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Newham CCG Primary Health Care
Strategy 2013-18
Dr Margaret Chirgwin
Consultation Draft 20 December 2013
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Contents
1. GLOSSARY .........................................................................................................................................3
2. Executive Summary ...........................................................................................................................6
3. Introduction ......................................................................................................................................9
3.1. A definition of Primary Health Care ........................................................................... 9
3.2. General Practice ....................................................................................................... 9
3.3. Why does Newham CCG need a Primary Health Care Strategy? ........................... 10
3.4. This strategy states: ................................................................................................ 12
4. Our Vision for Primary Health Care Services in Newham ................................................................... 12
4.1. Outputs/outcomes from this strategy ....................................................................... 14
5. Our Health Environment .................................................................................................................. 17
5.1. The Population ........................................................................................................ 17
5.2. The Primary Health Care Provider Landscape ........................................................ 30
5.3. Activity and Finance ................................................................................................ 40
5.3.1. Activity .................................................................................................................. 40
5.3.2. Finance ................................................................................................................. 42
5.4. The Outcomes......................................................................................................... 45
5.4.1. Health Outcomes .................................................................................................. 45
5.4.2. Newham CCG Outcome Framework 2013/14 ....................................................... 51
5.5. What our population says about their local health services ..................................... 54
5.5.1. National NHS Surveys........................................................................................... 54
5.5.2. Local NHS Surveys ............................................................................................... 55
5.5.3. LBN Surveys ......................................................................................................... 57
5.5.4. The population’s local service development priorities ............................................ 61
6. High Quality Primary Care Providers ................................................................................................. 62
6.1. Primary Medical Services (PMS,GMS, APMS) ........................................................ 62
6.2. Extended Primary Care Providers – practices, clusters, networks and federations .. 62
6.3. The support the CCG will provide to General Practices and Groups of General Practices ............................................................................................................................. 63
6.4. Non-General Practice extended primary care providers (including specialist outreach services) ............................................................................................................................. 65
7. Enablers .......................................................................................................................................... 66
7.1. IT infrastructure and capabilities .............................................................................. 66
7.2. Workforce Development .......................................................................................... 68
7.3. Estates .................................................................................................................... 69
8. Treating People in the Community ................................................................................................... 72
8.1. Self-care.................................................................................................................. 73
8.2. Primary Medical Services ........................................................................................ 73
8.3. Extended Primary Care Services ............................................................................ 73
8.4. Secondary (specialist) care to be provided in a primary care setting ....................... 74
9. Development of Clusters as Commissioners ...................................................................................... 75
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10. Procurement and contract management .......................................................................................... 77
10.1. Newham CCG Procurement Strategy, Policy .......................................................... 77
10.2. Procurement Process and Annual Procurement Plan .............................................. 78
10.3. Use of the NHS Standard Contract .......................................................................... 79
10.4. Quality Performance Management Processes......................................................... 80
10.5. Activity and Quality Reports .................................................................................... 81
11. Working with our Stakeholders ........................................................................................................ 82
11.1. Our population......................................................................................................... 82
11.2. Health and Well-being Board ................................................................................... 83
11.3. NHSE and LBN ....................................................................................................... 83
12. Key Activity and Products Time Line ................................................................................................. 85
13. Investment Plan .............................................................................................................................. 90
Appendices .................................................................................................................................................. 91
Appendix A. Newham Practices ...................................................................................... 91
Appendix B. PMS Contracts KPI Performance Summary ........................................... 101
Appendix C. General Practice High Level Indicators .................................................. 105
Appendix D. Public Health Outcome Framework Indication ....................................... 106
Appendix E. ELFT Community Health Service Specifications .................................... 109
Appendix F. Contracting and Procurement Work Plan for 2013/14 ............................ 110
Appendix G. Activity Trends ......................................................................................... 114
Appendix H. Details from Report on Newham Health Debate 2010/11 ....................... 124
Appendix I. August 2013 Community Reference Group – Feedback Notes .............. 132
Appendix J. LBN Survey Results .................................................................................. 134
Appendix K. Draft Terms of Reference Information Management and Technology and Working Group ................................................................................................................ 136
Appendix L. Draft Terms of Reference Newham Education and Training Academy Board Draft 1 ................................................................................................................... 138
Appendix M. NHS England – Commissioning GP Premises – October 2013 Group . 140
Appendix N. Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013 + update for 14/15 ...................................................................... 148
Appendix O. List of Outreach Services presently contracted by Newham CCG from Barts Health 149
Appendix P. Cluster Member Practices, Representatives, and Leads ....................... 150
Appendix Q. Draft Terms of Reference for Cluster Development Working Group .... 152
Appendix R. Newham CCG Procurement Strategy ...................................................... 154
Appendix S. Newham CCG Procurement Policy 2013 ................................................. 156
Appendix T. Contracting and Procurement Group Draft TOR .................................... 157
Appendix U. Impact Table ............................................................................................. 160
Appendix V. Code of Conduct Template to be completed when GPs have a financial interest in possible provider .......................................................................................... 161
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1. GLOSSARY
A&E Accident and Emergency CSU Clinical Support Unit
ACS Ambulatory Care Sensitive CVD Cardiovascular Disease
ADQ Average Daily Quantities CYANA Cancer charity
AF Atrial Fibrillation DC Day case
APMS Alternative Provider Medical Services
DES Directly Enhanced Scheme
AQP Any Qualified Provider DIPs Data Improvement Plans
BME Black and Ethnic Minority DSR Directly Standardised rate
BMI Body Mass Index ECG Electrocardiogram
BP Blood Pressure ELFT East London Foundation Trust
BPAS British Pregnancy Advisory Service EMIS Egton Medical Information Systems
C2C Consultant to consultant ENT Ear Nose and Throat
CAPI Computer-Assisted Personal Interviewing
EOLC End of Life Care
CBT Cognitive Behavioural Therapy EPCS Extended Primary Care Services
CCG Clinical Commissioning Group EU European Union
CEG Clinical Effectiveness Group FACET Survey
Combination of 6 surveys
CHD Coronary Heart Disease FM Facilities Maintenance
CHN Community Health Newham FTE Full Time Equivalent
CHP/LIFTCo Community Health Partnership GLA Greater London Authority
Co-op Cooperative (not for profit) GMS General Medical Services
COPD Chronic Obstructive Pulmonary Disease
GP General Practitioner
CQUINs Commissioning for Quality and Innovation
GPwSI General Practitioner with a Special Interest
CSP Commissioning Strategic Plan HbA1C Glycerated Haemoglobin
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HCA Health Care Assistant LIFT Local Improvement Finance Trust
Hib Haemophilus b LSOA Local Super Output Area
HIV Human immunodeficiency virus LTCs Long term Conditions
HMRC Her Majesty's Revenue & Customs Ltd Limited (for profit)
HPV Human papilloma virus MH Mental Health
ICT Information and communications technology
MRI Magnetic resonance imaging
IFCC International Federation of Clinical Chemistry
MRSA Meticillin-Resistant Staphylococcus Aureusis
IM&T Information Management and Technology
MSK Musculoskeletal
IMD Index of Multiple Deprivation NCB National Commissioning Board
IP In Patient NCCG
Newham Clinical Commissioning Group
IT Information Technology NCMP
National Child Measurement Programme
IV Intravenous NELCSU
North East London Commissioning Support Unit
JSNA Joint Strategic Needs Assessment NELIE
KPI Key Performance Indicators NELs Non-Electives
LA Local Authority NETA Newham Education and Training Academy
LAS London Ambulance Survey NHS National Health Service
LAT Local Area Team NHSE National Health Service England
LBN London Borough of Newham NHSPS NHS Property Services
LBW Low Birth Weight NICE National Insitute for Clinical Excellence
LES Local Enhanced Scheme NSAID Non-steroidal Anti-Inflammatory Drugs
LETB Local Education and Training Board
OBC Outline Business Case
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OCUs Opiate/Crack Users SLA Service Level Agreement
ONS Office for National Statistics SMI Severe Mental Illness
OOH Out of Hours SOM Single Operating Model
OP Out Patient Star-PU Specific Therapeutic group Age-sex Related Prescribing Units
OPD Out Patient Department TB Tuberculosis
PCT Primary Care Trust tbc to be confirmed
PMS Personal Medical Services TOPs Termination of pregnancy
PPV Pneumococcal Polysaccharide Vaccine
TOR Terms of Reference
PROMS Patient Reported Outcome Measures
UCC Urgent Care Centre
QIPP Quality Innovation Productivity and Prevention
UK United Kingdom
QOF Quality Outcome Framework VTS Vocational Training Scheme
SDIPs Service Development and Improvement Plans
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2. Executive Summary
Why do we need a Primary Health Care Strategy? (pages 10-12) - health knowledge and
technology is changing; the people we serve are changing; demands are changing and the workforce
and buildings are not fit for purpose.
Our Vision for Primary Health Care in Newham (pages 12-17) - to deliver universally accessible high quality out of hospital services that:
• promote the health and wellbeing of our local community • ensure that our population receive the right treatment at the right time and in the right place • reduce early death and improve the quality of life of those living with long term conditions; and • reduce health inequalities
High Quality Primary Health Care Providers Primary Medical Services (page 62) – the CCG will work closely with our population, NHSE and LBN Public Health to ensure practices are supported to develop new ways of working and all patients have equal access to the services they need.
General Practices and Groups of General Practices providing Extended Primary Care (pages 62-63) – the CCG will support the development of local General Practices and Groups of General Practices to provide a wide range of services as close as possible to the patient. We will support Clusters of GP Practices to achieve activity and access targets for their populations. We will purchase Extended Primary Care Services from General Practices using the National Standard Contract which allows sub-contracting of service provision to other providers. All practices will be expected to provide access for their patients to all EPCSs if they sign a contract with the CCG.
The support the CCG will provide to General Practices and Groups of General Practices (pages 63-65) - the CCG will provide quality performance data and facilitate Clusters of General Practices as providers to discuss and agree what they need to do as individual providers to reduce any validated quality variations and to develop and manage sub-contracting within the cluster and to other providers. We will continue to provide prescribing, PPG development and safeguarding support as well as support with IT, workforce and estates.
Other Extended Primary Care Providers (pages 65-66) – the CCG will work to integrate service provision of all NHS out of hospital health service providers (GP, optician, community pharmacy, dentist, Bart’s outreach, etc.), LBN and the voluntary sector.
Enablers IT Infrastructure and capabilities (pages 66-67) – the CCG at present manages a delegated IT budget from NHSE to support IT for core GMS/PMS/APMS service provision. The CCG will identify an additional IT budget which in combination with the NHSE budget will provide training, software (including on-going development of searches to support practices to achieve best practice) and hardware. The CCG will have an IM&T Strategy which will continue to focus on supporting all primary care and out of hospital health service providers to effectively use fully compatible health records systems that will allow all providers to share all relevant live records with the patient’s explicit consent. Within the life of this strategy the intention is to ensure that this ability to share electronic records will include key parts of our local acute provider (those who share the care of those with long term conditions), London Ambulance Service and relevant LBN staff subject to patient consultation.
Workforce development (pages 68-69) - the CCG will support the development of Newham Education and Training Academy (NETA) as the body that will understand our workforce needs and support on-going professional development with a focus on accrediting training for Extended Primary Care Services and developing programmes to attract and retain all health professions in Newham. This will include the development of research capacity within a number of Newham
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practices. The aim will be for NETA to become independent of the CCG by 2018.
Estates development (pages 69-71) – the CCG will work with NHSE to ensure all estate meets all basic requirements and to develop capacity for the extended services. The focus will be on providing the necessary facilities to ensure we can provide the right services to the right patient in the right place and as much as possible ensuring that geographic access is equally good across all of Newham. We therefore support a dispersed model of service provision that gives greatest possible access to the largest population. We will support all practices to provide extended services when appropriate and the largest number of provision sites that is financially viable where the service cannot be provided within all practices. We plan to undertake a FACET survey of all General Practice Estate and will include mapping of practice populations and isochrones. This will be used to prioritise estates improvements and where necessary new developments. We will establish an Estates Working Group that will include NHSE, all NHS bodies with estate in Newham, and LBN to develop a comprehensive 10 year Estates Strategy.
Treating Patients in the Community (pages 72-74) - from 2013-2018 the CCG will prioritise developing:
Self-Care Aware General Practices
A joint Self-care and prevention strategy with Public Health (LBN)
Access to a range of standard primary medical services 8am to 8 pm 7 days a week through a combination of GP practice, Extended Hours and Out of Hours Services provision with full access to a patient’s notes irrespective of how or where access occurs. This will include use of technology to develop a number of non-face-to-face consultations including emails and telephone triage of the majority of appointment requests
GPs able to consult consultants using emails/texts/phone/advice and guidance/Skype
Outreach of elderly care specialist services in the primary care setting including a patient’s home and local nursing homes
Outreach of cardiology specialist services in the primary care setting including a patient’s home and local nursing homes (this is already in place for diabetes)
Outreach of respiratory specialist services in the primary care setting including a patient’s home and local nursing homes
A range of health and social care services that will support an individual to be treated at home or in a nursing home when previously they would have been treated in a hospital. This will include provision of IVs in the community – antibiotics and chemo therapy; and rapid access to a named clinician for those with complex health and social care needs
A full range of support services to allow all those who wish to die at home to do so.
Development of Clusters as Commissioners (pages 75-77) - the CCG will invest in the development of the skills necessary in both its GP member practices and the CCG support staff to allow a maximum of 7 clusters (all Newham practices being members of one of these clusters) to hold and commission with a full delegated budget by April 2015.
Procurement of Extended Primary Care and Specialist Outreach from the acute setting (pages77-78) - the CCG’s procurement strategy will focus on achieving the best services for the patients and for most services this will mean that integration and proximity/access (so long as the quality meets the required standard) will drive the choice of procurement route.
Contract and Performance Management (pages 78-81) - the CCG will use the National Standard Contract with all out-of-hospital service providers including General Practices and Groups of General Practices. All service specifications will clearly state the staff skills and equipment requirements that
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must be met to provide the service. Pricing will explicitly include cost of the estate and support staff. Subcontracting to another Newham General Practice or Group of General Practices or when appropriate another provider will be allowed as long as there is full access to the patient notes. A performance management system will be put in place following the processes defined in the National Standard Contract. This performance management process with our local General Practices will be shared with NHSE and LBN, as key commissioners of services from these providers, through performance management pre-meets and joint meetings with CCG Clusters as providers.
Working with our Stakeholder (pages 81-82) – the CCG has developed key outcomes of this strategy with members of local PPGs and the voluntary sector. We will report regularly against these to all the participation forums. Patients will be represented in the process to develop new out of hospital care pathways that the Strategy supports. The CCG will establish with NHSE and LBN quarterly General Practice quality review meetings at cluster level including a pre-meet to discuss issues on performance and provider developments including planned training, investments and service developments. The CCG will work closely with other local health service providers (opticians, pharmacists, dentists, ELFT, Bart’s etc.) to develop new and improved services.
Time Line (pages 84-89) – this shows key Strategy deliverables over the 5 years.
Investment Plan (page 89) – this will support implementation of the strategy.
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3. Introduction
3.1. A definition of Primary Health Care
The World Health Organization (WHO) Alma-Ata declaration of 1978 defined primary health
care as:
Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.1
Though written over 30 years ago this remains a good definition of Primary Health Care.
For the purposes of this Primary Health Care Strategy Primary Health Care will include all
non-specialist health care provided outside of hospitals but not those health services in the
community that are commissioned by other parts of the system and for which the CCG has
no responsibility. In particular: community pharmacists, opticians and dentists but also those
services purchased by LBN Public Health and NHSE that are not purchased from General
Practices.
3.2. General Practice
The European Definition of General Practice/Family Medicine was used to develop the
competences that the RCGP 2006 General Practitioner curriculum develops and as such is
the best available definition of General Practice in the UK. The contracts that GPs hold with
the NHS all rely on these competencies but are regularly changing and themselves cannot be
used as a definition of General Practice. In England General Practice:
is available to all the English population through registration at a practice which means
that the individual becomes part of the practice list. The services an individual receives
1 World Health Organization, 1978. Declaration of Alma Ata, International conference on PHC, Alma-Ata, USSR,
6-12 September, available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf (accessed June 2009).
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directly from the practice are therefore often referred to as “list based” services. As
General Practices develop and form new structures they will continue to hold lists. For
clarity, throughout this document any new grouping of practices providing Extended
Primary Care Services to those on their lists will be called Groups of General Practices.
is normally the point of first medical contact within the healthcare system, providing
open and unlimited access to its users, dealing with all health problems regardless of
the age, sex, or any other characteristic of the person concerned
makes efficient use of healthcare resources through co-ordinating care, working with
other professionals in the primary care setting, and by managing the interface with
other specialities. It also means taking on an advocacy role for the patient when needed
develops a person-centred approach, orientated to individuals, their family, and their
community
has a unique consultation process, which establishes a relationship over time through
effective communication between doctor and patient
is responsible for the provision of longitudinal continuity of care as determined by the
needs of the patient
has a specific decision-making process determined by the prevalence and incidence of
illness in the community
manages simultaneously both the acute and chronic health problems of individual
patients
manages illness which presents in an undifferentiated way at an early stage in its
development, some of which may require urgent intervention
promotes health and well-being by both appropriate and effective intervention
has a specific responsibility for the health of the community
deals with health problems in their physical, psychological, social, cultural and
existential dimensions.
3.3. Why does Newham CCG need a Primary Health Care Strategy?
In general terms the NHS in England needs to change in response to a number of factors:
Changes in health knowledge and technology
– So much more can now be done than when the NHS was established. The
structure and function of the different parts of the NHS system was set up in a
very different technological age without computers, transplantation, clot
busting drugs and the pill
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Changes in the people the NHS serves
– The age profile of the population of England is changing with a projected
massive increase in the percentage of the population over the age of 65, 75 and
85 in the next 30 years
– Increasing levels of obesity, lack of exercise and alcohol but less smoking
– Patterns of disease are changing with less infections and more time spent living
with a disease such as diabetes or high blood pressure
Changes in demand
– Individual expectations are changing with most patients expecting more
involvement in decisions about their health and more understanding of their
options
– Patients wish to have a choice about when and where they are treated and
about who will provide their care (this is not universally the case. Its importance
varies with the kind of care being provided. For some kinds of care it is not
important if quality is guaranteed)
– How individuals want to use the service is changing with a greater demand for
immediate access to services and increasing expectations that access may not
need to be face to face. Thus increasing use of texts, email, phone and on line
Workforce and buildings are not fit for purpose
- The workforce was developed for a service which was structured differently and
functioned very differently. Many are approaching retirement whilst the new
generation has a different expectation of how they will work (a reduction in GP
partners and an increase in salaried GPs of particular note)
– Many GP premises were developed from residential housing and are simply
unable to expand any further.
Newham has its own local mix of these national issues requiring a Newham specific
response. The vibrant, diverse, multicultural community established across Newham has one
of the youngest growing populations in Europe coupled with a relatively high turnover of
people who arrive from other countries and who have not used the NHS before and bring
expectations and health service understanding from very different systems.
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Therefore we need a health service that can fully support both the established population
and the transient one - so that when people leave Newham they have an awareness of how
to use health and social services appropriately and so that people choose to stay in Newham
partly because its health services are understood and experienced as exceptional.
We need a 21st century healthcare system that provides accessible flexible care and takes a
strong approach to educating people on how and when to self-care with local communities
and the voluntary sector supporting the services and population.
As one of the largest regeneration areas in Europe we have a unique opportunity to develop
state of the art facilities particularly in the Docks and Canning Town developments and with
the Olympic legacy in Stratford.
3.4. This strategy states:
1. Our Vision for Primary Health Care Services in Newham and the planned outputs we
expect from implementing this strategy over the next 5 years
2. What we will do to support the development of our General Practices and other
extended primary care providers
3. The Services we plan to develop over the next 5 years to provide treatment in the
community
4. How we will develop our Clusters as Commissioners
5. How we will procure services to provide treatment in the community
6. How we will contract and performance manage these services
7. How we will work with key stakeholder: our population, NHSE, LBN and local providers
to develop and manage providers and develop new services.
4. Our Vision for Primary Health Care Services in Newham
To deliver universally accessible high quality out of hospital services that:
• promote the health and wellbeing of our local community
• ensure that our population receive the right treatment at the right time and in the
right place
• reduce early death and improve the quality of life of those living with long term
conditions; and
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• reduce health inequalities.
It is envisaged that General Practices, as providers (core and extended together), will be:
Providing a cradle to grave prevention (primary, secondary and tertiary) and
treatment service with the GP as the named and accountable clinician for his or her
patients i.e. the GP will be the key to the effective integration of an individual’s care
Ensuring continuity of an individual’s care
Providing access to essential services 7 days a week
Working in an equal partnership with patients, their families and carers with each
contact empowering the patient and their family and carers to manage their health
and make informed choices about their care
Accessing a wide variety of other skilled workers to support the GPs in providing
holistic and integrated care to their patients
Directly employing or contracting the majority of the generally skilled workers
Proactively identifying those at risk of ill-health
Diagnosing and managing the risk factors for long term conditions and the long term
conditions over the patient’s life time and through the course of the disease with
support from secondary care experts
Managing as much ill-health as possible outside of hospital and using technology
where appropriate to facilitate this
Accessing the secondary care expertise to support a patient’s care without needing
the patient to visit the hospital except when this is the best place for the care to be
provided
Working in collaboration with social care and the voluntary sector
Using a single patient record and, with the patient’s consent, sharing relevant parts
of this record with all local health and social care providers who will be able to add
information directly to the patient record
We aim to:
Reduce the years of life lost from causes amenable to health care by 2018:
o To the England average for men; and
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o To less than 10% above the average (was 17% in 2011) for women
Reduce the gap in life expectancy between wards:
o For men from 11.5 years (2008-20010) to less than 10 in 2015/16 and less
than 8 in 201 7/18
o For women from13.5 years (2008-10) to less than 12 years in 2015/16 and
less than 10 years in 17/18.
Increase the levels of satisfaction with the service
o Improve the overall satisfaction with the GP service to the England Av by
2015/16
o Improve the overall satisfaction with the Out of Hours service to the
England Av by 2015/16
The health outcome measures will not be available until 2 or more years after the period
measured so are not useful for measuring the implementation of the Strategy however the
satisfaction measures will be available within 12 months.
4.1. Outputs/outcomes from this strategy
The following are more specific service outputs/outcomes the strategy plans to achieve.
Outcome measure Baseline 2013
By March 2015
By March 2016
By March 2018
Access
1 % of Newham practice population able to speak with a GP by phone within 4 hours 5 days a week
2 % of Newham practice population able to see a doctor or nurse (as requested) within 48 hours
3 % of Newham practice population able to book an appointment 5 days in advance with a doctor of their choice
Quality
4 Outcome Framework measure: Proportion of people feeling supported to manage their condition
55.45 (Jan-Sept 2012)
65% England Average
England Average
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5 a) Number of practices (without a valid non- clinical quality reason) with Trigger Point 2 against the 1 or more GP High Level Indicators
b) Number of practices (without a valid non- clinical quality reason) with Trigger Point 1 against the 1 or more GP High Level Indicators
Need to work this out
?
0 0
0
0
0
6 a) Percentage who die on Palliative Care Register
b) Percentage of those on Palliative Care Register who die where wish to die
14%
13% 2013/14 Q1 and 2
20%
20%
40%
40%
50%
60%
7 Number of referrals made by General Practices to alternative(non-NHS) support services
Enablers
8 Percentage of CCG budget spent on out of hospital services (including ELFT community and mental health; GP prescribing; reimbursement schemes where this is funding practice to provide extended services and another mechanisms developed to fund this; any outreach services provided by an acute provider or an AQP or other form of contract out in the community; ? money transferred to LBN but being spent on services provided by health professionals)
? Need baseline to have a reasonable estimate of this.
9 Number of providers using a patient records system for recording all patient contact activity, which is interoperable with the GP clinical record with a live view of patient information and the ability to import coded data from the GP systems and for the GPs to be able to import coded data from the ELFT patient record, with a clinical governance compliant patient consent control system.
All GP practices
OOH
All Community Services with mobile access
Diabetic OPD
All OPD at NUH
LAS
Relevant SS teams (adult and children)
10 a) NETA facilitating access to a full range of training opportunities to all primary care clinical and non-clinical
None
GP
HCA
All
All
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staff
b) NETA funding from CCG
Minimal support
Practice Nurses
Management
50% of management support rest paid for by Practices
Fully funded by those using the services
11 FTE GPs/capita
FTE Practice nurses/capita
FTE HCAs/capita
1800/GP
?
?
1,700/GP 1,600/GP 1,500/GP
12 a) Number of Surgeries that are below the acceptable standard for facilities (need to agree what this is but from previous survey there were 12 practices in this group
b) Number of surgeries in the middle category (need to define -there were 44 practices in this category. I would prefer to be more specific with this picking off only a portion of these)
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44
6
40
0
30
0
20
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5. Our Health Environment
5.1. The Population2
5.1.1. Our Population
The 2011 National Census estimates that the total population of Newham is 308,000 which
is a significant increase from previous estimates. However there are 371,000 individuals
registered with Newham GPs (from the Exeter system) and it is this figure that is now being
used by NHS England as the raw CCG population.
Population age sex profile
The borough has an unusually young age profile in comparison to the age profile for
England. Newham has a larger than average proportion of people aged under 10 years, and
aged 20 to 39 years, with a correspondingly smaller than average proportion aged 40 and
above.
2 Information in this section from NEWHAM JOINT STRATEGIC NEEDS ASSESSMENT 2011/12 September 2012 Update
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People aged 65 and over make up a relatively small proportion of the Newham population in
comparison to London and England as a whole. In 2011 just 6.7% of Newham’s population
was estimated to be aged 65 and over (around 20,700)2 compared to 16.5% nationally.
52% of the borough’s population are males, a higher proportion than the national average of
49.2%.
Ward Level Age Profiles
There is marked variation in age profile between different wards. The proportion of people
aged over 65 living in each ward ranges from 4.5% (Beckton) to 11.1% (Plaistow South). The
proportion of people aged under 18 living in each ward ranges from 23.7% (Plaistow South)
to 36.5% (East Ham South).
Table 1: Population age profile by ward
Area Name Under 18 18 - 64 65 plus
ENGLAND 21.1 62.4 16.5
LONDON 23.0 66.0 11.0
NEWHAM 26.8 66.1 7.1
Beckton 22.7 73.2 4.1
Boleyn 28.3 63.3 8.4
Canning Town North 29.5 63.6 7.00
Canning Town South 28.1 63.4 8.5
Custom House 27.6 64.0 8.4
East Ham Central 28.5 64.6 6.9
East Ham North 30.5 63.7 5.8
East Ham South 33.5 58.4 8.1
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Forest Gate North 25.1 68.0 7.0
Forest Gate South 23.3 71.4 5.3
Green Street East 28.9 64.3 6.8
Green Street West 26.8 65.6 7.7
Little Ilford 31.0 62.5 6.5
Manor Park 26.4 64.6 9.0
Plaistow North 27.3 64.9 7.87
Plaistow South 20.2 68.9 10.9
Royal Docks 22.1 72.8 5.1
Stratford and New Town 21.8 72.2 6.00
Wall End 30.4 63.3 6.3
West Ham 27.8 64.7 7.6
Source: GLA Round 2011 Population Projection SHLAA - PUBLISHED APR 2012
Birth Rates
Newham has the highest birth rate in England (113.9 live births per 1,000 female population
of reproductive age) compared to the London average (72.1); and this in turn is higher than
the England average (65.5). In 2010 there were 6,262 live births to Newham residents.
In 2010, over 76% of these babies were born to mothers who themselves were born outside
the UK. The largest percentage was from Asia & the Middle East (49%), followed by Africa
(25%) and the EU (20%).
Newham has the second highest proportion of new-borns with low birth weight (less than
2500g) in London.
20
Population Growth
The total population of Newham increased from approximately 244,000 in the 2001 Census
to 308,000 in the 2011 Census. Some of that increase may be explained by improved census
completion in 2011, but the increase also reflects increasing regeneration in the past decade
and migration into the borough. Housing development and regeneration will accelerate
during the next decade across several areas of Newham, which is likely to result in continued
population growth.
Local modelling, taking account of housing development as well as migration, birth and
deaths, predicts a population increase of over 30,000 people between 2011 and 2016, an
increase of around 10%. The largest growth is expected in Stratford and New Town and
Canning Town South (around 11,000 and 5,000 people in each, a 55.8% and 34% increase
respectively).
Population Turnover
High population churn impacts on local services and areas in a number of ways. An area with
high churn will generally be a greater burden on local services even though the population
may be identical. If the population is unchanged in size but the already resident population
were all replaced by new people, the churn index would take a value of 100%. Population
turnover measures the magnitude of flows into and out of an area. For example, the
population of an area may be unchanged, but the people that live there may be completely
different from those at a previous snapshot. If an area retained exactly the same people
between two points in time, then the turnover is defined as zero.
In Newham 6.9% of the population was born between 2007 and 2011. In this same time
period the total population grew by 10.7%, 31.6% of residents were new to Newham and
7.7% had moved their address. Within this broad picture there was more substantial
variation by ward driven in large part by re-generation - in some areas of Newham there
has been a 50%+ turnover of people.
Borough Population in 2011
% change since 2007
% of 2011 stock born since 2007
% of 2011 stock new to borough by in-migration
% of 2011 stock due to internal movement
% of 2011 stock unchanged since 2007
Newham 298,916 10.7 6.9 31.6 7.7 53.9
21
Source: Comparative analysis of the resident population of the six Olympic host boroughs -sources and uses of locally owned administrative data. Dr Les Mayhew ; Gillian Harper; Sam Waples. 2011
Regeneration
The regeneration plans for Newham, will have a significant impact on the level of population
and the boroughs infrastructure.
Geographically, the areas of concentrated regeneration are located along the east and west
sides of the Borough as well as along the borders of the river Thames. This land is mostly
former industrial or dockside land which is currently underutilised. New technologies of land
reclamation mean that this land now represents "an arc of opportunity" for redeveloping
Newham. Maps of land use or road systems highlight how this ground is currently relatively
empty when compared to the interior of Newham Borough.
22
From the figures submitted for planned new-builds we are able to determine the extent and
timing of the regeneration-driven growth at the Community Forum level.
From 2011 onwards, Stratford & West Ham, the Royal Docks and Custom House &
Canning Town Forums will experience fast and significant growth.
By 2019, Stratford & West Ham and Custom House & Canning Town Community Forums
will have surpassed any other Community Forum in the Borough by 10,000 habitants.
This is a significant pace and scale of this change.
23
Ethnicity Profile
Until further information becomes available from the 2011 Census, the best available
estimates of the ethnicity profile for Newham come from GLA 2010 ethnic group
projections. These projections reflect the considerable ethnic diversity of Newham.
GLA Ethnic Breakdown
GLA Aggregated ethnic
Group
2011 %
White 80,107 29.8
Black Caribbean 17,833 6.6
Black African 42,863 15.9
Black Other 8,246 3.1
Indian 31,066 11.6
Pakistani 28,808 10.7
Bangladeshi 28,495 10.6
Chinese 4,365 1.6
Other Asian 12,933 4.8
Other 14,137 5.3
Source: GLA 2010 Round Ethnic Group Projections – SHLAA
The population of Newham, in terms of ethnic group, varies substantially by age group. Of
people aged under 20 years, 20.7% of the population are black African and 16.5% are
Bangladeshi. Of people aged 20-64 years, 15% of the population are black African and 8.7%
are Bangladeshi. In contrast, 16% of the under 20s age range population are white, rising to
33% of the 20-64 age range population and 55% of 65 years and over population.
24
5.1.1. Socio-economic determinants of health
As the Marmot Review restated, socioeconomic status is an important predictor of health
status. The exact relationship between the ‘wider determinants of health’ (for example,
income, housing quality, education) and individual health outcomes is complex, but has a
profound impact on health. Socioeconomic status is a useful predictor of health outcome,
particularly at a population level, but does not, on its own, explain any one individual’s
health outcomes.
Deprivation
Based on the Index of Multiple Deprivation (IMD), Newham is the 3rd most deprived local
authority area in the country. In 2010, all (20 out of 20) of Newham wards were ranked in
the 20% most deprived in the country and 8 were ranked in the 5% most deprived.
Source: Public Health England Newham Health Profile September 2013
The figure below shows variation in deprivation within Newham based on the IMD. The
chart divides Local Super Output Areas into quintiles based on deprivation index score. The
higher the IMD score, the more deprived an area is so that the areas shaded dark blue are
more deprived than those in lighter shades.
25
Source: Public Health England Newham Health Profile September 2013
Employment
According to the Office for National Statistics (ONS) Annual Population Survey, in Apr 2011-
Mar 2012 Newham had an unemployment rate of 14.6% (the highest in London) compared
to 13.0% in Tower Hamlets (2nd highest), 12.5% in Enfield (3rd highest) and 9.3% in London.
Housing
London has a higher percentage of local authority homes not meeting the decent homes
standard than other parts of the country (25% local authority stock homes in London are
non-decent compared to 16% in England in 2010). The proportion of non-decent homes in
Newham is higher than the London average, with 27% not meeting the decent homes
standard. The highest rates are reported in Havering with 57% and Tower Hamlets with 56%.
26
Newham has a high proportion of households living in fuel poverty, the 4th highest in
London and the 2nd highest proportion of unfit dwellings.
Recent data suggest that Newham has the highest proportion of housing classified as
‘overcrowded’ in London. In 2010, 17.9% of homes in Newham were defined as
overcrowded compared to 7.5% in London.
In Newham there were 2, 710 households living in temporary accommodation in Quarter 1
of 2011, the number of households living in temporary accommodation in Quarter 1 of 2010
was 3,873.
Homelessness
Although homelessness has a significant impact on the health of the local population, the
problem is not extensive in Newham. In the period between April 2010 and March 2011,
Newham had 97 households reported as being homeless and in priority need. This equates
to a rate of 1.05 homeless households and in priority need, compared to a London average
of 3.14 per 1000 households. Although the number of households reported as being
homeless and in priority need in Newham is below the London average, the proportion of
households in temporary accommodation is higher. Newham has a rate of 19.24 per 1000
households in temporary accommodation compared to a London average of 11.05.
Crime
Violent crime impacts on health both directly and through its impact on the community.
Rates of violent crime in Newham (31 offences per 1,000 population) are considerably
higher than the London average (23 per 1,000). 48% of residents in Newham perceive anti-
social behaviour to be a problem in the local area (the highest percentage of all London
boroughs).
Road Traffic Incidents
Although levels of car ownership in Newham are low relative to the London average, in 2011
74 people were killed or seriously injured on Newham’s roads.
Child Poverty
The HMRC define poverty as: “The proportion of children living in families in receipt of out of
work (means-tested) benefits or in receipt of tax credits where their reported income is less
than 60 per cent of median income.”. In Newham, the proportion of children (age under 16
years) in poverty in 2009 was 38.2%. The London average, by comparison was 29.7% and the
England average was 21.9%.
27
Map of London Showing Relative Levels of Child Poverty (Newham highlighted in red)
Source: Newham Child Health Profile 2012, Children and Maternal Health Observatory
Disabilities
The Newham Disabled Children and Young People’s Service caseload numbers (on a week
by week basis) nearly halved in two years, from 788 in September 2009 to 377 in
December 2011.
5.1.2. Individual life style determinants of health
Lifestyle factors may have a direct impact on individual health outcomes. For individuals
who smoke, are inactive, have a poor diet, or abuse drugs or alcohol, lifestyle changes can
have a significant impact on their health.
Smoking
Smoking remains the single biggest preventable cause of ill health and premature mortality
in England. Data from the Local Tobacco Control Profiles for England indicate that the
proportion of adults who smoke in Newham is close to the national average – 21%.
However, the impact of smoking on health in Newham is disproportionate, with the
proportion of death that can be attributed to smoking being significantly worse than the
national average. In contrast, the rates of smoking amongst women giving birth are
significantly better than the national average.
28
Within the Newham population there is considerable variation in rates of smoking
between different ethnic groups, and between men and women within ethnic groups.
Highest rates of smoking are found in white British men and women, east Europeans and
Bangladeshi and Pakistani men. The lowest rates are amongst Pakistani and Bangladeshi
women.
Obesity
Using modelled estimates from the Health Survey for England, it is estimated that 25.3% of
the adult population in Newham are classified as obese. This is higher than England (24.2%)
and higher than London (20.7%).
Physical Activity
Two sources of data are available describing physical activity levels in Newham. The Sport
England Active People Survey report for April 2012 states that 27.8% of Newham adults
engage in moderately intense activity of 30 minutes at least once a week, one of the lowest
participation rates in England. However, the Active People Survey focuses on sport
participation as opposed to overall physical activity.
The Newham Household Panel Survey Wave 6 report found that 73% of residents took part
in only one physical activity in previous 4 weeks. Physically active housework and brisk
walking were the most commonly identified activities.
Healthy Diet
National guidance recommends that individuals eat at least 5 portions of different fruit and
vegetables a day. The Newham Household Panel Survey Wave 6 reported that 40% of
Newham residents eat 5 A Day on at least 5 days a week.
Substance Misuse
Drug Misuse
In 2009/10 there were an estimated 2,049 Opiate/Crack Users (OCUs) in Newham. This is
lower than the previous year’s estimate of 2,590 (This is a difference of 541, or 21% lower).
There are an estimated 571 Opiate/Crack Users not known to treatment, or ‘treatment
naïve’, or 28% of OCUs. Whereas, the previous year’s estimate stated that there were 1138
treatment naïve and therefore a much higher prevalence at 44%.
Alcohol
The crude rate of alcohol-specific hospitals stays aged under-18 years is significantly lower
29
than the England average. In Newham 25.3 people aged under-18 per 100,000 were
admitted to hospital due to alcohol-specific conditions in 2007/08 to 2009/10 (pooled),
compared with 61.8 per 100,000 in England17. However, the age and sex standardised rate
of admission to hospital for alcohol related harm per 100,000 population in 2010/11 for
the whole of the Newham population was significantly worse than the England average. In
Newham the rate was 2760 per 100,000 population and the England average was 1895 per
100,000.
The proportion of the population estimated to fall into the category of “increasing and
higher risk drinking” in Newham is 15.7%, which is lower than, but not significantly
different to, the England average of 22.3%17. This suggests, therefore, that whilst Newham
has a similar proportion of increasing and higher risk drinkers, those that do use alcohol
are more likely to require admission to hospital for alcohol-related harm.
There were a total of 265 alcohol-related deaths in 2006-2010, of which, 86 were specific
to alcohol. 70% of the alcohol-specific deaths were male and 33% of people were aged 45
to 54. The majority of people were born in the UK (55%). The second most common area of
birth was Eastern Europe (14%).
Childhood Oral Health
There have been significant improvements in the oral health of five year-old children over
the past eight years. However dental decay remains much higher than the London and
national average with Newham having the second highest rates of dental decay in London
in this age group.
Childhood Obesity
The National Child Measurement Programme (NCMP) measures the height and weight of
children in Reception Class and in Year 6 and calculates their BMI by comparison to the
1990 UK growth charts. As these growth charts are based on a largely White British sample
there is some criticism that they may not accurately reflect the overall obesity risk to
individuals from other ethnic groups, which comprise over 90% of the Newham school age
population. Advice from the National Obesity Observatory is that the charts may
understate the risk to children from South Asian ethnic groups, including Bangladeshi,
Indian and Pakistani, but overstate the risk to children from Black African and Black
Caribbean groups. As children from the south Asian groups form a greater proportion of
the local school age population the overall impact for Newham at population level may
therefore be to understate the risk from obesity for Newham children.
30
Based on 2011 NCMP data, 12.9% of Reception Class children in Newham were
obese, the 5th highest in England. The rate for boys was 14.6% (5th highest) and for
girls was 11.3% (8th highest)
Based on 2011 NCMP data, 24.7% of Year 6 children in Newham were obese, the
10th highest in England. The rate for boys was 26.9% (10th highest) and for girls was
22.3% (13th highest)
5.2. The Primary Health Care Provider Landscape
5.2.1. The General Practices
We have 61practices - 32 PMS, 26 GMS and 3 APMS. The list of practices with their
contract type and population size can be found in Appendix A.
A legacy of NHS development is these different types of contract for primary care providers
which makes it difficult to ensure financial resources are deployed evenly, on a per-patient
basis, within a defined geography. GMS contracts are negotiated nationally. PMS are locally
negotiated contracts designed to reflect local conditions and objectives. This has led to
significantly different levels of funding to practices. Although during 12/13 there was
review and re-negotiation of the PMS contract in Newham there remains a significant
discrepancy in spend per head across PMS practices. Appendix B PMS Contract KPI
Performance Summary shows the additional services expected to be provided by the 32
PMS practices. There is more detail on financial aspects of this issue in the finance section
below.
The CCG does not hold these contracts so does not have the full data available on
practices. In particular we do not have data on how practices are functioning in terms of
opening hours, number of appointments/capita the use of telephone triage, the use of call
and recall systems. It appears likely that our practices are providing a higher level of
appointments than the England and London average in order to service this population and
achieve the secondary care activity level noted in section 5.3.1 below.
31
The table below gives a summary of Newham practices compared to the National average.
Of note Newham practices have smaller than average practice populations, higher list
turnover and very high levels of Black and Ethnic Minority (BME) patients. When comparing
Practice level achievements the CCG will seek CCGs with a similar profile (Tower Hamlets,
Brent and City and Hackney are the most similar).
32
Practice Distribution
General Practice High Level Indicators
NHSE has developed 38 general Practice High Level Indicator (Appendix C is the CCG average
achievement of these Indicators is compared to the national average) to monitor the activity
and quality of General practices. Practices are plotted on a National Funnel Plot. This shows
that Newham Practices are practicing very similarly to all England practices with no
significant statistically valid variation between practices. For many indicators all practices are
within the England funnel, and behaving and achieving very similarly to each other.
Of the 61 practices some are “outliers” against particular indicators. Below are listed those
indicators with 9 or more outliers:
33
Indicator Number of
Outlier
Practices
1 Emergency Cancer admissions per 100 population 13
2 Emergency Asthma admissions per 100 patients on disease register 10
3 Percentage of patients aged 25 -64 whose notes record a cervical
smear performed in last 5 years
9
4 Percentage of patients with diabetes in whom the last IFCC – HbA1c
is 64 mmol/mol
11
5 The percentage of patients with diabetes who have a record of
retinal screening in the previous 15 months
15
6 AF Prevalence ratio 10
7 Asthma Prevalence ratio 10
8 Diabetes Prevalence ratio 21
9 Overall experience of GP surgery 10
The high prevalence of diabetes in Newham due to the ethnic makeup of the population
means the prevalence ratio outliers are to be expected.
Public Health Outcome Framework Indicators – details can be found in Appendix D
Wider determinants of health
Newham has high levels of deprivation and a high proportion of children in poverty and
families living in temporary accommodation. Hospital admissions for violence, and violent
offences were high and there were high numbers of first time entrants to the youth justice
system. However, there was less social isolation and less sickness absence than average for
England.
34
Health improvement
Smoking prevalence in adults is 18.8% compared with England average of 20% and of over
4000 Newham residents annually who use smoking cessation services over half succeeded in
giving up smoking. Only 5.5% mothers are smokers at the time of their delivery compared
with England 13.2%. Breast feeding is initiated by 88.7% mothers in Newham compared with
74% in England. There were fewer births to Newham under 18s (teenage pregnancies) than
would be expected from national rates.
Fewer adults are physically active than in England as a whole and around 7% are recorded to
have diabetes compared with 5.8% nationally. High levels of obesity in 10 year old children
(39.8% overweight compared with 33.9% in England), if not tackled, will lead to earlier onset
of diabetes in middle age or earlier.
Uptake of NHS health checks is higher in Newham, but with large variations between
practices, and there is low uptake of cancer screening for breast and cervical cancer and for
screening for diabetic retinopathy.
Self-reported satisfaction score, worthwhile score and happiness score were lower and
anxiety was higher in Newham than in England. However the suicide rate was around
average for England.
Health protection
The child immunisation programme indicators show low uptake of all child vaccines, typically
under 90% which may be partly due to incomplete recording, but measles, mumps and
rubella (MMR) immunisation is even lower at under 80%. Influenza immunisation has
average uptake in over 65s and higher uptake for adults at risk. Coverage of pneumococcal
vaccine in over 65s is much lower than flu coverage in Newham whereas in England most
over 65s have had both flu and pneumococcal vaccination.
The programme to offer secondary school children HPV vaccine to prevent cervical cancer
has been successful with 91.2% uptake compared with 86.8% for England.
Newham has a high proportion of HIV being diagnosed at late stage suggesting a need for
earlier diagnosis through improved access to testing particularly for at risk groups.
Newham has highest incidence of tuberculosis in England but treatment completion is just
higher than the average for England.
35
Health care and premature mortality
Newham has high premature (before aged 75) death rates from cardiovascular disease.
Some of this is preventable through maintaining a healthy weight, taking exercise and not
smoking. Early intervention to control diabetes and raised blood pressure can lengthen lives
and prevent heart attacks and strokes. Diabetic eye disease contributes to higher rates of
blindness which may be preventable if identified and treated. Premature mortality from
cancer was average but deaths form respiratory disease and liver disease were higher than
expected from national rates.
Emergency readmissions within 30 days were lower in Newham than in England but that
may reflect the younger population.
Finance
As noted above a legacy of NHS development is that the different types of contract for
primary care providers which makes it difficult to ensure financial resources are deployed
evenly, on a per-patient basis, within a defined geography. GMS contracts negotiated
nationally and PMS negotiated locally has led to significantly different levels of funding to
practices.
Average spend per capita GMS contract in Newham =
Average spend per capital GMS nationally =
Average spend per capita PMS contract in Newham =
Average spend per capita GMS contract nationally =
Appendix A is the list of CCG practices with type of contract and spend per patient.
IT – hardware, software and utilisation
Since April 2013 all practices in Newham are now using EMIS web, previously all were on
older versions of EMIS. There is an on-going rolling programme of training supporting the
practices during this implementation phase. The benefits to patient care of being able to
share records with OOH, the UCC and each other are acknowledged but there are still
significant teething problems for practices and a need to develop practices skills to use the
power of the new system.
All practices have similar computing hardware but expertise within practices is varied and
utilisation is not yet optimal.
36
Workforce
At this time we do not have up-to-date information on practice staffing and vacancies. A
baseline survey is in process. Below is the information available at this time.
We have significantly less than the average GPs/capita than the England and the London
average. We believe this is also the case for practice nurses and health care assistants. Once
we have the baseline we will be able to assess our shortfalls.
GP FTE’s per 100,000 unified weighted population, London PCT’s 2011
37
Increase/decrease in FTE GP’s per 100,000 patients 2006-2011
The table below showing patients per full time GP is based on practice numbers in
November 2012 and data on GPs available to the PCT at that time. These are presented at
the level of LBN Community Forums. There are ten Community Forums covering the entire
borough, and anyone who lives or works in Newham is encouraged to get involved. The
Forums have been set up to enable local residents and stakeholders to agree priorities for
their local areas and provide feedback on the performance of the local area strategies. They
also provide an opportunity for the whole community to have their say, to get involved and
to influence what happens in their area. They are functional communities within the
Borough and as such looking at service distribution at this level makes sense.
38
Community Forum Population FTE GPs Patients/FTE GPs
Beckton 24,645 14 1,760
Customs House and
Canning Town
36,859 16 2,303
East Ham 31,873 16 1,992
Forest Gate 13,999 8 1,750
Green Street 89,458 42 2,130
Manor Park 73,120 42 1,740
Plaistow 34,653 20 1,732
Royal Docks 5,384 2 2,629
Stratford & West Ham 43,613 29 1,504
Grand Total 353,604 188 1,880
Age and gender profile of GPs 2012
• 37% GPs over 60 yrs
• Gender balance GPs - 70% male, 30% female
• 38% single handed (cf. 15% Hackney)
39
Estates
A significant number of practices are in premises that have been developed from
residential housing and are limited in their capacity for further development to
provide a wider range of services with a number being barely fit for purpose for
basic GMS/PMS service provision.
At present there are significant inconsistencies in condition, statutory compliance,
space utilisation, functional suitability, quality and accessibility across GP Estate in
Newham. A 6 Facet survey was last commissioned in 2005 by which provided
detailed analysis of all the points above but the information is too out of date to be
the basis for a detailed implementable Estates Strategy. Therefore the CCG will seek
support from NHSE to undertake a new FACET survey looking at the suitability of the
GP Practice estate for the present population it serves and the 5-10 year suitability
based on projected local population growth and likely facility requirements for
provision of an increased range of services in the community.
5.2.2. Out of Hours (OOH)
We have 54 practices still opted in to provide 24/7 services with their out of hours
service (OOH) being provided by a not-for-profit GP Co-op. This service is also
contracted by the CCG to provide OOH services to those practices that have opted
out of providing services 24/7. The GP Co-op also provides extended hours and a
group PPG for 26 practices at 10 sites across Newham.
5.2.3. Other out of hospital providers
There is one main community provider, East London Foundation Trust (ELFT). The list
of the services they provide at present can be found in Appendix E
There are a small number of mainly GP owned other providers of services out in the
community:
Dr Sen
iHealth
Patient First
Dr Bhasi
Dr Nasralla
40
Dr Gopinathan
Dr Madipalli
St Joseph’s Hospice
BPAS
In Health Ltd
Hestia Housing and Support
Mind in Tower Hamlets and Newham
CYANA
Newham Forum for Health and Wellbeing
A number of these services are provided by GPs with a special interest (GPwSI) or
hospital consultants. The list of services they were providing in April 2013 can be
found in Appendix F. These are in the process of being reviewed and either
decommissioned or re-commissioned using the National Standard Contract.
There are 69 community pharmacists and y community opticians in the Borough
whose main contracts are held by NHs England.
The CCG holds three contracts with community pharmacists:
Anticoagulation LES;
Directly Observed Treatment Of TB Scheme with community pharmacists; and
Minor Ailments Service LES with local pharmacists.
The CCG holds one contract with the community opticians:
Direct Cataract Referral Scheme LES with opticians.
The strategy does not cover the development of these providers because their main
contracts are with NHSE. However it may be the case that in implementing this
strategy the CCG will develop new contracts with these among other potential local
providers.
5.3. Activity and Finance
5.3.1. Activity
41
Our practices are achieving secondary care planned and unplanned activity levels very
similar to the rest of England and London and in some cases significantly lower than
the average and these results compare very well to those CCGs that serve similarly
populations - Tower Hamlets, City and Hackney and Brent.
Appendix G provides activity trends over the last 3 years and London and England
comparative data for 12/13 for:
A&E + UCC activity;
Planned and unscheduled admissions;
First Outpatient attendances;
Planned inpatient, day-case and outpatient procedures; and
Prescribing.
What Trend Compared to national rates
A&E + UCC 13/14 above 11/12 but probably below 12/13.
Approx. same as England and London average (same)
Unscheduled admissions
Basically flat. Possible slight downward trend.
Approx. England average and above London average
Outpatients 13/14 GP firsts below 12/13, about same as 11/12
Follow ups approx. 2.5 times firsts. Activity levels flat
GP firsts significantly below London average and slightly below England average
First to follow up ratio highest in London and well above both London and England averages
Planned procedures/ admissions
Inpatient and outpatient procedures flat with sudden doubling of OPD procedures since March 2012 now looks flat
IP+DC rates well below England and London averages – 6th lowest in London
Investigations Not enough information to comment
Prescribing Total prescribing budget increased by £3.8 million (11%) over 8 years giving an annual growth of 1.6%
Costs/1,000 well below England and London averages – 6th lowest in London
42
This activity data suggests that despite population growth and high levels of
deprivation Newham GP practices are containing the increasing demand from the
population though it also may indicate that there are areas where there may be under
activity particularly in planned care and prescribing.
5.3.2. Finance
The Financial Picture
The bulk of primary care funding was disaggregated to NHSE Primary Care
Commissioning as part of the re-organisation of the NHS arising from 2012 Health and
Social Care Act.
Spend in 2012/13 on Primary Care Commissioning is summarised as follows:
Description £’000
GP Contracts (GMS/PMS/APMS) 31,169
Primary Care Premises 4,073
QOF and Enhanced Services 8,646
Other development and support 4,692
Total GP Practice Support 48,580
Community Pharmacy 10,016
Community Dental 15,018
Community Ophthalmic services 3,679
Total 77,293
In addition prescribing costs totalled £37,524,107.
In Newham approximately £74.4million was transferred to NHSE for Primary Care as
part of the 2012/13 disaggregation with balances for Walk in Centres (£565,000), Out
of Hours Support (£590,000) and Local Enhanced Services (£981,000) being retained
within the CCG allocation in 13/14.
43
Other funding was disaggregated to the Local Authority and Public Health England.
The CCG no longer commissions the disaggregated element and is not funded to
support activities that should be provided as part of the core GMS/PMS/APMS
contracts or commissioned by any other Commissioner.
However, the CCG does currently budget for a number of primary care programmes
as follows:
Programme £’000
GP Local Enhanced Schemes rolled over £1,130
Out of Hours £590
Walk In Centre £850
GP IT (Delegated from NHSE) £1,319
Total £3,889
In addition approximately £37,670,000 is held as a prescribing budget and £500,000
to support the Community Pharmacy Minor Ailments Scheme giving a total budget of
£42,059,000.
A number of contracts are held by consortia or companies in which Newham GPs are
directors and services are also provided by Newham GPs with Special Interests.
As part of the preparation for CCG Authorisation a number of practice remunerations
schemes totalling approximately £750,000 were undertaken in 2012/13. In 2013/14
the Board agreed remuneration initiatives of a similar amount to support the
introduction of the Integrated Care initiative.
The Financial Challenge
Newham faces a significant financial challenge over the next three years, driven by
rapid population increase, low or zero increases in revenue allocation and the
requirement to redress unmet health need and unequal access to health provision in
a deprived and transient population.
44
The main financial pressures are
Demographic Growth – with an anticipated additional 6,000 residents per year
coming into the Borough and significant growth in specific developments such as
the Olympic Park.
Low or zero increases in the revenue allocation – Under the new allocations
formula Newham is currently funded above target. The CCG is anticipating a 0.5%
uplift in 2014/15 and 2016/17 and zero uplift in 2015/16.
Integrated Care – The implementation of integrated care to reduce the pressure
of the increasing demand on the acute sector will require additional investment
from the pooled Integrated Transformation Fund (identified from within current
CCG resources) to develop capacity for both NHS and Borough led provision.
As a result the CCG will be seeking to identify cumulative Quality, Innovation,
Productivity and Prevention (QIPP) savings totalling approximately £62 million or 9%
of total revenue over the period to ensure the necessary services and capacity to
meet the additional demand can be met.
The CCG currently splits it’s funding across the main sectors of health provision as
shown in the table below. This is compared to the proportional provision in two
similar CCGs, Tower Hamlets and Brent.
340,000,000
360,000,000
380,000,000
400,000,000
420,000,000
440,000,000
460,000,000
480,000,000
2013/14 2014/15 2015/16 2016/17
£'s
Newham CCG Summary - 'do nothing' costs against revenue
Anticipated Revenue Do Nothing Cost
45
Present financing of out of hospital services as percentage of total commissioning
spend
Type of spend Newham 12/13
%
GMS/PMS £50m 10%
Prescribing £38m 8%
Community Services £53m 11%
OTHER Out of Hospital £21m 4%
Continuing Care £9m 2.8%
TOTAL out of hospital £171m 36%
CCG Acute Spend £261m 55%
CCG Mental Health Services £46m 10%
Grand Total £478m 100%
As the CCG does not commission primary care contracted services directly detailed
and comparative data is not readily available. However, the anticipated spend by the
NHSE primary care teams for these services is approximately £75 million. To this can
be added a further allocations for specialised commissioning, services now
commissioned by the local authority and those commissioned by NHSE.
In total additional NHS services commissioned by authorities other than the CCG total
approximately £200m (figure to be verified).
Integrate care and the plan to move care from secondary care to primary care settings
are at the centre of the CCG’s plans to live within the allocated budget.
5.4. The Outcomes
5.4.1. Health Outcomes
High levels of socioeconomic deprivation combined with unhealthy lifestyles are likely
to have a negative impact on local health outcomes. This section covers some of the
key health outcome indicators for Newham.
Life expectancy
Life expectancy describes the average number of years that people can expect to live,
the figure below demonstrates that life expectancy has been increasing in England, in
46
London and in Newham. Life expectancy gap between Newham and London/England
has narrowed for women however it has increased for men.
Female life expectancy in Newham is 81.1 years, one and a half years less than the
England average of 82.6 (2008-10). Male life expectancy in Newham is 76.2 years,
nearly two and a half years less than the England average of 78.6 years (2008-10).
Trend of life expectancy at birth for males and females in Newham, London and England,
1991-1993 to 2008-2010
Source: The NHS Information Centre for health and social care
Gap in Average Life Expectancy in Newham
Men in Little Ilford have an average life expectancy of 71.6 years- this is 11.5 years
less than men in Green Street East, who have an average male life expectancy of 83.1.
Women in Canning Town North have an average life expectancy of 76.6 years, which
is 13.5 years less than the women within Royal Docks who have an average female life
expectancy of 90.2 years.
The gap in life expectancy within Newham increased markedly between 2007-2009
and 2008- 10. The life expectancy gap for 2007-2009 was 10.2 years for men and 10.6
years for women.
Life Expectancy Gap between Newham wards 2008-10 by Sex
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Source: The NHS Information Centre for Health and Social Care
Mortality Rates
Overall the mortality rate in Newham for the total population is the highest in London
and significantly higher than the national average. The directly standardised rate
(DSR) for men is the highest in London, 749 per 100,000 in Newham (compared to 656
per 100,000 in England). For women the DSR is the 2nd highest in London (533 per
100,000 compared to the London average of 438).
Newham has the highest directly standardised rate in London for mortality from all
causes amenable to healthcare in ages under 75 (141 per 100,000 compared to a
London average of 94).
However there is good news:
Over the 10 years 2001-2010 there has been a significant reduction in
mortality for both Newham and England
Mortality has fallen faster for both men and women in Newham than the
average for England thus reducing health inequalities (25% vs 21% drop for
men and 15% vs 13.6% for women)
In Newham early death (under 75) rates from cancer are now below the
England Average
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In Newham early death in now as likely to be from cardio-vascular disease as
cancer.
Source: Newham Health Profile Published by NHS England on 24th September 2013
There is more detailed information on this in the Public Health Outcome Indicators in
Appendix D.
Infant Mortality
Infant mortality rate reflects the number of deaths under one year of age for every
1,000 live births. The infant mortality rate in Newham in 2010 was 5.3 per 1,000 live
births, compared with the England average of 4.6 and the London average of 4.5.
Causes of Death (at all ages)
The main causes of death in Newham are cardiovascular disease, cancer and
respiratory disease.
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Source: Office for National Statistics, 2011
Circulatory (cardiovascular) disease
Newham has the highest cardiovascular disease (CVD) mortality rate in the
capital. The ratio of observed prevalence of coronary heart disease in Newham
(based on GP QOF disease registers in 2010/11) to estimated prevalence in 2011
(based on modelling that takes into account the age, gender and ethnic make-up
of the population) is lower than the England average at 0.35, compared with
0.5923. The ratio of observed (in 2010/11) to estimated prevalence of
hypertension (in 2011) is also lower than the England average, the ratio in
Newham is 0.38 compared with 0.44 in England. This suggests that a large
proportion of people with coronary heart disease (CHD) and hypertension in the
Newham population are not receiving appropriate management in primary care.
Emergency admission rates for CHD and stroke in Newham are significantly higher
than the national rate.
50
Source: Newham Health Profile Published by NHS England on 24th September 2013
Cancers
Newham has the 5th highest Directly Standardised mortality rate for all cancers
across London. Recently published figures show that Newham has the second
worst one-year survival rate for cancer in England. The main factors affecting one-
year survival are late presentation by the patient and delayed referral by the GP.
Source: Newham Health Profile Published by NHS England on 24th September 2013
Respiratory disease
Newham has the 6th highest mortality from Chronic Obstructive Pulmonary
Disease (COPD) in London (a standardised mortality ratio of 139 compared to a
London average of 97), which is due to higher smoking rates in some population
groups.
Tuberculosis (TB)
Newham has historically had highest TB rates in England, with rates of disease
approximately 8 times higher than the national average and 3 times higher than
the London average. Over 90% of Newham residents notified with TB during 2011
were born outside the UK, with 50% having arrived in the UK in the past 5 years.
During 2011 TB notifications for Newham residents increased by 77 cases to 381
representing an increase of 25% from the previous year and of 40% since 2006.
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5.4.2. Newham CCG Outcome Framework 2013/14
NHSE will be using the framework below as part of the CCG Balanced Score Card
to assess how well the CCG is performing compared to national averaged.
Outliers of note:
Female potential years of life lost from causes amenable to health care is
significantly higher than the England average
Male potential years of life lost from causes amenable to health care is
significantly higher than the England average but not as bad as
significantly high as for females
Under 75 mortality from cardiovascular disease is significantly worse than
England
Portion of people feeling supported to manage their condition is
significantly worse than England
Patient experience of GP services (overall experience of GP surgery) is
significantly worse than England
Patient experience of Out of Hours services is significantly worse than
England
Patient experience of inpatient care is significantly worse than England
Patient experience of outpatient services is significantly worse than
England
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Domain 1: Preventing people from dying prematurely Reporting period Current performance England average
Female potential years of life lost from causes amenable to health care 2011 2562 1844
Male potential years of life lost from causes amenable to health care 2011 2696 2325
Under 75 mortality from cardiovascular disease 2011 72.1 64.6
Under 75 mortality from respiratory disease 2011 31.6 27.4
Under 75 mortality from liver disease 2011 18.0 15.3
Under 75 mortality from cancer 2011 104.2 120.2
People with severe mental illness who have received a list of physical checks 2012/13 97.3% ?
Antenatal assessments < 13 weeks Q2 12/13 91.6% 90% national target, 86.3% England Average
Maternal smoking a delivery Q2 12/13 4.5% 12.7%
Breastfeeding prevalence at 6-8 weeks Q2 12/13 70.9% 47.4%
Domain 2: Enhancing quality of life for people living with long-term conditions Reporting period Current performance England average
Dementia diagnosis rates (prevalence – QOF data) Q4 2012 59.9% 46%
Proportion of people feeling supported to manage their condition Jan-Sept 2012 55.4% 69%
Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)
per 100,000 of population (indirectly standardised)
2011/2012 436.7 784.1
Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s per 2011/2012 246.8 309.1
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100,000 of population (indirectly standardised)
Domain 3: Helping people to recover from episodes of ill health or following injury Reporting period Current performance England average
Emergency admissions for acute conditions that should not usually require hospital
admission per 100,000 of population (indirectly standardised)
2011/12 396.5 1010.4
Emergency readmissions within 30 days of discharge from hospital 2010/2011 9.4 11.9
Patient Reported Outcomes Measures (PROMS) for elective procedures: i) Hip
Replacement, ii) Knee Replacement, iii) Groin Hernia, iv) Varicose veins
2011/2012 i) N/A ii) 0.207 iii) 0.085 iv) N/A
i) 0.411 ii) 0.299 iii) 0.087 iv) 0.094
Emergency admissions for children with lower respiratory tract infections per
100,000 of population (indirectly standardised)
2011/12 194.9 363.5
Domain 4: Ensuring that people have a positive experience of care Reporting period Current performance England average
Patient experience of GP services (overall experience of GP surgery) Jan-Sept 2012 80.2% 87.6%
Patient experience of Out of Hours services 07/2011 – 03/2012 59.5% 70.9%
Patient experience of inpatient care 2011/2012 70% 76%
Patient experience of outpatient services 2011/2012 73% 80%
Patient experience of community mental health services
Domain 5: Treating and caring for people in a safe environment and protecting them
from avoidable harm
Reporting period Current performance 2013/14 Plan
Incidence of healthcare associated infection: MRSA 10/2011 – 09/2012 2.69 0
Incidence of health care associated infection: C. difficile 04/12 – 03/13 9.7 10.4
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5.5. What our population says about their local health services
The local population has expressed its opinions about its health services through a variety of
routes. There are standardised NHS patient satisfaction surveys, there are local surveys and
other forums where the PCT and now the CCG have collected data and there is information
collected by LBN in the regular surveys it undertakes.
5.5.1. National NHS Surveys
55
These clearly indicate that the CCG and practices need to work with our population to
improve these national results.
5.5.2. Local NHS Surveys
BMG Research was commissioned in January 2011 by Newham NHS to analyse and report
upon the results from the 2010/2011 “Newham Health Debate” conducted from November
56
26th 2010 through to February 28th 2011. This is the third consecutive year in which this
programme of research has been conducted. The report presents the results of the
2010/2011 Health Debate, with comparisons made against available results from previous
years (2008 and 2009). Key variations in opinion among resident groups are highlighted.
The Newham Health Debate survey was delivered as an insert in the Newham Mag to
105,400 households across the borough. To ensure a community based approach to the
campaign, additional surveys and posters encouraging residents to complete a survey were
also distributed to all NHS health centres in the borough, public sites managed by the
London Borough of Newham including libraries, leisure centres, local service centres, the
Town Hall and to the 55 community centres across the borough.
The survey was also hosted electronically on the NHS Newham website for the duration of
the campaign, which ran from 26th November 2010 to 28th February 2011. A total of 1137
paper surveys and 350 online responses were received.
To ensure responses reflected the diverse makeup of Newham’s total population, the
campaign also incorporated a strong community engagement component. Over the period
of the campaign, a series of face to face presentations were delivered across many different
community spaces including to young people, BME groups and older people. A borough wide
Health Fair was also held to further promote the campaign’s objective to encourage
dialogue.
Results relevant to this Strategy:
How Newham NHS can help to improve the health of its residents When asked how NHS Newham can help improve the health of its residents a broad range of responses were given, the most common of which were: Promote / encourage exercise / healthy living (e.g. walking, swimming) (19%); Educate the public / promote health events / provide information e.g. health, exercise (14%); and, Promote / encourage healthy eating (12%). How Newham NHS can improve health services for its residents The most common suggestions respondents made regarding how health services in Newham could be improved were: Improve access generally (i.e. waiting times, extended hours) (24%); Employ more staff / medical staff (6%); Improve customer service (inc. better staff training) (5%); and, Information / advice / advertise on services available (5%).
More detailed responses can be found in Appendix H.
In August 2013 Newham Community Reference Group met and was asked to address 3
questions:
57
1. Would you agree that the Action Plan areas from the annual DES survey would
improve primary care or are there any other issues that we should also consider?
2. Given the range of services available how can commissioners promote use of these
as an alternative to A&E?
3. People between 20 – 29 (22.4%) are more likely to use A & E, what are your ideas on
how we might change this?
The detailed feedback can be found in Appendix I. But in general the DES Annual Feedback
Survey results were supported. In the DES survey patients identified key actions to improve
satisfaction with the surgeries was to:
• Provide more information about extended hours and other services
• Keep patients informed about progress to changes at the surgery
• Provide an alternative for on-line booking and repeat prescriptions
• Liaise more with pharmacies with regard to blood testing, repeat prescriptions and
minor ailments
• Keep patients informed about waiting times and if possibly say why they are running
late
• Text appointment reminders to all patients
5.5.3. LBN Surveys
A number of surveys are undertaken regularly by LBN. Below are key points on methodology and
results. Details can be found in Appendix J.
LBN Liveability Survey 2011
Methodology
• Face to face, household (CAPI) in August – October 2011
68% 50%
27% 9% 14% 9%
0%20%40%60%80%
58
• Random probability sampling, using sampling points (10 interviews per point)
• Targets set by total sample, CFA and ward (with +/-5% tolerance level)
• Targets by age, gender, economic status and ethnicity within ward
• Boost in regeneration areas
• 3,992 interviews completed in total. +/-1.6% confidence on an observed statistic of 50%
Results
Trust – GPs come out on top
Satisfaction with doctors and pharmacists is high
59
Since 2010 satisfaction with health services has improved
LBN Annual Residents Survey
Methodology
• 1,258 adults & 251 young people interviewed in home and on the door step using CAPI
• Fieldwork conducted from 30th October – 30th November 2012
• Random location sampling with quotas on age, gender, ethnicity, tenure & working status
Results
60
Q18. What is your opinion of...?
Newham residents are predominantly more positive about Council services than Londoners as a
whole (including health services)
61
Q60. I would like to ask you about services in this area. What is your opinion of…? Respondents
12-17 years old
5.5.4. The population’s local service development priorities
A meeting was held with local PPG members and members of Health Watch and a number of other
third sector organisations to discuss access, quality and continuity of care as these are the three
areas that have been highlighted by previous surveys of local priorities. The group prioritised the 7
outcome indicators below.
Access
1 % of Newham practice population able to speak with a GP by phone within 4 hours 5 days a week
2 % of Newham practice population able to see a doctor or nurse (as requested) within 48 hours
3 % of Newham practice population able to book an appointment 5 days in advance with a doctor of their choice
Quality
4 Proportion of people feeling supported to manage their condition (CCG Outcome Framework measure)
5 The number of practices (without a valid non- clinical quality reason) with Trigger Points 1 and 2 against the GP High Level Indicators
6 a) Increased the percentage of those who die who are on the Palliative Care Register – i.e. we will be recognising those that are likely to die in the next 12 months and have actively supported them and their family and carers through the process
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b) Increased percentage of those on Palliative Care Register who die where they wish to die
7 Increased number of referrals made by General Practices to alternative(non-NHS) support services
6. High Quality Primary Care Providers
6.1. Primary Medical Services (PMS,GMS, APMS)
As the CCG does not hold these contracts there is no formal contracting management role for the
CCG however these practices are our Members and they are our Members by virtue of holding a
GMS, PMS or APMS contract. The CCG has a role to support our Members. One of the key aims of
the CCG is to reduce any validated (real) quality variation. Also, as the CCG will be holding contracts
with these providers for Extended Primary Care Services, improvements in the core services will
increase the quality of these providers. Hence the CCG is committed to supporting practices to
transform their core services and achieve best practice in the management of their patients
particularly with respect to those with long term conditions.
Although during 12/13 there was review and re-negotiation of the PMS contract in Newham there
remains a significant discrepancy in spend per head across PMS practices. Recognising the reasons
for these contract differences, the CCG wishes to develop an environment of transparency and
support the movement over three years to standardising PMS contracts at £97.50 per patient and to
ensure that all patients have the same access to services whether they are registered with a PMS,
GMS or APMS service. At present the average spend per patient in a GMS practice is £15 less than a
PMS practice. The CCG will seek to recognise, and where necessary correct, the disparity in service
provision to patients with equal need and will work closely with NHSE on how this should be funded.
NHSE and LBN have equal interest in the capacity, capability and quality of these providers and the
CCG will work closely to ensure that the supports provided to practices are coordinated and do not
put unacceptable levels of stress on our Members.
6.2. Extended Primary Care Providers – practices, clusters, networks and federations
There will be legally enforceable contracts between the CCG as the commissioner and these
providers. The service specification will clearly define the quality and activity requirements of the
contract. Performance against these will be monitored by the contracting team and actions taken as
defined in the contract if the provider is failing to provide the agreed service in terms of quality and
or quantity see Section 9 below.
There are two possible kinds of list based providers of Extended Primary Care Services: GP Practices
or groupings of GP Practices into clusters, networks or federations. In this document clusters,
networks or federations will all be referred to as Groups of General Practices. There is much on-
63
going debate as to what is the ideal model for these groupings of practices and evidence is lacking as
to which structure works best. It is probably true that we will never have a clear evidence base for
what is “best” and “best” is likely to be different in different situation.
GP Practices themselves come in a number of forms and with great variation in size with the smallest
in Newham having 1,609 patients and the largest 16,213 with the average practice having 5,589
patients. What is clear is that the pressure on practices is ever increasing and that small practices will
have much greater difficulty providing long opening hours such as the suggested 8-8 7 days a week
even if in all other respects they are providing a very high quality service to their patients. Likewise
the Extended Primary Care Services that the CCG is intending to wish to purchase from GP Practice
or Groups of GP Practices will require specific training and expertise in the practice staff and again a
small practice will have more difficulty in meeting these prerequisites across a large number of
service specifications.
Therefore the CCG will support practices to work together to share capacity, specialist skills and
facilities to ensure all services are universally available to patients on every practice’s list. However
the CCG does not believe that there is one right way for this sharing to happen. We believe that
there are flexibilities within the Standard National Contract that will allow us to purchase all
Extended Primary Care Services from all GP Practices with some or all of these practices agreeing to
sub-contract activity to other local practices within a network of their choice so long as the CCG is
able to audit the sub-contract and assure ourselves that the sub-contractor has the necessary skills.
See Section 9.3 below for more details of how this will work.
The CCG plans to have a Quarterly Quality Review meeting with each Cluster as a cluster of
providers, we will also be supporting the development of clusters as commissioners (see Section 8
below) and we will incentivise clusters to achieve particular priority quality and activity metrics. This
will tend to support practices within clusters to sub-contract Extended Primary Care Services to
practices within their geographic cluster but this will not be a necessity if a practice is part of an
alternative network.
6.3. The support the CCG will provide to General Practices and Groups of General
Practices
The CCG has in place a Cluster Support Team that has supported the Clusters to develop a 13/14
Cluster Work Plan that includes joint working to support PMS/GMS/APMS contract requirements
such as QOF, QP and flu vaccination coverage.
The Cluster Work Plans include demand management work that is required to support the Cluster as
Commissioners. As noted in Section 8 below the CCG will work with the Clusters to develop their role
as commissioners and the Cluster Support Team will increasingly be focussed on this work but will
64
continue to facilitate Clusters in their provider roles and through practice visits will assist the
practices as providers to transform the way they provide core services as agreed by the cluster and
to develop their capacity to sub-contract to each other and other local providers. The CCG will
consider providing non-recurrent financial assistance to practices and clusters to facilitate the
adoption of new ways of working within the core contract and to develop their sub-contract
development and management skills. The CCG will work closely with NHSE and LBN to ensure that
this is not complementary to their priorities for transformation.
As noted on pages 32 and 33, NHSE has identified a range of General Practice High Level Outcome
Indicators (Appendix C) which measure how well a practice is performing compared to all other
practices in England. Being an outlier is not always a negative and the CCG considers there are 4 that
cannot be seen as negative – Diabetes Prevalence Ratio (high), Anti-depressants ADQ/Star PU (low),
Antibacterial Items/Star PU (low) and NSAIDs Ibuprofen & Naproxen % Items (high). When these are
removed from the list of practices in Newham with 5 of more outliers the CCG has 7 practices with 5
or more outliers.
A further indicator on Retinal Screening is being targeted by an extension of the present ELFT service
and we expect this to ensure that all practices are meeting the national norm. If this occurs there will
only be 4 practices with 5 or more outliers and these have a collective population of 25,645 patients
(7% of our population).
One of the aims of this strategy is to reduce the number of practice outliers against the indicators
that have no clinically valid reason for being outliers. The CCG staff will work with each practice to
decide which outliers have clinically valid explanations and to develop strategies to reduce those
without valid explanation.
More generally there are 3 key enablers for improvements in the quantity and quality of services
provided by General Practices. These are:
IT Infrastructure and capabilities;
Workforce Development; and
Estates
Each is covered in more detail in Section 6 below.
In addition the CCG will:
Provide regular and timely, cluster reports of activity and performance data:
o that use high quality validated data streams with 100% GP identifiers (no attribution of
activity to a practice without );
65
o which provide where possible national and local statistically valid comparisons (i.e. that
recognise age and sex differences and when available deprivation and ethnicity
differences in prevalences and behaviours – this is often done by comparing with CCGs
with similar ethnicity and or deprivation profiles);
o that are easy to interpret; and
o whose key messages in terms of variation between practices, clusters and CCGs is of
statistical significance.
Support regular cluster meetings to:
o discuss the above reports and agree what can be done to reduce any validated
significant negative variations in the quality of service provision
o these same reports can be used from a commissioner perspective to manage contracts
and to allow the clusters to monitor implementation of agreed new pathways or to
prioritise commissioning of new services etc.
Provide prescribing support including regular pharmacist visits to the practice and regular
practice specific reports with recommendations on areas for quality improvement and
assistance to implement changes. Also we will continue to provide Script switch to facilitate
change in practice and will work with the clusters to develop a rolling programme of work
using this resource
Provide briefings including recommendations to the Practice Council or clusters on new NICE
Guidance and the consequences for practices as service providers if these are to be
implemented
Provide support to practice to ensure they are meeting their responsibilities for both Child
and Adult Safeguarding.
Provide support to practices and the cluster to develop sub-contracting processes including
suitable legally binding contracts and contract performance management tools.
6.4. Non-General Practice extended primary care providers (including specialist
outreach services)
As with General Practices there will be legally enforceable contracts between the CCG as the
commissioner and these providers. The service specification will clearly define the quality and
activity requirements of the contract. Performance against these will be monitored by the
contracting team and actions taken as defined in the contract if the provider is failing to provide the
agreed service in terms of quality and or quantity see Section 9 below.
66
Possible providers would be:
pharmacists
opticians
the local acute
the community provider
third sector organisations
networks/federations of providers
others
The 3 key enablers (IT infrastructure and capabilities; Workforce Development and Estates) will be
relevant to these alternative providers. As stated in Section 9 of this document:
All service specifications within these contracts will include a clear statement of the staff
qualifications and equipment and facilities required to provide a service. Providers will have
to provide evidence that they meet these requirements to be able to tender and claim
against a service specification or make a case for why an alternative approach will provide an
equally good or better service to the patient.
During at least the first 3 years of this strategy the business cases for new extended primary
care services will include the training budget required to up-skill present staff. New providers
will have access to this training budget as will the present providers. During the contracting
process it will be agreed if the training budget will be held on behalf of the provider or the
provider will receive the budget and organise the necessary up-skilling. As the Newham
Education and Training Academy (see Section 6 above) develops and becomes independent
from the CCG the need for this financial support for training should be reduced as extended
primary care providers develop their capacity to up skill staff to meet new service
specification requirements without external support.
The payment structure and local tariff will be developed based on actual local cost to provide
the service and will always include a clear element for the full cost of the facilities (facilities +
soft and hard facility maintenance (FM)) and administrative support staff.
These alternative providers may therefore take full responsibility for all IT, workforce and estates
issues or these may be supported by the CCG as for General Practices. This would be negotiated at
the time of agreeing the final terms of a contract.
7. Enablers
7.1. IT infrastructure and capabilities
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Newham practices have been at the forefront of practice IT systems development and the
development of the wider IT environment. This has been led by an IT Committee which developed
an IT Commissioning Vision and Strategy for Newham 2013 – 2018 under the PCT. This committee
continues to meet and is now established as the IM&T Committee reporting to the Primary Care
Strategy Transformation Programme. The draft Terms of Reference of this Committee are attached
as Appendix K The purpose of the committee is to ensure that a coordinated approach to IM&T
strategy, commissioning and procurement is developed across the CCG and in conjunction with
relevant provider organisations with the aim of enhancing patient care via seamless integrated
and/or compatible IT systems. The Committee also has a responsibility for supporting and promoting
IM&T as an enabler for primary care development.
All Newham Practices are now on EMIS web as is the newly commissioned UCC and OOH provider.
ELFT CHN is in the process of adopting this patient record system as is the Diabetic Out Patient
Department at Barts. The CCG’s main IT priority is to continue to support all primary care and out of
hospital health service providers to effectively use fully compatible health records systems that will
allow all providers to share all relevant live records with the patient’s explicit consent. Within the life
of this strategy the intention is to ensure that this ability to share electronic records will include key
parts of our local acute provider (those who share the care of those with long term conditions),
London Ambulance Service and relevant LBN staff subject to patient consultation.
The committee has responsibility for:
1. Developing and implementing an IM&T strategy and work plan for Newham that is in
synergy with our main local providers and supports reducing health inequalities and
improving patient access
2. Managing by way of devolved responsibility the Newham CCG annual ICT budget and
assessing and agreeing IT spending priorities in-year. *The Governance and Risk Manager
shall be the NCCG budget holder for the non-core element of the Primary Care ICT budget
3. Working in partnership with other NCCG Commissioning Committees, Transformation
Programmes and other partners as required to support relevant IM&T developments and
priorities pertinent to the work of the committees
4. Supporting equity of IM&T development, infrastructure and training within primary care
5. Acting as the primary forum for discussion and communication between Newham CCG and
the NELIE project team regarding future strategic developments for the NELIE system from a
Newham perspective.
6. Supporting improved patient access by using IT to provide online access to patient care
records, appointments and repeat prescription ordering
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7. Supporting national programmes of working towards a paperless NHS
The CCG at present has a delegated IT budget from NHSE to support practice IT systems. This is
topped up with CCG funds. This model works well as this ensures no duplication of effort between
the CCG and NHSE. However this will only be the case if NHSE continues to fund the IT infrastructure
and training at an adequate level.
7.2. Workforce Development
NHS Workforce planning and development has a difficult job ensuring the right clinicians with the
right skills are available in the right quantity in the right place as there is a long lag time between
starting training and having a fully qualified clinician. As highlighted in Section 4 of this strategy it is
likely that Newham is short of all types of health care professionals. It is not entirely clear why this is
the case but this is likely to be partly because of the heavy workload and the lack of high quality
premises which means that staff do not experience working in Newham in a positive way. For
specific professional groups the issues will be different.
We are in the process of undertaking a baseline survey of all practice staff including age, plans for
retirement and present vacancies. Once this baseline is established it will be necessary to collect
further data on the issues for particular professional groups so the CCG can develop a package to
attract individuals to come to work in Newham and to stay beyond the initial contract period.
There are a number of NHS bodies that have responsibilities and resources for on-going professional
development as well as the initial training of different health cadre and the CCG is already
supporting a variety of educational activities for a range of workers and in particular employ a full
time practice nurse to provide training to practice nurses.
The CCG is supporting the development of Newham Education and Training Academy (NETA) as the
body that will understand our workforce needs and support on-going professional development with
a focus on accrediting training for Extended Primary Care Services and developing programmes to
attract and retain all health professions in Newham. NETA is established as a Working Group of the
Primary Care Strategy Transformation Programme and its draft Terms of Reference are attached as
Appendix L.
The committee has responsibility for:
1. Developing and implementing multi-professional workforce planning, education and training
strategy for Newham CCG
2. Support clinical leads and cluster leads and other primary shapers in spreading good practice
3. Running an accreditation scheme to accredit educational events, particularly small group
and practice based work to develop good educational practice
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4. Support professional appraisal
5. Oversee Friday educational events
6. To develop a portfolio of educational events and partner providers
7. To support GP VTS as the GP School changes
8. To work with practices and clusters to create a working environment that encourages
trainees (GPs, nurses and other staff groups) to stay in Newham after their training is
completed and to attract qualified professionals to Newham
9. Support the development of research capacity within Primary Care in Newham.
At present there is no formal educational budget within the CCG. Resources are found from a
number of different places. Working is on-going to see if this can be brought together in one budget
that will be managed by NETA. All new Extended Primary Care Services commissioned by the CCG
will include a staff development budget which will either be retained by NETA who will provide the
necessary training on behalf of the provider or the budget will be allocated to the provider to
undertake the necessary training. Much of NETAs work will be coordinating and facilitating access to
training funded by other NHS bodies such as the LET B. NETA will work with NHSE and LBN to ensure
that training they require is also covered by its programme of work.
Ultimately the development of the workforce is the responsibility of each provider but the CCG
believes that in collaboration with NHSE and LBN it has a significant role to play, particularly in the
next few years, to support the development of Primary Care providers that have high quality HR
policies and practice and particularly with a focus on the on-going professional development and
professional support for the development of all employees from admin to practice managers, HCAs,
practice nurses, nursing and allied professionals through to GPs.
In 5 years’ time we would expect the Primary Care providers to be purchasing this kind of workforce
development support rather than receiving it from the CCG, NHS and LBN.
7.3. Estates
NHS England is responsible for commissioning GP premises and have recently released a short
document “Commissioning GP Premises” which can be found in Appendix M. NHS England as a
national body is expected to work from national single operating models (SOM) and therefore is in
the process of developing an SOM for GP premises arrangements. A suite of documents have been
developed by Primary Care Premises Expert Advisory group to support Area Teams with decisions.
These are currently in the final stages of development and will hopefully be available from late 2013
alongside an NHSE Premises Policy. In the absence of the completion of the national SOM London
Region of NHSE has set in place a standardised interim process. This process clearly states that the
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CCG will be asked for a view as to whether it supports a proposed development at both the Project
Initiation Document and business case stages and there are some criteria that will be used until the
national prioritisation matrix is released. It is likely that the new national process will not be very
different from the interim process.
Newham is one of the largest regeneration areas in Europe and there are opportunities within this to
house new state-of-the-art healthcare facilities particularly in the Docks and Canning Town
developments and at the Olympic legacy site in Stratford.
With the growing population of Newham and the CCG vision of bringing increasing numbers of
services out of the hospital setting there is a need to ensure that the estate has the capability to
meet the increasing demand.
Aside from the scale of change, there is a risk of Newham generating a two-tier health system within
the borough. If new General Practices are to be commissioned for the new populations there will be
an increase in high quality estate in the regeneration areas while the population in the centre of
Newham continues to receive services provided in old estate. When developing and implementing
the Estates Strategy we must maintain a balance between the centre of Newham and outer areas of
regeneration.
To assist potential providers of Extended Primary Care Services to develop facilities to provide these
services the price of all Extended Primary Care Services will have a clearly identified component to
pay for the facilities (space, equipment and hard and soft FM) required to provide the service and
the CCG will work with NHSE on how this should be paid if the service uses space that is already paid
for by the GMS/PMS contract or are within other premises already owned and paid for within other
NHS contracts.
To develop a comprehensive Health Estates Strategy for Newham we will need to engage with all
health partners with estate interests across Newham, to include NHSE, Barts Health, East London
Foundation Trust, NHS Property Services, Community Health Partnerships and LBN. With a joint
working approach we can identify fit for purpose vacant estate which will assist in ensuring health
estate as a whole is effectively managed and utilised. This will also highlight where investment would
be needed and/or disposal of assets that are no longer fit for purpose.
At present there are significant inconsistencies to condition, statutory compliance, space utilisation,
functional suitability, quality and accessibility across GP Estate in Newham and there are other NHS
and Borough Estate that is not fully utilised. Our Strategy will seek the most cost effective utilisation
of all existing estate as long as this does not compromise quality and accessibility.
A 6 Facet survey was last commissioned in 2005 by Oakleaf which provided detailed analysis of all
the points above but the information is too out of date to be the basis for a detailed implementable
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Estates Strategy. Therefore the CCG will seek support from NHSE to undertake a new FACET survey
looking at the suitability of the GP Practice estate for the present population it serves and the 5-10
year suitability based on projected local population growth and likely facility requirements for
provision of an increased range of services in the community. The focus will be on ensuring that
geographic access is equally good across all of Newham so the survey will include mapping of
practice populations and populations within 5, 10 and 15 minute isochrones (a line on a map or
diagram connecting places from which it takes the same time to travel to a certain point).
When this survey is completed we will establish an Estates Working Group that will be used to
develop and implement, with our partners, a detailed Estate Strategy to prioritise estates
improvements and new developments.
When considering applications for GMS/PMS estates development
The CCG will support applications to NHSE initially for all practices that in some way “fail” the FACET
survey and then the rest but always prioritising those with a lower FACET score over higher. We will
only support significant practice estates development if the practice or practices jointly serve a
population of 8,000 patients or more or based on the catchment (isochrones to 10 minutes and
population growth in this zone) is likely to serve at least this population by 2018 and there is no
suitable health estate that does not increase the average journey time for the practice population by
more than 5 minutes.
Guiding principles when considering estates developments which will include provision of space
for Extended Primary Care Services
The CCG will:
1) Support estates developments where there is a minimum population of 20,000 within the 10
minutes isochrone.
2) Support a dispersed network able to provide similar levels of Extended Primary Care Services
across the whole of Newham with a maximum of 20 sites for extended services requiring more
than the GMS/PMS estates
3) Seek to use the most cost effective type of estate development (work is required to ascertain
what route is most cost effective – LIFT is seen as an expensive option but when all the real costs
of estate development and maintenance is included it is not clear whether NHS Property
Services estate, acute hospital, community provider or privately owned estate is the most cost
effective over the life time of the estate’s use for heath service prevision).
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8. Treating People in the Community
Implementation of this strategy will ensure the building blocks are in place to allow the provision of
high quality accessible primary medical services, extended primary care and secondary care
provided in a primary care setting. The sections below give an idea of the kind of services that we
expect to be providing outside the hospital setting by 2018. The building blocks (physical
infrastructure, provider organisations and commissioning and provider skills and expertise) will
take time to develop and the movement of services from their present setting into new provider
organisations or at least commissioned by the CCG using new contracting options will be
progressive. No big bang is planned. The CCG will encourage and support natural growth of the
types of providers we believe are needed.
Services may be provided by:
individual General Practices
Groups of General Practices
a Grouping of all General Practices in Newham
pharmacists
opticians
the local acute
the community provider
third sector organisations
networks/federations of providers
others
Appendix F: Contracting and Procurement Work Plan for 2013/14, Appendix E: ELFT Community
Health Services and Appendix N: Information provided to Newham CCG on Local Enhanced Services
(LES) in January 2013 + update for 14/15 and Appendix O: List of Outreach Services presently
contract by Newham CCG from Barts Health in addition to the 32 PMS, 26 GMS and 3 APMS
contracts constitute the present range of service being provided outside the hospital setting.
Clearly Newham already has an extensive range of services helping our population to stay out of
hospital and a number of strategies to transform the sector, in particular our Urgent Care Strategy
and our Integrated Care Strategy both of which are supported by CCG Transformation Programmes
that report to the CCG board. The Primary Care Strategy therefore supports the implementation of
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these Strategies with a focus on the Primary Care developments required to support system
transformation.
8.1. Self-care
Our Vision for Self-Care is an empowered population equipped with the knowledge and motivation
to self-care. A population with greater confidence to look after themselves: knowing when it’s safe
to self-care, when professional help is needed and where is should be sought.
Self-care includes: primal, primary, secondary and tertiary prevention; management of minor illness
and injury; and self-care following discharge from hospital.
2013-18 the CCG will support practices to become Self Care Aware practices and develop and
implement a joint Self-care Strategy with LBN Public Health. Implementation will be phased over the
5 years with the focus being on having a balanced and coordinated portfolio of self-care
interventions across the CCG and LBN.
Success of the Self-care Strategy will be monitored through improvements in a set of Outcome
Framework measures, a decrease in health inequalities and a decrease in the growth of NELs for
LTCs, A&E and UCC activity.
8.2. Primary Medical Services
Access to a full range of standard primary medical services 8am to 8 pm 7 days a week through a
combination of GP practice, Extended Hours and Out of Hours Services provision with full access to a
patient’s notes irrespective of how or where access occurs. This will include development of a range
of non-face-to-face consultations (including emails) and telephone triage of the majority of
appointment requests.
The intention is to ensure that a full range of services is available to all patients irrespective of
whether they are registered with a PMS, GMS or APMS practice. This will require close working with
NHSE on the best way to achieve this in contractual terms but will probably involve the development
of Extended Primary Care Service Specifications for the GMS practices for those additional services
that PMS practices are funded to provide. The GMS practices could provide these services
themselves or could sub-contract the extended services through other local practices.
8.3. Extended Primary Care Services
During 2013-18 we will develop business cases and seek to fund extended primary care services
that:
Enable GPs to consult hospital consultants using emails/texts/phone/advice and
guidance/Skype with or without the patient present
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Support an individual to be treated at home or in a nursing home when previously they
would have been treated in a hospital. This may include increasing rapid access to
investigations to avoid the admission. This will include provision of IVs in the community –
antibiotics and possibly chemo therapy.
Increase the palliative care services available to those who wish to die at home
Provide rapid access to a named clinician for those with complex health and social care
needs
Optimise the health and social care of people with the following long term conditions:
o diabetes (already well developed but further development of the service
specification will be required),
o CVD (AF diagnosis and warfarinisation, hypertension, heart failure and stroke,
cardiac rehab following MI)
o COPD
Optimise the health and social care of the frail elderly.
8.4. Secondary (specialist) care to be provided in a primary care setting
There are already significant on-going development in this area using both consultants and GPwSI
and other clinicians with a special interest. Appendix E Contracting and Procurement Work Plan
13/14 has a list of those provided outside the main contracts a number of which are in the process
of being re-tendered. Appendix E: ELFT Community Health Services is the full list of services provided
by CHN a number of which are provided by specialist clinicians and Appendix O: List of Outreach
Services presently contract by Newham CCG from Barts Health. These together show the range of
specialist services at present provided in the community.
There is a need to review the present services as there is some level of duplication of services
provided by the hospital and the community provider. A single pathway with the fewest possible
interfaces between providers will be commissioned for each long -term condition.
The priorities for 2013-18 will be:
Outreach of elderly care specialist services in the primary care setting including a patient’s
home and local nursing homes
Outreach of cardiology specialist services in the primary care setting including a patient’s
home and local nursing homes (this is already in place for diabetes)
Outreach of respiratory specialist services in the primary care setting including a patient’s
home and local nursing homes
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9. Development of Clusters as Commissioners
Clinical commissioning groups are established under the Health and Social Care Act 2012 (“the
2012 Act”).1 They are statutory bodies which have the function of commissioning services for the
purposes of the health service in England and are treated as NHS bodies for the purposes of the
National Health Service Act 2006 (“the 2006 Act”). The duties of clinical commissioning groups to
commission certain health services are set out in section 3 of the 2006 Act, as amended by section
13 of the 2012 Act, and the regulations made under that provision.
Clinical commissioning groups are clinically led membership organisations made up of general
practices. The members of the clinical commissioning group are responsible for determining the
governing arrangements for their organisations, which they are required to set out in a
constitution.
To be a member the organisation must hold a GMS, PMS or APMS contract with NHS England.
Paragraph 3.3.3 of the Newham CCG Constitution states:
Practice Clusters
The practice clusters will meet to review success, to learn, and to problem solve. They will
develop local shared service solutions and over time, these are anticipated to be formalised
into cluster based “contracts” with the CCG for the delivery of specific services. Cluster
meetings are an important element of the CCG governance structure as practices act as the
“powerhouse” to generate solutions to improve patient care and health outcomes. Local
intelligence is communicated to inform wider commissioning intentions within the
commissioning cycle. They collectively assess the local quality of care achievement against
CCG standards and best practice.
Since the Newham Constitution was signed by all Newham GP practices in December 2012 the
CCG has come into legal existence and much has changed. In particular the new organisational
structure has changed significantly and the constitution has been updated. 11 geographically
based clusters of GP practices of roughly equal population size have a GP representing them
on the CCG Board. In addition 8 of these clusters have identified Cluster Leads as a mechanism
to develop future leaders and to spread the CCG work load. The 11 clusters have begun to
group together and there are 7 active clusters where all practices in all 11 clusters are
represented.
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The 7 clusters are:
Cluster Population
1 Central 1 & 2 68,364 (27,019 + 41,345)
2 South 1 & 2 54,440 (32,649 + 21,791)
3 Central 3 and South 3 66,651 (43,571 + 23,080)
4 North West 1 51,072
5 North West 2 47,623
6 North East 1 30,624
7 North East 2 & 3 56,427 (29,324 + 27,103)
Clusters have now been meeting regularly for more than a year and have developed 13/14 Work
Plans and are in the process of implementing this plan. At present their role as a group of primary
care providers and as commissioners are not clearly separated and much of their work has been on
improving their performance as providers and to start to work together as a geographically based
group of providers. Section 4 above addresses the issues of developing the GP practices and others
as extended primary care providers in Newham. Appendix P provides the details of cluster practice
membership and representation.
Clusters as commissioners need to understand and be involved with all commissioning functions of
the CCG if they are, as stated in the constitution, to be the power house to generate solutions. Over
time they need to develop an understanding of and involvement with:
NHS budgeting and financial cycle including risk management
Agreeing the budget allocation methodology and how risk will be managed between
practices and between clusters
Monitoring of activity and spend against plan by contract and responding as required to
ensure the CCG and cluster live within budget
Using all the clauses of the National Standard Contract to full effect to increase the quality
and cost effectiveness of all CCG held contracts and thus reduce risk
The commissioning/contracting cycle
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o Commissioning Strategic Planning (CSP)
o Commissioning Intentions
o Scoping papers and full business cases
o Service Development and Improvement Plans (SDIPs)
o Key performance Indicators (KPIs); and
o Commissioning for Quality and Innovation (CQUINs) for the main contracts and for
GP practices as extended primary care providers
o Development of GP Practice Reimbursement schemes if this remains a useful tool
o Contract management processes
The development of the Plan on a Page ,QIPP Plan, Quality Premium, Annual Operating Plan
etc. as required by NHSE.
As the clusters develop their understanding and capacity they will increasingly be involved in the
decision making processes of the CCG. The CCG will invest in the development of the skills necessary
in both its GP member practices and the CCG support staff to allow a maximum of 7 clusters to hold
and commission with a full delegated budget by April 2015.
The CCG has established a Cluster Development Working Group that will report to the Primary Care
Strategy Transformation Programme. The Draft Terms of Reference for this group is attached as
Appendix Q. The initial work will be to review the Terms of Reference for the Clusters, Cluster Leads
Meeting and the job descriptions of the Cluster Leads and the Cluster Leads meeting Chair. These
will be taken the CCG Board for discussion, approval and thus inclusion in the Constitution. The
Working group will then develop and oversee the implementation of a Cluster development
programme to ensure that the Clusters are capable of managing a shadow budget from April 2014
and a fully delegated budget by April 2015.
The staffing support required by the clusters to support them to fulfil their approved Terms of
Reference will be assessed and agreed by the CCG Executive.
10. Procurement and contract management
10.1. Newham CCG Procurement Strategy, Policy
As noted above to keep more people out of hospital we will need to procure new services and/or
need to transform present service provision. This will require the transformation of our present local
providers so that they are capable of providing the new services and when necessary attracting new
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providers to Newham or developing new local providers to fill capacity/skills gaps, to increase choice
and when necessary to increase quality.
Newham CCGs long term Vision is to develop extraordinary levels of community cohesion, buy-in
and commitment which will unlock great health benefits for Newham by ensuring that we have a
focus on three strategic priorities: integrated care, health inequalities, and robust patient and public
engagement.
Our Procurement Strategy and Policy have been developed to support this vision and our need for
new services.
Appendix R is Newham CCG Procurement Strategy and Appendix S is the Newham CCG Procurement
Policy. It sets out the CCG’s approach to procurement and is not a procedural manual setting out in
great detail the operational process of running procurements but provides the framework in which
we will act.
The developing landscape for procurement of NHS funded healthcare services requires a consistent
but flexible approach rather than a rigid application of any particular procedure, the policy has been
written with this in mind and to ensure that the CCG’s statutory and regulatory duties and
obligations are clear and complied with.
10.2. Procurement Process and Annual Procurement Plan
The CCG has established a Contracting and Procurement Group (Draft TOR can be found in Appendix
T) which reports directly to the CCG Executive Committee and then to the Board. They will be
responsible for developing and implementing an Annual Procurement Plan.
The Contracting and Procurement Group will play a core role by ensuring that procurement activities
are planned and coordinated across the CCG, are properly authorised, follow the correct process and
paperwork is to the agreed standard. The role of the group is also to ensure that there is
documentation of the decision to go to the market and then to enter a contractual agreement with a
provider or to enter into contracts with our General Practices (a form of single tender action) or to
accept another single tender action instead of going to market.
The Impact Table in Appendix U will be completed for all investments in new services before the
route for a particular service development is agreed.
In addition, when the services are likely to be provided from local General Practices or other
organisations in which GPs have a financial interest the NHS England document: Code of Conduct:
Managing conflicts of interest where GP practices are potential providers of CCG-commissioned
services first published by the NHS Commissioning Board Authority in June 2012 and by the NHS
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Commissioning Board in October 2012 (or any document that replaces it) will be followed and the
Template in Appendix V completed.
Appendix F: Contracting and Procurement Work Plan for 13/14 is the list of small out of hospital
service contracts that were transferred to the CCG from the PCT in April 2013. There is an on-going
process to get all these contracts onto the National Standard Contract through a legally sound
procurement process. This will continue in 2014/15. The intention is this should be completed by
end of March 2015.
Appendix N: Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013
+ update for 14/15 is a list of the enhanced services that GP practices were providing in 12/13 and
shows whose responsibility these became in April 2014 and the present intention for these in 14/15.
There is an on-going process to review those that became the responsibility of the CCG and get
those that it is agreed should continue onto the National Standard Contract either through an AQP
process or a form of single tender waiver. This process will be completed by April 2014.
10.3. Use of the NHS Standard Contract
From April 2014 for all providers the CCG will use the NHS National Standard Contract including for
all services purchased from our GP practices and other extended primary care service providers.
This will include any Local Enhanced Services that the PCT held with Practices that the CCG decides
to continue with.
New services will need to be clearly specified as additional services that the CCG is purchasing above
the PMS/GMS/APMS contract a practice holds or a contract that another provider holds.
If there is significant overlap with a present service then the transformation process will require
either a Service Development and Improvement Programme (SDIP) with the current provider or
decommissioning and re-commissioning.
The new service specifications may include pathways that include increased access to investigations.
The normal contracting cycle (including issuing of 6 month commissioning intentions letters to
practices on 30th September each year), and contract levers including: KPIs, Service Development
and Improvement Plans (SDIPs), Data Improvement Plans (DIPs) and CQUINs, will be used.
Performance against these contracts will be monitored by the contracting team and actions taken as
defined in the contract if the provider is failing to provide the agreed service in terms of quality and
or quantity.
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10.4. Quality Performance Management Processes
As with all CCG contracts we will follow Newham CCG’s Approach to Commissioning for Quality 2013
– 2014 to develop the quality performance processes for these contracts.
Newham Quality Framework
The Quality Performance Management processes will be standardised by size of provider as these
should be proportionate to the value of the contract held with any particular provider. All will
include at least a quarterly quality review meeting. A system of these will be established with each
CCG Cluster as a group of GP Extended Primary Care Service providers. This will be overseen by the
CCG Quality Committee which will also establish an Amber Alert System for GP Practices as CCG
provider contractors and practices will be included in a performance quality database that the
Quality Committee is developing.
From the 13/14 NHS contract guidance: there are a number of stages to the contract management
process if there are concerns. These can be summarised as follows:
issue of contract query;
excusing notice (where relevant);
meet to discuss the contract query;
implement a remedial action plan and/ or joint investigation;
withhold funding in the event of failure to agree a remedial action plan;
issue an exception report where there is a breach in the remedial action plan
which remains un-remedied and withholding of funding;
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issue a second exception report to the boards where there is a breach of
time scales for remedy identified in the first exception report and permanently
retain withheld funding.
When GP practices will be the Extended Primary Care provider the CCG will work closely with NHS
England and LBN to support practices with performance issues before it becomes necessary to enter
the formal contract performance management process and issue a contract query.
NHS England has defined 28 GP High Level Indicators and has identified Achievement Categories for
each practice. Practices are stratified depending on the number of level 1 and level 2 triggers
associated with the Practices' achievements against each Indicator. Sometimes these data are out-
of-date or incorrect and therefore the trigger levels and achievement levels are a guide to the
achievement of a Practice, not a rule. The categories are assigned based on the achievement of the
practices compared to the London average for the standards. There are 40 standards in total,
although not every practice will have recorded data for every standard. Details on the standards can
be found on the NHS England website: www.primarycare.nhs.uk.
Higher Achieving Practices have less than four triggers in total, and have no level 2 triggers.
It is expected that only around 10-20% of practices will be in this group
Achieving Practices have between four and six triggers in total and no more than 1 level 2
trigger. It is expected that around 40-60% of London practices will be in this category
Approaching Review Practices have up to eight triggers in total, and no more than 2 level 2
triggers. These practices are not identified as having problems with achievement, but have
more than an average number of triggers. It is expected that around 10-20% of London
practices will be in this group.
Review Identified suggests that there is a need to review a Practices’ data to ensure the
recorded values are accurate. This group includes those with more than 11 triggers in total,
and all who have three or more level 2 triggers. It is expected that less than 10% of London
practices will be in this group.
The CCG will add any information on the achievements against the KPIs in the Extended Primary Care
Services contract to this to identify CCG Review Identified practices who will be offered support to
put in place strategies to reduce the number of triggers identified.
10.5. Activity and Quality Reports
Standardised activity and quality reporting using EMIS web templates and searches will be used
where the provider uses EMIS web and there is an intention for as many of our current out of
hospital service providers as possible to be on a fully read and write compatible system by 2018.
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New health service providers wishing to enter the Newham health economy will have to have such
an EMIS web compatible system in place to win a contract.
All Service specifications within these contracts will include a clear statement of the staff
qualifications and equipment and facilities required to provide a service. Providers will have to
provide evidence that they meet these requirements to be able to claim against a service
specification or make a case for why an alternative approach will provide an equally good or better
service to the patient.
During at least the first 3 years of this strategy the business cases for new extended primary care
services will include the training budget required to up-skill present staff. New providers will have
access to this training budget as will the present providers. During the contracting process it will be
agreed if the training budget will be held on behalf of the provider or the provider will receive the
budget and organise the necessary up-skilling. As the Newham Education and Training Academy (see
Section 6 above) develops and becomes independent from the CCG the need for this financial
support for training should be reduced as extended primary care providers develop their capacity to
up skill staff to meet new service specification requirements without external support.
The payment structure and local tariff will be developed based on actual local cost to provide the
service and will always include a clear element for the full cost of the facilities (facilities + soft and
hard facility maintenance (FM)) and administrative support staff.
When General Practices are the preferred route for procurement subcontracting to another
Newham General Practice or another approved provider that meets the staffing and facilities
requirements will be allowed as long as there is full access to the patient notes, physical access for
the patient will not be significantly affected, and it is clearly stated within the practice’s contract
with the CCG. Payment of the sub-contractor will be the responsibility of the list holding practice.
11. Working with our Stakeholders
11.1. Our population
During the development of this strategy Patient Participation Groups (PPGs) and local voluntary
organisations have helped to set the out-comes this strategy seeks to achieve.
The Newham CCG Communication and Engagement Strategy 2013-2014 provides details of how the
CCG plans to work with our population. Newham Clinical Commissioning Group (CCG) knows how
important patient engagement and communications is to improve and enhance local health services.
A key part of our vision for an improved and more responsive health services is to see patients at the
centre of all that we commission and do.
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The stakeholder landscape is complex and challenging in Newham but we have already established
thriving patient engagement structures including a Patient Forum, Community Reference Group and
a Health and Social Care Network. Through these structures we have engaged hundreds of people,
involving patients in developing our commissioning intentions, redesign of services and in the
tendering of new services.
During the implementation of this Strategy we will report regularly to these forums on progress. In
addition the Strategy envisages the development or modification of a number of services bringing
them out of the hospital when possible. Patients, carers, patient groups and the population in
Newham more generally will be involved in the development of these new pathways to ensure that
they are responding to our patient’s needs and recognise their ideas of quality not just those of
clinicians and managers.
11.2. Health and Well-being Board
The CCG is a full member of the Newham Health and Well-being Board (HWBB) and is fully
committed to the Health and Well-being Strategy (HWBS). Therefore the Primary Health Care
Strategy is one of the ways the CCG will implement the health service elements of the HWBS. The
HWBB will be regularly briefed on the implementation of the Primary Health Care Strategy and as
the HWBB develops new streams of work the Strategy will implement those elements that need to
occur in a primary care setting.
11.3. NHSE and LBN
NHS England and LBN will be holding contracts with many of the same providers as the CCG (the GP
Practices in particular but also with community pharmacists, opticians and others) and therefore we
need to work closely together as commissioners and in contract management.
In terms of procurement it will be important to be fully aware of each other’s procurement plans to
ensure that there is sufficient capacity in the providers to fulfil all contracts or to jointly prioritise
which contracts should use the limited resources and to develop the provider’s capacity in terms of
IT, workforce and estates. Details of the CCG strategies in these areas are covered in Section 6 of this
document. Where possible we should pool resources for IT, Workforce and Estates development.
It is proposed to ensure coordination and to share these plans the CCG Extended Primary Care
Commissioners should meet quarterly with NHSE and LBN to discuss issues they have with their GP
Practice and Groups of General Practices. This would be a pre-meet before meeting with the
providers.
To ensure that the performance of these providers is of an acceptable standard for all
commissioners it is proposed that LBN and NHSE should participate in the quarterly performance
84
management meetings with each cluster as a group of providers and that we share our soft and hard
intelligence about each provider. It is proposed that we develop a joint process to identify and
manage those GP practices and other extended primary care providers we have quality and or
performance concerns about as early as possible to avoid where possible entry into the more formal
performance management processes that would ultimately lead to removing a contract.
85
12. Key Activity and Products Time Line
GP practice
Provider
Development
IM&T NETA
development
Estates Clusters as
Commissioners
Development
Service
Development,
Procurement and
EPCS contract
management
January to
March 2014
Agree staff support
requirement and
development plan
including EPCS
investment for 14/15
Recruit as necessary
Develop contract for
EPCSs – including
reporting, payment
performance
management
processes
Develop sub-
contracting
mechanism including
payment and
performance
management process
Approve 2013-18
IM&T Strategy
Agree investment and
work plan for 2014/15
Develop and agree
SLAs with
CSU/EMIS/CEG for
14/15
BID to LETB for
support to develop
NETA
Agree staff support
requirement and
development plan
including investment
for 14/15
Recruit as necessary
FACET Survey
Establish joint
Working Group
Identify any
investment resources
available during
2014/15
Approve TOR for
Clusters and Cluster
leads meeting
Agree staff support
requirement and
development plan
including investment
for 14/15
Recruit as necessary
Agree budget setting
methodology for
2014/15
Agree risk sharing
methodology for
14/15
Agree cluster and
practice budgets for
14/15
Approve budget for
EPCS in 14/15
Develop service
specifications for all
agreed EPCS
Develop all CEG
templates and
payment process
Get all 61 practices
signed up including
identification of sub-
contract for those
not providing a
service
Develop audit
process
Approve
Procurement
Strategy, Policy and
work plan for 14/15
86
April to
September 2014
Support practices to
manage new EPCS
contract and any
subcontracts
Implement 2014/15
work plan
On-going programme
of workforce
development
2014-24 Joint Estates
Strategy
Implement Strategy
Shadow budgets in
place
Clusters monitoring
how contracts are
performing against
budget
Clusters taking action
to live within budget
Clusters developing
commissioning
intentions for 15/16
and feed into issuing
of 30th September
letters to all
providers (including
practices)
Quarterly
Commissioners pre-
meet and cluster
performance
management
meetings
Implement GP Amber
Alert process
Implement audit
process
2014-18 Joint Self
Care Strategy
October 14 to
March 2015
Work with practices
and clusters to
develop the sub-
contracts for any
new EPCS that have
been approved
Review how the EPCS
contract has worked
for practices
Continue to develop
sub-contracting
Review achievement
against IM&T Strategy
Agree investment and
work plan for 2015/16
Develop and agree
SLAs with
CSU/EMIS/CEG/others
for 15/16
Development of
proposed future
funding model
On-going
implementation of
plan
Review strategy,
identify investment
resources and
develop 15/16 work
plan
Cluster
commissioning
intentions developed
to full business cases
Review and modify if
necessary budget
setting methodology
and risk share
arrangements
Agree 15/16 cluster
budgets and QIPP
plans
Support service
developments
coming from QIPP,
Integrated Care, UUC
and Primary Care
strategies through
commissioning
intentions process
Review functioning
of all EPCS contracts
Identify investment
resources and
87
procurement route
for new/modified
EPCS in 15/16
All practices to be
signed up to new
EPCS and any other
planned
procurement route
implemented
On-going EPCS
contract
management
April to
September 2015
Second year of EPCS
contract. Further
develop the system
to manage the sub-
contract
performance
management
Implement 2015/16
work plan
NETA capacity to be
self-funding
developing. Reduced
funding from CCG.
On-going
implementation of
workforce
development plan
Implement strategy Budgets in place
Clusters monitoring
how contracts are
performing against
budget
Clusters taking action
to live within budget
Clusters developing
commissioning
intentions for 16/17
and feed into issuing
of 30th September
provider letters
On-going service
development leading
to procurement and
new contracts
On-going EPCS
contract
management
88
October 15 to
March 2016
Continuing support
to practices to sub-
contract
Review achievement
against IM&T Strategy
Agree investment and
work plan for 2016/17
Develop and agree
SLAs with
CSU/EMIS/CEG/others
for 16/17
NETA capacity to be
self-funding
developing. Reduced
funding from CCG.
On-going
implementation of
workforce
development plan
Review strategy,
identify investment
resources and
develop 16/17 work
plan
Cluster
commissioning
intentions developed
to full business cases
Review and modify if
necessary budget
setting methodology
and risk share
arrangements
Agree 16/17 cluster
budgets and QIPP
plans
On-going service
development leading
to procurement and
new contracts
On-going EPCS
contract
management
New EPCS signed
April to
September 2016
Continuing support
to practices to sub-
contract
Implement 2016/17
work plan
NETA capacity to be
self-funding
developing. Reduced
funding from CCG.
On-going
implementation of
workforce
development plan
Implement strategy Clusters monitoring
how contracts are
performing against
budget
Clusters developing
commissioning
intentions for 17/18
and feed into issuing
of 30th September
letters
On-going EPCS
contract
management
October 16 to
March 2017
Continuing support
to practices to sub-
contract
Review achievement
against IM&T Strategy
Agree investment and
work plan for 2017/18
Develop and agree
SLAs with
NETA capacity to be
self-funding
developing. Reduced
funding from CCG.
On-going
implementation of
workforce
Review strategy,
identify investment
resources and
develop 17/18 work
plan
Cluster
commissioning
intentions developed
to full business cases
Review and modify if
necessary budget
setting methodology
On-going service
development leading
to procurement and
new contracts
On-going EPCS
contract
89
CSU/EMIS/CEG/others
for 17/18
development plan and risk share
arrangements
Agree 17/18 cluster
budgets and QIPP
plans
management
New EPCS signed
April 17 to
March 2018
CCG no longer
supporting practices
as providers
Implement 2017/18
work plan
Review achievement
against IM&T Strategy
Agree investment and
work plan for 2018/19
Develop and agree
SLAs with
CSU/EMIS/CEG/others
for 18/19
CCG no longer
supporting NETA.
NETA fully funded by
other means. NETA
continues to support
practices in Newham
to develop the
necessary workforce
Implement strategy
Review strategy,
identify investment
resources and
develop 18/19 work
plan
Full commissioning
cycle
On-going service
development leading
to procurement and
new contracts
On-going EPCS
contract
management
New EPCS signed
April 18 to
March 2019
Review IM&T Strategy
and develop new
strategy for 2018-23
Implement strategy
Review strategy,
identify investment
resources and
develop 19/20 work
plan
Full commissioning
cycle.
On-going service
development leading
to procurement and
new contracts
On-going EPCS
contract
management
New EPCS signed
90
13. Investment Plan
This is in development and will only be confirmed once the Strategy is approved.
91
Appendices
Appendix A. Newham Practices
GP Code GMS/ PMS/ APMS
Practice Name List Size as of 31/3/11
Address Phone Principal GP Salaried GPs & Other Types of GPs
Partnership/ Single hander
1 F84004 PMS Market Street Health Group
11815 52 Market Street, East Ham E2 2RA
020 8548 2200 Dr Robert Waugh Dr Adekola Orimoloye Dr Gillian Hall Dr Olufemi Daramola
Dr Jane Obasi Dr Tamara Hibbert Dr Chetty (Registrar) Dr Ambrozie (Registrar)
Partnership
2 F84006 PMS Shrewbury Road Surgery
12011 The Shrewsbury Centre, Shrewsbury Road , Forest Gate, E7 8QP
020 8586 5111 Dr Sri-Ganeshan Dr Anita Bhasi Dr Girija Purushothaman Dr Navan Navaneetharaja Dr C Sunath
Dr N Kumar Dr Bapu Kunhipurayil Sathyajith Dr R Bhuvenandra (Associated Psychiatrist)
Partnership
3 F84009 PMS Stratford Village Practice
8717 50C Romford Road, Stratford, E15 4BZ
020 8534 4133 Dr Ashwin Mukand Shah Dr Sudha Shah
Dr Islam Majid Dr Shashi Prasad Dr Ruchika Khanna Dr Joyce Fernandes Dr Ahmed Hamza
Partnership
4 F84010 PMS St Bartholomew's Surgery
8647 292A Barking Road, East Ham, E6 3BA
020 8472 0669/1077
Dr Fola Ajanlekoko Dr Hasmukh Patel Dr Jonathan Ojukwu Dr Trevor Adrian Powell Dr S Chellappan
Dr Sabul Hussain
Partnership
92
5 F84014 PMS Upton Lane Medical Centre
7093 75/77 Upton Lane, Forest gate, E7 9PB
020 8471 6912 Dr Baljeet Saluja Partnership
Dr Gauri Shanker
Dr Rajendra Bishnoi
Dr Ravinder Kumar Khajuria
Dr Rowshan Begum
6 F84017 PMS Star Lane Medical Centre
12234 121 Star Lane, Canning Town, E16 4QH
020 7476 4862 Bharat Kumar Dr Bharat Patel Dr Carolyn Fang Dr Henry Edung Dr Ini Smith
Caroline Fang and Dr A Ekundayo Dr Bhavini Shantilal Lad
Partnership
7 F84022 PMS Stratford Health Centre
6104 121-123 The Grove, Stratford, E15 1EN
08443 878 019 Dr Mathew Khai Laing Chang
Dr W Naing (Permanent Locum) Dr Adetokunbo Osokoya (Salaried) Dr Mubeen Ali Dr T T Lwin (Permanent Locum) Dr M Mookerjee (Permanent Locum)
Single Hander - With Salaried
8 F84032 GMS Dr Inayatullah' Surgery
3263 34 Barking Road, East Ham, E6 3BP
020 8472 1347 Dr Inayat Inayatullah Dr I Aboh (Locum) Single Hander - With Salaried
F84032 GMS Dr Inayatullah' Surgery
154 High St South, East Ham E6 3RW
020 8472 9260 Dr Inayat Inayatullah
9 F84047 PMS Custom House Teaching & Training Medical Practice
12856 16 Freemasons Road, Custom House E16 2NA
020 7476 2255 Dr Alem Tsegaye Dr Eleanor Shore Dr Faiez Al-Shawk Dr Zuhair Zarifa
Dr Shabela Begum
Partnership
93
10 F84050 PMS Boleyn Medical Centre
9204 Ground Floor, 152 Barking Road, East Ham, E6 3BD
020 8475 8500 Dr Mohammed Khan Dr Nejat Chalabi
Dr Shani Bhaskaran Dr Imran Sheikh Dr Ali Ahmed-Shuaib Dr Abdul Nasir Khan
Partnership
11 F84052 PMS Essex Lodge 7409 94 Greengate Street, Plaistow E13 0AS
020 8472 4888 Dr Abu Khan Dr Anne Pauleau Dr Hardip Nandra Dr Ray Higgins
Dr Rupom Chatterjee Dr T Ali (Registrar) Dr A Noona (Registrar) Dr N Chung (SHO)
Partnership
12 F84053 PMS Greengate Medical Centre
7474 497 Barking Road, Plaistow, E13 8PS
020 8471 7160 Dr A Gopinathan Dr Shahab Din Kalhoro
Dr Soomro Humairah Dr Haleem Bhatti Dr Debasis Roy-Choudhury
Partnership
13 F84070 GMS Lathom Road Medical Centre
5032 2A Lathom Road, East Ham E6 2DU
020 8548 5640 Dr Reena Patel Dr Niranjan R Patel Dr Pratap Rai Dubal
Partnership
14 F84074 PMS Wordsworth Health Centre
11444 19 Wordsworth Avenue, Manor Park, E12 6SU
020 8548 5960 Dr Abdul Husain Kadhim Nasralla Dr Andrew Robert Pople Dr Jaqueline Buscombe Dr Pulickal Raghavan Sajilal
Dr Sophie Brandon Dr Lise Hertel Dr Elizabeth Ann Goodyear Dr Hussain (Registrar)
Partnership
15 F84077 GMS Dr Samuel & Dr Khan Surgery
6237 Vicarage Lane Health Centre, Stratford, E15 4ES
020 8536 2266 Dr Shahzada Khan Dr Roseline Samuel
Dr Jeyaseelan Selvarajah
Partnership
16 F84086 GMS Dr Driver & Partners
6742 Lord Lister Health Centre, 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7513 Dr Cathy Friel Dr Leung Ting Lam Kin Teng Dr Nowshir Driver
Dr Radhika Acharya
Partnership
94
17 F84088 GMS Plashet Road Medical Centre
3935 152 Plashet Road, Plaistow, E13 0QT
020 8472 0473 Dr Akram Qureshi Dr Thebo
Dr Zulfiqar Ali Thebo
Partnership
18 F84089 PMS Manor Park
Medical Centre
1,636 688 Romford Road, Manor Park, E12 5AJ
020 8478 5355 Dr S Dhariwal Dr. Karam Vir Kapur
Single Hander
19 F84091 GMS The Surgery - Dr C P Raina & Dr A Arshad
4486 57 Gladstone Avenue, Manor Park, E12 6NR
020 8471 4764 Dr Arslan Arshad Dr Chander Raina
Partnership
20 F84092 PMS Glen Road Medical Centre
5463 1 - 9 Glen Road, Plaistow, E13 8RU
020 7476 3434 Dr Venkateswara Madipalli Rao Dr Sudha Madipalli
Dr Shazia Jabeen Ali
Partnership
21 F84093 PMS Tollgate Medical Centre
15451 220 Tollgate Road, Beckton, E6 5JS
020 7473 9399 Dr Chander Kiran Sikka Dr David Erickson Watt Dr Gillian Lesley Goose Dr Kenneth James Cochran Dr Laura Ruhi Scott Dr Patricia T Rijsenburg Dr Stuart Sutton Dr Vasos Vrachimi Dr S Sutton
Dr Saila Chatakondu Dr M Sahemey
Partnership
22 F84097 PMS Claremont Clinic
8746 459-463 Romford Road, Forest Gate, E7 8AB
02085220222/0333
Dr Atmaji Manam Dr Ciaran Seamus Joyce Dr Hiran De Silva Dr Kiran Sinha Dr Sarah A Wood
Dr Annie Mireille Mackela Dr Hiran Gavin A Desilva
Partnership
23 F84111 GMS Abbey Road Medical Practice
7297 28A Abbey Road, Stratford E15 3LT
020 8534 2515 Dr Subir Sen Dr Kenny Uzoka
Dr Helen Yates Dr Gurvinder Singh Saluja Dr Sobhoshini Kugaprassad Dr Yser Abdul-Amir (Registrar)
Partnership
95
24 F84121 PMS E12 Health Centre
10224 The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7440 Dr Bhupinder Kohli
Dr Clare Thormod Dr Nusrat Jabeen Dr Kavita Gaur Dr Shanaz Husain Dr Preeti Bakshi Dr Abrar Hussain Dr Suparna Chakrabarti
Single Hander - With Salaried
25 F84124 PMS The Project Surgery
4274 10 Lettsom Walk, Plaistow E13 0LN
020 8472 5234 Dr Farzana Hussain Dr Sairah Ali
Dr Anya Leiva (GPR ST3) Dr Alexis Ahmedi (GPR ST1)
Partnership
26 F84631 PMS Dr Abiola Lord Lister Health Centre
3577 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7550 Dr Philip Abiola Dr Fatai Salau Single Hander - With Salaried Dr Kareem Magoub
(F2 Doctors)
27 F84641 PMS Birchdale Road Medical Centre
3771 2 Birchdale Road, Forest Gate, E7 8AR
020 8472 1600 Dr B K Sinha Dr A Dawoodjee Dr B Mandavia Dr A sheth
Single Hander - With Salaried
28 F84642 GMS Sinha Medical Teaching Practice
5846 1A Lucas Avenue, Plaistow, E13 0QP
020 8471 7239 Dr Anurag Sinha Dr B K Sinha
Partnership
29 F84654 PMS Roding Medical Practice
997 Romford Road, Manor Park, E12 5JR
020 8478 2711 Dr Chandra Prakash Dr Manjaya Shetty
Dr Edward Adeyemi Abimbola
Single Hander
2,171
30 F84657 PMS Cumberland Medical Centre
2,756 179 Cumberland Road, Plaistow, E13 8LS
020 7476 1029 Dr Ramnik Gonsai Single Hander
31 F84658 PMS Sangam Surgery
4371 31A Snowshill Road, Manor Park, E12 6BE
020 8911 8378 Dr Prakash Chandra Dr Chandra Gowda
Dr Sheetal Shah Partnership
32 F84660 GMS Dr C M Patel 2,186 2 Jephson Road, Forest Gate, E7 8LZ
020 8470 6429 Dr Chandrakant Patel Single Hander
96
33 F84661 PMS West Ham Medical Centre
2458 401 Corporation Street, Stratford, E15 3DJ
020 8555 0428 Dr Prasanta Bhowmik
Dr Jagadis Chandra Ray Dr A Asalkhou
Single Hander - With Salaried
34 F84666 GMS The Ruiz Medical Practice
2368 2 St. Luke's Square, Tarling Road, E16 1HT
020 7366 6440 Dr Encarnacion Ruiz-Gutierrez
Dr Joarder
35 F84669 PMS Newham Medical Centre
4634 576 Green Street, Plaistow, E13 9DA
0844 499 6992 Dr A U Ahmed
Edward Abimbola Dr Hadeel Hameed-Nasrat
Single Hander - With Salaried
36 F84670 GMS Westbury Road Medical Practice
4768 45 Westbury Road, Forest Gate, E7 8BU
020 8472 4123 Dr Alauddin Ahmed Dr Kabir Mahmud Dr Saidur Rahman
Partnership
37 F84671 GMS Katherine Road Medical Centre
1,809 511 Katherine Road, Forest Gate, E7 8DR
020 8472 7029 Dr Govind Bapna Single Hander
38 F84672 GMS Leytonstone Road Medical Centre
2,291 157 Leytonstone Road, Stratford, E15 1LH
020 8534 1026 Dr Abdul Qadri Single Hander
39 F84673 GMS Esk Road Medical Centre
2,650 12 Esk Road, Plaistow, E13 8LJ
020 7474 9002 Dr Rama Venugopal Single Hander
40 F84677 PMS East End Medical Centre
5011 61 Plashet Road, Plaistow, E13 0QA
020 8470 8186 Dr Ila Basu Dr Suniti Kumar Basu
Dr H Hameed-Nasrat Dr S Savla Dr Ashwinkumar Balabhadra
Partnership
41 F84679 GMS The Upper Road Medical Centre
3646 50 Upper Road, Plaistow, E13 0DH
020 8552 2129 Dr Abul Zakaria Single Hander
42 F84681 PMS Balaam Street Practice
6343 113 Balaam Street, Plaistow, E13 8AR
020 8472 1238 Dr Barry Sullman Dr Ghassan Al-Mudallal
Dr Jeevarani Shantini Navaratnam
Partnership
97
43 F84699 GMS Stratford Medical Centre
2,190 60 Leytonstone Road, Stratford, E15 1SQ
020 8534 1533 Dr A Q Brohi Single Hander
44 F84700 GMS DMC Health Care 1
1778 10 Vicarage Lane, Stratford, E15 4ES
020 8536 2277 Dr Ravi Gupta Dr Jane Muir-Taylor Partnership
45 F84706 GMS Dr S K Swedan 3,063 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7530 Dr S K Swedan Dr Fernandes
Partnership
46 F84707 PSU PSU - St. Luke's Health Centre
2478 2 St. Luke's Square, Tarling Road, E16 1HT
020 7366 6430 Dr Clare Davison
Dr D Malik Dr A Seresht Dr A Ali Dr Atul Kumar
PCT Practice
47 F84708 PMS Dr Lwin's Surgery
4,273 343 Prince Regent Lane, Custom House, E16 3JL
020 7511 2980 Dr Tun Lwin Dr Win Naing Single Hander - With Salaried
48 F84713 GMS East Ham Medical Centre
3623 1 Clements Road, East Ham, E6 2DS
020 8472 0603 Dr Prabha Shukla Dr Samuel Mandavilli
Partnership
49 F84717 PMS Royal Docks Medical Practice
9141 21 East Ham Manor Way, Beckton, E6 5NA
020 7511 4466 Dr Jim Lawrie
Dr S Nandakumar Dr Aung Kyi MYINT Dr Alpa Patel Dr Amjad Izmeth Dr Ophelia Cheng (salaried) Dr D Satananyana
Single Hander - With Salaried
98
50 F84724 PMS Woodgrange Medical Practice
11268 40 Woodgrange Road, Forest Gate, E7 0QH
0208 221 3100 Dr Sanjay Parmar Dr Yusuf Patel
Dr Muhammad Waqqas Naqvi Dr Tathagata Sadhu Dr Amber Ghaznavi Dr Anusha Durairatnam Dr Jagdeep Kaur Burdi Dr Bhavini Lad Dr Thana Shanamugadan Dr Timothy Carroll Dr Shoaib Patel Christina Linvell
Partnership
51 F84727 GMS Dr Qureshi's Surgery
2181 17 Stopford Road, Plaistow, E13 0LY
020 8552 6858 Dr S Qureshi Single Hander
52 F84729 PMS Dr N Bhadra's Surgery
4,072 778 Romford Road, Manor Park, E12 5JG
020 8478 7005 Dr Nirode Badra Dr Arun Sarkar Single Hander
53 F84730 GMS Dr P Knight 3945 10 Vicarage Lane, Stratford, E15 4HG
0208 536 2244 Dr Pakalapati Knight Dr Praveen Vangala Single Hander
54 F84734 GMS Boleyn Road Practice (Dr S Rafiq)
9461 162 Boleyn Road, Forest Gate, E7 9QJ
020 8503 5656 Dr Saeeda Sultana Rafiq Single Hander
55 F84735 GMS The Azad Practice
8168 1st floor Boleyn Medical Centre, 152 Barking Road, East Ham, E6 3BD
020 8475 8550 Dr Ajith Azad Dr Sajith Azad Dr Mohamed Faiz
Partnership
56 F84736 PSU PSU - Church Road
3812 The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7475 Dr Clare Davison Dr Anwar Syed Dr Lise Hertel Dr Rajesh Chadda Dr Nazia Ali
PCT Practice
99
57 F84739 PMS Dr Kugapala's Practice
5,278 243 High Street North, Manor Park, E12 6SJ
020 8470 2500 Dr Girija Kugapala Single hander
58 F84740 APMS Newham Transitional Primary Care Team
4,620 The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7460 Dr Duncan Trathen APMS
59 F84741 GMS Dr Krishnamurthy Practice
2,978 East Ham Memorial Hospital, Shrewsbury Road, Forest Gate, E7 8QR
020 8586 6555 Dr Thyagaraja Krishnamurthy
Single Hander
60 F84742 GMS The Summit Practice
2312 Old East Ham Memorial Hosp, Shrewsbury Road, Forest Gate, E7 8QR
020 8552 2299 Dr Aminu Yesufu Chukwuma Amayo
Partnership
61 F84749 PSU PSU - Carpenter's Road Medical Practice
1934 17 Doran Walk, Stratford, E15 2LJ
020 8534 8057 Dr Clare Davison Dr Rajesh Chadda Dr Dinesh Malik
PCT Practice
62 Y00225 APMS Vicarage lane Transitional Team
4041 10 Vicarage Lane, Stratford, E15 4ES
0208 536 2255 Dr E Kensah Dr Daniela Dinca
APMS
100
63 Y02823 APMS DMC Vicarage Lane
2842 10 Vicarage Lane, Stratford, E15 4ES
020 8536 2080
Dr Daniel Yevu Dr Chukwuma Amayo Dr G Ademiluyi Dr Iman Ismail Dr Oluwalogbon Rasheed Dr Eloho Veronica Odu Dr Jonathan W Turner
APMS
64 Y02928 APMS The Practice Albert Road
5171 76 Albert Road, North Woolwich, E16 2DY
020 8104 2222 Dr S Choudhury Dr Nazir Dr Mukherjee
APMS
65 Y02928 APMS The Practice Britannia Village
5171 12a Wesley Avenue, North Woolwich, E16 2RZ
020 3040 0100 Dr Mousumi Mukherjee (Clinical Lead)
Dr Shahidur Choudhury Dr Neeru Garg
APMS
101
Appendix B. PMS Contracts KPI Performance Summary
Ref. No
KPI Description Annual
Measure Performance
Band Payment
Band Weighting
QOF/CE
G/ Practice A B C A B C
1 Access 41 1.01 GP
appointments
The contractor must make available to patients a number of hours of GP appointments per week per 1000 patients. These clinical appointments can be delivered by either a GP, Registrar or suitably qualified nurse or approved HCA* (these hours can include telephone consultations verifiable as appointments on the clinical system and home visits) *HCA must meet an agreed training standard as agreed between the PCT and provider.
≥16.8 ≥14 <12 100% 66% 33%
19 1.02 Consultation
times A minimum of either one early session (starting at or before 8:30am) and one late session (last appointment at or after 6:20pm) or two early starts or two late finishes (excludes any Extended Hours provision).
Achieved Not
Achieved
100% 0% 0%
6 1.03 Practice
Opening Hours
The practice is open 8.00 am to 6.30 pm Monday to Friday (excluding Bank Holidays). That is, patients can access the premises, and have face to face access with a receptionist for a minimum of 52.5 hours per week.
≥52.5 ≥45 <45 100% 66% 33%
16
102
2 Training & Prescribing 3
2.01 Repeat Prescribing Procedue
Practices must have a robust written and communicated procedure in place to deal with repeat prescribing requests ensuring quality, safety and timely issue of repeat prescriptions in 28-day intervals (see the 'Repeat Prescribing Policy' on the Medicines and Prescribing intranet site.)
≥70% 60-
69.9% <60% 100% 66% 33%
3
3
Service Delivery 41
3.01 Cervical
Screening
Percentage of eligible patients aged from 25 to 64 whose notes record that a cervical smear has been performed in the last five years (as a % using National Screening data).
≥80% 73-
79.9% <73% 100% 66% 33%
3
3.02 Breast
Screening
Percentage of eligible patients screened. National target - 70% of eligible women screened / average for Newham Qtr 2 20010/11 - 64.8%
≥70% 60-
69.9% <60% 100% 66% 33%
2
3.03
Childhood immunisations and preschool
boosters
Percentage of patients aged below 5 whose notes record that all childhood immunisation, childhood pneumococcal and preschool boosters have been given in accordance with the Green Book (National target - 90%). Source Cover Data.
≥92% ≥90% <90% 100% 66% 33%
3
3.04 Influenza
immunisations
Percentage of patients aged over 65 whose notes record that the influenza immunisation has been given (as a%)
≥73% ≥70% <70% 100% 66% 33%
2
103
3.05 Influenza
immunisations
Percentage of patients within 'at risk' clinical groups whose notes record that influenza immunisation has been given ( as a %)
≥65% 55-
64.9%%
<55% 100% 66% 33%
2
3.06 CHD Maximise the %age of CHD patients with normal blood pressure (150/90)
≥75% ≥71% <71% 100% 66% 33%
3
3.07 Maximise the %age of CHD patients with cholesterol of 5mmol/l or less
≥75% ≥71% <71% 100% 66% 33%
3
3.08 At least 90% of CHD register has a smoking status recorded.
≥95% ≥90% <90% 100% 66% 33%
3
3.09
At least 90% of smokers on the CHD register have be offered advice and/or referral for smoking cessation.
≥90% ≥75% <75% 100% 66% 33%
3
3.10
Obesity The % of patients on either of the following disease registers, Diabetes, CHD and Hypertension, or new patients aged 25 & over, whose BMI has been recorded in the last 15 months ≥70% ≥60% <60%
100% 66% 33%
3
3.11
The % of new patients aged 25 & ove,r or patients on either of the CHD or Hypertension registers with a BMI > 30 checked for diabetes using fasting glucose testing ≥70% ≥60% <60%
100% 66% 33%
3
3.12
Diabetes Practices should achieve the standard for management of diabetic patients, with the aim of achieving 70% of diabetic patients with HbA1c of 8 or less.
≥75% ≥70% <70% 100% 66% 33%
3
3.13
Practices should achieve the standard for management of diabetic patients, with the aim of achieving 50% of diabetic patients with HbA1c of 7.5 or less.
≥52% ≥50% <50% 100% 66% 33%
3
104
3.14
Hypertension Practices should achieve the standard for management of hypertensive patients, with the aim of achieving 75% of patients with a normal blood pressure(150/90).
≥75% ≥70% <70% 100% 66% 33%
3
3.15
Infant feeding Using the CEG Child Health Surveillance template used at the 6-8 week check, practices should record infant feeding status (i.e. breastfed or artificial feeding), as % of total CHS 6-8 week checks.
98% ≥90% <90% 100% 66% 33%
2
4 Practice Specific 15
4.1
Objective 1: Local
The practice develops a proposal for a service which includes the rationale, which the service is for, how the target group will be identified and the outcomes sought. Where possible an evidence base will be provided to support the benefits along with a proposed means of measurement. A proposed price per patient along with proposed levels of uptake expected and associated expense for provision of the service with a reasonable margin
100% 66% 33%
4.2
Objective 2: Mild to moderate depression
All patients on the mild to moderate depression register will be offered treatment in line with NICE guidance (medication/CBT) and be assessed using an appropriate tool on a minimum of a quarterly basis
100 ≥90 <90 100% 66% 33%
4.3 Objective 3: ECG service
100% 66% 33%
4.4 Objective 4; Spirometry
100% 66% 33%
4.5 Objective 5: Urgent care
100% 66% 33% The provider will not be penalised for failure to deliver on a KPI if they can provide evidence to the PCT that they have made every endeavour to achieve the target. This includes but is not limited to, the application of best practice or gold standards, taking the advice of peers and the PCT (and or its advisers).
105
Appendix C. General Practice High Level Indicators
106
Appendix D. Public Health Outcome Framework Indication
Health Improvement – England and Newham (coloured)
Negatives of Note:
High number LBW babies Excess weight in 10-11 year olds
107
High percentage inactive adults High percentage recorded diabetes Low percentage for breast, cervical and retinal screening High percentage of people with low satisfaction/ low worthwhile and low happiness scores High percentage with high anxiety scores High number of injuries from falls 65-79 years old
Health protection – England and Newham (coloured)
Negatives of Note: High level of Chlamydia diagnosis High % presenting with HIV at late stage Extremely high TB incidence compared to England Low childhood imms coverage
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Health Care and Premature Mortality - England and Newham (coloured)
Negatives of Note:
High mortality rate from preventable causes High mortality rate CVD High preventable mortality rate CVD High mortality rate liver disease (not high for preventable liver disease) High mortality rate respiratory disease
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Appendix E. ELFT Community Health Service Specifications
Adults Services 1. Adult Speech and Language Therapy Service
2. Cardiac Rehabilitation
3. Continence Service
4. Continuing Care And Respite Care (In-patient Wards)
5. Continuing Care Liaison Team
6. Day Hospital (for people over 60) and Falls Prevention
7. Diabetes Specialist Nursing Service
8. Diabetic Retinal Screening Service
9. Extended Primary Care Team and Virtual Wards
10. Foot Health Service
11. Health Advocacy Service
12. Learning Disability Service
13. Community Neuro Service
14. Patient Appliances
15. Phlebotomy
16. Physiotherapy
17. Pulmonary Rehabilitation
18. Sexual Health and Reproductive Health
19. Tissue Viability Service
20. New Entrant Screening
21. Urgent Care Centre
22. Wheelchair Service
Children’s and Young People’s Services 1. Audiology
2. Child Development Centre
3. Child Health Admin Team
4. Children’s Therapy Service
5. Community Children’s Nursing Service
6. Community Paediatrics
7. Development Advisory Clinic
8. Health Visiting
9. Immunisation Team
10. Looked After Children
11. Safeguarding Children’s Team
12. School Nursing
13. Sickle Cell & Thalassemia Service
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Appendix F. Contracting and Procurement Work Plan for 2013/14
CONTRACTS EXPECTED TO REQUIRE TENDERING (WELC POD - NEWHAM): 2013/14 As at October 2013
Recommended Route to Market: ST = Single Tender, CT = Competitive Tender, AQP = Any Qualified Provider, TQ = Three Quotes, T = Terminate Contract
Contract Management Details Contract Particulars
SERVICE TYPE Service Provider
name
Service Commencement Date
Contract end date
Contract Term
Contract Notice period
Rec. Route
to Market
Notes
PRACTICE BASED SERVICE
Cardiology Dr Sen 01/01/2013 30/09/2013 9 Months tbc T Retendering of activities to identify new providers for contracts which
are coming to an end.
Competitive tender is recommended for services that will
continue in a similar form but where the CCG has an obligation to re-tender for these services at the
Contract end dates.
Termination is recommended for contracts which will be retendered as part of QIPP initiatives (i.e. the new services may be significantly
different from the current services) or where a change in the contract
or provider has been recommended.
PRACTICE BASED SERVICE
Chronic Pain* iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Dermatology Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Diabetes* Dr Bhasi 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Headache Clinic*
Dr Nasralla 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Minor Surgery Dr Gopinathan 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
MSK (op) Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Ophthalmology Service
Dr Madipalli 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Physiotherapy Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Physiotherapy iHealth 01/01/2013 30/09/2013 9 Months tbc T
111
PRACTICE BASED SERVICE
Rheumatology iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Trauma & Orthopaedics
iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Chronic Pain n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Diabetes n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Headache Clinic n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Specialist Pallative Care
St Joseph's Hospice
01/04/2013 31/03/2014 1 YEAR tbc CT
PRACTICE BASED SERVICE
Termination of Pregnancy Service (TOPS)
BPAS 01/04/2013 31/03/2014 1 YEAR tbc CT
QIPP/REFERRALS MANAGEMENT
Gynaecology n/a 01/11/2013 n/a tbc tbc CT
Projects to move services from acute setting into the community.
These CTs are important for the
delivery of QIPP savings.
Cardiology, Dermatology and Minor Surgery are currently provided as practice based
services.
QIPP/REFERRALS MANAGEMENT
MSK n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Cardiology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
ENT n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Ophthalmology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Dermatology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Minor Surgery n/a 01/11/2013 n/a tbc tbc CT
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DIAGNOSTIC SERVICES
MRI In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
Retendering of the LDS contract which is coming to an end. NB. Contract Values are for
Newham CCG 2012/13; because of local referral patterns the type of
services procured using AQP tender and Terminated
(redistributed to other contracted providers) will vary for other NEL
CCGs.
DIAGNOSTIC SERVICES
ULTRASOUND In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
BP+ECG In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
ENDOSCOPY In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
Audiology In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
DEXA Scan In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months T
DIAGNOSTIC SERVICES
X RAY In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months T
URGENT CARE CENTRE
Urgent Care Centre
n/a unknown 30/11/2013 unknown notice served
CT CT already underway; UCC
Contract expected to complete contract mobilisation by Nov2013
MENTAL HEALTH Mental Health Service User Involvement
Hestia Housing & Support
01/04/2013 31/03/2014 1 YEAR 12
months CT Retender because contract is
ending. CT is recommended as the services
cannot easily be redistributed between other contracted
providers.
MENTAL HEALTH Mental health advocacy
Mind in Tower Hamlets & Newham
01/04/2013 31/03/2014 1 YEAR 12
months CT
MENTAL HEALTH
RAID (Rapid Assessment Interface and Discharge) Pilot
Pilot Project 01/07/2013 n/a 9
MONTHS none ST
New Enhanced Psychiatric Liaison Service Pilot
COMMUNITY SERVICES
End of Life Care tbc tbc 31/03/2014 tbc tbc CT Retendering of existing services
NB status of 13/14 contract is to be confirmed
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COMMUNITY SERVICES
Cancer Support CYANA 01/01/2013 31/03/2014 9
MONTHS tbc ST
Contract has expired, single tender waiver to be signed to allow for
extension covering the period until a competitive tender can be
completed
COMMUNITY SERVICES
Diabetes Education
n/a 01/12/2013 n/a tbc tbc TQ Project to enhance Diabetes
services
COMMUNITY SERVICES
GP Cover for Nursing Homes
GPs (6-7 in Newham)
01/04/2014 n/a 1 year n/a CT Previous a LES. Services will be reviewed and then re-procured
based on the outcome.
CONTINING HEALTHCARE
Domiciliary Care
tbc 01/12/2013 tbc tbc tbc AQP
AQP started and process being agreed with DH. Procurement managed by Supply 2 Health with support from Shaju Jose.
PATIENT AND PUBLIC ENGAGEMENT
Forum for Health and Wellbeing
01/01/2013 31/03/2013 9
MONTHS n/a ST
Contract has expired, single tender waiver to be signed to allow for extension covering the period until a competitive tender can be completed
114
Appendix G. Activity Trends
115
116
117
118
0
1000
2000
3000
4000
5000
6000
7000
April May June July August September October November December January February March
Atte
nd
an
ce
s
First OP Attendances
Gp First Attendances 11/12
Gp First Attendances 12/13
GP First Attendances 13/14
C2C First 11/12
C2C First 12/13
C2C First 13/14
Any Other 11/12
Any Other 12/13
Any Other 13/14
119
120
121
122
123
124
Appendix H. Details from Report on Newham Health Debate 2010/11
6.1.20 Improve the health services generally More GP's, more District Nurses and also improve Newham General Hospital.
The single important thing is to help people in Newham is to improve the health service.
Keep trying to improve.
To be more helpful in A.E. I attended this department on 26th November 2010 and felt I was a trouble to them, they then sent me to Whipps Cross and that was "very good".
In my point of view more staff may need for an Accident and Emergency Department and Maternity (labour) ward.
A good GP.
It is important that the NHS service has more responsibility and provides good treatment for all of the Newham residents.
Give accessible and reliable health service.
Better NHS service.
We need good NHS doctors. We need to get rid of GPs like Doctor Ahmed in Westbury Terrace in Forest Gate.
Improve NHS to be equal to private health care.
We need more hospitals and more ambulance services.
By improving the cleaning standards of the hospitals and making medication cheaper to buy.
Build more hospitals and more GPs. 6.1.21 Provide quicker / set up appointments at earlier date Parents could reach a doctor instantly and quickly.
Improve GP appointments as it is very hard to get an appointment, all you get is an answering machine.
Waiting time for hospital appointment is too long.
Speed of consultations and treatment.
Fast appointment
We need more change in the GP appointments system.
Make it possible to book a doctor's appointment when you need one.
Able to get an appointment within four weeks of contacting them.
Reduce A&E waiting times.
Make it possible to get a GP appointment within a week. Newham Health Debate: 2010/2011 58 The staff at the hospital should improve the long waiting times.
Waiting time for appointments is too long. My husband has been waiting for 14 months for his catheter problem to be sorted out.
Foster relationships between doctors and patients, so that it is not just about treatment. Also, quicker treatment of people when there is something wrong with them. I have had health issues for nearly a year, which could have been sorted in 6 months if the waiting list was not so long! 6.1.22 Put facilities in local parks By have aerobic sessions in local parks available for the local residents and encourage the youth as well as the old to come along every morning.
Make parks more accessible to families e.g. more toilets, sitting down areas and play areas.
Improve local parks, install more fitness machines
Put basic gym equipment in parks.
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6.1.23 Improve customer service in health service Make staff respectful as if they are doing you a favour.
Better access to GPs i.e. clear information from them and less condescension from General Practitioners.
Offer a friendly service so people are not reluctant to visit G.P.
Treat people as equals, especially the mentally ill.
Be more respect of patient’s needs.
We need more qualified staff that care and are polite. Also, more rights for patients. 6.1.24 Improve access to services (i.e. waiting time, opening times) Make it easy to get an appointment with the doctor as well as with the hospital.
To be able to see a doctor in less than a week. I made an appointment on the 9th and the date they gave me was to see the GP was the 21st.
Easier access to doctors and not G.P.
Open market street health centre, so that I can access a G.P without having to take time off work.
Good GP's needed and surgeries should be open longer with good doctors giving appointments.
Improve response times e.g. physiotherapy, scans and consultant appointments, this following an accidental fall on 28/08/10. The response times for serious injury have not been responsive to the patient’s needs.
I am studying in Newham and would like to be able to use the facilities here.
Easy access to drop in centres.
Make appointment easy access.
Get rid of the GPs that have low availability of appointments and get more Doctor Practices like DMC.
The walk in centre is difficult to access. Reduce the queues when people visit the hospital.
Keep the chemists open during Thursday and Saturday afternoons.
Access to GPs opening times and closing times should be 8.00am - 8.00pm (Monday - Sunday).
Employ more staff and improve the training, so that the waiting time will be reduced.
Able to see the GP Whenever possible. See the one who is most familiar with your history.
Reduce waiting times.
Longer opening times for GP and chemists.
Better access for appointments at GP surgeries.
GP to be opened on Saturday, as its quite difficult for people who work to get a day off to see a doctor.
Make seeing a doctor easier. The surgery appointment system is useless; usually you can't get an appointment for days. Thus, have to book in as an emergency patient.
In Newham we should introduce a 24 hour pharmacy service as it would be very helpful. The pharmacy we have now closes early, so if someone becomes ill and is in desperate need for medicine they are unable to buy as the shop is closed. If we had a 24 hour pharmacy people could easily get medicine at any time and this would make a massive improvement with everyone's general health.
Build more hospitals.
Hospital access for children from first born to 18 years old.
Reduce waiting time for GPs and hospital appointments.
Improve access to General Practice; the lack of access at convenient times for people who work is a scandal. This would also take pressure off other sources of primary care e.g. the urgent care centre.
Good access to health services when required
Improve access to GPs
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More walk-in facilities (e.g. sexual health clinics for over 25's) More surgeries and better opening hours i.e. weekends 6.1.25 Encourage people to improve communication / listen Talk and listen to them as communication is so important, yet I feel there is a lack as listening is becoming less common.
Supervise GPs and tell them to take an interest in patients and not the time.
Listen.
Take time to listen and don't rush us in case we have forgotten something.
Listen and give more time.
To listen to the people's concerns.
6.2 Improving health services 6.2.1 Improve access generally (i.e. waiting times, hours) Reduce waiting times.
Less waiting times in A & E Newham. Do not book in 20 patients at 9.30am for clinics and then doctors do not turn up until 11.00am and then to be told why the delay, so if you have another appointment you do not miss it (this happens time after time). Cut down staff at clinics that spend their day walking about with a file or paper in their hands and just chatting amongst themselves.
Reduce waiting time to see a GP and reduce waiting time to see someone in a Walk-In-Clinic.
Cut waiting times.
Easier accessibility to GPs.
As a Newham resident, I do not use Newham based health facilities because of the poorer health outcomes. The Primary Care Trust (PCT) and Newham University Hospital should improve their reputation by raising their standards and raising the health standards of residents in line with those from more affluent areas.
Less waiting time in Accident and Emergency Department.
Making sure appointments are not cancelled at hospitals.
Dentists are too expensive and we wait too long for appointments.
When I had the flu I was very weak. I called the doctor and the receptionist said to call the next day as all the appointments were booked. The thing I didn't like was that they never gave me any medicine and just gave me paracetamol. I tried all the cold remedies but they never worked.
Improve waiting time for appointments at my GP.
Calling up for appointments should be improved, it should be improved to provide more appointments. There should be more confidentiality with the receptionist, as I think some details should only be discussed with your doctor.
It is hard to get an appointment with the dentist even when my children need to see the dentist.
Reduce waiting times and educate people.
I cannot get an appointment straightaway.
Provide more GP's and more flexible opening times.
Improve A&E waiting times to a minimum and not 24 hours or 36 hours in some cases.
The waiting time in Newham hospital is too long, so I go to King George Hospital to get seen to quicker.
I am always contacting the dentist to make an appointment but all I get is the voicemail.
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More service for GPs and an out of hours service.
Make more GP's available during the weekend. The GP should try to help when one has a cold and not only to be sent home with paracetamol. Organise more fitness events for families to promote healthy lifestyle.
To see a GP in seven days or less because it seems it is taking longer to see a GP.
Instant appointments for mediation and consultation.
Doctor's surgeries should open on Saturdays or late evening once a week.
Improve the way the public have access to their GPs and other doctors as well as hospital services.
Opening times of surgeries.
Better cleanliness and improve parking for A&E at night as I am a single disabled person.
Services to be more readily accessible in times of emergencies, without a lot of waiting time.
Improve customer services and waiting time in hospitals.
I think we can do a lot to improve health services in hospitals and G.Ps.
Open services on Saturdays and two hours on Sundays. Have advice centres about health within your surgery and don't ignore patients when they are talking about their health.
Better time keeping in hospitals. For example, if the appointment time is 10.00am then make sure the doctor, nurse or technician are there on time.
Quicker blood test results.
To make appointments quicker.
Keep to your time at the A&E and blood testing.
To get an appointment with your GP as soon as you need it. To make home visits for those unable to visit the doctor i.e. the elderly. Also to provide information on health care for those people in the community.
Reduce waiting time to see a consultant.
Personally, I had a few problems to get appointments to see the G.P (serious cases). Maybe provide more research about local surgeries and local G.P's. It is a good way to improve services or change some aspects.
We need more doctors and nurses to cut some of the waiting times in hospitals.
The A&E waiting time is very long. When people arrive they need to see somebody. The waiting time has to be improved. Also, improve time to see specialists in hospitals and waiting time for ultrasound and MRI CT scan.
Cut down on waiting time.
Reduce waiting time in hospital and GP surgeries. Ensure correct medication is given to patients.
Maintaining appointment times.
Improve access to GP surgeries.
G.P appointment days and times of availability.
Reduce waiting times with GP's and hospitals.
Make health services seamless. I had a baby 16 months ago and had to take him to the Vicarage Lane Clinic to have him weighed and take him to the doctor's to be measured, a waste of my time
128
and the GP's resources. Make the services and times more flexible as it is difficult to get appointments when you work.
G.P's should stick to the appointment times and not make us wait.
GP's should allow more than 5 minutes per patient as they can accurately know how much time each patient requires. We need G.P's and doctors to address the patients as soon as possible. The long waiting list makes patients depressed.
As soon as possible make an appointment.
To be able to see the GP more quickly.
The response times, especially physiotherapy.
Maintain the positive attitude that is currently in people being able to contact their GP. Maintain health checks and discussions between nurses and the general public.
Make access to GP's better as at the moment as it is not always possible to get through to a GP when you call. The advance booking is not always helpful.
Increase efficiently by investing in improved management framework (e.g. better computerised systems etc)
GP surgery waiting time be curtailed, same day access to GP.
In emergency wards is needed so that the staff actually realise that it is an emergency. I was with one of my friends in an emergency and it took us three hours for someone to see me.
Improve waiting time at the health centre and hospital.
Telephone response to GP's surgery quicker than at present. Access to A&E quicker if needed after surgery hours.
Improve waiting times at hospital.
Easier access to GP if needed after my own GP is contacted after normal surgery hours.
Quicker appointment.
The doctor's surgery needs more information and advice. Doctor's should care more about patients.
More time available for working parents to see their GP when required.
Receptionists need to be improved. Doctor‟s appointments are very bad.
I like to have quicker appointments, dentist has a long waiting list and also elderly people should have eye tests once a year.
Shorter time for appointments.
Improve waiting time at hospitals and also improve the appointment process at GP surgeries as you have to wait too long.
Waiting time.
Improve waiting time in hospital. We need more GPs in the area.
Improve appointments at GP surgery.
Reduce the waiting time as I was waiting less than three weeks to see a doctor and waiting less time at hospital. I went to hospital with a broken wrist and waited four hours before I was even looked at.
Try to extend longer hours during the week and weekend for medical services for people who are at work all day.
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Make it easier to see your own doctor. I had appendicitis and I couldn't see him so in the end I saw another doctor and at that point I was in agony and scared. I am 75 and I live alone. I rarely go to the doctors unless they send me an appointment.
Reduce waiting time hospitals.
More flexibility to GP appointments for full time employed residents.
Ensure emergency appointments at the GP are available for children. There is never an appointment available the same or next day and it is always for the following week that is not good enough!
Don't make hospital appointments from 9:00 am when the doctors and some nursing staff don't get there till 10:00 am. The local blood test clinic on Appleby Road used to have one person taking blood from 7:30 am - 4:00 pm now we have two people taking blood from 7:30 am - 11:00 am, but some people cannot get there at that time. It hasn't improved the service as we are there a lot longer waiting to be seen to. Reduce hospital waiting lists.
Less waiting time.
Less waiting times for appointments and doctors.
People have to wait too long at A&E and at their doctor's surgery.
To have shorter queues and more doctors to be there.
According to my knowledge the GPs are treating the symptoms, but they should treat the cause of the illness, they probably could prevent the most dangerous diseases.
Better hygiene and friendly staff.
By making doctors to be available during the weekend.
GP, hospital and more access for emergency appointments at GPs.
Easier access to GP because when you phone you either cannot get through or all the appointments are booked and you have to call another day.
Make the staff work more efficiently because half of the time in hospitals they are always chatting and don't seem to be working, yet there are people queuing up. Most of the time it's irrelevant chatting.
Better A&E waiting time and services.
Continue to make accessible by extending time/days-for GP's, clinics etc. Continue to make accessible by extending time/days for GPs and clinics.
GP waiting time needs to be improved.
Make appointments quicker.
Easier access to GPs for people that go to work i.e. late nights and Saturday surgeries. Quicker appointments after referral to hospital.
Cut waiting times and referrals.
Make appointments at the GP easier to make and not have to wait two weeks to see the doctor.
Better access to GP as it takes too long to wait for an appointment.
Improve hospitals waiting times.
Make it easier to get a doctor‟s appointment (two weeks waiting).
It takes too long to get an appointment to see a GP, why can't they make it easier?
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Reduce waiting time for appointments.
Reduce waiting time.
Open more hours.
Better access to GP.
Appointment and waiting times.
Cut down on waiting time for access to GP and hospital appointments.
Flexible appointments for working people. Cleaner rooms.
Waiting times.
Reduce waiting time in hospitals.
Easier access to GPs.
Reduce waiting times.
Waiting time for hospital appointments take too long. Supply transport for patients going there and back.
Improve waiting times.
Improve waiting times both in hospital and GP settings as the waiting time in Newham Hospital is far too long.
Improve waiting time GP surgeries.
In Newham Hospital, the A&E Department waiting times to see the nurses take long to see even if you are in a serious condition. Have a time slot to see patients with health conditions, emergency or accidents.
To improve appointment times e.g. to be seen sooner.
Reduce A&E waiting times.
Increase GP surgeries working hours from 8.00am to 8.00pm.
Reduce waiting time of GP surgeries.
It takes too long to wait for appointments.
We need shorter waiting lists, quicker appointments (less than 2 months). This is because too many cancellations are made by services due to lack of care/not friendly towards patients.
Make sure that when we have an appointment (at a certain time), then we get served at the right time, as we wait far too long to get served.
Easier to access GP'S.
Have weekend opening for GP's and blood taking centres.
Stop hospital waiting.
Improve waiting times at the GP'S surgery and have more time with GP's.
Improve waiting times in GP surgeries.
Improve appointment times.
Shorter waiting times for outpatient appointment
Shorter waiting list for outpatient appointments.
Improve waiting times in hospitals.
Improve hospital waiting times.
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Advertise more health campaigns such as blood testing, sugar level testing, Cholera tests and many more. Allow patients to access the health centre to check on their health.
The GP should employ more people to answer the phones at peak times. Ensure all GP surgeries have internet appointments/repeat prescriptions.
Improve the surgery waiting times. Allow, 15 minutes with the doctor, as most people need this time without feeling rushed.
Make it accessible to make an appointment with your preferred GP when you really need him/her. Make hospital referral appointments quicker than the normal 2-3 months.
I still find it almost impossible to see my GP. It has to be 'an emergency' to get a quick appointment. Its first come first served and I can never get them on the phone. I work full time and have to drop everything for a non urgent consultation, it's so frustrating.
Quick access to specialist doctors, as needed e.g... Children to be seen by a pediatrician rather than only by GP's.
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Appendix I. August 2013 Community Reference Group – Feedback Notes
1) Improving primary care The wider issues
Reality is we are under doctored in Newham, so we would struggle to meet demand even if we can make services accessible. CCG can’t recruit doctors because of conflict of interest but can work with NHS England.
Blockages to GP access are concentrated at certain times rather than evenly across the week, and we may actually have more capacity than appears at first site, but not at the times we are offering it. Are there ways of addressing this e.g. by working with national bodies to remove the requirement for offering appointments within 48 hours, or by offering people an option for more flexibility if they agree to wait longer?
Confidence in joined-up nature of care in community.
Appointments Walk-ins get better than booking via making appointment.
Wordsworth Practice – have call back / phone triage (much better).
Do people get given alternatives to GP appointments?
Online booking stopped in some GPs.
Automated booking system.
Telephone access is a problem but more resources needed in the system.
Internet bookings – what proportion of the population would / could use it? It is currently a cumbersome system, with no message about what’s happening or how the queue’s progressing (this may be linked to the PFI agreement).
We need to consider how to make patients understand cost of DNAs (name and shame), DNAs at appointments is 10-11%.
Answer phone for small hours of the night, even if it’s not reasonable or financially viable to have a human receptionist at that time.
different phone systems in doctor’s surgeries. Can we research to identify the best practice and then stream-line, perhaps by using the cluster system and / or working with NHS England commissioners.
Education and information Information about what alternatives there are to A&E e.g. Urgent Care ‘get people going to
the right place’: paper leaflets, Newham Mag, radio debates, press stories, Ads, Facebook.
Churn – population turnover – can we do anything to ensure people moving into the borough know about the local NHS culture.
Customer service and experience Receptionists: customer service training, triaging – not clear about training / right to do this.
Text reminders: great, well under way (for people with mobile phones).
Blood tests Could these be done at GP surgeries, would this save money and can CCG investigate?
Can CCG reduce duplication of tests by GPs and in hospital?
2) How can commissioners promote use of the range of
services in the community as an alternative to A&E? Information and education
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Information leaflets about minor ailment services available at Pharmacy.
Make sure all the different communities in Newham understand the NHS system.
Information to employers in Newham about alternative services to A&E.
Prioritise information and communication for maximum impact.
Vital information gets hidden in all the other leaflets.
Media and communications – get the message out about what services are appropriate for what.
Link with Darren as Healthwatch Newham and Migrants Right Network.
Commissioning decisions Commissioners need to go with the best and competent providers.
Ambulances being used unnecessarily – it’s usually older people with ambulance crews being unwilling to risk waiting for a doctor. There was an experiment in Kent and in Newham, we can already provide, for example, the Rapid Response Team. We also have new facilities for ambulance crews to consultant with GPs for urgent advice. We would need research to know if this is cost effective.
Ambulance – send out nursing care than taking into hospital.
3) Ideas for reducing emergency admissions for people aged 20-29 Story behind the data
Why and when are they going?
Need the real story behind the data – more information about this group of patients (who are they, what is their background, what are they going to A&E for etc.).
How can we find out about why so many young people attend A&E – can we work with Schools, use University research teams, build a better website to find out who they are?
Work related – 29 year olds usually under pressure to be back at work – GP practices lots of waiting
time for appointments so this might be why this group go to A&E.
Employers might also think it’s more serious if the employee goes to A&E.
Often it just might be a one off visit so it’s much easier to just go to A&E.
Information about alternatives to A&E Need more practices like Vicarage Lane Surgery in the borough.
Does this age group know about Vicarage Lane Surgery – we should ask them if they use / prefer this type of service.
Check numbers of people aged 20-29 using Vicarage Lane.
More use of minor aliment scheme to free up capacity.
Ideas for promoting alternatives to A&E Texting information and new technology.
Those not registered with a GP – know about need to register.
Target education to your audience.
More information available e.g. – use prescriptions to give messages.
Encourage self-care.
Life skills classes in secondary schools to education about use of A&E.
Healthwatch also wants to engage young people so we can work together – use the Young Mayor.
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Appendix J. LBN Survey Results
Newham Annual Resident’s Survey 2012
Content:
• Methodology
• Sample profile
• Areas of personal concern
• Local area
• Community cohesion
• The Council and service delivery
• Civic engagement
• Immigration
• Housing
• Olympics 2012
• Young people’s survey
Methodology:
• LBN is dedicated to hearing its residents’ views on the council & the borough as a place to live
• It has undertaken an annual survey of residents since 1991, which aims to:
• Find out residents’ personal concerns in relation to crime, health & other social issues
• Rate residents’ perceived image of the council
• Measure residents’ satisfaction with local services
• Gauge opinion on other important issues such as community cohesion & anti-social behaviour
• The results are used to help monitor the council’s & its partner agencies’ performance, as well as to
inform service planning & the assessment of council priorities
• The findings are compared with those of Londoners generally, using the annual Survey of Londoners
which contains the same ‘core’ questions. The Survey of Londoners was carried out using the same
methodology in October/November 2012.
Results Summary: Areas for Improvement
• Fewer residents regard street robbery and intimidating behaviour as something that bothers them
• Satisfaction with the local area continues to rise since 2010
• Satisfaction with the Council has increased significantly since 2011
• Residents are also significantly more likely to feel that LB Newham provides value for money and
would be more likely to speak highly of the Council since 2011
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• Satisfaction with most Council services has increased since 2011, especially parking services, refuse
collection, the housing benefit service, and the Council Tax benefit service
• Users of Council services are more likely to be positive about the service
• There is increased awareness of the name of the Mayor of Newham since 2011, and fewer say they
do not know about what the Mayor is doing for Newham
Results Summary: Areas for Consideration
• Crime and litter are bigger concerns for Newham residents than Londoners generally, and these are
increasing as concerns
• Crime is increasing as a concern
• A low level of crime, clean streets and job prospects are priorities for Newham residents
• Far fewer residents feel they can influence decisions affecting their local area, especially in Royal
Docks and East Ham
• Fewer residents feel informed about various aspects of the Council, including how well they are
performing
• There has been an increase in the proportion who find it difficult to get through to the Council on
the phone
• Satisfaction with the Council Tax collection service has decreased since 2011 and is far lower than
found across London as a whole
• Fewer residents feel immigration is good for Newham than in 2011
• There has been a reduction in residents believing there will be long term benefits from the Olympics
since 2011
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Appendix K. Draft Terms of Reference Information Management and Technology and Working Group
NHS Newham Clinical Commissioning Group Information Management and Technology Working Group
Terms of Reference
(As Adopted on ● ● 2013) 1) Introduction
The IM&T Commissioning Committee is established in accordance with Newham Clinical Commissioning Group’s constitution, standing orders and scheme of delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the clinical commissioning group’s constitution and standing orders
2) Membership
The committee shall comprise the following members:
Core Committee (voting) members 1) The NCCG Clinical Lead with responsibility for IT Commissioning, who shall be Chair 2) NCCG Head of Performance and Information, who shall be Deputy Chair 3) NCCG Governance and Risk Manager 4) NCCG Primary Care Development Lead 5) NCCG Localities Lead 6) NCCG Integrated Care Programme Lead 7) NCCG Finance team representative
Attending (non-voting members)
8) NELCSU Newham ICT Lead (or nominated representative) 9) NELCSU NELIE Project team Lead (or nominated representative) 10) Barts Health NHS Trust ICT Lead (or nominated representative) 11) East London Foundation Trust ICT Lead (or nominated representative) 12) London Borough of Newham ICT Lead (or nominated representative) 13) A minimum of two clinical or managerial representatives from Newham Primary Care GP
Practices
These shall be the permanent members of the committee. Other Clinical Leads, CCG officers, members of NELCSU, Clinical Effectiveness Group (CEG), Emis and other relevant officers or provider representatives may attend by invitation and according to the agenda.
3) Secretary
The Head of Governance and Engagement will nominate a deputy to provide secretarial support to the committee. The secretary will be responsible for supporting the Chair and Deputy Chair in planning agendas, distributing papers in advance of the meeting, taking minutes and following up meetings with a summary of actions. They will also be responsible for advising the committee on terms of reference and operating procedures in accordance with best practice, the provisions of the constitution and external regulations. .
4) Quorum The quorum sufficient for conduct of business will be four members at least two of whom should be voting members and one of whom shall be the Chair or Deputy Chair.
5) Frequency and notice of meetings
The meetings shall be held monthly on a schedule to be agreed by the Chair in consultation with the Secretary. The schedule of meetings shall be agreed for the financial year and to fit
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with other key committees or groups to whom the Committee reports and/or has a close working relationship.
Special meetings can be called outside of the schedule by the Chair and Deputy Chair and with at least 48 hours’ notice.
6) Remit and responsibilities of the committee
The purpose of the committee is to ensure that a coordinated approach to IT strategy, commissioning and procurement is developed across the CCG and in conjunction with relevant provider organisations with the aim of enhancing patient care via seamless integrated and/or compatible IT systems. The group also has a responsibility for supporting and promoting IT as an enabler for primary care development.
The committee has responsibility for:
1) Developing and implementing an IM&T strategy and work plan for Newham that is in synergy with our main local providers and supports reducing health inequalities and improving patient access
2) Managing by way of devolved responsibility the Newham CCG annual ICT budget and assessing and agreeing IT spending priorities in-year. *The Governance and Risk Manager shall be the NCCG budget holder for the non-core element of the Primary Care ICT budget
3) Working in partnership with other NCCG Commissioning Committees, Transformation Programmes and other partners as required to support relevant IM&T developments and priorities pertinent to the work of the committees
4) Supporting equity of IM&T development, infrastructure and training within primary care 5) Acting as the primary forum for discussion and communication between Newham CCG
and the NELIE project team regarding future strategic developments for the NELIE system from a Newham perspective.
6) Supporting improved patient access by using IT to provide online access to patient care records, appointments and repeat prescription ordering
7) Supporting national programmes of working towards a paperless NHS 7) Reporting Relationship
The Committee reports to the Primary Care Transformation Programme. It will provide a monthly written report summarising actions taken and recommendations made by the Committee. The Committee will also make available these reports to the Executive Committee via the Primary Care Transformation Programme. The committee will review these reporting arrangements every six months to ensure that they remain in line with wider CCG objectives and governance arrangements.
8) Policy, best practice and conduct of meetings The Committee will ensure that papers are provided 4 working days in advance of meetings and that minutes and follow up actions are available within 3 working days after the meeting. The Committee shall act in accordance with the principles of good governance as set out in the CCG’s constitution and behave in accordance with the Staff Charter as agreed in July 2013. The Committee shall develop an annual work plan that will be updated as required.
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Appendix L. Draft Terms of Reference Newham Education and Training Academy Board Draft 1
NETA Background
NETA is the educational arm of Newham CCG. It is an umbrella group bringing together all primary care educational stakeholders to ensure a co-ordinated multi-professional strategy is developed and implemented.
There are 8 key work streams in NTEA
1. Developing and implementing multi-professional workforce planning, education and training strategy for Newham CCG
2. Support clinical leads and cluster leads and other primary shapers in spreading good practice 3. Running an accreditation scheme to accredit educational events, particularly small group and
practice based work to develop good educational practice 4. Support professional appraisal 5. Oversee Friday educational events 6. To develop a portfolio of educational events and partner providers 7. To support GP VTS as the GP School changes
8. To work with practices and clusters to create a working environment that encourages trainees (GPs, nurses and other staff groups) to stay in Newham after their training is completed and to attract qualified professionals to Newham.
Role of Board
Responsibility for developing an effective educational strategy covering all professional groups within Newham CCG.
Responsible for ensuring strategy is implemented
Responsible for monitoring and tracking strategy
Supervision of the work of the NETA core group
Membership
Chair, CCG Education and training lead
Vice Chair
LETB primary care forum reps, CCG educational support manager, CCG nurse education lead, practice management rep, VTS programme director, Appraisal lead, Primary care strategy lead,
Quorum
One third of the membership
Frequency of meetings
The Board will meet 3 times per year . Extraordinary meetings may be called by the chair or CCG support manager
Notice of meetings
A yearly calendar of meetings will be produced to allow members to plan their time effectively. Agendas and papers will be circulated 1 weeks before a meeting.
Reporting responsibilities
The NETA board will report to ( The Primary Care Strategy Committee / the CCG board?)
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Authority
We need to agree if there will be an education and training budget (including staffing costs) managed by this Working group.
( to be completed by XXXX)
Sub committee
The NETA core group is a sub-committee of the Board and will meet every 1-2 months as required to take operational responsibility for strategy implementation and will comprise of the CCG Education Lead ( Chair) , Primary care forum reps, CCG support manager and nurse educational lead.
The core group will be responsible to the NETA board.
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Appendix M. NHS England – Commissioning GP Premises – October 2013 Group
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143
144
145
146
147
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Appendix N. Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013 + update for 14/15
Primary Care Trusts (PCT) will cease to exist from the 31st March 2013. Under the terms of the Health and Social Care Act (HSCA) 2012, the responsibility of these agreements will transfer to the following organisations from the 1st April 2013:
o The Clinical Commissioning Groups (CCG) o The Local Authorities (LA) o The National Commissioning Board (NCB)
The extension letter you received from the PCT today will mean that the new organisations have instructed the PCT to extend the service from 1st April 2013 to 31st March 2014 (with a 6 month review). The new organisations will therefore be legally responsible for the operation and payment of invoices from 1st April 2013 onwards.
Below is a table showing the various services GP practices and pharmacies have agreed to provide in Newham in 2012/13. This table will explain who the new responsible organisation will be for each service and whether this service has been extended by the PCT for 2013/14. For services not extended by the PCT via this communication, the new organisations will be in contact with you in due course.
Note: DES and NES agreements included here for information purposes. These agreements are the responsibility of the NCB from 1st April 2013.
No. Name of Service
Who is the new receiver
organisation from 1st April
2013?
Was the service
operational in 2012/13
within PCT area?
Has the 2013/14
extension been
completed by the PCT via
this extension letter?
Who will communicate
2013/14 intensions to the provider?
2014/15 CCG update
Local Enhanced Services (LES)
1 Anticoagulation LES with community pharmacists
CCG YES YES PCT - Done To continue
2 Chlamydia screening LES LA YES NO LA NA
3 Contraceptive Implants LES LA YES NO LA NA
4 Diabetes LES CCG YES NO CCG
To continue with further
developments
5 Direct Cataract Referral Scheme LES with opticians
CCG YES YES PCT - Done To continue
6 Directly Observed Treatment
Of TB Scheme with community pharmacists
CCG YES YES PCT - Done To continue
7 IUCD LES LA YES NO LA NA
8 Management of Problem Drug Use (Shared Care) LES
LA YES NO LA NA
9 Minor Ailments Service LES with local pharmacists
CCG??? YES YES PCT - Done To continue
10 Needle Exchange LES LA YES NO LA NA
11 NHS Health Check LES LA YES NO LA NA
12 Palliative Care Services LES CCG NO NO CCG ?
13 Sexual Health LES LA YES NO LA NA
14 SMI-DEPOT LES CCG YES YES PCT - Done To continue
15 Smoking Cessation LES LA YES NO LA NA
16 Supervised Consumption LES LA YES NO LA NA
Directed Enhanced Services (DES)
17 Alcohol DES NCB YES NO NCB NA
18 Childhood Immunisations
DES NCB YES NO NCB NA
19 Extended Hours DES NCB YES NO NCB NA
20 FLU DES NCB YES NO NCB NA
21 Minor Surgery DES NCB YES NO NCB NA
22 Patient Participation DES NCB YES NO NCB NA
23 Violent Patients DES NCB YES NO NCB NA
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Appendix O. List of Outreach Services presently contracted by Newham CCG from Barts Health
Not available at this time.
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Appendix P. Cluster Member Practices, Representatives, and Leads
Cluster meeting takes place 1st Thursday of every other month @1pm, Market Street Health Centre.
Cluster Lead: Rotational Chair as no nominations
Cluster meeting takes place 4rth Tuesday of every month @1:00 pm WKH.
Cluster Lead: Dr Barry Sullman & Dr Stuart Sutton
Code Central 3 & South 3 F84052 Essex Lodge (Dr Higgins)
F84681 Balaam Street (Dr Al-Mudallal)
F84679 Upper Road Medical Centre (Dr Zakaria) F84727 Dr S.Qureshi's Practice (Dr Qureshi)
F84734 Boleyn Road Practice ( Dr Rafiq)
F84641 Birchdale Road Medical ( Dr BK Sinha)
F84642 Sinha Medical Centre & Teaching Practice (Dr AK Sinha)
F84032 Barking Road Medical Practice (Dr Inayatullah)
Y02928 The Practice - Albert Road (Dr Mukherjee)
F84093 Tollgate Health Centre (Dr Watt)
F84700 DMC Health Care 1 (Dr Jane Muir Taylor)
Cluster meeting takes place 4th Thursday of every month @1pm, Room F54, Vicarage Lane Health Centre
Cluster Lead: Dr Prasanta Bhowmik
Code North West 1 Y02823 DMC Vicarage Lane (Dr Jane Muir Taylor)
F84699 Stratford Medical (Dr Brohi)
Y00225 Vicarage Transitional Team (Dr Kensah)
F84009 Stratford Village Surgery (Dr Shah)
F84077 Dr Samuel & Dr Khan's Practice
F84730 Dr PCL Knight's Practice
F84661 West Ham Medical Practice (Dr Bhowmik)
F84111 Abbey Road Medical Practice (Dr Yates)
F84022 Stratford Health Centre (Dr Chang)
F84672 Leytonstone Medical Practice (Dr A Qadri)
Code Central 1&2 F84050 Boleyn Medical Centre ( Dr Chalabi)
F84735 The Azad Practice (Dr Azad)
F84750 The Project Surgery (Dr Jones)
F84669 Newham Medical Centre (Dr Ahmed)
F84010 St Bartholomew Surgery (Barking Road, Dr Patel)
F84004 Market Street (Dr Waugh)
F84053 Greengate Medical Practice (Dr Kalhoro)
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Cluster meeting takes place 2nd Thursday of every month @1pm, Claremont Clinic
Cluster Lead: Mohammad Naqvi
Code North West 2 F84706 Lord Lister Health Centre (Dr Swedan)
F84086 Lord Lister Health Centre (Dr Driver)
F84631 Lord Lister Health Centre (Dr Abiola)
F84097 Claremont Clinic (Dr Wood)
F84742 The Summit Practice (Dr Yesufu)
F84724 Woodgrange Medical Practice (Dr Y Patel)
F84736 Church Road PSU (Dr Davison)
F84707 St Luke's Health Centre (Dr Davison)
F84749 Carpenters Lane (Dr Davison)
Cluster meeting takes place 3rd Monday of every month @7pm, East Ham Care Centre
Cluster Lead: Dr Saidur Rahman
Code North East 1 F84658 Dr Chandra
F84671 Katherine Road (Dr Bapna)
F84660 Dr CM Patel
F84088 Plashet Road (Dr Umrani)
F84670 Westbury Road (Dr A.Ahmed)
F84091 Dr Raina Surgery
F84654 Roding Medical Centre (Dr Shetty)
F84713 East Ham Medical Centre (Dr Mandavilli)
F84729 Dr Bhadra
Cluster meeting takes place 3rd Wednesday of every month @1pm, Wordsworth Health Centre
Cluster Lead: Dr Nusrat Jabeen & Dr Bapu Sathyajith
Code North East 2 & 3 F84121 E12 Health Centre (Dr Kohli)
F84089 Manor Park (Dr Dhariwal)
F84739 Dr Kugapala
F84014 Upton Lane (Dr Shanker)
F84006 The Shrewsbury (Dr Sri-Ganeshan)
F84074 Wordsworth (Dr Nasralla)
F84741 Dr Krishnamurthy
F84070 Dr Dubal
F84740 Newham Transitional Team (Dr Duncan Trathen)
Cluster meeting takes place 3rd Thursday of every month @1pm, Star Lane
Cluster Lead: Dr Jim Lawrie
Code South 1&2 F84708 Dr Lwin
F84047 Custom House Surgery (Dr Zarifa)
F84666 Dr Ruiz
F84677 East End Medical (Dr Basu)
F84657 Cumberland Medical Centre (Dr Gonsai)
F84092 Glen Road Medical Centre (Dr Rao)
F84673 Esk Road (Dr Venugopal)
F84717 Royal Docks Medical Centre (Dr Lawrie)
F84017 Star Lane Medical Centre (Dr Patel)
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Appendix Q. Draft Terms of Reference for Cluster Development Working Group
Background/Context
The Cluster Development Working Group is established in line with the agreed governance structure of the
Primary Care Transformation Programme
These Terms of Reference (ToR) set out the role, responsibilities, membership and reporting arrangements
of the working group.
Role and Function
Responsibilities
Develop a work plan for the development of clusters
Oversee the implementation of the plan
To develop the Reimbursement Scheme for 14/15 and ensure this is embedded in the yearly commissioning intention cycle
Ensure that clusters are engaged in the development of QIPP especially those relevant to primary care
Ensure the development of reports/reporting formats for all data to be used at cluster and practice level
To ensure that practice indicative budget statements are developed and rolled out to clusters
Develop an accountability framework for clusters
Ensure that QIPP are represented in cluster plans for 2014/15
Develop a yearly planning template to incorporate the cluster priorities for the year 2014/15
Develop a process where practices are identified for high intensity support
General
Membership and Accountabilities
Membership of the Cluster Development Working Group will include the following roles outline below
however additional members will be co-opted when required
Core Membership:
CCG Deputy Director of Delivery
CCG Clinical Cluster Leads chair
CCG Localities Manager
CCG Primary Care
CCG Programme Director-Primary care Strategy
CCG Senior commissioning manager
CCG Finance Manager
CSU Senior Manager
Accountabilities
The Cluster Development working group reports to the Primary Care Transformation Programme
The TOR and work plan of the cluster development working group are subject to the approval of the Primary Care Transformation Programme
Convenor/Chair
The Cluster Development working group will be chaired by the cluster lead chair
Secretary
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The administrative support for the Cluster Development working group will be delegated to practice
facilitators who provide the administrative function for clusters.
Frequency & Quorum of Meetings
Schedule to meet monthly.
Quorum:
Work Plan
The Cluster Development working group will develop a work plan that represent the delivery of its
responsibility outline in 2. This plan will be reviewed monthly at meetings and progress summarised for the
Primary Care Transformation Programme.
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Appendix R. Newham CCG Procurement Strategy
When making a decision about which contracting/procurement route we will use for developing and
procuring a particular service the CCG will take into account 4 key principles:
Quality
Access
Integration; and
Value for money
To enable Newham CCG to demonstrate compliance with the principles of good procurement
practice we will also ensure adherence to the following:
Transparency
Proportionality
Non-discrimination; and
Equality of treatment
Quality
The first consideration will always be the quality of service - all service development/procurement
decisions will consider the impact of the contracting/procurement choice on the likely quality of all
services that will be impacted by the choice made.
For instance: if an increase in quality can be achieved, but how it is likely to be provided using a
particular procurement route is likely to have a negative impact on the quality of another service,
this must be included in the procurement decision making process. During the process of deciding
on the procurement route the CCG will undertake analysis of this wider impact and this will be
included in the criteria for evaluation if a competitive process is used. The highest total quality
option for all services will get the highest score. We will also use a concept of “good enough” quality,
rather than driving for absolute quality improvements, to allow us to consider all service
development procurement options that will be acceptable under this criteria.
These considerations may well lead the CCG to choose to purchase a new service from a local
provider rather than developing the market and encouraging providers from outside the
geographical area because reducing the services provided by our main provider(s) may reduce the
viability of that provider or at least negatively impact on their ability to provide other services.
Access
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The second most important driver for our decisions with respect to service specification and
therefore the appropriate procurement route for a service is the likely impact a service specification
will have on access to the service. Quality overrides access up to some point but if the decreased
access means that our population will use the service less than the optimum amount then the
increase in quality ceases to be more important than access.
As a general rule the more complex and acute a service the further people will travel for it. The
evidence is that for prevention services/activities individuals and their families and carers are not
willing to travel far – access/the right choice – needs to be as easy as possible. The impact of difficult
access on use of services increases with social deprivation. Thus increasing the difficulty of access
will increase health inequalities.
Therefore the CCG will seek to procure the provision of all kinds of prevention services including
management of long term conditions as close to our population as possible (ie at multiple sites) to
reduce the likelihood of increasing health inequalities. This may require the development of more
local providers of some services and the CCG will structure procurement of prevention and
management of long term conditions services to encourage the development of local providers if
this will improve the local access.
Integration
The integration of services to ensure we provide a seamless service to those with complex illness is a
priority for the CCG. Thus, when considering the route to procurement, we will prioritise NOT
increasing the number of interfaces between providers and where possible aim to decrease the
number of providers along any particular pathway of care.
In addition we recognise that generalists (e.g. GPs, practice nurses and district nurses) provide and
should continue to provide much of care outside of hospital and that these generalists are key
workers in multiple pathways. Thus when procuring new services we will not seek to procure
individual pathways of care from different providers - rather seek providers willing and capable of
providing all key pathways and able to grow the skills and capacities of available generalist staff.
Value for Money
This also is a key driver for the CCG but we will assess the impact on using the cheapest provider on
access and integration and will be willing to pay a higher tariff where there is significant evidence
that either of these will be compromised by the cheapest provider winning a tender. Clearly any
provider that does not meet the “good enough” quality will not be considered.
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Appendix S. Newham CCG Procurement Policy 2013
In development
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Appendix T. Contracting and Procurement Group Draft TOR
Contracting & Procurement Group
Terms of Reference (Draft)
Background
From April 2013, Newham CCG is responsible for the procurement of award of contracts for health care in Newham. There are several contracts which are due to expire in 2013/14 and decisions need to made on their route to the market (e.g. to AQP, open competition, single provider) and awards of contract. The Newham QIPP plan also outlines many new services or changes to patient pathways which require identification of new service providers and contracts.
Newham CCG governance is currently under review. Although the responsibility for contract management and procurement sit with the programme boards, the process for monitoring and ensuring programme level procurements is not clear. Therefore a due diligence process is required to ensure that procurements are properly authorised, delivered on time and are run in accordance with the CCG commissioning strategic plan. A formal procurement governance structure of the CCG is important for evidencing transparency of the procurement decisions and provides first defence to challenges of anti-competitive commissioning.
Structure and process
The Contracting and Procurement Group will play this core role by ensuring that procurement activities are planned and coordinated across the CCG, are properly authorised, follow the correct process and paperwork is to an agreed standard. The role of the group is also to ensure that there is documentation of the decision to go to market, to enter a contractual agreement with a provider and when to accept single tender action instead of going to market.
There is a duty on the CCG Board to ensure that procurement decisions are made with due regard to the Principles of Co-operation Choice and competition published by the Department of Health. (Section 75 of the Health and Social Care Act ‘Requirements as to procurement, patient choice and competition’)
Programme Boards are required to generate new business cases for procurement activities, show how the procurement activity fits with CCG strategy, how it will improve patient experience and be cost effective. Service specification development and the detail of tender process design can be done at Programme Board level then be reported back to the CCG Exec.
The CCG Exec would receive final reports of procurements authorised by the Contracting and Procurement Group and give final authorisation for the CCG enter into contract with the successful bidder (unless the contract value required escalation to the CCG Board for authorisation). Any single tender waivers or procurement business cases not previously reviewed at the C&P group would need to be reviewed by the CCG Exec meeting.
Contracting and
Procurement group
CCG Exec NCCG Board
Review and accept
Procurement plans /
business cases
Ensures procurement
is in motion and
progress monitored
Acknowledges all
procurement activity
and decisions Pu
rpo
se
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Purpose of Contract & Procurement Group
The role of the Contracting & Procurement Group (NCCG C&PG) is to assess the most appropriate route for procuring a service, whether through an existing provider or through market testing. To approve plans for reviewing the progress and reaching the desired outcome of each procurement process and to provide assurance to the NCCG Executive and Board that the process of deciding on the preferred bidder has followed best practice and meets the requirements of CCG Standing Financial Instructions.
assess the most appropriate route for procuring a service (as defined by a business case submitted by the relevant programme board) and then to review the outcome of each procurement process to provide assurance to the Board that the process of deciding on the preferred bidder has followed best practice
ensure a balance between the need to stimulate the market and encourage plurality, and innovation in the health care market
ensure partnerships with existing providers who provide high quality care and best value for money
ensure there is full engagement of relevant CCG Board Members, Clinical Leads and other key stakeholders relevant to the procurements under discussion.
provides assurance to the CCG Board that the process and outcome has been fair. The process of decision-making must be transparent and robust. Clear management of potential conflicts of interest and consistency are required throughout
Membership
Dr Zuhair Zarifa CCG Chair (Proposed chair of C&PG)
Dr Ashwin Shah Clinical Lead (proposed vice chair of C&PG)
Steve Gilvin CCG Accountable Officer
Scott Hamilton CCG Director of Delivery
Chad Whitton CCG Director of Finance
Chetan Vyas CCG Associate Director of Quality
Nicholas Garforth CSU Procurement (provides procurement expertise)
Lee Walker CSU Contracting (provides contracting expertise)
Carl Edmonds CSU Commissioning Support (supports and track delivery)
Reporting Structure
The Group will be sub-group of the CCG Executive Committee. Contract and procurement leads (who will be members of the relevant programme board) will supply reports to the Executive committee. Minutes of the group will be recorded and sent to the CCG Executive.
Quorate
The chair or vice and 2 other CCG members.
Freq
D
ecis
ion
s
Route to market
To enter contract
Tender waivers
For £200k+ value
Route to market
To enter contract
Approve new
business cases /
tender waivers
Ad hoc Monthly Monthly
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Accountability
Chair: Dr Zuhair Zarifa? Administration: CCG
Frequency
This is an ad hoc and meetings will be organise with a minimum notice period of two weeks (papers supplied one week before the meeting).
Review
The terms of reference of the contracting and procurement group will be reviewed on an annual basis. The next review will take place on XXXXXXXXXXXXXXXXX
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Appendix U. Impact Table
Procurement or Contracting Option
Quality Access Integration VFM
Contract Variation
Contract Management
Waivers
Single Tender Action
(NHS Procurement, Patient Choice & Competition) Regulations 2013)
Competitive Dialogue
Negotiated Procedure
Framework Agreement Call-off
AQP
(Any Qualified Provider)
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Appendix V. Code of Conduct Template to be completed when GPs have a financial interest in possible provider
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