southwark primary care commissioning committee€¦ · nick langford assistant head of primary...

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Chair: Dr Jonty Heaversedge Accountable Officer: Andrew Bland Managing Director: Ross Graves

The best possible health outcomes for Southwark people

Southwark Primary Care Commissioning Committee

Tuesday 23 July 2019, 14.00 - 16.00

Cambridge House, 1 Addington Square, London SE5 0HF

Item Time Item ENC Lead

Part One

Introductory items

1 14.00 Welcome, introductions, apologies and declarations of interest - Chair / All

2 14.05 Minutes and Actions of last meeting: May 2019 A Chair

3 14.10 Open Public Space - Chair

Standing items

4 14.20 Contract Action Log B Nick Langford

5 14.30 Finance Report C Malcolm Hines

6 14.40 Quality Report D Kate Moriarty Baker

7 14.50 Urgent planned PCCC decisions for reporting E Sam Hepplewhite

Items for discussion

8 15.00 System reform F Sam Hepplewhite

9 15.15 Healthwatch Enter and View Visits – Action plan update G Rachel Doherty

10 15.30 GP Patient Survey Results H Sam Hepplewhite

11 15.40 2018/19 Year End GP Resilience Report I Rachel Doherty

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The best possible health outcomes for Southwark people

Item Time Item ENC Lead

Closing items

12 15.50 AOB - Chair

13 15.50 Public Open Space - Chair

14 16.00 Close

1 Agenda

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NHS Southwark Clinical Commissioning Group (CCG)Primary Care Commissioning Committee – PART 1

Tuesday 29 May 2019, 2pmCambridge House, 1 Addington Square, London, SE5 0HF

MINUTES

Present:Robert Park (Chair) Lay Member, Southwark CCG (SCCG) RPAndrew Nebel Lay Member, SCCG ANSam Hepplewhite Director of Integrated Commissioning, SCCG SHMalcolm Hines Chief Finance Officer, SCCG MHRichard Gibbs Lay Member, SCCG Conflict of Interest Guardian RGDr Emily Gibbs Clinical Lead, Primary Care, SCCG EGJean Young Head of Primary Care Commissioning, SCCG JYNick Langford Assistant Head of Primary Care, South East London Primary

Care teamNL

Ami David Registered Nurse Member, SCCG ADRachel Doherty (notes)

Primary Care Commissioning Manager, SCCG RDo

Bron Thomas Southwark Healthwatch BTDr Kishor Vasant Southwark Local Medical Committee KVApologies:Joy Ellery Lay Member, SCCG JERoss Graves Managing Director, SCCG RGrKate Moriarty-Baker Director of Quality, SCCG KMBCllr Evelyn Okoto Health and Wellbeing Board Representative EOStephen Whittle Southwark Healthwatch SWJill Webb Head of Primary Care, South East London Primary Care team JWDr Rob Davidson Clinical Lead, Primary Care, SCCG RDa

1.0 IntroductionIntroductions and apologies were noted as above.

1.1 Declarations of InterestThe group were asked to declare if there had been changes to their interests and if they had a conflict with an agenda item. All members confirmed no changes to their declarations. EG confirmed that she worked for Nexus Health Group as a salaried GP but there was no item on the agenda relating to a decision.

2.0 Minutes from the last meeting The minutes were agreed as an accurate record with the initial on page 3 and 4 changed to CN. There were no outstanding actions from the previous meeting.

3.0 Public Open Space

No questions were raised.

4.0 Contract Action Log

NL presented the contract action log. BT asked for a statement on the progress Nexus were making. It was noted that the CCG is taking the CQC report for Nexus very seriously and

A Minutes


recognise patients will be concerned by the report. It was explained the CCG continues to meet with Nexus as part of the contract management process and have been seeing improvements from Nexus since the inspection tool place. It was explained Nexus have commissioned external support to ensure all issues highlighted by the CQC have been addressed. Nexus have responded to the remedial and breach notice which is being reviewed by the CCG.

5.0 Finance Report

MH presented the report It was noted that some final figures will not be known until June / July and that the report included estimates.

It was asked why there is a significant year to date variance for the SELDOC contract. It was noted that contract negotiations were ongoing and linked to a later start date for the integrated urgent care service.

6.0 Quality Report

The Committee noted the report. It was asked what assurance the CCG receives in terms of infection control audits if a practice refuses a visit from the commissioning support unit nurses. It was noted that practices are encouraged to have face to face audits as these have been commissioned to support practices. If the practice does refuse the audit, they have to provide assurance that they have completed an audit to the same standard.

7.0 Urgent planned PCCC decisions for reporting

JY presented the report. It was noted that the Committee took an urgent planned decision to issue Dr Misra with a formal action plan following a CQC rating of requires improvements.

8.0 Bermondsey Spa Medical Practice Business Plan and Progress Update

JY presented the paper for information and outlined the process the CCG had followed. It was explained the Committee had agreed on the practice business case on 12th April, by an urgent planned decision, which noted if all areas in the remedial notices had not been complied with the contractors would hand back their contract. It was explained that the CCG had reviewed the information submitted and it was agreed that all areas had been complied it. It was noted that there were some areas of improvements in relation to best practice which the CCG would provide feedback to the practice on.

JY noted that the contract management meetings were ongoing and that these were positive meetings and there had been a change in the engagement and culture at the practice.

RG noted the commendable outcome and that it was encouraging there has been a change in culture at the practice. It was noted that an update with come back to the Committee in approximately a years’ time.

9.0 Borough Medical Centre and Blackfriars Merger Update

It was noted that the merger was currently on hold following approval by the Committee and the practice had updated information on their website and discussed with their patient participation groups. Further updates will be given to the Committee.

10.0 Primary Care Networks (PCNs)

SH explained that practices have agreed for 19/20 for the primary care networks is that there would be two PCNS in Southwark aligned to the GP federation footprint. The governance processes in relation to PCN approval was explained.

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The Committee endorsed this proposal.

11.0 Any other Business 11.1 Sir John Kirk Close

It was noted that the contract for Sir John Kirk Close was ending but the premises will continue to be used for general practice services by Nexus as a branch site to their PMS contract.

12.0 Public Open Space

It was asked if practices are required to ask patients the friends and family test. It was notedthe premium specification in Southwark notes practices should aim to survey at least 60% of patients and practices mainly use text messages but there also should be paper copies of the survey available. It was noted that similar to the GP patient survey there was variation in results.

It was asked if practices are being encouraged to amalgamate. SH explained it was a business decision for a practice to merge and this required a business case to be submitted to the Committee. It was noted that primary care networks are not mergers but will be individual practices working together.

13.0 Close

A Minutes


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Southwark CCG Committee Report

ITEM FOR DISCUSSION /ASSURANCE

CCG Committee

Primary Care Commissioning Committee

Month July Year 2019

Item title: Contract Action Log

Enclosure number:

B

Any know conflict of interest

No

B Contract Action Log


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The item is being presented to the committee for (select only one):

Discussion Assurance ¸

Report Author Responsible Director

Name Nick Langford Name Sam Hepplewhite

Job titleAssistant Head of Primary Care Job title

Director of Integrated Commissioning

Directorate N/A Directorate Integrated Commissioning

Email [email protected] Email [email protected]

1. Purpose of the paper (why does the committee need to discuss / receive assurance?)

The purpose of this paper is to provide information to the Committee as to when breach and/or remedial notices and requests for action plans have been sent to practices following PCCC decisions.

The paper provides details when practice’s responses have provided sufficient information to assure commissioners that all the required improvements have been addressed.

2. Describe the issue being presented to the committee for discussion or assurance

Decisions to issue practices with breach and/or remedial notices following poor contract performance are made by the Primary Care Commissioning Committee.

London developed a standard operating procedure (SOP) to enable borough Committees to take a consistent approach to issuing breach and/or remedial notices in response to Care Quality Commission ‘requires improvement’ reports. Decisions where practices have been rated as inadequate and placed in special measures are made in line with a national SOP.

This paper provides information to the Committee on the status of the remedial and/or breach notices and confirms if the practices response has provided commissioners with satisfactory information to demonstrate that the required improvements have been made.

3. What stakeholder engagement has taken place?



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N/A

4. What equality and diversity considerations have been highlighted in the Equality Analysis and how have they been addressed?

N/A

Supporting information / documents

Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc.

Appendix # Name of document

i Southwark CCG CQC Contract Action Log (July)

Date paper completed

16 July 2019



NHS Southwark CCG - CQC Contract Action Log

No. Practice Name CodeCQC inspection date

CQC report publication

Date considered by the Committee

Outcome ReasonDate sent to practice

Date response received

Status Comments

27 Camberwell Green Surgery G85013 1/23/2018 26/03/2018 4/25/2018Remedial breach notice

CQC overall RI 21/05/2018 15/06/2018 Open

CQC inspection visit on 23 Jan 2018, puplished on 26 March 2018. PCCC decision made on 25/4/2018 to issue Breach and Remedial Notice and Action plan by 9 May 2018. There has been a short delay in sending to the practice as officers had been unable to speak to the practice regarding the meeting to discuss the B&R notice. Meeting was held with practice on 05.06.2018 and the practice submitted action plan requirements on 15.06.2018. Submission has been reviewed by officers and further evidence has been requested by 1/08/2018. The further evidence was requested at a meeting held between commissioners and the practice on 5/09/2018 and an extension to submit the evidence was agreed with the practice until 28th September which was met by the practice.CCG and SEL PCT reviewed the evidence and are assured the practice has taken actions to address all areas in the remedial notice, with the exception of infection control. The practice is in the process of updating the carpeted areas in consultation rooms. The CCG will not be taking any further action, however this will remain open and monitored until the practice completes the actions in relation to the carpeted consultation rooms.

33Dr K Misra - Borough Medical Centre

G85106 1/31/2019 15/03/2019 4/23/2019 Action Plan CQC overall RI 02/05/2019 30/05/2019 Closed

CQC visit 31/01/2019. Report published 15/03/2019. Rated overall Requires Iimprovement with Safe and Well-led Requires Improvement.CCG and SELPCT met with practice on 10 April 2019 to go through the issues identified in the CQC report and give the practice an opportunity to explain the actions taken in response to CQC report. PCCC paper with recommendation to issue action plan was agreed by the Committe on 26 April 2019. Action plan was issued to the practice on 2 May 2019 and the response from the practice is due on 30 May 2019. Practice has submitted a response to the action plan and this is due to be reviewed by commissioners by the end of June 2019. The practice has provided all the required documentary evidence and a compliance letter was sent to the practice on 3/07/2019.

32 Nexus - CQC inadequate G8503401/11/2019 - 28/11/2019

26/02/2019 3/26/2019 Remedial Notice CQC-Inadequate 26/04/2019 24/05/2019 Open

The report was published on 26 February 2019 and was rated 'Inadequate' overall with 'Inadequate' in 'Safe' and 'Well-led' and 'Requires Improvement' in 'Effective' and 'Responsive'. A paper was taken to the March Committee where it was agreed that the practice be issued with breach and remedial notices. Remedial notice was issued on 24.04.2019 and the response from the practice is due on 22 May 2019. The practice has submitted a response to the remedial notice. A meeting with the practice is taking place on 16 July 2019, where the evidence will be reviewed by officers. A verbal update will be provided to the Committee.

B C

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NHS Southwark CCG - Contract Management Framework Action Log

Practice Name Code Date sent Ref No. Type Breach /Remedial theme Action required by the practice Practice response Was the notice satisfied Next steps Outcome Bermondsey Spa G85623 28/06/2018 N/A Remedial notice 1) Failure to respond to information

requests

2) Duty to cooperate

Practice was required to respond within 28 days (28 July 2018)

Practice responded on 26/07/2018 No for reasons sent to the practice on 1 October 2018

The CCG wrote to the practice on 1 October 2018 and requested additional information to be provided within 28 days.

The practice did not respond by 28 October 2018 and has therefore further breached the contract (see breach notice ref 3)

CLOSED NO FURTHER ACTION

Bermondsey Spa G85623 28/06/2018 N/A Remedial notice Clinical Governance processes Practice was required to respond within 28 days (28 July 2018)



The practice did not respond by 28 October 2018 and has therefore further breached the contract (see breach notice ref 4)


Bermondsey Spa G85623 28/06/2018 N/A Remedial notice PPG – patient complaint, lack of PPG meetings. No evidence to 2017/2018 eDec

Practice was required to respond within 28 days (28 July 2018)



The practice did not respond by 28 October 2018. The CCG issued a breach notice to the practice on 7 December 2018 as the practice was unable to evidence that the practice held PPG meetings in 2017.


Bermondsey Spa G85623 15/11/2018 1a Breach notice For areas highlighted in the CQC inspection and the subseqent report published on 18 September 2018 that were repeated from the remedial notice issues to the practice on 23 Feb 2016.

The practice is required not to repeat the breach

N/A – no response due. The practice is required not to repeat the breach

N/A N/A N/A


Bermondsey Spa G85623 15/11/2018 1b Remedial notice To remedy the areas highlighted in the CQC inspection and the subseqent report published on 18 September 2018, which were repeated from the remedial notice issues to the practice on 23 Feb 2016.

Within 28 days due 13 December 2018

Ongoing deadline 13 December 2018

No for the reasons sent to the practice on 28.12.18 see tab enclosed. The CCG wrote to the practice on 28.12.18 and requested additional information to be provided within 28 days.

The CCG wrote to the practice on 28.12.18 and requested additional information to be provided within 28 days. The response to the request for additional information was received within the deadline but assurance was not provided in relation to four items relating to effective systems of infection control, evidence of training relating to identifying incidents, an improvement plan relating to cancer screening and information relating to access. The CCG met with the practice on 20 February 2019 and agreed that the outstanding issues will be included in the improvement plan which will be included as part of the contract variation that will be issued to the practice, following agreement by the Primary Care Commissioning Committee to the practices business case.

The practice has now satisfied the requirements of the breach and remedial notices, which formed part of the business case.

CLOSED

Areas of further improvement have been suggested to the practice, which will be monitored at contract management meetings.

Bermondsey Spa G85623 15/11/2018 2 Remedial notice To remedy new areas highlighted within the practices CQC inspection report published on 18 September 2018

Within 28 days due 13 December 2018

Ongoing deadline 13 December 2018

No for the reasons sent to the practice on 21.12.18 see tab enclosed

The CCG wrote to the practice on 21.12.18 and requested additional information to be provided within 28 days. There are areas where the CCG was not satisfied with areas relating to management of test results, the audit of exception reporting and the call and recall protocol but these areas will be included in the improvement plan.

As per line above.

CLOSED As per line above.

Bermondsey Spa G85623 22/11/2018 3 Breach notice 1) Failure to respond to information requests

2) Duty to cooperate



N/A N/A N/A


Bermondsey Spa G85623 22/11/2018 4 Breach notice Clinical Governance processes The practice is required not to repeat the breach


N/A N/A N/ACLOSED NO FURTHER ACTION

Bermondsey Spa G85623 22/11/2018 5 Breach notice Failure to ensure that staff have safeguarding training appropriate to their role.



N/A The practice has been issued with a remedial notice to address the issue (see 5a)

N/ACLOSED NO FURTHER ACTION

Bermondsey Spa G85623 22/11/2018 5a Remedial notice To remedy the safeguarding breach but sending evidence of training log and certificated to the CCG.

No for the reasons sent to the practice on 28.12.18

The CCG wrote to the practice on 28.12.18 and requested additional information to be provided within 28 days. The CCG reviewed the evidence and was satisfied that the practice had taken the required steps to remedy the concerns. A compliance letter was sent to the practice on 5 March 2019.

N/A


Bermondsey Spa G85623 06/12/2018 6 Breach Notice No PPG Meetings held in 17/18 The practice is required not to repeat the breach


N/A N/A N/ACLOSED NO FURTHER ACTION

Status

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CCG Committee



Item title:Primary Care Finance Report: Month 3 2019-20

Enclosure number:

C

Any knownconflict of interest

No


Discussion ☐ Assurance ¸

C Finance Report


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Name Vincent Kelly Name Malcolm Hines

Job title Acting Head of Finance Job title Director of Finance

Directorate Finance & Business Directorate Finance & Business



This report provides the Primary Care Commissioning Committee with assurance and information with regard to the financial performance of the Primary Care budgets for the 2019/20 financial year to date.


Delegated Primary Care

As at Month 3, Delegated Primary Care is showing a £74k overspend for the 2019/20 financial year.

The primary care medical budget calculated for the CCG results in a funding gap of £578k against the 18/19 allocation of £47,153k. Most of this gap arises from the reduction in funding to set up the national clinical negligence scheme for GP’s.

C Finance Report


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C Finance Report


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C Finance Report


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Other Primary Care Health Services

Other Primary Care Health Services are mainly operating in line with budget with the exception of Prescribing.

Prescribing spend is showing favourable at this point of the year. This is mainly due to favourable underspends being carried forward from the previous year. We have one month IPP and PMD information available so the position is uncertain. It is hoped that the Practice Prescribing position will be resolved before month 4.

Other than that, all other areas are showing break-even or near break-even. It is expected that more information once it is available later in the year will show some budgetary variances.


N/A


N/A

C Finance Report


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i Title of appended document.

Date paper completed Monday, 15 July 2019

C Finance Report


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ITEM FOR DISCUSSION / ASSURANCE

CCG Committee



Item title: Quality Report

Enclosure number:

D


No

D Quality Report


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Discussion ☐ Assurance


Name Harpinder Priest Name Kate Moriarty-Baker

Job title Quality Manager Job title Director of Quality and Chief Nurse

Directorate Quality & Nursing Directorate Quality & Nursing



The purpose of this paper is to provide an update on quality in relation to primary care.


1. Recent CQC Inspection reports and actions taken The CQC inspection process is a national programme. Current ratings are summarised in Appendix 1 and full reports are available on the CQC website http://www.cqc.org.uk/ The CCG engages with the local population through locality Patient Participation Groups (PPGs) on issues which may relate to quality. Since the last Committee meeting in May 2019, no Southwark General Practice providers have had their CQC inspection reports published. However, the CQC have published inspection reports on the two extended primary care services operating in the north and south of the borough. Improving Health Limited (IHL) and Quay Health Solutions (QHS). IHL provides and extended primary care service in the south of the borough, based at The Lister Primary Care Centre and QHS provides a similar service in the north, based at Bermondsey Spa Medical centre. Table 1 – results of Southwark CCG CQC inspection reports published since May 2019:

Site Inspection date

Report publication

date

Overall rating

Safe Effective Caring Responsive Well-led

IHL Extended Hours

Primary Care Service

18/03/2019 24/05/2019 Good Good Good Good Good Requires

improvement

(QHS) Extended Extended

Access Clinic

18/03/2019 16/05/2019 Good Good Good Good Good Good

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http://www.cqc.org.uk/

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a. Improving Health Limited (IHL) Extended Hours Primary Care Service:

Overall rating – Good The CQC carried out their inspection at IHL on the 18 March 2019. The inspection found that the service had a strong focus on conitinous learning and improvement at all levels of the organisation and the service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered to evidence based guidelines. The inspection also identified that the service did not have adequate systems in place to ensure oversight of risk management and there was lack of oversight of staff training and recruitment. There was a good system in place to identify and manage significant events. The CCG continues to work closely with it’s General practice primary care providers enursing there is access to expertise support and guidance from across the CCG teams. The full inspection report can be access via this link: https://www.cqc.org.uk/location/1-1761474067

b. Quay Health Solutions (QHS) Extended Access Clinic Overall rating – Good

The CQC carried out their inspection of QHS on 27 March 2019. The inspection found that the service had good systems in place to manage risk and safety incidents. It found the service routinely reviewed the effectiveness and appropriateness of the care it provided to it’s patients and that staff were involved and engaged and treated patients with kindness, dignity and respect. The inspection identified that improvements were required in records management in relation to staff inductions, the advertising of translation services and management of sharps waste. The CCG continues to work closely with it’s General practice primary care providers enursing there is access to expertise support and guidance from across the CCG teams. The full inspection report can be access via this link: https://www.cqc.org.uk/sites/default/files/new_reports/AAAJ2551.pdf

2. Infection Prevention and Control (IPC) in Primary Care Update The new infection prevention and control (IPC) resource pack for practices was received by the CCG in June. Commissioned from NEL (CSU) by Southwark and Lambeth CCGs, the pack contains information, guidance and recommended policies to assist colleagues working in general medical practice and reflects current evidence-based regulations and NICE guidance. The CCG IPC Lead Nurse attended the Practice Nurse and Healthcare Assistants’ Forum to launch the pack and also presented an update on audit, local infection rates and objectives. In addition, the resource pack has been sent to all Southwark practice managers. The NHS England IPC primary care audit tool has also been distributed and widely publicised to practices as the approved recommended tool for IPC self-assessment by practices across London to assist with meeting CQC requirements. Nine Southwark practices will be audited by the NEL IPC team this year using the tool.

D Quality Report


https://www.cqc.org.uk/location/1-1761474067

https://www.cqc.org.uk/sites/default/files/new_reports/AAAJ2551.pdf

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Ongoing IPC support and advice has continued to be provided to practices at their request or as required by the CCG, including pre and post CQC inspections and those practices requiring contract management.

3. Learning, Development and Nursing in General Practice PLT and Practice Nurse Forum - There were two Protected Learning Time events held in the last quarter; Medicines Optimisation and Child Safeguarding level 3, both were very well attended. The PLT event in April was practice based, with an opportunity to attend a Dermatology update that was organised by the team at GSTT. There were also two Practice Nurse and HCAs forums whose genda items included Cancer prevention and screening, Infection Control, Digital projects in primary care, Preceptorship and Clinical Supervision among other updates. HEE ACP and GPN Programmes – Similar to last year, The Advanced Clinical Practice training opportunity offered by the HEE was promoted 5 places on the programme have been successfully secured for nurses and pharmacists. Work has started on the GPN programme which offers funding for training and support to newly qualified nurses and those new to primary care. Annual updates for Immunisation, Flu and Travel have been set. The first events were held in June. The second set of will be in October, all events are open to nurses and Allied Health Professionals (AHPs). The Advanced Communication day course for Nurses and HCAs is also being promotede. An NHS Health Check update was provided by Southwark Public Health team earlier in the month. GP incident awareness training - the Quality team with the support of training and development in Southwark have set up training dates for General practice staff in South East London to attend Patient Safety Systems sessions. The first event took place in early July and feedback was very positive. Two further sessions are due to take place in August and September. Further details can be found in the CCG GP bulletins. Sessional GP Forum – the launch event for this forum was held on 25 of June. The actions following this event are to develop an online platform to enable discussions and information sharing, create a Southwark starter pack with advice and guidance for locum GPs and to improve the engagement and involvement.

4. GP Incident reporting systems NHS England London patient safety team have recently issued helpful guidance for General practices on Reporting and learning from patient safety incidents and significant events – A working guide for general practices. The guidance is soon to be available on the CCG members and staff zone and will be made available to practices via the CCG GP bulletin. In parallel to the issuing of this guidance, the Quality team have commissioned a training provider to deliver GP incident awareness training for GPs, primary care clinical staff and practice managers. The training is open to all clinical staff in a GP practice including practice mangers and the aims of the training is to raise awareness in identifying, reporting, managing and learning from incidents occurring in a GP practice setting. The training is being carried out on four separate dates and has been promoted via the GP bulletins, Training hubs and other contacts lists.

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The CQC inspection process is a national programme. NHS Southwark CCG continues to engage with patients on the quality of general practice service in Southwark through engagement workshops, via the locality patient participation group meetings.


None highlighted.




i CQC Inspection update table and ratings

Date paper completed Wednesday, 17 July 2019

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Appendix 1 CQC Outcomes

The following chart illustrates the current position of CQC overall ratings for Southwark General

Practices the rating for each domain.

Note: The Lister Practice, managed by AT Medics, has yet to undergo a CQC inspection. This provider

incorporated two providers previously know as ‘Hurley Group caretaking at the Lister’ and ‘Dr Hossain’s

Practice at the Lister’.

Overall CQC Ratings for Southwark

General Practices

2

30

31

Inadequate Good Requires… Not yet inspected

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30

31

30

32

29

2

3

4

2

4

3

1

1

1

2

1

1

1

1

1

0 5 10 15 20 25 30 35 40

Safe

Effective

Caring

Responsive

Well-Led

Total rating for each CQC Domain

Good Requires Imrovement Inadequate Not yet inspected

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Overal

l CQC

Rating

GP Practice Name Inspection

Date

Publication

Date

Safe? Effectiv

e?

Caring? Respon

sive?

Well-

led?

I (SM) NEXUS CONTRACT

Princess Street

Practice

Surrey Docks HC

Aylesbury Med Ctre

Dun Cow Surgery

Commercial Way Sgy

Decima Street &

Artesian

Manor Place

01/11/2018 28/02/2019 I RI G RI I

I (SM) Dr Shabir Bhatti 10/07/2018 18/09/2018 I I I I I

RI Dr Alan M Campion 26/06/2018 03/09/2018 RI G G RI RI

RI Lister

Dr P Arumugaraasah's

& Partners

10/05/2018 16/07/2018 G RI RI G RI

RI Sir John Kirk Close 09/05/2018 12/07/2018 I G G G RI

G Lordship Lane

Dr SAKM Doha's

Practice

12/12/2018 28/01/2019 G G G G G

G Forest Hill Group

Practice

08/02/2018 29/03/2018 G RI G G G

G Concordia Parkside

Medical Centre

22/06/2017 15/08/2017 G G RI G G

G Concordia Melbourne

Grove

08/09/2016 12/01/2017 G G RI G G

G The Acorn& Gaumont

Surgery

12/04/2018 22/06/2018 G G RI G G

G Dr R S Durston &

Partners

12/09/2018 14/11/2018 G G G G RI

G The Trafalgar Surgery 30/01/2018 04/04/2018 G G G G G

G Falmouth Road Group

Practice

26/04/2018 15/06/2018 G G G G G

G Dr Bhatt – Park

Medical Centre

17/05/2018 18/07/2018 G G G G G

G Elm Lodge Surgery 10/04/2017 26/05/2017 G G G G G

G Silverlock Medical

centre

10/05/2017 05/06/2017 G G G G G

G Sternhall Lane Surgery 14/03/2018 26/04/2018 G G G G G

G Nunhead Surgery 20/09/2016 30/01/2017 G G G G G

G Dulwich Medical

Centre

11/08/2016 14/12/2016 G G G G G

G The Garden's Surgery 05/08/2016 03/11/2016 G G G G G

G Dr Kaushal Kishore

Misra

22/10/2015 18/06/2015 G G G G G

G Dr Ramesh Sharma 15/10/2015 10/12/2015 G G G G G

G Dr Shivraj Chudha 29/04/2015 06/08/2015 G G G G G

G Penrose Surgery 22/06/2016 01/08/2016 G G G G G

G Albion Street Practice 30/01/2019 05/03/2019 G G G G G

G Dr Mahreen Chawdery

306 Medical Centre

26/05/2016 15/08/2016 G G G G G

G Hambledon 09/06/2016 20/06/2016 G G G G G

G St Giles Surgery

Dr Virji/Begley

23/08/2016 04/11/2016 G G G G G

G St Giles Surgery

Roseman/Vasant

18/08/2016 04/11/2016 G G G G G

G DMC Healthcare 29/09/2016 21/12/2016 G G G G G

G Old Kent road Surgery 22/06/2016 23/01/2017 G G G G G

G The Surgery

301 East Street

27/11/2017 01/02/2018 G G G G G

G Villa Street Medical

Centre

08/12/2016 30/03/2017 G G G G G

G Maddock Way Surgery 14/03/2017 14/05/2017 G G G G G

G Queens Road Surgery 01/08/2017 08/09/2017 G G G G G

Not yet

inspect

ed

The Lister Practice (AT

Medics) Formerly

Hurley Group at

Lister/Dr Hossain)

TBC TBC

The Hurley Group & Dr Hossain's practice CQC ratings

and reports can be accessed via the CQC website. The

new Lister Practice contract incorporating these two

practices, has not yet been inspected.

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CCG Committee



Item title:Primary Care Commissioning Committee Decisions for reporting

Enclosure number:

E


No


E Decisions for Reporting


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Name Rachel Doherty Name Sam Hepplewhite

Job titlePrimary Care Commissioning Manager

Job titleDirector of Integrated Commissioning

Directorate Integrated Commissioning Directorate Integrated Commissioning



The purpose of this paper is to report in public decisions taken by the Primary Care Commissioning Committee in between the Committee’s held in public.


The Primary Care Commissioning Committee (PCCC) is held every other month in public. The Primary Care Commissioning Board meets in the month that public meeting is not held. This is made up of members of the Primary Care Commissioning Committee and can make urgent planned PCCC decisions if required. Where ever possible, decisions are made in public. However on occasions, decisions, either planned or unplanned, will need to be made before the next public meeting.

The actions detailed in this report are being reported following the:

∑ Urgent planned Primary Care Commissioning Committee decision taken on 25 May 2019




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Stakeholders were engaged with prior to decisions being made. The appendix provides a summary.




iSummary of the decisions taken by the Primary Care Commissioning Committee (PCCC) voting members prior to the public Primary Care Commissioning Committee.

ii PCN paper

iii Appendix 1 PCN paper




Chair: Dr Jonty Heaversedge Accountable Officer: Andrew Bland Managing Director: Ross Grave1

Summary of the decisions taken by the Primary Care Commissioning Committee (PCCC) voting members prior to the public Primary Care Commissioning Committee.

The following decisions are reported below:

No. Committee name Meeting date Agenda item Action taken under delegation by the committee

1

Urgent planned Primary Care Commissioning Committee decision

25.05.2019 Primary Care Networks

The Committee agreed to vary the general practice contracts in Southwark to include the national directed enhanced service for the agreed north and south Primary Care Networks (PCN). See paper for further information.

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ITEM FOR DECISION

CCG Committee


Month June Year 2019

Item title: Primary Care Networks Update

Enclosure number:

7


No


Name Jean Young Name Sam Hepplewhite

Job titleHead of Primary Care Commissioning






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Process followed for development of this paper:

Followed agreed CCG process in full ¸ Urgent paper ☐

For urgent papers only: explain the reason for urgency

Have you described the below impacts as part of this proposal?

Have you considered either of the below to be relevant to this proposal?

Impact on patients / service users

Financial impact

Impact on

providers

Estates impact

Workforce impact

Equalities legislation

OSC involvement

Yes ¸ ¸ ¸ ☐ ☐ ☐ ☐

N/A ☐ ☐ ☐ ☐ ☐ ¸ ¸

Does the recommendation align with the CCG’s objectives and responsibilities?

Deliver IAF improvement

Improve patient

outcomes

Improve quality / safety

Secure financial

sustainability

Support integration

Address health

inequalities / parity of esteem

Enable the delivery of

care coordination

Promote early action

☐ ¸ ☐ ☐ ☐ ¸ ☐ ☐



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1. Purpose of the paper

The purpose of this paper is to provide the committee with an update on the application of the Primary Care Networks (PCN) in Southwark and the response from NHS England submitted on 31 May as per the national timetable.

The outcome of the discussions regarding the proposed arrangements for the PCNs in Southwark was presented to the Primary Care Commissioning Committee (PCCC) for endorsement on 28 May 2018. The Committee agreed to a Chairs action for contract variations to be made to reflect the PCN application agreement by NHS England due to the short deadlines which meant the decision could not be actioned by the PCCC at a meeting. As the applications have now been endorsed the decision can come back to the PCCC for decision at the Primary Care Commissioning Committee mode of the Board meeting.

2. Describe the issue being presented to the committee

On the 31 January 2019 NHS England and the BMA published ‘Investment and evolution – a five year framework for GP contract reform to implement the NHS Long Term Plan. This document introduced an automatic entitlement for all GMS, PMS and APMS contract holders to a new primary care network contract.

The CCG has been working closely with Southwark GP practices, the LMC and the two GP Federations agree the approach to Primary Care Networks (PCN) in Southwark which are part of the new GP contract and have nationally set deadlines. We have also been working with Guys and St Thomas’ NHS Foundation Trust and South London and Maudsley Trust (SLAM) to ensure it aligns with community service provision as per the NHS England requirements. Community providers are fundamental to the delivery of PCNs.

All GP practices have endorsed a submission of 2 PCNs, 1 in the north covering the population of all practices working with the north GP Federation Quay Health Solutions (QHS). In the south there will also be one PCN covering the south practices and their combined registration working with the south GP federations Improving Health Limited. Please see appendix 1 for the map illustrating the coverage.

On 31 May the CCG submitted the 2 PCN applications to NHS England. It has now been confirmed that the PCNs were supported with the understanding that these fit with local arrangements and the PCNs would develop smaller neighbourhoods for local working which is in development.

The development of the PCNs in Southwark has been fully supported by Partnership Southwark which is keen to support the development of the networks to ensure the maximum opportunity is realised for the local residents, practices and wider system. The OHSEL Board endorsed all SEL PCN applications including Southwark’s on 22 May and at the Integrated Care System (ICS) Development Board on 21 May and 18 June.

The Primary Care Network contract start date is the 1 July 2019. The PCCC are reminded that in April 2019 they agreed to Chair’s action during June, at the latest 30 June, following regional/national endorsement for agreement that the PCN agreements are varied in the APMS,



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GMS and PMS contracts in Southwark. The Chairs Action was requested depending on the timeframes for confirmation of the PCN which has now been received in time for a formal meeting decision.

The CCG will continue to have Strategic Leadership and Operational meetings with the PCNs which will focus on the mobilisation of the PCNs and the new contractual service specifications. The PCNs have completed the extended access Directly Enhanced Service (DES) application which has been approved subject to minor conditions. The implications of this is PCNs are developing their approach to providing the extended DES rather than in individual practice approach. PCNs will be engaging with their Patient Participation Groups (PPG) on how this access should be best delivered for the PCN population and the PCCC will receive an update on this work in due course. The progress of this will be discussed at the CCG meetings with thePCNs in line with the contractual requirements.

3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?).

We would ask the committee to note the acceptance of the PCN proposals and to agree that contract variations will be actioned for all Southwark GP contracts in light of the PCN applications.

4. What is the rationale for your recommendation?

Local PCCCs are expected to agree to the contractual variations. It is in line with Southwark Partnership agreements and the delegated authority of primary care to agree significant contractual variations.


Southwark CCG has engaged fully with the South East London approach to the implementation of the Primary Care Networks by joining the weekly meetings.

The Primary Care team is implementing a local communication plan which ensures that all local stakeholders are engaged in the process and mobilisation of the contract. This includes an all practice joint event on the 24 April and a patient event on the 8 May 2019. The CCG will continue to support a programme of engagement over the way the PCNs operate to deliver services with the GP practices, federations and patients. Another CCG lead patient event is planned for September.

6. Do stakeholders support the recommendation being made?

The PCCC has already supported the PCN applications. The PCNs will engage with their patients on how the PCNs will work to deliver the services set out in the new GP contract. We will work with the PCNs on the patient engagement for the PCCC and will continue to update the PCCC.



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7. What other options were considered?

n/a

8. What are the risks in proceeding with the recommendation?

n/a

9. What are the risks in not proceeding with the recommendation?

The CCG does not make the contract variations for the GP contract to reflect the PCN agreements and therefore does not meet the new contractual requirements timetable.



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i Primary Care Network Map

Date paper completed 23 May 2019



North Southwark PCN

South Southwark PCN

North Southwark PCN

Practice List Size

G85019 Trafalgar Surgery 4296G85029 Falmouth Road Practice 6977G85034 Nexus Health Group (7 sites) 73355G85050 Sir John Kirk Close Surgery 4037G85052 Old Kent Road Surgery 10021G85082 Maddock Way Surgery 3187G85084 Penrose Surgery 9154G85087 Silverlock Medical Centre 11449G85106 Borough Medical Centre - Dr Misra 2645G85125 Park Medical Centre 6064G85138 Albion Street Group Practice 15329G85623 Bermondsey Spa Medical Practice 11143G85632 Villa Street Medical Practice 7842G85642 Blackfriars Medical Practice 8260G85705 New Mill Street Surgery 6341G85721 East Street Surgery 8044Y00454 Borough Medical Centre - Dr Sharma 2326Y06113 Southwark Care Homes GP Practice 372Total Population 190842

South Southwark PCN

Practice List SizeG85001 Forest Hill Group Practice 12229G85006 Acorn and Gaumont House Surgery 9311G85013 Camberwell Green Surgery 10249G85030 Concordia Parkside 6125G85031 Dulwich Medical Centre - Chadwick Road 6730G85040 Queens Road Surgery 8537G85042 St Giles Surgery - Dr Begley 5016G85051 Elm Lodge Surgery 8183G85091 306 Medical Centre 5230G85119 Sternhall Lane Surgery 5806G85132 Melbourne Grove and Hambleden Practice (2 sites) 12987G85134 Dr Aru, Lister Primary Care Centre 5177G85644 The Gardens Surgery 7276G85651 Dulwich Medical Centre - Crystal Palace Road 9237G85681 Lordship Lane Surgery 5250G85685 Nunhead Surgery 9457G85715 The Lister Practice 10675G85726 St Giles Surgery - Dr Roseman 7398Total Population 144873

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CCG Committee



Item title:Commissioning system reform in south east London -update

Enclosure number:

F


No


Discussion ¸ Assurance ☐

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Name Sam Hepplewhite Name Sam Hepplewhite






The Primary Care Commissioning Committee is asked to note the content of the attached paper which was presented to the Governing Body in public on 11 July 2019 and note the impact these changes will have the PCCC.


The purpose of this paper was to:

∑ Confirm the process by which we will pursue our CCG system reform programme∑ Update the Governing Body on our progress to date, including noting proposals that are

now considered established (as a result of our engagement to date) and will therefore form the basis of our CCG merger application and single CCG

∑ Outline the work planned and next steps to complete this programme of work.

The Committee are reminder that primary care contracting and commissioning is a delegated function from NHS England.


Extensive engagement throughout the whole reform programme to date – see 3.6 and 3.7 of the main report.


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N/A




i Commissioning system reform in south east London - update

Date paper completed Tuesday, 16 July 2019

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Governing Body Paper

Commissioning System Reform in south east London

Update report - July 2019

1. Introduction 1.1. In order to achieve our ambition to secure more integrated, high quality and

sustainable services for south east London’s residents and in response to the NHS Long Term Plan (January 2019), the six CCGs in south east London (SEL) have agreed to undertake a programme of commissioning system reform that will result in:

• the merger of our six organisations to establish a single south east London CCG from 1 April 2020; and

• the formation of local system boards (prime committees of the governing body – see section 4.5) within each borough that will oversee the planning and commissioning of local services across health and social care

1.2. Through these arrangements, we will be seeking to create a commissioning system for

SEL that:

• locates decision making for populations and services we serve at the scale at which they are best planned and delivered (at SEL, borough or neighbourhood level)

• brings about a greater integration of health and social care commissioning around the wider needs and well being of our populations and the whole person

• fundamentally shifts the interaction between providers and between commissioners and providers towards collaboration and collective responsibility for patient outcomes and living within available resources

1.3. We will be changing our commissioning arrangements alongside the establishment of

provider and commissioner alliances in each borough (Local Care Partnerships) and at SEL level as the platform for our emergent Integrated Care System (ICS), now formally recognised as the first London ICS to join the national roll out of ICS arrangements from June 2019.

2. Purpose 2.1. The purpose of this paper is to:

• confirm the process by which we will pursue our CCG system reform programme

• update the governing body on our progress to date, including noting proposals that are now considered established (as a result of our engagement to date) and will therefore form the basis of our CCG merger application and single CCG

• outline the work planned and next steps to complete this programme of work

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Recommendations 2.2. Governing bodies are asked to note the content of this paper and confirm their

continued support for the actions being pursued through the system reform programme

3. Process 3.1. In January 2019, the NHS Long Term Plan provided a clear direction on the expected

future role and function of CCGs in England:

‘… [ICSs will grow from] … the current network of Sustainability and Transformation Partnerships (STPs). ICSs will have a key role in working with Local Authorities at ‘place’ level and through ICSs, commissioners will make shared decisions with providers on how to use resources, design services and improve population health (other than for a limited number of decisions that commissioners will need to continue to make independently, for example in relation to procurement and contract award). Every ICS will need streamlined commissioning arrangements to enable a single set of commissioning decisions at system level. This will typically involve a single CCG for each ICS area. CCGs will become leaner, more strategic organisations that support providers to partner with local government and other community organisations on population health, service redesign and Long Term Plan implementation.’

(Pg. 29, Long Term Plan, January 2019)

3.2. The footprint of our ICS as the six SEL boroughs has been established for some time

and our reform programme seeks to secure the NHS Long Term Plan expectation whilst also developing an approach and operating model for the single CCG that makes sense locally.

3.3. In order to establish a new SEL CCG from the 1 April 2020 the following national

guidance will be adhered to: https://www.england.nhs.uk/wp-content/uploads/2019/04/procedures-ccgs-constitution-change-merger-dissolution.pdf.

This requires a formal application to be submitted to NHS England and NHS Improvement (NHSE&I) on either 30 September or 31 October 2019 (by exception).

3.4. In April 2019, following a process of engagement, our six CCGs confirmed their

intention to consider an application to NHSE&I’s Regional Director and over May 2019 each governing body received and confirmed support for an outline case for change for a single CCG and the process each CCG would undertake in support of that application. Our agreed case for change said that CCG merger would secure: • responsive population-based commissioning at very local (neighbourhood), borough

and system (SEL) place levels that our diverse communities require - simultaneously through the planning and co-ordination of a single commissioning authority

• a different approach to commissioning - that gives greater focus to system strategy, planning and oversight, greater integration of health and social care commissioning and frees up alliances of providers to take ‘traditional commissioning roles’ in service design, responding to populations of similar geography or need

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https://www.england.nhs.uk/wp-content/uploads/2019/04/procedures-ccgs-constitution-change-merger-dissolution.pdf

https://www.england.nhs.uk/wp-content/uploads/2019/04/procedures-ccgs-constitution-change-merger-dissolution.pdf

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• the ability to derive solutions at the required scale and pace to attend to the quality, performance and financial challenges that cannot be resolved by our current organisations

• the requisite capacity and different capability required to commission services for our populations going forward within a reduced management cost envelope

• the ability to take control and design our structures locally, in south east London, by acting now

(Case for Change Extract, CCG Governing Body Seminar, May 2019)

3.5. The timeline for our process is provided in Appendix A. 3.6. Over the first phase of that process, ending 30 May 2019, a series of engagement

discussions were undertaken with governing bodies, member practices, staff, providers and local government in order to confirm and accept a case for change.

3.7. The second phase, beginning in June and running over a three-month period, involves

an intensive period of design, engagement and testing of the proposed governance, decision-making, functions and operating model of the new CCG. This has included further discussions in governing body seminars with members from all six governing bodies (per CCG and then collectively) and also through ‘all staff’ briefings in each borough.

3.8. During this second phase and building in the results of the above engagement, we will

be completing a draft application covering the full arrangements for the new CCG in late July / early August 2019. These arrangements will be further tested with governing bodies, members and our stakeholders during August 2019. In September 2019, a final application proposal and approval to submit will be considered by each governing body, alongside a new constitution for the single CCG that will be recommended to our members.

3.9. Our current understanding is that approval of that application will be provided in late

October / November this year and an implementation phase would then be enacted ahead of dissolution of the six current CCGs and the formal establishment of a single SEL CCG from 1 April 2020. That implementation phase will establish the key features of our CCG in organisation and governance and related terms. Importantly, it will also involve some significant restructuring of the team and staffing structures across each part of our CCG system.

Programme Governance and Principles

3.10. The reform programme is led by a System Oversight Group (SOG), comprising the

Chairs and Accountable Officers of our six current CCGs and that group makes common recommendations to governing bodies.

3.11. The SOG is supported by a delivery board - the System Reform and Delivery Group

(SRDG) that brings together subject matter experts and senior responsible owners for the key workstreams of the programme. The SRDG has an independent Chair and is supported by a small but dedicated Programme Management Office (PMO) and Executive Director.

3.12. Each part of London is pursuing a similar programme of work and so our programme is

also linked to the London CCG Merger Support Group that brings together regulators and CCG leaders to develop and co-ordinate this process.

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3.13. As part of the programme’s initiation, the SOG agreed a set of principles by which the programme would be shaped and delivered, and these are included at Appendix B.

Engagement

3.14. We are committed to ensuring comprehensive engagement throughout the programme

with staff and our full range of stakeholders, noting this is a requirement of the national process but also a commitment we have made to our staff, members and other partners.

3.15. To date there have been more than 60 engagement meetings or activities as part of

the programme, with a further 40 (plus) planned over the summer. These have included regular cycles of engagement meetings with governing bodies, staff, providers, member practices and local authorities – supported by written materials and a ‘live’ Frequently Asked Questions (FAQs) document. We have endeavoured to demonstrate rapid consideration and response to feedback through these discussions and that has shaped our emerging proposals.

3.16. In June, we commenced a programme of engagement with our residents that will

occur in each borough and we are also involved in discussions with Healthwatch in each borough. We will also have further opportunities to engage residents in our NHS Long Term plan events over the next few months.

3.17. These engagement and testing events / activities will further inform and shape our

proposals ahead of any recommendation to the governing bodies.

Management Costs 3.18. In November 2018, each CCG in England was required to plan for and deliver a

management cost reduction of 20%, from 2017/18 management costs resource limits / allocations, by 1 April 2020. The SEL CCGs are already spending below the current allocations and the required saving of circa £8m for the six CCGs is reduced to circa £4.5m as a result.

3.19. The achievement of this management cost reduction will not be secured through the

merger programme alone and represents a corporate objective of the CCGs within their business as usual efficiency or QIPP programmes during 2019/20. We have also committed to minimise redundancies and ensure that we are maximising savings elsewhere whenever possible. However, it is clear that the merger of CCGs will contribute to this requirement as any resultant organisation must not have management costs that exceed the new limit.

3.20. Any released costs associated with this national requirement are reinvested into core

commissioned services; as they have been in previous years by current our CCGs.

4. Established features of the system reform programme

Ways of Working and Organisational Development 4.1. The most significant and prevalent feature of our engagement to date has been the

requirement to look beyond governance and organisational structures and to give focus to ways of working. This recognises that staff and organisations will operate in different partnerships (of commissioners and providers, NHS and local authority

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teams) and with different relationships between them - teams operating with different geographies or scope of population in mind.

4.2. As we bring forward details of our application and implementation plans it will be

important that governing bodies consider the organisational development requirements of this change; and consider ‘structural’ change in the context of those new ways of working.

Governance

4.3. A single CCG will require a single governing body and associated prime committees.

Proposals for these arrangements will be presented to the governing body according to the timetable at Appendix A.

4.4. As part of this governance it is now established that in addition to the SEL-wide

committees that will support the CCG, there will be six ‘Place’ or borough-based boards. These boards will operate as prime committees of the south east London CCG, and, with a formality to be agreed by each borough commissioning partnership, will bring together health and local authority commissioners to focus on local service planning and delivery of local or SEL commissioning intentions in each area.

4.5. The formality and population of these joint arrangements within each board is to be

determined, although there is consensus around the three potential models for establishing this from 1 April 2020 as outlined below.

4.6. Importantly, provided a local board is established in support of the SEL CCG’s

operating model, with the appropriate governance required by the CCG, the level of formality in each borough need not be uniform, but agreed with each partnership locally. However, a core expectation is that this arrangement enables a delegation of responsibility to borough level for the commissioning of primary and community based care (see below).

Decision-Making and Influence

4.7. The final proposals brought forward later this year will now be established based on an

agreed position around decision-making and influence across our diverse and complex system. Our arrangements will follow our ‘System of Systems’ ICS approach such that from 1 April 2020:

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• the commissioning strategy and planning functions and responsibilities of the new CCG will be undertaken once for SEL. The development process will however be reflective of the need for commissioning activities to occur throughout our system (at a borough and SEL level). As such the planning of health services will involve an interaction between place and system partnerships at each level but will be agreed once for SEL, noting this model meets the national NHS Long Term Plan expectations with regards to decision making.

• the commissioning of acute services with responsibility for associated budgets will be held at SEL level and undertaken once. Again, borough boards will have influence over these areas through the process of planning (as set out above) and the governance of the CCG (with equal representation of all boroughs on the governing body and associated committees).

• the commissioning of community-based services, including primary care and client group commissioning will be formally delegated to the borough board with responsibility for associated budgets; and the potential to bring those together with local authority budgets under the joint arrangements that that board is agreed to have.

• the governing body, in agreeing its strategy and commissioning intentions, will require at all levels, pursuit of an ambition or goal of ‘minimum standards, delivered everywhere’ alongside relevant local priorities.

4.8. It is important to note that the arrangements above represent the basis for the initial

establishment of the new CCG. It is expected that progress towards a full ICS for SEL will require a further change to system responsibilities and where they sit. It is also anticipated that some borough partnerships will wish to take further delegated responsibility at a borough board level. The principles by which that would be considered by the SEL CCG, either in shadow or final form, depending on when proposals are made, will be proposed to the governing bodies in September 2019.

Capacity and Capability Approach

4.9. The operating model and governance of the CCG will require the right skills and

capacity to ensure its success and our proposals will need to outline how this will be secured and also the management of change process, in Human Resources policy terms, that will be required to achieve it.

4.10. At this stage, the programme and its CCGs are undertaking an engagement process

on this specifically. We are clear that each CCG’s policies will be adhered to. We will involve representative bodies and are committed to minimising any redundancies as a result of this process. We will support our staff, as our most important asset, through this process.

4.11. Beyond these clear commitments the following principles will also shape our

programme of work in this regard:

• That testing of structures for teams, delivering the CCG’s functions, may require differential levels of time depending on the complexity of the area in question. To that end we will make proposals for phased changes to functions:

o Some in advance of April 2020 as they will be critical to the business of the new CCG either in terms of its safe functioning or because of its near-term objectives.

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o Some post April 2020 to provide a longer period for their consideration, design and testing (noting that current and future CCGs will always be pursuing ways to optimise their arrangements).

• That, in broad terms CCG teams will work in one of three ways:

o single teams undertaking their responsibilities once for SEL o teams with single leadership and point of coordination, but with resources

working on behalf of or embedded in each borough o borough based teams

4.12. Irrespective of the timing and method of deployment, we are clear that all functions

need to be designed in a way that optimises their delivery, are affordable and have the future ICS in mind.

4.13. The programme and the SOG has, through engagement to date, heard a clear

concern from general practices about ensuring their continued access to local primary care advice and support, medicines management support and GP IT support. Notwithstanding the process outlined above, the SOG has felt able to communicate an assurance to member practices that these features of our current CCG will continue to be available locally post April 2020.

5. Integrated Care System Development 5.1. The development of the SEL ICS as London’s only wave three partnership will take

place over the next two years and CCGs / partners have made clear their commitment to ensuring this current system reform is aligned to our ICS development.

5.2. As governing bodies consider the new CCG arrangements generally, this alignment

will need to be kept in mind. At this point in time, there appears to be two early and important points of consensus in this regard:

• that in the design of CCG functions and team structures there must be a focus on transformation ‘delivery’ and that associated resources and teams should not be CCG ‘owned’ but should in future represent ‘system teams’ either at SEL or borough level - resourced and directed by provider led alliances, working with health and care commissioners.

• that ‘Place’ or borough based boards will be commissioning entities, however they will sit alongside Local Care Partnerships in each borough and corresponding arrangements at SEL (e.g. South London Partnership or any emergent Acute Based Care partnerships). There should be a clear interaction between those groups if we are to adopt an ICS way of working, whilst ensuring clear governance for management of conflicts of interest is established.

6. Next Steps 6.1. As outlined above and included in Appendix A, the current work of the programme is

focused upon engagement, design and testing of our proposed operating model and governance.

6.2. Ultimately this will result in the production of draft proposals and the content of an

‘application’ (with associated documentation), as required nationally, in late July / early

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August for governing body review and further engagement with our stakeholders (internal and external).

6.3. Each governing body will then consider a single application for merger of the CCGs at

their September meeting in public (4-18 September 2019). Subject to that approval, the application will be submitted to NHSE&I and the constitution of that new body will be considered by memberships, according to their current requirements.

6.4. A successful application will allow an implementation phase in advance of April 2020.

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Appendix A

Since the initiation of our System Reform programme in March 2019, we have been developing our proposed approach to a South East London

CCG merger. The phasing of the full programme is shown below:

We have undertaken significant engagement work around principles and a case for change. Our engagement focus now shifts to

the design of our commissioning system, its functions, governance and ways of working

• This conversation can often feel transactional or ‘structure heavy’ – we mustn’t lose sight of our culture, Organisational Development and ways of working.

• In June, July & August we will be identifying and utilising engagement opportunities that build from our May discussions with Governing Bodies and stakeholders

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Appendix B

Set of Principles agreed through the System Oversight Group

1. Evidence enhanced effectiveness and enable our ICS development in response to

the Long Term Plan

2. Seek to drive best value out of all corporate investment; we will aim to minimise impact on staff by maximising efficiencies from estates, corporate costs and other non-pay costs

3. Ensure capacity and capability at each scale; the necessary cost savings will

need to be delivered but there must be assurance that the CCG and place based systems are able to undertake the CCG’s required functions effectively

4. Encourage integration with other partners; particularly at the borough level it is

expected that there could be increased blended teams with Local Authorities and other partners, and that some place based functions could be delivered with or by these partners

5. Initially include all functions; however some may be moved out of scope by the

System Reform Delivery Group or System Oversight Group

6. Speak to immediate and future operating environments; this programme should actively move us towards our ‘system of system’ ICS vision and therefore consider our resource requirements for the future as well as the immediate term

7. Support our staff through this change; we will aim to communicate regularly,

engage as much as possible, and offer options for our staff to minimise the concerns and impact related to these changes

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CCG Committee



Item title: Healthwatch Enter and View Visits – action plan update

Enclosure number:

G


Yes

G Enter and View Action Plan


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The purpose of this paper is to update the Primary Care Commissioning Committee (PCCC) on theprogress made by the CCG, GP Federations and practice following the recommendations made by Healthwatch after the Enter and View Visits which focused on GP practice appointment systems.


Between May and August 2017 Southwark Healthwatch visited all practices to review how appointment systems and services are delivered to patients across Southwark. As part of this, 39 practice managers completed online surveys about practice appointment systems, 50 receptionists were spoken to and 550 patients.

The report following the Enter and View visits is published here: https://healthwatchsouthwark.co.uk/sites/default/files/appointment_systems_at_southwark_gp_practices_-_are_they_working.pdf

In January 2018, the Primary Care Commissioning Committee was briefed on the report findings and recommendations made by Healthwatch for the CCG, GP federations and practices. In response to the recommendations the CCG provided a response to note the actions that would be progressed.



https://healthwatchsouthwark.co.uk/sites/default/files/appointment_systems_at_southwark_gp_practices_-_are_they_working.pdf

https://healthwatchsouthwark.co.uk/sites/default/files/appointment_systems_at_southwark_gp_practices_-_are_they_working.pdf

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The enclosed attachment provides an update on these recommendations and steps taken to support implementation where applicable.


The CCG and Healthwatch held a joint patient event where findings of the Healthwatch report were presented to patients. Details of ongoing patient engagement is included in the update report enclosed.




i NHS Southwark CCG and GP Federation response to the report




Recommendation CCG response/action Federation response/action CCG Update 2019 Federation Update 2019Contacting the practicePractices, with the support of Patient Participation Groups (PPGs), should review their telephone systems to identify if any improvements could be made. This should include:

phone lines / enough staff at busy periods to answer phones.

cancellations.

The CCG supports this recommendation and would expect practices to engage with PPG’s to identify if improvements can be made to individual telephone systems.

Telephone systems are the responsibility of the practice. Discussions about telephone appointments at north and south locality PPG meetings, including telephone triage system, automated telephone booking and cancellation service, digital services, including NHS App, practice website, EMIS Web. Sharing ideas to explore what works in other practices that can be adapted in other practices rather than adopting a one-size-fits-all approach. Update from QHS at north locality PPG about 8am – 8pm service (IHL update to be delivered at next south PPG meeting on 2 July 2019) commissioned by the CCG to provide additional primary care appointments. There have been some individual practices which have changed their phone systems in response to patient concerns engaging with their practice PPG.

IHL and QHS updated the North and South Southwark PPG's June/July meetings about EPCS delivery (and other Partnership Southwark and PCN development).

Practices, with the support of PPGs, should explore ways of promoting online booking other than use of flyers and posters - e.g. 1:1 conversation in the waiting area.

Patient Online materials are provided by NHS England. The CCG worked with Age UK to train volunteers to become digital champions to work in practices and support patients with online services and provided IT equipment to practices to support this work.Practices are encouraged to also have information regarding the online booking of appointments on their practice website.

Federations are supporting non clinical staff to develop connecting and communication skills through navigation and signposting training and development.

Booking online appointments can now happen through the NHS app. A national communications campaign is planned for Autumn 2019 to promote awareness. Locally the NHS app has been promoted at locality PPGs and is being presented at Southwark's network PPG with a demonstration on how to use it. This is with the aim that the PPG reps can explain back to patients at their representative practices on how to use this with 1:1 conversations.

Federations continue to support the training and development of front line practice staff in support of this objective. 2018 and 2019 development programmes include 'Active Signposting' and Team Management' training. In addition during 2019 PCNs will employ Link Workers who will work across practices and better connect patients to relevant services

NHS Southwark CCG and GP Federations should review the online booking system, to explore:

do people booking online bypass triage?)

those available via reception.

online only, or regardless of where the appointment was made?)The above should then be shared with practice staff and patients.

The CCG would expect practices to ensure that online appointments support practices individual appointment systems. We also expect practices to review the interface between patients booking online and the triage system for on the day appointments.The CCG expects that all appointments available to be booked online can also be booked over the phone, or via reception directly at the same time i.e. certain appointments are not offered by each different mode.The functionality of the patient online function is determined by the national system providers. Currently only appointments booked online through the patient online system can be cancelled via the patient online service. The CCG would encourage practices to make it easy for patients to cancel appointments to reduce DNA appointments. Examples of practice’s doing this is via text messaging or a separate telephone line.The CCG will have an on-going dialogue with practices through the Practice Manager Forum.

Federations are working with practices to support the increased the take up of online booking. This includes increasing patient awareness and reviewing booking systems – this is contributing to improvement. This support will continue in 2018/19 to help practices continue to improve patient access channels through peer review and sharing learning.

All practices offer online booking of appointments. Booking of appointments can now also be done through the NHS app.NHS England will be presenting at receptionist, GP and PPG events so that staff have the opportunity to ask questions regarding the new NHS app and their online booking processes. The CCG coordinates monthly Practice Managers forums and digital developments are discussed and promoted.

During 2018 and 2019 Federations have implemented a programme of practice visits to support the further take up of online booking. This has also been the subject of peer discussion at practice 'cluster' meetings and all practice membership meetings.

Practices, with the support of PPGs, should consider when same-day appointments should be made available (e.g. those that only release appointments in the morning could consider also releasing some in the afternoon - to not disadvantage people that aren’t able to call early in the morning).

The CCG encourages practices to review appointment systems with their patient participation groups. The CCG does not have any contractual levers to dictate patient appointment systems. However, we are aware of the difficulties patients report and will continue to work to facilitate improvements according to the need of patients.

The premium specification was introduced to enable practices resources to review their appointment systems and make changes to improve access for patients. There is also a requirement that practices engage with their PPG in relation to their appointment systems. All practices in 18/19 provided information to the CCG about how they engaged with their patients and reviewed data to make changes to appointment systems to improve access for patients. The CCG has funded also funded the APEX tool for practices to enable them to proactively review access for patients. The EPCS offers appointments on the same day for patients who need to be seen where there is no same day access at their individual practice.

NHS Southwark CCG and GP Federations should review the text reminder system and its impact on appointments where patients did not attend (DNAs), in order to determine whether it should be rolled out to all practices.

All practices have access to a text reminder service. This is funded by the CCG. Individual practices utilise this differently for their patient population. Practices are encouraged to review the impact of text messaging on their DNA appointments. As above the CCG has no specific contractual power, but we continue to work with practices and federations to improve this.

Federations are supporting practices to review their appointment systems and reduce DNAs that are one of the ’10 high impact areas’ identified in the GP Forward View

All practices have access to a text reminder services to reduce DNA's. In 19/20 practices will focus on identifying and reducing DNA's specifically as part of the access premium specification resources using the APEX tool.

Federations continue to support practices to maximise capacity for patients. In addition federations will work with practices to analyse information from the APEX tool and use this information to further improve access. In addition federations have developed plans to focus on reducing DNA s at federation EPCS. (Text reminders are already sent)

Practices, with the support of Patient Participation Groups (PPGs), should provide clear descriptions of the booking system, both in the waiting area and on the website.

The CCG supports this recommendation and will communicate this through the Practice Managers Forum, as other engagement forums with practices.

Discussions from locality PPGs suggests that the majority of practices provide descriptions of their appointment booking system in a poster format which is displayed in the reception area. Locality PPG members also noted that some members help practices to edit the information to make it accessible to all patients. The CCG also encourages practices to include this information on their websites.

Practices should involve their patients when considering making changes to their appointment systems, and if changes are made to systems, they should inform patients proactively about this.

The CCG support this recommendation and encourages practices to engage with their patient participation groups when making significant changes to appointment systems. We will review how we might have more impact in this area.

Practices have been encouraged to engage with their PPGs in relation to the NHS app and the appointment changes that may happen because of this implementation. There is a requirement that practices to engage with their PPG in relation to their appointment systems.

Practices, with support from NHS Southwark CCG and GP Federations, should consider:

appointments. This is to avoid patients being forced to request same-day appointments, due to lack of advance availability.

ensuring that there is a rationale for the system in operation (this is particularly important for practices who do not allow patients to book far ahead).

ahead.

Practices have individual appointment systems and operate different ratios of on the day appointments to routine appointments to need the needs of their population during different periods of the year.To support practices model their appointment systems such that they meet the needs of their population the CCG has commissioned a digital access tool to among other things provide data to practices to support practices consider and respond to patient patterns of need and make informed decisions to improve access to appointments.The CCG has engaged with Healthwatch and patients as well as practices to develop this tool.

Federations are supporting the development of the digital access tool and continue to support peer review. For example, cluster/neighbourhood meetings have focused on sharing access and also the availability of the Extended Primary Care Service (EPCS) which provides same day appointments.

The majority practices in Southwark have implemented the digital access tool, APEX to support them review their appointment data which will include clear information on the provision and utilisation of routine and same day appointments. This will support practices proactively review and make changes to their appointment systems to improve access for patients.

Federations are supporting practices to effectively manage demand and capacity in accordance with population need. This includes supporting PCNs to deliver Extended Hours and also maximising the utilisation of EPCS - utilisation has significantly increased since 2017

Practices should ensure they are carefully reviewing their triage system on an ongoing basis, from both a staff and patient perspective. This should include:

instances where they were not able to see a clinician face-to-face (or had to wait).

people are not triaged.

The supports the recommendation that practice’s review their triage systems on an on-going basis and the federations worked with practices in this area.The CCG encourages the sharing of good practice across practices to support improvements in access to appointments for patients. The Practice Managers Forum is used for sharing good practice.It is envisaged that the access tool commissioned by the CCG to support practices make improvement to access which can be reviewed on a regular basis.

The CCG will be hosting a workshop with practices in September 2019 which will focus on how practices have used the digital access tool, Apex, to improve access for patients. One aim of the workshop is to share best practice to learn from each other and improve access overall.

NHS Southwark CCG and GP Federations should explore the different triage systems in operation to determine:

Whether practices should adopt any good practice identified.

The CCG encourages the sharing of good practice across practices to support improvements in access to appointments for patients using the Practice Managers Forum.It is envisaged that the access tool commissioned by the CCG to support practices make improvement to access which can be reviewed on a regular basisGP federations have also been facilitating the sharing of good practice across practices.

Federations have supported the review of triage systems and will continue to facilitate the sharing of good practice at cluster. neighbourhood and member practice meetings.

As part of the contract management process the CCG reviews the clinical triage model including request of formal auditing process and continuous improvement process.

Practice triage audits are carried out for referrals to the extended access hubs. Feedback and peer discussion is driving continuous improvement as evidenced by repeat audits

Practices and GP Federations should consider how triage call-back systems could be improved from both a staff and patient perspective. This should look at:

The CCG supports this recommendation. GP federations and practices have been continuously improving this as part of the delivery of the extended primary care service.

The federations have carried out reviews of demand and call back (including timeliness and effectiveness) to improve access to EPCS. These reviews are shared with practices during practice meetings and good practice shared at cluster/neighbourhood meetings. Reviews will continue during 2018

As part of the contract management process the CCG reviews the clinical triage model including request of formal auditing process and continuous improvement process.

Good progress has been made as evidenced by high patient satisfaction levels and increase utilisation of the access hubs.

NHS Southwark CCG and GP Federations should monitor and evaluate the impact of the upcoming EPCS communications campaign (we support Deloitte’s recommendation (14) to - ‘Explore a way of developing a stronger awareness of EPCS’).

The CCG will complete this following the campaign. Federations will support the CCG evaluation Data available not able to demostrate use of service. Would need to consider other ways of measuring this.

Stronger awareness is now demonstrated though increase utilisation of the services.

NHS Southwark CCG and GP Federations should provide an update on their plans to look at quantifying practice/patient preference for flexible use of north and south EPCS (as stated in the CCG’s response to Deloitte’s recommendation (4) to - ‘Explore the possibility of allowing Federations to refer to either hub.’)

This will be reviewed as part of the work stream being undertaken by the GP federations and CCG in response to progressing the recommendations made in the EPCS evaluation report. However patient data sharing agreements currently do not enable this flexibility.

The Federations responses are aligned with the CCG comments The CCG and GP Federations are currently reviewing this as part of a wider review of the extended access hubs.

NHS Southwark CCG and GP Federations should investigate how the referral route to EPCS could be further streamlined, particularly in light of our recommendations around triage generally (in relation to Deloitte’s two recommendations relating to telephone management (2, 3) - ‘Explore if the pooled telephone management system should be started again’ and ‘Share best practice and promote cooperation across practices on telephone management’).

This will be reviewed as part of the work stream being undertaken by the GP federations and CCG in response to progressing the recommendations made in the EPCS evaluation report.IHL, the GP federation in south Southwark, tested centralised telephone triage for a number of practices however it was established that triage is more appropriate if done by a GP who knows the patient i.e. a clinician at the patient’s practice. The CCG and federations reviewed other areas and practices that have tested this and their outcome to see if we can learn from this locally.

Federations will continue to seek improvement. EPCS service improvement plans are reviewed monthly. The centralised telephone management tests did not improve efficiency or effectiveness and models of best practice will be reviewed and shared

There has been no change is the action and the CCG supports the federations and practices to continue to provide clinical triage into the EPCS in individual practices on the basis that the practices will have better knowledge of their registered patients. Best practice on telephone clinical triage is shared through the federation's meetings with practices

No further update

Understanding of appointment systems

Booking appointments in advance ('routine')

Clinical triage

Extended Primary Care Services (EPCS)



NHS Southwark CCG and GP Federations need to review staff training around EPCS, and explore further options, so the following can be avoided:

doesn’t offer same-day appointments).

can access their patient records.

benefit from seeing their named doctor.

At the start of the service significant training was completed to ensure practices and receptionists gave consistent messages regarding the service. Our GP federations are progressing this as providers of the service. This work needs to continue on an on-going basis and we will work with the GP federations to ensure this happens.Clinicians and operational managers at the extended primary care services discuss inappropriate referrals with individual practices so learning is shared.

Federations will progress as part of the workforce development. Specific programmes being implemented in 2017 and 2018 are focussed on practice front line staff and support connecting and communication skillsFederations audit referrals and share learning with practices individually and collectively to help ensure continuous improvement.

The federations working with practices to enable consistent offer across practices on a continuous feedback basis.

2018 and 2019 development programmes include 'Active Signposting' and Team Management' training. This is in addition to a programme of practice visits which include a focus on EPCS. Referral audits are completed quarterly and have resulted in quality improvement



NHS Southwark CCG and GP Federations should ensure receptionists’ training includes techniques for how to ask patients about their condition, such as:

information.

Funding has been available through the GP Forward View to up skill and train receptionists to become care navigators. A care navigator will have knowledge of local support services for patients that may support improved health and social outcomes.

Federations are implementing navigation and signposting training and development to better equip staff in practices with connecting and communication skills

The federations working with practices to enable consistent offer across practices on a continuous feedback basis.

During 2019 'Making Every Contact Count' training has been rolled out to include practice teams and also partners

Practices should explore how privacy could be improved at the reception desk. We know there is some good practice across the borough and encourage practices to learn from this.

The CCG supports the recommendation that practice’s should look at how patient privacy can be reviewed at reception desks

Federations actively work with the practice manager forum where privacy at reception has been discussed.

No further update

GP Federations should consider providing formal, coherent protocols for practices explaining under what circumstances receptionists might or might not suggest a) routine rather than urgent appointments, and b) services external to their surgery (including pharmacy, A&E, UCC, walk-in centres, 111). It should be clear at which point a clinician’s decision is necessary.

The CCG recognises that this recommendation would be helpful to practices, however due to the individual nature of practice’s appointment systems each practice should ensure they have coherent protocols for receptionists to follow.

Federations provide EPCS and ensure that clear protocols are in place. Audits are conducted, and the findings discussed with practices to help ensure continuous improvement

No further update

Practices, with guidance from GP Federations, should provide clear, written guidelines to receptionists about the limits of their responsibilities regarding patient redirection.

It is expected that practices should manage this as employers of receptionists. The primary care navigation training for receptionists will support this work.

Federations facilitate the training and development programmes previously described to enhance patient signposting / redirection and communication skills. This is supported by protocols for EPCS

No further update 2018 and 2019 development programmes previously described to enhance patient signposting / redirection and communication skills. This is supported by protocols for EPCS.

NHS Southwark CCG and GP Federations should review practices’ use of walk-in centres in other boroughs, including:

The CCG receives data regarding patient use of walk in centres in other boroughs.Individual practice utilisation of the extended primary care service is reviewed at the contract performance meetings. GP federations meet practices with low utilisation to understand barriers of utilising the extended primary care service. The priority is patient access to appropriate appointments which does vary on a practice by practice basis.The extended primary care services are near to operating at 100% capacity or utilisation. It is expected that utilisation may increase should the Lewisham walk-in centre closes for our registered population. The CCG will continue to review this.

Federations closely monitor the utilisation of EPCS by referral source and time of day. This comprehensive management information forms the focus for service development and contract meetings with the CCG

The CCG reviews practice use of EPCS against core GP access through local discussions. The CCG is reviewed against other South East London services and has higher funding ratio in the SEL. The CCG has worked with the providers to implement best practice from NHS England London region. There is a review of extended access taking place across London by NHS England the CCG has offered to host a visit by the review team. The CCG is working with the federations to meet the 85% ultlisation rate (excluding DNA)

NHS Southwark CCG should investigate whether the Pharmacy First system is being operated correctly at all pharmacies.

The CCG is currently reviewing the Pharmacy First Scheme and will be ensure this recommendation is included as part of this review.

The CCG reviews the PF service through normal contracting arrangements. The CCG has completed a review of the Pharmacy First Service which looked at the operation of the service across all community pharmacies in Southwark. Recommendations were made to the PCCC in relation to service changes. An equalities impact assessment is currently being completed and discussions with the Local Pharmaceutical Committee is required before progressing this work.

Practices should ensure that all receptionists are enabled to attend Protected Learning Time (PLT) sessions on a regular basis.

The CCG hosts practice learning time events every month which focuses on clinical training for clinicians.However, at this time the CCG often hosts non-clinical training for practice staff. All practices are encouraged to send attendees.

Federations are working with practices to deliver non clinical / reception training at times and places that suit these staff

Receptionists will have their own 1 hour event, it is in progress of being planned. All practices are encouraged to send attendees.

GP Federations should assist practices to complete a training audit for their reception staff, including key areas such as EPCS.

Federations provide support to practices where needed and facilitate workforce development programmes which all practices can benefit from

NHS Southwark CCG and GP Federations should involve patient representatives as they explore alternatives to face-to-face appointments (Healthwatch staff have been involved in some workshops). If practices decide that options such as online consultations would relieve pressure on surgeries and provide convenience for some of their demographic, patient choice should be paramount.

The CCG has been working with practices to develop a specification for online consultation development which meets needs of Southwark practices. This work is being completed to nationally set timescales.Healthwatch and patients have been involved in the development of the specification and the CCG will continue to engage with Healthwatch and patients in this work.

The federations will support practices to provide alternatives to face to face appointments if requested to do so

All practices in Southwark are now live with online consultations. Usage is increasing month by month as practices embed this way of working into their day-to-day. Further developments for alternatives to face-to-face include: An eHub model for triage of online consultations being explored by the GP Federations in order to streamline the referral/triage route.

Practices that do not already employ one should consider the benefits of upskilling existing nursing staff or employing an ANP (or other non-GP clinicians).

Practices employ staff based on the needs of their individual populations. The CCG recognises the importance of practices utilising a varied workforce with different skills. To support this the CCG has:

Guy’s based on primary and community care to increase exposure to nursing in a primary care community care setting thus supporting more recruitment and retention of nurses into this setting.

to support and compliment the work of GPs e.g. by completing medication reviews.

Federations have developed lead nurse roles who work with the CCG to provide more opportunities for nurse training and mentoring.Federations are part of the NHS England Clinical Pharmacists in General Practice program and have recruited 9 pharmacists to work across practices to provide enhanced medicines management services as part of the general practice team

The CCG is progressing with all of the projects mentioned within the CCG response.

Practices should consider adopting procedures so that if the ANP cannot treat the condition the patient they can be referred quickly to a GP (perhaps bypassing standard appointment systems) in order to avoid overall longer waits or multiple appointments.

Practices have processes in place to ensure that patients are booked with the correct clinician such as clinical triage or receptionists asking patients for the reason of the appointment. The CCG would expect practice’s to follow this recommendation if this situation was to occur.

GP Federations and practices should work together to display consistent information (so there are unified communications across Southwark) in GP waiting areas about ANPs (and other non-GP clinicians), their skills and training, and what they can and cannot treat. Some GP waiting areas do display such information.

The CCG would support this recommendation. Federations will work with practices and the CCG to help ensure consistency

Practices should provide better and clearer information about patients’ different options for accessing primary care, in order to help relieve demand. Leaflets and posters in waiting areas should be systematically rationalised so that people know where to look.

The CCG would support this recommendation. The CCG has provided EPCS communications materials.

Practices could consider a specific notice board focused on different topics around access, such as:

The CCG would support this recommendation.There are national and local materials which support some of these requests.

GP Federations should continue to provide resources for public education around DNAs. NHS Southwark CCG should consider a wider public education campaign to reinforce this.

The CCG will consider a wider public campaign on DNA appointments. Currently individual practice’s manage these messages to patients.

Federations will continue to support practices to provide resources as recommended

In 19/20 the CCG plan to focus on reducing DNA's specifically as part of the access premium specification using the APEX tool. It is expected practices action plans may include public education in relation to DNAs

Federations provide information to practices on EPCS DNAs and the practices follow up with their patients

NHS Southwark CCG should work closely with Southwark Council around regeneration projects and population change in the borough to ensure adequate GP coverage.

The CCG works closely with Southwark Council around regeneration projects and population change in the borough to ensure adequate GP coverage. The CCG is a member of the Health and Wellbeing Board. Southwark Council is also invited to attend the CCG’s Primary Care Commissioning Committee. The CCG presented to OSC Healthy Communities on this area.

Support and training for receptionists

Alternatives to face-to-face appointments

Use of Advanced Nurse Practitioners (ANPs)

Challenges and pressures

Receptionists asking about a patient's condition

The role of the receptionists - redirecting patients



1



ITEM FOR DISCUSSION / ASSURANCE

CCG Committee



Item title: GP Patient Survey Results and Patient Experience

Enclosure number:

H

Any known conflict of interest

Choose from the drop-down menu

H GP Patient Survey


2



Discussion Assurance ☐



Job title Primary Care Commissioning Manager

Job title Director of Integrated Commissioning




The purpose of this report is to review the CCG’s GP Patient Survey Results published in July

2019 and to provide a comparison against the national average and Lambeth and Lewisham

CCGs. To get a broader view of patient experience in Southwark the results for the Friends and

Family Test (FFT) are also presented. Practices often report results from the GP Patient Survey

are not representative as patients selected may have not attended the practice for some time,

whereas the FFT is available to patients attending the practice for appointments.

The report also outlines some of the work being completed by the CCG following the publication of

the results to support improvement in patient experience.


The CCG has a statutory obligation to support improvements in general practice. Following

publication of the GP patient survey (GPPS) results in July 2019 the enclosed report reviews

some of the question in key areas and compares Southwark’s results with the national average as

well and Lambeth and Lewisham CCGs. The report focuses on the questions related to access as

generally the CCG is aware that patient feedback and complaints are often related to access to

H GP Patient Survey


3


appointments. The full report of the GP Patient Survey is within the link - https://gp-

patient.co.uk/Slidepacks2019#S .

The GPPS results show that Southwark performs less well in most of areas compared to the national average and Lambeth and Lewisham CCG. The report notes actions that the CCG is following to ensure that practices review the results with their patient participation groups and identify areas where improvement is required. Practices with the lowest overall scores will be asked to submit action plans to the CCG which will be monitored.


The CCG has sent the results to practices and asked that they discuss them with their patient participation group to identify areas that require improvement. The results will also be reviewed at the locality patient participation groups (PPG) so they can request that their practices includes the results on the next PPG agenda for discussion.




i GP Patient Experience report

Date paper completed

Friday, 19 July 2019

H GP Patient Survey


https://gp-patient.co.uk/Slidepacks2019#S


2018/19 Patient Experience Report

July 2019

H GP Patient Survey


NHS Southwark CCG – 2018/19 Patient Experience Report

Page 2

Version Date Details/provenance/comments Author Sent to

1 July 2019 Version for PCCC Janita Patel PCCC

Table of Contents

1.0 Purpose .......................................................................................................................... 3

2.0 GP Patient Surgery (GPPS) ........................................................................................... 3 2.1 Overall experience ...................................................................................................... 4 2.2 Access by telephone ................................................................................................... 5 2.3 Experience of making an appointment ........................................................................ 7 2.4 Appointment times ...................................................................................................... 8 2.5 Practice Improvement Plans – GP Patient Survey Results ………………………………9 2.6 2019/20 Improvement Plans .... …………………………………………………………….10 3.0 Friends and Family Test (FFT) ................................................................................... 11 3.1 Practice submission .................................................................................................... 13 4.0 Southwark Premium .................................................................................................... 14 4.1 Southwark premium KPIs ............................................................................................ 15 5.0 Conclusion ……………………………………………………………………………………..16

H GP Patient Survey


1.0 Purpose

The purpose of this report is to review the CCG’s GP Patient Survey Results published in

July 2019 and to provide a comparison against the national average and Lambeth and

Lewisham CCGs.

The results for the Friends and Family Test (FFT) are also presented, as this shows real time

data of patients attending a recent appointment. The GP Patient Survey is a tool for

measuring patient access and satisfaction and for comparison with other boroughs.

However, it is recognized there are limitations with the GP Patient Survey representation as

a small percentage of patients respond who are selected randomly and may have not

attended the practice recently. The FFT should be available to patients attending the practice

for appointments.

The report also outlines the work being completed by the CCG with practices, GP

Federations and the newly formed Primary Care Networks to support improvement in access

and patient experience.

2.0 GP Patient Survey (GPPS)

The GP Patient Survey (GPPS) is an annual England-wide survey, providing practice-level

data about patients’ experiences of their GP practices.

The GP Patient Survey measures patients’ experiences across a range of topics, including:

Making appointments

Perceptions of care at appointments

Managing health conditions

Practice opening hours

Services when GP practices are closed (such as out of hours)

The GP Patient Survey provides data at practice level using a consistent methodology, which

means it is comparable across organisations.

The survey has limitations:

Sample sizes at practice level are relatively small, at approx. 1%

The survey does not include qualitative data which limits the detail provided by the

results.

The data is provided once a year rather than in real time.

It is not known if the patients that return the survey have attended or made contact with

the practice in the last year

However, given the consistency of the survey across organisations, GPPS can be used as one

element of evidence of patients experience of a practice. It can be triangulated with other

sources of feedback, such as feedback from Patient Participation Groups, local surveys and

the Friends and Family Test, to develop a fuller picture of patient journeys.

For the results published in July 2019 16,902 questionnaires were sent out to patients in

Southwark, and 3,443 were returned completed. This represents a response rate of 20%. Split

evenly across practices which equates to approximately 95 questionnaires being completed

for each practice.

H GP Patient Survey



Page 4

Table 1 highlights some of the key questions from the GP survey results published in August

2018 and July 2019 with a comparison against Lambeth and Lewisham CCGs our

neighboring boroughs.

H GP Patient Survey


Table 1 - Summary GP Survey Results July 2019

Aug-18 Jul-19

 

Survey

question

So

uth

wark

Lam

beth

Lew

ish

am

Nati

on

al

avera

ge %

 

So

uth

wark

Lam

beth

Lew

ish

am

Nati

on

al

avera

ge %

Overall experience of GP practice

Good 79% 84% 81% 84%   79% 84% 80% 83%

Poor 9% 6% 7% 6%   8% 5% 7% 6%

How easy is it to get through to someone at your GP practice on the phone?

Easy 73% 76% 63% 70%   69% 76% 61% 68%

Not easy 27% 24% 37% 30%   31% 24% 39% 32%

Overall how would you describe your experience of making an appointment

Good 62% 72% 65% 69%   60% 70% 62% 67%

Poor 18% 12% 18% 15%   18% 14% 20% 16%

How satisfied are you with the general practice appointment times that are available

to you?

Satisfied 61% 68% 64% 66%   60% 66% 60% 65%

Unsatisfied 21% 16% 19% 17%   21% 17% 21% 18%

2.1 Overall experience

79% 79%

84% 84%

81%

80%

84%

83%

76%

77%

78%

79%

80%

81%

82%

83%

84%

85%

Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19

Overall experience of GP practice - rated 'good'

Southwark Lambeth Lewisham National average %

H GP Patient Survey



Page 6

In 2019, 79% of patients in Southwark described their overall experience of their GP Practice

as 'good'. There is no changed compared to the 2018 results, whereas the national average

decreased by 1% and Lewisham’s overall average decreased by 1%. However, Southwark is

lower than Lewisham (80%), Lambeth (84%) and the national average (83%).

In comparison to last year, the percentage of patients reporting their overall experience as

‘poor’ has decreased slightly for Southwark and Lambeth but remained the same for

Lewisham and the national average. Southwark has the highest percentage of patients

reporting their experience as ‘poor’ compared to Lambeth, Lewisham and national averages.

2.2 Access to get through by telephone

9%

8%

6%

5%

7% 7%

6% 6%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%


Overall experience of GP practice - rated 'poor'


73%69%

76% 76%

63% 61%

70% 68%

0%

10%

20%

30%

40%

50%

60%

70%

80%


How easy is it to get through to someone at your GP practice on the phone - rated 'easy'


H GP Patient Survey



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The percentage of patients reporting that they found it difficult to get through on the phone

increased from 27% in 2018 to 31% in 2019. Although this percentage is high, it is lower than

the national average of 32%.

In 2019, 69% of Southwark patients and 76% of Lambeth patients found it 'easy' to get

through to someone at their surgery on the phone. This is higher than the national average of

68%. In Lewisham 61% of patients reported that it was ‘easy’ to get through to someone on

the phone. In Southwark the results in 2019 have increased by 4% compared to 2018. This is

a higher increase than the national average results which increased by 2% from 2018 to

2019.

2.3 Experience of making an appointment

27%

31%

24% 24%

37%39%

30%32%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


How easy is it to get through to someone at your GP practice on the phone - rated 'not easy'


62%

60%

72%

70%

65%

62%

69%

67%

54%

56%

58%

60%

62%

64%

66%

68%

70%

72%

74%


Overall how would you describe your experience of making an appointment - rated 'good'


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The national average for the percentage of patients reporting their overall experience of

making an appointment as 'good' decreased from 69% in 2018 to 67% in 2019. For

Southwark the average decreased by 2%, from 62% in 2018 to 60% in 2019.

In 2019, 18% of patients in Southwark reported their overall experience of making an

appointment was 'poor', compared to the national average of 16%, 14% in Lambeth and 20%

in Lewisham.

2.4 Appointment times

In 2018 a new question was added to ask patients how satisfied they were with appointment

times available to them.

Compared to Lambeth, Lewisham the Southwark average was lower, with only 60% of

patients being ‘satisfied’ with the appointment times available to them. The national average

was 65%. Reviewing the data at an individual practice level it does not appear that the GP

Patient Survey results correlate to utilisation of the extended primary care service is

Southwark which is open 8am – 8pm, 7 days per week. Therefore, it is thought that some

patients may not have used this service.

All practices in Southwark have information about the extended primary care services on

their websites and in reception areas. The CCG has also run a promotional campaign to

improve awareness of this service.

18% 18%

12%14%

18%20%

15%16%

0%

5%

10%

15%

20%

25%


Overall how would you describe your experience of making an appointment - rated 'poor'


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2.5 Practice Improvement Plans – GP Patient Survey Results

In 2018/19 the CCG’s primary care commissioning team asked that the five practices with the

lowest percentage of patients rating their overall experience of the practice as ‘good’ to submit

a formal action plan to the CCG to confirm the steps the practice is taking to support

improvements in patient experience. Practice action plans included the following areas:

Update practice website to advise of appointment options and produce posters to

better advertise recent changes made to appointment systems

Regularly check the proportion of online appointments to ensure availability in line

with patient demand as this changes

Staff to proactively encourage patients to utilise online services so that telephone

lines can be used for other patient services

Discuss training needs and develop a training programme for clinicians (nurses, GPs

and Clinical Pharmacists) to help improve patient interaction resulting in patients

being empowered to work with their clinician on managing their conditions

Re-advertise the role of the clinical pharmacist in assisting patients with long term

conditions and medicines optimisation to support the patients understanding of new

clinical roles in general practice

60%66%

60%65%

21%17%

21%18%

0%

10%

20%

30%

40%

50%

60%

70%


How satisfield are you with General Practice appointment times that are available to you - 2019

Satisfied Dissatisfied

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From this information in January 2019, the primary care team developed a document to

share themes and actions from the practice’s action plans in response to the GP patient

survey results across all practices in Southwark to support quality improvement.

Of the practices that submitted action plans in 2018/19, all have seen improvements in July

2019 compared to the results published in August 2018. See table below.

Practice Aug-18 Jul-19

The Acorn and Gaumont House 63% 83%

The Dulwich Medical Centre 66% 75%

Borough Medical - Dr Sharma’s 66% 87%

Bermondsey Spa 62% 59%

Falmouth Road 69% 65%

However, two practices from last year, Bermondsey Spa and Falmouth Road remain in the

bottom five. The CCG will continue to monitor their action plans to support improvements in

patient experiences.

2.6 2019/20 Improvement Plans

The five practices that have scored the lowest percentage of patients rating their overall

experience as ‘good’ in July 2019, compared to last year is shown in the table below.


Bermondsey Spa 62% 59%

The Lister Practice 60%

Sternhall Lane 72% 63%

Falmouth Road 69% 65%

Forest Hill 71% 66%

The CCG will contact the practices and ask them to submit an action plan to the CCG to

confirm the steps the practice is taking to support improvements in patient experience.

From the July 2019 GP patient survey results it is evidenced that there are have been

practices that have decreased their percentage significantly from last year’s report. The table

below shows those practices with 10% or more decrease.

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Queens Road 90% 75%

Melbourne Grove 81% 68%

DMC Chadwick 80% 70%

East Street Surgery 89% 79%

Borough Medical - Dr Misra 89% 73%

The CCG will contact the practices as a priority to ask for clarification about why their scores

have decreased significant and to find out how they will be working to improve their scores

and to offer support if required.

The GP patient survey results will be presented to the Engagement and Patient Experience

Committee (EPEC) in August, where discussions will focus on comparing Southwark results

to other London CCGs and how we can engage with patients on improvements

The full report of the GP Patient Survey is within the link - https://gp-

patient.co.uk/Slidepacks2019#S .

3.0 Friends and Family Test (FFT) (National via CQRS)

Practices are contractually required to report the numbers of Friends and Family Test (FFT)

responses to commissioners monthly via CQRS, as well as publishing their own results

locally to patients.

Practices usually report that FFT results are generally more representative of their patients

experience as patients surveyed are those that have attended the practice.

The below table highlights the patient results for the Friends and Family test (FFT) from April

2018 to March 2019. The table below compares the results to Lambeth and Lewisham and

the national average.

How likely are you to recommend our GP practice to friends and family if they needed similar

care or treatment?

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Southwark (08Q) Lambeth (08K) Lewisham (08L) National

average %

Mo

nth

2018

%

reco

mm

en

ded

% n

ot

reco

mm

en

ded

To

tal re

sp

on

ses

%

reco

mm

en

ded

% n

ot

reco

mm

en

ded

To

tal re

sp

on

ses

%

reco

mm

en

ded

% n

ot

reco

mm

en

ded

To

tal re

sp

on

ses

%

reco

mm

en

ded

% n

ot

reco

mm

en

ded

Apr-

18

85% 8% 2,483 88% 8% 2,560 82% 11% 2,276 90% 6%

May-

18

90% 5% 1,894 88% 8% 3,249 85% 9% 4,351 89% 6%

Jun-

18

86% 9% 3,543 91% 6% 4,684 87% 8% 4,581 90% 6%

Jul-

18

88% 7% 3,208 85% 10% 3,336 87% 8% 4,874 90% 6%

Aug-

18

88% 7% 2,961 89% 7% 2,770 88% 8% 4,219 90% 6%

Sept-

18

88% 6% 2,016 90% 6% 4,069 88% 7% 3,929 90% 5%

Oct-

18

88% 6% 1,654 89% 7% 4,547 87% 9% 4,719 90% 5%

Nov-

18

89% 6% 2,132 90% 7% 3,574 87% 8% 4,672 90% 6%

Dec-

18

77% 11% 6,182 89% 7% 2,298 87% 8% 3,306 90% 6%

Jan-

19

80% 11% 2,935 90% 7% 4,102 87% 8% 4,016 90% 6%

Feb-

19

87% 7% 1,275 89% 8% 2,716 87% 8% 3,824 90% 6%

Mar-

19

83% 8% 8,340 89% 7% 4,314 86% 9% 6,036 89% 6%

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In April 2018 the total number of Southwark responses was 2,483, which was 77 less

than Lambeth responses and 207 more less than Lewisham responses.

The average percentage of patients who would recommend their GP practice to

family and friends was 86% in Southwark, 87% in Lewisham and 89% in Lambeth.

The national average was 90%.

In December’s reporting, Southwark CCGs results show 12% drop in the number who

would recommend their GP practice, from the previous month even though the

number of responses had increased by 4,050. This may have been as a result of

winter pressures and practices coping with the demand.

In March, Southwark had the highest number of total responses from their practices

of 8,340 which is a good quality sample of patient experience feedback

The national average percentage of patients who reported that they would not

recommend their GP practice was 6%. The Southwark and Lewisham average was

8% and Lambeth was 7%, all above the national average 6%.

3.1 Practice data submission – National FFT via CQRS

The submission of FFT data via CQRS is as contract requirement, however not all practices

have been submitting data using this system. The table below shows the percentage of

practices that submitted data during the months of April to March via CQRS. Compared to

70%

75%

80%

85%

90%

95%

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

% of patients likely to recommend to Friends and Family

Southwark (08Q) % recommended Lambeth (08K) % recommended

Lewisham (08L) % recommended National average in England % recommended

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Lambeth. The CCG will continue to monitor results and will remind practices of their

obligation to submit their results via CQRS and to publish results locally as well as discuss

with their PPGs.

Month Southwark % Lambeth % Lewisham %

April 18 51% 40% 36%

May 18 76% 64% 59%

June 18 73% 68% 77%

July 18 86% 57% 77%

August 18 81% 59% 64%

September 18 65% 60% 69%

October 18 48% 63% 76%

November 18 65% 60% 64%

December 18 67% 60% 76%

January 19 66% 60% 73%

February 19 59% 53% 73%

March 19 69% 67% 57%

4.0 Southwark Premium

The CCG recognises the importance of access and good patient experience. In recognition

of this the Southwark premium specification includes an access specification where practices

are required to review appointment data to make changes to their appointment and access

systems to improve patient experience. The CCG has commissioned a digital tool, Apex, to

support practices with this and so they can make improvements to their appointment systems

based on their data. The premium specification also includes two patient experience key

performance indicators which are focused on the FFT test as below.

Q1. Would you recommend the practice to your friends and family?

The CCG set the target based on 2017/18 baseline data and practices will be working to

improve this target.

Band A = 81%

Band B = 70%

Q2. What was your overall experience of booking an appointment?

(Targets for this question have been agreed following the collection of baseline data).

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The specification notes practices should aim to have distributed the Friends and Family Test

to at least 60% of patients who attended the practice for an appointment. Where practices

have low response rates the CCG will ask for information about what the practice is doing to

ensure the data they are collecting is representative. Best practice will be shared across

practices to increase the number of patients surveyed.

It is recognised that the response rate for the question relating to the patients experience of

booking an appointment will be lower than the first FFT question because practices currently

do not have the ability to ask this question through I plato, the text messaging system

practices use. I plato are currently reviewing how the second question can be asked using

their systems and the CCG will keep practices updated with

4.1. Premium Specification Key Performance Indicators

The table below details the average percentage for each of the questions.

Month % of patients reporting how likely they

are to recommend their GP practice to

friends and family if they needed similar

care or treatment as ‘extremely’ or

‘likely’.

Variation of

practices

April 89% 68% - 100%

May 85% 40% - 100%

June 86% 59% - 100%

July 86% 59% - 100%

August 87% 66% - 100%

September 89% 63% - 100%

October 87% 58% - 100%

November 84% 61% - 100%

December 86% 61% - 100%

January 86% 55% - 100%

February 83% 27% - 100%

March 84% 54% - 100%

Month % of patients reporting their overall

experience of making an appointment as

‘excellent’ or ‘good’.

Variation of

practices

April 81% 47% - 100%

May 80% 56% - 100%

June 77% 50% - 100%

July 81% 13% - 100%

August 80% 62% - 100%

September 82% 55% - 100%

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October 80% 54% - 100%

November 80% 50% - 100%

December 79% 48% - 100%

January 79% 41% - 100%

February 76% 38% - 100%

March 79% 35% - 100%

This data shows that the number of patients reporting their experience of making an

appointment as ‘excellent or ‘good’ via the Southwark premium is significantly higher

compared to the GP Patient Survey results. There are different reasons for why this may be

which include:

- The Southwark premium questionnaire is surveying patients that have already had an

appointment whereas the GP Patient Survey may capture patients that have

contacted the practice but have been unable to get an appointment

- The GP Patient Survey results may include an experience from a patient that tried to

get an appointment a year ago and not since, therefore their perception of the

practice may not be an accurate reflection of the practice

5.0 Conclusion

The CCG will continue to work with practices, the GP federations, patients and the Primary

Care Networks to improve access needs for our local population. There is still further

progress to be made to continually focus on improvements, maximising resources for access

and reducing variation between practices. The GP survey results have not improved since

last year although the Friends and Family Test shows slightly better satisfaction overall. To

support improvements for patients and to support implementation of the Southwark access

premium specification the CCG is hosting a workshop in September 2019 for practices to

review the access data presented by the digital tool, Apex, and to find out from other areas in

London how they have used Apex to improve access for patients.

It should also be highlighted that practices are in the process of mobilising the new national

GP contract which includes resources to increase the workforce to provide patient care.

There has also be an introduction of the Primary Care Networks (PCN) which will be

providing the national extended access directed enhanced service (DES) rather than on an

individual practice basis. The CCG and PCNs will need to work on how this works with the

extended primary care services and how we engage with patients on how we can maximise

access for patients.

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1




CCG Committee



Item title: GP Forward View Resilience Funding

Enclosure number:

I


No



I GP Resilience


2









The purpose of this paper is to inform the Primary Care Commissioning Committee on how GP Forward View resilience funding has supported practices in 2018/19 and to summarise the process that will be followed to prioritise practices in 2019/20.


The GP Forward View (GPFV) made a commitment to support vulnerable practices through a national 4-year resilience programme.

2018/19

The GPFV made a commitment to support vulnerable practices through a national 4 year resilience programme. 2018/19 was the third year of the programme. Practices were prioritised using a range of indicators including CQC ratings, number of complaints, GP patient survey results and QOF. The Local Medical Committee was engaged with as part of this process. Funding for 2018/19 was confirmed for the following practices:

- Camberwell Green Surgery

- Lordship Lane Surgery

- New Mill Street Surgery

- Sir John Kirk Close Surgery

- Park Medical Centre

- Nexus Health Group

I GP Resilience


3


The enclosed report outlines the details of the practice resilience funding, and how practices used the funding.


n/a





i 2018/2019 GP Resilience Funding Report

Date paper completed Tuesday, 16 July 2019

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2018/2019 GPResilience FundingReport

July 2019

I GP Resilience


NHS Southwark CCG – 2018/19 GP Resilience Funding Report

Page 2

1.0 Purpose

The purpose of this report is to provide outline how practices utilised the GP Forward View (GPFV) resilience funding in 2018/19 and the outcomes that this delivered to support improvements in practice’s sustainability as well as improved patient care and experiences.

2.0 Background

The GPFV made a commitment to support vulnerable practices through a national 4 year resilience programme. 2018/19 was the third year of the programme. Practices were prioritised using a range of indicators including CQC ratings, number of complaints, GP patient survey results and QOF. The Local Medical Committee was engaged with as part of this process.

The table below outlines the practices that were prioritised in Southwark for resilience funding in 2018/19.

Practice Funding

Camberwell Green Surgery £12,860

Lordship Lane Surgery £1,198.80

New Mill Street Surgery £2,800

Sir John Kirk Close Surgery £4,800

Park Medical Centre £1,600

Nexus Health Group £62,480.20

3.0 Practice Case Studies

3.1 Camberwell Green Surgery

The practice required support following several GP partners retiring and subsequent difficulty in recruiting GP’s and a heavy clinical workload for the remaining permanent GP’s as well as CQC inspection in January 2018 which rated the practice as ‘requiring improvement.’ The practice used the funding to commission the Royal College General Practitioner (RCGP) to provide a programme of support to the practice.

RCCP programme focused on areas highlighted by the CQC inspection which included:

∑ Leadership

∑ Succession planning, capacity and recruitment

∑ Roles, relationships and governance processes

∑ Premises

An action plan was developed by the practice and RCGP which focused on:

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a) A review of clinical processes and leadership structures to support the development of a sustainable and resilient practice partnership and clinical workforce as well as robust governance processes

b) A review of management roles, processes and reporting structures to support efficiency and resilience which also included the development of a formal appraisaland training needs assessment

c) A review of nursing team capacity to support resilience and the development of a reporting structure for nursing team

As part of the action plan Camberwell Green Surgery recruited a nursing team which includes practice nurses and an advanced nurse practitioner. There is a formal reporting structure with a nurse lead and a weekly GP quality improvement session to foster and facilitate good inter practice/workforce relationships, system efficiencies and leadership. The practice has also an appraisal tool to support their appraisal processes.

The practice recognises that they need to continue to implement the actions as part of the RCGP. There has been a change in management structure and the implementation of efficient management processes is a priority which is being taken forward.

Following the RCGP programme the practice has been rated as good overall by the CQC after an inspection on 12 September 2018.

3.2 Lordship Lane Surgery

In March 2018 the practice received a focused CQC inspection which rated the practice as ‘requires improvement’ under the safe domain. The CQC noted that the practice should strengthen management areas especially in relation to risk assessments, staffing and training. It was also noted in the prioritisation data that the practice required support in relation to workforce sustainability.

The practice used the resilience funding for their practice manager to attend a Londonwide Local Medical Committee practice management training course.

The course has been written by senior practising practice managers, general practitioners

and topic specialists and was taught by practice manager educators. There are eleven

modules covering:

∑ Working in General Practice, Past, Present and Future

∑ The Manager and Their Practice

∑ Managing People and Self-management

∑ Overview of Practice Finance

∑ Regulation and Compliance in General Practice

∑ Premises – Financial Complexities and Legal Obligations

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∑ Clinical Governance and Safeguarding

∑ Service Delivery – a Climate of finite Resources

∑ The Practice-Patient Interface

∑ Training Practices

∑ Facilitating and Supporting Practice Development

Areas that the practice manager has led following the training includes a review of practice

processes.

a) The manager has led implementation of a new text messaging system to support GPs work more efficiency by texting patients with test results and informing them if they need to make an appointment for follow up. This saves clinical and admin time and support practice resilience.

b) The practice has recruited to additional administration roles as an outcome of this review

c) Staff training processes including a new system for recording mandatory training which will highlight if staff members have out of date training so this can be addressed

3.3 The New Mill Street Surgery

Following a CQC inspection on 26 June 2018, the practice was rated as ‘requires improvement’. This was an improvement on the inspection prior to this, on 9 November 2017 where the practice was rated as inadequate and placed into special measures.

The practice utilised the resilience funding to address the findings of the CQC report and implement the recommendations and have completed the works for the following areas:

a) A review processes and policies in relation to medicines management and safeguarding lead by the clinical lead

b) Additional management and admin support to focus on the development and implementation of an action plan from results of a local patient survey

c) Additional admin and clinical capacity to improve cervical cytology uptake

d) Additional management time to address premises issues which included:

∑ Improved disabled access∑ Refurbishment and redecoration work∑ Infection control compliance

The New Mill Street Surgery are waiting for a follow up CQC inspection.

3.4 Sir John Kirk Close

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The practice had a CQC inspection on 09 May 2018 and received an overall rating of requires improvement, with a rating of inadequate under the ‘safe’ domain.

The practice used resilience funding to backfill the clinical leads time to enable them to lead the action plan to address the concerns raised by the CQC. This was done by working with the Locality Manager and the Operations Manager. The areas which the CQC action plan focused on were:

∑ A review of the practice appointment system following areas of concern raised by the CQC which removed an element of reception signposting patients with certain symptoms to other services

∑ Conducted a comprehensive review of emergency drugs storage and the management of the cold chain, implementing new processes at the practice and ensuring staff were trained appropriately

∑ Reviewing management processes in relation to recruitment and training and overseeing the implementation of these.

Sir John Kirk Close Surgery has received their draft report from when they were reinspected by CQC on 31 May 2019. The practice was rated as good, with good across safe, effective, caring and well-led.

3.5 Park Medical Centre

In February 2019 the Primary Care Commissioning Committee approved the partnershipmerger of Park Medical Centre and Albion Street Group Practice to support general practice resilience in Southwark and improved service delivery to patients.

Following the decision, the practice applied for resilience funding to enable them to host an all staff quality improvement away day which focused on:

∑ NHS General Practice strategy and the benefits to patients and practices of working at scale

∑ Explored and discussed possible opportunities and challenges resulting from the merger developing action plans owned by all staff

∑ Prioritised key tasks for the practice in relation quality improvement with engagement from all practice staff.

Following the all staff away day the two practices have held joint practice learning time sessions which have focused on the development of joint policies and procedures. Thepractices have working groups around quality improvement areas to improve targets and patient engagement for cervical cytology and immunisations uptake which were identified as key areas at the away day.

Implementation will be monitored by the CCG through meetings where the improvement plan agreed as part of the merger will be reviewed.

3.6 Nexus Health Group

Following a comprehensive inspection by the CQC of Nexus Health Group in November 2018 the provider was rated as inadequate and placed in special measures.

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GP resilience view funding has been utilised by Nexus to support them address the issues highlighted to the CQC which focused on concerns in relation to a lack of governance systems and the impact this had on patient safety. Nexus have commissioned external project management and facilitation support to develop and implement robust governance systems across the organisation to address the issues highlighted in the CQC inspection report and to support the delivery of the organisations turnaround and transformation plan.

The CCG has held monthly meetings with Nexus to discuss and monitor their CQC action plan.

A CQC report published on 12 July 2019 following an inspection in June which focused on prescribing processes reported that Nexus had established a procedure to monitoring the prescribing of high-risk drugs and had taken action to comply with the conditions imposed on their registration an. A comprehensive inspection of Nexus is expected in Summer / Autumn 2019.

4.0 Conclusion

The majority of practices used the GP Forward View resilience funding in 2018/19 to develop and implement action plans in response to CQC inspections. Two practices that received funding in 2018/19 has received improved CQC ratings1 after follow up inspections. Three practices are waiting for CQC reinspection but have provided updates to the CCG which show that areas highlighted by the CQC have been addressed.

The CCG will continue to engage with these practices proactively to monitor further improvements in relation to their resilience and sustainability going forward.

1 Sir John Kirk report has not been published

I GP Resilience


southwark primary care commissioning committee€¦ · nick langford assistant head of primary...

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