north central london primary care committee in …...ms neeshma shah meena mahill mr anthony marks...

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

1 Welcome and Apologies

Chair

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3pm to 3:10pm

2 Declarations of interest -

3 Minutes and actions from the previous meeting on 21 June 2018 Item 3 3

4 Questions from the public (These must relate to items on the agenda for this meeting and should not be more than three minutes per person.)

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Items for discussion 5 Finance report for 2018/19 CCGs Item 5 18 3:10pm to

3:50pm 6 Quality Report Paul Sinden Item 6 30 7 Service Charge Comparisons Vanessa Piper Item 7 45 8 London-wide Service Charge Assistance Policy Vanessa Piper Verbal -

9 Update on Service Charge Financial Assistance Programme Vanessa Piper Verbal -

10 Update on the Vulnerable Patient Allocation Vanessa Piper Verbal - 11 Conflicts of Interest Andrew Spicer Item 11 50 12 Requirements for patient consultation Vanessa Piper Item 12 54

Items for decision

Contract Variations:

13

PMS Contract holder changes • Bounds Green Group Practice (Haringey) • Bridge House Medical Practice (Haringey) • Connaught Surgery (Enfield) • East Barnet Health Centre (Barnet) • Daleham Gardens Health Centre

(Camden) • Rainbow Practice (Enfield) • Dean House Surgery (Enfield)

Vanessa Piper / CCG Lead

Item 13 112

3:50pm to 4:15pm

14 Islington CCG

• Roman Way Medical Centre Vanessa Piper /

CCG Lead Item 14 121

15 Barnet CCG

• Finchley Memorial Hospital Vanessa Piper /

CCG Lead Item 15 126

Items to Note – Urgent Decisions Taken Since the June Meeting

16 None -

Items to Note and information 17 Risk Register Paul Sinden Item 17 135

North Central London Primary Care Committee in Common (Meeting Held in Public) Date: Thursday 16 August 2018 Time: 15:00-16:30 Venue: Camden CCG, Room 6LM1, Stephenson House, 75 Hampstead Road, London, NW1

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18 Committee Forward Planner Chair Item 18 140 4:20pm to 4:30pm 19 Any other Business Chair Verbal -

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

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Item: 3

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Voting Members Lay Member Representatives Ms Cathy Herman (Chair) Haringey CCG Ms Sorrel Brookes (Vice Chair) Islington CCG Ms Bernadette Conroy Barnet CCG Ms Kathy Elliott Camden CCG Ms Karen Trew Enfield CCG GP Representatives Dr Tal Helbitz Governing Body GP Member, Barnet CCG Dr Kevan Ritchie Dr Mateen Jiwani

Governing Body GP Member, Camden CCG Medical Director, Enfield CCG

Dr Punit Sandhu (representing Enfield CCG) (Apologies)

GP Member, Enfield CCG

Dr Dina Dhorajiwala Governing Body GP Member, Haringey CCG Dr Dominic Roberts Clinical Director, Islington CCG Officer Representatives Ms Colette Wood Director of Care Closer to Home, Barnet CCG Ms Sarah McDonnell- Davies Director of Primary & Community Care / Deputy COO, Camden

CCG Ms Deborah McBeal Director of Primary Care Commissioning and Deputy Chief

Operating Officer, Enfield CCG Mr John Piesse Head of Primary Care Commissioning, Enfield CCG Mr Anthony Browne (Apologies) Deputy Chief Finance Office, Islington CCG Ms Clare Henderson Director of Commissioning, Haringey CCG and Islington CCG Mr Paul Sinden NCL Director of Performance and Acute Commissioning Mr Simon Goodwin (Apologies)

NCL Chief Finance Officer

Practice Nurse Representative Ms Charlotte Cooley Governing Body Practice Nurse, Camden CCG Non-Voting Members Ms Emma Whitby Chief Executive, Healthwatch Islington Mr Greg Cairns Director of Primary Care Strategy, Londonwide LMCs To be confirmed

Health and Wellbeing Board Representative

In attendance Ms Vanessa Piper Mr Ian Bretman (Observer) Ms Neeshma Shah Meena Mahill Mr Anthony Marks Ms Sarah Hyde

Head of Primary Care, NCL Primary Care Team Lay member, Barnet CCG Director of Quality & Clinical Effectiveness, Camden CCG Director of Primary & Community Commissioning, Camden CCG NHS England Councillor at Islington Council

North Central London Primary Care Committee in Common Minutes (Part 1) Date: Thursday 21 June 2018 Time: 15.00 – 17.00 Venue: Camden CCG, Room 6LM1, Stephenson House, 75 Hampstead Road, London NW1

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Ms Bridie O'Shea Mr Paul Convery Mr Mark Collison Ms Sally McKinnon Ms Sarah Barron David Shepherd Lauren Crawford

Councillor at Islington Council Councillor at Islington Council Finance Lead, Camden CCG Transformation Programme Director, Camden CCG Primary Care Estates Lead, Haringey CCG Pensioners Association, Hampstead Town Hall Corporate Support Officer

Vivienne Ahmad (Minutes) Board Secretary, Islington CCG

1 Welcome and Apologies

1.1

The Chair welcomed members and attendees to the North Central London Primary Care Committee in Common. It was noted this was the last meeting for Bernadette Conroy, lay member for Barnet CCG. On behalf of the Committee, the Chair thanked Bernadette for her valuable contribution to the work of the Committee.

1.2

Apologies were received from Dr Punit Sandhu, Mr Simon Goodwin and Anthony Browne.

2 Declarations of interest

2.1

There were no declarations declared. For item 10 “The Improvement Grant Process” the Committee agreed that clinical representatives could participate in the discussion but Clinicians would not take part in any decision making.

3a Minutes from the previous meeting on 19 April 2018 3a.1 The minutes of 19 April 2018 were APPROVED.

3b Actions from the previous meeting on 19 April 2018

3b.1

The action log was reviewed and updated on the log sheet.

4 Questions from the Public

4.1

Mr Shepherd asked if there was a compendium of personnel CVs of all the five Sustainability and Transformation Plans (STPs) in London, and in response was directed to the declarations of interests for the Committee and CCG websites for information on CCG Governing Body Members. Mr Shepherd asked further if there were any CVs for Accountable Care Organisation (ACO) leaders, and in response was told that there were on ACOs in North Central London. Mr Paul Convery, Councillor of Caledonian Ward, Islington Council made a statement about the future of Roman Way practice in Islington indicating that the Council and its partners welcomed the approach by Islington CCG to further explore the options of re-providing the service following the resignation of the GP partners. Councillor Convery expressed a strong preference for Islington CCG to procure a new GP practice to replace Roman Way as being in the best interests of the patients living in the area. To do this the Council was willing to work with the CCG to identify premises solutions. The Council approach was influenced by local development plans for 12,000 new affordable homes which would add pressure to general practices in the area. The Council were hopeful that the CCG's approach would reflect the planned increase in the local population and the needs of the neighbourhood with a high level of deprivation.

4.2 The Chair thanked the Council and the member of the public for coming and making their comments known.

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ITEMS FOR DISCUSSION 5 Primary Care Strategy Update

5.1

The Programme Director for Health and Care Closer to Home presented the report, noting the apologies of the NCL Clinical Lead for Health and Care Closer to Home who was attending the London Digital Board. The development of the primary care strategy would also be discussed in more detail at the Committee Seminar to be held on 27 July 2018. The Committee was considering and early draft of the strategy developed through a dedicated task and finish group comprised of local stakeholders. The Committee was asked to consider three questions as part of the early engagement on the primary care strategy: • Comment on the aims of the strategy • Comment specifically on delivery of these aims; • Comment on the draft engagement plan In addition to commenting on the draft NCL Primary Care Strategy the Committee was asked to note the plans for developing primary care at scale with CCGs working alongside GP Federations to deliver this. The final draft would come to the Committee-in-Common and CCG Governing Bodies for approval in August 2018 and September 2018 respectively following completion of the engagement process. The subsequent Committee discussion focused on: • The strategy had a focus on developing general practice rather than broader primary

care services and could this be reflected in the strategy title; • The refresh of the strategy should consider the threads and continuity from the

previous NCL primary care strategy, with the development of collaborative working across practices and access being examples of the threads from the previous to refreshed strategy;

• The refresh should include an evaluation of delivery against the aims of the previous strategy (did we deliver what was expected);

• The need to further develop and resource primary care at scale; • The need to engage frontline staff in the development of the strategy including practice

nurses, and empower staff to be able to work differently; • Workforce should be one of the main focuses of the strategy; • The need to add deliverables and timelines to the strategy to support evaluation, and

aligned to this the need to set out resource implications for both finance and workforce; • The need to align the primary care strategy to other local strategies; • The early draft of the strategy was helpful in opening the engagement process and

would be further discussed at the Committee Seminar in July 2018.

5.2 The Committee NOTED the report 6

Finance report for 2017/18 and 2018/19

6.1

The report sets out the year-end position for 2017/18 and an overview of overall primary care budgets for 2018/19. Previously the committee have received finance reports detailing the General Practice Delegated Commissioning budgets. This paper had now expanded to include other primary care budgets managed within CCG allocations including primary care prescribing, locally commissioned service, out of hours service, and transformation funding to support delivery of the GP Forward View.

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For 2017/18 the report summarised the position for overall primary care budgets and for primary care delegated budgets within the overall spend. In 2017/18 delegated budgets underspent by £5.1m and overall primary care budgets by £3.7m. Funding for overall primary care budgets across North Central London in 2018/19 (£418m) had increased when compared to 2017/18 outturn (£406m) by £12m and by £8m when compared to plans for 2017/18 (£410m). The funding increase from 2017/18 to 2018/19 accrued from the increase to delegated budgets (£8.1m / 4%), but the increase was differential across CCGs. Uplifts to primary care delegated budgets in 2018/19 compared to 2017/18 were 3.4% nationally compared to 4.0% in North Central London. The budget uplifts are intended to cover a 1% increase in pay costs, a 3% increase in non-pay costs including cover for GP indemnity costs, an uplift to funding for the Quality Outcomes Framework in line with population increases, and uplift to fees for immunisations and vaccinations, demographic growth, and a 2% increase in premises costs to cover any increases in business rates and rent revaluations. The Committee were asked to note from 2018/19 budgets and allocations: • £4.5m net headroom (surplus) across NCL CCGs. Where relevant CCGs were

formulating plans for utilising the headroom; • The continuing pressure on Camden CCG budgets, with this being reflected in the

£2.2m forecast overspend in the month 2 position for the CCG; • All CCGs had budgeted for the following reserves in 2018/9 – 1% headroom and

0.5% contingency. This amounts to £3.2m and is over and above the net surplus position.

The subsequent Committee discussion focused on: • The useful context of seeing broader primary care budgets in addition to the core

primary care medical services budgets the Committee was delegated to oversee; • Whilst seeing the broader primary care budgets was useful the Committee needed to

adhere to its terms of reference and delegated authority for decision making; • Assurance that the underspend in 2017/18 had not resulted in reduced allocations for

2018/19; • Comparisons across CCGs should focus on funds per registered patient rather than

by practice (due to differential average list sizes across CCGs); • The need to consider the adequacy of future funding uplifts for core primary care

budgets against projected population increases and the aims of the refreshed primary care strategies;

• The continuing pressure on overall primary care budgets in Camden CCG following the allocation formula change in 2017/18;

• Differential investment in GP IT across the CCGs in 2018/19; • Whether investment in the core contract was included in budgets for 2018/19. The

Finance lead at Camden CCG stated he would look into this by contacting NHS England.

6.2 • Action 21-06-18-1: Investment in the core contract - Finance lead at Camden CCG to

look into this by contacting NHSE.

6.2 The Committee NOTED the report.

7. Quality Report

7.1

The Quality Report provided information by practice from publically available sources. For each practice this included demographic information, Care Quality Commission ratings, measures of patient experience through results from GP Patient Survey and Friends and Family Tests, workforce information and measures of patient care through the Quality Outcomes Framework, complaints, and access.

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In June 2018 the report provided a summary of comparative information across CCGs from the report. The report set out performance by CCG and an overview of practice outliers in performance compared to CCG averages. Performance for practices, and across CCGs, should be assessed against the range of indicators provided (Care Quality Commission ratings, patient experience responses, Quality Outcomes Framework achievement, and written complaints received) to arrive at a rounded view of performance rather than using single measures of performance. Demographic, finance, and workforce information was then provided as context. The Committee noted the following from demographic information: • The relatively high rates of deprivation in Enfield, Haringey and Islington; • The higher rate of over 75s in Barnet and Enfield; • Average list sizes per practice highest in Camden and Haringey and lowest in Barnet

and Enfield; • List size changes were for the 12 months to October 2017, with all CCGs

experiencing an increase in list size for respective practices. Increases were most material in Camden, Haringey and Islington;

• Payment per weighted patient was based on 2016/17 figures. To note from the Care Quality Commission assessments: • The majority of practices assessed to date ( by October 2017) had received a good

rating, ranging from 88% of practices assessed in Barnet to 98% of practices assessed in Enfield;

• Six practices had received an overall inadequate rating to date. These practices were subject to formal remedial action through the primary care medical services contract, as well as being required to complete an action plan to address concerns raised by the Care Quality Commission;

• Twenty practices across North Central London had yet to receive a visit from CQC and/or were yet to receive their report.

The report set out measures of patient experience through the GP Patient Survey and Friends and Family Test. Local performance on the Quality Outcomes Framework for each CCG area was above the national achievement of 94.7% in 2015/16. The report, by exception, identified the number of practices in each CCG with achievement materially below CCG average scores. The number of complaints received by practice was consistent across the five CCGs. Within each CCG there was a broad range of complaints received across practices. All practices in North Central London were able to refer into extended primary care access hubs seven days per week. In addition individual practices provide extended access through the Direct Enhanced Service with uptake varying from 70% of practices in Camden to 92% of practices in Barnet and Haringey. The subsequent Committee discussion focused on: • The collation of themes and learning from complaints, and how these were addressed

through the contact and interaction with practices; • Further development of the report to identify and correlation between quality measures

accruing from Care Quality Commission ratings, complaints, patient experience, and Quality Outcomes Framework delivery, and identify any impact on performance from demographic factors such as deprivation levels;

• The need to contextualise comparative data, with an example being the average payment per waited patient and the need to consider the differential impact of estates costs incurred by practices when making comparisons;

• The need for the report to contain as up-to-date information as possible; • Assurance that the Care Quality Commission would be inspecting all practices.

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7.2 • Action 21-06-02: To further develop the Quality Report based on Committee comments.

7.3 The Committee NOTED the report.

8. PMS review

8.1

The Head of Primary Care Commissioning presented the report. It was highlighted that by 31 May 2018, 90 out of 92 PMS practices across NCL had signed their contracts. In the process of doing so, there were two outstanding practices that were in dialogue with their individual CCGs about their contractual options. There were two recommendations made that (a) All CCGs conclude their PMS transition payment by year 5 (March 2023) applying the NCL transition model previously agreed and (b) All CCGs will initiate discussions with practices about their future commissioning intentions no less than 6 months before the end of the contract. The Committee noted Camden CCG’s intention to utilise the contract extension clause and their agreed commissioning intentions to realise the full PMS resource for the 5th year of delivery. To clarify the transitional period is as follows: Year 1 – 2018/19; Year 2 – 2019/20, Year 3 – 2020 / 2011; Year 4 - 2021/2022 and Year 5 2022/2023.

8.2 The Committee NOTED the report and AGREED the recommendations of this report.

9. Estates Update

9.1

This paper provided an overview of the overarching estates strategy for the North Central London Sustainability and Transformation Plan (STP) and focused on major premises developments across primary and secondary care health services. The paper set out locally determined priorities for wave four capital funding from NHS England. In response the Committee: • Requested assurance that primary care developments were given equal priority in

future waves of funding in line with the care closer to home strategy within the STP; • Requested assurance that the NCL STP estates strategy was informed by and

consistent with local CCG estates strategies.

9.2 The Committee NOTED the report

10 Improvement Grant Process

10.1

The Committee then received an overview of the improvement grant process for general practice for 2019/20. The improvement grant process focused on operational improvements to practice premises rather than strategic premises developments. Within the development of the overarching estates strategy for NCL it remained the responsibility of CCGs to prioritise improvement grant proposals. The papers set out the timetable for: a. The London Improvement Grant Process with applications to be submitted by 20

July, and within this: b. The CCG process and timescales in preparation for submission to NHS England by

20 July 2018. Practice applications for improvement grants to be received by CCGs by 10 July 2018.

CCGs would need to confirm support for any increase in revenue costs accruing from improvement grant awards. The Committee was asked to approve the process for prioritising improvement grant proposals across NCL and the supporting criteria for evaluating practice proposals.

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In response the Committee: • Asked that the award of improvement grants be cognisant of property ownership (not

add value to or fund work that was owned by / the responsibility of private landlords), and other sources of funding available including capital allocations from NHS Property Services;

• In response the Committee was assured that any benefit to private landlords from receipt of improvement grants for their property was offset by a rent abatement process and a due diligence process to ensure that the grants were not being used to fund work that was the responsibility of the landlords;

• Current premises directions indicated that successful applications would receive 66% of the cost of eligible works and the practice was required to fund 34% of the costs themselves. The Committee expressed concern that a cap of 66% reimbursement would mean that some opportunities for estates improvement would be missed and any flexibility for 100% improvement be considered;

• Revised Premises Costs Directions were expected to be published during 2018 that may include some flexibility for 100% reimbursement;

• Criteria focusing on appointments per thousand patients per week for GPs and Nurses should in future be cognisant of changing skill-mix within practices including new roles for pharmacists, physicians and healthcare assistants;

• The process for approving improvement grants was similar to that from previous years and sought to harmonise the process further across the five CCGs;

• The Committee requested information from NHS England on the budget available of improvement grants in 2019/20;

• The report responded to the request from the Committee for transparency over the process for prioritizing improvement grants.

10.2

• Action 21-06-18-3: To find out if there are any other sources of funding for NHS properties buildings

• Action 21-06-18-4: To find out the budget from the London Primary Care Board

10.3 The Committee APPROVED the recommendation. 11.

Service specification for Special Allocations Service

11.1

The Committee received an updated service specification for the procurement of the Special Allocation Service (SAS) for North Central London. The specification had been updated for comments received from the NCL Task and Finish group established to develop the specification, with the group including commissioning leads across all five CCGs, contracting leads from NHS England, clinical representation, premises leads, and GPIT. Representatives from Healthwatch across NCL were also being contacted in relation to commenting on the specification. The Committee was asked to comment on the specification to ensure it met the patient and service need requirements across NCL, and forward any comments to the NCL Head of Primary Care prior to the next formal meeting in August.

11.2

• Action 21-06-18-5: The Committee was asked to forward comments on the service

specification to the NCL Head of Primary Care prior to the next formal meeting in August 2018.

11.3 The Committee NOTED the report

ITEMS FOR DECISION

Contract Variations:

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12.

Islington CCG • Miller Practice

12.1

The Committee was asked to approve the practice request to reduce their boundary reduction on the basis of an agreed set of conditions between the practice and Islington CCG. Approval was recommended on the basis that the practice met access criteria and the reduction in boundary size would not have a significant impact on neighbouring practices.

12.2 The Committee APPROVED the recommendation. 13.

Camden CCG • Camden Health Improvement Practice

13.2

The Committee was asked to approve the re-procurement of services for homeless people provided under an Alternative Personal Medical Services (APMS) contract. Camden CCG having considered all elements of patient need, the views of stakeholders and political environment, made the recommendation that the preferred option was re-procurement of the contract. The rationale for this decision was: • Extending the contract annually did not provide stability or sufficient forward planning

for provider or commissioner; • If the practice list were to be dispersed, patients may have difficulty registering at

other practices and possibly disengage with Primary Care altogether. This would lead to increased urgent care spend for the commissioner and poorer outcomes for the patients;

• Procurement if successful could lead to improved services and decreased costs for the commissioner;

• With the publication of a London-wide service specification there was an opportunity to align services in a consistent way across London, achieving comparable value for money for commissioners.

13.2 The Committee APPROVED the recommendation. 14 Islington CCG • Islington Improved Access LIS – Practice Premises Closure Policy

14.1

Islington’s Improved Access Local Incentive Scheme (LIS) formed part of their PMS review commissioning intentions. The LIS specification states practices must agree to premise opening criteria. The CCG recognised there would be circumstances where practices required all staff to participate in practice learning and in such situations it would not be always possible to maintain the required premise opening criteria. The practice premises closure policy had been prepared to advise practices of the process that should be followed to request practice closures to avoid a breach of the improved access LIS conditions. The policy stated practices should submit requested closure dates for one financial year to the Primary Care Committee in Common (PCCC) for approval. This process ensured practices determined closures in advance and provided enough time to plan appropriately. The data also provided the CCG and PCCC with oversight of annual practice closures. The policy would be updated for any changes in national policy.

14.2 The Committee APPROVED the recommendation. ITEMS TO NOTE - URGENT DECISIONS TAKEN SINCE THE APRIL 2018 MEETING 15 Islington CCG • Roman Way

15.1

The Committee is asked to note the process being undertaken to manage the Resignation notice from the GMS contract by the contract holders on 31 August 2018. Included with the resignation was a notification to commissioners that the premises would not be available beyond 31 August 2018. The resignation notice was received in February 2018 and stakeholder engagement commenced in March 2018 to seek views on the options of procurement or dispersal.

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Prior to and during the consultation period local practices to Roman Way Medical Centre had expressed a wish to merge with the contract holders for the Roman Way Medical Centre. Commissioners therefore were in immediate support of exploring different contracting models to secure the patient list as an alternative option to the resignation notice. Separate meetings were held between two local practices, the contract holders at Roman Way Medical Centre and representatives from Islington CCG, NHS England and the London-wide LMC to discuss the process of merging. The outcome of these earlier negotiations to merge have not been successful therefore Dr Shah and Dr Ho have continued to express a wish to resign from their GMS Contract from 31 August 2018. During the stakeholder engagement commissioners have received objections from local councillors and MPs to the option of closing the practice and dispersing the list. The contract holders had agreed to meet again with commissioners and their London wide LMC representative to discuss the above risks and other potential contracting models. This meeting was due to be carried out before the end of June 2018. For the meeting the contract holders had been asked to: • Extend the notice period of their resignation to allow commissioners to work through

these risks; • Continue to work with commissioners in finding a solution for the patient list and the

management of vulnerable patients; • Allow commissioners sufficient time to explore suitable other premises; • Reopen negotiations with local practices regarding other contractual models that can

retain and safeguard their list The Committee was asked to note the process that had been followed by commissioners to manage the: • Resignation notice; • Planning for the safety of the patients registered on the list; • Responses that have been received as part of the stakeholder engagement; • Wellbeing of the contract holders to enable them to exit the contract but in a managed

approach.

15.2 The Committee NOTED the report. ITEMS TO NOTE AND INFORMATION

16.

Risk Register

16.1

This paper summarised the risks assigned to the NCL CCG Primary Care Committee-in-Common. The register for the June 2018 Committee incorporated the following changes from the previous iteration in April 2018: • Risk 1: Managing conflicts on interest – The Committee will receive a paper in

August 2018 on the application of conflicts of interest guidance to the work of the Committee;

• Risk 2: Governance and Operations – In April 2018 the Committee received a paper on the Standard Operating Procedure between NHS England and CCGs following the full delegation of primary care medical services budgets to CCGs in April 2017. The Committee will receive any future updates to the Standard Operating Procedures that change the responsibility of CCGs for approval;

• Risk 9: Loss of service provider without notice due to regulatory action – In April 2018 the Committee agreed to implement a local process for the direct allocation of vulnerable patients to another practice in the event of a practice closure. The local process will remain in place until direct allocation by Capita (Primary Care Support England service) is in place. NHS England is making representation to Capita on a London-wide basis to put in place the direct allocation of vulnerable patients from a closed practice to alternative practices rather than assignment to the three nearest practices;

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• Risk 12: Variation in Primary Care Quality and Performance across North Central London (NCL) – To support development of the refreshed primary care strategy for NCL, GP Federations in the patch have received £1.6m in 2018/19 to develop primary care at scale following presentation of plans to NHS England in May 2018;

• Risk 14: Alternative Primary Medical Service – Focus groups have been held in North Central London to support the procurement of a new NCL-wide service, with the new service starting in April 2019. The procurement will be based on a London-wide service specification. Procurement plans include a market event to ensure there is interest in providing the service. The specification includes a focus on returning people to mainstream general practice as soon as possible as requested by the Committee in April 2018;

• Risk 16: Embedding the NHS England Primary Care Commissioning Team into North Central London (NCL) – The next phase of delegation will consider the TUPE transfer of the team from NHS England into CCGs, subject to a consultation process. Development of the NCL primary care strategy will further align the development of core and enhanced primary care service offers;

• Risk 18: Primary Care Support England – NHS England have been asked to respond to the National Audit Office recommendation that some aspects of the Primary Care Support England service be in-housed back into the NHS due to concerns over the quality of the service provided;

• Risk 19: Securing funds for Primary Care at Scale development – Funds for developing primary care at scale in North Central London, working with GP Federations, have been approved by NHS England.

The Committee would give further consideration to the risk register at the Seminar to be held in July 2018.

16.2

• Action 21-06-18-6: An update on the review of the Capita contract to come back to the Committee on 16 August 2018.

16.3 The Committee NOTED the Risk Register and considered the updates.

17 Committee forward planner

17.1

The Committee NOTED the Committee Workplan for 2018/19. In August 2018 the Committee would receive papers on: • Service charge comparisons deferred from June 2018; • Conflicts of Interest; • London-wide Service Charge Assistance Policy

18 Any Other Business 18.1 No further business was discussed.

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NCL Primary Care Joint Committee

Action Log – Part 1

Meeting Date

Action No.

Minutes Ref

Action Action lead Deadline Status update Date closed

17/01/18 58 Anthony Browne to include the run rate and adjustments on future finance reports.

Anthony Browne

16/08/18 21/06/18 – To be kept open to receive ongoing reports. 19/04/18 - The Deputy Finance Officer to provide a run rate information to augment the finance report. To chase up NHSE and present at the next meeting in June 2018. 22/03/18 – AB is still waiting for a response from NHSE and will chase.

17/01/18 59 A paper to be brought to a future meeting, which compares service charges between practices.

Vanessa Piper 16/08/18 On Agenda for 16 August 2018 Recommend to close action

17/01/18 60 Vanessa Piper to bring a review paper on the London Wide Service Charge Financial Assistance Policy, to the August meeting and to be added to the workplan.

Vanessa Piper 16/08/18 To bring a review paper on the London Wide Service Charge Financial Assistance Policy to the August meeting and to add to the workplan. Deferred to August

17/01/18 63 A paper on how the bids for the estates capital funding will be managed going forward.

Simon Goodwin

21/06/18 On Agenda 21.6.18 21/06/18

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22/03/18 65 Mr Anthony Browne will bring finance planning for 2018/19 to the next meeting.

Anthony Browne / Paul Sinden

21/06/18 On Agenda 21.6.18

21/06/18

22/03/18 68 Vanessa Piper to share the NHSE SOP for relocation of GP practices and the responsibilities in relation to consultation and engagement with patients, stakeholders and other practices.

Vanessa Piper 16/08/18 Vanessa to provide an update at the August meeting.

22/03/18 71 To add the work of the Primary Care Operating Plan to the Committee's Workplan and discuss at the June Meeting.

Paul Sinden 21/06/18 Added to the workplan 21/06/18

19/04/18 2 5.3 The 2017/18 year-end financial position to be presented to the Committee on 21 June 2018.

Chief Finance Officer

21/06/18 On agenda for 21 June 2018

21/06/18

19/04/18 3 5.3 CCG budgets for 2018/19 to be presented to the Committee on 21 June 2018 for approval.

CCG reps 21/06/18 On agenda for 21 June 2018

21/06/18

19/04/18 4 6.3 A Committee Seminar would be held to allow further contribution to the development of the refresh of the primary care strategy, risk register, and developing the quality report.

Director of Performance, Planning & Primary Care

27/07/18 Seminar scheduled for 27 July 2018 Recommend to close action

19/04/18 5 6.3 The proposal for developing primary care-at-scale would be shared with the Committee in May 2018 and be presented to the Committee in June 2018


21/06/18 On agenda for 21 June 2018.

21/06/18

19/04/18 6 6.3 An update on the primary care strategy would be provided to the Committee in June 2018 addressing the questions on governance and stakeholder engagement above.


27/07/18 On Agenda for 21 June 2018 as well as on Agenda for Seminar on 27 July 2018 Recommend to close action

19/04/18 7 7.8 Camden primary care dashboard to be presented to a future Committee Seminar. Links to action 19-04-18-5.


27/07/18 On Agenda for Seminar on 27 July 2018 Recommend to close action

19/04/18 8 7.8 The quality report cover note to set out comparative and trend data in future reports.

Director of Performance,

21/06/18 On agenda for 21 June 2018. On-going.

21/06/18

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Planning & Primary Care

19/04/18 9 9a.3 Service specification for the special allocations service to be presented to the Committee in June 2018.

Head of Primary Care, NCL Primary Care Team

21/06/18 On agenda for 21 June 2018

21/06/18

19/04/18 10 9b.3 Assurance would be sought on the process to follow-up vulnerable patients who had not registered with a new practice


21/06/18 Agreement from Capita there is a process already in place post dispersal. They will bulk transfer patients that remain on the list. Vulnerable patients, pre-dispersal meeting on 22.6.18 to apply the same process. To be added to next agenda.

21/06/18

19/04/18 11 9b.3 A local allocation process would be put in place until any change in the Capita contract to revert from an assignment to allocation process was in place


21/06/18 Requested an update prior to next meeting?

19/04/18 12 9b.3 NCL would seek a change to the Capita contract through NHS England as part of a London-wide approach.


16/08/18 Requested an update prior to next meeting.

19/04/18 13 14.4 Risk Register to be discussed in more detail at Future Committee Seminar. Links to action 19-04-18-5.


27/07/18 Seminar to be scheduled for 27 July 2018 Recommend to close action

19/04/18 14 15.2 Managing Conflicts of Interest to come to the Committee in August 2018


16/08/18 On Agenda for 16 August 2018 Recommend to close action

21/06/18 1 6.1 Investment in the Core Contract – Finance Lead at Camden CCG to look into this by contacting NHSE.

Finance Lead at Camden CCG

16/08/18 To provide update at the next meeting on 16 August

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21/06/18 2 7.1 To bring back more information on themes and lessons learnt from Complaints within the Quality Report for the next meeting.


16/08/18 Quality Report to the Committee continues to be developed.

21/06/18 3 10.1 To find out if there are any other sources of funding for NHS properties buildings

The Primary Care Estates Lead from Haringey CCG


19/04/18 4 10.1 To find out the budget from the London Primary Care Board.

NCL Head of Primary Care


19/04/18 5 11.1 The Committee was asked to forward comments and issues to the NCL Head of Primary Care on the service specification for special allocations service prior to the next formal meeting in August 2018 but that this could be also discussed further at the seminar in July.

All 16/08/18

19/04/18 6 16.1 An update on the review of the Capita contract to come back to the Committee on 16 August 2018.


16/08/18 NHS England have responded to the National Audit Office (NAO) recommendation that some aspects of the Primary Care Support England service be in-housed back into the NHS due to concerns over the quality of the service provided. NHSE do not plan to bring any aspect of the contract back in house, but are using active contract management particularly in the areas of concern raised by the NAO - pensions, optometry payments and performer’s list management. This includes fining with service credits as appropriate and utilising external expertise to

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strengthen contract management.

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1

NCL Primary Care Committee in Common Meeting on 16th August 2018

Report Title Primary Care Finance Report

(Month 3 2018/19)

Date of report 9th August 2018

Agenda Item 5

Lead Director / Manager

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

Tel/Email [email protected]

GB Member Sponsor

Report Author

Helena Ndlovu Camden CCG – Financial Planning Manager


Report Summary

This report presents the Month 3 Primary Care financial position across the five north central London CCGs. The report also includes reference to the notified future year allocations for the GP Delegated Commissioning.

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

Identified Risks and Risk Management Actions

This report provides the forecast out-turn position for 2018/19.

Conflicts of Interest

N/A

Resource Implications

N/A

Engagement

N/A

Equality Impact Analysis

N/A

Report History and Key Decisions

N/A

Next Steps Appendices

N/A

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mailto:[email protected]


2

Which CCG does this relate to

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

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3

Primary Care Finance Report 2018/19 Month 3, June 2018

1. Introduction

1.1. This report presents the Primary Care financial position across the five North Central London (NCL) CCGs, Barnet, Camden, Enfield, Haringey and Islington CCGs, at Month 3, June 2018.

1.2. Previously the committee have received the finance report detailing 2018/19 Primary Care budgets for the NCL CCGs. This report now summaries the month 3 expenditure against the budgets.

1.3. A key message in 2018/19 is that NCL continues to face significant financial pressures across the wider health and care system with Primary Care forecasting overspends against budget contributing to this position. Any individual overspends need to be managed internally to ensure an overall position is balanced to the agreed budget.

1.4. Within the NCL Primary Care system the following areas have been identified as key components within the strategy:

Needs of the local people:- People are living longer, There is widespread deprivation and inequality; There are poor indicators of health for children

Care delivery and quality: - Disease and illness could be detected and managed much earlier There are challenges in primary care provision in some areas

2. 2018/19 Total Primary Care Budget

2.1. As at June 2018 the total primary care budgets for all CCGs are £419m and currently show a £3m (0.7%) overspend. The overspend is primarily within the GP Delegated Commissioning and Prescribing areas of Primary Care.

2.2. Table 1, below, summarises the total budget versus the month 3 forecast by each CCG and service area. Approximately half of the overall budget is attributable to GP Delegated Commissioning, with this area showing half of the total overspend.

2.3. Table 2 summarises the M3 position further by CCG.

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Table 1: Total Primary Care Expenditure per CCG by Service Area Budget versus FOT

* PC Other includes extended hours and staffing costs for Camden CCG, staffing costs for Islington CCG, online consultation for Haringey CCG and GP forward view for Barnet CCG.

The Prescribing costs are the full costs of the prescribing team, not just pharmaceutical costs.

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Table 2: 2018/19 Budget versus Forecast

Graph 1: Total Primary Care Expenditure YTD Month 3

The graph above shows the split by category and CCG of actual YTD spend.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Prescribing

Locallycommissioned

services

Out ofHours

PracticeTransformationSupport£3p/h

PC -Other

GP ITCosts

PrimaryCare CoCommissioning

NHS Islington CCG £6,294 £503 £899 £149 £216 £199 £8,194NHS Haringey CCG £7,438 £158 £612 £170 £97 £304 £10,077NHS Enfield CCG £9,520 £297 £570 £128 £339 £243 £10,282NHS Camden CCG £6,546 £686 £686 £90 £577 £547 £9,955NHS Barnet CCG £12,506 £186 £1,009 £153 £409 £310 £12,818

Spend by Service Area £'000

NHS Barnet CCG NHS Camden CCG NHS Enfield CCG

NHS Haringey CCG NHS Islington CCG

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3. General Practice Delegated Commissioning

3.1 General Practice Delegated commissioning is the budget associated with the core primary care contract. The budget represents the majority of the total Primary Care budget and is split into the main GP contracts, GMS, PMS and APMS.

3.2 The 2018/19 budget allocation for GP delegated commissioning is £212m across the five CCGs. Table 3, below, summarises the year to date (YTD) and the forecast outturn (FOT) position at month 3.

Table 3: GP Delegated Commissioning Summary

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3.3 Camden CCG: The YTD position for Camden is an overspend of £0.5m

against the budget with a FOT overspend of £2.2m. The overspend appears attributable to the actual registered population being higher than the population predictions that the allocation was based upon.

3.4 Barnet, Enfield, Haringey and Islington CCGs: The YTD and FOT for these four CCGs show a balanced position.

3.5 Each of the CCGs received an annual allocation based on the registered population. Table 4 below summarises the allocation per CCG from 2017/18 to 2020/21. The expected annual increase in allocation is shown in tables 4 and 5.

Table 4: Funding Allocations

Table 5: 2017/18 NCL Delegated Primary Care Budgets (% increase)

4. Prescribing

4.1 The GP practices are allocated a prescribing budget which is spent on pharmaceuticals for patients. Each CCG have teams of pharmacists who work closely with GP practices to advise and monitor the prescribing of pharmaceuticals to patients.

4.2 Table 6, below, summaries the Month 3 FOT versus the 2018/19 budget for prescribing. At month 3 the GP Prescribing budget forecasting an overspend of £171k across the NCL CCGs. The overspend is predominately at Camden CCG, £123k, and Enfield, £50k relating to prescribing costs.

CCG 17/18 18/19 19/20 20/21Barnet 49,258 51,271 53,422 56,627Camden 36,752 37,644 39,027 42,633Enfield 40,976 42,559 44,393 47,057Haringey 41,136 42,921 44,580 47,000Islington 35,408 37,164 38,657 40,490NCL Total 203,530 211,560 220,079 233,807

Delegated Primary Care Allocations 2017/18 - 2020/21 (£000's)

CCG 18/19 19/20 20/21Barnet 4.09% 4.20% 6.00%Camden 2.42% 3.68% 9.24%Enfield 3.87% 4.31% 6.00%Haringey 4.34% 3.87% 5.43%Islington 4.96% 4.01% 4.74%NCL Average 3.95% 4.03% 6.24%

Delegated Primary Care Allocations 2017/18 - 2020/21 (% change)

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Table 6: Prescribing Budgets at June 2018

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5. Locally Commissioned Services

5. Locally Commissioned Services (LCS), previously known as Locally Enhanced Services, relate to those areas where the CCG works with general practices to agree a schedule of additional primary care services which the practice will be contracted to provide.

5.2 These services are discretionary and are additional to the standard GP contract. These services will vary between CCGs and general practices within that CCG.

5.3 Delivery of the Locally Commissioned Services are monitored by the local CCG with payment being dependent upon achievement of deliverables.

5.4 At month 3 all the NCL CCGs are showing a balanced position against budget. Table 7, below, summaries the annual budget, and forecast, for each CCG.

Table 7: Locally Commissioned Services

6. GP Forward View Investment

6.1 For 2018/19 NHSE has confirmed that the NCL CCGs will be allocated from the GP Five Year Forward View (GPFV) access funding of £1.6m.

6.2 Below is a summary of how the additional investment by CCG.

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Table 8: GPFV funding for CCGs

6.3 In addition to the above funding the NCL CCGs are expected to receive an additional GP Forward View General Practice Access funding (GPAF) allocation in future months.

£3 per head

6.4 In addition to the above funding, CCGs are required to invest £3 per head of registered population over two years for primary care transformation.

6.5 The budget allocated to each CCG is detailed below for 2018/19. All the NCL CCGs are forecasting to spend the allocated budget.

Table 9: £3 per head

7. GPIT Capital

7.1 In addition to the revenue budgets detailed above, CCG’s are also able to apply for capital funding (often referred to CAPEX) across a variety of schemes. Such funding and use of expenditure is covered within NHSE financial guidelines and is allocated after receipt and approval of Business Cases.

7.2 The NCL GPIT capital budgets are for 2018/19 that have been confirmed by NHSE as £830k. This is a separate budget to the GPIT budget listed above in table 1 (page 2). The capital budgets summarised in table 10 below.

NHS Barnet CCG £'000

NHS Camden CCG £'000

NHS Enfield CCG £'000

NHS Haringey CCG £'000

NHS Islington CCG £'000 Total £'000

Transformation £3ph 612 360 513 682 595 2,761

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Table 10: 2018-19 Budgets - GPIT Capital Expenditure (£'000)

8. Summary 8.1 There is an emerging pressure forecast within Primary care relating mainly to

GP Delegated and Prescribing costs. At month 3 the cost pressure was forecast at £2.7m (0.7%). This cost pressure is been managed within the CCGs control totals.

NHS Barnet CCG £'000

NHS Camden CCG £'000

NHS Enfield CCG £'000

NHS Haringey CCG £'000

NHS Islington CCG £'000

Total CCG £'000

GPIT 325 200 305 0 0 830

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Report Title NCL Primary Care Committee in

Common Quality Report


Agenda Item

6




GB Member Sponsor

Report Author



Report Summary

1. Introduction

This report sets out: • The latest Quality Report for comment; • A summary of actions accruing from the quality report; • An overview of comparative performance across Boroughs, as

previously requested by the Committee.

2. Quality Report

The report is a consolidation of publicly available information on individual practice performance, and is therefore included in Part I of the Committee (a meeting in public). This report aims to highlight practice sustainability through an aggregation of national indicators and local knowledge. The table draws together a multitude of indicators from an array of sources, including data from Care Quality Commission (CQC) ratings, GP Patient Survey (GPPS) results and practice demographics. The metrics in this report have been used to identify and support practices in difficulty through the resilience programme. Local teams were asked to identify those practices which were considered in difficulty and those which would benefit from Resilience Programme support.

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2

National criteria in this report were created for use as a screening tool by local commissioners to guide their assessment with local stakeholders on offers of support to improve sustainability and resilience. Hard copies of the report for each CCG will be provided at the meeting.

2.1 Report construct

The report sets out: • Contract type held by each practice – General Medical Services /

Personal Medical Services / Alternative Personal Medical Services; • Practice demographics including deprivation in a range of 1-5, with 1

being the most deprived and 5 the least deprived; percentage of patients aged over 75; and ethnicity;

• An overview of quality through Care Quality Commission ratings and written complaints received;

• Workforce including a focus on succession (percentage of GPs and nurses aged over 55); the degree of reliance on locum GPs and coverage (number of patients per full-time GP and full-time nurse;

• Efficiency as measured through Quality Outcomes Framework achievement and exception rate, list size, and annual list size change;

• Patient experience measures from the Friends and Family Test (recommending the practice); and GP patient survey measures ( not recommending the practice, ease of telephone contact, ease of making an appointment);

• Payment per weighted patient; • Utilisation of Patients Online as measured through use of online

appointments and ordering repeat prescriptions online; • The offer of extended access. Appendices to the report include references for the information contained and a glossary of terms.

Recommendation The Committee is asked to NOTE and COMMENT on the report. Identified Risks and Risk Management Actions

The report outlines areas where support to practices is required.


The report is drawn from information available to the public


The report focuses on practice sustainability

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Strategic Objectives supported by this report:

The Quality Report is designed to support the responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning high quality primary care services in NCL.

Legal implications / regulatory requirements:

The report includes Care Quality Commission ratings for each practice.

Engagement

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


N/A


Development of a London-wide approach to the reporting of primary care quality is underway, and this report will be developed in accordance with the London-wide work.


6.1 – August 2018 Quality Report

Which CCG does this paper relate to:

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

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4

NCL CCG Primary Care Committee-in-Common Quality Report

1. Introduction This report sets out: • The latest Quality Report for comment; • A summary of actions accruing from the quality report; • An overview of comparative performance across Boroughs, as previously requested by the

Committee.

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

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

Domain Indicator Description of action taken

Quality Care Quality Commission (CQC) ratings; Complaints

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

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

3. Practice mergers 4. Infection control audits

Efficiency Quality Outcomes Framework (QOF); List size changes;

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

reduce unwarranted variations

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Friends and Family Test (FFT)

3. Care Closer to Home Integrated Networks (CHINs) / Neighbourhoods development

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

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

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

Patient Experience

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

Patient Online

Online appointments; Repeat Prescriptions

1.

Extended Access

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

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

Premises New schemes; Relocation into compliant buildings; Void space

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

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

percentage of patients aged over 75; • Average list size per practice and list size change over the 12 months to October 2017; • Average payment per weighted patient.

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Barnet Camden Enfield Haringey Islington Contract type GMS 35/62

PMS 27/62 APMS 0/62

GMS 15/34 PMS 16/34 APMS 3/34

GMS 19/48 PMS 27/48 APMS 2/48

GMS 16/39 PMS 23/39 APMS 0/39

GMS 29/33 PMS 2/33 APMS 2/33

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

1 4

17 34 6

6

12 8 5 2

23 4

12 6 3

16 10 7 4 0

16 16 1 0 0

Patients aged 75 and above on list 6.5% 4.0% 5.8% 4.3% 4.1% % list non-black & ethnic minority 63.6% 65.2% 59.2% 59.5% 67.0% Average list size 6,795 8,349 7,095 8,618 7,644 Annual list size change +5.5% +5.2% +1.9% +7.0% +2.2% Average payment per weighted patient

£133 £153 £139 £128 £136

To note: • The relatively high rates of deprivation in Enfield, Haringey and Islington; • The higher rate of over 75s in Barnet and Enfield; • Average list sizes per practice highest in Camden and Haringey and lowest in Barnet and

Enfield; • List size changes are for the 12 months to April 2018, with all CCGs experiencing an increase

in list size for respective practices. Increases were most material in Camden, Haringey and Barnet;

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

Care Quality Commission The Care Quality Commission (CQC) rates general practices to give an overall judgement of the quality of care. The CQC applies four ratings to practices, as is the case for other health and social care services. Practices are assessed across five key areas for quality of care (caring, effectiveness, responsiveness, safety, being well-led). The table below summarises Care Quality Commission (CQC) ratings for practices within each CCG as at June 2018:

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

0

49 5 2 6

0

29 0 1 3

0

41 0 2 5

0

28 3 1 6

0

31 2 0 0

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

1

53 2 0 6

0

28 2 0 3

0

42 1 0 5

0

30 2 0 6

0

31 2 0 0

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

0

47 7 2 6

1

28 0 1 3

0

40 1 2 5

0

29 2 1 6

0

30 3 0 0

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CQC ratings Barnet Camden Enfield Haringey Islington Rating for responsiveness: Outstanding Good Requires Improvement Inadequate Yet to be rated

0

53 2 1 6

0

29 1 0 3

0

42 1 0 5

0

30 1 1 6

1

31 1 0 0

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

0

47 7 2 6

0

29 1 0 3

0

39 3 1 5

0

27 4 1 6

0

32 1 0 0

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

1

48 5 2 6

0

29 0 1 3

0

41 1 1 5

1

27 3 1 6

0

32 1 0 0

To note from the above: • The majority of practices assessed to date ( by October 2017) have received a good rating,

ranging from 88% of practices assessed in Barnet to 98% of practices assessed in Enfield; • Six practices have received an overall inadequate rating to date. These practices will be

subject to formal remedial action through the primary care medical services contract, as well as being required to complete an action plan to address concerns raised by the Care Quality Commission;

• Twenty practices across North Central London have yet to receive a visit from CQC and/or are yet to receive their report. All practices have inspections scheduled with the CQC.

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

Quality Outcomes Framework 2015/16

Barnet Camden Enfield Haringey Islington

% achievement in 2016/17 96.7% 96.3% 95.2% 95.8% 96.4% % achievement in 2015/16 95.8% 96.3% 95.2% 96.1% 96.4% Practices with less than 70% 0 0 0 0 1 Practices with less than 80% 2 1 0 0 0 Practices with 80% to 90% 3 2 6 3 1

Aggregate performance for each CCG is above the national average. The table reports by exception the number of practices in each CCG with achievement materially below CCG average scores.

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Patient experience The GP patient survey is an independent survey run by Ipsos MORI on behalf of NHS England, with the survey being sent to over one million people nationally. The survey results presented are for July 2017. The Friends and Family Test asks patients how likely they are to recommend their GP service to friends and family based on their most recent experience of service use, with the results showing those likely or extremely likely to recommend their practice.

Patient Experience Barnet Camden Enfield Haringey Islington GP patient survey would not recommend the practice

10% 8% 11% 12% 10%

GP patient survey – not easy getting through by phone

6% 6% 10% 8% 6%

GP patient survey not able to get an appointment or speak to someone

13% 11% 14% 13% 13%

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

91%

39/62 43% - 100%

89%

19/33 68% - 100%

87%

34/48 56% - 100%

86%

25/38 50% - 100%

91%

20/33 80% - 100%

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

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

610 416 527 394 377

Average received per practice 10 12 11 11 11 Average per 1000 people on list 1.4 1.5 1.5 1.2 1.5 Range received per practice per 1000 people on the list

0 – 6.7 0 – 7.4 0.0 – 5.7 0.2 – 3.1 0 – 4.0

The number of complaints received by practice is consistent across the five CCGs. Within each CCG there is a broad range of complaints received across practices. Access The table below shows that all practice lists have extended access to general practice services seven days per week through primary care hubs, and where individual practices provided extended access through the Direct Enhanced Service.

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

100% 100% 100% 100% 100%

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

94% 71% 88% 90% 82%

Workforce The table below provides on overview of workforce information for each CCG. The information is sourced from the workforce minimum data set collected by NHS Digital. The information is experimental and needs to be treated with caution. The information is from August 2017.

Workforce Barnet Camden Enfield Haringey Islington % of GPs aged over 55 34% 20% 33% 40% 26% % locum GPs 2% 4% 11% 7% 5% % of nurses aged 55 and over 47% 20% 56% 49% 50% Number of patients per full-time GP 2,228 1,783 2,476 2,445 2,120

The information shows the need for succession planning for the GP and nurse workforce, some of which will be provided through the use of new skill-mix in general practice including pharmacists, physicians, physiotherapists and mental health professionals.

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Barnet CCGFinance

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Barnet E83003 Oakleigh Road Health Centre Del GMS 4 7% 70% 4 0 Medium-large 31% 0% 100% 1,724 6,432 99.3% 4.7 8,915 5% 2% 2% 8% £110 13% 0.0 12% 0.0 FULL 7 ✔Barnet E83005 Lichfield Grove Surgery Del PMS 4 6% 64% 8 1 Small-medium 33% 0% 100% 2,416 7,650 99.2% 7.4 6,259 1% 100% 6% 11% 9% £139 46% 0.0 46% 0.0 FULL 7 ✔Barnet E83006 Greenfield Medical Centre Del PMS 2 5% 58% 2 1 Medium-large 17% 0% 58% 2,191 6,177 98.8% 4.1 6,903 2% 88% 7% 3% 11% £147 35% 0.0 35% 0.0 FULL 7 ✔Barnet E83007 Squires Lane Medical Practice Del GMS 3 7% 59% 32 1 Medium-large 0% 25% 0% 1,764 17,863 98.8% 6.5 5,711 0% 73% 23% 14% 24% £132 26% 0.0 25% 0.0 FULL 7 ✔Barnet E83008 Heathfielde Medical Centre Del PMS 5 - Least Deprived 8% 78% 17 1 Medium-large 50% 0% 15% 2,422 4,301 99.9% 2.7 7,927 4% 8% 8% 17% £148 44% 0.0 44% 0.0 FULL 7 ✔Barnet E83009 Phgh Doctors Del PMS 5 - Least Deprived 8% 75% 25 0 Medium-large 11% 3% 78% 2,757 8,497 92.5% 5.7 10,840 1% 5% 6% 9% £144 31% 0.0 31% 0.0 FULL 7 ✔Barnet E83010 The Speedwell Practice Del PMS 4 7% 63% 38 2 Medium-large 13% 0% 41% 2,305 7,329 95.7% 4.2 11,340 1% 18% 30% 13% £130 21% 0.0 21% 0.0 FULL 7Barnet E83011 The Everglade Medical Practice Del GMS 1 - Most deprived 3% 42% 4 1 Medium-large 20% 9% 100% 1,640 9,107 99.9% 11.6 8,133 4% 80% 14% 12% 15% £114 12% 0.0 12% 0.0 FULL 7 ✔Barnet E83012 The Old Court House Surgery Del GMS 4 8% 77% 7 1 Medium-large 0% 0% 0% 2,325 7,689 99.6% 7.1 8,140 4% 7% 6% 8% £119 22% 0.0 22% 0.0 FULL 7 ✔Barnet E83013 Cornwall House Surgery Del GMS 4 7% 63% 6 0 Medium-large 33% 0% 0% 1,789 21,955 99.4% 8.1 6,503 1% * 10% 11% 14% £122 16% 0.0 15% 0.0 FULL 7 ✔Barnet E83016 Millway Medical Practice Del PMS 4 7% 65% 32 0 Large 2% 0% 13% 1,885 6,048 98.7% 4.0 18,411 2% 4% 17% 6% £162 103% 0.1 103% 0.1 FULL 7 ✔Barnet E83017 Longrove Surgery Del PMS 4 8% 79% 19 1 Medium-large 29% 0% 100% 1,977 6,921 97.4% 4.5 11,295 1% 80% 14% 13% 20% £140 24% 0.0 24% 0.0 FULL 7 ✔Barnet E83018 Watling Medical Centre Del GMS 3 6% 51% 9 0 Large 8% 0% 17% 1,722 4,867 96.8% 5.6 16,063 6% 67% 4% 9% 11% £120 27% 0.0 26% 0.0 FULL 7 ✔Barnet E83020 St. Georges Medical Centre Del PMS 4 6% 60% 13 0 Small-medium 0% 0% 0% 3,483 5,727 96.5% 4.4 10,948 7% 85% 4% 8% 10% £153 71% 0.1 71% 0.0 FULL 7 ✔Barnet E83021 Torrington Park Group Practice Del PMS 4 9% 63% 16 5 Medium-large 18% 0% 55% 2,086 10,526 93.9% 7.9 12,581 1% 89% 5% 16% 13% £139 27% 0.0 26% 0.0 FULL 7 ✔Barnet E83024 St Andrews Medical Practice. Del PMS 5 - Least Deprived 9% 72% 12 2 Large 15% 0% 63% 1,712 4,802 99.3% 4.0 10,767 4% 6% 8% 7% £166 44% 0.0 43% 0.0 no data - ✔Barnet E83025 Pennine Drive Practice Del GMS 3 6% 55% 3 1 Medium-large 22% 0% 0% 2,237 7,865 100.0% 7.8 8,941 0% 9% 11% 13% £119 8% 0.0 8% 0.0 FULL 7 ✔Barnet E83026 Supreme Medical Centre Del GMS 4 8% 65% 1 0 Small-medium 76% 0% 0% 1,559 5,622 91.6% 7.0 4,420 6% 13% 9% 15% £122 28% 0.0 28% 0.0 FULL 7 ✔Barnet E83027 188 The Practice Del PMS 4 9% 69% 14 2 Small-medium 7% 16% 0% 3,174 10,953 98.3% 7.3 7,408 -1% 90% 22% 6% 12% £142 18% 0.0 18% 0.0 FULL 7 ✔Barnet E83028 Parkview Surgery Del PMS 2 3% 47% 1 0 Small-medium 41% 22% 100% 2,219 7,593 99.6% 9.9 6,452 3% * 12% 2% 13% £129 12% 0.0 12% 0.0 FULL 7 ✔Barnet E83030 Penshurst Gardens Surgery Del GMS 4 10% 61% 16 0 Medium-large 0% 0% 0% 2,079 7,033 97.3% 5.4 6,519 4% 14% 27% 28% £122 67% 0.0 67% 0.1 FULL 7 ✔Barnet E83031 The Village Surgery Del PMS 4 8% 76% 2 1 Small-medium 46% 0% 100% 1,791 7,164 89.4% 2.7 5,085 4% 97% 3% 0% 3% £131 10% 0.0 10% 0.0 FULL 7Barnet E83032 Oak Lodge Medical Centre Del GMS 3 4% 43% 29 3 Large 0% 0% 17% 1,966 7,692 100.0% 9.9 18,526 0% 82% 9% 17% 17% £138 51% 0.0 51% 0.0 FULL 7 ✔Barnet E83034 Mulkis Hb-The Surgery Del GMS 3 6% 69% 6 1 Small-medium 100% 0% 100% 2,746 7,678 93.5% 4.8 5,474 -1% 8% 10% 13% £116 18% 0.0 18% 0.0 FULL 7 ✔Barnet E83035 Wentworth Medical Practice. Del PMS 4 7% 59% 7 1 Small-medium 11% 0% 0% 3,866 12,114 96.3% 3.0 11,296 5% 14% 17% 20% £157 29% 0.0 29% 0.0 PARTIAL 6 ✔Barnet E83036 Vale Drive Medical Practice Del GMS 3 7% 73% 1 0 Small-medium 100% 0% 0% 2,537 6,026 95.6% 3.6 5,330 20% 6% 0% 7% £152 18% 0.0 18% 0.0 FULL 7 ✔Barnet E83037 Derwent Crescent Medical Centre Del PMS 4 9% 68% 13 0 Small-medium 44% 0% 52% 1,953 4,789 99.4% 4.9 5,493 3% 92% 11% 0% 9% £151 85% 0.0 85% 0.0 FULL 7 ✔Barnet E83038 Jai Medical Centre Del GMS 3 8% 50% 41 4 Medium-large 21% 0% 76% 2,501 6,343 98.0% 4.8 8,324 1% 14% 7% 7% £120 15% 0.0 15% 0.0 FULL 7 ✔Barnet E83039 Ravenscroft Medical Centre Del PMS 4 4% 62% 2 0 Small-medium 93% 0% 100% 2,689 5,224 96.9% 4.0 7,367 2% 96% 2% 3% 3% £158 4% 0.0 4% 0.0 FULL 7 ✔Barnet E83041 The Surgery Del GMS 3 5% 40% 8 0 Small-medium 0% 17% 0% 2,718 6,226 97.1% 9.3 4,681 5% 11% 9% 24% £116 13% 0.0 13% 0.0 FULL 7 ✔Barnet E83044 Addington Medical Centre Del GMS 4 8% 76% 6 2 Medium-large 50% 0% 76% 1,792 6,582 98.6% 4.1 8,674 2% 94% 11% 7% 7% £120 26% 0.0 26% 0.0 FULL 7 ✔Barnet E83045 Friern Barnet Medical Centre Del GMS 3 6% 63% 9 0 Medium-large 44% 0% 100% 2,144 7,519 97.2% 4.4 8,792 19% 11% 8% 7% £114 18% 0.0 18% 0.0 PARTIAL 4 ✔Barnet E83046 Mulberry Medical Practice Del GMS 3 5% 53% 16 0 Medium-large 29% 0% 43% 2,370 3,160 85.1% 3.2 9,888 40% 76% 6% 5% 5% £135 18% 0.0 17% 0.0 FULL 7 ✔Barnet E83049 Langstone Way Surgery Del PMS 4 5% 59% 24 1 Medium-large 30% 0% 34% 2,221 2,506 91.2% 8.6 7,685 7% 86% 8% 12% 17% £160 15% 0.0 15% 0.0 PARTIAL 3 ✔Barnet E83050 East Finchley Medical Centre Del GMS 5 - Least Deprived 6% 77% 4 0 Small-medium 0% 0% 0% 2,640 90.4% 3.4 7,729 17% 12% 5% 10% £108 13% 0.0 15% 0.0 FULL 7 ✔Barnet E83053 Lane End Medical Group Del GMS 4 8% 60% 14 2 Large 18% 0% 0% 1,411 96.7% 7.4 13,026 2% 86% 8% 16% 15% £135 43% 0.0 33% 0.0 FULL 7 ✔Barnet E83600 Adler Js-The Surgery Del GMS 4 5% 73% 3 0 Small-medium 47% 0% 0% 2,543 9,566 97.2% 1.8 5,669 12% 3% 2% 0% £130 23% 0.0 24% 0.0 FULL 7 ✔Barnet E83613 Ebhc Dr D Monkman Del PMS 4 8% 76% 4 0 7,258 99.5% : 2,976 3% 3% 7% 5% £128 5% 0.0 5% 0.0 FULL 7 ✔Barnet E83621 Brunswick Park Medical Centre Del GMS 4 8% 68% 57 1 Medium-large 19% 0% 100% 2,349 5,255 98.4% 2.9 8,495 3% 76% 18% 13% 23% £121 33% 0.0 32% 0.0 no data - ✔Barnet E83622 Temple Fortune Medical Group Del GMS 5 - Least Deprived 8% 74% 5 0 Small-medium 51% 0% 55% 2,365 7,953 99.4% 7.5 7,111 2% 6% 4% 16% £112 10% 0.0 9% 0.0 no data - ✔Barnet E83624 Station Road New Barnet Surgery Del GMS 4 10% 76% 0 0 Single-handed 100% 0% 100% 2,089 3,047 95.6% 2.8 1,931 0% 2% 0% 2% £127 26% 0.0 26% 0.1 FULL 7 ✔Barnet E83629 Ebhc Dr P Weston Del PMS 4 6% 76% 3 0 8,963 99.9% 0.2 3,534 1% 8% 7% 5% £127 FULL 7 ✔Barnet E83632 Ebhc Dr Cj Peskin Del PMS 4 7% 76% 3 1 10,615 99.5% : 4,387 3% 6% 5% 14% £126 FULL 7 ✔Barnet E83637 Colindale Medical Centre Lp Del PMS 3 3% 41% 3 0 Small-medium 47% 0% 37% 3,153 11,746 98.6% 3.0 8,334 8% 60% 7% 7% 15% £132 17% 0.0 16% 0.0 FULL 7 ✔Barnet E83638 The Mountfield Surgery Del PMS 4 7% 66% 2 0 Small-medium 93% 0% 100% 2,079 4,157 95.3% 3.1 4,960 1% 9% 0% 6% £142 10% 0.0 10% 0.0 FULL 7 ✔Barnet E83639 Rosemary Surgery Del GMS 4 4% 62% 2 0 Small-medium 15% 0% 0% 1,492 93.2% 2.4 4,793 22% 4% 15% 16% £140 31% 0.0 30% 0.0 FULL 7 ✔Barnet E83649 The Hodford Road Practice Del PMS 4 5% 67% 3 0 Small-medium 100% 0% 0% 2,064 11,009 93.6% 2.2 3,574 2% 11% 4% 4% £145 85% 0.0 85% 0.0 FULL 7 ✔Barnet E83650 Gloucester Road Surgery Del GMS 4 13% 75% 0 0 Single-handed 100% 0% 100% 1,739 4,102 95.5% 2.6 1,684 2% 7% 2% 13% £121 25% 0.0 25% 0.0 PARTIAL 6Barnet E83653 The Phoenix Practice Del GMS 3 6% 61% 8 2 Small-medium 19% 0% 42% 3,305 5,205 93.9% 2.8 9,852 33% 0% 3% 6% £128 14% 0.0 14% 0.0 FULL 7 ✔Barnet E83657 The Hillview Surgery Del GMS 4 6% 62% 2 0 Small-medium 100% 0% 100% 1,842 7,779 95.0% 7.8 1,873 1% 7% 1% 8% £144 5% 0.0 5% 0.0 no data - ✔Barnet E83668 Dr Sp Talpahewa Del GMS 4 3% 52% 3 0 Small-medium 0% 0% 100% 2,226 5,565 96.7% 3.3 4,303 4% 6% 1% 7% £112 14% 0.0 14% 0.0 FULL 7 ✔Barnet Y00316 Woodlands Medical Practice Del PMS 4 6% 68% 11 1 Medium-large 0% 0% 0% 1,327 10,792 96.2% 4.0 4,393 2% 56% 27% 24% 21% £150 42% 0.0 42% 0.0 FULL 7 ✔Barnet Y02986 Cricklewood Health Centre Del PMS 2 0% 54% 11 2 Small-medium 0% 0% 100% 2,018 21,621 4,371 18% 7% 2% 14% 6% 0.0 6% 0.0 FULL 7Barnet Y03663 Hendon Way Surgery Del GMS 3 4% 53% 11 1 99.6% 8.8 8,353 1% 17% 34% 25% £132 27% 0.0 26% 0.0 FULL 7 ✔Barnet Y03664 Dr Azim & Partners Del GMS 3 4% 55% 18 2 98.6% 5.4 8,907 3% 12% 12% 22% £130 62% 0.0 61% 0.0 FULL 7 ✔

Extended AccessPractice Practice Demographics Quality Workforce Efficiency Patient Experience Patients Online

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Camden CCGFinance

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Camden F83003 Park End Surgery Del PMS 4 9% 79% 12 0 Large 12% 0% 0% 1,064 8,777 98.6% 3.6 7,032 3% 100% 1% 5% 10% £178 60% 0.0 59% 0.0 FULL 7 ✔Camden F83005 Gower Street Practice Del GMS 3 1% 61% 10 1 Medium-large 56% 0% 0% 2,327 95.7% 3.1 8,635 6% 93% 5% 2% 13% £109 17% 0.0 17% 0.0 FULL 7Camden F83006 Ampthill Practice Del GMS 1 - Most deprived 5% 55% 11 1 Large 26% 7% 100% 1,218 8,463 96.9% 3.7 8,380 -3% 79% 8% 4% 14% £128 14% 0.0 10% 0.0 FULL 7 ✔Camden F83011 Primrose Hill Surgery Del GMS 4 6% 79% 9 0 Medium-large 0% 0% 0% 1,826 96.9% 2.2 6,384 1% 7% 3% 9% £134 22% 0.0 22% 0.0 no data - ✔Camden F83017 Hampstead Group Practice Del PMS 3 5% 73% 24 0 Large 7% 9% 0% 1,351 8,422 98.1% 3.3 15,911 3% 93% 2% 5% 11% £165 28% 0.0 28% 0.0 FULL 7 ✔Camden F83018 Prince Of Wales Group Surgery Del PMS 1 - Most deprived 5% 63% 7 0 Large 17% 0% 40% 1,187 3,933 98.6% 4.0 9,077 1% 11% 23% 15% £173 33% 0.0 33% 0.0 FULL 7 ✔Camden F83019 Abbey Medical Centre Del GMS 2 5% 62% 14 2 Large 11% 0% 0% 1,640 11,938 99.2% 3.5 12,118 5% 8% 15% 10% £138 30% 0.0 29% 0.0 no data - ✔Camden F83020 Adelaide Medical Centre Del GMS 3 7% 71% 20 0 Medium-large 14% 0% 60% 2,003 4,663 97.9% 3.7 11,506 -3% 1% 2% 11% £137 49% 0.0 49% 0.0 FULL 7 ✔Camden F83022 Caversham Group Practice Del GMS 2 4% 70% 28 0 Large 43% 7% 0% 2,068 8,364 94.0% 3.3 15,385 6% 8% 2% 17% £135 19% 0.0 18% 0.0 PARTIAL 2 ✔Camden F83023 James Wigg Practice Del PMS 2 4% 67% 92 0 Large 8% 0% 13% 1,733 4,435 96.4% 4.5 21,318 2% 87% 7% 19% 25% £196 18% 0.0 18% 0.0 FULL 7 ✔Camden F83025 The Regents Park Practice Del PMS 2 5% 52% 14 0 Medium-large 0% 0% 35% 1,772 4,115 95.9% 3.3 6,271 -1% 77% 9% 3% 13% £163 7% 0.0 5% 0.0 FULL 7Camden F83042 Gray's Inn Road Medical Centre Del PMS 2 3% 58% 9 0 Medium-large 30% 0% 100% 1,004 10,218 93.4% 4.9 5,647 30% * 21% 10% 8% £169 6% 0.0 6% 0.0 NO 0 ✔Camden F83043 Ridgmount Practice Del GMS 2 0% 59% 4 0 Large 34% 0% 32% 2,607 5,499 99.7% 8.5 17,358 9% 82% 6% 6% 21% £151 34% 0.0 34% 0.0 PARTIAL 6Camden F83044 The Bloomsbury Surgery Del GMS 2 4% 52% 7 0 Medium-large 0% 0% 0% 1,256 2,378 93.3% 2.9 4,458 2% 7% 0% 8% £192 30% 0.0 25% 0.0 FULL 7 ✔Camden F83048 Brunswick Medical Centre Uhpc Del APMS 2 3% 56% 7 0 6,676 98.8% 7.3 6,879 5% 81% 12% 11% 6% £147 31% 0.0 31% 0.0 FULL 7Camden F83050 Fortune Green Road Surgery Del GMS 4 5% 69% 4 0 Small-medium 0% 19% 0% 2,429 27,028 97.4% 5.7 2,821 -2% * 20% 1% 17% £133 21% 0.0 21% 0.0 FULL 7Camden F83052 Brookfield Park Surgery Del GMS 3 6% 77% 3 0 Small-medium 35% 0% 0% 2,917 98.7% 3.8 3,405 4% 11% 12% 11% £148 25% 0.0 25% 0.0 FULL 7 ✔Camden F83055 West Hampstead Medical Centre Del PMS 3 3% 72% 30 0 Medium-large 19% 0% 53% 2,651 9,468 98.3% 4.2 13,168 7% 9% 25% 9% £147 94% 0.1 94% 0.0 PARTIAL 6 ✔Camden F83057 Parliament Hill Surgery Del PMS 3 4% 78% 6 0 Medium-large 3% 0% 100% 1,497 18,664 99.9% 3.1 7,092 2% 70% 5% 4% 3% £151 34% 0.0 34% 0.0 FULL 7 ✔Camden F83058 Holborn Medical Centre Del PMS 2 2% 57% 7 0 Large 24% 0% 0% 1,521 5,594 98.0% 4.5 11,375 1% 3% 3% 14% £158 15% 0.0 15% 0.0 FULL 7 ✔Camden F83059 Brondesbury Medical Centre Del PMS 2 3% 63% 16 0 Large 12% 0% 38% 1,229 14,577 97.9% 5.1 17,154 -2% 6% 6% 14% £170 30% 0.0 25% 0.0 FULL 7 ✔Camden F83061 Museum Practice Del PMS 2 4% 63% 4 0 Medium-large 0% 0% 0% 885 98.1% 3.4 4,889 10% 91% 5% 0% 1% £144 27% 0.0 26% 0.0 FULL 7 ✔Camden F83615 Cholmley Gardens Surgery Del PMS 4 4% 73% 7 1 Medium-large 47% 11% 0% 1,950 6,224 96.9% 3.4 7,968 8% 100% 5% 1% 4% £129 14% 0.0 14% 0.0 FULL 7 ✔Camden F83623 Keats Group Practice Del PMS 5 - Least Deprived 6% 79% 10 1 Large 12% 7% 0% 1,437 3,863 99.6% 2.8 11,810 4% 3% 5% 7% £191 34% 0.0 34% 0.0 FULL 7 ✔Camden F83632 Queens Crescent Practice Del GMS 1 - Most deprived 4% 61% 10 0 Medium-large 9% 0% 0% 1,041 6,468 98.0% 6.2 5,516 45% 96% 10% 2% 16% £140 6% 0.0 6% 0.0 FULL 7 ✔Camden F83633 Daleham Gardens Health Centre Del PMS 4 6% 73% 0 0 Small-medium 0% 0% 0% 1,299 5,766 98.6% 3.9 2,664 9% 0% 1% 2% £192 26% 0.0 26% 0.0 FULL 7Camden F83635 Kings Cross Surgery Del APMS 1 - Most deprived 2% 51% 4 1 Small-medium 6% 6% 0% 3,547 7,677 99.1% 10.3 4,717 9% 91% 19% 6% 19% £128 29% 0.0 29% 0.0 PARTIAL 3Camden F83658 Belsize Priory Medical Practice (Group) Del GMS 2 5% 62% 17 1 Small-medium 8% 34% 0% 2,722 93.4% 3.1 4,331 0% 20% 12% 12% £120 32% 0.0 32% 0.0 FULL 7 ✔Camden F83665 Swiss Cottage Surgery Del GMS 3 3% 66% 7 1 Medium-large 0% 0% 25% 2,288 4,857 99.2% 2.8 13,380 5% * 3% 4% 9% £156 38% 0.0 38% 0.0 PARTIAL 6 ✔Camden F83672 St Philips Medical Centre Del GMS 3 0% 63% 7 0 Medium-large 0% 9% 0% 2,912 9,328 -13% 96% 0% 0% 0% £88 3% 0.0 3% 0.0 FULL 7Camden F83677 The Matthewman Practice Del GMS 1 - Most deprived 4% 65% 1 1 Single-handed 100% 0% 0% 1,968 76.1% 2.8 2,040 11% 12% 0% 8% £129 22% 0.0 22% 0.0 PARTIAL 6 ✔Camden F83682 Rosslyn Hill Surgery Del PMS 5 - Least Deprived 4% 76% 9 0 Small-medium 93% 7% 0% 1,156 98.7% 2.3 1,806 2% 3% 1% 9% £244 29% 0.0 29% 0.0 FULL 7 ✔Camden F83683 Somers Town Medical Centre Del PMS 1 - Most deprived 3% 48% 88.4% 3.8 3,228 3% 100% 22% 11% 16% £170 2% 0.0 2% 0.0 FULL 7Camden Y02674 Camden Health Improvement Practice Del APMS 0% 6 0 Small-medium 0% 0% 50% 562 384 87.5% 9.4 816 12% 9% 0% 2% £1,199 4% 0.0 0% 0.0 FULL 7Camden Y05257 Camden Extended Access Service Del

Patients Online Extended AccessPractice Practice Demographics Quality Workforce Efficiency Patient Experience

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Enfield CCGFinance

CCGPractice Code

Practice Name

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Enfield F85002 Forest Rd Group Practice Del PMS 1 - Most deprived 5% 44% 8 0 Large 19% 3% 25% 1,216 3,101 97.6% 3.5 12,332 -2% 95% 11% 27% 29% £208 26% 0.0 26% 0.0 FULL 7 ✔Enfield F85003 Riley House Surgery Del PMS 1 - Most deprived 6% 60% 31 1 Medium-large 55% 0% 27% 2,791 7,359 93.7% 5.0 8,612 -2% 66% 29% 17% 24% £151 16% 0.0 15% 0.0 PARTIAL 1 ✔Enfield F85004 Eagle House Surgery Del PMS 1 - Most deprived 6% 53% 12 1 Medium-large 29% 0% 100% 3,019 4,428 96.9% 4.8 13,263 0% 14% 32% 15% £154 19% 0.0 18% 0.0 PARTIAL 3 ✔Enfield F85010 Keats Surgery Del GMS 2 7% 52% 1 0 Small-medium 100% 0% 100% 2,322 14,322 89.0% 2.9 4,735 1% 76% 5% 3% 12% £112 14% 0.0 14% 0.0 FULL 7 ✔Enfield F85015 Dover House Surgery Del GMS 1 - Most deprived 6% 44% 4 0 Small-medium 100% 0% 80% 2,166 8,662 91.9% 3.4 4,439 -2% 100% 11% 3% 6% £105 13% 0.0 13% 0.0 FULL 7 ✔Enfield F85016 Cockfosters Medical Ctre Del GMS 5 - Least Deprived 10% 76% 1 0 Medium-large 67% 0% 100% 1,746 7,828 87.7% 2.1 6,532 2% 13% 6% 9% £120 7% 0.0 7% 0.0 FULL 7 ✔Enfield F85020 The Woodberry Practice Del PMS 4 7% 74% 10 2 Medium-large 3% 0% 50% 2,549 6,426 97.8% 4.4 8,698 3% 6% 7% 9% £144 15% 0.0 15% 0.0 FULL 7 ✔Enfield F85023 The Ordnance Unity Centre For Health Del GMS 1 - Most deprived 3% 57% 11 0 Small-medium 0% 0% 0% 6,205 5,800 92.4% 5.5 8,917 17% 17% 13% 18% £143 13% 0.0 13% 0.0 no data -Enfield F85024 Dean House Surgery Del PMS 1 - Most deprived 4% 51% 1 0 Single-handed 100% 0% 100% 2,880 12,343 97.1% 4.0 2,369 2% 16% 0% 6% £184 23% 0.0 23% 0.0 NO 0 ✔Enfield F85025 White Lodge Medical Practice Del PMS 3 8% 78% 12 0 Large 30% 0% 19% 1,328 5,264 95.9% 3.0 11,236 -1% 3% 5% 6% £151 21% 0.0 20% 0.0 FULL 7 ✔Enfield F85027 Carlton House Surgery Del GMS 3 8% 80% 40 0 Medium-large 12% 0% 0% 2,051 5,914 97.2% 5.4 11,790 -2% 16% 31% 17% £124 23% 0.0 23% 0.0 FULL 7 ✔Enfield F85029 Abernethy House Surgery Del PMS 4 10% 79% 21 0 Large 33% 0% 55% 1,969 3,304 99.3% 5.1 13,090 1% 100% 4% 4% 9% £151 19% 0.0 19% 0.0 FULL 7 ✔Enfield F85032 Southgate Del PMS 4 8% 69% 25 0 Medium-large 44% 0% 0% 1,560 9,621 91.3% 3.8 9,572 5% 7% 6% 7% £137 22% 0.0 22% 0.0 FULL 7 ✔Enfield F85033 Winchmore Hill Practice Del PMS 5 - Least Deprived 9% 76% 57 1 Medium-large 0% 0% 58% 3,141 9,739 95.7% 3.2 17,194 4% 12% 13% 15% £153 41% 0.0 40% 0.0 no data - ✔Enfield F85035 Highlands Practice Del GMS 5 - Least Deprived 10% 73% 12 1 83.5% 2.7 10,125 5% 11% 15% 9% £122 37% 0.0 37% 0.0 PARTIAL 5Enfield F85036 Willow House Surgery Del GMS 3 7% 74% 3 0 Small-medium 38% 0% 0% 1,519 4,690 95.0% 3.4 4,352 5% 3% 0% 3% £104 23% 0.0 23% 0.0 FULL 7 ✔Enfield F85039 Rainbow Practice Del PMS 1 - Most deprived 5% 43% 6 0 Small-medium 26% 47% 100% 2,860 8,936 97.6% 4.0 4,921 4% 6% 6% 24% £155 26% 0.0 26% 0.0 FULL 7 ✔Enfield F85043 Boundary Court Surgery Del APMS 1 - Most deprived 4% 42% 5 2 Small-medium 0% 38% 0% 2,227 7,812 96.3% 5.8 3,928 3% 100% 8% 5% 20% £141 11% 0.0 11% 0.0 FULL 7 ✔Enfield F85044 The Bounces Road Surgery Del GMS 1 - Most deprived 5% 44% 2 0 Small-medium 0% 0% 43% 1,634 4,968 98.4% 4.3 5,169 8% 95% 10% 9% 4% £175 8% 0.0 8% 0.0 FULL 7 ✔Enfield F85048 Moorfield Road Health Ctr Del GMS 1 - Most deprived 6% 59% 1 0 Small-medium 70% 0% 0% 3,078 10,964 81.2% 2.8 4,861 5% 9% 6% 9% £107 10% 0.0 10% 0.0 PARTIAL 2 ✔Enfield F85053 Park Lodge Medical Centre Del GMS 4 6% 71% 35 2 Medium-large 25% 36% 0% 2,041 5,810 94.8% 3.3 6,129 -25% 15% 2% 6% £125 no data - ✔Enfield F85055 Connaught Surgery Del GMS 3 8% 63% 23 0 Small-medium 0% 0% 0% 2,910 13,990 96.0% 2.3 5,035 2% 80% 11% 6% 13% £117 16% 0.0 16% 0.0 PARTIAL 1 ✔Enfield F85058 Nightingale House Surgery Del PMS 2 6% 49% 19 0 Small-medium 20% 0% 100% 3,015 6,030 98.2% 4.6 6,566 3% 87% 10% 8% 13% £141 15% 0.0 14% 0.0 PARTIAL 4 ✔Enfield F85072 Grovelands Medical Centre Del PMS 3 7% 64% 4 0 Small-medium 51% 25% 100% 4,162 5,374 98.9% 3.8 9,766 2% 14% 12% 18% £138 11% 0.0 11% 0.0 FULL 7 ✔Enfield F85076 Freezywater Primary Care Centre Del PMS 1 - Most deprived 5% 62% 22 1 Large 16% 0% 58% 1,951 5,279 97.7% 4.2 12,991 -3% 83% 21% 35% 22% £142 22% 0.0 22% 0.0 PARTIAL 1 ✔Enfield F85625 Bincote Surgery Del PMS 4 8% 77% 3 1 Small-medium 69% 9% 0% 2,133 58,650 95.7% 3.2 6,291 2% 90% 8% 6% 13% £138 26% 0.0 25% 0.0 FULL 7 ✔Enfield F85634 East Enfield Practice Del PMS 1 - Most deprived 2% 51% 0 0 Small-medium 0% 0% 100% 2,093 5,966 99.6% 8.3 3,172 -1% 16% 9% 13% £152 9% 0.0 9% 0.0 PARTIAL 1 ✔Enfield F85642 The North London Health Centre Del GMS 3 7% 67% 5 0 Large 0% 0% 100% 1,372 10,356 95.0% 3.3 8,643 9% 89% 9% 7% 11% £118 22% 0.0 22% 0.0 FULL 7 ✔Enfield F85650 Morecambe Surgery Del GMS 2 7% 51% 6 1 10,113 96.9% 3.9 4,942 2% 23% 18% 22% £111 22% 0.0 22% 0.0 no data - ✔Enfield F85652 Southbury Surgery Del PMS 3 5% 73% 4 0 Small-medium 76% 0% 0% 2,322 9,867 93.7% 4.8 4,720 1% 4% 0% 2% £126 11% 0.0 11% 0.0 PARTIAL 6 ✔Enfield F85654 Brick Lane Surgery Del GMS 1 - Most deprived 6% 59% 2 0 Single-handed 0% 0% 100% 7,330 15,071 99.4% 5.5 3,992 -3% 65% 8% 4% 15% £122 11% 0.0 11% 0.0 NO 0 ✔Enfield F85656 Bush Hill Park Med Centre Del GMS 3 6% 68% 1 0 Small-medium 50% 0% 0% 1,897 89.8% 3.1 2,218 -1% 5% 4% 8% £116 11% 0.0 11% 0.0 FULL 7 ✔Enfield F85663 Latymer Road Surgery Del GMS 1 - Most deprived 7% 47% 4 0 Small-medium 34% 0% 0% 1,941 6,392 97.2% 4.2 4,738 -3% 8% 11% 11% £115 9% 0.0 9% 0.0 FULL 7Enfield F85666 Dr Me Silver's Practice Del PMS 1 - Most deprived 5% 43% 5 0 Small-medium 0% 47% 100% 1,873 11,507 97.4% 10.7 4,247 0% 92% 11% 13% 8% £144 11% 0.0 11% 0.0 NO 0Enfield F85676 Boundary House Surgery Del PMS 1 - Most deprived 5% 46% 12 4 Medium-large 31% 60% 100% 1,151 5,385 91.4% 3.5 4,855 -2% 100% 6% 6% 9% £164 18% 0.0 18% 0.0 FULL 7 ✔Enfield F85678 Town Surgery Del PMS 3 3% 71% 6 1 Small-medium 31% 0% 57% 2,716 8,516 99.2% 5.3 4,252 4% 6% * 7% £136 23% 0.0 22% 0.0 FULL 7 ✔Enfield F85681 Green Street Surgery Del PMS 1 - Most deprived 6% 57% 4 0 Single-handed 100% 0% 100% 2,899 28,988 88.1% 4.7 2,345 3% 73% 12% 13% 13% £137 25% 0.0 24% 0.0 PARTIAL 5 ✔Enfield F85682 Chalfont Road Surgery Del APMS 1 - Most deprived 3% 46% 4 1 Small-medium 0% 100% 100% 2,704 9,013 95.8% 5.2 4,666 -3% 100% 9% 4% 25% £132 15% 0.0 15% 0.0 FULL 7Enfield F85684 Curzon Avenue Surgery Del GMS 1 - Most deprived 3% 50% 9 0 Small-medium 40% 0% 0% 2,346 20,571 99.5% 5.5 5,676 -2% 83% 15% 14% 19% £117 17% 0.0 17% 0.0 FULL 7 ✔Enfield F85686 Trinity Avenue Surgery Del PMS 3 7% 66% 3 0 Small-medium 0% 0% 0% 1,945 96.1% 2.7 2,611 0% 86% 4% 1% 16% £136 6% 0.0 6% 0.0 PARTIAL 4 ✔Enfield F85687 Oakwood Medical Centre Del PMS 4 7% 71% 13 1 Small-medium 0% 0% 34% 2,572 4,830 99.3% 6.3 7,500 -2% 84% 12% 17% 24% £148 6% 0.0 6% 0.0 FULL 7 ✔Enfield F85700 Arnos Grove Medical Centr Del PMS 3 4% 61% 1 1 Small-medium 43% 94% 100% 2,734 2,515 97.0% 9.9 5,459 18% 12% 10% 16% 13% 0.0 13% 0.0 FULL 7 ✔Enfield F85701 Gillan House Surgery Del GMS 3 5% 66% 10 3 Medium-large 57% 3% 100% 2,465 8,789 99.6% 5.5 10,228 13% 92% 5% 4% 8% £119 19% 0.0 18% 0.0 FULL 7 ✔Enfield F85703 Lincoln Road Med Practice Del PMS 2 3% 61% 11 1 Medium-large 26% 0% 100% 1,874 8,902 96.2% 2.4 7,574 10% 92% 10% 12% 12% £251 27% 0.0 27% 0.0 FULL 7 ✔Enfield F85707 Enfield Island Surgery Del PMS 1 - Most deprived 2% 49% 10 0 Small-medium 50% 0% 100% 1,550 7,129 91.9% 3.1 3,869 -1% 18% 11% 14% £146 12% 0.0 12% 0.0 PARTIAL 1 ✔Enfield Y00057 Angel Surgery Del PMS 1 - Most deprived 2% 42% 4 2 Small-medium 57% 0% 100% 2,145 11,043 98.0% 3.6 5,354 7% 24% 5% 19% £126 20% 0.0 20% 0.0 FULL 7 ✔Enfield Y00612 Green Cedars Medical Centre Del GMS 1 - Most deprived 3% 44% 4 0 Small-medium 16% 36% 100% 2,530 12,786 97.3% 8.6 6,478 2% 69% 5% 2% 13% £110 9% 0.0 9% 0.0 FULL 7Enfield Y03402 Evergreen Primary Care Centre Del PMS 1 - Most deprived 3% 42% 40 1 Large 9% 10% 58% 2,945 11,583 96.2% 5.7 20,106 2% 95% 27% 39% 27% £151 34% 0.0 34% 0.0 FULL 7 ✔


of 142

Haringey CCGFinance

CCGPractice Code

Practice Name

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Haringey F85007 Lawrence House Surgery Del PMS 1 - Most deprived 3% 49% 31 0 Large 23% 2% 76% 1,643 5,745 99.7% 7.9 16,896 1% 80% 5% 8% 11% £168 59% 0.0 59% 0.0 FULL 7 ✔Haringey F85008 Staunton Group Practice Del GMS 2 4% 57% 33 2 Medium-large 38% 0% 27% 2,550 10,795 92.5% 6.5 14,643 0% 25% 40% 30% £135 5% 0.0 5% 0.0 no data - ✔Haringey F85013 Tynemouth Medical Practice Del PMS 1 - Most deprived 3% 44% 25 0 Medium-large 8% 0% 0% 1,969 3,183 10,497 -3% 19% 24% 31% £126 no data - ✔Haringey F85014 Highgate Group Practice Del PMS 4 7% 81% 22 1 Large 0% 0% 0% 2,126 6,708 98.0% 4.1 15,577 0% 100% 2% 3% 8% £139 70% 0.0 70% 0.0 FULL 7 ✔Haringey F85017 Charlton House Medical Centre Del GMS 1 - Most deprived 4% 43% 13 1 Small-medium 50% 0% 76% 4,293 8,723 99.8% 11.7 7,046 -2% 7% 8% 16% £114 30% 0.0 30% 0.0 no data - ✔Haringey F85019 Morris House Group Practice Del GMS 1 - Most deprived 4% 47% 41 3 Large 13% 0% 0% 1,729 13,036 95.8% 11.1 13,116 2% * 18% 16% 26% £162 19% 0.0 18% 0.0 FULL 7 ✔Haringey F85028 Bruce Grove Primary Health Care Ctr Del GMS 5% 2 2 Small-medium 65% 0% 100% 2,825 15,253 94.6% 5.7 7,853 -4% 30% 10% 18% £112 7% 0.0 7% 0.0 no data - ✔Haringey F85030 Somerset Gardens Family Health Centre Del PMS 1 - Most deprived 5% 42% 8 0 5,760 99.3% 10.7 13,779 2% 14% 32% 15% £141 10% 0.0 10% 0.0 FULL 7 ✔Haringey F85031 Westbury Medical Centre Del PMS 1 - Most deprived 4% 54% 31 0 Small-medium 0% 0% 100% 3,524 11,277 100.0% 6.0 10,629 2% 83% 11% 8% 7% £137 26% 0.0 26% 0.0 FULL 7 ✔Haringey F85034 Arcadian Gardens Surgery Del GMS 2 6% 60% 3 0 Small-medium 50% 7% 100% 1,738 8,141 93.5% 3.1 3,682 4% 75% 10% 1% 8% £116 24% 0.0 24% 0.0 FULL 7 ✔Haringey F85045 Queens Avenue Practice Del GMS 4 7% 80% 2 0 Small-medium 100% 0% 100% 2,274 17,284 94.7% 0.7 4,647 -2% 1% 0% 3% £107 16% 0.0 16% 0.0 no data -Haringey F85046 Hornsey Park Surgery Del GMS 2 3% 59% 10 3 Small-medium 100% 0% 0% 2,961 6,786 95.7% 5.6 4,430 1% 17% 2% 9% £109 15% 0.0 15% 0.0 FULL 7 ✔Haringey F85052 Spur Road Surgery Del GMS 1 - Most deprived 8% 50% 4 0 Small-medium 87% 0% 100% 1,244 14,306 96.9% 7.1 1,648 24% 12% 0% 10% £121 18% 0.0 18% 0.0 FULL 7Haringey F85060 Havergal Surgery Del PMS 2 5% 58% 1 0 Medium-large 10% 37% 90% 1,902 5,567 86.6% 3.5 6,102 3% 46% 10% 10% 11% £127 22% 0.0 18% 0.0 PARTIAL 5 ✔Haringey F85061 Christchurch Hall Surgery Del GMS 3 4% 73% 5 1 Small-medium 92% 26% 0% 2,263 91.7% 2.0 3,782 -1% 92% 4% 0% 7% £120 1% 0.0 1% 0.0 FULL 7 ✔Haringey F85063 The Muswell Hill Practice Del PMS 4 5% 82% 8 0 Large 18% 0% 0% 1,730 4,563 98.9% 5.5 14,100 4% 2% 4% 5% £133 43% 0.0 42% 0.0 FULL 7 ✔Haringey F85064 Stuart Crescent Health Centre Del PMS 2 5% 57% 8 3 Small-medium 0% 0% 0% 2,843 98.5% 6.9 4,751 7% 100% 7% 4% 12% £120 14% 0.0 14% 0.0 FULL 7 ✔Haringey F85065 Stuart Crescent Medical Practice Del GMS 1 - Most deprived 5% 56% 10 2 Small-medium 50% 0% 0% 1,306 7,835 94.0% 5.9 3,198 4% 10% 6% 9% £120 3% 0.0 3% 0.0 FULL 7 ✔Haringey F85066 Bounds Green Group Practice Del PMS 3 5% 65% 44 1 Large 12% 13% 37% 1,775 10,959 97.3% 6.1 17,098 4% 2% 8% 7% £133 47% 0.0 48% 0.0 PARTIAL 6 ✔Haringey F85067 The 157 Medical Practice Del PMS 2 7% 65% 0 0 Small-medium 50% 20% 100% 1,723 8,205 85.0% 3.2 4,542 -3% 19% 1% 16% £134 3% 0.0 3% 0.0 NO 0 ✔Haringey F85069 Crouch Hall Road Surgery Del PMS 3 4% 77% 4 0 Medium-large 67% 0% 54% 2,090 8,302 99.9% 4.4 8,349 4% 98% 1% 0% 5% 100% 0.0 100% 0.0 FULL 7 ✔Haringey F85071 Fernlea Surgery Del PMS 1 - Most deprived 3% 57% 2 0 Small-medium 32% 0% 100% 3,675 6,280 99.3% 6.1 9,031 7% 71% 15% 5% 20% £136 22% 0.0 22% 0.0 FULL 7 ✔Haringey F85615 Tottenham Health Centre Del PMS 1 - Most deprived 4% 43% 4 1 Small-medium 98% 0% 0% 2,326 6,350 95.8% 2.7 5,468 5% 12% 7% 10% £140 24% 0.0 22% 0.0 PARTIAL 4 ✔Haringey F85623 Grove Road Surgery Del PMS 1 - Most deprived 3% 48% 1 1 Small-medium 44% 0% 100% 1,668 18,769 93.9% 6.3 4,167 9% 100% 14% 1% 10% 11% 0.0 11% 0.0 no data - ✔Haringey F85628 Dowsett Road Surgery Del GMS 1 - Most deprived 5% 44% 4 0 Small-medium 0% 24% 100% 1,884 5,892 99.4% 6.0 4,521 8% 100% 9% 9% 13% £103 25% 0.0 25% 0.0 PARTIAL 4 ✔Haringey F85640 Evergreen House Surgery Del PMS 2 4% 61% 1 0 Small-medium 0% 0% 0% 2,551 5,182 94.5% 2.6 6,754 3% 6% 3% 12% £124 50% 0.0 50% 0.0 FULL 7 ✔Haringey F85645 Myddleton Road Surgery Del PMS 2 2% 60% 3 0 Single-handed 100% 0% 0% 3,023 6,215 93.7% 3.2 3,044 3% 32% 19% 4% 8% £132 41% 0.0 41% 0.0 FULL 7 ✔Haringey F85669 West Green Road Surgery Del GMS 1 - Most deprived 1% 54% 14 3 Medium-large 18% 21% 100% 2,547 47,005 97.1% 5.3 14,024 4% 89% 12% 0% 14% £101 6% 0.0 6% 0.0 FULL 7 ✔Haringey F85675 The Alexandra Surgery Del PMS 3 6% 70% 8 2 Small-medium 58% 17% 0% 3,132 99.6% 4.8 5,875 -3% 99% 14% 7% 13% £141 40% 0.0 40% 0.0 no data - ✔Haringey F85688 Rutland House Surgery Del PMS 4 4% 74% 1 0 Medium-large 21% 0% 100% 2,080 8,042 99.5% 5.8 6,650 6% 100% 4% 5% 12% £133 24% 0.0 22% 0.0 FULL 7 ✔Haringey F85697 The Old Surgery Del GMS 2 7% 61% 2 0 Small-medium 43% 0% 100% 1,992 10,795 96.6% 2.9 2,171 -7% 14% 2% 8% £104 4% 0.0 4% 0.0 FULL 7 ✔Haringey F85705 Js Medical Practice Del PMS 1 - Most deprived 3% 49% 2 0 Small-medium 50% 0% 40% 5,285 7,526 83.3% 3.7 12,495 1% 100% 9% 2% 21% £140 26% 0.0 26% 0.0 FULL 7 ✔Haringey Y01655 The Vale Practice Del GMS 3 1% 74% 2 1 Medium-large 55% 0% 0% 1,873 7,526 98.2% 4.3 11,076 5% 93% 5% 1% 3% £98 40% 0.0 40% 0.0 FULL 7 ✔Haringey Y02117 The Laurels Medical Practice Del PMS 1 - Most deprived 3% 50% 6 1 Small-medium 19% 56% 0% 5,509 21,409 99.4% 7.9 12,550 84% 94% 31% 27% 30% £139 7% 0.0 7% 0.0 FULL 7 ✔Haringey Y03035 Queenswood Medical Practice Del GMS 3 4% 75% 25 1 Large 6% 5% 22% 2,057 6,835 100.0% 5.6 22,229 7% 92% 2% 3% 6% £168 39% 0.0 38% 0.0 FULL 7 ✔Haringey Y03135 Bridge House Medical Practice Del PMS 2 4% 64% 14 0 7,671 90.9% 4.2 10,267 2% 27% 29% 33% £129 10% 0.0 10% 0.0 no data - ✔Haringey Y05330 Tottenham Hale Medical Practice Del PMS 0% 0 0 Small-medium 40% 0% 100% 1,449 5,797 2,181 77% 80% 28% 0.0 28% 0.0 FULL 7


of 142

Islington CCGFinance

CCGPractice Code

Practice Name

Co-c

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Cont

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Typ

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Disp

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Islington F83002 River Place Health Centre Del GMS 1 - Most deprived 4% 72% 12 0 Large 0% 0% 100% 1,376 5,586 100.0% 7.2 9,971 -3% 92% 7% 5% 12% £138 20% 0.0 18% 0.0 FULL 7 ✔Islington F83004 Archway Medical Centre Del PMS 1 - Most deprived 5% 66% 10 0 Small-medium 44% 0% 73% 2,483 4,123 98.1% 5.4 6,114 10% 6% 2% 12% £161 25% 0.0 24% 0.0 FULL 7 ✔Islington F83007 Roman Way Medical Centre Del GMS 1 - Most deprived 6% 66% 5 0 Medium-large 33% 19% 0% 1,349 92.0% 3.1 4,192 -1% 13% * 7% £125 17% 0.0 17% 0.0 FULL 7Islington F83008 The Goodinge Group Practice Del GMS 1 - Most deprived 4% 66% 23 1 Large 10% 0% 71% 1,344 9,210 94.6% 3.9 12,331 -3% 3% 8% 5% £126 25% 0.0 25% 0.0 FULL 7 ✔Islington F83010 Islington Central Medical Centre Del GMS 2 3% 73% 15 0 Medium-large 40% 0% 70% 4,191 6,792 99.1% 4.3 18,603 2% 80% 7% 23% 19% £135 56% 0.0 56% 0.0 FULL 7 ✔Islington F83012 Elizabeth Avenue Group Practice Del GMS 2 5% 73% 19 0 Large 0% 0% 0% 961 2,823 99.7% 6.5 7,251 -1% 100% 7% 3% 12% £149 38% 0.0 38% 0.0 FULL 7 ✔Islington F83015 St Johns Way Medical Centre Del GMS 1 - Most deprived 4% 67% 18 2 Large 17% 0% 0% 1,088 3,580 98.4% 8.9 13,052 2% 1% 2% 5% £130 24% 0.0 24% 0.0 FULL 7 ✔Islington F83021 Ritchie Street Group Practice Del GMS 2 3% 73% 45 1 Large 29% 0% 100% 2,166 12,355 97.7% 5.5 16,164 9% 95% 15% 17% 10% £128 28% 0.0 27% 0.0 FULL 7 ✔Islington F83027 Drs Bowry & Bowry's Practice Del GMS 1 - Most deprived 5% 66% 6 1 Medium-large 47% 0% 0% 1,556 96.2% 5.6 5,381 3% 10% 10% 18% £119 10% 0.0 10% 0.0 FULL 7 ✔Islington F83032 St Peter's Street Medical Practice Del GMS 2 3% 74% 21 0 Large 49% 0% 0% 1,892 12,263 99.7% 5.2 12,141 5% 71% 6% 6% 14% £125 17% 0.0 1% 0.0 NO 0 ✔Islington F83033 Dr Haffiz Del GMS 1 - Most deprived 7% 61% 2 0 Small-medium 0% 0% 100% 2,890 14,452 64.5% 11.1 3,047 -2% 23% 12% 18% £192 8% 0.0 8% 0.0 FULL 7Islington F83034 New North Health Centre Del GMS 2 9% 70% 1 0 Single-handed 100% 0% 0% 1,754 95.4% 5.7 1,733 -2% 15% 0% 4% £140 10% 0.0 10% 0.0 FULL 7 ✔Islington F83039 The Rise Group Practice Del GMS 1 - Most deprived 5% 64% 9 1 Small-medium 54% 6% 100% 1,909 4,123 87.1% 4.2 5,412 -1% 100% 12% 3% 11% £136 19% 0.0 19% 0.0 FULL 7 ✔Islington F83045 The Miller Practice Del GMS 2 4% 73% 20 0 Medium-large 45% 0% 60% 1,784 6,281 98.9% 4.7 10,303 -8% * 1% 1% 8% £132 34% 0.0 34% 0.0 FULL 7 ✔Islington F83051 Dr Ko & Partner Del GMS 2 4% 73% 4 0 Small-medium 0% 19% 100% 3,449 8,240 95.3% 3.5 3,861 -4% 9% 7% 13% £115 15% 0.0 15% 0.0 FULL 7 ✔Islington F83053 Mildmay Medical Practice Del GMS 2 4% 65% 0 0 Medium-large 32% 39% 100% 1,932 7,258 99.8% 6.0 6,381 0% 92% 19% 16% 25% £163 25% 0.0 25% 0.0 FULL 7 ✔Islington F83056 The Mitchison Road Surgery Del APMS 1 - Most deprived 3% 67% 19 0 Small-medium 44% 0% 0% 3,714 12,734 100.0% 6.4 4,743 2% 100% 17% 13% 15% £133 29% 0.0 28% 0.0 FULL 7Islington F83060 The Northern Medical Centre Del GMS 2 4% 67% 18 3 Medium-large 17% 0% 59% 1,855 6,255 97.3% 5.6 8,717 3% 11% 7% 11% £137 12% 0.0 12% 0.0 FULL 7 ✔Islington F83063 Killick Street Health Centre Del GMS 1 - Most deprived 3% 62% 9 0 Large 18% 0% 23% 1,668 2,721 100.0% 6.2 11,932 2% 2% 2% 9% £157 17% 0.0 17% 0.0 FULL 7 ✔Islington F83064 City Road Medical Centre Del GMS 2 5% 64% 19 1 Medium-large 0% 0% 0% 1,692 95.6% 6.3 7,149 5% 81% 18% 11% 20% £152 30% 0.0 30% 0.0 FULL 7 ✔Islington F83624 Clerkenwell Medical Practice Del GMS 2 2% 68% 17 1 Medium-large 13% 0% 7% 2,237 7,684 99.9% 6.0 12,428 11% 92% 4% 4% 4% £102 38% 0.0 38% 0.0 FULL 7Islington F83652 Amwell Group Practice Del GMS 2 2% 69% 23 2 Large 0% 6% 52% 1,212 5,560 99.8% 7.4 10,881 4% * 5% 2% 19% £160 27% 0.0 27% 0.0 FULL 7 ✔Islington F83660 Dr Trosser Del GMS 3 4% 72% 12 0 Medium-large 59% 11% 0% 2,673 8,452 94.0% 3.6 9,015 2% 100% 21% 5% 16% £112 17% 0.0 17% 0.0 FULL 7 ✔Islington F83664 The Village Practice Del GMS 1 - Most deprived 2% 57% 6 0 Small-medium 0% 0% 0% 3,238 5,992 96.8% 5.0 8,826 8% 14% 8% 14% £131 32% 0.0 32% 0.0 FULL 7 ✔Islington F83666 Andover Medical Centre Del GMS 1 - Most deprived 4% 58% 8 1 Medium-large 0% 11% 30% 1,063 4,333 98.1% 8.8 6,306 4% 88% 6% 5% 12% £126 19% 0.0 17% 0.0 FULL 7 ✔Islington F83671 The Beaumont Practice Del GMS 1 - Most deprived 3% 63% 2 0 Small-medium 80% 0% 100% 2,731 5,202 98.5% 7.7 2,955 5% 16% 8% 10% £144 33% 0.0 33% 0.0 FULL 7 ✔Islington F83673 Dr Edoman Del PMS 2 3% 65% 5 1 Small-medium 63% 0% 100% 1,963 3,836 100.0% 3.5 4,779 2% 9% 4% 9% £159 16% 0.0 16% 0.0 FULL 7 ✔Islington F83674 The Tufnell Surgery Del GMS 2 6% 71% 0 0 Small-medium 0% 54% 100% 2,831 4,357 99.4% 6.5 5,757 0% 12% 3% 10% 6% 0.0 6% 0.0 FULL 7 ✔Islington F83678 Dr Segarajasinghe Del GMS 2 7% 67% 1 1 Small-medium 0% 0% 0% 1,100 5,280 90.5% 13.5 2,627 0% 3% 5% 15% £109 15% 0.0 15% 0.0 FULL 7 ✔Islington F83680 Dr Gupta Del GMS 1 - Most deprived 4% 63% 4 1 Small-medium 57% 3% 100% 1,551 4,242 96.0% 2.7 3,939 3% 88% 10% 1% 18% £123 17% 0.0 17% 0.0 FULL 7 ✔Islington F83681 Partnership Primary Care Centre Del GMS 1 - Most deprived 5% 68% 4 0 Small-medium 7% 7% 100% 2,086 3,215 99.5% 8.8 3,319 4% 100% 11% 7% 18% £147 8% 0.0 8% 0.0 FULL 7Islington F83686 Stroud Green Medical Centre Del GMS 2 2% 67% 11 1 Small-medium 0% 0% 100% 3,271 9,539 98.6% 6.9 6,371 3% 91% 6% 0% 19% £113 16% 0.0 15% 0.0 FULL 7 ✔Islington Y01066 Hanley Primary Care Centre Del PMS 1 - Most deprived 3% 61% 9 0 Small-medium 0% 0% 0% 2,965 99.5% 5.8 6,592 8% 83% 15% 8% 20% £122 28% 0.0 26% 0.0 FULL 7


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General Practice Sustainability and ResilienceReferences

Purpose of document, and source data

Brief Description Source Time period

Main practicesData for GPs and GP Surgeries is supplied by the NHS Prescription Service of the NHS Business Services Authority. Medical Practices classed as active were included (from the Prescribing Cost Centre data).

NHS Digital Apr-18 May-18

Branch practices

GP branch surgeries in England. Peripheral branch surgeries are not included in the NHS Prescription Service data. The ODS maintain branch practice data based upon updates from users within the CCGs. The NHS Prescription Service supply updated files to ODS on a monthly basis.

NHS Digital Oct-17 Nov-17

Registered PopulationNumber of Patients Registered

at a GP Practice Data extracted as a quarterly snapshot in time from the GP Payments system maintained by NHS Digital. NHS Digital Jun-18 Jun-18

Primary Care Co-Commissioning

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

NHS England Apr-18 Apr-18

Contract Type

Dispensing Practice

Deprivation Practice patient level deprivation

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

Kings College London, Department

for Communities and Local Government

2015 Sep-16

% Aged 75+ Data extracted from the NHS Digital's GP Payments system. NHS Digital Jun-18 Jun-18

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

2015 Jul-16

General Practice Indicators (GPI) replaces the General Practice Outcome Standards (GPOS) and General Practice High level indicators (GPHLI) modules, creating a single unified set of 46 indicators. GP practices are grouped into one of four categories based on an overall assessment of performance across a range of indicators. For more details on the methodology, please visit the Primary Care Webtool.

NHS England Jan-18

OutstandingGoodRequires improvement

InadequateNo published rating

The NHS complaints procedure is the statutorily based mechanism for dealing with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure. This shows the counts of the number of written complaints made by (or on behalf of) patients, received between 1 April 2016 and 31 March 2017. Data are collected via two forms, the KO41a (NHS Hospital and Community Health Service (HCHS)) and KO41b (Family Health Service (GP including Dental) (FHS)). Please note this is experimental information.

NHS Digital 2016-17 Sep-17

Single-handed (=<1 FTE GP)

Small-medium (>1 and =<3)

Medium-large (>3 and =<6)

Large (>6 FTE GPs)

% FTE GPs aged 55 and over

% FTE Locum GPs

% FTE Nurses aged 55 and over

Number of patients per FTE GP

Number of patients per FTE Nurse

QOF Exception Rate

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

NHS Digital Jun-18 Jun-18

List Size Change +/- 5-10%Available quarterly, the annual percentage change of list size of all practices in England. NHS Digital Apr-18 Apr-18

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

NHS England Apr-18 Jun-18

Jan - Mar 17

Finance

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

NHS Digital 2016-17 Sep-17

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

The average number of times each enabled patient has accessed the online appointments service

GP practices provide functionality for patients to view/order repeat prescriptions electronically. Number of patients enabled to electronically view/order repeat prescriptions divided by the practice list size

The average number of times each enabled patient has accessed the online order repeat prescriptions service

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

Jun-18 References

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

Oct-172016-17

CQC

Jul-17

Mar-18

Jun-18

% likely to recommend the GP service to friends and family

QOF AchievementThe QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. The objective of the QOF is to improve the quality of care patients are given by rewarding practices for the quality of care they provide to their patients. Participation in QOF is voluntary, though participation rates are very high (95.4% in 16/17).

NHS Digital

Not able to get an appointment to see or speak to someone

NHS England

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

Published

Sep-17

SummaryTotal Practices

Delegated commissioning

Greater involvement

Joint commissioning

Practice Information & Demographics

Displays the contract type and if the practice is authorised to dispense drugs. Sourced from NHS Payments to General Practices in England for 2016/17 by individual General Practice

NHS Digital

Jun-18

Practice Size(Based on FTE GPs)

NHS Digital Sep-17

Written Complaints (total for practice)

Written Complaints (directed to NHS England)

General Practice Indicators:Practice ratings

CQC Rating

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

Not at all easy getting through by phone

The GP Patient Survey is an independent survey run by Ipsos MORI on behalf of NHS England. The survey is sent out to over a million people across the UK. The results (weighted) show how people feel about their GP practice. The specific questions presented are:- Would you recommend your GP surgery to someone who has just moved to your local area? (% no)- Ease of getting through by phone (% not at all easy)- Ability to get an appointment to see or speak to someone (% no)

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

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

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

Extended Access No. of extended access days

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

Sustainability and Resilience Reports - Conditions on Forward Use

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

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

sharing of the data.

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

2016-17

Would not recommend GP surgery

Patients Online

Average payment per weighted patient

Patient Experience

Efficiency

Workforce

% Of Reg Population with online appointment enabled

Average number a patient has accessed the online appointments service

Directed Enhanced Services(Extended Access payment)

Quality

May-18

% Of Reg Population with order repeat prescriptions online enabled

Average number a patient has accessed the online order repeat prescriptions service

Online Appointments Enabled

NHS Digital

CategoryFull/Partial/No extended access

Order Repeat Prescriptions Online Enabled

NHS England

Apr-18 Jun-18

Mar-18

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1


Report Title Service Charge costs to NCL

Practices Date of report 9th August 2018

Agenda Item

7




GB Member Sponsor

Report Author

Vanessa Piper


Report Summary

To provide the committee with information on the service charge costs for practices

Recommendation For DISCUSSION It is recommended that the data presented on the service charge costs be used for information only or as a basis for more exploratory data if commissioners are reviewing a premises scheme or application.


Financial


Not applicable


Not applicable


Implementation of the Primary Care Regulations and NHS Premises Cost Directions


Premises Cost Directions

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2

Engagement

Not applicable


Not applicable


None

Next Steps To note revised premises directions may be published in 2018.

Appendices

Not applicable


NCL STP

Document title:

Version number: 1.0

Prepared by: Vanessa Piper

Classification: Official

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3

1. Executive summary

Committee members requested an analysis of the service cost charges to NCL practices to get more insight into the minimum, maximum and average service charge costs.

This request was also following the award of service charge financial assistance to two NCL Practices under the NHS Premises Costs Directions (2013) using the methodology set out in the London Wide Policy.

The committee members are reminded for the two cases that were awarded financial assistance, the practices service charge costs were at a maximum of £36,606 and £45, 978 from year 2 onwards.

Table A

Practice A

Service charge costs

Practice share of service charge costs

Commissioners financial assistance

Year 1 (17/18) 28,902 13,269 15,633

Year 2 – 9 36,606 13,269 23,337

Year 1 it shows there is a 45: 55 percent contribution from the practice and commissioner. Year 2 onwards shows there is a 36: 64 percent contribution from the practice and commissioner. Table B

Practice 2

Service charge costs

Practice share of service charge costs

Commissioners financial assistance

Year 1 (17/18) 34,407 11,260 23,147

Year 2 – 9 45,978 11,260 34,718

Year 1 it shows there is a 33: 67 percent contribution from the practice and commissioner. Year 2 it shows there is a 24:76 percent contribution from the practice and commissioner.

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4

To review the current service costs for other practices across NCL commissioners emailed all practices requesting the information below where there is a leasehold occupancy;

1. Service charge costs 2. Space the practice occupies (square metre) 3. List size

There were 65 practices across the 5 CCGs whom responded but only 30 practices submitted accurate data.

Of the 30 practices that responded the analysis shows that;

Service Charge Cost

Square metre List size

1 Average £19,635 246 7025 2 Minimum £22,709 259 6915 3 Maximum £23,442 266 7331

From the practices that responded with accurate information there does not seem to be an extreme variation of service charges across the 30 practices.

Despite this, we cannot deem this as an affordable level to contract holders without knowing the practices full expenditure related to the running cost of the practice compared to their income.

It may also be difficult to use these figures as a true benchmark in the absence of knowing the quality and age of the building, for example, newer primary care centres are known to have a higher running cost due to the quality of the building and the larger size of the consulting rooms.

It is therefore recommended that this data be used for information only or as a basis for more exploratory data if commissioners are reviewing a premises scheme or application.

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5

Service charge costs by practice

Service charge costs Square metre List size

£20,000.00 204 5606

£14,202.00 784 12970

£13,000.00 257 8419

£5,938.24 16.54 2943

£11,434.20 30.81 3531

£11,982.62 31.22 4268

£32,247.28 372.28 12855

£13,568.00 213.6 8165

£6,760.00 0 7744

£0.00 121.32 5369

£19,000.00 0 8507 £15,770.39 0 4317

£0.00 127.77 4420

£0.00 0 6245

£0.00 478.27 11336

£11,053.92 354.98 9284

£0.00 270 5765

£16,625.60 158 2711

£0.00 0 N/A

£8,050.00 0 12084

£6,287.84 440 16317 £0.00 0 4872

£14,267.97 256.25 4926

£137,628.00 417.3 20173

£23,239.00 70.5 3890

£33,826.00 102.6 4642

£0.00 263.03 4247

£25,700.04 0 2316

£0 147.12 5200

£3,776.50 124.54 2362

£0.00 0 4928 £24,500.00 108 4700

£0.00 0 13348

£12,669.04 97.92 3254

£0.00 0 4700

£27,808.72 65 10423

£0.00 993 14576

£10,000.00 389 9070

£11,816.00 0 4882

£0.00 0 3184 £8,877.00 159.45 3710

£20,944.01 323.82 10185

£28,104.20 0 2617

£0.00 0 2316

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Report Title Overview of NHS England Conflicts of Interest

Guidance for Managing Conflicts of Interest


Agenda Item 11




GB Member Sponsor

Report Author

Andrew Spicer, Head of Governance and Risk for NCL CCGs


Report Summary

This report provides an overview of the NHS England statutory guidance on managing conflicts of interest for CCGs and how it pertains to the NCL Primary Care Committee in Common.

Recommendation The Committee is asked to note the report. Identified Risks and Risk Management Actions

This report helps to ensure conflicts of interest are managed robustly and in line with NHS England statutory guidance.


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


There are no resource implications arising from this report.

Engagement

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


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


None.

Next Steps To continue to manage conflicts of interest robustly. Appendices

11.1 - Overview of NHS England Conflicts of Interest Guidance for Managing Conflicts of Interest

Which CCG does this relate to

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

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Item 11.1

Overview of NHS England Conflicts of Interest Guidance for Managing Conflicts of Interest

Introduction In 2014 NHS England published statutory guidance on managing conflicts of interest within CCGs. This guidance was subsequently revised in 2016 and 2017 to take into account primary care joint and delegated commissioning and the lessons learned over the preceding periods. The full NHS England 2017 guidance can be found here: https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf Key points The key points of the guidance as they relate to delegated primary care commissioning are as follows:

• CCGs with fully delegated primary medical services commissioning arrangements must establish a primary care commissioning committee for the discharge of their primary medical services functions. The committee should be a committee established by the CCG and separate from the Governing Body;

• The interests of all committee members must be recorded on the CCG’s register of interests;

• The committee must have a lay and executive majority to be quorate. GPs can be members of the committee bust must not be in the majority;

• The committee must have a lay chair and vice char. The CCG’s audit chair must not be the chair of the primary care commissioning committee to ensure their role as Conflicts of Interest Guardian is not compromised. However, the CCG’s audit chair may be a member of the committee provided appropriate safeguards are put in place to avoid compromising their role as Conflicts of Interest Guardian

• Conflicts of interest must be properly and robustly managed; • At the beginning of each meeting the Chair should ask if anyone has any conflicts of

interest to declare in relation to the business to be transacted at the meeting. Each member should declare any interests which are relevant to the business of the meeting whether or not those interests have previously been declared. Any new interests which are declared at a meeting must be included on the CCG’s relevant register of interests to ensure it is up to-date. Any new offers of gifts or hospitality (whether accepted or not) which are declared at a meeting must be included on the CCG’s register of gifts and hospitality to ensure it is up-to-date;

• There are various measures that can be taken to manage situations where a member of the committee has a conflict of interest with the appropriate course of action depending on the particular circumstances:

o Where the chair has a conflict of interest, deciding that the vice chair (or another non-conflicted member of the meeting if the vice chair is also conflicted) should chair all or part of the meeting;

o Requiring the individual who has a conflict of interest (including the chair or vice chair if necessary) not to attend the meeting;

o Ensuring that the individual concerned does not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict;

o Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to

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leave the room and in public meetings to either leave the room or join the audience in the public gallery;

o Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting when any decisions are being taken in relation to those matter(s). This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared;

• There must be sufficient clinical expertise when taking into account the range of services being commissioned;

• The committee may establish sub-committees and subgroups to assist it with its business. However, ultimate decisions making responsibility must rest with the committee;

• If the committee has any sub-committees or sub groups reporting into it conflicts of interest must be managed appropriately;

• To ensure complete transparency in decision making robust records must be kept. If any conflicts of interest are declared or otherwise arise in a meeting the Chair must ensure the following information is recorded in the minutes:

o Who has the interest; o The nature of the interest and why it gives rise to a conflict, including the

magnitude of any interest; o The items on the agenda to which the interest relates; o How the conflict was agreed to be managed; and o Evidence that the conflict was managed as intended (for example recording the

points during the meeting when particular individuals left or returned to the meeting).

NCL Conflicts of Interest Policy The NCL Conflicts of Interest Policy has been updated to properly reflect and incorporate the requirements the 2017 NHS England’s statutory guidance on managing conflicts of interest. Committee Terms of Reference The NCL Primary Care Co-Commissioning Committee in Common (‘NCL PCCC’) has robust Terms of Reference which properly reflect and incorporate the requirements the 2017 NHS England’s statutory guidance on managing conflicts of interest. Worked Example: Practice Decision If the NCL PCCC would like to make a decision on a practice within its remit it will follow the process below when managing conflicts of interest:

1. The relevant CCG and committee members will be identified; 2. Prior to any papers being send to committee members the Chair of the NCL PCCC

will work with the NCL Governance Team/Corporate Affairs Team and lead directors to identify any actual or potential conflicts of interest;

3. Any potential conflicts of interest will be identified and investigated. A decision will be made as to which papers, if any, can be sent to the individual with a conflict of interest. This will be communicated to the committee members and papers will only be sent out as appropriate;

4. At the beginning of the NCL PCCC meeting the Chair will ask if anyone has any declarations of interest in relation to the business to be transacted at the meeting. The Chair will also ask if there are any new declarations of gifts and hospitality. These will be declared by committee members and minuted. New declarations will be added to the appropriate register of interests;

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5. The Chair will agree how any conflicts of interest will be managed in line with statutory guidance and the NCL Conflicts of Interest Policy;

6. If the member on the committee has a conflict of interest a decision will be made as to what level of involvement they may have on the particular item of business in which they are conflicted. This could be any member of the committee but is most likely to be a GP;

7. A number of factors should be taken into account when deciding the nature and extent of the conflict of interest including whether the person has: a. A direct financial interest; b. A non-financial professional interest; c. A non-financial personal interest; d. An indirect interest.

8. For GPs it is particularly important to consider whether there are any conflict of interest arising from new models of care such as federations or Closer to Home Integrated Networks (‘CHINS’);

9. Any conflicted individual will not take part in the decision making on items in which they have a conflict of interest. However, on a case by case basis depending on the situation and as appropriate either: a. Leave the meeting for the entirely of the meeting; b. Leave the meeting for the item on which they are conflicted; c. Stay for the item on which they are conflicted to participate in the discussions

on that item of business but leave the room when the matter is being decided on;

10. The NCL PCCC may need to consider whether to co-opt or delegate authority to non-conflicted individuals in order to proceed. This will be carried out in line with the authorities contained in the committee’s Terms of Reference;

11. The decision on how conflicts of interest will be managed will be taken by the Chair of the committee and communicated to all committee members present;

12. The meeting will proceed and conflicts of interest will be managed in accordance with the decision taken by the Chair;

13. The following will be recorded in the minutes of the meeting: a. Who had the interest; b. The nature of the interest and why it gives rise to a conflict, including the

magnitude of any interest; c. The items on the agenda to which the interest relates; d. How the conflict was agreed to be managed; and e. Evidence that the conflict was managed as intended (for example recording the

points during the meeting when particular individuals left or returned to the meeting).

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Report Title Commissioners’ obligation to consult for Primary Care Commissioned Services

Date of report

9th August 2018

Agenda Item

12

Considered at Part 1 ☒ Part 2 ☐ Urgent decision ☐

Lead Director /

Manager



GB Member Sponsor

Report Author

Su Nayee Tel/Email [email protected]

Report Summary

To provide an overview on the requirements to consult with patients

Recommendation Members of the Primary Care Commissioning Committee in Common are asked to NOTE:

1;Commissioners should always consider the benefits of involving the public in their work and seek to take account of feedback from the public about the services which they commission

2: Be aware on when commissioners should consult with the public when commissioning / making changes to services that may have an impact to patients.

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3: Be aware of the legal requirements to consult under section 13Q of the NHS Act 2006, commissioners have a statutory duty to ‘make arrangements’ to involve the public in the commissioning services for NHS patients.

Section 13Q applies to:

• The planning of commissioning arrangements • The development and consideration of any proposals

that would impact on the manner in which services are delivered to individuals or the range of services available to them

• Decisions that would impact on the manner in which services are delivered to individuals or the range of services available to them

The section 13Q duty only applies to plans, proposals and decisions about services that are directly commissioned by NHS England. This includes GP, dental, ophthalmic and pharmaceutical services. However, under the co-commissioning Delegation Agreement CCGs must act in a way that enables NHS England to comply with the 13Q requirements

Examples of when Section 13Q duty is likely to apply

• Changes to commissioning arrangements • The strategic planning of services, for example:

i) Plans to reconfigure or transform services to

improve health. • Plans in response to the latest Joint Strategic Needs

Assessment or Health and Wellbeing Strategy. • Developing and considering proposals to change

commissioning arrangements, for example: new service specifications, piloting new services or making changes to existing services or service reconfiguration. Eg Commencing a major procurement process.

Overview and Scrutiny referral

• Any instance in which a referral has been made to the local Overview and Scrutiny Committee.

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Other examples where public involvement may apply:

• decision in relation to the relocation of a GP practice • Closure of a GP practice and dispersal of the patient list

where there are only few practices available

Examples of ways to involve patients and the public

• Letters or emails to affected individuals • Newsletters • Information on notice boards • Suggestion boxes • Leaflet drops • Dedicated events to enable discussion • Online surveys or feedback pages • Seeking views at local events or venues e.g.

festivals, markets, schools, leisure centres, libraries etc.

• Working with local voluntary and community sector organisations, Local Healthwatch and the Patient Participation Group (PPG) at GP practices

• Providing opportunities for the public to meet commissioners.

• Formal consultations. • Social media e.g. Twitter, Facebook • Public and patient advisory or reference groups • Patient and public representatives involved in

governance

Where public involvement is required, NHS England has a broad discretion as to how it involves the public. However, this is not an absolute discretion: it must ensure that its arrangements are fair and proportionate.

For example –

• Closure of a small GP practice in an urban area is likely to close due to the retirement of the lead partner and difficulties relating to the condition of the practice

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premises. The patient list can be dispersed to a neighbouring GP practice two streets away. The public involvement duty would be engaged, but carrying out an extensive public involvement exercise in relation to the changes may be disproportionate.

• An urgent closure NHS England has the contractual right to terminate a GP contract on patient safety grounds. Unless a new provider is immediately available and able to use the premises, it is inevitable that patients will have to go to another location for consultations and treatment, at least for a temporary period. NHS England’s public involvement duty would be engaged in this scenario, but carrying out a detailed public involvement exercise before closing the practice could place patients at risk. It would therefore be sufficient for NHS England to notify all patients of the situation in this case, even though a more detailed level of public involvement would usually be required for the closure of a practice


Stakeholder interest with regard to provision of primary care services across NCL.


The report has been developed in line with conflicts of interest guidance.


Not applicable.


To meet legal requirements to secure safe and adequate primary care medical services for the population.


Compliance with requirement to secure adequate primary care medical services for the local population;

Ensure that services comply with primary care regulations

Ensure commissioners meet regulation requirements

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Engagement


Equality Impact Analysis will inform both the need to consult and consultation itself.


Not applicable

Next Steps Ensure the policy is followed.

Appendices 12.1 – Policy Statement

Which CCG does this relate to:

This relates to the shared responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning primary care services in NCL.

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NHS England supporting summary document of the requirements to consult policy book 4.6 The Involvement Duty (Page 42 – 54 of the policy book Overview 4.6.1 Under sections 13Q of the NHS Act 2006, NHS England has a statutory duty to ‘make arrangements’ to involve the public in the commissioning services for NHS patients. (This duty is also placed directly on to CCGs under section 14Z2.) 4.6.2 Section 13Q applies to:

o the planning of commissioning arrangements

o the development and consideration of any proposals that would impact on the manner in which services are delivered to individuals or the range of services available to them

o decisions that would impact on the manner in which services are delivered to individuals or the range of services available to them

4.6.3 The section 13Q duty only applies to plans, proposals and decisions about services that are directly commissioned by NHS England. This includes GP, dental, ophthalmic and pharmaceutical services. However, under the co-commissioning Delegation Agreement CCGs must act in a way that enables NHS England to comply with the 13Q requirements. 4.6.4 (The section 14Z2 duty applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a CCG in the exercise of the CCG's own functions i.e. commissioning of secondary care.) The commissioners' arrangements for public involvement 4.6.5 The statutory duty to ‘make arrangements’ under section 13Q of the NHS Act 2006 is essentially a requirement to make plans and preparations for public involvement.

4.6.6 NHS England has set out its plans as to how it intends to involve the public in the following publications: The Patient and Public Participation Policy

https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-policy.pdf

The Statement of Arrangements & Guidance on Patient and Public Participation in Commissioning. https://www.engage.england.nhs.uk/survey/strengthening-ppp/supporting_documents/ppppolicystatement.pdf-1

The Framework for Patient and Public Participation in Primary Care Commissioning

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https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/framwrk-public-partcptn-prim-care.pdf 4.6.7 These publications set out and explain the arrangements NHS England has in place: Corporate infrastructure – how public involvement is embedded in the way that NHS England is constituted and carries out its business

Involvement initiatives – initiatives designed to involve the public in strategic planning and the development of policy or other aspects of NHS England’s activities

Monitoring arrangements – a step-by-step process to help commissioners identify whether the section 13Q applies and decide whether sufficient public involvement activity is already in place or whether additional public involvement is required

Responsive arrangements – guidance to commissioners on how to make arrangements for public involvement where monitoring has indicated that such arrangements are required. 4.6.8 As well as setting out the above arrangements, which commissioners should follow, the documentation is regularly reviewed and updated and contains useful resources for commissioners, including: Details of existing corporate infrastructure and involvement initiatives which that could be drawn upon by commissioners to involve the public in their commissioning activities.

Reference to NHS England’s framework for involving patients and the public in primary care commissioning, which includes resources developed especially for primary care.

Resources to help commissioners identify whether the section 13Q applies, put in place appropriate arrangements for public involvement and avoid legal challenge.

Guidance on a variety of topics that often arise, such as what ‘public involvement’ means, how to involve the public, who to involve, when involvement should take place, urgent decisions and joint involvement exercises Case studies based upon primary care scenarios

Summaries of related legal duties

Details of how to seek further advice if needed. 4.6.9 The documentation is intended to be used by both commissioners (who need to understand and comply with the arrangements when commissioning services) and the public (to understand how NHS England involves the public in its commissioning of services). As noted, for CCGs co-commissioning under delegated authority from NHS England, these arrangements are supplementary to their own requirement to have in place arrangements for public involvement under section 14Z2 of the NHS Act 2006.

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4.7 Duty to Act Fairly & Reasonably 4.7.1 Commissioners have a duty to act fairly and reasonably when making its decisions. These duties come from case law that applies to all public bodies. Acting fairly 4.7.2 Normally, to act fairly a commissioner will need to act in accordance with its own policies. and relevant policies published by NHS England. For CCGs co-commissioning under delegated authority from NHS England, this will include NHS England policies concerned with the commissioning of primary care. A commissioner can depart from guidance if there is good reason to do so. In this scenario the commissioner will need to explain the situation fully to the people & organisations affected and give them a chance to provide their views on the procedure to be followed. This will include why it wants to depart from the usual policy and what it will do instead. 4.7.3 Commissioners also need to be careful about keeping to promises made to contractors or the public e.g. that there will be a public consultation before any final decision is made on closing a particular pharmacy. It is sometimes (but not always) possible depart from such promises. Therefore care should be taken about giving any clear commitments to a particular course of action until the commissioner is sure that it is what it wants to do. If a commissioner is considering departing from a commitment it has given to do a particular thing or follow a particular type of process, then, if the decision is being made by NHS England or by a CCG on NHS England's behalf as part of co-commissioning, the NHS England legal team should be contacted for further guidance.

Example: The Commissioner has to decide whether to approve a practice's application to stop opening on Wednesday evening and open on Saturday morning instead. The practice is based in an area with a high Jewish population. Relevant factors in this decision include whether services will become more or less accessible as a result of the change, any adverse impact on people with protected characteristics (is the Jewish population disadvantaged as Saturday falls on the Jewish rest day?) and any costs implications for the commissioner. An example of an irrelevant factor is that the commissioner has been promised some good publicity by the practice if it agrees to the change. 4.7.4 It is also important to act proportionately, taking into account any adverse impact on patients and/or contractors. Acting reasonably 4.7.5 The Commissioner has to take all relevant factors into account when making its decisions and exclude irrelevant factors. It is up to the commissioner how much weight it gives competing considerations and may give a factor no weight at all. The key point is that all the relevant factors are identified and documented.

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4.7.6 The reasons for the commissioner's decisions also need to "stack up". It is important for the commissioner to document its reasons for a decision as the commissioner needs not only to act reasonably but be able to show that it has acted reasonably by reference to contemporaneous documents. This means that particularly where a controversial decision is being made the thinking behind the decision needs to be carefully documented. 4.8 The Duty to Obtain Advice 4.8.1 A commissioner has a duty to "obtain appropriate advice" from persons with a broad range of professional expertise (in respect of NHS England, see section 13J of the NHS Act 2006; and, in respect of CCGs, see section 14W of the NHS Act 2006) 4.8.2 This means that decision-makers need to collect appropriate information before making decisions. If the commissioner does not have the information

it needs then it should seek out appropriate advice. In many cases it will not be necessary to do this as all the necessary information is to hand. 4.8.3 The duty is most relevant to strategic decisions taken at directorate level within NHS England, where decision-makers will need to document how they obtain advice from those with professional expertise (some of whom may be employees or secondees). 4.9 The Duty to Exercise Functions Effectively 4.9.1 The commissioner has a duty to exercise its functions effectively, efficiently and economically (in respect of NHS England, see section 13D of the NHS Act 2006; and, in respect of CCGs, see section 14Q of the NHS Act 2006) . 4.9.2 This is a statutory reformulation of a duty that has been contained for many years in Managing Public Money and its predecessors. If the commissioner has complied with the other duties in this guidance – in particular the duty to act reasonably – it is highly unlikely that it will breach this duty. 4.10 The Duty Not to Prefer One Type of Provider 4.10.1 NHS England must not try and vary the proportion of services delivered by providers according to whether the provider is in the public or private sector, or some other aspect of their status (section 13P). CCGs must also act in accordance with this duty when they are co-commissioning under delegated authority from NHS England. 4.10.2 This means that the commissioner must focus on the services delivered by an organisation and its sustainability. It should not make choices about contractors based solely on their status as e.g. company, partnership, public sector, private sector, charity or not for profit organisation.

Annex 1 Extracts from Legislation The NHS ACT 2006 – SECTIONS 13Q

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General duties of the Board [References to "the Board" are to NHS England and CCGs with delegated authority, by virtue of the terms and conditions laid out the delegation agreement 13Q Public involvement and consultation by the Board

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by the Board in the exercise of its functions ("commissioning arrangements").

(2) The Board must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways) –

(a) in the planning of the commissioning arrangements by the Board,

(b) in the development and consideration of proposals by the Board for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and

(c) in decisions of the Board affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

(3) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users.

(4) This section does not require the Board to make arrangements in relation to matters to which a trust special administrator's report or draft report under section 65F or 65I relates before the Secretary of State makes a decision under section 65K(1), is satisfied as mentioned in section 65KB(1) or 65KD(1) or makes a decision under section 65KD(9) (as the case may be).

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Statement of Arrangements and Guidance on Patient and Public Participation in Commissioning

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Document number: 04415 Issue: 30/11/2015 Version number: 1

Status: Approved Next review date: 31/03/2017 Page 2

NHS England INFORMATION READER BOX

Directorate

Medical Commissioning Operations Patients and Information

Nursing Trans. & Corp. Ops. Commissioning Strategy

Finance

Publications Gateway Reference: 04415

Document Purpose

Document Name

Author

Publication Date

Target Audience

Additional Circulation

List

Description

Cross Reference

Action Required

Timing / Deadlines

(if applicable)

Patient and Public Representatives, Voluntary and Community Sector,

partner organisations

Policy

Statement of Arrangements and Guidance on Patient and Public

Participation in Commissioning

NHS England/Public Participation Team

30 November 2015

NHS England Regional Directors, NHS England Directors of

Commissioning Operations, All NHS England Employees,

Communications Leads

0113 8250861

Guidance for commissioners on involving the public in commissioning in

line with the legal duty under Section 13Q of the NHS Act 2006 (as

amended).

Patient and Public Participation Policy and Transforming Participation

in Health and Care

Superseded Docs

(if applicable)N/A

For implementation

N/A

Contact Details for

further information

Public Participation Team

NHS England

Quarry House, Leeds

LS2 7UE

[email protected]

Document StatusThis is a controlled document. Whilst this document may be printed, the electronic version posted on

the intranet is the controlled copy. Any printed copies of this document are not controlled. As a

controlled document, this document should not be saved onto local or network drives but should

always be accessed from the intranet.

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Statement of Arrangements and Guidance on Patient and Public Participation in Commissioning Version number: 1 First published: November 2015 Prepared by: Head of Programme Delivery, Public Participation Team

The National Health Service Commissioning Board was established on 1 October

2012 as an executive non-departmental public body. Since 1 April 2013, the National

Health Service Commissioning Board has used the name NHS England for

operational purposes.

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This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet/internet is the controlled copy. Any printed copies of this document are not controlled.

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1 Contents

1 Introduction .......................................................................................................... 7

1.1 Commissioning .............................................................................................. 7 1.2 The duty to involve the public (section 13Q) .................................................. 7 1.3 Scope ............................................................................................................ 8 1.4 Who is this document for? ............................................................................. 8 1.5 Terminology used in this document ............................................................... 9 1.6 Further guidance and advice for NHS England staff...................................... 9

2 When does the section 13Q duty apply? ........................................................... 10

2.1 Triggers ....................................................................................................... 10

2.2 Assessment ................................................................................................. 11

3 What does the section 13Q duty require us to do? ............................................ 15

3.1 What is public involvement? ........................................................................ 15 3.2 What are the guiding principles in identifying how to involve the public? ..... 15

3.3 Who does NHS England need to involve? ................................................... 17 3.4 When should public involvement take place? .............................................. 18 3.5 Can we use existing information on the views and experiences of patients and the public? ...................................................................................................... 19 3.6 What if a decision needs to be taken urgently? ........................................... 20 3.7 Can we carry out a joint public involvement exercise with another organisation? ........................................................................................................ 21 3.8 Feeding back the outcome of public involvement activity ............................ 21 3.9 Assessing the effectiveness of public involvement exercises ...................... 21

4 Corporate infrastructure ..................................................................................... 23

4.1 Public involvement in governance ............................................................... 23 4.2 Communication with patients and the public ............................................... 24 4.3 Business planning ....................................................................................... 24 4.4 Publications Gateway clearance ................................................................. 25 4.5 Reporting and assurance ............................................................................ 25

5 Involvement initiatives ....................................................................................... 26

5.1 Frameworks for patient and public participation for each of NHS England’s commissioning responsibilities .............................................................................. 26 5.2 NHS Citizen ................................................................................................. 27 5.3 Reaching different communities .................................................................. 27 5.4 Using insight to influence commissioning .................................................... 29

6 Co-commissioning, delegation, devolution and new models of care ................... 31

6.1 Co-commissioning ....................................................................................... 31 6.2 Other forms of delegation ............................................................................ 31

6.3 Devolution ................................................................................................... 32 6.4 New models of care ..................................................................................... 32

7 Associated documentation ................................................................................ 33

Key related documents include: ............................................................................ 33

Appendix 1: 13Q Legal Duties .................................................................................. 34

Appendix 2: Communications Channels ................................................................... 38

Appendix 3: Public Involvement Assessment Process ............................................. 39

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Appendix 4: ............................................................................................................... 40

Section 13Q Duty Public Involvement Assessment Form ......................................... 40

Appendix 5: Case Study ........................................................................................... 42

Glossary ................................................................................................................... 47

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1 Introduction This document should be read alongside the NHS England Patient and Public Participation Policy which sets out our broad intentions and ambition to strengthen patient and public participation in all aspects of our work. This document sets out:

Guidance to commissioners on how to identify when the legal duty to involve the public applies and what action they are required to take.

Details of our existing processes and arrangements across NHS England which support our duty to involve patients and the public and our key public involvement initiatives.

1.1 Commissioning A significant part of what we do involves commissioning (specifying, securing and monitoring) certain NHS services in line with population health and care needs. The process of commissioning is illustrated in Figure 1 below.

Ref: The Commissioning Handbook

Figure 1 - The Commissioning Cycle

1.2 The duty to involve the public (section 13Q) Under section 13Q of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), NHS England has a statutory duty to ‘make arrangements’ to involve the public in commissioning services for NHS patients. The

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https://www.england.nhs.uk/ourwork/patients/ppp-policy/


http://commissioning.libraryservices.nhs.uk/commissioning-cycle

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exact wording of section 13Q is shown at Appendix 1, together with information about related legal duties and responsibilities. The section 13Q duty is aimed at ensuring that NHS England acts fairly in making plans, proposals and decisions in relation to the health services it commissions, where there may be an impact on services. The duty requires NHS England to make arrangements for public involvement in commissioning. Public involvement in commissioning is about offering people ways to voice their needs and wishes, and to influence plans, proposals and decisions about their NHS services. Patients and the public can often identify innovative, effective and efficient ways of designing and delivering services if given the opportunity to provide meaningful and constructive input.

1.3 Scope This document sets out NHS England’s arrangements for involving the public in the services it commissions. The services which NHS England currently commissions, and to which the section 13Q duty applies are:

Primary care, including GP, dental, ophthalmic and pharmaceutical services;

Specialised services, which are typically services commissioned on a national basis for rare conditions, provided in relatively few hospitals and/or accessed by comparatively small numbers of patients. These also include secure mental health services;

Other specified services, such as: o Secondary care dental services; o Mental health after-care in certain circumstances; o Health and justice healthcare services; and o Services for members of the armed forces and their families.

Some public health services commissioned on behalf of the Secretary of State for Health.

1.4 Who is this document for? This document is intended to be used by:

NHS England staff – who need to understand and comply with these arrangements and

The public – to understand how NHS England involves the public in its commissioning of services.

CCGs – for information only, particularly in relation to co-commissioning (see section 6). CCGs are under a separate duty to make arrangements for involving the public in the services they commission.

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1.5 Terminology used in this document References to ‘the Act’ are to the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012). References to other legislation are included in full. Please see the end of this document for a full glossary of terms.

1.6 Further guidance and advice for NHS England staff There are a range of sources of support on patient and public participation for NHS England commissioners. These include:

The relevant teams in each of the regional offices, which will have links with local partners, such as CCGs, local authorities and voluntary sector organisations and networks.

The Public Participation Team in the national support centre –[email protected] or telephone 0113 8250861.

The Communications Teams in the national support centre.

The Patient Experience Team in the national support centre. Members of the public should get in touch with the Customer Contact Centre in the first instance:

By telephone: 0300 311 22 33

Email: [email protected]

Post: NHS England, PO Box 16738, Redditch, B97 9PT. Associated documentation is listed in section 7.

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2 When does the section 13Q duty apply? Commissioners need to identify activities or circumstances to which the section 13Q duty applies and decide whether relevant insight sources and public involvement activity (nationally or locally) are already in place, and whether additional public involvement is required, and if so what this should be. This involves:

1. Identifying triggers (situations in which the section 13Q duty is likely to apply). 2. Making and documenting an assessment of whether or not the section 13Q

duty applies and if so, what (if any) further action is needed. Our arrangements set out a framework for a flexible and responsive approach. Many activities and decisions requiring public involvement will happen at a regional, service, or provider level and will necessitate a public involvement exercise in their own right. While there may be little public interest nationally, there could be significant public interest locally.

2.1 Triggers Commissioners should always consider the benefits of involving the public in their work and seek to take account of feedback from the public about the services which they commission. In some cases, the impact of commissioning activity on services and patients will be so significant and likely that the requirement to involve the public will be obvious. However, in other cases, there will be a need to assess more carefully whether section 13Q applies and, if so, what kind of public involvement is appropriate. The following list indicates some of the circumstances in which the section 13Q duty is likely to apply and there is a need to assess this and determine the appropriate response. As it is not possible to anticipate every such situation, the list is not exhaustive and commissioners should always be alert to other circumstances in which the 13Q duty may apply:

Examples of possible triggers

Changes to commissioning arrangements The strategic planning of services, for example:

o Plans to reconfigure or transform services to improve health. o Plans in response to the latest Joint Strategic Needs Assessment or Health

and Wellbeing Strategy. Developing and considering proposals to change commissioning arrangements,

for example: new service specifications, piloting new services or making changes to existing services or service reconfiguration. Commencing a major procurement process.

Overview and Scrutiny referral Any instance in which a referral has been made to the local Overview and

Scrutiny Committee.

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Equality

Any instance in which an Equality Impact Assessment is proposed or carried out.

Triggers may be identified at a number of stages throughout a single commissioning process. On each occasion this should prompt a consideration of whether a public involvement exercise is required. However, a new public involvement exercise is not required at every step, so long as existing plans are sufficient to secure the necessary public involvement.

For example…

Beginning to develop and consider options for a new service would trigger the public involvement duty under section 13Q, as would developing the final specification, starting a procurement exercise and awarding a contract to the successful bidder. However, plans for involving the public throughout this process can be formulated at the outset. Those plans could be for NHS England to consult the public on a shortlist of options following development by NHS England with stakeholders and representatives. Provided that there is no significant change to proposals following consultation, NHS England can consider the outcome of the initial consultation when developing the final specification, carrying out the procurement and awarding the contract without developing additional involvement plans for those activities. For service change and reconfiguration it will be decided during the assurance process whether public consultation is required. Public involvement should continue throughout the process regardless and the outcome of consultation activities should be referenced in proposals taken forward to decision making.

2.2 Assessment The four steps in the assessment process are summarised in a flowchart at Appendix 2. The assessment must be documented using the Section 13Q Duty Public Involvement Assessment Form (Appendix 4). Step 1 - Does the activity relate to NHS England’s commissioning responsibilities?

For example…

A decision in relation to the relocation of a GP practice does relate to NHS England commissioning.

A decision in relation to the relocation of one of NHS England’s administrative offices does not.

If yes, go to Step 2. If no, the section 13Q duty does not apply, but you should consider the further guidance on what other matters may need to be considered at the end of this section.

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Step 2 - what type of activity is it? The scope of the 13Q duty is limited to certain types of commissioning activity. These are:

1. Planning – this activity can take place at different levels within NHS England, from the national, strategic level to the local, service level. Under section 13Q NHS England is required to always have arrangements in place to involve the public in the planning of its commissioning arrangements, regardless of what the impact upon services such plans would have if they were implemented. If the activity relates to planning, go directly to step 4.

2. Proposals for change – this activity includes not only the consideration of proposals to change services, but also the development of such proposals. If the activity relates to proposals for change, go to step 3.

3. Operational decisions – this activity relates to decisions which change or affect the way a service operates. If the activity relates to operational decisions, go to step 3.

While the legislation distinguishes between these different types of commissioning activity, as can be seen by the examples below they often overlap and sometimes a plan, proposal or decision made by NHS England can fall into more than one category.

Examples of commissioning activities

Planning Proposals for change Operational decisions

The development of a national policy for the commissioning of specialised services.

Planning a new out of hours dental service to be commissioned in a particular area in response to increased patient demand in the area.

Development of options for the reconfiguration of primary medical services in a particular area and the subsequent consideration of any developed options or model.

Making changes to the services a provider is required to provide or the locations from which such services are to be provided.

The closure of a GP practice for operational reasons.

Step 3 – in respect of proposals for change or operational decisions, would there be an impact on the manner or range of services? If yes, go to step 4. If no, the section 13Q duty does not apply, but you should consider the further guidance on what other matters may need to be considered at the end of this section.

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An impact on services can arise in two ways: 1. An impact on the manner in which the services are delivered to individuals at their

point of delivery (e.g. the transfer of a service to another location); and/or 2. The range of health services available to individuals (e.g. the closure of a

service). The impact on services should be considered from the patient’s perspective and not necessarily limited to the clinical services being commissioned. Accessibility, transport links and ambulance availability are all examples of matters that could be significant in considering impact.

Examples of impacts on services

Impact on services No impact on services

The closure of a GP practice would mean patients having to find a new practice to seek treatment. This would impact upon the way in which services are delivered to patients. The degree of the impact will depend how far individuals will have to travel to access another GP practice as well as any specific care that may have been provided at the practice. In such circumstances it is likely that the public need to be involved in some way.

The retirement of a GP from a practice may mean that patients with a preferred choice of doctor will need to be seen by a different GP. However, this would not typically affect the range of services or the manner of their delivery, in which case public involvement is unlikely to be required.

The termination of a GP contract and the award of a new contract to a provider, with no change in the specification of such a contract, would not ordinarily be expected to result in changes to the way that services are delivered to patients or the range of services available. In such circumstances there may be no legal requirement to involve the public.

Step 4 – if public involvement has been identified as a requirement under section 13Q in either step 2 or step 3, review existing arrangements for involving the public in this activity (if any) and, where required, put in place additional arrangements before proceeding (see guidance in section 3). Guidance where the section 13Q duty does not apply If the section 13Q duty does not apply, it should nonetheless be considered whether any previous promises or established practice give rise to a separate duty to consult (Appendix 1) and whether public involvement could nonetheless be beneficial. This is particularly important where there is likely to be significant public interest or when a promise to consult has been made or a precedent to do so has been set.

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In such a case, it is strongly recommended that the Transforming Participation in Health and Care guidance and related resources are used to identify whether and how to involve patients and the public.

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3 What does the section 13Q duty require us to do? Where it has been identified that the section 13Q duty applies, commissioners should:

Consider whether there are sources of insight which can be used, such as complaints and regular surveys.

Consider the adequacy of any existing arrangements for involving the public. These may include corporate infrastructure and key involvement initiatives (see sections 4 and 5).

Where necessary, put in place additional arrangements to involve the public before proceeding.

3.1 What is public involvement? The Act is not prescriptive about what constitutes involvement, however it explicitly states that people may be involved ‘by being consulted, or by being given information, or in other ways.’ Engagement, consultation, participation and patient voice are all phrases that can be used to describe different types of involvement activity. It is therefore clear that consultation and involvement are not mutually exclusive – rather, consultation is one of many possible types of public involvement that NHS England can carry out to discharge its duty under section 13Q.

Examples of ways to involve patients and the public

Letters or emails to affected individuals Newsletters Information on notice boards Suggestion boxes Leaflet drops Dedicated events to enable discussion Online surveys or feedback pages Seeking views at local events or venues e.g. festivals, markets, schools, leisure

centres, libraries etc. Working with local voluntary and community sector organisations, Local

Healthwatch and the Patient Participation Group (PPG) at GP practices Providing opportunities for the public to meet commissioners. Formal consultations. Social media e.g. Twitter, Facebook Public and patient advisory or reference groups Patient and public representatives involved in governance

3.2 What are the guiding principles in identifying how to involve the public?

Where public involvement is required, NHS England has a broad discretion as to how it involves the public. However, this is not an absolute discretion: it must ensure that its arrangements are fair and proportionate.

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Fair The courts have established guiding principles for what constitutes a fair consultation exercise. These principles (known as the Gunning principles) were developed by the courts within the context of what constitutes a fair consultation and will not apply to every type of public involvement activity. However, they will still be informative when making plans to involve the public. The Gunning principles are that the consultation:

Takes place at a time when proposals are still at a formative stage. If involvement is to be meaningful, it should take place typically at an early stage. However, it is often permissible to consult on a preferred option or decision in principle, so long as there is a genuine opportunity for the public to influence the final decision.

Gives the public sufficient information and reasons for any proposal to allow the public to consider and respond.

Allow adequate time for the public to consider and respond before a final decision is made.

The product of the public involvement exercise must be conscientiously taken into account in making a final decision.

Proportionate It is almost always possible to suggest that more can be done or that an exercise can be improved upon, particularly with hindsight. However, NHS England needs to balance its duty to make arrangements to involve the public with its duty to act effectively, efficiently and economically. Therefore, the arrangements for public involvement and activities flowing from those arrangements need to be proportionate. NHS England will need to consider the impact of its proposals on affected individuals. As a general rule, the greater the extent of changes and number of people affected, the greater the level of activity that is likely to be necessary to achieve an appropriate level of public involvement. However, the nature and extent of public involvement required will always depend on the specific circumstances of an individual commissioning process.

Considering impact

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NHS England should also consider the potential impact on other services, which may not be commissioned by NHS England (e.g. ambulance services), and issues for patients beyond the clinical services themselves such as accessibility, transport links and ambulance availability.

For example…

A small GP practice in an urban area is likely to close due to the retirement of the lead partner and difficulties relating to the condition of the practice premises. The patient list can be dispersed to a neighbouring GP practice two streets away. The public involvement duty would be engaged, but carrying out an extensive public involvement exercise in relation to the changes may be disproportionate. Local commissioners arrange to write directly to all current patients of the practice informing them of the planned change, and ensure that clear notices are displayed on noticeboards at the surgery and local community venues, and that information is included on the practice website. They talk to the patient participation groups of both surgeries about the impact of the proposed changes and arrange a drop-in session at the practice for patients to find out more. Specific efforts are made to reach those who may be easy to overlook, including seeking advice from the local community and voluntary services about the impact on groups in the local community that experience the greatest inequalities.

3.3 Who does NHS England need to involve? Where NHS England is carrying out an activity in respect of which the public should be involved, it must involve individuals to whom the services are being or may be provided. The pool of such service users who must be involved will depend on the service in question and the significance of the activity. As well as involving members of the public who are currently service users or patients, it may be helpful to involve carers, members of self-help and support groups, user groups, charities or other representative groups. In some cases, the significance of the decision will mean it is necessary to involve the public as a whole. An example would be any proposals for substantial reconfiguration of health services in a local area. While the duty on NHS England is to make arrangements to involve individuals to whom the services are being or may be provided, case law has established that in some cases public involvement can take place via representatives. For example, a policy or review group with appropriate expertise and representatives of those affected may be sufficient where direct public involvement is not practicable. Where involvement takes place via representatives, NHS England should try to ensure that they offer a fair representation of the views of those for whom they speak, rather than a narrower or different interest. However, often the views of a whole community cannot be fully represented by a single person or group. In such cases, it will be necessary to provide service users or the public as a whole the opportunity to be involved. Involvement should be accessible, inclusive and diverse. Particular care should be taken to engage those most significantly affected by the activity, particularly those who may experience a greater impact due to a characteristic which is protected by the Equality Act 2010. Reference should be made to the Equality Act and related

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guidance for further information about protected characteristics and to the Transforming Participation in Health and Care guidance. Location, access and demographic issues need to be taken into account, for example, considering how a population in a rural area or how children and young people may be particularly affected by a change to services. These issues also need to be considered when planning participation itself.

For example…

A commissioner is considering closing a small dental practice which will not have an impact on the wider availability of dental services in the area. They may decide to involve just the currently registered patients and their carers from the practice.

Based on the evidence in the local Joint Strategic Needs Assessment a commissioner is considering changing the services available in pharmacies across a local area. They decide to involve the general public in considering its proposals.

3.4 When should public involvement take place? The timing of public involvement is again a matter of broad discretion for NHS England. However, involvement, when it does take place, should meet the requirements of fairness set out above in order to be meaningful. Involvement should not typically be a stand-alone exercise (e.g. a formal consultation open for 12 weeks). It will generally be part of an ongoing dialogue or take place in stages. A phased approach can often maximise involvement Commissioners should consider who will be involved, when and how this will take place, and the purpose of engagement. It is good practice to provide regular communications throughout and have a documented engagement plan. The public does not necessarily need to be involved at the earliest possible opportunity. If involvement takes place too early there may be insufficient information for the public to consider. It will sometimes be appropriate to first develop a proposal, shortlist of options, a preferred option or even a decision in principle. However, involvement should never be left to the last minute. For example… Involvement will rarely be a linear process; it will take place at different points in the commissioning cycle and the public will be involved in different ways, for example: Involvement in developing options: NHS England uses a wide range of sources to identify the need for change and to develop early thoughts about the range of options available including the JSNA, equality impact assessments, the Health and Wellbeing Strategy, survey and insight data, and information from previous involvement activity. The commissioners also engage with key stakeholders including relevant voluntary sector umbrella bodies, Healthwatch, patient groups, and other relevant charities. Involvement in refining options: NHS England seeks to build on existing sources of insight information and prior engagement work. Focus groups and public events

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are used to co-produce potential options. Participants might include targeted groups of stakeholders such as relevant voluntary sector groups, user forums, interested patient leaders and experts and patient groups. NHS England may also convene a co-production group to support the development and consideration of the options available, including the involvement of people and communities who are often overlooked. Consulting on a limited number of options: As some of the options proposed will impact on both the nature and location of services NHS England runs a more formal consultation following good practice and Cabinet Office guidelines. This consultation is targeted at the wider public and uses an appropriate and proportionate spectrum of involvement activity to reach the community. More formal consultations will usually last for a minimum of twelve weeks. Informing: NHS England publishes information about the option it has chosen and how and when this will be implemented in a range of formats and through relevant channels, including the NHS England website, local media, social media and by making contact with relevant community groups and user forums. Specific efforts are made to reach those who may be easy to overlook.

3.5 Can we use existing information on the views and experiences of patients and the public?

As part of the need to act efficiently and proportionately, commissioners should consider whether there are existing arrangements or sources such as complaints and regular surveys, which can be used in order to gain insight into the views the public. These could include NHS England resources, or be external, for example Care Quality Commission (CQC) reviews, academic research and intelligence from NHS bodies, the voluntary sector or local authorities. In some cases it is possible that an earlier public involvement exercise was sufficient to involve the public in the new plans, proposals or decision in question. However, if that is the case, then NHS England should still carefully consider whether any further public involvement is required, in particular:

Is the new proposal the same as the one previously considered?

Did the earlier exercise involve the public in considering the basic features of the proposal now being considered, or was it something significantly different?

How long ago was the public involvement? Does it remain relevant?

Who was involved previously? Has there been a significant change in the identity or type of individuals who now need to be involved?

Did previous involvement fully address the diversity of patients and communities?

Has NHS England received new information which may require further involvement to enable the public to comment on that new information before the decision is taken?

Has the context changed due to, for example, a significant development in the local health economy, that affects the proposal or the impact it will have?

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For example…

Example 1: At a national level, NHS England has consulted and engaged widely on new guidelines for commissioning some types of dental services. This process included a wide range of national and local participation activity and new guidelines have been agreed. In order to implement the national guidelines, local NHS England commissioners need to procure the service to a specification which reflects the new national guidelines. They develop a plan which includes the following: letters to patients, notices in dental practices, meetings with local patient & public voice partners and representatives to ensure they have considered the needs of groups that experience health inequalities, and involvement of patient representatives in the development of the specification and the tendering process.

Example 2: NHS England is considering reducing the number of GP practices in a local area. A comprehensive review into primary care services in the area was undertaken a year ago and made a number of recommendations. The public were widely involved in this process. However, the population of the local area has changed significantly since this time and there are a number of significant housing developments being built and young families moving into the area. This has both increased patient lists and also changed the nature of services required. Whilst undertaking their 13Q assessment, the commissioners decide to consider the findings of the previous involvement activity but also to undertake new involvement activity to support them to better understand the needs and views of the current population. They also plan public involvement to support the implementation of the recommendations.

3.6 What if a decision needs to be taken urgently? In an urgent situation, it may be necessary to balance the duty to make arrangements for public involvement in a decision with the public interest in maintaining continuity of care and protecting the health, safety or welfare of patients or staff. It will only be reasonable to justify carrying out a limited or no public involvement exercise on grounds of urgency when the lack of time was genuinely caused by an urgent development or where there is a genuine risk to the health, safety or welfare of patients or staff. It does not permit NHS England to leave public involvement until the last moment without enough time to carry out a fair and proportionate exercise, when the public could and should have been involved earlier or to a greater extent. For example…

NHS England has the contractual right to terminate a general dental services contract on patient safety grounds. Unless a new provider is immediately available and able to use the premises, it is inevitable that patients will have to go to another location for consultations and treatment, at least for a temporary period. NHS England’s public involvement duty would be engaged in this scenario, but carrying out a detailed public involvement exercise before closing the practice could place patients at risk. It would therefore be sufficient for NHS England to notify all

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patients of the situation in this case, even though a more detailed level of public involvement would usually be required for the closure of a dental practice.

3.7 Can we carry out a joint public involvement exercise with another organisation?

Yes – this is encouraged as it will reduce burden on patients and the public and help ensure different public bodies in a locality adopt a ‘joined up’ approach. Regardless of whether responsibility for public involvement falls on NHS England, another body or is shared, it will often be logical and beneficial for any public involvement exercise to be carried out jointly by NHS England and other bodies, so as to avoid the NHS consulting twice on the same proposals and the confusion to patients and inefficiency that this can entail. NHS England can also request the assistance of providers in informing, reaching out to and engaging with patients where changes to services are proposed. In some circumstances the provider may be under a contractual obligation to co-operate with NHS England in this regard (e.g. where a GP practice is closing and patients need to be informed of this and how to register with a new practice). However, NHS England cannot delegate its responsibility for public involvement to providers and will need to be satisfied that involvement activities have met legal requirements, even if carried out by the provider.

For example…

Plans to reconfigure and integrate all forms of health and social care in a locality will require collaboration between a number of commissioners and providers. These typically include NHS England, clinical commissioning groups, local authorities and NHS trusts/foundation trusts. These bodies all have separate but similar obligations to consult or otherwise involve the public. However, as they are all considering the same set of proposals together, they can develop a joint involvement exercise to save time and money and give the public a “one stop shop” for involvement.

3.8 Feeding back the outcome of public involvement activity The outcome of any consultation or engagement exercise should be fed back to participants. Feedback should include an explanation of how views have been considered and impacted on decisions, as well as the rationale for decisions taken. This important stage is often overlooked but is central to good participation and will encourage further participation.

3.9 Assessing the effectiveness of public involvement exercises As already set out above, fairness requires that the product of public involvement must be conscientiously taken into account in making a final decision. However, it is also worthwhile taking stock of whether the public involvement exercise, once complete, has been sufficient. If not, it may be appropriate to revisit public involvement or the proposals under consideration before implementing a decision.

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Whether public involvement has been sufficient in any given case will depend upon the circumstances. However, the following are examples of potential issues that may warrant further consideration:

Where feedback suggests that the needs of a particular group (possibly with a protected characteristic) have not been adequately considered as part of the proposal;

Where there is an unexpectedly small response from a group that NHS England anticipated would be significantly affected by the proposal;

Where a lot of feedback queries the same point, suggesting that it is has not been clearly conveyed or that consultees lacked sufficient information; or

If the response to a consultation or attendance at public events has been very poor.

If such issues arise, NHS England should try to understand why this is the case and how they could be addressed. This could include attempting different engagement methods or approaching voluntary and community sector groups for advice on how to reach certain groups. Ultimately, regardless of whether NHS England decides to carry out further public involvement in response to such issues, it will need to be satisfied that the legal duty has been met before taking a final decision.

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4 Corporate infrastructure NHS England is working to continuously strengthen its corporate infrastructure arrangements for patient and public participation. Existing arrangements include, but are not limited to, those outlined in this section. You can also find further information on the NHS England website.

4.1 Public involvement in governance

Board meetings

Meetings of the Board of NHS England are held in public, which means that members of the public may attend to observe. They are broadcast live on NHS England’s website and recorded for future viewing online.

Copies of the agenda and other papers are published in advance of the Board meeting and the meeting minutes published afterwards.

Non-executive directors (NEDs) of the Board seek to ensure, through constructive challenge and in other ways, that the interests of patients, taxpayers and the public are represented at Board meetings. The skills, experience and knowledge to represent these interests are an explicit requirement of the NED role at NHS England. Development and support are provided to NEDs, as appropriate. Two-way communication between NEDs and lay representatives on various committees, groups and programme boards is facilitated. This enables lay representatives to have direct access to the Board and enables NEDs to have a ‘line of sight’ throughout the organisation, providing a valuable source of assurance about the way that the organisation is developing its ways of working and the impact of patient and public participation.

It is common for the Board at the conclusion of its public business to resolve to go into closed session to consider agenda items which are confidential and cannot be discussed in public at the time of the meeting, for example information which is confidential to patients, commercially sensitive or legally privileged. The Board also works together informally between meetings in briefing sessions and developing strategic options for further development by the executive team.

Annual General Meeting

The Annual General Meeting (AGM) is open to members of the public. It is also broadcast live on NHS England’s website and recorded so that it can be viewed at a later date if required.

Committees, groups and programme boards

Lay people who can bring the perspective of patients and the public will be involved in NHS England activity as appropriate to the requirements of the

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programme. This will include involvement in committees, groups and programme boards, and in developing plans, proposals or decisions which impact on services, nationally, regionally and locally. This will provide assurance that appropriate public involvement is taking place.

4.2 Communication with patients and the public Communications channels

NHS England currently communicates with patients and the public in a variety of ways, on a regular basis. More details about our existing communications channels can be found in Appendix 2.

Customer Contact Centre

We publish our telephone, email and postal addresses on our website so that the public can contact us with their views, comments, concerns, or to make a formal complaint or enquiry.

Freedom of information

NHS England is subject to the provisions of the Freedom of Information Act 2000, which promotes transparency and scrutiny by allowing members of the public to request information held by NHS England. The organisation must provide any requested information it holds, subject to the requirements and exemptions set out within the legislation.

NHS England’s publication scheme signposts individuals to information which is proactively released as and when it becomes available.

4.3 Business planning

Each year, NHS England publishes a corporate business plan setting out its priorities for the year ahead. The business plan reflects the organisation’s broad strategy (the Five Year Forward View) and particular areas of focus for each Directorate. In addition, the four regions of NHS England produce their own related work plans.

The business planning process involves consideration of future programmes of work and future resources. All those responsible for business planning at corporate, directorate and regional level are required to: demonstrate how insight gathered from patient and public participation has

influenced planning and priorities for the year ahead.

set out in an appropriate level of detail how the public will be involved and how this will be funded in relevant future programme(s) of work. If this is not done, programmes may not be approved or funded through the business planning process. See the Bite-size guide on budgeting for participation.

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4.4 Publications Gateway clearance

NHS England has a Publications Gateway clearance process to assure all national policies, strategies, consultations, publications and external publications to the NHS. This requires confirmation from the Public Participation Team in the national support centre that patients and the public have been involved in the development of the work if relevant and/or that any involvement activity planned is relevant for patients and the public and in line with our responsibilities.

4.5 Reporting and assurance

In July each year, NHS England publishes an annual report on its work for the previous financial year. The annual report includes an assessment of how effectively NHS England has discharged its statutory duty to involve the public and information on its related statutory duties to have regard to the need to reduce health inequalities and to continuously secure improvement in the quality of health services.

The Board receives additional reports on patient and public participation activity and outcomes. Reporting (both quantitative and qualitative) is continuously being developed through the Patient and Public Participation Oversight Group to provide assurance to the Board.

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5 Involvement initiatives NHS England’s involvement initiatives cover a wide range of activities at different levels. Involvement initiatives may be national or apply to a particular geographical area; they may be temporary or permanent; they may be for the general public or particular groups of people; they may relate to all aspects of NHS England’s business or specific programmes of work. Much of NHS England’s involvement work (notably in relation to primary care commissioning) takes place at the local level, in collaboration with local communities and partner organisations such as CCGs and local authorities. Information about local involvement initiatives is available at the local level (generally through CCGs or the regional offices of NHS England through the Customer Contact Centre). The following paragraphs set out the main involvement initiatives at the national level. These initiatives are constantly evolving and the latest information is available on our website.

5.1 Frameworks for patient and public participation for each of NHS England’s commissioning responsibilities

Within specialised commissioning patients and carers are involved at almost every level of governance, including on panels for Individual Funding Requests and the Cancer Drugs Fund. A range of stakeholders including patient and the public representatives (both individuals and from the voluntary sector) are involved directly in policy development through the various Clinical Reference Groups. We hold regular stakeholder engagement sessions to inform our work and when appropriate have undertaken formal public consultations around different work areas which are publicised widely to relevant groups and key voluntary sector partners. Registered stakeholders are kept informed of our work via the Specialised Commissioning Bulletin, the NHS England website or through targeted communications. Additionally, we have the Patient and Public Participation Assurance Group (PPVAG). The PPVAG maintains oversight of the implementation of the participation model, ensures there is appropriate patient and public participation in decision making and reviews and advises on patient and public participation processes.

For primary care commissioning, a framework for public participation is currently being co-produced by NHS England and key organisations representing patients and the public. This framework will identify opportunities for involvement including citizen voice in governance, influence on policy, service redesign and contracting, and assurance. It will also outline roles and responsibilities of different stakeholders, identify key networks, groups and patient insight sources, and take account of how arrangements can be implemented within current resources. A range of guidance, best practice and resources is being developed. The framework will be regularly reviewed to ensure it continues to be fit for purpose based on the experience of implementing it and changes to the policy and commissioning environment.

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In Health and Justice and Armed Forces commissioning, NHS England is also working with key partners and voluntary organisations that work in secure environments and with armed forces personnel and their families to co-produce a framework for participation. This will crucially ensure that these ‘seldom heard’ groups are heard and their voice is represented in governance. Most importantly we are working with key voluntary sector organisations to develop the necessary structures to enable us to support direct participation from those people in secure environments and the armed forces’. Public involvement in our Public Health commissioning responsibilities is at an early stage of development. We will be developing our approach alongside our partners at Public Health England, who have primary responsibility in this commissioning area, to ensure a complementary approach.

5.2 NHS Citizen NHS Citizen is a programme which is designed to enable patients and the public and NHS England to have a dialogue about issues that matter to them. Through this, people can influence priorities and decision-making, and can hold the organisation to account. As part of the NHS Citizen design, there is a process to gather and select issues for discussion both online and face to face; selecting those issues of most significance, relevance or interest through an independently selected group of people (citizens’ jury); and working to co-design ways forward for those issues at a national Assembly that brings together patients, carers, advocates, members of the public with the Board and staff of NHS England. In addition to the discussion at this meeting, NHS England will consider and take follow up action as appropriate in response to the issues raised, and provide feedback on this. Through NHS Citizen, NHS England is also developing:

A ‘People Bank’, a participation management system which enables people to register and be matched to potential opportunities for getting involved; and

A ‘Participation Academy’, a host for training and guidance materials to enable more people to develop the skills needed to effectively influence the work of NHS England.

5.3 Reaching different communities NHS England has a number of public involvement initiatives and partnerships in place to reach out to communities and service users from diverse backgrounds. These seek to ensure that participation approaches and activities are accessible and inclusive and hear the views of groups who may be termed ‘harder to hear’. Equality Delivery System – EDS2

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with characteristics protected by the Equality Act 2010. By using EDS2, NHS England will help to deliver on the Public Sector Equality Duty. NHS England Youth Forum

Recognising the need for different ways to communicate with children and young people and hear their experiences, needs and wishes, NHS England has worked with partner organisations to develop a Youth Forum. This comprises around 20 young people recruited from all over the country and linked in to a Facebook network of hundreds more young people. The Forum works in partnership with NHS England, Public Health England and the Department of Health to improve services for children and young people.

Voluntary and community sector

The voluntary and community sector makes an invaluable contribution to health and care in England. NHS England has a range of partnerships with different organisations at different levels to collaborate on shared priorities.

Together with the Department of Health and Public Health England, NHS England works with a network of 22 voluntary sector partners. The strategic partner programme includes organisations from across the breadth of the voluntary sector, enabling reach into different communities, in total over 350,000 individuals and voluntary sector organisations throughout England. The network provides direct input to policy development.

Healthwatch

Healthwatch was created with the purpose of understanding the needs, experiences and concerns of service users and to speak out on their behalf. Established through the Health and Social Care Act 2012, this created a model that operates both locally and nationally.

Healthwatch England has statutory powers to provide NHS England (and other bodies) with information and advice on: The views of people who use health or social care services and of other

members of the public on their needs for and experiences of health and social care services; and

The views of local Healthwatch organisations and of individuals on the standard of health and social care services. Local Healthwatch organisations operate across England and work with commissioners and providers in their area, including through the Health and Wellbeing Boards.

NHS England works closely with Healthwatch England to ensure that we listen

and respond to the views of people about the quality and availability of health and care services.

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http://www.voluntarysectorhealthcare.org.uk/

http://www.voluntarysectorhealthcare.org.uk/

http://www.healthwatch.co.uk/

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Clinical Commissioning Groups (CCG) Lay members

NHS England has established a network for lay members on CCG governing bodies to be involved directly and influence the work of NHS England.

Through this network, lay members can amplify views and concerns from their locality.

Networks supporting NHS England to reach diverse communities

NHS England has also developed a number of networks specifically to ensure those who experience the greatest health inequalities or poorest health outcomes can be heard e.g. the learning disability network and the gender identity network.

5.4 Using insight to influence commissioning NHS England monitors the quality of the services it commissions through feedback from patients and the public gathered in a variety of ways. This feedback is used to influence commissioning and make improvements.

National patient surveys The different mechanisms used to generate this feedback directly to commissioners include national patient surveys such as:

GP Patient Survey

Inpatient Survey

Community Mental Health

Accident and Emergency Survey

Outpatient Survey

Maternity Survey

Cancer Patient Experience Survey

VOICES survey of bereaved people

CQC Children and Young People’s Survey

Patient Reported Outcome Measures (PROMs) - used to calculate the health gains after surgical treatment using pre and post-operative surveys in four specialties.

Friends and Family Test Alongside the national surveys, commissioners can also use the Friends and Family Test (FFT). The FFT is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient

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https://www.england.nhs.uk/ourwork/patients/public-voice/lay-members

https://www.england.nhs.uk/ourwork/patients/ld-forum/

https://www.england.nhs.uk/ourwork/patients/public-voice/identity/

https://www.england.nhs.uk/ourwork/patients/public-voice/identity/

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

http://www.cqc.org.uk/content/inpatient-survey-2014

http://www.cqc.org.uk/content/community-mental-health-survey-2015

http://www.cqc.org.uk/content/community-mental-health-survey-2015

http://www.cqc.org.uk/content/accident-and-emergency-survey-2014

http://www.cqc.org.uk/content/accident-and-emergency-survey-2014

http://www.cqc.org.uk/content/outpatient-survey-2011

http://www.cqc.org.uk/content/maternity-services-survey-2013

http://www.cqc.org.uk/content/maternity-services-survey-2013

http://www.quality-health.co.uk/surveys/national-cancer-patient-experience-survey

http://www.ons.gov.uk/ons/rel/subnational-health1/national-bereavement-survey--voices-/2012/index.html

http://www.cqc.org.uk/content/children-and-young-peoples-survey-2014

http://www.hscic.gov.uk/proms

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experience. This kind of feedback is vital in transforming NHS services and supporting patient choice. FFT results data for inpatient, A&E, and maternity services and the staff FFT is available online. FFT results for GP, mental health, community, outpatient, dental and ambulance (patient transport) is available online.

Concerns, compliments and complaints received by the Customer Contact

Centre The Customer Contact Centre is the initial point of contact for patients and their representatives who require information or want to comment on the services we commission.

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http://www.england.nhs.uk/ourwork/pe/fft/friends-and-family-test-data/

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6 Co-commissioning, delegation, devolution and new models of care

6.1 Co-commissioning NHS England’s co-commissioning programme has seen Clinical Commissioning Groups (CCGs) take on greater responsibility for commissioning primary medical services (i.e. GP services). The scope of co-commissioning may expand over the coming years into wider primary care services (e.g., community pharmacy, dental and eye health services). Any expansion of co-commissioning would be considered with full and proper engagement of the relevant professional groups. Co-commissioning can take three forms:

Greater involvement in primary care decision making;

Joint commissioning arrangements; or

Delegated commissioning arrangements. Under greater involvement, NHS England and CCGs work together to commission the specified services (currently primary medical services). However, NHS England retains the legal responsibility for commissioning the services and the duty to involve the public. NHS England will therefore apply the arrangements set out in this document. Under joint commissioning, NHS England and CCGs establish joint committees to make decisions about primary medical services. NHS England and CCGs have separate but virtually identically worded duties (see section 14Z2 of the Act) to involve the public and these duties will run concurrently. NHS England will apply the arrangements set out in this document and CCGs will need to make their own arrangements. Under delegated commissioning, NHS England delegates full responsibility and funding for the commissioning of primary medical services to CCGs. While NHS England retains ultimate liability for the exercise of all of its functions, including those delegated to CCGs, the CCGs are bound by their own public involvement duty in respect of the services they commission (section 14Z2 of the Act). The Delegation Agreement and Terms of Reference make clear that it is the responsibility of CCGs to involve the public in the commissioning of services. NHS England’s arrangements set out in this document will therefore not apply. NHS England will nonetheless require assurance that the duty to involve the public is being discharged effectively by the CCG as part of the CCG assurance process.

6.2 Other forms of delegation NHS England may delegate responsibility and funding for commissioning services to other organisations other than through co-commissioning (e.g. local improvement schemes). The extent to which NHS England retains day-to-day responsibility for making arrangements to involve the public will depend upon the model for delegation used in

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each instance. However, as NHS England retains ultimate liability for the exercise of its functions, it will still need to be satisfied that appropriate arrangements are in place to involve the public, even if it does not make those arrangements itself.

6.3 Devolution In the Queen’s Speech 2015, plans were announced to introduce legislation to provide for the devolution of powers to cities with elected mayors and work has already commenced to achieve the delegation and ultimate devolution of health and social care responsibilities in Greater Manchester. The extent to which NHS England retains day-to-day responsibility for making arrangements to involve the public will depend upon the model for devolution used in each instance. However, as NHS England retains ultimate liability for the exercise of its functions, it will still need to be satisfied that appropriate arrangements are in place to involve the public, even if it does not make those arrangements itself.

6.4 New models of care In its Five Year Forward View NHS England set out the need to develop new care models for promoting health and wellbeing and supporting the improvement and integration of services. A number of ‘vanguard’ sites have been chosen and are taking a lead on the development of new care models. The development of new care models at vanguard sites will involve substantial changes in the way services are delivered to patients. However, due to unique nature of vanguards and the variety of services, commissioners and providers involved, the arrangements for involving the public will be decided at the local, vanguard level. To any extent that services for which NHS England is primarily responsible for commissioning are affected, NHS England will need to be satisfied that appropriate arrangements are in place to involve the public, even if it does not make those arrangements itself.

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7 Associated documentation Key related documents include:

Patient and Public Participation Policy

Transforming Participation in Health and Care

Planning, assuring and delivering service change for patients.

Resources on the Public Participation section of the NHS England website and, for staff, also on the intranet

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https://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/10/plan-ass-deliv-serv-chge.pdf

https://www.england.nhs.uk/ourwork/patients

https://nhsengland.sharepoint.com/

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Appendix 1: 13Q Legal Duties Section 13Q of the National Health Service Act 2006 ‘(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by the Board in the exercise of its functions (“commissioning arrangements”). (2) The Board must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways) —

(a) in the planning of the commissioning arrangements by the Board, (b) in the development and consideration of proposals by the Board for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the Board affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.

(3) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users. (4) This section does not require the Board to make arrangements in relation to matters to which a trust special administrator's report or draft report under section 65F or 65I relates before the Secretary of State is satisfied as mentioned in section 65KB(1) or 65KD(1) or makes a decision under section 65KD(9) (as the case may be).’ Related legal duties and responsibilities In addition to the duty to involve the public under section 13Q of the Act, NHS England is under a number of other duties which may overlap, interact or arise separately in a variety of scenarios. This document does not provide detailed guidance on those duties or set out how NHS England plans to discharge them; however, the most relevant duties are summarised below for reference. Duty to promote involvement of each patient (section 13H of the Act) NHS England is under a duty to promote the involvement of patients, and their carers and representatives (if any), in decisions which relate to the prevention or diagnosis of illness in the patients or their care or treatment. This duty, under section 13H, is separate to the public involvement duty under section 13Q. These duties place separate obligations upon NHS England however they regularly overlap and interact with each other. The key difference between the duties is that

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the patient involvement duty (section 13H) relates to involving patients in making shared decisions about their own care, whereas the public involvement duty (section 13Q) relates to involving the public in decisions about the commissioning of services generally. The patient involvement duty (section 13H) is intended to give effect to the policy of “no decision about me without me”. The duty would apply to any decisions at all stages of that individual’s health care, from preventative measures, diagnosis of an illness, and any subsequent care and treatment they receive. Effective involvement of patients in these decisions might include such things as opportunities for patients to participate in treatment decisions in partnership with health professionals, to be supported to make informed decisions about the management of their care and treatment and to discuss opportunities for patients to manage their own condition.

Examples of…

Patient involvement Public involvement

Personal health budgets, which allow people living with long term conditions to have greater control over their health.

Shared decision-making and patient decision aids.

Providing support for self-management of conditions.

Informing the public of a proposal to open a new walk-in centre.

Seeking patients’ views on a change to the opening hours of an out-of-hours dental service.

Consulting the public about plans being developed by NHS England and CCGs to reconfigure and integrate local health services.

There are a number of initiatives which are primarily aimed at discharging the section 13H duty by involving patients in decisions about their own care. However, NHS England can make arrangements to capture feedback from those patient involvement initiatives and use this information to inform its commissioning activities. Such arrangements can enhance public involvement and influence commissioning decisions and therefore also help discharge the public involvement duty (section 13Q). As this document is focused upon public involvement under section 13Q, it does not set out every initiative to involve patients in their own care. However, where arrangements are in place to use the information from such initiatives to influence decision-making, they are included. Implied duty to involve the public While section 13Q sets out an explicit statutory duty for NHS England involve the public in certain circumstances, it may in other circumstances be incumbent upon a public body to involve the public as part its general duty to act fairly. Such circumstances – in which it can be said that there is an “implied duty” to involve the public – have been developed through case law over a number of years. Acting fairly does not always require involving the public; equally, a lack of involvement on a decision does not automatically render it unfair. However, there

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are a number of circumstances in which fairness may require NHS England to consult the public, even if the section 13Q duty is not engaged. These include:

Promises – consultations are often promised in order to allay public concerns about a proposed course of action that has not previously been consulted upon. Fairness typically requires that such promises are kept.

Past practice – sometimes a well-established and consistent past practice of consulting the public in respect of particular decisions can give rise to the expectation that such practice will continue in future. Fairness typically requires that such expectations are met.

The section 13Q duty is deliberately aimed at ensuring the public are involved in the most important plans, proposals and decisions taken when commissioning services. The circumstances in which section 13Q is not engaged, but an implied duty to involve the public in commissioning is, are therefore likely to be rare. Equality and health inequalities duties The Equality Act 2010 prohibits unlawful discrimination in the provision of services on the grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. These are the ‘protected characteristics’. As well as these prohibitions against unlawful discrimination the Equality Act 2010 requires NHS England to have ‘due regard’ to the need to:

Eliminate discrimination that is unlawful under the Equality Act 2010;

Advance equality of opportunity between people who share a relevant protected characteristic and people who do not share it; and

Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

This is known as the ‘public sector equality duty’ (section 149 of the Equality Act 2010). NHS England is also under a separate statutory duty to have regard to the need to reduce health inequalities between patients in access to health services and the outcomes achieved (section 13G). To help comply with the above duties, it is often necessary to carry out equality and health inequality analyses and consult and engage with all individuals across the protected characteristics. It is therefore common for proposals to engage the public sector equality duty, the duty to reduce health inequalities and the duty to make arrangements to involve the public. Public involvement that is accessible, inclusive and diverse can help to achieve all of these duties at the same time. Overview and scrutiny Local authorities have a role in reviewing and scrutinising matters relating to the planning, provision and operation of health services in their local area. NHS England is one of a number of NHS bodies which may commission services in a particular area.

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NHS England must consult the local authority where it is considering any proposal for a substantial development or variation of the health service in the area. The local authority may scrutinise such proposals and make reports and recommendations to NHS England and the Secretary of State for Health. Legislation provides for exemptions from the duty to consult in certain circumstances, for example where the decision must be taken without allowing time for consultation because of a risk to safety or welfare of patients or staff. As part of the overview and scrutiny process, the local authority will invite comment from interested parties and take into account relevant information available, including that from Local Healthwatch. The overview and scrutiny process can therefore enhance public involvement in NHS England’s commissioning arrangements. The threshold for reporting proposals to the local authority under the overview and scrutiny process is higher than that for arranging to involve the public under section 13Q. However, the duties frequently overlap, particularly where significant changes to the configuration of local health services are under consideration For further information, see Part 4 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. The Compact The Compact is a voluntary agreement which supports partnership working between public bodies and the voluntary and community sector. It provides a framework for partnership working to enable different sector working together to agree the fundamental principles underpinning the relationship. As an Arm’s Length Body to Government, NHS England is a default signatory to the Compact and thus should consider its principles and undertakings throughout its business.

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Appendix 2: Communications Channels Public newsletter

In Touch is a newsletter for members of the public which enables people to be informed about the latest NHS England news, as well as highlighting opportunities to get involved in NHS England’s work through events, consultations, representation on advisory groups and more.

In Touch informs people about plans, programmes and decision making in NHS England and provides the opportunity to become more directly involved.

The NHS England website

Our website is a constantly updated source of news about plans, programmes of work and opportunities to get involved. It allows users to easily converse with us by directly commenting on articles and blogs.

A wide range of public consultations and surveys on both local and national issues are regularly published via the NHS England Consultation Hub.

Social media

Our Twitter account (@NHSEngland) actively shares news about plans, programmes of work and opportunities to get involved, including the facilitation of real time tweet chats with stakeholders.

Our YouTube channel gives access to videos which explain our work in an engaging way and showcase examples of participation.

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http://www.england.nhs.uk/

http://www.engage.england.nhs.uk/

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Appendix 3: Public Involvement Assessment Process

Does the activity relate to NHS England’s commissioning responsibilities?

Yes

What type of activity is it?

No

Proposals for change

Operational decision

Planning

Arrangements for involving the public are required under section 13Q.

Document assessment using

Public Involvement Assessment Form.

Review existing arrangements for involving the public in this activity (if any)

and, where required, put in place additional arrangements before

proceeding.

Arrangements for involving the public are not required under section 13Q.

Document assessment using

Public Involvement Assessment Form.

Consider whether any previous promises or established practice give rise to a

separate duty to consult. Consider whether public involvement

may nonetheless be beneficial.

If implemented, would there be an impact upon services? This could be:

The manner in which the services are delivered to individuals at their point of delivery; and/or

The range of health services available to individuals.

No Yes

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Appendix 4: Section 13Q Duty Public Involvement Assessment Form Step 1 - Details of the commissioning activity

Describe the commissioning activity:

Step 2 – Identify type of commissioning activity

Type of activity: Planning Proposals for change Operational decision

Step 3 – In respect of proposals for change or operational decisions, assess the impact on service users

If the plans, proposals or decisions are implemented, would there be:

An impact on the manner in which the services are delivered to the individuals at the point when they are received by users? Yes No

An impact on the range of health services available to users? Yes No Explain why you have answered yes or no to the above:

Step 4 – section 13Q duty

Does the section 13Q duty apply to the activity? Yes No Explain why you have answered yes or no to the above: If yes, (a) identify any existing arrangements to involve the public which are already in place (national or local involvement initiatives): (b) whether it is considered necessary to make further arrangements for this activity and if so what these will be:

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Confirm whether a further assessment needs to be carried out in future and, if so, when or in what circumstances that will be carried out:

Name: Job Title: Date:

If you are unsure as to the answer to any of these questions, seek advice from

the relevant team in your region or the Public Participation Team in the national support centre.

Completed assessment forms must be retained and will be required for

reporting and monitoring purposes.

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Appendix 5: Case Study Case Study Note: this is a fictional case study and is for illustrative purposes only. The public involvement required in any given case will always depend on the circumstances. Anytown has a local population of 50,000 and is served by 10 GP practices. One such practice is Bloggs & Doe Practice, in North Anytown. The practice holds a general medical services contract with NHS England and has a relatively small practice list size of 2,000 patients. The contract is held by Dr J Bloggs and Dr J Doe in partnership. The practice is located in a residential area with generally good public transport links to other parts of Anytown, however the nearest bus stop to the practice is a ½ mile away. Some registered patients live in the immediate vicinity but most travel to the practice. There is also a large cohort of unregistered patients in the area who tend to rely upon walk-in centres and the A&E at Anytown Hospital. In April 2013, Dr Bloggs decides to retire and leaves the partnership. However, he nominates Dr Doe to continue to hold the contract as a sole contractor. This is agreed by NHS England and the contract is varied accordingly. However, all requirements under the contract remain the same and Dr Doe decides to employ an additional salaried GP to ensure continuity of the level of services. Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation by using the Public Involvement Assessment flowchart. The decision to agree to the change is identified as an operational decision, but one that will not have any impact on the range of services available or the manner of their delivery. Therefore, no arrangements for public involvement are required. This assessment is recorded using section 13Q Duty Public Involvement Assessment Form.

However, in the interests of patients, NHS England requests that the practice notifies all patients who had nominated Dr Bloggs as a preferred practitioner of the change and of the on-going arrangements for their care and to also notify the practice’s Patient Participation Group of the changes.

Dr Doe now holds the GMS contract with NHS England as a sole practitioner. However, in August 2013, Dr Doe passes away unexpectedly. Under the terms of the contract, it will terminate within 7 days. NHS England holds an urgent meeting to decide what to do. Two options are being considered:

1. Entering into a temporary 6 month contract with an interim provider in order to ensure continuity of services, until a final decision is made;

2. Not replacing the contract and “dispersing” patients to other practices in Anytown which have indicated that they have capacity for additional patients.

Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation using the Public Involvement Assessment flowchart. It is identified

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that it is considering proposals for changes in its commissioning arrangements. Proposal 1 (temporary contract) is identified as not having an impact upon services, if implemented. However, Proposal 2 (dispersal) is identified has having a significant impact on services if implemented, as patients will have to register and travel to other practices. Therefore, it is identified that arrangements for public involvement are required. This assessment is documented using the Section 13Q Duty Public Involvement Assessment Form.

NHS England considers what is fair and proportionate in the circumstances. Proposal 2 presents a high likelihood of a significant impact on services. However, due to the urgency of the situation, NHS England needs to balance the duty to make arrangements with the duty to maintain continuity of care and protect the health and safety of patients. NHS England therefore decides it is not proportionate to seek to engage with all patients of the practice. However, it seeks views and insight from Local Healthwatch, Anytown CCG and relevant Patient Participation Groups.

Ultimately, it is decided that Proposal 1 is preferable, in order to ensure continuity of services and allow a fuller public involvement exercise prior to making a final decision about the long-term future of the practice.

An urgent market-testing exercise and liaison with the Local Medical Committee identifies only one suitable provider. A temporary 6 month contract is awarded and it is agreed that existing practice staff will transfer to the interim provider.

The decision to award the temporary contract in and of itself is an operational decision, but does not affect the manner or range of services provided to patients so does not ultimately have an impact upon services. Therefore, further arrangements are not required, but NHS England liaises with the interim provider to ensure that all patients are notified of the new contractor.

In September 2013, NHS England identifies that along with the above temporary contract, two other GP contracts in Anytown with relatively small patient lists are due to expire on 1 April 2014. NHS England is decides to carry out a strategic review of the needs of the local population and begins the process as laid out in “Planning and delivering service change for patients”. No proposals are formally tabled at this stage, but neither are any options ruled out. There is the potential for reorganisation of the provision of GP services in Anytown. A shortlist of proposals will be developed as part of this strategic review. Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation by using the Public Involvement Assessment flowchart. It is identified that it is involved in the strategic planning of local health services. It is also developing proposals, which may include changes to commissioning arrangements which would have an impact on services. It is therefore necessary to have arrangements in place for public involvement. This assessment is documented using the Section 13Q Duty Public Involvement Assessment Form.

NHS England therefore decides to carry out the following activities:

o Consult the Joint Strategic Needs Assessment prepared by the Health and Wellbeing Board

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o Consult with the Health and Wellbeing Board, Local Healthwatch, the Local Medical Committee, Anytown CCG, the Overview and Scrutiny Committee and relevant Patient Participation Groups.

o Review insight gathered through the Friends and Family Test, GP Survey, NHS Choices and other intelligence held by NHS England.

At this stage, NHS England is not formally considering proposals for change or making a final decision, so while it is recognised that a wider public involvement exercise is likely to be required in due course, it decides to postpone this exercise until proposals have been developed further. This will help ensure that involvement happens at a time when proposals are sufficiently detailed to provide the public with sufficient information and reasons for proposals to enable a meaningful engagement. However, engagement will happen at a formative stage before a final decision is taken.

NHS England carefully considers the insight gathered from the above review and, in consultation with the above stakeholders, develops a shortlist of proposals which are felt to be realistic, feasible options for meeting the needs of the local population. These are:

1. Re-commission the three GP contracts as they are; or

2. Do not re-commission the three GP contracts, and instead commission a single larger GP contract in premises currently being developed in the same building as a walk-in and minor injuries centre commissioned by the CCG, which has excellent transport links. This is NHS England’s preferred option.

NHS England learns that the CCG is also reviewing the provision of walk-in/minor injury centres in the area and is proposing to carry out its own engagement exercise. Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation by using the Public Involvement Assessment flowchart. It identifies that Proposal 1 has no impact on services. However, Proposal 2 has a significant impact upon the provision of services. It is therefore necessary to have arrangements in place for public involvement. This assessment is documented using the Section 13Q Duty Public Involvement Assessment Form.

NHS England considers what is fair and proportionate in the circumstances. There is a high likelihood of significant impact on services and ample time to carry out a wide and meaningful public engagement exercise before making a final decision. It is also considered possible, and most straightforward for patients, to carry out the engagement exercise in conjunction with the CCG in order to provide the public with a ‘one stop shop’ for expressing their views.

NHS England considers the Transforming Participation in Health and Care guidance to assist in identifying ways in which the public can be involved.

NHS England draws up an engagement strategy.

NHS England decides to carry out the following activities:

o Carry out a public engagement exercise in conjunction with the CCG, to seek patient’s views on the proposals. The exercise will allow anyone to

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express their views by completing a questionnaire online or in writing. Sufficient information and reasons will be provided to allow the public to properly consider and respond to the proposals. The exercise will be publicised by notifying stakeholders (including voluntary, charity and representative organisations), writing to directly affected patients, placing information in the relevant GP practices, social media and by placing information on the NHS England website. Dedicated public events will also be held to explain the proposals, answer questions and seek feedback. The exercise will allow the public 8 weeks to provide their feedback so as to provide adequate time to respond.

o Engaging with local voluntary sector groups including local Healthwatch to seek the views of groups who may be affected, and also those who views may not be heard.

o Carry out an Equality Impact Assessment.

o Consult with the Overview and Scrutiny Committee. Before taking a decision, NHS England conscientiously takes into account the product of all of the above activities. While a wide range of views are received, there is broad support for Proposal 2 due to the accessibility and range of services available at the health centre. The equality impact assessment is also supportive of Proposal 2, as is the Overview and Scrutiny Committee. NHS England decides not to renew the three GP contracts and proceeds with the decision to instead procure a single, larger GP contract at the health centre. The existing contractors are notified and formal procurement exercise is carried out, through which a successful bidder is identified. The outcome of the decision is announced. Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation by using the Public Involvement Assessment flowchart. NHS England identifies that the above decision is an operational decision which has an impact upon services. This assessment is documented using the Section 13Q Duty Public Involvement Assessment Form.

However, it has already made arrangements to involve the public and has taken the insight gathered into account in making this decision. Similarly, the following procurement exercise is based upon such insight. Therefore, while arrangements are required, the existing arrangements are sufficient to involve the public in this decision.

On 1 March 2014, it becomes apparent that the new premises for the new GP practice will not be available until 1 July 2014. The existing contractors agree to continue to provide services from the existing practices until then and the new contractor agrees to postpone the opening of the practice. NHS England therefore decides to postpone the transfer of services to the new GP practice in the health centre.

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Arrangements for public involvement…

NHS England considers whether the section 13Q duty would apply to this situation by using the Public Involvement Assessment flowchart. NHS England identifies the above as an operational decision which has an impact upon services, as it affects the manner in which services will be provided between 1 April and 1 July 2014. Therefore, arrangements to involve the public are required. This assessment is documented using the Section 13Q Duty Public Involvement Assessment Form.

As this decision is consistent with its previous decision and public involvement exercise, it is considered fair and proportionate not to carry out any further engagement exercise and to rely upon the existing arrangements. However, patients are notified, the delay is publicised and all stakeholders are informed.

On 1 April 2015, NHS England delegates responsibility for commissioning primary medical services to Anytown CCG under the co-commissioning programme. The CCG wishes to carry out a further review of all services it commissions in order to consider how the Five Year Forward View can be advanced in Anytown. Arrangements for public involvement…

The CCG is proposing the strategic review of services in Anytown. While NHS England retains ultimate liability for the commissioning of primary medical services, the responsibility for doing so has been delegated to the CCG. Therefore, the public involvement duty falls primarily upon the CCG in these circumstances and the CCG will need to make its own arrangements for public involvement. However, NHS England may liaise with the CCG to share its insight gathered from previous exercises.

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Glossary 13Q: 13Q is the section of the NHS Act 2006 (amended by the Health and Social Care Act 2012) which outlines NHS England’s duty to make arrangements to ensure that the public are involved in commissioning activity. Commissioners: in this document this refers to NHS England commissioning teams. Commissioning: the process of specifying, securing and monitoring services to meet people’s needs (Ref: Audit Commission). The commissioning cycle is a useful tool outlining the commissioning process. Coproduction: The design and delivery of services by citizens and professionals in equal partnership. Source: Co- production Practitioners Network (NESTA). Corporate infrastructure: Corporate infrastructure refers to existing processes and arrangements across NHS England which support our duty to involve patients and the public, as set out in section 4. Insight: Understanding gained from the evidence from patient experience and engagement in order to make services better and inform decision-making. Involvement initiatives: NHS England programmes that support public involvement in the planning, development and consideration of policy, as set out in section 5. Patient: Someone who is receiving medical care or treatment, whether in a health or care setting (such as a hospital or care home) or at home. Sometimes used interchangeably with ‘service user’, which is the generally preferred term in the social care sector. Planning and delivering service change for patients: a guidance document produced by NHS England to assist commissioners conducting service reconfiguration. It outlines the four tests of service change which all reconfigurations must be assured against. Primary Care: Primary care services are GP practices, dental practices, high street and local pharmacies and high street optometrists. Public: for the purposes of the section 13Q duty, this means the individuals to whom the services are being or may be provided. What this means in practice will depend on the context and type of service. Specialised services: Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills. Specialised services account for approximately 14% of the total NHS budget. The commissioning of specialised services is the responsibility of NHS England.

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http://commissioning.libraryservices.nhs.uk/commissioning-cycle

http://coproductionnetwork.com/page/about-coproduction

https://www.england.nhs.uk/commissioning/spec-services/

https://www.england.nhs.uk/commissioning/spec-services/

OFFICIAL



Transforming Participation in Health and Care: Transforming Participation in Health and Care is statutory guidance published by NHS England in September 2013. It provides guidance to NHS England and clinical commissioning groups about how they should discharge their public involvement duties. Trigger: Activities which have been identified as particularly likely to engage the 13Q duty, or indicate that changes are being considered that are likely to trigger the duty. Voluntary and community sector (VCS): VCS is a common umbrella term for organisations known variously as charities, third sector organisations, not-for-profit organisations, community groups, social enterprises, civil society organisations and non-governmental organisations.

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OFFICIAL

1


Report Title PMS Contract holder changes

and contract variation summary paper


Agenda Item

13



Owen Sloman, Haringey CCG


GB Member Sponsor

Report Author

Honorine Focho Tel/Email [email protected]

Report Summary

To set out practice requested PMS contract holder changes for approval.

Recommendation NCL Primary Care Committee in Common members are asked to confirm their APPROVAL.


Risks and mitigations addressed or contract variation summary for each practice.


Paper prepared in line with conflicts of Interest guidance.


Any resource implications will be funded from within CCG primary care medical services allocations.



NCL PCCC PMS partnership changes summary paper

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OFFICIAL

2


Compliance with requirement to secure adequate primary care medical services for the local population; Ensure that services comply with primary care regulations

Engagement

Not required: there is no change in service.


Not required: there is no change in service.


Contract variations will previously have been considered by CCG Committees.

Next Steps Progression of contract variations subject to committee approach.

Appendices

Practice contract variation summaries.

Which CCG does this relate to:

Haringey CCG Barnet CCG Enfield CCG Camden CCG

Document Title: PMS contract holder changes summary paper Version number: 1.1 Published: August 2018 Prepared by: NCL Primary Care Team Classification: OFFICIAL

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OFFICIAL

3

Contents

1 Executive summary ............................................................................................. 4

2 Background ......................................................................................................... 4

3 Table of requested PMS practice provider changes ............................................ 5

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OFFICIAL

4

1 Executive summary The below table summarises the contractual changes requested by PMS practices in NCL.

The corresponding CCG is asked to make determination for the PMS provider changes in their

area.

2 Background PMS practices are required to submit contractual change requests with 28 days notice to allow

the commissioner to consider the appropriateness of the request. The Commissioner should

be satisfied that the arrangements for continuity of service provision to the registered

population covered within the contract are robust and may wish to seek written assurances

of the post-variation contractor's ability and capacity to fulfil the obligations of the contract

and their proposals for the future of the service.

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3 Table of requested PMS Practice Provider Changes

Practice CCG approver

List Size 1/1/18

Contractual Change

Comment Recommended guide based on: 72 GP appointments per 1000 patients

Apps x 10 min (app) / 180 (3 hour session)

Recommendation to committee

Bounds Green Group Practice

Haringey 17000 Resignation of GP Provider

Recommended Guide • 1228 GP app per week • 65 Sessions per week

--------------------------------------------------------------------------------------------------- What the practice state they are providing following this contract change: Dr J Mansfield will be resigning from the contract with effect 01.08.18

• Currently the practice has 5 GP Partners and 6 Salaried GPs. • Practice currently provides 1355 appointments per week across 64

sessions. • There is a shortfall of 1 sessions. • Practice has recruited 2 partners on 5 sessions each. • Practice confirmed that two new partners will join

It should be noted that:

The practice made an application in April 2017 to reduce catchment area but the application was withdrawn in December 2017.

To Approve

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OFFICIAL

6

Bridge House Medical Practice

Haringey 10276 Resignation of GP Provider and Addition of new GP


--------------------------------------------------------------------------------------------------- What the practice state they are providing following this contract change: Dr JM Haas will be resigning from the PMS Agreement with effect 30.09.18. Dr J Thomas will be joining the agreement with effect 01.10.18.

• Currently the practice has 2 Clinical Partners (and 1 non-clinical) and 3 Salaried GPs.

• Practice currently provides 540 appointments per week across 31 sessions.

• There is a shortfall of 8 sessions. • Dr Thomas will replace Dr Haas in providing 6 sessions per week. • The Practice is currently advertising for an additional salaried GP

with a view to increasing the number of partners to 4 in the longer term. They plan to further employ and train FY2 doctors and engage in GP training.

• Both Dr Thomas and the existing/remaining partner Dr Brothers will cover additional session in the interim.

• NHS England will monitor to ensure adherence to current service standards and improvement/recruitment as planned.

To Approve

Forest Road Group Practice (MHP) Riley House Surgery (MHP) Freezywater PCC (MHP) Southbury Surgery (MHP) Green Street Surgery (MHP)

Enfield 79240 Addition of a GP

The following 7 PMS practices, which form part the Medicus Health Partners (made up of 4 GMS & 7 PMS practices) have requested to add the Connaught surgery GMS contract to their Super Partnership Connaught surgery is currently a single-handed GMS contract with a list size of 5060. The contract holder is, Dr Datta and he is supported by 3 salaried GPs. Joining MHP will provide:

• Patient access to multiple sites, with Connaught site being open to MHP patients

• MHP GPs would provide cover if needed across the group

To Approve

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OFFICIAL

7

Lincoln Road Medical Practice (MHP) Enfield Island Surgery (MHP)

• Shared back office functions with a single clinical governance process

• Larger peer pool for reviews and improvement implementation • Further stability to the current single-handed contractor newly in post

East Barnet Health Centre (Drs Weston & Dr Helbitz)

Barnet 3529 Resignation of GP


--------------------------------------------------------------------------------------------------- What the practice state they are providing following this contract change: Dr P Weston will be resigning from the contract with effect 30.09.18.

• Currently the practice has 2 GP Partners (Dr Weston & Dr Helbitz) & and 1 Salaried GP (Dr Frankl).

• Practice currently provides 313 appointments per week across 14 sessions (22 appointments per session).

• The Practice is looking to recruit an additional salaried GP to provide the 4 sessions (90 appointments) currently offered by Dr Weston each week, and possibly a clinical pharmacist/physician associate.

• NHS England will monitor to ensure adherence to current service standards and recruitment as planned.

• The practice are exploring succession planning, including a possible merger.

To approve

F83633 Daleham Gardens Health Centre

Camden 2670 Addition of GP Urgent Decision taken in July 2018 Addition of Dr Fard to the contract


To Note

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OFFICIAL

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--------------------------------------------------------------------------------------------------- What the practice state they are providing following this contract change: Dr Pehzman N-Fard will join the contract with effect 01/08/18

• Currently the practice has 2 GP Partners. • When Dr Fard joins sessions will be increased to 17 per week. • This is above the recommended guide. • Practice has advised that the appointment duration for Dr McGrath

will remain 15 minutes but other GPs will move to 10 minute appointments.

It should be noted that:

• The practice currently closes half day and is not open full core hours (0800 – 1830 Monday to Friday)

• The practice gave notice on their lease when their plan was to hand back the contract. Negotiations are ongoing between tenant and the landlord to try to secure a suitable lease.

• Due to the resignation of the contract holders the 2018/19 PMS variation was not signed in May 2018. Dr McGrath has since rescinded her resignation.

• The CCG has met with the GPs and agreed additional actions the practice will take to improve quality and outcomes.

Approval was sought via Urgent Approval process due to effective change date. Approved subject to the following conditions:

o Daleham Gardens opening full core hours (0800 – 1830 Monday to Friday)

o The new contract holder would sign the 2018/19 PMS variation by 1 September 2018

o The provider will continue to work with the landlord with regards to securing a lease for the existing or secure an alternative suitable premises

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9

F83633 Daleham Gardens Health Centre

Camden 2670 Removal of GP

Removal of Dr Wong from the contract Recommended Guide

• 193 GP app per week • 11 Sessions per week

--------------------------------------------------------------------------------------------------- What the practice state they are providing following this contract change:

• Currently the practice has 3 GP Partners. • When Dr Wong leaves, Dr Pehzman N-Fard will provide his sessions

on joining the contract with effect 01/08/18 • The Practice plans to offer additional sessions per week, and are

changing most of their sessions to provide 10-minute appointments instead of the 15-minute appointments currently offered.

• They will also extend their current opening hours to core hours standards i.e. 8am-630 Monday-Friday as requested by NHS England as a condition of the requested contract changes.

• The Practice plans to offer service at scale and will continue to increase sessions and appointments offered as the patient population increases.

• Sessions/appointments offered are above the recommended guide.

To Approve

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OFFICIAL

1


Report Title Roman Way Medical Centre - Relocation

Date of report

9th August 2018

Agenda Item

14


Lead Director /

Manager

Clare Henderson – Director of Commissioning, Haringey CCG & Islington CCG


GB Member Sponsor

Report Author Anthony Marks Tel/Email [email protected]

Report Summary

Request to approve the relocation of the GMS contract from its current location to a nearby practice where it would be co-located.

The current building will not be available after 31 August 2018. The co-location site is within 0.6 miles and has capacity to accommodate the list.

There will be no reduction on services; patients will be able to access a wider clinical team as two new GP partners join the contract.

Recommendation Members of the Primary Care Commissioning Committee in Common are asked to APPROVE the relocation of services.


Political interest with regard to provision of services within Islington.

Local MP and Councilors have expressed concerns about Primary Care provision.

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OFFICIAL

2


This paper has been developed in line with conflicts of interest guidance.


The relocation can be funded within primary care allocations on an ongoing basis.

Strategic Objectives supported by this report


Legal Implications / Regulatory requirements

Compliance with requirement to secure adequate primary care medical services for the local population;

Ensure that services comply with primary care regulations

Ensure that providers and premises are registered with the CQC

Engagement

Both Practices have undertaken engagement with their patients.

Local stakeholders do not want a reduction in Primary Care access.


Stakeholder consultation has been undertaken.


The Committee has previously seen an update report on service and procurement options for Roman Way Medical Centre.

Next Steps Relocation of the practice subject to committee approval.

Appendices None

Which CCG does this belong to:

Islington CCG

Document Title: Roman Way Medical Centre, Islington – Practice Relocation Version number: 1.1 Published: August2018 Prepared by: Anthony Marks Classification: OFFICIAL

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OFFICIAL

3

Contents REPORT TO THE NORTH CENTRAL LONDON PRIMARY CARE COMMISSIONING COMMITTEE IN COMMON (PCCC) .............................................. Error! Bookmark not defined.

1 Executive summary .......................................................................................................... 4 2 Background ....................................................................................................................... 4 3 Commissioning Decision ................................................................................................... 5

NCL PCCC Roman Way Medical Centre, Islington – Practice Rolcation

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OFFICIAL

4

1 Executive summary The committee members are asked to approve a contract holders request to relocate their GMS contract from Roman Way Medical Centre to purpose built premises at Islington Central Medical Centre, a distance of approximately 0.6 miles. In February 2018 the Roman Way Medical Centre GPs gave notice on their contract with an end date of 31 August 2018. The premises would also no longer be available after this time as the intention to sell the building was stated. In July 2018 Dr Stanley Ho informed NHS England and Islington CCG that he would continue Roman Way Medical Centre contract with Drs Hai and Rodrigues from Islington Central Medical Centre joining the contract. As the Roman Way building would not be available after 31 August 2018 the Practices proposed to co-locate from 1 September 2018. The contract holders at Islington Central Medical Centre have advised commissioners that there is sufficient capacity with some room re-configuration to accommodate the Roman Way Medical Centre Patient list.

Commissioners at Islington CCG and NHS England are satisfied that the practice has provided sufficient assurance in relation to the relocation:

• The catchment area for both practice areas will be retained and not reduced • Access will be not be reduced by the move • There will be a cost savings related to rent reimbursement at Roman Way

Medical Centre • No additional rent reimbursement will be incurred at Islington Central Medical

Centre in respect of the co-location

2 Background

Date of relocation The contract holders have requested to relocate to Islington Central Medical Centre by 1st September 2018

Impact on patients The distance between the two sites is approximately 0.6 miles, 12 minutes walking distance. Islington Central Medical Centre is close to Highbury & Islington Underground and Overground rail services, with nearby access to bus routes 4, 19, 31 and 43

Roman Way Medical Centre and Islington Central Medical Centre have a considerable overlap of their catchment areas.

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Stakeholder engagement When the contract holders at Roman Way Medical Centre resigned they undertook patient engagement and held meetings with their Patient Participation Group (PPG). NHS England and Islington CCG wrote to all patients and local stakeholders to find out their views on the available options for the Roman Way Medical Centre patient list.

Local stakeholders were concerned about the possibility of the practice closing and voiced their opposition to this outcome.

When the practice informed Islington CCG and NHS England that whilst Dr Bina Shah would still resign, Dr Stanley Ho intended to continue running Roman Way Medical Centre with Drs Hai and Rodrigues joining the contract, all patients were also informed.

Benefits There will be enhanced delivery and sustainability through sharing resources and good practice across the two surgeries based on one site and enhancing clinical governance. Patients will transfer to the new building without the need to re-register providing continuity of care.

Financial Impact As a result of the relocation, the premises at Roman Way Medical Centre will no longer be required and will release a surplus of £64,880 (rent reimbursement)

3 Commissioning Decision

The Committee is asked to approve the decision to relocate Roman Way Medical Centre from 58 Roman Way, London N7 8XF to Islington Central, 28 Laycock Street, N1 1SW

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Report Title Finchley Memorial Hospital

Primary Care Provision – Expression Of Interest update and Financial Support Package.


Agenda Item

15


Colette Wood, Director of Care Closer to Home


GB Member Sponsor

Report Author

Carol Kumar / Kelly Poole, Associate Head of Primary Care

Tel/Email

Report Summary

To provide update on FMH Expression of Interest (EOI)and to seek agreement from PCCC on elements of Financial Support Package (FSP)

Recommendation NOTE the EOI process for primary care provision at Finchley Memorial Hospital APPROVE implementation of the Financial Support Package


CCG will continue to incur void costs if a preferred provider cannot be appointed


The paper has been prepared in accordance with conflicts of interest guidance.


The paper recommends a financial support package to be funded from delegated primary care medical services budgets.


- Care Closer to Home - Transforming Primary Care - Delivering primary care at scale


Barnet CCG will work with NHSE on project plans for any implications with regards to this as Finchley Memorial Hospital (FMH) project mobilises.

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Engagement

Barnet CCG will work with NHSE on project plans for any implications with regards to this as Finchley Memorial Hospital (FMH) project mobilises.



Primary Care Working Group- 11 Jan 2018 Primary Care Procurement Committee - 22 Feb 2018


Finchley Memorial Update


Barnet CCG

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MEETING Primary Care Committee in Common

REPORT Finchley Memorial Hospital Primary Care Provision – Expression Of Interest update and Financial Support Package.

DATE OF REPORT 1st August 2018

LEAD DIRECTOR/

GOVERNING BODY MEMBER

Colette Wood, Director, Care Closer to Home

DIRECTOR SIGN OFF and DATE

Colette Wood

9/8/2018

AUTHOR Carol Kumar/Kelly Poole

Associate Head of Primary Care

CONTACT DETAILS [email protected] / [email protected]

EXECUTIVE SUMMARY

This paper outlines the ‘Expression of Interest’ (EOI) process Barnet CCG has followed in order to progress plans to move primary care services into Finchley Memorial Hospital. This paper aims to provide assurance on the process followed and seeks the Committee’s approval to implement the ‘Financial Support Package’ (FSP).

Barnet Clinical Commissioning Group has been running a programme to transform how Finchley Memorial Hospital (FMH) is utilised. The site was developed on the basis that a GP practice would part-occupy the unit, but the relatively high service charge has proven prohibitive during past attempts to move primary care services in. This new opportunity, backed by a financial support package, offers the CCG and patients a unique opportunity to develop a pioneering model of care based on the Vanguards being delivered nationally and aligns with the CCG’s strategic priorities around Care Closer to Home, Transforming Primary Care and developing primary care at scale. As part of this work, a service specification was developed for the incoming provider to work to and will work as an enabler to the CCG’s strategic objectives.

1. Expression of Interest (EOI) process

Barnet Clinical Commissioning Group (CCG) conducted an ‘Expression of Interest’ (EOI) exercise whereby all Barnet practices were offered the opportunity to submit a business

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case application to move to the site. This process was led by Barnet CCG, with input from NHSE primary care team colleagues and the NEL CSU procurement team.

The timeline below depicts the key project points:

• On 30th April, EOI packs were sent to all Barnet GP practices with an invitation to submit a business case application to relocate to FMH. The packs detailed the application process, service specification the provider is required to work to (in addition to contractual requirements), scoring criteria and FAQs. The FAQs contained detail on the FSP. This is further explained in section 2.

• On 30th May, an engagement event was held at FMH, which was jointly led by the estates and primary care leads from Barnet CCG. It was attended by 27 participants, representing 17 practices. The CCG made a further offer of individual meetings with interested parties.

• Following the event, revised FAQs were circulated to all Barnet Practices which were updated to reflect questions raised at the above event and via email.

• One individual practice visit was requested. This was attended by BCCG Heads of Primary Care.

• 30th June was the closing date for applications. 3 were received. • On 16th July, a panel was convened to score the applications. The panel was

chaired by an NEL CSU procurement team colleague. Representatives included a BCCG NED and STP senior manager, as well as BCCG Directors and senior managers. The applications were jointly scored. One application was discounted because it did not meet the requirements of the EOI. From this, the highest scorer was appointed as the CCG’s preferred provider.

• On 2nd August, letters confirming the outcome of the panel scoring process were sent to the applicants. The CCG has entered a voluntary standstill period, which ends at midnight on 13 August.

2. Financial Support Package (FSP)

The CCG is incurring void costs of approximately £180,000 PA on the void space for primary care at Finchley Memorial Hospital. In view of this and owing to the reasons previous attempts to establish primary care provision at the site failed, the CCG has offered a Finanical Support Package (FSP). This was included with the EOI documentation.

Question Answer Points for Committee to note

What will the service charge be per annum?

Current estimated service charge for GP space at FMH is £39,174.

Nil.

Who is liable to pay the service charge cost?

BCCG will part-fund the service charge for the duration of the lease via a bespoke FMH ‘Financial Support Package (FSP)’ on the basis that a GMS/PMS or APMS contract is in

The PCCC are asked to note that the service charge costs element within the FSP is outside of the London Policy on how to assess Service Charge

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place during this time. Should the contract be brought to an end or the contract holder/s resign, the service charge will cease to be reimbursed from the date the contract terminates.

costs of which the PCCC signed off in January 2018. BCCG has included another approach within the package to ensure we attract a practice to relocate and to ensure it is affordable to the contract holders. The committee members are therefore asked to note that this is a one off offer for the FMH project and we ask members to approve this approach which differs to what members approved for NCL practices in January 2018.

How much will rent be?

Rent will be reimbursed. Barnet CCG as commissioners will review the need for a contribution if the rent charged by the landlord is higher than the rent valued by the District Valuer, but the CCG will need to be part of the negotiations on lease terms in order to consider this.

To note.

Will there be list size income protection, if so for how long?

The CCG is unable to protect the incoming practice/s list size. However, we do not envisage that your list size will be negatively impacted by the move

To note.

Who will pick up project management costs?

The CCG will provide a financial support package (FSP) for one off costs, which covers this.

To note. The CCG does not anticipate that these costs will be significant. PCCC to approve the one of costs to meet the strategic objective of the FMH project

Who will pick up removal costs?


PCCC to approve the one of costs to meet the strategic objective of the FMH project

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Who will pick up scanning medical records costs (to reduce storage space at FPM)?



Who will pay for external record storage?

The CCG will provide a financial support package (FSP) which covers year one of this.


Who will pick up legal costs?

Practices should apply for this via Premises Cost Direction (PCD). Applications will go through the usual CCG governance process, including referral to the NCL Primary Care Commissioning Committee. Under the terms of the PCD, a contribution can be made as a discretionary payment dependent on the primary care budget. It should be noted that the CCG is committed to ensuring that this move is cost neutral for the incoming practice/s.

To note.

Who will pay for stamp duty land tax?

Practices should apply for this via Premises Cost Direction (PCD). Applications will go through the usual CCG governance process, including referral to the NCL Primary Care Commissioning Committee. Under the terms of the PCD, a contribution can be made as a discretionary payment dependent on the primary care budget. It should be noted that the CCG is committed to ensuring that this move is cost neutral for the incoming practice/s.

To note.

Who will pick up any redundancy costs?

The practice will be responsible for paying any associated redundancy costs. The CCG will not fund redundancy costs.

To note.

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What car parking is available for staff and patients, and at what cost?

For patients there is a free 3 hour car park. The CCG will request four dedicated practice parking spaces as part of the offering from the landlord CHP. These will be included as part of the District Valuer’s CMR evaluation

To note.

Who will complete patient engagement/consultation activities associated with this move?

The preferred provider will be responsible for consulting their patients regarding a move to FMH, but the CCG communications team will provide support to do so. Any costs associated with this will be funded via the FSP.

To note. NHSE has confirmed that though this is a relocation, as it is outside usual 1 mile radius a full consultation is likely to be needed. BCCG/NHSE are still discussing the process for this for agreed route of action. BCCG will ensure that Patients and any are wider stakeholders are liaised with as required.

Will I need to bring my own furniture to FMH?

No, this will not be necessary. Clinical rooms are furnished. However, we would encourage the preferred provider to visit the space and make a judgement about whether they would like to bring across some smaller pieces of furniture they already have.

Nil.

What are the expected timescales for this move

It is expected that, from the time a preferred provider is appointed, the move will take place as soon as possible but no longer than one year.

Nil.

How will the financial support package be given to the practice?

The CCG will pay on receipt of invoice or quote (where applicable). Payment can be made on account to aid cash flow if required. (To note we we will only reimburse on invoice out of the primary care budget)

To note.

RECOMMENDED ACTION

NOTE the EOI process for primary care provision at Finchley Memorial Hospital

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APPROVE implementation of the Financial Support Package

Objective(s) / Plans supported by this paper: (How does this report help to deliver the objectives plans and strategies of the CCG?)

- Care Closer to Home - Transforming Primary Care - Delivering primary care at scale

Audit Trail: (Details of the groups or committees that have received the paper including dates)

Primary Care Working Group- 11 Jan 2018

Primary Care Procurement Committee– 22 Feb 2018 (see appendix one)

Patient & Public Involvement (PPI):

None

Equality Impact Assessment:

N/A

Risks:

CCG will continue to incur void costs if a preferred provider cannot be appointed

Resource Implications:

FSP will be funded from void costs currently incurred

Next Steps: (This section will set out what will happen next, including when the item may next be reported to a committee or the Board. It should include explicitly any communication plan)

Following the satisfactory completion of the standstill period, BCCG will seek to appoint the preferred provider and begin mobilising the move. BCCG will work up project plans with the preferred provider, including specifying space requirements (so that the service charge can be accurately costed) and the process to notify patients and stakeholders (in conjunction with NHS colleagues).

A further paper will then be brought to PCCC, which will contain financial detail on the FSP costings specifically in relation to the preferred provider.

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Appendix 1

PCPC minutes 22.2.2018 – Re FSP Agreement

4.0 Minutes PCPC 22 Feb 2018 bc.pdf

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Report Title NCL Primary Care Committee in Common

Risk Register


Agenda Item 17




GB Member Sponsor

Report Author



Report Summary

This paper presents an overview of the risks, and associated mitigations, that fall within the remit of the Primary Care Committee-in-Common. In October 2018 the risk register for the NCL Primary Care Committee in Common Risk will be updated in line with the review of risk registers across North Central London. The review will ensure that the risk registers for the Committee are aligned with those for the NCL Sustainability and Transformation Plan, NCL CCG Joint Commissioning Committee and individual CCGs. In July 2018 the Committee Seminar considered the Committee risk-register in detail with the following outcomes: • Ensuring that the risk register is consistent with the terms of reference for the

Committee. This will be delivered through the review of risk registers across NCL referenced above and due for completion by October 2018. The terms of reference for the Committee will also be reviewed in 2018/19;

• Check the state of readiness for business continuity plans and responses to critical incidents;

• Risks to delivering primary care at scale, including securing recurrent funding and the development and maturity of GP Federations, to be include on the risk register

The register for the August 2018 Committee incorporates the following changes: • Risk 1: Managing conflicts on interest – The Committee will receive a

paper in August 2018 on the application of conflicts of interest guidance to the work of the Committee;

• Risk 9: Loss of service provider without notice due to regulatory action – In April 2018 the Committee agreed to implement a local process for the direct allocation of vulnerable patients to another practice in the event of a practice closure. The local process will remain in place until direct allocation by Capita (Primary Care Support England service) is in place. NHS England is making representation to Capita on a London-wide basis to put in place the direct allocation of vulnerable patients from a closed practice to alternative practices rather than assignment to the three nearest practices;

• Risk 14: Alternative Primary Medical Service – Focus groups have been held in North Central London to support the procurement of a new NCL-wide service, with the new service starting in April 2019. The procurement will be based on a national service specification. Procurement plans include a market event to ensure there is interest in providing the service. The specification

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includes a focus on returning people to mainstream general practice as soon as possible as requested by the Committee in April 2018;

• Risk 18: Primary Care Support England – NHS England have responded to the National Audit Office (NAO) recommendation that some aspects of the Primary Care Support England service be in-housed back into the NHS due to concerns over the quality of the service provided. NHSE do not plan to bring any aspect of the contract back in house, but are using active contract management particularly in the areas of concern raised by the NAO - pensions, optometry payments and performer’s list management. This includes fining with service credits as appropriate and utilising external expertise to strengthen contract management.

• Risk 19: Securing funds for Primary Care at Scale development – Funds for developing primary care at scale in North Central London, working with GP Federations, have been approved by NHS England for 2018/19 on a non-recurrent basis. Recurrent funds are required;

• Risk 20: DOCMAN - This is a new risk on the register following concerns raised in Southwest London. There is a risk that not all documents transferred into general practices through DOCMAN have been processed appropriately. This is a risk across general practice in England where DOCMAN is used. Further detail on this risk is set out below;

• Risk 21: Business Continuity – This risk has been added to the register following the Committee Seminar held in July 2018. All practices have business continuity plans. There is an opportunity to update the plans for the development of primary care at scale and Care and Health Integrated Networks (CHINs).

The Committee is asked to: • Review the current risks included within the risk register and consider any

further risks for inclusion; • Consider the updates to the risk register for the August 2018 Committee.

Recommendation NCL Primary Care Committee in Common members are asked TO DISCUSS and AGREE the latest iteration of the Committee Risk Register.


The identified risks have been outlined in the cover paper and supporting risk register.

Conflicts of Interest Paper written in accordance with conflicts of interest guidance.


Not applicable.


This risk register relates to the shared responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning high quality primary care services in NCL.


A number of the risks identified in the risk register relate to the legal responsibilities of CCGs as commissioners.

Engagement

The risk register fully considers public engagement and partnership working as part of the risk mitigation / control process.


The mitigations will reflect the public sector duty requirements to consult with the public and key partners.


Previous versions of the NCL Primary Care Committee in Common risk register have been presented and discussed.

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This risk register relates to the shared responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning high quality primary care services in NCL.

Next Steps Register sets out further actions to mitigate risks. Appendices

17.1 – PCCC Risk Register


This risk register relates to the shared responsibilities of Barnet, Camden, Enfield, Haringey and Islington CCGs for jointly commissioning primary care services in North Central London

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APPENDIX 17.1

Ref Risk Category Potential impact Date Opened

Inherent Likelihood

Inherent Impact

Inherent Risk Score Mitigation Owner Residual

LikelihoodResidual

ImpactResidual

Risk Score Next action / comments

1

Co-C

omm

issioning

Conflicts of InterestRisk that there may be an actual or perceived conflict of interest. This is particularly the case for GP members of the Committee where their judgements as a commissioner could be, or be perceived to be, unduly influenced and impaired by their own concerns and obligations as a provider.

15-Jul-16 3 4 12 A register of interest is in place and is published with the papers for every Committee meeting.

Declarations of interest requested at start of each Committee and recorded in formal minutes.

The Committee is only quorate if it has a lay member and officer majority. Quoracy is supported by options for co-option to avoid conflicts of interest.

The NCL Conflicts of Interest Policy was updated to reflect this new guidance in November 2016.

NHS England / CCGs

3 2 6 NHS England have published new conflicts of interest guidance for CCGs (June 2016).Completion of mandatory training by Committee members.

The workplan for the Committee schedules a review of the application of conflicts on interest to the Committee in August 2018.

2

Co-C

omm

issioning

Governance and Operations Cause and Effect1) NHSE financial responsibilities may cause cost pressures on CCG budgets. 2) Risk of additional work without correlating resources correctly identified and aligned to the activity. 3) Unintended change to CCGs relationship with member practices where CCG becomes a decision maker over contractual matters for practices

06-Mar-17 4 5 20 Full delegation for all five CCGs from April 2017. Memorandum of Understanding between NHSE and CCGs drafted to support delegation of primary medical services budgets. Memorandum sets out responsibilities for CCGs and NHSE under delegated conditions.

Robust representation on Committee from all CCGs enables management of risk resources.

Bi-monthly update to CCG Governing Bodies through minutes of the meetings and Governing Body and Committee membership overlap

Finance reports to the Joint Committee established, reporting on fully delegated budgets. Headroom in financial position across the five CCGs in 2017/18, although differential across the CCGs.

Agreement of local budget setting and risk-share arrangements to Governing Bodies in November 2017.

London Primary Care Board established to align work of CCGs and NHS England

Director of Performance and Acute Commissioning

3 4 12 Standard Operating Procedure developed between NHSE and London STPs. Any changes to CCG responsibilities in Standard Operational Procedures will be presented to the Committee for approval.

Developing NCL commissioning arrangements will need to take account of local resources for primary care development.

9

Primary C

are Provision

Loss of Service Provider without notice due to lack of notice or regulatory intervention (CQC, GMC, NHSE)There is a risk that patients will not be able to receive services or that they will seek care from other providers including- U&EC service providers-other GP practicesthis is unsafe and has system and financial impact for commissioners and providers

01-May-16 4 5 20 NHSE undertakes assessment of practice resilience to identify those at risk of failure

Resilience support built into CCG primary care commissioning plans for 2017/18 and beyond

NHSE shall accelerate normal list dispersal arrangements to support registration

NHSE and CCGs can accelerate processes to appoint a care-taker or "step-in" provider

Terms of reference for the Committee include provision for urgent and immediate decision-making between Committee meetings

Agreement of local allocation scheme for vulnerable patients until allocation process restored through the Capita contract. NHSE asked to make representation to Capita through the London Primary Care Management Board

NHS England / CCGs

3 3 9 Development of plans for primary care at scale for 2018/19 to develop the Resilience Programme. Plans will be supported by GP Forward View monies.

Development of a standard operating procedure (SOP) to address financial support that can be offered.

CCGs may develop solutions as part of their provider development and commissioning intentions, including through development of GP Federations

To work with NHS and Capita to reinstate a process of allocation for vulnerable patients

Development of IT solutions to allow for service provision from other sites

12

Primary C

are Provision

Variation in Primary Care Quality & Performance Across NCLLack of granularity in current standard report to Primary Care Joint Committee makes it difficult to understand areas of concern in a meaningful way. There is a risk that the current variation in the quality and performance of primary care services in NCL will not be addressed effectively and in a timely manner.

01-May-16 4 3 12 An NCL Sustainability and Transformation Plan has been developed as part of a 5 year plan to reduce variation across NCL and to improve the quality of care provided to patients.

NHSE identifies poor performance using published data on performance and works with CQC and CCG's to performance manage practices where safety is a concern

The NCL Primary Care Joint Committee has agreed the establishment of a working group to review 'what good looks like' with regards to how quality and performance is monitored across NCL.

NHSE has established a London working group to improve the information provided to decision makers (Committees, providers and commissioners)

GP Federations in NCL have received £1.6m to support the development of primary care at scale in 2018/19

CCG Primary Care Budgets for 2018/19 presented to the June 2018 Committee for approval.

NHS England / CCGs

4 3 12 Implementation of Care Closer to Home Integrated Networks (CHINs) and Quality Improvement S Teams (QISTs) through the Care Closer to Home STP workstream.

Development of performance report to incorporate qualitative aspects of performance. London QSAG report adopted for Primary Care Committee-in-Common this will be further developed by adding local reports.

Development of refreshed primary care strategy for NCL has a focus on reducing unwarranted variation and reducing inequalities

Plans for utilising primary care growth monies in 2018/19 being developed and will come to the Committee in June 2018.

13

Primary C

are Provision

Primary care workforce developmentIf the CCGs are ineffective in developing the primary care workforce then this may have an adverse impact on the delivery of the primary care strategyThis could mean that for example, patients with long term conditions are not fully supported in primary care and require more frequent hospital care.

06-Mar-17 4 3 12 The education programme for GPs, practice nurses and practice staff.

The primary care team is now fully established, and Assistants Director (8d) post recruited to.

Development funding in primary care strategy for practice managers, practice nurse and practice-based pharmacists.

Creation of blended roles for urgent care developed through Community Education Provider Networks (CEPN) Primary Care monies used to establish practice based pharmacists and potential for physiotherapists too subject to NHSE release of investment monies.

Establishment of STP workforce workstream

Islington CCG 4 3 12 A programme for practice nurses to enhance deliver of the '6 C' strategy is being scoped.

The emergence of the GP federation and a review of locally commissioned services will help meet the development and support needs of member practices and enable a streamline of commissioning to ensure resilience and equity. Develop framework for CCGs to work with respective Federations.

Development of the refreshed primary care strategy has a focus on workforce including retention, skill-mix, and portfolio careers

14 Primary Care Provision

Alternative Primary Medical Service Cause: A temporary provider for services in Camden, Enfield, Haringey and Islington has not been commissioned as planned in March 2016. A procurement to secure a permanent NCL provider with effect from 01/04/17 has not yet commenced as planned in March 2016. Effect: Although less than 100 patients are affected, there is a risk and impact of no service being available for these patients.Impact: There is current no provider of services in Camden and Islington. The Haringey provider has no premises from which to deliver the service and the Enfield provider will cease providing services on 31/03/17.

02-Mar-17 5 4 20 NHSE undertakes an assessment of patient impact and risk

NHSE and CCGs to accelerate processes to appoint a care-taker or "step-in" provider for Camden. Haringey and Islington

Implement communication and engagement plan

Temporary service in place for Camden, Islington and Haringey residents. Notify relevant patients of mobilising interim service for the three CCGs (service in place for Barnet and Enfield)

Stakeholder events held in NCL to support the procurement

NHS England / CCGs

3 4 12 NCL CCG procurement underway based on London-wide service specification.

Sign-off of service specification for the service by the Committee


PMS ReviewCause: Responsibility for completing PMS Reviews now delegated to CCGs to complete by 1st October 2017.Effect: There is a risk that there is insufficient time and capacity to complete the PMS review process by the 1st October 2017 deadline. There is also a risk that the funding required to deliver an equitable offer in general practice will not be available leading to the destabilisation of practices.Impact: CCG implementation of SCF and STP proposals are compromised due to delay in releasing premiumGMS practices and their patients are not able to access premium funding.This may create uncertainty for practices and delay additional investment in primary care.

03-Mar-17 5 3 15 NCL CCGs to complete a baseline assessment of impact on practices.

Baseline assessment to inform financial modelling of impact on PMS practices and future commissioning intentions.

PMS Oversight Group established for NCL CCGs. Transition period for PMS and GMS equalisation agreed.

NCL CCGs commissioning intentions will aim to minimise impact of PMS reviews on practices while delivering equalisation across GMS and PMS.

Commissioning intentions for all 5 CCGs signed off by primary care committee-in-common, and by NHS England and Local Medical Committee through London-wide process.

Contract variations sent to all PMS practices for signature by end of May 2018.

PMS transition to start across NCL CCGs in April 2018

NCL CCGs 3 3 9 Work with PMS practices to secure contract variation sign-off by the end of May 2018.

Agreed that the PMS transition process will commence on 1 April 2018.

Implement commissioning intentions for 2018/19 across all practices in North Central London

16 Fully Delegated Commissioning

Embedding of NHSE Team into STPThe impact of new NCL commissioning arrangements and embedding of the NHSE team with a vacant Head of Primary Care role may result in the loss of its core knowledge base and continuity. This could significantly reduce the effectiveness of the Primary Care Committee and how the committee works with the NHSE Primary Care Commissioning Team.

19-Apr-17 4 4 16 Only one change in Primary Care Commissioning team means that continuity and knowledge base of team is preserved.

Recruitment to Head of Primary Care for NCL team completed

Establishment of Primary Care Committee-in-Common

Joint workshop for primary care held on 14 December 2017

Director of PCC (NHSE)/NCL Director of Performance and Acute Commissioning

Enfield Commissioning Workstream Lead

3 3 9 Develop work programme that better aligns intentions for core and enhanced primary care: - Primary care team support for care closer to home strategy;- Opportunity to better align incentives for primary care – Quality Outcomes Framework (QOF), Locally Commissioned Services (LCS), and GP Forward View: - Stronger links into London-wide work on primary care.

Next phase on delegation will consider the TUPE transfer of the primary car team from NHS England to CCGs


Committee in common QuoracyIn light of the changes to the terms of reference for the Primary Care Committee in common that require quoracy attendance to be met for all 5 CCGs, there is an increased chance of the meeting being inquorate and therefore unable to make decisions. This will result in an increase in urgent decisions being taken outside of the committee forum reducing the transparency and scrutiny of decisions and potentially impacting on the consistent approach proposed across the 5 CCGs.

19-Apr-17 4 3 12 Committee membership has been formally defined in advance and approved by CCG Governing Bodies.

Terms of reference incudes provision for co-option to support quoracy

2 Independent GPs have been included in the membership to provide co-option arrangements for CCGs unable to field a clinical representative who wish to delegate this responsibility to an alternative clinical lead.

Committee meeting schedules are reviewed at each meeting to identify in advance issues in attendance.

NCL Director of Performance and Acute Commissioning can act as Executive lead for any of the 5 CCGs.

Dates for 2018/19 meetings set to support quoracy

Practice nurse representative appointed to the Committee

Committee Secretary

2 3 6 CCGs to clarify deputies to attend for members.

Permanent recruitment to CCG Primary Care Commissioning Teams provides a more stable Executive Officer presence.

Schedule of meetings agreed for 2018/19 to maximise attendance.


Primary Care Support EnglandThere is a risk that the NHS England Primary Care Support Services functions (commissioned and managed by NHS England) result in impact on business continuity of GP services, quality of service to primary care users and cost pressures to fully delegated CCGs

19-Apr-17 4 4 16 Inclusion of independent contractors in operational review group for London.

Monthly report by independent contractor groups (LMC) to NHS England-London primary care team on recurrent issues being reported by contractors in relation to PCSE Increasing scrutiny and validation of this action on a case by case basis by NHS England

National Audit Office (NAO) report on Capita contract.

NHSE do not plan to bring any aspect of the contract back in house, but are pursuing active contract management in response to the National Audit Office report and recommendations.

Director of Primary Care Commissioning (NHS England)

4 4 16 Standing agenda item on Committee agenda comprising regular update from risk owner on current issues/cases for NCL and progress to date with resolution of these.


Primary Care at ScaleThere is a risk that NCL will not receive the transformation funds from NHS England to support the development of primary care at scale in 2018/19.

19-Apr-18 4 3 12 Refresh of primary care strategy for NCL

Collaborative approach across CCGs to develop delivery plans working with GP Federations.

Clinical leadership for primary care commissioning and provision in place.

Process agreed with NHS England for development of plans and release of monies.

High coverage of practice participation in Federations and other collaborative arrangements.

Primary care at scale monies received by NCL GP Federations £1 6m received for 2018/19

NCL Programme Director for Care Closer to Home

3 3 9 Identification of recurrent funds to support primary care at scale.

Further support for the development of GP Federations in North Central London

North Central London Primary Care Joint Committee Risk Register as at August 2018

of 142

Ref Risk Category Potential impact Date OpenedInherent Likelihoo

d

Inherent Impact

Inherent Risk

ScoreMitigation Owner

Residual Likelihoo

d

Residual Impact

Residual Risk

ScoreNext action / comments

10

Primary C

are Provision

PMS Contract ReviewRisk of delays due to ongoing negotiations with key stakeholders.CCG implementation of SCF and STP proposals are compromised due to delay in releasing premiumGMS practices and their patients are not able to access premium funding This may create uncertainty for practices and delay additional investment in primary care.

01-May-16 5 3 15 Extension to the deadline has been agreed by NHS England which will support alignment with the NCL Sustainability and Transformation Plan.

National guidance issued to CCGS

NHS England / CCGs

4 2 8 Ongoing discussions are underway with key stakeholders regarding the timeline for completing PMS contract reviews.

Risk superseeded by Risk no. 15

11

Primary C

are Provision

PMS Review (Threat)Cause: If NHS England fail to successfully complete the PMS Review.Effect: There is a risk that the funding required to deliver an equitable offer in general practice will not be available leading to the destabilisation of practices.Impact: This may impact on core PMS funding resulting in CCGs being unable to deliver the Primary Care Mandate commitment - a consistent offer for patients in general practice in Camden.

Risk superseeded by Risk no. 15

3

Service Transformation / STP

Regeneration projectsImpact on local population and practices' ability to absorb increase in population.Issues: 1. Alignment of NHS strategic planning with LA planning timescales2. Affordability of new premises which will initially have void capacity

01-May-16 2 5 10 - CCG Estates Strategies in place

- Engagement with local stakeholders, developers and council planners.

- Impact assessment and review of GP services in the area.

- CCGs have recently submitted bids for additional funding through the Estates and Technology Transformation Fund (June 2016).

CCGs 2 2 4 CCGs are awaiting outome of recently submitted bids for additional funding through the Estates and Technology Transformation Fund.

6

Primary C

are Provision

Resignation of a provider where premises will not be available to reprovide the service resulting in a list dispersalImpact to registered patients and the local population. Issues: 1. Possible disruption of service continuity for patients who need to register with a new practice2. Increased workload for receiving practices who may already be under strain

01-May-16 4 2 8 Processes in place to:1. identify vulnerable patients who can be allocated to a new practice2. provide information to patients to support re-registration3. additional capitation payments for new patients4. implement communication and engagement with patients and other stakeholders

NHS England/CCG

4 1 4 Options and decisions relating to resignation of providers are brought to the NCL Primary Care Joint Committee. Where required, an urgent decision making process is in place.Resilience Programme is considering how receiving practices can be supported in the future. CCG's may address sucession planning as part of STP and provider developmentDevelopment of IT solutions to allow for service reprovision from other sites

7

Primary C

are Provision

Resignation of a provider with insufficient notice to appoint a new provider under long term APMS arrangementsThe current lead time to appoint under competitive procurement is circa 12 months whilst notice periods are either 3 or 6 months. If this is not addressed there will be a service gap necessitating the need for high cost care-taking arrangements and uncertainty for patients

01-May-16 3 3 9 Joint commissioners should ensure that care-taking arrangements are for fixed term whilst a procurement is initiatied. Where possible caretaking providers should be directed to improve the quality and/or viability of the service.

Implement Communication and engagement plan

NHS England/CCG

2 2 4 CCG's may address via provider development workstreams to promote new operational models that enhance viability.Development of IT solutions to allow for service reprovision for other sites

8

Primary C

are Provision

Resignation of a strategically essential provider with a small listThe list size means that procurement is likely to be unsuccessful due to the viability of the service

01-May-16 2 4 8 London APMS programme undertakes a strategic assessment and a viability assessment of all proposed procurements. This will establish whether there is a need to maintain the service and if so, the viability under APMS arrangements. Where viability is an issue but can be addressed through service growth or development, then support payments may be offered to the bidders.

NHS England/CCG

2 2 4 CCG's to address via provider development workstreams to promote new operational models that enhance viability

North Central London Primary Care Joint Committee Closed Risks

of 142

NCL PRIMARY CARE COMMISSIONING COMMITTEE item: 18

WORK PLAN 2018 / 19

Area

19 April 2018

21 June 2018

16 Aug 2018

18 Oct 2018

Dec 2018

Feb 2019

Governance

Review of Risk Register- item for seminar on 27 July 2018

X X X (seminar) X X X

Review of Terms of Reference (TOR) X

Revised Conflicts of Interest Policy - item for seminar on 27 July 2018

X (seminar)

Review of Committee Effectiveness

Committee Annual Report X

Contracting

Decisions relating to GMS, PMS and APMS contracts eg: practice mergers

X X X X X

Local Commissioned Services X X

Alternative Patient Allocation Service X X X X X

NHSE SOP for relocation of GP Practices and the responsibilities in relation to consultation and engagement with patients, stakeholders and other practices (VP)

X

of 142

Quality & Performance

Quality and Performance Report X X X X X X

Primary Care Support England X

Finance Report

Finance Report - to include the run rate and adjustments on future finance reports.

X X (financial planning for 2018/19 and final 2017/18

finance report)

X X X X

Strategy

Sustainability & Transformation Plan Development and Implementation ( includes plans for finance, estates, workforce and IT)

X X X X X X

Other papers

Report which compares service charges between practices

X

London wide service charge financial assistance policy

X

Paper on how bids for the estates capital funding will be managed

X

Primary Care Operating Plan X

Camden's Dashboard - item for seminar on 27 July 2018

X (seminar)

of 142

Case Study on the remedial action - item for seminar on 27 July 2018

X (seminar)

Learning from other CCG LCSs on reducing inequality and improving quality - item for seminar on 27 July 2018

X (seminar)

Barnet Case Study about Care Closer to Home - item for seminar on 27 July 2018

X (seminar)

of 142

north central london primary care committee in …...ms neeshma shah meena mahill mr anthony marks...

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