agenda - lewisham · dr faruk majid chair, lewisham ccg dr sebastian kalwij clinical director dr...

Chair: Dr Faruk Majid Accountable Officer: Andrew Bland Managing Director: Martin Wilkinson

AGENDA A meeting of the Primary Care Commissioning Committee in public

Date: Tuesday 17th December 2019 Time: 09:45 – 11:45 Venue: Room 4, Civic Suite, Lewisham Town Hall, SE6 4RU Chair: Peter Ramrayka, Governing Body Lay Member, Primary Care

Enquiries: Chima Olugh Tel: 020 3049 1191 Email: [email protected]

Voting Members Name Role Peter Ramrayka Chair Anne Hooper Vice Chair: Lay Member – Patient Public Engagement Shelagh Kirkland Lay Member, Chair of the Audit Committee and Conflicts of Interest Guardian Dr Faruk Majid Chair, Lewisham CCG Dr Sebastian Kalwij Clinical Director Dr Jacqueline McLeod Clinical Director Alison Browne Registered Nurse Member Martin Wilkinson Managing Director David Maloney Chief Financial Officer Diana Braithwaite Director of Commissioning & Primary Care

a. 3 x Lay Memberso Chair: Lay Member for Primary Careo Vice Chair: Lay Member responsible for Patient Public Engagemento Lay Member: Chair of the Audit Committee and Conflicts of Interest Guardian

b. CCG Chairc. 2 Governing Body GP Membersd. Registered Nurse or Secondary Care Specialist (single member)e. CCG Managing Directorf. CCG Chief Financial Officerg. Director of Commissioning & Primary Care

Non-Voting Members

a. Local Medical Committee Representativeb. Healthwatch Representativec. Local Authority Representative of the Health and Wellbeing Board (Elected Member or Mandated

Officer)d. Officers as required to undertake business of the committeee. NHS England Representative

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mailto:[email protected]


Quorum

1. The quorum shall be a minimum of 4 members, of which 2 must be Lay Members.2. Where a quorum cannot be convened from the membership, owing to arrangements for the

management of conflicts of interest or potential conflicts of interest; the Chair of the meeting willcomply with the conflicts of interest policy.

3. This may result in;a. The meeting being deferredb. A discussion being undertaken but the decision deferred until the next meetingc. Discussion being undertaken being deferred to the Governing Body

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Order of Business

No. Time Item Papers Presented by

1. 09:45 Welcome and introductions Chair

2. Apologies for absence Chair

3. Declarations of Interest Members should discuss any potential conflicts of interest with the Chair prior to the meeting.

Chair

4. 09:50 Minutes: • To approve the minutes of the October 2019

PCCC Enc 1 Chair

5. 10:00 Actions: Review of Actions Enc 2 Chair

Standing items

6. 10:05 Financial Report – 2019/20

• Month 7Purpose: To note.

Enc 3 Michael Cunningham

7. 10:15 GP Forward View (GPFV):

• Implementation UpdatePurpose: To note.

Enc 4 Ashley O’Shaughnessy

8. 10:30 Primary Care Operational Group Chairs Report Purpose: To note.

Enc 5 Dr Jacky McLeod

Items for Approval

9. 10:40 Practice Merger

• Brockley Road Medical Centre and Hilly FieldsMedical Centre

Purpose: To approve.

COI: There is a direct COI for Dr Majid as a partner of Hilly Fields Medical Centre/Brockley Road Medical Centre. As Such, Dr Majid will not take part in any discussions or the decision on this item

Enc 6 Nick Langford

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Items to Discuss

10. 11.10 Minor Ailments (Pharmacy First) Scheme Purpose: To discuss.

Enc 7 Erfan Kidia

Items to Note

11. 11:20 CQC Update Reports a) Wells Park Practiceb) Queens Road Partnership

Purpose: To note.

Enc 8 Nick Langford

12. 11:30 Discretionary funding

• Inclusion of the SE London Special AllocationScheme APMS registered list as part of theSevenfields PCN

Purpose: To note.

Enc 9 Jill Webb

13. 11:40 AOB Chair

14. 11.45 Meeting Close Chair

Date of the next meeting: 18th February 2020

Forward Planner

• Interpreting and Translation Services

• Hurley at the Waldron APMS dispersal: final report

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Managing Conflicts of Interest: Governing Body, committees, sub-committees and working groups 1. The chair of the Governing Body and chairs of committees, subcommittees and working groups will

ensure that the relevant register of interest is reviewed at the beginning of every meeting, and updatedas necessary.

2. The chair of the meeting has responsibility for deciding whether there is a conflict of interest and theappropriate course of corresponding action. In making such decisions, the chair may wish to consultthe member of the governing body who has responsibility for issues relating to governance.

3. All decisions, and details of how any conflict of interest issue has been managed, should be recordedin the minutes of the meeting and published in the registers.

4. Where certain members of a decision-making body (be it the governing body, its committees or sub-committees, or a committee or sub-committee of the CCG) have a material interest, they should eitherbe excluded from relevant parts of meetings, or join in the discussion but not participate in thedecision-making itself (i.e., not have a vote).

5. In any meeting where an individual is aware of an interest, previously declared or otherwise, in relationto the scheduled or likely business of the meeting, the individual concerned will bring this to theattention of the chair, together with details of arrangements which have been confirmed by thegoverning body for the management of the conflict of interests or potential conflict of interests. Whereno arrangements have been confirmed, the chair may require the individual to withdraw from themeeting or part of it. The new declaration should be made at the beginning of the meeting when theRegister of Interests is reviewed and again at the beginning of the agenda item.

6. Where the chair of any meeting of the CCG, including committees, sub-committees, or the governingbody, has a personal interest, previously declared or otherwise, in relation to the scheduled or likelybusiness of the meeting, they must make a declaration and the deputy chair will act as chair for therelevant part of the meeting. Where arrangements have been confirmed with the governing body forthe management of the conflict of interests or potential conflicts of interests in relation to the chair, themeeting must ensure these are followed. Where no arrangements have been confirmed, the deputychair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair,the members of the meeting will select one.

7. Where significant numbers of members of the governing body, committees, sub committees andworking groups are required to withdraw from a meeting or part of it, owing to the arrangementsagreed by the Governing Body for the management of conflicts of interest or potential conflicts ofinterest, the remaining chair will determine whether or not the discussion can proceed.

8. In making this decision the chair will consider whether the meeting is quorate, in accordance with thenumber and balance of membership set out in the CCG’s standing orders or the relevant terms ofreference. Where the meeting is not quorate, owing to the absence of certain members, thediscussion will be deferred until such time as a quorum can be convened. Where a quorum cannot beconvened from the membership of the governing body, committees, sub committees and workinggroups owing to the arrangements for managing conflicts of interest or potential conflicts of interest,the chair may invite on a temporary basis one or more of the following to make up the quorum so thatthe CCG can progress the item of business:(a) an individual GP or a non-GP partner from a member practice who is not conflicted(b) a member of the Lewisham Health and Wellbeing Board;(c) If quorum cannot be achieved by (a) or (b) (above) a member of a governing body of another

clinical commissioning group.9. These arrangements will be recorded in the minutes.

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1 | P a g e P C C C D e c e m b e r 2 0 1 9

Primary Care Commissioning Committee Tuesday 15 October 2019

Present Peter Ramrayka (PR) Chair, Lay Member Shelagh Kirkland (Ski) Lay Member Audit and Conflict of Interest Anne Hooper (AH) Lay Member Public Engagement Dr Faruk Majid (FM) Chair, Lewisham CCG Ashley O’Shaughnessy (AOS) Deputy Director of Primary Care Jill Webb (JW) Head of South East London Primary Care Contracting Team Chima Olugh (CO) Commissioning Manager Michael Cunningham (MC) Head of Finance Magna Aidoo (MA) Healthwatch Representative Martin Wilkinson (MW) Managing Director Dr Simon Parton (SP) Chair, Local Medical Committee Lesley Aitken (LA) Interim Board Secretary (minutes)

Apologies David Maloney (DM) Chief Finance Officer Diana Braithwaite (DB) Director of Commissioning and Primary Care Alison Browne (AB) Director of Nursing and Quality Dr Jacqueline McLeod (JM) Senior Clinical Director, Governing Body Member Nick Langford (NL) Assistant Head of SEL Primary Care Contracting Team

1. Welcome and Introductions

1.1 The Chair welcomed all to the meeting.

1.2 PR informed the Committee that DM has been appointed to the post of SE London Director of Corporate Finance commencing 1 November 2019. He also holds the post of Deputy Chief Financial Officer. Congratulations were given on his appointment.

2. Apologies for absence

2.1 Apologies were noted.

3. Declarations of Interest

3.1 Other than the declarations recorded on the LCCG register, there were no additional declarations made at the meeting.

4. Minutes of the previous meeting

4.1 The minutes of the meeting held on 18 June 2019 and the minutes of the urgent planned PCCC meeting held on 6 August 2019 were taken as an accurate record. The

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urgent planned meeting in August 2019 had previously been reported on at the September Governing Body meeting.

4.2 The papers from the urgent planned PCCC meeting on 6 August 2019 were included in this committees meeting papers for information.

5. Review of the actions The Committee reviewed the outstanding actions and the log was updated.

• Action 10.2 AH has met with DB concerning supporting practices in engagement around

service change. It was explained that this piece of work could now be undertaken SE London wide. It would be discussed at the SE London Primary Care Executive meeting later that day. This action was subsequently closed.

Action 7.6: This item on ASK NHS GP APP was included in the meeting papers. This action was subsequently closed.

5.1 AH, referring to the minutes of the last meeting relating to the Wells Park CQC item,

requested an update on their action plan. CO explained that following that meeting the practice had been visited and issued a remedial notice with 28 days to respond. There was an action plan in place which met the recommendation given.

5.2 To provide assurance to the Committee a report would firstly go to the Primary Care Operational Group with a report back to the PCCC in December 2019.

ACTION: In order to provide assurance to the PCCC, SELPCT to bring an update report back to the December 2019 meeting. 6. Finance Report – 2019/20 - Month 5

6.1 MC explained that the report given for M5 covered the six SE London CCGs.

6.2 For Lewisham, at year to date, there is an underspend of £76k with a forecast outturn

of £183k, the driver of which is a reduction in the number of PCNs established in Lewisham compared to the original assumptions that were made.

6.3 JW explained that when PCNs were conceived by NHSE they were based on 30k – 50k populations for each PCN. This was before general practices decided how they wanted to work together. In Lewisham, the PCNs formed in groups greater than 30k and as such the original budget allocation wasn’t fully required.

6.4 AOS explained that the Federation was working with the PCNs to coordinate the claims process for additional roles which would include the recruitment of clinical pharmacists and social prescribers in 2019/20. MW added that the funding for PCNs for social prescribers is only for staff. There is more funding available through the Better Care Fund for the voluntary sector although this could not be looked at isolation as there is joint work being undertaken with local authority and LIMOS.

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6.5 SP added that there are different streams of activities, and not all PCNs are doing the

same, but most are supported through the Federation. The funding is central to fund sessions for prescribing. One of the risks to PCNs is to the leadership, as the six individuals heading up the PCNs have capacity and cost pressures. There is only a small amount of funding for development. There is a need to look at how to support them, either financial, training or head space support. There is a pilot in N1 PCN regarding mental health on integrating IT systems and integrating front line mental health in primary care with other healthcare partners.

6.6 AOS added that there were two other funding streams to support PCNs, the £1.50 per head, which would be backdated to April 2019, and PCN development support with an allocation of £1.4m across SEL. An exercise has just been undertaken with PCNs to complete a maturity assessment which resulted in a development plan for each PCN. There would be consideration of what could be supported at a local and SE London level. SK said that it would be useful for future reports to include all funding streams.

6.7 SK, referred to table 3, which indicated that the percentage increase in patient numbers was higher in Lewisham than the other boroughs. JW clarified that every CCG was budgeted to have an expectation of the same percentage growth. AOS added that from a PCN perspective, allocations were as accurate as possible as they were based on registered lists as of 1st April 2019.

RESOLVED: The PCCC noted the Month 5 Financial Report.

7. GP Forward View (GPFV) Implementation Update AOS stated that the report would be in two parts; an Implementation Update and a summary of the 2019/20 allocations and associated delivery plans.

7.1 GPPV Implementation Update: AOS updated the PCCC on the latest figures from the GP Extended Access (GPEA) Service as of September 2019. This showed that there was 74% utilisation against the Operating Plan target of 75%. Lewisham was in the middle of the pack of SE London CCGs with this percentage. The main challenge continues to be the number of DNAs for which the Federation had ongoing work to address the problem. The aim was to meet the trajectory by the end of March 2020. Lambeth and Bromley CCGs were being looked at to share their good practice. There was also underutilisation of patients being directed from the Urgent Care Centres to GP practices. Healthwatch had undertaken a review at the GPEA, MA confirmed that the report would be available soon.

SK, acknowledging that the work undertaken on DNAs, highlighted that a year on there is no change therefore what assurance could the committee have that there will be an improvement. AOS explained that there was three ways to attending a GP appointment; GP direct appointments, redirection from the Urgent Care Centre (UCC) and appointments booked through 111. The concern is around the slots allocated to the UCC and 111 and trying to get that balance right which would aid the work around achieving the 4-hour A&E target. It was recognised that further work was needed to

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addressing DNA’s including more information to patients on what to do if they are unable to attend an appointment. SK queried whether the 75% target was ambitious enough.

7.2 AH referring to the point that there would be a new contract when the current one ends at the end of March 2019, would like assurance on the process for that contractual renewal including a more ambitious utilisation rate. AOS responded that there were plans in place taking into account the national access review being undertaken. In response to whether there was a geographical variation on DNAs, AOS said that the Federation were undertaking a deep dive on this issue.

7.3 General Practice development programme: AOS reported that nine practices had

reached the end of the latest wave of the Productive General Practice programme.

7.4 ASK NHS GP app: the report showed the breakdown of registrations by practice and PCN. AOS stated that the number of registrations was positive. The Federation would look at the differences across PCNs. There were 18k patients registered for the app. In response to SK on whether targets would be set on a percentage basis for practices, AOS said that there was an expectation that 60k – 80k patients would be registered in total in the next 12 months. Individual practice targets were being looked at and the motivation for the practices to reach them. AH asked whether the Communication and Engagement Plan, requested by the Primary Care Operational Group (PCOG), would have tangible outcomes. AOS responded that a report would go to the PCOG by the end of October 2019 with assurance provided back to the December 2019 PCCC.

7.5 Healthwatch would be requested to obtain patient stories on the impact of the service. The Federation intend to set up a stall in Laurence House and at the hospital to inform staff and members of the public about the APP and encourage downloads. Receptionists would also be specifically supported to push the app out to patients.

7.6 Practice Resilience Scheme: The Committee were informed that there was £44k of allocated funding for the 2019/20 scheme. All practices have been invited to self-nominate for the support. Practices which were rated Inadequate or Requires Improvement for resilience by the CQC or practices that had recently merged or were planning to merge would be prioritised.

7.7 Reception and clerical staff training: this project is intended to align with PCN’s social prescribing roles. In response to MA on whether the funding allocated could be used for other training, for example any areas identified in appraisals, AOS said that the funding was specifically for training on signposting and managing medical correspondence. FM added that the training for care navigation needed to be ongoing as services change. AOS would take note of all the comments made.

7.8 General Practice development programme; there was £91k this year for online consultations to support continued implementation of the ASK NHS GP app.

7.9 GP Retention: AOS explained that work on this programme was ongoing. A GP Crisis conference had been held looking at possible solutions. SP added that useful

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conversations had been held at the conference though there was a disappointing turnout, young GPs needed to be encouraged to attend such events.

RESOLVED: The PCCC noted the implementation update of the GP Forward View and the Lewisham 2019/20 GPFV allocations and associated delivery plans. 8. Primary Care Operational Group Chairs Report

AOS gave the report from the PCOG from the meeting held on 15 October 2019.

8.1 2018/19 Minor Ailments Scheme (Pharmacy First) Report - In 2018/19 the service

had 17k+ interactions from 12k patients. This had helped manage the demand on GP services and for A&E services. The service will be relaunched in Lewisham to be aligned to the winter communications campaign. AOS would take comments from AH on how, following the relaunch, would the PCCC have assurance on tangible outcomes and value for money and from SK on how Pharmacy First was funded. A report would be brought back to the PCCC in December.

8.2 In response to MA on patients paying for the pharmacy services and does the medication given get flagged to their GP, SP explained that usual arrangements for payment was in place.

8.3 FM added that pharmacists in practices would drive change. SP asked what the geographical spread of the service was and suggested that going forward that the local population needs should be identified.

RESOLVED: The PCCC noted the Primary Care Operational Group Chairs report.

9. Primary Care Quality Improvement

9.1 CO reported that the CCG had convened a team of clinicians, CCG officers, Healthwatch and LMC representatives to look at available quality data, including information from the 2019 GP Patient Survey and the CQC.

9.2 The information gathered showed that in relation to the GP Patient Survey some Lewisham practices were consistently lower than the CCG and national averages and down from 2018/19. In 2019 nine practices were consistently above average, these practices would be asked to share good practice.

9.3 The data was also linked to the FFT for which practices have to submit results monthly.

9.4 CQC ratings of Lewisham practices CQC ratings indicated that 33 practices in Lewisham are rated as ‘good’ overall. One practice, Queens Road Partnership, is rated as ‘inadequate’ overall. One practice, Wells Park practice, is rated as ‘requires improvement’ overall. Both Queens Road Partnership and Wells Park Practice have action plans in place

and have been supported by commissioners.

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9.5 Eight practices had been identified as outliers across multiple areas. The CCG would visit these practices to discuss and identify concerns and offer support, this would include putting forward a submission for GPFV Practice Resilience funding support.

9.6 AOS added that improvement plans for those practices underperforming were being put in place. Some practices were carrying out their own internal practice surveys which interestingly showed different results from those of the national GPPS.

9.7 AH thought it was an excellent report. She suggested that the rag rating should be compared with the national average. AOS responded that the rag rating should highlight the London effect whereby London practices are usually always below the national averages. Referring to the FFT, it appeared that only one practice had a Patient Participation Group (PPG) report or minutes. The PPG meetings were now in the core contract for practices and the FFT is a contractual monthly requirement. JW added that there should be a triangulation between the FFT and GP Practice Survey. Internal Audit would review this as part of the Contract Management review.

9.8 It has been discussed for Healthwatch to support an interim assessment against the eight outlier practices on progress made following utilisation of Resilience funding.

RESOLVED: The PCCC noted the Primary Care Quality Improvement Report 10. Any Other Business

JW reported that a discussion on the Special Allocation Scheme had been held in private as it was in the procurement stage for a new model for SE London. One Health Lewisham (OHL) has now been awarded the contract for SE London with a commencement date of 4 November 2019.

11. Forward Planner

Interpreting and Translation Services Hurley at the Waldron APMS dispersal: final report.

12. Date of the next meeting

The next scheduled meeting of the Primary Care Commissioning Committee held in public is on Tuesday, 17 December 2019, 9.45 am, at Room 4, Civic Suite, Lewisham Town Hall, SE6 4RU.

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Enclosure 2: ACTION TRACKER: Live

Date Reference Action Description Due Date Lead Status update Date closed

15.10.2019 5.1 An update on the Wells Park Practice CQC inspection report and subsequent action plan to be brought back to the December 2019 PCCC meeting

17.12.2019 Nick Langford 13.12.19: Item on agenda for 17.12.19 PCCC meeting

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1 | P a g e P C C C D E C E M B E R 2 0 1 9

PCCC Primary Care Commissioning Committee Tuesday 17th December 2019

Enclosure: 3 Financial Report – 2019/20 Month 7

CLINICAL LEAD: Dr Jacky McLeod, Clinical Director – Primary Care Lead

MANAGERIAL LEAD: David Maloney, Director of Finance

AUTHOR: Michael Cunningham, Head of Finance

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to note the financial position year to date (YTD) and forecast outturn (FOT) as at month 7 2019/20.

SUMMARY: Appendix A shows the financial position year to date (YTD) and forecast outturn (FOT) as at month 7 2019/20 broken down by budget line. Overall there is a small YTD overspend of £14k and FOT overspend of £20k. Appendix B shows a breakdown of PCN funding for 2019/20.

CORPORATE AND STRATEGIC OBJECTIVES: Contract Management: To manage effectively the CCG’s contract portfolio to ensure that the CCG’s Operating Plan‘s commitments are met in 2019/20. This includes ensuring our financial targets are met and value for money is achieved.

CONFLICT OF INTEREST (CoI): No conflicts of interest are identified to the Primary Care Commissioning Committee in relation to this item.

CONSULTATION HISTORY: Not applicable for this briefing.

PUBLIC ENGAGEMENT: Not applicable for this briefing.

HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: No adverse impacts identified.

RESPONSIBLE MANAGERIAL LEAD CONTACT: Name: David Maloney; E-mail: [email protected]

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Primary Care Medical Services Lewisham Appendix AFinancial Summary - 19/20 Oct-19

DescriptionAnnual Budget

YTD BudgetYTD Actual

ExpenditureIn Month Accruals

YTD Reported Spend

YTD Variance YTD commentaryForecast Out-turn

Forecast variance

Forecast Commentary

£000 £000 £000 £000 £000 £000 £000 £000

PMS Essential and Additional Services 27,827 16,232 16,272 0 16,272 40 27,895 68PMS Premium Services 3,114 1,816 1,705 111 1,816 0 3,114 (0)GMS Global Sum & MPIG 1,935 1,129 1,145 0 1,145 16 1,963 28GMS Premium Services 214 125 118 7 125 0 214 (0)APMS Essential and Additional Services 0 0 0 0 0 0 0 0APMS Premium Services 0 0 0 0 0 0 0 0Caretaking - Management Fee 0 0 0 0 0 0 0 0Subtotal Core contract 33,090 19,302 19,241 118 19,358 56 33,186 95Population/List Growth ear-marked fund 430 251 0 184 184 (67) 314 (116)Total Core contract 33,521 19,553 19,241 302 19,543 (11) 33,500 (21)

QOF aspiration 2,254 1,315 1,306 9 1,315 0 2,254 0QOF achievement 1,043 609 0 609 609 0 1,043 0Total QOF 3,298 1,923 1,306 618 1,923 0 3,298 0

Minor Surgery DES 129 75 12 63 75 (0) 129 (0)Extended Hours DES 530 309 288 28 316 7 543 12Learn Dsblty Hlth Chk DES 82 48 9 39 48 0 82 (0)SAS/Violent patients scheme 34 20 7 13 20 0 34 (0)Out of area registration DES 0 0 0 0 0 0 0 0PCN Practice participation DES 568 331 332 0 332 0 568 0PCN DES 390 353 73 283 356 4 397 6Total enhanced services 1,733 1,135 721 426 1,147 11 1,752 19

Rent 2,933 1,711 1,577 137 1,713 2 2,937 4Rent - CHP/NHS PS 1,230 717 359 289 648 (70) 1,110 (119)In-year revaluation budget 106 62 0 62 62 0 106 (0)Business Rates 617 360 223 143 366 6 628 10Business Rates - CHP/NHS PS 99 58 36 27 63 5 107 8CHP Primary Care Void Charges 0 0 0 70 70 70 120 120Other Premises 56 33 13 20 33 (0) 56 (0)Total Premises Reimbursements 5,041 2,940 2,207 747 2,954 14 5,064 23

Seniority 223 130 88 42 130 0 223 (0)Locum reimbursements 400 233 74 164 238 5 408 8Retainer Scheme 8 5 0 0 0 (5) 0 (8)PADM Prescribing Fees Admin 158 92 22 70 92 0 157 (0)CQC Fees reimbursement 209 122 86 36 122 0 209 (0)Total PCO administered 998 582 269 313 582 0 997 (0)

Other 20 12 0 12 12 0 20 (0)Indemnity - transfered to GPFV Mth 3 0 0 0 0 0 0 0 0Clinical waste 67 39 3 36 39 0 66 (0)MOU costs 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0Total Other Medical Services 87 50 3 47 50 0 86 (0)

Total Primary Care Medical Services 44,677 26,185 23,747 2,452 26,199 14 44,697 20

Summary £000 £000 £000 £000 £000 £000 £000 £000Core contract 29,762 17,361 17,417 0 17,417 56 29,858 96Population/List Growth ear-marked fund 430 251 0 184 184 (67) 314 (116)Caretaking Management 0 0 0 0 0 0 0 0Premium Services 3,328 1,941 1,824 118 1,941 0 3,328 (0)QOF 3,298 1,923 1,306 618 1,923 0 3,298 0Enhanced Services 1,733 1,135 721 426 1,147 11 1,752 19Premises and other reimbursements 5,041 2,940 2,207 747 2,954 14 5,064 23PCO administered 998 582 269 313 582 0 997 (0)Other 87 50 3 47 50 0 86 (0)

00

Ledger Total 44,677 26,185 23,747 2,452 26,199 14 44,697 20

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Appendix B

PCNRaw List size as at

01/04/19

Normalised Weighted List size

as at 01/04/19

Network payment Clinical Director contribution £prp 1/9th payable from July

Core PCN Funding £prp (back dated to April)

Network Payment extended hours access 1/9th payable mthly from July 19

Network Participation Payment(PRACTICE LEVEL PAYMENT)

£0.514 per registered patient to cover July 2019 to March 2020 (equating to £0.057 per patient per month)

£1.50 per registeredpatient per year(equating to £0.125per patient permonth)

£1.099 per registered patient to cover period July 2019 to March 2020 (i.e. equating to £0.122 per patient per month) Note: This amount is pro-rata from £1.45 over 12 months

£1.761 per weighted patient per year, equating to £0.147 per patient per month

Lewisham Alliance PCN 51,611 50,439 26,528.00£ 77,417.00£ 56,720.00£ 88,823.08£ Lewisham Care Partnership PCN 58,124 54,469 29,876.00£ 87,186.00£ 63,878.00£ 95,919.91£ Modality Lewisham PCN 38,634 37,847 19,858.00£ 57,951.00£ 42,459.00£ 66,648.57£ North Lewisham PCN 76,536 73,501 39,340.00£ 114,804.00£ 84,113.00£ 129,435.26£ Sevenfields PCN 60,457 58,482 31,075.00£ 90,686.00£ 66,442.00£ 102,986.80£ Aplos PCN 50,622 48,049 26,020.00£ 75,933.00£ 55,634.00£ 84,614.29£

335,984 322,787 172,697.00£ 503,977.00£ 369,246.00£ 568,427.91£

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ENCLOSURE: 4 GP Forward View - Implementation Update

CLINICAL LEAD/S: Dr Jacky McLeod, Clinical Director lead for Primary Care MANAGERIAL LEAD: Ashley O'Shaughnessy, Deputy Director of Primary Care

AUTHOR: Ashley O'Shaughnessy, Deputy Director of Primary Care

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to note the;

• Update on the implementation of the GP Forward View (GPFV).

SUMMARY: • NHS England set out its ambitions for the transformation of general practice services in the GP

Forward View (GPFV), published in April 2016 (https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf)

• This paper provides a high level update on new developments in the local implementation of the GPFV in Lewisham since the update given to the last PCCC meeting in October 2019 (see Appendix 1)

CORPORATE AND STRATEGIC OBJECTIVES: • Planned Care: To support people with long term conditions better with proactive, holistic care

which improves the quality of their lives, is provided ‘out of hospital’ and reduces the requirement for hospital based outpatient attendances and inpatient admissions.

CONFLICT OF INTEREST (CoI): The Primary Care Commissioning Committee is asked to note this high level update on the local implementation of the GPFV in Lewisham and the supporting delivery plans. However, it is recognised that Clinical Directors in their role as General Practitioners may benefit from the funding and support provided through the GPFV. Therefore, in order to mitigate perceived/potential CoI and/or any undue influence;

• All decisions on how GPFV monies are committed will be taken through the appropriate governance structures with any CoIs managed as necessary.

• The funding levels stated in this update are already available in the public domain. • The update does not contain any practice specific information.

CONSULTATION HISTORY: • Primary Care Operational Group • Primary Care Commissioning Committee • Lewisham LMC

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https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf


PUBLIC ENGAGEMENT: Engagement undertaken as appropriate at a programme level.

HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: No specific adverse impacts identified – detailed assessment undertaken at a programme level.

RESPONSIBLE MANAGERIAL LEAD CONTACT: Name: Ashley O’Shaughnessy; Email: [email protected]

AUTHOR CONTACT: Name: Ashley O’Shaughnessy; Email: [email protected]

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Appendix 1: GPFV Implementation Update Programme Area

Purpose Update

GP Access Fund

The General Practice Forward View published in April 2016 set out plans to enable clinical commissioning groups (CCGs) to commission and fund additional capacity across England to ensure that, by 2020 everyone has improved access to GP services including sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services.

GP Extended Access (GPEA) Service

• Validated activity data for October 2019 is as follows;

Number of appointments available

3207

Number of appointments booked

2984

Number of DNAs 486 Overall utilisation (%) 78%

• Broken down by day;

Number of appts available

Number of appts

booked

Number of DNAs

Monday 430 408 61 Tuesday 507 432 48 Wednesday 442 436 52 Thursday 638 596 93 Friday 354 332 68 Saturday 428 419 79 Sunday 408 361 85

• Overall utilisation is now above the 75% target for 2019/20 but the CCG continue to work with the service provider to try and reduce DNAs.

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https://www.england.nhs.uk/gp/gpfv/


General practice development programme

The General practice development programme provides practical support to help practices manage their workload better through releasing time for care. This includes support for practice managers and investment in online consultation systems which will make general practice more sustainable and improve care for patients.

It will have immediate effects through making workload more sustainable and releasing time for staff to spend with the patients who need it most. It will also have longer terms benefits through strengthening collaboration between practices and other organisations in the health and care system, establishing a renewed focus on patient benefit within federations, and building capacity and capability for service improvement.

Online Consultations • Please see the appended presentation which

summarises the latest position in regard to the implementation of the ASK NHS GP APP in Lewisham (November 2019).

• OHL have also shared their detailed Communication and Engagement Strategy with the Primary Care Operational Group who are assured of the content and approach.

Practice Resilience Scheme

The purpose of the fund is to deliver support that will help practices to become more sustainable and resilient, better placed to tackle the challenges they face now and into the future, and secure continuing high quality care for patients.

Lewisham received £44,152 in 2019/20 for GPFV Practice Resilience. As in previous years, practices were invited to self-nominate for the GPFV resilience support funding.

The deadline to receive applications was the 18th October 2019. The CCG received a total of 12 applications

covering 14 GP practices.

8 from single practices 2 from two groups of practices 1 application was for systems and process

support not financial support

Assessment of the self-nominations was undertaken in-house by Lewisham CCG with peer review by the London-wide Medical Committee and a CCG lay member

The assessment criteria prioritised;

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practices rated Inadequate or Requires Improvement by the CQC

practices where available data suggested resilience issues (i.e. GP patient survey)

practices that are planning or who have recently merged.

Every practice that applied for funding was

awarded at least part of the funding requested.

Elements of applications where funding was declined fell in those areas where there is already funding/support being supplied for Lewisham as a whole e.g. Admin & Clerical Training, provided by Lewisham Community Education Provider Network, or where there were other options.

Practices were informed of the outcomes of their applications on 10th December 2019 and Memorandum of Understanding (MOUs) have been circulated.

Funding will be released to practices once the

MOUs have been signed and sent back.

An evaluation of impact will be undertaken in April 2020.

Please see annex 2 for a summary of Practice

Resilience Funding Allocations

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Annex 2: Summary of Practice Resilience Funding Allocations

GP Practice Support Required Funding Allocation Lewisham Care Partnership (Modern Hill/Hilly Fields/Brockley Road/Honor Oak/St Johns/Belmont Hill)

Professional review of telephony hardware and software in the context of moving to a centralised call centre arrangement across the partnership.

£6,000.00

Modality Lewisham Division (Jenner HC/South Lewisham Group Practice/Bellingham Green Surgery)

Funding support for non-GP staff to attend the 2020 Modality Talent Management and Leadership course.

£6,000.00

New Cross Health Centre Funding support for ‘Understanding Policies and Procedures’ training for all staff. This would ensure staff are prepared for CQC inspections. Backfill support to trial longer appointments/group consultations for patients with Long Term Conditions.

£4,680.00

Nightingale Surgery Assistance with clinical searches, Scriptswitch and repeat dispensing. N/A – support to be provided through

existing CCG resources

Novum Health Partnership Funding support for Human Resources training and coaching. Support for a facilitated away day for partners and managers.

£3,000.00

Oakview Family Practice Support to develop and implement a robust succession plan which will ensure continued quality service provision for patients.

£5,000.00

Queens Road Partnership Bespoke software to support the monitoring of high risk drugs and clinical safety. Backfill support to analyse an audit carried out to better understand the impact of appointments on clinicians’ time.

£3,600.00

Sydenham Green Group Practice Funding support to purchase and implement a new telephone system. £9,600.00 Wells Park Practice Funding support to conduct a piece of work to identify and analyse

frequent callers and agree a mechanism of supporting them. £1,035

Woodlands Health Centre Funding support to purchase a self-test height and weight monitor to improve practice efficiency and patient experience.

£5,237.00

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ASK NHS GP App

Monthly Report30 November 2019

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Key Points● All 35 practices onboarded

● 21,568 patients registered

● 23% (4,961) are of 25-34 years of age, the highest users

● 19% (853) the highest of activities, was observed on Monday

● 36% (1,622) of activity is out of hours, reducing recourse to UCC and A&E

● 13% (572) used Self-Care menu, thus empowered to self-manage

● 23% (1,038) used Manage My Appointments menu, further reducing DNAs

● 46% (2,054) used Symptom Checker menu of which 12% were signposted to Self-care

● 9% (419) used Admin Request menu, reducing demand and increasing efficiency

● No reported complaint or Serious Untoward Incident

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Patient Registration

0%, 20%, 6

0%, 460%, 231%, 42

3%, 1493%, 3004%, 1014%, 7075%, 3496%, 2676%, 3827%, 3937%, 7887%, 865

7%, 2788%, 4449%, 7519%, 2829%, 5319%, 680

10%, 55710%, 443

10%, 110211%, 435

11%, 150111%, 86911%, 449

11%, 144912%, 975

12%, 110712%, 1088

16%, 75218%, 173219%, 1559

117583876

106784876

59875637

96782866

160926677

443359195972

1123412156

38415623

85213164

58527420

58404607

107273996

135047796

399412674

80729137

89454783

95258096

150174544

112795557

73707559

117933375

208449045

55886873

747013852

147815338

675911745

39646788

91127559

589512776

661317495

101325365

163759611

1179610997

681311911

10568

0 5000 10000 15000 20000 25000

The Jenner Practice (21-Feb-19)Clifton Rise Family Practice (19-Jun-19)

Lewisham Medical Centre (7-Jan-19)

Kingfisher Medical Practice (9-Jan-19)New Cross Health Centre (3-Jan-19)

Bellingham Green Surgery (21-Feb-19)Lee Road (5-Jun-19)

Deptford Medical Centre (12-Feb-19)Novum Health - Rushey Green (13-Nov-18)

Woodlands Health Centre (30-Jan-19)Brockley Road (13-Feb-19)

Deptford Surgery (30-Oct-18)Triangle Group Practice (17-Dec-18)

Vale Medical Centre (21-Mar-19)St Johns Medical Centre (6-Nov-18)

Oakview Family Practice (8-Jan-19)Belmont Hill Surgery (25-Feb-19)

Wells Park Surgery (22-Nov-18)Mornington Surgery (7-Mar-19)

Vesta Road Surgery (6-Dec-18)Morden Hill Surgery (9-Apr-19)

Woolstone Medical Centre (6-Dec-18)

Burnt Ash Surgery (18-Dec-18)

Amersham Vale Practice (21-Jan-19)Nightingale Surgery (18-Dec-18)

Sydenham Green (11-Oct-18)

Honor Oak Group Practice (20-Dec-18)

Park View Surgery (20-Nov-18)South Lewisham Group Practice (21-Feb-19)

Queens Road Partnership (13-Feb-19)

Torridon Road Medical Practice (2-Apr-19)Grove Medical (22-Nov-18)

Downham Family Medical Practice (17-Dec-18)

Hilly Field Medical Practice (13-Feb-19)

ICO Health Group (1-Sep-18)

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Registrations by Practice / PCN

PCN Practice Date

OnboardedRaw List

Size

Eligible Patients over 16

No. of Registrations

of Adults over 16

% of Registrations

of Adults over 16

% of Registrations of List Size

Nor

th L

ewis

ham

Grove Medical 22-Nov-18 10997 8945 1088 12% 10%Queens Road Partnership 13-Feb-19 9611 8072 975 12% 10%Amersham Vale Practice 21-Jan-19 12776 10727 1102 10% 9%Mornington Surgery 07-Mar-19 3964 3164 282 9% 7%Vesta Road Surgery 06-Dec-18 6788 5852 474 8% 7%Deptford Surgery 30-Oct-18 6873 5919 382 6% 6%Deptford Medical Centre 12-Feb-19 3375 2866 101 4% 3%New Cross Health Centre 03-Jan-19 7370 5987 42 1% 1%Kingfisher Medical Practice 09-Jan-19 5557 4876 23 0% 0%Clifton Rise Family Practice 19-Jun-19 4544 3876 6 0% 0%

Lew

isha

m

Allia

nce

Nightingale Surgery 18-Dec-18 6613 3996 435 11% 7%Burnt Ash Surgery 18-Dec-18 5895 4607 443 10% 8%Triangle Group Practice 17-Dec-18 7470 5972 393 7% 5%Woodlands Health Centre 30-Jan-19 9045 6677 349 5% 4%Lee Road 05-Jun-19 11793 9678 300 3% 3%Lewisham Medical Centre 07-Jan-19 11279 10678 46 0% 0%

Lew

isha

m

Car

e Pa

rtne

rshi

p Hilly Field Medical Practice 13-Feb-19 11911 9525 1732 18% 15%Honor Oak Group Practice 20-Dec-18 10132 7796 869 11% 9%Morden Hill Surgery 09-Apr-19 9112 7420 680 9% 7%Belmont Hill Surgery 25-Feb-19 6759 5623 444 8% 7%St Johns Medical Centre 06-Nov-18 14781 12156 865 7% 6%Brockley Road 13-Feb-19 5588 4433 267 6% 5%

Seve

nfie

lds ICO Health Group 01-Sep-18 10568 8096 1559 19% 15%

Downham Family Medical Practice 17-Dec-18 6813 4783 752 16% 11%Torridon Road Medical Practice 02-Apr-19 11796 9137 1107 12% 9%Park View Surgery 20-Nov-18 5365 3994 449 11% 8%Oakview Family Practice 08-Jan-19 5338 3841 278 7% 5%Novum Health Partnership 13-Nov-18 20844 16092 707 4% 3%

Aplo

s H

ealth

Sydenham Green 11-Oct-18 17495 13504 1501 11% 9%Woolstone Medical Centre 06-Dec-18 7559 5840 557 10% 7%Wells Park Surgery 22-Nov-18 11745 8521 751 9% 6%Vale Medical Centre 21-Mar-19 13852 11234 788 7% 6%

Mod

ality

Le

wis

ham South Lewisham Group Practice 21-Feb-19 16375 12674 1449 11% 9%

Bellingham Green Surgery 21-Feb-19 7559 5637 149 3% 2%The Jenner Practice 21-Feb-19 15017 11758 2 0% 0%

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Registrations by PCN

PCN Practice Raw List Size

Eligible Patients over 16

No. of Registrations of Adults over 16

% of Registrations of Adults over 16

% of Registrations of

List Size

Sevenfields 60724 45943 4852 11% 8%Lewisham Care Partnership 58283 46953 4857 10% 8%Aplos Health 50651 39099 3597 9% 7%North Lewisham 71855 60284 4475 7% 6%Modality Lewisham 38951 30069 1600 5% 4%Lewisham Alliance 52095 41608 1966 5% 4%Grand Total 332559 263956 21347 8% 6%

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Monthly Registration

0

5000

10000

15000

20000

25000

Sep

20

18

Oct

20

18

No

v 2

01

8

Dec

20

18

Jan

20

19

Feb

20

19

Mar

20

19

Ap

r 2

01

9

May

20

19

Jun

20

19

Jul 2

01

9

Au

g 2

01

9

Sep

20

19

Oct

20

19

No

v 2

01

9

286 664 1243 19602961

52936546

7801

10562

1352215844

18628 1938520583

21568

27 of 119

Gender of Registrations

Male, 8649, 40%

Female, 12919,

60%

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Age Bands

GP Practices Lewisham Population16-17

1%

18-2412%

25-3423%

35-4422%

45-5420%

55-6414%

65-746%

75-841%

Over 851%

Age Groups

16-17

18-24

25-34

35-44

45-54

55-64

65-74

75-84

Over 85 0 10000 20000 30000 40000 50000 60000 70000

16-17

18-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

3%

9%

7%

8%

9%

9%

8%

2%

5%

6371

28068

67237

60680

46232

33187

17131

10155

4099

16-17 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

ASK NHS GP App patients 212 2588 4961 4745 4314 3020 1294 219 216

Lewisham Patients 6371 28068 67237 60680 46232 33187 17131 10155 4099

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Activity – Time

08:00 - 13:00, 1909, 43%

13:01 - 18:30, 956, 21%

18:31 - 00:00, 1035, 23%

00:01 - 07:59, 587, 13%

08:00 - 13:00

13:01 - 18:30

18:31 - 00:00

00:01 - 07:59

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Activity – Day 0 200 400 600 800 1000

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

19%, 853

15%, 699

14%, 635

17%, 742

15%, 715

9%, 436

11%, 473

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Menu Utilisation

GP

0 -

Imm

edia

te 1

: 9

99

, 86

, 6%

GP1 - Immediate 2: 4 hours

17%

GP2 - Urgent: 8 hours, 304, 23%

GP3 -Moderate: 12-

36 hours, 357, 27%

GP4 - Routine: 36-72 hours,

197, 15%

NONE: Self-Care, 165, 12%

About Ask NHS,

206, 5%

Admin Request,419, 9%

Manage My Appointments,

1038, 23%

Self-Care, 572, 13%

Service Finder, 198, 4%

Symptom Checker, 2054,

46%

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Top 5 Admin Requests

0 10 20 30 40 50

Request a medical examination

General administrative query

Fit or sick note

Nurse request

Request a GP letter

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Primary Care Commissioning Committee (PCCC) Tuesday 17th December 2019

Enclosure: 5 Primary Care Operational Group (PCOG): Chairs Report

Report from: Dr Jacky McLeod, Clinical Director, Primary Care Lead and Chair of PCOG PCOG date: Thursday 5th December 2019 Managerial Lead: Ashley O’Shaughnessy, Deputy Director of Primary Care Author: Chima Olugh, Commissioning Manager

Introduction The Primary Care Operational Group (PCOG) meets monthly to oversee and manage the day to day business associated with commissioning and contracting of all primary care activity and reports to the Primary Care Commissioning Committee. Key highlights from the last meeting are as follows: 1. Primary Care Priority Actions

1.1 As raised at the November 2019 Integrated Governance Committee, the Group discussed specific CCG priority actions which could help support and strengthen primary care.

1.2 Five identified actions are:

To support community services to use the EMIS clinical system which will help address delays, inefficiencies and risks to care of complex patients. This will also support the CCG integrated working strategy.

To improve the level of business as usual ICT support services delivered to GP practices. To move at least one community service area (e.g. dermatology or diabetes) into primary

care.

To revive the ‘making time in general practice’ work stream, which considers the impact others in the system have on primary care and how to better manage this.

To ensure primary care is visibly celebrated and recognized for its good work.

2. PMS Premium Improvement Plans

2.1 In line with the PMS Premium Contract and Performance Management Framework the CCG initiated the agreed improvement plan approach for the PMS Premium Key Performance Indicators and service specifications. 2.2 A letter has been sent to all practice Lead GPs requesting them to develop and submit one improvement plan to address all areas where there is non-delivery or practices have under-performed. 2.3 Submission deadline for improvement plans is Monday 6th January 2020. 3. Practice Merger - Brockley Road Medical Centre and Hilly Fields Medical Centre

The Group reviewed the draft merger business case and supporting improvement plan and endorsed this to go to the PCCC for formal approval.

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4. Ask NHS GP App – Communications and Engagement Plan

The Group reviewed the detailed Communications and Engagement Plan for the Ask NHS GP App developed by One Health Lewisham and were assured by the content and approach. 5. Next meeting

The next Primary Care Operational Group is scheduled for the 9th January 2020.

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1 | P a g e P C C C D E C 2 0 1 9

PCCC Primary Care Commissioning Committee Tuesday 17 December 2019

ENCLOSURE 6: Practice Merger Business Case - Hilly Fields Medical Centre and Brockley Road Medical Centre

MANAGERIAL LEAD: Diana Braithwaite, Director of Commissioning & Primary Care

AUTHOR: Nick Langford – Assistant Head of Primary Care, South East London Primary Care Team

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to approve

1. the merging of the patient lists for Hilly Fields Medica Centre and Brockley Road Medical Centre from 27 January 2020;

2. the closing of the Brockley Road Medical Centre site from 13 March 2020; It is recommended that the PCCC support as follows: Agreement to the proposed partnership being reflected in the PMS agreement, the contractual merger and contractualisation of the service improvement plan, subject to:

1. Feedback from Lewisham LMC 2. Lewisham PCCC endorsing the stakeholder engagement plan, noting the report from that will

be shared with the PCCC at the relevant point in time The PCCC is also asked to approve the following financial assistance contributions:

1. Cost of patient mail out – centrally funded if within PCSE guidelines. 2. Costs associated with the merge of IT systems – £629 + VAT for the clinical system merger.

SUMMARY: This paper is to consider the request made to NHS Lewisham CCG by the Hillyfields Medical Centre (HFMC) and the Brockley Road Medical Centre (BRMC) to merge their contracts from 1 April 2020 and close the site at BRMC in order to operate solely from HFMC premises at 72 Adelaide Avenue, Brockley, London SE4 1JN. The BRMC site lease expires on 31st March 2020 and, in line with the Lewisham Care Partnerships 2016 strategy, this has given an opportunity to review estates, and by merging the lists it will allow the Partnership to start moving towards its wider plan of working at scale with fewer contracts with larger patient lists. The Partnership has included within its business case an update on the progress it has made since the Partnership was formed 2 ½ years ago, including strategic organisational and clinical performance oversight across it contracts, aligning its business processes and sharing of best practice, shared staff working across all sites, centralisation of its finances/Payroll and HR functions etc. The merged practice would have a combined list size of nearly 17,500. Both practices currently hold separate PMS contracts with NHS Lewisham CCG and are located 0.9 miles apart with adequate transport services between them.

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2 | P a g e P C C C D E C 2 0 1 9

The strategic drivers that support this scheme are to: 1. Provide a modern fit for purpose premises for BRMC patients; 2. Ensure the long-term viability of the merged practice and divert financial resources to quality

care and patient experience; 3. Provide increased and a different range of opening hours for BRMC patients; 4. Ensure a more efficient use of clinical space at HFMC and allow the practice to grow and

expand clinical services; 5. Enable the Lewisham Care Partnership to offer new workforce and development opportunities

across the organisation; and 6. Support the NHS England and Lewisham CCG’s strategy for larger practices delivering a

wider range of services from a central accessible location. There are further savings to the premises budget in the order of £40,053.00 per annum through pass through rent and rates. The financial support is made up of the following estimates costs as follows:

1. Mail Out Costs – nil as long as the patient letter meets PCSE specifications; 2. ICT Costs - £629 + VAT for the clinical system merger.

KEY ISSUES: • The lease for Brockley Road is due to expire at the end of March 2020, and the building is not

ideal for the delivery of primary care services, given it is not DDA compliant, and is a converted house and not a purpose-built health facility.

• Hillyfields Medical Centre is currently not being used to full capacity;

• The merging of the practices will provide savings for the merged practice in relation to the reduction of overheads and increased efficiency.

• The Partnership has been working towards its 2016 business plan and has made progress in a number of areas as detailed in the business case.

• The merging of the contracts aligns with the Lewisham Care Partnerships wider strategy of working at scale with fewer contracts with larger patient lists.

• The merging of the practices will release savings to the Lewisham CCG of circa £40,053.00 through pass through rent and a reduction in overheads.

• The proposal aligns to the CCG estates strategy

• There are a number of alternative practices within 1 mile for patients to choose to register with, if the proposed relocation is agreed and patients would prefer not to move with the practice to the new site, with 4 out of 5 local practice confirming capacity for up to 6,000 patients.

• There is a clear service improvement plan in place, which has been agreed with officers, which addresses any differences in performance between the practices.

• Initial patient engagement and engagement with stakeholders about the proposed move has been carried out, and there is a plan in place which includes further engagement, including vulnerable patients.

CORPORATE AND STRATEGIC OBJECTIVES: 1. Support the NHS England and Lewisham CCG’s strategy for larger practices delivering a

wider range of services from a central accessible location; 2. Alignment with Lewisham CCG’s estates strategy

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3 | P a g e P C C C D E C 2 0 1 9

CONFLICT OF INTEREST (CoI): There is a direct COI for Dr Majid as a partner of Hilly Fields Medical Centre/Brockley Road Medical Centre. As Such, Dr Majid will not take part in any discussions or the decision on this item.

CONSULTATION HISTORY: Primary Care Operational Group.

PUBLIC ENGAGEMENT: Lewisham Healthwatch. Healthier Communities Select Committee.

HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: Equality Analysis Screening undertaken and no adverse impacts have been identified.

RESPONSIBLE MANAGERIAL LEAD CONTACT: Name: Diana Braithwaite; Email: [email protected]

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1

Enclosure 6a: CRITERIA FOR CONSIDERING A REQUEST FOR PRACTICE MERGER

London Region

Practice Name Hilly Fields Medical Centre PMS G85055 Lewisham CCG Practice Name Brockley Road Medical Centre PMS G85048 Lewisham CCG Date Application made: 2 December 2019 Region: London Report template completed by Julie Partridge & Nick Langford Date completed 11 December 2019

ASSESSMENT CRITERIA ATTACHMENTS PRESENTATION OF CASE

Background in respect of each of the practices

Business Case

Hilly Fields Medical Centre (HFMC) and Brockley Road Medical Centre (BRMC) wish to merge their PMS contracts from 1 April 2020 and close the site at BRMC to operate solely from HFMC premises from 1 April 2020. The list merger will occur on 27 January 2020. Dr G Malde, Dr R Sharma, Dr F Majid, Dr L Emordi, Dr M Adesi, Dr O Oduwaiye and Dr O Sobolewski are the same signatories for both contracts. It is proposed that the BRMC premises are vacated from 13 March 2020 to allow time for any dilapidations to be made good when the building is handed back to the landlord by the end of lease date on the 31 March 2020.

All future services will be provided from the HFMC premises at 72 Adelaide Avenue, Brockley, London SE4 1JN and the merged practice would have a combined list size of over 17,500 patients.

HFMC and BRMC are members of The Lewisham Care Partnership and are currently working under a ‘super partnership model’, each retaining their current Personal Medical Services (PMS) contracts, which the Lewisham Care Partnership holds in trust.

Both practices are located 0.9 miles apart.

Information about local demography and capacity of surrounding practices to accept patients

Demonstrated

in Business Case

Both BRMC and HMRC practices are located in the Brockley ward in Lewisham. In the 2011 census the population of BRMC was 17,156 and is made up of approximately 50% females and 50% males. The average age of people in Brockley is 33, while the median age is lower at 31. 60.2% of people living in Brockley were born in England. Other top answers for country of birth were

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2

Capacity Audit

3.2% Nigeria, 3.2% Jamaica, 1.8% Ireland, 1.6% South America, 1.6% India, 1.4% Scotland, 1.0% China, 1.0% Ghana, 0.9% Wales. 82.4% of people living in Brockley speak English. The other top languages spoken are 2.0% French, 1.5% Spanish, 1.3% Polish, 1.0% Portuguese, 0.9% All other Chinese, 0.8% Italian, 0.8% German, 0.7% Turkish, 0.4% Tamil. The patients of both practices are broadly similar demographically; HFMC has slightly more patients over the age of 65 (12.7% v. 10.2%). BRMC has a larger cohort of BAME patients (39.1% v 26.7%). Work will be done to identify any particular needs with this group so that they can be carried into the merged practice. Deprivation scores are fairly similar (21.67 v 18.98) for HFMC and BRMC respectively, and in line with the CCG average (28.6). The patients of HRMC are typically concentrated within the immediate area of the practice as indicated in the heat map contained within Appendix 1. When the two current boundaries are overlaid, the area covered by both will be the merged practices patient boundary.

There are adequate transport links between HFMC and BRMC. The 122 bus runs door to door and takes no more than 10/15 minutes. It is approximately an 18-minute walk between both sites.

Following a review of the capacity and quality of 5 practices within 1 mile of BRMC: • All practices have open lists; • There is confirmed capacity at the 4 out of 5 local practices to register up to 6,000 patients.

One practice confirmed that its list was open and didn’t specify a maximum, but an analysis of the practice boundary against that of BRMC shows that around 419 patients reside within its boundary. One practice confirmed that its list is open but has been unable to confirm the number of patients that it is able to register within its current resources. A verbal update will be provided to the committee in this regard.

• CQC – 4 of the local practices are rated as ‘Good’ by the CQC. Was is rated ‘Good’ + ‘outstanding’ in one area and another is rated ‘Good’ + ‘outstanding’ in 2 areas.

• FFT - Were data is available, all practices perform better than Brockley Road Surgery • GPPS question “Would describe their experience of this GP practice as good” - 5 practice

perform better than or within 10% of Brockley Road 1 performs 10% less than Brockley Road. • GPPS Question “Find it easy getting through on phone” - All practice perform the same as, or

better than Brockley Road • GPPS Question “Are satisfied with the general practice appointment times available” - 5

practice perform better than or within 10% of Brockley Road and 1 performs 10% less than Brockley Road

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3

What are the strategic benefits of agreeing a merger and do they meet the criteria set out above

Demonstrated in Business Case

The strategic drivers that support this scheme are to: • Provide a modern fit for purpose premises for BRMC patients; • Ensure the long-term viability of the merged practice and divert financial resources to quality

care and patient experience; • Provide increased and a different range of opening hours for BRMC patients; • Ensure a more efficient use of clinical space at HFMC and allow the practice to grow and

expand clinical services; • Enable the Lewisham Care Partnership to offer new workforce and development opportunities

across the organisation; and • Support the NHS England and Lewisham CCG’s strategy for larger practices delivering a

wider range of services from a central accessible location.

Revenue Implication/ Capital Requirements

Business Case & Appendices

The Practice merger together with the closure of BRMC will make financial savings for both the merged Practices and Lewisham CCG. Lewisham Care Partnership has indicated in its Business Case that there will be financial savings for the practice in relation to greater efficiency through working at scale, and reduction of overheads. There are further savings to the premises budget in the order of £40,053 per annum through pass through rent and rates. The practice has indicated in its business case that it will present a business case to officers, at the relevant point in time, to request capital to form a centralised hub for delivery of back office functions. This will enable space currently used for non-clinical work across the sites of the Partnership to be freed up and use for clinical service delivery The financial support is made up of the following estimates costs as follows:

• Mail Out Costs – nil as long as the patient letter meets PCSE specifications; • ICT Costs - £629 +VAT for the clinical system merger.

Performance of the individual Contractors within each practice

The Medical Directorate has confirmed that currently no issues have been identified that might affect the ability of the new merged list practice to hold a PMS contract.

Practice performance


NHS Digital

The following has been listed by Year, % achievement and England average difference

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4

Performance Data

QOF Results

QOF Year Hillyfields % Brockley % CCG Average

2014/2015 435.44/559 77.9% 491.63/559 87.8% 94.7% 2015/2016 511.96/559 91.6% 530.89/559 90.7% 94.2% 2016/2017 544.98/559 97.5% 554.78/559 99.3% 96.8% 2017/2018 548.38/559 98.1% 555.56/559 99.4% 97.3% 2018/2019 531.60/559 95.10% 539.92/559 96.43% 96.87%

The above indicates that Brockley Road is achieving at or above the CCG average and has improved over time. Hillyfields is slightly below the CCG Average but has also improved over time and up to 2018/19 was also achieving above the CCG Average. This shows that Hillyfields should not be inheriting any particular performance issues from Brockley Road in relation to QOF indicators. Practice Performance In the Public Health Outcomes Reports 2018-19 Hillyfields & Brockley Road achieved the following:

PH Indicators Hillyfields Brockley Road

CCG Average

National Average

Imms (2 years) 3 doses DTaP/IPV/Hib) 95% 93.1% 95% 91.1%

Imms (5 years) 1 dose DTaP/IPV booster 85.8% 83.9% 86% 95.6%

Cervical screening (age 25-64) 75.7% 73.5% 66% 72.0% Flu (over 65s) 58.8%* 56.2% 67.8% 72.6%

Flu (under 65s at risk) 39.5%* 36.6% 68% 48.9% Pneumococcal, over 65s 73% 74.5% 72.3% 69.5%

Both HFMC and BRMC are below the national average for Imms (5 years) and below the national average for both flu categories.

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5

Contractual Issues

GP Patient Survey 2019

Practice Achievement Hillyfields 12 Level 1 Triggers 0 Level 2 Triggers Brockley 7 Level 1 Triggers 0 Level 2 Triggers There are no contractual concerns for either provider held on file. The overall service improvement plan provided by the practice includes measures to be put in place to across a number of clinical indicators which have bene identified by the provider and officers. The improvement plan has been reviewed and aligns with the improvements identified by officers during their review of performance data relating to the two practices. BRMC ratings in relation to patient experience are not all equal to or above the national average. The practice is above the national average for patient experience in finding the receptionists at the Practice helpful; waiting 15 minutes or less after their appointment time to be seen at their last general practice appointment; had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment; but are well below the national average for being satisfied with the general practice appointment times available; and agreeing that the healthcare professional they saw or spoke to was good at giving them enough time during their last general practice appointment. Whereas patient experience ratings for HFMC were all equal or below the national average with scores relating to patient’s experience of making an appointment; finding it easy to get through to the GP Practice by phone; patients describing their overall experience of this GP practice as good; being treated by the healthcare professional with care and concern and the healthcare professional recognising or understanding mental health needs being well below the national average.

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6

CQC

The practice has included an improvement plan which addresses these areas of underperformance within its business case. HFMC had a full inspection by CQC on 25th August 2016 under the new method of inspection and was issued with a Good rating with one area of improvement needed. A focussed inspection took place on 20th April 2017 found that the required improvements had been made and the practice was rated overall as Good. BRMC had a full inspection on the 8 November 2016 and was issued with Good ratings across all domains, and Good overall.

Will the merger result in services being provided from premises that are fit for purpose in accordance with minimum standards set out in 2013 GMS Premises Costs Directions, or that have a Business Plan to achieve within no more than 12 months

Business Case

Brockley Road Medical Centre The BRMC site is privately owned and the lease expires on 31st March 2020. This has provided the Lewisham Care Partnership with an opportunity to review its estates strategy. As identified in the business case, the building is not ideal for the delivery of primary care services, given it is not DDA compliant, and is a converted house and not a purpose-built health facility.

Hilly Fields Medical Centre HFMC is in a completely modernised GP Practice; is DDA compliant and has an onsite pharmacy. The practice has 16 clinical rooms and there is capacity to accommodate the transfer of patients from BRMC. This will be further supported by a further review of working practices to enable clinical rooms to be freed up when not needed i.e. use of hot desks for non-patient facing work.

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7

Has specified a clear plan of service improvements that will arise as a result of the merger


Lewisham Care Partnership recognises a difference in performance on a number of indicators and has produced an action plan to address these as part of the merger. All patients will benefit from the increased choice of GPs and Nurses. BRMC patients will benefit from the relocation to HFMC as it is a more modernised and fit for purpose building which is DDA compliant and is within reasonable walking distance or convenient public transport services from the previous location of their practice.

What are the views of patients, the CCG, LMC & Lewisham Health Watch on the proposed merger

Business Case

Patient Views BRMC and HFMC have a joint Patient Participation Group (PPG). Since 2016, they have been kept fully informed of the potential merger and working across fewer sites which the PPG endorses. The Partnership has started initial engagement with patients, including vulnerable patients and relevant stakeholders and have carried out surveys at both practices, including using a dedicated email address and notices on the website which was advertised with notices in both waiting rooms.

32 emails were received with one response in favour of the merger. Themes relating to access to appointments, staff redundancies, the location of the proposed site and the impact on vulnerable patients have been included in the business case and responses have been set out.

28 questionnaires were returned by patients, which included targeted vulnerable/housebound patients and carers. 14 responses were received. A breakdown of the survey has been included in the business case and the and the Partnership has included a patient and stakeholder engagement plan, which will include further engagement to address the views of patients, as well as working with vulnerable patients to support them through the process including registering with another practice if this is their choice. In addition, the provider will provide a post-merger report to officers on progress and key issues that were highlighted and have been addressed by the Partnership.

A patient-led public petition regarding the closure was compiled and the Partnership met with the patient to discuss the concerns and the reason for the merger/site closure. Concerns were raised regarding continuity of care and the Partnership explained that no staff would be made redundant and that all staff would transfer to the proposed new site. Concerns were also raised regarding travel

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8

between sites which were addressed. The patient confirmed that he will continue with the collect signatures

Wider stakeholder engagement will commence on approval of the business case, which the Partnership has included in its plans.

Healthwatch Lewisham has fed back to officers that it recognises that practices are having to merge for many different reasons. HW has met regularly with the CCG which has kept HW abreast of the development of the proposed merger. HW recognises that both of the GP Practices that are involved in this merger have been working together for some time now and that one of the reasons for this merger is that the lease at Brockley Road Surgery is coming to an end. HW recognises that other challenges to this merger are being addressed and mitigating actions put in place, and that these actions are being shared with patients, carers and their families. Should the merger be approved, HW has stated that it has been assured that there is a commitment to continue this engagement and that there has been a good process put in place to support vulnerable patients through the merger. The chair of the Health Communities Select Committee (HCSC) and local MP Vicky Foxcroft have also been briefed on the proposed merger. Commissioners will write to all registered patients providing information regarding how to register with another provider if they choose to, and providing details of other practices within the vicinity. With regard to patient choice, patients will be able to choose to continue to receive services from the merged practice at the location of BRMC, or register with any of the other practices located within one mile if they prefer as follows:

Name Contract Borough Distance (NHS Choices)

Honor Oak Group Practice PMS Lewisham 0.4 Jenner Health Centre PMS Lewisham 0.7 Novum Health Partnership - Rushey Green PMS Lewisham 0.9 Woolstone Medical Centre PMS Lewisham 1.0 Forest Hill Group Practice PMS Southwark 1.0

Subject to the Primary Care Commissioning Committee’s approval of this Business Case, the two Practices will commence their formal meetings and consultations with both sets of patients through their respective PPG forums, a wider patient consultation and publication of an information leaflet/Q&A to patients.

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As part of the practices plans, formal patient engagement events will be arranged once the merger and closure is approved to further understand the views of the patients with regard to services and improvements they would like to see as a result of the merger. This will also cover support for vulnerable, elderly and housebound patients.

Region recommendation to the Panel (will be subject to patient engagement)

The Primary Care Commissioning Committee is asked to approve:

1. the merging of the patient lists for Hilly Fields Medica Centre and Brockley Road Medical Centre from 27 January 2020;

2. the closing of the Brockley Road Medical Centre site from 13 March 2020;

It is recommended that the PCCC support as follows:

Agreement to the proposed partnership being reflected in the PMS agreement, the contractual merger and contractualisation of the service improvement plan, subject to:

1. Feedback from Lewisham LMC 2. Lewisham PCCC endorsing the stakeholder engagement plan, noting the report from that will

be shared with the PCCC at the relevant point in time

The PCCC is also asked to approve the following financial assistance contributions:

1. Cost of patient mail out – centrally funded if within PCSE guidelines. 2. Costs associated with the merge of IT systems – £629 + VAT for the clinical system merger.

Date of the Committee December 17 2019 Outcome: Please delete

as appropriate Approved / Approved with Conditions/ Rejected

Feedback from the Committee Please insert Panel Members: Please insert

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Appendix 1

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Enclosure 6b

Practice profiles

Hilly Fields Medical Centre And

Brockley Road Medical Centre November 2019

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Contents

Practice age profiles ..................................................................................................................................................................................................................... 3

G85048 The Brockley Road Surgery Patient location / numbers of registered patients ............................................................................................................. 4

G85055 Hilly Fields Medical Centre Patient location / numbers of registered patients ............................................................................................................. 5

Merged patient heatmap of G85048 and G85055 ...................................................................................................................................................................... 6

Boundary area of G85048 Boundary area of G85055 ........................................................................................................................................................ 7

Merged boundary areas of G85048 and G85055 ........................................................................................................................................................................ 8

Merged Patient Heatmap and boundary areas of G85048 and G85055 ..................................................................................................................................... 9

Quality and Outcomes Framework 2018/19 ............................................................................................................................................................................. 10

NHS Choices ............................................................................................................................................................................................................................... 10

CQC............................................................................................................................................................................................................................................. 10

GP Patient Survey summary – July 2019 .................................................................................................................................................................................... 11

GP Patient Survey comparison – July 2019 ................................................................................................................................................................................ 13

General Practice Indicators – Hilly Fields and Brockley Road comparison (2019 Data Refresh) ............................................................................................... 21

Delivery of services .................................................................................................................................................................................................................... 26

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Practice age profiles

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G85048 The Brockley Road Surgery Patient location / numbers of registered patients

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G85055 Hilly Fields Medical Centre Patient location / numbers of registered patients

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Merged patient heatmap of G85048 and G85055

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Boundary area of G85048 Boundary area of G85055

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Merged boundary areas of G85048 and G85055

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Merged Patient Heatmap and boundary areas of G85048 and G85055

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NHS Choices

Hilly Fields Medical Centre – 2.5 Stars based on 29 ratings Brockley Road Medical Centre – 3 Stars based on 16 ratings CQC Hilly Fields Medical Centre – overall GOOD (20th April 2017) Brockley Road Medical Centre – overall GOOD (8th November 2016)

Quality and Outcomes Framework 2018/19

Practice Total QOF points

Hilly Fields Medical Centre 531.58 out of 559 points

Brockley Road Medical Centre 539 out of 559 points

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GP Patient Survey summary – July 2019

Hilly Fields Medical Centre summary

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Brockley Road Medical Centre summary

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GP Patient Survey comparison – July 2019

Hilly Fields Medical Centre The Brockley Road Surgery

% of patients who find it easy to get through to this GP practice by phone

39% Local (CCG) average: 61%

National average: 68%



% of patients who find the receptionists at this GP practice helpful





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% of patients who are satisfied with the general practice appointment times available





% of patients who usually get to see or speak to their preferred GP when they would like to





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% of patients who were offered a choice of appointment when they last tried to make a general practice appointment





% of patients who were satisfied with the type of appointment they were offered





% of patients who took the appointment they were offered





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% of patients who describe their experience of making an appointment as good





% of patients who waited 15 minutes or less after their appointment time to be seen at their last general practice appointment





% of patients who say the healthcare professional they saw or spoke to was good at giving them enough time during their last general practice appointment





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% of patients who say the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment





% of patients who say the healthcare professional they saw or spoke to was good at treating them with care and concern during their last general practice appointment





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% of patients who were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment





% of patients who had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment





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% of patients who felt the healthcare professional recognised or understood any mental health needs during their last general practice appointment





% of patients who felt their needs were met during their last general practice appointment





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% of patients who say they have had enough support from local services or organisations in the last 12 months to help manage their long-term condition(s)





% of patients who describe their overall experience of this GP practice as good





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General Practice Indicators – Hilly Fields and Brockley Road comparison (2019 Data Refresh)

Clinical Domain Practice Indicator Name Time Period Trigger Denominator. Numerator. Value.

Coronary heart disease The Brockley Road Surgery % AF anticoagulation therapy CHADS2-VASc score >1 2017/18 No Trigger 35 26 74.3

Coronary heart disease Hilly Fields Medical Centre % AF anticoagulation therapy CHADS2-VASc score >1 2017/18 No Trigger 80 59 73.8

Medicines Management The Brockley Road Surgery

% antibiotics Co-amoxiclav, Cephalosporins, Quinolones 2019/20 Q1 No Trigger 1832 153 8.4

Medicines Management Hilly Fields Medical Centre

% antibiotics Co-amoxiclav, Cephalosporins, Quinolones 2019/20 Q1 Level 1 4967 551 11.1

Respiratory The Brockley Road Surgery % Asthma RCP assessment 2017/18 Positive 198 166 83.8 Respiratory Hilly Fields Medical Centre % Asthma RCP assessment 2017/18 Positive 612 516 84.3

Respiratory The Brockley Road Surgery % Asthma variability reversibility 2017/18 No Trigger 64 59 92.2

Respiratory Hilly Fields Medical Centre % Asthma variability reversibility 2017/18 No Trigger 167 145 86.8

Coronary heart disease The Brockley Road Surgery % CHD cholesterol 5 mmol/l or less 2017/18 No Trigger 68 46 67.6

Coronary heart disease Hilly Fields Medical Centre % CHD cholesterol 5 mmol/l or less 2017/18 No Trigger 194 119 61.3

Public Health The Brockley Road Surgery % Child Imms DTaP/IPV/Hib (age 1 year) 2017/18 Level 1 104 95.999904 92.3

Public Health Hilly Fields Medical Centre % Child Imms DTaP/IPV/Hib (age 1 year) 2017/18 Level 1 161 148.999865 92.5

Public Health The Brockley Road Surgery % Child Imms Hib/MenC booster 2017/18 Level 1 107 96.999994 90.7

Public Health Hilly Fields Medical Centre % Child Imms Hib/MenC booster 2017/18 Level 1 192 180.999936 94.3

Public Health The Brockley Road Surgery % Child Imms MMR (Age 2 yrs) 2017/18 Level 1 107 99.999953 93.5

Public Health Hilly Fields Medical Centre % Child Imms MMR (Age 2 yrs) 2017/18 Level 1 192 180 93.8

Public Health The Brockley Road Surgery % Child Imms PCV Booster 2017/18 Level 1 107 99.999953 93.5

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Public Health Hilly Fields Medical Centre % Child Imms PCV Booster 2017/18 Level 1 192 177.999936 92.7

Respiratory The Brockley Road Surgery % COPD review dyspnoea scale 2017/18 No Trigger 34 33 97.1

Respiratory Hilly Fields Medical Centre % COPD review dyspnoea scale 2017/18 No Trigger 103 98 95.1

Diabetes The Brockley Road Surgery % Diabetes BP reading 140/80 mmHg or less 2017/18 No Trigger 158 126 79.7

Diabetes Hilly Fields Medical Centre % Diabetes BP reading 140/80 mmHg or less 2017/18 Level 1 483 363 75.2

Diabetes The Brockley Road Surgery % Diabetes cholesterol 5 mmol/l or less 2017/18 No Trigger 177 134 75.7

Diabetes Hilly Fields Medical Centre % Diabetes cholesterol 5 mmol/l or less 2017/18 Level 1 479 358 74.7

Diabetes The Brockley Road Surgery % Diabetes IFCC-HbA1c 64 mmol/mol or less 2017/18 No Trigger 201 172 85.6

Diabetes Hilly Fields Medical Centre % Diabetes IFCC-HbA1c 64 mmol/mol or less 2017/18 Level 1 480 383 79.8

Mental Health The Brockley Road Surgery % first choice generic SSRIs 2019/20 Q1 No Trigger 1819 1302 71.6 Mental Health Hilly Fields Medical Centre % first choice generic SSRIs 2019/20 Q1 No Trigger 4402 2788 63.3

Coronary heart disease The Brockley Road Surgery % Hypertension BP reading 150/90mmHg or less 2017/18 Positive 508 453 89.2

Coronary heart disease Hilly Fields Medical Centre % Hypertension BP reading 150/90mmHg or less 2017/18 Level 1 1148 876 76.3

Respiratory The Brockley Road Surgery % LTC patients who smoke 2017/18 No Trigger 916 143 15.6 Respiratory Hilly Fields Medical Centre % LTC patients who smoke 2017/18 No Trigger 2153 323 15 Respiratory The Brockley Road Surgery % LTC Smoker offer support 2017/18 No Trigger 143 142 99.3 Respiratory Hilly Fields Medical Centre % LTC Smoker offer support 2017/18 No Trigger 323 318 98.5

Mental Health The Brockley Road Surgery % MH comprehensive care plan 2017/18 Positive 36 36 100

Mental Health Hilly Fields Medical Centre % MH comprehensive care plan 2017/18 No Trigger 122 113 92.6

Medicines Management The Brockley Road Surgery % Naproxen and Ibuprofen 2019/20 Q1 No Trigger 559 405 72.5 Medicines Management Hilly Fields Medical Centre % Naproxen and Ibuprofen 2019/20 Q1 No Trigger 1760 1254 71.3

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Mental Health The Brockley Road Surgery % SMI alcohol record 2017/18 Positive 47 47 100 Mental Health Hilly Fields Medical Centre % SMI alcohol record 2017/18 No Trigger 131 122 93.1 Mental Health The Brockley Road Surgery % SMI BP record 2017/18 No Trigger 37 36 97.3 Mental Health Hilly Fields Medical Centre % SMI BP record 2017/18 No Trigger 136 124 91.2

Respiratory The Brockley Road Surgery % Smoking patients over 15 recorded 2017/18 No Trigger 4619 3560 77.1

Respiratory Hilly Fields Medical Centre % Smoking patients over 15 recorded 2017/18 No Trigger 9965 7982 80.1

Respiratory The Brockley Road Surgery % Smoking status recorded 2017/18 Positive 916 872 95.2 Respiratory Hilly Fields Medical Centre % Smoking status recorded 2017/18 No Trigger 2153 2026 94.1 Urgent Care The Brockley Road Surgery A&E Attendance Rates 2019/20 Q1 No Trigger 5531 2145 387.814 Urgent Care Hilly Fields Medical Centre A&E Attendance Rates 2019/20 Q1 No Trigger 12039 4573 379.848 Medicines Management The Brockley Road Surgery Antibacterial Items/Star Pu 2019/20 Q1 Positive 2895.367 1839 0.635 Medicines Management Hilly Fields Medical Centre Antibacterial Items/Star Pu 2019/20 Q1 Positive 6359.433 5004 0.787 Public Health The Brockley Road Surgery Cervical Screening 2018/19 Q4 Level 1 1689 1242 73.5 Public Health Hilly Fields Medical Centre Cervical Screening 2018/19 Q4 Level 1 3748 2839 75.7

Patient Experience The Brockley Road Surgery Confidence and trust in healthcare professional 2018/19 No Trigger 13.0498 13.0498 100

Patient Experience Hilly Fields Medical Centre Confidence and trust in healthcare professional 2018/19 No Trigger 35.43273 27.03104 76.3

Mental Health The Brockley Road Surgery Dementia Face to Face review 2017/18 Positive 17 16 94.1 Mental Health Hilly Fields Medical Centre Dementia Face to Face review 2017/18 Positive 84 77 91.7 Clinical Diagnosis The Brockley Road Surgery Detection rate Cancer 2017/18 No Trigger 11 8 0.727 Clinical Diagnosis Hilly Fields Medical Centre Detection rate Cancer 2017/18 Positive 31 22 0.71 Urgent Care The Brockley Road Surgery Emergency ACS Admissions 2019/20 Q1 No Trigger 5531 64 11.571 Urgent Care Hilly Fields Medical Centre Emergency ACS Admissions 2019/20 Q1 No Trigger 12039 159 13.207 Urgent Care The Brockley Road Surgery Emergency Admissions 2019/20 Q1 No Trigger 5531 387 69.969 Urgent Care Hilly Fields Medical Centre Emergency Admissions 2019/20 Q1 No Trigger 12039 861 71.517

Urgent Care The Brockley Road Surgery Emergency Asthma Admissions 2019/20 Q1 No Trigger 233 2 0.858

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Urgent Care Hilly Fields Medical Centre Emergency Asthma Admissions 2019/20 Q1 No Trigger 699 14 2.003

Urgent Care The Brockley Road Surgery Emergency Cancer Admissions 2019/20 Q1 Level 1 105 19 18.095

Urgent Care Hilly Fields Medical Centre Emergency Cancer Admissions 2019/20 Q1 No Trigger 220 14 6.364

Urgent Care The Brockley Road Surgery Emergency CHD Admissions 2019/20 Q1 No Trigger 91 4 4.396 Urgent Care Hilly Fields Medical Centre Emergency CHD Admissions 2019/20 Q1 No Trigger 214 19 8.879 Urgent Care The Brockley Road Surgery Emergency COPD Admissions 2019/20 Q1 Positive 47 1 2.128 Urgent Care Hilly Fields Medical Centre Emergency COPD Admissions 2019/20 Q1 No Trigger 130 9 6.923

Urgent Care Hilly Fields Medical Centre Emergency Dementia Admissions 2019/20 Q1 No Trigger 90 1 1.111

Urgent Care The Brockley Road Surgery Emergency Diabetes Admissions 2019/20 Q1 No Trigger 241 1 0.415

Urgent Care Hilly Fields Medical Centre Emergency Diabetes Admissions 2019/20 Q1 No Trigger 581 8 1.377

Patient Experience The Brockley Road Surgery Frequency seeing preferred GP 2018/19 No Trigger 24.35321 8.41469 34.6

Patient Experience Hilly Fields Medical Centre Frequency seeing preferred GP 2018/19 No Trigger 64.7864 17.22322 26.6

Patient Experience The Brockley Road Surgery

Healthcare professional treating with care and concern 2018/19 No Trigger 68.07601 54.54292 80.1

Patient Experience Hilly Fields Medical Centre

Healthcare professional treating with care and concern 2018/19 Level 1 145.22736 109.58466 75.5

Medicines Management The Brockley Road Surgery Hypnotics ADQ/Star Pu 2019/20 Q1 No Trigger 11348.567 7876 0.694 Medicines Management Hilly Fields Medical Centre Hypnotics ADQ/Star Pu 2019/20 Q1 No Trigger 26310.567 12144 0.462 Medicines Management The Brockley Road Surgery Oral NSAIDS ADQs/STAR-PU 2019/20 Q1 No Trigger 6083.1 14527.15 2.388 Medicines Management Hilly Fields Medical Centre Oral NSAIDS ADQs/STAR-PU 2019/20 Q1 No Trigger 14176.8 37116.148 2.618 Exception Rating The Brockley Road Surgery Overall Exception Rate 2017/18 Level 1 9313 987 0.106

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Exception Rating Hilly Fields Medical Centre Overall Exception Rate 2017/18 No Trigger 21937 1779 0.081

Patient Experience The Brockley Road Surgery Overall experience of your GP practice 2018/19 No Trigger 73.50349 51.88801 70.6

Patient Experience Hilly Fields Medical Centre Overall experience of your GP practice 2018/19 No Trigger 152.77396 99.74052 65.3

Patient Experience The Brockley Road Surgery Satisfaction with appointment times 2018/19 No Trigger 69.09216 34.33422 49.7

Patient Experience Hilly Fields Medical Centre Satisfaction with appointment times 2018/19 Level 1 138.5641 55.20484 39.8

Mental Health The Brockley Road Surgery Select antidepressants ADQs/STARPU 2019/20 Q1 Positive 119847.233 105649.498 0.882

Mental Health Hilly Fields Medical Centre Select antidepressants ADQs/STARPU 2019/20 Q1 Positive 267644.933 210510.12 0.787

Respiratory The Brockley Road Surgery Spirometry achievement 2017/18 Positive 19 19 100 Respiratory Hilly Fields Medical Centre Spirometry achievement 2017/18 No Trigger 66 61 92.4

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Delivery of services

Direct Enhanced Services, QOF and other services

Quality O

utcomes Fram

ework

Rotavirus

Learning Disabilities Health Checks

Pertussis (Pregnant wom

en)

Pneumococcal

Seasonal Influenza

Childhood Seasonal Influenza

Shingles (Routine)

Shingles (catch-up)

Meningococcal ACW

Y (MenACW

Y)

Meningococcal B (M

en B)

Meningococcal Booster Vaccination

HPV Booster Vaccination

Hep B (New

born babies)

MM

R (aged 16 and over)

PCV Hib/MenC Vaccination (optional)

Minor Surgery

Extended Hours

Chlamydia Screening

Dementia

Zoladex

Engagement LIS

Smoking Cessation

Hilly Fields Medical Centre

Brockley Road Medical Centre

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Enclosure 6c

Practice Merger Business Case

Hillyfields Medical

Centre And


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Application for consideration of a Contract Merger

1. Summary Practice Name Practice ODS

Code Contract Type Clinical

System Registered Population

CQC overall rating


G85048 PMS EMIS 5,593 Good

Hillyfields Medical Centre

G85055 PMS EMIS 11,911 Good

Which contract and G code do you propose that the newly merged practice will hold?

G85055

What is the proposed name of the new practice


What is the intended date of the merger and are there any time pressures associated with this?

Contractual/EMIS Merger: 27th January 2020 Brockley Road Medical Centre to be vacated on the 13th March 2020 to allow time for any dilapidations to be made good when building is handed back to landlord by end of lease on the 31st March 2020

What is the distance between practices?

0.9 mile on foot

Does the proposed newly merged practice boundary exclude any area(s) that were previously covered by either of the practice’s

No. Please see proposed new catchment area below which will be an amalgamation of the current catchment areas.

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original boundaries?

There are no de-registrations anticipated for existing patients.

Service Provision Practice Name

Premises Address Opening Hours

Brockley Road Medical Centre 47 Brockley Road London SE4 2PJ

Monday 07:00 – 18:30 Tuesday 07:00 – 18:30 Wednesday 08:00 – 19:00 Thursday 08:00 – 18:30 Friday 08:00 – 18:30 Saturday Closed (but access at Hilly Fields to nurse appointments 09:00-12:00) Sunday Closed

Hillyfields Medical Centre 172 Adelaide Avenue SE4 1JN

Monday 08:00 – 20:00 Tuesday 08:00 – 20:00 Wednesday 08:00 – 20:00 Thursday 08:00 – 18:30 Friday 08:00 – 18:30 Saturday 09:00 – 12:00 Sunday Closed

Are any changes planned to the existing premises It is proposed that the existing Brockley Road

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set-up Medical Centre site be vacated by the 31st March 2020 when the current lease expires. An options appraisal supporting this decision is included in appendix 1.

Which site will services be delivered from? Hilly Fields Medical Centre, 172 Adelaide Avenue, SE4 1JN

Are there any planned changes to the opening hours?

Yes. There will be an increase in opening times for Brockley Road Medical Centre patients including Saturday opening for GP appointments and Monday, Tuesday, Wednesday evenings. There will be an increase in opening times for Hilly Fields Medical Centre patients Monday and Tuesday between 7:00-8:00.

Are there any services currently provided by either practice that will not be provided by the newly merged practice?

No

Are there any Services NOT currently provided by either practice that WILL be provided by the newly merged practice?

Yes. Minor Surgery, which is currently provided by Hilly Fields, which will be available to Brockley Road patients.

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2. Business case for merger

A. SUMMARY

It is proposed that the registered patient list of the Brockley Road PMS contract is merged with the Hilly Fields PMS registered patient list, and that the Brockley Road site will be closed on 13th March 2020. This will create a single registered patient list of 17,504, retaining the Lewisham ODS code of G85055 operating out of the Hilly Fields Medical Centre site.

B. BACKGROUND

On 8th February 2017, the Lewisham Primary Care Joint Committee approved the formation of the Lewisham Care Partnership, which consists of the following practices:

• Hilly Fields Medical Centre • Brockley Road Medical Centre • St Johns Medical Centre • Honor Oak Group Practice • Modern Hill Surgery

On 30th March 2017, the Lewisham Primary Care Joint Committee approved the addition of the Belmont Hill Surgery to the Lewisham Care Partnership (TLCP).

These practices are currently working under a ‘super partnership model’, each retaining their current Personal Medical Services (PMS) contracts, which the Lewisham Care Partnership holds in trust.

The original vision for the Lewisham Care Partnership (detailed in the originally approved business case) included the intention for all 6 practices to eventually merge their PMS contracts. The ‘super partnership model’ allows practices to benefit from the integration of clinical services and economies of scale in relation to back office functions such as staff cover and overhead costs.

Some of the key aspirations of the super partnership model’ are to:

• Improve the quality of care and the experience of our patients; • Reduce our cost base thus freeing up financial resources to further enhance the quality

of care and patient experience; • Deliver a better work-life balance for our partners and staff; • Offer more flexible working arrangements for our partners and staff; • Offer new workforce and development opportunities across the organisation; • Be an exemplar employer; • Offer more services to our patients and better access to all services; • Work closely with both the CCG and One Health Lewisham to assess the changes

required to deliver health and care to our diverse and growing population; • Be innovative and seek out new ways of working whether it be clinical areas, IT or better

ways of communicating with our patients; • Actively seek out and share best practice; • Work with neighbouring practices who are not part of the super practice to ensure their

viability and sustainability and will always be open to expanding our super partnership

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should circumstances be right for all parties.

In the 2 ½ years since the original business care was approved there has been significant process made towards these aspirations including:

• TLCP board set up and providing strategic oversight across the partnership with representation across all sites

• Monthly clinical cabinet meetings across all sites to monitor clinical contract performance, quality and share best practice

• Monthly manager meetings across all sites (led my managing partner) to discuss operational issues

• Monthly nurse meetings across all sites to share best practice • All 23 Partners of The Lewisham Care Partnership have signed on to all the contracts

across all practices (i.e. all partners are on each practice contact). In addition, a delegated authority/mandate has been signed to allow the managing partner and one nominated GP to sign contract variations on behalf of the Partnership therefore streamline the management of the contract

• We have launched an overarching TLCP website and are working to align all practice-based websites to ensure consistency and sharing of best practice

• Since June 2017, all staff have been employed by TLCP which enables staff to work across sites providing flexibility as needed

• Finance has been centralised as well as payroll and HR which uses SNODEN OFFICE (an online application)

• Work is progressing towards central purchasing arrangements to further enhance efficiency and effectiveness

• We are planning to centralise clinical support functions (i.e. document handling, referrals, prescribing) to free up space to use for clinical use and to provide resilience

• We are also reviewing our telephony options and looking to implement a centralised call centre to cover all incoming patient calls

• We are also exploring secure home working for staff to support recruitment and retention and better work life balance

• We are working to expand and diversify the workforce (i.e. we already have 5 WTE pharmacists working across sites), including utilisation of the opportunities through the PCN DES additional roles reimbursement scheme

In addition, the Lewisham Care Partnership is also now a Primary Care Network in its own right which provides real opportunity to further enhance at scale working both in terms of core contract delivery and the services that will be commissioned and provided at a PCN level.

C. MERGER PROPOSAL

It is proposed that the registered patient list of the Brockley Road PMS contract is merged with the Hilly Fields PMS registered patient list, and that the Brockley Road site will be closed on 13th March 2020. This will create a single registered patient list of 17,504 retaining the Lewisham ODS code of G85055 operating out of the Hilly Fields Medical Centre site.

The rationale supporting this proposal are as follows:

The lease on the Brockley Road Medical Centre is due to expire on 31st March 2020, which has provided the Lewisham Care Partnership with an opportunity to review its estates strategy.

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The Brockley Road Medical Centre is a converted house and not a purpose-built health facility. It doesn’t meet full disability access to all floors.

Hilly Fields Medical Centre has been completely modernised as a GP practice, has disability access to all floors and has an onsite pharmacy.

Hilly Fields Medical Centre has 16 clinical rooms. Utilisation has been reviewed and there is capacity to accommodate the shift of patients from Brockley Road surgery. This will be further supported by a review of working practices to enable clinical rooms to be freed up when not needed i.e. use of hot desks for non-patient facing work. Hilly Fields is also leading the way in Lewisham/London with the shift to digital contact for patients (i.e. the ASK NHS GP APP, online booking, online repeat prescriptions) which will positively impact the volume of patients who may need to actually visit the practice in person. As described above, there are also plans to centralise clinical support functions across TLCP to free up space for clinical use.

TLCP are actively involved in strategic estates discussions across all our sites to consider any impacts of population growth and how this might be best managed.

Both Hilly Fields Medical Centre and Brockley Road Medical Centre are currently already run by the same Partners, share a practice manager and hold a joint Patient Participation Group (PPG) so there is already a large degree consistency and cross fertilisation across the sites.

Following the merger, there will be an increase in opening times for Brockley Road Medical Centre patients including Saturday opening for GP appointments and Monday, Tuesday, Wednesday evenings. There will also be an increase in opening times for Hilly Fields Medical Centre patients Monday and Tuesday between 7:00-8:00. The PPG has been asked to comment on the extended hours proposals for the merged practice. These will be displayed in both receptions and will form the basis of the request to the CCG/SEL for change of PCN extended hours service. Request to CCG/SEL for the amendments to the extended hours will be made mid-December, once the views of patients have been collated.

It is becoming increasingly difficult to adequately cover both sites with appropriate staff from all disciplines especially at short notice due to sickness etc and consolidating into one site will support this.

The transport links between Brockley Road and Hillyfields are good. The 122 bus runs door to door and takes no more than 10/15 minutes. It is a approx. 18-minute walk between sites.

The patient demographics are similar at both sites. See Practices profile paper for details

It is acknowledged there are some challenges around access on both sites and the gender mix of GPs needs to be addressed.

In regard to gender mix, delivering services from one site will enhance the opportunity to attract female GPs and concentrate the nursing specialists on one site. The need for increased female GPs will hopefully be met in a number of ways. Firstly, an advert saying that the site is underrepresented by female GPs and the second phase is to negotiate with current salaried female GPs within the Partnership to set up a rotational type arrangement

The access issues are mainly referenced around answering the telephone and the number of

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appointments. The telephone issue will be overcome by the installation of a Partnership wide telephony system and central call centre arrangement. It is hoped for installation Feb-July 2020. As mentioned, we are looking to increasingly support a shift to digital access which will support reduced unnecessary demand on practice appointments. We are also looking to diversify the workforce to support increased capacity including pharmacists, social prescribers and first contact physios as supported by the PCN DES. The centralisation of clinical resources on the Hillyfields site could also help to increase appointments as there will be no element of wasted travel time between sites which could be used to deliver more appointments.

Whilst Hilly Fields Medical Centre and Brockley Road Medical Centre are run by the same partners, Honor Oak Group Practice is in fact the nearest practice to Brockley Road Medical Centre. As explained above, the Honor Oak Group Practice is part of the wider Lewisham Care Partnership and is covered by the same culture, ethos and working practices indeed both clinical and non-clinical staff work are already shared across sites. Patients who did not want to travel to the proposed site would have the option to re-register at the Honor Oak Group Practice (or any other local practice) if this would be more convenient to them.

In line with the GP Forward View and the NHS England direction of travel, a merged practice would benefit from efficiencies through at scale working and would be more resilient going forward with an increased practice list, additional partners able to offer a better range of services, different appointment types and clinical staff to support future developments.

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Hilly Fields Medical Centre (PMS) Brockley Road Medical Centre (PMS)

Registered list

(Q3 19/20)

RAW PRACTICE LIST SIZE: 11917

PRACTICE WEIGHTED INDEX LIST SIZE: 11439

RAW PRACTICE LIST SIZE: 5560

PRACTICE WEIGHTED INDEX LIST SIZE: 4998

Partners Dr G Malde (0.6 WTE)

Dr R Sharma (0.6 WTE)

Dr F Majid (0.8 WTE)

Dr L Emordi (0.8 WTE)

Dr M Adesi (0.8 WTE)

Dr O Oduwaiye (0.6 WTE)

Dr O Sobolewski (0.6 WTE)

ALL PARTNERS MALE

Same Partners as Hillyfields

Staff Shared resource across both sites

Practice Manager – 1.00 WTE

Admin – 3.00 WTE

IT – 0.58 WTE

Reception – 5.13 WTE

Secretary – 1.90 WTE

Domestics – 1.78 WTE

Practice Nurse – 2.87 WTE

HCA – 1.00 WTE

See appendix 2 for more detail

Shared resource across both sites

Practice Manager – 1.00 WTE

Admin – 3.00 WTE

IT – 0.58 WTE

Reception – 5.13 WTE

Secretary – 1.90 WTE

Domestics – 1.78 WTE

Practice Nurse – 2.87 WTE

HCA – 1.00 WTE

Dedicated resource for Brockley Road

Reception/admin – 5.66 WTE

Admin – 0.85WTE

See appendix 2 for more detail

Languages spoken

Hindi , Gujarati, Bengali Hindi , Gujarati, Bengali

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Patient catchment areas

See practice profiles for current and proposed.

See practice profiles for current and proposed.

Patient demographics

38% - BME population 42% - BME population

Locality working

One of the Practices of The Lewisham Care Partnership (core contract delivery) and The Lewisham Care Partnership Primary Care Network (PCN)

Active member of One Health Lewisham

One of the Practices of The Lewisham Care Partnership (core contract delivery) and The Lewisham Care Partnership Primary Care Network (PCN)

Active member of One Health Lewisham

Services offered

Minor Surgery

Extended Hours

Chlamydia Screening

Dementia

NHS Health Checks

Zoladex

Engagement LIS

Smoking Cessation

Extended Hours

Chlamydia Screening

Dementia

NHS Health Checks

Zoladex

Engagement LIS

Smoking Cessation

See further information at appendix 2 (practice profiles)

D. ENGAGEMENT D1. Staff Engagement The engagement of all staff across The Lewisham Care Partnership has been of paramount importance since before the Partnership was officially formed in June 2017.

All staffs are employed by The Lewisham Care Partnership not individual sites and indeed already work across both sites that we are proposing to merge. Staffs from all practices move freely across the partnership sites covering gaps in the staffing rota both on a permanent and temporary basis.

The Managing Partner has engaged on a face to face basis with staff permanently based at Brockley Road to assure them that they will be moved to Hillyfields. He also talked to temporary staff to explain that whilst they had a temporary contract to work at Brockley Road the benefit of being part of a much larger group was that we would attempt to place them in suitable positions in one of our other sites.

All staff of TLCP are meeting on the 3rd December 2019 to discuss amongst other things this specific contract merger and future developments in bringing our current GP contracts into one

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contract. There are no planned redundancies as part of the merger. D2. Patient Engagement Brockley Road and Hillyfields Practices have for a good few years had a joint Patient Participation Group (PPG). They have been fully informed since before the partnership merger of the reasons for working at scale and the probability of sites closing and merging the patient services on fewer sites as the developments moved on. They fully endorse the need to concentrate the services on the best site acknowledging, particularly, the more efficient use of the workforce.

Please see appendix 3 which shows extracts from PPG meetings dating back to 2018 including a request that patients are kept informed and have the opportunity to comment on any merger plans (which has been provided) and explicit support for the merger proposal given on 15th October 2019.

Initial direct engagement of both practices wider patient population was undertaken in May/June 2019. A dedicated email address and notices on the website regarding the proposed changes were implemented (see appendix 4). This was also backed up with notices in both waiting rooms (see appendix 5) and comment sheets that could be returned to reception or handed in when convenient.

To date, 32 emails have been received regarding the merger/closer. There was one positive response in favour of the merger – key themes/issues from the other emails and responses to these can be found in the table below. All emails will be replied to referencing the evidence set out in this business case. This will be completed by the 1st December 2019.

No comments sheets were returned.

Further patient engagement took place during Mid November 2019 when patients attending Brockley Road were actively encouraged by reception staff to complete a questionnaire about the merger/closure. 28 questionnaires were returned.

The survey was also sent directly to 19 vulnerable patients, 34 housebound patients and 57 carers on 15th November 2019 to support maximum engagement and feedback (appendix 6). 14 responses to these targeted groups were received.

All responses are detailed in appendix 7/8 - the main findings are as follows and responses to issues identified are encapsulated in the table below.

• 20/33 were aware of the merger/closure proposal • 17/31 said they thought moving to Hilly Fields Medical Centre would give them transport

problems • 28/32 said yes to the question “The practice at Hilly Fields is open on Saturdays 9.00-

12.00 - is this useful for you?” • 30/32 said yes to the question “Extended hours are available at Hillyfields in the evening

- does this interest you?” • 29/32 said yes to the question “Minor Surgery is available at Hillyfields - is this a service

you would welcome?”

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We are also aware of the public petition that has been compiled in relation to the closure of the Brockley Road Medical Centre site. We appreciate the concerns that have been raised, but as explained in this business case, we do feel this is the right decision in the longer term for both patients and the partnership.

The TLCP Managing Partner has also had a face to face discussion with the patient who started the petition. He explained that whilst he understood the concerns of patients it would have been ideal if he had come in and discussed the aim of the petition when some of the reasons and mitigations could have been explained .The Managing Partner explained that the lease was running out and that the partnership did not receive full reimbursement and as such was spending money on the rent that could be used for clinical staff. The patient expressed a personal concern about the continuity of clinical care. It was pointed out that all staff, clinical and non-clinical would be moving to Hillyfields. He had slight concerns re transport but did recognise the 122 bus went door to door from the 2 sites. The outcome was that the patient said he would continue to collect signatures by going door to door asking residents to sign against the closure. The practice has been given a copy of the petition signatures. No attempt has been made to cross check these against current patients at Brockley Road Practice.

The main points that were raised in the petition, emails and survey and our responses to these are as follow:

Issue raised in petition

Number of emails that referenced the issue

Partnership response

Access to appointments

15 Plans to purchase a new telephony system and centralise management of incoming calls will improve patient experience. Hilly Fields is already leading the way in use of digital access to practices and will continue to do so. Increasing use of wider clinical team (pharmacists, physios) to increase capacity and support patients to get the best care, first time. Patients will have access to increased extended hours appointments including on Saturdays, early mornings and late evenings. Continued use of GPEA where appropriate.

Staff redundancies 8 There are no planned redundancies as a result of the merger

Reduction in access to GPs who speak other languages

0 All Brockley Road Medical Centre GPs will move across to the Hilly Fields Medical Centre site

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Location of Hilly Fields Medical Centre site

8 As part of the merger process all patients will be written to explain what is happening and their right to re-register with another local practice if that is what they choose. Patients who wish to stay under the care of the Lewisham Care Partnership can register with the nearby Honor Oak Group Practice if they do not wish to move to the Hilly Fields Medical Centre site. It is an approx. 18-minute walk between sites and there is a direct bus route between sites (122).

Access to home visits

0 There will be no impact on access to home visits following the merger.

Impact on vulnerable patients

4 Vulnerable patients will be directly identified and contacted by the practice to support them through the process including registering with another practice if this is their choice.

D3. Stakeholder Engagement There has been no direct contact with wider stakeholders other than patients. The direction of travel is the same as originally outlined in our wider business case which had wide stakeholder circulation prior to June 2017 merger. Once the business case has been approved full engagement with health partners, stakeholders and patients will take place. We are aware that the CCG have provided a briefing to the local MP (Vicky Foxcroft MP) and the Chair of the Healthier Communities Select Committee about the proposed merger following queries from constituents.

E. COSTS

Current rent reimbursement costs are as below:

• Hilly Fields Medical Centre rent and rates: £69,100.00 • Brockley Road Medical Centre rent: £38,300.00 • Brockley Road Medical Centre annual business rates: £1,753.00

There will be a saving to commissioners of the Brockley Road Medical Centre rent and rates but it is intended that negotiations between the Partnership and NHSE/CCG will enable an element of these savings to be used to support capital and/or revenue costs for the Partnership to form a centralised hub for delivery of back office functions. This will enable space currently used for non-clinical work across the sites of the Partnership to be freed up and use for clinical service delivery. An appropriate business case will be put forward at the relevant time to support this.

There will be a cost involved in the merging of the EMIS clinical system which will be met from the CCG IT budget (£629+VAT). Computer equipment currently used at Brockley Road Medical Centre will be utilised as appropriate across the Partnership.

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There will also be a cost for communicating the change to patients through a letter which will need to be funded by the CCG as per usual practice.

The sites are part of The Lewisham Care Partnership and as such come under the same legal entity therefore there are no legal or extra accounting costs involved.

To support with some of the areas identified in the improvement plan, the Partnership have made a bid against the 19/20 GPFV practice resilience programme. The bid seeks support to improve patient access, particularly in regard to patients getting through on the phone and their overall experience of making an appointment. The Partnership would like to invest in developing their websites, staff training and the move towards a central telephone call centre across all sites.

F. IMPROVEMENT PLAN Enclosure 6d

G. MERGER PLAN Enclosure 6e

H. STAKEHOLDER ENGAGEMENT PLAN Enclosure 6f

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Appendix 1: Estates options appraisal

The Partnership have decided that due to the lease on Brockley Road expiring on the 31st March 2020, the premises cost rent not being fully reimbursed based on the District Valuers assessment and that the building is unlikely to be fit for purpose during the length of any lease extension that might be offered by the landlord, now is the right time to relinquish the lease. See below full options appraisal to support this decision.

Option Pros Cons Summary Agree new lease at Brockley Road Medical Centre

• No change to services for patients

• Premises not purpose built (converted house)

• Premises not DDA compliant

• Would need to agree a long lease on premises that do not fit with partnership or CCG estates strategy

• Current gap between landlord charged rent and District Valuer agreed reimbursable rent

Although this would prevent any change to patient access at the Brockley Road site, it is felt that this site would need to be vacated in the very near future in any event. With the lease expiring, this presents the opportunity to consider the long term estate strategy of the partnership now which does not realistically include continued service delivery at the Brockley Road site.

Consider alternative (purpose built) site, close to Brockley Road Medical Centre

• Less change to services for patients

• Services delivered from purpose built facilities with long term future

• Unlikely to find suitable and affordable premises in available timeframe

This is not felt to be a realistically viable option

Co-location of services at the Hilly Fields Medical Centre with closure of Brockley Road Medical Centre site

• Services delivered from purpose built facilities with long term future

• Co-location of services will allow the practice to consolidate service delivery for patient

• Some patients may need to travel further to the practice

This is the preferred and recommended option. The lease expires on 31st March 2020 but it is envisaged that the Brockley Road Medical Centre will move into the Hilly Fields Medical Centre site approximately in

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benefit • Extended

opening hours for patients

• Maximised use of the Hilly Fields Medical Centre site

• Patients who wish to stay under the care of the Lewisham Care Partnership can register with the nearby Honor Oak Group Practice if they do not wish to move to the Hilly Fields Medical Centre site

mid- March 2020 to allow time for any dilapidations to be made good and equipment to be removed before handing the site back to the landlord

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Appendix 2 – summary of staff WTE

Postion Title All Staff Hillyfield &

Brockley Road. Those in RED work exclusively at Brockley Road and will

transferred to HF if they have a permanent

contract

Status FT or PT Hours

or Sessions

Domestic PERM PT 15.00

Administrator PERM FT 37.50

IT Manager PERM PT 22.00

Administrator PERM FT 37.50


Practice Manager PERM PT 37.50



Receptionist/Admin PERM FT 37.50

Receptionist PERM FT 37.50

Head of Reception PERM FT 37.50

Admin/Receptionist PERM PT 35.00

Admin/Receptionist PERM PT 27.50

Administrator PERM PT 32.00

Admin/Receptionist PERM FT 37.50

Receptionist/Admin PERM FT 37.50

HCA PERM FT 37.50

Receptionist TEMP PT 30.00

Senior Administrator PERM FT 37.5

Admin/Receptionist TEMP FT 37.5

Receptionist TEMP FT 37.5

Domestic Temp PT 15

Receptionist Temp PT 30


Secretary PERM FT 34

Salaried GP PERM PT 2


Receptionist TEMP FT 37.5

Practice Nurse PERM FT 37.5

Admin/Receptionist TEMP FT 37.5

Practice Nurse PERM FT 37.5

Practice Nurse Temp PT 8.5

Practice Nurse PERM PT 24

Rec/Sec PERM FT 37.5

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Appendix 3 – summary of discussions with PPG

EXTRACTS FROM JOINT BROCKLEY ROAD & HILLYFIELDS PPG MINUTES 2nd October 2018 Colin advised that we are now moving towards merging contracts. Rushey Green & Baring Road have now merged their contracts. Merging databases did not go well. Patients at either practice can now go to either site. At Hilly Fields & Brockley Road we won’t be doing that (yet) but patients will gain from varied clinical expertise. 30th April 2019

Super Practice There is much happening in the back office, but at this point the only thing to report to the PPG is that Brockley Road Surgery will close in March 2020. This date may be brought forward. Brockley Road will physically move to Hilly Fields and the patient lists will be merged. This will be a trial for the Super Practice merger. The best ways to communicate this development to the Brockley Road patients are being worked out at CCG level. The move has been a possibility for around ten years, and therefore many patients are aware of the likelihood of the Surgery’s closure. John asked that a mechanism be put in place, so that those who are concerned about the move are informed as to where or to whom to address their concerns. 9th July 2019

Update on Brockley Road/Hilly Fields Lease comes to an end March 2020, notices are displayed at Brockley road and Hillyfields, email address displayed on the notice board address for patients to contact to express concerns; Colin mentioned not many emails received as yet. Plan to merge databases and Emis. This will be a dry run for merging others practices in the group at a later date Colin drafting Brockley Road closure business plan case for CCG to approve. CCG will send a formal letter to all patients once merger is approved. Nearest surgeries to Brockley Road are Honor Oak Surgery & Jenner Health Centre Roger asked whether the Jenner accept patients - Colin to check Jenner Health Centre’s catchment area. Colin says it will take roughly 5 weeks to move medical/computer equipment. Colin to liaise with Chair, John Keidan, if anything delayed or other concerns emerge. 15th October 2019 Colin asked the meeting is they could endorse the proposed merger/closure of Brockley Road and Hillyfields practices. John put this to the meeting, it was unanimously agreed to confirm the development.

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Appendix 4 – web banner

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Appendix 5 – practice poster

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Appendix 6 - letter sent directly to vulnerable, housebound patients and carers

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Appendix 7 – summary of responses from survey

How old are you? Male/Female

Are you aware of the merger/closure proposal for of Brockley Road Medical Centre?

Do you think moving to Hilly Fields Medical Centre will give you transport problems?

Do you have ay access needs?

The practice at Hilly Fields is open on Saturdays 9.00-12.00 - is this useful for you?

Extended hours are available at Hillyfields in the evening - does this interest you?

Minor Surgery is available at Hillyfields - is this a service you would welcome? Any other comments

18-30 female yes no no yes yes yes46-64 female no yes yes yes yes yes difficult parking HF46-64 female no yes no no yes yes31-45 female yes no no yes yes yes31-45 female yes no no yes yes yes18-30 female yes yes yes no no no65+ female yes no no yes yes yes31-45 female no no no yes yes yes31-45 female yes no no yes yes yes65+ female yes yes no yes yes yes65+ female no yes no yes yes yes worried about 90 year old mum access HF

31-45 male no yes yes yes yes yesworried about 90 year old grand mother accessing services

65+ male yes yes yes yes yes yesmobility issues some concerns over transport

65+ female yes yes no yes yes yes31-45 male no no no yes yes yes31-45 male yes no no yes yes yes46-64 male no yes yes yes yes yes31-45 female yes yes no no yes yes31-45 female no no no yes yes yes65+ male yes yes no yes yes yes65+ female no no no yes yes yes65+ female yes yes yes yes yes yes65+ male yes yes yes yes yes yes31-45 male yes yes no no no no46-64 male no no no yes yes yes31-45 female yes yes no yes yes no46-64 female yes yes yes yes yes yes31-45 female yes no no yes yes yes

18-30: 2 Female: 19 yes: 18 yes:16 yes:8 yes:24 yes:26 yes:2531-45: 12 Male: 9 no: 10 No:12 No:20 No:4 No:2 No:346-64: 565+: 9

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Appendix 8 – summary of responses from letter sent directly to vulnerable, housebound patients and carers

How old are you? Male/Female

Are you aware of the merger/closure proposal for of Brockley Road Medical Centre?

Do you think moving to Hilly Fields Medical Centre will give you transport problems?

Do you have ay access needs?

The practice at Hilly Fields is open on Saturdays 9.00-12.00 - is this useful for you?

Extended hours are available at Hillyfields in the evening - does this interest you?

Minor Surgery is available at Hillyfields - is this a service you would welcome? Any other comments

65+ male no no no yes yes yes

65+ male no

I am housebound. Please ensure my medication is still delivered to my address. Also district nurse as required.

65+ female yes no no yes yes yes65+ female yes yes yes yes yes Too far for me to walk46-64 female no no yes yes yes

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Enclosure 6d

Hilly Fields Medical Centre (HF) & Brockley Road Medical Centre (BR) - Improvement Plan The merger of Hilly Fields Medical Centre & Brockley Road Medical Centre gives an opportunity to review and improve / update some key areas in the practice through benefit of shared learning. There are some areas that one practice exceeds above the other and there are some similar areas where both practices can improve on.

No. Improvement area Action Due Action Status Person Responsible Action By 1 Quality and Outcomes

Framework achievement - Review processes on how QOF is managed at

each practice - Standardise according to best practice - Update all staff and allocate areas of

responsibility (clinical and non-clinical)

QOf monitoring already undertaken by team across both sites

PM with appropriate clinical and admin support

To be completed prior to merger of data bases

2 HF - Level 1 Trigger - % antibiotics Co-amoxiclav, Cephalosporins, Quinolones

- 2019/20 Q1 - Review underway

In progress Drs Sobolewski & Emordi 30.9.20

3 HF - Level 1 Triggers – Diabetes 3 treatment targets

- Validate data as based on 2017/18 In progress Drs Malde & other GP’s 30.9.20

4 HF & BR - Level 1 Trigger – cervical screening

- Validate data as based on 2017/18 - Identify reasons for low achievement - Nurse recruitment to increase capacity - Review of recall / failsafe procedures

In progress Review of Data. New nurses recruited. Call and recall system being reviewed with the option of all call and recall being done at partnership level

PM plus Partnership Managers Group

30.9.20

5 HF & BR - Lever 1 Triggers – child immunisation rates

- Validate data as based on 2017/18 - Review of call / recall processes - Involve nursing team - Review and update communications plan to

include text messages. - Review non-attenders by lead safeguarding GP.

Call and recall system being reviewed with the option of all call and recall being done at partnership level. Data being reviewed

PM plus Partnership Managers Group

30.9.20

6 HF - Level 1 Trigger – % Hypertension BP reading 150/90mmHg or less

- Validate data as based on 2017/18 - Review of call / recall procedures and align to

medication reviews

In progress Dr Adesi, PM with support from other GPs

30.9.20

7 HF – Level 1 Trigger - % Diabetes cholesterol 5 mmol/l or less

2017/18 Review of call / recall procedures and align to medication reviews

In progress Dr Gostling 30.9.20

8 HF – Level 1 Trigger - % Diabetes BP reading 140/80mmHG or less

2017/18 Review of call / recall procedures and align to medication reviews

In progress Dr Gostling 30.9.20

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9 BR - Level 1 Trigger - Emergency Cancer Admissions

- Macmillan cancer toolkit completed In progress Dr Oduwaiye, PM with support from other GPs

30.9.20

10 BR - Level 1 Trigger - Overall Exception Rate

- Validate data as based on 2017/18 In Progress PM with support from GPs

30.9.20

11 Patient Survey (ease of getting through by phone)

- Increase in number of staff on telephones - Review of telephony options - The telephone issue will be overcome by the

installation of a new Partnership wide telephony system and central call centre arrangement. This will help improve patient experience. Staff training

- Centralised call centre - Increased promotion of online services

In progress PM supported by Managing Partner

Review to be completed by 31.1.20. Telephony issues are being dealt with on Partnership basis and are reliant on HSCN installation at all sites February – July 2020

12 Patient Survey (overall experience of making an appointment)

- Linked to issue of getting through on the phone - Action in conjunction with patient stakeholder

plan. - Use innovations in patient access such as Ask

NHS App,

In progress As above 31.1.20

13 Patient Survey (overall experience of your GP practice)

- Conversation with PPG about ways to improve patient experience and ongoing monitoring (14th January 2020)

- Local surveys already being undertaken to validate GPPS results

In progress PM 31.1.20

14 Patient Survey (Ease of use of GP website)

- New website already commissioned - Specific conversation with PPG to test and

refine as needed - Link to OHL work on websites to ensure sharing

of best practice

In progress PM , Managing Partner New version of website delivered in process of being checked go live 30.11.19

15 PMS End of Life Care - Raise at partnership meetings (clinical cabinet and managers meeting)

- Arrange update training as needed - Submission of formal PMS improvement plan

to CCG to cover this area

In progress Clinical lead - Dr T.Singharo, PM & Managing Partner

31.1.20

16 Transportation - Support patients who might have difficulty travelling to Hilly Fields Medical Centre to register with a practice of their choice.

Not started PM 31.3.20

17 Gender mix of GPs (no female GPs at present)

- Issue of advert saying that the practice site is under represented by female GPs

- Negotiation with current salaried female GPs within the Partnership to set up a rotational

In progress PM , Managing Partner 30.9.20

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type arrangement -

18 Opening Hours Request to CCG/SEL for the amendments to the extended hours once the views of patients have been collated.

Not started Manager partner 24.12.19

19 Workforce skill mix - The practice will diversify the workforce to support increased capacity including pharmacists, social prescribers and first contact physios as supported by the PCN DES.

- The centralisation of clinical resources on the Hillyfields site could also help to increase appointments as there will be no element of wasted travel time between sites which could be used to deliver more appointments.

Managing partner 30.9.20

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Enclosure 6e: Planned Closure/Merger of Practice Action Plan - Brockley Road and Hilly Fields (G85048 & G85055)0 "Pre Planning" - 3 months to 8 weeks prior to closure1 "Pre Planning" - 8 weeks to closure date2 "Post Closure" - Closure day - 4 weeks post closure3 "Post Closure" - 6 weeks - 2 months

Priority

Status

Not Started;In Progress;Completed;

N/A

Responsible Organisation Action to be completed: Assigned to who Date Completed Comments/Notes

0 Completed CCG Inform IT - CSU Chima Olugh 12/11/2019

0 Completed CCG IT Advise clinical system supplier of closure/merger Lindsey Young 27/01/2020

In Progress SEL PCT Merger Business Case to PCCC Nick Langford 17/12/2019

0 Completed SEL PCT/ CCG/Practice Arrange initial meeting with Practice Chima Olugh 12/11/2019

0 Not Started SEL PCT/Practice Contract meetings agreed Julie Partridge0 Not Started SEL PCT Draft contract produced with finance schedule Julie Partridge0 N/A Practice Legal review by appointed solicitor Julie Partridge0 Not Started SEL PCT/Practice Final contract variation agreed Julie Partridge0 Not Started SEL PCT/Practice PMS Contract Variation signed Julie Partridge0 N/A SEL PCT/Practice Agreed process for further partnership business development in place Julie Partridge

1 Not Started SEL PCT Finalise patient decision / engagement letter Chima

1 Not Started SEL PCT/Practice Prepare final FAQs Practice

1 Completed SEL PCT Prepare list of local practices within 1 mile Chima/Nick

1 Not Started Practice Prepare patient information insert if applicable Colin Stears Is this to go in the PCSE patient letter - is there an additional charge

1 Not Started SEL PCT Instruct PCSE to send patient letter Julie Partridge1 Not Started SEL PCT Patient letters sent out PCSE1 Completed Practice Liaison with PPG Colin Stears 14/01/2020 - joint PPG1 Not Started Practice Inform patients via note on repeat prescriptions Colin Stears1 Not Started Practice/SEL PCT Poster notice at premises Colin Stears1 Not Started Practice/CCG Update agreed telephone message Chima/Colin

0 N/A SEL PCT Communication & engagement strategy signed off steering group Colin Stears0 Completed Practice Review/discuss Practice Patient Participation Groups (PPGs) Colin Stears0 N/A Practice New PPG arrangements & meetings in place for 2019/20 Colin Stears0 In Progress Practice/CCG Engagement event organised for all patients to attend Colin Stears Colin and Jacqueline to agree dates

0 In Progress CCG/PracticeEngagement with local community including Healthwatch, community councils, Community Action, voluntary sector organisations and residents groups completed Chima

0 In Progress CCG Inform Local MPs and Councillors Chima0 Not Started SEL PCT Inform LPC of decision Julie0 Not Started SEL PCT Inform local pharmacies within a mile of practice of decision Julie0 Not Started CCG All local health providers aware of merger & merger date Chima0 In Progress CCG Discuss/Inform Lewisham Council including OSC and Health and Wellbeing Leads completed Ashley1 Not Started CCG Inform IT of decision and initiate actions Chima LH sent co intructions this morning (25/07)

1 Not Started SEL PCT Inform LMC of decision Julie1 In Progress SELPCT Inform local practices within a mile of practice of decision Julie1 Not Started CCG/SEL PCT Agree process for dealing with media queries Chima NELCSU - Reactive lines

1 Not Started SEL PCT Inform NHS Customer Centre Julie1 Not Started SEL PCT Inform Complaints team Julie1 Not Started CCG Inform Community Nursing Chima1 Not Started CCG Inform Drug & Alcohol Team (Substance Misuse - Public Health) Chima1 Not Started CCG Inform Mental Health provider Chima

1. Preparation

3. Patient Communications

2. Contract Variation

4. Stakeholder Communications

5. Informing NHS Teams & Other Agencies

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1 Not Started SEL PCT Inform Medical Directorate /Performers list team (if relevant) Julie1 Not Started SEL PCT Inform screening SEL PCT public health- quality and safety systems lead Julie1 Not Started SEL PCT Inform SEL PCT Imms team Julie1 Not Started SEL PCT Inform Finance Julie1 Not Started SEL PCT Inform PCSE Julie1 Not Started CCG Inform PCWT (Primary Care Web Tool) Chima PCWT no longer exists1 Not Started CCG Inform CQRS Chima1 Not Started CCG Inform NHS Digital Chima1 Not Started CCG/Practice Inform Out of Hours provider - SELDOC Chima1 Not Started CCG Inform Hospitals via relevant CCG Chima

1 Not Started

CCG Inform authorised signatory in CCG Medicines Management team who informs NHSBSA re prescribing closedown. (Then the HSCIC team will be notified to deactivate ODS listing for practice).

Chima

1 Not Started CCG IT Inform clinical system supplier Lindsey Young1 Not Started CCG IT Inform Tracking Database Administrator Anolrd1 Not Started Practice Inform CQC regarding merger/closure and registration Colin Stears1 Not Started SEL PCT Removal from MyHealthLondon Colin Stears2 In Progress Practice Update practice websites Colin Stears1 Not Started CCG Removal from NHS Choices BR Chima1 Not Started SEL PCT Comms Team Julie1 Not Started SEL PCT Notify 111/DOS to remove the practice details Julie

1 In Progress Practice All partners to have up to date DBS 6 months prior to transfer date Colin Stears1 N/A Practice CQC application made to transfer partners Colin Stears

1 Not Started Practice/CCG med management team Liaise with medicines management to identify key tasks Meds Mgnt

1 Not Started Practice Project plan for prescribing agreed

1 Not Started Practice Prescribing budget and authorisation allocated to new partnership

1 N/A Practice Agreed lead for prescribing on Executive Board

1 Not Started Practice Prescribing team in place and reviewing quality

1 Not Started Practice Prescribing incentive scheme achieved

1 N/A Practice Improvement on overall achievement of PIS

1 Not Started Practice Controlled drugs systems reviewed and in place

1 Not Started Practice Consistent prescribing policies and procedures in place

1 N/A SEL PCT /CCG Prepare press release if applicable

1 Not Started Practice All outstanding payments completed prior year/quarter

2 Not Started SEL PCT Financial reconciliation

1 N/A Practice Accountants appointed

1 N/A Practice Agree procedures for dealing with final reconciliation and production 19/20 accounts

1 N/A Practice Accounts for 2019/20 produced

1 N/A Practice Appoint project manager for IM&T if applicable

1 N/A Practice Project plan produced

1 N/A CSU/Practice System ready to be tested

1 N/A CSU/Practice All required hardware in place

1 N/A CSU/Practice Asset register updated with CSU

1 N/A CSU/Practice Agreed priorities for further development of telephony agreed

1 N/A Practice/CCG Inform trading partners (Exeter, pathology labs, hospital departments, iPlato etc) Chima2 N/A CCG IT / Practice Freeze access to NHS emails if applicable2 N/A CCG IT / Practice Smart card deactivation if applicable1 N/A CCG IT Arrange suitable and appropriate location for clinical server if applicable2 N/A CCG IT Collect N3 tokens-suspend/reallocate3 Not Started CCG IT/Practice N3 link issues

7. Prescribing

11. IT & Telephony

8. Media

9. Finance

6. REGULATORY incl CQC

10. Practice Finance

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2 N/A CCG ITClosed practice - N3 link closure on site (notify N3 CRM Team of pending closure, submit formal request to cease N3) and organise BT collection for network

2 Not Started CCG IT Collect Hardware: PC/Printers/legacy tape to be identified for removal 2 N/A CCG IT Raise schedule A for authorisation Ascertain with Colin Edwards1 Not Started Practice/CCG IT Inform registration authority1 Not Started CCG/CSU/Practice Clarify ownership of IT assests onsite (self check in screen, Jayex screens)1 Not Started PCSE- capita/CCG IT Monitor DTS to ascertain which trading partner are actively sending1 Not Started CCG/CSU/Practice Decommissioning Docman1 Not Started CCG IT Arrange transport and storage if required

1 Not Started Practice/CCG/CSU Liaise with CCG/CSU regarding process to merge list Anorld

1 Not Started Practice/CSU Practice lists merger Anorld1 N/A Practice/CSU Agreed process for links administration post merger Anorld Ascertain with Colin Edwards1 Not Started Practice/CSU Registration links process complete for merged list Anorld Ascertain with Colin Edwards1 N/A Practice/CSU Process for notes summarisation & GP2GP implemented for new list Anorld

1 N/A Practice Agree time frames for TUPE process

1 Completed Practice Staff consultation process started

1 N/A Practice All staff TUPE to new partnership

1 N/A Practice Contact NHS pensions authority to review arrangements to set up single pension provider1 N/A Practice New NHS pension employing authority established for partnership

1 N/A Practice All business support EA records updated with new partnership/salaried GPs

1 N/A Practice Review current HR functions/support in each partnership

1 N/A Practice New centralised HR function in place

1 N/A Practice Agree outline new contractual terms all staff with executive board

1 N/A Practice Standardised contracts and T&C for all newly employed staff in place

1 Completed Practice Identify any recruitment required or currently underway

1 Completed Practice Recruitment and retention processes in place

1 In Progress Practice Contact vulnerable patients and idenitfy any support required for re-registering Colin Stears1 In Progress SEL PCT Vulnerable patients letter sent out (2wks before closure)1 In Progress Practice Substance misuse patients identified1 In Progress Practice Substance misuse patients handed over

2 In Progress Practice Current arrangements for booking in current sites continue

2 In Progress PracticeImplementation of centralised appointments booking for both routine and same day appointments

2 In Progress Practice Plan for implementation of changes for specialist clinics agreed

2 In Progress Practice Implementation of centralised appointments booking for specialist clinics

2 In Progress Practice Review of all proposals with PPGs and patients

2 In Progress PracticePlan for implementation of changes to appointments systems for new methods of accessing care

2 Not Started NHSE /Practice Physical full records collection2 Not Started CCG /Practice Patients records may be digitialised. Confirm what is happening here1 N/A Practice Printing of patients records summary from the clinical system to LG envelopes Verify with EMIS what transfers and safe guards are necessary - Lindsey

1 Not Started Practice Arrange destruction of patient identifiable shredding (in line with guidelines)1 Not Started Practice Identify Private Patient/inform patient/Records1 Not Started SELPCTE / PCSE Report from PCSE re transferred patients if applicable2 Not Started Practice Childhood Imms data to RIO team

2 Not Started Practice/CCGConfirm with trading partners regarding information sent via links before EMIS merge. (hospital/pathology results) Anorld

2 Not Started CCG - meds management Cancel prescribing codes Erfan Chima to double check this can be done at the start2 Not Started Practice Public Health Targets - Final Data 1 Not Started Practice Arrange collection of stationery/ prescription pads/NHS forms etc. Ask Julie P

1 N/A Practice Appointed Solicitor review of current leases & property issues

1 N/A Practice Employers and premises insurance in place

1 N/A Practice All maintenance contractors including cleaners informed of new partnership

17. Premises

13. Human Resources

16. Records, Data & Forms

14. Vulnerable Patients

12. List Merger

15. APPOINTMENTS SYSTEMS

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1 N/A Practice Discussion of new proposals for premises development with CCG/NHSE

2 N/A CCG Agreement that HF will not be double charged rent for BR in July Chima1 N/A Practice Updated business continuity policy in place

1 In Progress Practice Premises - notifty suppliers (utilities etc.) of end date 1 In Progress Practice Arrange Phone contract closure ( fter agreed period of message)1 In Progress Practice Premises - lease end date if applicable1 In Progress Practice Premises - arrange any restoration / refurbishment1 In Progress Practice/SEL PCT Arrange redirection of mail Colin Stears1 In Progress Practice Confirm last day of access to premises1 N/A Practice Performers List regarding intention to remain on list 2 Not Started Practice Secure/empty drugs cupboard2 Not Started Practice Arrange deactivation of fax number 2 Not Started Practice Photocopier - check if it stores memory3 Not Started CCG Room requested to hold DBP patient records Chima2 Not Started Practice collection of sharps bin and clinical waste

18. Other Operational Issues

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No. Required Action Action to be taken Outcome Remaining Action Person Responsible Action by Action Status

1 Engagement with patients prior to the merger proposal - informal

Discussions to be held with PPG and posters raising possibility of merger to be put up in both practices. Initial notices brought 32 emails regarding the closure.Further notices and and comment forms in reception at Brockley road generated 28 replies . Letters to housebound and vunerable paties mid november generated 14 replies

PPG informed at last 4 meeting up to 10/10/19 Keep PPG informed of on going progress. Colin Stears 17/12/2019

On going

in progress

2 Regular PPG meetings/consultations are held to address the following: - Concerns about the proposed merger - Suggestions as to how practice can deliver services in a better way in the future as a merged organisation.

Patients can also give feedback by doing the following: - completing the online survey- by completing a form at the surgery- Send messages and feedback by accessing the messaging system on the website- Use the suggestion box at the reception desk

Regular PPG meetings/consultations are held to address concerns from both practices and minutes of meetings/consultations with FAQs raised are published on the practice website

Patients informed via web site and notices in waiting area.

Opportunity to feed back either via dedicated email address or in writing to either practice 32 emails received across hillyfields/brockley road. Further consultation at Brockley Rd in mid November generated 28 written responses.

A vast majority were happy with incease in extended hours and minor surgery as a result of the merge. A small number were concerned about transport costs and capacity.14 replies were from elderly patients at Brockley road - main concern transport links.

Keep all patients informed of progress/developments via web site and notices in waiting room. Reply to patients who gave their details from the second consultation at Brockley Road. On going opportunity for patients to comment. Once date of merger/closer known arrange drop in sessions at Brockley Road including evening and saturday morning

Colin Stears 14/01/2020 - Next PPGon going

in progress

3 Ensure that all patients are made aware of the merger and the date of commencement

On going publicity as detailed above. Date of merger is not set as we do not know the EMIS integration date.

Waiting for dates to be confirmed Colin Stears When dates known on hold

Organise Q&A drop in sessions for patients from both practices prior to leading up to the merger

January & February 2020 Not started

4 Mitigation of disruptions caused to the care of vulnerable patient groups

Patients falling under this group will be contacted to inform them of the merger, and supported, when the date is confirmed.

Safeguard vulnerable patient groups Once dates known assessment of vunerable groups undertaken

PM with appropriate clinical team members

14/11/2019on going

5 Risk assessment to be carried out regarding the related risks of those patients who want their care continued under the new partnership

Currently in the process of informing all patients in this group. All information gained from these conversations to be collated.

review any risks to specific patient groups internal discussions taking place PM with appropriate clinical team members January & February

2020 Not started

6 Investigate the effects caused to all patient groups from both practices.

Discussions have taken place with the PPG whereby their views expressed were noted and recorded on information media for all to be able to access (e.g. surgery website and notice board).

review any risks to specific patient groups internal discussions taking place PM with appropriate clinical team members End of February 2020 on going

7 Close monitoring of the removal requests from the clinical system.

Estimations at this stage only Make sure patients have GP services Make sure any deductions actioned asap PM on going pre and post merger on going

11 Ensure staff are TUPED over to the new partnership (legal requirement).

General staff discussions and updates have been carried out with all staff to explain the merger. These meetings and individual consultions will continue and reassurance will be given that they will be transferred in the new partnership. It is anticipated all clinicians and admin staff will be happy to be TUPED to the new partnership.

All staff already employed by The Lewisham Care Partnership no TUPE requirement

Not Application as all staff are with the same

employer (TLCP) since June 2017.

completed

12 Active engagement with local GP's, pharmacies, ward councillors and support organisations & other key stakeholders*

*Other Key Stakeholders we will communicate with as part of our communication and engagement plan• SELDOC • Local practices• Local acute and community care providers (LGT )• SLAM• 111 •Lewisham Healthier Select committee• Lewisham CCG• Local MPs • Local Councillors • Local Medical Committees in both Lewisham

Local GPs have been informed and the CCG has carried out a capacity audit.

Wider practice managers to be informed at meeting on Main local pharmacies have been informed and will work together to minimise risk of disruption to medicines supply during transition.

Discussions started with health visitors, midwives and district nursing to consider effects of merger and ways to minimise disruption.

This list is not exhaustive and some of the key stakeholders will have already been consulated and engaged with as part of the proposal, as detailed above, however all stakeholders will be formally notified of the outcome once the actions for the agreement in principle given on 17thy December 2019 by CCG committee have been concluded

Inform appropriate partner organisations. MP and Council have already been informed. One Health Lewisham have been informed.

ongoing with more information deceminated once dates known

Colin Stears/PM/CCG

final information once dates for

merger/closure are known

on going

13 Update Report Post Merger As part of our overall strategy for comms and engagement and to ensure that patients views are addressed, we will complete and submit a report (post merger) to Lewisham CCG on progress and key issues that were highlighted, have been rectified and addressed (and if not then why), including timelines.

review of outcome and learning post completion wait until changes completed Colin Stears

post completion/merger Not started

Enclosure 6f: Hilly Fields Medical Centre and Brockley Road Medical Centre - Patient and Stakeholder Engagement Plan Patient & Stakeholder engagement is fundamental to the process of the merger and future as this will allow us to strengthen our service going forward, help design the service around patient needs and proactively address patient needs and concerns. We will have a clear

message that together, we can provide better primary care services to the combined patient population and patients will experience greater access to appointments and services as part of the new partnership.

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Practice Name The Brockley Road Surgery

Honor Oak Group Practice


Jenner Health Centre

Novum HealthRushey Green

Woolstone Medical Centre

Forest Hill Group Practice

Practice Code G85048 G85089 G85055 G85004 G85633 G85061 G85001

Distance 0 0.4 0.7 0.7 0.9 1 1

CCG Area Lewisham Lewisham Lewisham Lewisham Lewisham Lewisham Southwark

Contract Type PMS PMS PMS PMS PMS PMS PMS

Contract End Date 31/03/2020 N/A N/A N/A N/A N/A N/A

Raw List Size (1.10.19) 5,560 10,191 11,917 15,030 21,127 7,592 8,871

Known Capacity issues? N/A N/A N/A N/A N/A N/A N/A

Workforce outlier? N/A No No No No No

Selected for resilience programme support in 2017/18 or 2018/19? N/A Yes Yes Yes Yes Yes

CQC rating Good Good Good Good Good Good + 1 outstanding

Good + 2 outstanding

FFT rating (would recommend practice) CCG Average 86%

80%(Sep 2019)

83%(Sep 2019)

No Data Available

90%(Sep 2019)

84%(Sep 2019) No data 87%

(Sep 2019) Where data is available, all practices perform better than Brockely Road Surgery

GPPS - Would describe their experience of this GP practice as good (CCG Average 80%)

71% 79% 65% 82% 78% 90% 66% 5 practice perform better than or within 10% of Brockley Road1 performs 10% less than Brockley Road

GPPS - Find it easy getting through on phone (CCG Average 61%)

39% 55% 39% 66% 45% 72% 47% All practice perform the same as, or better than Brockley Road

GPPS - Are satisfied with the general practice appointment times available (CCG Average 60%)

50% 55% 40% 63% 59% 71% 33% 5 practice perform better than or within 10% of Brockley Road1 performs 10% less than Brockley Road

Number of additional patients which can be registered

Max 4000 N/A 2000Confirmed list

is open and No Maximum

1000 TBC7000

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Equality Analysis Screening Tool Date of Assessment

25/11/2019 Assessor Name(s) & Job Title(s)

Chima Olugh, Primary Care Commissioning manager

Organisation

Lewisham CCG

Name of the policy, function, service development

GP Practice merger

Aim/Purpose of the policy, function, service development

Merger of Brockley Road Medical Centre and Hilly Fields Medical Centre

1. Do you consider the policy/function/service development to have an adverse equality impact / health inequality impact on any of the protected groups as defined by the Equality Act 2010? Write either ‘yes’ or ‘no’ next to the appropriate group(s)

Protected Group Yes or No



Age

No Pregnancy/Maternity No Marriage/Civil Partnership (employment matters)

No

Disability

No Race No

Gender

No Religion/Belief No

Gender Reassignment

No Sexual Orientation No

2. If you answered ‘yes’ to any of the above, give your reasons why

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3. If you answered ‘no’ to any of the above, give your reasons why No protected group should have any adverse equality impact/health inequality impact as a result of this merger. Brockley Road and Hilly Fields Medical Centre’s belong to the super partnership, Lewisham Care Partnership. Some current Brockley Road Medical Centre may have to travel further to the Hilly Fields Medical Centre site. However, the Brockley Road Medical Centre site is a purpose built building which is easily accessible for patients including those with mobility issues as there are car parking facilities and bus stops in close proximity to the site. As articulated in the business case, a service improvement plan will be implemented as part of the merger which will seek to reduce any variation in current outcomes between the two practices. Although there will be a reduction in access as the Brockley Road site will be closed, there will also be an increase in extended hours available to patients following the merge. The Brockley Road site is not DDA compliant whereas the Hilly Fields site is fully compliant regarding the needs for patients with a disability Patients have been engaged as part of this proposed change and views have been incorporated into the service improvement plan.

4. Please indicate if a Full Equality Analysis is recommended NO

Project Lead

Chima Olugh, Primary Care Commissioning manager

Date completed

25th November 2019

Signature of reviewing NELCSU Equality and Diversity Lead

Valerie Richards, Equality, Diversity & Inclusion Manager NEL Commissioning Support Unit

Date reviewed:

2nd December 2019

The signed and completed Screening Tool should be attached as an appendix to the policy or function/service development documentation as evidence of completion and proof of review

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ENCLOSURE: 7a Minor Ailments Scheme (Pharmacy First) Update Report

CLINICAL LEAD/S: Dr Jacky McLeod, Clinical Director lead for Primary Care MANAGERIAL LEAD: Ashley O’Shaughnessy, Deputy Director of Primary Care

AUTHOR: Chima Olugh, Primary Care Commissioning Manager

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to: Note the progress made to date on the Minor Ailments Scheme and plans for the future.

SUMMARY: The scheme has been developed by Lewisham CCG Medicines Management Team based on the

needs of the local population.

In areas of deprivation, Pharmacy First schemes that allow access to a limited range of NHS- funded over the counter medicines for low income and deprived families to support self-care have been shown to be cost-effective in reducing demand on GPs, walk-in-centres and Accident and Emergency.

To date 45 out of 55 pharmacies in Lewisham provide the scheme.

The scheme is currently undergoing a refresh and will be relaunched in February 2020.

Please see appendix A for more detail.

CORPORATE AND STRATEGIC OBJECTIVES: Quality: Improving the quality and safety of the services commissioned by the CCG.

CONFLICT OF INTEREST (CoI): There are no conflicts of interest.

CONSULTATION HISTORY: The Prescribing and Medicines Optimisation Group Lambeth, Southwark & Lewisham Local Pharmaceutical Committee Lewisham Primary Care Operational Group.

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PUBLIC ENGAGEMENT: The Lewisham Patient Reference Group has been consulted.

HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: The scheme has helped improve and develop primary care in Lewisham.

RESPONSIBLE MANAGERIAL LEAD CONTACT: Name: Ashley O’Shaughnessy; Email: [email protected]

AUTHOR CONTACT: Name: : Chima Olugh, Email: [email protected]

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Appendix 1 Minor Ailments Scheme (Pharmacy First) Update Report 1. Purpose

The CCG’s locally commissioned Pharmacy First scheme provides advice and support to people on the management of a defined list of common conditions (e.g. Constipation, Hay fever, Sprains/strains, Head lice, Cold and flu, Cold sore, Mouth ulcer, Conjunctivitis, Headache, Ear wax) from community pharmacists at local pharmacies. The scheme has been in existence for over 15 years. Community pharmacy can support self-care for long term conditions, coughs and colds and other complaints and support better health through provision of healthy lifestyle advice. The scheme has been developed by Lewisham CCG Medicines Management Team based on the needs of the local population. It is a walk in service to facilitate easy access to a health care professional led consultation for the defined ailments. Patients who are exempt from paying prescription charges will also be exempt from paying for any formulary-listed medication supplied by the pharmacist. Patients who pay for medication may purchase any medication over the counter at the list price or the price of a single prescription charge per item, whatever is cheaper. The aim of the scheme is to reduce avoidable pressure on GP practices and provide patients with more flexible access to care. It is intended to capture a specific cohort of patients who would have otherwise presented to a GP led service i.e. GP, Accident and Emergency, Out of Hours or Urgent Care with a common ailment. It is not a service intended for the general public to access if they would have ordinarily bought an over the counter medication from the pharmacy. 2. How the service is supported

45 out of 55 pharmacies in Lewisham provide the service. All service providers have a service protocol and product formulary. The service protocol contains: A Service Summary Common Ailments Consultation Guidance Patient Pathway Conditions that are covered Formulary of medications Professional and Patient Resources A Service Specification A Service Level Agreement

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3. Service outcomes The aim of the scheme is to reduce the number of avoidable patient presentations at GP led services (GP practice, Urgent Care Centre and Accident & Emergency) for common ailments that can be adequately treated by a pharmacist. In the period between April 2018 and March 2019 the scheme has had 17,546 interactions from 11,397 patients. Of these audited interactions, had the scheme not been available: 15,480 (88.2%) would have gone to the GP 63 (0.4%) would have gone to A and E 196 (1.1%) would have gone to a Walk-in Centre

4. Value for money The average cost of a GP appointment is £301; this is equivalent to a cost avoidance of £464,000

in GP appointments alone. In 2017/18 the cost of an A+E attendance was £1602, this is equivalent to a cost avoidance of

approximately £10,000. In 2018/19 the service cost was £124,590. The scheme also mitigates the impact on those who would be disproportionately affected by the

introduction of national over the counter medication deprescribing in GP practice3 and provides equitable access to patients in vulnerable groups i.e. the elderly and those who are least likely to access their GP practice.

5. Future of the Service The service is currently undergoing a total refresh with a target relaunch date of February 2020. Changes being made include: Logo and brand redesign Simplified service pathway (patient self-referral) Formulary review Service protocol update Updated pharmacist training and declaration requirements in order to provide the service Updated provider resources included in the Service Protocol New promotional material

1 https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/ 2 https://improvement.nhs.uk/documents/1972/1_-_Reference_costs_201718.pdf 3 https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

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https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/

https://improvement.nhs.uk/documents/1972/1_-_Reference_costs_201718.pdf

https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

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PCCC Primary Care Commissioning Committee 17 December 2019

ENCLOSURE: 8a Wells Park Practice Contractual Remedial Notice Update


AUTHOR: Julie Partridge – Commissioning Manager. South East London Primary Care Team

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to note this update.

BACKGROUND: The Care Quality Commission (CQC) carried out an announced comprehensive inspection at the practice premises in September 2018 and issued a report on 5 November 2018 that was overall “Requires Improvement” for the quality of care provided and particularly in the areas “Are services safe?”, “Are services effective?”, “Are services responsive?” and “Are services well led?”. The practice has a history of CQC non-compliance; receiving an overall rating of Requires Improvement following an inspection in 2016 and an overall rating of Good following a CQC desk top review in April 2017. The overall rating of Requires Improvement for the CQC inspection held on 11 September 2018, is a downward movement from the April 2017 desk top review, where the practice continued to be rated as Requires Improvement for “Are services responsive” for the third successive time. On the 6 August 2019, an Urgent Planned meeting of the Primary Care Commissioning Committee approved the recommendation that a contractual Remedial Notice be issued to the contractor of Wells Park Practice following an inspection by the CQC on the 11th September 2018. The recommendation was approved subject to Commissioners monitoring the contractor’s action plan to ensure compliance. CONTRACTUAL REMEDIAL NOTICE Officers issued the contactor with a contractual Remedial Notice and an action plan on 28 August 2019 and asked that the action plan, together with supporting evidence, be returned within 28 days. The contractor was required to demonstrate what actions it was going to take (or had already taken) to remedy the issues identified by the CQC. The practice manager submitted the action plan together with the supporting evidence to officers on 26 September 2019. A review of the action plan supporting evidence was undertaken by subject matter experts, and following this review, feedback was provided in relation to staff appraisals and medicines management (specifically controlled drugs audit/monitoring and risk assessment). This advice was fed back to the contractor on the 9 December 2019 and the contractor has been asked to resubmit this evidence, which will be reviewed. Should the contractor demonstrate that it has addressed the requirements of the Remedial Notice, the contractor will be issued with a letter

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of compliance.

CORPORATE AND STRATEGIC OBJECTIVES: Contract Management: To manage effectively the CCG’s contract portfolio to ensure that the CCG’s Operating Plan‘s commitments are met. This includes ensuring our financial targets are met and value for money is achieved.

CONFLICT OF INTEREST (CoI): None identified.

CONSULTATION HISTORY: Primary Care Commissioning Committee (June/August 2019) Primary Care Operational Group (1st August 2019)

PUBLIC ENGAGEMENT: Not applicable

HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: No adverse impacts identified


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ENCLOSURE: 8b The Queens Road Partnership Contractual Remedial Notice Update


AUTHOR: Julie Partridge – Commissioning Manager. South East London Primary Care Team.

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to note this update.

BACKGROUND The Care Quality Commission (CQC) carried out an announced comprehensive inspection at the practice’s premises on 21 February 2019. As a result of the findings on the day of the inspection, the CQC issued the practice with warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The full CQC report that was subsequently issued as a result of the inspection on 21 February 2019 was published on 15 April 2019. The contractor was rated as ‘Inadequate’ for ‘Are Services Safe?’ and ‘Are Services Well Led?’. The contractor was rated as ‘Requires Improvement’ for ‘Are Services Effective’ and ‘Are Services Responsive?’. The contractor was rated as ‘Good’ for ‘Are Services Caring?’. The contractor received an overall rating of ‘Inadequate’ and was placed into “special measures”. On the 18 June 2019, the Lewisham Primary Care Commissioning Committee (PCCC) approved the recommendation by Commissioners that a Breach and contractual Remedial Notice be issued to The Queens Road Partnership. A follow up announced focused inspection was carried out by the CQC on 25 June 2019 to review in detail the actions taken by the practice to confirm that it was now meeting legal requirements as detailed in the warning notices. The unrated report published on 19 August 2019 noted that there were outstanding areas where the practice was not in compliance with the required legislation, which included:

1. The provider had not completed documented health and safety premises and security risk assessments. The practice could not assure themselves that all fire safety hazards had been identified and actioned. This was a repeated issue from the first inspection;

2. The arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not operated effectively, in particular in relation to the management of health and safety in the practice environment. This was a repeated issue from the first inspection.

3. The complaints procedure did not ensure patient needs were met and was not in line with national guidance.

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CONTRACTUAL REMEDIAL NOTICE Officers issued the contactor with a contractual Remedial Notice and an action plan on 28 August 2019 and asked that the action plan together with supporting evidence be returned within 28 days. The contractor was required to demonstrate what actions it was going to take (or had already taken) to remedy the issues identified by the CQC, including those issues highlighted at the CQC focused inspection on 25 June 2019. The practice manager submitted the action plan together with the supporting evidence to officers on 27 September 2019. A review of the action plan and supporting evidence was undertaken by officers and subject matter experts to determine whether the evidence met the requirements of the Remedial Notice. Following this review, there were several areas which required further clarification from the contractor relating to missing evidence, which officers asked to be resubmitted by 8 November 2019. The contractor subsequently submitted further evidence on 8 November 2019, which is currently under review by subject matter experts. A verbal update will be provided to the committee on the status of the review of this evidence.



CONSULTATION HISTORY: Primary Care Commissioning Committee (June 2019)


HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: No adverse impacts identified


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ENCLOSURE: 9 Discretionary funding - Inclusion of the SE London Special Allocation Scheme APMS registered list as part of the Sevenfields PCN


AUTHOR: Nick Langford. Assistant Head of Primary Care – South East London Primary Care Team

RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to note the Discretionary payment to the Sevenfields PCN.

SUMMARY: The purpose of this paper is for the Lewisham Primary Care Committee (PCCC) to be aware that officers have approved a Discretionary payment adjustment to the Network Contract DES payments (‘the Payment’) in favour of Sevenfields PCN, which has agreed to incorporate the new SE London wide SAS APMS contract provider (One Health Lewisham) as a member of its PCN Network. BAKGROUND: As the Payment to PCNs is fixed in 2019/20 according to NHS England’s Network Contract DES rules, this means that regardless of the new SE London SAS contract being established on the 4th November 2019 and the new contract holder joining Sevenfields PCN, there would be no Payment to Sevenfields PCN prior to the next financial year, when list sizes will be rebased on 1st January 2020 national core and weighted list sizes, unless a Discretionary payment, as defined within NHS England’s GP Policy & Guidance Manual (page 262, Process for Financial Assistance) was approved by the PCCC. The 2019/20 Network Contract DES funding for PCNs was based on the 1st April 2019 list size. However, OHL did not have a registered list for the Special Allocation Scheme list at that time, as the contract did not exist. Instead, all SAS patients would have been registered with practices which provided the SAS service across each of the South East London CCG’s. Consequently, the associated Payment for registered patients is allocated to the PCN in which the former SAS practice is now a member. The table below shows the Payments due to Sevenfields PCN for the five-month period until the end of the financial year based on an estimated core and weighted list size of 140 patients (actual weightings not known). The last column shows the average Payment required from each of the six CCGs in SE London to enable Sevenfields PCN to receive their Payment for hosting the SE London SAS APMS contract. This would need to be deducted from the relevant PCNs in which the former SAS practices are now members.

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Funding streams based on NHS England 2019/20 allowances

List size by end of March 2020 Raw: 140 Weighted: 140*

Associated funding for 5 months

Average funding required

from each CCG

Practice Network Participation (£1.761 per weighted patient)

£246.54 £102.73 £17.12

Network administration payment (£1.50 per head)

£210.00 £87.50 £14.58

Clinical director funding (0.514 per patient)

£71.96 £29.98 £5.00

Extended Hours** (£1.099 per head) £0.00 £0.00 £0.00

Total £528.50 £220.21 £36.70 *140 The final weighted figure is calculated by Exeter based on the complex needs of needs, age of these patients and other factors. It is not possible, at this time, to estimate the weighted list size, given that these patients are registered across SEL. While this payment is calculated on this basis, the raw figure has been used as an example. **Extended Hours under the PCN contract will not be provided to the patients under the SAS APMS Contract as the service only operates during core hours, in accordance with the national specification, therefore these sums have not been included in the totals. Given the immateriality of the additional Payment of £220.21 that would need to be allocated to the Sevenfields PCN for the period 4 November 2019 – 31 March 2020, together with the significant administrative cost involved in transferring an average of £36.70 from each CCG, which would need to deduct a proportion of that from their relevant PCNs, SE London PC team officers have made the decision, in collaboration with senior Primary Care colleagues at Lewisham CCG, to approve this indicative additional Discretionary Payment from the underspent Lewisham CCG PCN budget in 2019/20. From 1st April 2020, the budget will be reset to take into account that patients registered with the SEL SAS OHL provider should be funded based on the latter’s membership of Sevenfields PCN.



CONSULTATION HISTORY: Not applicable


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HEALTH INEQUALITY & PUBLIC SECTOR EQUALITY DUTIES: The funding will – in principle – enable patients registered under the SAS APMS contract to receive Network DES services, for which they are eligible.


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