AGENDA NEL Primary Care Committee in Common (NEL PCCC) · Minutes of the North East London Primary...

AGENDA

NEL Primary Care Committee in Common (NEL PCCC)

Date/Time: Monday 13 January 2020, 14:00-16.00

Location: The Old Town Hall, 29 Broadway, Stratford, London, E15 4BQ

Chair Julia Slay, Lay member – Tower Hamlets CCG and Chair of Tower Hamlets Primary Care Commissioning Committees)

Item No.

Time Item Description Action required

Presenter Paper Or Verbal

PART A - BUSINESS SESSION

1. 2:00pm (5 mins)

Welcome None Chair Verbal

2. 2:05pm (5 mins)

Declaration of Interests

Note Chair Verbal

3. 2:10pm (5 mins)

Minutes from the last meeting and Action Tracker Agree Note

Chair Paper 3.1 & 3.2

4. 2:15pm (10 mins)

North East London Local Incentive Schemes

Note and Discuss

Alison Goodlad

Paper 4

5. 2:25pm (10 mins)

Network Contract DES – Draft Specifications

Note and Discuss

Alison Goodlad

Paper 5

6. 2:35pm (25 mins)

APMS Contracts Update and Future Developments

Recent tranche 7 Procurement overview outcome/issues

APMS equalisation

SAS procurement outcome/next steps/risks

Future process for procurements (incl: new pseudo-dynamic purchasing system)

Digital First Providers – consultation outcome and potential implications for NEL

Note and Discuss

Alison Goodlad /Angela Ezimora-West Gohar Choudhury

Paper 6

7. 3:00pm

Questions from the public Discuss Chair Verbal

8. 3:05pm AOB Note Chair Verbal

9. To note: GP Patient Survey – Overall Experience by BME Group (see action tracker)

Paper 9

Minutes of the North East London Primary Care Commissioning Committees in Common (NEL PCCC)

1 October 2019,

2.00pm – 4.00pm, The Old Town Hall, 29 Broadway, Stratford, London E15 4BQ

Part 1 Minutes

Present

Chair

Name Title / Organisation Initials

Richard Coleman Lay Member, Havering CCG RC

NEL Primary Care team

Name Title / Organisation Initials

Jane Lindo Director of Primary Care , NEL JL

Alison Goodlad Deputy Director of Primary Care , NEL AG

Pri Vinayak Senior Corporate Business Manager / Board Secretary PV

Lorna Hutchinson Assistant Head of Primary Care, NEL LH

Gohar Choudhury Assistant Head of Primary Care, NEL GC

Angela Ezimora-West Assistant Head of Primary Care, NEL AEW

Maxine Grimes Primary Care Commissioning Manager, NRL MG

Caroline Santos-Ekwuozor

PC Transformation Programme Management Officer, NEL CSE

City & Hackney CCG

Name Title: Initials

Sue Evans Lay Member, CHCCG SE

Sunil Thakker Director of Finance, CHCCG ST

Lee Walker Senior Contracting Manager, CHCCG LW

BHR CCGs


Ceri Jacob Managing Director, BHR CCGs CJ

Sarah See Director of Primary Care Transformation, BHR CCGs SS

Jacqui Himbury Nurse Director, BHR CCGs JH

Barking & Dagenham

Name: Title: Initials:

Dr Adedayo Adedeji GP, B&D CCG AA

Matthew Cole Director of Public Health, London Borough of Barking & Dagenham

MC

Kash Pandya Lay member, B&D CCG KP

Havering


Dr David Derby GP, Havering CCG DD

Terilla Bernard Barking & Dagenham & Havering LMC TB

Redbridge


Khalil Ali Lay Member, Redbridge CCG KA

WEL CCGs

Name: Title: Initials

Jenny Mazarelo Interim Director of Primary Care, WEL CCGs JM

Chetan Vyas Director Of Quality CV

Newham


Zulfiqar Ali Councillor, London Borough of Newham ZA

Tower Hamlets


Julia Slay Lay Member (Patient & Public Involvement), THCCG JS

Mariette Davis Lay Member (Governance), THCCG MD

Maggie Buckell Lay Member (Nurse Member), THCCG MB

Steve Collins Financial Advisor, THCCG SC

Virginia Patania Lay Member (Primary & Urgent care), THCCG VP

Jenny Cooke Deputy Director of Primary Care, THCCG JC

Jo-Ann Sheldon Head of Primary Care, THCCG JS

Gareth Perry Project Support Officer GP

Waltham Forest


Caroline White Deputy Chair & Lay Member, WFCCG CW

Ian Clay Deputy Director of Finance, WFCCG IC

Aysha Patel Head of Primary Care, WGCCG AP

Sangeeta Kundra Executive Assistant SK

In attendance


Kate McFadden-Lewis Board Secretary, NELCA KML

Janaka Perera Strategy & Programme Lead – London Pharmaceutical Committee (LPC)

JP

MF Chowdhury NEL London Pharmaceutical Committee (LPC) MFC

Apologies:

Name: Title: Initials

Honor Rhodes Chair, CHCCG HR

Siobhan Clarke Governing Body, Nurse member, CHCCG SC

David Maher Managing Director, CHCCG DM

Mark Ricketts Primary Care Quality Clinical Lead, GP, CHCCG MR

Mike Fitchett Independent GP Advisor, CHCCG MF

Saleema Abdin Governance & Assurance Officer, CHCCG SA

Koray Ahmet Director of Finance, BHR CCGs KA

Dr Gurkirit Kalkat Clinical Director, B&D CCG GK

Dr Jagan John Chair, B&D CCG JJ

Elspeth Paisley Healthwatch Manager EP

Dr Atul Aggarwal Chair, Havering CCG AA

Sarita Symon Barking & Dagenham and Havering LMC SS

Anne-Marie Dean Barking & Dagenham and Havering LMC AMD

Dr Shabnam Ali GP, Redbridge CCG SA

Cathy Turland Chief Executive, Healthwatch, Redbridge CT

Gladys Xavier Director of Public Health, London Borough of Redbridge GX

Karen Bollan Healthwatch Representative, Tower Hamlets KB

Denise Radley Corporate Director, Health, Adults & Community, LBTH DR

Item

1 Introduction

Welcome and apologies

The Chair welcomed commissioning members of the public, and attendees to the first North East London Primary Care ‘Committees in Common’ meeting.

The apologies were noted as above.

The Chair informed members that the core terms of reference remained the same as their local Primary Care Commissioning Committees.

2 Declarations of Interest

The Chair informed members that the declaration of interests were circulated with the papers by email.

There were no further declarations of interest.

3 Background and Purpose of Primary Care Commissioning ‘Committees in Common’

Ceri Jacob (CJ) gave a verbal update on the purpose of the meeting, explaining it would be a forum where colleagues can learn from each other with regards to primary care, population needs and challenges. It would allow;

I. Decision making once on shared issues and concerns; II. Benefits of working and sharing with each other across North East London.

CJ explained to members that they could shape the meeting going forward in order to do things better.

There were no questions noted from the CCGs.

4 NHSE Primary Care Policy & Guidance Manual

Lorna Hutchinson (LH) presented this agenda item to the meeting. LH shared the background to NHSE Primary Medical Care Policy and Guidance Manual (PGM), which provides commissioners with the context, information and tools to safely commission and manage GP contracts.

LH informed members that the latest version of the PGM could be accessed online as the manual.

LH informed members that each CCG is required to complete a declaration that they are adhering to the PGM, as part of the annual Primary Care Activity Return submitted to NHS England.

Members were asked to note the changes to the PGM in the three key areas of:

Section 96 Discretionary Funding;

Support to GP Practices with premises running costs and service charges;

List Dispersal following practice closures

Members had a discussion on the changes on the key areas noted above which included the following;

- Value for money - Financial aspects - MOU (memorandum of understanding) for Section 96 payments - Section 96 and legal advice - Process for Section 96 payments over £200K

5 Development of Primary Care Networks in North East London

Alison Goodlad (AG) presented this agenda item to the meeting. AG informed members that 47 geographically aligned primary care networks (PCNs) were currently established, varying in size.

AG explained to members that there 19/20 was mostly a developmental and preparatory year but there were 2 key service requirements:

1. Extended Hours access and impact on half day closing 2. Additional roles of a clinical pharmacist and social prescriber

AG highlighted to members that north east London has been allocated indicative recurrent funding (2019/20 – 2023/24) of £1.5m per annum for PCN development. All PCNs were asked to complete and return a development plan template and maturity matrix evaluation sheet by 30 September 2019. The NEL Primary Care Team are collating and analysing them, identifying common themes.

Two PCN development support groups will review the summaries and plans and agree common areas of development that can be met once for the NEL though the pooled funding. One group will cover City and Hackney, Tower Hamlets, Newham and Waltham Forest and the other group will cover Barking and Dagenham, Havering and Redbridge. These groups will include representation from CCGs, NEL Primary Care Team and the LMC and will agree common areas of development that could be met once for NEL

through pooled funding, thus gaining economies of scale and facilitating peer to peer leadership development. The remainder of the funding allocation would be allocated on a capitation basis

AG informed members that a NEL-wide Clinical Directors Event is planned for November.

Members had a discussion on the following areas:

governance / holding contracts

future of PCN development funding

how employee pharmacists operate in their roles

how to address quality of care

accountability framework and relationships with the federations

The Chair emphasised the importance of data, in population and health management.

6 GP Patient Survey Performance across NEL

Alison Goodlad (AG) presented this agenda item to the meeting. AG highlighted some key points from the summary of outcomes from the GP patient experience survey by CCG across north east London and actions that CCGs are taking to improve patient experience. AG informed members that this was for further discussion at the individual CCG committees to consider further action to be taken at a CCG / Network level. Members highlighted that the sample sizes at practice level were small and queried whether there was data linked to patient ethnicity in order to highlight any health inequalities. AG agreed to check this.

7 Future Forward Planner PCCC Meetings

Alison Goodlad (AG) presented this agenda item to the meeting.

AG suggested some potential items of agenda for future meetings i.e.

Premises & Estates

Consolidated Risk Register

Overarching Finance Report

Local Incentive Schemes (LIS) across NEL

The frequency of the meetings are to be held quarterly with the next meetings in January 2020 and April 2020.

Feedback from members

Shared learning between the CCGs / Stakeholders Headlines and snap shots and less focus on the details Second part to be opened up to learning from best practice, performance data

etc. Incorporate a business part to the agenda / meeting for sign off of agenda items CCGs review their membership to ensure the right people are present to take

primary care forward

Consideration of patients’ holistic care.

8 Questions from the Public

There were no questions from the public.

9 Any Other Business

Alison Goodlad (AG) tabled the Digital First Consultation feedback paper to the meeting, which had been released by NHS England a few days before.

AG informed members that NHS England Board agreed the launch of a consultation on digital-first primary care at its meeting on 27 June. On 23 August the consultation closed. Analysis of responses, conclusions and next steps were set out in the response document.

AG informed members that further details were expected. Members had a brief discussion about the paper.

The Chair thanked everyone and closed Part 1 of the meeting.

North East London Primary Care Commissioning Committees in Common (NEL PCCC) – action tracker

Last updated: 7 January 2020

Send update to: Pri Vinayak ([email protected])

Last # used: 1

Closed actions:

# Meeting date

Item Lead Action Progress Due Status

1 01/10/2019 6 AG GP Patient Survey - 2019 It was queried whether there was data linked to patient ethnicity in order to highlight any health inequalities. AG agreed to check this.

Data on this has been Included with the agenda and papers for information at the January 2020 meeting.

13/01/2020 Closed

mailto:[email protected]

To: Meeting of the North East London Primary Care Commissioning Committees –

Committees in Common

From: Alison Goodlad, Deputy Director of Primary Care (NEL)

Date: 13 January 2020

Subject: North East London Local Incentive Schemes

Executive summary

A review has been undertaken of Local Incentive Schemes (LISs) in operation within

North East London with a view to common Local Incentive Schemes being across

implemented across North East London. It was agreed in the first instance to develop a

common LIS based on a Duty Doctor Scheme.

In line with the requirements of a letter sent by NHS England/Improvement in July 2019, it

was also agreed to work towards adopting a NEL-wide Local Incentive Scheme for GP

reports related to Safeguarding Children and Vulnerable Adults.

The aim is that these LIS will be operational from 1 April 2020 with the potential to pilot the

Duty Doctor Scheme before the end of 19/20.

Recommendation

The Committees are asked to:

Note the report

1.0 Background

1.1 A review has been undertaken of Local Incentive Schemes (LISs) in operation within

North East London with a view to common Local Incentive Schemes being

implemented across North East London. At the NEL Chairs’ meeting held on 6

November 2020 it was agreed in the first instance to develop a common LIS based

on a Duty Doctor Scheme. Such a scheme is already in place in City and Hackney.

The aims of the scheme are as follows: -

To improve communication between practices and other health and social care

providers

To provide a practice-based response to health and social care providers that

reduces A&E attendances and admissions

To provide a practice-based response to health and social care providers that

facilitates discharge from hospital

1.2 In line with the requirements of a letter sent by NHS England in July 2019, it was also

agreed to work towards adopting a NEL-wide Local Incentive Scheme for GP reports

related to Safeguarding Children and Vulnerable Adults. The aim is that these two

LISs will be operational by 1 April 2020.

2.0 Task and Finish Group

2.1 A NEL-wide Task and Finish Group has been established to oversee the adoption of

new LISs, based on the original NEL Finance Task and Finish Group. The

membership includes representatives from the NEL Primary Care Team, each NEL

system, NEL Urgent and Emergency Care Network and the LMC.

3.0 Development of the Duty Doctor LIS

3.1 Local system leads will develop specifications with clinicians from each system. It

will be important to define core deliverables across NEL and what can be flexed

locally so that the scheme works effectively within the context of each system. City

and Hackney will look to develop an enhancement to their existing duty doctor

scheme.

3.2 Work will be undertaken to define the cost of the service and the return on

investment, looking at the impact across the system and how this will be measured

and what the benefits will be for patients.

3.3 Workforce and skill-mix will be considered, exploring innovative models of service delivery. 3.4 Worked up proposals will be discussed with the relevant LMCs, Federations and GP

Networks in each system and plans will be presented to the NEL Emergency and

Urgent Care Board.

3.5 The potential for the Duty Doctor Scheme to be piloted in 19/20 as part of the

planned UEC Integration Programme will be explored. NHSE has allocated some

non-recurrent funding to the STP in December for the purpose of supporting winter

pressures in primary care as needed, with a focus on providing extra capacity and

communications and signposting. Some of this funding could be used to accelerate

the Duty Doctor scheme.

4.0 Development of the Safeguarding LIS

4.1 In July 2019, NHS England and Improvement wrote to local systems to raise the

issue that the sharing of information by general practice on request from local

authorities is not resourced under national NHS contracts. It was pointed out that

statutory and professional duties apply on individual GPs to share information in a

timely fashion, but GP practices are nevertheless entitled to seek payment for this

local authority requested work and it was requested that local systems undertook

reviews supporting (including resourcing) general practice in undertaking this work,

for example in the form of a Local Incentive Scheme.

4.2 Over the past year, Tower Hamlets CCG have been working on a LIS for payments

for local authority requested safeguarding reports/input into case conferences. This is

based on a model in Coventry led by NHS England’s Clinical Advisor on

Safeguarding. A draft specification will be available to share with NEL CCGs in early

January with a view to developing a standard core NEL LIS that CCGs can take

through their approval processes.

5.0 Resources/investment

To be determined.

6.0 Equalities

6.1 N/A

7.0 Risk

7.1 Risk that CCGs would not be compliant with requirement to support effective

safeguarding arrangements in general practice.

8.0 Managing conflicts of interest

8.1 Decisions on each LIS would need to go through the appropriate part of CCG’s

PCCCs.

Author: Alison Goodlad

Date: 30 December 2020



From: Alison Goodlad, Deputy Director of Primary Care, North East London Primary

Care Team


Subject: Network Contract DES – Draft Specifications

Executive summary

The GP contract framework sets out seven national service specifications that will be

added to the Network Contract DES. Outline draft specifications were released on 23

December 19.

These specifications are released for comment by 15 Jan and following review of

comments and GP contract negotiations will be released in full in early 2020,

Funding is not allocated directly for delivery of the specs, but through the other

funding available to PCNs especially workforce and in future through the

Investment and Impact Fund

Requirements will be phased in over the 4 years except for Medication review and

Enhanced Care in Care Homes which are to be implemented in full this year.

As these are draft, CCGs should not take final decisions about existing locally

commissioned services until the final version is published

CCGs may need to continue to make investments in existing locally commissioned

services and phase out over time as the new specs phase in

Where CCGs previously invested in local services provision, this should be

reinvested with primary and community services. This will be monitored.

Over the next few months, each network will need to identify clinical leads who will

be responsible for the delivery of the service requirements for each spec

Recommendations


Note the report

1.0 Purpose of the Report

1.1 The purpose of this report is to update the committee on the seven national service

specifications that will be added to the network contract DES from April 2020. These

were released in draft form on 23 December 2019.

2.0 Background

2.1 The GP contract framework sets out seven national services specifications that will

be added to the Network DES. Draft outline requirements, including proposed

network dashboard metrics, for the first five services have now been made available

in draft form to enable opportunities for stakeholders to review and comment,

together with an on-line survey to facilitate the provision of feedback1. The deadline

for comments is 15 January 2020. This feedback, together with GP contract

negotiations, will shape the final version of the service requirements for 2019/20.

2.2 Elements of the Anticipatory Care and Enhanced Health in Care Home specifications

will be delivered by providers of community services and it is planned to commission

these service requirements via the NHS Standard Contract. These requirements form

part of the consultation on the Standard Contract, which runs to 31 January 20202

2.3 The final version of the specifications will be published in early 2020 as part of the

wider GP contract package for 2020/21. The final versions will include further detail

for each requirement, followed by guidance for implementation.

3.0 Funding

3.1 Funding is not allocated directly for delivery of the service specifications. Rather the

largest portion of network funding provides reimbursement for additional workforce

roles that PCNS can engage to support the delivery of the specifications and alleviate

wider workforce pressures. CCGs and ICSs will be asked to support PCNs and their

community providers to institute shared workforce models to help maximise

collaboration.

3.2 Other funding is available to PCNs through the contract agreement, for example

through their share of the Investment and Impact Fund where they make strong

progress in delivering the service specifications. An average PCN could secure

funding of c.£60,000 in 2020/21, rising to an additional c.£240,000 by 2023/24.

1 https://www.engage.england.nhs.uk/survey/primary-care-networks-service-specifications/ 2 https://www.england.nhs.uk/nhs-standard-contract/20-21/

4.0 Phasing

4.1 In order not to overburden PCNs at an early stage, it is proposed to phase in service

requirements. This means implementing the requirements of two of the five

specifications in full from 20/21. These are:

Structured medication review and optimizations

Enhanced Care in Care Homes

For the remaining three specifications, the requirements will be phased in over the

period from 20/21 to 23/24. These are:

Anticipatory Care

Personalised Care

Early Cancer Diagnosis

5.0 Support from the wider system

5.1 The document sets out areas in which CCGs will be required to play a major role in

helping to co-ordinate and support delivery of the specifications:

CCGs should focus on those that involve close collaboration with other partners

such as the care homes specification.

CCGs should also support PCNs to develop standard operating processes for

their partnership arrangements.

ensure a clear and agreed contribution to service delivery is made by other

system partners within ICSs – documented in a local agreement. It is

recommended that the LMC should be involved in the development of the local

agreement.

where PCNs are struggling to recruit, CCGs and systems should take action to

support them i.e. through shared recruitment processes, brokering integrated

workforce arrangements with other providers i.e. through rotational posts and

working with local representative groups and other stakeholders to match

people to unfilled roles.

6.0 Relationship with existing locally commissioned services

6.1 It is recognised that, for some of the specifications, a locally commissioned service

may already exist which covers some or all of the proposed requirements set out in

the document. As these proposals are in draft, CCGs are advised that they should

not, therefore, take final decisions about existing locally commissioned services until

the final Network Contract DES for 2020/21 is published.

6.2 Once the specifications have been finalised, CCGs should work with PCNs,

community services providers, LMCs, and other stakeholders to support the transition

– and, where required, enhancement – of existing local service arrangements to meet

the new requirements whilst avoiding destabilisation of existing provision. CCGs are

expected to make an assessment of any investment that they continue to make in

these areas, recognising that particularly as the expectations of the specifications

incrementally rise to 2023/24, it may in the meantime be appropriate for them to

maintain delivery

6.3 Funding previously invested by CCGs in local service provision which is delivered

through national specifications in 2020/21 should be reinvested within primary

medical care and community services. NHSE/I will be collecting data on current

spend and further requirements in this respect will be set out at the conclusion of the

GP contract negotiations for 2020/21

6.4 A summary of proposed service models and service requirements is outlined below.

For each of the five specifications, PCN are required to identify a clinical lead who will

be responsible across the PCN for the delivery of the service requirements.

7.0 Structured Medication Review (SMR) and Medicines Optimisation

7.1 It is proposed that PCNs identify people who would benefit most from receiving an

SMR. The document outlines a range of cohorts including all patients in care homes,

patients with complex polypharmacy, patients with multiple long term conditions.

7.2 A variety of tools have been developed to help clinicians to identify patients with

complex polypharmacy with multi-morbidity. PCNs can select appropriate tools that

help them to proactively identify appropriate patients through audits of GP IT

systems. Guidance will be published to support PCNs in the identification of patients,

including a guide to the selection of these tools. It is proposed that PCNs also

develop processes for identifying patients who need to be referred for an SMR

reactively.

7.3 PCNs must ensure that only appropriately trained clinicians working within their

sphere of competence should undertake SMRs. These reviews would take

considerably longer than an average GP appointment and be conducted in line with

the principles of shared decision making, and consider the holistic needs of the

patient, providing advice, signposting and making onward referrals where relevant.

Regular review and management should be undertaken and SMRs should not be

treated as a one-off exercise.

7.4 Proposed Service requirements for 20/21

• Locally-defined processes should be put in place at least twice yearly, on a six-

monthly basis, to identify the patients within the practice-registered population that

require SMRs as well as local processes for reactive SMRs.

• 100 % of identified patients should be written to and invited for an SMR.

• undertake SMRs and follow-up consultations in line with detailed guidance using

appropriate clinical decision-making tools. CCGs will review variation in the

numbers of SMRs undertaken, which will inform the potential development of a

standardised requirement in future years;

• clearly record all SMRs within GPIT systems, as well as using appropriate clinical

codes to signify the reasons for an SMR;

• develop local PCN action plans to reduce inappropriate prescribing of (a)

antimicrobial medicines, (b) medicines which can cause dependency, and (c)

nationally identified medicines of low priority. This plan will react to guidance

specifying how the PCN will deliver against the guidance;

• work with community pharmacies locally to ensure alignment with delivery of both

the New Medicines Service (to support adherence to newly-prescribed medicines)

and developing medicines reconciliation services (to support effective transfers of

care between hospital and community);

8.0 Enhanced Health in Care Homes (EHCH)

8.1 Delivery of this specification must happen in partnership between general practice

and community services. The proposed Standard Contract requirements will ensure a

contractual basis for the requirements attributable to community service providers,

and CCGs will oversee local agreements between providers within a PCN to ensure

that primary and community care are supported in delivery by relevant partners being

held to account.

8.2 It is anticipated that CCGs will also support delivery of this service by holding a list of

care homes in the area and agreeing the responsibilities of PCNs in relation to each

home, including making sure that each care home is aligned to a single PCN. An

approach to the reinvestment in primary care of existing expenditure by CCGs in this

area of work and the potential for uneven distribution of care homes between PCNs

will be discussed as part of contract negotiations.

8.3 The EHCH service will focus on national roll out of the first four clinical elements of

the EHCH framework: enhanced primary care support; multidisciplinary team

support; reablement and rehabilitation; and high-quality end-of-life care and dementia

care. The service requirements are shared across both PCNs and other providers

(particularly community services) who will work together to deliver the model.

8.4 It is expected that this service would be delivered, in full, during 2020/21. In future

years, consideration will be given as to whether and how to bring out of hours’

provision under the authority of PCNs, to ensure more effective and coordinated out

of hours support for care homes.

8.5 All people who live permanently in care homes (both residential and nursing) would

be eligible for the service. This includes people living in residential and nursing

homes that deliver specialist support.

8.6 Proposed service requirements for 20/21

• By 30 June 20, ensure each care home should be aligned to a single PCN and its

MDT. Everyone living in a care home must have a named clinical team, including

staff from the PCN and relevant community service providers.

• By 30 June 20, the MDT should be established, working across organisational

boundaries to develop and monitor personalised care and support plans.

Protocols should be established between the care home and wider system

partners for information sharing and shared care planning.

• By 30 September 20, a weekly ‘home round’ should be delivered, led by a suitable

clinician and involving staff from the MDT.

• By 30 September 20, personalised care and support plans should be in place and

delivered for all people living in care homes.

• By 30 Sept 20, provide, through the MDT, identification and assessment of

eligibility for urgent community response services.

• By 30 September 20, work with the CCG to establish processes that improve

efficient transfer for clinical care between care homes and hospices and hospitals

and clear referral routes and information sharing arrangements between care

homes, PCNs, out of hours’ providers and providers of a full range of community

based services.

9.0 Anticipatory Care

9.1 The service aims to benefit patients with complex needs, and their carers, enabling

them to stay healthier for longer, reducing the need for reactive health care and

delivering better interconnectedness between all parts of the health system and

voluntary and social care sectors. These aims would be achieved through a

combination of population segmentation, followed by risk stratification to identify

those who would benefit most and multi-disciplinary primary care community teams,

including social care and the voluntary sector working together. As there are a range

of different approaches and the evidence base is still developing, the aim is to

monitor these and establish a standardised approach to the identification of

individuals to receive the service in future years.

9.2 The first year of the service is described as predominately a preparatory year, with

target populations to be agreed by the PCN through discussion with their CCG and

ICS. CCGs and ICSs will support PCNs by sharing information and access to risk

stratification tools successfully in use that could be used by PCNs.


• By 30 June 20, present a coherent local Anticipatory Care Model by assisting with

the development of system-level population health management approaches to

identify appropriate patients, developing accountability and governance

arrangements and taking a leading role in coordinating the care and support of

people as patients begin to be treated by Anticipatory Care.

• By 30 June 20, with CCG support, develop and sign data sharing agreements

between practices and other providers to support the operation of MDTs and

support the development of system-level linked data sets to build population

health analytics.

• By 30 June 20, identify a priority list of patients who are at rising risk of

unwarranted health outcomes.

• By 30 June 20, establish and manage an MDT to meet regularly to coordinate and

manage the care of the cohort of people on the Anticipatory Care list. Needs

assessments or care coordination reviews should be undertaken and the delivery

of support offers should be coordinated.

10.0 Personalised Care

10.1 The six key components of personalised care are:

1. Shared decision making

2. Personalised care and support planning

3. Enabling choice, including legal rights to choose

4. Social prescribing and community-based support

5. Supported self-management

6. Personal health budgets (PHBs) and integrated personal budgets.

Over each of the four years of the Network Contract DES, increasing levels of

activity across the six component areas will be phased in.


From April 20, practices working as part of PCNs will:

• increase the number of personalised care and support conversations

and plans for identified cohorts across a PCN, in line with the standard

replicable model, so that at least 5:1000 weighted population receive a

Personalised Care and Support Plan. In 2020/21 the required cohorts

are:

• People in last 12 months of life

• Individuals eligible in the Anticipatory Care and Enhanced Health in

Care Homes cohorts

• promote personal health budgets across a PCN to enable delivery of

legal rights to a Personal Health Budget.

• deliver shared decision making for different clinical situations using

available decision support tools. The priority cohorts for 2020/21 are

patients with musculoskeletal conditions. These conversations will be

led by trained physiotherapists.

• facilitate relevant training, shared learning and quality improvement for

staff in PCNs.

• support the delivery of effective social prescribing so that at least

4:1000 weighted population receive a referral.

• use Patient Activation Measures to enable more personalised support

for people with different levels of knowledge, skills and confidence. For

2020/21 the required cohorts are:

• People living with newly diagnosed Type 2 diabetes

• People referred to social prescribing link workers

11.0 Supporting Early Cancer Diagnosis

11.1 By 23/24, all PCNs will be expected to be undertaking a range of activity to contribute

to realisation of their local Cancer Alliance target for number of people diagnosed at

stages 1 and 2, set through their LTP planning process. National and local datasets

will enable PCNs to understand and explore trends in cancer presentation and

diagnosis. It is anticipated that the scope of activity undertaken by PCNs will

increase year on year. The requirements of the specification will be phased over the

four years from 20/21 to 23/24.


Improving referral practice

• Enable and support practices to improve the quality of their referrals for suspected

cancer (including recurrent cancers), in line with NICE guidance and making use

of new RDC pathway for people with serious but non-specific symptoms where

available.

• Introduce safety netting approach for monitoring patients referred for suspected

cancer and those who have been referred for investigations to inform decision to

refer.

• Ensure patients receive high-quality information on their referral.

Increasing uptake of National Cancer Screening Programmes

• Building on existing practice-level actions, lead and coordinate practices’

contribution to improving screening uptake.

• Develop a PCN screening improvement action plan for 2021/22 that contributes to

delivery of the local system plan (shared with Public Health Commissioning team

and Cancer Alliance)

Improving outcomes through reflective learning and local system partnerships

• Develop a community of practice across the PCN and encourage practices’

engagement with local system partners, in particular the Cancer Alliance, to

enable delivery of the service requirements.

12.0 Resources/investment

12.1 Nationally, the Network Contract DES provides funding entitlements worth

£552m in 2020/21, rising to £1.799bn by 2023/24. This comes on top of

increases to the core practice contract worth £296m in 2020/21, rising to £978m

in 2023/24. Funding is not allocated directly for delivery of the service

specifications. Rather the largest portion of network funding provides

reimbursement for additional workforce roles that PCNS can engage to support

the delivery of the specifications and alleviate wider workforce pressures. Other

funding is available to PCNs through the contract agreement, for example

through their share of the Investment and Impact Fund where they make strong

progress in delivering the service specifications. An average PCN could secure

funding of c.£60,000 in 2020/21, rising to an additional c.£240,000 by 2023/24.

13.0 Equalities

There are no equalities implications arising from this report.

14.0 Risk

14.1 Failure to deliver the North East London Primary Care Strategy and NHS Long Term

Plan


15.1 N/A.

Author: Alison Goodlad, Deputy Director of Primary Care (NEL)

Date: 30 December 2019



From: Alison Goodlad, Deputy Director of Primary Care, North East London Primary

Care Team


Subject: APMS Contracts Update and Future Developments

Executive summary

There will be 25 APMS contracts in North East London on 1 April 2020 (around 9% of the

total number of contracts in NEL).

This report provides an update on:

Recent tranche 7 APMS Procurement overview outcome/issues. This involved

5 contracts being procured across NEL

APMS equalisation – Progress on bringing APMS contracts in line with GMS

and PMS

Special Allocation service procurement outcome/next steps/risks – Following

agreement of preferred bidder at the last meeting, the contract was awarded to

One Lewisham. This paper outlines the mobilisation process with a planned 3

sites across NEL and highlights risks and mitigations

Future process for procurements – This provides an update on the new

pseudo-dynamic purchasing system which is due to become operational

nationally next year

Digital First Providers – This summarises the national consultation outcome

and considers potential implications for NEL

Recommendations


Note the report

1.0 Purpose of the Report

The purpose of this report is to update the committee on the following:

Recent tranche 7 APMS Procurement overview outcome/issues

SAS procurement outcome/next steps/risks

APMS equalisation

Future process for procurements (including the new pseudo-dynamic purchasing

system)

Digital First Providers – consultation outcome and potential implications for NEL

2.0 Background

APMS contracts are time-limited contracts underpinned by the APMS Directions.

They are the contract form with the greatest flexibility as to the types of organisations

that can enter into APMS contracts, the types of services and payment mechanism

that can be agreed and the greatest flexibility around duration and termination

provisions. There are around 100 APMS contracts in London and as at April 2020

there will be 25 APMS contracts in North East London (around 9% of the total

number of contracts in NEL).

3.0 Tranche 7 (T7) APMS Procurement

3.1 In September 2017 the 5 London STPs agreed that delegation of responsibilities from

NHS England to Clinical Commissioning Groups (CCGs) meant that London’s APMS

Programme should no longer be managed at a London level, since CCGs now

retained responsibility for their local commissioning arrangements. However, it was

decided that in order to build upon the previous work from preceding tranches, NEL

CSU Procurement Team (funded by NHSE/I) would work with the 5 STPs through 5

identified STP Procurement Leads, using a standard model, ensuring that the “Once

for London” approach to APMS procurement continued. As with previous tranches,

there was agreement from all participating CCGs for the procurement team to

commission subject matter experts (SMEs) and additional procurement support to

help deliver the T7 procurement programme.

3.2 Following commissioner and market engagement, and approval from the national

Commissioning Executive Group (CEG), the standard London APMS contract term

was amended in order to align to national and local strategic priorities regarding

Primary Care Networks and the development of longer term provider relationships.

The APMS contracts procured in London are therefore being offered for a period of

five years with the option to extend for a further five years twice at the discretion of

commissioners (5+5+5). This still enables commissioners to remain flexible by not

committing to anything beyond 5 years, yet allows for a contract of up to 15 years

should performance and strategic alignment allow.

3.3 Overview

3.3.1 A total of 15 contracts were included in London’s APMS T7 Programme, of which 5

were in NEL.

3.3.2 All 5 of the procurements were for practices with existing APMS GP Contracts that

were due to expire between 31 March 2020 and early August 2020. Between them,

these 5 practices serve the primary medical care needs of approximately 48,000

patients and have a combined contractual value of approximately £62.1 m over a 15-

year contract term.

Table 1 Summary of NEL contracts in T7

CCG Contract List Size1 No. Bidders

Contract Awarded

City & Hackney Allerton Road 5,491

2 Yes

Newham

Carpenters Road 15,369 3 Yes

Newham

Newham Transition 4,932 4 Yes

Tower Hamlets Goodman’s Field

11,209 5 Yes

Waltham Forest

SMA 11,026 5 Yes

3.4 Outcome

3.4.1 A total of 19 bids were received, with each contract attracting between 2 and 5 bids

each. All 5 contracts were successfully awarded. Of the 5 successful bidders, 4 were

the incumbent contract holders. No challenges to the award decisions were

received.

3.5 Procurement related Issues

3.5.1 There were a number of issues that arose during the procurement process which are

being reviewed by NEL CSU procurement team.

3.5.2 Moderation

Moderation spreadsheets received late truncated the time available for

moderation to take place.

Additional moderation was requested by the central procurement team after the

evaluation process (ITT questions and interview) had closed, which should have

been carried out during the timetabled moderation period.

3.5.3 Reports and Letters

The additional ITT question moderation that was required impacted the central

procurement team’s ability to notify bidders of the outcome in line with the published

timeline.

1 Raw list size as of 1 April 2019.

Consequently, Award Reports, debriefing and award letters were delayed. It was

often not entirely clear what feedback bidders received about these delays and

whether they were kept regularly updated.

3.5.4 Invoices

Bexley CCG was the host CCG for making payments to the SMEs, sundry items and

the additional project support that was commissioned. The agreement was for STP

Leads to be responsible for due diligence, however invoices were sent straight to

Bexley CCG, leading to STP leads not being able give assurance to CCGs about

whether invoices should be paid. The STP leads are in discussion with NEL CSU

procurement team at how to resolve this issue.

3.6 Issues regarding local bidders competing in the APMS marketplace

3.6.1 The one incumbent bidder that was unsuccessful in being re-appointed in Tranche 7

was a well-regarded local Community Interest Company. This has raised questions

as to how local bidders can compete in the APMS marketplace against very

experienced providers of APMS services with multiple contracts. It is important that

before the procurement process commences, bidders ensure that they are well

placed to submit a strong bid, if necessary bringing in appropriate expertise to

support this.

4.0 Contract Equalisation and Documentation

4.1 In 2017, London CCGs undertook reviews of their GP contracts with a view to

equalising their primary care offer at a CCG level across all contract forms - PMS,

GMS and APMS, creating equity of opportunity for providers and consistent service

provision for all patients within the same CCG area. Each NEL CCG participating in

T7 is offering a CCG equalised APMS contract which aligns its service specification,

contract management arrangements and price with those for its GMS and PMS

contracts, (with an additional £5 per weighted patient to reflect the time limited nature

of the contract) moving away from the old London KPIs to offering the same Local

Incentive Schemes funded from the PMS premium as those being offered to PMS

and GMS practices.

4.2 As of 1 April 2020, there will be 25 APMS contracts commissioned across the STP.

Of these, 6 will be equalised contracts. This figure will increase to 11 in April 2021 –

44% of all APMS contracts. See Appendix 1 for details. With the exception of the

block contracts for specialist services, the remaining contracts will be transferred onto

equalised contracts through a process of renegotiation or by issuing an equalised

contract when it is re-procured.

4.3 An equalised contract document will consist of the standard national APMS

agreement plus locally agreed schedules which reflect the CCG’s PMS premium

funded services. The schedules will need to contractualise areas such as the pricing

mechanism, service specification and management regime.

4.4 NEL CCGs Commissioners with contracts being re-procured in T7 have agreed in

principal to engage external support to develop an equalised APMS template which

would provide the necessary framework ready for local detail to be populated.

5.0 Special Allocation Service Procurement

5.1 The North Central London (NCL), North East London (NEL) and South East London

(SEL) Area Teams undertook a procurement process for the Special Allocation

Scheme (SAS) in line with the new national guidance.

5.2 The NEL Primary Care Commissioning Committees in Common at the last meeting

on 1 October 2019 approved the Award Recommendation Report to award the SAS

APMS contract to Bidder 2, One Health Lewisham. This provider was also

successful in being awarded the SAS contract for SEL; services in SEL started in

November 2019. The start date for the new NEL contract will be 1 February 2020.

5.3 The NEL Primary Care Team has been in detailed discussion with One Health

Lewisham (OHL), taking learning from the SEL mobilisation and progress has been

made as follows:

Existing SAS providers have confirmed their termination notices

OHL has met up with existing providers to agree handover.

Two sites in NEL have been confirmed – Loxford Primary Care Centre

(Redbridge) and Forest Road Medical Centre (Waltham Forest). Negotiations

are still ongoing for the third site, identified at Kenworthy Road Health Centre

(City and Hackney).

IT and clinical systems are in the process of being ordered. OHL will use their

site at Rushey Green, The Primary Care Centre, Hawstead Road, Catford, SE6

4JH for telephone and back office functions.

New practice and prescribing codes have been requested.

OHL already have identified administration and clinical staff in place for the

NEL SAS.

The contract will be held by Tower Hamlets CCG as an APMS practice.

5.4 The risks identified are –

The third site will not be agreed and operational in time for 1 February 2020.

This will only affect face to face consultations. Discussions with OHL and the

availability of the two identified sites in Redbridge and Waltham Forest means

that additional sessions can be provided at these two sites. It is expected that

the service will be operational by 1 March 2020.

In the event that IT, telephones and clinical systems should not delivered and

ready. Business continuity plans are being discussed with OHL.

There is a risk that practice and prescribing codes not issued by PCSE and

BSA in time for contract start. This has been an issue with the SEL contract.

OHL have already taken lessons learned from this and have contingency plans

in place.

5.5 Weekly updates are being provided by OHL, estates and other partners. Plans are

on track for service provision to commence from 1 February 2020.

6.0 Future Processes for APMS Procurement – New National Pseudo Dynamic

Purchasing System

6.1 A new online procurement tool called a ‘Pseudo’ Dynamic Purchasing System’

(PDPS) will be introduced in 2020 for securing GP services, including caretaker

services. This is a national NHS England and NHS Improvement collaboration with

Commissioning Support Units.

6.2 The key objectives are to establish a procurement portal/platform, available to local

commissioners where APMS services can be procured, achieving cost and non-cost

benefits for both commissioners and providers by creating a quicker and easier and

leaner process that saves time.

6.3 Nationally, over a hundred standalone APMS procurement projects are conducted

each year for GP services with 69 contracts procured in London since 2003. The

typical procurement timescale is around 6-9 months. Use of the PDPS is not

compulsory but would provide commissioners with access to a dynamic (growing) list

of pre-approved GP providers to make is easier for future Call-Offs (Call for

Competitions) when needed.

6.4 The process involves GP providers applying to get onto the PDPS by undertaking an

eligibility and evaluation process. Providers can be added at any time but being on

the list is no guarantee they would be successful in winning APMS contracts. Once a

provider is on the list, they can tender without the time-consuming process of

completing qualification forms. Tenders are then undertaken through a call-off/mini

competition process. Local commissioners will develop specific requirements and

use the PDPS to shortlist and seek suitable GP providers to deliver services under an

APMS contract.

6.5 A series of 6 rounds for GP providers to apply to get onto the national PDPS will take

place throughout 2020. Providers will specify which geographical areas they are

interested in.

6.6 As outlined in 3.1, the approach in London has been to undertake APMS

procurements on a ‘Once for London’ approach, batching contracts due for

procurement together in tranches and running one market engagement process and

ITT process for the whole of London using a pool of trained subject matter experts.

Consideration will need to be given as to how future procurements will be undertaken

and it is looking likely that these will be undertaken on an STP-wide rather than

London-wide basis in future, but continuing to batch contracts for procurement

together.

7.0 Digital First Primary Care Providers

7.1 Following the emergence of new models of digital-first delivery, such as that provided

by Babylon GP@Hand, a public consultation on Digital First Primary Care Provision

took place between June and August 2019. This included proposals to change

patient registration, payment and contracting rules. An outline response to the

consultation on Digital First providers was published in September 2019.

7.2 The response reiterates that the main route to delivery of digital first primary care will

be through supporting existing GP practices expand their digital offer through core

digital-first capabilities such as online and video consultation systems and triage

mechanisms but recognises that some GP practices may choose to support their own

services by buying/sub-contracting additional clinical capacity from digital suppliers

directly.

7.3 A proposal was put forward in the consultation to disaggregate contracts from the

new digital first providers registering patients across a large geographical area due to

challenges in delivering integrated services, screening services and local planning

and budgeting. Following support demonstrated through the consultation, it was

agreed to take forward the proposal to disaggregate a patient list and create a new

APMS contract, when a provider registers 1,000 out-of-area patients in another CCG.

This will ensure that digital-first services are connected back wherever possible to

local service delivery via a new APMS contract in that CCG. In order to enact list

disaggregation, changes will be required to GMS, PMS and APMS Directions.

Guidance will be issued to commissioners and providers setting out how the process

will work and this will be agreed with the BMA GPC prior to the regulations coming

into force. Nationally, it is expected that around 10-20 contracts will be triggered, but

with CCG mergers, this number is expected to reduce.

7.4 To reflect the automatic migration from GMS or PMS contract terms, the APMS

contract would be offered on a rolling basis without a fixed length subject to

acceptance that the provider would deliver against prevailing national APMS terms

which could be amended by commissioners. Where CCGs merge, the contracts

would transfer to the new CCG. Following a merger, there may be an opportunity for

a provider to merge disaggregated lists, with agreement of the CCG. It would

normally be expected that premises would be established under each new APMS

contract, unless the local commissioner (who holds the new contract) agrees

otherwise, based on guidance likely to be based on reasonable travel times. This

may lead to agreement that no premises are required, for example in particularly

urban areas where premises are easily accessible in a neighbouring CCG. Where

premises are to be set up, this would need to take place within 12 months of the

threshold being reached. There would be no default entitlement to rent and rates

reimbursement under the APMS contract.

7.5 There was broad agreement that NHS E/I only create new opportunities for providers

to set up new digital-first services in areas of greatest need e.g. under-doctored

areas or areas with poorest access and long waits for a GP appointment and that

these providers should set up physical premises in deprived areas. These practices

will be expected to registered patients from a defined catchment area only. During

2020/21 NHSE/I will aim to create a list of approved providers who could set up new

digital-first practices in under-doctored areas only. The impact of this this will be

subject to evaluation. Over the next few months, NHSE/I will develop a methodology

to identify which CCGs are under-doctored and/or have access challenges, develop

the standard APMS contract terms and design the assessment process and

associated criteria to assess providers for the list.

7.6 Following consultation on payment aspects, out-of-area registration rules will not be

abolished nor out-of-area payment levels payment levels reduced and no change will

be made to the new patient registration premium. There will however be an

adjustment to CCG budgets based on the age and gender of the patients registering

with digital-first practices, plus the practice they were previously registered with.

Further details are expected to be published by end March 2020. These proposals

will be rolled out from April 2020.

7.7 Potential Implications for North East London

7.7.1 The most recent available data indicates that there are four CCGs in NEL with over

1,000 patients registered with GP@Hand. These are Tower Hamlets, City and

Hackney, Newham and Waltham Forest. Babylon GP@Hand has one site in NEL

within Tower Hamlets CCG situated in Canary Wharf, a short walk from Canary

Wharf tube and DLR. As the requirements to disaggregate are likely to take place in

20/21, this would mean that there would be at least four disaggregated contracts in

NEL. However, there is likely to be flexibility to merge contracts post planned CCG

merger in April 21, particularly if there are contracts in CCGs with no premises, due

to proximity of existing GP@Hand premises. It is not yet known what the guidance

will state around reasonable travel times. Public transport travel times to the

premises in Canary Wharf from the central hub of each borough are as follows:

35 minutes from City and Hackney (Hackney Central)

18 minutes from Newham (Stratford Station)

44 minutes from Waltham Forest (Walthamstow Central)

7.7.2 There is also the possibility that parts of the STP area will fall into the category of

areas of greatest need e.g. under-doctored areas or areas with poorest access and

long waits. The outer parts of the STP i.e. BHR with high ratios of GPs and nurses to

patients and low numbers registered at GP@Hand may potentially fall into this

category. This would mean that an approved provider could set up a new digital-first

practice in these areas. It is unlikely that the necessary arrangements would be in

place for this until late 20/21 and the full details would not will be available until early

2020.

7.0 Finance

The contractual value of the 5 practices in Tranche 7 is approximately £62.1 m over a

15-year contract term.

8.0 Equalities

N/A

9.0 Risk

9.1 Risk and mitigations in relation to the SAS contract mobilisation process are outlined in

4.4


10.1 N/A.

Authors: Alison Goodlad, Deputy Director of Primary Care (NEL)

Gohar Choudhury, Assistant Head of Primary Care (NEL)

Angela Ezimora-West, Assistant Head of Primary Care (NEL)


Appendix 1 – Details of APMS Contracts in NEL and Equalisation Status

CCG Practice Name Contract End Date

Equalised Contract by 01.04.20

Comments

Barking and Dagenham

Porters Avenue Surgery

31/03/2024 No

Barking and Dagenham

Broad Street Medical Practice

31/03/2025 No

City & Hackney

Sandringham Practice 30/09/2022 No

City & Hackney

Allerton Road Surgery 31/03/2025 Yes

City & Hackney

Greenhouse Surgery 31/03/2024 No Homeless service. Block contract. 5+5 term

City & Hackney

Spring Hill 30/09/2022 No

City & Hackney

Trowbridge Surgery 31/03/2021 No Contract will be equalised by 21/22.

Havering Kings Park Surgery 31/12/2022 No

NEL NEL Special Allocation Scheme (SAS)

31/01/2025 No The contract is due to go live on 1 Feb 2020 and will be hosted by THs CCG on behalf of all NEL CCGs. The contract is a 5+5 block contract.

Newham Newham Transitional Practice

31/03/2025 No Homeless service. Block contract. 5+5 term

Newham Lantern Health 30/06/2025 Yes

Newham Albert Road & Britannia Village Surgeries

30/06/2020 Yes

Newham Lucas Avenue Surgery 31/07/2021 Yes

Newham Liberty Bridge Road Practice

01/02/2024 Yes

Redbridge Aldersbrook Medical Practice

31/03/2024 No Standard 5+5 London contract

Redbridge Loxford Surgery 31/07/2021 No Standard 5+5 London contract

Tower Hamlets

Health E1 31/03/2024 No Homeless service. Block contract. NHS Standard Contract with an APMS bolt on. 5+5 term

Tower Hamlets

Island Medical GP Practice

31/03/2023 No

Tower Hamlets

St Paul's Way Medical Practice

31/03/2021 No Forming part of APMS re-procurement process currently in progress. Will move to equalised contract payment terms April 2021.

Tower Hamlets

Whitechapel Health GP Practice

30/09/2024 (planned merger date 01/09/2024)

No Practice to merge with Goodman's Field at the end of contract and as part of that process will move to equalised contract payment terms April 2024.

Tower Hamlets

St Andrews Health Centre

31/03/2021 No APMS re-procurement process currently in progress. Will move to equalised contract payment terms from April 2021.

Tower Hamlets

East One Health (Goodman’s Field)

08/08/2020 No Equalised contract and payment terms in from August 2020.

Tower Hamlets

The Barkantine Practice

31/03/2021 No APMS re-procurement process currently in progress. Will move to equalised contract payment terms from April 2021.

Tower Hamlets

Pollard Row Practice 31/03/2021 No Capsticks APMS contract.

Waltham Forest

Orient Practice 31/01/2020 No List being dispersed at the end of January 2020

Waltham Forest

SMA Medical Practice 31/03/2025 Yes Equalised contract commences on 01.04.20

An alliance of North East London Clinical Commissioning Groups

City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

Chair: Dr Anwar Khan I Accountable officer: Jane Milligan



From: Alison Goodlad, Deputy Director of Primary Care, North East London Primary Care

Team


Subject: GP Patients Survey – Overall Experience by BME Group

Executive summary Further to a discussion on the GP Patient Survey 2019 at the last Committee in Common on 1 October 2019, further information was requested on experience by BME groups, to assess if there are any potential health inequalities issues. A table is attached giving information on overall positive experience of general practice by ‘Any White Background’ and ‘All Other Backgrounds’ from the GP Patient Survey 2019 for all CCGS in London. The only CCG with higher than the London average percentage score for groups from both backgrounds is City and Hackney. There is little difference in scores from respondents from white and non-white backgrounds’ in City and Hackney and Waltham Forest. Barking and Dagenham and Newham report better experience for respondents from non-white backgrounds compared to white backgrounds’. Havering, Redbridge and Tower Hamlets report better experience for respondents from white backgrounds compared to non-white Backgrounds’. The largest gap is in Redbridge.

Recommendations

This is a follow up action provided for information.

NHS England and NHS Improvement

General Practice Patient Survey 2019: Summary of London resultsAugust 2019

2 |2 |

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

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

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

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

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

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

About the survey

GPPS 2019: London summary

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

3 |3 |

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

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

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

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

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

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

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

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

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

National headlines 1


4 |4 |

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

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

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

National headlines 2


5 |5 |

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

• Key areas of variation are:

• London has lower overall satisfaction levels than the England average: 80.4% described their overall experience as good or very good, compared to 82.9% nationally

• London respondents are more likely to have booked an appointment online, and to be offered a choice of appointment. However they are less satisfied with available choices, mainly because the next appointment was not soon enough.

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

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

• This is a similar pattern to the 2018 results.

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

London findings


6 |6 |

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


7 |7 |

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

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

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

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

Changes in London results since 2018


8 |8 |

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


9 |9 |

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

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

• Chart 3 shows the other areas of high variation between London CCGs:

• When practice closed, received care / treatment in about the right time (highest: Wandsworth

61.5%; lowest: Kingston 26.0%)

• Reason for not taking appointment – offered one wasn’t soon enough (Central London

50.8%; Waltham Forest 19.2%)

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

Lambeth)

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

82.9%; Newham and Enfield both 57.9%)

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

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

•

Variation within London


10 |10 |

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


11 |11 |

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


12 |12 |

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


13 |13 |

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

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

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

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

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

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

Summary

Presentation title

14 |14 |

• In London findings have been shared with STPs:

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

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

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

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

• South West: STP is sighted on findings

• Analysis is being prepared offindings at Primary Care Network level to include in data pack for Clinical Directors.

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

Responding to the findings

Presentation title

15 |15 |

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


Percentages in green are significantly higher than London average, percentages in red are significantly lower

(based on 1 standard deviation above / below mean)

Overall

experience

Response

rate Genera

lly e

asy t

o g

et

thro

ugh t

o

som

eone a

t your

GP

pra

ctice o

n

the p

hone

Receptionis

ts a

t your

GP

pra

ctice

are

help

ful

Aw

are

ness o

f bookin

g a

ppoin

tments

onlin

e

Aw

are

ness o

f ord

eri

ng r

epre

at

pre

scri

ptions o

nlin

e

Booked a

ppoin

tment

onlin

e in p

ast

12 m

onth

s

Ord

ere

d r

epeat

pre

scri

ption o

nlin

e

in p

ast

12 m

onth

s

Satisfied w

ith a

vaila

ble

appoin

tment

tim

es

Alw

ays /

a lot

get

to s

peak t

o

pre

ferr

ed G

P

Off

ere

d a

choic

e o

f appoin

tment

Satisifed w

ith t

ype o

f appoin

tment

off

ere

d

Reason f

or

not

takin

g a

ppoin

tment:

off

ere

d o

ne w

asn’t s

oon e

nough

Inste

ad o

f ta

kin

g o

ffere

d

appoin

tment,

went

to A

&E

Good o

vera

ll experi

ence o

f m

akin

g

appoin

tment

Healthcare

pro

fessio

nal w

as g

ood a

t

giv

ing e

nough y

ou t

ime

Healthcare

pro

fessio

nal w

as g

ood a

t

liste

nin

g

Healthcare

pro

fessio

nal w

as g

ood a

t

treating y

ou w

ith c

are

and c

oncern

Healthcare

pro

fessio

nal re

cognis

ed

and/o

r unders

tood a

ny m

enta

l

health n

eeds t

hat

you m

ight

have

had

Involv

ed a

s m

uch a

s w

ante

d t

o in

decis

ion a

bout

your

care

You h

ad c

onfidence a

nd t

rust

in

pro

fessio

nal w

ho s

aw

you

Thin

kin

g a

bout

the r

eason f

or

your

appoin

tment,

your

needs w

ere

met

When w

ante

d t

o s

ee a

GP

but

pra

ctice c

losed,

went

to A

&E

inste

ad

Receiv

ed c

are

or

advic

e in a

bout

the r

ight

tim

e

Overa

ll experi

ence w

as g

ood

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

London average 25.8% 68.8% 86.0% 48.4% 36.9% 20.1% 13.2% 63.9% 46.1% 65.2% 69.9% 32.7% 17.1% 66.1% 83.3% 86.6% 84.1% 82.4% 91.4% 94.0% 92.9% 42.6% 42.4% 80.4%

Barking & Dagenham 23.6% 61.2% 83.7% 37.6% 26.4% 17.5% 10.4% 58.4% 41.4% 59.0% 61.8% 28.7% 16.9% 57.5% 78.1% 81.7% 78.3% 78.1% 88.0% 91.9% 91.5% 41.5% 47.3% 73.6%

City & Hackey 27.4% 73.7% 89.0% 38.2% 31.3% 15.3% 10.4% 68.9% 44.7% 68.5% 74.9% 21.4% 13.7% 70.3% 84.8% 88.1% 86.5% 84.2% 93.1% 95.0% 93.2% 41.1% 39.0% 83.0%

Havering 33.3% 63.5% 86.1% 39.8% 32.4% 12.8% 10.5% 60.3% 54.1% 58.8% 67.7% 37.3% 18.5% 62.6% 82.8% 84.1% 81.6% 82.5% 91.4% 92.6% 92.0% 36.4% 40.7% 78.3%

Newham 35.1% 57.9% 80.8% 51.5% 30.8% 25.0% 10.1% 63.1% 40.2% 63.8% 66.9% 28.6% 22.4% 62.3% 79.5% 83.7% 81.0% 75.9% 87.9% 91.3% 90.6% 46.4% 47.9% 75.6%

Redbridge 20.4% 51.9% 79.1% 49.8% 32.5% 21.4% 11.0% 58.2% 41.7% 56.6% 65.0% 30.4% 19.3% 57.3% 80.5% 85.0% 82.6% 80.7% 91.1% 94.4% 92.7% 40.6% 48.5% 74.0%

Tower Hamlets 25.4% 67.2% 83.5% 52.9% 36.5% 24.9% 11.5% 60.3% 44.1% 65.5% 63.9% 31.6% 15.7% 61.0% 79.6% 83.7% 79.7% 82.0% 90.1% 93.0% 91.3% 40.8% 42.2% 74.7%

Waltham Forest 24.0% 60.7% 83.3% 47.6% 29.5% 20.7% 9.5% 63.4% 43.7% 61.4% 68.7% 19.2% 16.4% 63.4% 80.7% 84.4% 81.9% 80.7% 90.1% 92.7% 91.7% 42.6% 59.6% 77.3%

East London STP 27.0% 62.3% 83.6% 45.4% 31.3% 19.7% 10.5% 61.8% 44.3% 61.9% 67.0% 28.2% 17.6% 62.1% 80.8% 84.4% 81.7% 80.6% 90.2% 93.0% 91.9% 41.4% 46.5% 76.6%

Barnet 29.0% 60.4% 82.6% 45.5% 35.3% 18.7% 13.8% 58.1% 42.1% 59.7% 66.4% 35.0% 17.1% 59.8% 83.1% 87.0% 84.5% 83.0% 91.8% 94.1% 93.2% 41.4% 44.7% 78.2%

Camden 20.2% 77.3% 88.2% 48.0% 35.1% 20.6% 11.6% 64.4% 45.0% 69.6% 72.0% 50.0% 22.2% 69.6% 85.6% 90.3% 85.6% 88.7% 94.7% 95.5% 94.7% 47.2% 42.6% 83.2%

Enfield 26.7% 57.9% 84.8% 47.6% 32.9% 18.4% 11.1% 59.9% 42.5% 60.4% 66.3% 28.1% 18.0% 58.9% 80.9% 84.5% 82.0% 78.9% 89.9% 92.7% 91.2% 44.2% 43.5% 77.0%

Haringey 23.9% 67.8% 84.0% 41.1% 31.3% 17.2% 10.9% 62.5% 41.7% 64.9% 69.0% 24.1% 12.0% 64.1% 81.3% 85.1% 81.6% 80.1% 89.5% 92.8% 92.5% 45.8% 44.0% 78.5%

Islington 33.3% 78.2% 88.5% 40.6% 35.1% 15.5% 12.3% 64.1% 51.7% 66.6% 72.6% 32.4% 16.5% 69.7% 85.2% 88.6% 87.0% 85.3% 93.7% 95.1% 93.5% 38.4% 34.2% 83.8%

North Central London STP 26.6% 68.3% 85.6% 44.6% 33.9% 18.1% 11.9% 61.8% 44.6% 64.2% 69.3% 33.9% 17.2% 64.4% 83.2% 87.1% 84.1% 83.2% 91.9% 94.0% 93.0% 43.4% 41.8% 80.1%

Brent 23.2% 64.2% 85.1% 44.3% 34.7% 19.3% 14.3% 63.5% 44.3% 66.7% 66.8% 28.6% 23.2% 64.0% 81.7% 84.8% 82.8% 80.8% 89.2% 93.0% 91.5% 43.4% 45.8% 78.0%

Central London 21.7% 80.7% 84.4% 51.3% 43.6% 24.8% 18.2% 60.7% 48.2% 69.2% 63.6% 50.8% 19.7% 64.8% 82.6% 85.9% 81.6% 82.5% 90.5% 92.0% 91.3% 38.7% 46.0% 78.8%

Ealing 28.8% 73.0% 84.4% 41.6% 34.3% 15.3% 13.5% 64.3% 45.7% 64.0% 70.7% 32.2% 18.8% 66.5% 81.6% 85.9% 83.1% 81.2% 90.5% 93.2% 91.8% 46.6% 42.5% 78.5%

Hammersmith & Fulham 21.6% 73.6% 83.6% 55.7% 42.7% 28.3% 17.3% 66.2% 39.5% 67.1% 69.4% 40.6% 20.4% 68.8% 81.3% 86.5% 83.5% 79.4% 91.5% 93.7% 92.3% 50.2% 42.1% 80.7%

Harrow 28.4% 66.9% 85.9% 56.2% 45.7% 22.5% 19.7% 64.3% 42.8% 65.8% 69.6% 26.0% 13.7% 65.5% 85.2% 88.2% 86.1% 82.2% 92.5% 94.9% 93.9% 42.6% 44.8% 81.2%

Hillingdon 30.4% 70.8% 86.0% 45.4% 40.6% 16.0% 19.0% 62.2% 45.8% 61.9% 69.2% 38.1% 23.7% 66.7% 81.9% 84.5% 82.9% 79.1% 90.8% 93.5% 92.8% 45.4% 43.0% 79.0%

Hounslow 22.4% 66.6% 85.2% 48.5% 40.3% 19.1% 17.7% 64.3% 47.4% 63.2% 69.7% 28.0% 18.3% 65.0% 80.3% 83.5% 81.0% 81.0% 89.0% 92.1% 91.2% 46.0% 42.6% 77.8%

West London 18.3% 82.9% 88.7% 41.0% 35.7% 15.7% 15.6% 71.2% 53.4% 74.1% 72.2% 36.4% 22.1% 73.5% 84.9% 88.4% 86.3% 85.5% 91.6% 94.1% 93.7% 46.3% 59.1% 84.7%

West London STP 24.3% 72.3% 85.4% 48.0% 39.7% 20.1% 16.9% 64.6% 45.9% 66.5% 68.9% 35.1% 20.0% 66.9% 82.5% 85.9% 83.4% 81.5% 90.7% 93.3% 92.3% 44.9% 45.7% 79.8%

Bexley 34.7% 61.4% 85.7% 53.9% 39.4% 17.1% 11.9% 60.5% 47.4% 59.9% 68.1% 33.1% 23.0% 61.0% 84.1% 87.9% 85.6% 85.3% 91.9% 95.9% 94.2% 48.0% 37.8% 80.4%

Bromley 34.7% 68.2% 88.6% 48.2% 37.1% 18.6% 14.5% 64.3% 49.6% 63.9% 74.1% 33.0% 17.1% 68.6% 85.3% 87.8% 86.4% 87.3% 93.3% 95.4% 94.3% 45.2% 38.8% 83.9%

Greenwich 26.7% 65.8% 87.3% 45.5% 30.4% 18.9% 7.4% 62.6% 44.8% 64.4% 66.4% 32.0% 14.7% 65.7% 82.4% 85.0% 81.8% 78.6% 88.5% 92.3% 91.1% 45.0% 39.6% 79.3%

Lambeth 24.0% 75.7% 88.1% 52.4% 39.8% 20.6% 13.1% 66.1% 47.8% 70.3% 73.2% 27.7% 13.4% 70.3% 85.8% 88.7% 86.7% 82.1% 92.7% 95.1% 94.0% 31.3% 33.9% 83.8%

Lewisham 18.9% 61.2% 85.7% 60.6% 42.3% 27.6% 15.3% 60.4% 45.0% 64.3% 68.6% 34.6% 16.3% 62.4% 82.9% 87.0% 85.1% 81.8% 92.3% 94.2% 93.0% 44.5% 41.9% 80.4%

Southwark 33.7% 69.4% 86.5% 43.4% 33.2% 17.0% 10.7% 60.2% 42.7% 65.8% 65.3% 30.0% 11.1% 60.2% 83.4% 86.9% 83.6% 81.3% 90.8% 94.2% 93.7% 38.9% 37.4% 79.3%

South East London STP 28.8% 67.0% 87.0% 50.6% 37.0% 20.0% 12.2% 62.3% 46.2% 64.8% 69.3% 31.7% 15.9% 64.7% 84.0% 87.2% 84.9% 82.7% 91.6% 94.5% 93.4% 42.2% 38.2% 81.2%

Croydon 25.9% 72.3% 87.5% 49.5% 38.9% 19.4% 12.6% 67.1% 48.0% 66.0% 73.3% 27.2% 12.3% 69.6% 84.9% 88.0% 86.0% 82.8% 92.4% 94.4% 94.2% 43.3% 38.5% 82.3%

Kingston 21.0% 69.7% 89.6% 52.0% 44.1% 20.7% 16.9% 68.3% 49.0% 67.6% 77.1% 23.2% 6.9% 72.8% 87.1% 88.1% 86.1% 81.0% 93.0% 95.7% 92.6% 37.3% 26.0% 84.1%

Merton 28.2% 63.9% 87.4% 55.5% 38.9% 24.1% 11.6% 67.3% 45.6% 67.3% 74.0% 24.0% 7.8% 68.7% 81.7% 84.7% 83.2% 83.3% 90.2% 93.4% 93.2% 47.9% 40.5% 81.0%

Richmond 27.6% 81.5% 89.8% 49.3% 43.3% 19.6% 15.3% 67.6% 53.3% 71.1% 77.3% 43.9% 16.3% 74.2% 89.7% 92.4% 90.2% 89.4% 95.0% 97.0% 95.8% 37.3% 28.5% 87.9%

Sutton 18.4% 76.8% 90.3% 55.4% 42.5% 22.1% 11.5% 70.6% 51.8% 67.8% 76.8% 45.5% 18.4% 75.0% 87.6% 90.7% 88.1% 86.5% 94.3% 96.3% 95.8% 44.2% 31.9% 86.8%

Wandsworth 20.2% 78.4% 88.9% 58.1% 42.8% 26.8% 13.4% 71.8% 48.9% 72.6% 76.4% 43.3% 20.7% 73.8% 87.4% 89.9% 88.1% 85.9% 94.1% 96.2% 94.7% 36.2% 61.5% 87.4%

South West London STP 23.6% 73.8% 88.9% 53.3% 41.8% 22.1% 13.5% 68.8% 49.4% 68.7% 75.8% 34.5% 13.7% 72.4% 86.4% 89.0% 86.9% 84.8% 93.2% 95.5% 94.3% 41.0% 37.8% 84.9%

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

16 |16 |

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


Percentages in green are significantly higher than London average, percentages in red are significantly lower

(based on 1 standard deviation above / below mean)

Overall

experience

Response

rate Genera

lly e

asy t

o g

et

thro

ugh t

o

som

eone a

t your

GP

pra

ctice o

n

the p

hone

Receptionis

ts a

t your

GP

pra

ctice

are

help

ful

Aw

are

ness o

f bookin

g a

ppoin

tments

onlin

e

Aw

are

ness o

f ord

eri

ng r

epre

at

pre

scri

ptions o

nlin

e

Booked a

ppoin

tment

onlin

e in p

ast

12 m

onth

s

Ord

ere

d r

epeat

pre

scri

ption o

nlin

e

in p

ast

12 m

onth

s

Satisfied w

ith a

vaila

ble

appoin

tment

tim

es

Alw

ays /

a lot

get

to s

peak t

o

pre

ferr

ed G

P

Off

ere

d a

choic

e o

f appoin

tment

Satisifed w

ith t

ype o

f appoin

tment

off

ere

d

Reason f

or

not

takin

g a

ppoin

tment:

off

ere

d o

ne w

asn’t s

oon e

nough

Inste

ad o

f ta

kin

g o

ffere

d

appoin

tment,

went

to A

&E

Good o

vera

ll experi

ence o

f m

akin

g

appoin

tment

Healthcare

pro

fessio

nal w

as g

ood a

t

giv

ing e

nough y

ou t

ime

Healthcare

pro

fessio

nal w

as g

ood a

t

liste

nin

g

Healthcare

pro

fessio

nal w

as g

ood a

t

treating y

ou w

ith c

are

and c

oncern

Healthcare

pro

fessio

nal re

cognis

ed

and/o

r unders

tood a

ny m

enta

l

health n

eeds t

hat

you m

ight

have

had

Involv

ed a

s m

uch a

s w

ante

d t

o in

decis

ion a

bout

your

care

You h

ad c

onfidence a

nd t

rust

in

pro

fessio

nal w

ho s

aw

you

Thin

kin

g a

bout

the r

eason f

or

your

appoin

tment,

your

needs w

ere

met

When w

ante

d t

o s

ee a

GP

but

pra

ctice c

losed,

went

to A

&E

inste

ad

Receiv

ed c

are

or

advic

e in a

bout

the r

ight

tim

e

Overa

ll experi

ence w

as g

ood

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

London average 0.0% -1.0% -1.5% 5.1% 4.6% 3.8% 2.6% -0.6% -1.3% 0.3% -0.4% -1.0% -0.3% -0.3% 0.3% 0.3% 0.1% -1.0% 0.1% 2.7% -0.4% 0.9% -15.8% -0.2%

Barking & Dagenham -1.5% -2.9% 0.4% 3.4% 3.0% 3.9% 2.8% -4.3% -2.4% -1.8% -2.2% 0.5% -1.2% -3.1% 0.3% -0.8% -1.0% 0.0% 1.5% 5.3% 1.2% 4.2% -4.9% 0.0%

City & Hackey 5.2% -2.2% -1.5% 7.5% 4.4% 4.9% 1.0% -1.0% -2.6% 2.0% 0.1% -2.6% 1.5% -2.3% -0.5% 0.2% 0.9% -0.9% 1.8% 3.6% -0.2% -2.3% -21.6% -1.2%

Havering -1.1% -2.2% -3.2% 4.6% 3.1% 1.6% 1.5% -1.8% -1.4% -2.2% -2.2% -4.8% 5.2% -1.9% -0.5% -1.4% -1.7% -4.0% -0.3% 1.0% -2.1% 5.6% -16.3% -4.8%

Newham 15.0% 2.0% -0.2% 5.2% 3.9% 3.9% 2.6% 1.1% -0.5% 0.6% 3.5% 0.3% 2.7% 2.1% 2.4% 1.4% 1.5% 0.0% 1.0% 4.5% -0.8% 4.6% -3.1% -2.0%

Redbridge -6.7% 0.4% -1.8% 1.8% 1.1% -0.1% 0.5% 0.7% -3.7% -0.7% -0.8% 7.9% -0.4% -0.3% -0.9% -1.2% -0.6% -0.8% 0.2% 3.5% -1.1% 0.2% -4.0% -6.4%

Tower Hamlets 6.8% -3.8% -1.5% 4.7% 3.4% 5.1% 1.7% -3.1% 0.4% -1.1% -3.9% -13.2% 1.7% -3.9% 0.2% -0.5% -0.7% 0.2% -0.5% 2.4% -0.7% 0.9% -7.9% -7.2%

Waltham Forest -2.1% -0.7% -1.7% 6.9% 7.5% 3.8% 2.6% -1.8% -2.6% 0.0% -1.1% -7.5% 4.8% -0.2% 1.3% 1.7% 2.2% 1.0% -0.1% 2.5% -0.5% 1.7% 0.0% -7.6%

East London STP 2.2% -1.3% -1.3% 4.9% 3.8% 3.3% 1.8% -1.5% -1.8% -0.5% -0.9% -2.8% 2.0% -1.4% 0.3% -0.1% 0.1% -0.6% 0.5% 3.3% -0.6% 2.1% -8.3% -4.2%

Barnet -1.5% -2.1% -3.0% 6.3% 3.8% 2.5% 1.8% -3.8% -2.9% 0.5% -2.0% 14.5% 1.5% -2.6% -0.8% -0.3% 0.5% -0.1% 0.0% 2.4% 0.3% -2.6% -7.4% -1.8%

Camden 0.2% -0.3% -3.0% 7.7% 5.9% 7.3% 2.4% 0.0% 0.7% -0.9% -1.4% 4.5% 10.5% 1.4% 0.6% 1.8% 0.1% 0.9% 0.4% 1.3% 1.4% 1.8% -19.0% 6.0%

Enfield -2.8% -2.3% 0.3% 7.3% 2.9% 3.9% 1.2% -2.7% -3.2% -2.0% -2.0% -1.0% -5.8% -3.7% -0.3% 0.1% -0.5% -2.6% 1.0% 3.8% -0.7% -0.4% -12.4% -4.0%

Haringey -1.5% -2.9% -2.7% 2.9% 1.8% 2.5% 2.1% -1.1% -4.0% 1.1% 0.4% -11.0% -9.0% -0.8% -0.7% -0.2% -1.9% 0.1% -0.6% 2.7% -0.4% 4.3% -20.1% 4.5%

Islington 9.4% 2.5% -0.7% 5.9% 4.5% 3.0% 3.2% 1.0% 4.6% 1.5% 2.5% -1.5% 7.8% 2.1% 1.9% 2.0% 2.1% 0.6% 1.5% 2.8% -1.1% 8.1% -27.9% 4.8%

North Central London STP 0.7% -1.0% -1.8% 6.0% 3.8% 3.9% 2.1% -1.3% -0.9% 0.0% -0.5% 1.1% 1.0% -0.7% 0.2% 0.7% 0.1% -0.2% 0.5% 2.6% -0.1% 2.3% -17.4% 1.9%

Brent -1.4% -2.3% -0.9% 5.9% 6.6% 3.7% 4.7% -1.5% -1.6% 1.7% -0.7% 4.0% 0.8% 0.7% 0.5% -0.9% 0.0% -0.7% -0.7% 3.1% 0.2% 0.1% -6.4% 0.4%

Central London 2.7% -2.0% -2.2% 5.3% 11.6% 8.1% 6.5% -1.5% -1.9% 0.5% -5.7% -1.9% 6.9% -1.0% 0.6% 2.3% -1.1% -3.5% 0.4% 1.9% -0.9% -4.6% -10.5% -1.3%

Ealing 3.4% 1.9% -1.6% 5.0% 6.7% 2.7% 3.2% 1.2% -1.8% 2.6% 1.7% 1.9% -6.1% 0.8% 0.3% 0.9% 0.9% 1.1% 0.7% 3.4% -0.9% 0.1% -12.2% 0.3%

Hammersmith & Fulham 0.3% -0.5% -4.0% 5.8% 6.5% 8.1% 6.2% 1.6% -3.6% 1.3% 0.7% -6.7% -9.5% 3.6% -0.1% 0.8% 0.4% -3.7% 0.4% 2.6% -1.1% 8.9% -21.4% 1.2%

Harrow -1.5% -0.5% -0.4% 4.9% 6.5% 1.7% 3.7% 1.2% -1.8% 0.3% 0.7% -10.4% -8.0% 0.7% 1.6% 0.8% 1.5% -2.1% 0.8% 3.2% 0.5% 0.4% -5.3% 0.5%

Hillingdon 0.5% 3.4% -0.7% 2.7% 6.7% 1.2% 6.7% 2.3% -1.8% 2.1% 0.8% 1.2% 3.2% 3.5% 2.0% 1.4% 1.9% -2.4% 0.0% 2.8% 1.1% 1.6% -13.7% -1.0%

Hounslow -5.1% -3.2% -1.8% 4.7% 6.7% 4.4% 5.1% -2.3% -0.4% 1.1% 0.3% 0.3% -7.5% -1.4% -0.8% -1.1% -1.9% -1.3% -0.7% 2.4% -1.6% -1.6% -14.8% -9.3%

West London -2.6% -2.9% -1.2% 2.5% 2.9% 0.9% 3.0% -1.3% -1.9% 1.0% -2.6% -1.1% -2.9% -0.3% -0.4% 0.0% -0.2% -0.7% -1.5% 1.0% -0.4% 2.0% 0.0% -2.5%

West London STP -0.5% -0.8% -1.6% 4.6% 6.8% 3.8% 4.9% 0.0% -1.8% 1.3% -0.6% -1.6% -2.9% 0.8% 0.4% 0.5% 0.2% -1.7% -0.1% 2.5% -0.4% 0.9% -10.5% -1.5%

Bexley -0.7% -1.2% -0.2% 5.7% 4.3% 2.9% 1.9% 1.0% -1.6% -0.3% -0.8% -10.0% 8.3% -0.8% 0.8% 2.2% 0.9% -1.0% -0.1% 3.8% -0.2% 1.6% -21.2% 0.7%

Bromley -0.6% -2.0% -1.3% 1.6% 1.3% 1.7% 1.1% -1.2% -1.0% -1.0% -0.4% 1.1% -1.7% -1.8% -1.5% -1.1% -0.6% -2.1% -0.5% 1.6% -0.7% -2.2% -23.3% 6.4%

Greenwich 1.1% -2.6% -3.1% 4.7% 3.4% 4.3% 0.9% -0.4% 0.0% -0.9% -0.2% 1.5% -5.1% -0.3% -0.7% -0.8% -2.3% 0.2% -1.7% 2.1% -1.6% -5.7% -15.5% -2.2%

Lambeth 2.9% -0.5% -2.8% 4.4% 3.4% 2.9% 1.1% -1.9% 0.1% -1.3% -0.3% -3.1% 4.0% -1.2% 0.7% 0.1% 0.1% -1.9% 0.2% 2.6% -0.2% -3.7% -30.6% 2.1%

Lewisham -5.2% -1.9% -2.6% 4.9% 5.3% 5.4% 4.7% -3.8% 2.1% -0.3% -2.4% 3.4% 6.0% -2.1% -1.7% -0.8% -0.3% -2.7% 0.0% 1.9% -1.3% 3.8% -18.8% 6.0%

Southwark 11.9% -3.5% -1.7% 4.9% 5.1% 5.0% 2.4% -1.0% -1.9% 0.0% -0.4% -12.3% -3.5% -1.8% 2.5% 1.0% 0.3% -2.0% -0.3% 3.0% 0.9% -0.7% -19.8% -4.0%

South East London STP 1.6% -1.9% -2.0% 4.4% 3.8% 3.7% 2.0% -1.2% -0.4% -0.6% -0.7% -3.3% 1.3% -1.3% 0.0% 0.1% -0.3% -1.6% -0.4% 2.5% -0.5% -1.2% -21.5% 1.5%

Croydon -1.7% -2.3% -1.2% 6.0% 3.7% 5.6% 0.7% -0.6% -1.0% -0.2% 0.0% 4.2% -4.6% -1.4% -0.2% -0.4% 0.1% 0.1% 1.0% 3.0% 0.4% 3.9% -18.8% -0.7%

Kingston -10.1% 1.0% -1.4% 3.9% 2.9% 4.5% 3.8% -0.3% -3.7% 3.9% 2.0% 2.8% -4.9% 2.2% 1.0% -0.3% -0.9% -4.5% -1.1% 1.5% -2.8% -1.1% -41.0% 0.8%

Merton 0.3% -1.3% 0.2% 3.9% 2.1% 3.9% 1.4% -0.1% -1.1% 1.3% 1.3% -16.9% -9.0% 2.0% -1.1% -2.2% -0.3% 0.9% -0.8% 2.3% -0.9% 3.5% -23.1% -0.1%

Richmond -7.3% 0.5% -0.5% 7.7% 4.3% 7.3% -0.2% 2.2% -3.1% 1.6% 0.2% 7.2% -3.7% 0.4% 1.5% 1.2% 1.6% 0.9% 0.3% 2.3% 0.6% 0.3% -40.6% 3.9%

Sutton -16.2% -1.6% -2.0% 8.9% 4.0% 4.4% -0.3% -0.7% -0.5% -2.4% -1.4% 17.1% -5.2% -1.1% -0.1% 0.8% 0.6% -1.1% 0.6% 2.6% 0.1% -2.5% -27.3% -0.3%

Wandsworth -4.0% -1.1% -2.3% 1.0% 1.0% -0.3% 0.0% 0.8% -2.5% -0.1% 1.2% 1.6% 13.5% -0.8% 0.6% -0.3% 0.4% -0.4% -0.8% 1.3% 0.5% -2.2% 0.0% 9.6%

South West London STP -6.5% -0.8% -1.2% 5.2% 3.0% 4.3% 0.9% 0.2% -2.0% 0.7% 0.6% 2.7% -2.3% 0.2% 0.3% -0.2% 0.3% -0.7% -0.1% 2.2% -0.3% 0.3% -25.1% 2.2%

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

17 |17 |

Further information

CQC Maternity Services Survey 2018: London Region Review

Full results available at www.gp-patient.co.uk

CCG slide packs with comparisons between practices available at http://www.gp-patient.co.uk/surveysandreports

Case studies on how different organisations and services use GPPS data: www.gp-patient.co.uk/uses-of-gpps

This report compiled by:

NHS England London Region Nursing Directorate

Contact:

Jamie Keddie

Clinical Quality Manager – North West London / Patient Public Voice

[email protected]

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

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

http://www.gp-patient.co.uk/uses-of-gpps

mailto:[email protected]

AGENDA NEL Primary Care Committee in Common (NEL PCCC) · Minutes of the North East London Primary...

Documents

Transcript of AGENDA NEL Primary Care Committee in Common (NEL PCCC) · Minutes of the North East London Primary...