1.1.1 Annex A - Template Business Case for Practice Merger ...
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1.1.1 Annex A - Template Business Case for Practice Merger • Template Business Case for Practice Merger 1. Explanation of the practice merger Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach. If appropriate some context is required here in relation to how and why the arrangements for a merger have come about. Merger model Based upon Primary Medical Care Policy and Guidance Manual (Version 3). GP partners from Practice 2 – Manchester Medical (GMS P84616) will join the partnership of Practice 1 – Longsight Medical Practice (P84689). Practice 1's contract will be varied to include the services originally provided by Practice 2. Practice 2’s contract will cease. Rationale Longsight Medical Practice and Manchester Medical believe that this merger is the critical enabler to ensure safe and effective recovery of primary care services for a large proportion of the population in Central Manchester. To inform our recovery of services plan we recognise the health challenges that existed prior to Covid19. We also recognise that the pandemic has further exacerbated these health inequalities and to fully realise the benefits of the merger we will require support from commissioners and our system provider partners. Data from Public Health England shows the merged practice serves a population with significant health inequalities: 1. Index of Multiple Deprivation – most deprived decile with significant digital illiteracy and poverty. 2. life expectancy below the national average for both men and women. 3. children and young people make up over 40% of the registered patient lists with above average rates of child poverty. 4. Large student populations. 5. Higher than Manchester average of people with learning disability. 6. Rates of unemployment above the national and Manchester average. 7. Poverty amongst the elderly amongst the highest in the country with both practices within the top 5 most affected in Manchester. 8. People from a Black, Asian or Minority Ethnic background represent over 63% of the combined registered patient list with a significant majority who do not have English as a first language. A paper was produced by MHCC and based on the city growth data to predict the impact on primary care provision. The merged practice is projected to have a patient list of over 16000 by 2024/2025. This equates to 2% of the city’s population should the growth
Transcript of 1.1.1 Annex A - Template Business Case for Practice Merger ...
1.1.1 Annex A - Template Business Case for Practice Merger
• Template Business Case for Practice Merger 1. Explanation of the practice merger
Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach.
If appropriate some context is required here in relation to how and why the arrangements for a merger have come about.
Merger model
Based upon Primary Medical Care Policy and Guidance Manual (Version 3).
GP partners from Practice 2 – Manchester Medical (GMS P84616) will join the partnership of Practice 1 – Longsight Medical Practice (P84689).
Practice 1's contract will be varied to include the services originally provided by Practice 2.
Practice 2’s contract will cease.
Rationale
Longsight Medical Practice and Manchester Medical believe that this merger is the critical enabler to ensure safe and effective recovery of primary care services for a large proportion of the population in Central Manchester.
To inform our recovery of services plan we recognise the health challenges that existed prior to Covid19. We also recognise that the pandemic has further exacerbated these health inequalities and to fully realise the benefits of the merger we will require support from commissioners and our system provider partners.
Data from Public Health England shows the merged practice serves a population with significant health inequalities:
1. Index of Multiple Deprivation – most deprived decile with significant digital illiteracy and poverty.
2. life expectancy below the national average for both men and women. 3. children and young people make up over 40% of the registered patient lists with
above average rates of child poverty. 4. Large student populations. 5. Higher than Manchester average of people with learning disability. 6. Rates of unemployment above the national and Manchester average. 7. Poverty amongst the elderly amongst the highest in the country with both practices
within the top 5 most affected in Manchester. 8. People from a Black, Asian or Minority Ethnic background represent over 63% of the
combined registered patient list with a significant majority who do not have English as a first language.
A paper was produced by MHCC and based on the city growth data to predict the impact on primary care provision. The merged practice is projected to have a patient list of over 16000 by 2024/2025. This equates to 2% of the city’s population should the growth
Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach.
If appropriate some context is required here in relation to how and why the arrangements for a merger have come about.
modelling be realised. Both Practice 1 and Practice 2 current registered lists are already above the figures projected for 2022/2023.
Covid19 has had a disproportionate impact on our practice populations. Our patients have had amongst the highest rates of infection; some of the highest covid morbidity rates resulting in hospital admission; and unfortunately, our population is overrepresented within excess deaths during the pandemic relating to both covid and non-covid cause mortality. Our local communities are also amongst the most vaccine hesitant in the country.
2. Practices' characteristics and intentions for the merged practice
Current Provision – Practice 1 Current Provision – Practice 2 Merged Practice
Name and address of practice
(provide name and address)
Longsight Medical Practice, Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Manchester Medical, Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Manchester Integrative Medical Practice
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
@Hulme
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Contract type
(provide addresses of all premises from which practice services are
Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20
provided) Monton Street, Hulme, Manchester, M14 4GP
Practice area
Appendix 1b
Ardwick, Chorlton, Fallowfield, Hulme, Moss Side, Rusholme and Whalley Range (including Old Trafford) wards
Appendix 1c shows the combined area
Appendix 1d shows the distribution of patients across Central South Manchester currently registered with the practices
List size
(provide both, raw and weighted list and date provided)
5040 (Aug 2021) 8892 (Aug 2021) 13932 (Aug 2021)
Appendix 1e shows the combined age and gender profile at Jan 2021
Number of GPs and clinical sessions
(provide breakdown and the number of wte GPs)
0.15WTE Principal GPs (1 doctor)
1.5WTE Sessional GPs (3 doctors)
2.4WTE Principal GPs (4 doctors)
0.4WTE Sessional GP (1 doctor)
2.55WTE Principal GPs (5 doctors)
1.9WTE Sessional GPs (4 doctors)
Number of other practice staff
(provide breakdown)
(provide breakdown and number of wte nurse and nurse practitioner)
Sessions/hours of other health care professionals such as HCA, PA and PCN resources.
1.1WTE Practice Nurse
0.2WTE Practice Nurse
2.3WTE Practice Nurse
CCG area(s)
NHS Manchester NHS Manchester NHS Manchester
PCN Areas Ardwick and Longsight Practice not currently within a Ardwick and Longsight
List PCN(s) in which practices are located)
PCN
Please confirm if current and future agreement to sign up to the PCN Network DES
Current Will adopt current for Practice 1
Which computer system/s
(list system(s) used)
(provide names)
Clinical Governance Lead, Caldicott Guardian and Safeguarding Lead – Dr Tariq Chauhan
Clinical Governance Lead and Caldicott Guardian – Dr Faizan Ahmed
Freedom to Speak Up Guardian – Dr Alasdair Honeyman
Safeguarding Lead – Dr Almas Agha
Clinical Governance Lead and Caldicott Guardian – Dr Tariq Chauhan
Freedom to Speak Up Guardian – Dr Alasdair Honeyman
Safeguarding Lead – Dr Almas Agha
Provide organisational chart showing roles and responsibilities including workforce, corporate governance and finance
GMS Senior Partner – Dr Tariq Chauhan
CQC Registered Manager – Linda Connors
GMS Senior Partner and CQC Registered Manager – Dr Faizan Ahmed
GMS Senior Partner – Dr Tariq Chauhan
CQC Registered Manager – Linda Connors
Appendix 1f demonstrates the proposed organisational structure of the merged practice.
Training practice
PCN Extended hours delivered by the practices
(list days and times)
Extended hours
Covid Vaccination
Covid Vaccination
Enhanced Care Home *
Structured Medication Review *
* Arrangements in place between MHCC and Primary Care Manchester (PCM) to ensure patients registered at Manchester Medical receive PCN services
Covid Vaccination
Enhanced services
(list all enhanced services delivered whether they are commissioned by NHSE, CCG or LA)
LD
the address for each premises and confirmation of main/branch status
Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Premises
indicate whether premises are owned or leased and when the lease is due to expire
Leased from NHS Property Services
Leased from NHS Property Services
Leased from NHS Property Services
Premises
For leased premises please confirm length of lease remaining including and break clauses.
tbc tbc tbc
2. Patient benefits
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Service alignment:
The service development plan aims to provide an equitable single service from each site with the phased approach due completion by Q4 2022/2023. This incorporates parallel recovery of primary care and mitigates for a winter covid booster vaccination programme.
Children and young people
To combat school age children missing valuable learning time, the combined practice will continue to offer the After School Clinic, with dedicated same-day appointments available for parents and guardians to book Monday to Friday after 3.30pm. Our young carers will be prioritised for these appointments too. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Building on the work commenced in 2017 in partnership with Manchester Local Care Organisation Community Paediatric Service, Practice 2 is recognised as the exemplar GP service for Looked After Children. Sadly, young patients who are unable to access high quality care locally, travel from across Manchester to register with the practice. Following covid, the combined practice with MLCO will table a proposal to the commissioner for a new integrated service offer.
Prior to the decommissioning of the Barnardo’s Young Care Leavers service, Practice 2 provided dedicated weekly appointments to Young Care Leavers. The appointments were an hour in length to support the holistic approach required. Following covid, the combined practice will seek to re-engage with the local community and voluntary sectors partners to relaunch the service.
The combined practice will adopt the ‘Pentagon D’ approach developed by Practice 2 for supporting student health and wellbeing with focus on Diet (eating disorders), Depression and anxiety (mental health), Drink (alcohol), Drugs (legal and illicit), and Sexually Transmitted Disease (risk management).
People of working age
Many of our patients do not work traditional Mon-Fri 9-5 jobs and are unable to access the current offer of evening extended hours. The combined practice will launch a new weekend service for people who work with a priority focus on population health such as NHS health screening. Subject to merger date approval, we plan for this service to go live Q3 2021/2022.
People who are carers
Our patients who are also unpaid carers tend to have some respite on the weekend when others can help. Our young carers are often unable to access the After School Clinic and so access will be prioritised for this group as part of the new weekend service. The combined practice will have dedicated appointments on weekends as part of the extended hours offer. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Older people
As part of the covid response our practices developed a proactive approach with regards to the care needs of our older patients who were shielding. Interventions included prophylactic prescribing of vitamin D through to recording whether patients had pets who would need minding should their owners become hospitalised. The combined practice will continue to provide dedicated appointments for Older people. These appointments will be available Monday to Friday. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
People with Learning Disability
A significant cohort of our patients with a recognised learning disability do not have English as their first language. Our practice teams are experienced in multilingual communication with many residing locally. The combined practice will continue to provide dedicated appointments for people with Learning Disability. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Patients with long-term conditions
Our GPs have special interests in Integrative Medicine, Diabetes, Family Planning, Mental Health and Minor Surgery. Patients of the combined practice will have access to system leading expertise.
The combined practice will be supported by the Beacon GP Care Medicines Quality Team to ensure patients have access to their regular treatment, are monitored to ensure medicine safety, and are invited for reviews to ensure the best personalised care. Each site has a service that already exists, subject to merger date approval, service go live date is planned for Q2 2021/2022.
Our practices provide bespoke services to patients who have diabetes and choose to fast as part of religious practice. Such patients receive a medication review 6 weeks prior to Ramadan to prevent complications related to diabetic medication such as hypoglycaemia and dehydration. The combined practice will continue to serve our local communities in a culturally sensitive way.
People with long-term Mental Illness
The green therapy garden at Practice 2 created with the support of patients and organisations such as Gaskell Project, has been life changing for patients. The combined practice will work with NHS Property Services to access the garden at Practice 1 to create a similar therapeutic space.
The combined practice will continue to provide dedicated appointments for people with long- term Mental Illness. These appointments will be available Monday to Friday. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
People who are Homeless
The combined practice will continue to support active outreach registering of patients who are homeless and will champion work done under the Beacon GP Care Homeless Friendly scheme. The combined practice will continue to support patients in providing a ‘postbox’ as their address for correspondence. Single site provision currently exists, subject to merger date approval, the dual site service is planned to go live by 2021/2022 end.
Extended Hours Access
Extended hours will move to the weekend with a multidisciplinary team (GP, PA, Nurse, Pharmacist, HCA, Phlebotomist) offer delivering the DES specification. As the service develops and in collaboration with our PCN and MLCO partners we envisage a service supported by additional services such as focussed care, social prescribing, physiotherapy and diagnostics. Provision will alternate monthly between the two sites to reduce the need for patients to travel between sites and to maintain a consistent, high quality offer for both legacy patient lists. Subject to merger date approval, we plan for this service to go live Q3 2021/2022.
Population Health
Our practices have worked with community partners to tackle covid vaccine hesitancy. The combined practice will build on these partnerships to further health promotion programmes such as NHS Couch to 5K.
P84616 has successfully led a bid for funding to support Manchester Cycle and Stride scheme with the aim of encouraging women from a BAME background to become more active. The combined practice will support this health improvement programme.
Our practices continue to work with our community partners and patient voice advocates in encouraging uptake of breast screening amongst women with a BAME background, encourage cervical screening in women who have been subject to female genital mutilation and encouraging middle aged black men to attend for prostate cancer screening blood test. The combined practice will continue to adopt a proactive approach.
Workforce, Training and Development
Our combined clinical team will have access to Beacon GP Care Academy to support continuing professional development in order that they deliver the highest quality care.
Our practices are accredited by Health Education England as community NHS providers of GP, Foundation Doctor, Practice Nurse and Physician Associate training programmes. Further, our practices have Designated Medical Supervisors accredited by the Centre for Pharmacy Postgraduate Education and are accredited by University of Manchester as community providers of Medical Student training programmes.
Our practices are committed to continuing to develop as a centre of excellence for community-based training, inspiring the next generation of health and care professionals from our local community, and improving the employment prospects for all regardless of background.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Through the NHS Induction and Refresher Scheme, our practices have supported GPs to return to work following ill health, having previously left the NHS and retirement. Our practices have supervised remediation of doctors in collaboration with the GMC and NHS England. Further, our practices have supported refugee doctors to begin their first steps towards providing NHS services in collaboration with Reache NW. Following covid, the combined practice will recommence hosting refugee medical practitioners.
Research
The first pharmacological treatment (Dexamethasone) for Covid19 was the result of NHS driven research and innovation. Our practices are research-active sites which engage patients and our staff in research studies aimed at improving health outcomes for our patients and populations beyond. Examples of studies supported include: Diabetes My Way (trial of innovative app to support people with T2DM), Moodbuster (trial of online CBT for people suffering with low mood) and the RCGP Research Surveillance Centre COVID-19 serological and virological surveillance programmes. Our practices are committed to boosting recruitment of BAME and socioeconomically deprived populations which are traditionally underrepresented in clinical research.
3. Financial considerations
Please provide comments from a financial perspective on the following matters if they are relevant to the proposed practice merger.
Premises
• Legal fees • SDLT payments • Rent reimbursement • Any potential savings
due to site closure • Or potential increase
in rent reimbursement if the newly merged practice will change premises utilisation
Projected spend.
Capital:
Funding is sought from the commissioner to vacate and develop the space currently utilised for storage of paper records at each site.
Revenue:
Funding is sought from the commissioner to service current unmet need through allocation of additional clinical space and the associated logistical space at each site.
IT
• Moving servers • Upgrading telephony
Capital:
Funding for digitisation of paper medical records is sought from the commissioner to support data quality improvement.
Revenue:
Please provide comments from a financial perspective on the following matters if they are relevant to the proposed practice merger.
Funding is sought from the commissioner to service additional remote and on-site digital provision.
TUPE Projected spend to account for legal advice and associated management costs. Funding is not sought from the commissioner for this aspect.
Redundancy There are no planned redundancies and hence cost neutral.
QOF An increase in spend is projected driven by quality improvement programme for the combined service.
Pension/seniority No changes in Pension allocation are planned.
Seniority payments ended 31 Mar 2020 and hence no impact.
MPIG/PMS Premium Neither practice was allocated MPIG and hence no impact.
Both practices are GMS and hence not subject to PMS premium. Neither practice was allocated MPIG and hence no impact.
Both practices are GMS and hence not subject to PMS premium.
Dispensing n/a
4. Service delivery
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
QOF QOF and Manchester Standards will be subject to national standard operating procedure updates and refresh of the local quality standards scheme respectively. The combined practice will respond and adapt as updates are released.
Access locations:
The journey between the sites using different modes of transport – 35minute walk; 12minute bicycle ride; 8minute car ride; number 53 bus operates every 15 minutes between both sites with a 26minute journey (some walking required). The practice will build on good will relationships developed through covid with local community taxi firms to assist where vulnerable patients require dual site access.
Both sites have visitor parking and bicycle stands.
Both sites have disability access including hearing loops and braille on door signage
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
Telephone:
The combined practice cloud telephony system will retain the three legacy numbers. Further, the system will provide patients with an indication of their place in the virtual queue but also offer a call back function if they are unable to wait.
Digital:
The combined practice will ensure patients are redirected from legacy websites to the new one. We are delighted that Healthwatch Manchester will provide critical input into the new website to ensure information is accessible to those with internet access.
Primary Care Web Tool The combined practice will continue to utilise as well as use Tableau to inform service improvement.
Recent or ongoing breaches of contract
Nil of note
Nil of note
If one practice's service delivery is of a lower standard, is there a proposal to improve performance
For 2019/2020 both practices achieved excellent results well above the CCG average of 95% (Practice 1 97.56% and Practice 2 98.04%).
For 2020/2021 Manchester Primary Care Standards achievements can be found at Appendix 1g for Practice 1 and Appendix 1h for Practice 2.
The merged practice through quality improvement methodology, will adopt the pathways from each legacy practice that deliver the best outcomes for patients. As an example, there is a 20% difference between each practice’s achievement for the Paediatric Asthma quality standard.
The Clinical Pharmacy team will implement the higher achieving pathway at both sites.
Will there be any cessation of services post-merger?
No
Will there be a reduction of hours for which services are provided post- merger?
No
Hours of opening will remain Monday to Friday 08:00 to 18:30.
Extended Hours will be condensed on Saturday mornings and occur once a month.
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
Will there be a change in the hours at which services are provided?
Yes
Extended Hours will be condensed and provided on Saturday mornings and occur once a month.
Will there be a reduction in the number of locations or a change in the location of premises from services are provided?
No
The combined practice will continue to operate from the two sites.
Resilience – where the merged patient list is over 10,000, how will the practices ensure resilience to ensure that performance and patient experience is maintained and improved.
Performance:
Patient experience:
Frontline staff at each site will remain in current multidisciplinary teams to maintain continuity of care. The multidisciplinary team approach enhances capacity and hence improves access with patients being seen by the most appropriate clinician.
Primary Care Networks (PCN) – what are the benefits of the proposed merger for the PCN?
e.g. offer space for PCN services, taking leadership of delivering services on behalf of the PCN
Established multidisciplinary training site able to lead and support PCN ARRS. Practice 2 has a fully developed Physician Associate preceptorship programme and Clinical Pharmacist training programme. Both programmes will be accessible for the PCN.
Established structured medication review and medicines optimisation standard operating procedures able to lead and support PCN DES. Beacon GP Care has provided Practice 1 with medicines optimisation support for over 5 years. Practice 2 has had an inhouse medicines optimisation team since 2012. The combines service will be accessible for the PCN.
Established sites for PCN services such as Seasonal Influenza and Covid19 mass vaccination.
Primary Care Networks (PCN) – what are the implication of
Increase to Ardwick and Longsight PCN population size by 8892 (correct at Aug 2021). Increasing the PCN size from 68,182 to 77, 074
the proposed merger for the PCN?
e.g. where two practice premises is located in two different PCNs
Extension to Ardwick and Longsight PCN boundary to include Practice 2 area.
5. Patient and stakeholder engagement
Please provide comments on the following matters.
Have the practices engaged with patients and/or stakeholders on the practice merger?
Stakeholders may include local LMC, Healthwatch, PCN members, Community and voluntary services
Yes – further information in appendices 1i and 1j
Note: Practices must engage with patients/stakeholders
When did/will you engage with patients/stakeholders?
The engagement process commenced February 2021.
In what form did/will you engage with patients/stakeholders?
Telephone interviews with members of both Patient Participation Groups.
1:1 covid secure conversations with patients (and their carers) attending for face-to-face appointments (including via interpreters). Neighbourhood Health Development Co- ordinator support will be sought with multilingual patient information.
Direct messaging to patients using sms text message systems.
Notice on each practice website including feedback link to go live by 1/06/2021.
Meetings with stakeholders via MS Teams.
With whom did/will you engage?
Patients, Carers and Patient Voice Advocates
Longsight Medical Practice Patient Participation Group
Manchester Medical Patient Panel
Please provide comments on the following matters.
Healthwatch Manchester
MACC
LGBT Foundation
Community Service Providers
Local Authority Elected Leadership
Longsight Ward Councillors
Hulme Ward Councillors
Right Honourable Afzal Khan MP
Right Honourable Lucy Powell MP
If you have already carried out engagements, what was the outcome?
Please provide evidence
Appendix 1i contains the Patient Engagement Plan.
Healthwatch Manchester are supportive of the merger and we are delighted that they will be ensuring our digital service offer is accessible to all our patients.
Please provide comments on the following matters.
Manchester Local Care Organisation are supportive of the merger with an agreement in principle on future working arrangements with integrated neighbourhood teams.
Current (pre 6/5/21) ward councillors are supportive of the merger as are the two MPs.
6. Contractual actions
Please provide below an explanation of any contractual variations that you consider are necessary to effect the proposed practice merger.
Vary P84689 to include P84616 contract holders.
Administer termination of P84616 with contract merged into P84689.
7. Procurement and competition
Please provide below any comments on the procurement and/or competition matters that may arise as a result of the proposed contract merger.
The merger proposed would not trigger procurement or consideration of competition matters for the commissioner.
8. Merger mobilisation
Please set out below a step by step plan to the mobilisation of the merger if the business case is approved including what actions are required of the practices and third parties, such as commissioners, the order in which the actions need to be undertaken and timescales for the actions to be completed. A template mobilisation plan that can be used but will need to be amended to fit the proposed practice merger is set out at Annex 12B.
Appendix 12 contains the template mobilisation plan with steps (including risk log) to be agreed with MHCC as soon as the Board approves the merger.
8. Additional information
Please provide any additional information that will support the proposed practice merger.
The leadership team at Practice 2 retain organisational memory in relation to the successful merger of two legacy practices in 2014.
9. Signatures
Please ensure all Contractors under the current practice contracts sign below to indicate they agree with the information provided in this business case.
[name] [signature]
Please ensure all Contractors under the current practice contracts sign below to indicate they agree with the information provided in this business case.
[name] [signature] See picture above
[name] [signature]
• Template Business Case for Practice Merger 1. Explanation of the practice merger
Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach.
If appropriate some context is required here in relation to how and why the arrangements for a merger have come about.
Merger model
Based upon Primary Medical Care Policy and Guidance Manual (Version 3).
GP partners from Practice 2 – Manchester Medical (GMS P84616) will join the partnership of Practice 1 – Longsight Medical Practice (P84689).
Practice 1's contract will be varied to include the services originally provided by Practice 2.
Practice 2’s contract will cease.
Rationale
Longsight Medical Practice and Manchester Medical believe that this merger is the critical enabler to ensure safe and effective recovery of primary care services for a large proportion of the population in Central Manchester.
To inform our recovery of services plan we recognise the health challenges that existed prior to Covid19. We also recognise that the pandemic has further exacerbated these health inequalities and to fully realise the benefits of the merger we will require support from commissioners and our system provider partners.
Data from Public Health England shows the merged practice serves a population with significant health inequalities:
1. Index of Multiple Deprivation – most deprived decile with significant digital illiteracy and poverty.
2. life expectancy below the national average for both men and women. 3. children and young people make up over 40% of the registered patient lists with
above average rates of child poverty. 4. Large student populations. 5. Higher than Manchester average of people with learning disability. 6. Rates of unemployment above the national and Manchester average. 7. Poverty amongst the elderly amongst the highest in the country with both practices
within the top 5 most affected in Manchester. 8. People from a Black, Asian or Minority Ethnic background represent over 63% of the
combined registered patient list with a significant majority who do not have English as a first language.
A paper was produced by MHCC and based on the city growth data to predict the impact on primary care provision. The merged practice is projected to have a patient list of over 16000 by 2024/2025. This equates to 2% of the city’s population should the growth
Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach.
If appropriate some context is required here in relation to how and why the arrangements for a merger have come about.
modelling be realised. Both Practice 1 and Practice 2 current registered lists are already above the figures projected for 2022/2023.
Covid19 has had a disproportionate impact on our practice populations. Our patients have had amongst the highest rates of infection; some of the highest covid morbidity rates resulting in hospital admission; and unfortunately, our population is overrepresented within excess deaths during the pandemic relating to both covid and non-covid cause mortality. Our local communities are also amongst the most vaccine hesitant in the country.
2. Practices' characteristics and intentions for the merged practice
Current Provision – Practice 1 Current Provision – Practice 2 Merged Practice
Name and address of practice
(provide name and address)
Longsight Medical Practice, Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Manchester Medical, Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Manchester Integrative Medical Practice
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
@Hulme
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Contract type
(provide addresses of all premises from which practice services are
Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20
provided) Monton Street, Hulme, Manchester, M14 4GP
Practice area
Appendix 1b
Ardwick, Chorlton, Fallowfield, Hulme, Moss Side, Rusholme and Whalley Range (including Old Trafford) wards
Appendix 1c shows the combined area
Appendix 1d shows the distribution of patients across Central South Manchester currently registered with the practices
List size
(provide both, raw and weighted list and date provided)
5040 (Aug 2021) 8892 (Aug 2021) 13932 (Aug 2021)
Appendix 1e shows the combined age and gender profile at Jan 2021
Number of GPs and clinical sessions
(provide breakdown and the number of wte GPs)
0.15WTE Principal GPs (1 doctor)
1.5WTE Sessional GPs (3 doctors)
2.4WTE Principal GPs (4 doctors)
0.4WTE Sessional GP (1 doctor)
2.55WTE Principal GPs (5 doctors)
1.9WTE Sessional GPs (4 doctors)
Number of other practice staff
(provide breakdown)
(provide breakdown and number of wte nurse and nurse practitioner)
Sessions/hours of other health care professionals such as HCA, PA and PCN resources.
1.1WTE Practice Nurse
0.2WTE Practice Nurse
2.3WTE Practice Nurse
CCG area(s)
NHS Manchester NHS Manchester NHS Manchester
PCN Areas Ardwick and Longsight Practice not currently within a Ardwick and Longsight
List PCN(s) in which practices are located)
PCN
Please confirm if current and future agreement to sign up to the PCN Network DES
Current Will adopt current for Practice 1
Which computer system/s
(list system(s) used)
(provide names)
Clinical Governance Lead, Caldicott Guardian and Safeguarding Lead – Dr Tariq Chauhan
Clinical Governance Lead and Caldicott Guardian – Dr Faizan Ahmed
Freedom to Speak Up Guardian – Dr Alasdair Honeyman
Safeguarding Lead – Dr Almas Agha
Clinical Governance Lead and Caldicott Guardian – Dr Tariq Chauhan
Freedom to Speak Up Guardian – Dr Alasdair Honeyman
Safeguarding Lead – Dr Almas Agha
Provide organisational chart showing roles and responsibilities including workforce, corporate governance and finance
GMS Senior Partner – Dr Tariq Chauhan
CQC Registered Manager – Linda Connors
GMS Senior Partner and CQC Registered Manager – Dr Faizan Ahmed
GMS Senior Partner – Dr Tariq Chauhan
CQC Registered Manager – Linda Connors
Appendix 1f demonstrates the proposed organisational structure of the merged practice.
Training practice
PCN Extended hours delivered by the practices
(list days and times)
Extended hours
Covid Vaccination
Covid Vaccination
Enhanced Care Home *
Structured Medication Review *
* Arrangements in place between MHCC and Primary Care Manchester (PCM) to ensure patients registered at Manchester Medical receive PCN services
Covid Vaccination
Enhanced services
(list all enhanced services delivered whether they are commissioned by NHSE, CCG or LA)
LD
the address for each premises and confirmation of main/branch status
Longsight Health Centre, 526- 528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Longsight Health Centre, 526-528 Stockport Road, Longsight, Manchester, M13 0RR
Moss Side Health Centre, 20 Monton Street, Hulme, Manchester, M14 4GP
Premises
indicate whether premises are owned or leased and when the lease is due to expire
Leased from NHS Property Services
Leased from NHS Property Services
Leased from NHS Property Services
Premises
For leased premises please confirm length of lease remaining including and break clauses.
tbc tbc tbc
2. Patient benefits
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Service alignment:
The service development plan aims to provide an equitable single service from each site with the phased approach due completion by Q4 2022/2023. This incorporates parallel recovery of primary care and mitigates for a winter covid booster vaccination programme.
Children and young people
To combat school age children missing valuable learning time, the combined practice will continue to offer the After School Clinic, with dedicated same-day appointments available for parents and guardians to book Monday to Friday after 3.30pm. Our young carers will be prioritised for these appointments too. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Building on the work commenced in 2017 in partnership with Manchester Local Care Organisation Community Paediatric Service, Practice 2 is recognised as the exemplar GP service for Looked After Children. Sadly, young patients who are unable to access high quality care locally, travel from across Manchester to register with the practice. Following covid, the combined practice with MLCO will table a proposal to the commissioner for a new integrated service offer.
Prior to the decommissioning of the Barnardo’s Young Care Leavers service, Practice 2 provided dedicated weekly appointments to Young Care Leavers. The appointments were an hour in length to support the holistic approach required. Following covid, the combined practice will seek to re-engage with the local community and voluntary sectors partners to relaunch the service.
The combined practice will adopt the ‘Pentagon D’ approach developed by Practice 2 for supporting student health and wellbeing with focus on Diet (eating disorders), Depression and anxiety (mental health), Drink (alcohol), Drugs (legal and illicit), and Sexually Transmitted Disease (risk management).
People of working age
Many of our patients do not work traditional Mon-Fri 9-5 jobs and are unable to access the current offer of evening extended hours. The combined practice will launch a new weekend service for people who work with a priority focus on population health such as NHS health screening. Subject to merger date approval, we plan for this service to go live Q3 2021/2022.
People who are carers
Our patients who are also unpaid carers tend to have some respite on the weekend when others can help. Our young carers are often unable to access the After School Clinic and so access will be prioritised for this group as part of the new weekend service. The combined practice will have dedicated appointments on weekends as part of the extended hours offer. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Older people
As part of the covid response our practices developed a proactive approach with regards to the care needs of our older patients who were shielding. Interventions included prophylactic prescribing of vitamin D through to recording whether patients had pets who would need minding should their owners become hospitalised. The combined practice will continue to provide dedicated appointments for Older people. These appointments will be available Monday to Friday. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
People with Learning Disability
A significant cohort of our patients with a recognised learning disability do not have English as their first language. Our practice teams are experienced in multilingual communication with many residing locally. The combined practice will continue to provide dedicated appointments for people with Learning Disability. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Patients with long-term conditions
Our GPs have special interests in Integrative Medicine, Diabetes, Family Planning, Mental Health and Minor Surgery. Patients of the combined practice will have access to system leading expertise.
The combined practice will be supported by the Beacon GP Care Medicines Quality Team to ensure patients have access to their regular treatment, are monitored to ensure medicine safety, and are invited for reviews to ensure the best personalised care. Each site has a service that already exists, subject to merger date approval, service go live date is planned for Q2 2021/2022.
Our practices provide bespoke services to patients who have diabetes and choose to fast as part of religious practice. Such patients receive a medication review 6 weeks prior to Ramadan to prevent complications related to diabetic medication such as hypoglycaemia and dehydration. The combined practice will continue to serve our local communities in a culturally sensitive way.
People with long-term Mental Illness
The green therapy garden at Practice 2 created with the support of patients and organisations such as Gaskell Project, has been life changing for patients. The combined practice will work with NHS Property Services to access the garden at Practice 1 to create a similar therapeutic space.
The combined practice will continue to provide dedicated appointments for people with long- term Mental Illness. These appointments will be available Monday to Friday. A single site service currently exists, subject to merger date approval, a dual site service is planned to go live Q3 2021/2022.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
People who are Homeless
The combined practice will continue to support active outreach registering of patients who are homeless and will champion work done under the Beacon GP Care Homeless Friendly scheme. The combined practice will continue to support patients in providing a ‘postbox’ as their address for correspondence. Single site provision currently exists, subject to merger date approval, the dual site service is planned to go live by 2021/2022 end.
Extended Hours Access
Extended hours will move to the weekend with a multidisciplinary team (GP, PA, Nurse, Pharmacist, HCA, Phlebotomist) offer delivering the DES specification. As the service develops and in collaboration with our PCN and MLCO partners we envisage a service supported by additional services such as focussed care, social prescribing, physiotherapy and diagnostics. Provision will alternate monthly between the two sites to reduce the need for patients to travel between sites and to maintain a consistent, high quality offer for both legacy patient lists. Subject to merger date approval, we plan for this service to go live Q3 2021/2022.
Population Health
Our practices have worked with community partners to tackle covid vaccine hesitancy. The combined practice will build on these partnerships to further health promotion programmes such as NHS Couch to 5K.
P84616 has successfully led a bid for funding to support Manchester Cycle and Stride scheme with the aim of encouraging women from a BAME background to become more active. The combined practice will support this health improvement programme.
Our practices continue to work with our community partners and patient voice advocates in encouraging uptake of breast screening amongst women with a BAME background, encourage cervical screening in women who have been subject to female genital mutilation and encouraging middle aged black men to attend for prostate cancer screening blood test. The combined practice will continue to adopt a proactive approach.
Workforce, Training and Development
Our combined clinical team will have access to Beacon GP Care Academy to support continuing professional development in order that they deliver the highest quality care.
Our practices are accredited by Health Education England as community NHS providers of GP, Foundation Doctor, Practice Nurse and Physician Associate training programmes. Further, our practices have Designated Medical Supervisors accredited by the Centre for Pharmacy Postgraduate Education and are accredited by University of Manchester as community providers of Medical Student training programmes.
Our practices are committed to continuing to develop as a centre of excellence for community-based training, inspiring the next generation of health and care professionals from our local community, and improving the employment prospects for all regardless of background.
Please explain below the consequences of the proposed practice merger for patients. You should include comments on any benefits or adverse effects on patients in relation to matters such as access to services and service delivery arrangements.
Through the NHS Induction and Refresher Scheme, our practices have supported GPs to return to work following ill health, having previously left the NHS and retirement. Our practices have supervised remediation of doctors in collaboration with the GMC and NHS England. Further, our practices have supported refugee doctors to begin their first steps towards providing NHS services in collaboration with Reache NW. Following covid, the combined practice will recommence hosting refugee medical practitioners.
Research
The first pharmacological treatment (Dexamethasone) for Covid19 was the result of NHS driven research and innovation. Our practices are research-active sites which engage patients and our staff in research studies aimed at improving health outcomes for our patients and populations beyond. Examples of studies supported include: Diabetes My Way (trial of innovative app to support people with T2DM), Moodbuster (trial of online CBT for people suffering with low mood) and the RCGP Research Surveillance Centre COVID-19 serological and virological surveillance programmes. Our practices are committed to boosting recruitment of BAME and socioeconomically deprived populations which are traditionally underrepresented in clinical research.
3. Financial considerations
Please provide comments from a financial perspective on the following matters if they are relevant to the proposed practice merger.
Premises
• Legal fees • SDLT payments • Rent reimbursement • Any potential savings
due to site closure • Or potential increase
in rent reimbursement if the newly merged practice will change premises utilisation
Projected spend.
Capital:
Funding is sought from the commissioner to vacate and develop the space currently utilised for storage of paper records at each site.
Revenue:
Funding is sought from the commissioner to service current unmet need through allocation of additional clinical space and the associated logistical space at each site.
IT
• Moving servers • Upgrading telephony
Capital:
Funding for digitisation of paper medical records is sought from the commissioner to support data quality improvement.
Revenue:
Please provide comments from a financial perspective on the following matters if they are relevant to the proposed practice merger.
Funding is sought from the commissioner to service additional remote and on-site digital provision.
TUPE Projected spend to account for legal advice and associated management costs. Funding is not sought from the commissioner for this aspect.
Redundancy There are no planned redundancies and hence cost neutral.
QOF An increase in spend is projected driven by quality improvement programme for the combined service.
Pension/seniority No changes in Pension allocation are planned.
Seniority payments ended 31 Mar 2020 and hence no impact.
MPIG/PMS Premium Neither practice was allocated MPIG and hence no impact.
Both practices are GMS and hence not subject to PMS premium. Neither practice was allocated MPIG and hence no impact.
Both practices are GMS and hence not subject to PMS premium.
Dispensing n/a
4. Service delivery
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
QOF QOF and Manchester Standards will be subject to national standard operating procedure updates and refresh of the local quality standards scheme respectively. The combined practice will respond and adapt as updates are released.
Access locations:
The journey between the sites using different modes of transport – 35minute walk; 12minute bicycle ride; 8minute car ride; number 53 bus operates every 15 minutes between both sites with a 26minute journey (some walking required). The practice will build on good will relationships developed through covid with local community taxi firms to assist where vulnerable patients require dual site access.
Both sites have visitor parking and bicycle stands.
Both sites have disability access including hearing loops and braille on door signage
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
Telephone:
The combined practice cloud telephony system will retain the three legacy numbers. Further, the system will provide patients with an indication of their place in the virtual queue but also offer a call back function if they are unable to wait.
Digital:
The combined practice will ensure patients are redirected from legacy websites to the new one. We are delighted that Healthwatch Manchester will provide critical input into the new website to ensure information is accessible to those with internet access.
Primary Care Web Tool The combined practice will continue to utilise as well as use Tableau to inform service improvement.
Recent or ongoing breaches of contract
Nil of note
Nil of note
If one practice's service delivery is of a lower standard, is there a proposal to improve performance
For 2019/2020 both practices achieved excellent results well above the CCG average of 95% (Practice 1 97.56% and Practice 2 98.04%).
For 2020/2021 Manchester Primary Care Standards achievements can be found at Appendix 1g for Practice 1 and Appendix 1h for Practice 2.
The merged practice through quality improvement methodology, will adopt the pathways from each legacy practice that deliver the best outcomes for patients. As an example, there is a 20% difference between each practice’s achievement for the Paediatric Asthma quality standard.
The Clinical Pharmacy team will implement the higher achieving pathway at both sites.
Will there be any cessation of services post-merger?
No
Will there be a reduction of hours for which services are provided post- merger?
No
Hours of opening will remain Monday to Friday 08:00 to 18:30.
Extended Hours will be condensed on Saturday mornings and occur once a month.
Please provide comments from an improving service delivery perspective on the following matters if they are relevant to the proposed practice merger.
Will there be a change in the hours at which services are provided?
Yes
Extended Hours will be condensed and provided on Saturday mornings and occur once a month.
Will there be a reduction in the number of locations or a change in the location of premises from services are provided?
No
The combined practice will continue to operate from the two sites.
Resilience – where the merged patient list is over 10,000, how will the practices ensure resilience to ensure that performance and patient experience is maintained and improved.
Performance:
Patient experience:
Frontline staff at each site will remain in current multidisciplinary teams to maintain continuity of care. The multidisciplinary team approach enhances capacity and hence improves access with patients being seen by the most appropriate clinician.
Primary Care Networks (PCN) – what are the benefits of the proposed merger for the PCN?
e.g. offer space for PCN services, taking leadership of delivering services on behalf of the PCN
Established multidisciplinary training site able to lead and support PCN ARRS. Practice 2 has a fully developed Physician Associate preceptorship programme and Clinical Pharmacist training programme. Both programmes will be accessible for the PCN.
Established structured medication review and medicines optimisation standard operating procedures able to lead and support PCN DES. Beacon GP Care has provided Practice 1 with medicines optimisation support for over 5 years. Practice 2 has had an inhouse medicines optimisation team since 2012. The combines service will be accessible for the PCN.
Established sites for PCN services such as Seasonal Influenza and Covid19 mass vaccination.
Primary Care Networks (PCN) – what are the implication of
Increase to Ardwick and Longsight PCN population size by 8892 (correct at Aug 2021). Increasing the PCN size from 68,182 to 77, 074
the proposed merger for the PCN?
e.g. where two practice premises is located in two different PCNs
Extension to Ardwick and Longsight PCN boundary to include Practice 2 area.
5. Patient and stakeholder engagement
Please provide comments on the following matters.
Have the practices engaged with patients and/or stakeholders on the practice merger?
Stakeholders may include local LMC, Healthwatch, PCN members, Community and voluntary services
Yes – further information in appendices 1i and 1j
Note: Practices must engage with patients/stakeholders
When did/will you engage with patients/stakeholders?
The engagement process commenced February 2021.
In what form did/will you engage with patients/stakeholders?
Telephone interviews with members of both Patient Participation Groups.
1:1 covid secure conversations with patients (and their carers) attending for face-to-face appointments (including via interpreters). Neighbourhood Health Development Co- ordinator support will be sought with multilingual patient information.
Direct messaging to patients using sms text message systems.
Notice on each practice website including feedback link to go live by 1/06/2021.
Meetings with stakeholders via MS Teams.
With whom did/will you engage?
Patients, Carers and Patient Voice Advocates
Longsight Medical Practice Patient Participation Group
Manchester Medical Patient Panel
Please provide comments on the following matters.
Healthwatch Manchester
MACC
LGBT Foundation
Community Service Providers
Local Authority Elected Leadership
Longsight Ward Councillors
Hulme Ward Councillors
Right Honourable Afzal Khan MP
Right Honourable Lucy Powell MP
If you have already carried out engagements, what was the outcome?
Please provide evidence
Appendix 1i contains the Patient Engagement Plan.
Healthwatch Manchester are supportive of the merger and we are delighted that they will be ensuring our digital service offer is accessible to all our patients.
Please provide comments on the following matters.
Manchester Local Care Organisation are supportive of the merger with an agreement in principle on future working arrangements with integrated neighbourhood teams.
Current (pre 6/5/21) ward councillors are supportive of the merger as are the two MPs.
6. Contractual actions
Please provide below an explanation of any contractual variations that you consider are necessary to effect the proposed practice merger.
Vary P84689 to include P84616 contract holders.
Administer termination of P84616 with contract merged into P84689.
7. Procurement and competition
Please provide below any comments on the procurement and/or competition matters that may arise as a result of the proposed contract merger.
The merger proposed would not trigger procurement or consideration of competition matters for the commissioner.
8. Merger mobilisation
Please set out below a step by step plan to the mobilisation of the merger if the business case is approved including what actions are required of the practices and third parties, such as commissioners, the order in which the actions need to be undertaken and timescales for the actions to be completed. A template mobilisation plan that can be used but will need to be amended to fit the proposed practice merger is set out at Annex 12B.
Appendix 12 contains the template mobilisation plan with steps (including risk log) to be agreed with MHCC as soon as the Board approves the merger.
8. Additional information
Please provide any additional information that will support the proposed practice merger.
The leadership team at Practice 2 retain organisational memory in relation to the successful merger of two legacy practices in 2014.
9. Signatures
Please ensure all Contractors under the current practice contracts sign below to indicate they agree with the information provided in this business case.
[name] [signature]
Please ensure all Contractors under the current practice contracts sign below to indicate they agree with the information provided in this business case.
[name] [signature] See picture above
[name] [signature]
![1.1.1 evolution[1]](https://static.fdocuments.in/doc/165x107/55aaace71a28ab507a8b460f/111-evolution1.jpg)
