MEETING NHS Barnet CCG Governing Body Meeting - Part I DATE 26 January 2017 REPORT LEAD DIRECTOR / GOVERNING BODY MEMBER AUTHOR CONTACT DETAILS Procurement of Extended Access in Primary Care Dr Ahmer Farooqi, GP Board Member Neil Snee, Director of Commissioning Beverley Wilding, Head of Primary Care Beverley.wilding@barnetccg.nhs.uk EXECUTIVE SUMMARY This document sets out the case to formally procure a GP extended access service, which will enable 8am to 8pm, seven days per week access to GP appointments for patients registered in Barnet. This procurement will enable Barnet CCG to meet the requirements of the GP Forward View and London Primary Care Strategic Commissioning Framework. The report also sets out how the procurement will be led, at a North Central London (NCL) and local level, in order to secure potential efficiencies and also to deliver equity of offer across the five boroughs. RECOMMENDED ACTION The Governing Body is asked to: SUPPORT the intention to procure across NCL, extended access services; ENDORSE the approach set out in the specification that will deliver extended primary care services; DELEGATE to The Barnet Primary Care Procurement Committee the approval of the procurement process. Objective(s) / Plans supported by this paper: Provide value and live within our means Commission a comprehensive range of health services in ways which are cost-effective and accessible, make the best use of public resources, are responsive to local needs and promote the health and wellbeing of local residents. We are committed to living within our means through the exercise of value-driven, outcomes-based commissioning. 1
Prior consideration by Committees and other partners: Update report received by the Barnet Executive Management Team on 3 November 2016. Patient & Public Involvement (PPI): Healthwatch Islington has contributed to the draft specification they bring a level of knowledge through the development of the Islington I-Hub pilot which was funded from Prime Ministers Challenge Fund. A patient representative from all NCL CCGs will be invited to take part in the tender evaluation process. Barnet Healthwatch has advertised the opportunity and interest has been expressed. Equality Impact Assessment: The procurement of extended primary care access will ensure that all patients of Barnet will have access to an equitable service. Risks: The risks of not procuring Extended Access in Primary Care: Not delivering the London Primary Care Strategic Commissioning Framework or General Practice Forward View requirements; Risk to CCG assurance level through the Operating Plan; Impact on patient flows to other parts of the urgent care system including general practices and A&E. Resource Implications: The CCG will receive resource from NHSE to support extended access. The North Central London share of the London investment is 6.1m for 2016/17 of which Barnet will receive 675k and 5.72m for 2017/18 which is allocated on a two-year basis; the split between NCL CCGs has yet to be agreed. SUPPORTING PAPERS: Appendix 1: Draft service specification for North Central London Appendix 2: Procurement Timeline; Appendix 3: KPIs and minimum data set. 2
1. Introduction NHS England (NHSE) has set out its intention to deliver seven day services in the Five Year Forward View. In London, the Primary Care Strategic Commissioning Framework has been developed to support equity of provision across the capital. All CCG s in North Central London (NCL) have signed up to the delivery of this framework with an ambition to deliver 8am to 8pm access, seven days a week from April 2017. This has been reflected in the NCL Sustainability and Transformation Plan (STP) that sets out an expected additional 189,000 appointments per year to be delivered through extended access - with an additional expectation that this will support reduced attendance at A&E. To meet the requirements of the London Primary Care Strategic Commissioning Framework as well as the newly developed Sustainability and Transformation Plan, North Central London CCG s are keen to deliver a common offer of extended access from April 2017. Camden and Islington CCGs, in discussion with the other CCGs have led a piece of work to develop a common specification that can be used to procure a new extended access offer across NCL. This is based on the specification developed by Enfield and Haringey CCG s to support extended access around North Middlesex Hospital in 2016 and acknowledges the dependencies with the new Integrated Urgent Care Service. The draft service specification is appended to the report. The service specification is expected to be finalised by the end of January 2017. The plan is to procure a new service from April 2017. This will cover the four boroughs of Barnet, Camden, Haringey and Islington. Enfield has put in place separate arrangements, although are working closely with the other NCL CCGs. 2. Extended Access in London NHS England (London region) has identified two options for offering extended access, which are: Top up: Hubs provide general practice services to all registered patients in the area; Specifically in the hours core when general practice is not open; e.g. weekdays: 6.30pm to 8pm (some areas also aim to provide early morning or later appointments) Weekends: 8am to 8pm; This ensures all patients will be able to access general practice in the evenings and weekends Stand alone: Hubs provide general practice services to all registered patients in the area This provides additional capacity throughout the proposed hours of service; e.g. 8am to 8pm, seven days per week Some areas will also provide additional capacity for the full twelve hours per day seven days per week The CCGs in North Central London have based plans on delivering the Top up model the extended access service currently provided in Barnet is based on the Top up model. 3
Diagram 1 below sets out the London requirements for offering extended access. Diagram 1. London specification for extended access 3. Funding According to the NHS Operational planning guidance 2016/17 to 2018/19, the total national investment to improve access to General Practice services in 2017/18 is up to 138m. This funding is categorised as recurrent in the guidance. There is expected to be further national funding coming on stream in 2018/19, taking the total to 258m. In London CCGs were notified in September 2016 that 26m would be made available. The North Central London share of the investment is 6.1m for 2016/17 and 5.72m for 2017/18 which may mean that some CCGs across North Central London will have to contribute funding to ensure extended access delivery from 2017/18 onwards. 4
Table 1 below sets out the GP Access Fund (GPAF) allocated to each CCG by NHS England. CCGs will need to work together to identify an approach to the allocation of funding in to 2017/18, with discussions underway on how this decision will be made across the CCGs in North Central London. CCG 2016/17 2017/18 GPAF allocation Funds to be transferred in Dec GPAF allocation Barnet 725k 725k TBC Enfield 1.8m 900k TBC Haringey 1.3m 1.3m TBC Islington 1.3m 1.3m TBC Camden 900k 900k TBC Total 6.1m 3.4m 5.72m The funding is committed and can be considered as a two-year allocation for 2017/18 and 2018/19 and as indicative for 2019/20. Funding is indicated at an STP level and it is assumed agreement will be reached regarding how this is shared by the end of January 2017. The funding requests for 2017/18 have been reduced by NHS England (London region) to a minimum commitment of 93% of the STPs ask to fit within the 26m allocation. NHS England (London region) have indicated that access to further funding may be available if there are underspends in other areas. 4. Sustainability and Transformation Plan Extended Access is a key element in the Primary Care section of the NCL STP. The assumptions underpinning extended access in the STP initiatives across North Central London are as follows: An estimated additional 189,000 primary care appointments by 2020/21; By 2020/21 there is expected to be a gross reduction in A&E costs creating a gross saving of 5m and a net saving of 3.1m; It is estimated that A&E attendance activity will reduce by 72,121 by 2020/21, compared to the 2016/17 baseline, as a result of extended access provision. 5. Current Commissioning Arrangements Barnet CCG has been commissioning the Barnet Federated GPs Ltd to provide extended access since December 2015, using CCG recurrent funding of 750k from the Primary Care Budget. The current NHS Standard Contract with the Federation is due to end on 31 March 2017. The service has provided an additional 20,000 appointments between the period December 2015 to November 2016 and is available to all Barnet registered patients. All but one practice has signed a data sharing agreement to allow electronic access through EMIS community to the medical record; efforts continue to encourage the remaining practice to sign. The CCG evaluated the service at the end of August 2016 which showed that both patient and clinicians welcomed the service and that 76% of Barnet practices had engaged with the new service. 5
The following are learning points from the current Extended Access Service and which we are using to influence commissioning arrangements going forward: Borough wide advertising to ensure that all registered patients are aware of the extended access service; A central telephone number that patients can call to direct book and cancel appointments; Onward referral of all secondary care referrals (currently only referrals for 2 week waits and diagnostics are managed); 6. Contract form for the new Service Advice from NHSE suggests that CCG s should offer APMS contracts for extended access services rather than the NHS Standard Contract, although CCGs are still waiting for final confirmation. The contract will be for a period of three years. However, funding is only confirmed for 2017/18 and 2018/19 with an indicative amount for 2019/20, the CCG therefore may want to consider letting a two-year contract with an option to extend for a third year once funding is confirmed and/or there is evidence that extended access in primary care is having a beneficial impact on the urgent care system. 7. Specification The draft specification has been developed to ensure it meets national requirements and those of the Strategic Commissioning Framework. Core elements of this specification include (See Appendix 1): Appointments available 6.30 to 8pm Monday to Friday; Appointments available 8am to 8pm Saturday and Sunday; Available to all registered patients in an area; Same day and pre-bookable appointments available; Bookable via the practice and NHS 111 service; Has access to patient records; Provides additional capacity over and above current availability (at least 30 minutes/1000 population); Location of service considers accessibility/ transport links. NCL has also set out aspirations that extended access can link with other services such as A&E so that redirection or direct booking can be considered where appropriate. 8. Timeline and next steps The timeline for the procurement is set out as Appendix 2. Key actions within this are: Draft specification finalised by commissioners January 2016; A market event with providers scheduled for 26 January 2017; Specification signed off by Governing Bodies January 2017; Delegated authority to the CCG s Primary Care Procurement Committee to oversee the procurement process locally agreed at the Governing Body meeting January 2017: ITT released 1 February 2017; ITT returned 17 February 2017; ITT evaluated 28 February 2017; Approval and Recommendation to the Barnet Primary Care Procurement Committee March 2017 Ratification of Recommendation to March 2017 Governing Body; Service mobilisation from 1 April 2017. 6
9. Managing Conflicts of Interest Primary Care Clinical Leads have reviewed the specification but will not take part in the procurement or decision making process. An independent clinician will join the procurement panel along with patient representation. Key decisions and recommendations relating to the procurement will be delegated to the Primary Care Procurement Committee in line with the CCG s conflict of interest policy and subsequently ratified by the Barnet Governing Body. A procurement checklist has been completed to provide assurance over the process to be adopted and will be shared as part of the overall approval by Barnet s Primary Care Procurement Committee. 10. Conclusion Nationally there has been a drive to improve access to primary care by extending access to seven days a week from 8am to 8pm. Across London this is reflected in the London Primary Care Strategic Commissioning Framework that all CCGs in London have signed up to. In addition, within the NCL Sustainability and Transformation Plan (STP) additional access is expected to deliver system wide impacts, both in terms of activity but also efficiency. Across NCL it was agreed to procure a service to a common specification, partly as an opportunity to drive efficiency within the process but also to secure a common offer across the patch. The service specification has been informed by the commissioning arrangements for current extended access services such as the Islington I-HUB. This paper sets out the procurement approach, timeline and specification, with the intention to deliver a new service from April 2017. 7