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North Central London Primary Care Committee in Common (Meeting Held in Public) – AGENDA Date: Thursday 17 October 2019 Time: 15:00-16:30 Venue: Islington CCG – Clerkenwell Room, Second Floor, Laycock Centre, Laycock Street,

London, N1 1TH

Section Lead Paper Pages Time Pre-meet to be held for committee members from 1430-1500 PART 1 AGENDA

1 Welcome and Apologies

Chair

3pm to 3:15pm

2 Declarations of interest Register Item 2 3

3 Declarations of Interest relating to the items on the Agenda

4 Minutes from the previous meeting on 22 August 2019 Item 4 10

5 Actions from the previous meeting on 22 August 2019 Item 5 22

6 Matters Arising

7 Questions from the public (These must relate to items on the agenda for this meeting. Can ask up to three questions per individual or organisation.)

Items for discussion

8

Finance Report - October 2019

Tracey Lewis Item 8

31 3:15pm to

3:45pm

9 NCL Quality & Performance Report Vanessa Piper Item 9 40

10 Update on Primary Care Networks Vanessa Piper Verbal Items for decision

Contract Variations:

11

All Boroughs

PMS Contract Changes

Barnet Mountfield Surgery

Enfield (Medicus Health Partnership) Forest Road Group Practice (MHP)

Riley House Surgery (MHP)

Freezywater PCC (MHP)

Southbury Surgery (MHP)

Green Street Surgery (MHP)

Lincoln Road Medical Practice (MHP)

Vanessa Piper / CCG Lead

Item 11

76

3:45pm to

4:15pm

of 2

Enfield Island Surgery (MHP)

Dean House Surgery(MHP)

Enfield Eagle House Surgery

Camden Daleham Gardens Surgery

Haringey Cheshire Road Surgery

12

Enfield

Relocation of Bush Hill Avenue and Trinity Park Avenue Surgery to Lincoln Road Surgery

Vanesa Piper / CCG Lead Item 12

86

13

Enfield

Relocation of Southbury Road Surgery to Willow House Surgery and Lincoln Road Surgery

Vanesa Piper / CCG Lead Item 13

91

14

Camden

Rosslyn Hill Practice relocation to Hampstead Group Practice

Vanessa Piper / CGG Lead

Item 14

97

Items to Note – Urgent Decisions Taken Since 22 August 2019 Meeting

15

Approval of Appointment of Medicus Health Partners as the provider of NCL SAS service

Vanessa Piper / CGG Lead Item 15

102

Items to Note and information 16 PCCC Risk Register Vanessa Piper Item 16 139

4:20pm to 4:30pm 17 Committee Forward Planner Chair Item 17 149

18 Any other Business Chair Verbal

19

Date of Next Meeting: 19 December 2019 - Islington CCG – Clerkenwell Room, Second Floor, Laycock Centre, Laycock Street, London, N1 1TH

Resolution to exclude observers, the public and members of the press from the remainder of the meeting. By reason of the confidential nature of the business to be transacted in accordance with Section 1, Subsection 2 of the Public Bodies (Admissions to Meetings) Act 1960 and clause 22 of the Terms of Reference of this Committee and clauses 9 and 10 of the Standing Orders of this Committee.

Report Title Declaration of Interests Register –

NCL Primary Care Committee in Common

Agenda Item: 2

Governing Body Sponsor

N/A Tel/Email

Lead Director / Manager

Paul Sinden, NCL Director of Performance, Planning and Primary Care

Tel/Email [email protected]

Report Author

Vivienne Ahmad, Board Secretary, Islington CCG


Report Summary

The Committee Members and attendees are asked to review the agenda and consider whether any of the topics might present a conflict of interest, whether those interests are already included within the Register of Interests, or need to be considered for the first time due to the specific subject matter of the agenda item. A conflict of interest would arise if decisions or recommendations made by the Committee could be perceived to advantage the individual holding the interest, their family, or their workplace or business interests. Such advantage might be financial or in another form, such as the ability to exert undue influence. Any such interests should be declared either before or during the meeting so that they can be managed appropriately. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. If attendees are unsure of whether or not individual interests represent a conflict, they should be declared anyway. PCNs - The declaration document has been updated to include reference to PCNs and we have commenced the annual refresh of declarations for all key parties.

Recommendation To NOTE the Declaration of Interests Register and invite members to inspect their entry and advise the meeting / Board Secretary of any changes.

Identified Risks and Risk Management Actions

The risk of failing to declare an interest may affect the validity of a decision / discussion made at this meeting and could potentially result in reputational and financial costs against the CCG.

North Central London

Primary Care Committee in Common Meeting

17 October 2019

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mailto:[email protected]


Conflicts of Interest

The purpose of the Register is to list interests, perceived and actual, of members that may relate to the meeting.

Resource Implications

Not Applicable

Engagement

Not Applicable

Equality Impact Analysis

Not Applicable

Report History and Key Decisions

The Declaration of Interests Register is a standing item presented to every Committee Meeting.

Next Steps The Declaration of Interests Register is being presented to every Committee Meeting and regularly monitored.

Appendices

The Declaration of Interest Register.

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Register of Interests - NCL Primary Care Committee in Common - October 2019

From To

Fina

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sts

Non

-Fin

anci

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Prof

essi

onal

In

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sts

Non

-Fin

anci

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Pers

onal

In

tere

sts

Representatives from Haringey CCGDina Dhorajiwala GP Partner, Vale Practice Vale Practice Yes No No Direct Practice Partner 15.3.2018

current 8.11.2018 11.09.2019

West GP Member, Governing Body Vale Practice is a member of Federated4Health,the pan-Haringey federation of GPPractices

Yes No No Direct Practice Partner 15.3.2018

current

8.11.2018 11.09.2019

Member, Strategy and Finance Committee The Vale Practice is a memberof WISH,the Urgent Care CentreProvider at Whittington Health

Yes No No Direct Practice Patner 15.3.2018

current

8.11.2018 11.09.2019

Member, Clinical Cabinet WISH, the Urgent Care Centre Provider at Whittington Health.

Yes No No Direct Director 15.3.2018current

8.11.2018 11.09.2019

Primary Care Lead, Governing Body NHS England Yes No No Direct GP Appraiser 15.3.2018 current 8.11.2018 11.09.2019

Member, NCL Primary Care Committee in CommonVale Practice

No No Yes IndirectHusband is a practice partner and GP Principal. 1.3.2018 current 8.11.2018

11.09.2019

Member, Primary Care Steering Group West Central Primary Care Network yes no yes direct Practice is a member 01.07.2019 current 11.09.2019

Member, Primary Care Transformation Group Member, Health and Wellbeing BoardMember, NCL Clinical Leads Reference Group

Cathy Herman Lay Member, Governing Body No No No N/A 15.3.2018 current 8.10.2018 08.08.2019Chair, NCL Primary Care Committee in CommonMember, Health and Well Being BoardChair, Investment CommitteeMember, Audit CommitteeMember, Quality and Performance CommitteeMember, Primary Care Transformation Group and Organisational DevelopmentChair, Engagement Network

Rachel Lissauer Director of Commissioning and Integration, Haringey School for Children with Special Educational Needs in Haringey

No No Yes Direct Co-opted Governor 13.07.2017 06.11.2018

Representatives from Islington CCGSorrel Brookes Lay Vice Chair Help on Your Doorstep No No Yes Direct Trustee 20.09.2017 current 20.09.2017 21.08.2019

Member of Governing BodyMember,Strategy & FinanceMember, Quality & Performance CommitteeMember,PPP Committee

Member, Audit Committee

Member of Remuneration CommitteeMember,NCL Primary Care Committee in CommonMember NCL Joint Commissioning Committee

Clare Henderson Director of Commissioning for Haringey & Islington CCGs No 5.3.2018 22.10.2018 08.08.2019Attendee of CCG Governing Body Attendee, Strategy and Finance CommitteeAttendee, NCL Primary Care Committee

Date of InterestDate declared Update

Is the interest direct or indirect?

First Name Second Name Current position (s) held- i.e. Governing Body, Member practice, Employee or other

Declared Interest- (Name of the organisation and nature of business)

Type of Interest

Nature of Interest

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Clinical Director, Islington CCG y y n direct Clinical Director 07/11/2018 current 07/11/2018 02/08/2019

Member of the Executive Management Team y y n direct member 07/11/2018 current 07/11/2018 02/08/2019

Conflict of interest issues for the G i B d d CCG

n y n direct Lead 07/11/2018 current 07/11/2018 02/08/2019Caldicott Guardian for Islington & Haringey

n y n direct Caldicott Guardian 07/11/2018 current 07/11/2018 02/08/2019

Freedom to Speak up Guardian for Islington & Haringey

n y n direct Guardian 07/11/2018 current 07/11/2018 02/08/2019

Freedom to Speak up Guardian for Islington Federation

n y n direct Guardian 07/11/2018 current 07/11/2018 02/08/2019

Individual Funding Request Panel direct Chair 07/11/2018 current 07/11/2018 02/08/2019

Locally Commissioned Services Working Group

direct Chair 07/11/2018 current 07/11/2018 02/08/2019

Islington & Haringey on the NCL Primary Care Joint Committee

direct Clinical representative 07/11/2018 current 07/11/2018 02/08/2019

Supporting and managing the Clinical Leads (including Darzi fellow) - recruitment, bi-monthly network meetings, appraisals, finance.

direct Support and manage 07/11/2018 current 07/11/2018 02/08/2019

Medicines and devices Safety Officer (MSO & MDSO)

direct Safety Officer 07/11/2018 current 07/11/2018 02/08/2019

MSO/MDSO network for local CCGs and Providers

direct Chair 07/11/2018 current 07/11/2018 02/08/2019

Controlled drugs safety lead and Antimicrobial stewardship lead.

direct Lead 07/11/2018 current 07/11/2018 02/08/2019

Whittington Care Quality Review Group

n direct member 07/11/2018 current 07/11/2018 02/08/2019

Map of medicine teamdirect Provide clinical leadership 07/11/2018 current 07/11/2018 02/08/2019

Serious incident reviews & patient safety

direct Provide clinical leadership 07/11/2018 current 07/11/2018 02/08/2019

GP Practice Qualitydirect Provide clinical leadership 07/11/2018 current 07/11/2018 02/08/2019

Pressure ulcer task and finish group.

direct Provide clinical leadership 07/11/2018 current 07/11/2018 02/08/2019

Federation Working Groupdirect Provide clinical leadership 07/11/2018 current 07/11/2018 02/08/2019

Chair board Link visits direct Chair 07/11/2018 current 07/11/2018 02/08/2019

NLP IG Working Group direct Chair 07/11/2018 current 07/11/2018 02/08/2019Locum GP y y n direct Homerton Hospital OOH care, Paradoc

emergency home visiting service , Tower Hamlets, SELDOC GP OOH services and Croydon (ad hoc sessions in various GP surgeries across London, excluding Islington)

07/11/2018 current 07/11/2018 02/08/2019

Greenland Passage residential association

n y y direct Board Director 07/11/2018 current 07/11/2018 02/08/2019

1-12 Royal Court Ltd n y y direct Secretary & director 07/11/2018 current 07/11/2018 02/08/2019Novo Nordisk pharmaceutical company.

n n n Indirect My Sister is a Medical Advisor 07/11/2018 current 07/11/2018 02/08/2019

St Helier Hospital in Sutton. n n n Indirect Partner is an ITU Consultant 07/11/2018 current 07/11/2018 02/08/2019

BMA y y n direct member 07/11/2018 current 07/11/2018 02/08/2019

RobertsDominic

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Elizabeth Avenue practice n n n Indirect Personal friend of GP Partner 07/11/2018 current 07/11/2018 02/08/2019

City and Hackney Local Medical Committee

n y n direct member 07/11/2018 current 07/11/2018 02/08/2019

City & Hackney Urgent Healthcare Social Enterprise -providing out of hours care for City & Hackney CCG residents.

y y n direct I am a GP - I do shifts for the Paradoc emergency home visiting service.

07/11/2018 current 07/11/2018 02/08/2019

Communitas, a private provider seeing NHS patients,

y y n direct I undertake clinical sessions in my role as a GP with a Special interest in ENT.

07/11/2018 current 07/11/2018 02/08/2019

Haringey CCG as an external GP y y n direct as an external GP on their transformation group and investment committee. I also support some of their procurement work streams and other CCG duties as required as an external

07/11/2018 current 07/11/2018 02/08/2019

Babylon, a private provider for digital GP consultations.

y y n direct locum GP. Babylon supports the 111 service in London.

07/11/2018 current 07/11/2018 02/08/2019

Hackney VTS GP training scheme y y n direct Programme director, employed by the London Specialty School of General Practice, Health Education England.

07/11/2018 current 07/11/2018 02/08/2019

I am a GP Appraiser for the London area.

y y n direct GP Appraiser 07/11/2018 current 07/11/2018 02/08/2019

I am a mentor for GPs under GMC sanctions.

y y n direct GP Mentor 07/11/2018 current 07/11/2018 02/08/2019

I am currently mentoring a salaried GP at a practice in Haringey.

y y n direct Salaried GP 07/11/2018 current 07/11/2018 02/08/2019

Representatives from Enfield CCGPeter Lathlean Care Closer Home Manager (seconded from Primary Care

Development Manager) Motor Neurone Disease (N London)

NO NO yes N/A

Committee member (voluntary)Partner is a clincal development pharmacistRegistered with an Enfield GP N/A N/A 28.03.2018

18.10.2018

Karen Trew Governing Body Member and Lay member for Audit and Governance and Vice Chair

Barnet CCG, CCG Audit Committee

Yes Yes No Direct Member of Barnet CCG Audit Committee and NCL ACIC

Jul-18 Current 31.10.2018

Member of Enfield Finance and Performance Committee Chair of Enfield Audit Committee Member of NCL Audit Committee in Common

NHS England Performer List Decision Panel (outside of North Central London)

Yes Yes No Indirect Chair of Panel Apr-13 Current 31.10.2018

Chair of NCL Joint Commissioning Committee Chair of Enfield Procurement Committee Member of Clinical Commissioning Committee

Broxbourne School Hertfordshire No No Yes N/A Chair of the Governing Body (previously Governing Body membersince Nov. 2004)

Jun-15 Current 31.10.2018

Wormley C of E Primary SchoolHertfordshire

No No Yes N/A Chair of the Governing Body Jun-06 Current 31.10.2018

Lloyds Pharmacy Clinical Homecare

No No Yes Indirect Son employed in operational role Apr-17 Current 31.10.2018

Janet High Clinical Lead CCG Clinical Lead for Dermatology and Neurology as well as Clinical Lead for Enfield Referral Service. This involves overview of Polce and occasional attendance at NCL IFR panels.

Yes yes no

direct

This involves overview of Polce and occasional attendance at NCL IFR panels. 04/11/2018 current 04/11/2018

several practices in Enfield and occasionally do Extended Access Hub sessions.

Yes yes no

direct Work as GP locum 04/11/2018 current 04/11/2018

Enfield CCG

No yes yes

indiect

May be invited to attend CCG sub committees as and when appropriate . Regularly attend TPG and CRWG. 04/11/2018 current 04/11/2018

Enfield CCG

no yes yes

indirect

Have been involved with STP Polce and Dermatology projects- attending regular meetings. 04/11/2018 current 04/11/2018

GP Federation

yes yes no

indirect

I work as a locum for several practices. The GP Federation is a pan Enfield organisation but all I do is clinical sessions and I do not get involved in any Federation business. 04/11/2018 current 04/11/2018

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NHSE yes yes no indirect GP Appraiser 04/11/2018 current 04/11/2018Elektron Eye Technology no no no indirect Husband is Chairman of company 04/11/2018 current 04/11/2018Elektron Eye Technology no no no indirect Son in Law is employee of company 04/11/2018 current 04/11/2018

Deborah McBeal Deputy Director of Primary Care and Deputy ChiefOperating Officer

We are Pareto No No No N/A Director of company, dormant, non-trading

2013 Present 28.03.2018 15.10.2018

Member of Enfield Finance and Performance Committee Member of Enfield Clinical Commissioning Committee

Charlotte Hampstead Group Practice Yes Yes No Direct Part Time Nurse Practitioner 18/07/2017 current 11/09/2018 09/10/2019Islington GP Federation Yes Yes No Direct Part Time Senior Nurse 11/09/2018 current 11/09/2018 09/10/2019Daleham Gardens Practice Yes Yes No Direct Part Time Practice Nurse 11/09/2018 current 11/09/2018 09/10/2019Royal College of Nursing No Yes No Direct Member 18/07/2017 current 11/09/2018 09/10/2019City University Yes Yes No Direct Honorary lecturer for nursing and midw 29/09/2017 current 11/09/2018 09/10/2019Royal College of GP Yes Yes No Direct Education Assessor 11/04/2018 current 11/09/2018 09/10/2019Dr Matthewman General PracticYes Yes No Direct Part Time Lead Nurse 07/03/2019 current 15/03/2019 09/10/2019Culford School, Suffolk Yes Yes No Direct Employed as residential school nurse 29/08/2019 current 29/08/2019 09/10/2019

Sarah McDonnell-Davies Director of Primary Care and Commissioning & Deputy Chief Operating Officer

PA Consulting Yes No No Direct Shareholder PA Consulting 15.06.2018 current 20.06.2018

Dr Kevan UCLH Council of Governors No Yes No Indirect Camden CCG representative on the UCL 01.03.2018 current 02.11.2018 04/09/2019Bloomsbury Surgery Yes Yes No Direct GP Partner 13.06.2017 current 02.11.2018 04/09/2019Central Health Evolution Limited Yes Yes No Direct GP Practice is a Member 13.06.2017 current 02.11.2018 04/09/2019Central Camden Primary Care Network

Yes No no Direct GP Practice is a Member 01.07.2019 current 01/05/2019 04/09/2019

CCAS Assessor Yes Yes No Direct 2-4 sessions per month 13.06.2017 current 02.11.2018 04/09/2019Neeshma Shah Director of Quality and Clinical Effectiveness

Member of Camden Quality and Safety Committee Independent consultant Yes Yes No Direct Occasional ad hoc consultancy work on

sole trader basis on subject matter relating to medicine, the pharmacy profession and the health and social care landscape

24.04.2013 current 24.10.2018 14.08.2019

Glenys The Young Foundation No Yes Yes Direct Senior Fellow 18.05.2018 current 02.11.2018Member of the House of Lords No Yes No Direct Baroness Thornton - Labour and Co-

operative Member From 1.11.2017: Opposition spokesperson for Health

09.08.2017 current 02.11.2018

London School of Economics No Yes Yes Direct Emeritus Governor 09.08.2017 current 02.11.2018Social Enterprise UK No Yes Yes Direct Patron 09.08/2017 current 02.11.2018Healthcare and Assistive Technology Society

No Yes Yes Direct Chair of the Advisory Panel and Patron 09.08.2017 current 02.11.2018

Phone Coop Foundation for Co-Operative Innovation

Yes Yes No Direct Chair until 1 June 2018 as the Coop merged with Mid Counties cooperative

18.05.2018 01.06.2018 02.11.2018

Power of Empathy No Yes Yes Direct Board Member 09.01.2019 current 31.01.2019

Social Business International No Yes Yes Direct Senior Associate - Group Leader of Social Enterprises who provide public services and supporting 'Bold Commissioners' Group of public sector commissioners

31.10.2018 current 02.10.2018

Rebecca Booker Director of Finance No No No None 18.10.2017 21.08.2019

Tracey Lewis Interim Head of Finance no no no none 21.02.2019

Representatives from NCLSimon Goodwin Chief Finance Officer

Member, NCL CCG Governing BodiesEast London Foundation Trust No No Yes Indirect Wife is Senior Manager at the Trust 14.6.2017 current 12.10.2018 08.08.2019

Member of all five CCG Finance CommitteesAttendee, CCG Audit Committees and NCL Audit Committee in Common Attendee, NCL Joint Commissioning Committee

Ritchie Elected GP RepresentativeMember of Camden Finance and Performance CommitteeMember of Camden Audit Committee Member of NCL Audit Committee in Common

Thornton Lay Member Member of Camden Audit Committee Member of NCL Audit Committee in Common Chair of Camden Procurement Committee

Elected Practice NurseChair of Camden Quality and Safety Committee

CooleyRepresentatives from Camden CCG

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Attendee, NCL Primary Care Co Commissioning in Common

Paul Sinden NCL Director of Performance, Planning & Primary Care No No No N/A 30.4.2018 16.08.2019

Attendance at Governing Body for all 5 CCGs in NCL 30.04.2018 16.08.2019

Attendance of NCL Committees - Primary Care and Joint Committee 30.04.2018

16.08.2019

Vanessa Piper Head of Primary Care, NC London No No No N/A 31.10.2018Attendee of NCL Primary Care Committee in Commonand other committees when required 31.10.2018

StakeholdersEmma Whitby Healthwatch Islington r representation at the CCG Governing

Body Healthwatch Islington

London Catalyst

Gendered Intelligence

Age UK East London

no no no direct Chief Executive

Trustee

01/10/2018 current 09/08/2019 09/08/2019

Greg Cairns Director of Primary Care StrategyLondonwide LMCs

No No No N/A 03/10/2019 03/10/2019

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NORTH CENTRAL LONDON PRIMARY CARE COMMITTEE IN COMMON (Meeting held in public)

DRAFT Minutes of the Meeting held on Thursday 22 August 2019 between 3pm and 4:30pm

Enfield CCG - Committee Rm, Holbrook House, Cockfosters Road, Barnet, Herts EN4 0DR. Present: Voting Members: Ms Sorrel Brookes (Chair) Governing Body Lay Member & Vice Chair of PCCC, Islington CCG

(deputised for Cathy Herman, Chair of PCCC and represented both Haringey & Islington CCGs)

Mr Ian Bretman Governing Body Lay Member, Barnet CCG (deputised for Karen Trew, Enfield CCG) also (Dominic Tcaczyk deputised for Ian Bretman in item 10)

Mr Dominic Tcaczyk Governing Body Lay Member, Barnet CCG (deputised for Ian Bretman in item 10)

Ms Kathy Elliot Governing Body Member, Camden CCG (deputised for Glenys Thornton, Camden CCG)

GP Representatives Dr Dina Dhorajiwala Governing Body GP Member, Haringey CCG Dr Dominic Roberts Clinical Director, Islington CCG (deputised for Kevan Ritchie,

Camden CCG) Dr Janet High Governing Body GP Member, Enfield CCG Dr Arnold Fertig Independent GP Advisor represented Barnet CCG Officer Representatives Ms Sarah McDonnell -Davies

Deputy Chief Operating Officer and Director of Primary and Community Care, Camden CCG

Colette Wood Director of Care Closer to Home, Barnet CCG ((Paul Sinden deputised for Colette Wood, Barnet CCG in item 10)

Mr Tony Hoolaghan Chief Operating Officer for Haringey and Islington CCGs (deputised for Rachel Lissauer, Haringey CCG)

Mr Liam Beadman Head of Primary Care Development, Islington CCG (deputised for Clare Henderson, Islington CCG)

Mr Riyad Karim Interim Head of Primary Care, Enfield CCG (deputised for Deborah McBeal, Enfield CCG)

Mr Paul Sinden NCL Director of Performance, Planning and Primary Care ((deputised for Colette Wood, Barnet CCG in item 10)

Practice Nurse Representative

Ms Charlotte Cooley Governing Body Practice Nurse, Camden CCG In Attendance Noelle Skivington Healthwatch Representative, Enfield (Deputised for Deborah

Fowler, Healthwatch Enfield) Ms Tracey Lewis Head of Finance, Camden CCG Ms Neeshma Shah Director of Quality & Clinical Effectiveness, Camden CCG Ms Vanessa Piper Head of Primary Care, NCL Primary Care Team Mr Greg Cairns Director of Primary Care Strategy, London wide LMCs Mr Andrew Spicer NCL Head of Governance & Risk

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Mr Don Neame Independent Consultant for Finchley Memorial Hospital Ms Kelly Poole Assistant Director of Primary Care Transformation, Barnet CCG Ms Robyn Sandler Communications & Engagement Manager, Barnet CCG Ms Vivienne Ahmad (Minutes)

Board Secretary, Islington CCG

Ms Helen Austin Executive Assistant, Enfield CCG Apologies: Ms Cathy Herman (Chair) Governing Body Lay Member, Haringey CCG Ms Glenys Thornton Governing Body Lay Member, Camden CCG Ms Karen Trew Governing Body Lay Member, Enfield CCG Dr Murtaza Khanbhai Governing Body GP Member, Barnet CCG Dr Kevan Ritchie Governing Body GP Member, Camden CCG Ms Clare Henderson Director of Commissioning & Integration, Islington CCG Ms Rachel Lissauer Director of Commissioning & Integration, Haringey CCG Ms Deborah McBeal

Director of Primary Care Commissioning and Deputy Chief Operating Officer, Enfield CCG

Mr Simon Goodwin NCL Chief Finance Officer Ms Deborah Fowler Healthwatch Representative, Enfield Members of the Public Dr Brian Golden Member of the Public Ms Lesley Golden Member of the Public Ms Dina Woolf Member of the Public Mr Paul Blom Member of the Public Mr Michael Harrison Member of the Public Mr Anil Makwana Member of the Public Mr G Goldstein Member of the Public Mrs Eva Spector Member of the Public Mr Geoffrey Behrman Member of the Public M.Zargo Member of the Public Ying Liu Member of the Public Aliza Haye Member of the Public Kashmira Chohan Member of the Public Mr Stephen Colman Member of the Public Ms Miriam Hackenbroch Member of the Public Mr Sam Vape Member of the Public

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1. Welcome & Apologies 1.1 The Vice Chair presided and welcomed everyone to the meeting, as the Committee

Chair was unable to attend and had given apologies.

1.2 Apologies were recorded as above.

2

Declarations of Interests Register

2.1 The Declarations of Interest Register was considered. Mr Greg Cairns informed the Committee that his prior declaration of interest relating to the potential practice move into Finchley Memorial Hospital (FMH) was no longer relevant, as Local Medical Committee representation for the six practices raising a formal complaint against the identification of Ravenscroft Medical Centre to move into FMH was complete.

3 Declarations of Interest Relating to Items on the Agenda

3.1 The three voting Barnet members of the Committee would be conflicted for agenda item 10 - the Relocation of Ravenscroft Medical Centre to Finchley Memorial Hospital. The declarations were as follows: Ian Bretman and Colette Wood declared that they were members of the panel that

assessed the expressions of interest from Barnet practices;

Dr Murtaza Khanbhai declared a conflict of interest as a GP in Barnet.

To manage these conflicts of interest in line with NHS England statutory guidance, the CCG’s Conflicts of Interest Policy and the Committee’s Terms of Reference it was agreed that three non-conflicted members would be co-opted in their place to ensure decision-making was independent and made without any conflicts of interest. The following independent members were appointed accordingly: Dr Murtaza Khanbhai was not in attendance at the meeting and was replaced as the

Barnet clinical representative by Dr Arnold Fertig, an independent GP; Colette Wood would be in attendance to present the item but would not be involved

in the decision making. She was replaced as a decision maker by Paul Sinden, Director for Planning, Performance and Primary Care for the NCL CCGs;

Ian Bretman was in attendance at the meeting, as he was deputising for the lay member from Enfield CCG on the Committee and would not be involved in the decision making on this item. He was replaced as a decision maker by Dominic Tkaczyk, Lay Member for Barnet CCG.

4 Minutes of the previous meeting held on 20 June 2019

4.1

The minutes were APPROVED as an accurate record of the meeting subject to the following amendment in regards to attendance: Dr Janet High (incoming GP representative for Enfield CCG) should have been added

to the voting members section rather than being in attendance.

4.2 Action: To amend the minutes of the meeting held on 20 June 2019 as per Section 4.1 above.

(Vivienne Ahmad) 5 Actions from the previous meeting held on 20 June 2019

5.1

The action log was reviewed and updated.

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6 Matters Arising 6.1 None

7 Questions from the public 7.1 The Committee received seven questions from two members of the public, Mr Richards

and Dr Golden, in advance of the meeting for which written answers had been given, Responses were also published on the CCG websites and provided at the meeting alongside the Committee papers. The Committee received further questions at the meeting from Dr Brian Golden and Ms Dina Woolf. Dr Golden, previously a senior partner of the Ravenscroft Medical Centre for 29 years, asked to address the Committee about the potential move of Ravenscroft Medical Centre into Finchley Memorial Hospital. The Committee agreed to the request. Dr Golden then addressed the Committee asking for further clarification on the written questions in particular relating to the letter from Barnet CCG on 2 August 2018 sent to six Finchley Medical Practices indicating that following an evaluation process their application for provision of primary care services at Finchley Memorial Hospital (FMH) had been unsuccessful. Dr Golden distributed a copy of the letter to Committee members, alongside a copy of page 58 of the CQC Guidance for Providers on Meeting Regulations , Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3): Regulation 15: Premises and Equipment. Two sentences were highlighted: That the Care Quality Commission (CQC) must refuse registration if providers could

not evidence compliance with this clause; and That all premises and equipment used by the provider must be appropriately located

for the purpose for which they are being used. Dr Golden asked the Committee to consider their decision in the light of his view that: The practice move was 3.2 miles and no practice relocation in London had ever been

in excess of three miles and no practice had ever relocated two miles outside the perimeter of its own practice catchment area;

86% of respondents opposed the move whereas 12% supported it but only because they trusted the practice staff;

Opponents to the proposal included Mr Mike Freer (MP for Finchley and Golders Green), Ms Theresa Villiers (MP for Chipping, Barnet), Mr Andrew Dismore (Member of the London Assembly for Barnet and Camden), Primary Care Networks 2 and 3 representing roughly half the Barnet population, the 23 practices and local Conservative, Labour and Liberal Democrat Councillors;

The assertion that the proposal contravened CQC regulation 15.1f; that all premises must be appropriately located for the purpose for which they are being used;

Lane End Medical Group withdrawing from the proposal; The patient consultation report was completed in June but results were only released

on 15 August 2019; As landlord of the property, he cautioned that if Ravenscroft Medical Centre moved

into FMH the premises would no longer be available for use by the NHS. Given the above Dr Golden requested that the Committee decline the proposal for Ravenscroft Medical Centre to move into Finchley Memorial Hospital (FMH), and indicated that if the proposal was approved by the Committee a judicial review may be sought to overturn the decision. Ms Dina Woolf, a patient at Ravenscroft Medical Centre, also opposed to the relocation of the practice to FMH, commenting that the relocation was not suitable for patients who were disabled, elderly or parents with young children. She said that herbrother, who lived in the London NW4 area, was advised to leave the practice as he was not in the catchment area.

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https://en.wikipedia.org/wiki/Member_of_the_London_Assembly

https://en.wikipedia.org/wiki/Member_of_the_London_Assembly

https://en.wikipedia.org/wiki/Barnet_and_Camden_(London_Assembly_constituency)

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ITEMS FOR DECISION Contract Variations

8 All Boroughs – Personal Medical Services (PMS) Contract Changes

8.1 BARNET - the Village Surgery 8.1.1 The Committee was asked to approve the removal of a GP from the partnership

agreement leaving a sole partner supported by two salaried GPs. Commissioners would work with the practice to ensure they work towards increasing the number of sessions and appointments until a new GP partner was recruited.

8.1.2 The Committee APPROVED the recommendation. 8.2 BARNET - Longrove Surgery 8.2.1 The Committee was asked to approve the 24 hour retirement of a GP signatory, leaving

four GP partners. The practice had appointed a salaried GP to cover the absence so that the clinical capacity and patient access was not impacted. The practice was also using clinical pharmacist capacity.

8.2.2 The Committee APPROVED the recommendation. 8.3 BARNET - St Andrews Medical Practice 8.3.1 The Committee was asked to approve the addition of a GP partner (the sole contract

holder of the Derwent Medical Practice) as the seventh signatory to the practice Personal Medical Services (PMS) agreement.

8.3.2 The Committee APPROVED the recommendation. 8.4 BARNET - Derwent Medical Practice 8.4.1 The Committee was asked to approve six additional signatories from the St Andrews

Medical Practice to the PMS agreement. This recommendation was considered in conjunction with section 8.3 above.

8.4.2 The Committee APPROVED the recommendation. 8.5 ENFIELD - (Medicus Health Partnership- MHP)

Forest Road Group Practice, Riley House Surgery, Freezywater PCC, Southbury Surgery, Green Street Surgery, Lincoln Road Medical Practice, Enfield Island Surgery and Dean House Surgery

8.5.1 The Committee was asked to approve the removal of a GP signatory from the 8 PMS practices that form part of MHP with effect 1 October 2019 due to retirement. Two GP partners would provide capacity at Green Street to cover the resignation, and patients could also access services across the fourteen Medicus Health Partnership sites.

8.5.2 The Committee APPROVED the recommendation. 8.6 HARINGEY - The 157 Medical Practice 8.6.1 The Committee was asked to approve the removal of a non-clinical partner and the

addition of a new non-clinical partner on behalf of Federated4Health to the practice Personal Medical Services (PMS) contract.

8.6.2 The Committee APPROVED the recommendation. 9 Barnet CCG - Cricklewood Health Centre - Options Appraisal 9.1 The Committee was asked to consider options for the GP practice post termination of

the current contract on 31 March 2020 with the options being the re-procurement of the APMS contract (Alternative Provider Medical Services) or to consider a list dispersal. To make the decision the Committee was asked to consider: The GP contract had previously been extended to better align to the decision timeline

for the co-located walk-in-centre, with legal advice indicating that the practice contract extended to the maximum length permissible under procurement rules. BARNDOC ran both services;

Patient and stakeholder consultation had favoured re-procurement of the GP contract, although some local practice had noted their capacity to take on patients if the list was dispersed. Consultation on the future of the walk-in-centre had just commenced;

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The preferred option was to re-procure the practice list rather than dispersal even though the list was currently below the 6,000 threshold for re-procurement. Re-procurement was recommended due to list size growth at the practice, nearby housing developments in Cricklewood and Brent Cross with a projected population growth of 25,000, and the practice was within a regenerations area with the landlord submitting a planning application to develop new housing units and redevelop the practice premises.

The Committee was then asked to: Approve the option to re-procure the contract for the GP practice at Cricklewood

Health Centre; Approve that the procurement be undertaken locally rather than through the London-

wide Tranche 8 programme (which would be too late); Approve a provision to extend the current contract for 3 months beyond March 2020

to cover any potential slippage in the procurement timeline.

9.2 The Committee APPROVED the recommendation to re-procure the practice list as set out in Section 9.1 above.

10 Barnet CCG - Relocation of Ravenscroft Medical Centre to Finchley Memorial

Hospital 10.1 As stated earlier in section 3.1, it was declared that the conflict of interest the

three standing Committee members from Barnet CCG had for this agenda would be managed robustly and in line with NHS England statutory guidance on the management of conflicts of interest, the CCG’s Conflicts of Interest Policy and the Committee’s Terms of Reference. It was agreed that three non-conflicted members would be co-opted in their place to ensure that decision-making on the proposed relocation was independent. The Committee then received an overview of, and context for, the proposal to relocate Ravenscroft Medical Centre to Finchley Memorial Hospital. It was noted that in advance of the meeting Committee members had received all correspondence received from correspondents on the proposals prior to the Committee to inform the discussion and decision-making, with Committee members confirming receipt and that they had had sufficient time to read the papers.. Finchley Memorial Hospital is a flagship healthcare facility, which provides a unique opportunity to deliver integrated primary care and community services in line with both national new models of care and local plans for integrated care partnerships. Previous attempts to locate a practice in Finchley Memorial Hospital (FMH) since 2012/13 had been unsuccessful due to the high service charge costs for the building, with the lack of general practice provision at the site resulting in void cost of £180,000 a year being incurred by Barnet. Barnet CCG had undertaken to Barnet Health Overview and Scrutiny Committee that a final attempt would be made to locate a practice into FMH. On 18 April 2018, Barnet CCG therefore launched an application process to locate a practice into FMH. The application process, based on an expression of interest rather than procurement approach, was open to all Barnet practices to ensure transparency and fairness, as the relocation proposal include a financial support package over and above standard contract provisions. Following this 17 practices attended the launch of the application process at Finchley Memorial Hospital.

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The application process was supported by a detailed service specification and scoring mechanism designed to encourage service innovation, enhance patient experience, and an integrated model of care across primary and community services. Barnet CCG received three applications for the relocation into Finchley Memorial Hospital (FMH). The preferred applicant identified through the evaluation process was Ravenscroft Medical Centre, with the practice submitting a joint application with Millway Medical Practice, Lane End Medical Group and the local community services provider CLCH. The proposal set out a set of service innovations and multi-speciality provider approach encouraged by the service specification and designed to deliver improved patient experience, better outcomes, and integrated pathways across health and social care sectors along with responsive and accessible primary care. The application process was challenged by six practices, which had also applied to move; and referred to NHS England who investigated the complaint and decided that Barnet CCG had followed due process and as such recommended that the CCG could proceed with a public consultation on the proposed relocation of Ravenscroft Medical Centre into Finchley Memorial Hospital. The CCG then conducted a 12-week consultation from 1 February 2019 to 25 April 2019 on the proposed relocation, with a letter sent to all patients over the age of 16 on the practice list and information displayed in the practice and on the CCG website. In addition 12 drop-in sessions were held to allow patients to discuss the relocation proposal. A response to the consultation was received from c16% of the practice list, with 86% of responses not in favour of the relocation and 12% in favour. Unfavourable responses equated to 13% of the practice list. The CCG acknowledged the significant response and concern from patients about the proposed relocation particularly from those patients who felt unable to travel to Finchley Memorial Hospital (FMH). In response to these concerns Barnet CCG had: Contacted the eight practices within a mile of the current location of Ravenscroft

Medical Centre (RMC), with six practices confirming capacity to register any patients from RMC unwilling to travel to FMH;

Contacted Transport for London to identify opportunities to improve public transport links to FMH, and to Royal Free London Charitable trust for the same purpose (a shuttle bus as per provided to Chase Farm site);

Undertaken a Quality Impact Assessment and Equalities Impact Assessment, in particular to protect outcomes for people with protected characteristics. Benefits for the practice list from transferring to Finchley Memorial Hospital included more integrated care;

Begun to develop a mobilisation plan to ensure a safe and compassionate implementation of the relocation particularly for vulnerable patients. The plan included a named member of staff to work with vulnerable patients on the Ravenscroft Medical Centre (RMC) list to ensure continuity of care (this offer would be extended to all patients); safe records transfer; resilience funding to neighbouring practices receiving patients wishing to transfer from RMC rather than follow the practice relocation; and work with Healthwatch on patient communications.

The CCG acknowledges that GPs close to Finchley Memorial Hospital were concerned about the proposal destabilising their practices, but there is no current proposal for Ravenscroft Medical Centre to change it’s catchment area, therefore would be unable to register there. The CCG confirmed that any subsequent request to change the catchment area would need to be approved by the Committee, with decision-making taking into account the impact on neighbouring practices.

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The relocation of Ravenscroft Medical Centre into Finchley Memorial Hospital would save and put c£150k per annum back into the local health economy after accounting for practice running costs and the removal of void costs. The Committee was also asked to note that Lane End GP practice withdrew its participation on 23rd July 2019 from the original application. The addendum provides the committee with the due diligence followed to provide the committee with assurance that the move should still go ahead. From the above the Committee was asked to note that Finchley Memorial Hospital is a modern, purpose built building that was designed to have a GP practice at its heart, co-located with other services. The CCG recognised that the majority of respondents to the consultation did not support the relocation of Ravenscroft Medical Centre to Finchley Memorial Hospital but there are clinical and outcome-based benefits to the move which were developed and expressed when all Barnet GP practices were invited to submit business case applications, patient experience benefits and financial benefits to the local NHS economy. Barnet CCG had undertaken an exhaustive, fair and transparent process to identify a practice to move into Finchley Memorial Hospital and this approach would continue with the mobilisation plan.

10.2 In response to the report the Committee: Received further assurance on the application and decision-making process, noting: An expression of interest, rather than procurement, process was used supported

by a detailed service specification; All Barnet practices were eligible to apply as a financial support package over and

above core contract provisions was in place; The evaluation panel included independent experts and did not include any Barnet

GPs to avoid conflicts of interest; All three applications included members of the CCG Governing Body and/or GP

Federation; The evaluation identified a clear strongest application, and the unsuccessful

applicants were advised why their applications had not been successful; The NHS England review of the process, following a complaint, found that due

process had been followed. Were informed that Transport for London would only consider changes to transport

routes retrospectively (once the practice had moved to Finchley Memorial Hospital), but this would be pursued;

Noted that communications would be further developed to inform stakeholders, particularly patients on the practice list, about the service and outcome benefits that would accrue from the practice move, building on examples in Barnet such as the frailty service;

Noted that the Ravenscroft Medical Centre would remain in the same primary care network post the move to Finchley Memorial Hospital, aligned to initially maintaining the same catchment area;

Noted that work would need to, and was intended to be, undertaken to retain the goodwill with Finchley practices to ensure that their patients benefited from the integrated care service model centred on Finchley Memorial Hospital;

Noted that whilst the decision was complex the relocation was innovative and provided a blueprint to benefit the rest of the borough for the future. The decision would therefore need to be taken in the context of benefits to the practice patients, the practice itself, and the broader population of Barnet;

Noted that the integrated service model would most benefit elderly patients and people with long term conditions, using an example of a previous practice relocation in Cambridge where the move brought together primary, community and hospital outreach services to provide a holistic model of care;

Noted that there are eight practices within a mile radius of Ravenscroft medical Centre.

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Were assured that the mobilisation plan put safeguards in place to allow the safe and compassionate transfer of the practice, with the move scheduled to take place in January 2020.

The three non-conflicted and co-opted Barnet voting members indicated that they had sufficient information to make a decision.

10.3 The Barnet members of the Committee APPROVED all three recommendations: The relocation of Ravenscroft Medical Centre to Finchley Memorial Hospital; Approve the amended revenues; Approve the proposed next steps: Ensure reasonable time for relocation to ensure patients had sufficient time to make

their choice; Ensure a high-quality package of communications to ensure patients were able to

make good choices that were right for them (including a letter to detail information on local practices and facilitate registration where this was the patient’s choice; and details of the local commissioning team if there were issues regarding registration);

Ensure patient records were transferred in a safe and timely manner; Ensure vulnerable patients were allocated a named member of staff ; Ensure regular communication and support to GP practices near Ravenscroft’s

patient population, to ensure they could manage any new patient registrations and maintain high-quality services. This included not restricting the time when patients had to register; providing additional appointments for vulnerable patients requiring early review; providing additional appointments for patients requiring urgent repeat prescriptions if required;

Implement the equality impact assessment recommendations; Pursue potential mitigations including enhanced public transport links.

. 10.4 Following the Committee decision members of the public asked for details of the appeals

process. They were directed to the Barnet CCG website for the complaints process and escalation procedure, and were informed that they could also take this to the Parliamentary Ombudsman where there was a nationally agreed process to follow.

11 Management of practices that close half a day

11.1 The Committee received an update on the process to ensure that all practice that closed for half a day had adequate cover arrangements in place to improve patient access. Eleven practices from the original thirty-seven were now identified as not having confirmed that the required cover arrangements were in place. Three significant changes in national guidance and regulation had resulted in practices reviewing their half day closure which were: Extended hours Directed Enhanced Service (DES) introduced in October 2017 –

practices closing for half a day were not eligible for continued funding through the extended access DES if adequate cover arrangements were not in place;

Meeting reasonable needs of patients set out in March 2018 NHS England national guidance - expectations of what practices should provide to meet the needs of the patients via their subcontracting arrangement during the half day closure;

Primary Care Network (PCN) Directed Enhanced Service (DES) introduced in July 2019 - ‘if a practice participating in the PCN DES does close half a day on a weekly basis without prior written approval and without appropriate sub-contracting arrangements in place, they will be in breach of the DES, as will the PCN practices.

The Committee was asked to approve the next steps in the process building in the emphasis to date of local resolution rather than a contractual approach: Step 1- issue a contract request for information to the remaining eleven practices that

continued to close half a day to either confirm if they were now open for the half-day

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or had a sub-contract agreement in place. Practices had 28 days to respond, and responses would come to the Committee in October 2019 for approval. To help the process commissioners would meet practices with the Local Medical Committee if requested;

Step 2 – request the approval and issue of remedial notices at the October 2019 Committee to practices not responding to the contract request for information and not having adequate cover arrangements in place.

11.2 In response to the report the Committee:

In line with the process to date hoped that resolution would be achieved in step one avoiding any need to issue contract remedial notices;

Received clarity on the definition of adequate sub-contracting arrangements in the NHS England guidance on meeting the reasonable needs of patients which set out that patients should be able to walk in, book an appointment, see the GP, get a prescription and be referred onwards where necessary;

Noted a request that approval should be on the basis of regulations rather than guidance.

11.3 The Committee APPROVED the recommended next steps as set out in section 11.1 above.

12 Primary Care Committee in Common Terms of Reference 12.1 The Committee was asked to approve a change to the Committee terms of reference to

allow deputations from patients and the public in line with CCG Governing Bodies. If the Committee approved the change the next step would be to present the revised terms of reference to the five CCG Governing Bodies in September 2019 for approval.

12.2 The Committee APPROVED the recommendation.

ITEMS FOR DISCUSSION 13 Finance Report

13.1 The Committee received the month four finance position (July 2019) for delegated

primary care budgets, with the Committee being asked to note: An overall overspend of £1.6m at month four and a forecast outturn pressure for the

year of £1.9m; The year-to-date pressure accrued from the costs of the GP at Hand service allocated

to NCL; The continuing pressure at Camden CCG was caused by the under estimate of the

population included in the financial allocation to the CCG; Development of the overall primary care finance report for the Committee was

progressing with CCG primary care and finance leads. The October meeting would receive the full report including both delegated and CCG expenditure. The actions for this was therefore kept open;

In line with a request from a previous meeting the Committee had received separately a report on the year-end position for 2018/19.

13.2 The Committee NOTED the report. 14 NCL Performance & Quality Report

14.1 Paul Sinden presented the paper, now produced locally by the NCL Primary care

Commissioning Team, noting that the paper addressed some of the actions the Committee had previously requested: An overview of new national guidance published setting out the role of CCGs in

responding to serious incidents in general practice;

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A summary of support for primary care development in NCL received from the Healthy London Partnership (HLP), with overall commissioning intentions for 2020/21from HLP under review across London;

A summary of the work that each CCG had undertaken with practices in response to patient survey results.

14.2 The Committee were further requested to note:

The recorded list size increase in all CCGs in the last year, alongside the increase in the average list sizes, particularly in Barnet, through the primary care development work including practice mergers;

West Green Surgery in Haringey had received an overall 'outstanding' rating from the Care Quality Commission;

The early warning system to support the struggling practices would be brought back to the Committee in October (as per the action log);

NHS England had been asked to provide further information on complaints themes through the London Primary Care Management Board meeting and had agreed to provide twice yearly updates on complaint themes;

The report on workforce development would come to the next Committee Seminar.

14.3 In response to the report the Committee: Noted Local Medical Committee concern about the guidance in managing serious

incidents in general practice, with this being picked up at the next NCL liaison meeting;

Noted the national review of access to general practice following the recent changes to GP contracts and introduction of Primary Care Networks. The national review would be informed by a practice visit in Islington and a meeting in Camden;

Welcomed the national access review, and asked that the context of patient survey results demonstrating difficulties with access be fed into local strategies alongside developments such as extended access hubs, digital access, and development of primary care networks. These service development were expected to improve in-hours access and the Committee asked that their impact on the use of extended access hubs be monitored. This would require the collection of GP appointment data to assess demand;

Noted the preparation of an NCL response to the ‘Digital-first’ Primary Care policy consultation on patient registration, funding and contracting rules’. The questionnaire had been circulated to all NCL practices to inform the response;

Requested that good practice from West Green Surgery in Haringey that had received an “outstanding” rating from the Care Quality Commission be shared across NCL;

14.4 Action: Review the good practice and lessons learnt from West Green Surgery in Haringey

which received an outstanding rating from the Care Quality Commission. (Rachel Lissauer).

14.5 The Committee NOTED the report. 15 Protocol for the PCC to provide clarity on the process for managing any changes

to Primary Care Networks. (PCNs) 15.1 The Committee received a report, in response to the request at the June 2019 meeting,

summarising the responsibilities of CCGs and Primary Care Networks (PCNs) for changes to PCN composition, monitoring and financial responsibilities, as set out in national guidance through the Directed Enhanced Services (DES) specification. The guidance covered actions required for scenarios such as practice withdrawal from networks, practice splits and mergers, relocations, list closures, and catchment area changes impacting on other networks.

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The Directed Enhanced Service would run until March 2024 and involved significant funding flows, and therefore a local process for monitoring PCN payments had been developed including quarterly reports from all payees.

15.2 In response to the report the Committee requested a more detailed review of the national guidance at a future Committee Seminar in the context of: The impact on network financial stability and workforce accruing from any changes to

PCN composition, with changes being made in line with the process set out in the national guidance;

The alignment of core funding through the contract (including through the PCN Directed Enhanced Service) and enhanced primary care funded by CCGs.

15.3 Action: To discuss the process for managing changes to PCNs at the next Seminar. (Paul

Sinden)

15.4 The Committee NOTED the paper. ITEMS TO NOTE - URGENT DECISIONS TAKEN SINCE 20 JUNE 2019 16 None taken.

ITEMS TO NOTE AND INFORMATION 17 PCCC Risk Register 17.1 Paul Sinden presented the paper summarising actions to address the risks falling within

the remit of the Committee. In line with the Committee request in June 2018 a new risk relating to the establishment of Primary Care Networks (PCNs) through the new national GP contract introduced in April 2019 with the risk focusing on alignment of the PCNs to the primary care provider landscape and managing conflicts of interest. The risk had been rated below the risk reporting threshold but was included in the August 2019 report for the sake of completeness.

17.2 The Committee NOTED the risk report.

18 Committee Forward Planner 18.1 The Committee NOTED the forward planner. 19 Any other Business 19.1 None. 20 Date of next meeting 20.1 Thursday 17 October 2019, 3pm to 4:30pm at Islington CCG, Clerkenwell Room, 2nd

Floor, Laycock Centre, Laycock Street, London N1 1TH.

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Item 4 - NCL Primary Care Joint Committee - Action Log Open Actions

Meeting Date

Action No.

Minutes Ref

Action Action lead

Deadline Status update Date closed

22.08.19 2 14.4 NCL Performance & Quality Report - To review the good practice and lessons learnt from West Green Surgery in Haringey which received an outstanding rating from the CQC.

Owen Sloman

17.10.19 08.10.19 – Please see attached paper on West Green Surgery at the back of the action log. Recommend to close the action.

22.08.19 3 15.3 Protocol for the PCN to provide clarity on the process for managing any changes to PCNs - To discuss the process for managing changes to PCNs at the next Seminar.

Paul Sinden / Vivienne Ahmad

17.10.19 04.10.19 – Scheduled for the PCCC Seminar on 21 November 2019. Recommend to close the action.

20.06.19 1 3.2 Declarations of Interest relating to items on the Agenda – Declarations for Part I and Part II meetings from all practice representatives to be updated for Primary Care Network (PCN) membership, including roles as Clinical Director, and if their practices were acting as a payee for a PCN.

Vivienne Ahmad

TBC 04.10.19 - Awaiting updates from Enfield and Camden CCGs. 22.08.19 - The Committee agreed to keep this action opened. The declaration document has been updated to include reference to PCNs and we have commenced the annual refresh of declarations for all key parties.

20.06.19 5 8.3 Finance Report: June 2019/20 - To provide the following to the next Finance Report:

• Update on the registered list size • comparison to the previous year and

the growth breakdown per CCG • to include the PCN funding and a

breakdown per CCG to understand the allocation better.

• level of deprivation across the boroughs

• waiting list size

Tracey Lewis

17.10.19 04.10.19 – Until further notice, the Committee will received a bi-monthly delegated report. 22.08.19 - The Committee agreed to keep this action opened. It was noted the information requested for this meeting was progressing with all the commissioning leads of all CCGs and primary care and would now be reported at the next meeting in October 2019. This will be a half year report

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which will be extensive, precise and have correct headings. It will also include the discretionary spends in the CCGs and the primary care areas as well as the delegated commissioning expenditure. 26.07.19 - The information requested has been added to the Finance report going to the August meeting.

20.06.19 6 9 .3 NCL Quality & Performance Report - • Future reports to incorporate PCN

performance • Report to be produced locally for

meeting on 22 August 2019 • Greater granularity on NHSE themed

review of complaints • Additions to early warning system

suggested by Healthwatch • CCG work with practices on

improving patient experience into August 2019 report.

Paul Sinden / Anthony Marks

Vanessa Piper /

CCG Reps

17.10.19 04.10.19 - The Committee agreed to keep this action opened. Report on the early warning system deferred to December 2019 from October 2019. Healthwatch suggestions added into framework for early warning system. NHSE have been asked to provide greater detail on complaints themes through London Primary Care Management Board (reports on complaints themes to be received every six months)

20.06.19 11 18.2 AOB – (a) To provide an update on the role of

the Committee post any merger of NCL CCGs.

(b) to provide an update on the roles and recruitment to the external clinical posts over and above the current practice nurse member as stated in the PCCC Terms of Reference.

Paul Sinden

17.10.19 04.10.19 – Role of Primary Care Committee to be determined through overall governance review for NCL CCGs. 22.08.19 - The Committee agreed to keep this action opened. 14.08.19 - Governance arrangements from April 2020 are being developed. The primary care committee to consider delegated primary care medical services will be maintained, with terms of reference to be developed.

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Closed Actions

Meeting Date

Action No.

Minutes Ref

Action Action lead Deadline Status update Date closed

22.08.19 1 4.2 Minutes of the previous meeting held on 200 June 2019 - To amend the minutes of the meeting held on 20 June 2019. Janet High should have been added to the voting members section rather than being in attendance.

Vivienne Ahmad

23.08.19 23.08.19 - The minutes were duly amended. Recommend to close this action.

22.08.19

20.06.19 2 4.2 Minutes of the previous meeting held on 18 April 2019 - To amend the minutes and add that Kathy Elliot was deputising for Glenys Thornton at the PCCC meeting on 18 April 2019 and to amend Mr Richards first name to Mr Phillip Richards.

Vivienne Ahmad

21.06.19 22.08.19 - The Committee agreed to close this action. 21.06.19 - This was duly updated. Recommend to close the action.

22.08.19

20.06.19 3 7.2 Questions from the Public - To clarify the definition 'Stakeholders' to be consulted through the Online Engagement Hub.

Francesca McNeil

22.08.19 22.08.19 - The Committee agreed to close this action. 14.08.19 - For the development of the Online Engagement Hub we have involved the following stakeholders: Communication and Engagement teams from all NLP Partners - Local Authorities, Providers NHS Foundation Trusts, CCGs, residents, Healthwatch (Barnet, Camden, Enfield, Haringey, Islington), representatives from community voluntary sector through Engagement Advisory Board, NLP staff. Recommend to close the action.

22.08.19

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20.06.19 4 7.3 Questions from the Public - To bring back the Terms of Reference (TORs) including deputations and further updates on the PCCC membership.

Andrew Spicer 22.08.19 22.08.19 - The Committee agreed to close this action. 26.07.19 - TORs are on the agenda for 22 August 2019. Recommend to close this action.

22.08.19

20.06.19 7 10.8 Primary Care Networks (PCNs) – A paper on the process for managing any changes to Primary Care Network membership and on the assurance role of the Committee with regards to the Networks to come to the Committee in August 2019.

Sarah Mcilwaine / Paul Sinden

22.08.19 22.08.19 - The Committee agreed to close this action. 12.08.19 – A paper is on the agenda for 22 August 2019. Recommend to close this action.

22.08.19

20.06.19 8 11.2 Learning from the GP Patient Survey - Each CCG to provide a summary of work undertaken in response to patient survey results within the Quality and Performance Report for the Committee in August 2019.

CCG Representatives

22.08.19 22.08.19 - The Committee agreed to close this action. 14.08.19 - Included in the Quality and Performance Report. Recommend to close this action.

22.08.19

20.06.19 9 14.2 Contract Variations – • Future contract variation reports to

include practice Primary Care Network (PCN) membership.

• Future practice boundary variations that cross CCG boundaries receive approval from both CCGs before the variation is brought to the Committee.

All 22.08.19 22.08.19 - The Committee agreed to close this action. 14.08.19 - Included in the Contract Variation Report. Recommend to close this action.

22.08.19

20.06.19 10 16.3 PCCC Risk Register - Addition of the risk relating to establishment of Primary Care Networks incorporating governance risks (conflicts of Interest) and alignment with Integrated Care Systems, with the risk falling within the remit of the Committee.

Paul Sinden 22.08.19 22.08.19 - The Committee agreed to close this action. 14.08.19 - Included in the Risk Register. Recommend to close this action.

22.08.19

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18.04.19 2 3.3 Minutes of the previous meeting held on 21 February 2019 - To provide an update on the roles and recruitment to the external clinical posts over and above the current practice nurse member as stated in the Terms of Reference.

Paul Sinden 20.06.19 22.08.19 - The Committee agreed to close this action as it was a duplication of action 11 of 20 June 2019. 20.06.19 –The roles and recruitment will be determined in line with moving the five CCGs into a single structure.

18.04.19 3 8.3 NCL Quality & Performance Report - To clarify with NHSE the reduction (in each CCG) of the list size from February 2019.

Paul Sinden 22.08.19 22.08.19 - The Committee agreed to close this action. 20.06.19 – There was an error in the early reports. List sizes will now be sourced from local reports. Recommend to close this action.

22.08.19

21.02.19 1 5.2 Matters Arising: GP Practice space declared surplus to requirements – To agree the governance process for declaring GP Practice space as being declared surplus to requirements.

Paul Sinden and Andrew

Spicer

20.06.19 22.08.19 - The Committee agreed to close this action. 20.06.19 – NCL Primary and Community Estates Board makes recommendations for release of surplus practice space on basis of CCG recommendations and in line with GP contract.

22.08.19

21.02.19 8 16.3 Management of practices who close half a day - An update report to be received by the Committee in April 2019.

Vanessa Piper 20.08.19 22.08.19 - The Committee agreed to close this action. 20.06.19 – Paper on the agenda for PCCC meeting on 22 August 2019.

22.08.19

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Recommend to close this action. 11 out of original 37 practices have yet to put in place adequate cover arrangements. Progress to date through working with practices rather than through contract remedy.

20.12.18 6 7.3 Performance & Quality Report - to agree with NCL CCGs’ Directors of Quality the proposal that QISTs would support practices re SI and sharing the learning; a paper summarising the implementation of incidents in general practice, teasing out the role of CCG Quality and Safety teams, GP practices, Federations and QISTs.

Paul Sinden / Neeshma Shah

/ Dominic Roberts

22.08.19 22.08.19 - The Committee agreed to close this action. 22.07.19 – Overview of guidance included in the report. Recommend to close this action.

22.08.19

20.12.18 7 8.3 London Strategic Framework for Primary Care - To assess the degree of alignment of Healthy London Partnership (HLP) initiatives with those of the CCGs to help determine the level of synergy that exists.

Paul Sinden 22.08.19 22.08.19 - The Committee agreed to close this action. 20.06.19 - Overview of guidance included in the Quality and Performance Report. Recommend to close this action.

22.08.19

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Lessons from West Green

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• West Green surgery serves 15,000 patients in a deprived area of South Tottenham. Practice was formed by Dr Muhammed Akunjee senior, whose family grew up in the flat above the surgery. Two of his sons Muhammed and Nazmul became GPs and took over the practice.

• The two brothers have won a series of innovation awards. These include the Royal College of GPs Innovation award for their Proactive Virtual GP Clinic, winner of the innovation award in the NHS Sustainability award and the General Practice award for Clinical Team of the year in Respiratory practice. The two brothers are also joint authors of primary care text books.

• Nazmul Akunjee is the CCG’s GPIT lead and a member of the CCG’s Primary Care Steering Group. Muhammed Akunjee is the Clinical Director for the East Central Primary Care network, which includes two practices which have been placed in special measures.

• The practice has outgrown its building and the CCG is working to secure the practice a new building in a prominent location.

West Green is the only practice in NCL to be rated as “Outstanding” by the CQC

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CQC rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care. This element was supported by evidence of a bespoke IT application that was used to analyse patient data and send automated bulk SMS messages to patients. The message would include the patients actual blood test values with target aims and compared the most recent result to the previous result identifying whether the patients’ condition had worsened, improved or been maintained. The practice surveyed patients to identify the effectiveness of standard information leaflets inserted in medicine packaging and received feedback that patients frequently found these difficult to read and understand. To help patients better understand and manage their own health, the practice created medicine specific warnings, advice and guidance and arranged for these to be printed onto the medication packaging given to patients by a pharmacist.

• There were innovative approaches to providing integrated person-centred care. The practice created an online portal, available through the practice website, where patients could undertake guided health checks at home and submit information to the practice, for instance, blood pressure, an asthma questionnaire and smoking status. The practice encouraged patients to submit blood pressure results in line with NICE guidance which states home readings are more accurate than clinical readings as they reduce ‘white-coat’ hypertension.

• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

CQC rated the practice as outstanding for providing Well-led services because:

• The culture of the practice and the way it was led and drove the delivery and improvement of high-quality, person-centred care.

• Governance systems were supported by innovative solutions to ensure priorities were achieved.

“I think the crux of the success in the surgery is two fold. 1. using IT and efficient solutions and processes to give the patient a service that is more tailored to their needs. 2. having a slim but hardworking, responsive, caring and united workforce who go the extra mile for the patient.” Dr Muhammed Akunjee

3

Practice won outstanding award for its responsive services and leadership

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Central London Primary Care Committee in Common Meeting – 17 October 2019 Report Title Primary Care Finance

Report (October 2019)

Date of report

7th October 2019

Agenda Item

8




GB Member Sponsor

N/A

Report Author

Tracey Lewis – Interim Head of Finance for NCL Primary Care


Name of Authorising Finance Lead

Rebecca Booker Camden CCG Deputy Director of Finance

Summary of Financial Implications 19/20 Primary Care Delegated Commissioning budgets, YTD expenditure and FOT as at M5 for the five North Central London CCGs.

Report Summary

This report presents the 19/20 Primary Care Delegated Commissioning budgets, YTD expenditure and FOT as at M5 for the five North Central London CCGs.

Recommendation The Primary Care Committee in Common is asked to NOTE the contents of this report.


This report is one element used to monitor the Clinical Commissioning Group’s financial and other performance in terms of adherence to core statutory duties.



There are no resource implications arising from this report.

Engagement

This report is being presented to the Committee which includes lay members, clinicians and key stakeholders.


This report was written in accordance with the provisions of the Equality Act 2010.


N/A

Next Steps N/A

Appendices None

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Primary Care Delegated Commissioning Finance Report

M5 2019/20

1 of 150

Executive Summary

2

• This report presents the 2019/20 Delegated Primary Care financial position across the five North Central London (NCL) CCGs (Barnet, Camden, Enfield, Haringey and Islington CCG) as at Month 5, August 2019

• The report summarises the Month 5 expenditure against budgets. Previously the committee have received the finance report detailing the position as at Month 3, June 2019

• As at Month 5, the NCL Primary Care budget is forecasting a net over-performance of £1.87m against an allocation of £222.4m

• In 2019/20 NCL continues to face significant financial pressures across the wider health and care arena and Primary Care expenditure is managed within each individual CCG control totals

• GP At Hand is a significant risk to NCL in 2019/20

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2019/20 NCL Primary Care Delegated Commissioning Summary as at Month 5

• The table below summarises the 2019/20 NCL Primary Care Delegated Commissioning Summary as at Month 5 • The total Primary Care Delegated Commissioning Allocation for 2019/20 is £220.5m (18/19 £211m)• There is a planned 2019/20 cost pressure to Camden CCG of circa £1.9m • The M5 overspend variance of £2.1m is primarily due to the GP At Hand YTD costs being attributed to Delegated

Commissioning

3

£000's £000's £000's £000's £000's £000'sPMS 94,952 39,562 39,852 (290) 94,952 0GMS 96,108 40,044 40,298 (254) 96,108 0APMS 11,337 4,724 4,856 (132) 11,337 0Other Medical Services 7,392 3,079 5,281 (2,201) 7,392 0Other Committed Funds 10,752 3,792 3,035 757 12,619 (1,867)Total Primary Care Medical Services 220,541 91,200 93,321 (2,121) 222,408 (1,867)

YTD Variance Fav/(Adv)Service

Annual Budget YTD BudgetYTD Actual

Expenditure

Forecast Variance

Fav/(Adv)

Forecast Outturn

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2019/20 Primary Care Delegated Commissioning Expenditure by CCG as at

Month 5

4

• The tables below summarise the 2019/20 Primary Care Delegated Commissioning expenditure by CGG as at Month 5 • Barnet, Enfield, Haringey and Islington are all forecast to breakeven• There is a planned 2019/20 cost pressure to Camden CCG of circa £1.9m

Barnet CCG £000's £000's £000's £000's £000's £000'sPMS 23,105 9,627 9,732 (106) 23,105 0GMS 25,306 10,544 10,448 96 25,306 0APMS 466 194 202 (8) 466 0Other Medical Services 3,091 1,288 1,792 (504) 3,091 0Other Committed Funds 1,252 522 199 322 1,252 0Total Primary Care Medical Services 53,220 22,174 22,373 (199) 53,220 0

Forecast Outturn

Forecast Variance

Fav/(Adv)Annual Budget YTD Budget

YTD Actual Expenditure

YTD Variance Fav/(Adv)

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5


Month 5

Camden CCG £000's £000's £000's £000's £000's £000'sPMS 20,695 8,623 8,506 117 20,695 0GMS 15,580 6,492 6,370 122 15,580 0APMS 3,306 1,377 1,380 (2) 3,306 0Other Medical Services 1,521 634 870 (236) 1,521 0Other Committed Funds (1,867) (778) 405 (1,183) 0 (1,867)Total Primary Care Medical Services 39,234 16,348 17,531 (1,183) 41,101 (1,867)

Enfield CCG £000's £000's £000's £000's £000's £000'sPMS 26,604 11,084 11,422 (338) 26,604 0GMS 11,594 4,830 5,211 (381) 11,594 0APMS 2,230 929 939 (10) 2,230 0Other Medical Services 1,251 521 316 205 1,251 0Other Committed Funds 3,036 1,265 814 451 3,036 0Total Primary Care Medical Services 44,715 18,630 18,703 (73) 44,715 0

Forecast Variance

Fav/(Adv)Annual Budget YTD Budget

YTD Actual Expenditure

YTD Variance Fav/(Adv)

Forecast Outturn


ExpenditureYTD Variance

Fav/(Adv)Forecast Outturn

Forecast Variance

Fav/(Adv)

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6


Month 5

Haringey CCG £000's £000's £000's £000's £000's £000'sPMS 22,971 9,571 9,533 38 22,971 0GMS 14,144 5,893 5,611 282 14,144 0APMS 3,525 1,469 1,532 (64) 3,525 0Other Medical Services 1,010 421 500 (80) 1,010 0Other Committed Funds 2,885 1,202 1,616 (414) 2,885 0Total Primary Care Medical Services 44,535 18,555 18,792 (237) 44,535 0

Islington CCG £000's £000's £000's £000's £000's £000'sPMS 1,578 657 658 (1) 1,578 0GMS 29,484 12,285 12,658 (373) 29,484 0APMS 1,810 754 802 (48) 1,810 0Other Medical Services 519 216 1,803 (1,586) 519 0Other Committed Funds 5,446 1,581 0 1,581 5,446 0Total Primary Care Medical Services 38,837 15,494 15,922 (428) 38,837 0

Forecast Variance

Fav/(Adv)




Forecast Variance

Fav/(Adv)




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7

2019/20 Primary Care Delegated Commissioning Breakdown by CCG as at Month 5

NHS Barnet CCG £'000

NHS Camden

CCG £'000

NHS Enfield

CCG £'000

NHS Haringey

CCG £'000

NHS Islington

CCG £'000 Total £'000


NHS Camden

CCG £'000

NHS Enfield

CCG £'000

NHS Haringey

CCG £'000

NHS Islington

CCG £'000

Total £'000


NHS Camden

CCG £'000

NHS Enfield

CCG £'000

NHS Haringey

CCG £'000

NHS Islington

CCG £'000 Total £'000

General Practice - GMS 19,128 11,309 8,893 10,288 22,104 71,722 7,940 4,627 3,702 4,092 9,199 29,560 19,128 11,309 8,893 10,288 22,104 71,722General Practice - PMS 17,869 15,485 20,490 18,383 1,293 73,519 7,548 6,361 8,656 7,745 522 30,832 17,869 15,485 20,490 18,383 1,293 73,519Other List-Based Services (APMS incl.) 393 2,585 1,707 3,102 1,293 9,080 164 1,064 711 1,289 539 3,767 393 2,585 1,707 3,102 1,293 9,080Premises cost reimbursements 5,091 6,009 4,012 4,318 4,292 23,721 2,058 2,473 1,985 1,772 1,909 10,197 5,091 6,009 4,012 4,318 4,292 23,721Enhanced services 2,062 1,556 1,746 1,609 1,495 8,468 819 705 715 597 953 3,788 2,062 1,556 1,746 1,609 1,495 8,468QOF 4,336 2,635 3,580 2,942 2,395 15,887 1,853 1,026 1,805 1,181 997 6,861 4,336 2,635 3,580 2,942 2,395 15,887Other - GP Services 3,091 1,521 1,251 1,010 519 7,392 1,792 870 316 500 1,803 5,281 3,091 1,521 1,251 1,010 519 7,392Other Committed Funds 1,252 (1,867) 3,036 2,885 5,446 10,752 199 405 814 1,616 0 3,035 1,252 0 3,036 2,885 5,446 12,619

TOTAL 53,220 39,234 44,715 44,535 38,837 220,541 22,373 17,531 18,703 18,792 15,922 93,321 53,220 41,101 44,715 44,535 38,837 222,408

YTM5 Actuals FOT @ M5

GP Primary Care Co Commissioning

Annual Budget

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2019/20 Primary Care Delegated Commissioning Risks as at Month 5

8

• The table below summarises the 2019/20 Primary Care Delegated Commissioning risks as at Month 5 • The total reported risk is £3.22m all relating to GP At Hand

Total

£'000

GP At Hand (478) (972) (176) (568) (1,028) (3,222)

Total Risk (478) (972) (176) (568) (1,028) (3,222)

Islington

£000's

Barnet

£000's

Camden

£000's

Enfield

£000's

Haringey

£000's

Reported Risk

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North Central London Primary Care Committee in Common Meeting 17 October 2019

Report Title Performance and Quality Report Date of

report 3 October 2019

Agenda Item 9




GB Member Sponsor


Report Author



Report Summary

1. Introduction This report sets out: • The latest Quality Report for comment. This has now been

produced locally following NHS England no longer preparing the report. The report therefore provides:

• An overview of the quality and performance report; • A summary of actions accruing from the quality report; • An overview of comparative performance across Boroughs, as

previously requested by the Committee; • Following the summary of CCG work with practices in response to

patient survey results provided in August 2019 a comparison of London and national performance from NHS England is provided.

Recommendation The Committee is asked to:

• NOTE and COMMENT ON the performance and quality report;


The report outlines areas where support to practices is required, and where formal action requiring remedial actions plans are required.


Conflicts of interest are managed robustly and in accordance with the CCG’s conflict of interest policy.

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2


The report helps to identify practices in need of resilience funding. Local primary care development plans, including the GP Forward View and developing primary care at scale seek to address variations in care and access described in the report.

Engagement

The report includes patient experience measures from the Friends and Family Test and GP Patient Survey carried out by Ipsos MORI.


This report was written in accordance with the provisions of the Equality Act 2010.


The Quality Report relates to the shared responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning primary care services in North Central London.

Next Steps Local reporting will be further extended through work with the Care Closer to Home workstream and CCGs.

Appendices

• Quality Report to the NCL Primary Care Committee-in-Common; • NHS England report on patient survey results.

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3

NCL CCG Primary Care Committee-in-Common Quality Report

1. Introduction This report sets out: • The latest Quality Report for comment. This has now been produced locally following NHS

England no longer preparing the report. The report therefore provides: • An overview of the quality and performance report; • A summary of actions accruing from the quality report; • An overview of comparative performance across Boroughs, as previously requested by the

Committee; • Following the summary of CCG work with practices in response to patient survey results

provided in August 2019 a comparison of London and national performance from NHS England is provided.

2. Quality Report The report is a consolidation of publicly available information on individual practice performance, and is therefore included in Part I of the Committee (a meeting in public). The reports has been produced locally by the primary care commissioning team (from within existing resources) following NHS England ceasing production. This report aims to highlight practice sustainability through an aggregation of national indicators and local knowledge. The table draws together a multitude of indicators from an array of sources, including data from Care Quality Commission (CQC) ratings, GP Patient Survey (GPPS) results and practice demographics. The metrics in this report have been used to identify and support practices in difficulty through the resilience programme. Local teams were asked to identify those practices which were considered in difficulty and those which would benefit from Resilience Programme support. National criteria in this report were created for use as a screening tool by local commissioners to guide their assessment with local stakeholders on offers of support to improve sustainability and resilience. Hard copies of the report for each CCG will be provided at the meeting. Appendices to the report include references for the information contained and a glossary of terms.

3. Actions accruing from the report This section summarises how the report is used to make commissioning decisions and apply primary care medical contracts where applicable. The table below summarises commissioning actions undertaken against the performance domains in the report:

Domain Indicator Description of action taken

Quality Care Quality Commission (CQC) ratings; Complaints

1. Informal remedial action - Number of practices under improvement plan review

2. Formal remedial action - number of practices issued a remedial notice

3. Practice mergers 4. Infection control audits

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Efficiency Quality Outcomes Framework (QOF); List size changes; Friends and Family Test (FFT)

1. Performance improvement plans 2. Quality Improvement Support Teams (QISTs) to

reduce unwarranted variations 3. Care Closer to Home Integrated Networks (CHINs) /

Neighbourhoods development 4. Resilience funding 5. Financial assistance (Section 96)

Workforce Age profile; Full-time equivalents (FTE) for GPs and Nurses

1. Pharmacists in Practice 2. GP retention scheme 3. Medical Assistance Programme 4. Training programmes

Patient Experience

GP Patient Survey 1. National access programme 2. GP access Hubs 3. Performance improvement plans

Patient Online

Online appointments; Repeat Prescriptions

1. Differential access linked to deprivation levels in some CCGs – ensure digital inclusion part of roll-out.

Extended Access

Extended access days; Direct Enhanced Service (DES) sign up

1. GP Hubs 2. DES sign up 3. National access programme

Premises New schemes; Relocation into compliant buildings; Void space

1. Improvement grant awards 2. Capital funding awards 3. Service charge financial assistance applications

The report will also be used to provide as a source of information to help develop and early warning system to identify struggling practices and enhance current levels of support prior to any regulatory action being taken. The early warning system will be developed across North Central London. The report has enabled the following actions to be undertaken: • Remedial notices have been issued to practices receiving Care Quality Commission (CQC)

ratings of inadequate or requires improvement, with practices developing action plans to address CQC findings. This has in turn prompted the following work by CCGs: Development of an early warning system to identify struggling practices before regulatory

action required has begun; Practice Caretaking arrangements put in place where required to secure service continuity; Practice resilience support programme; CCG have facilitated practice mergers to support struggling practices and reduce variations

in care; • Practices with low Quality Outcomes Framework (QOF) scores receive a performance report

with a series of actions agreed with NHS England Medical Directorate to improve delivery; • Actions to address workforce gaps includes participation in international recruitment, focus on

workforce in general practice strategy for NCL, employment of greater skill-mix in practices (this will now be supported by the new GP contract and extended definition of core staff that will attract funding);

• CCG teams have been working with practices in response to the results of the patient survey with updates on the work being provided to the Committee by each CCG in June 2019;

• The identification of differential access to patient on-line initiatives according to deprivation;

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• Access developments include action to ensure all practices have adequate cover arrangements for any half-day closures in operation. 100% population coverage for extended access schemes in place across NCL;

• Development of NCL-wide process to identify both major capital schemes for general practices and the award of minor improvement grants. Estates and Technology Transformation Funds (ETTF) received for general practice strategic developments (Haringey business cases considered by the Committee in February 2019. The Committee has also considered amendments to premises directions to ensure premises are used effectively and support primary care development.

4. Overview of performance This section sets out an overview of performance across CCGs from the quality report. The report sets out performance by CCG and an overview of practice outliers in performance compared to CCG averages. Performance for practices, and across CCGs, should be assessed against the range of indicators provided (Care Quality Commission ratings, patient experience responses, Quality Outcomes Framework achievement, and written complaints received) to arrive at a rounded view of performance rather than using single measures of performance. Demographic, finance, and workforce information is then provided as context. 4.1 Demographics This section provides a summary of population profiles for practices including: • Deprivation in a range of 1-5, with 1 being the most deprived and 5 the least deprived;

percentage of patients aged over 75; • Average list size per practice and list size change over the 12 months to February 2019; • Average payment per weighted patient

Barnet Camden Enfield Haringey Islington Contract type GMS 29/52

PMS 23/52 APMS 0/52

GMS 15/35 PMS 16/35 APMS 4/35

GMS 18/47 PMS 27/47 APMS 2/47

GMS 15/37 PMS 22/37 APMS 0/37

GMS 28/32 PMS 2/32 APMS 2/32

Deprivation: 1 = most deprived 2 3 4 5 = least deprived Null

1 3

14 29 5 0

6

12 8 5 2 2

22 4

12 6 3 0

15 9 7 4 0 2

16 15 1 0 0 0

Patients aged > 75 on list 6% 4% 6% 4% 4% % list non-black & ethnic minority 63% 65% 60% 58% 67% Average list size 8,265 8,642 7,372 8,784 8,123 Annual list size change +3% +4% +1% +3% +5% Average payment per weighted patient

2017/18 £138 2016/17 £133

2017/18 £150 2016/17 £153

2017/18 £136 2016/17 £139

2017/18 £133 2016/17 £136

2017/18 £138 2016/17 £136

To note: • The relatively high rates of deprivation in Enfield, Haringey and Islington; • The higher rate of over 75s in Barnet and Enfield;

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• Average list sizes per practice highest in Camden and Haringey and lowest in Enfield. Increase in Barnet average following merger of the three practices in East Barnet Health Centre;

• List sizes, and annual changes, are based on June 2019, with all CCGs showing an annual increase in list size varying from 1% in Enfield CCG to 5% in Islington CCG;

• Payment per weighted patient is based on 2017/18 figures with previous reports based on 2016/17 figures. The headline figures need further analysis to isolate cost differentials across CCGs in particular for estates costs.

4.2 Care Quality Commission The Care Quality Commission (CQC) rates general practices to give an overall judgement of the quality of care. The CQC applies four ratings to practices, as is the case for other health and social care services. Practices are assessed across five key areas for quality of care (caring, effectiveness, responsiveness, safety, being well-led). The table below summarises Care Quality Commission (CQC) ratings for practices within each CCG as at June 2019:

CQC ratings Barnet Camden Enfield Haringey Islington Overall rating: Outstanding Good Requires Improvement Inadequate Yet to be rated

0

50 1 0 1

0

35 0 0 0

0

44 3 0 0

1

32 0 3 1

0

30 2 0 0

Rating for caring: Outstanding Good Requires Improvement Inadequate Yet to be rated

0

51 0 0 1

0

34 1 0 0

0

47 0 0 0

0

33 1 2 1

0

32 0 0 0

Rating for effectiveness: Outstanding Good Requires Improvement Inadequate Yet to be rated

0

50 1 0 1

1

33 1 0 0

0

44 3 0 0

0

33 1 2 1

0

30 1 1 0

Rating for responsiveness: Outstanding Good Requires Improvement Inadequate Yet to be rated

0

49 2 0 1

0

34 1 0 0

0

47 0 0 0

1

33 0 2 1

0

31 1 0 0

Rating for safety Outstanding Good Requires Improvement Inadequate Yet to be rated

0

48 3 0 1

0

35 0 0 0

0

44 3 0 0

0

33 1 2 1

0

31 0 1 0

Rating for being well-led: Outstanding Good Requires Improvement Inadequate Yet to be rated

1

49 1 0 1

0

35 0 0 0

0

44 3 0 0

2

31 0 3 1

0

30 2 0 0

To note from the above:

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• The majority of practices assessed to date have received a good rating, with this including all practices in Camden;

• The first practice in North Central London has received an overall “outstanding” rating – West Green Road Surgery in Haringey;

• Three practices in NCL are currently rated as inadequate by the Care Quality Commission (CQC), with an additional practice in Haringey receiving this rating offset by a practice in Camden moving from an inadequate to good rating. These practices will be subject to formal remedial action through the primary care medical services contract, as well as being required to complete an action plan to address concerns raised by the CQC;

• Six practices (previously seven practices in August 2019) across NCL have received a requires improvement rating;

• Two practices (previously three practices) across North Central London have yet to receive a visit from CQC and/or are yet to receive their report. All practices have inspections scheduled with the CQC;

• An early warning system is going to be developed to identify struggling practices, and enhance existing support mechanisms, prior to regulatory action being required. Once developed the early warning system will be applied to all practices that have yet to receive their Care Quality Commission (CQC) inspection.

4.3 Quality Outcomes Framework The Quality Outcomes Framework (QOF) was introduced as part of the new General Medical Services contract in April 2014, with the intention to improve the quality of care patients are given by rewarding practices for the quality of care they provide to patients. The table below summarises performance for each CCG area, and for comparison the national achievement was 94.7%. Note the data is now available for 2017/18 as well as 2016/17 and 2015/16.

Quality Outcomes Framework Barnet Camden Enfield Haringey Islington % achievement in 2017/18 96.8% 96.3% 95.3% 95.8% 96.4% % achievement in 2016/17 96.7% 96.3% 95.2% 95.8% 96.4% % achievement in 2015/16 95.8% 96.3% 95.2% 96.1% 96.4% Practices with less than 70% 0 0 0 0 1 Practices with less than 80% 0 1 0 0 0 Practices with 80% to 90% 2 2 6 2 1

Aggregate performance for each CCG is above the national average. The table reports by exception the number of practices in each CCG with achievement materially below CCG average scores. Quality Outcomes Framework (QOF) outcomes for those practices achieving less than 90% when cross-referenced to Care Quality Commission ratings show: • For the 2 Barnet practices both practices have an overall good CQC rating; • All 3 Camden practices have an overall good CQC rating; • For the 6 Enfield practices 5 practices have received an overall good CQC rating and 1

practice a requires improvement rating; • For the 3 Haringey practices 2 practices have an overall good CQC rating, with the other

practice yet to receive an assessment. The 3 practices with an inadequate rating all have QOF scores in excess of 90%;

• For the 2 Islington practices 1 practice has an overall good CQC rating and 1 practice has an overall requires improvement rating.

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4.4 Patient experience The GP patient survey is an independent survey run by Ipsos MORI on behalf of NHS England, with the survey being sent to over one million people nationally. The survey results presented were published in August 2018 and cover the period from January to March 2018. The Friends and Family Test asks patients how likely they are to recommend their GP service to friends and family based on their most recent experience of service use, with the results showing those likely or extremely likely to recommend their practice. Results are from December 2018.

Patient Experience Barnet Camden Enfield Haringey Islington GP patient survey – good overall experience of the practice

79% 83% 78% 78% 83%

GP patient survey – easy getting through by phone

64% 79% 63% 71% 79%

GP patient survey – satisfied with type of appointment offered

68% 73% 67% 70% 72%

Friends and family test: Average recommendation % Practices with results Range of recommendation %

87%

18/52 55% - 100%

90%

16/35 59% - 100%

85%

31/47 69% - 100%

84%

18/37 57% - 100%

87%

12/32 68% - 100%

The friends and family test does not provide an outcome for each practice, so the average is shown for those practice with a patient response recorded. A broad range of recommendation across practices is shown within each CCG area. 4.5 Complaints The NHS Complaints procedure is the statutorily based mechanism for dealing with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure. The table shows the average number of written complaints made by patients and/or their carers during 2017/18 per practice and in total, previous figures for 2016/17 are in red.

Written complaints received Barnet Camden Enfield Haringey Islington Number of complaints received in 2017/18 and 2016/17

582 610

430 416

530 527

411 394

346 377

Complaints escalated to NHSE 31/582 8/430 39/530 36/411 18/346 Average received per practice 10 11 12 13 11 11 11 11 11 11 Average per 1000 people on list 1.4 1.4 1.5 1.5 1.5 1.5 1.2 1.3 1.5 1.4 Range received per practice per 1000 people on the list

0 – 4.8 0 – 6.7

0 – 5.9 0 – 7.4

0 – 4.9 0 – 5.7

0 – 3.4 0.2 – 3.1

0 – 4.8 0 – 4.0

The number of complaints received by per head of population, and by practice, is consistent across the five CCGs. Within each CCG there is a broad range of complaints received across practices. This report adds in the complaints escalated to NHS England as they have not been resolved locally by the practice. In response to the Committee request to have a view of complaints themes and trends – the national team at NHS England have been asked to check the granularity of the information available through reporting on the governance portal.

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4.6 Access The table below shows that all practice lists have extended access to general practice services seven days per week through primary care hubs, and where individual practices provided extended access through the Direct Enhanced Service.

Access to general practice Barnet Camden Enfield Haringey Islington Seven-day extended access to general practice though primary care hubs

100% 100% 100% 100% 100%

Practices participating in Direct Enhanced Service for practice-based extended access

50/54 24/34 41/47 34/37 27/33

4.7 Workforce The table below provides on overview of workforce information for each CCG. The information is sourced from the workforce minimum data set collected by NHS Digital. The information is experimental and needs to be treated with caution. The information is based on the position as at March 2018 and was published in September 2018.

Workforce Barnet Camden Enfield Haringey Islington % of GPs aged over 55 32% 19% 32% 40% 28% % locum GPs 2% 5% 11% 7% 6% % of nurses aged 55 and over 46% 21% 55% 53% 50% Number of patients per full-time GP 2,288 2,021 2,455 2,661 2,144

The information shows the need for succession planning for the GP and nurse workforce, some of which will be provided through the use of new skill-mix in general practice including pharmacists, physicians, physiotherapists and mental health professionals. The Sustainability and Transformation Plan workforce workstream have been asked to provide an overview of work on developing the primary care workforce for the proposed Committee Seminar in November 2019.

5. Early Warning System for struggling practices A proposal for the early warning system will come to the Committee in December 2019. The proposal will include recommendations from the Committee in June 2019 to identify struggling practices.

6. Patient survey results In August 2019 the Committee received and overview of the work each CCG was undertaking with practices in response to patient survey results. Appended to this report is an overview from NHS London of general practice survey results for 2019 in London. The report focuses on findings relating to accessing appointments, experience of the last appointment, alternatives when the practice is closed, and using online services. The survey also covers management of long-term conditions, care planning and dentistry.

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National headlines In England the overall experience of general practice remains positive and people’s confidence in the quality of care is high: • 82.9% of respondents rated their overall experience as good or very good; • 95.5% had confidence and trust in the healthcare professional they saw; • 94.5% felt their needs were met during their last appointment; • However, experiences are worse for access to the GP and getting an appointment and some

areas have decreased compared to 2018; For example: • 67.4% of patients rated their experience of making an appointment as good, a decrease of

1.2 percentage points; • 68.3% said it was easy to get through to their GP practice on the phone, a decrease of 2.0

percentage points; • 61.7% were offered a choice of appointment, a decrease of 0.6 percentage points compared

with 2018 (62.3%). • Over half of all patients (51.8%) have a GP they prefer to see. Less than one in two patients

who have a preferred GP said they saw them always, almost always or a lot of the time (48.0%), a decrease of 2.2 percentage points compared with 2018 (50.2%).

• Around seven in ten patients (69.5%) waited 15 minutes or less after their appointment time to be seen, an increase of 0.5 percentage points compared with 2018;

• For patients needing an appointment when their practice was closed, there was an improvement in the proportion of patients who rated alternative services as good (69.5%, up 0.8 percentage points);

• The use of some online services has increased. For example, 16.2% said they had used online services in the last 12 months to order repeat prescriptions, an increase of 1.9 percentage while 14.9% say they used online services to book appointments, an increase of 2.0 percentage points compared with 2018 (12.9%).

London findings The report highlights where London significantly diverges from the national average. The pattern is very similar to the 2018 results, with key areas of variation being: • London has lower overall satisfaction levels than the England average: 80.4% described their

overall experience as good or very good, compared to 82.9% nationally; • London respondents are more likely to have booked an appointment online, and to be offered

a choice of appointment. However they are less satisfied with available choices, mainly because the next appointment was not soon enough;

• When they did see a health professional, there were less likely to be given enough time, to be treated with care and concern, and to have any mental health needs recognised;

• Another behavioural difference is that they were more likely to go to A&E rather than take the next available appointment, and to go there when their practice was closed. They were much less likely to say they received out of hours care or advice in the right time;

• This is a similar pattern to the 2018 results. Changes in London results since 2018 The main areas of change are shown in Chart 2: • There is a growing awareness and use of online services to book appointments and order

repeat prescriptions, for example the proportion who had booked an appointment online in the past year rose 3.8 percentage points;

• Confidence in healthcare professionals also increased from 2018, by 2.0 percentage points;

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• Less positively, respondents are now more likely to go to A&E rather than taking an offered appointment (5.2 percentage points increase from 2018). The largest change was for receiving out of hours care or advice in the right time –a decrease of 15.8 percentage points;

• Appendix 2 in the report breaks down the full difference in London scores for 2018 and 2019. Variation within London The London trend is to have lower scores for most questions than the England average, however there is a wide variation in experiences within London. So while there is a large decrease in people saying they receiving care or advice in the right time when the practice is closed, it is particularly large for Kingston (41.0 percentage points lower than 2018), Lambeth (30.6) and Richmond (40.6), while the score has not changed for Waltham Forest, Wandsworth and West London CCGs; Chart 3 in the report shows the other areas of high variation between London CCGs: • When practice closed, received care / treatment in about the right time (highest: Wandsworth

61.5%; lowest: Kingston 26.0%); • Reason for not taking appointment –offered one wasn’t soon enough (Central London 50.8%;

Waltham Forest 19.2%); • When practice closed, went to A&E instead (Hammersmith & Fulham 50.2%; 31.3%

Lambeth); • Generally easy to get through to someone at your GP practice on the phone (West London

82.9%; Newham and Enfield both 57.9%); • At STP level there is a consistent pattern across many of the questions. Experience of

services in South West London is generally better than elsewhere, while experience is consistently less positive in East London. Chart 4 shows overall positive experience for each CCG and the change since 2018. The 3 highest scoring CCGs are in SW London; the lowest 4 in East London;

• There is also variation between different patients. For example, Chart 5 shows overall positive experience by BME groups. Nationally and in most London CCGs patients from a white background report a better experience than non-white patients. The gap is largest in Redbridge, Havering and Kingston.

Summary Nationally there are signs of increased pressure on general practice as people find it harder to get an appointment that meets their needs or to see their preferred GP. Quality of care remains high. • Overall satisfaction and scores for most questions are lower in London than the rest of

England; • Phone remains the preferred way to make appointments, but there is wide variation among

London CCGs on how easy this is. There is also wide variation in the quality of out-of-hours services;

• While Londoners are more likely to be offered a choice of appointment, the survey indicates that what is offered is less likely to meet their needs and so they are more likely to attend A&E instead;

• While confidence and trust in healthcare professionals is lower in London than the national average, this has improved since 2018. However people are now less likely to say professionals recognised any mental health needs they had;

• Primary care transformation to reduce hospital demand is a key element of the Long Term Plan. Although the majority of patients in London report a positive experience of general

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practice in the GP Patient Survey there are a number of findings from the latest survey that are of concern. Despite the availability of extended access services, many people did not receive the care or advice in the time they wanted; not getting an appointment quickly enough remains a reason people went to A&E instead.

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Finance

Practice Code

Practice Name

Co-c

omm

issi

onin

g m

odel

Cont

ract

Typ

e

Dis

pens

ing

Prac

tice

Prac

tice

Link

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D

(Nat

iona

l Qui

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% P

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CQC

Ratin

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CQC

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l led

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2018

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Size

(Bas

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55 y

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and

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yea

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Num

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N

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Rate

List

size

Annu

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Chan

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to re

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P se

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frie

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= n

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A =

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Enh

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1 E83003 Oakleigh Road Health Centre Del GMS 4 7% 70% 11 0 Medium-large 20% 0% 100% 1,797 6,683 99.3% 4.7 9010 0.9% 92% 88% 92% 78% £123 19% 150 18% 185 FULL 7 ✔

2 E83005 Lichfield Grove Surgery Del PMS 4 5% 64% 8 1 Small-medium 15% 0% 100% 2,358 7,780 99.2% 7.4 6253 -0.4% NA 82% 71% 76% £141 52% 166 51% 190 FULL 7 ✔

3 E83006 Greenfield Medical Centre Del PMS 2 6% 58% 5 0 Medium-large 17% 0% 58% 2,207 6,221 98.8% 4.1 6776 -1.3% 90% 84% 66% 70% £153 38% 265 38% 173 FULL 7 ✔

4 E83007 Squires Lane Medical Practice Del GMS 3 7% 59% 7 2 Medium-large 0% 20% 1,712 0 98.8% 6.5 5780 1.0% 75% 64% 54% 62% £130 35% 166 34% 137 FULL 7 ✔

5 E83008 Heathfielde Medical Centre Del PMS 5 - Least Deprived 8% 78% 9 0 Medium-large 50% 0% 15% 2,489 4,422 99.9% 2.7 8355 5.1% NA 89% 93% 77% £150 44% 152 44% 297 FULL 7 ✔

6 E83009 PHGH Doctors Del PMS 5 - Least Deprived 8% 75% 24 2 Medium-large 25% 3% 100% 2,749 10,822 92.5% 5.7 11114 2.1% 89% 75% 60% 64% £151 37% 187 37% 486 FULL 7 ✔

7 E83010 The Speedwell Practice Del PMS 4 7% 63% 38 0 Medium-large 13% 0% 36% 2,300 6,337 95.7% 4.2 11496 1.6% NA 67% 41% 66% £176 33% 330 32% 325 FULL 7

8 E83011 The Everglade Medical Practice Del GMS 1 - Most deprived 3% 42% 1 1 Medium-large 21% 1% 0% 1,630 8,226 99.9% 11.6 8433 3.3% 84% 79% 65% 58% £141 13% 37 13% 57 FULL 7 ✔

9 E83012 The Old Courthouse Surgery Del GMS 4 9% 77% 0 0 Medium-large 0% 0% 0% 2,052 7,840 99.6% 7.1 8399 3.1% 85% 89% 73% 85% £126 23% 14 23% 51 PARTIAL 6 ✔

10 E83013 Cornwall House Surgery Del GMS 4 8% 63% 0 0 Medium-large 33% 0% 0% 1,807 22,176 99.4% 8.1 6285 -3.5% NA 59% 35% 47% £138 23% 56 22% 109 FULL 7 ✔

11 E83016 Millway Medical Practice Del PMS 4 7% 65% 64 0 Large 2% 0% 12% 2,065 5,909 98.7% 4.0 18536 0.6% NA 85% 40% 66% £165 99% 873 98% 986 FULL 7 ✔

12 E83017 Longrove Surgery Del PMS 4 8% 79% 17 2 Medium-large 29% 0% 53% 1,954 5,848 97.4% 4.5 11353 0.3% NA 85% 58% 55% £146 27% 85 27% 441 FULL 7 ✔

13 E83018 Watling Medical Centre Del GMS 3 6% 51% 20 0 Large 7% 0% 0% 1,483 5,990 96.8% 5.6 16335 1.5% 93% 79% 61% 68% £125 32% 485 32% 748 FULL 7 ✔

14 E83020 St George’s Medical Centre Del PMS 4 6% 60% 1 1 Medium-large 0% 0% 0% 3,231 4,473 96.5% 4.4 11503 4.9% NA 82% 41% 63% £146 78% 849 78% 422 FULL 7 ✔

15 E83021 Torrington Park Group Practice Del PMS 4 9% 63% 9 0 Medium-large 27% 0% 55% 2,120 10,698 93.9% 7.9 12501 -0.9% * 82% 52% 74% £158 35% 289 35% 250 FULL 7 ✔

16 E83024 St Andrews Medical Practice. Del PMS 5 - Least Deprived 9% 72% 2 2 Large 15% 0% 48% 1,745 6,921 99.3% 4.0 10979 1.6% NA 90% 59% 63% £165 44% 185 44% 294 FULL 7 ✔

17 E83025 Pennine Drive Practice Del GMS 3 6% 55% 9 2 Medium-large 24% 0% 0% 2,437 7,879 100.0% 7.8 9002 0.4% NA 74% 61% 66% £124 10% 34 10% 95 FULL 7 ✔

18 E83026 Supreme Medical Centre Del GMS 4 8% 65% 2 0 Small-medium 76% 0% 0% 1,636 5,900 91.6% 7.0 4366 -1.5% NA 79% 59% 64% £145 32% 67 32% 104 FULL 7 ✔

19 E83027 The Practice @ 188 Del PMS 4 9% 69% 10 1 Small-medium 7% 16% 0% 3,149 10,866 98.3% 7.3 7935 6.7% 91% 77% 71% 60% £143 20% 83 20% 108 FULL 7 ✔

20 E83028 Parkview Surgery Del PMS 2 3% 47% 6 0 Small-medium 40% 15% 100% 2,854 7,624 99.6% 9.9 6575 1.9% NA 83% 68% 63% £136 15% 48 15% 57 FULL 7 ✔

21 E83030 Penshurst Gardens Surgery Del GMS 4 10% 61% 33 0 Medium-large 0% 0% 0% 2,116 7,157 97.3% 5.4 6710 2.8% NA 68% 24% 53% £151 67% 226 67% 521 no data - ✔

22 E83031 The Village Surgery Del PMS 4 9% 76% 1 0 Medium-large 42% 0% 100% 1,683 7,315 89.4% 2.7 5254 3.7% NA 94% 92% 91% £138 18% 40 18% 159 FULL 7

23 E83032 Oak Lodge Medical Centre Del GMS 3 4% 43% 32 0 Large 0% 0% 11% 1,965 5,078 100.0% 9.9 18421 -0.5% NA 65% 36% 51% £139 50% 635 50% 520 FULL 7 ✔

24 E83034 Mulkis Hb-The Surgery Del GMS 3 6% 69% 0 0 Small-medium 100% 0% 100% 2,735 7,647 93.5% 4.8 5378 -1.4% NA 80% 80% 78% £121 27% 103 27% 189 FULL 7 ✔

25 E83035 Wentworth Medical Practice. Del PMS 4 7% 59% 24 2 0% 12,399 96.3% 3.0 11620 2.8% 80% 77% 63% 73% £162 32% 191 32% 224 FULL 7 ✔

26 E83036 Vale Drive Medical Practice Del GMS 3 7% 73% 7 0 Small-medium 100% 0% 0% 2,633 6,253 95.6% 3.6 5735 6.9% NA 75% 71% 69% £136 24% 70 24% 89 FULL 7 ✔

27 E83037 Derwent Crescent Medical Centre Del PMS 4 9% 68% 4 0 Small-medium 41% 0% 52% 1,852 4,894 99.4% 4.9 5565 1.3% 90% 89% 88% 71% £168 86% 214 86% 245 FULL 7 ✔

28 E83038 Jai Medical Centre Del GMS 3 8% 50% 8 0 Small-medium 31% 0% 76% 5,246 6,350 98.0% 4.8 8334 0.2% NA 79% 73% 71% £124 17% 54 18% 67 FULL 7 ✔

29 E83039 Ravenscroft Medical Centre Del PMS 4 4% 62% 2 0 100% 5,323 96.9% 4.0 6980 -5.7% NA 79% 73% 69% £161 6% 34 6% 46 FULL 7 ✔

30 E83041 Wakeman’s Hill Surgery Del GMS 3 5% 40% 8 1 Small-medium 0% 17% 0% 2,790 6,391 97.1% 9.3 4594 -1.9% NA 71% 69% 65% £124 14% 34 14% 22 FULL 7 ✔

31 E83044 Addington Medical Centre Del GMS 4 8% 76% 8 0 Medium-large 50% 0% 76% 1,797 6,602 98.6% 4.1 9284 6.9% 88% 85% 75% 75% £124 30% 233 30% 296 FULL 7 ✔

32 E83045 Friern Barnet Medical Centre Del GMS 3 6% 63% 0 2 Medium-large 42% 0% 100% 2,633 8,670 97.2% 4.4 9274 4.7% NA 79% 57% 66% £126 20% 68 20% 130 PARTIAL 5 ✔

33 E83046 Mulberry Medical Practice Del GMS 3 5% 53% 31 1 Medium-large 23% 0% 26% 2,559 2,386 85.1% 3.2 9795 -1.2% NA 63% 47% 56% £127 25% 260 25% 173 no data - ✔

34 E83049 Langstone Way Surgery Del PMS 4 5% 59% 48 2 Medium-large 30% 0% 34% 2,313 2,610 91.2% 8.6 8149 5.2% NA 79% 52% 66% £169 18% 41 18% 108 FULL 7 ✔

35 E83050 East Finchley Medical Centre Del GMS 5 - Least Deprived 6% 77% 12 0 Small-medium 0% 0% 0% 3,027 17,972 90.4% 3.4 7883 1.5% NA 64% 55% 52% £115 18% 8 19% 204 no data - ✔

36 E83053 Lane End Medical Group Del GMS 4 8% 60% 15 1 Large 18% 0% 1,413 0 96.7% 7.4 13171 0.8% 86% 72% 44% 58% £146 47% 330 39% 489 FULL 7 ✔

37 E83600 Adler Js-The Surgery Del GMS 4 4% 73% 0 0 Small-medium 50% 0% 0% 2,661 10,011 97.2% 1.8 5926 3.4% 100% 94% 78% 83% £133 25% 10 25% 207 FULL 7 ✔

38 E83613 East Barnet Health Centre Del PMS 4 7% 76% 6 0 40% 7,360 99.5% : 11453 5.0% 88% 96% 72% 83% £143 14% 40 14% 131 FULL 7 ✔

39 E83621 Brunswick Park Medical Centre Del GMS 4 9% 68% 14 1 100% 5,382 98.4% 2.9 8529 0.3% 86% 82% 56% 60% £125 39% 181 38% 435 FULL 7 ✔

40 E83622 Temple Fortune Medical Group Del GMS 5 - Least Deprived 8% 74% 0 0 Small-medium 51% 0% 55% 2,381 8,008 99.4% 7.5 7445 4.5% NA 83% 83% 71% £121 23% 48 23% 183 no data - ✔

41 E83637 Colindale Practice (Dr Lamba) Del PMS 3 3% 41% 5 0 Small-medium 47% 0% 65% 3,240 13,384 98.6% 3.0 9273 10.5% 100% 76% 67% 72% £141 24% 57 24% 138 FULL 7 ✔

42 E83638 The Mountfield Surgery Del PMS 4 7% 66% 1 0 Small-medium 93% 0% 100% 2,060 4,120 95.3% 3.1 5096 2.5% NA 88% 90% 83% £157 13% 9 13% 53 FULL 7 ✔

43 E83639 Rosemary Surgery Del GMS 4 4% 62% 0 0 Small-medium 15% 0% 1,664 0 93.2% 2.4 5579 14.7% 96% 79% 72% 69% £132 43% 179 43% 132 FULL 7 ✔

44 E83649 The Hodford Road Surgery Del PMS 4 5% 67% 1 0 Small-medium 100% 0% 0% 2,088 14,850 93.6% 2.2 3792 5.7% NA 82% 88% 75% £147 84% 82 83% 112 FULL 7 ✔

45 E83650 Gloucester Road Surgery Del GMS 4 12% 75% 0 0 Single-handed 100% 0% 100% 1,771 4,178 95.5% 2.6 1896 12.7% NA 91% 93% 85% £116 25% 4 25% 48 FULL 7

46 E83653 The Phoenix Practice Del GMS 3 6% 61% 11 1 Medium-large 13% 0% 42% 2,311 5,317 93.9% 2.8 10148 3.0% NA 87% 63% 76% £130 25% 57 24% 257 FULL 7 ✔

47 E83657 The Hillview Surgery Del GMS 4 7% 62% 1 0 Small-medium 100% 0% 100% 1,855 7,833 95.0% 7.8 1875 0.2% NA 92% 97% 88% £154 6% 0 6% 12 NO 0 ✔

48 E83668 Medical Centre (Deans Lane) Del GMS 4 3% 52% 4 0 Small-medium 0% 0% 100% 2,307 5,767 96.7% 3.3 4246 -1.0% NA 84% 92% 71% £129 17% 3 16% 31 FULL 7 ✔

49 Y00316 Woodlands Medical Practice Del PMS 4 6% 68% 14 0 Small-medium 0% 0% 0% 2,223 10,968 96.2% 4.0 4404 -0.4% 55% 61% 45% 53% £142 46% 64 46% 146 FULL 7 ✔

50 Y02986 Cricklewood Health Centre Del PMS 2 0% 54% 8 3 Small-medium 0% 0% 100% 2,164 23,186 5059 15.0% NA 78% 65% 67% £130 20% 128 20% 59 no data -

51 Y03663 Hendon Way Surgery Del GMS 3 3% 53% 4 4 0 99.6% 8.8 8781 4.3% NA 61% 38% 52% £127 27% 121 27% 108 no data - ✔

52 Y03664 Dr Azim & Partners Del GMS 3 4% 55% 28 2 0 98.6% 5.4 9144 2.4% NA 60% 35% 54% £128 60% 18 60% 232 FULL 7 ✔

Patient Experience Patients Online Extended AccessBarnet CCG

OCTOBER 2019

Comments:

Efficiency

No. 38 - E83613 East Barnet Health Centre list size increase reflects merger of Monkman (E83613), Weston (E83629) and Peskin (E83632) practices now under East Barnet Health Centre (E83613)

Practice Practice Demographics Quality Workforce

of 150

Finance

Practice Code

Practice Name

Co-c

omm

issi

onin

g m

odel

Cont

ract

Typ

e

Dis

pens

ing

Prac

tice

Prac

tice

Link

ed IM

D

(Nat

iona

l Qui

ntile

s)

% P

atie

nts A

ged

75+

% P

atie

nts N

on-B

ME

CQC

Ratin

g - O

vera

ll

CQC

- Car

ing

CQC

- Effe

ctiv

e

CQC

- Res

pons

ive

CQC

- Saf

e

CQC

- Wel

l led

Writ

ten

com

plai

nts (

Tota

l)20

18/1

9

Writ

ten

com

plai

nts (

via

NH

SE)

2018

/19

Prac

tice

Size

(Bas

ed o

n FT

E G

Ps)

% G

Ps a

ged

55 y

ears

and

ove

r

% L

ocum

GPs

% N

urse

s age

d 55

yea

rs a

nd o

ver

Num

ber o

f pat

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s per

FTE

GP

Num

ber o

f pat

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s per

FTE

N

urse

QO

F Ac

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t

QO

F Ex

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Rate

List

size

Annu

al L

ist S

ize

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geJu

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une

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FFT:

% li

kely

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d G

P se

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e to

frie

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fam

ily (J

uly

2019

)(*

= n

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A =

zero

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Aver

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Dire

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Enh

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1 F83003 Park End Surgery Del PMS 4 9% 79% 5 0 Medium-large 14% 0% 0% 1,259 8,813 98.6% 3.6 7,117 1% NA 97% 83% 89% £170 64% 137 64% 279 FULL 7 ✔

2 F83005 Gower Street Practice Del GMS 3 1% 61% 7 2 Medium-large 55% 0% 0% 2,354 22,783 95.7% 3.1 8,309 -3% NA 78% 92% 69% £146 19% 74 19% 58 FULL 7

3 F83006 Ampthill Practice Del GMS 1 - Most deprived 5% 55% 1 1 Large 25% 7% 0% 1,153 8,423 96.9% 3.7 8,095 -3% 88% 90% 78% 86% £129 16% 36 12% 129 FULL 7 ✔

4 F83011 Primrose Hill Surgery Del GMS 4 7% 79% 14 1 0% 96.9% 2.2 6,486 1% NA 82% 82% 75% £159 26% 58 26% 177 FULL 7 ✔

5 F83017 Hampstead Group Practice Del PMS 3 5% 73% 27 0 Large 7% 9% 0% 1,361 8,484 98.1% 3.3 15,833 -1% 94% 87% 95% 83% £172 29% 131 29% 321 FULL 7 ✔

6 F83018 Prince Of Wales Group Surgery Del PMS 1 - Most deprived 5% 63% 0 0 Medium-large 22% 0% 55% 1,611 5,324 98.6% 4.0 8,880 -2% 83% 71% 65% 56% £162 33% 38 33% 129 FULL 7 ✔

7 F83019 Abbey Medical Centre Del GMS 2 5% 62% 19 0 Large 11% 0% 0% 1,660 12,087 99.2% 3.5 11,923 -1% * 77% 52% 67% £145 31% 55 30% 141 PARTIAL 1 ✔

8 F83020 Adelaide Medical Centre Del GMS 3 7% 71% 14 0 Large 12% 12% 60% 1,722 4,555 97.9% 3.7 11,648 1% NA 89% 86% 83% £139 49% 165 49% 260 FULL 7 ✔

9 F83022 Caversham Group Practice Del GMS 2 5% 70% 38 0 Large 46% 8% 0% 2,295 9,293 94.0% 3.3 15,615 2% NA 87% 81% 72% £141 24% 287 23% 450 PARTIAL 2 ✔

10 F83023 James Wigg Practice Del PMS 2 4% 67% 91 3 Large 13% 0% 17% 1,701 5,683 96.4% 4.5 21,642 1% 100% 87% 64% 54% £186 21% 138 21% 392 FULL 7 ✔

11 F83025 The Regents Park Practice Del PMS 2 5% 52% 8 0 Medium-large 0% 0% 35% 1,762 4,091 95.9% 3.3 6,157 -1% 95% 84% 81% 75% £163 9% 4 7% 44 FULL 7

12 F83042 Gray's Inn Road Medical Centre Del PMS 2 2% 58% 13 0 Medium-large 30% 0% 100% 1,216 12,371 93.4% 4.9 6,722 19% NA 90% 83% 78% £146 15% 25 15% 21 FULL 7 ✔

13 F83043 Ridgmount Practice Del GMS 2 0% 59% 8 0 Large 29% 13% 2,421 99.7% 8.5 17,640 4% 94% 77% 88% 83% £137 52% 168 52% 61 FULL 7

14 F83044 The Bloomsbury Surgery Del GMS 2 4% 52% 1 1 Medium-large 0% 0% 0% 1,476 2,412 93.3% 2.9 4,435 0% 80% 85% 93% 72% £155 41% 64 37% 32 PARTIAL 6 ✔

15 F83048 Brunswick Medical Centre Uhpc Del APMS 2 3% 56% 6 0 Single-handed 0% 0% 0% 8,990 12,838 98.8% 7.3 7,019 2% 89% 66% 68% 61% £195 40% 55 40% 40 FULL 7

16 F83050 Fortune Green Road Surgery Del GMS 4 6% 69% 1 0 Small-medium 0% 19% 0% 2,396 26,653 97.4% 5.7 2,834 1% * 92% 95% 80% £133 22% 42 22% 59 FULL 7

17 F83052 Brookfield Park Surgery Del GMS 3 6% 77% 8 2 Small-medium 35% 0% 0% 2,960 6,788 98.7% 3.8 3,552 4% NA 91% 82% 78% £142 30% 26 30% 52 FULL 7 ✔

18 F83055 West Hampstead Medical Centre Del PMS 3 3% 72% 30 1 Large 13% 0% 53% 1,989 9,944 98.3% 4.2 15,439 16% 83% 76% 53% 67% £160 91% 753 91% 406 FULL 7 ✔

19 F83057 Parliament Hill Surgery Del PMS 3 4% 78% 7 1 Medium-large 3% 0% 100% 1,747 18,972 99.9% 3.1 7,509 6% NA 91% 92% 84% £150 43% 109 43% 129 FULL 7 ✔

20 F83058 Holborn Medical Centre Del PMS 2 2% 57% 14 0 Large 24% 0% 0% 1,556 8,022 98.0% 4.5 11,401 1% 100% 86% 66% 60% £169 16% 38 16% 53 FULL 7 ✔

21 F83059 Brondesbury Medical Centre Del PMS 2 3% 63% 35 0 Large 10% 0% 31% 1,015 11,838 97.9% 5.1 18,089 5% NA 87% 78% 70% £169 35% 211 31% 232 FULL 7 ✔

22 F83061 Museum Practice Del PMS 2 4% 63% 1 1 Medium-large 0% 0% 901 98.1% 3.4 4,864 4% 100% 96% 100% 85% £141 44% 152 43% 33 FULL 7 ✔

23 F83615 Cholmley Gardens Surgery Del PMS 4 4% 73% 3 0 Medium-large 40% 10% 0% 1,727 6,435 96.9% 3.4 8,116 1% * 78% 84% 71% £131 16% 11 16% 105 FULL 7 ✔

24 F83623 Keats Group Practice Del PMS 5 - Least Deprived 6% 79% 9 1 Large 12% 7% 0% 1,473 3,928 99.6% 2.8 12,404 4% 100% 91% 74% 81% £186 37% 72 37% 325 FULL 7 ✔

25 F83632 Queens Crescent Practice Del GMS 1 - Most deprived 4% 61% 0 0 Medium-large 5% 0% 0% 1,062 6,404 98.0% 6.2 5,566 1% 92% 80% 70% 70% £135 10% 30 10% 81 FULL 7 ✔

26 F83633 Daleham Gardens Health Centre Del PMS 4 5% 73% 3 0 Small-medium 0% 0% 0% 1,393 6,180 98.6% 3.9 3,120 17% * 82% 90% 77% £162 36% 58 35% 51 FULL 7

27 F83635 Kings Cross Surgery Del APMS 1 - Most deprived 1% 51% 7 1 Small-medium 6% 6% 0% 3,694 7,995 99.1% 10.3 6,135 29% NA 62% 60% 49% £137 30% 189 30% 75 FULL 7

28 F83658 Belsize Priory Medical Practice (Group) Del GMS 2 5% 62% 1 1 Small-medium 76% 40% 2,472 93.4% 3.1 4,320 0% NA 91% 75% 83% £128 32% 37 32% 38 FULL 7 ✔

29 F83665 Swiss Cottage Surgery Del GMS 3 3% 66% 21 2 Medium-large 0% 0% 40% 3,280 7,980 99.2% 2.8 14,110 5% 100% 80% 82% 73% £151 45% 18 45% 127 FULL 7 ✔

30 F83672 St Philips Medical Centre Del GMS 3 0% 63% 3 0 Medium-large 0% 0% 2,674 10,229 10% NA 79% 79% 62% £159 24% 138 24% 48 PARTIAL 6

31 F83677 The Matthewman Practice Del GMS 1 - Most deprived 3% 65% 0 0 Single-handed 100% 0% 2,043 76.1% 2.8 1,805 -11% 88% 81% 100% 93% £204 19% 0 19% 6 FULL 7 ✔

32 F83682 Rosslyn Hill Surgery Del PMS 5 - Least Deprived 5% 76% 4 0 Small-medium 59% 41% 735 98.7% 2.3 1,821 1% NA 91% 82% 79% £231 34% 45 34% 88 FULL 7 ✔

33 F83683 Somers Town Medical Centre Del PMS 1 - Most deprived 3% 48% 6 1 0% 88.4% 3.8 4,180 28% 59% 59% 64% 57% £189 11% 39 11% 29 FULL 7

34 Y02674 Camden Health Improvement Practice Del APMS 0% 5 0 Small-medium 0% 0% 50% 589 402 87.5% 9.4 819 -3% NA 74% 83% 57% £1,005 4% 0 0% 0 no data -

35 Y03103 Special Allocation Scheme (SAS) 0% 0 0 61 35.6% NA ~ ~ ~ £3,012 NO 0

Patient Experience Patients Online Extended Access

Comments:

Camden CCGOCTOBER 2019

Practice Practice Demographics Quality Workforce Efficiency

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1 F85002 Forest Rd Group Practice Del PMS 1 - Most deprived 5% 44% 27 0 Large 21% 4% 23% 1,275 4,681 97.6% 3.5 12,642 3% 67% 65% 23% 61% £216 80% 798 80% 962 FULL 7 ✔

2 F85003 Riley House Surgery Del PMS 1 - Most deprived 6% 60% 34 1 Medium-large 55% 0% 27% 2,783 7,338 93.7% 5.0 8,491 -2% NA 67% 59% 61% £149 PARTIAL 1 ✔

3 F85004 Eagle House Surgery Del PMS 1 - Most deprived 6% 53% 3 3 Medium-large 29% 0% 100% 3,012 4,418 96.9% 4.8 13,434 1% 78% 74% 35% 63% £155 24% 125 23% 281 PARTIAL 4 ✔

4 F85010 Keats Surgery Del GMS 2 7% 52% 1 1 Small-medium 100% 0% 100% 2,370 14,616 89.0% 2.9 5,031 6% 88% 82% 86% 77% £122 16% 36 16% 90 PARTIAL 6 ✔

5 F85016 Cockfosters Medical Ctre Del GMS 5 - Least Deprived 11% 76% 10 0 Medium-large 67% 0% 100% 1,759 7,887 87.7% 2.1 6,670 2% NA 85% 76% 83% £123 17% 4 17% 96 FULL 7 ✔

6 F85020 The Woodberry Practice Del PMS 4 8% 74% 13 1 Medium-large 3% 0% 50% 2,150 6,519 97.8% 4.4 8,854 2% NA 83% 66% 83% £145 19% 53 19% 113 FULL 7 ✔

7 F85023 The Ordnance Unity Centre For Health Del GMS 1 - Most deprived 3% 57% 45 3 Small-medium 0% 0% 0% 6,586 6,155 92.4% 5.5 9,732 9% 68% 65% 41% 55% £149 18% 128 18% 104 no data -

8 F85024 Dean House Surgery Del PMS 1 - Most deprived 5% 51% 5 1 Single-handed 100% 0% 2,586 97.1% 4.0 2,272 -4% NA 72% 89% 73% £151 NO 0 ✔

9 F85025 White Lodge Medical Practice Del PMS 3 9% 78% 18 1 Large 18% 6% 13% 1,210 3,705 95.9% 3.0 11,262 0% 88% 84% 86% 76% £161 33% 232 33% 517 FULL 7 ✔

10 F85027 Carlton House Surgery Del GMS 3 8% 80% 34 0 Large 11% 0% 0% 1,863 5,866 97.2% 5.4 11,726 0% 86% 78% 37% 67% £131 PARTIAL 4 ✔

11 F85029 Abernethy House Surgery Del PMS 4 10% 79% 10 0 Large 27% 0% 51% 1,633 4,284 99.3% 5.1 13,243 1% 90% 92% 87% 70% £147 28% 314 27% 590 FULL 7 ✔

12 F85032 Southgate Del PMS 4 8% 69% 19 0 Medium-large 44% 0% 0% 1,604 9,894 91.3% 3.8 9,773 2% 90% 86% 64% 76% £142 24% 238 24% 340 no data - ✔

13 F85033 Winchmore Hill Practice Del PMS 5 - Least Deprived 9% 76% 47 3 Medium-large 0% 0% 58% 3,227 10,007 95.7% 3.2 17,158 0% NA 75% 40% 73% £159 49% 490 48% 793 FULL 7 ✔

14 F85035 Highlands Practice Del GMS 5 - Least Deprived 10% 73% 1 1 83.5% 2.7 10,581 4% NA 79% 49% 73% £124 41% 277 41% 322 PARTIAL 5

15 F85036 Willow House Surgery Del GMS 3 7% 74% 6 1 Small-medium 38% 0% 0% 1,536 5,762 95.0% 3.4 4,400 1% * 85% 92% 83% £132 FULL 7 ✔

16 F85039 Rainbow Practice Del PMS 1 - Most deprived 4% 43% 2 0 Small-medium 29% 42% 0% 3,270 11,548 97.6% 4.0 5,243 6% 80% 88% 84% 74% £133 24% 27 24% 77 PARTIAL 6 ✔

17 F85043 Boundary Court Surgery Del APMS 1 - Most deprived 4% 42% 2 0 Small-medium 0% 38% 0% 2,238 7,853 96.3% 5.8 4,075 5% 93% 74% 66% 58% £133 15% 84 15% 31 FULL 7 ✔

18 F85044 The Bounces Road Surgery Del GMS 1 - Most deprived 4% 44% 4 0 Medium-large 0% 0% 0% 1,290 9,152 98.4% 4.3 5,562 7% 100% 77% 60% 76% £135 23% 26 23% 39 FULL 7 ✔

19 F85048 Moorfield Road Health Ctr Del GMS 1 - Most deprived 5% 59% 0 0 Small-medium 70% 0% 0% 3,164 11,273 81.2% 2.8 5,214 7% NA 83% 81% 67% £119 PARTIAL 2 ✔

20 F85053 Park Lodge Medical Centre Del GMS 4 6% 71% 11 0 Medium-large 25% 36% 0% 1,692 4,816 94.8% 3.3 5,685 -6% NA 68% 30% 62% £116 no data - ✔

21 F85055 Connaught Surgery Del GMS 3 8% 63% 11 0 Small-medium 0% 0% 0% 3,145 7,047 96.0% 2.3 5,053 0% 89% 83% 72% 59% £124 PARTIAL 6 ✔

22 F85058 Nightingale House Surgery Del PMS 2 6% 49% 25 0 Small-medium 20% 0% 100% 3,053 6,105 98.2% 4.6 6,663 1% 90% 87% 60% 67% £148 18% 68 18% 98 PARTIAL 4 ✔

23 F85072 Grovelands Medical Centre Del PMS 3 7% 64% 2 0 Small-medium 40% 42% 100% 3,291 12,121 98.9% 3.8 10,224 5% NA 77% 80% 69% £144 13% 35 13% 105 FULL 7 ✔

24 F85076 Freezywater Primary Care Centre Del PMS 1 - Most deprived 6% 62% 20 8 Large 16% 0% 58% 1,930 5,221 97.7% 4.2 12,883 -1% 83% 71% 35% 58% £145 PARTIAL 2 ✔

25 F85625 Bincote Surgery Del PMS 4 8% 77% 0 0 Small-medium 69% 9% 0% 2,138 58,781 95.7% 3.2 6,428 2% 81% 87% 71% 79% £142 32% 49 31% 222 PARTIAL 2 ✔

26 F85634 East Enfield Practice Del PMS 1 - Most deprived 2% 51% 3 1 Small-medium 0% 0% 100% 2,083 5,936 99.6% 8.3 3,207 0% 92% 81% 66% 75% £149 32% 12 32% 36 PARTIAL 1 ✔

27 F85642 The North London Health Centre Del GMS 3 7% 67% 6 0 Medium-large 0% 0% 35% 2,448 3,743 95.0% 3.3 8,782 1% 86% 81% 57% 64% £122 25% 126 25% 298 no data - ✔

28 F85650 Morecambe Surgery Del GMS 2 6% 51% 8 0 100% 10,285 96.9% 3.9 5,071 2% 100% 69% 58% 48% £128 23% 39 23% 136 FULL 7 ✔

29 F85652 Southbury Surgery Del PMS 3 5% 73% 5 0 Small-medium 100% 0% 100% 3,034 9,860 93.7% 4.8 4,664 -1% 71% 82% 88% 69% £136 FULL 7 ✔

30 F85654 Brick Lane Surgery Del GMS 1 - Most deprived 6% 59% 4 2 Single-handed 30% 0% 100% 5,060 14,959 99.4% 5.5 4,065 2% NA 77% 54% 68% £124 46% 24 46% 34 PARTIAL 1 ✔

31 F85656 Bush Hill Park Med Centre Del GMS 3 6% 68% 3 0 Small-medium 50% 0% 1,852 89.8% 3.1 2,163 -1% NA 89% 89% 84% £129 FULL 7 ✔

32 F85663 Latymer Road Surgery Del GMS 1 - Most deprived 7% 47% 2 2 Small-medium 34% 0% 0% 1,897 6,246 97.2% 4.2 4,580 -3% NA 64% 34% 49% £112 15% 15 15% 99 FULL 7

33 F85666 Edmonton Medical Centre Del PMS 1 - Most deprived 6% 43% 4 0 Small-medium 0% 47% 100% 1,858 11,411 97.4% 10.7 3,722 -12% 93% 91% 66% 71% £152 18% 29 18% 40 FULL 7

34 F85676 Boundary House Surgery Del PMS 1 - Most deprived 5% 46% 7 0 Small-medium 19% 19% 100% 2,335 5,357 91.4% 3.5 4,995 3% 76% 69% 49% 60% £164 20% 27 20% 46 PARTIAL 2 ✔

35 F85678 Town Surgery Del PMS 3 3% 71% 4 0 Small-medium 31% 0% 100% 2,756 8,641 99.2% 5.3 4,317 1% NA 88% 85% 69% £141 23% 59 23% 65 FULL 7 ✔

36 F85681 Green Street Surgery Del PMS 1 - Most deprived 6% 57% 2 0 Single-handed 100% 0% 100% 2,934 7,653 88.1% 4.7 2,301 -2% 86% 79% 65% 72% £144 PARTIAL 1 ✔

37 F85682 Chalfont Road Surgery Del APMS 1 - Most deprived 4% 46% 9 1 Small-medium 0% 100% 100% 2,656 8,852 95.8% 5.2 4,451 -4% 92% 82% 65% 66% £137 19% 49 19% 43 FULL 7

38 F85684 Curzon Avenue Surgery Del GMS 1 - Most deprived 4% 50% 14 1 Small-medium 40% 0% 0% 2,319 17,082 99.5% 5.5 5,606 -1% 100% 72% 37% 56% £120 PARTIAL 3 ✔

39 F85686 Trinity Avenue Surgery Del PMS 3 7% 66% 3 0 Small-medium 0% 0% 1,934 96.1% 2.7 2,805 6% 69% 82% 85% 76% £143 22% 22 22% 47 PARTIAL 4 ✔

40 F85687 Oakwood Medical Centre Del PMS 4 7% 71% 19 1 Small-medium 19% 0% 0% 2,528 8,071 99.3% 6.3 7,506 0% 88% 75% 53% 62% £148 14% 71 14% 125 FULL 7 ✔

41 F85700 Arnos Grove Medical Centr Del PMS 3 4% 61% 4 1 Small-medium 43% 94% 100% 3,057 2,812 97.0% 9.9 6,036 9% NA 69% 64% 53% £137 21% 0 20% 56 FULL 7 ✔

42 F85701 Gillan House Surgery Del GMS 3 5% 66% 5 1 Medium-large 41% 8% 100% 1,890 9,275 99.6% 5.5 10,860 5% 89% 83% 71% 64% £127 25% 208 24% 267 FULL 7 ✔

43 F85703 Lincoln Road Med Practice Del PMS 2 3% 61% 0 2 Medium-large 23% 0% 100% 1,705 9,290 96.2% 2.4 8,153 6% 89% 75% 47% 60% £143 PARTIAL 2 ✔

44 F85707 Enfield Island Surgery Del PMS 1 - Most deprived 2% 49% 3 1 Small-medium 50% 0% 100% 1,571 7,226 91.9% 3.1 3,767 -3% NA 61% 73% 66% £153 FULL 7 ✔

45 Y00057 Angel Surgery Del PMS 1 - Most deprived 4% 42% 10 2 Small-medium 57% 0% 100% 2,246 11,559 98.0% 3.6 10,907 11% 83% 77% 78% 71% £133 13% 64 13% 54 FULL 7 ✔

46 Y00612 Green Cedars Medical Centre Del GMS 1 - Most deprived 3% 44% 12 3 Small-medium 16% 36% 100% 2,555 16,350 97.3% 8.6 6,410 -2% 70% 64% 59% 57% £118 11% 7 11% 24 FULL 7

47 Y03402 Evergreen Primary Care Centre Del PMS 1 - Most deprived 3% 42% 19 2 Large 9% 10% 58% 2,962 11,650 96.2% 5.7 19,805 -2% 91% 66% 32% 48% £146 36% 574 36% 218 FULL 7 ✔


Comments:No.45 - List size reflects merger with Dover House (F85015) in October 2018Figures for 'Patient Online' section relating to MHP practices all recorded under F85002 Forest Road Group Practice.

Enfield CCGOCTOBER 2019


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1 F85007 Lawrence House Surgery Del PMS 1 - Most deprived 3% 49% 34 1 Large 25% 5% 82% 2,070 6,189 99.7% 7.9 16,653 -1% 90% 78% 74% 77% £141 58% 240 58% 392 FULL 7 ✔

2 F85008 Staunton Group Practice Del GMS 2 4% 57% 82 6 Medium-large 39% 0% 27% 2,893 10,673 92.5% 6.5 14,390 -1% 58% 68% 51% 65% £126 10% 125 10% 219 no data - ✔

3 F85013 Tynemouth Medical Practice Del PMS 1 - Most deprived 4% 44% 16 1 Medium-large 8% 0% 26% 1,918 3,101 10,099 -4% 89% 62% 32% 54% £148 no data - ✔

4 F85014 Highgate Group Practice Del PMS 4 7% 81% 13 1 Large 0% 0% 0% 2,042 4,969 98.0% 4.1 15,845 1% 85% 88% 83% 70% £138 69% 304 69% 522 FULL 7 ✔

5 F85017 Charlton House Medical Centre Del GMS 1 - Most deprived 5% 43% 1 1 Small-medium 50% 0% 76% 4,165 8,463 99.8% 11.7 6,910 -1% NA 68% 61% 62% £113 43% 101 43% 169 PARTIAL 1 ✔

6 F85019 Morris House Group Practice Del GMS 1 - Most deprived 4% 47% 15 2 Large 15% 0% 0% 1,910 15,583 95.8% 11.1 13,243 1% 80% 72% 44% 72% £142 26% 220 26% 149 FULL 7 ✔

7 F85028 Bruce Grove Primary Health Care Ctr Del GMS 5% 0 0 Small-medium 65% 0% 100% 2,730 14,739 94.6% 5.7 7,976 2% NA 65% 71% 72% £135 10% 55 10% 52 no data - ✔

8 F85030 Somerset Gardens Family Health Centre Del PMS 1 - Most deprived 5% 42% 5 5 42% 5,791 99.3% 10.7 13,575 -2% NA 66% 28% 65% £141 12% 9 12% 266 FULL 7 ✔

9 F85031 Westbury Medical Centre Del PMS 1 - Most deprived 4% 54% 25 1 Small-medium 0% 0% 100% 3,572 11,430 100.0% 6.0 10,882 2% NA 83% 80% 68% £142 32% 70 32% 208 FULL 7 ✔

10 F85034 Arcadian Gardens Surgery Del GMS 2 6% 60% 5 1 Small-medium 7% 13% 100% 3,338 8,355 93.5% 3.1 4,012 9% NA 76% 70% 67% £126 29% 19 29% 110 FULL 7 ✔

11 F85045 Queens Avenue Practice Del GMS 4 7% 80% 5 1 Small-medium 100% 0% 100% 2,291 17,411 94.7% 0.7 4,577 -2% * 91% 85% 77% £111 22% 10 22% 201 FULL 7

12 F85046 Hornsey Park Surgery Del GMS 2 3% 59% 0 0 Small-medium 100% 0% 0% 4,108 6,847 95.7% 5.6 4,491 2% NA 79% 92% 78% £113 17% 42 17% 45 FULL 7 ✔

13 F85052 Spur Road Surgery Del GMS 1 - Most deprived 7% 50% 2 0 Small-medium 87% 0% 100% 1,323 15,216 96.9% 7.1 1,832 11% 100% 79% 95% 66% £116 34% 7 34% 22 FULL 7

14 F85060 Havergal Surgery Del PMS 2 5% 58% 18 0 Medium-large 10% 37% 90% 1,912 5,597 86.6% 3.5 6,176 1% 78% 76% 56% 63% £140 38% 144 34% 64 FULL 7 ✔

15 F85061 Christchurch Hall Surgery Del GMS 3 4% 73% 6 1 Small-medium 92% 26% 0% 2,201 9,040 91.7% 2.0 3,598 -5% NA 80% 94% 58% £125 5% 2 5% 9 FULL 7 ✔

16 F85063 The Muswell Hill Practice Del PMS 4 5% 82% 5 0 Large 21% 0% 0% 2,049 7,016 98.9% 5.5 14,532 3% NA 87% 62% 68% £135 45% 339 45% 456 FULL 7 ✔

17 F85064 Stuart Crescent Health Centre Del PMS 2 6% 57% 3 1 Small-medium 0% 0% 2,929 98.5% 6.9 5,112 6% 100% 83% 79% 83% £134 23% 40 23% 63 FULL 7 ✔

18 F85065 Stuart Crescent Medical Practice Del GMS 1 - Most deprived 5% 56% 8 1 Small-medium 50% 0% 0% 1,348 8,090 94.0% 5.9 3,252 1% 82% 69% 60% 65% £122 23% 13 23% 22 FULL 7 ✔

19 F85066 Bounds Green Group Practice Del PMS 3 4% 65% 22 3 Large 12% 13% 37% 1,816 11,216 97.3% 6.1 17,654 3% NA 80% 57% 77% £143 49% 885 49% 864 PARTIAL 6 ✔

20 F85067 The 157 Medical Practice Del PMS 2 7% 65% 1 1 Small-medium 60% 20% 100% 1,704 8,116 85.0% 3.2 4,357 -4% NA 75% 59% 58% £154 6% 6 5% 48 NO 0 ✔

21 F85069 Crouch Hall Road Surgery Del PMS 3 4% 77% 8 0 Medium-large 73% 0% 54% 2,314 8,443 99.9% 4.4 8,408 1% NA 94% 98% 89% £146 99% 186 98% 225 FULL 7 ✔

22 F85071 Fernlea Surgery Del PMS 1 - Most deprived 3% 57% 19 0 Small-medium 32% 0% 100% 3,802 6,497 99.3% 6.1 9,775 8% 84% 75% 67% 55% £137 24% 27 24% 101 FULL 7 ✔

23 F85615 Tottenham Health Centre Del PMS 1 - Most deprived 3% 43% 2 0 Small-medium 98% 0% 0% 2,390 5,137 95.8% 2.7 5,513 1% NA 75% 71% 73% £152 28% 17 27% 72 FULL 7 ✔

24 F85623 Grove Road Surgery Del PMS 1 - Most deprived 3% 48% 0 0 Small-medium 44% 0% 100% 1,710 19,233 93.9% 6.3 4,541 9% NA 91% 96% 84% £141 14% 21 14% 29 FULL 7 ✔

25 F85628 Dowsett Road Surgery Del GMS 1 - Most deprived 4% 44% 4 0 Small-medium 0% 31% 100% 1,782 6,090 99.4% 6.0 4,798 5% 60% 88% 82% 83% £109 24% 32 24% 44 FULL 7 ✔

26 F85640 Cheshire Road Surgery Del PMS 2 4% 61% 1 0 Small-medium 0% 0% 0% 2,573 5,226 94.5% 2.6 6,747 -1% NA 81% 76% 70% £128 47% 71 47% 63 FULL 7 ✔

27 F85645 Myddleton Road Surgery Del PMS 2 2% 60% 1 0 Single-handed 100% 0% 0% 3,061 6,292 93.7% 3.2 3,117 2% 85% 83% 81% 82% £147 39% 1 39% 45 FULL 7 ✔

28 F85669 West Green Road Surgery Del GMS 1 - Most deprived 1% 54% 17 3 Medium-large 19% 17% 100% 2,710 47,547 97.1% 5.3 15,090 7% 96% 83% 93% 71% £107 7% 3 7% 44 FULL 7 ✔

29 F85675 The Alexandra Surgery Del PMS 3 7% 70% 0 0 Small-medium 58% 17% 3,073 99.6% 4.8 5,633 -4% NA 74% 65% 73% £140 48% 152 47% 255 no data - ✔

30 F85688 Rutland House Surgery Del PMS 4 4% 74% 10 1 Small-medium 24% 0% 100% 2,488 8,295 99.5% 5.8 6,834 3% NA 81% 70% 75% £138 29% 83 28% 140 FULL 7 ✔

31 F85697 The Old Surgery Del GMS 2 7% 61% 0 0 Small-medium 43% 0% 100% 1,899 10,289 96.6% 2.9 2,084 -3% NA 80% 93% 73% £121 5% 0 5% 2 FULL 7 ✔

32 F85705 JS Medical Practice Del PMS 1 - Most deprived 3% 49% 3 0 Small-medium 50% 0% 40% 5,247 7,472 83.3% 3.7 12,577 1% 100% 87% 77% 74% £136 55% 98 56% 214 FULL 7 ✔

33 Y01655 The Vale Practice Del GMS 3 0% 74% 0 0 Medium-large 55% 0% 66% 1,889 7,590 98.2% 4.3 11,220 1% 95% 89% 93% 71% £132 41% 92 41% 247 FULL 7 ✔

34 Y02117 The Laurels Medical Practice Del PMS 1 - Most deprived 1% 50% 2 2 Small-medium 19% 56% 0% 5,449 21,176 99.4% 7.9 13,458 7% 94% 62% 56% 58% £143 12% 126 12% 139 FULL 7 ✔

35 Y03035 Queenswood Medical Practice Del GMS 3 3% 75% 39 0 Large 6% 0% 0% 2,035 8,906 100.0% 5.6 22,624 1% NA 86% 73% 69% £140 44% 445 43% 492 FULL 7 ✔

36 Y03135 Bridge House Medical Practice Del PMS 2 4% 64% 16 1 Small-medium 50% 0% 0% 5,135 7,131 90.9% 4.2 10,406 1% 57% 73% 37% 46% £135 14% 113 14% 106 FULL 7 ✔

37 Y05330 Tottenham Hale Medical Practice Del PMS 4% 0% 6 0 Small-medium 40% 0% 100% 1,927 7,706 3,023 35% 86% 71% 84% 70% £219 26% 68 26% 45 FULL 7


Comments:

Haringey CCGOCTOBER 2019


of 150

Finance

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1 F83002 River Place Health Centre Del GMS 1 - Most deprived 4% 72% 8 0 Large 0% 5% 83% 1,276 4,530 100.0% 7.2 10,055 1% 87% 88% 73% 68% £130 21% 62 19% 131 FULL 7 ✔

2 F83004 Archway Medical Centre Del PMS 1 - Most deprived 4% 66% 6 0 Small-medium 44% 0% 73% 2,632 4,370 98.1% 5.4 6,592 8% NA 86% 81% 68% £148 28% 45 27% 79 FULL 7 ✔

3 F83007 Roman Way Medical Centre Del GMS 1 - Most deprived 6% 66% 0 0 Medium-large 35% 30% 0% 1,418 10,873 92.0% 3.1 3,483 -15% NA 77% 82% 75% £123 19% 0 18% 19 FULL 7

4 F83008 The Goodinge Group Practice Del GMS 1 - Most deprived 4% 66% 8 4 Large 21% 0% 0% 1,329 8,849 94.6% 3.9 12,271 -1% NA 95% 84% 84% £129 29% 153 29% 230 FULL 7 ✔

5 F83010 Islington Central Medical Centre Del GMS 2 3% 73% 0 0 Medium-large 41% 0% 100% 4,285 22,321 99.1% 4.3 19,046 2% NA 88% 47% 78% £134 57% 158 57% 284 FULL 7 ✔

6 F83012 Elizabeth Avenue Group Practice Del GMS 2 5% 73% 11 1 Large 0% 0% 0% 1,111 2,830 99.7% 6.5 7,536 4% * 91% 86% 74% £146 36% 24 36% 164 FULL 7 ✔

7 F83015 St Johns Way Medical Centre Del GMS 1 - Most deprived 5% 67% 16 1 Large 22% 6% 27% 1,465 3,585 98.4% 8.9 12,811 -2% NA 90% 90% 71% £128 25% 152 25% 336 FULL 7 ✔

8 F83021 Ritchie Street Group Practice Del GMS 2 3% 73% 33 0 Large 25% 0% 31% 1,962 11,412 97.7% 5.5 17,962 10% NA 82% 66% 77% £135 44% 437 42% 397 FULL 7 ✔

9 F83027 Drs Bowry & Bowry's Practice Del GMS 1 - Most deprived 5% 66% 3 0 Medium-large 47% 0% 1,569 0 96.2% 5.6 5,402 0% NA 84% 70% 70% £121 11% 26 11% 67 FULL 7 ✔

10 F83032 St Peter's Street Medical Practice Del GMS 2 3% 74% 17 0 Large 49% 0% 0% 1,885 12,218 99.7% 5.2 12,033 0% NA 88% 90% 67% £127 19% 116 3% 20 FULL 7 ✔

11 F83033 Dr Haffiz Del GMS 1 - Most deprived 7% 61% 3 0 Small-medium 0% 0% 100% 2,850 14,250 64.5% 11.1 3,124 2% NA 78% 70% 64% £140 9% 6 9% 16 no data -

12 F83034 New North Health Centre Del GMS 2 9% 70% 0 0 Single-handed 100% 0% 1,771 0 95.4% 5.7 1,672 -4% NA 88% 98% 96% £147 14% 4 14% 7 FULL 7 ✔

13 F83039 The Rise Group Practice Del GMS 1 - Most deprived 5% 64% 5 0 Small-medium 54% 6% 100% 1,890 4,083 87.1% 4.2 5,184 -4% NA 81% 75% 70% £139 21% 12 21% 73 FULL 7 ✔

14 F83045 The Miller Practice Del GMS 2 4% 73% 14 1 Large 33% 0% 100% 1,598 7,991 98.9% 4.7 10,624 3% 100% 91% 93% 82% £132 38% 198 38% 314 FULL 7 ✔

15 F83053 Mildmay Medical Practice Del GMS 2 4% 65% 15 0 Medium-large 32% 39% 100% 1,932 7,259 99.8% 6.0 6,157 -3% 88% 69% 70% 67% £199 28% 0 28% 71 FULL 7 ✔

16 F83056 The Mitchison Road Surgery Del APMS 1 - Most deprived 3% 67% 3 0 Small-medium 44% 0% 0% 3,715 12,737 100.0% 6.4 5,424 14% NA 70% 75% 60% £150 33% 103 33% 74 FULL 7

17 F83060 The Northern Medical Centre Del GMS 2 4% 67% 1 1 Medium-large 17% 0% 59% 1,893 6,384 97.3% 5.6 8,981 3% NA 76% 76% 66% £133 15% 48 15% 45 FULL 7 ✔

18 F83063 Killick Street Health Centre Del GMS 1 - Most deprived 3% 62% 22 1 Large 20% 0% 21% 1,829 2,548 100.0% 6.2 12,033 1% 96% 82% 76% 71% £153 21% 1 21% 219 FULL 7 ✔

19 F83064 City Road Medical Centre Del GMS 2 4% 64% 9 0 Medium-large 0% 0% 1,730 0 95.6% 6.3 7,532 5% 79% 83% 79% 69% £151 35% 0 35% 75 FULL 7 ✔

20 F83624 Clerkenwell Medical Practice Del GMS 2 1% 68% 20 0 Medium-large 13% 0% 7% 2,414 8,293 99.9% 6.0 13,484 8% 95% 88% 95% 82% £133 37% 231 37% 168 FULL 7

21 F83652 Amwell Group Practice Del GMS 2 2% 69% 10 0 Large 0% 5% 52% 1,187 5,627 99.8% 7.4 11,009 2% NA 88% 90% 64% £159 32% 72 31% 83 FULL 7 ✔

22 F83660 Highbury Grange Medical Practice Del GMS 3 4% 72% 8 0 Medium-large 59% 11% 0% 2,681 8,479 94.0% 3.6 9,142 1% NA 92% 84% 78% £122 23% 92 23% 131 FULL 7 ✔

23 F83664 The Village Practice Del GMS 1 - Most deprived 2% 57% 9 1 Small-medium 0% 0% 0% 3,342 6,184 96.8% 5.0 8,929 1% NA 68% 67% 49% £138 39% 77 38% 127 FULL 7 ✔

24 F83666 Andover Medical Centre Del GMS 1 - Most deprived 5% 58% 8 1 Medium-large 0% 11% 30% 1,247 4,392 98.1% 8.8 6,452 1% 79% 78% 74% 72% £141 24% 38 22% 60 FULL 7 ✔

25 F83671 The Beaumont Practice Del GMS 1 - Most deprived 3% 63% 0 0 Small-medium 80% 0% 100% 2,769 5,275 98.5% 7.7 3,023 2% NA 83% 75% 71% £149 34% 4 34% 46 FULL 7 ✔

26 F83673 The Medical Centre Del PMS 2 3% 65% 8 0 Small-medium 100% 0% 16% 1,981 4,142 100.0% 3.5 5,283 10% 91% 93% 82% 84% £151 22% 80 22% 51 FULL 7 ✔

27 F83674 The Junction Medical Practice Del GMS 2 5% 71% 16 0 Small-medium 0% 54% 100% 2,757 4,243 99.4% 6.5 9,539 65% NA 75% 90% 76% £166 18% 54 18% 148 FULL 7 ✔

28 F83678 The Pine Street Medical Practice Del GMS 2 7% 67% 0 0 Small-medium 0% 0% 0% 1,094 5,252 90.5% 13.5 2,538 -3% NA 88% 65% 79% £162 21% 33 21% 19 no data - ✔

29 F83680 Sobell Medical Centre Del GMS 1 - Most deprived 4% 63% 4 0 Small-medium 57% 3% 100% 1,579 4,816 96.0% 2.7 4,221 7% 91% 85% 76% 67% £127 19% 63 19% 54 FULL 7 ✔

30 F83681 Partnership Primary Care Centre Del GMS 1 - Most deprived 4% 68% 6 1 Small-medium 10% 10% 100% 2,985 3,283 99.5% 8.8 3,803 13% 83% 84% 76% 61% £170 11% 26 11% 47 FULL 7

31 F83686 Stroud Green Medical Centre Del GMS 2 2% 67% 3 0 Small-medium 0% 0% 100% 3,374 9,841 98.6% 6.9 6,770 5% 89% 77% 94% 81% £123 23% 95 23% 95 FULL 7 ✔

32 Y01066 Hanley Primary Care Centre Del PMS 1 - Most deprived 2% 61% 14 3 Small-medium 0% 0% 3,071 0 99.5% 5.8 7,820 17% 68% 60% 66% 67% £239 34% 73 33% 242 FULL 7


Comments:No. 27 - List size change reflects merger with Dr. Ko and partner (F83051) in October 2018.

Islington CCGOCTOBER 2019


of 150

General Practice Sustainability and ResilienceReferences

Purpose of document, and source data

Brief Description Source Time period

Total Practices Main practicesData for GPs and GP Surgeries is supplied by the NHS Prescription Service of the NHS Business Services Authority. Medical Practices classed as Active and with a GP Practice prescribing setting are included.

NHS Digital Jan-19 Feb-19

Registered PopulationNumber of Patients Registered

at a GP Practice Data extracted as a quarterly snapshot in time from the GP Payments system maintained by NHS Digital. NHS Digital Feb-19 Feb-19

Primary Care Co-Commissioning

Primary care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View. Co-commissioning aims to support the development of integrated out-of-hospital services based around the needs of local people. It is part of a wider strategy to join up care in and out of hospital. Delegated commissioning: CCGs assume full responsibility for the commissioning of general practice services.Greater involvement: an invitation to CCGs to collaborate more closely with their local NHS England teams in decisions about primary care services.Joint commissioning: enables one or more CCGs to jointly commission general practice services with NHS England through a joint committee.

NHS England Apr-18 Apr-18

Contract Type

Dispensing Practice

Deprivation Practice patient level deprivation

Patient level IMD has been calculated from IMD 2015 data. For each practice, NHS Digital gives the number of registered patients in each LLSOA (based on their registered address). Kings College London then calculate a weighted mean based on the mean IMD-2015 scores for all patients (in turn, based on LLSOA residency) registered at the practice.

Kings College London, Department

for Communities and Local Government

2015 Sep-16

% Aged 75+ Data extracted from the NHS Digital's GP Payments system. NHS Digital Feb-19 Feb-19

% Non-BME Estimated proportion of non-BME ethnic groups in the practice population (weighted average over the contributing LSOAs).

English Indices of Deprivation,

Department for Communities and Local Government

2015 Jul-16

OutstandingGoodRequires improvement

InadequateNo published rating

The NHS complaints procedure is the statutorily based mechanism for dealing with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure. This shows the counts of the number of written complaints made by (or on behalf of) patients, received between 1 April 2017 and 31 March 2018. Data are collected via two forms, the KO41a (NHS Hospital and Community Health Service (HCHS)) and KO41b (Family Health Service (GP including Dental) (FHS)). Please note this is experimental information.

NHS Digital 2017-18 Sep-18

Single-handed (=<1 FTE GP)

Small-medium (>1 and =<3)

Medium-large (>3 and =<6)

Large (>6 FTE GPs)

% FTE GPs aged 55 and over

% FTE Locum GPs

% FTE Nurses aged 55 and over

Number of patients per FTE GP

Number of patients per FTE Nurse

QOF Exception Rate

List size Number of patients registered to the GP Practice. Data extracted as a monthly snapshot in time from the GP Payments system.

NHS Digital Feb-19 Feb-19

List Size Change +/- 5-10%Available quarterly, the annual percentage change of list size of all practices in England. NHS Digital Jan-19 Jan-19

The Friends and Family Test asks patients how likely they are to recommend their GP service to friends and family based on their most recent experience of service use. This indicator presents the percentage of those 'Likely' or 'Extremely likely' to recommend their practice.

NHS England Dec-18 Feb-19

Jan - Mar 18

Oct-182017-18

CQC

Aug-18

Sep-18

Feb-19

% likely to recommend the GP service to friends and family

QOF AchievementThe QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. The objective of the QOF is to improve the quality of care patients are given by rewarding practices for the quality of care they provide to their patients. Participation in QOF is voluntary, though participation rates are very high (94.8% in 17/18).

NHS Digital

NHS England

This report aims to highlight practice sustainability through an aggregation of national indicators and local knowledge. The table draws together a multitude of indicators from an array of sources, such as the General Practice Indicators, along with data from CQC ratings, GPPS and practice demographics. In January 2016, £10m was allocated for a pilot programme to support practices in difficulty, and a further £40m was made available over four years (to 2020) under the General Practice Resilience Programme. Local teams were asked to identify those practices which are considered vulnerable* and those which would benefit from Resilience Programme support. These practices have been highlighted in the regional and DCO tables.

Published

Dec-18

Summary

Delegated commissioning

Greater involvement

Joint commissioning

Practice Information & Demographics

Displays the contract type and if the practice is authorised to dispense drugs. Sourced from NHS Payments to General Practices in England for 2017/18 by individual General Practice

NHS Digital

Feb-19

Practice Size(Based on FTE GPs)

NHS Digital Mar-18

Written Complaints (total for practice)

Written Complaints (directed to NHS England)

CQC Rating

The CQC rates General Practices to give an overall judgement of the quality of care. There are four ratings that we give to health and social care services. The rating examines five key areas for the quality of care: Caring, Effective, Responsive, Safe, Well-led. When no rating is shown, no published rating is available.

The GP Patient Survey, an independent survey run by Ipsos MORI on behalf of NHS England, is sent to over a million people across the UK. The results (weighted) show how people feel about their GP practice. The survey was extensively redesigned for 2018. Due to this, and the inclusion of 16-17 year olds, comparisons cannot be made with previous years' results even where question wording remains similar. Note that two of the questions reported have changed in 2018: d ll f ( f l d)

The primary data source for General and Personal Medical statistics is the workforce Minimum Data Set (wMDS) collected via the Primary Care Web Tool (PCWT) Workforce Census module and the workforce Minimum Data Set Collection Vehicle (wMDSCV). These statistics are labelled Experimental so care needs to be taken when interpreting the figures.

Note that all indicators are based on Full Time Equivalent (FTE) staffing and not numbers of staff.

The number of patients registered at the GP practice is also taken from the wMDS return.

2017-18

Good overall experience of GP practice

Patient Experience

Efficiency

Workforce

Quality

Easy to get through on the phone

of 150

Finance

This figure is taken from the NHS Digital report 'NHS Payments to General Practice, England'. It represents the total payments figure divided by the number of weighted patients. Values are included only where a full year of data is available. The number of weighted patients is calculated by the Global Sum process. Global Sum Payments are a contribution towards the contractor’s costs in delivering essential and additional services, including its staff costs. For more information, please visit NHS Digital's website.

NHS Digital 2017-18 Dec-18

GP practices provide functionality for patients to book/cancel appointments electronicallyNumber of patients enabled to electronically book or cancel an appointment divided by the practice list size

Total number of appointment scheduling or cancelling transactions using an Online Patient Transaction Service.

GP practices provide functionality for patients to view/order repeat prescriptions electronically. Number of patients enabled to electronically view/order repeat prescriptions divided by the practice list sizeTotal number of prescriptions ordered using an Online Patient Transaction Service. (Note that ordering several items at once to be counted as one prescription).

Whether or not a practice received a Directed Enhanced Services payment for Extended Hours Access in 2016/17 NHS Digital 2016-17 Sep-17

Feb-19 References

* National criteria has been created to be used as a screening tool by local commissioners to guide their assessment with local stakeholders on offers of support to improve sustainability and resilience. This criteria includes 9 data indicators out of the 16 identified examining areas such as Safety, Workforce, Efficiency and Patient Experience/Access.

Satisfied with the type of appointment offered

- Good overall experience of GP practice (% very or fairly good)- Ease of getting through by phone (% very or fairly easy)- Satisfied with the type of appointment offered (% yes)

Extended Access No. of extended access days

Bi-annual data collection monitors availability of pre-bookable appointments in practices at evenings and weekends. Launched in Oct 2016 in response to the government’s mandate to NHS England “to ensure everyone has easier and more convenient access to GP services, including appointments at evenings and weekends”, data are published as experimental statistics as they are new and undergoing evaluation.

Sustainability and Resilience Reports - Conditions on Forward Use

Sustainability and Resilience reports provide NHS England Management Information at an individual practice level, including potentially sensitive information relating to practices status in the Vulnerable Practice Programme, GP Resilience Programme and Personal Medical Services Reviews.

This information therefore needs to be managed accordingly and should be held in strict confidence, not for onward transmission to any other individual or organisation (other than CCGs), or the details of any practice disclosed publicly. Measures should therefore be taken locally to guard against unauthorised access or

sharing of the data.

NHS England local teams will need to be satisfied these conditions and controls are equally understood and applied by CCGs when sharing any reports under co-commissioning arrangements.

Patients Online

Average payment per weighted patient

% Of Reg Population with online appointment enabled

Total no. pt transactions using online appointments service

Directed Enhanced Services(Extended Access payment)

Nov-18

% Of Reg Population with order repeat prescriptions online enabled

Total no. prescriptions ordered via online pt transaction service

Online Appointments Enabled

NHS Digital

CategoryFull/Partial/No extended access

Order Repeat Prescriptions Online Enabled

NHS England

Jan-19 Feb-19

Sep-18

of 150

NHS England and NHS Improvement

General Practice Patient Survey 2019: Summary of London resultsSeptember 2019

of 150

2 |2 |

• The latest national GP Patient Survey (GPPS) was published in July, based on fieldwork carried out January-March 2019. The survey provides information on patients’ overall experience of primary care services and their overall experience of accessing these services.

• Data are weighted by age and gender so that results represent the eligible registered list population of each practice and CCG.

• This annual survey is the largest in the NHS with over 770,000 patients in England completing a survey (33.1% response rate). In London 131,000 returned forms were submitted, a response rate of 25.8%.

• This summary report focuses on findings relating to accessing appointments, experience of the last appointment, alternatives when the practice is closed, and using online services. The survey also covers management of long-term conditions, care planning and dentistry.

• In 2018 the questionnaire was significantly redeveloped to reflect changes to primary care services in England as set out in the GP Forward View. In addition, for the first time the sample included 16-17 year olds to improve the inclusivity of the survey. These changes mean questions are not comparable with results from previous publications and 2018 is the baseline for measuring change

• Findings are presented at region, STP and CCG levels for these aspects of experience. Practice level results are available on the survey website.

About the survey

GPPS 2019: London summary of 150

http://www.gp-patient.co.uk/

3 |3 |

• In England the overall experience of general practice remains positive and people’s confidence in the quality of care is high:

• 82.9% of respondents rated their overall experience as good or very good

• 95.5% had confidence and trust in the healthcare professional they saw

• 94.5% felt their needs were met during their last appointment.

• However, experiences are worse for access the GP and getting an appointment and some areas have decreased compared to 2018. For example:

• 67.4% of patients rated their experience of making an appointment as good, a decrease of 1.2 percentage points

• 68.3% said it was easy to get through to their GP practice on the phone, a decrease of 2.0 percentage points

• 61.7% were offered a choice of appointment, a decrease of 0.6 percentage points compared with 2018 (62.3%).

• Over half of all patients (51.8%) have a GP they prefer to see. Less than one in two patients who have a preferred GP said they saw them always, almost always or a lot of the time (48.0%), a decrease of 2.2 percentage points compared with 2018 (50.2%).

National headlines 1


4 |4 |

• Around seven in ten patients (69.5%) waited 15 minutes or less after their appointment time to be seen, an increase of 0.5 percentage points compared with 2018.

• For patients needing an appointment when their practice was closed, there was an improvement in the proportion of patients who rated alternative services as good (69.5%, up 0.8 percentage points).

• The use of some online services has increased. For example, 16.2% said they had used online services in the last 12 months to order repeat prescriptions, an increase of 1.9 percentage while 14.9% say they used online services to book appointments, an increase of 2.0 percentage points compared with 2018 (12.9%).

National headlines 2


5 |5 |

• Chart 1 shows where London significantly diverges from the national average. The pattern is very similar to the 2018 results.

• Key areas of variation are:• London has lower overall satisfaction levels than the England average: 80.4% described

their overall experience as good or very good, compared to 82.9% nationally• London respondents are more likely to have booked an appointment online, and to be

offered a choice of appointment. However they are less satisfied with available choices, mainly because the next appointment was not soon enough.

• When they did see a health professional, there were less likely to be given enough time, to be treated with care and concern, and to have any mental health needs recognised

• Another behavioural difference is that they were more likely to go to A&E rather than take the next available appointment, and to go there when their practice was closed. They were much less likely to say they received out of hours care or advice in the right time.

• This is a similar pattern to the 2018 results.

• Appendix 1 give the overall results for London CCGs for the questions covered in this report.

London findings


6 |6 |

Chart 1: Variation between national and London averages, GPPS 2019


7 |7 |

• The main areas of change are shown in Chart 2. There is a growing awareness and use of online services to book appointments and order repeat prescriptions, for example the proportion who had booked an appointment online in the past year rose 3.8 percentage points.

• Confidence in healthcare professionals also increased from 2018, by 2.0 percentage points.

• Less positively, respondents are now more likely to go to A&E rather than taking an offered appointment (5.2 percentage points increase from 2018). The largest change was for receiving out of hours care or advice in the right time – a decrease of 15.8 percentage points.

• Appendix 2 breaks down the full difference in London scores for 2018 and 2019.

Changes in London results since 2018


8 |8 |

Chart 2: Change in London average between 2018 and 2019 GPPS


9 |9 |

• The London trend is to have lower scores for most questions than the England average, however there is a wide variation in experiences within London.

• So while there is a large decrease in people saying they receiving care or advice in the right time when the practice is closed, it is particularly large for Kingston (41.0 percentage points lower than 2018), Lambeth (30.6) and Richmond (40.6), while the score has not changed for Waltham Forest, Wandsworth and West London CCGs.

• Chart 3 shows the other areas of high variation between London CCGs:• When practice closed, received care / treatment in about the right time (highest: Wandsworth

61.5%; lowest: Kingston 26.0%)• Reason for not taking appointment – offered one wasn’t soon enough (Central London

50.8%; Waltham Forest 19.2%)• When practice closed, went to A&E instead (Hammersmith & Fulham 50.2%; 31.3%

Lambeth)• Generally easy to get through to someone at your GP practice on the phone (West London

82.9%; Newham and Enfield both 57.9%)

• At STP level there is a consistent pattern across many of the questions. Experience of services in South West London is generally better than elsewhere, while experience is consistently less positive in East London. Chart 4 shows overall positive experience for each CCG and the change since 2018. The 3 highest scoring CCGs are in SW London; the lowest 4 in East London.

• There is also variation between different patients. For example, Chart 5 shows overall positive experience by BME groups. Nationally and in most London CCGs patients from a white background report a better experience than non-white patients. The gap is largest in Redbridge, Havering and Kingston.

•

Variation within London


10 |10 |

Chart 3: Variation between highest and lowest scoring CCGs in London, GPPS 2019


11 |11 |

Chart 4: Overall positive experience and change since 2018 by London CCG, GPPS 2019


12 |12 |

Chart 5: Overall positive experience by BME groups by London CCG, GPPS 2019


13 |13 |

• Nationally there are signs of increased pressure on general practice as people find it harder to get an appointment that meets their needs or to see their preferred GP. Quality of care remains high.

• Overall satisfaction and scores for most questions are lower in London than the rest of England

• Phone remains the preferred way to make appointments but there is wide variation among London CCGs on how easy this is. There is also wide variation in the quality of out of hours services.

• While Londoners are more likely to be offered a choice of appointment, the survey indicates that what is offered is less likely to meet their needs and so they are more likely to attend A&E instead

• While confidence and trust in healthcare professionals is lower in London than the national average, this has improved since 2018. However people are now less likely to say professionals recognised any mental health needs they had.

• Primary care transformation to reduce hospital demand is a key element of the Long Term Plan. Although the majority of patients in London report a positive experience of general practice in the GPPS there are a number of findings from the latest survey that are of concern. Despite the availability of extended access services, many people did not receive the care or advice in the time they wanted; not getting an appointment quickly enough remains a reason people went to A&E instead.

Summary

Presentation title of 150

14 |14 |

• In London findings have been shared with STPs:

• North West: Survey summary for each CCG has been to each primary care committee and some CCGs are working with local HW to develop improvements. The Quality Dashboard for NWL has been updated with latest survey data.

• North Central – survey went to STP SMT and all CCGs have been asked to provide a response on how addressing findings

• North East – STP has shared findings with and will be on SMG agenda to determine how to take forward

• South East: survey has been to primary care committees for discussion and comparative analysis of findings done for SEL. To confirm whether going to SMT

• South West: STP is sighted on findings

• Healthy London Partnership has produced some high level analysis at PCN level and discussions are taking place with STP leads as to if/how they might want to use and share this data locally

• The Primary Care Delivery Oversight Group will invite STP leads to share how they are responding to the findings.

Responding to the findings

Presentation title of 150

15 |15 |

Appendix 1: Breakdown by London CCGs and STPs, GPPS 2019

GPPS 2019: London summary

Percentages in green are significantly higher than London average, percentages in red are significantly lower (based on 1 standard deviation above / below mean)

Overall experience

Response rate G

ener

ally

eas

y to

get

thro

ugh

to

som

eone

at y

our G

P pr

actic

e on

th

e ph

one

Rec

eptio

nist

s at

you

r GP

prac

tice

are

help

ful

Awar

enes

s of

boo

king

app

oint

men

ts

onlin

e

Awar

enes

s of

ord

erin

g re

prea

t pr

escr

iptio

ns o

nlin

e

Book

ed a

ppoi

ntm

ent o

nlin

e in

pas

t 12

mon

ths

Ord

ered

repe

at p

resc

riptio

n on

line

in p

ast 1

2 m

onth

s

Satis

fied

with

ava

ilabl

e ap

poin

tmen

t tim

es

Alw

ays

/ a lo

t get

to s

peak

to

pref

erre

d G

P

Offe

red

a ch

oice

of a

ppoi

ntm

ent

Satis

ifed

with

type

of a

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red

Rea

son

for n

ot ta

king

app

oint

men

t: off

ere

d o

ne w

asn’t s

oon e

nough

Inst

ead

of ta

king

offe

red

appo

intm

ent,

wen

t to

A&E

Goo

d ov

eral

l exp

erie

nce

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akin

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t

Hea

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e

Hea

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nal w

as g

ood

at

liste

ning

Hea

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re p

rofe

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nal w

as g

ood

at

treat

ing

you

with

car

e an

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nH

ealth

care

pro

fess

iona

l rec

ogni

sed

and/

or u

nder

stoo

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enta

l he

alth

nee

ds th

at y

ou m

ight

hav

e ha

d

Invo

lved

as

muc

h as

wan

ted

to in

de

cisi

on a

bout

you

r car

e

You

had

conf

iden

ce a

nd tr

ust i

n pr

ofes

sion

al w

ho s

aw y

ou

Thin

king

abo

ut th

e re

ason

for y

our

appo

intm

ent,

your

nee

ds w

ere

met

Whe

n w

ante

d to

see

a G

P bu

t pr

actic

e cl

osed

, wen

t to

A&E

inst

ead

Rec

eive

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re o

r adv

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ht ti

me

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expe

rienc

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as g

ood

England average 33.1% 68.3% 89.3% 44.1% 40.6% 14.9% 16.2% 64.7% 48.0% 61.7% 73.6% 26.6% 11.8% 67.4% 86.7% 88.9% 87.4% 86.2% 93.4% 95.5% 94.5% 36.6% 66.0% 82.9%

London average 25.8% 68.8% 86.0% 48.4% 36.9% 20.1% 13.2% 63.9% 46.1% 65.2% 69.9% 32.7% 17.1% 66.1% 83.3% 86.6% 84.1% 82.4% 91.4% 94.0% 92.9% 42.6% 42.4% 80.4%Barking & Dagenham 23.6% 61.2% 83.7% 37.6% 26.4% 17.5% 10.4% 58.4% 41.4% 59.0% 61.8% 28.7% 16.9% 57.5% 78.1% 81.7% 78.3% 78.1% 88.0% 91.9% 91.5% 41.5% 47.3% 73.6%City & Hackey 27.4% 73.7% 89.0% 38.2% 31.3% 15.3% 10.4% 68.9% 44.7% 68.5% 74.9% 21.4% 13.7% 70.3% 84.8% 88.1% 86.5% 84.2% 93.1% 95.0% 93.2% 41.1% 39.0% 83.0%Havering 33.3% 63.5% 86.1% 39.8% 32.4% 12.8% 10.5% 60.3% 54.1% 58.8% 67.7% 37.3% 18.5% 62.6% 82.8% 84.1% 81.6% 82.5% 91.4% 92.6% 92.0% 36.4% 40.7% 78.3%Newham 35.1% 57.9% 80.8% 51.5% 30.8% 25.0% 10.1% 63.1% 40.2% 63.8% 66.9% 28.6% 22.4% 62.3% 79.5% 83.7% 81.0% 75.9% 87.9% 91.3% 90.6% 46.4% 47.9% 75.6%Redbridge 20.4% 51.9% 79.1% 49.8% 32.5% 21.4% 11.0% 58.2% 41.7% 56.6% 65.0% 30.4% 19.3% 57.3% 80.5% 85.0% 82.6% 80.7% 91.1% 94.4% 92.7% 40.6% 48.5% 74.0%Tower Hamlets 25.4% 67.2% 83.5% 52.9% 36.5% 24.9% 11.5% 60.3% 44.1% 65.5% 63.9% 31.6% 15.7% 61.0% 79.6% 83.7% 79.7% 82.0% 90.1% 93.0% 91.3% 40.8% 42.2% 74.7%Waltham Forest 24.0% 60.7% 83.3% 47.6% 29.5% 20.7% 9.5% 63.4% 43.7% 61.4% 68.7% 19.2% 16.4% 63.4% 80.7% 84.4% 81.9% 80.7% 90.1% 92.7% 91.7% 42.6% 59.6% 77.3%East London STP 27.0% 62.3% 83.6% 45.4% 31.3% 19.7% 10.5% 61.8% 44.3% 61.9% 67.0% 28.2% 17.6% 62.1% 80.8% 84.4% 81.7% 80.6% 90.2% 93.0% 91.9% 41.4% 46.5% 76.6%Barnet 29.0% 60.4% 82.6% 45.5% 35.3% 18.7% 13.8% 58.1% 42.1% 59.7% 66.4% 35.0% 17.1% 59.8% 83.1% 87.0% 84.5% 83.0% 91.8% 94.1% 93.2% 41.4% 44.7% 78.2%Camden 20.2% 77.3% 88.2% 48.0% 35.1% 20.6% 11.6% 64.4% 45.0% 69.6% 72.0% 50.0% 22.2% 69.6% 85.6% 90.3% 85.6% 88.7% 94.7% 95.5% 94.7% 47.2% 42.6% 83.2%Enfield 26.7% 57.9% 84.8% 47.6% 32.9% 18.4% 11.1% 59.9% 42.5% 60.4% 66.3% 28.1% 18.0% 58.9% 80.9% 84.5% 82.0% 78.9% 89.9% 92.7% 91.2% 44.2% 43.5% 77.0%Haringey 23.9% 67.8% 84.0% 41.1% 31.3% 17.2% 10.9% 62.5% 41.7% 64.9% 69.0% 24.1% 12.0% 64.1% 81.3% 85.1% 81.6% 80.1% 89.5% 92.8% 92.5% 45.8% 44.0% 78.5%Islington 33.3% 78.2% 88.5% 40.6% 35.1% 15.5% 12.3% 64.1% 51.7% 66.6% 72.6% 32.4% 16.5% 69.7% 85.2% 88.6% 87.0% 85.3% 93.7% 95.1% 93.5% 38.4% 34.2% 83.8%North Central London STP 26.6% 68.3% 85.6% 44.6% 33.9% 18.1% 11.9% 61.8% 44.6% 64.2% 69.3% 33.9% 17.2% 64.4% 83.2% 87.1% 84.1% 83.2% 91.9% 94.0% 93.0% 43.4% 41.8% 80.1%Brent 23.2% 64.2% 85.1% 44.3% 34.7% 19.3% 14.3% 63.5% 44.3% 66.7% 66.8% 28.6% 23.2% 64.0% 81.7% 84.8% 82.8% 80.8% 89.2% 93.0% 91.5% 43.4% 45.8% 78.0%Central London 21.7% 80.7% 84.4% 51.3% 43.6% 24.8% 18.2% 60.7% 48.2% 69.2% 63.6% 50.8% 19.7% 64.8% 82.6% 85.9% 81.6% 82.5% 90.5% 92.0% 91.3% 38.7% 46.0% 78.8%Ealing 28.8% 73.0% 84.4% 41.6% 34.3% 15.3% 13.5% 64.3% 45.7% 64.0% 70.7% 32.2% 18.8% 66.5% 81.6% 85.9% 83.1% 81.2% 90.5% 93.2% 91.8% 46.6% 42.5% 78.5%Hammersmith & Fulham 21.6% 73.6% 83.6% 55.7% 42.7% 28.3% 17.3% 66.2% 39.5% 67.1% 69.4% 40.6% 20.4% 68.8% 81.3% 86.5% 83.5% 79.4% 91.5% 93.7% 92.3% 50.2% 42.1% 80.7%Harrow 28.4% 66.9% 85.9% 56.2% 45.7% 22.5% 19.7% 64.3% 42.8% 65.8% 69.6% 26.0% 13.7% 65.5% 85.2% 88.2% 86.1% 82.2% 92.5% 94.9% 93.9% 42.6% 44.8% 81.2%Hillingdon 30.4% 70.8% 86.0% 45.4% 40.6% 16.0% 19.0% 62.2% 45.8% 61.9% 69.2% 38.1% 23.7% 66.7% 81.9% 84.5% 82.9% 79.1% 90.8% 93.5% 92.8% 45.4% 43.0% 79.0%Hounslow 22.4% 66.6% 85.2% 48.5% 40.3% 19.1% 17.7% 64.3% 47.4% 63.2% 69.7% 28.0% 18.3% 65.0% 80.3% 83.5% 81.0% 81.0% 89.0% 92.1% 91.2% 46.0% 42.6% 77.8%West London 18.3% 82.9% 88.7% 41.0% 35.7% 15.7% 15.6% 71.2% 53.4% 74.1% 72.2% 36.4% 22.1% 73.5% 84.9% 88.4% 86.3% 85.5% 91.6% 94.1% 93.7% 46.3% 59.1% 84.7%West London STP 24.3% 72.3% 85.4% 48.0% 39.7% 20.1% 16.9% 64.6% 45.9% 66.5% 68.9% 35.1% 20.0% 66.9% 82.5% 85.9% 83.4% 81.5% 90.7% 93.3% 92.3% 44.9% 45.7% 79.8%Bexley 34.7% 61.4% 85.7% 53.9% 39.4% 17.1% 11.9% 60.5% 47.4% 59.9% 68.1% 33.1% 23.0% 61.0% 84.1% 87.9% 85.6% 85.3% 91.9% 95.9% 94.2% 48.0% 37.8% 80.4%Bromley 34.7% 68.2% 88.6% 48.2% 37.1% 18.6% 14.5% 64.3% 49.6% 63.9% 74.1% 33.0% 17.1% 68.6% 85.3% 87.8% 86.4% 87.3% 93.3% 95.4% 94.3% 45.2% 38.8% 83.9%Greenwich 26.7% 65.8% 87.3% 45.5% 30.4% 18.9% 7.4% 62.6% 44.8% 64.4% 66.4% 32.0% 14.7% 65.7% 82.4% 85.0% 81.8% 78.6% 88.5% 92.3% 91.1% 45.0% 39.6% 79.3%Lambeth 24.0% 75.7% 88.1% 52.4% 39.8% 20.6% 13.1% 66.1% 47.8% 70.3% 73.2% 27.7% 13.4% 70.3% 85.8% 88.7% 86.7% 82.1% 92.7% 95.1% 94.0% 31.3% 33.9% 83.8%Lewisham 18.9% 61.2% 85.7% 60.6% 42.3% 27.6% 15.3% 60.4% 45.0% 64.3% 68.6% 34.6% 16.3% 62.4% 82.9% 87.0% 85.1% 81.8% 92.3% 94.2% 93.0% 44.5% 41.9% 80.4%Southwark 33.7% 69.4% 86.5% 43.4% 33.2% 17.0% 10.7% 60.2% 42.7% 65.8% 65.3% 30.0% 11.1% 60.2% 83.4% 86.9% 83.6% 81.3% 90.8% 94.2% 93.7% 38.9% 37.4% 79.3%South East London STP 28.8% 67.0% 87.0% 50.6% 37.0% 20.0% 12.2% 62.3% 46.2% 64.8% 69.3% 31.7% 15.9% 64.7% 84.0% 87.2% 84.9% 82.7% 91.6% 94.5% 93.4% 42.2% 38.2% 81.2%Croydon 25.9% 72.3% 87.5% 49.5% 38.9% 19.4% 12.6% 67.1% 48.0% 66.0% 73.3% 27.2% 12.3% 69.6% 84.9% 88.0% 86.0% 82.8% 92.4% 94.4% 94.2% 43.3% 38.5% 82.3%Kingston 21.0% 69.7% 89.6% 52.0% 44.1% 20.7% 16.9% 68.3% 49.0% 67.6% 77.1% 23.2% 6.9% 72.8% 87.1% 88.1% 86.1% 81.0% 93.0% 95.7% 92.6% 37.3% 26.0% 84.1%Merton 28.2% 63.9% 87.4% 55.5% 38.9% 24.1% 11.6% 67.3% 45.6% 67.3% 74.0% 24.0% 7.8% 68.7% 81.7% 84.7% 83.2% 83.3% 90.2% 93.4% 93.2% 47.9% 40.5% 81.0%Richmond 27.6% 81.5% 89.8% 49.3% 43.3% 19.6% 15.3% 67.6% 53.3% 71.1% 77.3% 43.9% 16.3% 74.2% 89.7% 92.4% 90.2% 89.4% 95.0% 97.0% 95.8% 37.3% 28.5% 87.9%Sutton 18.4% 76.8% 90.3% 55.4% 42.5% 22.1% 11.5% 70.6% 51.8% 67.8% 76.8% 45.5% 18.4% 75.0% 87.6% 90.7% 88.1% 86.5% 94.3% 96.3% 95.8% 44.2% 31.9% 86.8%Wandsworth 20.2% 78.4% 88.9% 58.1% 42.8% 26.8% 13.4% 71.8% 48.9% 72.6% 76.4% 43.3% 20.7% 73.8% 87.4% 89.9% 88.1% 85.9% 94.1% 96.2% 94.7% 36.2% 61.5% 87.4%South West London STP 23.6% 73.8% 88.9% 53.3% 41.8% 22.1% 13.5% 68.8% 49.4% 68.7% 75.8% 34.5% 13.7% 72.4% 86.4% 89.0% 86.9% 84.8% 93.2% 95.5% 94.3% 41.0% 37.8% 84.9%

Your local GP services Making an appointment Your last appointment When practice closed

of 150

16 |16 |

Appendix 2: Change since 2018 by London CCGs and STPs, GPPS 2019

GPPS 2019: London summary

Percentages in green are significantly higher than London average, percentages in red are significantly lower (based on 1 standard deviation above / below mean)

Overall experience

Response rate G

ener

ally

eas

y to

get

thro

ugh

to

som

eone

at y

our G

P pr

actic

e on

th

e ph

one

Rec

eptio

nist

s at

you

r GP

prac

tice

are

help

ful

Awar

enes

s of

boo

king

app

oint

men

ts

onlin

e

Awar

enes

s of

ord

erin

g re

prea

t pr

escr

iptio

ns o

nlin

e

Book

ed a

ppoi

ntm

ent o

nlin

e in

pas

t 12

mon

ths

Ord

ered

repe

at p

resc

riptio

n on

line

in p

ast 1

2 m

onth

s

Satis

fied

with

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ilabl

e ap

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tmen

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ays

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erre

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P

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red

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type

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son

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ot ta

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ead

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ent,

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Goo

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You

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al w

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aw y

ou

Thin

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ason

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ent,

your

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met

Whe

n w

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see

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actic

e cl

osed

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inst

ead

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me

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expe

rienc

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as g

ood

England average -1.0% -2.0% -0.3% 3.5% 2.7% 2.0% 1.9% -1.3% -2.2% -0.6% -0.7% 0.3% 0.7% -1.2% -0.2% -0.1% 0.0% -0.8% -0.1% 2.0% -0.3% 1.0% 1.0% -0.8%

London average 0.0% -1.0% -1.5% 5.1% 4.6% 3.8% 2.6% -0.6% -1.3% 0.3% -0.4% -1.0% -0.3% -0.3% 0.3% 0.3% 0.1% -1.0% 0.1% 2.7% -0.4% 0.9% -15.8% -0.2%Barking & Dagenham -1.5% -2.9% 0.4% 3.4% 3.0% 3.9% 2.8% -4.3% -2.4% -1.8% -2.2% 0.5% -1.2% -3.1% 0.3% -0.8% -1.0% 0.0% 1.5% 5.3% 1.2% 4.2% -4.9% 0.0%

City & Hackey 5.2% -2.2% -1.5% 7.5% 4.4% 4.9% 1.0% -1.0% -2.6% 2.0% 0.1% -2.6% 1.5% -2.3% -0.5% 0.2% 0.9% -0.9% 1.8% 3.6% -0.2% -2.3% -21.6% -1.2%Havering -1.1% -2.2% -3.2% 4.6% 3.1% 1.6% 1.5% -1.8% -1.4% -2.2% -2.2% -4.8% 5.2% -1.9% -0.5% -1.4% -1.7% -4.0% -0.3% 1.0% -2.1% 5.6% -16.3% -4.8%Newham 15.0% 2.0% -0.2% 5.2% 3.9% 3.9% 2.6% 1.1% -0.5% 0.6% 3.5% 0.3% 2.7% 2.1% 2.4% 1.4% 1.5% 0.0% 1.0% 4.5% -0.8% 4.6% -3.1% -2.0%Redbridge -6.7% 0.4% -1.8% 1.8% 1.1% -0.1% 0.5% 0.7% -3.7% -0.7% -0.8% 7.9% -0.4% -0.3% -0.9% -1.2% -0.6% -0.8% 0.2% 3.5% -1.1% 0.2% -4.0% -6.4%Tower Hamlets 6.8% -3.8% -1.5% 4.7% 3.4% 5.1% 1.7% -3.1% 0.4% -1.1% -3.9% -13.2% 1.7% -3.9% 0.2% -0.5% -0.7% 0.2% -0.5% 2.4% -0.7% 0.9% -7.9% -7.2%

Waltham Forest -2.1% -0.7% -1.7% 6.9% 7.5% 3.8% 2.6% -1.8% -2.6% 0.0% -1.1% -7.5% 4.8% -0.2% 1.3% 1.7% 2.2% 1.0% -0.1% 2.5% -0.5% 1.7% 0.0% -7.6%East London STP 2.2% -1.3% -1.3% 4.9% 3.8% 3.3% 1.8% -1.5% -1.8% -0.5% -0.9% -2.8% 2.0% -1.4% 0.3% -0.1% 0.1% -0.6% 0.5% 3.3% -0.6% 2.1% -8.3% -4.2%

Barnet -1.5% -2.1% -3.0% 6.3% 3.8% 2.5% 1.8% -3.8% -2.9% 0.5% -2.0% 14.5% 1.5% -2.6% -0.8% -0.3% 0.5% -0.1% 0.0% 2.4% 0.3% -2.6% -7.4% -1.8%Camden 0.2% -0.3% -3.0% 7.7% 5.9% 7.3% 2.4% 0.0% 0.7% -0.9% -1.4% 4.5% 10.5% 1.4% 0.6% 1.8% 0.1% 0.9% 0.4% 1.3% 1.4% 1.8% -19.0% 6.0%Enfield -2.8% -2.3% 0.3% 7.3% 2.9% 3.9% 1.2% -2.7% -3.2% -2.0% -2.0% -1.0% -5.8% -3.7% -0.3% 0.1% -0.5% -2.6% 1.0% 3.8% -0.7% -0.4% -12.4% -4.0%Haringey -1.5% -2.9% -2.7% 2.9% 1.8% 2.5% 2.1% -1.1% -4.0% 1.1% 0.4% -11.0% -9.0% -0.8% -0.7% -0.2% -1.9% 0.1% -0.6% 2.7% -0.4% 4.3% -20.1% 4.5%

Islington 9.4% 2.5% -0.7% 5.9% 4.5% 3.0% 3.2% 1.0% 4.6% 1.5% 2.5% -1.5% 7.8% 2.1% 1.9% 2.0% 2.1% 0.6% 1.5% 2.8% -1.1% 8.1% -27.9% 4.8%North Central London STP 0.7% -1.0% -1.8% 6.0% 3.8% 3.9% 2.1% -1.3% -0.9% 0.0% -0.5% 1.1% 1.0% -0.7% 0.2% 0.7% 0.1% -0.2% 0.5% 2.6% -0.1% 2.3% -17.4% 1.9%

Brent -1.4% -2.3% -0.9% 5.9% 6.6% 3.7% 4.7% -1.5% -1.6% 1.7% -0.7% 4.0% 0.8% 0.7% 0.5% -0.9% 0.0% -0.7% -0.7% 3.1% 0.2% 0.1% -6.4% 0.4%Central London 2.7% -2.0% -2.2% 5.3% 11.6% 8.1% 6.5% -1.5% -1.9% 0.5% -5.7% -1.9% 6.9% -1.0% 0.6% 2.3% -1.1% -3.5% 0.4% 1.9% -0.9% -4.6% -10.5% -1.3%Ealing 3.4% 1.9% -1.6% 5.0% 6.7% 2.7% 3.2% 1.2% -1.8% 2.6% 1.7% 1.9% -6.1% 0.8% 0.3% 0.9% 0.9% 1.1% 0.7% 3.4% -0.9% 0.1% -12.2% 0.3%Hammersmith & Fulham 0.3% -0.5% -4.0% 5.8% 6.5% 8.1% 6.2% 1.6% -3.6% 1.3% 0.7% -6.7% -9.5% 3.6% -0.1% 0.8% 0.4% -3.7% 0.4% 2.6% -1.1% 8.9% -21.4% 1.2%Harrow -1.5% -0.5% -0.4% 4.9% 6.5% 1.7% 3.7% 1.2% -1.8% 0.3% 0.7% -10.4% -8.0% 0.7% 1.6% 0.8% 1.5% -2.1% 0.8% 3.2% 0.5% 0.4% -5.3% 0.5%Hillingdon 0.5% 3.4% -0.7% 2.7% 6.7% 1.2% 6.7% 2.3% -1.8% 2.1% 0.8% 1.2% 3.2% 3.5% 2.0% 1.4% 1.9% -2.4% 0.0% 2.8% 1.1% 1.6% -13.7% -1.0%Hounslow -5.1% -3.2% -1.8% 4.7% 6.7% 4.4% 5.1% -2.3% -0.4% 1.1% 0.3% 0.3% -7.5% -1.4% -0.8% -1.1% -1.9% -1.3% -0.7% 2.4% -1.6% -1.6% -14.8% -9.3%

West London -2.6% -2.9% -1.2% 2.5% 2.9% 0.9% 3.0% -1.3% -1.9% 1.0% -2.6% -1.1% -2.9% -0.3% -0.4% 0.0% -0.2% -0.7% -1.5% 1.0% -0.4% 2.0% 0.0% -2.5%

West London STP -0.5% -0.8% -1.6% 4.6% 6.8% 3.8% 4.9% 0.0% -1.8% 1.3% -0.6% -1.6% -2.9% 0.8% 0.4% 0.5% 0.2% -1.7% -0.1% 2.5% -0.4% 0.9% -10.5% -1.5%

Bexley -0.7% -1.2% -0.2% 5.7% 4.3% 2.9% 1.9% 1.0% -1.6% -0.3% -0.8% -10.0% 8.3% -0.8% 0.8% 2.2% 0.9% -1.0% -0.1% 3.8% -0.2% 1.6% -21.2% 0.7%Bromley -0.6% -2.0% -1.3% 1.6% 1.3% 1.7% 1.1% -1.2% -1.0% -1.0% -0.4% 1.1% -1.7% -1.8% -1.5% -1.1% -0.6% -2.1% -0.5% 1.6% -0.7% -2.2% -23.3% 6.4%Greenwich 1.1% -2.6% -3.1% 4.7% 3.4% 4.3% 0.9% -0.4% 0.0% -0.9% -0.2% 1.5% -5.1% -0.3% -0.7% -0.8% -2.3% 0.2% -1.7% 2.1% -1.6% -5.7% -15.5% -2.2%Lambeth 2.9% -0.5% -2.8% 4.4% 3.4% 2.9% 1.1% -1.9% 0.1% -1.3% -0.3% -3.1% 4.0% -1.2% 0.7% 0.1% 0.1% -1.9% 0.2% 2.6% -0.2% -3.7% -30.6% 2.1%Lewisham -5.2% -1.9% -2.6% 4.9% 5.3% 5.4% 4.7% -3.8% 2.1% -0.3% -2.4% 3.4% 6.0% -2.1% -1.7% -0.8% -0.3% -2.7% 0.0% 1.9% -1.3% 3.8% -18.8% 6.0%Southwark 11.9% -3.5% -1.7% 4.9% 5.1% 5.0% 2.4% -1.0% -1.9% 0.0% -0.4% -12.3% -3.5% -1.8% 2.5% 1.0% 0.3% -2.0% -0.3% 3.0% 0.9% -0.7% -19.8% -4.0%

South East London STP 1.6% -1.9% -2.0% 4.4% 3.8% 3.7% 2.0% -1.2% -0.4% -0.6% -0.7% -3.3% 1.3% -1.3% 0.0% 0.1% -0.3% -1.6% -0.4% 2.5% -0.5% -1.2% -21.5% 1.5%

Croydon -1.7% -2.3% -1.2% 6.0% 3.7% 5.6% 0.7% -0.6% -1.0% -0.2% 0.0% 4.2% -4.6% -1.4% -0.2% -0.4% 0.1% 0.1% 1.0% 3.0% 0.4% 3.9% -18.8% -0.7%Kingston -10.1% 1.0% -1.4% 3.9% 2.9% 4.5% 3.8% -0.3% -3.7% 3.9% 2.0% 2.8% -4.9% 2.2% 1.0% -0.3% -0.9% -4.5% -1.1% 1.5% -2.8% -1.1% -41.0% 0.8%Merton 0.3% -1.3% 0.2% 3.9% 2.1% 3.9% 1.4% -0.1% -1.1% 1.3% 1.3% -16.9% -9.0% 2.0% -1.1% -2.2% -0.3% 0.9% -0.8% 2.3% -0.9% 3.5% -23.1% -0.1%Richmond -7.3% 0.5% -0.5% 7.7% 4.3% 7.3% -0.2% 2.2% -3.1% 1.6% 0.2% 7.2% -3.7% 0.4% 1.5% 1.2% 1.6% 0.9% 0.3% 2.3% 0.6% 0.3% -40.6% 3.9%Sutton -16.2% -1.6% -2.0% 8.9% 4.0% 4.4% -0.3% -0.7% -0.5% -2.4% -1.4% 17.1% -5.2% -1.1% -0.1% 0.8% 0.6% -1.1% 0.6% 2.6% 0.1% -2.5% -27.3% -0.3%Wandsworth -4.0% -1.1% -2.3% 1.0% 1.0% -0.3% 0.0% 0.8% -2.5% -0.1% 1.2% 1.6% 13.5% -0.8% 0.6% -0.3% 0.4% -0.4% -0.8% 1.3% 0.5% -2.2% 0.0% 9.6%South West London STP -6.5% -0.8% -1.2% 5.2% 3.0% 4.3% 0.9% 0.2% -2.0% 0.7% 0.6% 2.7% -2.3% 0.2% 0.3% -0.2% 0.3% -0.7% -0.1% 2.2% -0.3% 0.3% -25.1% 2.2%

When practice closedYour local GP services Making an appointment Your last appointment

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Further information

CQC Maternity Services Survey 2018: London Region Review

Full results available at www.gp-patient.co.ukCCG slide packs with comparisons between practices available at http://www.gp-patient.co.uk/surveysandreports

Case studies on how different organisations and services use GPPS data: www.gp-patient.co.uk/uses-of-gpps

This report compiled by:NHS England / Improvement London Region Nursing DirectorateContact:Jamie KeddieClinical Quality Manager – North West London / Patient Public [email protected]

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http://www.gp-patient.co.uk/

http://www.gp-patient.co.uk/surveysandreports

http://www.gp-patient.co.uk/uses-of-gpps


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Report Title REPORT TO THE NORTH CENTRAL

LONDON PRIMARY CARE COMMISSIONING COMMITTEE (PCCC)

Date of report

Agenda Item

Considered at Part 1☒ Part 2 ☐ Urgent decision ☐

11



Tel/Email

[email protected]

GB Member Sponsor

Not Applicable

Report Author

NHS England Primary Care Commissioning

Tel/ Email

0203 688 1993 [email protected]

Report Summary

Detail of the request to vary PMS Agreements and any conditions to be applied

Recommendation APPROVAL of the proposed changes outlined below and any conditions


Not maintaining the stability of the agreement. The risk can be mitigated by approving the variations with appropriate conditions.


Not Applicable


Not Applicable

Engagement

Not Applicable


Not Applicable


Not Applicable

Next Steps Issue appropriate variations with conditions where applicable Appendices

Not Applicable

Which CCG does this relate to:

Barnet

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Contents Contents ..................................................................................................................... 2

1 Executive summary ............................................................................................. 3

2 Background ......................................................................................................... 3

3 Appointment benchmarking ................................................................................. 3

4 Table of requested PMS Agreement Changes .................................................... 4

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1 Executive summary The below table summarises the Agreement Changes requested by PMS Practices in NCL.

The corresponding CCG is asked to make determination for the PMS Agreement Changes in

their area.

2 Background PMS practices are required to submit agreement change requests with 28 days’ notice to allow

the commissioner to consider the appropriateness of the request. The Commissioner should

be satisfied that the arrangements for continuity of service provision to the registered

population covered within the agreement are robust and may wish to seek written assurances

of the post-variation individuals ability and capacity to fulfil the obligations of the agreement

and their proposals for the future of the service.

3 Appointment benchmarking

As a part of the due diligence undertaken when assessing PMS Practices’ requests to vary the

PMS Agreement, the number of GP appointments offered by the Practice is assessed. All

weekly GP appointments (face to face, telephone, home visit) are totalled and compared to

the benchmark of 72 appointments per 1000 patients per week. This figure is a requirement

in all new Standard London APMS contracts and is described in the BMA document Safe

working in general practice1 as developed by NHS England via McKinsey but widely accepted.

Where Practices do not meet the 72 GP appointments per 1000 patients Commissioners will

seek to work with the provider to increase access.

1 https://www.bma.org.uk/-/media/files/pdfs/working%20for%20change/negotiating%20for%20the%20profession/general%20practitioners/20160684-gp-safe%20working-and-locality-hubs.pdf

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https://www.bma.org.uk/-/media/files/pdfs/working%20for%20change/negotiating%20for%20the%20profession/general%20practitioners/20160684-gp-safe%20working-and-locality-hubs.pdf



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4 Table of requested PMS Agreement Changes

Practice CCG approver

List Size 1/7/19

PCN membership Agreement Change

Comment Recommended guide based on: 72 GP appointments per 1000 patients

Apps x 10 min (app) / 180 (3 hour session)

Recommendation to committee

E83638 Mountfield Surgery

Barnet 5094 Practice is a member of CHIN 3/PCN 3 Primary Care Network, comprising: • 16 Practices 118015 patients at 1/07/19

Resignation of GP signatory and addition of new GP signatory (list size 5094 patients at 1/7/19)

Background The current signatories Dr Patrick Keane and Dr Ann Robinson wish to add Dr Sharmili Bose as a signatory with effect from 01/09/19. At the same time, Dr Robinson will leave the PMS Agreement, becoming a Salaried GP at the Practice. Clinical Sessions provided

• 370 GP appointments and 17 sessions per week, provided by - 2 GP PMS Signatories - 2 Salaried GPs

• Walk in service Mon-Fri mornings open to all patients, in addition to the above appointments

Recommended Guide

• 367 GP appointments and 20 sessions per week

The Practice is offering fewer sessions than is recommended, but these are longer and provide more than the minimum total required. Additionally, any patient needing same-day access may attend the morning walk in service. The Practice is hoping to add more sessions following this change.

To approve

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List Size 1/7/19





Nursing appointment figures have not been provided. There will be no reduction in the number of sessions being provided by Dr Keane, Dr Robinson, Dr Bose and the second salaried GP Dr Mond.

1. Forest Road Group Practice (MHP)

2. Riley House Surgery (MHP)

3. Freezywater PCC (MHP)

4. Southbury Surgery (MHP)

5. Green Street Surgery (MHP)

6. Lincoln Road Medical Practice (MHP)

7. Enfield Island Surgery (MHP)

Enfield Total of 14 MHP GMS/PMS Practices – 89,335 patients List size at Riley House (8491) Currently 34 signatories including 1 non- clinical.

Practice is a member of Enfield Unity PCN Primary Care Network, comprising: • 23 Practices 158,737 patients as at 1/07/19

Approve addition of a signatory to 8 PMS practices who form part of MHP

The 8 PMS practices which form part the Medicus Health Partners (MHP) (made up of 6 GMS & 8 PMS practices) have requested the addition of Dr Nirav Varsani with effect 1st October 2019. Dr Varsani will be offering 74 appointments and 5 sessions per week at Riley House Surgery. Clinical sessions/Appointments provided

• 662 GP appointments per week • 38 GP sessions per week • 352 nurse appointments per week • 12 nurse sessions per week

Recommended Guide Based on the list size at Riley House


To approve

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List Size 1/7/19





8. Dean House Surgery (MHP)

With the addition of Dr Varsani’s proposed sessions, recommended GP appointments and sessions are met. There is a shortfall of 3 nurse sessions per week, however, the practice are delivering significantly more nurse appointments (72 above) than recommended.

F85004 Eagle House

Enfield 13434 Practice is a member of Enfield Unity PCN Primary Care Network, comprising: • 23 Practices 158,737 patients as at 1/07/19

Retirement of Dr Margaret Barnes

Partners Retirement of Dr Barnes will leave 5 partners to the contract. Clinical sessions/Appointments provided

• 1325 GP appointments per week • 53 GP sessions per week • 548 nurse appointments per week

(including 108 HCA appointments) • 26 nurse sessions per week

(including 6 HCA sessions)

Recommended Guide • 968 GP appointments per week • 51 GP sessions per week • 444 nurse appointments per week • 24 nurse sessions per week

Recommended GP appointments and sessions met.

To approve

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List Size 1/7/19





Recommended nurse appointments and sessions met.

Daleham Gardens Surgery

Camden 3121 Practice is a member of North Camden, comprising of • 7 Practices 55,178 patients as at 1/04/19

Removal of Dr Corinne McGrath

Removal of Dr McGrath will leave Dr Fard remaining on the PMS agreement as a single-hander Clinical sessions/Appointments provided


Recommended Guide


There is a shortfall of 30 GP appointments per week but the practice offer a 1 additional GP session per week above the recommend guide. Dr McGrath has appointments of 15 minute duration. There is a shortfall of 58 nurse appointments per week and 4 nurse sessions per week.

Approve subject to the following condition: Dr Fard to clarify his work pattern at Daleham Gardens Surgery and how he will continue to provide clinical leadership in the practice.

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List Size 1/7/19





Dr McGrath will remain as a salaried GP for the practice and will offer the same number of sessions. There will be no loss of GP or reduction in services. Practice currently have a lease at will, removal will allow Dr Fard to sign as a sole leaseholder and secure tenure in the building. Currently Dr Fard provides one clinical session per week at Daleham Gardens. Dr Fard is also the singlehanded contract holder at Grays Inn Road Medical in Camden which is 3 miles away from Daleham Gardens Surgery. The Practice has been advised of the need to increase GP appointments and NCL Commissioning Team will monitor, providing advice if necessary.

F85640 Cheshire Road Surgery

Haringey 6750 Haringey – North Central

Addition of Non-Clinical Partner – Jessica Benson

Partners Addition of Ms Jessica Benson will give a total of 3 partners to the PMS Agreement Clinical sessions/Appointments provided

• 337 GP appointments per week • 21 GP sessions per week • 150 Nurses appointment per week • 15 Nurses sessions per week

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List Size 1/7/19





Recommended Guide • 486 GP appointments per week • 26 GP sessions per week • 223 Nurses appointments per week • 12 Nurses sessions per week

There is a shortfall of 149 GP appointments and 5 sessions. There is also a shortfall of 73 Nurses appointments As from November 2019, practice has the following action plan in place:-

• Recruit a long term locum to cover the 5 sessions short fall, which will create additional 95 GP appointments per week;

• Reduce all 15 minutes GP appointments to 10 minutes and this will create an extra 20 GP appointments per week;

• Practice will offer an extra 40 GP telephone appointments per week;

This will provide 5 additional GP sessions and 155 appointments per week.

• Recruit and extra nurse from the Federation that will create additional 4

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sessions and 64 appointments per week.

• Practice also plan to increase nurses’ telephone appointments by an extra 9 per week.

This will provide 4 additional nurses’ sessions and 73 Nurses appointments per week.

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Report Title Relocation of Bush Hill Park and Trinity

Avenue Surgery to Lincoln Road Surgery Date of report

Agenda Item 12


Deborah McBeal, Director of Primary Care Commissioning and Deputy Chief Operating Officer


GB Member Sponsor


Report Author

Vanessa Piper Tel/Email [email protected]

Report Summary

Committee members are asked to consider the case of the relocation of Bush Hill Park Surgery and Trinity Avenue Surgery to Lincoln Road Surgery. Bush Hill Park Surgery and Lincoln Road Surgery contracts are held by Medicus Health Partnership, which is a super partnership of 35 contract holders, whom operate over 14 sites. Trinity Avenue Surgery Contract is held by Dr Boakye and Dr Barnie but there is an agreement between both contracts holders and Medicus Health Partnership to co locate the patient list. PCCC members should note that in June 2019 members did not approve the addition of Dr Boakye and Dr Barnie to the 8 PMS contract held by MHP on the grounds that, (1) the variation did not resolve the issue of the practice operating out of a site that was not fit for purpose. (2) It provided no resilience to the 2 contract holders and (3) there were limited benefits for patients in terms of the constraints of what services could be delivered from that site. MHP have responded by setting out a provisional estates strategy, which includes rationalisation of the number of premises which they operate from. MHP have stated that the benefits of this plan will give patients more of a uniform experience, support better resilience, recruitment and retention, including removing professional isolation from smaller MHP sites. Commissioners deem this as a positive request from the contract holders to relocate Bush Hill Park Surgery and Bush Hill Trinity Avenue Surgery because both sites are converted residential houses, which are not compliant with the relevant premises standards and regulations. Therefore, the proposed relocation has significant benefits for patients in ensuring services are accessed from fit for purpose buildings. Combined list size of Bush Hill Park and Trinity Avenue Surgery

- Bush Hill Park 2163 patients (July 2019) - Trinity Avenue Surgery 2805 (July 2019) - Combined list of 4968 patients

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Based on a DV guidance of 1 consultation room to 1800 patients the practices will require 3 consultation rooms. MHP have submitted room utilisation charts, which show that rooms are not used to capacity but have confirmed that both sites have under provision of nursing capacity, which will need to be increased for patients. Therefore, 4 consultation rooms and 1 treatment room is being requested to accommodate the relocation of the practice and patient list. Build option considered in Lincoln Road Surgery

- Proposal for a 2nd floor extension in Lincoln Road Surgery - 6 consultation rooms - 2 treatments rooms - Administration and reception space

Rooms Bush Hill Park and Trinity Avenue Surgery will occupy

- Combined list of 4968 patients - 4 consultation rooms - 1 treatment room

It should be noted that an additional 2 consultation rooms and 1 treatment rooms have been requested to also accommodate a portion of the patient list for Southbury Road Surgery. This proposal is set out in separate PCCC paper titled ‘Relocation of Southbury Road Surgery to Lincoln Road and Willow House Surgery. Cost Implications of the relocation

1. Capital - MHP have set out in the PID that the capital costs of the build will be £900,000 for the 2nd floor extension for Lincoln Road Surgery of which MHP can self-fund 100% of the build costs

2. Rent - MHP have set out in the PID that they agree that there will be no

increase in the current market rent (CMR) reimbursed for Bush Hill Park Medical Centre and Trinity Avenue Surgery. The combined CMR currently reimbursed for both sites is £49,000 per annum

a. £24,000 per annum - Bush Hill Park Surgery b. £25,000 per annum – Bush Hill Trinity Avenue Surgery

3. GPIT (Cabling)– MHP request commissioners to approve GPIT costs

related to new cabling only

4. GPIT (Equipment) - MHP have stated that there will be no request for additional IT equipment and are not seeking approval for these costs

Risks As this is a new build option for a 2nd, floor extension commissioners deem that there may be increased rent implications, due to there will be higher premises specification for the extension, because the plans will need to meet building regulations. Therefore, commissioners are aware of this risk and would be requesting a District Valuation (DV) to assess the architect plans of the extension and implication to the current market rent.

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Timelines for the build and relocation MHP have set out the following timelines which commissioners are in support of;

- October 2019 – submission to commissioners for PCCC approval - October 2019- Design confirmed - March 2020 – Project tendered - April 2020 – sign up - May 2020 – Extension / Redevelopment on work on each site - November 2020 – Practical completion

Distance of each practice from Lincoln Road Surgery Both practices are less than 1 mile from Lincoln Road surgery, therefore, commissioners deem there to be a low impact to patients from the relocation.

- Bush Hill Park Medical Centre is 0.6 miles from Lincoln Road Surgery - Bush Hill Park Trinity Avenue Surgery 0.6miles from Lincoln Road

Surgery Patient Engagement Due to the number of patients, including vulnerable patients on each list commissioners have requested MHP and the contract holders for Trinity Avenue Surgery (Dr Boakye and Dr Barnie) to immediately commence engagement with their patient groups to seek their views on the relocation and to identify their needs. Commissioners will work with the contract holders in identifying the at risk groups of patients and identifying any specific needs which will be required to take into consideration as part of the relocation. Patient maps have also been requested to identify where patients reside across the two sites compared to where Lincoln Road Surgery is positioned. Commissioners will review the outcome of the patient engagement and will return the findings to PCCC members if there is strong opposition to the relocation.

Recommendation On the basis of the outline of the case set out above committee members are asked to; APPROVE the relocation of Bush Hill Park Medical Centre and Bush Hill Trinity Avenue Surgery to Lincoln Road Surgery in principle on the following conditions; 1. The first stage of the early planning can commence by MHP in line with

their timeline (design confirmed between October 2019 to March 2020) 2. The DV assesses the architect plans of the additional space 3. The DV provides a current market rent based on the architect plans to

assess if there will be an increase in the CMR reimbursed; a. Bush Hill Medical Centre £24,000 per annum b. Trinity Avenue Surgery £25,000 per annum

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4. Patient engagement commences with the registered list for Bush Hill Park Medical Centre and Bush Hill Trinity Avenue Surgery regarding the relocation

5. Patient engagement commences with the registered list for Lincoln Road

Surgery patients to gage their views on the impact of up to 5000 new patients accessing the site and potential impact to clinical services

6. GPIT costs to the CCG will be based on cabling only 7. No additional costs to the CCG for IT equipment 8. 100% of the capital costs (£900,000) for the 2nd floor extension will be self

– funded by MHP and no further costs will be sought from commissioners 9. A 2nd floor extension to be built on the top floor of Lincoln Road Surgery 10. The build of 6 consultation rooms and 2 treatment rooms 11. Relocation should occur before or in November 2020


Increase in CMR reimbursed is currently unknown at the time of the PCCC decision. This will be mitigated by commissioners instructing the DV to assess the architect plans and if the rent is excessively above the existing CMR, this will be referred back to PCCC. Risk to patients being impacted by the relocation. There will be 4968 patients that will be relocated. Commissioners deem the impact will be low as Lincoln Road Surgery is 0.6 miles from both practices. There will be further mitigation though the patient engagement and identifying vulnerable patients to assess their specific needs.


None


Financial – rent reimbursement

Engagement

Patient engagement will commence


To be carried out by MHP as part of the engagement process


The relocation has not been considered before

Next Steps Set out above

Appendices

List size growth – Appendix A

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Appendix A – List Size Growth Bush Hill Park Medical Centre – Raw List size growth Practice list size in 2014, 2015, 2016, 2017,2018

(Source of data- Global sum list from PCIS)

Year Apr Jul Oct Jan

2016 4933 4993 4988 4979

2017 4969 4979 4938 4910

2018 4828 4714 4638 tbc

Bush Hill Park Trinity Avenue – Raw list size growth Practice list size in 2014, 2015 ,2016 and 2017

(Source of data- Global sum list from PCIS)

April July October January 2014 2826 2815 2791 2753 2015 2687 2663 2610 2664 2016 2621 2620 2609 2605 2017 2584 2596 2593 2581 2018 2578

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Report Title Relocation of Southbury Road Surgery Date of

report Agenda Item

13




GB Member Sponsor


Report Author

Vanessa Piper Tel/Email [email protected]

Report Summary

Committee members are asked to consider the case of the relocation of Southbury Road Surgery patient list to Willow House Surgery and Lincoln Road Surgery All three contracts are held by Medicus Health Partnership (MHP), who are a super partnership of 35 contract holders, operating over 14 sites. MHP have set out a provisional estates strategy, which includes rationalisation of the number of premises which they operate from. MHP have stated that the benefits of this plan will give patients more of a uniform experience, support better resilience, recruitment and retention, including removing professional isolation from smaller MHP sites. Commissioners deem this as a positive request from the contract holders to relocate Bush Hill Park Surgery and Bush Hill Trinity Avenue Surgery because both sites are converted residential houses, which are not compliant with the relevant premises standards and regulations. Therefore, the proposed relocation has significant benefits for patients in ensuring services are accessed from fit for purpose buildings. Commissioners had also raised concerns with MHP regarding the management and business continuity of small sites still traditionally operating with 1 single or 2 contract holders within such a large partnership. MHP have responded positively by submitting the PIDs and their estates strategy. The proposal to relocate the Southbury Road Surgery patients over 2 sites is due to the following; Southbury Road Surgery Patients where they reside and distance to each site

- The registered list of Southbury Road Surgery reside between Willow House Surgery and Lincoln Road Surgery

- The Southbury Road Surgery site is a converted residential house which is not fit for purpose in terms of the room sizes and there is no opportunity to expand

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Current capacity and utilisation of Southbury Road Surgery

- There are 4664 patients (July 2019) that are registered at Southbury Road Surgery

- Using the DV guide of 1 consultation room to 1800 patients the practice should as a minimum operate from 3 consultation rooms

- Southbury Road surgery currently operate from 3 consultation rooms - MHP have submitted a room utilisation chart which shows that the

rooms are used to full capacity and does not provide much scope to deliver more appointments and longer clinical sessions if required

- MHP are therefore requesting that 5 consultation rooms and 1 treatment room are required for the Southbury Road list size

Willow Road Surgery Build option

- Proposal for a 2nd floor extension - 3 consultation rooms - Administration space - To relocate a proportion of the patient list for Southbury Road Surgery

whom reside close to the Willow Road Surgery Lincoln Road Surgery build option – Southbury Road Patients

- Proposal for a 2nd floor extension - 2 consultation rooms - 1 treatment rooms - Administration and consultation space - To relocate a proportion of the patient list for Southbury Road Surgery

whom reside close to the Lincoln Road Site With the Lincoln Road proposal, committee members are reminded, that a total of 6 consultation and 2 treatment rooms have been requested by MHP, but 4 of the consultation and 1 of the treatment rooms will be occupied by the relocation of Bush Hill Park and Trinity Avenue Surgery. Cost implications of the relocation

1. Capital – MHP have set out in the PID that the capital costs of the build will be £250,000 for the Willow House Surgery extension of which MHP will self-fund 100% of the build costs

2. Rent – MHP have set out in the PID that they agree that there will be

no increase in the current market rent (CMR) reimbursed for the Southbury Road Surgery. The current CMR for Southbury Road Surgery is £21,000

3. GPIT (Cabling) – MHP request commissioners to approve GPIT costs

related to new cabling only

4. GPIT (equipment) – MHP have stated that there will be no request for additional IT equipment and are not seeking approval for these costs

Risks As this is a new build option for a 2nd, floor extension for both Willow House Surgery and Lincoln Road Surgery commissioners deem that there may be

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increased rent implications; due to there will be a higher premises specification for the extension because the plans will need to meet building regulations. Therefore, commissioners are aware of this risk and would be requesting a District Valuation (DV) to assess the architect plans of the extension and any implications to the current market rent. Timelines for the build and relocation MHP have set out the following timelines which commissioners are in support of;

- October 2019 Business case submitted to commissioners for PCCC approval

- October 2019 – Design confirmed - February 2020 – Planning application approved - March 2020 – Project tendered - April 2020 – Sign up - May 2020 – Extension / redevelopment on work on each site - November 2020 – Practical completion

Distance of Southbury Road Surgery to Willow House and Lincoln Road Surgery Both practices are within 1 mile from Southbury Road Surgery

- Southbury Road Surgery is 0.8 miles from Lincoln Road Surgery - Southbury Road Surgery is 1 mile from Lincoln Road Surgery

Patient Consultation Commissioners have requested MHP to commence immediate patient consultation with patients on

- Disaggregation of the Southbury Road Surgery patient list across two sites

- Impact to patients in both Lincoln Road Surgery and Willow House surgery from the rapid growth of the patient list by on average 2332 patients

Commissioners will work with the contract holders in identifying the at risk groups of patients and any specific needs which will need to be taken into considered as part of the relocation. Patient maps have also been requested to identify where patients reside across the two sites compared to the where Lincoln Road Surgery is positioned. Commissioners will review the outcome of the patient consultation and will return the findings to PCCC members if there is strong opposition to the relocation.

Recommendation On the basis of the case set out above committee members are asked to; APPROVE the relocation of Southbury Road Surgery to Willow House and Lincoln Road Surgery on the following conditions;

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1. The first stage of the early planning can commence by MHP in line with their timeline (design confirmed October 2019 and submission of the planning application)

2. Commissioners refer the architect plans to the District Valuer (DV) 3. The DV provides a CMR based on the architect plans to assess if there will

be an increase in the current CMR reimbursed of a. £21,000 for Southbury Road Surgery

4. Patient consultation immediately commences with the registered list for

Southbury Road Surgery as the disaggregation of the list is deemed as a change to how the patient list was previously managed

5. Patient engagement commences with the registered list for Lincoln Road

Surgery and Willow House Surgery 6. GPIT costs to the CCG will be based on cabling only 7. No additional costs to the CCG for IT equipment 8. 100% of the capital costs (£250,000) for the 2nd floor extension will be self-

funded by MHP and no further costs will be sought from commissioners 9. A 2nd floor extension to be built on the top floor of Lincoln Road Surgery

and Willow House Surgery 10. The build of;

a. 6 consultation rooms and 2 treatment rooms for Lincoln Road Surgery, including additional administration space

b. 3 Consultation rooms in Willow House Surgery including additional administration space

11. Relocation should occur before or in November 2020


Increase in CMR reimbursed that is currently unknown at the time of the PCCC decision. This will be mitigated by commissioners instructing the DV to assess the architect plans and if the rent is excessively above the existing CMR, this will be referred back to PCCC. Risk to patients being impacted by the relocation. There will be 4664 patients that will be relocated but across 2 sites within 1 mile. The disaggregation of the list will require patient consultation. There will be further mitigation though the patient consultation process and identifying vulnerable patients to assess their specific needs.


None


Financial – rent reimbursement

Engagement

Patient engagement will commence

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To be carried out by MHP as part of the engagement process


The relocation has not been considered before

Next Steps Set out above Appendices

List Size growth – Appendix A

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Appendix A – List Size growth Southbury Road Surgery Practice list size (Source of data- Global sum list from PCIS)

Year Apr Jul Oct Jan2016 4635 4653 4677 46752017 4695 4715 4733 47342018 4729 4712 4799 4744

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Report Title Rosslyn Hill Surgery co-location with Hampstead Group Practice

Date of report

Agenda Item

Considered at Part 1☒ Part 2 ☐ Urgent decision ☐

October 2019

14


Sarah McDonnell-Davies Tel/Email [email protected]

GB Member Sponsor

Sarah McDonnell-Davies

Report Author

Anthony Marks Tel/Email [email protected]

Report Summary

This paper sets out the case for the committee to agree commissioners’ recommendations to approve the relocation of the PMS contract from its current location to a nearby practice where it would be co-located. The sites are 0.4 miles apart or 8 minutes walk.

The Rosslyn Hill Surgery landlord is seeking the return of the building when the lease expires in July 2020

Recommendation Members of the Committee are asked to APPROVE the merger subject to the conditions:

• The providers will source any funds for reconfiguration and digitisation precipitated by the re-location from alternative sources not the CCG

• There will be no increase in the rental revenue costs to the CCG as a result of the re-location


Risk: Rosslyn Hill Surgery may experience a sustained period of uncertainty over tenure in their building leading patients to register elsewhere and destabilise the practice Mitigation: relocation to a purpose built Health Centre, stabilisation for the contract Risk: Stakeholder perception the practice is closing Mitigation: engagement with stakeholders, confirmation that the relocation will allow the practice to remain open


Not Applicable


Re-location costs for IT equipment. Saving of rent and rates reimbursement (£60K) for the Commissioners

Engagement

The Patient Participation Groups (PPG) at both practices have been engaged and are supportive of the relocation. Wider patient and stakeholder engagement will follow once reconfiguration funding is secured.

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OFFICIAL

2


Not Applicable


Not Applicable

Next Steps Convene a project group to manage the relocation process

Appendices Not Applicable


Camden

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1.0 Recommendation The committee members are asked to approve a contract holders request to relocate their PMS contract from Rosslyn Hill Surgery, Rosslyn Hill to purpose built premises at Hampstead Group Practice, a distance of approximately 0.4 miles or 8 minutes walk. Approval is subject to the following conditions: • The providers will source any funds for reconfiguration and digitisation precipitated

by the re-location from alternative sources not the CCG • There will be no increase in the rental revenue costs to the CCG as a result of the

re-location The landlord at Rosslyn Hill Surgery has given notice that they require the building back when the lease expires July 2020. Whilst the practice may have tenancy at will rights a sustained period of instability may see the list size reduce. The surgery has a list of 1821 as at 1 July 2019. Relocation to the Hampstead Group Practice will allow the surgery to remain open and patients be seen in a purpose built health centre. The Commissioners will save the current Rosslyn Hill rent and rates reimbursement of approximately £60,000 per annum.

2.0 Background

The Rosslyn Hill Surgery contract holder has informed Commissioners that the current lease expires July 2020 and the landlord requires the building at the earliest opportunity. PMS services are currently provided from a converted house. Hampstead Group Practice has assessed the feasibility of accommodating the Rosslyn Hill Surgery practice and staff. In order to do this effectively some reconfiguration of space and the digitisation and removal of paper records from site is required. The practices are seeking to fund the cost of these works from alternative funding streams and confirm that the CCG will not be required to resource this. Impact on patients The distance between the two sites is approximately 0.4 miles, 8 minutes walking distance. The location where Rosslyn Hill Surgery patients reside is included in Figure 1 and Figure 2 below.

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OFFICIAL

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Figure 1

Figure 2

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Stakeholder engagement The PPGs at both practices have been engaged and are supportive of the move. Wider engagement with all patients will be undertaken by the practices. Local stakeholders will be engaged once the reconfiguration and digitisation costs funding is secured by the practices. Benefits The practices which are a part of the same Primary Care Network (PCN) will work more closely together to deliver services and are open to exploring a merger in the future. There will be no decrease in access for patients. The surgeries will be able to share good practice across the two surgeries. Patients will transfer to the new building without the need to re-register providing continuity of care. Rosslyn Hill patients will have easier access to additional PCN services as they develop as some will likely be delivered from the new location, something not possible from the current Rosslyn Hill Surgery building. Financial Impact As a result of the relocation, the premises at Rosslyn Hill Surgery can be returned to the landlord and will release a surplus of £60,000 (rent and rates reimbursement).

3.0 Patient and Stakeholder Engagement

The practices have already informally consulted with their PPGs and intend to consult further with them and the broader patient list formally if approval from PCCC is agreed. The GP federation and the PCN are aware of the plan to co-locate.

4.0 Next Steps

If committee members approve the relocation, commissioners will meet with the practices to convene a project group to complete actions and ensure that the conditions outlined above are met.

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North Central London Primary Care Committee in Common – 17 October 2019

Report Title Approval of appointment of Medicus

Health Partners as the provider of NCL SAS service

Date of report 2 October 2019

Agenda Item

15

Considered at Part 1 ☒ Part 2 ☐ Urgent decision ☐


Paul Sinden, NCL Director of Performance and Acute Commissioning


GB Member Sponsor


Report Author


Report Summary

Commissioners are requesting committee members to note the Urgent Decision made to approve the contract award of the NCL SAS service to Medicus Health Partners (MHP). The full Urgent Decision paper follows. Mobilisation has commenced 2 October and meetings with MHP and GPIT underway. MHP has already made progress towards securing suitable clinical workforce for the service. St Anns site will go live for the commencement of the contract, the Margarete Centre will be utilised for November and December 2019. Meetings are scheduled with the landlord at the Margarete Centre to explore nearby solutions to be ready from 1 January 2020. Contingency locations elsewhere are also being explored should premises not be available in the South of NCL.

Recommendation Commissioners are asking committee members to NOTE the Urgent Decision made


Risks on the continued provision of services to patient registered on the Special Allocation Scheme


Not Applicable


The contract value for the first 5 years is £220,733 per annum as previously approved by Committee.

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Engagement

Not Applicable


Not Applicable


Papers were presented in the August, October, December 2018, and February 2019 Primary Care Commissioning Committee Meetings.

Next Steps Refer to NHS England

Appendices

Not Applicable


Barnet, Camden, Enfield, Haringey, Islington

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North Central London Primary Care Committee in Common – Urgent Decision

Report Title Approval of appointment of Medicus

Health Partners as the provider of NCL SAS service

Date of report September 2019

Agenda Item

Considered at Part 1 ☐ Part 2 ☐ Urgent decision ☒




GB Member Sponsor


Report Author


Report Summary

The report sets out the case to approve the contract award of the NCL SAS service to Medicus Health Partners (MHP). The Award Recommendation Report (included as Appendix 1) details the scope of the service; procurement process; management of conflicts of interest; contract duration (5+5 years); evaluation and moderation; financial evaluation. Three STP areas in London participated in a joint procurement to seek providers for three separate SAS services. The NCL contract advertised to market received one bid from MHP. The bid was evaluated in terms of

1. Selection Questionnaire (Pass/Fail) 2. ITT Questionnaire (85% Scored) 3. Financial Model Template (10% Scored) 4. Presentation and Interview (5% Scored)

The ITT Questionnaire covered topics including patient experience and access; model of care; infrastructure; mobilisation; governance; workforce; prescribing and finance. The bidder was asked to present on the atypical service model, and the role of the SAS in meeting the needs of challenging patients and the most extreme patient behaviour. The contract value for the first 5 years is £220,733 per annum as previously approved by Committee.

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All bids across the three STPS were evaluated and moderated in a consistent way in compliance with procurement processes. The overall evaluation of the MHP offer was 69.80%, which was above the compliant value (3/5 rating) the Procurement Project Team deemed appointable. As only one bidder applied to provide the NCL SAS service it is not necessary to observe a 10 day standstill period. Following Committee approval to award the contract will be secured at NHS England Contract mobilisation will begin as soon as practical and no later than 4 October, for service commencement from 4 November 2019. During mobilisation commissioners will continue work to secure an alternative delivery site to the Margarete Centre which will be unavailable from 1 January 2020

Recommendation The committee is asked to approve the recommendation to NHS England that Medicus Health Partners are awarded the NCL SAS service APMS contract


Risks on the continued provision of services to patient registered on the Special Allocation Scheme


Not Applicable


The contract value for the first 5 years is £220,733 per annum as previously approved by Committee.

Engagement

Not Applicable


Not Applicable


Papers were presented in the August, October, December 2018, and February 2019 Primary Care Commissioning Committees

Next Steps Refer to NHS England

Appendices

Not Applicable


Barnet, Camden, Enfield, Haringey, Islington

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Recommendation The committee is asked to approve the award of an APMS contract to Medicus Health Partners (MHP) for the provision of Special Allocation Scheme (SAS). The procurement process generated one bid for the NCL contract and this was assessed for quality and financial viability by a cross-London project team. The MHP bid was deemed to be above the level set at which the contract could be awarded. A full description of the procurement process, evaluation and MHP scores is included at Appendix 1.

Background In February 2019 committee approved the reprocurement of SAS services on a single contract for the whole of NCL. Further to this committee approved

1. Revenue costs for the service of £220,733

2. Apportionment of the costs per CCG by weighted population, as there is more, of an even distribution of the costs per CCG

a. Barnet (25%) £54,720 b. Camden (19%) £40,850 c. Enfield (20%) £44,247 d. Haringey (20%) £43,063 e. Islington (17%) £37,851

3. Islington CCG being the lead commissioner with support for the finance and contract management through the NCL Primary Care Commissioning and Contracting team

4. Proceed with two sites for patients; a. St Ann’s Hospital in Haringey being up to 1 hour travel time for where patients

reside b. Margarete Centre in Camden’s, travel distance being from 30 minutes to 1

hour from where patients reside

It should be noted that the Margarete Centre site will be unavailable from 1 January 2020 and commissioners will continue to pursue an alternative site to allow patients in the South of NCL a more local point of access. Bidders were made aware of the need to work with commissioners to secure alternative premises.

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Next steps

• The committee approved award recommendation report will be referred to NHS England for authority to proceed to contract award.

• MHP will be notified • Mobilisation will begin • Continue exploration of an alternative site to the Margarete Centre • 4 November 2019 contract commences

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APPENDIX 1

Document title: Award Recommendation Report

Project title: APMS Special Allocation Service Project reference: PRJ735

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SUMMARY

Document Name: Award Recommendation Report for APMS Special Allocation Service contract.

Document Purpose This report requests approval to proceed to contract award in line with NHS England’s Standing Financial Instructions SFIs..

Contract Title: NHS Alternative Provider Medical Services Contract 2017/2018

Contracting Authority/ NCL CCGs

Commissioner:

CCG Project Lead(s): Anthony Marks

Contract Reference: PRJ-735

Contract Start Date: 4th November 2019

Contract End Date: 3rd November 2024 with an option to extend by a further 5 years (maximum 5 years)

Date Report Produced: 11th September 2019

Author(s): Natalie Polyblank, Senior Procurement Manager, NEL

Date Tenders Issued: 27th June 2019

Date Tenders Returned: 22nd July 2019

Number of Tenders Returned: 1

Projected Contract Value £220,733 per annum for the first 5 years.

(Ex VAT): for the first 5 years, with the option to extend for a further 5 years if required

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Contents 1. INTRODUCTION ......................................................................................................... 10

Overview and Objectives ...................................................................................... 10

2. SCOPE ....................................................................................................................... 11

Scope of Services ................................................................................................. 11

Procurement Timeline ........................................................................................... 13

Conflicts of Interest ............................................................................................... 13

3. PRE-PROCUREMENT ................................................................................................ 13

Project Team ........................................................................................................ 14

Bidder Pool ........................................................................................................... 14

Advertisement ....................................................................................................... 14

4. KEY CONTRACT INFORMATION .............................................................................. 14

Form of Contract ................................................................................................... 14

Contract Duration .................................................................................................. 14

Contract Value ...................................................................................................... 15

5. ITT STAGE.................................................................................................................. 15

ITT Expressions of Interest ................................................................................... 15

ITT Clarifications ................................................................................................... 15

ITT Submissions ................................................................................................... 15

ITT Evaluation ....................................................................................................... 15

ITT Evaluation and Moderation ............................................................................. 16

ITT Evaluation Criteria and Weightings ................................................................. 17

Financial Evaluation .............................................................................................. 18

6. ITT RESULTS ............................................................................................................. 19

7. RECOMMENDATIONS ............................................................................................... 19

8. RISKS ......................................................................................................................... 19

9. CONTRACT MOBILISATION AND IMPLEMENTATION ............................................. 19

10. SIGNATURES ............................................................................................................. 20

Appendix A –Bidder Questions and Evaluators ................................................................... 22

Appendix B – Final Moderated ITT Questionnaire Scores ................................................... 29

Appendix C – Interview Panel ............................................................................................. 37

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1. INTRODUCTION

Clinical Commissioning Groups are required to ensure provision of essential medical services to all people normally resident within their (CCG’s) geographical area. This includes people who have been removed from their mainstream GP practice list as a result violent of behaviour or behaviour which led to the practice staff fearing for their safety. Care for this group of patients is provided under the Special Allocation Scheme (SAS) (also known as the Violent Patient Scheme).

SAS Services have historically been provided on an individual CCG basis with consequent significant variation in service specification and provision In order to help address this variation, NHS England included guidance on the commissioning of a robust SAS in its November 2017 Primary Medical Care Policy and Guidance Manual (PGM). https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/. The guidance includes a detailed draft specimen specification.

The detailed nature of the new national guidance would seem to lend itself to supra-CCG arrangements i.e. to commission services at STP level and this was agreed across the 3 London STPs involved in this procurement (SEL; NEL; NCL).

This report deals with the procurement outcome for the NCL STP but the processes from drafting of detailed contract requirements to procurement were common across the 3 STPs

The current contracts for the provision of SAS in the NCL STP are due to expire on 3rd November 2019.

Overview and Objectives The SAS allows Commissioners to balance the rights of patients to receive services from GPs with the need to ensure that specified persons, including GPs, their staff, patients and others on the premises, deliver and receive those services without actual or threatened violence or other reasonable fear for their safety.

The overarching objectives behind a SAS are: firstly to ensure any patient removed under the violent patient regulations has access to essential and additional medical services; and secondly to communicate behavioural expectations to patients and educate them to behave responsibly

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https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/



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wherever possible, while at the same time minimising the risks to the safety of health professionals and others.

The key objectives of The Procurement are to:

• Secure ongoing primary medical services to patients registered with The SAS • Maintain, and where necessary improve the quality of primary medical care services

available to patients; • Deliver affordable and Value for Money NHS primary medical care services; and • Only patients who fit the criteria should be referred to a SAS and it should not be used for

any other purpose. • To provide patients on the scheme with full access to NHS primary medical care services

within a reasonable distance to the patient’s home. • To improve the quality of primary medical care available to patients in a controlled and safe

environment. • To deliver the service in line with the national guidelines which includes call handling and

security arrangements. • To ensure the service is underpinned by effective audit and best practice. • To ensure that the provider has effective links with acute, mental health and community

service providers within the locality. • To ensure that GP practice staff in general can practice and provide services without

concerns about their own safety and wellbeing. • To ensure that prescriptions will be issued to the patient’s nominated pharmacy and the SAS

will ensure that the pharmacy is informed that the patient is going to collect the prescription.

• To ensure patients on the scheme are managed appropriately and rehabilitated, preferably within a 12 month period, so they can re-register with a GP practice of their choice

2. SCOPE

Scope of Services The provider will register any patient meeting the service entry requirements referred into the scheme via Primary Care Services England (PCSE).

The service is intended to provide primary medical care to adults who have been subject to immediate removal from their GP’s list as a result of violent or aggressive behaviour. A contractor will be expected to provide the full range of essential and additional services as contained in the current standard GMS contract.

There is balance between the right to receive services from GPs with the need to remove a threat or risk of violence to GPs, staff, patients and others in the primary care service environment.

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Referral can be made without prior warning in cases of physical violence and serious nonphysical violence which resulted in the involvement of the police or the recording of the incident with police. Under the SAS, designated GP practices/providers will provide services to patients by prior appointment and at specific locations and times as detailed in individually agreed contracts.

Given the nature of the service the contractor will be required to complete a thorough risk assessment for each Registered Patient to determine the level of security and safety measures required and to employ professional security guards to be present on the premises for half an hour before and after face to face consultations.

The risk assessment will include where necessary a personal risk assessment by staff providing services to patients on the SAS.

The contractor will be working with other agencies as appropriate, provide support for rehabilitation of Registered Patients in order to address the underlying causes of violent or aggressive behaviour and encourage and support facilitation of return to mainstream general practice, normally within 12 months of first registration with the SAS.

The full national template service specifications published by NHS England can be found in Section 6 of the Primary Medical Care Policy and Guidance Manual (PGM) (v2). The link to the PGM is: https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

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Procurement Timeline

Key Milestones Date

Advert published on Contracts Finder / OJEU / ProContract 27th June

Invitation to Tender (ITT) issued 27th June

Deadline for receipt of ITT clarification questions 17th July 2019

Deadline for receipt of ITT submissions 12pm Noon, 22nd July 2019

ITT Evaluation 24th July - 8th August

ITT Moderation 12th - 16th August

Panel Presentations 27th August

Recommendation to Authority decision-making group 2nd - 15th Sept

Inform bidders of outcome and observe standstill period 24th Sept - 3rd October

Contract award 4th October

Mobilisation

5th Oct - 3rd Nov

Service Start Date 4th November


To safeguard against potential conflicts of interest influencing the procurement process and evaluations, all panel members signed conflict of interest declarations and non-disclosure agreements. Project members and Evaluators were informed of their role and the importance of the confidential nature of this procurement.

Consequently, on the basis of responses received, and the evaluation process used, (i.e. consensus scoring between multiple evaluators) NHS England are confident that the process was not prejudiced in any way as a result of any actual, potential or perceived conflicts of interest.

3. PRE-PROCUREMENT

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Project Team A cross-functional team were involved in delivering this project. A number of Evaluators were involved in scoring the responses from the bidders (see Appendix A).

Bidder Pool

The Commissioner expected to receive responses to the ITT from suitably qualified and experienced Providers with the necessary capacity and capability (or a demonstrable ability to provide the necessary capacity and capability within the requisite timescale, which was notified to Potential Bidders in the ITT) to provide the range of Services as set out in the ITT for the Lot(s) they were bidding for, in a safe and effective manner. Subject to any conditions specified in the Contract or any tender documents issued in connection with the Procurement.

Potential Bidders were able to bid as a sole provider, lead bidder or in partnership with other organisations as part of a consortium, subject to them appointing a consortium lead to act on their behalf as the lead contracting party taking overall responsibility for delivery of the service(s) in accordance with the requirements of the contract(s).

Advertisement The formal Procurement process was advertised on 27th June 2019 on Contracts Finder and OJEU in accordance with the requirements of a procurement under the Light Touch Regime (previously “Part B” services) and the Public Contracts Regulations 2015. The advertisement contained information about the Tender opportunity. This information and the ITT documentation was made available online simultaneously with the intention to provide sufficient information for potential Bidders to determine whether to bid for the contract opportunity.

4. KEY CONTRACT INFORMATION

Form of Contract

The contract will be awarded on an NHS Alternative Provider Medical Services Contract 2017/18.

Contract Duration

The Core Contract period will be a 5 year term, with the Commissioner having the option to extend the Contract for up to a further 5 years by agreement with the provider. This means the maximum contract duration should the extension option be taken up, will be 10 years.

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Contract Value

The Commissioner has a budget available as follows: £220,733 per annum for the first 5 years.

Payments will be made as stipulated by the payment mechanisms in the Contract, unless this is altered by mutual agreement of the Commissioner and Provider at a later date.

5. ITT STAGE

ITT Expressions of Interest Following the advertisement, 28 providers submitted expressions of interest (EOIs) by accessing the e-tendering portal.

ITT Clarifications

A clarification question (CQ) and answer process operated during the ITT stage from 27th June to 17th July 2019. Bidders asked clarification questions via the portal and responses were published to all Bidders in line with transparency and equal treatment requirements.

ITT Submissions The ITT closed at 12:00 noon on 22nd July 2019. There was a sole response interested in the NCL contract.

ITT Evaluation Responses were downloaded and compliance checked before being made available to the evaluation panel via the Portal for subsequent evaluation. The ITT evaluation process consisted of four elements:

5. Selection Questionnaire (Pass/Fail) 6. ITT Questionnaire (85% Scored) 7. Financial Model Template (10% Scored) 8. Presentation and Interview (5% Scored)

The Selection Questionnaire was based on the standard Cabinet Office document. Evaluation of the Selection Questionnaire was undertaken by Procurement, Commissioning evaluators as well as some being automatic Pass/Fail. The ITT questionnaire responses were assigned to individual panel members as detailed in appendix 1 to this report.

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All Evaluators were offered training and before the evaluation commenced all panel members undertook evaluator training on 9th July 2019 to 25th July 2019, to go through the tendering portal, procurement governance, ethics and approach. All Evaluators were provided with an “Evaluator Guidance document” and a PowerPoint presentation on how to use the Procurement Evaluation Portal to aid their actual evaluation of the Bids.

ITT Evaluation and Moderation

ITT questions were assigned to each panel member to score depending on each evaluator’s area of expertise. The panel were given until 8th August 2019 to complete their individual evaluation. Moderation of all scores was completed on 15th August 2019 between the evaluators in order to achieve a consensus. This provided evaluators with opportunity to fully discuss the rationale behind individual differences in scores and commentary. The final consensus scores agreed form the basis for the final scoring calculations.

5.6 Presentation/Interviews Within the published evaluation methodology and weighting criteria 5% of the available score was assigned to the interview stage, which was held immediately following the ITT evaluation period. Bidders were asked to attend an interview which included a bidder presentation. All bidders were sent confirmation of their presentation time slot, the presentation subject and the question themes via the e-tendering portal. Interviews took place on 27th August 2019, and bidders were allowed a set amount of time for their presentation and for answering the questions. The interview panel are detailed in Appendix C. The presentation title and interview questions consisted of the following: Presentation Scenario – Value 3% The topic of the presentation was:

'What role does the provider have in supporting other primary care practitioners in the management of patient aggression and in disseminating relevant learning and knowledge?' Question Themes – Value 2%

The question were: Q1 - Service Model – The service model involves sessional working at various sites across the STP. Consequently, the normal practice infrastructure may not be able to support patient care. What will be the key challenges in operating this model and how would you expect to address them. Value = 1%

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Q2 - Role of the SAS – The SAS is required by commissioners in order to address the primary care needs of patient who have been removed from their mainstream practice as a result of demonstrating aggressive behaviour. There will be a subset of patients whose behaviours is especially challenging. Recognising that the SAS is the primary care failsafe service for commissioners to meet their obligations, how would you manage patients who had the most extreme behaviour? Value = 1%

All Presentations were evaluated on the evaluation criteria published in the ITT using a 0-5 scale as shown in the table at 5.6 below

The score provided for the presentation element for the bidder is:

Score on scale of 0 to 5 Weighted Score out of available

5% Presentation 3 1.80 Q1 - Service Model 3 0.60 Q2 - Role of the SAS 3 060

Total Presentation Score 3.00

ITT Evaluation Criteria and Weightings

Selection Questionnaire – Pass / Fail

ITT Questionnaire (Scored)

Detailed scoring methodology and weighting criteria were published within the ITT documentation in accordance with procurement regulations.

The evaluation was conducted in line with the published weightings and the agreed 0-5 scoring/pass fail criteria and definitions as indicated in the table below.

Grade Label Score % Definition

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Non-compliant

0 0% No response given; partial response and poor evidence provided in support of it. Does not give the commissioner confidence in the ability of the Bidder to deliver the Contract, and meet the Authority’s requirements.

Weak 1 20% Inadequate response given; or addresses only part of the question; or does not meet requirements, or represents a risk to patients and their safety; supported by a weak standard of evidence in several areas giving rise to concern about the ability of the Bidder to deliver the Contract.

Minor reservations

2 40% Response addresses the whole question and is supported by a satisfactory standard of evidence in most areas. However, one or a few areas lack detail/evidence giving rise to some minor concerns but these can be addressed as a condition of Contract award and service go live

Compliant

3 60% Addresses the entire question with a detailed response; and demonstrates a thorough understanding of the requirements. The Authority is confident that it meets the requirements of Contract award.

Very good 4 80% Response is comprehensive and supported by a high standard of evidence. Addresses the entire question with very detailed response, which not only demonstrates a thorough understanding of the requirements, but also incorporates thorough description of safe, innovative delivery, including forward planning. Gives the Authority a high level of confidence in the ability of the Bidder to deliver the Contract.

Excellent 5

100% Response is very comprehensive and supported by a very high standard of evidence. Gives the Commissioner a very high level of confidence in the ability of the Bidder to deliver the contract. Exceeds the Commissioner’s requirements in most respects.

Table 1: Scoring methodology

Financial Evaluation

The financial evaluation was based on Bidders’ response to a financial model template (FMT) that was evaluated on weighted score basis with a narrative to support it. This was evaluated by the finance lead for NCL STP, Tracy Lewis. The financial templates were checked and evaluated in detail to ensure they were compliant and that no errors or clear omissions had been made. The financial templates were also checked and evaluated for their robustness. The score provided for the FMT element for the bidder is:

FMT Score Maximum Score of 10% Medicus Health Partners 6%

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6. ITT RESULTS

Following the evaluation process, a single consolidated score was established for the Bidder. The final ITT scores are detailed in Appendix B.

Bidder Total Score (including Presentation and FMT

scores) Medicus Health Partners

69.80%

7. RECOMMENDATIONS

Based on the outcome of the evaluation, against the evaluation model and criteria stipulated by the Authority within the ITT documentation, it is recommended that the contract be awarded to: Medicus Health Partners.

8. RISKS

All scores recorded below a 3 (Compliant) will be sent to the Commissioner following the approval of this paper. These areas will be listed as caveats on the provisional award letter. In order for the Bidder to proceed beyond the provisional award stage all caveats must be satisfied.

9. CONTRACT MOBILISATION AND IMPLEMENTATION

The planned contract commencement date is 4th November 2019. As this is a sole successful provider for this Lot, there is no requirement for the 10 day standstill period. Contract award and mobilisation will commence immediately following contract award notification.

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10. SIGNATURES

The Project Board and the below-mentioned signatories request the approval from NCL STP’s PCCC for Contract Award and subsequent mobilisation of this Contract

PREPARED BY

Name Natalie Polyblank

Position Senior Procurement Manager, NEL CSU

Signature Natalie Polyblank

Date 11th September 2019

RECOMMENDED BY

Name Vanessa Piper

Position Head of Primary Care, NCL

Signature

Date 13/09/2019

APPROVED BY

Name

Position

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Signature

Date

Name

Position

Signature

Date

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Appendix A –Bidder Questions and Evaluators

QUESTION TITLE Questions Tender

Weighting

Word Limit

Evaluator 1 Evaluator 2 Evaluator 3

1 Patient Experience and Access 20

1.1 Patient Experience Dignity and Respect

Bidders must describe the policies and systems they will put in place to ensure that service users are treated with dignity and respect at all times within the practice and any outreach services. How will you ensure that patient feedback is used to inform aspects of service delivery which can be improved within the particular requirements of the SAS specification.

5 500 Anne-Marie Dean – Lay Member,

NEL

Rebecca Kingsnorth -

CCG Commission

er - NCL

Neil Ross – Lay

Member - SEL

1.2 Contractual Access Describe how you will ensure that there is a duty doctor/ nurse practitioner available throughout the contract core hours to provide urgent consultations including face to face where necessary. Describe how you will ensure that full reception services are available throughout contractual core hours, including answering the telephone, answering and co-ordinating patient queries and requests, signposting to other services and issuing repeat prescriptions.

5 500 Denise Patmore –

Commissioner - NEL

Anthony Marks –

Area Team Commission

er - NCL

1.3 Collaborative Working

Which types of organisations / service providers do you anticipate will be the key stakeholders for this group of patients How will you establish and develop effective relationships with them so as to improve patient health and care outcomes?


NEL

Gohar Choudhury – Area Team

Commissioner - NEL

Neil Ross – Lay

Member - SEL

2 Model of Care 15

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2.1 Access and Model of Care

Describe the specific challenges you expect to face in providing care for this group of patients and how you will address them. Where possible evidence previous experience of managing patients who show particularly challenging behaviour. Describe how your model of care will effectively manage mainstreaming of and deduction of SAS patients.

7.5 1200 Arnold Fertig – GP - NEL

Mateen Jiwani – GP -

NCL

Neil Ross – Lay

Member - SEL

2.2 Model of Care How will ensure that you are able to provide the full range of ongoing primary medical services and give an outline of your service including management of health promotion and prevention, acutely presenting problems and Long Term Conditions?


Chris Fatoyinbo –

GP - SEL

3 Infrastructure 17.25

3.1 Technology How will you harness technology to improve the ways in which care is delivered to SAS patients? How would you ensure that patients who do not/cannot use these technologies are not disadvantaged?


NEL

Denise Patmore –

Commissioner - NEL

Jean Young

Commissioner - SEL

3.2 Premises - Infection Control

What are likely to be the challenges in providing a safe and hygienic environment for both patients and staff given that the 'surgery' locations will not be under your management. How do you propose to manage these challenges?

5 500 Rebecca Kingsnorth – Commissione

r - NCL

Harry Goldingay- Area Team

Commissioner - SEL

3.3 Clinical Safety & Medical Emergencies

Describe the system(s) and equipment you will have in place to deal with medical emergencies safely and appropriately at the various locations. Also describe how you will ensure that all staff are adequately trained, and their competencies tested, to deal with medical emergencies safely and appropriately.



NCL

Harry Goldingay- Area Team Commissio

ner - SEL

4 Resilience / Development

8

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4.1 Mobilisation Please confirm that you are able to begin the full delivery of this service on the commencement date of the 3rd November 2019? Please note that this is a pass fail question as the continuity of this Service is of the utmost importance and only bidders able to deliver on this date will be considered

P/F Gohar Choudhury - Area Team

Commissioner - NEL

Anthony Marks –

Commissioner - NCL

Harry Goldingay - Area Team Commissio

ner - SEL

4.2 Mobilisation The procurement timetable envisages a 4 week mobilisation period. Describe your mobilisation plan for this contract, and how you will ensure that the service will be fully operational at the proposed contract start date. How will you ensure that arrangements for on-site security presence before during and after clinical sessions is in place? Provide a Gantt Chart which covers all areas of mobilisation, key activities and milestones leading up to or following the commencement date and any impact on services. Include in your response a table of risks and issues to mobilisation of this contract, along with any mitigating actions that will be taken.

4 500 Denise Patmore –

Commissioner - NEL

Gohar Choudhury - Area Team

Commissioner - NEL

Jean Young

Commissioner - SEL

4.3 Business Continuity Describe how you will ensure business continuity for delivery of the service in the event of an IT failure, lack of security personnel or other unplanned events.

4 500 Rebecca Kingsnorth – Commissione

r - NCL

Anthony Marks –

Area Team Commission

er - NCL

5 Governance 7.75

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5.1 Governance Clinical governance is a system through which healthcare organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care, by creating an environment in which clinical excellence will flourish Bidders must describe how Integrated Governance that incorporates Clinical Governance is core to its business and governance arrangements. This response from Bidders should include an explanation of: • How Clinical Governance will be incorporated in a system of Integrated Governance, in particular with regard to patient safety, management of clinical risk and implementation of lessons learned; • Their understanding and clarity of approach to patient safety; • Their systems of clinical risk assessment and risk reduction; • Their culture and systems that facilitate learning from experience and action planning to improve patient safety and quality of care.

5 750 Arnold Fertig – GP - NEL


NCL

Harry Goldingay - Area Team Commissio

ner - SEL

5.2 Information Governance

Describe your information governance approach and how you will ensure that compliance with best practice, guidance and legislation, including NHS Data Security & Protection Toolkit (DPS Toolkit) and General Data Protection Regulations (GDPR).

0.75 250 Denise Patmore –

Commissioner - NEL

Anthony Marks –

Commissioner - NCL

5.3 Information Management/ Clinical

How will you ensure that patients receive appropriate follow-up care following diagnostic tests, visits to A&E or Urgent Care Centres?


Chris Fatoyinbo –

GP - SEL

5.4 Record Keeping Describe the standards you propose to implement to ensure good medical records keeping and internal and external data processing. How will these standards be monitored for all data entries, and poor implementation identified and remedied?

0.75 250 Mateen Jiwani – GP -

NCL

Chris Fatoyinbo –

GP - SEL

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5.5 CQC Please confirm the following: 1. Your registration status with the CQC. 2. Your CQC registration number. 3. If the CQC has instituted any enforcement action against you or your Registration has conditions attached to it or you are registered with an agreed action plan, please provide details. 4. if you are not currently CQC registered please detail the steps you would take to achieve CQC registration as a condition precedent to the service commencement date, including an action plan.

0.5 250 Denise Patmore –

Commissioner - NEL

Gohar Choudhury - Area Team

Commissioner - NEL

6 Workforce 7

6.1 Recruitment & Retention /

How will you ensure that sufficient numbers of appropriately skilled staff are in place to deliver the service throughout the life of the contract? Responses should include a description of any specific challenges that you foresee in relation to recruitment and retention and how, within the boundaries of the contract/specification, these could be overcome to ensure that patient experience and quality of care is not adversely affected.


Chris Fatoyinbo –

GP - SEL

Jean Young

Commissioner - SEL

6.2 Workforce Development

Provide an organisation structure chart and details of proposed staffing levels and skill mix, together with a brief outline of roles and responsibilities for the required service. Your response should be consistent with the data provided in your submitted FMT. Describe your approach to managing and supporting the staff identifying and taking into account the challenges the patient group may present to staff.

1.5 500 Anne-Marie Dean – Lay Member,

NEL


NCL

Rebecca Kingsnorth

– Commissioner - NCL

6.3 Safeguarding Safeguarding is everyone's responsibility. Describe your safeguarding arrangements for both Children and Adults and how they align to Legislative and statutory guidance as well as the Multi agency London procedures.

4 500 Arnold Fertig – GP - NEL

Chris Fatoyinbo –

GP - SEL

Jean Young

Commissioner - SEL

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6.4 TUPE (NCL only)

Describe how you would effectively manage the transfer of staff under the TUPE regulations in line with the relevant regulations and good practice. TUPE responses should include approaches to both receiving staff through mobilisation and transferring staff to another employer at the end of the contract in the event that the service is awarded to an alternative provider. Please include indicative timings of key stages and your approach to working and communicating with key stakeholders and staff. Please note that all bidders are required to provide a full response to this question.

P/F 700 Rebecca Kingsnorth – Commissione

r - NCL

Anthony Marks –

Commissioner - NCL

7 Prescribing / Medication 10

7.1 RD - Prescribing Please specify the approach you will adopt in relation to high quality, safe and cost-effective prescribing, the response should include but not limited to: • Policies and processes in place for ensuring clinical staff adhere to national and local prescribing recommendations, guidance and pathways and how improved outcomes and quality improvements are achieved; • Details of the policy and process you would put in place to ensure that monitoring of treatment with high risk drugs that require blood tests takes place; • Describe policies and process for ensuring the security of prescriptions and how it conforms with best practice;

5 800 Mateen Jiwani – GP -

NCL

Chris Fatoyinbo –

GP - SEL

7.2 Medicine Management

Describe how you will ensure that medication reviews are carried out safely and effectively. Your response should cover the following: • Process of medication reviews; • Patient and Carers Education; • Prescription Management.

5 800 Mateen Jiwani – GP -

NCL

Chris Fatoyinbo –

GP - SEL

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8 Finance 10

8.1 Financial Management Template

Please submit a completed FMT using the MS Excel template provided for the service. This will be evaluated in line with the wording within the FMT and using the criteria stated in Table 4 of ITT Governance Document.

10 Pravin Bhalsod –

Finance NEL

Tracey Lewis – Finance -

NCL

Sian Clapton – Finance -

SEL

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Appendix B – Final Moderated ITT Questionnaire Scores

Score 3 (Medicus Health Partners)

Patient Experience and Access Weighted Score

% Score against

Weighting

Quality Score

1 Patient Experience Dignity and Respect

Bidders must describe the policies and systems they will put in place to ensure that service users are treated with dignity and respect at all times within the practice and any outreach services. How will you ensure that patient feedback is used to inform aspects of service delivery which can be improved within the particular requirements of the SAS specification.

5 3.00 3

2 Contractual Access Describe how you will ensure that there is a duty doctor/ nurse practitioner available throughout the contract core hours to provide urgent consultations including face to face where necessary. Describe how you will ensure that full reception services are available throughout contractual core hours, including answering the telephone, answering and co-ordinating patient queries and requests, signposting to other services and issuing repeat prescriptions.

5 4.00 4

3 Collaborative Working Which types of organisations / service providers do you anticipate will be the key stakeholders for this group of patients? How will you establish and develop effective relationships with them so as to improve patient health and care outcomes?

10 8.00 4

Total Weighting 20 15.00

Model of Care

4 Access and Model of Care

Describe the specific challenges you expect to face in providing care for this group of patients and how you will address them. Where possible evidence previous experience of managing patients who show particularly challenging behaviour.

7.5 7.50 5

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Describe how your model of care will effectively manage mainstreaming of and deduction of SAS patients.

5 Model of Care How will ensure that you are able to provide the full range of ongoing primary medical services and give an outline of your service including management of health promotion and prevention, acutely presenting problems and Long Term Conditions?

7.5 6.00 4

Total Weighting 15 13.50

Infrastructure

6 Technology How will you harness technology to improve the ways in which care is delivered to SAS patients? How would you ensure that patients who do not/cannot use these technologies are not disadvantaged?

5 3 3

7 Premises - Infection Control

What are likely to be the challenges in providing a safe and hygienic environment for both patients and staff given that the 'surgery' locations will not be under your management. How do you propose to manage these challenges.

5 2 2

8 Clinical Safety & Medical Emergencies

Describe the system(s) and equipment you will have in place to deal with medical emergencies safely and appropriately at the various locations. Also describe how you will ensure that all staff are adequately trained, and their competencies tested, to deal with medical emergencies safely and appropriately.

7.25 4.35 3

Total Weighting 17.25 9.35

Resilience / Development

9 Mobilisation Please confirm that you are able to begin the full delivery of this service on the commencement date of the 3rd November 2019?

P/F Pass

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Please note that this is a pass fail question as the continuity of this Service is of the utmost importance and only bidders able to deliver on this date will be considered

10 Mobilisation The procurement timetable envisages a 4 week mobilisation period. Describe your mobilisation plan for this contract, and how you will ensure that the service will be fully operational at the proposed contract start date. How will you ensure that arrangements for on-site security presence before during and after clinical sessions is in place? Provide a Gantt Chart which covers all areas of mobilisation, key activities and milestones leading up to or following the commencement date and any impact on services. Include in your response a table of risks and issues to mobilisation of this contract, along with any mitigating actions that will be taken.

4 2.40 3

11 Business Continuity Describe how you will ensure business continuity for delivery of the service in the event of an IT failure, lack of security personnel or other unplanned events.

4 2.40 3


Governance

12 Governance Clinical governance is a system through which healthcare organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care, by creating an environment in which clinical excellence will flourish Bidders must describe how Integrated Governance that incorporates Clinical Governance is core to its business and governance arrangements. This response from Bidders should include an explanation of: • How Clinical Governance will be incorporated in a system of Integrated Governance, in particular with regard to patient safety, management of clinical risk and implementation of lessons learned; • Their understanding and clarity of approach to patient safety; • Their systems of clinical risk assessment and risk reduction; • Their culture and systems that facilitate learning from experience and action planning to improve patient safety and quality of care.

5 4.00 4

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13 Information Governance

Describe your information governance approach and how you will ensure that compliance with best practice, guidance and legislation, including NHS Data Security & Protection Toolkit (DPS Toolkit) and General Data Protection Regulations (GDPR).

0.75 0.60 4

14 Information Management/Clinical

How will you ensure that patients receive appropriate follow-up care following diagnostic tests, visits to A&E or Urgent Care Centres?

0.75 0.30 2

15 Record Keeping Describe the standards you propose to implement to ensure good medical records keeping and internal and external data processing. How will these standards be monitored for all data entries, and poor implementation identified and remedied?

0.75 0.45 3

16 CQC Please confirm the following: 1. Your registration status with the CQC. 2. Your CQC registration number. 3. If the CQC has instituted any enforcement action against you or your Registration has conditions attached to it or you are registered with an agreed action plan, please provide details. 4. if you are not currently CQC registered please detail the steps you would take to achieve CQC registration as a condition precedent to the service commencement date, including an action plan.

0.5 0.50 5


Performance Management

17 Recruitment & Retention /

How will you ensure that sufficient numbers of appropriately skilled staff are in place to deliver the service throughout the life of the contract? Responses should include a description of any specific challenges that you foresee in relation to recruitment and retention and how, within the boundaries of the contract/specification, these could be overcome to ensure that patient experience and quality of care is not adversely affected.

1.5 1.20 4

18 Workforce Development

Provide an organisation structure chart and details of proposed staffing levels and skill mix, together with a brief outline of roles and responsibilities for the required service. Your response should be consistent with the data provided in your submitted FMT.

1.5 0.90 3

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Describe your approach to managing and supporting the staff identifying and taking into account the challenges the patient group may present to staff..

19 Safeguarding Safeguarding is everyone's responsibility. Describe your safeguarding arrangements for both Children and Adults and how they align to Legislative and statutory guidance as well as the Multi agency London procedures.

4 3.20 4

20 TUPE (NCL only)

Describe how you would effectively manage the transfer of staff under the TUPE regulations in line with the relevant regulations and good practice. TUPE responses should include approaches to both receiving staff through mobilisation and transferring staff to another employer at the end of the contract in the event that the service is awarded to an alternative provider. Please include indicative timings of key stages and your approach to working and communicating with key stakeholders and staff. Please note that all bidders are required to provide a full response to this question.

P/F Pass


Prescribing / Medication

21 RD - Prescribing Please specify the approach you will adopt in relation to high quality, safe and cost-effective prescribing, the response should include but not limited to: • Policies and processes in place for ensuring clinical staff adhere to national and local prescribing recommendations, guidance and pathways and how improved outcomes and quality improvements are achieved; • Details of the policy and process you would put in place to ensure that monitoring of treatment with high risk drugs that require blood tests takes place; • Describe policies and process for ensuring the security of prescriptions and how it conforms with best practice;

5 3.00 3

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22 Medicine Management Describe how you will ensure that medication reviews are carried out safely and effectively. Your response should cover the following: • Process of medication reviews; • Patient and Carers Education; • Prescription Management.

5 4.00 4


Finance

23 Financial Management Template

Please submit a completed FMT using the MS Excel template provided for the service. This will be evaluated in line with the wording within the FMT and using the criteria stated in Table 4 of ITT Governance Document.

10 6.00 3


Presentations

Presentation Topic What role does the provider have in supporting other primary care practitioners in the management of patient aggression and in disseminating relevant learning and knowledge?

3 1.80 3

Question 1 The service model involves sessional working at various sites across the STP. Consequently, the normal practice infrastructure many not be able to support patient care What will the key challenges in operating this model and how would you expect to address them?

1 0.60 3

Question 2 Role of the SAS - The SAS is required by commissioners in order to address the primary care needs of the patient who have been removed from their mainstream practice as a result of demonstrating aggressive behaviour. There will be a subset of patients whose behaviours is especially challenging. Recognising that the SAS is the primary care failsafe service for commissioners to meet their obligations, how would you manage patients who had the most extreme behaviour?

1 0.60 3


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ITT Sections Published Weightings

Patient Experience and Access

20.00

15.00

Model of Care 15.00

13.50

Infrastructure 17.25

9.35

Resilience / Development

8.00

4.80

Governance 7.75

5.85

Performance Management

7.00

5.30

Prescribing / Medication

10.00

7.00

85.00

60.80

Finance 10.00

6.00

Presentations 5.00

3.00

69.80

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Appendix C – Interview Panel

Role Panel member Status

Head of Primary Care, SE London Primary Care Team, NHS South East London Commissioning Alliance

Jill Webb Chair (Non-scoring)

Senior Primary Care Commissioning Manager, North London Partners in Health & Care (STP)

Anthony Marks Evaluator (Scoring)

Head of Primary Care Commissioning, NHS Southwark Clinical Commissioning Group

Jean Young Evaluator (Scoring)

NHS Redbridge CCG Denise Patmore Evaluator (Scoring)

Independent GP Advisor to BHR CCG’s Dr Arnold Fertig Evaluator (Scoring)

Camden CCG Governing Body, GP Partner, Hampstead Group Practice

Dr Sarah Morgan Evaluator (Scoring)

Primary Care Commissioning Manager, North East London Primary Care Commissioning Team

Maxine Grimes Evaluator (Scoring)

Senior Procurement Manager, NEL Commissioning Support Unit

Natalie Polyblank Procurement advisor (Non scoring)

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North Central London Primary Care Committee in Common Meeting Thursday 17 October 2019

Report Title North Central London Primary Care

Committee in Common Risk Register Date of report 3 October 2019

Agenda Item 16




GB Member Sponsor

Not applicable.

Report Author



Report Summary

North Central London Primary Care Committee in Common Risk Register

1. Introduction This paper provides an overview of the risk register for the North Central London (NCL) Primary Care Committee in Common (PCCC) for scrutiny and oversight. The risk register includes the key risks within the remit of the Committee. The paper sets out strategic updates on risks held on the NCL PCCC risk register for October 2019.

2. Risks The NCL PCCC is asked to note the most material risks, with current risk ratings of 12 and above. There are 7 risks on the NCL PCCC risk register with 4 risks having a current risk score of 12 or higher. One risk has reduced below the threshold and is included in this report for completeness. Key highlights: PCCC12: Failure to address variation in Primary Care Quality and Performance across NCL (Threat): Mitigations in place to help reduce unwarranted variation in quality and performance across general practices include:

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2

• Sign-off of plans to establish primary care networks (PCNs) in NCL, as part of the new national GP contract, by the Committee in June 2019 and development of payment process for NCL;

• Use of GP Forward View monies from NHS England to support the development of primary care networks and GP Federations, and develop a resilience programme for general practice;

• The new GP contract also introduces a greater quality improvement focus in the Quality Outcomes Framework;

• Development of an early warning system to identify struggling practices has begun, but paper deferred to December 2019 from October 2019

PCCC13: Failure to develop primary care workforce in line with requirements for developing primary care services in the STP (Threat): Development of primary care workforce is included within the approved strategy for general practice. The Committee will focus on workforce in a Seminar in November 2019. The local response to the NHS Long Term Plan, scheduled for autumn 2019, will include workforce plans that are aligned to finance and activity plans. The NCL Strategy for General Practice, approved in November 2018, focuses on workforce development through primary care networks (with pharmacists, physicians and social prescribers supporting practice staff) and the benefits of working at scale. The new GP contract allows core funding to be used to extend skill-mix in practices in this way. PCCC18: Inadequate support from Primary Care Support England (Capita contract) for general practices (Threat): Capita have recommenced the patient list cleansing process in agreement with NHS England. The London process will start in North Central London. The timeline for the list cleansing process, requested by the Committee in April 2019, is set out below: • Current - people aged over 100 on practice lists; • From June 2019 – People under 16 and demolished properties; • From September 2019 - homes with high multiple occupancy,

students (this may be moved forwards), and transient population.

PCCC22: Opportunities to support struggling practices are sometimes delayed by the absence of a systematic early warning system (Threat): This risk has been added to the risk register as regulatory action has been taken with a series of practices recently following “inadequate” or “requires improvement” ratings following Care Quality Commission (CQC) inspections. Action in some cases has included having to put in place caretaking arrangements at practices at

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very short notice. The aim of the risk is to promote earlier recognition of struggling practices, and ensure that support is provided before regulatory action is required. This risk continues the work to address the now closed risk PCCC9 relating to “Loss of service provider at short notice due to regulatory intervention”. The existing quality report provides an overview of performance and variation across a range of indicators alongside local intelligence. Development meetings have been held in April and July 2019 to consider the framework for an early warning system to identify struggling practices and enhance current levels of support before regulatory action is required. [PCCC24: The establishment of Primary Care Networks, as set out in the new national GP contract, needs to align with local primary care strategies and primary care provision including GP Federations, and avoid potential conflicts of interest (Threat): The following work has been undertaken to manage the establishment of primary care networks (PCNs): • Establishment of PCNs in NCL in line with national guidance including

geographic coherence and population size, and through a bottom-up process with practices and the Local Medical Committee;

• Approval of PCN proposals across NCL by the Committee in June 2019;

• Organisation development programme being developed for Clinical Directors of the PCNs;

• Establishing primary care provider meetings to align the work of GP Federations and PCNs;

• Amendment of declarations of interest to include PCN membership for general practice members of CCG Governing Bodies.]

Reducing Risk The following risk has reduced below the threshold for the NCL PCCC risk report. It will continue to be monitored below this level. PCCC14: Special Allocations Service - service continuity through the re-procurement of the new service across NCL for this vulnerable patient group at risk (Threat): Following completion of the procurement process through London-wide process a preferred provider has been identified. The Committee has been asked, through the urgent decision-making process, to approve the appointment of the preferred provider. The service offer is in accordance with the service specification and within the financial envelope approved by the Committee in February 2019.

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The new NCL-wide service will start in November 2019 as scheduled, with any slippage in mobilisation covered by the Committee decision in April 2019 to approve contracts for existing services to be extended to October 2019 (with an option to run until March 2020 for any delays) to ensure service continuity. Work is underway with Camden and Islington Foundation Trust to secure premises for the southern site for the service, with the other site being at St Ann’s Hospital in Haringey. Given completion of the procurement and the identification of a preferred provider the risk rating is [recommended] to move from 12 to 9.

Recommendation The NCL PCCC is asked to: • NOTE the report and updates to the Committee risk register; • Provide feedback on the risks included; • Identify if there are any new or additional strategic risks falling within

the remit of the Committee; • [Approve a revised risk rating of 9 (from 12) for PCCC14 following

completion of the procurement process for the NCL Special Allocations Service.]


The risk register will be a standing item for each meeting of the NCL PCCC.


Conflicts of interest are managed robustly and in accordance with the CCG’s conflict of interest policy.


The risk register focuses on risks relating to delivery of the strategic objectives of the five CCGs in North Central London delegated to the Committee: • Commission the delivery of NHS constitutional rights and pledges; • Improve the quality and safety of commissioned services; • Improve health outcomes, address inequalities and achieve parity of

esteem; • Maintain financial stability and ensure sustainability through robust

planning and commissioning of value-for- money services.

Engagement

The risk register fully considers public engagement and partnership working as part of the risk mitigation/control process.


The report was written in accordance with the provisions of the Equality Act 2010.

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The initial risk register for the Committee has been developed with reference to existing risk registers from individual CCGs, and then updated for actions to mitigate existing risks and the addition of new emerging risks.

Next Steps Work is underway to streamline risk reporting across North Central London, with registers across the Sustainability and Transformation Plan, CCGs, the NCL Joint Commissioning Committee and NCL Primary Care Committee-in-Common.

Appendices

Appendices are: 1. The Committee Risk Tracker; 2. The Committee Risk Heat Map; 3. Risk scoring key; 4. Detailed risk register

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Risk ID Risk Title Risk Owner Strategic Update APR JUN AUG OCT

PCCC12

Failure to address variation in Primary Care Quality and Performance across NCL (Threat)

Paul Sinden, Director of Performance, Planning and Primary Care

The new GP contract also introduces a greater quality improvement focus in the Quality Outcomes Framework.Mitigations in place to help reduce unwarranted variation in quality and performance across general practices include:• Sign-off of plans to establish primary care networks (PCNs) in NCL, as part of the new national GP contract, by the Committee in June 2019 and development of payment process for NCL;• Use of GP Forward View monies from NHS England to support the development of primary care networks and GP Federations, and develop a resilience programme for general practice; • The new GP contract also introduces a greater quality improvement focus in the Quality Outcomes Framework;• Development of an early warning system to identify struggling practices has begun, but paper deferred to December 2019 from October 2019.

12 12 12 12 6

PCCC13

Failure to develop primary care workforce in line with requirements for developing primary care services in the STP(Threat)


Development of primary care workforce is included within the approved strategy for general practice. The Committee will focus on workforce in a Seminar in November 2019.

The local response to the NHS Long Term Plan, scheduled for autumn 2019, will include workforce plans that are aligned to finance and activity plans.

The NCL Strategy for General Practice, approved in November 2018, focuses on workforce development through primary care networks (with pharmacists, physicians and social prescribers supporting practice staff) and the benefits of working at scale. The new GP contract allows core funding to be used to extend skill-mix in practices in this way.

12 12 12 12 6

PCCC14

Special Allocations Service - service continuity through the re-procurement of the new service across NCL for this vulnerable patient group at risk (Threat)


Following completion of the procurement process through London-wide process a preferred provider has been identified.

The Committee has been asked, through the urgent decision-making process, to approve the appointment of the preferred provider. The service offer is in accordance with the service specification and within the financial envelope approved by the Committee in February 2019.

The new NCL-wide service will start in November 2019 as scheduled, with any slippage in mobilisation covered by the Committee decision in April 2019 to approve contracts for existing services to be extended to October 2019 (with an option to run until March 2020 for any delays) to ensure service continuity.

Work is underway with Camden and Islington Foundation Trust to secure premises for the southern site for the service, with the other site being at St Ann’s Hospital in Haringey.

12 12 12 9 ↓ 4

PCCC18

Inadequate support from Primary Care Support England (Capita contract) for general practices (Threat)


Capita have recommenced the patient list cleansing process in agreement with NHS England. The London process will start in North Central London.

The timeline for the list cleansing process, requested by the Committee in April 2019, is set out below:• Current - people aged over 100 on practice lists;• From June 2019 – People under 16 and demolished properties;• From September 2019 - homes with high multiple occupancy, students (this may be moved forwards), and transient population.

16 16 16 16 6

PCCC Risks- Highlight Report 2019/20Movement From

Last ReportTarget Risk

ScoreCurrent Risk Score

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PCCC22

Opportunities to support struggling practices are sometimes delayed by the absence of a systematic early warning system (Threat)


This risk has been added to the risk register as regulatory action has been taken with a series of practices recently following “inadequate” or “requires improvement” ratings following Care Quality Commission (CQC) inspections. Action in some cases has included having to put in place caretaking arrangements at practices at very short notice.

The aim of the risk is to promote earlier recognition of struggling practices, and ensure that support is provided before regulatory action is required. This risk continues the work to address the now closed risk PCCC9 relating to “Loss of service provider at short notice due to regulatory intervention”.

The existing quality report provides an overview of performance and variation across a range of indicators alongside local intelligence.

Development meetings have been held in April and July 2019 to consider the framework for an early warning system to identify struggling practices and enhance current levels of support before regulatory action is required.

16 16 12 12 6

Risk Key

Risk Improving

Risk Worsening

Risk neither improving nor worsening but working towards target

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BAF Risk Heat Map

2 3 4 5

3

4

5

Consequence

Likelihood

2

1

1

Current Risk Score: Target Risk Score:x x

PCCC 12

PCCC 13

PCCC 12

PCCC 14

PCCC 22

PCCC 13

PCCC 18

PCCC 18

PCCC 23

PCCC 24

PCCC 24

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ID Risk Owner Risk Manager Objective Risk

Consequence (Initial)

Likelihood (Initial)

Rating (Initial)

Controls in place Evidence of Controls

Overall Strength of Controls in place

Consequenc

e (Current)

Likelihood (C

urrent)

Rating

(Current)

Controls Needed Actions Action Deadline Update on Actions

Consequence (Target)

Likelihood (Target)

Rating

(Target)

Strategic Update for CommitteeDate of Last Update

Status

PCCC12 Paul Sinden - NCL Director of Performance, Planning and Primary Care

Primary Care Provision

Failure to address variation in Primary Care Quality and Performance across NCL (Threat)

Cause: If NCL CCGs fail to identify and address variations in Performance and Quality

Effect: There is a risk that practices across NCL will offer differential access and services for NCL residents

Impact: This may result in plans to reduce health inequalities and move more care closer to home to be less effective than planned risking inferior patient experience and poor cost effectiveness

4 4 16 C1. NCL PCCC supported by Practice based Quality and Performance ReportC2. Committee sign off of Primary Care Network proposals for NCL on 20 June 2019C3. Existing CCG work on resilience, sustainability and delivering primary care-at-scaleC4. Sign-off of NCL CCG Strategy for General Practice in November 2018C5. Establishment of CCG Quality Improvement Support Teams (QISTs) through Health and care Closer Home STP workstream

C1. ReportC2. Report and Committee minutesC3. CCG papersC4. CCG Governing Body papers C5. CCG papers and STP workstream papers

Medium 3 4 12 CN1. Development of early warning system to earlier identify struggling practices. CN2. Action Directed Enhanced Service (DES) for PCNsCN3. Further development of performance and quality report

A1. Establishment of working group to develop early warning system. A2. Commence DES on 1 July 2019A3. Stocktake of Committee and CCG reportsA4. Proposal for early warning system to Committee in August 2019

A1. 12.07.19A2. 01.07.19A3. 31.07.19A4. 22.08.19

A1. Initial report to NCL PCCC on development of early warning system in June 2019, with a follow-up meeting on 12 July 2019. CompleteA2. Committee signed off PCN proposals for NCL on 20 June allowing DES to start on 1/7/19. CompleteA3. Sample reports received from CCGs. Complete A4. Sub-group established to use outcomes of meetings to develop early warning system proposal

3 2 6 Mitigations in place to help reduce unwarranted variation in quality and performance across general practices include:• Sign-off of plans to establish primary care networks (PCNs) in NCL, as part of the new national GP contract, by the Committee in June 2019 and development of payment process for NCL;• Use of GP Forward View monies from NHS England to support the development of primary care networks and GP Federations, and develop a resilience programme for general practice; • The new GP contract also introduces a greater quality improvement focus in the Quality Outcomes Framework;• Development of an early warning system to identify struggling practices has begun, but paper deferred to December 2019 from October 2019

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Failure to develop primary care workforce in line with requirements for developing primary care services in the STP(Threat)

Cause: If NCL CCGs do not develop the primary care workforce

Effect: There may be an adverse impact on delivering strategies for health and care closer to home and for general practice

Impact: This could result in care remaining in secondary care that could be appropriately provided in primary care

4 4 16C1. NCL Strategy for general practice focus on workforce development and delivering primary care at scale

C2. Plans to implement the new GP contract introduced in April 2019 extends core staff that attract funding to include pharmacists, physicians, physiotherapists, and social prescribers

C3. Blended roles created through Community Education Provider Network

C4. Establishment of STP workforce workstream

C5. Education programme for GPs, nurses and practice staff

C6. Participation in international GP recruitment

C1. Strategy. CCG Governing Body minutes for approval.C2. National guidance on new GP contractC3. Meeting papers / CCG investment plansC4. Workstream papers and minutesC5. Meeting notesC6. Meeting notes

Medium 3 4 12 CN1. Develop workforce plans in line with DES for primary care networksCN2. Workforce report to August 2019 CommitteeCN3. Stocktake of current workforce baseline to support DES investment

A1 Establish workforce baselines for practices and Primary Care Networks (PCNs)A2. Compile workforce initiatives for Committee report across STP, HLP and local CCG initiatives

A1 30.03.19A2. 20.08.19

A1. New GP contract sets out workforce requirements through the Directed Enhanced Service. CompletedA2. Committee workplan amended with workforce report scheduled for Seminar in November 2019

2 3 6 Development of primary care workforce is included within the approved strategy for general practice. The Committee will focus on workforce in a Seminar in November 2019.

The local response to the NHS Long Term Plan, scheduled for autumn 2019, will include workforce plans that are aligned to finance and activity plans.

The NCL Strategy for General Practice, approved in November 2018, focuses on workforce development through primary care networks (with pharmacists, physicians and social prescribers supporting practice staff) and the benefits of working at scale. The new GP contract allows core funding to be used to extend skill-mix in practices in this way.

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Special Allocations Service - service continuity through the re-procurement of the new service across NCL for this vulnerable patient group at risk (Threat)

Cause: If NCL CCGs fail to re-procure the service in line with current timescales through the London-wide APMS procurement

Effect: A service gap may occur if the procurement is further delayed and current services cannot further extend current provision

Impact: This could result in no primary care service provision for this patient cohort, with A&E and/or urgent care centres used instead

5 4 20 C1. Participation in London-wide APMS procurement for Special Allocation service

C2. Market event held in December 2018 for potential bidders

C3. Committee approved finances and service spec for procurement in Feb and June 2019

C4. Contracts with current service providers extended to November 2019 (start date for new service) with option to extend to March 2020 if procurement delayed

C5. Procurement for new NCL service completed and preferred provider identified

C1. Procurement documentationC2. Meeting notes and attendanceC3. Committee papers and minutes from Feb and June 2019C4. Contracts / Committee papers and minutesC5. Procurement documentation

Medium 3 3 9 CN1. Secure premises for 2-site service for NCL. Further assurance from C&IFT on premises requiredCN2. Procurement evaluation team in place including stakeholdersCN3. Committee approval of preferred provider to allow mobilisation

A1. Work with C&IFT to secure a premises solutionA2. Compile NCL evaluation team A3. Urgent decision process to be used with Committee members

A1. 31.07.19A2. 31.07.19A3. 147.10.19

A1. Correspondence with C&IFT. Trust will support any premises search requiredA2. CompletedA3. Committee asked to approve preferred provider through urgent decision route

2 2 4 Following completion of the procurement process through London-wide process a preferred provider has been identified.

The Committee has been asked, through the urgent decision-making process, to approve the appointment of the preferred provider. The service offer is in accordance with the service specification and within the financial envelope approved by the Committee in February 2019.

The new NCL-wide service will start in November 2019 as scheduled, with any slippage in mobilisation covered by the Committee decision in April 2019 to approve contracts for existing services to be extended to October 2019 (with an option to run until March 2020 for any delays) to ensure service continuity.

Work is underway with Camden and Islington Foundation Trust to secure premises for the southern site for the service, with the other site being at St Ann’s Hospital in Haringey.

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16 Weak

North Central LondonPrimary Care Committee in CommonRisk Register October 2019

16 CN1. Assurance on process and timeline for practice list cleansingCN2. Details of provider response to NAO findings and contract management meetings

A1. Obtain Capita schedule for list cleansingA2. Update on Capita Contract management through Primary Care Management Board

A1. 20.06.19A2. 31.07.19

4 4C1. Monthly report from Local Medical Committee to NHS England (London) primary care team on practice issues accruing from the contract

C2. Contract management by NHS England

C3. National Audit Office (NAO) report on Capita Contract

C4. Inclusion of independent contractors on operational review group for London

C5. Capita schedule for restarting practice list cleansing process

C1. Meeting notesC2. Contract meeting notesC3. Audit reportC4. Meeting notesC5. Committee papers


Fully Delegated Commissioning

4Inadequate support from Primary Care Support England (Capita contract) for general practices (Threat)

Cause: If the primary care support services provided by Capita do not operate effectively and in line with the contract held by NHS England

Effect: There is a risk that support to general practices falls below the standard required to support effective service delivery

Impact: This may result in risks to business continuity of GP services, reduce the quality of service to primary care users, and result in cost pressures to budgets delegated to CCGs

4

open

15.08.2019

6A1. High-level timeline provided to Committee in June 2019. CompletedA2. NHS England asked to establish Primary Care Management Board meetings for 2019/20 through which updates on Capita contract will be received.

2 3 Capita have recommenced the patient list cleansing process in agreement with NHS England. The London process will start in North Central London.

The timeline for the list cleansing process, requested by the Committee in April 2019, is set out below:• Current - people aged over 100 on practice lists;• From June 2019 – People under 16 and demolished properties;• From September 2019 - homes with high multiple occupancy, students (this may be moved forwards), and transient population.

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Fully delegated commissioning

Resources available for primary care commissioning are insufficient to carry out delegated functions taken on by CCGs in April 2017 from NHS England(Threat)

Cause: A reduction in primary care commissioning team capacity or additional CCG responsibilities put in place through the Standard Operating Procedure (SOP) with NHSE without any resource transfer

Effect: Will result in a mismatch in capacity and demand

Impact: That may result in delays to support for practices, delays in delivery against contract requirements, and undue pressure on the primary care commissioning team

4 4 16 C1. Standard Operating Procedure in place between CCGs and NHS England

C2. Process established for any changes to SOP to be approved by the Committee

C3. Transfer of primary care commissioning team from NHS England to NCL in April 2019

C4. Establishment of London Primary Care Management Board to align work of CCGs and NHS England via the SOP

C1. Current SOPC2. Committee papers / notes from London Primary Care Management BoardC3. Transfer documentation / notes from London primary care transition groupC4. Meeting papers and minutes

Medium 3 3 9 CN1. Ensure continuation of London Primary Care Management BoardCN2. Consolidate joint working with CCGs for primary care commissioning team

A1. Meet with NHS London Primary Care Lead A2. Workshop to be held in July 2019

A1. 27.01.19 A1. Met with NHS London primary care lead re re-establishing London Primary Care Management Board

3 2 6 This risk focuses on the need to ensure on-going capacity is in place to deliver the delegated responsibilities (from April 2017) for Primary Care Medical Services, and following the transfer of the primary care commissioning team from NHS England to NCL in April 2019. Following the transfer the team still has support from functions retained by NHS England including the Medical Directorate and legal advice.

A Standing Operating Procedure (SOP) is in place between NHS England and NCL CCGs to support the delegated function, with any changes to the balance of responsibilities set out in the Standard Operating Procedure subject to Committee approval.

A London Primary Care Management Board has been established to manage the interface between CCGs and NHS England for commissioning primary care medical services (GP contracts).

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The establishment of Primary Care Networks, as set out in the new national GP contract, needs to align with local primary care strategies and primary care provision including GP Federations, and avoid potential conflicts of interest (Threat)

Cause: The networks add complexity and another layer of provision and commissioning to primary care

Effect: Will require the identification of services to be provided and commissioned at a practice, network and borough level including extended access

Impact: That may result in sub-optimal commissioning decisions being taken making provision less efficient.

4 4 16 C1. Committee sign-off of Network plans in June 2019 with networks established in line with national contract requirements

C2. Bottom-up process with practices, GP Federations and Local Medical Committee to establish networks

C3. Consistency with existing NCL strategy for general practice (networks included)

C4. NCL-wide approach to managing potential conflicts of interest, including declarations of interest for practice members of CCG Governing Bodies and Committees

C5. Identification of Clinical Directed for the networks, and establishment of a supporting OD programme

C6. Identification of Network payees for Directed Enhanced Service for Networks

C1. Committee papers and minutesC2. Committee papers and CCG papersC3. NCL strategy for general practices and strategy updatesC4. Meeting papersC5. Committee papersC6. Committee papers

Medium 3 3 9 CN1. Update primary care plans for 2020/21 for Direct Enhanced Service specifications for NetworksCN2. Alignment of Networks into emerging Borough Partnerships for integrated careCN3. Primary Care quality reports developed to include Network summaries

A1. Network established in 2019/20 for introduction of specifications in 2020/21A2. Shadow Borough partnerships established across NCLA3. Network summaries requested by Committee in June 2019

A1. 31.03.20A2. 31.03.20A3. 30.09.19

A1. Networks established in preparation for introduction of service specificationsA2. Primary care provider meetings held to consider the introduction of the networksA3. Local report amendment for October 2019 Committee

2 2 4 The following work has been undertaken to manage the establishment of primary care networks (PCNs):• Establishment of PCNs in NCL in line with national guidance including geographic coherence and population size, and through a bottom-up process with practices and the Local Medical Committee;• Approval of PCN proposals across NCL by the Committee in June 2019;• Organisation development programme being developed for Clinical Directors of the PCNs;• Establishing primary care provider meetings to align the work of GP Federations and PCNs;• Amendment of declarations of interest to include PCN membership for general practice members of CCG Governing Bodies.

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C1. Committee performance and quality report

C2. Established NCL early Warning System working group

C3. Resilience programme and supporting funding

C4. Primary care at scale developed through GP Federations

C5. Establishing Primary Care Networks

C6. Development of Quality Improvement Support Teams (QISTs) through health and care closer to home STP workstream

45 A1. Development of framework through the working groupA2. Updated report to August CommitteeA3. Stocktake of CCG primary care reports / dashboardsA4. Agree CCG support programme for practices for 2019/20

CN1. Development of NCL framework for early warning system following task group meetingsCN2. Further development of performance and quality report to provide triangulated view of practice performanceCN3. Development of practice resilience programme for 2019/20

32A1. Next working group meeting on 8 July 2019A2. Local generation of report after NHSE cease productionA3. CCG reports receivedA4. Programmes in development

A1. 30.09.19A2. 22.08.19A3. 31.07.19A4. 31.07.19

This risk has been added to the risk register as regulatory action has been taken with a series of practices recently following “inadequate” or “requires improvement” ratings following Care Quality Commission (CQC) inspections. Action in some cases has included having to put in place caretaking arrangements at practices at very short notice.

The aim of the risk is to promote earlier recognition of struggling practices, and ensure that support is provided before regulatory action is required. This risk continues the work to address the now closed risk PCCC9 relating to “Loss of service provider at short notice due to regulatory intervention”.

The existing quality report provides an overview of performance and variation across a range of indicators alongside local intelligence.

Development meetings have been held in April and July 2019 to consider the framework for an early warning system to identify struggling practices and enhance current levels of support before regulatory action is required.

15.08.2019

open


Paul Sinden - NCL Director of Performance, Planning and Primary Care

PCCC22 61243MediumC1. Committee reportsC2. Meeting notesC3. Meeting notes and practice correspondenceC4. CCG Committee papersC5. Committee in Common papersC6. Meeting notes and practice correspondence

20Opportunities to support struggling practices are sometimes delayed by the absence of a systematic early warning system (Threat)

Cause: If there are delays in identifying struggling practices

Effect: There is a risk that greater number of practices will go through regulatory processes and receive poor Care Quality Commission ratings

Impact: This may result in more practices receiving formal contract remedies for completion, more caretaking arrangements being in place, more list dispersals / procurements being undertake, and practices not being aligned with primary care networks

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NCL PRIMARY CARE COMMISSIONING COMMITTEE

FORWARD PLANNER 2019 / 20

Area

Feb 2019

18 April 2019

16 May 2019

(seminar)

20 June 2019

22 Aug 2019

17 Oct 2019

21 Nov 2019

(seminar)

19 Dec 2019

Governance

Review of Risk Register X X X X X X

Review of Terms of Reference (TOR)

X X

Review of Committee Effectiveness X

Contracting

Decisions relating to GMS, PMS and APMS contracts eg: practice mergers

X X X X X X X

Local Commissioned Services

Alternative Patient Allocation Service

X

Quality & Performance

Quality and Performance Report X X X X X X

Finance Report

Finance Report - to include the run rate and adjustments on future finance reports.

X X X X X X

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Strategy

NHS Long Term Plan X X X

Other papers

Proposal on the CCG role for responding to Sis in General practices.

X

Developing Primary Care workforce X X

GP Patient Survey learning X

ETTF Business Cases - Primary Care Estates leads

Management of practices who close half a day

X X

New GP Contract X X X

PCN Development X

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