Agenda item no: AI 09 Royton & Crompton Family Practice & Parks Medical Practice Merger Report to: NHS Primary Care Commissioning Committee Royton and Crompton Family Practice and The Parks Medical Practice Merger Clinical Director/MET Sponsor: Nicola Hepburn, Associate Director of Commissioning Report Author and Officer Contact: Marion Colohan, Senior Commissioning Business Partner Primary Care Ext. 4294 th 6 March 2020 Page 1 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE Document tracking Version Issued to Date Author Brief description of amendment 0.1 MET 10.02.2020 Marion 1st draft Colohan 0.2 MET 26.02.2020 Marion NH amends Colohan Page 2 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE Reason for Decision: The purpose of this paper is seek approval of the proposed merger of Royton and Crompton Family Practice and The Parks Medical Practice. Under the proposed model the contract with The Parks Medical Practice would cease and its contract terminated and the GMS contract for Royton and Crompton Family Practice (P85013) continue. Report Summary: The GMS contract for Royton and Crompton Family Practice (P85013) is held by Dr A Vance, Dr Z Ahmad and Dr S Mohammad. The PMS contract for the Parks Medical Practice (P85006) is held by Dr R Kohli and Dr K Kohli. Oldham CCG was formally notified of the practices intention to merge on 29th October 2019. The application is included in appendix one. If approved the Practices intend to merge on 1st April 2020. This would be subject to EMIS lead times Corporate Objectives Ensuring delivery of core primary care services in line with the development of new models of care that aim to provide services at scale to deliver better outcomes for patients. Ensure delivery of high quality primary care services and improved outcomes. Ensure delivery of primary care medical services is efficient, effective and providing value for money. Financial Implications: No financial implications to the CCG Recommendations: The Primary Care Commissioning Committee is asked to review the details of this paper and approve the recommendation to merge Royton and Crompton Family Practice and The Parks Medical Practice with the caveat that existing practice boundaries are not reduced. Page 3 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE 1 Background 1.1 Oldham CCG supports the vision for a safe, sustainable and high quality primary care service, provided in modern premises that are fit for purpose to support resilience in General Practice. There is an increasing trend towards delivery of ‘Primary Care at Scale’, with the traditional small GP partnership model often recognised as being too small to respond to the demographic and financial challenges facing the NHS. Working at scale should result in a number of benefits including access to a wider range of local services for patients within the local community, increased staff resilience, improved staff satisfaction, work life balance and learning opportunities, and improved financial sustainability. 2 Current Position 2.1 Existing Practices The GMS contract for Royton and Crompton Family Practice (P85013) is held by Dr A Vance, Dr Z Ahmad and Dr S Mohammad. The PMS contract for the Parks Medical Practice (P85006) is held by Dr R Kohli and Dr K Kohli. Oldham CCG was formally notified of the practices intention to merge on 29th October 2019. The application is included in appendix one. If approved the Practices intend to merge on 1st April 2020. This would be subject to EMIS lead times The registered raw list size (source NHS Digital) at October 2019 of the practices is: Royton and Crompton Family Practice: 16,652 The Parks Medical Practice: 6,005 Both practices are members of North Primary Care Network. They are co- located in the Royton and Crompton Health and Wellbeing Centre with all the clinical rooms for both Practices running along one ground floor corridor. The branch site of The Parks Medical Practice, Trent Road closed on 31st January 2020. Under the proposed model the contract with The Parks Medical Practice would cease and the GMS contract for Royton and Crompton Family Practice (P85013) continue. Current Care Quality Commission ratings for both Practices are below: Practice Date of Date Overall Safe Effective Caring Responsi Well led Last Report ve Inspection Published The Parks 29/11/2019 10/01/2020 Good Good Good Good Good Good Page 4 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE Royton & 23/03/2016 16/05/2016 Good Good Good Good Good Good Crompton Family Practice During their previous inspection in April 2019 The Parks Medical Practice had been given an overall rating of inadequate. The Practice has made significant changes in workforce, practice governance and systems and processes to achieve this improvement. They still have further work to do to improve the management of medication. The practices have stated that as a result of a merger, patients will benefit from improved access and a broader range of services in addition to improved practice resilience, quality and sustainability for the future. The Practices state that bringing together both practices situated in the same building will have many benefits for the patients and staff. Patients will have continuity of the same building but with a wider skill set and greater pool of healthcare professionals allowing all patients access to new services and specialities of Doctors. Existing clinical staffing levels at the Practices are below: Staff (WTE) Royton and Crompton Family Practice The Parks Medical Practice GP Partners 3 2 Salaried GP's 7.5 0 IPPA - Independent Pharmacist Prescriber 0 0.6 Nurse Practitioner 1.9 0 Practice Nurse 2.3 0.6 Health Care Assistant 0.8 1 Trainee Health Care Assisstant 2 0 Total 17.5 4.2 Royton and Crompton Family Practice are a training practice. Dr Z Ahmad is the Practice Lead for teaching and training along with Dr S Mohammad. The Practice is fully accredited for GPSTs, FY2, 4th and 5th year medical students, Physician associates students and paramedic students. The Practice was awarded GOLD status award for their training in 2019, this grading is awarded by the feedback from the Trainees. The practice is also registered for Tier 2 Doctors sponsorship. Currently both practices are collaboratively working together to ensure patient treatments are done in-house rather than referring to outside services. The merger will enable greater sharing of responsibility to ensure CQC and NHS/CCG requirements are fulfilled. The merging of back office functions and management systems would result in savings for the practice that would allow for investment in patient care. 2.2 Practice Boundaries The proposed and existing Practice boundaries are included in the table below. The proposed boundary of the merged boundary would mean a slight reduction in the area covered as The Parks Medical Practice current boundary extends down to Oldham Road / Chadderton. Page 5 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE The practices have stated that they will not remove any patients from the list who are registered with either practice outside the existing boundaries although they will not accept new out of boundary registrations. No nursing or residential home cover is negatively impacted by the request to reduce the boundary. Proposed Boundary: Royton and Crompton Family Practice current boundary: Page 6 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE The Parks Medical Practice current boundary: 2.3 Patient Consultation The Practices’ ran a public engagement and consultation process in for four weeks commencing 6th January 2020. The Consultation plan is included in appendix three. The practices contacted patients about the proposal. They had information and a questionnaire on the websites as well as hard copies in the surgeries. Information was also displayed in the local sports centre, library and shopping precinct. The Patient Participation Groups of both Practices met to discuss the proposal and are supportive of the merger. The practices according to their EMIS system have a current combined list size of 22, 543 patients. Responses to the proposed merger where received from 262 patients, 1.16% of the registered list. Of the respondents 172 were in favour of the merger and 90 were not supportive. The responses are included in full in appendix four. 3 Options/Alternatives 3.1 Option 1 (Preferred Option) Page 7 of 24 DOCUMENT NAME Document Ref: AI 09 NHS Oldham CCG Primary Care Commissioning Committee – DATE Approve the application to merge Royton and Crompton Family Practice and The Parks Medical Practice with the caveat that existing practice boundaries are not reduced. Option 2 Approve the application to merge Royton and Crompton Family Practice and The Parks Medical Practice and accept the boundary reduction. Option 3 Reject the application to merge Royton and Crompton Family Practice and The Parks Medical Practice. 4 Preferred Option 4.1 The preferred option is Option 1, to approve the practices request with the caveat that existing practice boundaries are not reduced. The merger will mean that patients will have continuity of the same building but with a wider skill set and greater pool of healthcare professionals allowing all patients access to new services and specialities of Doctors. To ensure stability and continuity for patients and communities currently covered by the existing practice boundaries and to mitigate any negative impact on neighbouring practices the recommendation is to approve the merger but not the boundary reduction. This would not prevent the practice making a further application to reduce their boundary in the future.