DRAFT Version 5

London’s GP consortia Development Programme – Application form

For information on the applications process please review the guidance document on London’s GP consortia development programme – available at www.london.nhs.uk

Please provide all applications to strategycommissioning@london.nhs.uk

You can use this template to demonstrate your evidence, but supporting documents can also be provided.

Consortium Details:

Please complete the table below for all applications.

Consortium Name Lambeth Clinical Commissioning Collaborative

Sector for consortium South East London

Primary PCT for consortium NHS Lambeth

Local Authorities for consortium London Borough of Lambeth

Lead contact for application

Name Dr Adrian McLachlan

Designation Chair, Lambeth CollaborativeCo-Chair, NHS Lambeth Clinical Board

Email address Adrian.mclachlan@nhs.net

Telephone number 07973 614943

List of practices in consortium (including practice codes)

1. Baldry Gardens Family Practice, G85677

2. Beckett House Practice, G85100

3. Binfield Road Surgery, G85123

4. Brixton Hill Group Practice, G85025

5. Brixton Water Lane, G85088

6. Brockwell Park Surgery, G85137

7. Clapham Family Practice, G85011

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8. Clapham Park Group Practice, G85109

9. Crown Dale Medical Centre, G85022

10. Dr Ala's Surgery, G85674

11. Dr Curran & Partners, G85708

12. Dr Irani, G85060

13. Dr Ivor Ferreira, G85700

14. Dr Sheila Santamaria, G85010

15. Dr Wickremesinghe, Y00020

16. Dr. Gunasuntharam Surgery, G85682

17. Dr. Masterton's Surgery, G85021

18. Dr. Ramanan’s Surgery, G85096

19. Drs Patel & Cresswell, G85073

20. Edith Cavell Practice, G85724

21. Foxley Square Surgery (APMS Solutions), G85695

22. Herne Hill Group Practice, G85016

23. Herne Hill Road Medical Practice, G85690

24. Hetherington Group Practice, G85045

25. HGP at the Pavilion Practice, Y03063

26. Hurley Clinic, G85053

27. Iveagh House Surgery, G85135

28. Lambeth Walk Group Practice, G85054

29. Mawbey Group Practice, G85130

30. Myatts Field Health Centre, G85078

31. Norwood Surgery, G85113

32. Palace Road Surgery, G85041

33. Paxton Green Group Practice, G85039

34. Riverside Medical, Y01962

35. Sandmere Road Practice, G85083

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36. Springfield Primary Care Centre, G85673

37. Stockwell Group Practice, G85028

38. Streatham Common Group Practice, G85014

39. Streatham High Practice, G85002

40. Streatham Hill Group Practice, G85662

41. Streatham Place Surgery, G85118

42. The Corner Surgery, G85127

43. The Courtyard Surgery, G85618

44. The Deerbrook Surgery, G85129

45. The Exchange Surgery, G85647

46. The Knights Hill Surgery, G85047

47. The Rosendale Surgery, G85706

48. The South Lambeth Road Practice, G85086

49. The Tulse Hill Practice, G85133

50. The Vauxhall Surgery, G85102

51. Valley Road Surgery, G85044

52. Waterloo Health Centre , G85136

Registered patient population for consortium 377,624 (as at 01.1.2011)

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Pathfinder phase – Design, planning and preparation:

For applications to the design, planning and preparation stage please provide evidence against the criteria listed in the table below:

Strong GP leadership and support GP practices in Lambeth welcome the opportunity to fully develop as GP commissioners by April 2013 and as such access the pathfinder programme to benefit from the resources and expertise available to inform our development.

We build upon a strong history of Practice Based Commissioning, initially in 4 localities, which we evolved last year into 3 localities to match existing Local Authority and provider neighbourhood working and Polysystem locality populations/geography. All Lambeth practices have contributed to PBC working as individual localities and teaming up to form the Lambeth PBC Collaborative. We have previously polled all practices to confirm support for our governance and structures, with good results, and have undertaken a process of seeking explicit sign-up to our pathfinder application. To date xx% of Practices have explicitly opted into the Lambeth Clinical Collaborative arrangements. A systematic process for discussing concerns with Practices who have not completed the opt-in form has been agreed, which includes peer to peer meetings, in order to address outstanding issues before the 1st April 2011.

Over the last year we have held regular locality meetings and Lambeth wide collaborative meetings. The agenda and format for these meetings have been GP led and they have played a significant role in engaging practices in commissioning activity.

In preparation for GP commissioning, in September 2010 Lambeth practice based commissioners hosted an event attended by all Lambeth practices which confirmed;a) the establishment of a Lambeth wide consortium, supported by a locality level

working and engagementb) that existing PBC leads had the mandate to lead GP commissioning development

for local practices until March 2011c) that by March 2011, a formal selection and election process would take place for

the formal appointment of GP commissioning leads and governance arrangements from April 2011

A further Lambeth wide event was held on 26th January, which re-affirmed this pathfinder application and reviewed in more detail the agreed priorities for action and development, including the 2011/12 Operating Plan.

GP commissioning leads and NHS Lambeth have worked collaboratively to establish a Clinical Board with majority clinical membership, and delegated commissioning responsibilities from the NHS Lambeth Board. The Clinical Board has met formally since November 2010. Building on the involvement of GPs, and broader primary care clinicians, in last year’s Lambeth Strategic Plan, the Clinical Board has been a key driver in the development of the refreshed Strategic Plan, the 2011/12 Operating Plan, QIPP schemes and the agreement of in-year financial contingency proposals and service delivery. Much of the work has required close working with the SE London sector, especially in relation to the interface with acute commissioning. This has resulted in robust GP commissioning leadership for strategic and resource planning and delivery during this transitional phase and in building the legacy for GP commissioning.

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From April 2011, Lambeth GP Commissioners will operate in shadow form and the Clinical Board will be replaced by the Lambeth Clinical Commissioning Collaborative Board (LCCCB), as a sub-committee of the Lambeth PCT Board. During January and February 2011 GP Practices across Lambeth will confirm leadership arrangement for April 2011, including membership of the LCCCB from across the three localities.

In order to provide focused support for GPs in the transition to GP Consortia, NHS Lambeth has consulted and agreed on the structure of a Lambeth Business Support Unit (BSU). The Lambeth BSU will work alongside SE London colleagues and the Sector Team to support the development of the GP Commissioning and provide the necessary commissioning support including support to pathway redesign, public health, finance, contracting, administration and organisational development. To ensure the BSU and sector arrangements provide effective commissioning and management support for GPs, the Lambeth PBCs have been instrumental in shaping the size, structure and content of the Business Support Unit.

Clinical Board members have been actively involved in the design of future PCT arrangements on a sector wide basis. GP and Pharmacist Leads from the Clinical Board have started a series of engagement sessions with workforce from NHS Lambeth; commissioning and provider staff to keep them abreast of the local plans for the development of the new commissioning system.

A vision for the consortium

Lambeth GP Commissioners fully support the intentions set out in the White Paper: Equity and Excellence, Liberating the NHS to create an NHS which is much more responsive to patients, achieves better outcomes, with increased autonomy and accountability at every level.

Lambeth has a number of features of note: A highly diverse, deprived, mobile and young population Particularly high prevalence of HIV and mental health problems Higher rates of premature mortality from major causes such as cancer and

vascular disease Diversity within Primary Care Potential complexity at boundaries with our neighbours, eg St George’s and the

relationship with non-SE London commissioners Provider landscape; King’s Health Partners, and nearby other London teaching

hospitals and foundation trusts

As GP Commissioners we recognise the need for a rigorous, population needs based approach to commissioning with the support of public health, aiming to improve the health of our community and reduce inequalities. Our vision is therefore that:

We will maintain a thriving financially viable health economy delivering safe, effective high quality care, improving the health of our communities and reducing health inequalities.

We will work jointly with colleagues across boundaries, both geographical and organisational.

We will co-operate with King’s Health Partners, for example with the Integrated care Pilot.

We will support teaching, training and research.

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We will value diversity amongst our providers, but will expect excellent outcomes. We will look first to local colleagues for management support.

Building on our experiences of practice based commissioning, we are committed to ensuring resources are used effectively to enable local people to optimise their health and well-being, and when required benefit from the right holistic care (including prevention), at the right place and at the right time. We will continue work on reducing health inequalities. We have a strong track record of ensuring that commissioning decisions are underpinned by clinical insight and knowledge of local healthcare needs assessment and have fully engaged in developing the NHS Lambeth 2011/12-2014/15 Strategic Plan, Operating Plan and QIPP opportunities, which set out clear priorities for action.

In terms of our intention to develop as a well informed and efficient commissioning body, we would like to make effective use of the experience and expertise available, so will look first to local colleagues from NHS Lambeth and SEL Sector for management support.

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A plan for how the consortium will work with its constituent GP practices

Structures and governance arrangements will be informed by the experience and trust developed during practice based commissioning. From 2010/11, PBC in Lambeth has been comprised of 3 GP commissioning localities, working within agreed Lambeth wide collaborative arrangements (the Lambeth PBC Collaborative).

From April 2011, the Lambeth wide arrangements will be formalised, through a Clinical Commissioning Collaborative Board comprising two board members (supported and nominated from general practice) elected from each of the three localities. The Chair will be selected/elected and the wider membership will include Non-Executive Director, Lambeth Business Support Unit Managing Director and the Director of Public Health. A job description for board members and a separate job description for the chair are in place. Further work will be undertaken between now and March to determine the final Board representation in order to ensure that there is adequate breadth of clinical and non-clinical expertise.

During 2011/12, responsibility for commissioning decisions delegated by the PCT Board will rest with the Lambeth Clinical Commissioning Collaborative Board (LCCCB), as a sub-committee of the PCT Board. The three localities will remain a critical part of our working, offering closer engagement with practices, and the ability to work with the breadth of primary care practitioners across Lambeth. The role of the locality specific GP commissioning leads on the LCCCB is to ensure successful two-way communication between the practice level and locality responsibility for improving patient care, and broader strategic decision making. This will be supported by GP led locality meetings, based on the existing PBC format, to facilitate group discussion and agreement on a wide range of clinical issue. The existing programme of clinician to clinician peer support meetings will continue to be used as an opportunity to discuss clinical practice on an individual basis.

Clinical Board members will carry a responsibility relating to engagement with practices in their locality, as well as a portfolio of areas of commissioning responsibility. This will ensure that all practices have the opportunity to be involved in commissioning activities and that any local performance issues are highlighted and resolved.

We propose that in addition to the Board, there will be a Clinical Reference Group, which will continue the breadth of clinical engagement established by the NHS Lambeth PEC, across a range of clinical disciplines and drawn from a wide range of local providers. This will support pathway redesign and also act as a means to nurture the next generation of clinical leaders.

Under PBC, we have run practice based incentive schemes supported by practice based action plans to review referrals, A&E attendances and prescribing. The development and review of these plans has been supported by peer to peer visits by PBC locality board members. We will build on this work to ensure continued practice level planning results in the piloting of innovative approaches to the delivery of services.

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Agreement from the consortium to work within current legislation and operating plans

Clinical Board members have committed to working within current legislation and Operating Plans, including supporting delivery of Quality, Innovation, Productivity and Prevention (QIPP) schemes.

Practice Based Commissioners contributed to the development of the 5-year Strategic Plan 2010/11-2014/2015 and in recent months, GPs have actively engaged in developing the 2010/11 refresh managed through the Clinical Board and the delivery of the Integrated (Operating) Plan within local and national timescales. GP commissioners are thoroughly committed to the six priority health goals within the Strategic Plan:

1. Serious mental illness: to provide more high quality care in community and primary care settings through psychosis and forensic pathways re-engineering

2. Cardiovascular disease: To provide services within the polysystems to achieve good blood pressure control

3. Diabetes: To maximise the use of services within a polysystem arrangements to better manage blood sugar controls

4. HIV: To increase general awareness and non-acute screening services to diagnose more HIV+ people who do not yet know they have HIV, before a hospitalisation event

5. Smoking: To improve targeting of prevention and stop smoking services6. Childhood obesity: To provide a childhood obesity service (prevention and

weight management

In addition, GP Commissioners understand and have informed both sector and borough-based QIPP plans. Local priorities have been determined on the basis of information analysis and stakeholder (including comprehensive clinical) engagement. This included a borough-wide event regarding the scale of challenge and local priorities for decommissioning and transformation. For 2010/11 this has been refreshed and as GP commissioners we have worked in partnership with NHS Lambeth to lead the strategy for transformation, identifying a small number of key priorities for transformation, the scale of ambition and the pace of change. A simple methodology has been agreed which has underpinned our local Strategic Plan decommissioning and transformation modelling and GP Commissioners are committed to implementation.

NHS Lambeth has a Service Transformation Programme which drives the delivery of our key priorities. GP Commissioners have been engaged in this process through participation in the Clinical Programme Boards and implementation of pathway re-design.

One of key organisational priorities in 2010/11 has been the implementation of Transforming Community Services and the associated transfer of Lambeth Community Health to Guys and St Thomas’ Foundation Trust. GP engagement has been integral to the planning of the transfer and the establishment of service specifications to support Community Services transformation and the future contract arrangements.

GPs have been key stakeholders in the development of the Lambeth Living Well Collaborative which is a key foundation of the strategic plan for mental health services. This has included a series of involvement workshops across Lambeth for practices to shape and co-create community based services for people with serious mental illness.

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During 2010/11 GPs have been increasing involved in contract management, including attendance at the regular Quality and Contractual Meetings and involvement in the process of selecting locally determined CQUINs with our acute, community and mental health providers. Arrangements have been made to ensure that GPs are proactively informing the 2011/12 contract negotiations.

Lead GP commissioners in Lambeth are working closely with GP commissioners in Southwark and are currently working on a joint work programme and joint commissioning intentions across community, mental health and acute services. This will include a joint priority list for services redesign/transformation. This builds on a history of collaborative working and joint leadership on individual projects such as gynaecology redesign.

GP Commissioning leads across Lambeth and Southwark meet regularly with the Medical Director and clinical leads for King’s Health Partners and we are running quarterly workshops for clinicians across primary, community and acute services to improve joint working. Integral to this is the development of an Integrated Care Pilot which has secured the support of NHS London and the Guys’ & St Thomas’ Charity. The Chair of Lambeth PBC Collaborative is Co-Chair of the Integrated Care Pilot programme Board.

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A proposed process for decision making within the consortium, including identification of who will hold accountability within the consortium

From April 2011 the Lambeth Clinical Commissioning Collaborative Board (LCCCB), formerly known as the Clinical Board, will build on the existing responsibility for strategic and commissioning decisions delegated by the PCT Board. This will include prioritisation of commissioning intentions across the whole of the commissioning portfolio, priorities for transformation, contract monitoring, strategy for key contract negotiations and performance management of GP commissioned activity and performance management of GP Commissioning delivery and implementation, including budget performance.

Terms of reference for the Lambeth Clinical Commissioning Collaborative Board (LCCCB) are being finalised, based on the current Clinical Board, which will include quoracy, voting rights and the tenure of Board members.

We are about to launch a selection/election process for GP practice membership of the LCCCB to ensure board members and a chair is in place for 1 April 2011 with the support of practices across Lambeth. Practices will elect two representatives per locality, plus a Lambeth wide Chair, to the LCCCB.

LCCCB members will be responsible for ensuring Locality Boards are appropriately consulted, wherever possible i.e. there is not a time delay that would have strategic or revenue consequences. In the event a vote is required, Locality Boards will have one vote per practice.

A plan for engaging with clinicians and other Allied Health Professionals on joint working

Lambeth has a strong history in working with other clinicians and the PEC was constituted from a wide range of clinical backgrounds. The PEC Chair is a pharmacist and he is also currently co-Chair of the Clinical Board supporting the transition. With the dissolution of the PEC and the creation of a Clinical Board, former PEC members have continued to provide clinical support to the Programme Boards and this will continue. We will continue to work with the breadth of clinicians across the care pathways who will be involved in pathway redesign.

A Clinical Board has been established to cover the period to March 2011. This is currently co-chaired by the Chair of the Lambeth-wide GP Commissioning Collaborative and the PEC Chair. Our current PBC Collaborative board has GP, Practice Manager representation, derived from the localities, and the locality boards currently have membership drawn from GP principals, non-principals, nurses and practice managers. It is proposed that this will form the basis of the future governance arrangements, with consideration being given to opportunities for widening the clinical engagement. The Lambeth Clinical Commissioning Collaborative Board (LCCCB) members will be expected to demonstrate a commitment and competency in multi-professional and multi-agency engagement. GP Commissioners will build on the existing track record to continue to engage multi-professionals in determining strategic planning priorities.

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GP Commissioners are proposing the establishment of a Clinical Reference Group, building on the breadth of clinical engagement established by the NHS Lambeth PEC, across a range of clinical disciplines and drawn from a wide range of local providers. There is already a joint meeting and event schedule with KHP to ensure engagement with secondary care clinicians. GP commissioners also attend the AHP forum and Practice Nurse Forum to ensure engagement with these groups of clinicians.

We have informed the current business case template and assessment criteria for the commissioning of redesigned services and these require evidence of appropriate multidisciplinary engagement. Key examples of GP commissioning engagement of appropriate professionals in redesign have included optometrists in the ophthalmology pathway development, orthopaedic and rheumatology consultants and physiotherapists in musculoskeletal, diabetologists, nurses, dieticians and podiatrists in diabetes. Business cases for redesign require evidence of multidisciplinary engagement.

GP commissioners will meet with all the local practitioner committees to ascertain how they can assist in ensuring the breadth of primary care clinicians are actively engaged in ongoing redesign.

Local Authority engagement:A joint statement of intent for developing partnership working with Local Authorities

Lambeth GP Commissioners recognise the need for a rigorous, population needs based approach to commissioning with the support of public health, aiming to improve the health of our community and reduce inequalities. This is reflected in our Vision for GP Commissioning as set out earlier. As such our relationship with Local Authority colleagues will be extremely important going forward. A supportive statement is provided in a letter from Lambeth Council’s officer lead on health issues, the Executive Director of Adults’ and Community Services.

The success of the developing partnership between the consortium and the Council will be critical. GP leaders have been engaged in the plans to develop the Lambeth Health and Well Being Board, working with the lead Cabinet Member for Health and Wellbeing, the Council Chief Executive, the Joint Director of Public Health, the lead officer for health and the Executive Director of Adults’ and Community Services, all of whom are committed to working with the consortium.

Working with Council and public health colleagues we have developed a strong approach to developing the Joint Strategic Needs Assessment. As part of the development of BSU structures we have fully developed our approach to integrated commissioning, extending existing arrangements in both adults and children’s commissioning teams, through jointly funded posts. We are working with LA colleagues on the consultation response to the Public Health White Paper; Healthy Lives, Healthy People. Assuming that the main strategic direction remains following the national consultation, we will continue to work with the LA and the PCT Directorate of Public Health to ensure commissioning of healthcare services are based on the health needs of the local population and on clinical and cost effective services which are equitable and aim to reduce health inequalities. We will also work with the LA on the two other elements of the public health functions, namely health protection and health improvement.

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GPs are a key part of the Lambeth Living Well Collaborative, which brings together service users, carers, local GPs, Community Mental Health Teams, psychiatrists, commissioners and the voluntary sector to provide a joined up service for people with mental health needs. The new service will provide easier and better ways to access support and advice, from the right person, when needed. This example demonstrates how GPs in Lambeth work with a range of relevant stakeholders, including the Council to improve services.

GPs are also actively involved in working with the Council Adults’ and Community Services Department on the Lambeth Rough Sleepers Task Force and contributing to planning of mental health services.

We are working collaboratively with Lambeth Council in the development of neighbourhood resource centres (NRCs) for the delivery of integrated care services in Lambeth. We are developing four NRCs in Clapham, North Brixton, Norwood and Streatham (already open) which will include council services. In planning the new centres and services we have detailed communications plans, developed in partnership with the council.

Consideration for how to participate in the development and shaping of local Health and Wellbeing Boards

Lambeth is a Department of Health Early Implementer for Health and Wellbeing Boards (H&WB) and as such has agreed a phased approach to establishing a new style H&WB over the course of 2011.  This approach has been developed and agreed by a joint GP, Local Authority and PCT working group. 

Phase 1 will be achieved through a series of workshops run over the course of 2011 with the aim of building understanding, relationships and consensus between partners. These will focus on identifying agreed objectives and outcomes to form the focus of the Board, the most effective structures and processes to address those objectives and outcomes and early wins for joint working that can be achieved in 2011.   The final product of these workshops will be an updated and agreed joint strategic needs assessment and a clear high level health and wellbeing strategy for the borough

Phase 2 will see the establishment of a formal Health and Wellbeing Board to take forward the delivery of the borough’s health and wellbeing strategy. This will be established in line with the legal requirements by early 2012 and will oversee joint commissioning for healthcare, social care, health improvement and safeguarding.

A set of shared principles has been agreed under which these workshops and the board will operate. These are that they will have:

- Members who are able to lead decision making within their respective organisations   

- A public and transparent decision making process - A clear line of democratic accountability - An effective and transparent process for establishing improvement priorities

based on Joint Strategic Needs Assessment- Clear and effective mechanisms for involving Lambeth residents - A public and transparent process for reporting progress

In the first instance the GP membership of the workshops will include the Chair of the

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Clinical Board and a lead GP for each of the three localities.  It will also include Lambeth Council Cabinet Members, representatives from other political parties represented on the Council and Executive Directors, the joint Director of Public Health, NHS Lambeth Chair, Non Executive Directors and Chief Executive, PEC Chair, Lambeth Local Involvement Network and King’s Health Partners representative.

London Borough of Lambeth and NHS Lambeth have a strong track record of working in partnership on promoting wellbeing along with a wide range of other partners as set out in its Wellbeing & Happiness Programme 2009-13. The partnership is one of only a small number nationally with a current express commitment and action plan to improve the wellbeing of the local population.

A plan for engaging other stakeholders (please list all relevant stakeholders)

Lambeth GP Commissioners have a strong commitment to stakeholder engagement and have developed close relationships, including:

Neighbouring PCTs and emerging GP Consortia SE London Sector Lambeth Council Local NHS providers Voluntary sector bodies and patient representative groups Lambeth LINk Lambeth Health Scrutiny Contractor representative groups

A formal engagement plan will be developed and will build on our local experience and processes of stakeholder engagement throughout the key stages of commissioning Examples of stakeholders identified and processes used at each stage, i.e. strategic planning, designing and procuring and monitoring and evaluating is summarised below:

Strategic PlanningThe current Strategic Plan has been informed via prioritisation criteria developed with all key local stakeholders in August and September 2009. Both of these events included local PBC clinicians alongside representatives from Lambeth Council, local voluntary groups and the Lambeth LINk. The emerging priorities were also tested with the public at local community events, including the Lambeth Country Show, two Lambeth Expo events and an evening discussion event with local service users who brought an ‘expert by experience’ perspective. The plan was then further tested through a discussion event with an invited group of more than 30 local people in December 2009.

In addition, GP commissioners have proactively engaged and influenced the strategic planning of key partners, including King’s Health Partners and co-chair the programme board for an Integrated Care Pilot Programme across Lambeth and Southwark GP commissioners and King’s Health Partners.

Designing and Procuring ServicesOngoing patient and public engagement informs our commissioning and care pathway redesign improvement in key priority areas. Examples include mental health, long term conditions (stroke, diabetes), children’s and young people’s services, sexual health services, teenage pregnancy, and the development of community primary care services. In addition, engagement has taken place with gynaecology, MSK, dermatology,

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headache and gastroenterology service users through the care pathway redesign team, seeking engagement on proposed QIPP changes related to long term conditions, right care, planned care, decommissioning, and shift through focus groups, service user surveys, and 1:1 interviews.

As part of the Mental Health Improvement Programme, service users have been involved in service improvement work on a co-production basis, which includes substantial feedback on experience of services. A “Living Well Collaborative” has also been established, consisting of GPs, voluntary sector, users and carers, SLaM, Lambeth Community Health, London Borough of Lambeth, and PCT representatives and this collaborative has presented proposals to wider partners and stakeholders. The LMC and LINk have also been consulted on proposed changes and the Overview and Scrutiny Committee have been engaged for future consultation.

GP commissioners will use the benefits of closer integration with London Borough of Lambeth to plan a more integrated approach to stakeholder and community engagement focused around GP commissioning localities/polysystems which were reconfigured in 2010 to reflect LBL neighbourhoods. We will work with the London Borough of Lambeth to support their Cooperative Council strategy.

Ability to contribute to the delivery of the local QIPP agenda in the consortium’s locality

Participation in the 2011/12 QIPP planning round at PCT and sector level, including developing and agreeing priorities for the local population

The QIPP planning round for 2011/12 has been led by the South East London Sector with local leadership by NHS Lambeth. The Lambeth priorities and assumptions to support the refreshed Strategic Plan (including QIPP) were agreed through the Lambeth Clinical Board. QIPP plans were developed through programme boards including GP commissioning programme leads in out of hospital care, community services, mental health, long term conditions and staying healthy, end of life care and sexual health. Having been involved in the planning stages, GPs are also actively engaged in the delivery of our priority QIPP programmes. Assumptions and focused areas for acute outpatient savings were agreed through the Lambeth Practice Based Commissioning Collaborative. These were based on priority areas identified through Practice Based Commissioning locality groups and subsequent care pathway redesign project groups including GP locality representatives. The major capital schemes proposed and funded through the Strategic Plan have had engagement from local GPs and the next phase of planning for Norwood Hall a significant scheme for the south of the borough is led by a Project Board including the Chair And Vice Chair of the South East Lambeth PBC Group.

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Local ownership of meeting the QIPP challenge

The Clinical Board receives monthly briefings for discussion on the Lambeth financial position, including delivery of QIPP schemes and financial contingency planning. QIPP plans have been formally agreed through the Clinical Board and so GP Clinical Board members are actively involved in the agreement of financial contingency plans to achieve financial balance. GPs and the PCT are working on revising current programme arrangements to deliver and provide assurance on QIPP to GP Commissioners. GP Commissioners have identified leads for acute, community and mental health service contracts and programme leads. Practice based action incentive plans are in place to deliver QIPP plans for primary care prescribing and reduced outpatient attendances have been agreed through PBC Groups. These are being supported by peer to peer visits. Practices are provided monthly reports of activity and spend against their indicative budgets and this will be expanded to include all areas of delegated spend over 2011/12.

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Pathfinder Phase – Some delegated responsibilities:

For applications to take on some delegated responsibilities from April 2011 please provide evidence against the criteria listed in the table below.

Some delegated responsibilities:

Clearly defined outcomes for the activities the consortium wishes to take delegated responsibility for

The local GPs, through the Lambeth Clinical Commissioning Collaborative Board (LCCCB), plan to take delegated responsibility for focused areas of commissioning from April 2011, building incrementally towards our ambition of full delegated responsibility by April 2012.

Proposed areas:1. Adult Mental Health, including opportunities arising from the Lambeth Living Well

Collaborative and management of Forensic services.

2. Community Contract, including prioritising district nursing, services for the frail elderly and opportunities for integration.

3. Prescribing including further work to unify formulary between acute and primary care and common approaches to the entry of new drugs.

4. Acute Outpatient Activity, including referral management and continuing the existing work on pathways of care e.g. for musculo-skeletal services, gynaecology, neurology, ophthalmology, diabetes, CVD, and respiratory care,

The outcomes for these delegated commissioning activities will be refined over the coming months but will cover:

Stable financial position Patient reported outcomes Patient experience of services and care Percentage shift of care to out of hospital setting (planned and actual)

In order to ensure a phased approach to the delegation of responsibilities, the following timetable will be used:

Mental health Q1 Community Q2 Prescribing Q3 Outpatients Q4

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A plan for how the consortium will achieve the specified outcomes, including how they will manage the risks (specifically financial risk) associated with them

GP commissioners are already well embedded in planning the redesign of services to achieve planned outcomes, including financial savings. The agreed structures for the Business Support Unit to support GP commissioning from April 2011 include a service redesign team working with GP Commissioners across both health and social care. This will work with a similar team in Southwark, on a shared programme of work, to support pathway changes linked to reducing activity in secondary care and shift to primary care community settings.

One of the key issues for Lambeth GP commissioners will be working with the sector based primary care contracting team and sector acute team to commission services to reduce variation in primary care, particularly in the care of people with long term conditions. We are currently developing locality based approaches to this. NHS Lambeth will take a lead in London on the implementation of the United Health Population Health Managements and Clinical Checking Tool originally commissioned by Commissioning Support for London which will support monitoring of acute activity at practice level, risk stratification and verification of acute activity including medicines management. We are in the process of implementing the system to go live in April 2011. This will build on a product NHS Lambeth commissioned from Bupa Health Dialog to risk stratify patients to support prevention of admission. This is populated with acute data from SUS and practice data extracted from practice systems.

The current overall NHS Lambeth baseline is £634 million. All practices currently receive financial reporting information on the 80% of NHS Lambeth Commissioned services on a monthly basis, of which:

Acute Services and Prescribing are reported on a full expenditure and activity basis and total £276 million (44%)

Mental Health, Community, Children, Older Adults and other Care Groups, are not activity based and total £222 million (35%)

Primary Care, Dental and Hosted Services are amongst those areas excluded from the PCT baseline.

GP Commissioners receive monthly financial and activity reporting information and have access to practice level analysis on Xiom (a web-based data warehousing system). This will be extended to include community and mental health budgets at practice level and to develop activity information to this level.

Through the existing PBC Collaborative structure, GPs have been involved in the development of PBC budget setting in accordance with national guidelines.  NHS Lambeth is participating in the road test of a fair shares pilot budget model for use during the 2011/12 budget setting round.  The PCT is working with GPs over the coming weeks to ensure the delivery of an agreed set of budgets for 2011/12.

The Clinical Board, comprising GP representation, has been actively involved in the delivery of financial balance during 2010/11 and the development, agreement and implementation of contingency proposals to mitigate risk and ensure financial balance.  This process has and will involve working with business support unit commissioning staff to review existing budgets and identify, and risk rate proposals to deliver in year savings without compromising patient safety or delivery of key financial targets.

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A plan for the performance management of activities they wish to take delegated responsibility for

The performance management of delegated responsibilities will be through the Clinical Commissioning Collaborative Board. The three localities that sit under the LCCCB will play a key role in undertaking peer review, highlighting any local performance issues, agreeing solutions and implementation actions. The PCT, GP Commissioners and SEL sector have worked together to put in place a process to ensure involvement of GP commissioners in the setting of commissioning intentions and contract negotiation process. This is to ensure that contracts reflect the views and concerns of GP commissioners in advance of them taking on responsibility by April 2012. The Clinical Board has agreed CQUIN priorities to take into negotiation with trusts following discussion with lead GPs

Lead GPs currently attend contract review and quality review meetings with trusts and this will be further developed during 2011/12, including appropriate feedback mechanisms to practices.

We currently report activity and finance data at practice, locality and borough level on a monthly basis. During 2011/12 we will improve the quality and timeliness of data, its analysis and presentation. This will be supported by the new Population Health Management and Clinical Checking Tool.

The existing Service Transformation/QIPP Programme Management arrangements are being reviewed as part of the new governance to support GP commissioning and the delegated responsibilities held by the GPs in 2011/12.

A plan for how the consortium will access the commissioning support it needs to deliver any delegated responsibilities it may take on

The Lambeth Clinical Commissioning Collaborative, will access commissioning support through the recently agreed Lambeth Business Support Unit (BSU) and SE London sector arrangements in particular acute contracts. Local GPs have worked closely with the PCT to ensure that all necessary commissioning support (currently managed in the PCT and sector), including public health, finance, contracting and admin is provided in an accessible way. The BSU has been structured specifically to support the GPs in the transition to GP Consortia. The Organisational Development capacity in the structure will be focused on ensuring that the BSU provides the necessary support to GP commissioners during the transition and that the Lambeth Clinical Commissioning Collaborative are fully equipped to take on full commissioning responsibilities by April 2013, as a GP Consortia. We understand that the Lambeth PBC Collaborative was the only GP commissioning group in the sector to formally respond to the consultation on changes in structures.

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Established governance structures for managing delegated responsibilities, including how the consortium reports to the PCT Board in order to meet current statutory requirements

The PCT and GP Commissioners formally established the Clinical Board in November 2010. This is a formal sub-committee of the PCT Board with delegated authority on commissioning. It has replaced the previous Professional Executive Committee. Its membership is: PCT Chair, GP Commissioning Consortium Chair, the four GP Commissioning locality chairs PEC Chair and Vice Chair, one PCT Non executive director and 2 executive directors. The Clinical Board reports to the PCT Board. The Clinical Board is supported by a Lambeth Collaborative Commissioning Consortium made up of three representatives from each PBC locality group.

From April 2011 the Lambeth Clinical Commissioning Collaborative Board (LCCCB) will build on these governance arrangements. Membership of the LCCB will comprise two board members (from general practice) elected from each of the three localities. In addition, a Chair will be selected/elected with total Board composition of 7 GP commissioning leads and wider membership including Non-Executive, the Lambeth Business Support Unit Managing Director and the Director of Public Health. Further work will be undertaken between now and March to determine the final Board representation in order to ensure that there is adequate breadth of clinical and non-clinical expertise. During 2011/12, responsibility for commissioning decisions delegated by the PCT Board will rest with the Lambeth Clinical Commissioning Collaborative Board, as a sub-committee of the PCT Board.

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Supporting information:

In order to assist NHS London in its support for GP consortia some additional information would be helpful when applying to become a pathfinder. The optional questions outlined below are not a required part of the applications, but answers to them would be welcomed with all applications.

Optional questions:

What delegated commissioning responsibilities do the GP practices within the consortium currently hold (e.g. existing Practice Based Commissioning arrangements), and how effective these have been?

Practices currently hold Indicative budgets for acute commissioning and the PBC LES. Examples of work undertaken include commissioning of polysystem based services for musculo-skeletal conditions and headache management.

Achievements to date include: High patient satisfaction with new services Lower waits for assessment and treatment High clinical indicators/proxies for appropriateness (e.g. increase in conversion to

surgery rate in MSK)

GPs have achieved a downward trend in growth of referrals, but not global sustained savings. Further work is being undertaken at practice level and reviewing referrals against checklists/referral criteria. Lambeth GP commissioning leads are working with Southwark and Kings Health partners to develop a Referral Management Service to improve information on referrals, including greater information on sub specialty referrals, to assess against agreed criteria and re-direct to community based alternative services where appropriate.

Practices have identified areas for contractual challenge including, glucose tolerance tests being charged as a day case.

What services and / or functions is the consortium looking to take on delegated responsibility for in the next stage of being a pathfinder, and when would it like to take them on?

Discussions will take place on the timetable for delegation of further responsibilities for elective and emergency admissions to acute care, remaining mental health and community services. Further clarification is needed nationally on the commissioning of enhanced services.

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What are the main areas for development for the consortium, including any key issues that need to be resolved?

Training and Development will be a key element of the GP Pathfinder and so as part of the establishment of the Lambeth Clinical Commissioning Collaborative a development plan will be agreed that combines the clinical and non-clinical development needs. The plan will outline the organisational and individual development and training required in the transition period for primary care and the support services provided by the Lambeth Business Support Unit. It will cover:

Clinical leadership Capacity and capability in general practice and the Lambeth Business Support

Unit Governance (developing the collaborative as a robust and effective organisation) Financial and non-financial risk management Information management and knowledge management (data to support intelligent

commissioning e.g. whole patient pathway, understanding of health economics and phasing of financial benefits)

Service Improvement and leadership Provider influence and management PPI

What forms of engagement and learning are most preferred by the consortium and its constituent GP practices?

We are keen to ensure that we support all of primary care with the necessary learning opportunities in order to build commissioning capacity and capability. Options for doing this will be included in the development plan for the Lambeth Clinical Commissioning Collaborative.

The GP practices have already been working together in the form of localities so have developed a range of communication and learning methods depending on the nature of the issue:

Face-to-face engagement and learning takes place via a programme of clinician led practice visits.

Teleconferencing and telephone calls are used to maintain contact on an ad hoc basis.

Meetings are held on a regular basis in each locality and also on a Lambeth wide basis and the agendas for these combine information sharing and learning opportunities

Email, letters and newsletters are used to share information. A buddying system which matches practices and clinicians to facilitate a

comprehensive level of engagement across Lambeth. Lambeth GPs have our own website at www.lpbcc.com

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Additional comments:

Please provide any additional comments:

None

Please provide any other relevant information:

None

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