring and managing performance within primary care is more complex than it is for one organisation e.g. an acute hospital Trust – there are many providers with different issues with regards demographics, geography and size, and even for a relatively small set of KPIs there are a very large number of data points. The number of data points makes it difficult to produce comprehensive reports without an automated reporting system, and at present there is no automated reporting system for the GP Quality Contract. Therefore, at present, the graphs in this report reflect only those KPIs where data is extracted from EMIS and is able to be manipulated and analysed. Furthermore, some KPIs are measured in such a way that means that a graph is not the best way to present this information, e.g. where achievement is based on submitting something and is measured by either ‘Yes’ or ‘No’. On this basis those KPIs where a) the data is not extracted from EMIS, and b) are not measured in a manner best presented in a graph, are represented in this report in a separate table.

Within this set of KPIs there was strong achievement across the high majority of practices in:

• 70% of high risk patients prescribed anti-coagulants • No secondary care referrals for Ambulatory Blood Pressure Monitoring • Make 70% of changes recommended by the Medicines Optimisation team • Ensure there is a National Diabetes Audit completed by the practice

Conversely, a low number of practices achieved the following KPIs:

• Evidence how information from Membership Council and Peer Groups are disseminated to practice staff. • Completion of 3 core aspects in End of Life records • Antibiotic items prescribed

Quality Improvement Process

GP Quality Contract information is monitored on a quarterly basis, and included within the CCG RADAR meetings. The RADAR meetings use a scorecard of KPIs – which include but are not limited to quality contract KPIs – to assess practices’ overall performance. Quality visits are planned for all practices during this financial year; however, the practice assessment is used to prioritise which practices are visited first and the agenda for the visit. Actions are agreed at these visits to improve against any outlying areas, with updates sought

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee 4 September 2019 Page 25 later in the year. Visits with all three outlying practices described above are planned within the first round of visits.

Conclusion

Given the number of KPIs that have significantly improved at CCG level over the last 12 months, the 2018/19 contract year can be seen as a success in terms of quality and performance improvement, and in driving forward the key areas of work related to commissioning priorities. Improvement has not been across the board, there are areas of underachievement across most practices – however, in these cases, there is more visibility because of the inclusion of these areas within the quality contract, and therefore more opportunity to put actions in place with practices to improve. Furthermore, these areas of underachievement have highlighted issues that are CCG wide, and can now influence CCG level actions or schemes in the future.

Similarly, the high number of practices achieving over 60% against all KPIs, and nearly a quarter achieving over 90%, highlights practice level improvement and the reduction in quality variation. There is still high variation across practices against some KPIs, even where there has been steep CCG level improvement; however, through monitoring these KPIs the CCG is now more aware of outlying and underachieving practices, both for specific KPIs and more generally against a range of indicators. This has helped prioritise these practices for quality visits and further support.

Andy McAllister Senior Performance Manager Chorley & South Ribble and Greater Preston CCGs

GP Quality Contract – Performance for 2018/19 Primary Care Commissioning Committee 4 September 2019 Page 26

GP Quality Contract 2018/19: End of Year Position Page 27 Page

2018/19 GPQC Analysis

KPIs achieved % KPIs NOT achieved CSR practices KPI achievement of threshold out of 40 KPIs P code threshold achieved threshold out of 40 out of 40 45 P81038 39 97.50% 1 40 Y00347 39 97.50% 1 P81117 38 95.00% 2 35 P81186 38 95.00% 2 30 P81033 37 92.50% 3 25 P81076 37 92.50% 3 20 P81082 36 90.00% 4 P81010 35 87.50% 5 15 P81181 35 87.50% 5 10 P81687 34 85.00% 6 5 6 Y03656 34 85.00% 0 P81127 33 82.50% 7 P81143 33 82.50% 7 P81180 33 82.50% 7 P81044 32 80.00% 8 P81062 32 80.00% 8 P81171 32 80.00% 8 P81655 30 75.00% 10 The end of year analysis showed that of the 30 practices, 28 practices achieved above P81057 29 72.50% 11 60% of the KPIs with seven practices achieving over 90% with the worst practices P81701 29 72.50% 11 achieving 57.50%. P81741 29 72.50% 11 P81083 28 70.00% 12 P81154 28 70.00% 12 P81642 27 67.50% 13 P81692 27 67.50% 13 P81769 27 67.50% 13 Y02466 25 62.50% 15 P81740 24 60.00% 16 P81173 23 57.50% 17 P81689 23 57.50% 17

Page 28 Page

Pulse Screening

Snapshot at Q4

Overall Improvement Overall performance against this indicator shows significant improvement throughout the year, with an increase of over 40 percentage points, from 28.8% in Q1 to 70% in Q4. However, this is still below the target of 80%.

Variation Of the 30 practices 11 achieved this target this year, however, 20 practices in total were over the threshold of 70% for non-application of financial recovery. There is one particular outlier P81154 at 31.1%, and P81038 is also low at 46.2% - outliers are discussed at the CCG RADAR meeting for potential further action. Page 29 Page

CCG level position

Carers

Snapshot at Q4 Snapshot at Q4

Overall Improvement Significant improvement throughout the year, from 1.16% at Q1 to achieving the target level of 2% at year end (rounded up from 1.99%). This may be skewed slightly by the one practice achieving significantly over target, however, the improvement overall is based on more than just the improvement at this particular practice.

Variation One practice stands out as the best performing – P81082 are at 7.2%, with the next best at 3.49% (P81010). Twelve practices have achieved the target this year, however, only three are under the threshold of 1%.

30 Page CCG level position

Dementia

Snapshot at Q4

Overall Improvement Although the improvement over the year has looked modest, this has led to the CCG achieving and sustaining its own dementia prevalence target. Achievement this year was enabled by the inclusion of a similar KPI in the 1718 contract – 70% of total estimated prevalence. However, this was changed in 2018-19 to refer to the over 65s only, to take account of differing practice demographics.

Variation Of the 30 practices 18 achieved this target this year, with particularly high performance at Y02466 (13.96%) and P81701 (9.09%) – this may be ‘too high’ and could require further investigation. Six practices were below 3%.

31 Page CCG level position

EPaCCS templates

Snapshot at Q4

Overall Improvement Significant improvement over the 18 month period, by over 40 percentage points overall from 32.8% in Q3 1718 to 74.4% in Q4 2018-19 - with a particular rise in Q4. However, the CCG position is under target for the year.

Variation With only 6 practices achieving the 95% target this year, and only 6 more getting over the threshold of 85%, it could be argued that this is a difficult KPI to achieve. However, there are some clear outliers in terms of poor performance, with 8 practices achieving under 40%, and 3 at zero. There is significant variation across practices – from 3 at 0% to 4 at 100%. Page 32 Page

CCG level position

End of Life

Snapshot at Q4

Overall Improvement There is modest improvement over the 18 month period this KPI has been in the contract, however, overall performance is well above the 2018-19 minimum 0.4% target at 0.52%.

Variation 15 out of 30 practices achieved the minimum level of 0.4% in 2018-19, however, a further 11 are over the 0.3% threshold, with 4 outliers – P81171, P81689, Y02466, Y03656.

33 Page CCG level position

COPD

Snapshot at Q4

Overall Improvement Significant improvement over the year, and is now well above the 70% target at 81.6%.

Variation All practices except one Y03656 are above target at year end, and all are above the 50% threshold, so little variation across practices with improvement achieved for all.

34 Page CCG level position

Peak Flow

Snapshot at Q4

Overall Improvement Improvement over the year from 89% to 92.6%, achieving the 90% threshold (but not the 100% target).

Variation Of the 30 practices, 25 achieved 80% or over with 22 practices achieving the threshold of 90% and six achieving the target. The outlier practice was P81769 who achieved 10.14%. Page 35 Page

CCG level position

LVSD

Snapshot at Q4

Overall Improvement Clear improvement over the 18 month period and overall CCG level achievement of the threshold of 90% at 97.6% (but not the target of 100%).

Variation Only three practices are under the threshold of 90%, with clear improvement overall, this shows the KPI has been a success. Two are significant outliers under 80% P81642 (66.7%) and Y03656 (78%). Page 36 Page

CCG level position

Learning Disabilities Register

Snapshot at Q4

Overall Improvement Significant improvement over the year, from 59.4% at Q1 to 86.6% at Q4, with a particular step up in Q4. Although still short of the 100% target, the improvement shows the impact this target has had.

Variation There is significant variation across practices, with 16 practices achieving the 100% target, but nine below 80%. The five significant outliers (below 40%) are P81044, P81173, P81642, P81692 and Y02466. Page 37 Page

CCG level position

Cancer

Snapshot at Q4

Overall Improvement The minimum target of 45% has been achieved in every quarter over the 18 month period. However, the target itself does not appear to have had that much impact, with no discernible improvement over this time.

Variation All practices achieved over the 45% minimum target, with the lowest at 74.1% and the highest 97.1%.

Page 38 Page CCG level position

Cancer diagnosis 70% of patients with a diagnosis of "cancer" since 1/10/16 excluding all skin cancers (except malignant melanoma) and carcinomas in situ, have had or declined an annual face to face or telephone cancer care review SnapsShnoatpasthQo4t at Q4

Overall Improvement There has been some improvement over the year at CCG level, moving from 60% in Q1 to above the 70% target by Q4, which has supported the intention to improve earlier diagnosis.

Variation There is still variation across practices, with the lowest at 30.3%. However 20 out of 30 practices have achieved the target.

Page 39 Page CCG level position

GP Quality Contract 2018/19: End of Year Position Page 40 Page

2018/19 GPQC Analysis

KPIs KPIs NOT achieved GrP practices KPI achievement of threshold out of 40 KPIs achieved % P code threshold out of 40 threshold achieved 45 out of 40 40 P81067 39 97.50% 1 35 30 P81184 38 95.00% 2 25 P81040 37 92.50% 3 20 P81071 37 92.50% 3 15 P81046 36 90.00% 4 10 P81169 36 90.00% 4 5 P81103 35 87.50% 5 0 P81107 35 87.50% 5 P81664 35 87.50% 5 P81018 34 85.00% 6 P81093 34 85.00% 6 The end of year analysis showed that of the 24 practices, 23 practices P81213 34 85.00% 6 achieved above 60% of the KPIs with six practices achieving over 90% with P81685 33 82.50% 7 P81748 33 82.50% 7 the worst practice achieving 52.50%. P81119 31 77.50% 9 P81196 31 77.50% 9 P81179 31 77.50% 9 P81647 31 77.50% 9

P81770 31 77.50% 9

P81055 30 75.00% 10

P81735 30 75.00% 10

13 P81185 27 67.50% P81015 26 65.00% 14 P81750 21 52.50% 19 Page 41 Page

Pulse Screening

Snapshot at Q4

Overall Improvement Overall performance against this indicator shows significant improvement throughout the year, with an increase of over 40 percentage points from 32.8% in Q1 to 77% in Q4. However, this is still below the target of 80%.

Variation Of the 24 practices, 10 achieved this target this year, however, in total 18 practices were over the threshold of 70% for non-application of financial recovery. Three practices are under 60% P81018, P81107 and P81750. Page 42 Page CCG level position

Carers

Snapshot at Q4

Overall Improvement Significant improvement throughout the year at CCG level, from 1.1% at Q1 to 1.6% in Q4, however, still below target at year end.

Variation Only four practices achieved this target in 2018-19, despite the overall improvement at CCG level. However, only two practices were under the 1% threshold for financial consequences P81196 and P81750.

Page 43 Page CCG level position

Dementia

Snapshot at Q4

Overall Improvement Although the improvement over the year has looked modest, this has led to the CCG achieving and sustaining its own dementia prevalence target. Achievement this year was enabled by the inclusion of a similar KPI in the 2017-18 contract – 70% of total estimated prevalence. However, this was changed in 2018-19 to refer to the over 65s only, to take account of differing practice demographics.

Variation Of the 24 practices, 14 achieved this target this year. However, two practices were below 3% P81750 and P81770.

CCG 44 Page level position

EPaCCS templates

Snapshot at Q4

Overall Improvement Significant improvement over the 18 month period, by over 50 percentage points overall from 25.6% in Q3 1718 to 76.7% in Q4 2018-19 - with a particular rise in Q4. However, the CCG position is under target for the year.

Variation Of the 24 practices, 12 were over the target level, with a further three over the threshold, so only nine practices were under the threshold for this target. There are a number of significant outliers, including P81750 (0%) and P81196 (24.3%).

CCG 45 Page level position

End of Life

Snapshot at Q4

Overall Improvement There is significant improvement over the 18 month period this KPI has been in the contract, with levels improving to the standard of Chorley and South Ribble practices, despite starting from a lower baseline. Overall performance is well above the 2018-19 minimum 0.4% target.

Variation Of the 24 practices, 16 were above the minimum target level, with a further three above the threshold. There are significant outliers, with P81770 (0.08%%) and P81685 (0.12%) being the lowest.

CCG 46 Page level position

COPD

Snapshot at Q4

Overall Improvement Significant improvement over the year, and is now well above the 70% target at 78%.

Variation All but four practices are above target, and all are above the 50% threshold, so little variation across practices with improvement achieved for all.

CCG level position Page 47 Page

Peak Flow

Snapshot at Q4

Overall Improvement Improvement over the year from 81.6% to 90.4%, achieving the 90% threshold ( but not the 100% target).

Variation Of the 30 practices, 19 achieved over 80% with 14 practices achieving the threshold of 90% and one achieving the target. The two outliers were P81735 at 61.82% and P81055 at 64.12%.

Page 48 Page CCG level position

LVSD

Snapshot at Q4

Overall Improvement Clear improvement over the 18 month period by nearly 4 percentage points and overall CCG level achievement of the threshold of 90% at 94% (but not the target of 100%).

Variation All but three practices are over the threshold of 90%. Variation is slight apart from one significant outlier – P81015 at 46%.

CCG 49 Page level position

Learning Disabilities Register

Snapshot at Q4

Overall Improvement Significant improvement over the year, from 47.9% to 90.3%, with a particular step up in Q4. Although still short of the 100% target, the improvement shows the impact this target has had.

Variation Generally variation has been between 80-100%, however, there are three practices between 60-65%, and two significant outliers – P81750 (0%) and P81055 (2.9%). 10 practices achieved the 100% target.

CCG 50 Page level position

Cancer

Snapshot at Q4

Overall Improvement The minimum target of 45% has been achieved in every quarter over the 18 month period. However, the target itself does not appear to have had that much impact, with no discernible improvement over this time.

Variation All practices achieved over the 45% minimum target, with the lowest at 63.8% and the highest 94.9%.

CCG 51 Page level position

Cancer diagnosis

Snapshot at Q4

Overall Improvement There has been some improvement over the year at CCG level, moving from 60% in Q1 to above the 70% target by Q4, which has supported the intention to improve earlier diagnosis.

Variation There is still variation across practices, which is steeper than that in Chorley & South Ribble, with the lowest at 0% and 6 practices under 50%. However 15 out of 24 practices have achieved the target.

CCG 52 Page level position

Other KPIs

KPI CCG Target Threshold No. of No. of practices practices achieved achieved target threshold

70% of high risk patients to be prescribed anti-coagulants CSR 70% N/A 26/30 N/A GrP 70% N/A 23/24 N/A *No patients should be referred into secondary care for 24 hour ABPM as a primary procedure CSR 0% *5% 25/30 N/A GrP 0% *5% 19/24 N/A *Influenza Vaccination - those aged 65 years and over CSR 75% 65% 13/30 29/30 GrP 75% 65% 6/24 24/24 *Influenza Vaccination - those aged 6 months to 64 years in a clinical at risk group CSR 75% 50% 0/30 17/30 GrP 75% 50% 0/24 10/24 *Influenza Vaccination - Pregnant Women CSR 75% 50% 1/30 14/30 GrP 75% 50% 18/24 23/24 *Influenza Vaccination - Ages two, three or four CSR 40-60% 30% 28/30 30/30 GrP 40-60% 30% 0/24 3/24 *Pneumonia Vaccinations - those aged 65 years and over CSR 90% 65% 0/30 23/30 GrP 90% 65% 0/24 23/24 *Pneumonia Vaccinations - those aged 2 to 64 years and defined as in a clinical risk group CSR 90% 50% 0/30 3/30 GrP 90% 50% 0/24 11/24 Date of review of Business Continuity Plan CSR Yes N/A 14/30 N/A GrP Yes N/A 18/24 N/A Complete a safeguarding self-assessment to evidence practice arrangements. This is to be submitted to the CCG by 31 December 2018. CSR Yes N/A 23/30 N/A GrP Yes N/A 21/24 N/A Complete a PIR document or be involved in the completion of the PIR document, and/or engage in the Panel discussions for 100% of community CSR 100% N/A 29/30 N/A cases identified as practice patients for Clostridium Difficile MRSA and E-Coli septicaemia Infection GrP 100% N/A 24/24 N/A 3 out of 4 Membership Council meetings attended by nominated clinical representative in line with the constitution. CSR 3 3 27/30 27/30 GrP 3 3 23/24 23/24 6 out of 8 Peer Group meetings attended by nominated clinical representative CSR 6 6 23/30 23/30 GrP 6 6 22/24 22/24 Practice to evidence how the GP lead disseminates information from Membership Council and Peer Groups to Practice Staff CSR Yes N/A 12/30 N/A GrP Yes N/A 12/24 N/A Attendance of at least 2 out of the 3 external PETS sessions for each practice CSR 2 2 29/30 29/30 GrP 2 2 23/24 23/24 Practice to evidence internal PETs sessions and subjects covered CSR Yes N/A 14/30 N/A GrP Yes N/A 17/24 N/A

Minimum 53 Page of 3 core aspects completed for every EPACCS template: DNACPR, GSF register, Preferred place of death CSR Yes N/A 9/30 N/A GrP Yes N/A 6/24 N/A

Other KPIs cont..

KPI CCG Target Threshold No. of No. of practices practices achieved achieved target threshold

Scriptswitch – maintain an acceptance rate >25% CSR 25% 25% 24/30 24/30 GrP 25% 25% 16/24 16/24 Medicines Co-ordinator to provide monthly communications sheet (detailed in point 3.6 of Medicines Co-ordinator Service Specification) and CSR Yes N/A 11/30 N/A demonstrate engagement. GrP Yes N/A 8/24 N/A Practice to make a minimum of 70% of changes suggested by Medicines Optimisation Team - Cumulative Data CSR 70% 50% 25/30 28/30 GrP 70% 50% 22/24 24/24 Total Antibiotic items prescribed per STAR PU (Specific Therapeutic group Age-sex Related Prescribing Units) - (Rolling 12 month) CSR 0.965 N/A 14/30 N/A GrP 0.965 N/A 6/24 N/A Increase the percentage of patients receiving all 8 care processes by 5% from 16/17 figures CSR 5% 4% 16/30 20/30 GrP 5% 4% 18/24 18/24 Ensure there is a National Diabetes Audit submission from your Practice CSR Yes N/A 30/30 N/A GrP Yes N/A 24/24 N/A *Achieve 80% of patients who are on the COPD register who have had a flu vaccination during the latest campaign CSR 80% 60% 16/30 29/30 GrP 80% 60% 9/24 23/24 70% of patients with a diagnosis of "cancer" since 1/10/16 excluding all skin cancers (except malignant melanoma) and carcinomas in situ, have had CSR 70% 60% 20/30 21/30 or declined an annual face to face or telephone cancer care review GrP 70% 60% 15/24 16/24 Practice to submit quarterly data of total number of offered appointments (one specified week per quarter) CSR Yes N/A 27/30 N/A GrP Yes N/A 20/24 N/A Practices are to submit their register of refusals every six months (end September and end March) CSR Yes N/A 14/30 N/A GrP Yes N/A 15/24 N/A Engage with the practice variation process as detailed in practice variation points 1-5 CSR Yes N/A 30/30 N/A GrP Yes N/A 24/24 N/A *By the end of Q4 18/19 no referrals should be rejected by the Referral quality Improvement Services (Triage Service) due to the reason that they are CSR 0 *10% 11/30 N/A Procedures of Limited Clinical Value GrP 0 *10% 7/24 N/A

*Due to various issues with these KPIs, all practices were awarded ‘achieved’ for financial purposes Page 54 Page

Agenda Item 7

Primary Care Commissioning Committee

Date of meeting 4 September 2019 Title of paper Station Surgery – Contract Options Paper Presented by Donna Roberts, Head of Primary & Elective Care Author Lina De Burgh, Service Transformation Co-Ordinator, CCG Clinical lead Confidential

Purpose of the paper To present to the Primary Care Commissioning Committee the options for ensuring continuity of general medical services to the patients of Station Surgery since the sudden death of Dr George Ahad, a single handed practitioner based in Leyland Executive summary Dr George Wadie Ahad, who held an individual contract at Station Surgery in Leyland, unfortunately passed away suddenly on 18 April 2019.

On 16th May 2019, following an expression of interest process, Park View Surgery in Preston was appointed as caretaker practice for the patients and staff of Station Surgery for a six month period commencing on the 25th May 2019, the date for the arrangement to end is the 25th November 2019.

Park View Surgery have maintained delivery of the services which were previously provided under Station Surgery

This paper is to present to the committee the options available to ensure continued access to General Medical Services for the patients of Station Surgery.

The options considered in this paper are:

List dispersal – To support patients in registering with an alternative existing practice of their choice following the cessation of the current temporary arrangements

Procurement - Appoint a new provider to provide general medical services under a new Alternative Provider Medical Services (APMS) contract.

The Primary Care Commissioning Committee is asked to consider this report and to make a determination on how continued access to General Medical Services will be secured for patients currently registered with Station Surgery.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 55 4 September 2019

Links to CCG Strategic Objectives SO1 Improve quality through more effective, safer services, which deliver a ☒ better patient experience SO2 Commission care so that it is integrated and ensures an appropriate ☐ balance between in-hospital and out-of-hospital provision SO3 Be an integral part of a financially sustainable health economy ☐

SO4 Ensure patients are at the centre of the planning and management of ☒ their own care, and that their voices are heard SO5 Be a well-run clinical commissioning group and the system leader ☒

Governance and reporting (list committees, groups or other bodies that have discussed this paper) Meeting Date Outcome N/A Were any conflicts of interest identified at previous meetings (mark X in the correct box below) Yes No X If conflicts of interest were identified what were these:

Implications Quality/patient experience Yes ☒ No ☐ N/A ☐ implications? (Potential) conflicts of interest? Yes ☐ No ☐ N/A ☒ Equality Impact Assessment? Yes ☒ No ☐ N/A ☐ Privacy Impact Assessment? Yes ☒ No ☐ N/A ☐ Are there any associated risks? Yes ☒ No ☐ N/A ☐ Are the risks on the CCG’s risk Yes ☐ No ☒ N/A ☐ register? If yes, please include risk description and reference number

Assurance

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 56 4 September 2019 1.0 Introduction

1.1 Dr George Wadie Ahad, who held an individual contract at Station Surgery in Leyland, unfortunately passed away suddenly on 18 April 2019. Park View Surgery was appointed a temporary contract from the 25th May 2019 until 25th November 2019 to continue to offer services to Station Surgery’s registered population.

2.0 Background

2.1 The death of an individual medical practitioner is covered in the General Medical Services (GMS) Contract and Primary Medical Care Policy and Guidance Manual; extract attached at Appendix A.

2.2 These documents state that the contract is to terminate at the end of the period of seven days after the date of the contractors death unless, before the end of that period, the commissioner and a personal representative agree to continue clinical services for a period of up to twenty eight days starting on the day after the end of the seven day period.

2.3 The notification of the contractor’s death was received by NHS England and Chorley & South Ribble Clinical Commissioning Group (CCG) on Tuesday 23 April 2019 which was five days following the date of death. This delay in notification was due to the Easter Bank Holiday weekend.

2.4 Once notification had been received, the options available were considered. These options were to terminate the contract after seven days or, following a request by a personal representative, to continue the contract for up to a maximum of twenty eight days. Following discussions with the Practice Manager a letter was received from the next of kin and Practice Manager requesting an extension to the contract for the maximum of twenty eight days.

2.5 The CCG Senior Management Team approved this extension request of twenty eight days to ensure continuity of care for patients and stability to the practice.

2.6 The twenty eight day extension did not allow enough time to carry out a full options appraisal on the options for the long term provision of General Medical Services to the patients.

2.7 The Policy Guidance states that in circumstances, such as the death of a contractor, the commissioner may be required to put in place an urgent temporary contract to allow a full options appraisal of permanent provision. In line with this guidance, the CCG awarded a temporary 6 month caretaker contract following an expression of interest sent to all practices across both Chorley and South Ribble & Greater Preston CCGs.

2.8 The Primary Care Commissioning Committee, held on 16th May 2019, reviewed the process and appointed Park View Surgery in Preston as caretaker for Station Surgery

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 57 4 September 2019 3.0 Station Surgery Practice Profile and Demographics

3.1 Station Surgery’s (unweighted) list size is 2779 patients as at June 2019. Over the past twelve months the list size has remained relatively stable.

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 2772 2791 2798 2807 2805 2812 2810 2824 2801 2812 2813 2779

3.2 Of the total number of registered patients 2678 live within the current boundary of Station Surgery (Appendix B). The remainder are out of area and the practice has utilised their discretion in maintaining these registrations (Appendix C and D)

3.3 The distribution is shown below.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 58 4 September 2019

3.4 3.22% of the practice registered patients are from the BME population and 0.14% of patients are care home residents.

4.0 Practice Premises

4.1 Station Surgery is located at 8 Golden Hill Lane, Leyland, PR25 3NP.

4.2 The premises are owned by Dr A.S Massoud, Dr Ahad’s son in law.

4.3 Dr A Massoud has confirmed that he would be willing to sign a long term lease with any new tenant to provide General Medical Services from the premises. He has not indicated the rental costs he would be asking (Appendix F)

4.4 Dr Ahad held a lease which would have run until March 2021 and was paying an annual rent of £45,000.

4.5 A notional rent review has been ongoing for some time however, due to Station Surgery appealing the decision on a number of occasions; no final decision has been agreed. Notification received from the District Valuer confirms that the Current Market Rent is held at £36,000 (see Appendix E). As per the “National Health Service (General Medical Services Premises Costs) Directions 2013” this is the maximum amount the CCG can reimburse a practice occupying these premises.

4.6 In the CCG Estates Strategy (July 2016) the property was reported as in condition C and is therefore likely to require modernisation.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 59 4 September 2019 5.0 Workforce

5.1 Following Dr Ahad’s death, Park View Surgery employed the staff on a temporary 6 month basis. The CCG sought legal advice and confirmation was received that TUPE transfer did not apply.

5.2 One Practice Manager and two administrators were employed on a temporary basis by the caretaker practice; however all these staff have since resigned from the practice.

6.0 Services Provided

Near Patient Testing Routine GMS / Access to Anti- Diabetic Treatment (Secondary Ring P Code PMS / Primary Coagulati Diabetes Foot Room Care Pessary APMS Care on Screening Initiated Changing Drugs) P81741 Station GMS Yes Yes Yes Yes Yes Yes No Surgery

7.0 Quality

Demographics Practice Performance

Childhood % antibiotics - A&E rate per Childhood Childhood Childhood Childhood Vaccinations - Co-amoxiclav, 1000 Vaccinations - Vaccinations - Vaccinations - Vaccinations - QoF Exception QoF Exception QoF Exception DtaP-IPC Antibacterial Cephalosporins Average = QoF Exception Cervical DtaP-IPC-Hib at PCV at 12 MMR1 at 5 MMR2 at 5 Rate Rate Rate booster at 5 Prescribed and Quinolones CSR= 258.3 Rate Screening % 12 months months ye ars ye ars Diabetes COPD Hypertension ye ars Items per STAR as a % of all P Code CCG CQC Rating GP= 326.3 Average = Average = % % % % Average = Average = Average = % PU prescribed CSR = 5.95 CSR = 78.7 % T arget = 95% T arget = 95% T arget = 95% T arget = 95% CSR = 13.5 CSR = 16.1 CSR = 4.7 T arget = 95% CSR = 0.965 Antibacterials (Does not GrP = 6.32 GP = 72.5 % Average Average Average Average GrP = 11.9 GrP = 18.0 GrP = 4.0 Average GP = 0.965 for Current include urgent CSR = 97.1 % CSR = 97.1% CSR = 97.2% CSR = 88.6% CSR = 90.9% Rolling 12 care figures) GP = 91.4% GP = 91.9 % GP = 94.9% GP = 81.4% GP = 81.3% Months

Rolling 12 12 months to Date / Period of Data 18/10/2018 2017/2018 2017/2018 2017/2018 2017/2018 2017/2018 2016/2017 2016/2017 2016/2017 2016/2017 2016/2017 months - June 2019 March 2019

CSR average 258.3

P81741 Above Above Station CSR Good 310.9 5.54 9.90 12.4 3.9 79.2% 96.8% 96.8% 87.1% 100.0% 87.1% Target Target Surgery

8.0 Finance

8.1 The fixed costs associated with Station Surgery are:

8.2 The remaining costs are variable on a price per patient basis.

9.0 Local Housing

9.1 From local housing plans 642 homes have been identified that will potentially impact upon the Leyland area.

9.2 Development sites in Leyland

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 60 4 September 2019 Station Surgery

9.3 If each of the homes generates 2.3 additional people (consistent CCG methodology), then the new homes could generate an additional 1477 new patients across the Leyland area. These patients would be distributed across the ten practices which are within a three mile radius of Station Surgery.

10.0 Options appraisal

10.1 In order to ensure continued access to general medical services for the patients currently registered at Station Surgery, there are two options available to the CCG:

• List dispersal – To support patients in registering with an alternative existing practice of their choice following the cessation of the current temporary arrangements.

• Procurement - Appoint a new provider to provide general medical services under a new APMS contract.

11.0 List Dispersal

11.1 There are seventeen practices situated within the current Station Surgery boundary providing patients with a choice of alternative practice options in the area.

11.2 There are ten practices within a three mile radius of Station Surgery. Throughout the paper these are described as the “local” surgeries.

11.2 All seventeen of these practices have open lists. Letters (Appendix G) were sent to local practices to gain an understanding of local capacity, a number have indicated they have capacity to take additional patients and would welcome the opportunity to grow their lists (Appendix H).

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 61 4 September 2019 11.3 An assessment of travel times from local surgeries has been undertaken to show which patients can access an alternative practice within five and ten minutes by public transport (Appendix Ha).

11.4 An assessment of bus routes around Leyland has been undertaken (Appendix Hb).

11.5 If list dispersal is the agreed option, the CCG would implement a managed dispersal, through allocating each patient a local GP to ensure all patients have continuity of care available to them with no gap in service. This does not take away from patient choice and any patients unhappy with their allocation will be free to register with an appropriate GP of their choice.

11.6 As there are currently no closed lists within either of the two CCGs those patients who live outside of the current Station Surgery boundary will also be allocated via the same methodology.

12.0 Procurement of a New Contract

12.1 If procurement is the agreed option, the CCG would run an open procurement process in order to select a preferred provider of general medical services.

11.2 The new contract would be a 10 year APMS contract with an option to extend for 5 years.

12.3 The proposed boundary included in any procurement process would be at a maximum, the practice boundary covering 2678 patients currently registered with the practice, or as a minimum, the area of Leyland which would cover a smaller number of patients.

12.4 Any procurement process would take a minimum of seven months including mobilisation.

13.0 Patient and Stakeholder Engagement

13.1 In order to inform the options appraisal a full patient and stakeholder engagement process has been undertaken and the report is included at Appendix Q.

13.2 A brief summary of the 207 comments made are summarised below. There is a clear feeling from the responders that they wish the surgery to remain open. The comments have been summarised into five main categories:

13.3 Positive patient experience

Patients have told us that they have had a great experience at the surgery. They have told us that the surgery is well run and that they have had a good service from the practice.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 62 4 September 2019 Some comments include: “excellent service”, “fantastic practice”, “the atmosphere at Station Surgery is second to none”, “always feel welcome”, “reliant appointments, no waiting time”, “the locums are friendly and efficient, and the practice seems to run well”, “we are treated by a family doctor, and not as a number” , “this is a ‘homely’ practice”, “I have always been treated with the greatest respect by all the team members at the surgery”, “Station Surgery is an integral part of the community providing a valued and wonderful service”.

13.4 Surgery staff

There were lots of positive comments received in relation to the staff at Station Surgery. Staff were described as being a “close knit team,” They are perceived to be friendly, helpful, pleasant, efficient and polite. Patients feel that they can trust the staff and have built up a positive relationship with them.

Some comments include “all the staff go out of their way to help fit me in to see the doctor”, “nothing is too much trouble” and “dedicated GPs”.

There is also a lot of support for the caretaker provider. Patients told us that they would “like Park View Surgery get the contract”, and “the interim arrangements are superior”. They feel that they would “continue Dr Ahad's legacy”.

13.5 Legacy

The highest number of comments (39%) related to Dr Ahad’s legacy. Many patients told us that they had been registered at the practice for many years and commented on the legacy that Dr Ahad had left. They told us that they felt that Dr Ahad has worked hard to open the practice and it would be “a very bad thing to close it with him looking down at it”. A selection of other comments included “I have been here for 20 years. They know me and I know them”, “really hoping the surgery remains open! After moving further away I still choose to use this surgery”, “I’ve been here since a child. Dr Ahad and the staff here made this surgery a success”, “as a patient at this practice for over 30 years, I feel strongly that the practice should remain open at these premises”.

13.6 Access

Patients felt very strongly about access. Patients told us that the surgery is accessible for a lot of local people. Many responders commented that the surgery was “near to home”. They told us that Station Surgery is within walking distance of their homes. For many responders, this was important as they had no form of transport. Many told us that the surgery is in a prime place in Leyland for people to get to and that parking was good. A lot of older patients told us that they could easily walk to the surgery; One patient

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 63 4 September 2019 commented “I am 83 years old and this is the only surgery within walking distance”, several people thought that the surgery is in the right place for the people of Farrington, especially the older residents.

13.6 Pressure on other practices

Several comments related to where patients would be dispersed to. There were concerns about the number of houses that were being built in the area that would put even more pressure on other practices. Some of the comments included; “closing it will just lump more pressure on other surgeries who's lists are already swollen”,

“If we are all sent to other GP practices in Leyland it will make it very difficult to get an appointment as they're already busy without this practice patients”

“where are over 2,800 patients going to go”

“as the population of Leyland is growing, appointments at other surgeries are difficult to get” “other practices have long waits”

13.7 Other comments received

Many responders simply said “keep Station Surgery open”. Several patients expressed concerns over the number of new houses that were being built in the area with some stating that there needs to be more GP surgeries, not less. A small number of patients were worried that starting afresh with a new GP would be detrimental to their mental health and would heighten their anxieties.

Some patients told us that they would not mind registering with another practice. One patient commented “if it can't remain open with a consistent team then I'd rather the staff merged with another surgery to safely care for the 2,000 plus patients”. Some patients said that they only stayed because Dr Ahad knew them and their families so well. Some patients commented that the surgery needs updating, needs to be open more and needs to offer online appointments.

12.0 Equality Impact and Risk Assessment Screening Tool

12.1 The above screening tool has been used to assess any potential risks in the following three areas:

12.1.1 Equality 12.1.2 Human rights 12.1.3 Privacy

12.2 The full screening tool is included (Appendix R)

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 64 4 September 2019 12.3 Equality highlights some impact, but little risk. This is mainly due to patients of limited mobility having to access alternative premises if the dispersal is the chosen option.

12.4 Human rights highlight little chance of impact.

12.5 Privacy highlights some chance of a breach. This is due to patient records needing to be shared with new providers, which may occur in the event of either option.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 65 4 September 2019 15.0 Options Appraisal

Option 1 – List Dispersal Detail Advantage Disadvantage Appendix Premises • Alternative local practices building • Whilst local practices have said they conditions are all category A or B can accommodate additional • The CCG has recently invested patients they may in the future ask for additional revenue to support additional revenue in order to support N building expansions in a number of expansions practices within Leyland and Lostock Hall in order to create additional capacity Clinical Services • Larger surgeries have the ability to • Smaller surgeries have a greater utilise a wider clinical skill mix in order ability to deliver continuity of care to deliver: through access to a consistent GP o Access to a wider choice of • 6 local practices provide a smaller clinicians number of local enhanced services o Access to a wider range of than Station Surgery services o Financial efficiencies O • Larger surgeries have the opportunity to offer dedicated long term condition management clinics such as diabetes and COPD • 4 local practices provide an equal or larger range of local enhanced services than Station Surgery Patient Choice • Patients can choose from 10 • Patients will be allocated to a alternative practices within an 3 mile provider and if unhappy will need to radius of Station Surgery if they are register with an alternative practice J unhappy with the one they have been of their choice allocated to Quality • Across a range of indicators local • Patient experience surveys show practices provide equal or better that patients are often more satisfied quality with smaller practices due to the K continuity of care and personal approach Patient Access • There are a number of local practices • There are a number of local to Services that achieve higher results across the practices that achieve lower results Ha patient survey indicators across the patient survey indicators • A large number of patients who live • Those patients who live in close Hb within the boundary of Station Surgery proximity to Station Surgery will live within a 1.5 mile radius of an need to travel a further distance L alternative local practice and the • Those patients who currently walk to majority within 3 miles Station Surgery may need to find M • Those patients who live outside of the alternative modes of transport boundary of Station Surgery will have • Patients who travel by public P surgeries which are closer to their transport may need to use homes alternative bus routes Finance • The CCG will make efficiency savings on the premises fixed costs associated with Station Surgery Strategic • The national strategic direction of Direction of travel is general practice working at Travel scale to deliver a wider range of services and alternative clinical workforce roles

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 66 4 September 2019 Option 2 – Procurement Detail Advantage Disadvantage Appendix Premises • Premises are available on a long term • Current rent paid to the landlord is lease more than the notional rent value which may cause issues in N negotiating a long term lease • Building is condition C and will require updating in the near future Clinical Services • Smaller surgeries have a greater • Small surgeries have limited ability ability to deliver continuity of care to utilise a wider clinical skill mix in through access to a consistent GP order to deliver: • The new contractor can be mandated o Access to a wider choice of clinicians to provide all local enhanced services o Access to a wider range of services O o Financial efficiencies • Small surgeries have limited opportunity to offer dedicated long term condition management clinics such as diabetes and COPD Patient Choice • Patients do not need to register with • Patients who are unhappy with the an alternative practice as they will new provider will need to reregister J automatically be allocated to the new with an alternative of their choice provider Quality • Tender process will be designed to • The newly appointed provider may ensure high quality service provision have no or a worse track record or • delivery against the quality Patient experience surveys show that K patients are often more satisfied with indicators than local providers smaller practices due to the continuity of care and personal approach Patient Access • Patients will continue to access the • The newly appointed provider may to Services existing premises via their current have no or a worse track record or L mode of transport delivery against the patient survey indicators than local providers M

Finance • The CCG will make efficiency savings on the fixed costs associated with Station Surgery Strategic • The national strategic direction of Direction of travel is general practice working at Travel scale to deliver a wider range of services and alternative clinical workforce roles Market Interest • The current care taker practice has • Nationally and locally the number of shown an interest in bidding for the single handed practices is reducing contract • A number of CCGs who have • There were a number of local conducted market testing for practices who expressed an interest procuring a single handed practice in the caretaker contract have had no interest from potential bidders

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 67 4 September 2019 13.0 Risks

13.1 Dependant on the decision made by the committee a number of risks have been identified.

13.2 Identified risks:

Decision Associated risks Mitigations

- Patient and/or stakeholder - Ensure a fair and thorough complaints due to options appraisal and dissatisfaction with the decision making process has List dispersal decision been followed

- Patients do not register with - Follow a managed dispersal an alternative GP as described above

- No bids are received - The number of bids received for the care taking contract indicates there is market interest

- Patients continue to leave - Ensure process is conducted

Station Surgery until the list in a timely manner and Procurement becomes unviable patients are kept updated on the process and timescales

- If any issues regarding the - Maintain ongoing notional rent cannot be communication with the resolved then alternative landlord to ensure any premises may need to be issues are identified quickly sourced

14.0 Recommendations

17.1 The committee is asked to make a decision on whether to disperse the patient list or procure a new contract to ensure continued access to general medical services for the patients of Station Surgery.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 68 4 September 2019 Appendix Index

Appendix Description

A Extract from Primary Medical Care Policy and Guidance manual

B Station Surgery current practice boundary

C Station Surgery patient plot May 2019

D Station Surgery boundary and patient mapping

E Letter from District Valuer confirming current notional rent

F Letter confirming Station Surgery premises available for long term lease

G Letter sent to practices regarding capacity to take additional patients Surrounding practices distance from Station Surgery and capacity to H take additional patients Ha Travel times from local surgeries by public transport

Hb Public transport routes in Leyland

Boundaries of practices within Station Surgery boundary I Station Surgery boundary and boundary of practices within a 3 mile J radius Quality indicators of Station Surgery and local surgeries K

Patient experience indicators of Station Surgery and local surgeries L M GP patient survey graphs

N Building condition summary

O Local enhanced service provision of Station Surgery and local practice

P Map showing 1, 1.5, 2 and 3 mile radius around each local practice

Q Patient and stakeholder engagement report

R Equality Impact and Risk Assessment Screening Tool

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 69 4 September 2019

Appendix A

Extract from Primary Medical Care Policy and Guidance Manual

3.2 Individual - GMS Contract

3.2.1 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:

3.2.1.1 the contractor's personal representatives have confirmed in writing to the Commissioner that they wish to employ or engage one or more general medical practitioners to assist in the continuation of the provision of clinical services under the contract; and

3.2.1.2 the Commissioner agrees to provide reasonable support which would enable the provision of clinical services under the contract to continue; and

3.2.1.3 the Commissioner and the personal representatives agree the terms upon which clinical services under the contract can continue to be provided; and

3.2.1.4 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.

3.2.2 The Commissioner should issue a confirmation letter setting out the timescales of the continuation. A template letter is provided in Annex 1.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 70 4 September 2019

Appendix B

Station Surgery current practice boundary

• Source – Dr Ahad’s General Medical Services contract Page 71 Page

Station Surgery – Contract Options Paper Primary Care Commissioning Committee 4 September 2019

Appendix C

Station Surgery Patient Plot May 2019

• Depicts patient spread based on postcode of residence Page 72 Page

Station Surgery – Contract Options Paper Primary Care Commissioning Committee 4 September 2019

Appendix D

Alternative Station Surgery boundary and Patient Mapping

• Depicts concentration of patients Page 73 Page • Darker shaded areas = higher concentration

Station Surgery – Contract Options Paper Primary Care Commissioning Committee 4 September 2019 Appendix E

Letter from District Valuer confirming current notional rent

Hi Linda

Both myself and the representative for the practice, Mr Batty were sorry to hear about the passing of Dr Ahad.

The Current Market Rent (CMR) was held at the previous figure of £36,000 as of 1st Feb 2016 at the last review.

We had a brief discussion regarding the CMR assessment on the 11th July 2019.

I conveyed my opinion that the value applied to the surgery was already at the top-end of comparable evidence for building age and specification at the review date.

I proposed that the appeal be withdrawn.

Mr Batty apologised, explained that he had some pressing commitments and would come back to me as soon as possible.

Mr Batty has yet to provide any evidence to support a higher reimbursement figure.

Hope this helps.

Kind Regards

Daniel K Moore MRICS Registered Valuer | Senior Surveyor | DVS Property Services | Valuation Office Agency (VOA)

St Mary’s House | Stanley Street | Preston | PR1 4AT | Telephone: 03000 504919 | Mobile: 07918 225164 | Email: [email protected]

Connect with us on LinkedIn.

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 74 4 September 2019 Appendix F

Letter confirming Station Surgery premises available for long term lease

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 75 4 September 2019 Appendix G

Letter sent to practices regarding capacity to take additional patients

Station Surgery GP Practice Questionnaire

Please complete and return to [email protected] by no later than Friday 26th July.

Practice Name:

P Code:

1. Do you currently have a closed list?

Yes

No

2. Do you have capacity to accept patients?

Yes - If so, potentially, what is your capacity? (No of patients you could potentially register?)

No

3. Any further comments?

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 76 4 September 2019 Appendix H

Surrounding Practices distance and capacity to take additional patients

Driving Walking Distance Distance Do you Do you have If Yes, potentially from from currently the capacity P what is your Station Station have a closed to accept CODE capacity? Surgery Surgery list? patients? (miles) (miles) P81057 2 1.5 No Yes 2000

P81076 1 0.2 No Yes 2000 No response received P81082 3.3 3 No Yes but has an open list No response received P81083 3.5 3.4 No Yes but has an open list P81117 0.5 0.4 No Yes 400

P81143 3.3 3 No No response received

P81171 2.6 2.4 No No N/A

P81173 6.3 5.6 See Buckshaw See Buckshaw See Buckshaw

P81180 3.5 3.2 No Yes 1000

P81186 2.1 1.8 No Yes 500-700

P81642 2.3 2.3 See Buckshaw See Buckshaw See Buckshaw

P81655 5.6 4.9 No Yes 150-200 No P81687 4.1 3.7 Yes 50-100

P81701 2.9 2.8 No Yes 5

P81769 2.4 2 See Buckshaw See Buckshaw See Buckshaw

Y02466 2.9 2.4 No Yes See Comments

800 - 1000 without Y03656 1.4 1.2 No Yes need to recruit

Total 7,405

Local practices

Station Surgery – Contract Options Paper Primary Care Commissioning Committee Page 77 4 September 2019

Appendix Ha

Travel times from local surgeries by public transport

Five minutes travel time

Page 78 Page Ten minutes travel time

Station Surgery – Contract Options Paper Primary Care Commissioning Committee 4 September 2019

Appendix Hb

Bus stops in Leyland

Bus stop

GP Surgery Page 79 Page

Station Surgery – Contract Options Paper Primary Care Commissioning Committee 4 September 2019

Appendix I

Boundaries of practices within Station Surgery boundary

Page 80 Page

Appendix J

Station Surgery boundary and boundaries of practices within 3 miles radius

/

Page 81 Page 27

Appendix K

Quality indicators of Station Surgery and local surgeries

Demographics Practice Performance

Childhood % antibiotics - A&E rate per Childhood Childhood Childhood Childhood Vaccinations - Co-amoxiclav, 1000 Vaccinations - Vaccinations - Vaccinations - Vaccinations - QoF Exception QoF Exception QoF Exception DtaP-IPC Antibacterial Cephalosporins Average = QoF Exception Cerv ical DtaP-IPC-Hib at PCV at 12 MMR1 at 5 MMR2 at 5 Rate Rate Rate booster at 5 Prescribed and Quinolones CSR= 258.3 Rate Screening % 12 months months years years Diabetes COPD Hypertension years Items per STAR as a % of all P Code CCG CQC Rating GP= 326.3 Average = Average = % % % % Average = Average = Average = % PU prescribed CSR = 5.95 CSR = 78.7 % Target = 95% Target = 95 % Target = 95 % Target = 95 % CSR = 13.5 CSR = 16.1 CSR = 4.7 Target = 95 % CSR = 0.965 Antibacterials (Does not GrP = 6.32 GP = 72.5 % Average Average Average Average GrP = 11.9 GrP = 18.0 GrP = 4.0 Average GP = 0.965 for Current include urgent CSR = 97.1 % CSR = 97.1% CSR = 97.2% CSR = 88.6% CSR = 90.9% Rolling 12 care figures) GP = 91.4% GP = 91.9 % GP = 94.9% GP = 81.4% GP = 81.3% Months

Rolling 12 12 months to Date / Period of Data 18/10/2018 2017/2018 2017/2018 2017/2018 2017/2018 2017/2018 2016/2017 2016/2017 2016/2017 2016/2017 2016/2017 months - June 2019 March 2019

CSR average 258.3

P81741 Above Above Station CSR Good 310.9 5.54 9.90 12.4 3.9 79.2% 96.8% 96.8% 87.1% 100.0% 87.1% Target Target Surgery Above Above P81057 CSR Good 264.2 6.10 13.30 14.6 6.1 77.8% 99.0% 99.0% 91.7% 97.0% 89.4% Target Target

Below Above P81076 CSR Good 254.8 6.91 13.10 19.1 9.4 77.9% 96.0% 96.0% 91.8% 95.5% 88.1% Target Target

Below Below P81117 CSR Good 264.0 5.32 10.80 14.6 3.7 76.9% 100.0% 100.0% 85.9% 100.0% 85.9% Target Target

Above Below P81171 CSR Good 192.8 4.54 12.30 5.2 3.7 78.9% 100.0% 100.0% 92.3% 94.2% 88.5% Target Target

Above Below P81186 CSR Good 281.1 6.86 16.30 18.1 2.4 74.8% 100.0% 100.0% 80.0% 100.0% 84.4% Target Target

Below Above P81642 CSR Good 272.3 3.92 6.90 14.9 1.8 86.8.% 95.0% 95.0% 100.0% 97.1% 97.1% Target Target

Above Below P81701 CSR Good 258.7 7.32 17.60 20.6 4.4 79.8% 97.0% 97.0% 82.4% 97.1% 79.4% Target Target

Below Below P81769 CSR Good 252.8 2.71 5.00 3.4 2.2 80.1% 88.9% 100.0% 100.0% 100.0% 100.0% Target Target

Above Below Y02466 CSR Good 263.9 5.45 18.80 15.0 4.2 84.1% 98.2% 98.6% 97.2% 99.1% 95.4% Target Target

Requires Below Below Y03656 CSR 314.5 8.33 18.30 23.6 5.7 79.2% 93.8% 92.6% 91.7% 100.0% 90.3% Improvement Target Target

Page 82 Page 28

Appendix L

Patient experience indicators of Station Surgery and local surgeries

Demographics Patient Experience

Patient Patient Patient Patient Survey - Survey - Survey - Survey - Overall Overall Friends & Family Good Good Satisfation Satisfation Recommendation Experience GMS / Experience (Patient (Patient % of Making an P Code PMS / List Size of Making an Survey Survey Appointment APMS Appointment Website) Website) CSR average =

85 % CSR CSR average CSR CSR average= = 71% average = average = 70% 87% 86%

Date / Period of Data 01/04/2019 Aug-18 Aug-18 Jul-18 Jul-18 Apr-19

P81741 GMS 2,812 79% 89% 78% 78% no data submitted Station Surgery

no data submitted P81057 GMS 12,536 66% 83% 61% 81%

no data submitted P81076 GMS 11,338 50% 76% 53% 79%

no data submitted P81117 GMS 4,428 69% 77% 60% 79%

P81171 GMS 4,254 79% 95% 71% 92% no data submitted

P81186 GMS 4,418 64% 87% 71% 89% 90%

P81642 GMS 2,551 91% 91% 87% 92% no data submitted

P81701 GMS 3,398 74% 82% 79% 87% 88%

no data submitted P81769 GMS 1,632 90% 89% 90% 91%

no data submitted Y02466 APMS 11,067 79% 92% 63% 73%

Y03656 GMS 5,556 47% 78% 39% 66% 84%

Page 83

good experience) saying patients of (% appointment? a making of experience your describe you would how Overall, good) saying patients of (% practice? GP your of experience your describe you would how Overall, GP Patient Survey graphs Appendix M 100% 100%

10% 20% 30% 40% 50% 60% 70% 80% 90% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% 0%

LEYLAND SURGERY LEYLAND SURGERY Local practices Local Station Surgery REGENT HOUSE SURGERY BUCKSHAW VILLAGE… CCG average CCG SANDY LANE SURGERY EAVES LANE SURGERY THE SURGERY CHORLEY STATION SURGERY

EAVES LANE SURGERY SANDY LANE SURGERYv

THE RYAN MEDICAL CENTRE CENTRAL PARK SURGERY CENTRAL PARK SURGERY CLAYTON BROOK SURGERY WORDEN MEDICAL CENTRE WORDEN MEDICAL CENTRE

BUCKSHAW VILLAGE… WITHNELL HEALTH CENTRE LIBRARY HOUSE SURGERY LIBRARY HOUSE SURGERY CCG THE SURGERY CHORLEY THE CHORLEY SURGERY REGENT HOUSE SURGERY DR R BAGHDJIAN SURGERY DR R BAGHDJIAN SURGERY THE EUXTON MEDICAL… CCG MOSS SIDE MEDICAL CENTRE THE CHORLEY SURGERY CLAYTON BROOK SURGERY PRESTON ROAD SURGERY COPPULL MEDICAL PRACTICE GRANVILLE HOUSE MED CTRE ROSLEA SURGERY MOSS SIDE MEDICAL CENTRE STATION SURGERY THE RYAN MEDICAL CENTRE PRESTON ROAD SURGERY ROSLEA SURGERY WHITTLE SURGERY LOSTOCK HALL VILLAGE… WITHNELL HEALTH CENTRE THE EUXTON MEDICAL… GRANVILLE HOUSE MED CTRE MEDICARE UNIT SURGERY ADLINGTON MEDICAL CENTRE CROSTON MEDICAL CENTRE KINGSFOLD MEDICAL CENTRE THE VILLAGE SURGERIES… MEDICARE UNIT SURGERY COPPULL MEDICAL PRACTICE NEW LONGTON SURGERY NEW LONGTON SURGERY BEECHES MEDICAL CENTRE WHITTLE SURGERY CROSTON MEDICAL CENTRE KINGSFOLD MEDICAL CENTRE THE VILLAGE SURGERIES… BEECHES MEDICAL CENTRE LOSTOCK HALL VILLAGE… ADLINGTON MEDICAL CENTRE

Page 84 Page

to manage your condition (or conditions)? (% of patients saying yes they had enough support) enough had they yes saying patients of (% conditions)? (or condition your to manage you to help organisations or services local from support enough had you have 12 months, last the In easy) is it patients saying of (% services? to or for access information website look to it practice’s your GP use is easy How 100% 100%

10% 20% 30% 40% 50% 60% 70% 80% 90% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% 0%

LOSTOCK HALL VILLAGE… EAVES LANE SURGERY LEYLAND SURGERY CLAYTON BROOK SURGERY CLAYTON BROOK SURGERY MEDICARE UNIT SURGERY EAVES LANE SURGERY DR R BAGHDJIAN SURGERY STATION SURGERY WITHNELL HEALTH CENTRE COPPULL MEDICAL PRACTICE REGENT HOUSE SURGERY BUCKSHAW VILLAGE… CENTRAL PARK SURGERY GRANVILLE HOUSE MED CTRE STATION SURGERY

SANDY LANE SURGERY CROSTON MEDICAL CENTRE WITHNELL HEALTH CENTRE ROSLEA SURGERY THE EUXTON MEDICAL… ADLINGTON MEDICAL CENTRE CROSTON MEDICAL CENTRE THE CHORLEY SURGERY CCG LEYLAND SURGERY WORDEN MEDICAL CENTRE PRESTON ROAD SURGERY KINGSFOLD MEDICAL CENTRE THE SURGERY CHORLEY BEECHES MEDICAL CENTRE THE EUXTON MEDICAL… THE RYAN MEDICAL CENTRE CCG THE CHORLEY SURGERY WORDEN MEDICAL CENTRE THE VILLAGE SURGERIES… KINGSFOLD MEDICAL CENTRE DR R BAGHDJIAN SURGERY NEW LONGTON SURGERY LIBRARY HOUSE SURGERY LIBRARY HOUSE SURGERY THE SURGERY CHORLEY BUCKSHAW VILLAGE… CENTRAL PARK SURGERY THE RYAN MEDICAL CENTRE NEW LONGTON SURGERY WHITTLE SURGERY PRESTON ROAD SURGERY GRANVILLE HOUSE MED CTRE ADLINGTON MEDICAL CENTRE COPPULL MEDICAL PRACTICE REGENT HOUSE SURGERY THE VILLAGE SURGERIES… ROSLEA SURGERY BEECHES MEDICAL CENTRE MEDICARE UNIT SURGERY SANDY LANE SURGERY WHITTLE SURGERY MOSS SIDE MEDICAL CENTRE MOSS SIDE MEDICAL CENTRE

31

Page 85 Page

Appendix N

Building condition summary

P Code Building Condition

P81741 Station Surgery C

P81057 B

P81076 A

B P81117

P81171 B

P81186 B

B P81642

A P81701

P81769 B

Y02466 A

A Y03656

Page 86 Appendix O

Local enhanced service provision of Station Surgery and local practices

Near Patient Testing Routine GMS / Access to Anti- Diabetic Treatment (Secondary Ring P Code PMS / Primary Coagulati Diabetes Foot Room Care Pessary APMS Care on Screening Initiated Changing Drugs)

P81741 GMS Yes Yes Yes Yes Yes Yes No

P81057 GMS Yes Yes No Yes Yes Yes Yes

P81076 GMS Yes No Yes Yes Yes Yes Yes

P81117 GMS Yes Yes Yes Yes Yes Yes Yes

P81171 GMS Yes No No No No No No

P81186 GMS Yes Yes Yes Yes Yes Yes No

P81642 GMS Yes Yes Yes Yes Yes No No

P81701 GMS Yes Yes No No No Yes No

P81769 GMS Yes Yes No Yes No No No

Y02466 APMS Yes No Yes Yes No Yes No

Y03656 GMS Yes Yes Yes Yes Yes Yes Yes

Page 87

Appendix P

Map showing 1 mile radius around each local practice

Page 88 Page

Map showing 1.5 mile radius around each local practice

Page 89 Page 35

Map showing 2 mile radius around each local practice

Page 90 Page 36

Map showing 3 mile radius around each local practice

Page 91 Page 37

Appendix Q Station Surgery Patient and Public Engagement Activity Report

Glenis Tansey, Engagement and Patient Experience Lead August 2019

Page 92 Contents

Page

1. Introduction 3

2. Patient and public communication and engagement activity plan 3

3. Timeline of communication and engagement 4

4. Engagement activity 4

5. Social media activity 10

6. Closing statement 10

Appendix 1:Initial patient letter 11

Appendix 2: Frequently Asked Questions 13

Appendix 3:Station Surgery Patient Questionnaire 17

Appendix 4: Drop in session questions and feedback 21

Appendix 5 Social Media Statistics 24

39

Page 93 1. Introduction

Station Surgery has around 2,800 registered patients as at June 2019. As part of the process to determine the future of Station Surgery following the sad death of Dr Ahad, the CCG is committed to ensuring that the voice of the service user is heard and considered alongside the other information that is being gathered.

It was agreed that the CCG and the caretaker practice, Park View Surgery (referred to as the practice within the report) will work together to:

• Reassure patients about access to services whilst temporary caretaker arrangements are in place. • Engage with registered patients to gather their views in respect of their experiences at Station Surgery that will feed into the decision making process.

This report outlines the engagement activity that has taken place and the findings from the engagement undertaken by the CCG.

2. Patient and public communication and engagement activity plan

Working in partnership with the practice, a comprehensive communication and engagement plan was agreed that would facilitate as much engagement with patients as possible.

The communication and engagement activities deployed by the CCG are illustrated in the following table.

Engagement activity Initial face to face event Practice based face to face drop in sessions Online patient survey Hard copy patient survey Question box and question cards placed in the surgery Targeted engagement with hard to reach patients Additional face to face drop in sessions to be available if required Schedule of social media engagement posts Communication tactics Initial letter to all registered patients informing them of; • Interim arrangements • Initial face to face event Frequently Asked Questions (FAQ) factsheet Poster to promote the online survey to be displayed in the practice Website promotion of the survey and FAQ factsheet Social media - Facebook promotion of the drop in sessions and survey Social media - Twitter promotion of the drop in sessions and survey CCG customer care mailbox available for patients to email into Letter to all patients informing them of the outcome once a decision has been made 40

Page 94 3. Timeline of communication and engagement

Planning for the interim arrangements for Station Surgery commenced immediately after Dr Ahad’s passing to ensure continuity of service for patients. A timetable of communication and engagement activity was subsequently agreed between the CCG and the practice. In summary;

14 June A letter (Appendix 1), drafted collaboratively by the practice and the CCG was sent to all registered patients informing them of the interim arrangements together with an invitation to attend a face to face event to meet the interim provider and representatives of the CCG, to discuss the temporary arrangements and future engagement opportunities.

W/C 17 June The period of engagement will begin

31 July The period of engagement will close

W/C 12 August Analysis of patient feedback will take and will be compiled into a report to be submitted to the Primary Care Commissioning Committee (PCCC) for consideration alongside the other information gathered as part of the process

4 September A PCCC meeting will be held to discuss and agree the future of Station Surgery

After 4 Sept Letter will be sent to patients informing them of the PCCC outcome decision and next steps

4. Engagement activity

A total number of 319 patients (11.4%) engaged with the CCG during the engagement period.

This section summarises all of the activity that has taken place during this period and illustrates the findings. More in-depth findings can found in the appending documents.

Initial patient meeting, 19 June 2019 Total number of patients engaged with: 60

An initial patient information event was held at the surgery on Wednesday 19 June, hosted in partnership between the CCG and new interim provider, Park View Surgery. At this event, patients were introduced to the new GPs and practice staff and were provided with an explanation of the interim arrangements put in place by the CCG to ensure continuity of access following the passing of Dr Ahad. The CCG’s Head of Primary and Elective Care provided this update and responded to a number of questions from patients including the process for how a decision would be reached on the future of the practice.

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Page 95 This list of questions and the answers provided can be viewed within Appendix 2; Frequently Asked Questions (FAQ’s)

At the conclusion of the event, the CCG’s communications and stakeholder relations manager outlined to those in attendance the opportunities which would be available for all patients to have their say on the future of the surgery.

Patient survey - online and hard copy Total number of patients engaged with: 236

The CCG worked with the practice to develop an online patient survey. Hard copies of the survey were printed for the practice to hand out, or for patients to collect at the surgery.

Completed hard copies of the survey that were retrieved from the collection boxes at the drop-in sessions were manually inputted into the online survey.

The survey was widely promoted via: the CCG website, the practice website, CCG and practice social media channels. A poster was also displayed in the surgery and at the initial engagement event.

The survey opened on 24 June 2019 and was closed on 31 July 2019. A copy of the survey is illustrated within Appendix 3.

Key survey findings:

236 people completed the survey. All 236 responders answered all of the survey questions which are summarised below.

Q1. Which of the below best describe you? Of the 236 people who completed the survey, 94% were registered patients and 6% were either a carer or friend of a registered patient or had an interest in the surgery.

Q2. How did you find out about this questionnaire? Most of the respondents (35%) found out about the survey via Facebook, 20% were told about it by practice staff, 11% received the information at the initial meeting on 19 June, 8% were told by a friend or family member, 7% saw a poster displayed in the practice, 6% saw it promoted on a website (practice or CCG), 3% were handed it at a drop in event with the remainder (10%) stating that they had received it via text, the internet, from a solicitor or a letter.

Q3.What is the first part of your postcode? 83% of reasoners stated that they live within the PR25 postcode area. The remaining 17% stated that they lived in the PR26, PR7, PR5, PR1 or other postcode areas.

Q4. In the last 12 months, how often have you visited Station Surgery? 3% of the responders had not visited the surgery in the past 12 months.

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Page 96 36% of patients told us that they had visited the practice 4 – 6 times in the past 12 months, 33% had visited between 1 and 3 times, 11% between 7 and 9 times and 17% had made over 10 visits to the practice in the past 12 months.

Q5. What has been the main reason for you attending the surgery? 68% had visited the surgery for a GP appointment with 32% accessing the surgery for other services such as health MOT’s, blood tests, diabetic appointments, midwifery and prescription services.

Q6. How do you usually travel to the surgery? 50% of responders told us that they travelled to the surgery via car. 40% said that they walked to the surgery, 1% travelled by taxi. The remaining 9% told us that they got the bus, relied on a lift in or used a mobility scooter.

Q7. Have you ever attended another local GP practice for an evening or weekend appointment? 91% of responders had not attended another practice whilst 9% told us that they had.

Q8. On a scale of 1-10, with 1 being Station Surgery to remain open with services continuing to be provided from the existing premises and 10 being a decision to close Station Surgery and you being required to register at another nearby GP surgery, please rate how strongly you feel about these two options. With an average response rate of 2, the responders feel very strongly that the surgery should remain open

Q9. Is there anything else you would like to tell us about your experience of Station Surgery to date or about your opinions on the long-term future of the surgery?

207 comments were made. There is a clear feeling from the responders that they wish the surgery to remain open. The comments have been summarised into five main categories: Positive patient experience, surgery staff, legacy, access and pressure on other practices.

Positive patient experience Patients have told us that they have had a great experience at the surgery. They have told us that the surgery is well run and that they have had a good service from the practice.

Some comments include: “excellent service”, “fantastic practice”, “the atmosphere at Station Surgery is second to none”, “always feel welcome”, “reliant appointments, no waiting time”, “the locums are friendly and efficient, and the practice seems to run well”, “we are treated by a family doctor, and not as a number” , “this is a ‘homely’ practice”, “I have always been treated with the greatest respect by all the team members at the surgery”, “Station Surgery is an integral part of the community providing a valued and wonderful service”.

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Page 97 Surgery staff There were lots of positive comments received in relation to the staff at Station Surgery. Staff were described as being a “close knit team,” They are perceived to be friendly, helpful, pleasant, efficient and polite. Patients feel that they can trust the staff and have built up a positive relationship with them.

Some comments include “all the staff go out of their way to help fit me in to see the doctor”, “nothing is too much trouble” and “dedicated GPs”.

There is also a lot of support for the caretaker provider. Patients told us that they would “like Park View Surgery get the contract”, and “the interim arrangements are superior”. They feel that they would “continue Dr Ahad's legacy”.

Legacy The highest number of comments (39%) related to Dr Ahad’s legacy. Many patients told us that they had been registered at the practice for many years and commented on the legacy that Dr Ahad had left. They told us that they felt that Dr Ahad has worked hard to open the practice and it would be “a very bad thing to close it with him looking down at it”. Other comments included “I have been here for 20 years. They know me and I know them”, “really hoping the surgery remains open! After moving further away I still choose to use this surgery”, “I’ve been here since a child. Dr Ahad and the staff here made this surgery a success”, “as a patient at this practice for over 30 years, I feel strongly that the practice should remain open at these premises”, “having been with the surgery since it first opened, I feel it would be extremely sad to see it go”, “I have been registered at this surgery for 27 years; Dr. Ahad was the heart of the surgery. I would be very sad to see the surgery close”, “I have been a patient at Station Surgery for 29 years approx and would be gutted if it closes”, “I have been a registered patient of Station Surgery since it first opened and the ethos established by Dr Ahad and his staff has meant that my family and I have always been treated with respect, kindness and great care”.

Access Patients felt very strongly about access. Patients told us that the surgery is accessible for a lot of local people. Many responders commented that the surgery was “near to home”. They told us that Station Surgery is within walking distance of their homes. For many responders, this was important as they had no form of transport. Many told us that the surgery is in a prime place in Leyland for people to get to and that parking was good. A lot of older patients told us that they could easily walk to the surgery; One patient commented “I am 83 years old and this is the only surgery within walking distance”, several people thought that the surgery is in the right place for the people of Farington, especially the older residents.

Pressure on other practices Several comments related to where patients would be dispersed to. There were concerns about the number of houses that were being built in the area that would put even more pressure on other practices. Some of the comments included; “closing it will just lump more pressure on other surgeries who's lists are already swollen”,

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Page 98 “If we are all sent to other GP practices in Leyland it will make it very difficult to get an appointment as they're already busy without this practice patients” “where are over 2,800 patients going to go” “as the population of Leyland is growing, appointments at other surgeries are difficult to get” “other practices have long waits”

Other comments received Many responders simply said “keep Station Surgery open”. Several patients expressed concerns over the number of new houses that were being built in the area with some stating that there needs to be more GP surgeries, not less. A small number of patients were worried that starting afresh with a new GP would be detrimental to their mental health and would heighten their anxieties.

Some patients told us that they would not mind registering with another practice. One patient commented “if it can't remain open with a consistent team then I'd rather the staff merged with another surgery to safely care for the 2,000 plus patients”. Some patients said that they only stayed because Dr Ahad knew them and their families so well. Some patients commented that the surgery needs updating, needs to be open more and needs to offer online appointments.

Face to Face practice based drop-in sessions: Total number of patients engaged with: 20

The CCG recommended that a variety of timings for the drop in sessions were offered that would accommodate working and non-working patients. The practice informed the CCG of when they would like the sessions to take place. Four sessions were agreed with the caveat that that further sessions would be scheduled if required.

The drop-in sessions were undertaken by the CCG’s Engagement and Patient Experience Lead and Engagement Officer.

At each drop-in session, the CCG team explained that this was an opportunity ask any questions about the current arrangements, and the process that was being undertaken, as well as an opportunity to express any views they had in relation to the surgery. Each patient was given an FAQ factsheet.

The main themes of the questions at each session were in relation to the options of dispersal or procurement of a new GP provider, the option to meet with the PCCC face to face, access; new housing being built in the area and the impact on other practices.

The full question list is documented within Appendix 4.

Hard copies of the completed survey were retrieved from the collection box at each session and added to the online survey.

Drop in session 1. 18 July 2019: 08:30am - 10:30am

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Page 99 No patients attended as part of the bespoke drop in session. Whilst waiting for their appointments, patients were asked if they were aware of the current arrangements, and were asked if they would like to complete a questionnaire if they hadn’t done so already.

No questions were asked by patients, but the CCG team supported 17 patients to complete the survey.

60 hard copy surveys were retrieved from the collection box 0 question cards were retrieved from the question box

The CCG team noticed that although there was a poster displayed advertising the surveys, the drop in sessions were not promoted. A poster was drafted and emailed to the practice on 19 July.

Drop in session 2. 18 July 2019: 3:30pm-5:30pm 6 surveys completed by patients at the drop-in session 0 surveys in the collection box 0 question cards were retrieved from the question box 8 patients attended the drop in session.

Drop in session 3. 23 July 2019: 3:30pm-5:30pm 6 surveys completed at the drop-in 8 surveys were retrieved from the collection box 0 question cards were retrieved from the question box 9 individuals attended the drop-in

In addition to the questions asked illustrated within Appendix 4, the following statements were asked to be recorded:

• Conflict of interest with Dr Bangi, concerns that even though Dr Bangi has no voting rights there is an area of persuasion. • Park View surgery has expressed an interest in securing the GP contract to keep Station Surgery open. • 31 bed and 32 bed (sic) properties being built in the locality of the practice, concerns where these individuals will register. • The wording of question 8 (in the survey) is a catch 22 situation and misleads individuals when completing the patient questionnaire. • Concerns over having to build new relationships with staff if moved to another surgery. • Increased levels of anxiety due to forging new relationships with practice staff. • Wish to be referred to as people/individuals and not patients, feel dehumanised when referred to as patients. • One 82-year old individual wished it to be noted that should the practice close they will not be moving to another surgery. • Collectively wished concerns around the lack of transparency so far (surrounding the procurement process) and option to appeal the final decision to be noted.

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Page 100 • If the current practice is working properly then it should stay.

It was noted that the poster promoting the drop-in sessions was still not displayed when attending this session. The CCG team re-sent the poster to the practice manager.

Drop in session 4. 25 July 2019: 8.30am – 10.30am 1 survey completed at the drop-in; 0 surveys in the collection box; 3 individuals attended the drop-in session 0 question cards were retrieved from the question box

No requests were made from patients or the practice to undertake any further drop in sessions.

Targeted engagement Total number of patients engaged with: 0

The CCG are committed to ensure that everyone registered at the practice had the opportunity to have their say and asked for a breakdown of patients who may benefit from some targeted engagement. A total of 154 patients were identified and were broken down into three categories:

• Housebound patients • First language not English • Patients with impaired vision

The CCG team asked how the practice interacted with these patients already so that, for consistency, they could replicate the engagement method (s) used by the practice. Unfortunately, in spite of several attempts to get this information, the practice did not respond, and as such no targeted engagement took place.

Customer care activity Total number of patients engaged with: fewer than 5 Less than five general enquiries in relation to Station Surgery have been received by the CCG’s customer care team. The main themes within these enquires were; a request for a face to face meeting with the PCCC, conflicts of interest, new housing developments in the local area, access and affordability of transport to attend another practice. All three enquiries have been responded to in full.

Social media activity Total number of people reached: 41,879 People reached are the number of unique users who have viewed a post on a social media platform. A full table of social media activity is contained within Appendix 5. Due to the nature of social media, it is not possible to ascertain if all people reached were local.

It is worth noting that the initial article posted on the CCG website to promote the survey and the FAQ’s has been visited 422 times to date. 47

Page 101 Closing statement NHS Chorley and South Ribble CCG is committed to listening and responding to patient experiences of local healthcare services to ensure that we buy services that are high quality, safe and meet the needs of our local population. We have endeavoured to gather as many patient views as possible to feed into this process and would like to thank everyone who has taken part. Appendix 1: Initial Patient letter

Our Reference: C&SR\Station Surgery\Patient Letter NHS Chorley and South Ribble CCG

Chorley House

Lancashire Business Park Centurion Way Tel: 01772 214232 E-mail: [email protected]

Wednesday 12 June 2019

[insert name] [insert address line 1] [insert address line 2] [insert address line 3] [insert postcode]

Dear Patient,

Station Surgery, Leyland

We are writing to you to keep you informed of the arrangements for services provided from Station Surgery following the sad and sudden death of Dr GW Ahad on 19th April 2019.

At NHS Chorley and South Ribble Clinical Commissioning Group (CCG) we are responsible for funding and purchasing – otherwise known as commissioning – local health services.

Interim arrangements

In order to make sure that you continue to have access to a GP and other services previously provided, a ‘caretaker’ practice – the Park View Surgery in Preston - was appointed to look after the patients and staff of Station Surgery, following Dr Ahad’s death.

This caretaker practice will maintain delivery of the services for a six month period whilst a permanent solution is sought. This caretaker period started on the 25th May 2019, and the tentative date for the role to end is the 25th November 2019. 48

Page 102 Dr Fiaz Yousaf, one of the partners at Park View Surgery, will be the lead GP at Station Surgery over this time period. The services available from Station Surgery will remain unchanged and continue to run as they have in the past, under Dr Ahad’s stewardship

The key change you are likely to notice as a patient of Station Surgery, is that there will be different clinical staff providing the service. The aim is to focus on providing continuity of care through regular clinical staff. Station Surgery will continue to operate as usual from 8 Golden Hill Lane Leyland PR25 3NP, and will continue to have the same administration staff.

Long-term arrangements

Both Park View Surgery, as the caretaker practice, and the CCG will be gathering your views on what will happen to Station Surgery and the services provided after the 25th November 2019. There are a number of possibilities, which range from procuring another GP practice to provide care from the existing Station surgery premises to dispersing the list of registered patients to other local GP practices and closing the surgery.

Wednesday 19 June 2019

We understand that this whole period is unsettling for both the patients registered with Station Surgery, and the staff employed by the surgery. We would like to offer you an opportunity to come and meet some of the team, both of Park View Surgery and Station Surgery, and representatives of the CCG so that any questions you may have can be answered. You can do this by joining us at Station Surgery on Wednesday 19 June 2019 at 6pm.

There will be lots of further opportunities for you to have your say on what you think should happen to Station Surgery at the end of the caretaker period. The CCG will be in contact with all registered patients about these opportunities, which are likely to involve a survey, drop-in sessions and other mechanisms, in due course.

In the meantime, if you would like to share your views on your experiences of Station Surgery and the future of the practice then you should speak with the practice staff who will be happy to record these and pass on to the CCG as necessary.

The CCG will listen to and consider all feedback before any final decision is made by the Primary Care Commissioning Committee – a group of local GPs, who based upon their expertise and experience, assess and agree any proposals for local primary care services.

We hope to see you on the 19 June.

Yours sincerely,

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Page 103

Donna Roberts Head of Primary and Elective Care

Appendix 2: Frequently Asked Questions (FAQ)

Frequently Asked Questions from patients of Station Surgery

What impact will patients’ comments have on the final decision? The CCG will listen to and consider all feedback from patients as well as consider various other factors and information before the CCG's Primary Care Commissioning Committee (PCCC) – a group of local GPs, other clinicians, appointed lay members and CCG executives - who based upon their expertise and experience, will make a decision on the long-term future of services provided at Station Surgery.

If the surgery closes, do patients have a say as to which practice they would be registered at? Yes, as a patient you always have the right to choose which practice you are registered at. If the surgery was to close you would be free to decide which practice you wish to register at. As long as you live within the boundary of any new practice you will be able to register with this new practice.

Which local surgeries are within the current boundary? There are 10 GP practices within three miles of Station Surgery. All of these practices are accepting new patients: • Lostock Hall Village Surgery, 1 William St, Lostock Hall, Preston, PR5 5RZ • Medicare, 1 Croston Rd, Lostock Hall, Preston, PR5 5RS • Preston Road Surgery (Dr Hamad), 652 Preston Rd, Clayton-le-Woods, Chorley, PR6 7EH • Central Park Surgery, Balfour St, Leyland, PR25 2TD • Moss Side Medical Centre, 16 Moss Side Way, Leyland, PR26 7XL • Worden Medical Centre, West Paddock, Leyland, PR25 1HR • Leyland Surgery, Westfields, West Paddock, Leyland, PR25 1HR • Sandy Lane Surgery, Sandy Lane, Leyland, PR25 2EB • Buckshaw Village, Buckshaw Village Health Centre, Unity Place, Buckshaw Village, Chorley, PR7 7HZ • The Euxton Medical Centre, 23 St Mary's Gate, Euxton, Chorley, PR7 6AH

Who sits on the PCCC? The PCCC includes the following members: • CCG Chair* • GP Director for Primary Care* • Governing Body Nurse

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Page 104 • Secondary Care Doctor • Lay Member for Governance • Lay Member for Audit, Finance, and Conflicts of Interest • Chief Officer; and • Chief Finance and Contracting Officer.

*non- voting, following an amendment to the terms of reference in December 2018 to remove them as voting members

Who employs the members of the committee? The CCG is the legal entity which employs the committee members.

Who is the boss of the CCG? Denis Gizzi is the Chief Officer of both NHS Chorley and South Ribble CCG and NHS Greater Preston CCG. Dr Gora Bangi, a local GP, is the chair of NHS Chorley and South Ribble CCG.

Will the report compiled for the committee have a recommendation on it? There is no set requirement for reports presented to the PCCC to have a recommendation included. The committee members will assess and analysis all of the information provided to them within the report in and reach and agreed decision based upon this.

Will new housing plans be taken into consideration? Yes, we are working closely with the local authorities to analysis ongoing housing developments and future intentions for house building within the local area so that we can assess what the future demand on healthcare services might be.

Are Park View happy to take on the contract longer term, would they put in a bid following the end of the caretaker contract? This would be entirely up to the partners of the Park View practice.

Has anyone else shown any interest in the longer term contract? No. This cannot be discussed with any other possible future provider until after a decision has been made by the PCCC in September.

If the surgery is to stay open, when would the CCG go out to market for a new provider? This would happen after any decision by the PCCC meeting in September.

Can private providers i.e. Virgin bid for the new contract? Yes, any provider can bid for the contract.

What is the process for assessing and accepting bids from providers? All bids are submitted are anonymised and then assessed against a number of criteria. The same group of people reviews each of the bids to make sure that the process is fair and consistent for all bidders.

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Page 105 Would patients have a say in assessing any longer-term provider if this is the decision made by the PCCC? The CCG would work with the practice to facilitate this. It would likely involve a patient representative from the practice’s Patient Participation Group (PPG) being involved in the assessment process.

Will the same services be available at the surgery? Yes, all core primary-care services previously provided by Dr Ahad are still available at Station Surgery. However, during the interim period, Park View Surgery as the new provider may wish to add other services based upon the skills and experience of the new clinical staff.

If patients try to register at other practices, will they be discriminated against because of their age? No. If patients are within the chosen practice boundary, no patient should be refused registration at any practice.

What about continuity of care for patients, why does this not seem to be taken into consideration, why can’t Park View just be given the contract long term? The CCG must adhere to laws surrounding the purchasing and awarding of public services, otherwise known as procurement. This means that if the PCCC decides that services should continue to be provided from Station Surgery, a new longer-term contract would be awarded to a provider. As this is a new and separate contract from the current interim contract, a full, fair and competitive procurement process as outlined within the EU public procurement rules would need to be applied. If this process was not followed correctly, the CCG would be in breach of the law.

How long would any new longer-term contract be for? If the committee decides that services should continue to be provided from Station Surgery, a contract could be awarded to a new longer-term provider for a maximum of 15 years.

Would the current surgery staff remain if a new long-term contract is procured? A formal HR process would be undertaken with any appointed to provider to consider if the current staff should be transferred to the new provider. This is called TUPE or Transfer of Undertakings.

Who are the CCG answerable to? The CCG has delegated responsibility from NHS England to commission local primary care services. However, overall, the CCG is statutorily regulated by NHS England.

What is included in the report to the PCCC? The report to the PCCC will include the patient feedback and experiences received as well as various other information which is deemed as required to help the committee make an informed decision. This could include the usage of the services at the surgery, the current and possible future health needs of the local population, plus other local context like the number of other nearby GP surgeries. 52

Page 106 Will there be an appeals process if the patients are not happy with the decision, if so what will this be? There is no appeals process for decisions made by the PCCC. However if you do not agree with the decision you can make this known by a complaint to the CCG as follows: Contact the customer care team by telephone: 01772 214602 or 01772 214601 Please note that calls to these numbers will be recorded for training and monitoring purposes. Contact the customer care team by email: [email protected] Please note, this is a new email address. We will continue to acknowledge receipt of emails within 3 working days. If you do not receive an acknowledgement of your email within this timeframe, please call us on the number above. Contact the customer care team by post: Customer care team - Chorley & South Ribble CCG Chorley House Lancashire Business Park Centurion Way Leyland Lancashire PR26 6TT

Is the CCG aware of where all the patients who are registered at Station Surgery live? Yes, the CCG has a detailed map showing where each patient is located.

Is the number of patients registered at Station Surgery unusual for a previously single handed practice? Single handed practices; which are a surgery owned and operated by a single doctor; usually have around 1,500 to 2,500 registered patients. Station Surgery has around 2,800 registered patients at June 2019.

Can patients still register at Station Surgery? Yes, Park View Surgery which is now operating Station Surgery is accepting new patients who wish to register at Station Surgery.

If a long term contract is awarded, will there be a trial period? There is no trial period when contracts are awarded to provide healthcare. However, all contracts to provide services are monitored by the CCG on and ongoing basis to make sure that patients receive the safest and highest quality care possible.

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Page 107 Appendix 3: Station Surgery Patient Questionnaire

Station Surgery patient questionnaire Share your views

At NHS Chorley and South Ribble Clinical Commissioning Group (CCG) we are responsible for funding and purchasing – otherwise known as commissioning – local health services.

Interim arrangements In order to make sure that you continue to have access to a GP and other services previously provided at Station Surgery, a ‘caretaker’ practice – the Park View Surgery in Preston - was appointed to look after the patients and staff of Station Surgery, following Dr Ahad’s sad death in April 2019.

This caretaker practice will maintain delivery of the services for a six month period whilst a permanent solution is sought. This caretaker period started on the 25th May 2019, and the tentative date for the role to end is the 25th November 2019.

Dr Fiaz Yousaf, one of the partners at Park View Surgery, will be the lead GP at Station Surgery over this time period. The services available from Station Surgery will remain unchanged and continue to run as they have in the past, under Dr Ahad’s stewardship

The key change you are likely to notice as a patient of Station Surgery, is that there will be different clinical staff providing the service. The aim is to focus on providing continuity of care through regular clinical staff. Station Surgery will continue to operate as usual from 8 Golden Hill Lane Leyland PR25 3NP, and will continue to have the same administration staff.

Long-term arrangements Both Park View Surgery, as the caretaker practice, and the CCG will be gathering your views on what will happen to Station Surgery and the services provided after the 25th November 2019. There are a number of possibilities, which range from procuring another GP practice to provide care from the existing Station surgery premises to dispersing the list of registered patients to other local GP practices and closing the surgery.

The CCG will listen to and consider all feedback from patients as well as consider various other factors and information before the CCG's Primary Care Commissioning Committee – a group of local GPs, other clinicians, appointed lay members and CCG executives - who based upon their expertise and experience, will assess and agree a decision for the long- term future of services provided at Station Surgery.

Please take 5 minutes to complete this survey and share your views on the future of Station Surgery.

This survey will close on Friday 19 July 2019.

1. Which of the below best describes you?

A patient registered at Station Surgery

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Page 108 A carer of a patient at Station Surgery

A relative of a patient at Station Surgery

A friend of a patient at Station Surgery

I am not a registered patient at Station Surgery but interested in the surgery and service

Other (please specify below)

2. How did you find out about this questionnaire?

Told by practice staff

Website (practice or CCG)

Poster displayed in the practice

Facebook

Twitter

Drop-in event

Patient information event on 19 June 2019

A friend or family member told me

Other (please specify below)

3. What is the first part of your postcode?

4. In the last 12 months how often have you visited Station Surgery?

Never 55

Page 109 1-3 times

4-6 times

7-9 times

10 +

5. What has been the main reason for you attending the surgery? GP appointment

Other service or services (please specify below)

6. How do you usually travel to the surgery? Walk

Bus

Car

Taxi

Other (please specify)

7. Have you ever attended another local GP practice for an evening or weekend appointment? Yes

No

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Page 110 8. On a scale of 1-10, with 1 being Station Surgery to remain open with services continuing to be provided from the existing premises and 10 being a decision to close Station Surgery and you being required to register at another nearby GP surgery, please rate how strongly you feel about these two options. Please circle below.

1 2 3 4 5 6 7 8 9 10

9. Is there anything else you would like to tell us about your experience of Station Surgery to date or about your opinions on the long-term future of the surgery?

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Page 111 Appendix 4: Drop-in session questions and feedback

Drop in session 2. 18 July 2019: 3:30pm-5:30pm Question Response 1 Will the board listen to us? Yes, all feedback will be presented to the PCCC 2 Will a member of the board come out and The question will be asked. The see us? PCCC meeting on the 4 September will be held in public and there will be the opportunity to submit questions to the Committee 3 Why would the surgery close? What will A range of information is being be the overriding factor for this? scrutinised. Refer to FAQ 4 Why can’t Park View continue running the Refer to FAQ. A competitive surgery and keep continuity? procurement process as outlined within the EU public procurement rules must take place 5 South Ribble BC have confirmed that 284 Refer to FAQ. New housing plans houses have been built but will not appear are being considered on the 2019 plan. What happens to hidden occupants as not all are registered with a GP, where will they go? 6 If the surgery does get closed will other Yes, patients will have a choice of practices be able to accommodate the several surgeries to choose from increase in patients and provide access to late night appointments? 7 How many practices have closed since None of the CCG practices have 2015? closed, however some practices have merged 8 Are these sessions just an academic No. the CCG is committed to exercise? ensuring that patient voice is embedded in the work it does 9 How strong of a threat is closure? We cannot answer this. As explained, a range of information will be considered before a decision is made 10 Question 8 on the survey appears to be a This has not caused a problem so trick question. People will automatically far in the responses that have been select 10 on a sliding scale, what is going received. The survey was to happen with question 8? developed in partnership with the practices 11 Why does the tender have to go out for Refer to FAQ. EU procurement procurement again following the interim rules contract with Parkview? Why can’t they just take over? 12 If it goes out to procurement who is Any provider can tender eligible to tender? 13 Why is there no appeals process and is Refer to FAQ. There is no appeals

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Page 112 there anything further we can do? process, but patients can write into the CCG’s customer care team and make a formal complaint 14 Is there a Patient Charter? There is an NHS constitution outlining patient rights 15 What happens if the surgery is closed and That is a personal choice we don’t want to move to another surgery

Drop-in session 3: 23 July 2019 3.30pm – 5.30pm Question Response 1 Who is the Dr on the on the panel (Chair)? Referred to FAQ: Dr Bangi

2 Is distance taken into consideration? Referred to FAQ: There are 10 GP Especially for those with health issues and surgeries within the current who are too old to travel! boundary 3 79,000 people in new build homes not Referred to FAQ: New housing registered where will they go? plans are being taken into consideration 4 Travel to other surgeries taken into See Q2 account? Bus routes and schedules not always reliable. 5 When is the meeting likely to take place? The PCCC will be meeting on 4 September 2019 6 Is future housing taken into account and See Q3 how far is the boundary for this? 7 Is consideration of the size of the surgery Estates will be considered in the premises taken into account? Station decision Surgery premises would be able to accommodate additional Dr’s. 8 Who wrote the questionnaire? The practice and the CCG

9 How will extra patients be accommodated The current list as at June 2019 is at other practices if Station Surgery is around 2,800 registered patients closed? 10 If Station Surgery is closed and individuals Yes move to other single-handed practices and a similar situation occurs, would there be the same process? 11 Why do individuals registered at the Feedback from registered patients practice not get a say? is being gathered and will be considered 12 Will any of the reports and evidence The reports will be uploaded with submitted to the PCCC be available for all the Committee papers public consumption (verbatim)? 13 Is there an appeals process following the No. Refer to FAQ final decision? 14 Is there a link where individuals can If there is a procurement process, it access the criteria followed during the is standard practice to involve

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Page 113 procurement process? patients in the process 15 Why will people from the PCCC panel not The question will be asked. The come and speak with us? PCCC meeting on the 4 September will be held in public and there will be the opportunity to submit questions to the Committee 16 When will feedback relating to the drop-in It will be available when the sessions be available? Committee papers are published.

17 What is the date of the final decision? The PCCC will be meeting on 4 September 18 If the practice stays open what will the To be agreed length of the new contract be?

Drop-in session 4: 25 July 2019 8.30am – 10.30am Question Response 1 Could an informal meeting be arranged The question will be asked. The with the PCCC panel? They don’t get to PCCC meeting on the 4 September see the personal side. A face-to-face will be held in public and there will meeting would help to get the human be the opportunity to submit element across. questions to the Committee 2 Why are they contemplating closure when This is only one option. Other Leyland is growing as a community? options will be discussed and considered 3 Do you have meetings with the other No. Refer to FAQ. All 10 practices surgeries asking how patients feel about within the current boundary are the increase in patients registering if accepting new patients Station Surgery does close? 4 Surgeries pick up money for patients even Statement not a question if they can’t be seen due to long waiting times for appointments and then go to Urgent Care to be seen 5 Concerns that Sandy Lane and Worden See Q3 Medical Centre have a large number of patients registered how will they cope with accommodating nearly 3,000 more? 6 If the surgery closes will it be closing in This will have to be discussed and November? (Staff receptionist) Concerns agreed around the PCSE and timescales with medical records. 7 Are there any more planned drop-in The CCG will accommodate further sessions prior to the decision (after sessions if the practice requires us 6:00pm) to undertake them

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Page 114 Appendix 5: Social Media Statistics

The below data has been gathered from NHS Chorley and South Ribble CCG social media pages. This does not include other social content that was published on local resident community groups.

Facebook People reached: The number of unique users who viewed the post. Date & Message Statistics 26/06/2 Are you a patient of Station Surgery? 628 people reach 11:51 If so, please refer to the links below to read the latest update alongside an opportunity to share your experiences via a short 251 total questionnaire. engagements Website article: https://www.chorleysouthribbleccg.nhs.uk/…/pati 45 likes, comments of-stat… shares Questionnaire: https://www.surveymonkey.co.uk/r/stationsurgery 206 post clicks 03/07/2 Are you a patient of Station Surgery? 140 people reach 11:25 You still have until the 31st July to have an opportunity to share y 10 total engagem experiences via a short questionnaire.. link below 👇👇 http://bit.ly/2LvmXue 3 likes, comments shares 7 post clicks

05/07/2 *Patients of Station Surgery*❗ 95 people reache 13:19 We've organised numerous drop-in sessions at the surgery to giv you an opportunity to ask any questions and complete a survey. 1 total engageme You can also complete the survey online here: 1 likes, comments https://www.surveymonkey.co.uk/r/stationsurgery shares If you're going to be in attendance, please click 'going' on our ev 0 post clicks listed below 👇👇 18th July - 08:30 to 10:30 https://www.facebook.com/events/474863159963479/ 18th July - 15:30 to 17:30 https://www.facebook.com/events/1211294399031653/ 23rd July - 15:30 to 17:30 https://www.facebook.com/events/494750557956399/ 25th July - 08:30 to 10:30 https://www.facebook.com/events/696760714095968/

14/07/2 Are you a patient of Station Surgery? 251 people reach You still have until the 31st July to have an opportunity to share 26 engagements experiences via a short questionnaire.. link below 👇👇 http://bit.ly/2LvmXue 4 likes, comments shares 22 post clicks

16/07/2 Are you a patient of Station Surgery? 861 people reach Then take a look below for a list of drop-in sessions. This is an opportunity for all patients to complete a survey and ask any 156 total engagements questions. 👇👇 Sessions held at 8 Golden Hill Lane, PR25 3NP, Leyland, Lancs. 20 likes, comments July 18th 08:30-10:30 shares 🔴🔴 136 post clicks 🔴🔴 July 18th 15:30-17:30 🔴🔴 July 23rd 15:30-17:30

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🔴🔴 July 25th 08:30-10:30 Remember, you can still complete the survey online until the 31s here: https://www.surveymonkey.co.uk/r/stationsurgery

Facebook Events Event Date Event Name Statistics Time 18/07/2019 Station Surgery – Patient drop-in session 88 people reached 08:30 – 10 1 engagements 1 interested 0 went 18/07/2019 Station Surgery – Patient drop-in session 35 people reached 15:30-17:3 1 engagements 0 interested 1 went 23/07/2019 Station Surgery – Patient drop-in session 33 people reached 15:30 – 17 0 engagements 0 interested 0 went 25/07/2019 Station Surgery – Patient drop-in session 647 people reached 08:30 – 10 20 engagements 15 interested 5 went

Twitter Date Message Statistics 26/06/19 Are you a patient of Station Surgery? 17,227 people reached 11:50 If so, please refer to the links below to read the latest 25 total engagements update alongside an opportunity to share your 3 responses experiences via a short questionnaire. 19 link clicks 1 like Website article: http://bit.ly/2RzB7vD 3 retweets

Questionnaire: http://bit.ly/2RCkEa4 03/07/19 Are you a patient of Station Surgery? 2,676 people reached 11:09 You still have until the 31st July to have an opportuni 17 total engagements share your experiences via a short questionnaire.. lin 1 response 14 link clicks below 👇👇 1 like http://bit.ly/2LvmXue 1 retweet 14/07/19 Are you a patient of Station Surgery? 3500 people reached 18:00 You still have until the 31st July to have an opportuni 16 total engagements share your experiences via a short questionnaire.. lin 1 response below 14 link clicks 👇👇 0 likes 62

Page 116 1 retweet http://bit.ly/2LvmXue 16/07/19 Patients of Station Surgery ❗ 15,698 people reached 15:00 See below for a list of drop-in sessions - an opportun 3 total engagements ask any questions. 1 response 1 like Sessions held at 8 Golden Hill Lane, PR25 3NP, Leyl 1 retweet Lancs. 🔴🔴 July 18th 08:30-10:30 🔴🔴 July 18th 15:30-17:30 🔴🔴 July 23rd 15:30-17:30 🔴🔴 July 25th 08:30-10:30

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Page 117 Appendix R

Equality Impact and Risk Assessment Screening Tool

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65 Page 119

This page is intentionally left blank Agenda Item 8

Primary Care Commissioning Committee

Date of Meeting 4 September 2019 Title of paper Application for merger P81740 Adlington Medical Centre Presented by Lysa Hasler – NHS England Author Steven Harris – NHS England Clinical Lead Confidential

Executive Summary The purpose of this report is to present the application to merge received from P81740 Adlington Medical Centre. The surgery proposes to merge with P81173 Croston Medical Centre, P81642 Medicare Unit, P81689 Eaves Lane Surgery and P81769 The Village Surgery – Lostock Hall.

Recommendations The Primary Care Commissioning Committee is asked to Approve the merger between P81740 Adlington Medical Centre, P81173 Croston Medical Centre, P81642 Medicare Unit, P81689 Eaves Lane Surgery and P81769 The Village Surgery – Lostock Hall.

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 121

Links to CCG Strategic Objectives SO1 Improve Quality through more efficient, safer services which deliver a ☐ better patient experience SO2 Commission care so that it is integrated and ensures an appropriate ☐ balance between in-hospital and out of hospital provision SO3 Be an integral part of a financially sustainable health economy ☐ SO4 Ensure patients are at the centre of the planning and management of ☐ their own care and their voices are heard SO5 Be seen as a well-run clinical commissioning group and the system ☐ leader

Governance & Reporting (list committees, groups or other bodies that have discussed this paper) Meeting Date Outcome

Implications Quality/patient Experience Yes ☐ No ☐ N/A ☐ implications (Potential) Conflicts of Interest Yes ☐ No ☐ N/A ☐ Equality Impact Assessment Yes ☐ No ☐ N/A ☐ Privacy Impact Assessment Yes ☐ No ☐ N/A ☐ Are there any associated risks? Yes ☐ No ☐ N/A ☐ Are the risks on the CCG’s risk Yes ☐ No ☐ N/A ☐ register

Assurance Explain where assurances will be provided on delivery Q&P Audit Programme Boards

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 122

Application to merge - P81740 Adlington Medical Centre, P81173 Croston Medical Centre, P81642 Medicare Unit, P81689 Eaves Lane Surgery and P81769 The Village Surgery – Lostock Hall.

Chorley House

4 September 2019

Introduction

The purpose of this report is to present the application to merge received from:

• P81740 Adlington Medical Centre • P81173 Croston Medical Centre • P81642 Medicare Unit • P81689 Eaves Lane Surgery • P81769 The Village Surgery – Lostock Hall

The practices have applied to merge their contracts and terminate 4 of the current practice codes.

Background and Summary

The application from P81740 Adlington Medical Centre, P81173 Croston Medical Centre, P81642 Medicare Unit, P81689 Eaves Lane Surgery and P81769 The Village Surgery – Lostock Hall is to merge contracts resulting in the termination of P81173, P81642, P81689 and P81769 with the contract continuing under P81740.

Practice P Code Contract List Size as Number of Type at June 2019 GP partners

Adlington Medical Centre P81740 GMS 2,026 1 Partner Croston Medical Centre P81173 GMS 3,768 1 Partner Medicare Unit P81642 GMS 2,523 1 Partner Eaves Lane Surgery P81689 GMS 2,108 1 Partner The Village Surgery – Lostock Hall P81769 GMS 1,618 1 Partner

The practices are located at:

• Adlington Medical Centre – 22-24 Babylon Lane, Adlington, PR6 9NW • Croston Medical Centre – 30 Brookfield, Croston, Leyland, PR26 PHY • Medicare Unit – 1 Croston Road, Lostock Hall, Preston, PR5 5RS • Eaves Lane Surgery – 311 Eaves Lane, Chorley, PR6 0DR • The Village Surgery Lostock Hall – 1 William Street, Lostock Hall, Preston, PR5 5RZ

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 123

The practices have identified that all the contracts that they wish to merge are registered and contracted with the same provider. They feel that the merging of the contracts is predominantly requested for operational business reasons. Currently, each surgery contract is being managed as a separate entity with separate EMIS clinical system databases. This means that they are duplicating numerous returns to Commissioners including claims and QOF. The Care Quality Commission currently have five individual registrations for the surgeries and this necessitates separate regulatory handling (including inspections and multiple/duplicate returns. They have also highlighted that their registration and annual returns for the information Commissioner’s office (data protection toolkit) are also duplicated.

The practice has detailed that their business acquisition plan has seen them take over responsibility for 5 practices in addition to their other site at Buckshaw Village Surgery. The practices have managed to integrate their business operations across the various sites and now feel in a position where merging seems the next logical step

Benefits to patients

The practices have identified that patients will see benefits in a number of ways, though not immediately obvious or visible to them. They will see no change in how they access services, or the services that are available to them. All sites will remain open and their clinical provision will remain unchanged.

The merging of clinical systems will result in full system functionality regardless of which site patients choose to attend. Whilst patients will not necessarily be aware of this benefit, it will ultimately result in the patient experiencing seamless and real time prescription and referral functionality. This is a significant improvement to the current paper based system with the unnecessary delays this incurs. Patient documentation, referrals and follow-ups will be centralised and will reduce the potential for errors and delays. Patients will benefit from a more efficient and streamlined service without being disadvantaged in any way.

The practice has identified that the proposed merger is in effect the merger of back off functions. There will be no negative impact on patients and the patient experience will remain the same. They have stated that since 2013 they have been engaged in providing patients with “at scale” primary care provision across multiple sites. They provide a hub and spoke model along with site specific specialised services, with each site acting as a centre of excellence for the group patients. With each of the acquisitions they have continued to provide core services at each location whilst opening up enhanced and specialist treatment options to all patients accessible at their other locations (focussed at Buckshaw Village Surgery).

Currently the practice operates as a system with all patients already being able to access appointment at all sites. They have centralised their existing telephone system, back office functions and organisation’s staffing base, with contracts supporting this. The proposed merger will achieve the same integration of their technology and systems and will allow them to introduce the next stage of their centralised working programme.

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 124

Benefits to the practice

A primary benefit to the practice will be the removal of four clinical systems from their network, with a combined system running across all sites. Internal processes will be simplified with duplication and chances for error being reduced.

They have identified that they have been working collaboratively with The Leyland Surgery and the Surgery Chorley, operating at scale for over 35,000 patients and now have this formally accepted and recognised as their Primary Care Network (PCN). The proposed merger forms part of their PCN’s business requirements. The other PCN partners are also keen to merge their contracts with the outcome, if approved, being two “at scale” organisations with eight practice sites. The practices feel that this would be a hugely beneficial situation for the strategic vision for the PCNs as outlined in the recent NHS Plan.

The practices have already established a PCN senior management team with a robust and tested governance framework in place. The PCN already provides increased access and Clinical Pharmacist services to all their patients.

Hours

Existing hours (all sites) Mon 8:00am – 6:30pm Tues 8:00am – 6:30pm Wed 8:00am – 6:30pm Thur 8:00am – 6:30pm Fri 8:00am – 6:30pm Sat Sun

Proposed hours Mon 8:00am – 6:30pm (6:30pm-8pm Buckshaw Village) Tues 8:00am – 6:30pm (6:30pm-8pm Buckshaw Village) Wed 8:00am – 6:30pm (6:30pm-8pm Buckshaw Village) Thur 8:00am – 6:30pm (6:30pm-8pm Buckshaw Village) Fri 8:00am – 6:30pm (6:30pm-8pm Buckshaw Village) Sat Sun

Boundary

The practice area for the following the proposed merger is a combination of all existing individual boundaries into one. A map detailing this area is at Appendix A.

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 125

Patient consultation/engagement

Collectively the practices have a combined Patient Participation Group (PPG) that meets together and acts as one body. The practice has stated that they have engaged with their PPG who are aware of their proposal and are fully supportive. The practices have acknowledged the importance of patient consultation, but in this instance and situation feel that this could result in significant confusion and fear for their patients. They have stated that patients are not losing existing services, nor any of the places where those services are provided from. This proposal is fundamentally a change to streamline back office functions and clinical systems.

Financial Impact

No financial implications have been identified that would be the result of this proposed merger. The practices have stated that their demographic profiles are similar and it is therefore not expected that there would be a significant increase to their Quality and Outcomes Framework (QOF) levels.

Risks

If the proposal is refused, the practice would continue to experience the inefficiencies of managing multiple contracts and clinical systems. Medical records would remain decentralised and the benefits of merging would not be felt.

If approved, there is the potential that patient choice could be affected, although all of the existing sites are currently managed by the same practice team and patients can already access services from various sites.

Policies

The underlying principle for the CCG to consider when any such proposal is made to them is what the benefit is for the patients and what the financial implications are.

This policy describes the process to determine any contract variation, whether by mutual agreement or required by regulatory amendments, to ensure that any changes reflect and comply with national regulations so as to maintain robust contracts.

The application meets all relevant regulatory requirements and is consistent with the Primary Medical Services Policy and Guidance Manual which requires consideration in relation to the benefits to patients and the financial consequences.

Policy context in relation to primary care contract changes is at Appendix B.

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 126

Options

There are three ways in which practices can propose to merge contracts:

1. Each contractor becoming a party to the other contractor's contract (through variations of the contracting parties); or 2. Terminating one existing contract, continuing the other contract but varying it to include the other contractor as a party to the contract followed by the termination of one P code; or 3. By terminating the two existing contracts and creating a single organisation or partnership which will enter into one new contract;

In the case of the two practices concerned, they are proposing to merge utilising option 2, becoming parties to each other’s contracts, then requesting a termination of one P code, as indicated above, to operate under one single contract.

Recommendation

Members of the Primary Care Commissioning Committee are asked to consider the contents of this report and the Approve the termination of P81173, P81642, P81689 and P81679, allowing the practice to continue under P81740.

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Appendix A – proposed practice area

Application for merger P81740 Adlington Medical Centre Primary Care Commissioning Committee 4 September 2019 Page 128

Appendix B – policy and guidance manual

Contract Variations • Chapter 7 – Contract Variations of the Primary Medical Care - Policy and Guidance Manual The policy focuses on primary medical care contracts in their various forms and has been developed in line with national legislation and regulations.

General Medical Services (GMS) arrangements are governed by the GMS Contract Regulations (SI No.2004/291, as amended from time to time).

Variations to contracts fall broadly within four categories: changes due to legislation or regulatory change; changes to the contracting parties; changes to services; changes to the payment arrangement. In determining all variations the following guidance, legislation and regulations are considered:

• GMS regulations. • PMS regulations and guidance. • APMS directions. • Statement of Financial Entitlements. • NHS Act(s). • EU procurement legislation. • The public contracts regulations. • Department of Health procurement guide. • Principle and rules of co-operation and competition (issued by the • Department of Health).

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