Report to Bristol Joint Commissioning Meeting from NHS England SW

Report to Bristol Joint Commissioning Meeting from NHS England SW

Report to Bristol Joint Commissioning Meeting from NHS England SW Version number: 1 First published: 07 July 2016 Updated: (only if this is applicable) Prepared by: Marina Muirhead, Head of Primary Care, NHS England SW Classification: (OFFICIAL) 2

Contents Contents... 3 1 Purpose of this report... 4 2 Contracts... 5 2.1 Position as at 1 st March and 1 st May 2016... 5 2.2 CQC Reports Published 1 st March 2016 11 th May 2016... 5 2.3 Contract Terminations... 6 2.4 Practice mergers... 6 2.5 Closed list Applications... 7 2.6 Branch Surgery Closures... 7 2.7 Reduction in branch surgery opening hours... 7 3 Primary Medical Care End of Financial Year 15/16 - Finance Report... 7 4 Primary Care Development Fund... 9 5 Vulnerable Practices... 11 6 One Care Consortium BNSSGs Primary Care at Scale Organisation... 11 7 Primary Care Support England... 13 8 Primary Care Commissioning Involving the Public... 14 9 Accessible Information Standards... 14 3

1 Purpose of this report This is the third report to the Joint Committee. Where decisions are required between committees the virtual decision making process will be used. This report is provided to the Bristol Joint Commissioning Committee by NHS England, South, (South West) by way of update. Marina Muirhead Head of Primary Care NHS England, South (South West) 4

2 Contracts 2.1 Position as at 1 st March and 1 st May 2016 CCG APMS PMS* GMS Total Bristol 3 43 6 52 Bristol 3 40 6 49 *NHS England has offered new contracts to all PMS practices (bar one). A standardised contract is being issued to all PMS practices which will enable easier amendment reflecting changes to regulations as required. This contract will also reflect the changes to funding for PMS practices following the PMS review. 2.2 CQC Reports Published 1 st March 2016 11 th May 2016 and primary care quality CCG Practice Publication Date Rating Bristol The Southville Surgery 08/04/2016 Good Greenway Community Practice 12/04/2016 Good Pembroke Road Surgery 15/03/2016 Good Stockwood Medical Centre 22/03/2016 Good Shirehampton Group Practice 31/03/2016 Good Practices with Inadequate CQC reports since 1 st April 2015 CCG Practice Notes Bristol Clifton Village 4 inadequate reports Practice now closed A Quality and sustainability hub has been established between NHS England and the CCGs to focus on improving patient safety, clinical outcomes and patient experience through sharing best practice, developing an open and blame free culture, use of professional networks and peer review and improved reporting mechanisms. Greater patient engagement is also seen as key to this approach. The first meeting of the group focused on understanding what information CCGs and NHSE had access to with regards to primary care and quality. Since the first meeting NHSE SW has appointed an interim Director of Nursing to cover the initially vacant position who is currently in the process of reviewing all internal quality groups and will then be looking at this quality and sustainability hub alongside the south of the patches Q&SH and will be discussing a future plan which also supports delegated commissioning with CCG/s Director of Nursing. This group will have a key role in improving the quality in primary care whilst seeking to resolve the workload and workforce issues in primary care number 3 must do within the Forward View 16/17 planning guidance. 5

Procurements The following procurements are currently progressing: Service CCG Status Expected Contract Award date Broadmead Bristol Contract awarded to Homeless Health Violent Patient Scheme Bristol All CCGs Brisdoc Contract awarded to Brisdoc Preferred bidder appointed Service commencement date 25/05/16 01/10/2016 25/05/16 01/10/2016 19/05/2016 04/07/2016 2.3 Contract Terminations None to report 2.4 Practice mergers The following mergers took place on 1 st April 2016 CCG Bristol Practices Bradgate, Avonmouth, Ridinglease Armada, Green There are also a number of other practices who have approached NHS England about closing their lists: Practice Status List Closure Period Southville Surgery Approved 17/11/14 31/8/15 Broadmead Medical Centre Not Approved (June 15) - Bedminster Family Practice Approved 29/9/15 23/01/16 Malago Surgery Approved 23/9/15 23/1/16 Gaywood House Surgery Approved 1/4/16 30/6/16 Armada Family Practice Not Approved (June 16) - Hillview Family Practice Not Approved (June 16) - Falloden Way Medical Centre Approved 27/6/16 27/9/16 Two practices in the South Bristol area applied to close their lists, one due to GP capacity and the other due to impending GP capacity issues. As part of the process NHS England circulates the applications for comment to the other local practices. At this point it became apparent that there were other practices facing pressures 6

(including GP capacity). On this basis both applications were refused and an urgent meeting with the South Bristol practices called to consider the options as it was unlikely that a list closure was going to resolve the position and could also potentially cause problems for other practices. Further work is being done to support both individual practices and the locality to explore the solutions, these may include subcontracting with other providers and/or a more radical change in the model of service delivery in this locality. GP recruitment is causing challenge across the South West/the country, different skill mix models are being tried, (please see One Care Consortium update in this report). 2.5 Closed list Applications Practice CCG Agreed End Notes date Gaywood House Bristol 30/06/2016 Approved 2.6 Branch Surgery Closures None to report. 2.7 Reduction in branch surgery opening hours None to report. 3 Primary Medical Care End of Financial Year 15/16 - Finance Report 7

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4 Primary Care Development Fund With a backdrop of increasing pressure of demand on primary care, quality, recruitment and financial challenges, there is a heightened need to facilitate the development of resilient and sustainable models of primary care in the short term. There is a growing acceptance that Primary Care managed at-scale is the most pragmatic option to explore, along with multi-disciplinary team development and care delivery. NHSE is also keen to support practices already operating at scale and who are now ready to introduce further innovation and new ways of working. Proposals are likely to include pro-active management of long term conditions and frailty; usually involving a segregation of planned and unplanned care systems. Applications can either be from practices wanting to work together who need support as they develop a new working structure (e.g. practice merger or federation) or from groups where the new organisational form is in place and the next stage is delivery of a new model of care for patients. General Practices told us that they needed the head space to think about solutions to the wicked issues within general practice that they are all grappling with: 1. Programme and change management support to develop the local vision and underpin that vision with robust project and business planning to drive implementation 2. The availability, sharing and production of business models to support chosen sustainable solutions mergers/federations/integrated providers 3. Operating models to support sustainability changes in skill-mix/organisation of primary care delivery, integration with community provision both statutory and voluntary sector and increased self-care and social-prescribing 9

4. Demand and capacity planning to support the locality/ place- based model of service delivery but also to develop solutions to support specific needs such as extreme rurality, practices with high proportions of recent migrants/patients with no or limited English language. NHS has appointed a PMO leader and the supporting staff have also been appointed to. One Care Consortium has also successfully appointed 2 change managers to support practices across BNSSG and they commence work during late July 2016. The programme overview is: The workstream areas are: The Programme Board COG north will have a follow-on meeting to undertake the Programme Board role for PCDF related activity this will be coordinated by the PMO Lead. 10

Regular reporting using highlight reports will be made available and will be a combination of the local reports the change managers will be required to submit. There are some existing programmes of work in train which will contribute to the success of the programme and we will be ensuring overlay with these such as the AHSN workforce groups and the NHSE and CCG premises assurance panel. 5 Vulnerable Practices NHS England launched in late 2015 a national 10m vulnerable practice fund. At a SW level we were allocated 531,891.00 to distribute across 2015 and 2016 on practices who met the vulnerable practice criteria. Practices designated vulnerable were done so based on a number of factors including, workforce instability, financial instability (PMS review), small list sizes etc. NHSE in conjunction with CCGs and practices designated the following numbers of practices in Bristol area as a vulnerable practice and allocated funding for practices to work towards a more sustainable future including working with others. It should be noted that NHSE SW is the only region to have allocated and spent its full allocation, primarily based on the tying in of this scheme to the transformation of general practice programme as per the above section of this report. Bristol CCG 8/49 GP practices marked as vulnerable 6 One Care Consortium BNSSGs Primary Care at Scale Organisation As CCGs are aware we at NHS England asked the Primary Care Foundation to help us identify who will be responsible for maintaining and developing the assets associated with the GP Access Fund programme (such as the IT infrastructure) for the continued benefit of the local healthcare community. A large number of people attended the workshops that took place throughout March or sent feedback via other means, it has been invaluable. The evaluation has been issued to OCC, CCGs and GP practices and I would point to the following highlights: There was a clear consensus across the four different discussions at the workshops that One Care has delivered benefits and would be best placed to maintain the legacy of the programme as well as providing a continuing framework for supporting practices to work together. This was described in various ways, including as the provider equivalent of a CSU, or a Provider Support Unit. 11

What practices were less clear about was whether One Care could develop a viable and sustainable business plan. They wanted One Care to be given the opportunity to make the case to practices, based on a clear sense of purpose and realistic assumptions about what funding might be available to support different functions and activities. There was also a sense of what might be lost if One Care simply winds down and closes at the end of the three-year programme. And there was a feeling that, were the legacy to be handed over to any other organization, they would not provide the same responsive support to practices. There were many ideas for what a future organisation working across all BNSSG practices might do in addition to maintaining the legacy of the programme. There was general support for the idea that general practice, as a collective provider of services, needed a clear voice and representation at the NHS top table and that a new One Care would be well-placed to do this. Similarly, as new contracts are tendered across the system, sharing collective expertise is likely to be particularly important. The current procurement of sexual health services was used as an example of this. There were also other ideas for how a new One Care could take some of the current load off individual practices, such as supporting recruitment or looking ahead of the curve to future opportunities. In June 2016 a vote of all members identified this organisation to be the voice of primary care across Bristol, North Somerset and South Gloucestershire and hold a seat for primary care at the Systems Leaders Group. The organisation has been piloting the following initiatives and decisions will need to be made by way of CCG / STPs alongside member practices as to the future commissioning of these initiatives should formal evaluation and business cases make them viable and a further update will be provided to this committee in September on the below initiatives: o Weekend Reviews o e-consultations and on-line access to self-care advice (Web GP and Ask My GP) o Rapid access to physiotherapy o Enabling of shared read and write access to patient records via EMIS o Clinical Pharmacist in General Practice initiative o Mental Health nurses in Primary Care o Nurse/HCA Led Clinics o Telephony Procurement for Call handling and management of calls o Artemis - Intranet for BNSSG GP practices o Improving the repeat prescribing process o Exploring ways of communicating between practices and patients, i.e. On-Line Access o Development of a Self-Care Patient Awareness Toolkit 12

7 Primary Care Support England NHS England is aware that many practices up and down the country have experienced a dip in service since the full roll out of primary care support england via capita. Whilst this is a national programme the primary care team within the SW are continuing to receive communications from practice relating to the service they are receiving. The main area of contact relates to the collection of medical records and Capita has provided the following update: Medical Records Movement Update 1 July 2016 In March, PCSE began to introduce the new medical records movement process for GP practices. Changes are being introduced in stages. The first step was replacing the many local courier arrangements with a single national provider, CitySprint. The majority of practices now have a weekly medical records collection and delivery service, and Capita are collecting and delivering around 90,000 records every week. Capita recognise however that there are currently some localised issues in the regularity of delivery and collections. They are working closely with CitySprint to resolve this. If practices have had a collection of records from CitySprint, and have previously had a collection service from PCSE, or if they experiencing an irregular service, please let Capita know by emailing PCSE.enquiries@nhs.net and put Records collections query in the subject line. Processing records Records are being processed at a central PCSE office, where they are labelled and forwarded securely to their end destination. We re making continuous enhancements to improve this interim service. In June, we increased the number of staff working in our processing centre, which has improved our processing speed and increased the number of records we process each day. As a result, practices should start seeing an increase in records delivered. CitySprint CitySprint have introduced larger vans on many routes to provide additional capacity. All CitySprint vehicles should carry boxes to put medical records in for collection and delivery. Capita have stated that they are seeing service improvements in aggregate as a result of the improvement plans, but it is apparent that there are still some localised issues regarding delivery/collection of medical records and supplies. Capita are continuing to improve the management information available, which is enabling more a targeted analysis and response to remaining issues. Please continue to flag any concerns to my team. With this in mind we are extending the period of time for the special dispensation for practices to obtain sterile products from other sources but this should only be used where absolutely necessary. 13

8 Primary Care Commissioning Involving the Public Over recent months we have been working with colleagues on the public participation team to strengthen our approach to involving patients and the public in primary care commissioning. To help achieve this we have developed a framework or guide for primary care commissioners, in NHS England and Clinical Commissioning Groups (CCGs), on how to involve patients and the public in the commissioning of primary care services. It has been co-designed with members of the Working Group for Patient and Public Participation in Primary Care Commissioning and stakeholder feedback has been taken account in its development. We have also produced information for patients and the public so that they understand how they to get involved in primary care commissioning including an easy read version. This information is available on the NHS England website alongside the framework. NHS England would encourage CCGs working with NHS England on the joint commissioning of primary care to ensure that this process and information is well embedded within the joint commissioning structures and primary care teams ensuring those who need to be aware of the framework and associated documents. 9 Accessible Information Standards The Accessible Information Standard tells organisations how they should make sure that disabled patients receive information in formats that they can understand and receive appropriate support to help them to communicate. Read a short overview of the Accessible Information Standard. The Accessible Information Standard is made up of: Accessible Information Standard specification Accessible Information Standard implementation guidance Implementation of the standard By 1 September 2015 all organisations that provide NHS or publicly funded adult social care must have started to prepare for implementation of the Accessible Information Standard. This includes: Assessing current systems and processes; and Developing and commencing roll out of a local implementation plan. 14

By 1 April 2016 all organisations that provide NHS or publicly funded adult social care must identify and record information and communication needs with service users: At the first interaction or registration with their service As part of on-going routine interaction with the service by existing service users. SCCI1605 accessible information implementation plan (Word version) SCCI1605 accessible information implementation plan (PDF version) By 31 July 2016 all organisations that provide NHS or publicly funded adult social care must have fully implemented and conform to the Accessible information Standard. To support implementation across primary care NHS England has written out to all primary care bodies via the weekly bulletins and we have also engaged all primary care professional bodies such as the Local Medical Committee alongside the pharmaceutical, dental of optometric committees to support introduction of the standard. 15