overview panel (hop) on gp provision in kingston. report ... · st a lba n’s m e dica l c e ntre...

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Report for the Royal Borough of Kingston Health Overview Panel (HOP) on GP Provision in Kingston.

Author: Kathryn MacDermott, Director Primary Care & Planning, Kingston & Richmond CCGs

Contact: [email protected]

Contributions from and thank you to:

KCCG Primary Care Team KCCG Performance & Information Team SWL Primary Care Contacting Team

mailto:[email protected]

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Contents

1. GP Provision in Kingston - background...........................................................................................4

2. Kingston Medical Services – the local primary care strategy .........................................................4

2.1 Quality in Primary Care – local engagement in Kingston Medical Services ..................................5

3. The GP Forward View .....................................................................................................................6

3.1 Investment....................................................................................................................................7

3.2 Workforce.....................................................................................................................................7

3.3 Work load .....................................................................................................................................7

3.4 Infrastructure................................................................................................................................8

3.5 Care redesign ..........................................................................................................................8

4. The South West London STP...........................................................................................................9

5. Services provided by GP Practices in Kingston ...............................................................................9

5.1 Contract by contract type...........................................................................................................10

5.2 Core primary care medical services ............................................................................................11

5.3 Locally Commissioned Services ..................................................................................................11

5.4 National Directed Enhanced services .........................................................................................12

5.5 Kingston Medical Services – local KPIs........................................................................................13

5.6 GPs with Specialist Interest ........................................................................................................14

6. Access to general practices...........................................................................................................15

7. Extended Primary Care Services ...................................................................................................17

7.1 Weekend additional capacity .....................................................................................................17

7.2 National DES extended hours .....................................................................................................17

8. Urgent Primary Care services .......................................................................................................21

8.1 Urgent Treatment Centres..........................................................................................................21

8.2 GP Out of Hours Services............................................................................................................22

8.3 NHS 111 ......................................................................................................................................22

9. Primary Care data .........................................................................................................................23

9.1 Numbers and ages of registered patients ..................................................................................23

9.2 Deprivation by practice ..............................................................................................................25

9.3 Ethnicity by practice .............................................................................................................26

9.4 Usage of GP appointments .........................................................................................................27

10. General practice workforce ......................................................................................................29

10.1 Kingston primary care workforce as of March 2016: ...............................................................29

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10.2 Patient to GP Ratio ...............................................................................................................30

10.3 Total Health Care professionals per practice FTE .....................................................................31

10.4 GPs by Age Band .......................................................................................................................32

11. The GP Patient Survey ..............................................................................................................33

11.1 Overall experience of GP surgeries...........................................................................................33

11.2 Patient experience of telephone access ...................................................................................34

11.3 Success in getting an appointment...........................................................................................34

11.4 Waiting time at the GP surgery ................................................................................................35

11.5 Patient perception of care ........................................................................................................36

11.6 Patient satisfaction with opening hours ...................................................................................36

12. Care Quality Commission (CQC) ratings ...................................................................................37

13. Primary Care Governance.........................................................................................................39

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1. GP Provision in Kingston - background

There are currently 22 practices listed as members of Kingston CCG. One practice whilst a member of Kingston CCG is geographically located in the borough of Merton. At this point in time three practices also have branch surgeries. This means that in Kingston there are 26 locations at which patients can see a GP. In addition to the individual GP practices Kingston also provides three extended primary care services that offer 8 to 8, 7 day a week access to a GP and/or nurse appointment.

2. Kingston Medical Services – the local primary care strategy

The local primary care strategy covers delivery of the GP Forward View transformation of primary care whilst aiming to provide the same services across all practices in Kingston. To achieve this KCCG is investing additional money into Kingston general practices through a range of locally developed services known as KPIs. In 2016/17 the additional investment was £1m. In 2017/18 the additional investment is £1.5m. The intent is to be able to invest an additional £2m in 2018/19 to achieve the transformation and equalisation of services. However, this level of additional investment is only sustainable if we can change the flow of patients into hospitals, change patient behaviours and move money around the local healthcare system.

The local Kingston Medical Services strategy invests in a range of additional services including extended primary care services, primary care mental health, paediatric same day appointments, supports practices to make informed referral decisions, supports practices identify vulnerable patients that require additional care and/or referral to Kingston Coordinated Care, audiology services, respiratory services, and supports practices set a minimum number of GP appointments based on list size (not currently stipulated in the GMS contract). The local strategy is in the middle of being rolled out and the GMS practices are already delivering a range of the local KPIs. The PMS practices will be moving from their existing PMS KPIs to the new Kingston Medical Services local KPIs for the 1st April 2018. The table below sets out the current pattern of delivery for the new KPIs:

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Practice

Audi

olog

y

GPFV

(new

)

Men

tal H

ealth

&

Early

inte

rven

tion

Paed

iatr

ic S

ame

Day

appt

s.

Prim

ary

Care

Acc

ess

Stan

dard

(new

)

Refe

rral

M

anag

emen

t

Resp

itato

ry (n

ew)

Risk

Str

atifi

catio

n

Wee

kend

Add

ition

al

Capa

city

Berrylands SurgeryBrunswick Surgery

Canbury Medical CentreCentral Surgery

Chessington Park Surgery (Merrick Centre)

Churchill Medical CentreClaremont Medical CentreFairhill Medical PracticeGroves Medical Centre

Holmwood Corner SurgeryHook Surgery (Merrick centre)

Kingston Health CentreLangley Medical Practice

Manor Drive Medical CentreOrchard Practice Red Lion Surgery

(Mediventure Ltd)Roselawn Surgery

St Alban’s Medical CentreSunray SurgeryVillage Surgery

West Barnes Surgery

2.1 Quality in Primary Care – local engagement in Kingston Medical Services

Kingston CCG launched a public engagement programme at its AGM in September. The aim is to have a public conversation about the quality of locally provided general practice and community pharmacy across Kingston & Richmond CCGs. It has been 18 months since Kingston CCG took on the responsibility for commissioning primary care medical services and we included a commitment in our commissioning intentions to actively engage the local population in the design of local services.

Kingston CCG completed an engagement programme in primary care in 2015. The feedback from this programme helped inform the primary care strategy – Kingston Medical Services. We wish to build on what local people have already told us about local GP practices and pharmacies, and develop a set of quality pledges for primary care. To do this we will be

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talking to patients, carers, local people, clinicians and staff, to understand what good quality looks like. Over the next four months KCCG will be talking to people across Kingston and asking ‘what matters most to you when visiting your GP and/or local pharmacy?

We also want the perspective of clinicians and staff working in local GP practices and pharmacies about what good quality primary care looks like and what matters most to them about the services they deliver.

3. The GP Forward View

Kingston Medical Services sits alongside the General Practice Forward View (GPFV) published in April 2016 by NHS England, with support from Royal College of GPs (RCGP) and Health Education England. The GPFV sets out a substantial 5 year package of investment and transformation that aim to support practices respond to the changing environment. It sets out a plan to stabilise and transform general practice, improving services for patients and investing in new ways of providing primary care. The key actions set out in the plan include: accelerated funding of primary care; expanding and supporting GP and wider primary care staffing; reducing the burden on practices to help release time for patient care; develop the primary care estate and invest in better technology and a major programme of improvement support to practices.

The illustration below attempts to illustrate how the delivery of the GP Forward View intends to impact on general practice, patients and the wider healthcare system.

Strengthening General Practice

• Stabilise practices • Support for stressed GPs• Resilience programme• Development programme• Workforce expansion• Streamlined processes

StandardContract

Proportionate regulationStreamlined payment systems

Review of requirements e.g. QOF/AUA

GreaterSpecialistSupport

Demand Management• Self-help e.g. nhs.uk• Better sign posting

o Minor Ailmentso Social prescribing

• Enhanced remote care• Care Planning Approach• Reformed 111/Urgent Care

CollectiveWorking

Access Hub

Community Services

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The GP Forward View is structured into five sections:

1) Investment2) Workforce 3) Workload4) Practice infrastructure5) Care redesign

3.1 Investment

The GP Forward View states “by 2020/21 recurrent funding to be increased by an estimated £2.4 billion a year, decisively growing the share of spend on general practice services”. This is clearly positive news and taken with Kingston CCGs strategy to invest in Kingston Medical Services represents a unique opportunity in Kingston to general practices to support the significant redesign of care pathways and patient flows.

The new funding formulae for general practices (to replace the existing Carr-Hill formulae) is proposed and being worked by up NHSE with the BMA and is designed to take into account ‘atypical’ population lists, i.e. practice lists with significant older populations, high rates of students, black and minority ethnic communities etc. This work is expected to be completed in the summer of next year.

3.2 Workforce

The GP Forward View recognises that there is a significant workforce challenge for primary care and refers to new incentives for training, recruitment, retention and return to practice. The ambition is to double the workforce and ongoing work across London to understand how this could be achieved.

There are a number of positive initiatives proposed including the health & wellbeing of GPs, training ‘hubs’, practice nurse development, leadership development, and piloting clinical pharmacists in general practice. Across SWL the CCGs are collaborating on the development and delivery of a shared workforce strategy.

3.3 Work load

“Releasing Time for Patients” is a development programme to support general practice ‘release time’ by enabling the care of patients to be provided by the appropriate professional, at the right time, in the right place. This refers predominantly to the care and self-management of people living with long term conditions.

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The GP Forward View suggests that CCGs look to local community pharmacy to help with patients with long term conditions and minor ailments. This is a key element within the Kingston plan, included in the extended primary care services communications materials and a key question in the current quality in primary care engagement programme.

3.4 Infrastructure

The infrastructure section covers both estates and technology. The GPFV signalled a change in the way CCGs could apply for capital funding for estates bids, establishing the Estates and Technology Transformation Fund (ETTF). Kingston CCG currently has a proposal in the ETTF ‘round; for a new primary care centre on the Kingston Hospital site.

Most of the focus on infrastructure within the GPFV focusses on changing the way people can access general practice through technology. This includes:

Technology that enables self-care and self-management for patients Helps to reduce workload in practices Helps practices who want to work together to operate at scale Supports greater efficiency across the whole system Support uptake of online consultation systems Digital Primary Care Maturity Index – sets out the support general practice can

expect from IT services

3.5 Care redesign

Care redesign focusses on enhanced primary care access (8 to 8, 7 days a week), and the integration of core general practice with out of hours and urgent care services. This element has been recently expanded on in the Urgent Care Guidance, and is informing the extended primary care services commissioning intentions for 2018/19 onwards.

The GPFV lists 10 high impact actions supporting care redesign and releasing capacity for practices. These include:

Active signposting New consultation types Reduce DNAs (did not attends) Develop the team Productive workflows Personal productivity Partnership working Social prescribing Support self-care Develop Quality Improvement expertise (QI)

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4. The South West London STP

The South West London (SWL) Sustainability & Transformation plan includes a chapter on general practice and sets out the plan to integrate primary care and community services. However primary care is threaded throughout the strategy and is the bedrock of the out of hospital transformation of care.

The framework of the SWL STP chapter on general practice is currently structured around the 17 London specifications (Access, Coordinated & Proactive). This framework overlaps in a number of ways with the delivery of Kingston Coordinated Care.

5. Services provided by GP Practices in Kingston

Nationally there are three types of contracts that a general practice can sign up to. There are two contract types in place for general practices in Kingston, GMS & PMS.

The GMS contract covers the delivery of general medical services (GMS). It is the nationally set NHS contract between NHSE and a practice, not the individual GP. This came into force on 1st April 2004. Services in the GMS contract are split into three groups: essential, additional and enhanced.

Essential services are mandatory. Practices must provide essential services for people who are sick or perceive themselves to be sick with conditions from which recovery is expected, chronic disease management and general management of terminally ill patients.

Additional services are ‘expected’ under the GMS contract but Practices have the option to opt out. Additional services include cervical screening, contraceptive services, vaccination and immunisation, child health surveillance, maternity services (including intra partum care) and some minor surgery procedures.

Enhanced services can be either essential or additional services that are delivered to a higher standard, or extra/additional, specialised services, such as minor surgery or extended hours. These are known as Directed Enhanced Services (DES). Directed Enhanced Services are voluntary and NHSE commissions the national Directed Enhanced Services (on behalf of the CCGs).

Directed Enhanced Services are NHSE defined and funded services that practices can opt to provide. An example is the extended hours DES which a number of Kingston practices provide. Additionally, Kingston CCG commissions Locally Commissioned Services (LCS) that are designed and funded locally to meet local population needs.

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PMS contracts build on the GMS contract. A practice with a PMS contract has contractually agreed to provide additional services as part of their core contract.

GMS and PMS contracts were introduced in 2004 as part of The NHS Plan. The intention was to move away from simply paying practices on the number of registered patients by introducing a number of quality indicators. The basic principle is that high quality practices receive additional resources to support continuation of quality services.

5.1 Contract by contract type

Kingston CCG is made up of a number of practices, some of which include branch surgeries. These are listed below by contract type as requested:

Practice Branch GMSBrunswick Surgery GMS

Canbury Medical Centre Berrylands GMSClaremont Medical Centre GMS

Groves Medical Centre GMSHook Surgery (Merrick centre) GMS

Kingston Health Centre GMSManor Drive Medical Centre GMS

Orchard Practice Part of Churchill Medical GMSSt Alban’s Medical Centre GMS

West Barnes Surgery GMS

Practice PMSCentral Surgery PMS

Chessington Park Surgery (Merrick Centre) PMSChurchill Medical Centre Surbiton & Tudor Drive PMSFairhill Medical Practice Fairfield & University PMS

Holmwood Corner Surgery PMSLangley Medical Practice PMS

Red Lion Surgery (Mediventure Ltd) PMSRoselawn Surgery PMS

Sunray Surgery PMSVillage Surgery PMS

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5.2 Core primary care medical services

All Kingston general practices provide the essential GMS services. In addition half of Kingston practices also provide additional services as part of the PMS contract. The additional services provided by a PMS practices includes:

1) A stretch target (i.e. higher than the GMS target) for childhood immunisation target. PMS practices are expected to achieve 95% coverage of all childhood immunisations DTP, MMR, Hib, Men C, PCV, etc.

2) Stretch target on QOF (Quality Outcomes Framework). PMS practices are expected to achieve greater than 950 QOF points.

3) Stretch target on cervical cytology (screening). PMS practices are expected to achieve 85% or more coverage of women aged between25-64 years of age.

4) Stretch target on flu & pneumococcal vaccination for patients aged 65 and over. PMS practices are expected to achieve 75% coverage of flu vaccination cover for patients who meet the DH criteria for flu immunisation.

5) Mental Health: PMS practices are expected to achieve 65% of patients diagnosed with dementia provided with an annual physical check-up including a regular review of any antipsychotic medication prescribed.

6) Obesity: The practice will offer a health check for 95% of new registrations over age 18 to include waist, weight and height measurements and offer referral to local weight management and exercise referral schemes where higher risks are identified and schemes are available e.g. Weigh-to-Go, Rosemary Conley, Get Active, Walk-4-Life and Cyle-4-Life.

7) Choose and Book: PMS practices are required to continue to deliver Choose and Book.

8) Carers: Have a carer’s register, routinely identify carer’s, have a ‘carer’s liaison officer’.

9) PMS practices are required to provide data on the delivery of any of the DH Vital Signs Targets (limit up to 3). The data is fed back to child health for reporting coverage to the DH for public health information

5.3 Locally Commissioned Services

Kingston CCG also invests in locally commissioned services, which all practices can opt into delivering. These local services are designed to meet the needs of the local population and can be different across different boroughs. The range of locally commissioned services provided by Kingston practices are illustrated in the table below:

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Kingston Locally Commissioned Services

Practice

Alc

ohol

(PH

LCS

)

ABP

M (b

lood

pr

essu

re

mon

itor

ing)

Leg

Ulc

er C

are

Com

plex

Wou

nd

Care

Shar

ed C

are

Pres

crib

ing

COPD

Dia

bete

s

Phle

boto

my

Ring

Pes

sary

Sexu

al H

ealt

h (P

H L

CS)

Subs

tanc

e M

isus

e (P

H L

CS)

Vas

cula

r







Manor Drive Medical CentreOrchard Practice

Red Lion Surgery (Mediventure Ltd)

Roselawn SurgerySt Alban’s Medical Centre

Sunray SurgeryVillage Surgery

West Barnes Surgery

5.4 National Directed Enhanced services

In addition to locally commissioned services, that are developed and paid for locally, there are a range of nationally developed enhanced services that are managed by NHSE. Kingston practices also deliver a range of the nationally directed enhanced services illustrated below. Further detail on directed enhanced services can be found in section 6.2:

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National Directed Enhanced Services

Practice

Exte

nded

H

ours

Min

or

Surg

ery

Pati

ent

wit

h Le

arni

ng

Dif

ficu

lty

Out

of

Are

a Re

gist

rati

on

Berrylands Surgery With Canbury

Brunswick SurgeryCanbury Medical Centre

Central SurgeryChessington Park Surgery

(Merrick Centre)Churchill Medical Centre

Claremont Medical CentreFairhill Medical PracticeGroves Medical Centre



Manor Drive Medical CentreOrchard Practice Red Lion Surgery

(Mediventure Ltd)Roselawn Surgery


West Barnes Surgery

5.5 Kingston Medical Services – local KPIs

Unique to Kingston is the investment that KCCG is putting into primary care through Kingston Medical Services. This new investment is enabling the roll out a suite of new services to all practices. Kingston Medical Services will ensure that all practices are able to offer the same range of services to their patients regardless of the type of national contract the practice holds with NHSE (i.e. GMS or PMS).

Kingston Medical Services has to demonstrate that it can achieve a shift in patient activity to enable the non-recurrent investment currently underpinning Kingston Medical Services to become recurrent.

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PracticeGMS

Essential Services

PMS Additional

ServicesLCS KPIs







Manor Drive Medical CentreOrchard Practice

Red Lion Surgery (Mediventure Ltd)Roselawn Surgery


West Barnes Surgery

5.6 GPs with Specialist Interest

Kingston has a number of GPs trained in specialised areas. These are known as GPs with a specialist interest (GPwSI). We currently have eight GPwSI and a number of them are specialist in more than one area.

Specialist GP advice is available on:

Dermatology Dementia Neurology Urology Vasectomy Minor Surgery

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GPs with a specialist interest provide this additional service through a number of clinics that a patients GP can refer a patient to.

6. Access to general practices

The GMS contract describes core general practice hours as 8am to 6.30pm. However the GMS contract does not stipulate that the practice must be open for all core hours only that practices must provide essential services to meet the 'reasonable needs' of their patients.

The table below illustrates the current opening hours of practices in Kingston and illustrates the range of hours available. This range is due to a number of factors:

The extended hours provided under the national extended hours enhanced service If the practice has chosen to deliver the Kingston Weekend Additional Capacity KPI

that provides for Saturday morning appointments. If a practice closes for lunch If a practices closes to allow for staff training time

There has been recent national attention paid to the contractual requirement to be open for the full core hours and future revisions to the GMS contract may clarify this point.

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Kingston GP Hours

Practice Hours (core hours are 8.00 to 18.30)Practice provides cover outside of core opening

times (8am - 18.30pm) GP practices open on Saturdays Online services

Berrylands Surgery Extended hours Mon & Fri only Yes. Extended hours Mon & Fri only Yes YesBrunswick Surgery 7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed Yes. 7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed No Yes

Canbury Medical Centre Extended hours Mon & Tues only Extended hours Mon & Tues only Yes YesCentral Surgery 7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri Yes. 7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri No Yes

Chessington Park Surgery8am - 13.00 Mon to Fri, 14.00 to 18.30 Mon, Tues, Fri, 14.00 to 20.00 Wed 7 Thur No Every 2nd Sat am NoChurchill Medical Centre,

Kingston8.00am - 20.00 Mon to Fri 8.00am - 20.00 Mon to Fri 8.30am - 11.10 Yes

Churchill Medical Centre, Surbiton

8.30am - 12.00, 16.00 - 18.00 Mon, Tues, Thur, Fri. Wed 8.30am - 12.00, 15.00 - 17.00, 18.00 - 20.00

Wed eve to 20.00 No Repeat Prescribtions only

Churchill Medical Centre, Tudor Br

8.30am - 12.00 Mon to Fri. 16.00 - 18.00 Mon to Thur. No No Repeat Prescribtions only

Claremont Medical Centre 8.30am to 13.00 Mon, Tues, Thur, Fri. Wed 8.30 am to 19.50. Thur 14.10 - 19.20. Fri 14.10 - 18.50

Wed eve to 19.50. Thur eve to 19.20. Fri eve to 18.50 Yes Yes

Fairhill Medical Practice 8.00am - 18.30 Mon to Fri No No YesFairhill Branch 8.00am - 18.30 Mon to Fri No No Yes

Fairhill University Branch 8.00am - 17.30 Mon to Fri No No YesGroves Medical Centre 8.30am - 13.00, 14.00 - 18.30 Mon to Fri 7.00am on Tues & Thurs. 20.00 on Wed eve Yes Repeat Prescribtions only

Holmwood Corner Surgery8.50am to 11.30, Mon, Thur & Fri, 8.30am to 11.30 Tues & wed. 16.00 - 18.00 Mon. 15.00 - 19.30 Tues & Thur. 14.00 -

17.30 Wed eve. 15.00 - 18.00 Fri eve.Tues & Thurs eve to 19.30. 9.00 - 10.30 Yes

Hook Surgery 8.00am - 13.00, 14.00 - 19.00 Mon to Fri Eves to 19.00 Every 2nd Sat am 8.30 - 10.30 YesKingston Health Centre 8.00am - 18.30 Tues to Thur, 7.15am - 18.30 Mon & Fri. Mon & Fri 7.15 am start Yes Yes

Langley Medical Practice 8.00am to 18.30 Mon to Fri No No Yes

Manor Drive Medical Centre 9.00 - 11.00 Mon to Fri, 15.30 - 18.00 Mon, Tues, Thur & Fri, 17.00 on Wed, 18.30 - 20.00 Mon eve.

Mon eve to 20.00 Yes Yes

Red Lion Surgery (Mediventure Ltd)

8.30 - 11.30 Mon & Thur, 9.00 - 11.30 Tues, 9.30 - 11.30 Wed, 8.30 - 10.30 Fri, 16.30 - 18.30 Mon & Wed, 16.30 -

19.30 Tues, 16.30 - 19.00 Fri.Tues eve, 18.30 - 19.30, Fri eve 18.30 - 19.00 No Repeat Prescribtions only

Orchard Practice 7.30 - 18.30 Mon, Wed & Fri, 7.30 - 20.00 Tues & Thur 7.30 am, Tues & Thur eve to 20.00 Yes Yes

Roselawn Surgery 8.30 - 13.00 Mon to Fri, 14.00 - 19.30 Mon, 14.00 - 19.00 Tues, Wed & Fri.

Mon, Tues, wed & Fri extended eve hours. No Yes

St Alban’s Medical Centre 7.30 - 18.00 Mon to Fri, closed 12.00 - 13.30. No No YesSunray Surgery 8.00 - 13.00, 15.00 to 18.30 Mon - Fri Mon eve 20.00 No NoVillage Surgery 8.30 - 18.30 Mon to Fri, 19.30 Wed & Thur. Wed & Thur eve to 19.30. No Repeat Prescribtions only

West Barnes Surgery 8.00 - 19.00 Mon - fri To 19.00 Mon to Fri, Wed am 7.30 to 8.00, Fri eve 18.30 to 19.40.

Yes Yes

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7. Extended Primary Care Services

Kingston has three extended primary care services across Kingston that provides access to GP and/or Nurse Appointments, 8 to 8, 7 days a week.

The three services are based at:

Surbiton Health Centre Kingston Health Centre Merritt Health Centre

Access to the weekday appointments are made by the patients GP through their clinical system. The appointments for each week (Monday to Friday) are available to be booked from Monday morning.

For access to weekend appointments patients can book via a single shared phone number. All callers will have access to the appointment available in all three extended primary care services, providing an element of patient choice. The weekend extended services is not advertised as a walk-in service. Where patients do walk-in they are allocated the next free appointment slot.

The extended primary care services and all Kingston practices are on the same clinical system (EMIS). This ensures that no matter where a patient is seen the clinician will be able to access their clinical records.

7.1 Weekend additional capacity

Weekend Additional Capacity is the name given to one of the local KPIs in the Kingston Medical Services contract. This KPI requires a practice to be open on a Saturday morning with a minimum number of appointments available (based on list size). There are two options for delivery of the Weekend Additional Capacity KPI. One requires that practices offers booked appointments, up to 5 days in advance. The second option requires practices to offer both booked in advance and same day appointments. Practices can choose which option best meets the needs of their local population.

7.2 National DES extended hours

The national DES (directed enhanced services) extended hours is commissioned and managed by NHSE. For Kingston CCG as a level 3 commissioners we would want to ensure that the extended provision provided through the national DES, local KPIs and the extended primary care services formed a holistic and seamless approach to extended hours that did not duplicate or create gaps in service provision for Kingston residents.

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The next two tables are drawn from NHSE information on Kingston practices that have signed up to provide DES extended services. The detail provides a clear illustration of the extended hours provided and the clinical professional providing the services:

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Practice Name

Monday - Extended HoursMorning - start time

Monday Extended HoursMorning - end time

1 GP 2 GPs 3 GPs 1 Nurse 2 Nurses HCA

Monday - Extended HoursEvening - start time

Monday Extended HoursEvening - end time

1 GP 2 GPs 3 GPs 1 Nurse HCA

Tuesday - Extended HoursMorning - start time

Tuesday Extended HoursMorning - end time

1 GP 2 GPs 1 Nurse HCA Other

Tuesday - Extended HoursEvening - start time

Tuesday Extended HoursEvening - end time

1 GP 2 GPs 1 Nurse

Canbury Medical Centre 07:00 08:00 1 GP HCA Advanced Nurse PractitionerBrunswick Surgery 07:00 08:00 3 GPs 1 Nurse 18:30 19:00 1 GPThe Groves Medical Centre 07:00 08:00 1 GP 1 Nurse HCA 18:30 19:30 1 GPFairhill Medical Practice 18:30 20:00 2 GPs 18:30 20:00 2 GPsHook Surgery 18:30 19:00 2 GPsChurchill Medical Centre 18:30 20:00 2 GPs 18:30 20:00 1 GPSt Alban's Medical Centre 07:30 08:00 2 GPs 2 Nurses HCA 07:30 08:00 2 GPs 1 NurseThe Orchard Practice 07:30 08:00 1 GP 18:30 20:00 1 GPHolmwood Corner Surgery 18:30 20:15 1 GPChessington Park SurgeryRoselawn Surgery 18:30 19:30 2 GPs 18:30 19:00 2 GPsBerrylands Surgery 07:30 08:00 2 GPsRed Lion Road Surgery (Mediventure Ltd) 06:30 07:30 1 GP 18:30 19:30 1 GPKingston Health Centre 07:00 08:00 1 GP 1 Nurse HCALangley Medical Practice 07:00 08:00 1 GP 1 Nurse 07:30 08:00 1 Nurse 18:30 20:00 1 GPSunray Surgery 07:30 08:00 1 GP HCA 18:30 20:00 1 GP 1 NurseClaremont Medical Centre 18:30 20:00 3 GPs 18:30 19:00 1 NurseThe Village SurgeryManor Drive Medical Centre 18:30 20:30 2 GPs 1 Nurse HCAWest Barnes Surgery 18:30 19:00 1 GP 1 Nurse 18:30 19:00 2 GPs

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Practice Name

Wednesday - Extended HoursMorning - start time

Wednesday Extended HoursMorning - end time

1 GP 2 GPs 1 Nurse 2 Nurses HCA Other

Wednesday - Extended HoursEvening - start time

Wednesday Extended HoursEvening - end time

1 GP 2 GPs 1 Nurse

Thursday - Extended HoursMorning - start time

Thursday Extended HoursMorning - end time

1 GP 2 GPs 1 Nurse HCA

Thursday - Extended HoursEvening - start time

Thursday Extended HoursEvening - end time

1 GP 2 GPs 1 Nurse

Friday - Extended HoursMorning - start time

Friday Extended HoursMorning - end time

1 GP 1 Nurse 2 Nurses HCA

Friday - Extended HoursEvening - start time

Friday Extended HoursEvening - end time

1 GP

Saturday - Extended HoursMorning - start time

Saturday Extended HoursMorning - end time

1 GP 1 Nurse

Canbury Medical Centre 07:00 08:00 2 GPs HCABrunswick Surgery 18:30 19:45 1 GP 07:30 08:00 1 GPThe Groves Medical Centre 07:30 08:00 1 Nurse 18:30 20:00 2 GPs 07:00 08:00 2 GPsFairhill Medical Practice 18:30 20:00 1 GP 18:30 20:00 1 GP 07:30 08:00 1 GP 08:00 11:30 1 GPHook Surgery 07:30 08:00 Nurse Practitioner 18:30 19:30 2 GPsChurchill Medical Centre 18:30 20:00 1 GP 18:30 20:00 1 GP 18:30 20:00 1 GPSt Alban's Medical Centre 07:30 08:00 2 GPs 1 Nurse HCA 07:15 08:00 2 GPs 1 Nurse HCA 07:30 08:00 1 GP 1 NurseThe Orchard Practice 18:30 20:00 1 GP 07:30 08:00 1 GP 18:30 20:00 1 GPHolmwood Corner Surgery 18:30 20:15 1 GP 09:00 11:45 1 GPChessington Park Surgery 18:30 20:00 1 GP 1 Nurse 18:30 20:00 1 GPRoselawn SurgeryBerrylands Surgery 07:00 08:00 1 GPRed Lion Road Surgery (Mediventure Ltd) 18:30 19:00 1 GPKingston Health Centre 07:00 08:00 1 GP 1 Nurse HCA 07:00 08:00 1 GP 1 Nurse HCA 07:00 08:00 1 Nurse HCALangley Medical Practice 07:00 08:00 1 GP 1 NurseSunray SurgeryClaremont Medical Centre 18:30 19:30 2 GPs 1 Nurse 08:30 11:30 1 GPThe Village Surgery 18:30 19:45 1 GP 18:30 19:45 1 GPManor Drive Medical CentreWest Barnes Surgery 07:30 08:00 1 GP 1 Nurse HCA 18:30 18:45 1 Nurse 18:30 19:00 1 GP 08:30 11:15 1 Nurse

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8. Urgent Primary Care services

8.1 Urgent Treatment Centres

National guidance on Urgent Treatment Centres was published recently. It includes the definition of an Urgent Treatment Centres (UTC) as:

“Urgent treatment centres (UTCs) are community and primary care facilities providing access to urgent care for a local population. They encompass current Walk-in Centres, Minor Injuries Units, GP-led Health Centres and all other similar facilities, including the majority of those currently designated as “Type 3 and Type 4 A&E Departments”. Urgent treatment centres will usually be led by general practitioners, and are ideally co-located with primary care facilities, including GP extended hours / GP Access Hubs or Integrated Urgent Care Clinical Assessment Services (formerly known as “GP out of hours” services)”.

The guidance sets out clear ‘minimum standards by which UTCs should operate. These include:

• Urgent treatment centres should be open for at least 12 hours a day seven days a week, including bank holidays. Typically this will be an 8-8 service

• Urgent treatment centres must include minor illness and injury in adults and children of any age:

• including wound closure, removal of superficial foreign bodies and the management of minor head and eye injuries.

• Access to investigations including:• swabs, pregnancy tests and urine dipstick and culture. Near patient blood

testing, such as glucose, haemoglobin, d-dimer and electrolytes should be available. Electrocardiograms (ECG) should be available, and in some urgent treatment centres near-patient troponin testing could also be considered.

• Bedside diagnostics and plain x-ray facilities, particularly of the chest and limbs, are desirable and considerably increase the assessment capability of an urgent treatment centre, particularly where not co-located with A&E.

• Where these facilities are not available on site, clear access protocols should be in place.

• Provide both pre-booked, same day and “walk-in” appointments• Apply an effective and consistent approach to the primary prioritisation (triage) of

pre-booked appointments and “walk-in” appointments, and the allocation of pre-booked routine and same day appointment slots (ratio)

• Ability to book an appointment in the urgent treatment centre by a single phone call to NHS 111; patients should be encouraged to use NHS 111 as the primary route to access an appointment at an urgent treatment centre.

• Patients who have a pre-booked appointment made by NHS 111 should be seen and treated within 30 minutes of their appointment time

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• Patients who have a pre-booked appointment made by their GP should be seen and treated within 30 minutes of their appointment time

• Patients who “walk-in” to an urgent treatment centre should be clinically assessed within 15 minutes of arrival

• but should only be prioritised for treatment, over pre-booked appointments, where this is clinically necessary.

• Following clinical assessment, walk in patients will be given an appointment slot, which will not be more than two hours after the time of arrival.

• Be able to issue prescriptions, including repeat prescriptions and e-prescriptions• Access to the electronic (up to date) patient care record• Ability for other services (e.g. NHS 111) to electronically book appointments directly

Kingston Hospital is currently developing a UTC for the front end of Kingston A&E. The current KHFT plans include the triage of patients, and could include redirection of patients to the extended primary care services. The current contract with Kingston GP Chambers for extended primary care services includes the provision for the extended primary care service to be able to provide appointments for redirected patients. The contract for the Teddington walk in centre that many Kingston residents use is being updated for 2018/19 to include the ability to provide appointments for Richmond patients that are redirected.

8.2 GP Out of Hours Services

GP out of hours services are provided from 6.30pm to 8am on weekdays and all day at weekends and on bank holidays. For Kingston residents this service is provided by a partnership of Vocare and SELDOC. Sutton CCG manages this contract on behalf of Kingston CCG and four of the other five SWL CCGs.

8.3 NHS 111

NHS 111 is a national telephone based service that helps callers identify the most appropriate service for them to use. The intention is to integrate NHS 111 with the GP OOH services and enable 111 to book directly into the extended primary care services/hubs, enabling a seamless transfer for a patient calling the service.

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9. Primary Care data

9.1 Numbers and ages of registered patients

As of 1st April 2017 there were 204,821 patients registered with a Kingston CCG practice. The number of patients registered per practice as of 1st April 2017 is set out below, by age band:

Practice

Code

Practice

Name

0 to 04

05 to 09

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 to 94

95+ Total

WP

H84053 Berrylands Surgery 263 247 211 159 231 298 304 361 302 315 273 255 216 215 177 124 102 71 36 8 4,168 4,013H84015 Brunswick Surgery 554 501 410 345 362 530 729 756 648 619 545 419 331 286 215 151 114 81 38 22 7,656 6,725H84010 Canbury Medical Centre 598 707 619 550 489 598 671 817 807 841 726 664 536 478 343 209 150 98 49 24 9,974 8,821H84030 Central Surgery 788 783 687 564 533 789 1,033 1,135 1,113 980 903 696 580 580 490 361 272 198 102 44 12,631 11,588H84050 Chessington Park Surgery 480 459 389 447 422 481 457 469 478 475 537 421 392 339 303 168 156 90 41 13 7,017 6,647H84027 Churchill Medical Centre 1,471 1,460 1,044 743 922 1,426 1,795 1,881 1,800 1,449 1,121 905 680 600 531 331 226 149 63 25 18,622 16,137H84619 Claremont Medical Centre 860 626 462 356 400 875 1,338 1,505 1,213 946 626 463 301 247 214 143 100 63 24 8 10,770 8,624H84020 Fairhill Medical Practice 892 920 751 1,406 6,559 3,043 1,653 1,409 1,262 1,014 872 637 524 455 398 254 170 121 59 17 22,416 18,772H84042 Holmwood Corner Surgery 818 824 709 688 730 851 992 1,078 1,049 968 883 682 549 546 415 323 277 198 83 30 12,693 11,192H84025 Hook Surgery 518 509 414 355 401 491 604 582 539 534 446 385 313 274 252 178 139 90 42 15 7,081 6,693H84058 Kingsdowne Surgery 172 168 179 205 209 280 309 296 283 272 278 225 242 228 188 143 109 64 29 11 3,890 3,786H84062 Langley Medical Practice 511 458 378 316 381 567 642 678 635 623 556 455 346 336 301 195 159 105 29 12 7,683 7,091H84635 Manor Drive Surgery 966 866 719 646 613 808 985 1,164 1,132 927 902 791 665 600 551 367 277 162 76 22 13,239 11,755H84054 Red Lion Road Surgery 146 172 163 179 174 216 259 254 240 239 192 164 128 125 98 76 69 33 16 14 2,957 2,610H84061 Kingston Health Centre 746 707 630 501 735 945 1,064 1,109 976 870 688 385 302 290 189 102 81 48 27 6 10,401 8,513H84051 Roselawn 352 345 404 374 368 477 487 451 508 482 457 323 238 219 180 111 95 64 26 11 5,972 5,087H84033 St Albans Medical Centre 410 508 498 434 313 341 345 480 560 582 615 504 387 362 311 218 166 103 54 16 7,207 6,624H84618 Sunray Surgery 236 330 308 272 242 289 348 360 315 290 307 256 202 152 115 59 48 26 8 2 4,165 3,379H84016 The Groves Medical Centre 780 1,071 1,093 962 742 912 929 1,185 1,204 1,254 1,166 972 784 704 529 415 315 267 149 52 15,485 13,916H84034 The Orchard Practice 450 519 520 479 485 571 577 639 566 594 665 534 422 427 345 244 166 141 45 19 8,408 8,286H84629 Village Surgery 217 296 304 288 307 478 462 385 442 413 344 301 221 170 167 102 56 34 8 1 4,996 4,090H85055 West Barnes Surgery 331 424 409 431 436 473 475 600 566 582 546 509 415 376 292 222 142 93 48 20 7,390 6,247

KCCG 12,559 12,900 11,301 10,700 16,054 15,739 16,458 17,594 16,638 15,269 13,648 10,946 8,774 8,009 6,604 4,496 3,389 2,299 1,052 392 204,821 180,598

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The illustrations below allow you to see how the age bands by sex are spread across the Kingston registered population.

Age Band Male Female Male Female0 to 04 6,433 6,126 -6433 6,12605 to 09 6,506 6,394 -6506 6,39410 to 14 5,657 5,644 -5657 5,64415 to 19 5,115 5,585 -5115 5,58520 to 24 6,965 9,089 -6965 9,08925 to 29 7,605 8,134 -7605 8,13430 to 34 8,111 8,347 -8111 8,34735 to 39 9,053 8,541 -9053 8,54140 to 44 8,744 7,894 -8744 7,89445 to 49 8,219 7,050 -8219 7,05050 to 54 7,219 6,429 -7219 6,42955 to 59 5,691 5,255 -5691 5,25560 to 64 4,386 4,388 -4386 4,38865 to 69 3,946 4,063 -3946 4,06370 to 74 3,226 3,378 -3226 3,37875 to 79 2,050 2,446 -2050 2,44680 to 84 1,505 1,884 -1505 1,88485 to 89 881 1,418 -881 1,41890 to 94 335 717 -335 71795+ 102 290 -102 290

101,749 103,072

10000 8000 6000 4000 2000 0 2000 4000 6000 8000 10000

0 to 04

05 to 09

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 to 94

95+

Kingston CCG Practice List Size Apr 2017

Male Female

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9.2 Deprivation by practice

Kingston is a relatively affluent borough with deprivation scores well below the England average. There is however variation across Kingston with all of the practices in the two localities of Chessington and New Malden with a score over the CCG average.

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9.3 Ethnicity by practice

The population in Kingston, like most London boroughs, is made up of a range of people from differing ethnic backgrounds. The practices in New Malden have the greatest mix of ethnicity with Chessington the least.

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9.4 Usage of GP appointments

In the last year in Kingston there have been over 800,000 GP appointments. That roughly equates to an average of 4 appointments per patient. 27% of these GP appointments could have been seen by a community pharmacist or nurse. Each and every GP in Kingston has more than 8 appointments a week missed. This does not include appointments where a patient has contacted the practice and cancelled, this is where a patient simply does not turn up for a booked appointment. This adds to the pressure on appointments that could be avoided.

Appointments Not Attended Column LabelsRow Labels 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Grand Total2 - Appointment Cancelled By, Or On Behalf Of, The Patient 7,449 13,194 26,900 14,103 16,169 31,590 31,146 34,072 38,369 13,276 226,2683 - Did Not Attend - No Advance Warning Given 15,799 18,251 20,786 18,688 19,333 16,915 19,098 20,061 20,863 6,031 175,8254 - Appointment Cancelled Or Postponed By The Health Care Provider 4,421 14,140 27,123 13,984 12,634 30,832 37,187 41,563 45,317 15,376 242,577Grand Total 27,669 45,585 74,809 46,775 48,136 79,337 87,431 95,696 104,549 34,683 644,670

In Kingston we have three extended primary care services that also offer GP appointments. The take-up of these appointments during the week is high and the service is well used. However the weekday appointments also have a high level of ‘did not attend’ (averaging over 10%).

The weekend appointments have a low utilisation with only 50% of available appointments booked on a Saturday and even less on a Sunday. Saturday and Sunday also have high levels of ‘did not attend’. Kingston CCG is currently working with the provider Kingston GP Chambers to maximise the use of the service / redesign to better meet patient’s needs.

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10. General practice workforce

The general primary care workforce is made up of GPs (as partners and salaried members of the practice), Registrars, Nurses, Allied Health Professionals, Medical Secretaries, Trainee Nurses, Health Care Assistants, and Practice Managers. General practices can also employ therapists, pharmacists, pharmacy support staff, and physician associates amongst other roles.

10.1 Kingston primary care workforce as of March 2016:

GPs N= fte Male / female Over / under 55 yearsPartners 65 54.57 42 Male 23 Female 19 over 55Salaried GP 1 0.32 Male OverRegistrar (ST3/4) 3 1.81 1 Male 2 Female UnderGP Registrar 1 0.8 Male Under

Nursing staff N= fte Male / female Over / under 55 yearsAdvanced Nurse Practitioner

12 8.43 All female 5 aged 55 and over

Health Care Assistants 22 14.41 All female 7 aged 55 and overNurse specialist 1 0.15 Female OverPractice Nurse 49 27.23 All female 16 aged 55 and over

Admin/non-clinical N= fte Male / female Over / under 55 yearsPractice Manager / management

32 25.43 28 Female 4 Male 7 aged 55 and over

Receptionist 138 82.18 133 Female 5 Male 44 aged 55 and overMedical Secretary 28 18.53 All female 14 aged 55 and overAdmin / estates / ancillary

30 21.41 28 Female 2 Male 12 ged 55 and over

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10.2 Patient to GP Ratio

Practice Name Patients GP FTEPatient to GP

RatioNote

BERRYLANDS SURGERY 4139 4.67 887BRUNSWICK SURGERY 7538 3.85 1956CANBURY MEDICAL CENTRE 9937 4.89 2033CENTRAL SURGERY 12561 0.00 0 Data not availableCHESSINGTON PARK SURGERY 6849 4.56 1502CHURCHILL MEDICAL CENTRE 18440 11.37 1621CLAREMONT MEDICAL CENTRE 10994 4.50 2444FAIRHILL MEDICAL PRACTICE 21920 0.00 0 Data not availableGOSBURY HILL GP CLINIC 801 0.00 0 Data not availableGRAY'S MEDICAL CENTRE 766 0.00 0 Data not availableHOLMWOOD CORNER SURGERY 12522 7.09 1767HOOK SURGERY 6813 3.61 1888KINGSDOWNE SURGERY 3794 0.00 0 Data not availableKINGSTON HEALTH CENTRE 9842 0.00 0 Data not availableLANGLEY MEDICAL PRACTICE 7432 4.16 1787MANOR DRIVE MEDICAL CENTRE 13066 5.73 2279RED LION ROAD SURGERY 2925 0.00 0 Data not availableROSELAWN 5867 3.56 1648ST ALBANS MEDICAL CENTRE 7149 4.27 1676SUNRAY SURGERY 3926 2.53 1550THE GROVES MEDICAL CENTRE 15544 0.00 0 Data not availableTHE ORCHARD PRACTICE 8080 4.53 1782VILLAGE SURGERY 4848 2.93 1653WEST BARNES SURGERY 7397 3.12 2371

203150 75.38 2695

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10.3 Total Health Care professionals per practice FTE

Practice Name GPS Other Doctors Senior Partners Provisional Partners Nurses Dental Practitioners Total Health ProfessionalsBERRYLANDS SURGERY 4.67 4.67 0.89 2.22 1.23 0 13.68BRUNSWICK SURGERY 3.85 3.85 1 2.43 1.61 0 12.74CANBURY MEDICAL CENTRE 4.89 4.89 0.89 1.56 3.03 0.91 16.17CENTRAL SURGERY 0 0 0 0 4.27 1.77 6.04CHESSINGTON PARK SURGERY 4.56 4.56 1.07 1.07 1.68 0.51 13.45CHURCHILL MEDICAL CENTRE 11.37 11.37 0.87 1.13 3.25 2.17 30.16CLAREMONT MEDICAL CENTRE 4.5 4.5 0.67 2.13 1.08 0 12.88FAIRHILL MEDICAL PRACTICE 0 0 0 0 1.65 1 2.65GOSBURY HILL GP CLINIC 0 0 0 0 0 0 0GRAY'S MEDICAL CENTRE 0 0 0 0 0 0 0HOLMWOOD CORNER SURGERY 7.09 7.09 0.7 5.8 3.03 1.4 25.11HOOK SURGERY 3.61 3.61 1.09 1.09 1.37 0.8 11.57KINGSDOWNE SURGERY 0 0 0 0 0.48 0.32 0.8KINGSTON HEALTH CENTRE 0 0 0 0 1.27 1.81 3.08LANGLEY MEDICAL PRACTICE 4.16 4.16 0.53 2.13 1.29 0 12.27MANOR DRIVE MEDICAL CENTRE 5.73 5.73 1.2 2.4 1.71 0.53 17.3RED LION ROAD SURGERY 0 0 0 0 0.32 0 0.32ROSELAWN 3.56 3.56 1 2 1.01 0.83 11.96ST ALBANS MEDICAL CENTRE 4.27 4.27 0.67 2.13 1.76 1 14.1SUNRAY SURGERY 2.53 2.4 0.8 1.6 0.45 0 7.78THE GROVES MEDICAL CENTRE 0 0 0 0 4.81 3.55 8.36THE ORCHARD PRACTICE 4.53 4.53 0.13 0.88 1 1.21 12.28VILLAGE SURGERY 2.93 2.93 1.2 1.2 0.96 0 9.22WEST BARNES SURGERY 3.12 3.12 0.53 2.59 0.91 0.93 11.2

075.37 75.24 13.24 32.36 38.17 18.74 253.12

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10.4 GPs by Age Band

Practice Name

GPs UNDER

30

GPs Between 30

AND 34

GPs Between 35

AND 39

GPs Between 40 AND 44






GPs 70 and Above

GPs 60 And Above

(overall)BERRYLANDS SURGERY 0 1 1 2 2 0 0 0 0 0 0BRUNSWICK SURGERY 0 0 0 5 0 0 0 0 0 0 0CANBURY MEDICAL CENTRE 0 2 1 2 1 0 0 0 0 0 0CENTRAL SURGERY 0 0 0 0 0 0 0 0 0 0 0CHESSINGTON PARK SURGERY 0 0 1 2 1 1 1 0 0 0 0CHURCHILL MEDICAL CENTRE 0 3 5 3 1 3 1 0 0 0 0CLAREMONT MEDICAL CENTRE 0 1 1 2 3 0 0 0 1 0 1FAIRHILL MEDICAL PRACTICE 0 0 0 0 0 0 0 0 0 0 0GOSBURY HILL GP CLINIC 0 0 0 0 0 0 0 0 0 0 0GRAY'S MEDICAL CENTRE 0 0 0 0 0 0 0 0 0 0 0HOLMWOOD CORNER SURGERY 0 3 1 1 1 0 2 0 0 0 0HOOK SURGERY 0 0 1 2 1 0 1 0 0 0 0KINGSDOWNE SURGERY 0 0 0 0 0 0 0 0 0 0 0KINGSTON HEALTH CENTRE 0 0 0 0 0 0 0 0 0 0 0LANGLEY MEDICAL PRACTICE 0 2 1 1 0 1 0 0 0 0 0MANOR DRIVE MEDICAL CENTRE 0 0 3 0 1 1 0 0 0 0 0RED LION ROAD SURGERY 0 0 0 0 0 0 0 0 0 0 0ROSELAWN 0 0 1 0 1 0 0 1 1 0 2ST ALBANS MEDICAL CENTRE 1 0 0 0 0 0 2 0 1 1 2SUNRAY SURGERY 0 0 2 1 0 1 0 0 1 0 1THE GROVES MEDICAL CENTRE 0 0 0 0 0 0 0 0 0 0 0THE ORCHARD PRACTICE 0 2 2 1 1 2 1 0 0 0 0VILLAGE SURGERY 0 0 0 0 1 0 0 1 0 1 2WEST BARNES SURGERY 0 0 1 0 0 3 0 0 0 0 0

1 14 21 22 14 12 8 2 4 2 8

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11. The GP Patient Survey

The GP Patient Survey is an England wide survey commissioned by NHSE provided by ipsos MORI. The information below is taken from the July 2017 Patient Survey.

The results published are based on 2,491 responses to the 7,112 questionnaires were sent out; a response rate of 35%. ipsos MORI acknowledge that the survey has limitations:

Sample sizes at practice level are relatively small The survey does not include qualitative data which limits the detail provided by the

results The data are provided once a year rather than in real time

However Kingston CCG through its Primary Care Commissioning Committee and Primary Care Patient Forum recognises the feedback on telephone access to practices and has collaborated with Kingston GP Chambers to secure investment to roll out a new, pan practice integrated telephone system that we believe will address the telephony issues currently being experience by Kingston patients.

11.1 Overall experience of GP surgeries

Kingston practices score 83% ‘Good’ against a national average of 85%. The ‘Good’ experience across practices ranged from 73% to 87%.

Results from the GP Patient Survey on overall experience are illustrated below:

38%

45%

12%4%

Very good

Fairly good

Neither good nor poor

Fairly poor

Very poor

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11.2 Patient experience of telephone access

Kingston practices achieve a score of 63% on the ease of getting through to the surgery on the phone, against a national average of 68%.

Results from the GP Patient Survey on telephone access are illustrated below:

16%

47%

22%

11%4% Very easy

Fairly easy

Not very easy

Not at all easy

Haven't tried

Kingston CCG in partnership with Kingston GP Chambers submitted a bid to the Estates & Technology Transformation Fund (ETTF) to provide investment to introduce a new, integrated across practices telephony system. Kingston GP Chambers is in the process of rolling VOIP out across the Kingston practices.

11.3 Success in getting an appointment

Kingston practices score 85% ‘Yes’ against a national average of 84% on the question ‘Last time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to get an appointment to see or speak to someone?.

Results from the GP Patient Survey on getting an appointment are illustrated below:

35

68%

17%

11%4%

Yes

Yes, but I had to callback closer to or on thedayNo

Can't remember

11.4 Waiting time at the GP surgery

Kingston practices score 61% ‘Don’t wait too long’ against a national average of 58% on the question ‘How do you feel about how long you normally have to wait to be seen?

Results from the GP Patient Survey on waiting times are illustrated below:

61%25%

7%8% I don't normally have to wait

too longI have to wait a bit too long

I have to wait far too long

No opinion/doesn't apply

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11.5 Patient perception of care

Kingston practices score 95% on the question ‘Did you have confidence and trust in the GP you saw or spoke to?’ in line with the national average of 95%.

Kingston practices score 97% on the question ‘Did you have confidence and trust in the nurse you saw or spoke to?’ in line with the national average of 97%.

11.6 Patient satisfaction with opening hours

Kingston practices score 75% on the question ‘How satisfied are you with the hours that your GP surgery is open?’ against a national average of 76%.

Results from the GP Patient Survey on opening hours are illustrated below:

34%

41%

11%

7%3%4% Very satisfied

Fairly satisfied

Neither satisfied nordissatisfiedFairly dissatisfied

Very dissatisfied

I'm not sure when my GPsurgery is open

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12. Care Quality Commission (CQC) ratings

The CQC inspects and regulates health and social care services. The role of the CQC is to regulate through registration and continuously monitor the quality of the services provided through inspections. The inspection of a GP service covers five key areas:

Safe Is the patient protected from abuse and avoidable harmEffective Does the care, treatment and support achieve good outcomes, helping patients to

maintain quality of life and is based on the best available evidenceCaring Do the staff involve and treat patients with compassion, kindness, dignity and

respectResponsive Are services organised so that they meet patients’ needsWell led Is the leadership, management and governance of the organisation making sure

that it is providing high-quality care that's based around patient individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture

A summary of the CQC findings for Kingston practices is below:

• Overall quality of care in Kingston is good• All of the 22 practices in Kingston have been inspected and had reports

Practices that have received ‘requires improvement’ or ‘inadequate’ ratings work towards addressing the issues within a set timeframe. This is overseen by KCCG Primary Care Quality & Development Group (PCQDG) which reports to the Primary Care Commissioning Committee.

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A summary of the Kingston practice CQC ratings is provided below:

Practice Overall Rating Caring Effective Responsive Safe Well-led

Berrylands Surgery Good Good Good Good Good GoodCanbury Medical Centre Good Good Good Good Good GoodCentral Surgery Good Good Good Good Good GoodChessington Park Surgery Good Good Good Good Good GoodChurchill Medical Centre Good Good Good Good Good GoodClaremont Medical Centre Good Good Good Good Good GoodFairhill Medical Practice Good Good Good Good Good GoodGroves Medical Centre Good Good Good Good Good GoodHook Surgery Good Good Good Good Good GoodHolmwood Corner Surgery Good Good Good Good Good GoodKingston Health Centre Good Good Good Good Good GoodLangley Medical Practice Good Good Good Good Good GoodManor Drive Medical Centre Good Good Good Good Good GoodOrchard Practice Good Good Good Good Good Good

Red Lion Road Surgery Requires Improvement

Requires Improvement Good Requires

ImprovementRequires Improvement

Requires Improvement

Roselawn Surgery Good Good Good Good Good Good

St Albans Requires Improvement Good Requires

Improvement Good Inadequate Requires Improvement

Sunray Good Good Good Good Good GoodVillage Surgery Good Good Good Good Good GoodWest Barnes Surgery Good Good Good Good Good Good

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13. Primary Care Governance

The first illustration below sets out the governance structure for primary care commissioning within KCCG. KCCG is a level 3 commissioner of primary care medical services. This means that KCCG has taken on the responsibility of directly commissioning primary care medical services. This responsibility was delegated to KCCG in April 2016. The Primary Care Commissioning Committee is the subcommittee of the Governing Body who has responsibility for ensuring this duty is carried out. RBK are represented on the PCCC through councillor representation and the Director of Public Health.

The Primary Care Commissioning reports to the Governing Body and the Council of Members. It meets monthly and is a meeting held in public.

Primary Care Governance Structure

Council of Members

Kingston CCG Governing Body

Primary Care Commissioning Committee

Primary Care Quality & Development GroupGP IT Steering Group

Primary Care Patient Forum

Locally Commissioned Services Steering Group

The second illustration sets out the place of the primary care governance within the totality of the CCG governance structure.

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KCCG Governance Structure

Council of Members

Kingston CCG Governing Body

Joint Executive Management Team

Primary Care Commissioning CommitteeFinance Committee

Audit Committee

Integrated Governance Committee

Quality, Safety & Performance

The CCG has a range of stakeholders that can be broadly described in three groups: Delivery partners Strategic partners Assurance

The SWL Primary Care Contracting team is the NHSE primary care team that have been seconded to the SWL area to support delivery of primary care commissioning at a local level. The Primary Care Contracting team are responsible for contract management and performance. The contracting team have a representative on the Primary Care Commissioning Committee and provide regular updates to that meeting.

GP Chambers if the federation of all GP providers in Kingston and is commissioned to provide the three extended primary care services at Surbiton Health Centre, Merritt Health Centre and Kingston Health Centre.

Kingston and Richmond CCGs are now working together in one Local Delivery Unit (LDU). This has had no impact of the way primary care services are commissioned and the two CCGs continue to operate separate governance arrangements for the commissioning of primary care services. The benefit of operating in a LDU has included the development of a primary care team that works across both Kingston and Richmond enabling best practice to be shared across both boroughs.

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Stakeholders

Health & Wellbeing Board

Delivery partners Strategic partnersSWL Transforming

Primary Care Delivery Group

Assurance

SWL Primary Care contracting

Team

Pan London GPFV Delivery Oversight

Group

NHSE / Healthy London

Partnership

LMCCQC

Richmond CCG

GP Chambers

Healthwatch

K&R Local Transformation

Board

Strategic partners include RBK Health & Wellbeing board, the Kingston & Richmond Local transformation Board and SWL and London level partnerships. These are important is ensuring that primary care is included in local commissioning and transformation plans.

There are a range of national, regional and local stakeholders that monitor general practices and provide assurance on the quality of services provided. The GP contracts continue to be monitored by NHSE, through the team that is now seconded to SWL. The CCG is responsible for monitoring performance against any locally commissioned services. The Locally Commissioning Services Steering Group is responsible for the monitoring of performance against the locally commissioned services (listed below). In addition Kingston CCG has invested significantly in general practices locally to equalise the services offered by general practices to enable all practices to be able to provide the ‘additional’ services that previously only PMS practices were able to offer.

overview panel (hop) on gp provision in kingston. report ... · st a lba n’s m e dica l c e ntre...

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