Item for: Decision X Recommendation Information AGENDA ITEM NO: 7.0 Meeting Title/Date: Primary Care Commissioning Committee 18 August 2020 Options Appraisal following Notice given on Personal Medical Report Title: Services Agreement: Windermere and Bowness Medical Practice Kay Wilson / Date of Paper Prepared By: August 2020 Kate Hudson Paper: Responsible Executive Sponsor: Hilary Fordham Kate Hudson Manager: Committees where Paper Previously Presented: N/A Background Paper(s): N/A Summary of Report: Windermere and Bowness Medical Practice informed NHS Morecambe Bay CCG of its intention to resign from the PMS Agreement with effect from 31 March 2021. The purpose of this report is to set out the steps the Committee needs to consider, in light of this notification, specifically in relation to the future provision of services to patients registered at the practice. Recommendation(s): The Committee is asked to consider the attached report, as well as the options set out in it, with a view to agreeing the future arrangements for providing primary medical care to the registered patient population. Please Select Y/N Identified Risks: (Record Dispersal of the current list of registered related, Assurance Framework patient to neighbouring practices may not be or Risk Register reference an option in this instance due to the number of number) registered patients. The current agreement is due to end on 31 March 2021, which is a short timescale in which to complete a successful Yes procurement exercise. There is a risk that the CCG may need to enter into an ‘emergency contract’ with a provider for a short period of time, which will have financial implications for the CCG. Impact Assessment: A full impact assessment together with patient (Including Health, Equality, and stakeholder engagement will be N Diversity and Human Rights) undertaken following the Committee’s decision. Strategic Objective(s) Please Select Supported by this Paper: (X) Better Health - improve population health and wellbeing and reduce health X inequalities Better Care - improve individual outcomes, quality and experience of care X Delivered Sustainably - create an environment for motivated, happy staff and X achieve our control total Please Contact: Kate Hudson Head of Primary Care [email protected] Options Appraisal Notice to Terminate PMS Agreement, Windermere & Bowness Medical Practice _________________________________________________________________________ MORECAMBE BAY CCG PRIMARY CARE COMMISSIONING COMMITTEE OPTIONS APPRAISAL FOLLOWING NOTICE GIVEN ON PERSONAL MEDICAL SERVICES AGREEMENT WINDERMERE & BOWNESS MEDICAL PRACTICE (A82046) 1. INTRODUCTION 1.1 One Medical Group is the holder of a Personal Medical Services (PMS) Agreement for the provision of primary care medical services to patients registered with Windermere and Bowness Medical Practice and provides Essential, Additional and Enhanced Services. The registered list size as at 01 July 2020 was 5,653 patients (weighted population of 5,380.49). Services are provided from Windermere Health Centre, Goodly Dale, Windermere. The practice is a member of the Grange and Lakes Primary Care Network (PCN). 1.2 One Medical Group (the ‘Provider’) notified NHS Morecambe Bay CCG on 15 July 2020 of its intention to resign from the Agreement with effect from 15 January 2021. Following discussion with the Provider and the Head of Primary Care, it was agreed that the period of notice would be extended to 31 March 2021. 1.3 The reasons cited in the resignation letter from One Medical Group for taking this action relate both to the financial aspect of the practice as well as the staffing model. 1.4 This paper sets out information relating to the local area (see Appendix 1 Health Needs Analysis – Windermere and Bowness’) as well options available to the Primary Care Commissioning Committee in order for a decision to be made in respect of the future provision of primary medical services to the patients registered with Windermere and Bowness Medical Practice. 2. BACKGROUND 2.1 One Medical Group has held the contract for approximately 5 years. Latterly, the Provider has worked with both NHS Morecambe Bay CCG and NHS England in relation to problems to staffing the contract. One Medical Group has also highlighted the fact that the practice is ‘significantly loss making and has been for a number of years’1 and that despite the efforts by One Medical Group to address this issue, the Group does not feel that keeping the contract is sustainable in the longer term. 2.2 At the Committee meeting held in February 2019, Members approved a request from a neighbouring practice, St Mary’s Surgery (Windermere), to temporarily close the 1 Extract from letter of resignation _________________________________________________________________________ Page 1 of 28 Options Appraisal Notice to Terminate PMS Agreement, Windermere & Bowness Medical Practice _________________________________________________________________________ patient list to new patients. This request had been made in view of the number of patients which had left Windermere and Bowness Medical Practice and wished to register at St Mary’s Surgery. Both the CCG and NHS England worked with One Medical Group to assist the Group in addressing the clinical workforce pressures and the CCG has continued to engage with One Medical Group since that time. 2.3 However, One Medical Group wrote to the Morecambe Bay CCG on 15 July 2020 to serve notice of its intention to resign from the Agreement effective from 15 January 2021. 2.4 Following receipt of this notice, Kate Hudson, Head of Primary Care, agreed with the directors of One Medical Group an extension of the notice period until the end of the financial year. Consequently, the Agreement is due to terminate on 31 March 2021. Clause 54 of the standard PMS Agreement states: “Termination by Serving Notice “58.1 The Contractor or the Board may at any time terminate this Agreement by serving notice in Writing on the other party or parties to the Agreement. The period of notice shall be [six (6) months]. ”58.2 The notice given under clause 58.1 must specify the date on which the termination is to take effect (which must be calculated in accordance with the period specified in clause 58.1) and the Agreement terminates on the date so specified. “58.3 This clause 58 does not affect any other rights to terminate this Agreement which the Contractor and the Board may have.” [source: NHS England Standard PMS Agreement, 2019] 3. CURRENT SITUATION Provision of services / Clinical Workforce 3.1 The Provider is required to continue providing primary medical services to the registered population until the end of the contract. One of the on-going challenges at Windermere and Bowness Medical Practice has been the ability to maintain a consistent number of GPs working at the practice. It is understood that One Medical Group has relied heavily on the engagement of Locum GPs, which as well as being a significant cost to the Group, is also an untenable position in the long term as One Medical Group had highlighted to the CCG that the practice was not generating sufficient income. The Group has also commented that, following the development of PCNs, the practice would benefit from the provider being based within the local geography. 3.2 In July 2020, a GP from the Grange and Lakes PCN contacted the Head of Primary Care to express concerns on behalf of the PCN about the long-term viability of Windermere and Bowness Medical Practice due to the staffing structure. The concerns were: the practice had one full-time GP working at the practice who was on a period of extended sick leave; a second salaried GP had been appointed but ultimately did not take up the position and the long-term locum had left. A meeting between key members of the PCN, One Medical Group and the CCG was held on 03 August 2020; the purpose of this meeting was to explore the support available to One Medical Group from the PCN. At this meeting One Medical Group confirmed its intention to terminate the PMS Agreement; it was, therefore, agreed that a further _________________________________________________________________________ Page 2 of 28 Options Appraisal Notice to Terminate PMS Agreement, Windermere & Bowness Medical Practice _________________________________________________________________________ meeting would be held with the entire PCN when CCG representatives could attend and explain the situation further. 3.3 At the meeting on 03 August, the Provider confirmed that one member of staff who had been on sick leave had returned to work and that efforts to recruit additional staff would continue. In discussions with Kate Hudson, Head of Primary Care, the Provider also confirmed that it was confident sufficient GP locum cover had been booked to continue providing services until the end of the Agreement. The Provider will be asked to share information relating to staffing rotas with the CCG in order for this situation to be monitored. Engagement 3.4 Again, following the meeting on 03 August, it was agreed that it was necessary to inform patients of the decision taken by One Medical Group; this was achieved by the publication of a press statement on 10 August 2020. This decision was made in view of the fact that both practice staff and members of the PCN had been informed of the development, albeit on a confidential basis; all parties were in agreement that patients needed to be formally notified of the situation. 3.5 However, on-going patient and stakeholder engagement will need to be undertaken throughout the period to 31 March 2020. This will be achieved by a number of methods, including written correspondence to all patients and stakeholders as well as patient engagement sessions. It is unlikely, in the current situation, that face-to-face patient engagement sessions will take place; the CCG’s Communications Team has been asked to provide advice on a Communications Plan in these circumstances.