Southwark Primary Care Commissioning Committee

Transcription

1 Southwark Primary Care Commissioning Committee Tuesday 28 November 2017 Part pm Cambridge House Item Time Item ENC Lead Part One Introductory items Welcome, introductions, apologies and declarations of interest - Chair / All Minutes and Actions of last meeting: September 2017 A Chair Public Open Space - Chair Standing items Primary Care Finance Report: Month C Malcolm Hines Primary Care Quality Improvement Report D Kate Moriarty- Baker Contract Action Log E Jill Webb Items for decision CQC Potential Requires Improvement Contract Remedial and Breach Notices a) Sternhall Lane Surgery F Jill Webb Relocation Silverlock H Jean Young Avicenna APMS decision I Jean Young Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

2 Item Time Item ENC Lead Items for discussion/assurance GP Forward View Plan J Caroline Gilmartin AOB - Chair Public Open Space - Chair Close - Chair Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

3 NHS Southwark Clinical Commissioning Group (CCG) Primary Care Commissioning Committee Tuesday 26 September, 1pm Cambridge House, 1 Addington Square, Camberwell, London SE5 0HF MINUTES Present: Robert Park (Chair) Lay Member, Southwark CCG (SCCG) RP Caroline Gilmartin Director of Integrated Commissioning, SCCG CG Jean Young Head of Primary Care Commissioning, SCCG JY Rachel Doherty (notes) Primary Care Commissioning Manager, SCCG RD Richard Gibbs Lay Member, SCCG Conflict of Interest Guardian RG Jill Webb Head of Primary Care, South East London primary care JW team Nick Langford Assistant Head of Primary Care, South East London NL primary care team Ami David Registered Nurse Member AD Dr Emily Gibbs Clinical Lead, Primary Care, SCCG EG Andrew Nebel Lay Member, SCCG AN Christine Caton Interim Finance Director, SCCG CC Joy Ellery Lay Member, SCCG JE Aarti Gandesha Southwark Healthwatch AG Dr Penny Ackland Southwark Local Medical Committee PA Apologies: Dr Jonty Heaversedge Chair, SCGG JH Kate Moriarty-Baker Interim Director of Quality and Chief Nurse KMB Andrew Bland Chief Officer, SCCG AB Julian Wescott Head of Finance, SCCG JW 1.0 Introduction Introductions and apologies were noted as above. 1.1 Declarations of Interest The group declared if there had been changes to their interests and if they had a conflict with an agenda item. All confirmed no changes or conflicts. RG as the CCG s conflict of interest guardian confirmed there were no known conflicts for GP members in relation to the agenda items. 2.0 Public Open Space There were no questions from the public. 3.0 Minutes from the last meeting The minutes were agreed as an accurate record. PA asked for a change to remove that JC welcomed the approach of a local QOF framework for the benefit of patients. The Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

4 Committee confirmed that it was welcomed and this was accurately recorded but agreed to addendum to the minutes being made which stated the LMC neither welcomed or objected to a local QOF framework. Date of Meeting Action Point Lead Status RD to make an addendum to the minutes. RD NEW 3.1 Actions from the last meeting The actions were discussed as follows: Date of Meeting Action Point Lead Update To report the themes from Southwark general practice CQC inspections and the resource tool developed to support practice make improvements at the next meeting To issue the remedial and breach notices to Lordship Lane Surgery as agreed by the Committee To send formal letter to Acorn and Gaumont requesting an action plan in response to the CQC inspection report. RD / KMB JW JW KMB is on leave and a report regarding the CQC themes will be presented in November. A link to the resource tool will be sent to Committee members. Completed. Closed. Completed. Closed It was noted that an action regarding the experience of care navigation recorded on page 7 of the minutes should be recorded as an action: Date of Meeting Action Point Lead Status The CCG to ask the GP federations to review the impact of the care navigation work on patient experience. RD Closed. 3.2 Matters Arising Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

5 JY explained that at the June meeting it was notified that the CCG had completed a procurement process to appoint a caretaker provider for the patients of Avicenna Health Centre. It was agreed to make an addendum to June s minutes to confirm that it was reported that AT Medics were the new provider following the procurement process. Date of Meeting Action Point Lead Status JY to make an addendum to the June minutes as agreed. JY NEW 4.0 Primary Care Finance Report Month /18 CC presented the report. It was noted that month 5 results to 31 August 2017 are showing an overspend of 349k. It was noted that the concern is the gap between the allocation and required budget. NHS England has confirmed the 1% headroom of 432k in the delegated primary care budget can be utilised in year and that the CCG is utilising the 0.5% primary care contingency to reduce this gap to 1.19m. It explained that the CCG is meeting in November to discuss how this gap can be bridged recurrently. This will be reported at the Committee in November. NB asked if the report could show where the variance funding between the budget and money allocated could be shown split across the different areas. It was explained that as the report develops this would be shown. RG asked if the cost of the caretaking contracts could be shown separately to demonstrate if this was causing a cost pressure. It was agreed that this could be done. JW noted that the caretaking costs were shown in the APMS line. CG noted that the caretaking contractors were working to improve the quality of services for patients significantly and that the turnaround of practices meant there were additional costs for the CCG. 5.0 Quality Report JY presented the report and summarised the CQC report outcomes published since the Committee in June. It was noted that Forest Hill Group Practice and Trafalgar Surgery had been rated as inadequate and placed in special measures. It was confirmed that the CCG had met with both practices to discuss their action plan and that they had been prioritised for resilience funding. JY also explained that Sternhall Lane Surgery have had their rating published since the circulation of papers and that the practice had been rated as requires Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

6 improvement overall but inadequate in safe. It was noted this was due to the practice s repeat prescribing processes and that the CCG would be monitoring their action plan to make the required improvements. JE noted the outstanding practices recognised by the CQC at Queens Road Practice and asked what the plans were for sharing this learning across practices. It was explained that the outstanding practice was in relation to a document management system and that IHL were in discussions with AT Medics about rolling this out across all practices in south Southwark. AG explained that Healthwatch could provide support to practices in relation to engagement with their PPGs which CQC reviews at their inspections. Date of Meeting Action Point Lead Status CCG and AG to discuss support Healthwatch could provide to practices in preparation for their CQC inspections. JY NEW JY noted in follow up to July s Committee that the GP patient survey results had been discussed and presented to the Locality Patient Participation Group (PPG) Meetings. It was explained that PPG Chairs in attendance fed back that their experiences were in line with the results. 6.0 CQC potential requires improvement contract remedial and breach notices 6.1 Dr Aru, Lister Health Centre JW explained that Dr Aru s practice had been re-inspected on 31 January 201 and that the practice had been rated as requires improvement overall. It was noted that this had resulted in the practice coming out of special measures and the section 29 notice, which was served following the first inspection in January 2017, being lifted. It was explained that the practice had submitted an action plan to commissioners and provided evidence that actions had been complete and therefore the recommendation was to formally request an action plan for the practice to complete. It was noted that there were some wider concerns about the practice s performance in terms of long term conditions management which is outside of the CQC report, however the letter will note concerns and asks for engagement in improvement in the management of patients as appropriate. The Committee agreed with the recommendation as it was in line with the standard operating procedure. Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

7 Date of Meeting Action Point Lead Status A letter to be sent to Dr Aru s practice requesting a formal action plan in response to the CQC inspection. JW NEW 6.2 Forest Hill Group Practice It was noted that for practices rated as inadequate and placed in special measures by CQC that there was a national standard operating procedure for the management of remedial breach notices. It was explained that in line with the national procedure the practice would be issued with a remedial and breach notice in line with the concerns highlighted by the CQC inspection. It was noted the practice was engaging well with the CCG and had an action plan in place to make the required improvements. It was explained that the practice was also receiving support from the LMC and Royal College of GPs. It was noted that long term condition management was also highlighted by the CQC as a concern and that specific information on patient outcomes and quality would be reported to the CCG s Quality and Safety Committee in line with new process since the CCG took on delegated primary care commissioning. The Committee approved the recommendation to issue a remedial and breach notice in line with the national standard operating procedure. Date of Meeting Action Point Lead Status To issue a remedial and breach notice to the Forest Hill Group Practice in line with the Committee s recommendation. JW NEW 6.3 Trafalgar Surgery JW explained that the practice had been placed in special measures and rated as inadequate following their first inspection. It was noted that the practice is receiving support from the GP federation in north Southwark (QHS) and that the CCG had met with the practice and QHS to discuss the practice s action plan. The Committee agreed with the recommendation to issue the practice with a remedial and breach notice in line with the national standard operating procedure. Date of Meeting Action Point Lead Status Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

8 To issue a remedial and breach notice to the Trafalgar Surgery in line with the Committee s recommendation. JW NEW 7.0 PMS Delays and mitigation CG explained that Londonwide LMC was reviewing the CCG s proposed paperwork to be sent to practices as part of the second round of assurance. CG reminded the Committee that initially the CCG and Southwark LMC had agreed a contract start date of 1 October 2017 for the new PMS contract. However due to the delays in the assurance process the earliest date possible would be 1 January It was explained that the CCG and LMC were working through a local improvement scheme (LIS) to mitigate the delay and to allow practices a 6 month mobilisation period as agreed locally. It was explained that this would support practice deliver the full contract from 1 April To enable this to be sent out in a timely manner, the Committee was asked to agree that the LIS could be signed off by Chair s action. The Committee agreed that the LIS should be signed off by Chair s action. 8.0 Camberwell Green / St Giles (Begley) merger business case CG presented the merger business case and explained that the practices have been in discussions for while regarding a merger to support their financial and workforce sustainability. It was explained that the practices are using the merger to look at how they can work differently across both practice sites. It was noted that the merger supported a steps towards at scale delivery of primary care but some Committee members highlighted their disappointed that the merger did not include the other practice located at St Gules Surgery. It was noted that this was the decision of this practice and the other two practices had engaged with this practice to explore if it could be an option. It was raised that the practice needed to consider patient messages carefully regarding the merger. AG noted that at the enter and view visit at St Giles Surgery often did not know which practice they were registered with. The Committee asked for more detail around the patient engagement plan and asked for the outcomes to come back to the Committee for review. Healthwatch offered to support with patient engagement. The Committee agreed that the 1 January 2018 was not a realistic timescale noting all of the outstanding actions that needed to be completed and proposed that the date of the merger should be pushed back to 1 April Chair: Dr Jonty Heaversedge 6 Chief Officer: Andrew Bland

9 It was agreed that the merger would be approved subject to: 1) The practice completing significant patient engagement and that the outcome of the patient and stakeholder engagement was reviewed by the Committee to provide assurance that as far as possible stakeholder and patient views are taken in to account, and where this is not possible an explanation is provided. 2) Confirmation that the practice will engage with patients before any proposed reorganisation of the appointment system including how this will work with the extended primary care services. 3) Formal feedback from the Local Medical Committee. 4) Formal feedback from the Southwark Oversight and Scrutiny Committee. The CCG will draft the template to inform OSC of the merger and will let you know if your attendance at a Committee is required. 5) The practice works with the CCG to detail and agree their joint improvement plan. 6) The merger taking place on 1 April The Committee agreed that the 1 January 2018 was not a realistic timescale noting all of the outstanding actions that needed to be completed. 9.0 Dr Hossain s caretaking arrangements summary JY reminded the Committee that the CQC had taken urgent enforcement action to cancel Dr Hossain s CQC registration following a second inspection of the practice on 8 August It was explained that the Magistrate s Court approved the CQC application and cancelled Dr Hossain s CQC registration from 10 August at 6.30pm. It was noted that the CCG had agreed a temporary caretaking arrangement with the Hurley Group, who manage another practice at the Lister Health Centre, to provide services for the patients of Dr Hossain s practice. This was agreed by the PCCC under the urgent unplanned governance processes. It was noted that subsequently Dr Hossain has confirmed that he will not be appealing the decision and therefore the arrangement with the Hurley will be for one year, with a possible 6 months extension while the CCG considers future commissioning intentions AOB None declared. Meeting closed 3.10pm Chair: Dr Jonty Heaversedge 7 Chief Officer: Andrew Bland

10 Southwark CCG Committee Report ITEM FOR DISCUSSION / ASSURANCE CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Primary Care Finance Report: Month Enclosure number: C Any know conflict of interest No The item is being presented to the committee for (select only one): Discussion Assurance Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

11 Report Author Responsible Director Name Malcolm Hines Name Malcolm Hines Job title Chief Finance Officer Job title Chief Finance Officer Directorate Finance & Business Directorate Finance & Business 1. Purpose of the paper (why does the committee need to discuss / receive assurance?) This report provides the Primary Care Commissioning Committee with assurance and information with regard to the financial performance of the Primary Care budgets for the 2017/18 financial year to date. As from 2017/18, the CCG has moved to Level 3 Delegated commissioning for Primary Care. 2. Describe the issue being presented to the committee for discussion or assurance Delegated Primary Care Seven months results to 31 st October 2017 are showing an overspend of 747k. Most areas of budget are performing broadly in line with plan, with the main areas of overspend being PMS Essential and Additional Services and Savings Target. The PMS overspend reflects significant in year list growth and impact of GMS practice closure. The overspend is partially offset by an underspend on GMS Global Sum and MPIG of 295k relating to a practice closure. This underspend is forecast to continue to the year end. It has been confirmed by NHSE that the 1% headroom of 432k in the Delegated Primary Care Budgets can be utilised in year, which has the effect of reducing the funding gap on Delegated Primary Care from 1.84m to 1.41m. The CCG is also utilising the 0.5% primary care contingency of 216k to further reduce the gap to 1.19m. This is currently forecast to be an adverse variance at year end and the CCG is planning to use a combination of other CCG budgets (including wider CCG reserves and underspends in other programme budgets) to mitigate the effect of this shortfall. These are non-recurrent solutions and we are working to identify recurrent solutions to this as part of our Operating Plan. There is a reduced gap in Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

12 2018/19 of 1.43m. The CCG is planning to use the Delegated Primary Care 1% headroom and the 0.5% Primary Care Contingency to help to meet this shortfall. The CCG has created a 759k earmarked reserve in 2018/19 to cover the remainder of the funding shortfall. If any further mitigations are identified through the planning process, they will be added and the earmarked reserve reduced accordingly. Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

13 Other Primary Care Health Services Other Primary Care Health Services are mainly operating in line with budget. There is a favourable variance of 360k on Extended Primary Care Services which is a benefit relating to prior year. Prescribing spend has moved favourably in Month 7, and actions are ongoing to resolve the issues identified in previous months to reduce the monthly overspend. Prescribing information is received 2 months in arrears. Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

14 3. What stakeholder engagement has taken place? N/A Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document None Date paper completed Monday, 20 November 2017 Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

15 Southwark CCG Committee Report ITEM FOR DISCUSSION / ASSURANCE CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Quality Report Enclosure number: D Any known conflict of interest No The item is being presented to the committee for (select only one): Discussion Assurance Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

16 Report Author Responsible Director Name Harpinder Priest Name Kate Moriarty-Baker Job title Quality Manager Job title Director of Quality and Chief Nurse Directorate Quality & Nursing Directorate Quality & Nursing 1. Purpose of the paper (why does the committee need to discuss / receive assurance?) The purpose of this paper is to provide an update on quality Issues relating to Primary care. 2. Issue being presented to the committee for discussion or assurance CQC Inspection reports and actions taken The CQC inspection process is a national programme and on 1 April 2015 the CQC began inspecting GP practices in Southwark. All of Southwark s 38 GP practices have now been inspected and have had their reports published. The ratings of all primary care providers is summarised in appendix ii. Full reports are available on the CQC website. ( ) NHS Southwark CCG continues to engage with patients on the quality of general practice service in Southwark through engagement workshops, via the Engagement and Patient Experience Committee and locality patient participation group meetings. Since the last Primary Care Programme Board the following practices have had their CQC inspection reports published. Dr Doha, Lordship Lane Surgery Dr Hossain at the Lister Primary Care Centre Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

17 Practice Dr Doha Lordship Lane Date of inspec tion 12/09/ 2017 Date report published Overall rating 20/10/2017 Good Safe Effective Caring Responsive Well-led Requires Improvement Good Good Good Good Dr Hossain at the Lister (being caretaken by the Hurley Group at the Lister 08/08/ 2017 a) Dr Doha Lordship Lane 09/11/2017 Inadequate Inadquate Inadequate Requires Improvement Requires Improvement Inadequate The practice was originally inspected by the CQC on 23 January 2017 and rated as Requires Improvement. The inspection in August 2017 saw an improved rating, Good. The practice achieved Good in the CQC domains of being Effective, Caring, Responsive and Well-led. It was rated as Requires Improvement in being Safe. The key findings of the first inspection found that systems and processes to address risks to patients were not entirely comprehensive, fire alarms were undertaken without the designated fire marshal being present and the safety risk assessment was found to be minimal with a limited review of risk areas. Improvements had been made in a number of areas since the first inspection, which include the security of medicines and the recording of vaccine refrigerator temperatures. Patients receiving high risk medicines were also receiving regular monitoring. The environment was clean and a comprehensive infection prevention and control audit had been carried out by the CCG lead. Since the last inspection the practice had set up a designated complaints information board, additionally a number of clinical audits conducted in the previous two years were being actioned and there is now improvements. Further details on the outcome of the inspection can be found on the CQC website ( ) b) Dr Hossain at the Lister Primary Care Centre The practice was originally inspected by the CQC in September 2016 which delivered a rating of Inadequate overall, and in the domains of Safe and Well-led, and so the practice was placed in special measures. A subsequent CQC inspection in August 2017 resulted in the practice remaining Inadequate and in breach of a number of Regulations of the Health and Social Care Act 2008 (Regulated Activities). The CQC applied to the local Magistrate s Court on 10 August 2017 to urgently cancel the practice s registration under section 30 of the Health and Social Care Act 2008; this was successful. The management of the practice and its registration list has since been undertaken by the Hurley Group at the Lister Primary Care Centre and this organisation continues to caretake the practice. Support and expertise has been offered by the CCG to ensure that improvements are made. Further details about the latest inspection can be found on the CQC website ( ). The CCG s quality team has developed a quality resource tool which is available to practices on the staff and member zone. This tool continues to be promoted and distributed as part of practice Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

18 visits, the Practice Managers Forum and Practice Nurse Forum. The contents were developed using the themes from the practice CQC inspections. Quality Alerts about General Practice In 2016 the CCG established a mechanism whereby alerts relating to quality issues in General Practice could be raised by a secondary care provider via the Quality team. Since April 2017 the CCG has been notified of 23 alerts, some of these have necessitated a Significant Event Audit, some have required a summary response and some have not been upheld. Work is underway by the Quality team to review themes and analysis trends. Quality alerts about General Practice are an important mechanism through which to promote a culture of system wide learning. The Quality Team at the CCG offer support to General Practice undertaking Significant Event Audits and responses to an alerts they receive. These are not seen as punitive, rather as opportunities to learn and improve patient care.. Current themes from alerts being reviewed include effective completion of referral forms to minimize delays and regular monitoring of patients and their medication. Learning from alerts raised about General Practice have been discussed at the CCG s Quality and Safety Committee and Protected Learning Time (PLT) sessions. Work continues to strengthen the process of supporting General Practice alerts and identify learning which can be shared across the system. Duty of Candour Duty of Candour is both a professional and a legal duty for clinicians, including GPs. It requires GPs to inform a patient and/or their families if a mistake has been made in their care and to provide them with a written apology. The need to support primary care with Duty of Candour was highlighted by a Serious Incident which occurred in Primary Care and involved a late cancer diagnosis. It emerged that Duty of Candour had not been undertaken adequately which led the CCG to explore options to improve GPs knowledge of their obligations. The CCG Quality Team has been working closely with the GMC to put together training for GPs on Duty of Candour. These sessions will support GPs to know that being open and honest when things go wrong is the right thing to do and equip them with the right way to do it. The sessions are free and dates have been made available for GPs to attend during December 2017 and January The sessions have been promoted via the Federations, CCG GP bulletin as well as at Locality meetings and other communication methods. To date, over 40 places have been booked. Infection Prevention and Control (IPC) Audit Update The general practice audit cycle re-commenced in January 2017 following the appointment of an Infection Prevention Specialist. Working with the Primary Care team, visits were prioritised based on the outcome of Care Quality Commission visits and local intelligence. Between January August 2017, 7 general practice surgeries were audited using the national Infection Prevention Society tool. Individual reports were sent to practices, along with a plan detailing actions to be completed with timescales. Progress was followed up by the Infection Control Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

19 Specialist. Key themes arising from the visits were staff training and environmental issues. All practices visited have completed or are making good progress against actions listed in their plan. The following practices have had visits conducted: Avicenna Health Centre Acorn & Gaumont Practice Dr Hossain s practice Extended Primary Care Service at the Lister with NHS Property services Lordship Lane Surgery Queens Road Surgery Sternhall Lane Surgery The following sites will be audited by February 2018: Aylesbury Health Centre Falmouth Road Surgery Forest Hill Group Practice Trafalgar Practice Dr Campion, New Mill Street The CCG also has responsibility for overseeing IPC targets in general practice including MRSA, C- diff and E-coli (which is linked to a Quality Premium). Nationally, a zero target for MRSA bacteraemia infection has been met in Southwark between April-November. An MRSA case was provisionally allocated to the CCG in September but the case has been sent for review as the likely source of infection was outside Southwark. Reported cases of C diff and E coli are over the CCG s trajectory and a local review is being undertaken to understand contributing factors. The review will be complete mid-december. General Practice Quality Framework The CCG became the delegated commissioner of general practice services in April 2017 and is reviewing its role to support and improve quality in general practice. As part of this the Primary Care Quality Framework has been refreshed and has developed into a new General Practice Quality Framework and Dashboard with the aim of supporting the CCG s approach to improving quality in general practice. The dashboard will enable the benchmarking of quality via a range of agreed indicators. The indicators will contribute to information covered on a programme of quality visits to practices within the scope of existing defined geographical clusters/neighborhoods. It is intended that information and knowledge arising from these visits will in turn feed into a collaborative forum which will include commissioners and general practice representatives and become a Primary Care Clinical Quality Review Group. (CQRG). The November Quality and Safety Committee held a discussion on the CCG s draft General Practice Quality framework and dashboard. The framework and dashboard are currently under design with the aim of measuring a range of quality indicators. This work is being done in conjunction with the CCG s Clinical Effectiveness Approach group and work is underway to engage with the Federations to further develop the framework and dashboard. Safeguarding Annual Review 2017, Adults & Children Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

20 The Safeguarding team at the CCG published the Primary Care Annual Review of Safeguarding Adults and Children in The review looked at how General Practice was implementing their legal obligations, and at best practice in safeguarding adults and children. The review will form the basis of an audit which will be launched in Adult and Safeguarding and an agreement of a baseline upon which to assess how improvements are being made in General Practice. Topics include: Practice Policy and Process Training Frontline Safeguarding Looked After Children (LAC) Recommendations from SCR/SAR and National Guidance 3. What stakeholder engagement has taken place? The CQC inspection process is a national programme. NHS Southwark CCG continues to engage with patients on the quality of general practice service in Southwark through engagement workshops, via the Engagement and Patient Experience Committee and locality patient participation group meetings. Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document i CQC Inspection update table Date paper completed Thursday, 16 November 2017 Chair: Dr Jonty Heaversedge 6 Chief Officer: Andrew Bland

21 Appendix i CQC Inspection update table Overall CQC Rating G CODE GP Practice Name Inspection Date Publication Date Safe? Effective? Caring? Responsive? Well-led? Special Measures G85019 The Trafalgar Surgery 25/04/ /08/2017 I RI G RI I Special Measures G85001 Forest Hill Group Practice 22/02/ /08/2017 I RI G G I 12/04/ /06/2016 RI RI G G RI Inadequate G85712 Dr Rashid Kadhim Inadequate G85029 Falmouth Road Group Practice Requires Improvement Good Requires Improvement G85134 G85681 G /01/ /03/2017 RI RI I I I 10/05/ /07/2016 I I I I I 20/10/ /02/2017 I RI RI I I 29/04/ /07/2015 RI RI RI RI I Lister 31/01/ /05/2017 RI RI RI G RI Dr P Arumugaraasah's 04/05/ /08/2016 RI I RI RI I & Partners Lordship Lane Dr SAKM D12/09/ /10/2017 RI G G G G Dr Bhatt Park Medical Centre 23/01/ /04/2017 RI RI RI G RI 19/05/ /07/2016 I RI RI RI RI 09/06/ /10/2016 RI G G G RI Requires G85119 Sternhall Lane Surgery 09/08/ /01/2017 RI G G G RI Improvement Requires G85013 Dr R S Durston & 30/08/ /01/2017 RI RI G G RI Improvement Partners Requires G85006 The Acorn& Gaumont 18/01/ /04/2017 G RI RI G G Improvement Surgery Good G85030 Concordia Parkside 22/06/ /08/2017 G G RI G G Medical Centre 19/05/ /10/2016 RI RI G G RI Good G85051 Elm Lodge Surgery Good G85132 Concordia Melbourne Grove Good G85087 Silverlock Medical centre 10/04/ /05/2017 G G G G G 10/05 &07/06 21/10/2016 RI G G G G /09/ /01/2017 G G RI G G 10/05/ /06/2017 G G G G G Good G85040 Queens Road Surgery 01/08/ /09/2017 G G G G G Good G85685 Nunhead Surgery 20/09/ /01/2017 G G G G G Good G85651 Dulw ich Medical Centre 11/08/ /12/2016 G G G G G Good G85644 The Garden's Surgery 25/11/ /02/2016 G G G G G 05/08/ /11/2016 Good G85106 Dr Kaushal Kishore 22/10/ /06/2015 G G G G G Misra Good Y00454 Dr Ramesh Sharma 15/10/ /12/2015 G G G G G Good G85705 Dr Alan M Campion 28/04/ /06/2015 G G G G G Good G85642 Dr Shivraj Chudha 29/04/ /08/2015 G G G G G Good G85084 Penrose Surgery 22/06/ /08/2016 G G G G G Good G85138 Albion Street Practice 15/12/ /03/2016 G G G G G Good G85091 Dr Mahreen Chaw dery 26/05/ /08/2016 G G G G G 306 Medical Centre Good G85715 Lister 12/04/ /08/2016 G G G G G Hurley Group Practice Good G85112 Hambledon 09/06/ /06/2016 G G G G G Good G85042 St Giles Surgery 23/08/ /11/2016 G G G G G Dr Virji/Begley Good G85726 St Giles Surgery 18/08/ /11/2016 G G G G G Good G85031 Roseman/Vasant DMC Healthcare 29/09/ /12/2016 G G G G G Good G85052 Old Kent road Surgery 22/06/ /01/2017 G G G G G Good G85721 The Surgery East Street Good G85623 Dr Adam Shabir Bradford Bhatti Good G85632 Villa Street Medical Centre Good Good Caretaking Arrangement G85034 NEXUS CONTRACT G85082 G /12/ /02/2017 G RI G G G 03/11/ /03/2017 RI G G G G 15/10/ /01/2016 I I RI I I 08/12/ /03/2017 G G G G G Bermondsey 22/04/ /07/2015 G G G G G &Landsdow n Medical Mission (inc Artesian Princess St Practice 22/04/ /08/2015 G G G G G Aylesbury Medical 14/01/ /04/2016 G G G G G CentreThurlow Surrey Docks Health 18/08/ /01/2017 RI G G G G Centre Manor Place Not inspected G G G G G now merged into Maddock Way Surgery 14/03/ /05/2017 G G G G G Lister Dr Sharif Hossain 05/07/ /09/2016 RI RI G G RI 22/09/ /02/ /11/2017 I I RI RI I G85050 Sir John Kirk Close CQC to confirm if practice to receive separate inspection as separate Registration Chair: Dr Jonty Heaversedge 7 Chief Officer: Andrew Bland

22 Southwark CCG Committee Report ITEM FOR DISCUSSION / ASSURANCE CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Contract Action Log Enclosure number: E Any know conflict of interest No The item is being presented to the committee for (select only one): Discussion Assurance Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

23 Report Author Responsible Director Name Rachel Doherty Name Caroline Gilmartin Job title Primary Care Commissioning Manager Job title Director of Integrated Commissioning Directorate Integrated Commissioning Directorate Integrated Commissioning 1. Purpose of the paper (why does the committee need to discuss / receive assurance?) The purpose of this paper is to provide information to the Committee as to when remedial breach notices and requests for action plans have been sent to practices following PCCC decisions. The paper provides details when practice s responses have provided sufficient information to assure commissioners that all the required improvements have been addressed. 2. Describe the issue being presented to the committee for discussion or assurance Decisions to issue practices with breach or remedial notices following poor contract performance are made by the Primary Care Commissioning Committee. London developed a standard operating procedure (SOP) to enable borough Committees to take a consistent approach to issuing breach and remedial notices in response to Care Quality Commission requires improvement reports. Decisions where practices have been rated as inadequate and placed in special measures are made in line with a national SOP. The PCCC previously has then not been sited on the responses from practices following decisions either to issue remedial or breach notices or formal requests for action plans in line with the London and National SOPs. This paper provides information to the Committee on the status of the remedial and breach notices and confirms if the practices response has provided commissioners with satisfactory information to demonstrate that the required improvements have been made. Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

24 3. What stakeholder engagement has taken place? n/a Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document i Contract Action Log Date paper completed Wednesday, 22 November 2017 Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

25 Primary Care Remedial/Action Plan Tracker CQC report Date considered by the Date response No. Practice Name Code CQC inspection date Outcome Reason Date sent to practice Status publication Committee received 1 Bermondsey Spa G October January 2016 Feb-16 Remedial breach notice Inadequate CQC report 23 February March 2016 Closed 2 Grange Road G November February 2016 Apr-16 Remedial breach notice Inadequate CQC report See comments n/a Closed 3 Falmouth Road G April July 2015 Sep-15 Remedial breach notice Inadequate CQC report 30 September October 2015 Closed 4 Falmouth Road G January May 2016 Aug-16 Remedial breach notice RI SOP See comments n/a Closed 5 Falmouth Road G October February 2017 Feb-17 Remedial breach notice Inadequate CQC report See comments n/a Closed Comments NHS England issued a letter to the practice on 8 August 2016 to confirm the response received to the remedial breach notice was compliant with the requirements. Remedial breach notice drafted but not sent, as practice went into caretaking on 3 May The breach notice was used as a basis for an improvement plan for the caretaking provider. The practice responded to the breach notice, but were not compliant. The practice was being supported by RCGP. The CQC revisited the practice in January 2016 The practice was not issued an action plan. The programme of monitoring the practice's performance/improvement continued from the first visit. The CQC revisited the practice in October 2016 After the CQC inspection visit, both partners resigned. Commissioners agreed to procure the contract to a new caretaking provider 6 Maddock Way Surgery G July September 2016 Feb-17 Action plan RI SOP - first inspection 17 May June 2017 Closed 7 St James Church Surgery G July September 2016 n/a n/a Inadequate CQC report n/a n/a Closed 8 Dr Aru, Lister Health Centre G May August 2016 Oct-16 Remedial breach notice Inadequate CQC report 26 January May 2017 Open NHS England issued a letter to the practice on 8 August 2016 to confirm the action plan received was compliant with the requirements. CQC cancelled registration, practice went into care taking arrangement Compliance letter was not sent as commissioners agreed to await for the outcome of the re-visit before the breach compliance letter is issued. The Committee decided in September that it was proportionate to issue an action plan letter in relation to the second inspection. See row 20 9 Avicenna Health Centre G May July 2016 Oct-16 Remedial breach notice Inadequate CQC report 24 February 2017 See comment Closed 10 Park Medical Centre G June October 2016 Dec-16 Action plan RI SOP - first inspection 17 May June 2017 Closed 11 Concordia Parkside G May October 2016 Dec-16 Action plan RI SOP - first inspection 17 May June 2017 Closed 12 Lordship Lane Surgery G May July 2016 Dec-16 Remedial breach notice RI SOP - first inspection 24 February March 2017 See row Dr Hossain G September February 2017 Mar-17 Remedial breach notice Inadequate CQC report 03 May June 2017 Closed n/a - CQC cancelled n/a - CQC cancelled Closed 14 Dr Hossain G August November 2017 Apr-17 CQC cancelled registration CQC cancelled registration registration registration 15 Sternhall Lane Surgery G August January 2017 May-17 Action plan RI SOP 18 August September 2017 Open 16 Lordship Lane Surgery G May July 2016 Jun-17 Remedial breach notice Failure to respond to 1st breach 26 July August 2017 Open 17 Lordship Lane Surgery G January April 2017 Jun-17 Remedial breach notice RI SOP 24 August September 2017 Open CQC temporarily suspended services at the practice under the care of Dr Kadhim with effect from 6:30 pm on 13th May 2016 for a period of up to three months. The Aylesbury provided cover for the three months. Dr Kadhim subsequently retired and the contract was procured to a caretaking provider. An action plan compliance letter was issued to the practice on 8 August Practice waiting for second CQC inspection An action plan compliance letter was issued to the practice on 8 August Practice now rated as Good overall Practice was not compliant, as a result a second breach notices was issue to the practice on 26 July 2017 The practice was not issued with a formal compliance letter as commissioners were awaiting the outcome of the second CQC inspection visit. CQC cancelled registration, practice went into care taking arrangement. Practice now managed by caretaking provider, therefore no breach notice was issued Practice is not fully compliant. 2 actions are not fully completed. Issues relate to staffing and repairs to the building. Practice is not fully compliant. 4 actions are not fully completed. Practice sent the same action plan they sent for the second breach notice. 18 Camberwell Green Surgery G August January 2017 Jun-17 Action plan RI SOP 18 August September 2017 Open Practice has been asked to provide assurance regarding 3 outstanding actions. Response deadline 20/11/2017 As discussed at the Committee the letter to the practice included the importance ofworking with the CCG to progress improvements. 19 Acorn and Gaumont G January April 2017 Jul-17 Action plan RI SOP n/a Closed 20 Dr Aru, Lister Health Centre G January May 2017 Sep-17 Action plan RI SOP - second inspection In progress Open Inadequate CQC report - first 21 Trafalgar Surgery G April August 2017 Sep-17 Remedial breach notice 07 November 2017 Open inspection Inadequate CQC report - second 22 Forest Hill Group Practice G February August 2017 Sep-17 Remedial breach notice 07 November 2017 Open inspection Sternhall Lane Surgery G July September November Open Practice needs to be sent an action plan letter following the September 2017 PCCC meeting. This is in progress. Response due date 5/12/17 Response due date 5/12/17 Paper submitted to November PCCC recommending a breach and remedial notice be issued in accordance with the RI SOP on the basis that breaches in the first RI CQC report were repeated in the second RI CQC report.

26 Southwark CCG Committee Report ITEM FOR DECISION CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Enclosure number: The Sternhall Lane Surgery Southwark Review of need for contractual action following Inspection by the CQC on 1 July 2017 F Any known conflict of interest Yes Report Author Responsible Director Name Christine Lancaster Name Caroline Gilmartin Job title Senior Commissioning Manager Job title Director of Integrated Commissioning Directorate Integrated Commissioning Directorate Integrated Commissioning - cgilmartin@nhs.net Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

27 Process followed for development of this paper: Followed agreed CCG process in full Urgent paper For urgent papers only: explain the reason for urgency Click here to enter text. Have you described the below impacts as part of this proposal? Have you considered either of the below to be relevant to this proposal? Impact on patients / service users Financial impact Impact on providers Estates impact Workforce impact Equalities legislation OSC involvement Yes N/A Does the recommendation align with the CCG s objectives and responsibilities? Deliver IAF improvement Improve patient outcomes Improve quality / safety Secure financial sustainability Support integration Address health inequalities / parity of esteem Enable the delivery of care coordination Promote early action Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

28 1. Purpose of the paper The purpose of this report is to seek approval from the Primary Care Commissioning Committee, to the recommendation, that Sternhall Lane Surgery be issued with a contractual breach and remedial notice following inspection by the CQC. This recommendation is in line with the London Standard Operating Procedure (SOP) for practices rated as requires improvement. 2. Describe the issue being presented to the committee First Inspection The Care Quality Commission (CQC) carried out an unannounced inspection of Sternhall Lane Surgery on 9 August 2016 where the practice was rated as Requires Improvement for Are services safe? and Are services well-led? The practice was rated as Good for Are services effective?, Are services caring? and Are services responsive to people s needs? The practice received an overall rating of Requires Improvement for the quality of care. NHS England and the CCG met with the practice on 4 May 2017 to provide support, discuss the action plan from the first CQC inspection and the progress the practice had made to address the concerns in the report. Second Inspection The Care Quality Commission (CQC) carried out a follow up inspection of Sternhall Lane Surgery on 11 July The practice was rated as Inadequate for Are services safe?, Requires Improvement for Are services effective? and Are services well-led? The practice was rated as good for, Are services caring? and Are services responsive to people s needs?. The practice received an overall rating of Requires Improvement for the quality of care. Click here for a copy of the report The report noted that not all issues identified in the first inspection had been adequately addressed. Since the first inspection, the practice has moved from Requires Improvement to Inadequate for Are services safe? and from Good to Requires Improvement for Are services effective. The practice has remained Requires Improvement for Are services well-led? The issues from first inspection on 9 August 2016 which had not been addressed by the second inspection included: reporting significant events and sharing of learning; assessment of infection control risk; consistent management of prescriptions in a safe way; appropriate training of staff including, infection control training and training in safeguarding to the level outlined in the practice s safeguarding policies; safeguarding policies that were out of date had not been archived; and equipment in the practice s emergency supplies had expired. There were also a number of new issues that were identified in the second inspection that had arisen since the first inspection. Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

29 The practice was given the opportunity to address any outstanding issues in the second CQC inspection on 11 July 2017 when they were asked to complete an action plan that was sent to them on 17 October 2017 to be submitted by 31 October 2017 (Action Plan). Southwark Primary Care Joint Committee (PCJC) previously approved the London region Standard Operating Procedure for Primary Medical contracts: A consistent approach to responding to Care Quality Commission Requires Improvement ratings. The considerations within this have been used to determine what formal contractual actions, if any, commissioners may recommend to the Southwark PCCC, as a result of the Sternhall Lane Surgery receiving a Requires Improvement notice. The considerations have included: 1. Should contractual action be considered? When a contractor is in receipt of a CQC report indicating that they Require improvement, they have immediately breached their contract. The Contractor shall comply with all relevant legislation and have regard to all relevant guidance issued by the Board or the Secretary of State or Local Authorities in respect of the exercise of their functions under the 2006 Act. It is therefore proportionate for commissioners to consider further contractual action. 2. Should a breach/remedial notice be issued based on CQC visit report evidence? Commissioners conclude that the report findings, on which the contractor has had the opportunity to comment, provide sufficient evidence of specified contractual compliance issues and that it is therefore able to issue a breach and remedial notice based on the evidence contained within. 3. What is the Contractor s track record/contractual history? Commissioners conclude that taking into account the full contractual history of this contractor, further contractual sanctions are deemed reasonable as there is documented evidence that concerns identified in a CQC report have been raised before. 4. Is it a proportionate response to issue a breach/remedial notice? Commissioners conclude that taking into account the response of the contractor to the CQC findings set out in their action plan below, together with the contractor s track record/contractual history confirmed above, it is proportionate to issue a breach/remedial notice. The contractor s current action plan has not addressed all of the actions in the CQC report. The table below shows the completed and uncompleted actions and also demonstrates that a number of issues identified in the CQC report following the first inspection on the 9 August 2016 had not been addressed by the follow up inspection on 11 July FURTHER DETAILS The Action Plan has been reviewed and the practice is still not compliant in relation to: reporting significant events and sharing of learning; assessment of infection control risk audits; consistent management of prescriptions in a safe way; ensuring that policies and procedures in relation to complaints are followed including: o Making sure that all responses to complainants are documented; and o providing patients with the contact information for external organisations that patients could escalate complaints to if they were unhappy with the practice's response". adequate systems in place to review safeguarding policies and the ability of staff to access Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

30 them; and providing assurance that the arrangements for managing medicines, including emergency medicines and vaccines in the practice always ensure that patients are kept safe. Issues/Concerns Ensure that there is evidence of discussion around significant events in practice meetings and staff learning from the outcome. The CQC report following the inspection on 11 July 2017 noted that even though this issue had been raised in the first inspection report, staff they spoke with were unaware of the correct process for reporting significant events and could not recall learning from recent events. Ensure that an Infection Control Audit is completed and that all staff have the relevant up to date Infection Control Training. The CQC report following the inspection on 11 July 2017 noted that even though this issue had been raised in the previous report, infection control risks had not been assessed and not all staff had received training in the last 12 months. Ensure Fire Drills and tests are documented. Ensure all staff are trained in Safeguarding to the level reflected in the Actions taken/actions not addressed Partially Completed: The practice supplied minutes of meetings that showed that shared learning in relation to significant events were discussed at meetings and assurance was given that these minutes are distributed to all staff. However, the practice did not address the significant event relating to services provided to a care home. On p17 the CQC report states However, we reviewed one significant event relating to one of the care homes the practice provided services to. This incident stemmed from May 2017 and we were told that this had still not been addressed. Partially Completed: An infection control audit dated 30 August 2017 was provided but the practice has not carried out a review of the audit or implemented any changes as a result of the audit. There are a number of infection control issues on the audit that need to be addressed including patient safety issues such as the safe positioning of sharps bins, ensuring that sharps bins are properly closed and the provision of hands-free waste bins. All staff have received infection control training. Completed: The practice provided a copy of the fire checks and a test log which records the dates of the fire alarm tests and fire drills. A fire safety folder has been placed in reception that provides access to the fire alarm test log, fire drill test log, fire safety policy and fire risk assessment. Fire drills are to be completed on a quarterly basis and fire alarms are tested weekly. The staff member responsible for maintaining the logs has been identified. Partially Completed: The practice states that all staff have received the level safeguarding training Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

31 practice policy. Consider a system of internal appraisal for salaried GP staff. Ensure that staff are made aware of clinical updates and actions and learning is evidenced. Review QOF domains where exception reporting is high and consider strategies to improve patient outcomes by reducing exception reporting in these areas. relevant to their role but acknowledges that practice policy states that non clinical staff should be trained to Level 2 in safeguarding and that Southwark CCG have asked that over a three year period of transition their practices should ensure that their non-clinical staff work towards level 2 training rather than level one. Processes have been put in place to ensure that the mandatory training log is reviewed on a monthly basis to ensure all non-clinical staff are at Level 2 by the required deadline. Completed: The practice provided us with documents that set out a system for carrying out inhouse appraisals of salaried GPs. Completed: The practice has implemented systems for meeting agendas to ensure that there is a running agenda item for NICE guidance updates. The outcomes and learnings from NICE guidelines are discussed during meetings and minuted. The minutes are saved on the shared drive and ed to all staff members along with a read receipt to ensure that those who work part time are kept informed. The responsible person for bringing updates to the meetings has been identified as the lead GP. Completed: The practice completed an exception reporting review which was implemented and submitted to the CQC after the 2017 visit. The outcomes were shared with the Lead GP, Care Home Lead GP and Regional Manager. It is stated that the Practice Operations Manager will review this yearly with the assistance of the Service Development Manager and Lead GPs. Review the process for Bowel and Breast Cancer Screening. Completed: The practice has appointed an Admin Lead to review processes in relation to Bowel and Breast Screening who will run quarterly searches for those patients who have not attended relevant screening sessions. They will then send reminder letters with information leaflets and they will also continue to send DNA letters. Chair: Dr Jonty Heaversedge 6 Chief Officer: Andrew Bland

32 Review process of inviting patients for Learning Disabilities Annual Health Checks. Ensure the complaints policy contains information in relation to: external agencies that patients could contact if they were dissatisfied with the practice s response; in the event that they were unhappy with the practice s response and all complaint's responses are recorded. Ensure that the prescription security policy is adhered to and that the uncollected prescription procedure is implemented. The CQC report dated 11 July 2017 states that although this issue had been raised before prescriptions were not consistently being managed in a safe way. Completed: The practice has appointed an Admin Lead to manage the process for inviting Learning Disability patients for annual health checks. The Admin lead will follow up all non-attenders with a phone call to the patient or carer. Home visits will be arranged for any housebound patients and the group will continue to centrally send invitations to patients. There will be quarterly monitoring and the Practice Operations Manager will oversee the process and make changes to the process when necessary. Partially Completed: The Practice's complaints policy has been made available on the shared drive, the intranet, practice website and a hard copy in Reception. The Practice response template is saved on the shared drive and is to be used in all responses. The complaints policy provides information in relation to who to complain to in the event that the patient is unhappy with the practice's response. The practice has identified the practice manager as being responsible for the complaints process. However, the practice has not addressed the statement on p28 that the complaints policy "had not been followed for all complaints" and that not all responses to complainants had been documented and "none of the complaints reviewed provided patients with the contact information for external organisations that patients could escalate complaints to if they were unhappy with the practice's response". Partially Completed: The practice has provided a prescription security policy. There is insufficient assurance that the review of uncollected prescriptions is being carried out frequently enough. The practice has not described any call or recall system for any patient that does not attend a medication review as a result of not collecting a prescription. There was no indication that each of the incidents described in the CQC report on p19 relating to incorrect doses, unsigned prescriptions and issuance of multiple prescriptions had been addressed or recorded as significant events and dealt with through the significant event procedures. The practice has not addressed the statement on Chair: Dr Jonty Heaversedge 7 Chief Officer: Andrew Bland

33 p19 that there were no systems in place to monitor the use of prescriptions. Ensure that the oxygen masks are in date. The CQC report following the inspection on 11 July 2017 noted that even though this issue had been raised at the previous inspection, they found expired equipment with the practice s emergency supplies. Completed: The paediatric mask has been ordered and delivered. The Practice Nurse and HCA are required to review the expiry dates of oxygen masks as part of their weekly emergency drug checks. Ensure that Child Safeguarding Policy is current/up to date version. The CQC report following the inspection on 11 July 2017 noted that even though this issue had been raised at the previous inspection, old safeguarding policies with out of date information had not been archived. Ensure that there are records of actions taken after safety alerts are recorded. Partially Completed: The practice has removed an out of date safeguarding policy but there is no assurance given that a system has been put in place to carry out a regular review of policies to ensure that they are kept up to date and that the relevant responsible person is identified. The practice has also not addressed the statement on p18 relating to the ability of all staff members to access safeguarding policies. Completed: A Practice meeting template has been implemented by the practice which holds a running agenda item for Patient Safety Alerts (CAS). CAS alerts and the outcome and learnings are discussed in the Practice meeting and minuted. This is detailed in the CAS policy. The minutes are saved on the shared drive and are now also ed to all staff members to ensure that those who work part time are kept informed. There is a CAS folder in the Practice Operations Manager's office where all CAS alerts are printed out, dated and actions taken recorded. This folder also includes the CAS alert policy. All relevant CAS alerts are also ed to all relevant staff alongside a read receipt to ensure that they have been read. The Practice Operations Manager and Lead GP are on the mailing list for CAS alerts and take responsibility for the cascading of these. The Practice Operations Manager and the Chair: Dr Jonty Heaversedge 8 Chief Officer: Andrew Bland

34 Lead GP are responsible for the maintenance of the CAS alert folder. The Practice Operations Manager is responsible for chairing the meetings, taking the minutes and cascading them. Ensure that there are systems in place for ordering, receiving and caring of vaccines by the relevant identified staff including during any absence from work by the practice nurse (i.e. annual or sick leave). Partially Completed: The HCA and Practice Operations Manager have been trained and are able to order vaccines. A vaccine log is kept in the reception area. Despatch notes are kept in order to keep a record of expiry dates and an expiry date log has now been implemented. However, the practice has not addressed the statement on p18 "The arrangements for managing medicines, including emergency medicines and vaccines in the practice did not always ensure that patients were kept safe (including obtaining, prescribing, recording, handling, storing, security and disposal)." There is no assurance that all aspects of the management of vaccines and emergency medicines have been addressed. We have been provided with a log that records the ordering of vaccines but we have not been provided with any policies or procedures in relation to the management of vaccines and emergency medicines. KEY ISSUES: The contractor was initially inspected on 9 August The report resulting from the CQC inspection of 9 August 2016 was published on 17 January 2017, with a finding that the contractor s overall rating is Requires Improvement for the quality of care provided. A request was made to the contractor on 15 February to submit an action plan and further follow up s were sent on 20 March and 24 March to request the submission of an action plan and arrange a meeting. The contractor did not submit the action plan within the specified deadline and it was escalated to the management of the Hurley Group; The action plan was submitted by the contractor to the CCG and NHS England on 6 April 2017 which showed how it had addressed the actions from the published CQC inspection report. NHS England and NHS Southwark CCG carried out a practice visit on 4 May 2017 to discuss the action plan and the progress the practice has made to address the concerns in the CQC report. A paper was submitted to the 23 May 2017 Primary Care Working Group meeting that contractual actions would not be taken following the visit and that a formal action plan should be requested. Chair: Dr Jonty Heaversedge 9 Chief Officer: Andrew Bland

35 A formal action plan was sent to the practice on 18 August 2017 and the practice responded on 18 September This response was assessed and there are two actions outstanding which relate to staffing issues and repair of the building. The contractor was revisited by the CQC on 11 July 2017 and it was found that although some issues had been addressed there were a number of issues that had arisen from the previous inspection that had not been adequately addressed including, but not limited to: o Reporting significant events and sharing of learning; o Assessment of infection control risk; o Consistent management of prescriptions in a safe way; o Appropriate training of staff including, infection control training and training in safeguarding to the level outlined in the practice s safeguarding policies; o Safeguarding policies that were out of date had not been archived; and o Equipment in the practice s emergency supplies had expired. In accordance with the Standard Operating Procedure for Primary Medical contracts, the contractual history shows that there is documented evidence that concerns identified in a CQC report have been raised before. Further issues have also arisen since the first inspection which have resulted in the practice now being rated as Inadequate for Are services safe? and Requires Improvement for Are services effective? and Are services well-led?. This demonstrates that there has been no overall improvement between the first and the second CQC report, that there has been a reduction in 2 of the CQC ratings and one rating has remained the same. The practice was given the opportunity to address any outstanding issues in the second CQC inspection on 11 July 2017 when they were asked to complete an Action plan that was sent to them on 17 October 2017 to be submitted by 31 October The practice s Action Plan does not show that all areas of concern have been addressed. Commissioners plan to visit the practice to discuss the action plan received from the contractor. 3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?). Commissioners recommend that formal contractual action is pursued on this occasion, based on concerns occurring in the CQC report from the inspection on 9 August 2016 being repeated in the CQC report from the inspection on 11 July 2017 and a failure by the practice to address these concerns in their action plan dated 24 October The Standard Operating procedures in relation to Requires Improvement CQC reports provides that when provided with a full contractual history of the practice, contractual sanctions may be deemed reasonable and an example given is where there is documented evidence that concerns identified in a CQC report have been raised before. Commissioners therefore recommend the issue of a breach and remedial notice as a proportionate response to the inspection published report. Chair: Dr Jonty Heaversedge 10 Chief Officer: Andrew Bland

36 Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document None Date paper completed Wednesday, 22 November 2017 Chair: Dr Jonty Heaversedge 11 Chief Officer: Andrew Bland

37 Southwark CCG Committee Report ITEM FOR DECISION CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Enclosure number: Silverlock Medical Centre Relocation H Any known conflict of interest Yes Report Author Responsible Director Name Jean Young Name Caroline Gilmartin Job title Head of Primary Care Commissioning Job title Director of Integrated Commissioning Directorate Integrated Commissioning Directorate Integrated Commissioning jean.young4@nhs.net cgilmartin@nhs.net Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

38 Process followed for development of this paper: Followed agreed CCG process in full Urgent paper For urgent papers only: explain the reason for urgency Click here to enter text. Have you described the below impacts as part of this proposal? Have you considered either of the below to be relevant to this proposal? Impact on patients / service users Financial impact Impact on providers Estates impact Workforce impact Equalities legislation OSC involvement Yes N/A Does the recommendation align with the CCG s objectives and responsibilities? Deliver IAF improvement Improve patient outcomes Improve quality / safety Secure financial sustainability Support integration Address health inequalities / parity of esteem Enable the delivery of care coordination Promote early action Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

39 1. Purpose of the paper The paper asks the Primary Care Commissioning Committee (PCCC) members to agree to the proposal to move the Silverlock Medical Centre (Silverlock) services from its current premises 2-3 Warndon St, Rotherhithe, London SE16 2SB to the estate currently occupied by Avicenna Health Centre (Avicenna), 2 Verney Way, London SE16 3HA, a purpose built Health Centre 0.7 miles away. The full business case can be found in appendix i. 2. Describe the issue being presented to the committee General Practice services Silverlock are delivered to registered patients through an Alternative Provider Medical Services (APMS) contract which expires on 30 June 2019 currently with AT Medics. AT Medics also provides the caretaking APMS contract at Avicenna Health Centre. Silverlock currently has 8,112 registered patients (weighted) and the current estate is considered inadequate premises for the following reasons: a) The current estate comprises of two divided buildings under a block of flats, with no internal connections between them: i. This means staff and patients are separated across 2 separate sites ii. This impacts on poor patient experience and potential safety as patients have to leave the waiting room in the main building to attend their appointment in the second building. i. It also creates difficulties for staff management and issues around lone working b) The current estate has 13 waiting room chairs in the main building, with limited space for pushchairs or wheelchairs. c) A total of 5 clinical rooms and inadequate admin space. The lack of space has caused issues with the attainment of local targets including Holistic Health Assessments as part of the population health contract between the NHS Southwark Clinical Commissioning Group (CCG) and GP Federations d) The location under residential estate has caused several issues for the practice with 5 floods over the last five years, including floods from the residence above which resulted in the ceiling in the waiting room, reception and nurses room to collapsing e) The lack of notes storage on site means that notes are now stored at Avicenna Health Centre, which can cause difficulties with access and delays in responding to requests f) The practice has worked to maximise use of the site but has increased from a registered list from 3623 to 8492 which means the practice is struggling to operate in this space g) The nearest health centre, Park Medical Centre is not an option for relocation as there is not enough room to locate another registered list size within the practice. There are no other health facilities in the area which could immediately accommodate this registered list with cost. Any non-health building would require significant configuration to access NHS and DDA standards. h) There are good public transport links between the two current sites. The 381 bus route runs between the two sites with the bus stops being within 350ft of each of the practice sites. Silverlock has 2 separate occupations for the 2 separate sites; one is directly with Southwark Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

40 Council with no lease in place and one through NHS Property Services (NHSPS). NHS PS is tied into a lease until the next break clause in 2021 and there will be costs to the NHS for both early redemption of the lease and dilapidations. The approximately expected cost of the latter s early redemption is approximate 47k, with dilapidation costs yet to be quantified. 3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?). The proposal is that the PCCC agrees, in principle, to the relocation of Silverlock subject to: a) Patient and stakeholder consultation b) Full confirmation of costs to the NHS for securing the release from both premises at Silverlock, and their associated affordability c) Confirmation of the Avicenna lease between the Landlord and NHS PS (which is in the final stages of agreement) d) The Avicenna premises being made compliant between December 2017 and 31 March 2018 using the funding secured through London Capital Committee, which has approved funding of 126k including VAT. e) Additional capital funding being secured to fulfil the requirements to maximise the clinical capacity for the 2 lists on the same site, Clinical capacity will be improved at Avicenna by utilisation of the first floor, and conversion of some administrative space into clinical space. Currently only 5 rooms are in use. This could be progressed using the Section 106 funding, the estimated cost of which is 87.5k. f) The CCG funding IT and formal patient communication costs, as is required g) The CCG funding costs for the decommissioning of the Silverlock site at approximately 55,000, excluding dilapidations costs. This includes the cost of exiting the lease at 47k which can be negotiated. 4. What is the rationale for your recommendation? a) Silverlock patients will be able to access a full range of GP practice services in a fit for purpose building in the local area b) Subject to PCCC endorsement of the separate part 1 paper, Avicenna patients will be able to maintain use of the same site and register as Silverlock patients, should they wish to. c) For those patients currently registered with Avicenna, there will be some continuity as AT Medics is currently caring for these patients under a caretaking APMS contract operating from the same site. d) The current Silverlock site could be handed back to the Council on Tuesday April 3, 2018, subject to agreement with Southwark Council. e) It will maximise health estate which is suitable for health use, subject to the minor works to enable further clinical capacity f) AT Medics will work with commissioners to determine whether their practice boundary may need to be expanded to improve patient choice in the area. 5. What stakeholder engagement has taken place? Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

41 This is subject to engagement with patients and stakeholders 6. Do stakeholders support the recommendation being made? n/a 7. What other options were considered? There are no other health sites in the area to relocate this practice. 8. What are the risks in proceeding with the recommendation? The costs need to be fully identified once the PCCC agrees, in principle, to this proposal, subject to the conditions set out in the recommendations. This will require discussion with the Council and NHSE PS. 9. What are the risks in not proceeding with the recommendation? a) Patients registered at Silverlock will continue to access services from premises not considered fit for purpose b) Patients registered at Silverlock will be unable to receive full access to full GP services on site c) That Avicenna will continue to be under utilised d) That there is insufficient capacity to register more patients. Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

42 Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document i Silverlock Medical Centre Relocation Business Case Date paper completed Tuesday, 21 November 2017 Chair: Dr Jonty Heaversedge 6 Chief Officer: Andrew Bland

43 BUSINESS CASE Project Name: Silverlock Medical Centre relocation into Avicenna Health Centre Author: Susan Sinclair 13 November 2017 Practice Name(s): Silverlock Medical Centre G85087 Key Contact(s) & contact details: Susan Sinclair (CEO) Dr Hasnain Abbasi (GP Director) Danielle Caswell (Regional Manager) Current address: 2-3 Warndon St, Rotherhithe, London SE16 2SB Version 2 Page 1 of 18

44 Contents Page No. 1 Executive Summary 3 2 Proposal 3 3 Practice/s Information 3 4 Case for Change 3 5 Financial Costs of the Proposal Recurrent and Fixed 4 6 Comments / Issues 4 7 Appendices 4 Page 2 of 18

45 Executive Summary This Business Case outlines the proposal to move the Silverlock Medical Centre (Silverlock) from its current premises 2-3 Warndon St, Rotherhithe, London SE16 2SB to the estate currently occupied by Avicenna Health Centre (Avicenna), 2 Verney Way, London SE16 3HA, a purpose built Health Centre 0.7 miles away (see map). It also outlines the necessary enabling work to ensure the Avicenna estate is fit for purpose from a capacity, infection control and health and safety perspective. Silverlock services are delivered through an APMS contract which expires in The current service is provided by AT Medics, a London Wide provider of primary care services who have a committed team in Southwark. The practice is a member of the Local Federation, Quay Health Solutions (QHS) and is committed to meeting local health priority targets, although the current footprint is making this increasingly challenging. Silverlock currently has 8,112 registered patients (weighted). The current estate is inadequate for a number of reasons: - The current estate comprises of two divided buildings under a block of flats, with no internal connections between them. This means staff and patients are separated, and in all weathers patients have to leave the waiting room in the main building to attend their appointment in the second building. It also creates difficulties for staff management and issues around lone working (see appendix 2). - The current estate has 13 waiting room chairs in the main building, with limited space for pushchairs or wheelchairs. - A total of 5 clinical rooms and inadequate admin space. The lack of space has caused issues with the attainment of local targets including Holistic Health Assessments. - The location under residential estate has caused several issues for the practice- with 5 floods over the last five years, including floods from the residence above which led to the ceiling in the waiting room, reception and nurses room to collapse. - The lack of notes storage on site means that notes are now stored at Avicenna Health Centre, which can cause difficulties with access and delays in responding to requests. Due to the estate layout there is no prospect for any estates improvement or expansion on this site, as the space is landlocked and the plant rooms for the residential accommodation are beneath the two current sites. The Silverlock lease has now expired, and therefore this is an opportunity to make this decision. The proposed site, Avicenna Health Centre is a purpose built Health Centre, with 3,100 Page 3 of 18

46 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 registered patients (raw). The GP Practice is currently under caretaking arrangements through AT Medics who were awarded the contract through competitive procurement. Lease arrangements are currently being agreed with the landlord.. Limited enabling works are required to convert more of the building from office and administrative space into clinical space, which will be over two floors. The premises will ultimately have: - 11 clinical rooms (on two floors) - Sufficient waiting space - Increased administration space. The increase in capacity, and adoption of modern technology in line with the GP Forward View will give capacity for a total of 14,000 patients on the Avicenna site, the current registered list at this building is AT Medics have experience in estates improvement and relocation, having recently moved the Queens Road Practice to Meeting House Lane in December 2016, working closely with Local and National Commissioners and Patients to achieve an improved estate and seamless move? 3. Proposal Context Silverlock Medical Centre has experienced rapid growth over the last 5 years, with the patient list size nearly tripling in that time Silverlock Registered List Size (raw) Source Open Exeter Silverlock currently has split site working in two areas at the base of a residential tower block (Appendix 2). The site currently has 5 clinical rooms, a 13 seated waiting area with Page 4 of 18

47 limited space for wheelchairs or pushchairs and extremely limited administration space. Through a combination of effective site management, remote working and extended hours the practice was able to accommodate the growing list size for general medical practice up until summer The space constraints have nonetheless impacted on the ability to deliver some local targets such as Holistic Health Assessments. In July 2017 AT Medics begun caretaking Avicenna Health Centre, which is 0.7 miles away, and in agreement with commissioners have used some of this space to jointly support Silverlock and Avicenna patients. The proposal of moving to Avicenna has been informally discussed at the local PPG, since patients are well aware of the difficulties we have with the estate at Silverlock. This proposal was met favourably, although further engagement is clearly required. The overall condition of the estate at Silverlock is good, and so a key dependency for the move is that the patients will be transferred to a similarly compliant estate, and work needs to take place to ensure that the estate has sufficient capacity, by dividing rooms on the first floor, and bringing administration space into clinical usage. Several other options have been considered to accommodate the growing list size over the previous years, however, there has been a lack of available estate in the vicinity, and therefore Avicenna marks the most logical option. The nearest Surgery to Silverlock is Park Medical Centre 200 yards away, Avicenna is 0.7 miles away and the Grove Medical centre 1 mile away. Grove Medical Centre is located in the borough of Lewisham. The practice completed a local search of premises but did not locate a suitable alternative location. Proposal The proposal is that: - Avicenna estates compliance and capacity is improved between December 2017 and 31 st March 2018, and Silverlock moves to the Avicenna on 24 th March Clinical capacity is improved at Avicenna by utilisation of the first floor, and conversion of some administrative space into clinical space. Currently only 5 rooms are in use. - Subject to commissioning decisions about the long term future of Avicenna Practice, and patient choice, Avicenna patients will be able to maintain the same site and register to become Silverlock patients. For those currently registered at Avicenna there will be some continuity for patients as AT Medics is currently caring for these patients under a caretaking APMS contract. - The current Silverlock site will be handed back to the Council on Tuesday April 3, Page 5 of 18

48 2018. This will enable more effective estates utilisation across Southwark, allow Silverlock to provide more holistic services for patients and enable full attainment of local health targets. Key milestones Description Owner Comment Primary Care Commissioning Committee decision SCCG Confirm scope of improvement works and gain quotes ATM December Confirm sources of funding ATM End Dec Lease issues Agree lease terms and sign lease CCG End Dec Obtain landlord consent to agreed works CCG End Dec Patient engagement (see detailed plan) PPG On decision of PCC ATM/ CCG December (monthly thereafter) PPG visit to new site ATM January Agreement of any proposed changes regarding comms strategy ATM January Enabling work s Enabling work starts- Avicenna (Phase One and Two) ATM January - March CSU addition ports CSU March Move Physical Relocations ATM 31-Mar Decant and decommissioning Silverlock ATM/ CSU Key dependencies Patient engagement and support for the plan Silverlock patients are aware through Patient Participation Group (PPG) meetings and the way that appointments are structured that Avicenna may create a long term solution for the Practice. Many have experienced the impact of crowded waiting rooms, a lack of flexibility because of room capacity and are also familiar with the established AT Medics practice such as telephone triage, which reduce the need to come to the surgery unnecessarily. During our recent experience of moving the Queens Road Surgery in Southwark the engagement with patients meant that we were able to significantly improve communications to patients regarding the move, get feedback from patients regarding some Page 6 of 18

49 of the estates requirements, and ensure that issue and concerns about the move were addressed in a timely manner. It is proposed that should the business case be approved, patients will be asked to attend an extraordinary PPG in order to ensure all concerns are addressed from the outset, and any additional factors, which have not been considered can be reviewed in partnership with patients and commissioners. Thereafter monthly PPG meetings will take place, including a practice visit to the new site, and an opening after the move. Our communications plan is included in Appendix 3. Lease agreement for Avicenna Currently the lease is via a Tenancy at Will. A key dependency to the move dates is that the lease is agreed and finalised in order that the enabling works can be carried out, to ensure the estate is fit for purpose in terms of compliance and capacity. Enabling works It is critical that the building improvements required are completed prior to the move in order to reassure patients that the move is an investment in the future of their practice. At the current time only 5 rooms are in use, and to enable sufficient capacity, the first floor will also need to be put into use for clinical care, with some dividing of rooms as a result, and safety and compliance issues resolved. For example the staircase is carpeted as it is not for clinical use at present but this is a slip hazard, and therefore the floor and rails will need to be refitted. In order to attain estates compliance on the Avicenna site limited works were approved by the London Capital Committee in October 2017 subject to the lease being agreed. This allowed capacity for the current Avicenna population, but not the capacity for the Silverlock patient list. A summary of the current capacity, approved enabling works, and additional enabling works can be found in the finance section. Practice Information Page 7 of 18

50 Silverlock practice is an APMS practice which has been run by AT Medics for the last 5 years. The contract will expire in During this time the practice has experienced a rapid list growth, and is now at 8,112 patients weighted (8387 raw). The practice catchment area (from Primary Care web tool) is below. Avicenna is marked by a black square. The practice serves a diverse community, with above average deprivation, deprivation affecting Children and barriers to housing. The move to accommodation with appropriate capacity will enable much greater flexibility of appointments, which are currently driven by room availability, a wider multidisciplinary team and the ability to have a wider team from outside the practice supporting patients. AT Medics would work with commissioners to identify if the boundary needs to be expanded to improve patient choice in the area. Page 8 of 18

51 The age demographics can be seen below (EMIS, Oct 2017); The Practice has a stable workforce and is able to support continuity of care through a multidisciplinary workforce which includes GP s, Pharmacists and Practice Nurses. The Practice workforce is below: Staff Group Role WTE Clinical Management Clinical Director time GPs Practice Nurse HCA Pharmacist Regional Manager Practice Manager* Administrators 1 session/ week 3 WTE 1.2 WTE 0.2 WTE 0.4 WTE 1 WTE 1 WTE 6 WTE *The Practice Manager works across both Avicenna and Silverlock to help drive improvement, create an appropriate environment for both Silverlock and Avicenna patients. Staffing is compromised due to the lack of space, and post move the following posts would be based at the new site: Staff Group Role Additional WTE Clinical GPs or equiv.5 WTE Page 9 of 18

52 Practice Nurse HCA Pharmacist.4 WTE.8 WTE.4 WTE Administration Administrators 2 WTE The practice is also a training practice, although the ability to accommodate trainees has become increasingly challenged. The current solution of using Avicenna estate has enabled temporary alleviation of this problem, although it separates the clinical team, and creates inefficiencies as a result. With the additional estate, a better training experience and increase in the number of trainees could be enabled. Health Needs Silverlock has good performance in many of the Local and National targets. Care Quality Commission (CQC) The practice has been rated as good by the Care Quality Commission following an inspection on 21 July Attainment of National targets 2016/ /17 Practice CCG QOF % 95.3% Child Imms (2 years) 90% 90% Child Boosters (5 years) 90% 87.8% Cytology 67.44% (2016) 66.7% Flu (over 65s) 68% 66% Flu (under 65s at risk) 55% 48.7% Flu (child) 43% 45.1% However, running services such as immunization campaigns can be challenging in the current space, as reserving capacity for walk in appointments is impractical given the competing demands of the practice. In other AT Medics sites this is a key component of our strategy. Similarly, to increase the number of smear tests undertaken, appointment flexibility is an important factor, and this is extremely limited at the moment due to the pressure on room space. Page 10 of 18

53 Attainment of local targets 2016/17 Ambulatory Blood Pressure Monitoring Health Checks Smoking - setters Smoking - quitters HHA - Practice 2016/17 target 1 April - 28 February 2017 Additional number to reach target 2016/17 target 1 April - 28 February 2017 Additional number to reach target With regard to local services, a clear trend has emerged, where targets that are not reliant on physical space are attained, such as, Hypertension and Ambulatory Blood Pressure Monitoring but struggle to meet targets which require significant physical space either during the appointment or afterwards, such as holistic assessments, learning disabilities health checks (2 undertaken in 2016/7) case management and health hecks. Without a long term solution to space constraints patients will continue to be disadvantaged as a result of physical space. 2016/17 target 1 April - 28 February 2017 Additional number to reach target 2016/17 target 1 April - 28 February 2017 Additional number to reach target Silverlock Medical Centre met met QHS Total met met 6 4 met /17 target 1 April - 28 February 2017 Additional number to reach target Target SMC above target 31/03/2017 HYPERTENSION hypertension :BP 150/90 or less (no 78% 83% exceptions DIABETES diabetes HBA1c recorded< 8 (no 75% 76% exceptions)ifcc64 DIABETES diabetes BP< 150/90 (no exceptions) 79% 91% DIABETES diabetes - cholesterol < 5 (no exceptions) 77% 78% below target STROKE stroke register-cholesterol <5 (no exceptions) CHD coronary Heart disease cholesterol <5 (no exceptions) SMC 31/03/ % 75% 83% 77% The new PMS services, which AT Medics have committed to deliver for the Silverlock population, will be an additional challenge without additional room space as many are predicated on long term follow up and physical health checks of at risk patients. The new coordinated care pathway requires an increased amount of clinical time for assessments and care planning, and with the current Silverlock footprint, they will be difficult to achieve. Relocation to Avicenna will mean there is additional clinical space to Page 11 of 18

54 hold clinics for both assessments and care planning with our clinical team, ultimately resulting in better outcomes for the moderately and severely frail multi morbid population. For example the Triple Target (diabetes), Mental Health Physical Reviews, and palliative care registers all require more capacity than we can currently offer with the Silverlock premises. Case for Change The current premises do not offer any development opportunity and are no longer fit for purpose. The split site working is not possible to design out due to the building layout. The size and complexity of the patient population means that the move to larger, purpose built premises is necessary in order to continue to provide high quality care, increased flexibility and meet emerging health needs. The proposed solution has several benefits: - It is in line with the Primary Care estates Strategy - Avicenna is a known Health Centre, with easy transport links from the current site of Silverlock (3 bus stops using 2 buses / 15 minute walk) - Silverlock patients are beginning to use this facility, and recognise that the current estate is inadequate - N3 connections are already in situ - Enabling costs are limited to refurbishment to meet statutory compliance, and to ensure the patient list size can be accommodated (for instance by dividing rooms into two to create clinical capacity) - The solution is available in the short term, but creates a long term benefit for both local patients and the health economy - Silverlock list size could grow by another 6,000 from its current raw of 8,112 in the new site at Avicenna. This will be enabled by additional physical space and the increasing use of technology to support patients, to reduce the amount of travel for patients and provide convenient access to patients. - The number of primary care estates in Southwark reduces, supporting the underlying viability of general practice, and ensuring that monies can be utilised appropriately - Patients will experience greater access, flexibility of appointments and range of clinicians as a result. For instance, currently the timing of nursing sessions have to be allocated against other priorities in the practice, such as on the day appointments, resulting in less flexibility of appointment time. With appropriate space we would be able to offer much more flexibility on these type of appointments and Long Term Reviews. Practice Improvement Plan Silverlock is already a strong performer in local and national measures. However there are key areas that we have not been able to provide the physical capacity to deliver services. Page 12 of 18

55 Silverlock s aspiration is to deliver all targets within the thresholds set within either the PMS Specification or Local Population Health Target, with continuous year on year improvement. The practice aims to be in upper quartile performance within the locality. Rapid improvement will be seen particularly in the following areas where estate has impacted upon performance. Metric 2016/17 Future Performance Hollistic assessments Practice 5/35 Meet annual target for our patients Case Management 1/11 Meet annual target for our patients Learning Disability checks 2/10 Undertake 90% of performance Financial Costs of the Proposal Recurrent and Fixed The main costs of this proposal relate to one off capital cost related either to the move, premises compliance, or the decommissioning of Silverlock site. The costs to make the practice fit for purpose for the current registered list agreed by the London Capital Committee are excluded from the table below. The estimated costs below have not been agreed and would be subject to securing additional funding through the section 106 funding as they relate to increasing clinical capacity at the Avicenna Health Centre to accommodate the relocation of Silverlock. There is also a cost to releasing the remaining years on the lease with the Council which is approximately 47k, if this cannot be reduced. Furthermore there would be liability for the dilapidations on the premises, this cost is unknown. Total (excluding VAT) Decommissioning costs Silverlock IT (N3) 3,500 Moving costs (removal) 4,000 Final clean costs 500 Costs for exiting lease at Silverlock (to be negotiated) 47,000 Dilapidations TBC Total decommissioning costs 55,000 Estimated costs for additional capacity for patients NICEC Inspection 5,000 Removal of waste/ spare equipment to make room for new clinical rooms 2,000 Costs required, clinical rooms (compliance) 31,192 Page 13 of 18

56 Waiting room chairs (compliance) 1,809 Room divided and soundproof (capacity building) 20,000 Plumbing works to install x2 sinks in 2 rooms 1,500 Non-slip patient stairs covering to the second floor and railing 2,500 Lighting changes in rooms to be split 1,500 Emergency lighting and exits first floor 4,000 Painting clinical rooms and making good 18,000 Total for additional capacity 87, Other IT commissioning (additional ports) 600 Comms support Silverlock patients 800 Legal (create tenancy/ licence to occupy costs) 2,000 Total Other 3,400 TOTAL 145,901 Conclusion: The Primary Care Commissioning Committee is asked to approve the proposal to move Silverlock from its current space constrained premises, which are now impacting on patient care to Avicenna Health Centre, less than a mile away. The CCG is also asked to support the application for section 10 funding for enabling works for Avicenna, which create sufficient clinical capacity and compliant estate for Silverlock patients and Avicenna patients who wish to remain at the practice. Page 14 of 18

57 7. Appendices Appendix 1 Distance between Silverlock Medical Centre (SE16 2SB) and Avicenna Medical centre (SE16 3HA) Page 15 of 18

58 Appendix 2 Silverlock Health Centre Patient clinical room x1 and admin space Patient reception clinical rooms Page 16 of 18

59 Appendix 3 Communications Plan- patients Launch Dates Following outcome of Capital committee Jan From January 15 th weeks prior to confirmed move date 6 weeks prior to confirmed move date Item Patient Participation Group Telephone system Telephone auto-attender Patient Letter Poster Practice Website Audience type Patients inform Service provider Patients inform Patients inform Patients inform Patients inform Activity - Extraordinary 30 minute meeting to brief patients and Patient Participation Group members, invite Healthwatch also. - Monthly until 1 month after move. - Migration visit planned at new site for 31 March. All numbers, including fax number, will be migrated with the same setup as at current premises. - Up to 31/03/2017: Auto attender to be updated with following: We are moving. From Monday 2 April 2018 we will be based at Avicenna Health Centre Verney Way, London SE16 3HA For more details, please visit southwarkgp.co.uk. - From 2/04/2018-6/08/2018: Auto attender to be updated with following: We have moved. Our surgery is now located at Avicenna Health Centre Verney Way, London SE16 3HA. For more details, please visit southwarkgp.co.uk. - Letter drafted and attached - To be sent to all patients, includes a map demonstrating walking directions and transport links - To be posted on patient notice boards and front door at current site from date of announcement, following input from PPG, with PPG dates and have your say box available for those that cannot attend the PPG - Website to receive news item and other content updates - to advise change of address, no changes to services, tel number etc - Web wrap a popup will display for 30 days for all visitors to the website, forcing visitors to learn about the change of address and Responsibility Practice manager Phone supplier Practice manager NHSE Practice manager Practice manager Page 17 of 18

60 Following move Signage Patients inform During move SMS Patients inform linking to the webpost - content to be consistent with above comms once date of move confirmed - Will use existing PVC banner temporarily on go live - To liaise with Southwark Council about road signage - to be issued to all remaining Avicenna and Silverlock patients, linking to website news item - First message to advise change, link to the web post - Second message 1 week before to remind change, link to the web post Practice manager Practice manager Page 18 of 18

61 Southwark CCG Committee Report ITEM FOR DECISION CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Enclosure number: Avicenna Health Centre Registered List I Any known conflict of interest Yes Report Author Responsible Director Name Nick Langford Name Caroline Gilmartin Job title Assistant Head of Primary Care Job title Director of Integrated Commissioning Directorate N/A Directorate Integrated Commissioning nick.langford@nhs.net cgilmartin@nhs.net Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

62 Process followed for development of this paper: Followed agreed CCG process in full Urgent paper For urgent papers only: explain the reason for urgency Click here to enter text. Have you described the below impacts as part of this proposal? Have you considered either of the below to be relevant to this proposal? Impact on patients / service users Financial impact Impact on providers Estates impact Workforce impact Equalities legislation OSC involvement Yes N/A Does the recommendation align with the CCG s objectives and responsibilities? Deliver IAF improvement Improve patient outcomes Improve quality / safety Secure financial sustainability Support integration Address health inequalities / parity of esteem Enable the delivery of care coordination Promote early action Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

63 1. Purpose of the paper The Avicenna Health Centre caretaking Alterative Provider Medical Services (APMS) contract is due to expire on 31 March 2018 and the Primary Care Commissioning Committee (PCCC) is required to make a decision on the future of this contract. The PCCC is asked to agree to the recommendation to ask patients registered at Avicenna to register with a practice of their choice, that has a catchment area covering the patient s address, following the completion of a full capacity audit of local practices and patient and stakeholder engagement. 2. Describe the issue being presented to the committee The PCCC is asked to agree to the proposal to ask patients registered with Avicenna Health Centre to register with a practice of their choice, providing the patient lives within the practice s catchment area as: Previous market engagement has indicated that it may be difficult to reprocure a list of fewer than 6,000 patients, as a list of this size is not financially viable. Avicenna currently has less than 3000 patients registered Avicenna is located in a building which has sufficient capacity to accommodate two patient lists and it will support the NHS to utilise existing premises more effectively. By co-locating Silverlock onto the Avicenna Health Centre site, patients currently registered with Avicenna can choose to re-register with a practice on the same site, which in turn is likely to result in a well performing practice with a larger, more sustainable list size occupying a fit for purpose premises. NHS England Medical Directorate completed a notes review prior to caretaking arrangements being put in place and confirmed there were no patient safety concerns The current caretaking provider has implemented their governance processes and, although this practice has yet to receive a follow up Care Quality Commission (CQC) visit, AT Medics have improved the CQC ratings at another practice which was rate inadequate, Falmouth Road Group Practice, and has a good rating at their nearby practice. The attached Appendix i Strategic Review document sets out the options available to commissioners and the issues which needed to be considered to enable the patients to register with another practice of their choice. Officers have undertaken a full capacity audit of local practices which is included within the attached strategic review. The outcome of the review of 11 local practices capacity and quality is: All practices have open lists Of the practices that were able to confirm a specific number of patients, there is confirmed capacity for up to 8,650 patients to be registered. However, 3 practices confirmed that whilst their list was open, they were unable to quantify a number of patients that they were able to register. One practice (Silverlock) stated they cannot grow their list any further due to significant capacity issues within their current premises. The practice has submitted a business case to request to co-locate with Avicenna, which will create capacity for both registered lists. Another practice has stated that it cannot take on a large number of patients at once. With additional resources, 8 out of 11 practices state that they would be able to register up to 12,000 additional patients however 4 of these were either unable to provide a figure or Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland

64 commissioners were unable to obtain at figure at the time of writing this paper. 10 out of the 11 local practices are rated better than Avicenna Health Centre by the CQC, which is currently rated as Inadequate 7 out of the 11 local practices perform better than Avicenna Health Centre, which is rated as Review identified 7 out of the 11 local practices perform above the CCG average for Friends and Family Test, five are below and there is no data another of the three practices. As there is no data for the practice, it is not known how it relates to surrounding practices. 6 out of the 11 local practices are rated lower than the practice and 5 are rated better than the practice for ratings on NHS Choices. All local practices perform better than the practice for Patients that would not recommend the practice under the patient survey. 5 out of 11 local practices better than the practice for Not easy getting through on phone. 4 out of 11 scored better than the practice for Not able to get an appointment This demonstrates that there is capacity of acceptable quality locally to ask patients to register with another practice. As detailed in the attached Strategic Review, there is a separate decision to be made relating to the proposed relocation of the nearby Silverlock site into the Avicenna Health Centre, which would enable ongoing and more cost effective use of the Avicenna site. This proposal will also release Silverlock from their current premises, which is not fit for purpose and does not provide sufficient capacity for their current list size, which continues to increase. The decision to ask patients currently registered with Avicenna to register with another practice of their choice, will also need to be agreed subject to patient and stakeholder engagement prior to relocation; and the completion of lease negotiations at Avicenna Health Centre. Patient and stakeholder engagement will include LMC, Healthwatch Southwark and Health Overview & Scrutiny Committee. Patient engagement will need to take place after the decision to relocate Silverlock, the feedback relating to which will be provided to a subsequent committee for assurance. 3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?). The PCCC recommendation is to ask patients currently registered with Avicenna to register with another practice of their choice at the end of March 2018, subject to; Patient engagement relating to the dispersal, to address any concerns, the results of which will be provided to the committee at a later date. The Silverlock relocation proposal being agreed by the committee to enable sufficient capacity for a patients in the local area and; Chair: Dr Jonty Heaversedge 4 Chief Officer: Andrew Bland

65 Supporting information / documents Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc. Appendix # Name of document i Avicenna APMS Strategic Review Date paper completed Tuesday, 21 November 2017 Chair: Dr Jonty Heaversedge 5 Chief Officer: Andrew Bland

66 GP Contract Strategic Review To be completed for an expiring GP contract The purpose of this form is to support commissioners in determining future options for an expiring GP contract and to provide evidence for any decisions made. STP Area: South East London CCG: Southwark CCG Commissioning Level: 3 Practice Name: The Avicenna Health Centre (AT Medics) Raw/Registered List Size at October 2017: 2983 Practice Code: G85712 Weighted List Size at October /2017: Current Provider: AT Medics Limited Current Contract Expiry Date: 31 March 2018 Current Contract Type: APMS Caretaking Reason for Contract Expiry: The contract was procured under an APMS caretaking agreement which commenced on 14 July 2017 and ends on the 31 March 2018 with a provision to extend for 6 months. Name of NHS England Commissioner Completing this Form: Nick Langford Name of CCG Commissioner Consulted about Completing this Form: Jean Young/Rachel Doherty Date Form Completed: 09/10/2017 Date Form Updated: 16/11/2017 Contract Extension: 1. Has this contract already been extended beyond its natural term? No If so, for how long? 2. Is there provision within the current contract to extend (further)? Yes If so, for how long? The contract states that it can be extended by a further 6 months until 30 September After that date the contract can be further extended for the purpose of meeting procurement timelines only. 3. Will an extension be required? (e.g. to allow for consultation / procurement) No, as it is not proposed that the contract will be procured 4. Will any required extension fall within the allowable timescale in 2 above? N/A Page 1 of 12

67 Background to this Practice Following an inspection in May 2016, services at the practice were suspended for a period of three months and the practice was placed in special measures. During the time of suspension Aylesbury Partnership (now part of Nexus Health Group) provided services to patients under a caretaking arrangement. After the three months the CQC confirmed that Dr Kadhim could resume providing services from the Avicenna Health Centre after demonstrating that the improvements required by the Care Quality Commission (CQC) had been made. The CQC carried out a second inspection on 9 January 2017 and rated the practice as Inadequate. The previous provider, Dr Kadhim, was a single handed contractor who tendered his resignation on 13 January As a result services are now provided under an APMS caretaking contract which was awarded to AT Medics following a procurement process. The APMS contract commenced on 14 July This contract will end on 31 March 2018 and has a provision to extend for a further six months. The practice is relatively isolated in comparison to other practices within the borough, and it is located in an area of deprivation, therefore it is recognised that there is a need for a practice within the area. The previous provider is the owner and landlord of the premises. Current Practice Performance Current Provider Contract Performance: CQC does this practice have an overall rating of inadequate or requires improvements (red or amber in the CQC overall rating column)? Yes (but relates to previous provider) Current Provider Contract Compliance: Since the new Provider was appointed (17 July 2017) there are no known issues reported. Indicators Achievement CCG average FFT No Data 87% GPPS 30% would not recommend 11% GPPS 41% Not easy getting through 26% by phone GPPS 18% Not able to get an appointment to see or speak to someone 13% NHS Choices Star rating: 3 out of possible 5 (21 responses) Page 2 of 12 Key issues raised relate mainly to the previous provider and include: Poor customer service from reception; difficulty obtaining an appointment; difficulty getting through by phone; inability to make appointments two weeks in advance; required to book another appointment for more than one ailment; poor attitude of doctors; medication taken off prescriptions without notification; doctors not available and only appointments with practice nurses offered; long wait past the appointed time for appointments (up to 2 hours); GP blames receptionists for

68 referrals that are not made. There is no data for the practice in relation to the Friends and Family Test. It can be seen from the table above that the practice was not achieving the CCG average in relation to each of the categories listed for the GP Patient Survey, however it should be noted that this achievement relates to the previous provider. There are no written complaints on record reported in relation to the new provider. List Size Considerations Please note that a list of 6,000 patients or more is generally considered viable under the standard terms of the London APMS contract. A decision to procure a list of fewer than 6,000 patients is likely to attract fewer bidders and cost more per patient. It is important, therefore, to evidence list size considerations carefully. List size movement over time: Date Raw List Size Weighted List Size Date of most recent list October Either one year or one quarter earlier whichever is most appropriate for this contract July 2016 Either two years or two quarters earlier - whichever is most appropriate for this contract July 2015 Either three years or three quarters earlier - whichever is most appropriate for this contract July Potential for List Growth: Until October 2017, where the list grew by 144 patients over 3 months, the list size has been reducing steadily over the past three years which is expected to be mostly due to patients deregistering following the outcome of the initial CQC inspection. In addition, a number of patients were removed from the list as part of central processes to update patient registered lists following commissioner letters to patients informing them about the caretaking arrangements. NHS Southwark Clinical Commissioning Group (CCG) confirmed the requirement to retain the Avicenna Health Centre premises for the ongoing provision of services to patients in this neighbourhood. There are plans to have a health centre as part of the Old Kent Road development in approximately 5-10 years times. Until then, the Avicenna Health Centre site is considered vital to providing health services to the local population which is growing due to building of residential property. Since the caretaking arrangements have been in place, concerns have been raised by AT Medics regarding poor infection control arrangements, the general state of the building requiring some improvements, as well as structural concerns to do with nearby building work. The structural concerns have now been rectified by the developers which caused the damage. Southwark CCG is responsible for ensuring that the premises from which it requires the APMS caretaker provider and the proposed co-located substantive APMS provider to operate are statutorily and contractually compliant, in accordance with the current NHS (General Medical Services Premises Costs) Direction In light of this, on 8 June 2017, Southwark CCG commissioned external support to review and provide expert advice on the minimum requirements and associated costs to make Avicenna Health Centre statutorily compliant. The request for funding to address these issues was successfully presented to the London Capital Committee on 10 October The improvements would allow services to be provided from a fit for purpose premises. Page 3 of 12

69 Premises Considerations Address of Current Premises: 2 Verney Way, London SE16 3HA Name of Landlord or Holder of Head Lease: Dr Kadhim Expiry Date of Current Lease/Sub Lease: Lease negotiations are being finalised with the landlord. There is currently a Tenancy at Will in place with the current providers. Are the Premises Statutorily and Contractually Compliant? Not currently but funding has been secured through NHSE s London Capital Committee to achieve compliance, once a lease is in place. Will the Premises be available for GP Services following the Expiry of the current Contract? Yes Are there Plans to Relocate this Practice? No Patient Choice Considerations If the patient list is below 6,000 patients, or suitable premises cannot be guaranteed or other factors point to a possible dispersal of the list, it is important to evidence patient choice considerations carefully. Other Practices with one mile (Source: NHS Choices): Summary The practice s list size is 2,983 which is well below the recommended 6,000 required to make a practice viable and attractive to the market. There are 11 surrounding practices within a mile that would be affected if the list was dispersed. All practices have open lists and of the practices that were able to confirm a specific number of patients, there is confirmed capacity for up to 8,650 patients to be registered. However, 3 practices confirmed that whilst their list was open, they were unable to quantify a number of patients that they were able to register. One practice (Silverlock) stated they cannot grow their list any further due to significant capacity issues within their current premises. The practice has submitted a business case to request to co-locate with Avicenna, this proposal would create capacity to accommodate both patient lists. Another practice has stated that it cannot take on a large number of patients at once. With additional resources, 8 out of 11 practice state that they would be able to register up to 12,000 additional patients however 4 of these were either unable to provide a figure or commissioners were unable to obtain at figure at the time of writing this paper. Nine of the surrounding practices are PMS practices and two are APMS. The Avicenna Health Centre was inspected by the CQC on 9 January 2017 and was rated Inadequate. Following the CQC Inadequate rating under the previous provider, NHS England undertook a clinical notes review which confirmed that there were no issues with face to face consultations, patients records and prescribing. Therefore there is no clinical risk in asking patients to register with another practice. Based on Table 1 set out below in Appendix 1, of the 11 practices within a 1 mile radius, eight are rated as Good following their CQC inspection, two are rated as Requires Improvement and one is rated as Inadequate. The CCG Friends and Family Test (FFT) rating average for would the practice be recommended to other people is 87% for Southwark. There is no data for the practice as this hasn t been submitted while 3 surrounding practices are above the CCG average, 5 are below and there is no data another of the 3 practices. As there is no data for the practice, it is not known how it relates to surrounding practices. Page 4 of 12

70 Out of a maximum five star ratings for NHS Choices, the practice is rated as three stars, one of the nearby practices is rated as one and a half stars, one practice has two stars, four practices are two and a half stars, two practices are three and a half stars, one practice is rated as four stars and two practices rated as four and a half. Therefore, of the surrounding practices, six are rated lower than the practice and five are rated better. Under the GP patient survey, the CCG average is 11% for patients that would not recommend the practice. The practice is rated as 30%. Of the surrounding practices, all are performing better than the practice and only two practices have a performance that is worse than the CCG average with three with no data. For the question Not easy getting through on phone, the CCG average is 26%, whereas the practice scored 41%. Of the surrounding practices, five perform better than the practice. For not able to get an appointment the CCG Average is 13%. The practice scored 18% where, of the surrounding practices, four scored better than the practice. It should be noted that the survey would have been during the period of the previous provider. *Source: NHS England national General Practice Sustainability & Resilience data file. Based on the list above, there is capacity of acceptable quality locally to disperse this list. Please refer to Appendix 2. Scattergram 1 shows the density of patients in relation to the practice, which demonstrates that the majority of patients are located within the immediate area of the practice. Scattergram 2 shows the number of practices within walking distance of the practice. This demonstrates that the practice is in an area of relative isolation. The nearest practices are around 20 minutes walking distance. Demographic Considerations - Demographics there is a mostly even split of males/females with a high proportion of patients aged (source Primary Care Web Tool) - *3% of patients are *Socioeconomic Practice Linked IMD: 1 - Most deprived - *51% of the Patients are Non-BME *Source: NHS England national General Practice Sustainability & Resilience data file: \\ims.gov.uk\data\dh\london\skh\nw098\nhs CB\Analytical Services\User Reports - National\Primary Care\Primary Care Sustainability & Resilience. Wider Strategic Considerations There is an imminent proposal to relocate nearby Silverlock APMS contract into Avicenna Health Centre, which would maximise the use of an underutilised building. The Silverlock premises are not fit for purpose and do not provide sufficient capacity for the current list size, which continues to increase. The Avicenna Health Centre is considered to have sufficient capacity for the two practices. This requires the lease negotiations on Avicenna to be completed which are expected to be complete by 1 April In addition Silverlock would need to engage with patients and stakeholders prior to relocation. Should Silverlock Medical Centre be relocated to Avicenna Health Centre, current patients would be able to continue to access general practices services on site or could choose to register at nearby practices, if they wished to do so. This would reduce the pressure of the full list registered patients onto nearby practices, which would struggle to accommodate significant numbers of patients, including Silverlock which is full to capacity in their current premises. Do any of these strategic considerations impact upon the timescales dictated by the contractual constraints noted on page 1? Page 5 of 12

71 No, subject to PCCC subsequent consideration of the Business Case for the Silverlock APMS contract relocation and the satisfactory conclusion of lease negotiation Do any of these strategic considerations preclude the use of the standard London APMS contract for this service going forward? No Equality and Health Inequalities As there is no change to the access of general practice services for this registered list as part of this recommendation, an EHI has not been completed. Patient Engagement There is a standard patient engagement process associated with re-procuring existing APMS contracts following the initial commissioning decision. Will any of the options listed below require additional patient engagement or consultation prior to a decision being made? Yes. Subject to recommended way forward, there will be differences in how patient engagement would be organised. It is therefore proposed that the CCG completes the patient engagement assessment form after the PCCC decision has been made as the decision is, in any event, subject to patient engagement. Options Taking into account the evidence above, the following are the options for the future of this patient list. Option 1: Extend caretaking contract by 6 months to align with Silverlock relocation and then ask patients registered with Avicenna to register with a practice of their choice, providing it is within its catchment area. Option 2: Reprocure at the end of the caretaking period Option 3: Ask patients to register with a practice of their choice, providing it is within its catchment area for the current APMS contract at 6 months Recommended Option Recommendation: Option 1 - Extend caretaking contract by 6 months to align with Silverlock relocation then ask patients registered with Avicenna to register with a practice of their choice, providing it is within its catchment area.. Rationale: Previous market engagement has indicated that it may be difficult to reprocure a list of fewer than 6,000 patients, as a list of this size is not financially viable. Additionally, Avicenna is located in a building which has sufficient capacity to accommodate two patient lists and it will support the CCG s strategy to utilise existing premises more effectively. By co-locating Silverlock into Avicenna Health Centre to Avicenna, registered patients can be offered the option of re-registering at their current site or register with another practice of their choice. It should be noted that there will be additional cost pressures in extending the caretaking contract Practical Considerations: A decision to ask patients to register with another practice of their choice will require a formal paper to be presented to a Part 1 committee which includes a full capacity audit of local practices and patient engagement, which would need to take place after the PCCC decision has been made as Page 6 of 12

72 the PCCC decision is subject to patient engagement. Approval Approval is sought for the recommended course of action detailed above Decision of Primary Care Commissioning Committee Support Recommendation / Reject Recommendation (if rejecting recommendation, please reference alternative proposals in comments below) Date: 24 th October 2017 Page 7 of 12

73 APPENDIX 1 Table 1 data for practices within a mile of The Avicenna Health Centre Name The Trafalgar Surgery Silverlock Medical Centre Nexus Health Group (Branch at SE1 3GF) Nexus Health Group (Branch at SE1 5LU) Park Medical Centre Nexus Health Group (Branch at SE15 6DB) Queens Road Surgery Bermonds ey Spa Medical Centre Acorn Surgery & Gaumont House Surgery Old Kent Road Surgery East Street Surgery CCG Area Southwark Southwark Southwark Southwark Southwark Southwark Southwark Southwark Southwark Southwark Southwark Contract Type PMS APMS PMS PMS PMS PMS APMS PMS PMS PMS PMS Contract End Date *N/A (not N/A 30/06/2019 N/A N/A N/A N/A 30/06/2019 N/A N/A N/A N/A applicable) Raw List Size 4,052 8,161 60,125 60,125 5,677 60,125 6,294 10,344 10,044 8,459 8,486 Known Capacity issues None None None None Issue recruiting GPs would cause capacity issues None None None No known No known None Workforce outlier? Yes No Data Yes Yes Yes Yes No No No No No Number of patients per FTE GP 3,714 N/A 7,516 7,516 2,491 7,516 1,538 3,656 2,842 5,341 2,049 Selected for resilience programme support? No No No No No No No Yes Yes No No CQC rating Red Green Green Green Amber Green Green Green Amber Green Green Page 8 of 12

74 GPHLI outlier? No No No No No No No No Yes No No Number of outlying points FFT rating (would recommend practice) (CCG Average 87%) NHS Choices star rating (full ratings is 5) Would not recommend Practice (CCG Average 11%) Not easy getting through on phone (CCG Average 26%) Not able to get appointment (CCG Average 13%) % 74% 85% 85% No Data 85% 80% No Data No Data 100% 93% 3.5 (10 reviews) 4 (36 reviews) 2.5 (13 reviews) 2.5 (13 reviews) 3.5 (13 reviews) 2.5 (13 reviews) 2.5 (22 reviews) 1.5 (68 reviews) 2 (36 reviews) 4.5 (24 Reviews) 11% 9% No Data No Data 3% No Data 20% 19% No Data 0% 11% 15% 12% No Data No Data 16% No Data 52% 36% No Data 6% 12% 19% 15% No Data No Data 14% No Data 28% 19% No Data 7% 8% 4.5 (24 Reviews) Page 9 of 12

75 APPENDIX 2 The Avicenna Health Centre with contractual boundary, surrounding GP practices and heat map boundaries by LSOA G85712 The Avicenna Health Centre Page 10 of 12

76 The Avicenna Health Centre with contractual and CCG boundaries, other local practices, walking distances by time (4-20 mins) Page 11 of 12

77 APPENDIX 3 Demographics Capacity Practice Name The Trafalgar Surgery Silverlock Medical Centre Nexus Health Group (Artesian Site) Nexus Health Group (Dun Cow Site) Park Medical Centre Nexus Health Group (Aylesbury MC site) Queens Road Surgery Bermondsey Spa Medical Centre Acorn Surgery Old Kent Road Surgery Practice Code G85019 G85087 G85034 G85034 G85125 G85034 G85040 G85623 G85006 G85052 G85721 Contract Type PMS APMS PMS PMS PMS PMS APMS PMS PMS PMS PMS Contract End Date N/A 30/06/2019 N/A N/A N/A N/A 30/06/2019 N/A N/A N/A N/A Distance from the practice (as stated in NHS Choices) (Miles) Raw List Size as at 01/10/2017 4,100 8,387 61,131 61,131 5,811 61,131 6,589 10,751 9,930 8,873 8,448 Is the practice list open? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Does the practice wish to grow their list? (Y/N) Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Confirmed that Confirmed that Not able to take Confirmed that No limit 150 How many patients can they take on their list is open their list is open a large number their list is open within current capacity resources but unable to but unable to of patients at but unable to (total maximum) quantify quantify once quantify Can they take on more patients with additional resources? Y/N If yes, how many? What additional resources do they need? East Street Surgery Yes No - Premises are at full capacity Yes Yes No No Yes Yes Yes Yes Yes DId not give a nknown at this stag No specific limit 3000 nknown at this stag specific number Another GP and some extra Nursing time. In discussion regarding relocating to a larger premises Capacity issues at the current site. More rooms, help with GP's, Nurses, Support staff Would welcome any discussion about having more immediate support for any potential significant increase in list size as this helps to provide more up front capacity quickly. N/A No capacity to have more staff. Practice in ongoing discussions with commissioners regarding long term solution Additional GP sessions Additional Nursing sessions Additional Admin Support More GPs, more rooms within the building Additional clinical rooms to recruit more GPs. More GPs. 2 more GPs however they are in the process of recruitment. Bigger premises Page 12 of 12

78 Southwark CCG Committee Report ITEM FOR DECISION CCG Committee Primary Care Commissioning Committee Month November Year 2017 Item title: Enclosure number: GP Forward View (GPFV) Plan J Any known conflict of interest No Report Author Responsible Director Name Rachel Doherty Name Caroline Gilmartin Job title Primary Care Commissioning Manager Job title Director of Integrated Commissioning Directorate Integrated Commissioning Directorate Integrated Commissioning rdoherty@nhs.net c.gilmartin@nhs.net Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland

79 Process followed for development of this paper: Followed agreed CCG process in full Urgent paper For urgent papers only: explain the reason for urgency Click here to enter text. Have you described the below impacts as part of this proposal? Have you considered either of the below to be relevant to this proposal? Impact on patients / service users Financial impact Impact on providers Estates impact Workforce impact Equalities legislation OSC involvement Yes N/A Does the recommendation align with the CCG s objectives and responsibilities? Deliver IAF improvement Improve patient outcomes Improve quality / safety Secure financial sustainability Support integration Address health inequalities / parity of esteem Enable the delivery of care coordination Promote early action Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland

80 1. Purpose of the paper The purpose of this paper is to update the Committee on the changes made to the Southwark General Practice Forward View (GPFV) Plan following comments from NHS England and ask committee members how they would like to be kept updated on progress i.e. quarterly progress reports. 2. Describe the issue being presented to the committee In December 2016, all SEL CCGs were asked to develop and submit their GPFV Plans for review and assurance by NHS England. The key components of the GPFV Plan are as follows: Extended Access Online Consultations Provider Development 3 per head CCG Investment PMS plan Growth and uncommitted headroom Training Care Navigators Workforce ETTF Schemes In January 2017, Southwark CCG received an overall assurance rating of Amber based on the following feedback on the workforce section. All other components of the Southwark GPFV plan were rated Green i.e. all components of the plan have been assured as shown below. Those components that were unrated, i.e. online consultations, PMS plan and ETTF were all at earlier stages of their life cycles and therefore did not form part of the initial review and assurance process. This paper provides the primary care commissioning committee with an updated GPFV Plan and identifies the actions that have taken place in the period of time from January 2017 to present and Chair: Dr Jonty Heaversedge 3 Chief Officer: Andrew Bland