NHS CROYDON CCG PRIMARY CARE COMMISSIONING …...Mark Creelman Interim Project Director Enclosure 3...

NHS CROYDON CCG PRIMARY CARE COMMISSIONING COMMITTEE

Meeting in Public

Tuesday 3 March 2020 12 00 – 13 30

The Recreational, Fairfield Halls Park Lane, Croydon CR9 1DG

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Croydon Clinical Commissioning Group Primary Care Commissioning Committee Meeting in Public

Agenda

Meeting: 3 March 2020, 12 00 – 13 30 Location: The Recreational, Fairfield Halls Park Lane, Croydon CR9 1DG Members of the public are welcome to attend this meeting of Croydon CCG’s Primary Care Commissioning Committee meeting. There will be the opportunity to ask questions during the Open Space. Questions will be limited to one question, plus one supplementary question, per person.

Item Time Authors Enclosure

1 12 00

Apologies for absence Verbal

2 Declaration of Interests

Verbal

3 Minutes of the meeting held on 3 December 2019 For agreement

Chair Enclosure 1

4 Matters Arising

• Action Log

Chair

Enclosure 2

Governance

5 12 10 Chair’s Report

Chair Verbal

6 12 15 Croydon Primary Care Governance For approval

Mark Creelman Interim Project

Director

Enclosure 3

7 12 25 Primary Care Finance Report – Month 10 For noting

Mike Sexton Joint Chief

Finance Officer

Enclosure 4

Transformation

8 12 30 Locally Commissioned Services For approval


Director

Enclosure 5

Assurance

9 12 40 Contractual and Commissioning Update For noting

William Cunningham

Davis, Director of Primary Care,

NHS England

Enclosure 6

10 12 50 Medicines Shortages Update For noting


Director

Enclosure 7

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11 12 55 Primary Care Quality Update

For discussion and noting

Dr Mike Simmonds, GP Governing Body

Member

Enclosure 8

12 13 15 Croydon Primary Care Estates Strategy For approval


Director

To follow

Open Space for Public Questions

13 13 20

Any Other Business

14 Any other business

Chair

Date of next Meetings in Public of

15 TBC

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Croydon Clinical Commissioning Group Primary Care Commissioning Committee

MINUTES

Date: 3 December 2019 Time: 12 00 – 13 30 Location: Markee Room, Croydon Conference Centre, Surrey House, 5 – 9 Surrey Street,

Croydon CR0 1RG

Present: In Attendance:

▪ Philip Hogan, (PH) Lay Member – Finance (Chair)

▪ Josh Potter (JP), Joint Director of Strategy and Transformation, CCG/ CHS

▪ Elaine Clancy (EC), Joint Chief Nurse, CCG/ CHS

▪ William Cunningham Davis (WCD), Head of Primary Care, SWL Primary Care Team

▪ Sarah Warman (SW), Director of Joint Commissioning, CCG/ Croydon Council

▪ Agnelo Fernandes (AF), Clinical Chair, Croydon CCG

▪ Mike Sexton (MS), Joint Chief Finance Officer, CCG/ CHS

▪ Vaishali Shetty (VS), GP Governing Body Member, CCG

▪ Mike Simmonds (MSi), GP Governing Body Member, CCG

▪ Roger Eastwood (RE), Lay Member Governance and Conflict of Interest Guardian, CCG

▪ Amy Page (AP), Registered Nurse, Governing Body Member, CCG

▪ Les Ross, (LR), Secondary Care Doctor, Governing Body Member

▪ Richard Brown (RB), Medical Director, Surrey and Sussex LMC

▪ Gordon Kay (GK), Health Watch ▪ Vasudha Rai (VR), Business

Manager, Croydon CCG (minutes)

Apologies ▪ Paulette Lewis (PL), Lay Member, PPI, CCG ▪ Emily Symington (ES), GP Governing Body

Member, CCG ▪ Sarah Blow (SB), Interim Accountable Officer,

Croydon CCG

Apologies ▪ Rachel Flowers (RF), Director of

Public Health, Croydon Council

Ref: 2019/12/01

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1 Welcome and Apologies for absence Action

1.1 Phil Hogan welcomed members to the meeting. Apologies were noted as above.

Ref: 2019/12/02

2 Declaration of Interests

2.1

GP colleagues declared their conflict of being commissioners as well as providers.

Ref: 2019/12/03

3 Minutes of the Meeting held on 3 September 2019

3.1 The minutes of the meeting held on 3 September 2019 were approved, pending the change in title for Phil Hogan.

Ref: 2019/12/04

4 Matters Arising

4.1

Action Log Medicines Shortages Josh Potter explained that this report had been deferred to the March Committee due to the pre-election period and partly as still work in progress to understand the final position.

JP

Ref: 2019/12/05

5 Chair’s Report

5.1 5.2 5.3 5.4

Phil Hogan reported that there had not been any meetings of the Primary Care Commissioning Committee held in private since the meeting in September and provided a verbal update on the changes. SWL CCG Merger In October 2019, NHS England approved the application from the SWL CCGs to merge and become one NHS South West London CCG on 1 April 2020.  There were a number of work streams underway to mobilise the new organisation. Staff Changes Phil Hogan reported that since the last Committee there had been some staff changes namely:

• Andrew Eyres had left and Sarah Blow had been appointed as the interim Chair for Croydon CCG;

• Martin Ellis was on a secondment at Kingston and Richmond CCG as Director of Transformation;

• Les Ross, had been appointed as the Secondary Care Doctor on the Governing Body

• Josh Potter, had been appointed as the Joint CCG/ CHS Director of Strategy and Transformation

Josh Potter added that Leilla Thomas, Head of Primary Care would be leaving Croydon CCG at the end of the month and Mark Creelman had been appointed as Interim Project Director and would have the Primary Care portfolio.

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5.5

Rita Barfoot Phil Hogan presented the Committee’s condolences to the family and friends of Rita Barfoot, who had recently passed away and paid tribute to her work in Coulsdon in the development of primary care provision.

Ref: 2019/12/06

6 Primary Care Finance Report – Month 7

6.1 6.2 6.3 6.4

Mike Sexton presented the Month 7 Finance report and explained that the CCG was reporting a year to date position of £0.1m underspend and a forecast position of £1.1m overspend for Primary Care Services. Additionally, a year to date position of £0.6m underspend and a forecast position of £0.4m underspend for Primary Care Delegated Commissioning was also being reported. The Committee noted that the key risks were in respect of the system’s inability to rapidly invest in Primary Care Network (PCN) workforce and primary care at scale development. There was also some rick in respect of GP IT support services. There was a discussion in regards to extended access. There was some concern that some practices had not been paid as per budgeted. The Committee noted that some practices had not provided this service during Quarter 3, therefore had not been paid. This could explain some of the discrepancy. The Committee noted that Locally Commissioned Services (LCS) were mainly activity driven and reflected that there was a need to engage and support practices to ensure that they were signing up to the LCSs. The Committee tasked the Primary Care Commissioning Working to define this engagement model. The Primary Care Commissioning Committee noted the report.

Ref: 2019/12/07

7 Croydon Primary Care Strategy – update on monitoring

7.1 7.2 7.3

Josh Potter presented this paper and explained that the Committee had approved the strategy in September but had asked for clarifications in regards to the methodology and how progress would be tracked and monitored. Agnelo Fernandes recognised that the strategy was evolving and was pleased to note that ICN development had been included both in the Primary Care Strategy as well as the Health and Care Plan, however would be keen to understand how Primary Care colleagues would be engaged in the process. Josh Potter explained that the engagement would be done mostly through the Primary Care Working Groups. The terms of reference for the Working Group would be discussed at the December meeting and would welcome comments and feedback from Committee members.

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7.4 7.5 7.6

The Committee noted that tasks and finish groups would also be set up as required. Phil Hogan reflected that there was a need to ensure that all the various components were appropriately managed and to ensure that once the SWL CCGs had merged, the assurance element was not lost. William Cunningham Davis reassured that SWL Primary care would maintain the same level of engagement as current practice with Croydon, post the merger. Gordon Kay referred to the patient involvement and wanted to know if the patient centred measures have had any further consideration and highlighted that Health Watch would be keen to be assist in that process. Josh Potter explained that patient engagement would be clarified as further evolution of the strategy and Health Watch would be engaged as required. The Primary Care Commissioning Committee noted the proposals for monitoring process against the Primary Care Commissioning Strategy.

Ref: 2019/12/08

8 Locally Commissioned Services (LCS)

8.1 8.2 8.3 8.4

Long Term Conditions Proactive and Preventative LCS Josh Potter explained that the NHS Long Term Plan identified the prevention, identification and management of diabetes, respiratory and cardiac disease as key national priorities where the NHS can make rapid impact on people’s health, save lives, reduce life years lost to disability and reduce the need for hospital services. In 2018, a detailed analysis was carried out illustrated the challenge to health and social care partners of the existing and cumulative impact of the Long- Term Conditions in Croydon. The Long-Term Conditions Proactive and Preventative Service LCS was developed as a response to the findings with a view to increase proactive identification of the estimated 2100 undiagnosed people with Atrial Fibrillation (AF) as well as providing targeted support for patients with either Hypertension, AF and/or Type 2 Diabetes in line with best practice. It was anticipated that the service would be implemented in 2020/21. The Committee noted that the Clinical Leadership Group had been engaged in the development of this LCS and they were supportive of the specifications. The Group Consultation approach and support being made available was noted and commended by the Committee. This LCS would be funded from the 2018/19 Quality Premium funding allocation.

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8.5 8.6 8.7 8.8

Following a query from Gordon Kay in respect of the patient engagement approached referred to in Phase 1, it was noted that practices would be required to demonstrate that patient engagement had been carried out. This could be evidenced by ensuring that documents would be made available in various languages. Attention was drawn to a patient engagement event that was planned for 11 December 2019. The invite for this event would be extended to Health Watch. The Primary Care Commissioning Committee approved the Long-Term Conditions LCS subject to funding. Spirometry Locally Commissioned Schemes Josh Potter explained that the Spirometry LCS had been developed to support the high level of undiagnosed COPD patients in Croydon. This LCS would incentivise practices in targeting high risk category patients for quality assured spirometry. The Respiratory Clinical Working Group have championed changes based on the awareness that accuracy of COPD diagnosis in primary care remains variable. The LCS takes into account NHS England’s best practice guidelines to reflect that clinicians delivering the test needed to be qualified with an Association for Respiratory Technology and Physiology (ARTP) Certificate of Competence and to be on the ARTP Spirometry Register by 2021. Additionally, colleagues involved in interpreting the results would also need to have the certification and be on the register. Attention was drawn to the uplift to the price of each test to consider the extra resource involved in delivering the changes. The Primary Care Commissioning Committee approved the Spirometry LCS subject to funding. Update on Locally Commissioned Service arrangements for 2020/21 Josh Potter provided an overview of the LCS Review undertaken as well as the work in progress to further refine these and the activity and finance impacts. The Primary Care Commissioning Committee noted the update on LCS arrangements for 2020/21.

Ref: 2019/12/09

9 Primary Care at Scale (PCAS) Funding

9.1

Josh Potter explained that the CCG had been allocated Transformation Funding to support PCAS and the delivery of Extended Access in 2019/20. The funding for extended access was already committed through existing contracts with an additional £300,000 earmarked for improving utilisation of the extended

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9.2 9.3

access hubs, and to meet the specification requirements. The CCG Primary Care have engaged with Primary Care Networks to understand the development needs. Clinical Directors completed a baseline assessment against the maturity matrix and had requested investment for Organisational Support to each Primary Care Network. There had also been an ask for additional roles reimbursement for the two larger Primary Care Networks. The Committee was pleased to note that organisational development support had been sought. The proposed investment of PCAS monies to support the development of PCNs was approved.

Ref: 2019/12/10

10 Croydon Urgent Care Alliance and GP Enhanced Access Contract Extensions

10.1 10.2

The Committee noted that the contract to provide Urgent Care services in Croydon, covering the Urgent Care Treatment Centre, GP Out of Hours service and the urgent care GP Hubs was awarded to the Croydon Urgent Care Alliance (CUCA), with the contract commencing on 1 April 2017 for a period of 3 years and due to expire on 31 March 2020 with the option to extend for up to a further two. Josh Potter explained that there have been a number of changes and initiatives that have changed the landscape of health and social care in Croydon. There was a need to consider these changes and initiatives and understand the right model for Croydon. The Committee noted that to enable this the Croydon Urgent Care Alliance had been extended for a period of two years subject to an improvement plan to be implemented during this period. The Primary Care Commissioning Committee ratified the decisions in respect of the Croydon Urgent Care Alliance and GP Enhanced Access Contract Extensions

Ref: 2019/12/11

11 Contractual Update

11.1 11.2

William Cunningham Davis presented the Contractual Update. Catchment area William Cunningham Davis explained that when Coulsdon Medical Practice closed on 26 October 2018, the patient list size was dispersed. One third of these patients chose to register with Old Coulsdon Medical Practice. The Primary Care teams had recommended the Practice to formally apply for an extension to their practice boundary. This application has been submitted. The Primary Care Commissioning Committee approved the

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11.3 11.4 11.5 11.6 11.7

extension to the catchment area. Annual Practice self-declaration (eDec) 2018/19 William Cunningham provided an update from practices in relation to their mandatory 2018/19 annual practice declaration and reported that most practices had provided sufficient assurance that no contractual action was required. Two practices had not confirmed that they had established a Patient Participation Group. The Committee had a discussion on the contractual obligations in respect of Patient Participation Groups. William Cunningham Davis explained that as long as practices were able to evidence engagement with their patient groups and NHS England would be supportive of any mechanism. William Cunningham Davis explained that an additional question in respect of training was included in the annual practice declaration and some practices had not confirmed that Mental Capacity Training had been undertaken. NHE England was keen to ensure that all practices had access to the required level of safeguarding and issues relating to Mental Health. There had been some early discussion as to whether some of these training would be made mandatory. Agnelo Fernandes reflected that as a practice it was good practice to do these trainings and can be used as evidence for CQC Inspections. The Primary Care Commissioning Committee noted the annual practice self-declaration (eDec 2018/19. Contractual Changes William Cunningham Davis presented the Quarter 2 Primary Care Contracts summary report highlighting the contract variations, infection control audit, CQC inspections. Amy Page noted a decrease in the number of remedial actions and would welcome a similar trend going forward. The Primary Care Commissioning Committee noted the contractual changes update.

Ref: 2019/12/12

12 Primary Care Quality Update

12.1 12.2 12.3

Mike Simmonds explained that the Primary Care Quality update was a summary of the GP Clinical Quality Review Group GP CQRG) held on 20 November 2019. As part of the wider South West London changes, there has been a need to review current arrangements for the GP CQRG to ensure there was sufficient governance to support the quality monitoring and improvement without unnecessary duplication. The meeting held in November 2019 had discussed the Learning

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12.3 12.4 12.5

Disabilities health checks as well as the National Diabetes Prevention Programme and NRLS Incidents reporting. Mike Simmonds reported that the GP CQRG had received its first influenza immunisation uptake data and had noted that the uptake amongst over 65s was significantly higher than last year’s data. The Primary Care Commissioning Committee noted that NHS England data indicated that Croydon’s performance in respect of immunisations, in general, was poor. William Cunningham Davis reported that NHS England had been having discussions on developing the appropriate support to practices to improve their immunisation rate. The Committee would welcome an immunisation improvement plan at the March Committee. The GP Patients Survey results had not been included in the quality report due to the timing of the Committee and the publication date. An update would be brought to the March Committee.

MS

MS

Ref: 2019/12/13

13 Open Space for Public Questions

13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8

Q: Member of public referred to projected takeover of BMI by Circle and wanted to know the impact on the current contractual agreements with BMI. A: The CCG was not aware of this proposal but would expect that the contractual agreements with BMI would be binding regardless of takeovers. Q: In the event of the take-over, whether there was a potential for the CCG to pay more for services commissioned? A: Contractual agreements would not be changed and would seek legal advice if needed. Q: Representative from GSK wanted to know how decisions would be taken post SWL Merger? A: Representative was reminded that this session was an opportunity for members of the public to ask question in regards to services commissioned and was not appropriate for these types of queries. Additionally, given that the CCG was in the pre-election period would not be able to answer this. Q: Member of the public referred to GP practices in Surrey being offered GP video consultations and wanted to know when this would be available in Croydon. A: The Committee explained that Doctor Link, which was being deployed by South West London would enable video consultations. This was part of the long-term plan. Richard Brown clarified that the video consultation in Surrey was for extended access and not available during contracted time. He also explained that whilst the leaflet referred to a GP there was a need to be mindful that this

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would not necessarily mean the GP that the patients normally see.

Ref: 2019/12/14

14 Any other Business

14.1 14.2

South West London Merger Phil Hogan referred to the March 2020 Primary Care Committee as the last meeting of the Committee under the current Terms of reference and recommended that it would be helpful for the Committee to have a review of how accountability and responsibilities have been discharged to date. There was no further business to discuss.

Ref: 2019/12/15

15 Date of Next Meeting

15.1 TBC

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Enclosure 2

CCG Primary Care Commissioning Committee Meeting - ACTION LOGOn target to meet resolution date

Up to 1 week behind target resolution date

Last updated: 27 February 2020More than 1 week behind target resolution date

Ref No CCG Date Owner (responsible)Action RAG Status

Due

DateNotes (progress to date, problems encountered, etc.)

12/12/2019 03-Dec-19 Martin Ellis Josh Potter Primary Care Quality Update

- A report on the GP Patients Survey results would be included in the March

Primary Care Quality Update

- An immunisation improvement plan would also be inlcuded in the March Primary

Care Quality Update

CLOSED 03-Mar-20This in included in the pack, to be presented by GP Chair of Quality forum (previous

CQRG)

07/09/2019 03-Sep-19 Martin Ellis Josh Potter Primary Care Finance Report – Month 4

The Committee requested that the report on Medicine shortages in Croydon and

what actions were being taken to mitigate this risk be brought to the December

Committee.

CLOSED 03-Dec-19 Due to the pre-election period this item has been deferred to the March Committee

12/09/2019 03-Sep-19 Martin Ellis Josh Potter Croydon Primary Care Estates Development Overview

The Committee noted that the Estates Board was developing a Croydon wide

strategy based around the ICN+ development as well as acute needs and

recommended that the strategy included an updated premise needs assessment

for all GP Practices. The refreshed strategy would be brought to the December

Committee.

CLOSED 03-Dec-19 This item is on the agenda

Key to RAG Status:

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING IN PUBLIC

3 March 2020

Title of Paper: Croydon Primary Care Governance

Lead Director Josh Potter Director of Strategy and Transformation

Report Author Andrew McMylor SWL Director of Primary Care Programmes

Committees which have previously discussed/agreed the report.

Primary Care Working Group

Committees that will be required to receive/approve the report

Primary Care Commissioning Committee

Purpose of Report For Approval

Recommendation:

The Primary Care Commissioning Committee is asked to:

▪ note the contents of the paper and the work is progressing with Croydon primary care team to ensure a seamless transition to the new governance arrangements by April 2020.

Background:

As part of the merger of the six SWL CCGs, there is a requirement to have a single Primary Care Commissioning Committee (PCCC) which will ratify (per the NHS England delegation agreement) a number of matters concerning primary care contracts.

Key Issues:

Extensive work in developing terms of reference, including ‘testing’ a number of worked examples has been conducted over the autumn in order to ensure the SWL CCG can deliver its requirements. This has involved discussions with a number of clinicians and managers, including discussions with the two Local Medical Committees across SWL. Information was also shared with Member Practices ahead of the merger vote on how primary care governance would work with the SWL CCG. Reason for Primary Care Commissioning Committee review: To provide assurance that detailed plans are in place with regards to primary care

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contracting as part of the SWL CCG from April 2020. The PCCC will already be aware as part of Moving Forwards Together discussions that all decisions around local primary care, such as strategy and budgets, will remain with the Croydon (Place Based) Committee. In addition, to provide the PCCC with further information and detail on how the governance for primary care contracting will be taken forward in the CCG.

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Governance: Corporate Objective The merger of the SWL CCGs into a single CCG

supports our delivery of the LTP objectives and enables us to deliver our commitments to the SWL population more effectively and efficiently.

Risks

The Croydon primary care team and SWL team are working together to ensure all existing actions requiring resolution by 1 April 2020 are completed; and an implementation plan for post-April 2020 is in progress.

Financial Implications

None specifically for primary care contracting.

Conflicts of Interest

N/A

Clinical Leadership Comments

Implications for Other CCGs

N/A

Equality Analysis

N//A

Patient and Public Involvement

N/A, however Patient and Public engagement groups have been engaged in the overall merger process through SWL Forums.

Communication Plan N/A

Information Governance Issues

Nil Known

Reputational Issues

Nil Known

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Primary Care governance from April 2020

Purpose of paper This paper is split into three main sections with the overarching objective of demonstrating how from April

2020 primary care governance will function, specifically in relation to the commissioning and contracting of

‘core’ general practice contracts.

The main sections;

- Primary Care governance; description of the governance operating at local level and the

relationship with the one SWL Primary Care Commissioning Committee (PCCC).

- Decision-making; articulating how decision-making will function including the relationship between

local level and SWL PCCC across a number of primary care functions.

- Terms of reference; the terms of reference for the SWL PCCC, a model terms of reference for a

local PCMG (for local additions to be made, e.g. membership) and an FAQ page that was sent to

Member practices ahead of the merger vote in Aug/Sep 2019.

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SECTION 1: Primary Care governance

1. The function of Primary Care Commissioning Committees

Primary Care Commissioning Committees (PCCCs) deliver the statutory functions of CCGs as set out by

NHS England as part of the delegation agreement for primary care.

Functions PCCCs deliver include ratifying new incentive schemes, agreeing significant changes to

practices or overseeing primary care contracts.

We currently have six PCCCs in SWL (i.e. one for each CCG). All operate with very similar terms of

reference and membership given the statutory functions are the same for each, as they will be for the

SWL CCG from April 2020.

Each PCCC is supported locally by Primary Care teams with the support of the SWL contracting team.

Typically they meet every two to three months in public and along with ensuring the statutory functions

are delivered, also provide a steer on the local primary care strategy and budget.

2. The role of the SWL PCCC from April 1st 2020

In keeping with the commitment to maintain and enhance primary care locally as part of the Moving

Forwards Together process, as much business as possible will be transacted at Borough level. The terms

of reference for the PCCC are included as an appendix to this paper, and have been developed following

detailed discussions with the Surrey & Sussex Local Medical Committee.

This approach will ensure that primary care continues to be strengthened and empowered within Croydon

with only matters needing formal PCCC ratification being escalated.

Whilst we are required to have a single PCCC for SWL to mirror one CCG, the PCCC needs to ensure

the statutory functions are delivered. These include (terms of reference in full at the end of this document)

the following;

- GMS, PMS and APMS contracts; taking contractual action such as issuing breach/remedial notices,

and removing a contract;

- Ratification of newly designed Local Incentive Schemes (LISs) on the recommendation of the relevant

Borough Committee of the CCG.

- Ratification of newly designed local incentive schemes as an alternative to the Quality Outcomes

Framework (QOF) on the recommendation of the relevant Borough Committee of the CCG.

- Decision making on whether to establish new GP practices in an area on the recommendation of the

relevant Borough Committee of the CCG.

- Approving practice mergers on the recommendation of the relevant Borough Level Committee of the

CCG; and

- Making decisions on ‘discretionary’ payments where Standard Operating Procedures do not exist on

the recommendation of the relevant Borough Committee of the CCG.

It is important to note that the PCCC ‘in attendance’ membership will contain a representative of the

Croydon Committee.

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The terms of reference for the PCCC are very similar to the existing Croydon PCCC given the statutory

functions will be the same. We envisage the PCCC meeting every two months in public initially.

The terms of reference have been overseen by the SWL Governance Oversight Group and have been

reviewed by Governance to ensure compliance with the legal and statutory framework for CCGs.

3. The role of the Croydon Primary Care Management Group

Croydon will have its own formal Primary Care Management Group (PCMG – mirroring the existing

Operational Group) where the vast majority of business can be agreed, delivered and monitored. Typically

the PCMG will meet monthly and will be chaired by a Croydon senior manager with membership including

local GPs, the LMC and the SWL Primary care team colleagues, along with any additional members as

required or requested.

The PCMG will report into the Croydon Committee who in turn will ensure the PCCC receive the

appropriate papers.

Only decisions formally needing PCCC approval will be sent to the PCCC.

The Croydon Committee may ask for advice or guidance from SWL colleagues before making a local

decision. Such an advisory group would help us share our learning and make sure we are making the

right decisions for local people, including managing any conflicts of interest if these could not be resolved

locally.

4. Reporting arrangements of the PCMG

In order to ensure the smooth running of the PCCC, the Croydon Committee and the PCMG need to

establish clear reporting lines.

PCMG reports to; The Croydon Committee; establishing appropriate relationships with other

committees for example quality and finance where required. It should be noted the vast majority of primary

care contracting is considered ‘business as usual’ and would not need discussion at the PCMG.

Membership; Monthly meeting chaired by a Croydon senior manager with membership including local

GPs, the LMC and the SWL contracting team. Its function is to have an understanding of all matters

concerning local primary care, with a specific approvals and recommendations remit in line with Standard

Operating Protocols (see below).

Responsible for; Across London and the UK, Standard Operating Protocols have been agreed covering

a number of transactional elements. For example, a request to vary a contract (e.g. one Partner retiring)

or a small boundary change amendment request. These areas can be discussed and agreed at the PCMG

without further escalation providing any conflicts of interest are managed accordingly.

However, there will be a number of functions that cannot (as set out in the statutory framework and

reflected in terms of reference for the PCMG and PCCC) be resolved by the PCMG and require the PCCC

approval.

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For example, a contract termination. On these matters the PCMG will develop a paper for the Croydon

Committee and/or key officers to scrutinise before a paper along with recommendation is sent to the

PCCC to make a formal decision.

The Croydon Committee may not require papers for some functions however it is suggested members

receive the papers before being sent to the PCCC, and as such the Croydon Committee will act as a

gate-keeper for the PCCC. This will ensure that all local leaders are fully sighted on Croydon primary

care matters.

5. Worked example – new APMS contract

Where it has been identified a new APMS contract is required in Croydon area (for example, a closure of

a large practice requiring new capacity) the following process would be used;

The Primary Care Management Group would develop the procurement documents, and with the input

of local GPs, SWL contracting team (to use their expertise and experience) and recommend any relevant

targets for the new provider to attain.

The Croydon Committee would take a wider-system view in ensuring that the service provider will play

a strong role in the Croydon health and care system, and also that the PCMG has developed a strong

service model for the provider to deliver against. The Croydon Committee would then recommend

approval to the PCCC.

The Primary Care Commissioning Committee would formally authorise the establishment of a new

APMS provider and assure itself that the process followed in Croydon was compliant with good-practise

procurement and will deliver value for money.

Members of the Primary Care Management Group would then oversee the implementation of the contract,

working with the provider to ensure the service is delivered as procured.

6. Worked example - Practices merging

Where two or more practices wish to merge, members of the Primary Care Management Group would

meet with the practices to understand the proposal and to work with them to ensure due process is

followed, for example, to consult with patients and to ensure the proposal would maintain or enhance

existing service delivery.

The Primary Care Management Group (managing conflicts of interest accordingly) would scrutinise the

subsequent business case proposal (of which, South West London Primary Care contracting team have

produced template for completion) from the practices and assure itself that any service changes are

clearly articulated, for example, a change of location(s) or opening hours of bases. In addition the Group

would ensure that any risks are highlighted and mitigated.

The Primary Care Management Group would also monitor the process to ensure key changes, for

example, new IT configuration have a deliverable action plan.

The Croydon Committee will seek assurances from the PCMG that the proposal supports the wider

primary care strategy of the borough, for example, in the development of Primary Care Networks.

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The Croydon Committee, or key officer(s) will make a formal recommendation to the Primary Care

Commissioning Committee that due process has been followed and the proposal maintains or enhances

existing service delivery.

The Primary Care Commissioning Committee would formally authorise the merger assuring itself that

all the appropriate documentation has been completed satisfactorily via the PCMG and Croydon

Committee. Where members of the PCCC require further information, this will be provided in advance so

that a decision can be made at the next available opportunity. As applications to merge must be submitted

four months in advance, scheduling onto a PCCC agenda will be achieved without causing a delay to the

process.

Members of the Primary Care Management Group would then oversee the contract, as per all other

primary care contracts.

7. Quality matters

Matters concerning the quality of primary care are of interest across all levels of the CCG.

On a contractual level, the PCCC would need to approve any relevant contract action, for example

resulting from a CQC inspection of a general practice. As described, such breach notices would be sent

to the PCCC from the local PCMG and Borough Committee for ratification.

However, whilst helpful to explicitly state the contractual role of the PCCC, there are a number of other

areas in which the CCG would support the quality of primary care in the aim of avoiding contractual action

in the first instance.

Locally, CCGs have Primary Care Quality Groups (or equivalent) which have a key role in bringing

together a number of strands of quality in a supportive and facilitative forum. For example, to maintain a

Borough view on any rising tide events in order to enable general practices to be better prepared.

Additionally, through the relationships local teams have worked hard with practices to develop, to provide

1:1 support and guidance to practices.

From April 2020 the Croydon Committee may wish to be appraised of any general themes across general

practice in order to better understand how, for instance, a primary care strategy can be developed to

support the quality and resilience of primary care. The Committee may of course be able to direct more

resources should there be a pressing issue either the PCMG or Quality Group wish to highlight that cannot

be resolved through normal business operations of either group.

How the local PCMG and Quality Group relate to one another is down to local discretion, though typically,

the PCMG is more focused on individual contractual matters (e.g. CQC breach notices and subsequent

monitoring of the remedial action plan) with pro-activeness of general themes and deep-dive on specific

quality matters the domain of the Quality Group.

Furthermore the SWL Quality, Performance and Oversight Committee from April 2020 will be able to

advise (as requested) on any local matters along with supporting any pan-CCG workstreams.

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SECTION 2: Decision-making

The London Primary Care Operating Model (unless identified with an * in the table below) identifies a

number of decisions and decision-making requirements of the CCG in respect of executing delegated

responsibilities for primary care.

Within SWL there will be;

- One Primary Care Commissioning Committee

- Six place-based Local Committees

- Six place-based Primary Care Management Groups

In order to understand the relationship between each of the groups along with the decision-making

accountability it is necessary to consider a number of functions given the very broad area covered within

primary care.

The table below identifies, per key function, the respective role of each of the three groups/committees

along with the final decision-making point.

Function Role of PCMG Role of Local Committee

Role of SWL PCCC

Final approval by

Comments

Development of local primary care strategy*

Provide data and intelligence to the Local Committee to aid the development of the strategy To oversee specific delivery actions as requested

Oversee the development and delivery Direct PCMG or sub-groups accordingly

N/A Local Cmte

A SWL Advisory Group can be established to provide advice and guidance to Local Committees with regards to any issue raised locally

Transformation of local primary care services*

Provide data and intelligence to the Local Committee to aid the development of the strategy To oversee specific delivery actions as requested

To ensure all services affecting primary care (i.e. not just those delivered solely by primary care) fit with local primary care strategy and that local clinicians

N/A Local Cmte

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are involved in the development


Role of SWL PCCC

Final approval by

Comments

Control of delegated primary care budgets*

Work with local finance colleagues to ensure a full understanding of the budget including any general themes or emerging issues

To receive standard report as per other delegated budgets

N/A – to be advised of general themes or emerging issues

Local Cmte

Primary Care core contracts and value are set nationally for which the CCG receives the annual allocation

Control of non-core contract budgets, e.g. Local Incentive Scheme* NB these remain under local control

Oversee the delivery of key indicators and to ensure services benefit patients and represent value for money

To receive standard report, flagging any issues/options for local consideration

N/A unless approving a new service

PCMG

Quality within primary care*

To work with other local groups, e.g. quality sub-committees to support practices on any emerging or key issues and to address pro-actively To deliver any actions as requested by the Local Committee

Receive reports from PCMG and other sub-committees, and to direct actions accordingly The SWL Quality Performance and Oversight Group may be asked for support and guidance as requested locally

N/A – to be advised of general themes or emerging issues

Local Cmte

Duty in relation to the quality of primary care medical services is the formal responsibility of the PCCC and therefore, working with other sub-committees of the CCG Governing Body, the PCCC may wish to adopt a holistic approach

List closure (three to four across SWL per year)

Approval of closure following the London Standard Operating Procedure

Consider impact of list closure and work with PCMG to ensure due process is followed Can direct PCMG for any related actions, e.g. securing a new APMS contract

N/A – to be advised at next meeting

PCMG London Standard Operating Procedure exists documenting the process to follow and to note this may or may not be as a consequence of CQC enforcement

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(requiring PCCC ratification) Officers may be involved pending appeal

Senior Local Manager to be notified


Role of SWL PCCC

Final approval by

Comments

Practice merger/move (10 to 15 across SWL per year)

To work with the affected practice(s) and to consider the impact of the proposal

Unlikely to be discussed in full at the Local Committee however may wish to consider impact of practice merger/move and work with PCMG

To ratify the recommendation of the Local Committee

PCCC Senior Local Manager to be notified

Boundary changes (three to four)

Approval/rejection of boundary change following London SOP

N/A N/A – to be advised at next meeting

PCMG London SOP exists

New APMS contracts (one to two in SWL)

With other groups, such as finance, to work up local performance indicators and overarching procurement documentation

Receive from the PCMG overall summary of the requirements and approach to ensure fit with primary care strategy Make recommendation to the PCCC

Receive recommendation from Local Committee. Ensure good governance conducted (e.g. represents value for money)

PCCC APMS procurements are often delivered following a London process

PMS Reviews Develop, alongside local GPs, appropriate service specifications for discussion with the relevant LMC

Ensure proposed service areas fit with local strategy, e.g. sufficient focus on local priority areas

Receive recommendation from Local Committee. Ensure good governance conducted

PCCC PCMG will also oversee regular reviews of current indicators to ensure continued delivery and fitness for purpose

Remedial and breach notices

Follow due process in ensuring relevant paperwork is complete and undertake practice visit(s)

Unlikely to be discussed at the Local Committee however the Local Senior Manager should be made aware

Approval to issue breach notice

PCCC

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and to sign-off paper for PCCC

CQC Inadequate & Requires Improvement notices

Follow due process in ensuring relevant paperwork is complete and undertake practice visit(s)

Unlikely to be discussed at the Local Committee (unless in private session to consider a PCMG report) however the Local Senior Manager should be made aware and to sign-off paper for PCCC

Approval to issue relevant notice. Whilst a paper will be received from PCMG, the notices are from the CQC and not open for CCG interpretation

PCCC In the public domain once CQC publish their report – PCMG will oversee any remedial actions and liaise with the practice and CQC


Role of SWL PCCC

Final approval by

Comments

Contractual changes (contentious/major impact) (10 to 12)

Provide an options paper to the Local Committee

Unlikely to be discussed at the Local Committee (unless in private session to consider a PCMG report) however the Local Senior Manager should be made aware and to sign-off paper for PCCC

Receive recommendation from the Local Committee and/or key officer(s)

PCCC

Locum reimbursements

Approval/rejection of contractual changes following the London SOP or local precedence

N/A however Local Senior Manager may be involved pending appeal



GP performer payments sickness

Approval/rejection of payment(s) following the London SOP or local precedence




Infection prevention & control

Ensure practices follow infection prevention & control guidance including regular inspections



PCMG London process established PCMG may work with other sub-groups, e.g. quality

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SECTION 3: Terms of Reference for PCCC, PCMG (generic) and FAQ sent to

Member practices in Aug/Sep 2019. Enc

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Document management

Revision history

Version Date Summary of changes

0.1 Pre 05/09/19 Comments as per tracker

0.2 06/09/19 Amendments as per tracker

0.3 02/12/19 Amendments following legal review. Amendments as per tracker (06/09/19 –

02/12/19)

0.4 20/02/20 Comments as per tracker (02/12/19 – 20/02/20)

Reviewers

This document must be reviewed by the following people:

Reviewer name Title/responsibility Date Version

Governance Lay Members September 19 -20 0.1-0.4

SMT September 19 -20 0.1-0.4

Chairs September 19 -20 0.1-0.4

LMC September 19 -20 0.1-0.4

Approved by

This document must be approved by the following people:

Name Signature Title Date Version

SWL Governing Body

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1. Introduction

1.1. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006

(as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 of

the Delegation Agreement to these Terms of Reference to NHS South West London Clinical

Commissioning Group (hereby known as the CCG).

1.2. The CCG Primary Care Commissioning Committee (hereby known as the Committee) is

established as a Committee of the CCG Governing Body (hereby known as the Governing Body) in

accordance with Schedule 1A of the “NHS Act”.

1.3. The Committee will exercise the delegated powers as outlined in these Terms of Reference.

1.4. The ongoing relationship the Committee will have with NHS England will be revised on an ongoing

basis, though is currently outlined as in Schedule 2 of the Delegation Agreement.

1.5. The Committee, in common with all CCG Governing Body Committees is formally accountable for

furnishing the Finance and Audit Committees with the formal reports it requires to assure the

Governing Body that Primary Care Co-Commissioning is being effectively governed and managed.

1.6. The members acknowledge that the Committee is subject to any directions made by NHS England

or by the Secretary of State.

2. Statutory Framework for the CCG

2.1. NHS England has delegated to the CCG authority to exercise the primary care commissioning

functions set out in Schedule 2 of the Delegation Agreement in accordance with section 13Z of the

NHS Act.

2.2. Arrangements made under section 13Z may be on such Terms and Conditions (including terms as

to payment) as may be agreed between NHS England and the CCG.

2.3. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of

any of its functions. However, the CCG acknowledges that in exercising its functions (including

those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act

and including:

2.3.1. Management of conflicts of interest (section 14O);

2.3.2. Duty to promote the NHS Constitution (section 14P);

2.3.3. Duty to exercise its functions effectively, efficiently and economically (section 14Q);

2.3.4. Duty as to improvement in quality of services (section 14R);

2.3.5. Duty in relation to quality of primary medical services (section 14S);

2.3.6. Duties as to reducing inequalities (section 14T);

2.3.7. Duty to promote the involvement of each patient (section 14U);

2.3.8. Duty as to patient choice (section 14V);

2.3.9. Duty as to promoting integration (section 14Z1);

2.3.10. Public involvement and consultation (section 14Z2).

2.4. The CCG will also need to specifically, in respect of the delegated functions from NHS England,

exercise those set out below:

2.4.1. Duty to have regard to impact on services in certain areas (section 13O);

2.4.2. Duty as respects variation in provision of health services (section 13P).

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3. Role of the Committee

3.1. The overall scope of the Committee consists of those primary care co-commissioning functions

formally delegated by NHS England to the CCG as a new CCG function from 1st April 2016.

3.2. In performing its role the Committee will exercise its management of the functions in accordance

with the agreement entered into between NHS England and the CCG, which will sit alongside the

delegation and Terms of Reference.

3.3. The functions of the Committee are undertaken in the context of a desire to promote increased co-

commissioning to increase quality, efficiency, productivity and value for money and to remove

administrative barriers.

3.4. The role of the Committee shall be to carry out the functions relating to the commissioning of

primary medical services under section 83 of the NHS Act.

3.5. This includes the following:

3.5.1. GMS, PMS and APMS contracts; taking contractual action such as issuing breach/remedial

notices, and removing a contract;

3.5.2. Ratification of newly designed Local Incentive Schemes (LISs) on the recommendation of

the relevant Borough Committee of the CCG;

3.5.3. Ratification of newly designed local incentive schemes as an alternative to the Quality

Outcomes Framework (QOF) on the recommendation of the relevant Borough Committee of

the CCG;

3.5.4. Decision making on whether to establish new GP practices in an area on the

recommendation of the relevant Borough Committee of the CCG;

3.5.5. Approving practice mergers on the recommendation of the relevant Borough Level

Committee of the CCG;

3.5.6. Making decisions on ‘discretionary’ payments where Standard Operating Procedures do not

exist on the recommendation of the relevant Borough Committee of the CCG; and

3.5.7. The Committee will receive quarterly reports form the Borough Committee on the decisions

that it has made in relation to the CCG’s delegation agreement.

4. Exclusions

4.1. Control of primary care (core contracts and discretionary such as LISs) budgets is delegated from

the CCG to individual Borough Committees and as such is not within the remit of the Committee.

As such, Borough Committees can develop local incentive schemes as per local strategy.

4.2. Design, development and delivery of Borough-level primary care strategies is not within the remit of

the Committee, with all such matters the responsibility of individual Borough Committees.

5. Geographical Coverage

5.1. The Committee will comprise of decisions relating to primary care within South West London, as

define in the Constitution.

6. Membership

6.1. The Committee shall consist of:

6.1.1. Members

6.1.1.1. Chair – Lay Member

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6.1.1.2. Lay or Independent Member (Vice Chair) 6.1.1.3. GP Lead for Primary Care 6.1.1.4. 2x CCG Executive Directors 6.1.1.5. Independent (non-SWL) GP

6.1.2. Attendees:

6.1.3. HealthWatch representative 6.1.4. Londonwide LMC representative or Merton, Sutton, Wandsworth representative 6.1.5. Surrey & Sussex LMC representative 6.1.6. Place based representative (Croydon) 6.1.7. Place based representative (Kingston) 6.1.8. Place based representative (Merton) 6.1.9. Place based representative (Richmond) 6.1.10. Place based representative (Sutton) 6.1.11. Place based representative (Wandsworth)* 6.1.12. SWL Director Primary Care 6.1.13. Primary Care representatives from Borough level as appropriate

*The Place Based representative will either be the GP Borough Lead or the Locality Director

6.2. The Chair of the Committee shall be a CCG Governing Body Lay Member, who should not be the

Chair of the Audit Committee.

6.3. The Vice Chair of the Committee shall be a CCG Governing Body Lay or Independent Member.

6.4. The Committee may appoint ad-hoc members to advise it on specific matters within its terms of

reference from time to time as appropriate.

6.5. There will be an annual review of the Committee’s membership to support its efficient functioning.

7. Conflicts of Interest

7.1. Conflicts of Interests will be managed in accordance with the Constitution that outlines the current

policy; ‘Standards of Business Conduct and Managing Conflicts of Interest Policy’.

7.2. Where a Committee member has, or may have, a conflict of interest, arrangements will be put into

place to manage that Conflict of Interest in accordance with the Constitution and the Conflicts of

Interest Policy.

8. Meetings and Voting

8.1. The Committee will operate in accordance with the CCG’s Constitution, Standing Orders and the

Delegation and Delegation Agreement, which take precedence in the event that there is any

inconsistency. The Secretary to the Committee will be responsible for giving notice of meetings.

This will be accompanied by an agenda and supporting papers and sent to each member

representative no later than five working days before the date of the meeting. When the Chair of

the Committee deems it necessary in light of the urgent circumstances to call a meeting at short

notice, the notice period shall be such as s/he shall specify.

8.2. The Committee will make decisions within the bounds of its remit.

8.3. The decisions of the Committee shall be binding on NHS England and the CCG.

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8.4. Each member of the Committee shall have one vote. The Committee shall reach decisions by a

simple majority of members present, but with the Chair having a second and deciding vote, if

necessary. However, the aim of the Committee will be to achieve consensus decision-making

wherever possible.

8.5. Members of the Committee have a collective responsibility for the operation of the Committee.

They will participate in discussion, review evidence and provide objective expert input to the best of

their knowledge and ability, and endeavour to reach a collective view.

8.6. Meetings of the Committee:

8.6.1. may resolve to exclude the public and non-voting attendees from a meeting that is open to

the public (whether during the whole or part of the proceedings) whenever publicity would be

prejudicial to the public interest by reason of the confidential nature of the business to be

transacted or for other special reasons stated in the resolution and arising from the nature of

that business or of the proceedings or for any other reason permitted by the Public Bodies

(Admission to Meetings) Act 1960 as amended or succeeded from time to time.

9. Quorum

9.1. The Committee will be Quorate with three of the five voting members in attendance, with at least

one Lay or independent Member present. A majority of Lay, Independent and Executive Members

must be maintained. Where a member(s) have a Conflict of Interest they may be excluded from the

agenda item decision. The Chair may ask them to be part of the discussion before the decision is

made.

10. Confidentiality

10.1. Members of the Committee shall respect confidentiality requirements as set out in the CCG

Constitution or Standing Orders.

11. Frequency of meetings

11.1. In the first year, the committee will meet a minimum of 6 times. After the first year, the

committee will meet a minimum of 4 times. The committee will always be in public and will rotate

across all boroughs.

11.2. The Chair can request additional meetings where required.

11.3. Where the Chair determines there is insufficient business to be conducted at the Committee,

a meeting may be cancelled providing five working days notice is given.

12. Urgent Decision Making

12.1. The Committee has a delegated responsibility from NHS England to make a range of

decisions relating to the commissioning of primary care medical services.

12.2. In the vast majority of cases these decisions can be made by the Committee as part of

business as usual. However, there may be occasion, when an urgent situation arises that requires

a decision or actions to be agreed either immediately or before the next Committee takes

place.

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12.3. Urgent Decision Making (UDM) meetings, in person or via teleconference, can be called by

the Chair (or vice-chair in their absence) or designated deputy. Wherever possible, members will

be given five working days notice.

12.4. A minimum of two voting members of the Committee must be present in person or on the

teleconference, both of whom must be either a CCG Governing Body Lay Member or an Executive

Member for it to be quorate.

12.5. A meeting will be convened by the Committee Chair (or Committee Vice-Chair in their

absence) and an Executive Director or designated deputy. Consultation will be made with the

Committee Vice-Chair and all other available members of the Committee unless in exceptional

circumstances where a time delay cannot be permitted. If other Committee members are not

consulted they will be informed at the earliest possible time.

12.6. All decisions will be reported at the next available Committee meeting.

13. Other Matters

13.1. The Committee may delegate tasks to such individuals, sub-committees or individual

members as it shall see fit, provided that any such delegations are consistent with the parties’

relevant governance arrangements, are recorded in a Scheme of Delegation, are governed by

Terms of Reference as appropriate and reflect appropriate arrangements for the management of

conflicts of interest.

13.2. The Committee may call additional experts to attend meetings on an ad hoc basis to inform

discussions.

13.3. The Committee shall:

13.3.1. Have access to sufficient resources to carry out its duties;

13.3.2. Be provided with appropriate and timely training, both in the form of an induction programme for new

members and an ongoing basis for all members;

13.3.3. Give due consideration to laws and regulations impacting on the work of the Committee;

13.3.4. At least once a year, review its own performance and terms of reference to ensure it is operating at

maximum effectiveness and recommend any changes it considers necessary to the Governing Body.

14. Reporting

14.1. The Committee will present its agreed minutes and an executive summary report to the

Governing Body, following each meeting, for information, including the minutes of any sub-

committees to which responsibilities are delegated.

14.2. There is a statutory requirement that the Committee publishes a register of its decisions,

outlining the management of any Conflicts of Interest.

14.3. The CCG will also comply with any reporting requirements set out in its Constitution.

15. Review of Terms of Reference

15.1. It is envisaged that these Terms of Reference will be reviewed annually, reflecting

experience of the Committee in fulfilling its functions. NHS England may also issue revised model

terms of reference from time to time.

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Document management

Revision history Version Date Summary of changes

0.1 Pre 05/09/19 Comments as per tracker

0.2 05/09/19 Amendments as per tracker

0.3 25/09/19 From LMC meeting on 18/09/19 - added 2.2.5 / 8.5 / 10.2

0.4 30/09/19 From LMC meeting on 26/09/19 – amended 5.2 to ‘bi-monthly’

0.5 02/12/19 Amendments made following legal review. Amendments as per tracker (36/09/19 – 02/12/19)

0.6 20/02/20 Amendments as per tracker (02/12/19 – 20/02/20)

Reviewers This document must be reviewed by the following people:

Reviewer name Title/responsibility Date Version

Governance Lay Members September 19 – February 20

0.2-0.6

SMT September 19 – February 20

0.2-0.6

Chairs September 19 – February 20

0.2-0.6

LMC September 19 – February 20

0.2-0.6

Approved by

This document must be approved by the following people:

Name Signature Title Date Version

PCCC

Borough Committee

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1. Introduction

1.1. The Primary Care Management Group (PCMG) is established as a sub-committee of the Croydon

Borough Level Committee of the South West London Clinical Commissioning Group.

1.2. PCMG’s role is to ensure the transactional aspects of primary care commissioning are undertaken

efficiently, clearly and in line with national regulation and local strategy.

1.3. The PCMG will establish a direct reporting arrangement with the Croydon Borough Level

Committee; acknowledging it has specific authority where there are London Standard Operating

Procedures ((SOPs) as outlined in sections 22 and 23 of the terms of reference),

1.4. Matters where the South West London Primary Care Commissioning Committee (PCCC) have

formal decision-making responsibilities, as outlined by the NHS England Delegation Agreement,

the PCMG will firstly make recommendations to the Croydon Borough Level Committee of the SWL

CCG who will provide the PCCC with a recommendation for ratification.

2. Authority

2.1. The PCMG is authorised by the Croydon Borough Level Committee of the SWL CCG to:

2.1.1. Apply the national Primary Care contracting regulations in the context of local strategy and

agreed London Standard Operating Procedures (SOPs);

2.1.2. Make recommendations to the Borough Level Committee and/or Local Senior Manager on

other matters;

2.1.3. Seek advice on aspects of its work requiring specialist knowledge (e.g. legal, estates) as

agreed with the Local Senior Manager.

3. Objectives

3.1. The priorities for the Primary Care Management Group will include, but are not limited to:

3.2. Assurance:

3.2.1. Implementing the strategy and work programmes of the Croydon Borough Level Committee

of the SWL CCG;

3.2.2. Lead on the management of the day to day responsibilities of delegated commissioning;

3.2.3. Providing the relevant data and information on issues to be discussed at relevant Quality

Committees, either at Croydon or SWL.

3.2.4. Support NHS England to manage the Reserved Functions as appropriate or as directed by

NHS England.

3.2.5. Support the ongoing quality improvement of primary care through pro-active support and

guidance (noting this excludes performance management), and working with other local groups

and Committees as established in relation to primary care quality.

3.3. Risk:

3.3.1. Manage risk within the framework of the authorities and duties of the PCMG as established in

sections 22 and 23 of the terms of reference;

3.3.2. Oversight of risk register with regards to sections 22 and 23 of the terms of reference.

3.4. Contracting:

3.4.1. Apply the national Primary Care contracting regulations in the context of local strategy and

agreed SOPs.

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3.4.2. Support the contract development and management processes associated with GMS, PMS

and APMS Practices.

3.4.3. Following approval via the relevant Committee; Implement and oversee any alternative

contracts for Quality Outcomes Framework (QOF), (as agreed by the SWL Primary Care Direct

Enhanced Services (DES) and Local Incentive Schemes (LIS).

3.4.4. NB control of primary care (core and discretionary such as LISs) budgets is delegated from

the SWL CCG to the CROYDON.

3.5. Engagement:

3.5.1. Liaising with GP practice and other primary care providers in conjunction with NHS England

representation on commissioning issues arising for practices.

4. Membership

4.1. The membership shall consist of:

4.1.1. Chair – Senior Local Manager;

4.1.2. Deputy Director of Primary Care (Vice Chair);

4.1.3. Head of Primary Care;

4.1.4. SWL Primary Care Contracting Team representatives

4.1.5. LMC Representative;

4.1.6. Locally elected clinical representatives FINAL NUMBER/ROLES TO BE INSERTED;

4.1.7. Senior Finance Manager.

4.2. The group may invite other individuals or organisations as required, for example the Local

Pharmaceutical Committee. Practice representatives may also be invited to attend for items that

concern them.

4.3. For some items, the input from the Performers’ List team at NHS England will be important. For this

reason, we will ensure that this team has early sight of the agenda for PCMG meetings and that

“Relevant Input from Performers’ List Team” is a standing item on all agendas.

5. Quorum

5.1. A quorum shall be the following three members; Chair or Vice Chair, at least one primary care team

member and a finance member.

6. Frequency of Meetings

6.1. Meetings shall be held monthly, however this is at the discretion of the Chair in relation to matters

requiring discussion.

6.2. As an absolute minimum, meetings will be held bi-monthly.

7. Urgent actions

7.1. In the vast majority of cases these actions can be made by the PCMG as part of business as usual.

However, there may be occasion, when an urgent situation arises that requires an action to be

agreed either immediately or before the next meeting takes place.

7.2. Urgent action meetings, in person or via teleconference, can be called by the chair (or vice-chair in

their absence). Wherever possible members will be given five working days notice.

7.3. A minimum of three members of the PCMG must be present for it to be quorate as per paragraph

4.

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7.4. An urgent action meeting will be convened by the Chair (or Vice-Chair in their absence).

Consultation will be made with the Vice-Chair and all other available members of the PCMG unless

in exceptional circumstances where a time delay cannot be permitted. If other PCMG members are

not consulted they will be informed at the earliest possible time. Where an urgent-action is taken,

this will be officially recorded as such immediately.

7.5. All actions will be reported at the next available PCMG meeting.

7.6. When national timescales demand it and in exceptional/operationally urgent situations a “virtual

meeting” may take place, using email or phone conferencing (this shall not be a reason for

inadequate planning.) Alternatively, after taking advice, Chair’s action may be taken and

immediately recorded as an urgent action being taken. Chair’s action will be ratified at the next full

meeting of the group. For example, this may occur when a statutory response time of 28 days

applies, as is the case in some procedures.

8. Duties

8.1. To apply the SOPs in regards to:

8.1.1. List closure;

8.1.2. List suspension;

8.1.3. Boundary changes;

8.1.4. Discretionary payments;

8.1.5. Contractual changes (transactional);

8.1.6. Locum reimbursements;

8.1.7. GP performer payments sickness;

8.1.8. Infection Prevention & Control.

8.2. To make recommendations in line with SOPs to PCCC via the Croydon Borough Level Committee):

8.2.1. Practice merger/move;

8.2.2. New APMS contracts;

8.2.3. PMS Reviews;

8.2.4. Remedial and breach notices;

8.2.5. CQC Inadequate & Requires Improvement ratings ;

8.2.6. Contract termination;

8.2.7. Contractual changes (contentious or major).

8.3. To correspond with practices on the above issues, to ensure actions are made with the fullest

possible information and to communicate back to practices clearly and promptly.

8.4. To improve quality, safety and patient experience of primary care services, as part of the CCGs

overall responsibilities for improving quality across all commissioned services. Relationships with

Quality Committee(s) will be established accordingly.

8.5. To give due consideration to the well-being and development needs of all staff providing and

delivering primary care services.

9. Reporting and Accountability

9.1. The PCMG will report to the Croydon Borough Level Committee of the SWL CCG. Regular reports

should be provided to the SWL Primary Care Commissioning Committee on any actions taken at the

PCMG.

10. Relationships

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10.1. The PCMG will have a working relationship with other local groups as established.

10.2. The PCMG will establish clear reporting lines with the SWL Quality, Performance and

Oversight Committee and the SWL Quality Surveillance Group.

10.3. The PCMG will establish a clear remit from the Croydon Borough Level Committee of the SWL

CCG with regards to its responsibilities around primary care strategy, including but not limited to, the

development of Primary Care Networks.

11. Reporting

11.1. A formal record of meetings will be kept and an action log maintained. Draft notes will be

made available within a week of the meeting. Notes will be subject to the Freedom of Information

Act. Certain parts of the notes may be redacted, if deemed confidential/not in the public interest.

12. Appeals

12.1. If a practice considers that the PCMG has not followed due procedure in its application of the

SOPs, it may appeal to the Local Senior Manager who in turn may refer the matter to the SWL

PCCC.

13. Conflicts of interest

13.1. Conflicts of Interests will be managed in accordance with the CCG Constitution that outlines

the current policy; ‘Standards of Business Conduct and Managing Conflicts of Interest Policy’.

13.2. Where a PCMG member has, or may have, a conflict of interest, arrangements will be put

into place to manage that conflict of interest in accordance with the Constitution and the Conflicts of

Interest Policy of the SWL CCG.

14. Review of Terms of Reference

14.1. It is envisaged that these Terms of Reference will be reviewed annually.

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FAQ sent to Member practices – August/September 2019

Who will the voting members be on the SWL PCCC, and how different is it to now?

In keeping with NHS England requirements, the PCCC will be chaired by a lay member along with key CCG officers. Local GPs will be non-voting members so they can provide advice and guidance to the voting members. The voting members are very similar to the existing PCCCs. This is because the requirements from NHS England on this are very clear.

Why can’t local GPs be a voting member of the PCCC?

Again, the requirements from NHS England are clear on this, and since PCCCs started over three years ago, none have had local GPs as voting members. The PCCC exists to ensure that any possible conflicts of interest, for example in the development of a new service with funding going to local GPs, are managed appropriately.

The PCCC has a vital governance role in ensuring that matters around individual contracts or new services have been developed fairly and there is no risk of a legal challenge. In fulfilling this role the PCCC acts as an important safety net to protect the integrity of the CCG and its Member practices.

What will be the relationship between the SWL PCCC and the Local Committee and PCMG?

The local PCMG and Local Committee will be responsible for developing any proposals that require the approval of the PCCC. Typically this is where the proposal recommends payment to GP practices or a decision has a large impact on one individual contract. The PCCC will receive all its information, along with a recommendation from the Local Committee on what to approve and why. The PCCC then acts as the final check to ensure the proposal represents good value for money and has been developed fairly.

Will the SWL PCCC reject local recommendations?

This is not the intention of the SWL PCCC. In the unlikely event the SWL PCCC had reason to question how a service or a proposal was developed, before approving it, the PCCC would wish to work with the Local Committee and PCMG to answer any questions.

Will the SWL PCCC be responsible for the primary care strategy across each Borough?

No, this sits firmly with the Local Committee and our commitment to enhance primary care support locally.

Won’t the SWL PCCC just do all the work of the six existing PCCCs?

Many changes affecting GP practices do not need the approval of the PCCC. For example, discretionary payments, GP rent review process, boundary changes, infection control and contract changes (for example, addition of a new Partner) can all be approved locally. Where items that significantly affect a contract require approval, for example a PMS Review, contract termination or merger along with the award of a new contract, only these matters need the approval of the PCCC. As stated, before they reach the SWL PCCC each will have been discussed locally with a recommendation made to the SWL PCCC.

Won’t have a meeting every two months slow our progress locally if we want to deliver a service?

Firstly, we would expect that the SWL PCCC will ‘forward plan’ so would know in advance of any new proposals requiring its approval, so that it could be timetabled accordingly. However if something required an urgent approval, then there are a number of options available. For example, the Chair could take a ‘Chair’s action’ in consultation with other voting-members to approve with the decision communicated at the next meeting in public. Of course, we could decide to meet more frequently and as such we will keep this under review.

Will the SWL PCCC manage primary care budgets?

No, this is delegated to the Local Committee to manage accordingly. This includes both core contracts as well as locally designed incentive schemes.

How will we ensure sufficient local debate and input into primary care?

By having more local GP input at the PCMG including the LMC we are confident this will ensure a healthy and robust debate. Equally, by having a clinical majority on the Local Committee, and by having the budgets delegated locally, there are a number of ways in which to input into primary care.

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE

3 MARCH 2020

Title of Paper: 2019/20 PRIMARY CARE FINANCE REPORT: PERIOD 10 (January 2020)

Lead Director Mike Sexton Chief Finance Officer

Report Author Edward Odoi Chief Management Accountant

Committees which have previously discussed/agreed earlier version of this report.

N/A

Committees that will be required to receive the report

N/A

Purpose of Report For discussion and noting

Recommendation:

The Primary Care Commissioning Committee is asked:

▪ To note that 2019-20 month 10 (January 2020) reported position of £0.4m underspend year to date and £0.5m forecast underspend. The two component elements of the budget are summarised below:

▪ Primary Care Services (£54.6m annual budget including Prescribing): £0.4m overspend year to date and £1.1m forecast overspend.

▪ Primary Care Delegated Commissioning (53.9m annual budget): £0.9m underspend year to date and £0.7m forecast underspend.

Background:

Following the publication of the Primary Care Medical allocations as part of the place-based funding for all CCGs, CCGs taking full delegation received the funding direct as a separate Medical Services recurrent allocation. The allocation is provided solely for commissioning Primary Care Medical services on behalf of NHS England under delegation therefore cannot be used for other CCG expenditure or vired to another budget area.

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Key Issues:

This finance report reflects 2019-20 Primary Care related expenditure. Cost pressures and benefits identified have been included in the reported position.

Governance:

Corporate Objective To achieve financial surplus of £3.5m in 2019/20

Risks See Risk Section. 50:50 risk share in operation between Trust and CCG on breach of control total

Financial Implications Management of risk within the agreed control and delivery of £27.5m CIP / QIPP Programme

Conflicts of Interest No specific conflicts of interest.

Clinical Leadership Comments Clinical Leadership Group and the Cost & Quality Oversight Board (CQOB) is supporting the delivery of the CIP / QIPP and transformation programme.

Implications for Other CCGs Croydon CCG works closely with the other SWL

CCGs as part of the SWL Health and Care

Partnership.

Equality Analysis All CIP / QIPP and expenditure programmes are

required to have an EIA, compliance monitored

by the PMO.

Patient and Public Involvement All service redesign, QIPP projects and

expenditure reductions must meet the requisite

PPI requirements.

Communication Plan The 2019/20 Financial Plan have been shared in the public domain and with stakeholders.


Restrictions on access to patient level activity data limiting the ability of CCG to review provider performance and to monitor some QIPP schemes.

Reputational Issues Delivery of financial plan.

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Primary Care Services - 2019/20 M10 (January 2020) 1. Overview: Croydon CCG is reporting a year to date position of £0.4m overspend and a forecast position of £1.1m overspend for Primary Care Services, and a year to date position of £0.9m underspend and a forecast position of £0.7m underspend for Primary Care Delegated Commissioning at month 10 (January 2020). The key risks are (i) the system’s ability to rapidly invest in PCN workforce and primary care at scale development, and (ii) financial pressures on GP IT support services. 2. 2019/20 Budgets: The combined total Primary Care annual budget of £108.5m includes £53.9m for Primary Care Delegated Commissioning, £43.9m for Prescribing, £6.6m for Community Based Services, £2.7m for GPFV and £1.3m for Primary Care IT. The budgets were set based on commitments and to meet all known costs in line with current contractual obligations. The budgets include an allowance for demographic growth. 3. Capitation Report

CCG

Normalised weighted list

as at 01/04/2018


as at 01/04/2019

Year on Year % Movement


as at 01/01/2020

YTD Movement 01/01/2020

% YTD Movement

Full Year budgeted Growth %

Croydon 377,819 382,058 1.1% 386,447 4,388 1.1% 1.1%

Croydon’s normalised weighted population increased by 1.1% (4,239) year on year from April 2018 to April 2019 and a further increase of 1.1% (4,388) from April 2019 to January 2020.

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4. Primary Care Expenditure: The 2019/20 M10 (January 2020) financial position all NHS Croydon CCG Primary Care Services is set out in tables below.

Primary Care Services - 2019/20 M10 (January 2020)

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Primary Care Commissioning - 2019/20 M10 (January 2020)

COST CENTRE NAME Budget Total

Commitment

Var 2019/20

Annual

Budget

Forecast

Outturn

Var

£000s £000s £000s £000s £000s £000s

Medicines Management Team 1,363 1,257 (107) 1,636 1,530 (105)

Prescribing:

GP Practice & Specialist Clinics(Inc. IPP-PMd Adj.) 32,297 33,375 1,078 38,468 39,956 1,488

East Surrey Reserve - - - - 172 172

PADM (Cost of Drugs) 1,008 1,000 (8) 1,210 1,219 9

Prescribing Cost Recharge (153) (221) (68) (184) (221) (37)

Community Education Provider Network(CEPNs) (9) - 9 (10) - 10

Medicines Optimisation - Community 87 - (87) 104 - (104)

Minor Ailments 192 123 (69) 230 123 (108)

Lipid Modification Proj 27 (34) (61) 32 32 -

Drugs Met Centrally 1,078 1,086 8 1,294 1,328 34

New Oxygen Service 339 309 (30) 407 385 (22)

Atrial Fibrillation Patient Optimisation 124 124 0 297 297 -

Scripswitch/Eclipse/Presqipp 97 161 64 116 161 44

Prescribing Incentives Scheme 277 277 - 333 333 -

Sub Total 35,364 36,199 836 42,296 43,783 1,487

Sub-total: Prescribing 36,727 37,456 729 43,932 45,314 1,382

Local Incentives Schemes:

Urology 33 23 (10) 40 32 (8)

Phlebotomy 208 170 (38) 249 212 (38)

Phlebotomy - CHS 148 157 10 177 189 12

Coeliacs 6 4 (3) 8 5 (3)

Barretts 12 14 2 14 17 3

Spirometry 115 70 (45) 138 88 (50)

Care Homes 290 146 (143) 347 204 (143)

Cardiology 98 91 (7) 118 110 (7)

MGUS CLL - - - - - -

Latent TB 32 32 (0) 38 38 -

Mental Health LES - - - - - -

Pre-Op Hernia 5 (3) (8) 6 (2) (8)

Diabetes 137 172 35 164 199 35

Basket 472 444 (28) 567 539 (28)

Elective Care Del. & Trans Prog (PDDS) 387 387 (0) 465 465 -

Proactive Care Management (PDDS) 1,705 1,705 (0) 2,046 2,046 -

PDDS & GP E-Referral excluding Prescribing Incentive Scheme 40 (411) (451) 48 (411) (459)

Primary Care - £1.5 per head 520 540 21 623 644 20

Sub Total 4,207 3,541 (666) 5,049 4,374 (675)

Primary Care Other:

Variation Team: Pay 207 204 (3) 249 245 (3)

Variation Team: NonPay 4 1 (3) 5 4 (0)

Rainbow PCTMS 32 84 52 38 95 57

Collaborative/Assessment Fees Claims 202 179 (23) 242 229 (13)

Out Of Hours - CUCA 808 808 (0) 969 969 (0)

Primary Care Other 1,252 1,276 23 1,503 1,542 40

Sub-total: Community Based Services 5,460 4,817 (643) 6,552 5,916 (635)

GPFV

Primary Care Network development and support funding 140 140 - 279 279 -

International Recruitment 46 46 - 81 81 -

Improving Access to General Practice 894 894 - 1,073 1,073 -

Primary Care at Scale (PCAS) 1,078 1,078 - 1,294 1,294 -

Sub Total 2,158 2,158 - 2,727 2,727 -

GP IT 1,103 1,427 324 1,344 1,730 386

Grand Total 45,447 45,857 410 54,555 55,687 1,132

PERIODS TO DATE FULL YEAR

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Primary Care Delegated Commissioning - 2019/20 M10 (January 2020)

COST CENTRE NAME Budget Total

Commitment

Var 2019/20

Annual

Budget

Forecast

Outturn

Var

£000s £000s £000s £000s £000s £000s

Primary Care Medical Services (PMS,GMS,APMS)

Essential and Additional Services 33,131 33,109 (22) 39,757 39,764 7

Enhanced Services 650 714 64 780 772 (8)

Quality and Outcomes Framework (QOF) 3,584 3,559 (25) 4,301 4,301 -

Premises Payment 3,783 3,812 29 4,540 4,604 64

Seniority 202 195 (7) 242 241 (1)

Other Administered Funds (Maternity etc) 543 507 (36) 651 631 (20)

Personally Administered Drugs 193 213 21 231 231 -

Other Medical Services 24 23 (1) 29 29 -

Primary Care Networks 1,651 1,197 (454) 1,981 1,532 (449)

Primary Care Transformation - OOH/PDDS 667 800 133 800 800 -

Additional Investment(Including care homes) 265 (41) (307) 392 71 (321)

Ear Syringing LCS 54 27 (27) 65 65 -

Nurse Lead, Named GPs & Others 142 160 18 170 180 9

District Valuer Charges 17 10 (7) 20 20 -

GP at Hand patient transfers (28) - 28 (33) - 33

East Surrey Reserve - - - - 278 278

Prior Year Accruals - (263) (263) - (263) (263)

Total Primary Care Delegated Commissioning 44,877 44,021 (856) 53,927 53,256 (671)

PERIODS TO DATE FULL YEAR

5. Financial Performance Summary At the end of month 10, for delegated Primary Care, there is year to date £0.9m underspend and a forecast underspend of £0.7m.Unutilised accruals from previous years has created a non-recurrent £263k benefit in the current year and is carried forward as part of the forecast as at Month 10. Locum costs are currently better than budget, and a re-assessment of likely costs in the remainder of the year has been made resulting in a forecast underspend £20k The “old” Extended Hours DES has been replaced by a PCN Extended Hours scheme, but the Quarter 1 payments made were £8k less than budget due to non-delivery of the full service by some practices, this has been included as a saving in the forecast. Minor Surgery and LD Health Checks DESs are currently over-spending but are forecast to fall back in line with budget. A significant % rent increase at Parkway Health Centre charged by NHSPS has contributed to a forecast overspend of £25k to be included for this rent increase, in additions a significant rent review adjustment was required for the Selsdon Park adjustment, which created a further £39k forecast overspend in premises (£64k in total). The CCG allocation for the delegated budget was reduced by £33k in month, for the impact of the GP at Hand practice adjustment.

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING HELD IN PUBLIC

3 March 2020

Title of Paper: UPDATE ON LOCALLY COMMISSIONED SERVICE ARRANGEMENTS FOR

2020/21

Lead Director Josh Potter Joint Director of Strategy and Transformation

Report Author Mark Creelman Project Director


Updates have been shared with SMT and Primary Care Working Group; Primary Care Committee will have previously reviewed an update in December 2019 on the overall LCS programme as well as specific papers / proposals on key schemes. Primary Care Working Group 26 February 2020 Procurement Advisory Group 25 February


Health Management Board (27 February 2020) Primary Care Commissioning Committee

Purpose of Report For Approval

Recommendation: The Primary Care Commissioning Committee is asked to:

▪ APPROVE the continuation of LCS schemes outlined herein for 2020/21 including: o APPROVE the approach for the Care Home and Proactive Management LCS’ for

2020/21 based upon the impact of the associated DES schemes o APPROVE the budget identified for the LCS programme o NOTE the changes to the previously agreed plans for spirometry – separate paper

for approval supplied

▪ APPROVE the additions to the service specification templates

▪ NOTE and comment on the risks identified

Background:

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During 2019/20 a review of all LCS arrangements was undertaken to:

1. Ensure that all services commissioned from General Practice outside the core contract meets the requirements of the procurement advisory group and are approved by the appropriate committees.

2. Ensure that all patients registered with a Croydon GP are able to access enhanced services provided through the primary care network model.

3. Ensure that all services delivered through an enhanced service are relevant to local population needs and are equitable, with clear and measurable outcomes.

4. Develop a contracting framework for General Practice LCS that is aligned to the network delivery model and reduces the administrative burden for commissioners and General Practice.

This work has been overseen by the Primary Care Quality, Planning and Finance Group which reports

to the Primary Care Working Group. Key outputs from this review has been the confirmation of the

commissioning principles for enhanced primary care services alongside CCG statutory requirements,

alignment with guidance in the long-term plan and our commissioning strategy and assess current

schemes against these principles to determine plans for 2020/21 and beyond.

Key Issues:

This paper aims to outline and summarise:

• The output of the LCS review undertaken in 2018/19 and 2019/20. This included consideration of the implementation of network based working to support ensuring population coverage for all schemes. Discussions have taken place with PCN leads for key schemes – notably spirometry and long term conditions. However, based upon feedback from practices it has been agreed to:

o Delay implementation of the new spirometry service specification until December 2020 to support practices and networks to ensure staff are appropriately accredited to deliver the service and develop network working where possible / required. This timeline also meets the national deadline for implementation.

o For all other schemes, the option for network based or cross practice arrangements to be implemented to ensure all patients have access to services has been included within the service specification. This includes new ways of working e.g. development and delivery of group consultations as part of the long term conditions LCS.

• Outline of LCS for implementation and continuation in 2020/21 and budgets including:

o New schemes previously agreed through PCCC / SMT e.g. long term conditions preventative and proactive LCS and insulin injectables and spirometry LCS’

o The impact of the release of the confirmed DES service specifications on local plans for the proactive management LCS’.

o Proposal for the continuation of the current care home LCS for April to September 2020, and development with stakeholders of a new model of care for implementation from October 2020. This approach aims to support the continuation of meeting local need, supporting the implementation of the DES care home service requirements from October 2020.

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• Update on the progress towards implementing automation of reporting for LCS’ through EMIS Enterprise.

Governance:

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Corporate Objective Ensure all services commissioned from primary care meet the requirements of the new contract.

Ensure that we commission services in primary care in line with our responsibilities under delegated commissioning authority, and with due diligence.

Risks

Key risks are outlined in section 4


Potential increase in activity have been reviewed by SMT based on the assumption of all practices signing up to key schemes – this has informed budget setting for 2020/21 (costs of schemes is outlined in appendix 1)


Conflicts of Interest have been managed where appropriate as per the Conflicts of Interest policy.


None – however, with the creation of SWL CCG, review and harmonisation of schemes will be required.

Equality Analysis

Plan to ensure all patients can access all commissioned enhanced services.


The majority of schemes are being retained with no overall change in service delivery. Where new schemes are in development, patient and public involvement would be undertaken in line with CCG policy.

Communication Plan Discussion with PCNs on the approaches to delivery of key schemes has been undertaken via the PCN Business Leads and Clinical Directors. In addition, updates will be discussed at relevant Croydon wide GP / Practice meetings over recent months. LMC representation has been included within the Primary Care Quality, Finance and Planning Group which is responsible for the development of LCS’. Where schemes have identified additional stakeholders for ongoing communication, these were identified within plans for each scheme.


None identified

Reputational Issues

None identified

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UPDATE ON LOCALLY COMMISSIONED SERVICE (LCS) ARRANGEMENTS FOR

2020/21

The following provides an overarching summary of the LCS review and plans for 2020/21 for

approval. A separate paper on the LCS’ for Spirometry has been provided.

1. Service Review Update on Progress During 2019/20 a review of all LCS arrangements was undertaken to:

5. Ensure that all services commissioned from General Practice outside the core contract meets the requirements of the procurement advisory group and are approved by the appropriate committees.

6. Ensure that all patients registered with a Croydon GP are able to access enhanced services provided through the primary care network model.

7. Ensure that all services delivered through an enhanced service are relevant to local population needs and are equitable, with clear and measurable outcomes.

8. Develop a contracting framework for General Practice LCS that is aligned to the network delivery model and reduces the administrative burden for commissioners and General Practice.

This work has been overseen by the Primary Care Quality, Planning and Finance Group which

reports to the Primary Care Working Group. Key outputs from this review has been the confirmation

of the commissioning principles for enhanced primary care services alongside CCG statutory

requirements, alignment with guidance in the long-term plan and our commissioning strategy and

assess current schemes against these principles to determine plans for 2020/21 and beyond.

Discussions regarding delivering population coverage for new LCS’ has taken place, however,

feedback from practices has highlighted a number of challenges. This includes the difference in

maturity of PCNs across Croydon and the work still in progress to embed this way of working. It has

therefore been agreed that:

1. Options for PCN / network based working have been built into new LCS’:

• Long term conditions proactive and preventative LCS – providing an option for PCN or practice based working to deliver group consultations.

• Spirometry – in-depth discussions have taken place with the aim of supporting network based approaches to ensuring sufficient accredited staff available to deliver the service. In order to provide sufficient time for practices / PCNs to develop the approach to delivering the revised service specification, implementation has been delayed until December 2020. The 2019/20 service specification for spirometry will remain in place for April to November 2020. A separate paper on this service has been provided.

2. For all other LCS’ the option for sub-contracting / referring to other practices has been included, to support delivery of population coverage. Further work is required to support practices wishing to implement this approach.

In addition, work is in progress with Croydon GP Collaborative to develop automation of reporting

through EMIS Enterprise where possible, to reduce the burden of reporting on practices and

validation for the CCG. To date this has been completed for the transforming elective care, care

homes and ear irrigation LCS’, and is in development for new schemes to be implemented in April

2020 i.e. long term conditions and insulin injectables.

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2. Plans for 2020/21 by LCS

For clarity schemes for 2020/21 have been separated into three groups (full list in appendix 1,

including financial implications.)

2.1. Services where there is no change: For most Schemes currently in place, there will be little or no change, other than to review key performance indicators and update service specifications where there is new or updated guidance. Key developments for these schemes are:

• Review of activity undertaken and links with other service developments to provide assurance of need

• Review of cost and 2020/21 predicted activity to inform budgets

• Review of service specification to provide a consistent approach (see section 3).

• For clarity and to support ongoing development, the ‘basket’ LCS has been separated into its component parts and therefore will become two LCS’ – one scheme for shared care / Zoladex and another for leg ulcer and wound management. This allows for ongoing development linked with both the current SWL shared care review and local urgent care services.

• This group also includes continuation of new schemes implemented in 2019/ 20 – mental health, elective care transformation and ear irrigation.

2.2. New or significantly revised services Significant work has been undertaken to develop the LCS for insulin injectables, long term conditions and spirometry. This has included engagement with practices and PCN business leads and clinical directors. All of these schemes have included the development of a network (PCN) based approach to support delivery of new ways of working e.g. to support delivery of group consultations or address work force issues where new accreditation is required. Given PCN working is in its infancy and at differing levels of maturity across Croydon, the implementation of a PCN based approach to these schemes from April 2020 has been identified as a challenge. Therefore, it has been proposed that the implementation of elements of these schemes is phased to support roll out:

• Spirometry – as outlined above will continue with the current 2019/20 service, with a revised service specification from December 2020.

• Insulin injectables – to be implemented in full from April 2020. The service is to fund general practice for taking on the extra care, time and responsibility for the management of patients with more complex needs including who require insulin or injectable glucogen-like-peptide-1 (GLP1) agent

• LTC Preventative and Proactive LTC – aims to identify a proportion of patients with either Hypertension and/or Type 2 Diabetes, who are not meeting their clinical treatment targets, and provide them with enhanced support pre-dominantly through group consultations, which may be network or practice based dependent upon local arrangements.

2.3. LCS impacted by changes to the national DES service specification consultation.

Following the outcome of the national consultation on the DES service specifications (including care homes and anticipatory care). It has been confirmed that:

• Structured Medication Review and Medicines Optimisation will be implemented from April 2020

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• Supporting Early Cancer Diagnosis will commence from April 2020

• Enhanced Health in Care Homes will commence October 2020, however, preparatory work is required between PCNs and the CCG to support alignment of care homes to PCNs and identify new ways of working.

• Anticipatory Care and Personalised Care are deferred until 2021/22. Full details on the DES schemes are available at https://www.england.nhs.uk/wp-content/uploads/2020/02/update-to-the-gp-contract-agreement-2021-2324.pdf

2.3.1. Care Home LCS The guidance on the implementation of the DES service specifications outlines the following:

• ‘A new ‘Care Home Premium’ will provide an additional and specific contribution, responding to concerns about care home distribution between PCNs. PCNs will be entitled to a recurrent £120 per bed per year. Given that the core requirements of the 2020/21 Enhanced Health in Care Homes service specification do not come into effect until 30 September 2020, this funding is on a half-year (£60 per bed) basis in the first year;

• Where a LES/LIS already exists for a service that is duplicated by the DES requirements, no decommissioning of that service by the CCG should take place until the DES requirements commence. For the care homes service, for example this will be 1 October 2020. Where the requirements in an existing LES/LIS exceed those in the DES, commissioners must, engaging with PCNs and LMCs and taking account of the PCN employment liabilities directly linked to delivery of the LES/LIS, consider maintaining this higher level of service provision to their patients, alongside an appropriate portion of existing funding additional to the entitlements of the national contract. And all funding previously invested by CCGs in LES/LIS arrangements which are now delivered through the DES must be reinvested within primary medical care.’

Further discussions are taking place with LMCs in early March 2020, and full guidance on implementation has yet to be released. Given the current position it is proposed that the Care Home LCS for 2020/21 take the following form: 1. The current LCS be continued for the period April to September 2020 2. A working group will be urgently implemented to develop a new model of care. This will

identify the service requirements to support implementation and delivery of the DES specification as well as meeting local needs and supporting continuation of care. A workshop is currently being planned for late March 2020 to commence this work, with input from GPs, practice managers, PCN clinical directors and business leads, LMC, Croydon GP Collaborative, community healthcare providers and other stakeholders.

In order to support and ensure sign up for the service from April 2020, the service specification has been revised to include the commitment to this development approach.

2.3.2. Proactive management LCS

This scheme was implemented in July 2019 with the aim of being replaced by the DES service specification for anticipatory care. Given the deferment of the implementation of the anticipatory care DES, early discussions have taken place with clinical leads to determine whether the current scheme is suitable for extension into 2020/21 and what, if any, further developments are required. Given the timescale for implementation it has bee recommended that the scheme continue in its current form. However, further review is warranted particularly in relation to:

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1. Reporting requirements - feedback from practices is that this is repetitive and onerous. Work is required to streamline reporting.

2. Huddle surveys were initially to be undertaken quarterly, however, due to the work involved and the limited benefit of this frequency it is proposed that the requirement for Q1 2020/21 be updated to reflect the requirement to feedback on actions taken to address issues identified within the survey undertaken in Q4 2020/21. For 2020/21 survey will therefore be undertaken in Q2 and Q4.

2.4. Automation of Reporting The CCG is working with the Croydon GP Collaborative to develop an approach to support automation of reporting for LCS’ where this is appropriate to the information required. This process is supported by a user guide and includes the process for reconciliation of returns in the next payment run, in exceptional events where errors have been identified Automation of reporting has been implemented for elective care transformation, ear irrigation and care homes LCS’. Work is in progress for the new schemes to be implemented from April 2020 – LTC and insulin injectables. In order to support use of automated returns it is recommended that payment will only be made on receipt of automated return and service specifications have been updated to reflect this approach. Support and feedback will be provided by the GP collaborative team to ensure practices are able to implement this process from Q1 2020/21. Where automation is not developed at the start of 2020/21, consideration will made regarding the feasibility of mid-year implementation taking into account potential additional work for practices to transfer to a new reporting approach. Automation of returns will include the development of EMIS templates which will be in line with current reporting requirements and will be supported by a user guide. Updated reporting workbooks will also be provided with clear direction on which LCS’ should be reported manually and which are only available for automated reporting. Where changes to reporting are identified, the CCG will work with CGPC and practices to seek feedback on proposals and ensure sufficient notice and support is implemented, commensurate with the impact of proposed new ways of working on practices.

3. Service specification updates:

In order to provide a consistent approach to LCS’ and alignment with the latest national NHS

contract framework all local LCS will be transferred to the national service specification template,

with the following additions where appropriate to each specification:

3.1. GP Practices are expected to provide the essential and additional services for which they are contracted to provide to their registered patients through their core contract. The specification of this service is designed to cover the enhanced aspects of clinical care for patients which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services.

3.2. Accessibility

The provider must ensure that the venues for clinics are accessible, local and suitable to undertake this clinical function. Accessibility must meet current accessibility compliance and

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the locations must be within reach by public as well as private transport. Patients will be offered choice of location and time of appointment. The premises must comply with relevant standards and meet the CCG’s estates requirements for safety and security. Other venues that offer similar standards of clinical functionality, infection control, privacy and dignity, clinical waste, can be considered as long as standards are met and in agreement with the commissioner. The service will also ensure that appropriate administrative support is present. The provider will need to ensure that reasonable adjustments are made to ensure services are accessible for all people with protected characteristics under the Equalities Act. Clinical support to people within Croydon will be provided irrespective of any other need (including, but not limited to, housebound, mental health diagnosis, learning disabilities, transgender, or disability)

3.3. Network based delivery

The ambition is for this model to facilitate closer working with a range of local providers,

including across primary care. In line with the ambition to realise integrated working the CCG

is supporting practices to work collaboratively to deliver the services outlined in this

specification. Some of the key benefits in operating in this way include;

o Primary care can operate more effectively in partnership with other providers o Better use of resources through economies of scale in pooling resources o Enable practices to benefit from partnership working and peer support o Take account workforce issues particularly around recruitment of specialist skills o Viability of providing care where patient numbers may be small on a practice level but

sufficient case load when at network level Practices may sub-contract delivery clinical services to another provider on the basis of the following conditions being met and in accordance with the relevant subcontracting clauses within the GMS, PMS or APMS contract that the provider is contracted to provide medical services under. Ensuring:

o Convenient access for patients will be maintained – patients to be referred to a neighbouring practice either within the network which the referring practice operates or with a reasonable and accessible radius of the practice premises

o The provider has assured themselves that the sub-contracted practice can deliver services to the level of skill and quality standards described in this specification

o Payment for activity delivered under the LCS will still be made directly to the provider. Arrangements for payment from sub-contracting arrangements to be managed between those parties

o The provider will ensure they inform the CCG where services are being delivered from under these arrangements

o To inform the CCG where the arrangements change within 30 day of the change becoming material

o The provider will ensure adequate data sharing arrangements are in place

3.4. Updated appendix to include reference to reporting requirements and automated reporting.

As well as the addition of relevant reporting templates and timelines service specifications will

include the following:

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3.4.1. For those schemes where automation has been developed the service specification will include the following:

‘The CCG is working with the Croydon GP Collaborative to develop an approach to support

automation of reporting for LCS’ where this is appropriate to the information required. This process is

supported by a user guide and includes the process for reconciliation of returns in the next payment

run, in exceptional events where errors have been identified.

Payment for this service will only be made upon receipt of automated returns. Where there are issues

with automation this should be highlighted to the Enhanced Services Contracts Team.’

3.4.2. For those schemes where automation has not yet been developed:

‘The CCG is working with the Croydon GP Collaborative to develop an approach to support

automation of reporting for LCS’ where this is appropriate to the information required. This process is

supported by a user guide and includes the process for reconciliation of returns in the next payment

run, in exceptional events where errors have been identified.

Where automation is not developed at the start of 2020/21, consideration will made regarding the

feasibility of mid-year implementation taking into account potential additional work for practices to

transfer to a new reporting approach. Automation of returns will include the development of EMIS

templates which will be in line with current reporting requirements and will be supported by a user

guide. Updated reporting workbooks will also be provided with clear direction on which LCS’ should

be reported manually and which are only available for automated reporting.

Where changes to reporting are identified, the CCG will work with CGPC and practices to seek

feedback on proposals and ensure sufficient notice and support is implemented, commensurate with

the impact of proposed new ways of working on practices.’

4. Risks Risk Mitigation

Risk that increased uptake of schemes by practices and / or increased activity undertaken due to changes in approach (e.g. move to PCN based models of care) or increased communication may incur additional spend over previous years outturn.

Where identified, increases in activity and associated costs for 2020/21 have been highlighted. Ongoing review will be undertaken through confirmation of uptake of schemes by practices and monitoring of activity reports.

Risk that changes to the funding streams for the care home LCS’ due to the implementation of the PCN DES from October 2020 will impact on the uptake and delivery of care home support, and on local financial arrangements. The DES service specification has been released at £120 per bed and therefore represents a significant reduction in remuneration for practices compared with the current funding (£220) for nursing home residents.

Review of current funding arrangements has been undertaken. It is proposed that the current LCS arrangements are implemented for the period April to September 2020. During this time co-design will be undertaken with practices, LMC, PCNs and other stakeholders to develop a model of care which meets local needs and supports delivery of the care home DES requirements, for implementation from October 2020.

Risk to continuity for supporting, overseeing and developing LCS’ due to changes in organisational structure within both the CCG and CSU. This will affect:

Processes are in place to record handover arrangements for CCG staff as part of the transition to SWL CCG.

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• Processes to ensure practice payment for Q4 of 2019/20 (due end of May 2020)

• Ongoing oversight and management of schemes for 2020/21

Confirmation of leads for key areas of LCS management have been sought and are to be confirmed.

5. Communication and Next Steps: Final approval for all schemes for 2020/21 will be sought from the Primary Care Working Group,

Procurement Advisory Group, SMT and Primary Care Commissioning Committee in February /

March 2020, enabling release of schemes to practices for sign up on 3rd March 2020. To support

sign up, service specifications for schemes which are continuing or have previously been approved

agreed (i.e. group 1 or 2 described above) will be shared with practices shortly.

The following provides a summary of next steps for the LCS programme for ease of reference:

Date Stakeholders Aim

By 21st February 2020 All practices Share service specifications for ongoing services with all practices ‘pending PCCC approval’ Plus update on approach for all schemes

25th February 2020 (TBC) Primary Care Working Group

Approval

25th February 2020 PAG Approval

25th February 2020 SMT Approval

3rd March 2020 PCCC Approval

3rd March 2020 Practices Release of final service specifications and contract sign up sheets

25th March 2020 Practices Return of sign up sheets

1st April 2020 Practices LCS’ go live

6. Recommendation:

The Committee are asked to:

1. APPROVE the continuation of LCS schemes outlined herein for 2020/21 including: a. APPROVE the approach for the Care Home and Proactive Management LCS’ b. APPROVE the budget identified for the LCS programme c. NOTE the changes to the previously agreed plans for spirometry – separate paper for

approval supplied 2. APPROVE the additions to the service specification templates 3. NOTE and comment on the risks identified

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Appendix 1: Summary and spend by LCS The following table outlines the plans for each LCS, including spend identified, and an update on the changes to the service specification / service delivery requirements:

Name of LCS (2019/20) Summary of plans for 2020/21 Predicted spend 2020/21

summary of changes to service specification

Group 1 - No change to existing services

Barretts Oesophagus Management

No change to service for April 2020; ongoing review regarding this pathway in progress.

£ 45,700 Aligned with NHS standard contract

framework including additional text as outlined within section 3

Leg ulcer management / wound management (formerly part of the Basket LCS)

No change in service requirements, activity or cost identified - LCS disaggregated to support ongoing development and alignment with arrangements for local urgent care services (some activity currently undertaken within GP Hubs)



Shared Care Prescribing / Zoladex (formerly part of the Basket LCS)

No change in service requirements, activity or cost - LCS disaggregated to support ongoing development and alignment with the approach for shared care across SWL



Coeliac No service change for April 2020, no change in activity or cost identified. £ 20,000 Aligned with NHS standard contract


ECG

No change to service for April 2020; however, ongoing review in progress due to end of contract for ECG reporting. Increased activity and associated costs identified for 2020/21 .



Latent TB No service change for April 2020, no change in activity or cost identified. £ 79 Aligned with NHS standard contract


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MGUS & CLL No service change for April 2020, no change in activity or cost identified. Development of hub based model to be undertaken.



Phlebotomy & Phlebotomy Community

No service change for April 2020, no change in activity or cost identified. £ 214,440 Aligned with NHS standard contract


Pre-op Hernia Service to be decommissioned from 30th March 2020 - approved by PCCC December 2019, and communicated to practices.

£ - NA

Urology (prostate) No service change for April 2020, no change in activity or cost identified. £ 32,661 Aligned with NHS standard contract


Ear Syringing To move from the pilot arrangements implemented in June 2019 to a substantive LCS for 20/21 (agreed by SMT 10th December 219)



Elective Care transformation (blue button)

No change in service delivery, cost and activity identified. Scheme for 2020/21 will request that practices either deliver the current 8% reduction in referrals or maintain if already achieved.



Mental Health Ongoing implementation of new scheme from 2019/20 £ 500,000 Aligned with NHS standard contract


Group 2 - new or significant change on current arrangements

LTC Proactive and preventative LCS (business case pending final approval)

New service specification developed and approved by PCCC in December 2019. This specification includes PCN based working to support delivery of enhanced reviews and care planning.

£ 270,164 As per service specification agreed by

PCCC in December 2019.

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Diabetes injectables

New service specification developed and approved by PCCC. Includes the option for injectable therapy delivery within the primary care networks. Increased activity and associated compared with 2018/19 and 2019/20. Engagement undertaken with PCN and practice leads.

£ 198,000 As per service specification agreed by

PCCC in December 2019.

Spirometry

New service specification developed and approved by PCCC in December 2019. This specification includes PCN based working to support delivery of the requirement regarding accreditation of staff undertaking spirometry. Funding previously identified included an increase in activity but no change in remuneration per test. However, on further discussion with practices potential increased costs have been identified as well as challenges with PCN working. Further report to be presented to the Primary Care Working Group in February 2020, including the option for delaying delivery of the revised service specification until late 2020. Spend updated to reflect this proposal

£ 131,000

2019/20 service specification aligned with NHS standard contract framework

including additional text as outlined within section 3

Group 3 - Services awaiting outcome of DES PCN Service Specification.

Proactive Management Proposal for continuation of the current service into 2020/21 outlined within section 2.3.2 given the DES service specification for anticipatory care has been delayed until 2021/22

£ 2,730,700 Aligned with NHS standard contract


GP Care Homes Proposal for continuation of the current service to September 2020 outlined within section 2.3.2 to support delivery of the DES service specification from October 2020.



TOTAL £ 6,072,649

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Appendix 2: Care Home LCS 1 April 2020 to 30 September 2020 - service specification

SCHEDULE 2 – THE SERVICES

A. Service Specifications

This is a non-mandatory model template for local population. Commissioners may retain the structure below,

or may determine their own in accordance with the NHS Standard Contract Technical Guidance.

Service Specification No. Draft specification – Pending PCCC approval 3rd March

2020

Service Enhanced Care Home Support

Commissioner Lead Kare Barkway

Provider Lead GP Practices

Period April 2020 – September 2020

Date of Review June 2020

1. Population Needs

Summary

This service aims to ensure that the best possible enhanced primary care is provided to people

living in both nursing and residential homes in Croydon. It does not replace the requirement

within the GMS core contract for practices to register patients who are residents of care homes

within their catchment area. However, it will operate as part of a wider, Care Home

Transformation programme, spanning secondary care, enhanced virtual support (telemedicine)

and other health and social care services. The overall aim is to improve outcomes and quality

of life for residents, enhance the care delivered in care homes and reduce avoidable pressures

on the wider healthcare system.

Problem statement

Croydon has the highest number of care homes in London, 131 care homes and approximately

2,700 beds (1517 in nursing homes and 1156 in residential homes). During 2017/18 demand

from unscheduled care from care homes generated the following pressures on the health and

social care system:

• Croydon has among the highest rate of ambulance call out rates in London: 2115

incidents in care homes between March 2017 and March 2018.

• Between March 2017 and March 2018, care home residents accounted for more than

2,000 non-elective admissions and 2,300 delayed days in 2017/18 (24% of all delayed

days).

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Local context

Croydon has good provision of health and social care services which support care homes; but

there are some gaps, inconsistencies and particular issues which need to be addressed:

• Inequitable split of patient registration and activity across different practices, with

practices registering higher or lower number of care home patients than would be

expected from their local care home population.

• Lack of consistent training and capability framework for care home staff, compounded

by high levels of staff turnover.

• Support services for care homes not consistently well co-ordinated or understood

• Evidence that care home staff do not know when and how to refer to care home

support services

• Significant pressure placed on primary care, leading to over reliance on emergency

services for crisis management

• Variable approach to pro-active care in managing chronic disease and medicine among

care homes residents

• Inconsistent approach to care planning, especially around end of life (EOL)

Many of the barriers to good care reflect the national picture: a narrow focus on medical rather

than holistic needs, reactive and inconsistent care and variable access for care home residents

to NHS services. This is compounded by the scale of Croydon’s care home market and

volume of patient need – which has created a compelling case for change and strong local

commitment for the successful delivery of a significant major multi-sector care home

transformation programme.

This programme is now being mobilised and includes a number of work-streams:

1. Enhanced primary care support for care homes through the delivery of this service specification

2. Mobilisation and effective embedding of telemedicine approach to support and enhance the delivery of care across Croydon’s care homes through addressing urgent care needs.

3. The development of the specialist care home support initiative which includes the Complex Care Support Service and enhanced medicines support.

4. The development of delivery of a LA/CCG bed commissioning strategy which seeks to achieve a consistent, streamlined and sustainable commissioning framework.

5. The development and delivery of a workforce development plan for care home staff focused on training and support designed to increase the capacity and capability of staff to support their patients and reduce unnecessary use of health and social care resources.

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Primary care

As part of wider transformation plans, NHS Croydon CCG supports primary care

transformation and more resilient and sustainable services to provide a consistent quality

service to residents of Croydon.

Following the release of the 1NHS Long Term Plan in January 2019, and the associated early

guidance on the approach for the 2GP Contract Framework, the requirements within this

specification have been aligned where possible to the latest national requirements. This

service therefore represents an interim arrangement for the period to 31st March 2020; and

aims to support the transition from the current service into the implementation of the national

service specification requirements.

Key within the NHS Long Term Plan is the development of Primary Care Networks (PCNs). A

network based approach to the support and management of Care Home residents has been in

discussion across Croydon for some time. Aiming to provide equitable registration, streamline

the number of practices supporting each individual Care Home, and continuing to build upon

the relationships between care homes and primary care, and facilitate inter- and intra-network

working to mitigate against the impact of the geographical spread of care homes and therefore

workload for these residents. The approach to network working for care homes will be

facilitated through PCNs in line with planning for the implementation of the new National

specification for ‘Enhanced Health in Care Homes’.

With the release of the DES Service specification for Enhanced Care in Care Homes in

February 2020, for implementation from October 2020, this LCS specification will be

implemented for the period April 2020 to 30 September 2020. The CCG will work with

wider primary care colleagues and other stakeholders to develop a new model of care

1 https://www.longtermplan.nhs.uk/

2 https://www.england.nhs.uk/publication/gp-contract-five-year-framework/

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which meets local needs and supports implementation of the DES requirements from

October 2020, enabling local requirements to be maintained and ensuring continuity of

care.

Telemedicine

The implementation of telemedicine to support care homes commenced in winter 2018/19. The

aim of this service is to provide support for both nursing and residential homes through remote

review of patients and provision of advice during periods of crisis or exacerbation of existing

conditions. Early data suggests that over 75% of the telemedicine contacts would have

otherwise contacted a GP for support, with only 27% of these requiring onward referral to a GP

service (both in and out of hours). This therefore provides an additional resource to support

care homes and reduce the reliance on GPs to respond to urgent requests for assistance.

Combined with the ward round and proactive review approach outlined within this specification

and the Proactive Management LCS service specification, this aims to provide a robust and

effective approach to managing the health needs of care home residents.

Service description: Enhanced care home LCS:

The overall aim is to improve outcomes and quality of life for residents, support nursing and

residential homes to provide more timely and appropriate care in the home, rather than utilising

the LAS and acute trust services. Other aims are to:

• Improve the quality of care delivered to care home residents and reduce avoidable pressures on the healthcare system.

• Provide consistency, co-ordination and a multidisciplinary (MDT) approach with rapid access to specialist advice when necessary.

• Promote independence and self-care for care home residents

• Support nursing and residential homes to provide more care in the home, rather than using emergency services inappropriately

1.3 Objectives

• Enhance access to personalised, high quality primary care for residents of care homes

• Ensure that the majority of care home residents are registered with Croydon practices which are delivering the LCS and located within reasonable proximity to the care home

• Ensure patients have high quality proactive care management plans (full requirements are outlined within the service specification for the Proactive Management LCS)

• Support medical optimisation of patients within nursing and residential homes

• Work with other services as required such as telemedicine, Integrated Care networks and the Complex Care Support Service

• Act as primary care resource for care home staff

• Improve: o Medicines management o Integrated and Proactive management planning o Patient experience; o Shared-care and joint working between health and social care professionals, and

care home teams o Shared Decision Making, including with residents, families and carers; o Self-care;

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2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quality of life for people with long-term conditions ✓

Domain 3 Helping people to recover from episodes of ill-health or following injury

✓

Domain 4 Ensuring people have a positive experience of care ✓

Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm

✓

2.2 Expected (local) outcomes

The Provider is expected to provide an enhanced primary care service for care homes (nursing

home and residential homes). This service will deliver the following outcomes:

Enhanced primary care service outcomes:

• Improved clinical care • Better co-ordination of services delivered within the care home • Alignment of services • Linkages with pathway development for complex care support • Better integration of proactive management pathway

Support wider Care home Transformation outcomes

• Better experience and outcomes for care home residents • Supported and sustainable care home model • Care home staff have tools, confidence and capability deliver timely and appropriate

care in the home • Reduce levels of inappropriate LAS call outs • Reduced levels of inappropriate A&E attendances • Reduces levels of inappropriate non-elective hospital admissions • Reduced length of stay following admission • Reduced inappropriate and lower acuity demand for unscheduled care services • Increase in positive CQC inspections • Reassurance for relatives and carers

▪

3. Scope

GP Practices are expected to provide the essential and additional services for which they are

contracted to provide to their registered patients through their core contract. The specification

of this service is designed to cover the enhanced aspects of clinical care for patients which are

beyond the scope of essential services. No part of the specification by commission, omission

or implication defines or redefines essential or additional services.

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3.1 Care Pathway and Requirements

The following diagram outlines the relationships and interdependencies between relevant

services:

Figure 1: Services supporting people with complex health needs

3.1.1 Proactive care management and review

The CCG has developed a proactive care clinical model which aims to ensure that patients

with complex and escalating needs receive the best care. Co-ordinate My Care (CMC) is used

as the template for the care plan. This approach is fully defined within the Proactive

Management LCS service specification.

The proactive plan should be a collaborative process between the patients (and carer/family).

The consultation should seek to address how their care will be managed to:

• Enable effective management of their long term conditions

• Enable optimum support for self-management

• Provide clear contact points for times of crisis/exacerbation

• Understand the patient’s interactions with other agencies providing support to them

• Consider the needs of the patient’s carers (this should be done via the Care home who

will have more contact with family on a regular basis)

• Review medications being taken by the patient and support improved compliance

where appropriate

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• Reduce their risk of avoidable admission to hospital

This plan will be regularly reviewed – on an annual basis as a minimum for stable patents - and

updated at key points including

• Unplanned admission

• Following discharge from intermediate care services (such as Living Independently For

Everyone (LIFE) services) (within 3 working days)

• New significant diagnoses,

• Contact with the Telemedicine service,

• Other significant change of circumstances.

This model operates across a joined-up continuum of care spanning enhanced primary care,

MDT Huddles and the Complex Care Support Service and is outlined within the above pathway

diagram (Figure 1 above).

3.1.2 MDT Huddles

MDT huddles are in place across all practices with Croydon. This multi-agency team aims to

discuss the care planning of people with complex health and care needs. The purpose is to

proactively plan care so to reduce the need for future hospital admissions or other escalated

care needs. Huddles are the cornerstone to the development of effective multi-agency working

and the establishment of Integrated Community Networks (ICNs). They provide a platform for

all community services to strengthen their working relationships through mutual learning and

open communication. The model provides opportunities to avoid delays, complex referral

processes and duplications for timely and efficient care for people.

Where required, MDT huddles may provide further opportunities to support care planning for

care home residents.

3.2 Key intervention points

Newly admitted care home residents will be visited within one week of admission to the care

home. The review should cover:

• Information gathering;

• Initial physical and mental health assessment;

• medication reconciliation; with a full medication review supported by a pharmacist within

1 month

• Completion of co-ordinate my care record (or review and updating if already developed)

▪ 3.3 Care Home Ward Rounds

Practices will provide regular routine ward MDT rounds which should include the care home GP,

other key individuals, such as pharmacists and other ICN staff, and senior care home staff. Ward

rounds should be mutually agreed with the care home and the frequency agreed with the Care

Home Manager appropriate to the size and complexity of the residents and performance of the

Care Home. The purpose of the ward round is to:

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• Co-ordinate clinical activities to enable the provision of timely, quality care for patients and their families – shifting the balance of care from reactive to proactive.

• Update the Co-ordinate My Care (CMC) record and comprehensive geriatric assessment as it develops.

• Identifying residents requiring proactive care to remain healthy • Providing responsive care in a timely way • A whole system approach to care delivery

3.3.1 Frequency of ward rounds

GPs will decide the most appropriate frequency of ward round based on clinical need and in

discussion with the Care Home Manager. However, a review on a weekly basis would be

recommended for nursing homes. For residential homes, a reduced frequency of ward rounds

is likely to be sufficient and is recommended to take place monthly as a minimum. Noting that,

as a new service for residential homes, more frequent ward rounds may be required initially.

The time required for a ward round will vary according to the number of patients, their needs

and the professional skills required.

3.4 Medication review

GPs will be expected to work with pharmacists to ensure medications are optimised as soon as

practically possible. Pharmacists will attend ward rounds until such medications are optimised.

Pharmacists may be members of the CCG medicines optimisation team or identified by the

practice and accredited by the CCG medicines optimisation team.

Once optimised, medication focussed ward rounds should take place every six months.

3.5 Emergency admissions review

Residents who have had an emergency admission should be reviewed during the agreed ward

rounds, and if further support and review is required, referred into the Complex care support

team

The review will cover:

• what could have avoided the emergency admission

• what will be done differently next time

• to identify gaps in service

3.6 Responsibilities of the GP

In order for the service to be effective participating GPs will be expected to:

• Work with care home staff and other specialists to prepare patients and families in

advance, when appropriate, to facilitate shared decision making and review

• Ensure that all relevant actions are implemented/handover over

• Attend best interest meetings

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• Develop clear management and clinical protocols to achieve clear communications with

all staff in the care home, including managers, nursing staff and administrative staff. This

could include agreed processes for repeat and urgent prescriptions, use of the

telemedicine service and how to obtain a telephone opinion or triage in urgent

circumstances;

• Liaise with patients previous GP (or current GP if only temporarily registered in Croydon)

where necessary

3.7 Additional responsibilities

Croydon CCG is strengthening specialist palliative care input to the care planning progress. This

includes:

• Expansion of the PEACE (PErsonalised Advisory CarE) planning model to at least 140

patients including 10 care homes. The PEACE plan is a document to help health care

professionals deliver the best care to frail, people with life-limiting illnesses who are

anticipated to be in the last year of their life and reside in a care home. PEACE will be

delivered by specialist nurses with community geriatrician oversight, the PEACE planning

process can indicate how best to deliver care in the care home, and what support is

available in the community to do this. GPs will not be responsible for the development

of this plan but may be requested to provide information where appropriate.

• EOLC focussed ICN huddles with specialist input from St Christopher’s hospice. These

occur on a 6 weekly basis, depending on GP list size.

3.8 Interdependence with other services/providers

GPs will be expected to work closely with:

• Complex Care Support Team which operates to enhance best practice and improve quality aligned to CQC domains.

• Highly Specialist Speech and Language Therapist which manages and supports patients with swallowing difficulties (dysphagia) and training to Care Home staff and other Health Professionals.

• Croydon Mental Health of Older Adults and Psychological Medicine (CHIT) • St Christopher’s Hospice provides training and education – joint End of Life care reviews • Integrated Community Networks.

The service will also be expected to give particular focus to support the effective delivery

of the following services:

Complex care support Team which is an extension of the existing Integrated Community

Networks. It comprises specialist staff (e.g. Community Geriatrician, mental health workers) and

will provide specialist advice/consultation; assessment and care planning support; and training

and development to support front line workers to proactively manage people with complex health

and care needs.

Telemedicine service Supporting 80 care homes across Croydon, this new service provides an

accessible single point of access 24/7 365 days per year, and access to a highly experienced

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telemedicine clinical team providing timely and responsive comprehensive “visual” assessments

of the resident via HD video links.

▪ 3.9 Care home workforce

Responsibilities of Care Home Managers to support the service are set out under appendix 1.

3.10 Network based delivery

The ambition is for this model to facilitate closer working with a range of local providers, including across

primary care. In line with the ambition to realise integrated working the CCG is supporting practices to

work collaboratively to deliver the services outlined in this specification. Some of the key benefits in

operating in this way include;

• Primary care can operate more effectively in partnership with other providers

• Better use of resources through economies of scale in pooling resources

• Enable practices to benefit from partnership working and peer support

• Take account workforce issues particularly around recruitment of specialist skills

• Viability of providing care where patient numbers may be small on a practice level but sufficient case load when at network level

Practices may sub-contract delivery clinical services to another provider on the basis of the following

conditions being met and in accordance with the relevant subcontracting clauses within the GMS, PMS or

APMS contract that the provider is contracted to provide medical services under. Ensuring:

• Convenient access for patients will be maintained – patients to be referred to a neighbouring practice either within the network which the referring practice operates or with a reasonable and accessible radius of the practice premises

• The provider has assured themselves that the sub-contracted practice can deliver services to the level of skill and quality standards described in this specification

• Payment for activity delivered under the LCS will still be made directly to the provider. Arrangements for payment from sub-contracting arrangements to be managed between those parties

• The provider will ensure they inform the CCG where services are being delivered from under these arrangements

• To inform the CCG where the arrangements change within 30 day of the change becoming material

• The provider will ensure adequate data sharing arrangements are in place

▪ 4. Applicable Service Standards

1. Practices participating in the LIS will be required to provide the following monitoring

information on an annual basis (as per workbook in Appendix 2)

I. Patient ID, and date arrived in care home

II. Dates of urgent / emergency visits or interventions undertaken by the GP to

support residents

III. Frequency of ward rounds undertaken by the GP Practice within the home and

the activity undertaken

IV. Confirmation whether telephone consultations are used to support patients

V. Number of advanced care plans completed (recorded in CMC in line with the

Proactive Management LCS requirements) including resuscitation decisions and

DNaCPR forms as required

VI. Number of medication reviews undertaken including anticipatory prescribing

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2. The above monitoring will be performance managed and validated through the Contracting

Team’s returns process from practices to claim their annual payments.

3. Practices are asked to ensure that patient contacts are appropriately recorded and coded

on EMIS / Vision to support the development of automated reporting.

5. Applicable quality requirements and CQUIN goals

Practices signing up to this scheme will be expected to participate fully in the initiatives and

services describes above to support Care Home Residents, as well as complying with and

supporting the delivery of, national guidance e.g. Managing Medicines in Care Homes NICE

Guidance3

6. Location of Provider Premises

Not applicable. The service will be delivered from Croydon care homes.

7. Individual Service User Placement

Not used

8. Payment

Practices signing up to this scheme will receive:

• £220 payment per patient per year for nursing homes

• £120 payment per patient per year for residential homes

NB:

• Workbooks should clearly articulate any changes to individual residents circumstances

(leaving care home or RIP – to be included within the field ‘ date patient no longer

permanent resident at care home’) to support payment on a per patient basis within the

total number of beds for that care home.

See appendix 1 for reporting requirements

Appendix 1: Reporting

The CCG is working with the Croydon GP Collaborative to develop an approach to support automation of

reporting for LCS’ where this is appropriate to the information required. This process is supported by a user

guide and includes the process for reconciliation of returns in the next payment run, in exceptional events

where errors have been identified.

3 https://www.nice.org.uk/Guidance/SC1

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Reporting for this LCS is through completion and submission of the automated return for care homes via EMIS

Enterprise and will be collected at the end of Q2 for the period April 2020 to September 2020.

Further queries on this process can be raised via:

▪ [email protected]

1. Submission of returns

▪ Submissions can only be made by e-mail and no paperwork copies will be accepted. Where automated

reporting is available through EMIS Enterprise, emails will not be accepted.

2. Submission Dates

▪ Data must be submitted to the CCG at the end of quarter 2. Please note the following submission dates for the

year:

• TBC

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Appendix 2: Responsibilities of Care Home Manager

The care home manager will be expected to

• Support proactive GP involvement for their homes and provide feedback to relevant

bodies of any concerns

• Arrange for a patient to be registered with the nominated GP practice under this

scheme as soon as possible upon arrival in the home unless the patient is choosing

to stay with another GP practice.

• Ensure that summary patient information from the patient’s previous practice, including

list of medications, is available to the GP within 3 days of the patient’s arrival

• Make sure that the patient’s medication record and any new any hospital-provided or

community service information is made available to the GP when visiting the patient.

• Provide the GP with a list of patients with queries/issues prior to every ward round visit

using a secure method of communication

• Arrange for the nurse in charge/on duty to be available to discuss patients on the list

with the visiting GP and accompany the GP to see any patients. Drug charts should

be to hand.

• Ensure that key points arising from these visits are communicated to colleagues or

written in nursing notes.

• Work with the GP to address medication issues in order to reduce prescribing errors

and promote high quality and cost effective prescribing.

• Ensure full engagement with the telemedicine service from all staff through training

and identification of a telemedicine champion.

• Make all reasonable efforts to contact the responsible GP practice; or telemedicine

service where an urgent review is required

▪

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Appendix 3: Assurance process for GP practice pharmacists undertaking medication reviews.

The Quality assurance process for GP practice pharmacists undertaking reviews in care homes as

part of the LCS 2019/20 has been approved and is attached below.

Assurance process

for GP practice pharmacists undertaking medication reviews in Care homes as part of the GP care home locally commissioned scheme 2019-20.pdf

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE (PART 1)

3 March 2020

Title of Paper: Commissioning Update

Lead Director William Cunningham-Davis Head of Primary Care Commissioning SW London Primary Care

Report Author SWL Primary Care Team


Primary Care Commissioning Working Group, 26th February 2020



Purpose of Report For Approval and for Noting

Recommendation:


• Approve the recommendation to issue a Remedial Notice relating to contractual breaches identified following the CQC’s inspection visit findings for East Croydon Medical Centre / Edridge Road.

• Approve the recommendation to issue a Remedial Notice relating to contractual breaches identified following the CQC’s inspection visit findings for Hartland Way Surgery.

• Note the merger update for Addington Medical Practice and Dr Baskaran, Parkway Health Centre.

Background & Key Issues:

• East Croydon Medical Centre / Edridge Road Community Health Centre This summary provides the Primary Care Commissioning Committee with an overview of the contractual requirements breached by East Croydon Medical Centre and Edridge Road Community Health Centre which have been identified following a joint inspection of the practices by the CQC as outlined below.

6 November 2019 visit (publication 8 January 2020) Overall ‘requires improvement’. ‘Requires improvement’ in ‘safe’, ‘effective’, ‘responsive’ and ‘well-led’ domains and ‘good’ in ‘caring’ domain.

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If a practice has been rated overall as ‘requires improvement’, the Standard Operating Procedure for Commissioners in responding to CQC reports, states that if three or more domains are rated as such, it is suggested that formal contractual action would be reasonable and proportionate. The concerns identified cover a high number of areas e.g. recruitment checks, staff records, appraisals, training, premises and security; governance systems; significant events systems and learning; medicines and safety alerts implementation system; infection control audit actions; monitoring of vaccine fridge temperature; blood tests reviews. PMS/APMS contractual clauses breached are respectively Clauses 76/69 ‘Compliance with Legislation and Guidance’; Clauses 9/4 ‘Quality Standards’; Clauses 11/50 ‘Clinical Governance’; Clauses 14/12 ‘Infection Control’; Clauses 21/14 ‘Training’. It is recommended that a Remedial Notice is issued to both practices, requesting that they complete and submit an action plan with supporting evidence to the Commissioners for review, within 28 days of the issue date, and that a visit to the practices will be arranged by Commissioners to progress this. This recommendation was agreed by the Primary Care Commissioning Working Group on 26 February 2020.

• Hartland Way Surgery This summary provides the Primary Care Commissioning Committee with an overview of the contractual requirements that have been breached by Hartland Way Surgery. The breaches in contractual compliance have been identified following an inspection of the practice by the CQC as outlined below.

3 November 2019 visit (report published on 7 January 2020) Overall ‘requires improvement’. ‘Requires improvement’ in ‘safe’, ‘effective’ and ‘well-led’ domains and ‘good’ in ‘caring’ and ‘responsive’ domains. The concerns identified by the CQC include – systems and processes requiring improvement to keep patients safe e.g. no robust system for recruitment management, safety system, infection prevention and control; medicines management; safety alerts; appropriate staff training incomplete; not demonstrating improved outcomes for patients from their quality improvement activities; governance arrangements need improving as no staff meetings to effectively share learning. PMS clauses breached are Clause 76 ‘Compliance with Legislation and Guidance’; Clause 9 ‘Quality Standards’; Clause 11 ‘Clinical Governance’; Clause 14 ‘Infection Control’; Clause 19 ‘Staff’; Clause 21 ‘Training’.

It is recommended that a Remedial Notice is issued to the practice, requesting that they complete and submit an action plan with supporting evidence to the Commissioners for review, within 28 days of the issue date, and that a visit to the practice will be arranged by Commissioners to progress this. This recommendation was agreed by the Primary Care Commissioning Working Group on 26 February 2020.

• Addington Medical Practice (AMP) and Dr Baskaran, Parkway Health Centre (PHC)

This summary provides the Primary Care Commissioning Committee with an overview of progress regarding the merger of AMP and PHC, for noting. The merger was approved in 2018 as a two-stage merger. The first stage involved

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varying both contracts to include the same partners on each contract from 1st April 2019, with the practices working as one practice, sharing services and staff. A full business case has been provided and the second stage for the full merger is currently underway, involving the IT systems merger and the termination of the PHC contract. The date of the full merger will be in the new financial year (2020/21), actual date to be confirmed. No change is required to the practice boundary as it covers both practice catchment areas.

Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time.

Risks

Need to ensure the best possible GP services to patients registered with this practice – adverse CQC reports highlight risks that need resolving


n/a


Any GP who may have an interest in providing services to practice’s patients

Clinical Leadership Comments n/a


n/a

Equality Analysis

n/a


n/a

Communication Plan n/a


n/a

Reputational Issues

Need to ensure the best possible GP services to patients registered with this practice – adverse CQC reports could potentially erode confidence in services in this practice.

SW London Primary Care Team [email protected] 26th February 2020

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South West London Primary Care Contracts

Summary Report 2019/20 Q3 – Croydon CCG

Date: 01/01/2020

Prepared by the SWL Primary Care Contracting Team on behalf of

Croydon CCG

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Contract Variations

2

Practice Code

Practice NameContract

TypeList Size

Type of Action Contract Variation Details

Number of Partners following variation

Date of Change

Status Status Action

H83013 Old Coulsdon Medical Practice PMS 14980 Partnership Change Dr has joined the partnership 5 01/04/19 Agreed Complete

H83015 Parkside Group Practice PMS 13222 Partner Retirement Dr has taken 24hr Retirement 4 01/04/19 Agreed Complete

H83027 Parkway Health Centre PMS 6264 Partnership Change Dr has joined the Partnership 5 01/04/19 Agreed Complete

H83028 Addington Medical Practice PMS 3308 Partnership Change 3 Drs has joined the partnership 5 01/04/19 Agreed Complete

H83011 North Croydon Medical Centre PMS 5362 Partnership Change Dr has resigned from the partnership 2 16/04/19 Agreed Complete

H83020 Eversley Medical Practice PMS 10629 Partner Retirement Dr has taken 24hr Retirement 3 01/05/19 Agreed complete

H83625Broughton Corner Medical Centre

PMS 3704 Partnership Change Dr has resigned from the partnership 1 01/07/19 Agreed Complete

H83050 The Moorings Medical Practice PMS 6146 Partner Retirement Dr has taken full retirement 2 30/09/19 Agreed Complete

H83016 Keston Medical Practice PMS 16108 Partnership Change 5 Drs has joined the partnership 7 01/10/19 Agreed Complete

H83050 The Moorings Medical Practice PMS 6146 Partnership Change 2 Drs has joined the partnership 7 01/10/19 Agreed Complete

H83010South Norwood Hill Medical Centre

PMS 6986 Partnership Change Dr (Managing Partner) will join the partnership 2 31/01/20 Withdrawn Practice has withdrawn the CV

H83010South Norwood Hill Medical Centre

PMS 6986 Partnership Change Dr will leave the partnership 2 01/02/20 PendingRequest on hold until additional GP partner joins

H83004 The Farley Road Surgery PMS 11669 Partner Retirement Dr will take 24hr Retirement 1 22/02/20 Agreed Complete

H83001 Portland Medical Centre PMS 12154 Partnership ChangeDr and Managing Partner will resign from their partnership

3 31/03/20 Pending Draft CV sent to Practice

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Contract Variations

Variations typeCroydon

Pending Withdrawn Agreed

Partnership Change 2 1 7

Partnership Retirement 4

Change in Practice Details

Contractual change

Merger

Terminations

PMS to GMS

Contractual Breach Notice

List Closure

Branch Open / Closure

Total2 1 11

Grand Total14

3

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Infection Control audits

4

Summary of Infection Control Visits - Croydon CCG 16/17 17/18 18/19 19/20

Contra

ct Type

Practic

e CodePractice Name

Main Practice

/Branch

Date of

Audit

Overall

Complia

nce

Score

RAG PriorityDate of

Audit

Overall

Complia

nce

Score

RAGMinor

Surgery

2018/19

Priority

Date of

Audit

Overall

Complia

nce

Score

Minor

SurgeryPriority

Date of

Audit

Overall

Complia

nce

Score

PMS H83001Portland Medical Centre Main Practice No No

PMS H83004The Farley Road Surgery Main Practice 01/07/16 99% Green Yes Yes

PMS H83004The Farley Road Surgery

(Holmbury Grove)Branch 01/07/16 98% Green Yes Yes

PMS H83005Upper Norwood Group Practice Main Practice 20/07/16 95% Green Yes Yes

APMS H83006AT Medics Parkway Health

CentreMain Practice 12/07/16 97% Green No Yes

APMS H83006AT Medics Fieldway Medical

PracticeBranch No Yes ==>

PMS H83007Violet Lane Medical Practice Main Practice Yes Yes

GMS H83008The Addiscombe Road Surgery Main Practice Yes ==> 11/09/18 14/14 Yes

GMS H83008The Addiscombe Road Surgery Branch Yes Yes

PMS H83009Norbury Health Centre Main Practice Yes Yes

PMS H83010South Norwood Hill Medical

CentreMain Practice 22/09/16 97% Green 25/07/17 88% AMBER Yes Yes

PMS H83011North Croydon Medical Centre Main Practice No ==> 18/09/18 10/14 No

PMS H83012St James' Medical Practice Main Practice Yes Yes

PMS H83012St James' Medical Practice Branch Yes Yes ==> 02/07/19 13/14

PMS H83013Old Coulsdon Medical Practice Main Practice 18/07/16 98% Green Yes Yes

PMS H83014Queenhill Medical Practice Main Practice Yes Yes

PMS H83015Parkside Group Practice Main Practice 21/07/16 95% Green Yes Yes

PMS H83016Keston Medical Practice Main Practice ==> 15/11/17 98% GREEN Yes Yes

PMS H83017Brigstock and South Norwood

Medical PartnershipMain Practice Yes Yes

PMS H83018The Selsdon Park Medical

PracticeMain Practice Yes Yes

PMS H83019Friends' Road Medical Practice Main Practice Yes Yes ==>

PMS H83020Eversley Medical Practice Main Practice 11/07/16 93% Amber Yes ==> 19/09/18 11/15 Yes

PMS H83021London Road Medical Practice Main Practice Yes Yes

PMS H83022Thornton Heath Medical Centre Main Practice ==> 21/11/17 79% RED Yes 15/05/18 12/14 Yes

PMS H83023Morland Road Surgery Main Practice Yes ==> Yes ==>

PMS H83024Woodcote Medical Main Practice 13/09/16 95% Green Yes 02/10/18 14/15 Yes

PMS H83024Woodcote Medical Branch 13/09/16 94% Amber Yes ==> 15/10/18 14/14 Yes

PMS H83027Parkway Health Centre Main Practice Yes ==> 11/09/18 11/14 No

PMS H83028Addington Medical Practice Main Practice No Yes

PMS H83028Gravel Hill Surgery Branch 01/09/16 97% Green No Yes

PMS H83029Hartland Way Surgery Main Practice Yes Yes ==>

GMS H83030Broom Road Medical Practice Main Practice 15/09/16 96% Green No N/A

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Infection Control audits

5

Summary of Infection Control Visits - Croydon CCG 16/17 17/18 18/19 19/20

Practic

e CodePractice Name

Contra

ct Type

Main Practice

/Branch

Date of

Audit

Overall

Complia

nce

Score

RAG PriorityDate of

Audit

Overall

Complia

nce

Score

RAGMinor

Surgery Priority

Date of

Audit

Overall

Complia

nce

Score

Minor

SurgeryPriority

Date of

Audit

Overall

Complia

nce

Score

H83031The Haling Park

PartnershipPMS Main Practice 22/08/16 96% Green No Yes

H83033Ashburton Park Medical

Centre GMS Main Practice 30/08/16 98% Green No No

H83034The Whitehorse Practice PMS Main Practice Yes Yes

H83037Auckland Surgery PMS Main Practice Yes Yes

H83039Stovell House Surgery PMS Main Practice Yes Yes

H83040Mitchley Avenue Surgery PMS Main Practice ==> 15/11/17 95% GREEN Yes Yes

H83042Leander Road Primary

Care CentreGMS Main Practice Yes Yes ==>

H83043Shirley Medical Centre GMS Main Practice Yes Yes

H83043Shirley Medical Centre GMS Branch ==> Yes Yes ==>

H83044East Croydon Medical

PracticePMS Main Practice Yes Yes

H83049AT Medics Headley Drive

SurgeryAPMS Main Practice 12/07/16 98% Green No Yes

H83050The Moorings Medical

PracticePMS Main Practice 31/08/16 93% Amber Yes Yes

H83051AT Medics Thornton Road

SurgeryAPMS Main Practice 23/08/16 99% Green No No

H83051AT Medics Valley Park

SurgeryAPMS Branch No No

H83052Bramley Avenue Surgery GMS Main Practice 19/09/16 99% Green No No

H83053Parchmore Medical Centre PMS Main Practice 05/09/16 99% Green Yes Yes

H83608Brigstock Family Practice PMS Main Practice No No

H83609Mersham Medical Centre PMS Main Practice 26/09/16 97% Green Yes Yes

H83611Selhurst Medical Centre GMS Main Practice 06/09/16 99% Green No N/A

H83624Fairview Medical Centre PMS Main Practice 28/09/16 94% Amber Yes Yes

H83625Broughton Corner Medical

CentrePMS Main Practice 03/10/16 95% Green No No

H83627The Birdhurst Medical

PracticePMS Main Practice No No

H83631Greenside Group Practice PMS Main Practice 19/07/16 99% Green Yes Yes

H83631Greenside Group Practice

(Lennard Road branch)PMS Branch 19/07/16 98% Green Yes Yes

Y02962Edridge Road Community

Health Centre APMS Main Practice 25/08/16 95% Green Yes ==>

Y05317Country Park Practice PMS Main Practice 27/04/16 96% Green Yes Yes

Y05318Denmark Road Surgery PMS Main Practice 26/04/16 99% Green Yes 09/11/18 6/15 Yes ==>

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6

Practice DetailsDates of CQC Inspection

or Annual Regulatory Review (ARR)CQC Ratings

Practice Code

Practice NameYear of

Inspection or ARR

Date of Inspection or

ARR

Date of Publication

CQC OVERALL Rating

SAFE Rating

EFFECTIVE Rating

CARING Rating

RESPONSIVE Rating

WELL-LED Rating

H83001 Portland Medical Centre 2017-18 14/07/17 17/08/17 Good Good Good Good Good Good

H83004 The Farley Road Surgery 2016-17 18/01/17 16/03/17 Good Good Good Good Good Good

H83005 Upper Norwood Group Practice 2016-17 08/03/17 30/03/17 Good Good Good Good Good Good

H83006 New Addington Group Practice 2018-19 19/12/18 11/02/19 Good Good Good Good Good Good

H83007 Violet Lane Medical Practice 2019-20 29/05/19 03/07/19 Good Good Good Good Good Good

H83008 The Addiscombe Road Surgery 2018-19 24/01/19 11/03/19 Good Good Good Good Good Good

H83009 Norbury Health Centre 2017-18 11/04/17 10/05/17 Good Good Good Good Good Good

H83010 South Norwood Hill Medical Centre 2017-18 15/02/18 29/03/18 Good Good Good Good Good Good

H83011 North Croydon Medical Centre 2016-17 21/06/16 06/11/17 Good Good Good Good Good Good

H83012 St James' Medical Practice 2016-17 18/08/16 08/02/17 Good Good Good Good Good Good

H83013 Old Coulsdon Medical Practice 2016-17 26/05/16 04/07/16 Good Good Good Good Good Good

H83014 Queenhill Medical Practice 2017-18 09/01/18 15/03/18 Good Good Good Good Good Good

H83015 Parkside Group Practice 2016-17 16/11/16 17/02/17 Good Good Good Good Good Good

H83016 Keston Medical Practice 2017-18 25/04/17 02/06/17 Good Good Good Good Good Good

H83017 Brigstock Medical Centre 2019-20 28/05/19 15/07/19 GoodRequires

ImprovementGood Good Good Good

H83018 The Selsdon Park Medical Practice 2016-17 05/07/16 23/09/16 Good Good Good Good Good Good

H83019 Friends' Road Medical Practice 2015-16 20/11/15 12/05/16 Good Good Good Good Good Outstanding

H83020 Eversley Medical Practice 2017-18 12/09/17 31/10/17 Good Good Good Good Good Good

H83021London Road Medical Practice/ Cavendish house

2016-17 05/09/16 26/10/16 Good Good Good Good Good Good

H83022 Thornton Heath Health Centre 2017-18 08/09/17 09/10/17 Good Good Good Good Good Good

H83023 Morland Road Surgery 2016-17 14/10/16 15/11/16 Good Good Good Good Good Good

H83024 Woodcote Medical 2016-17 28/06/16 01/08/16 Good Good Good Good Good Good

H83027 Parkway Health Centre (Dr B Baskaran) 2016-17 05/04/16 12/05/16 Good Good Good Good Good Good

H83028 Addington Medical Practice 2018-19 12/02/19 24/04/19 GoodRequires

ImprovementGood Good Good Good

H83029 Hartland Way Surgery 2016-17 17/05/16 22/06/16 Good Good Good Good Good Good

CQC inspections

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CQC inspections

7

Practice DetailsDates of CQC Inspection

or Annual Regulatory Review (ARR)CQC Ratings

Practice Code

Practice NameYear of

Inspection or ARR

Date of Inspection or

ARR

Date of Publication

CQC OVERALL Rating

SAFE Rating

EFFECTIVE Rating

CARING Rating

RESPONSIVE Rating

WELL-LED Rating

H83030 Broom Road Medical Practice 2017-18 25/07/17 12/09/17 Good Good Good Good Good Good

H83031 The Haling Park Partnership 2016-17 25/08/16 04/11/16 Good Good Good Good Good Good

H83033 Ashburton Park Medical Centre 2016-17 15/12/16 31/01/17 Good Good Good Good Good Good

H83034 The Whitehorse Practice 2015-16 31/03/16 24/08/16 Good Good Good Good Good Good

H83037 Auckland Surgery 2017-18 18/05/17 13/06/17 Good Good Good Good Good Good

H83039 Stovell House Surgery 2018-19 13/12/18 04/02/19 Good Good Good Good Good Good

H83040 Mitchley Avenue Surgery 2015-16 17/12/15 14/07/16Requires

mprovementRequires

ImprovementGood Good Good

Requires Improvement

H83042 Leander Road Primary Care Centre 2017-18 08/11/017 05/12/17 Good Good Good Good Good Good

H83043 Shirley Medical Centre 2018-19 23/01/19 22/03/19 Good Good Good Good Good Good

H83044 East Croydon Medical Practice 2018-19 05/09/18 14/11/18Requires

improvementGood


Good GoodRequires

Improvement

H83049 AT Medics Headley Drive Surgery 2016-17 11/08/16 24/02/17 Good Good Good Good Good Good

H83050 The Moorings Medical Practice 2017-18 11/05/17 13/06/17 Good Good Good Good Good Good

H83051 Thornton Road and Valley Park Surgery 2016-17 27/07/16 18/11/16 Good Good Good Good Good Good

H83052 Bramley Avenue Surgery 2017-18 25/04/17 25/05/17 Good Good Good Good Good Good

H83053 Parchmore Medical Centre 2016-17 10/05/17 07/06/17 Good Good Good Good Good Good

H83608 Brigstock Family Practice 2019-20 26/01/19 31/05/19 Good Good Good Good Good Good

H83609 Mersham Medical Centre 2019-20 03/07/19 16/08/19 Good Good Good Good Good Good

H83611 Selhurst Medical Centre 2016-17 05/05/16 24/06/16 Good Good Good Good Outstanding Good

H83624 Fairview Medical Centre 2017-18 24/05/17 27/06/17 Good Good Good Good Good Good

H83625 Broughton Corner Medical Centre 2016-17 17/06/16 05/12/16 Good Good Good Good Good Good

H83627 The Birdhurst Medical Practice 2018-19 12/12/18 08/02/19 Good Good Good Good Good Good

H83631 Greenside Group Practice 2019-20 08/05/19 12/07/19Requires

improvementRequires

ImprovementRequires


Y02962 Edridge Road Community Health Centre 2018-19 02/08/18 23/10/18 Inadequate Good InadequateRequires

ImprovementInadequate Inadequate

Y05317 Country Park Practice 2019-20 08/05/19 12/07/19Requires

improvementRequires

ImprovementRequires


Y05318 Denmark Road Surgery 2019-20 23/10/19 10/12/19Requires

improvementRequires

ImprovementRequires

ImprovementGood Good


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SWL Primary Care Contracting Team

Email : [email protected]

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE (PART 1)

Tuesday 3rd March 2020

Title of Paper: 2019 GP Patient Survey

Lead Director William Cunningham-Davis Head of Primary Care Commissioning SW London Primary Care

Report Author SWL Primary Care Team


Primary Care Working Group



Purpose of Report For Noting

Recommendation:

The Primary Care Commissioning Committee is asked to note the following: 1. 2019 Croydon CCG GP Patient Survey – SWL Primary Care Team 2. 2019 SWL GP Patient Survey – NHSE/I Patient and Public Voice Team

Background:

The 2019 GP Patient Survey results were published by Ipsos Mori in July 2019. 1. The SWL Primary Care Team undertook a review of the 2019/20 GP Patient Survey for

Croydon CCG (Appendix 1a). The slides provide a comparison against 2018 achievement and the SWL & NHS England averages, for a sample of the questions. Appendix 1b provides breakdown of the 2019 survey results for Croydon CCG published by Ipsos Mori.

2. The Patient and Public Voice Team at NHS England & Improvement have recently undertaken a review of the 2019 GP Patient Survey Results. Appendix 2 provides a copy of their review for South West London. This is the first time the team have undertaken this work, and currently the slides remain unpublished.

Key Issues:

n/a

Governance:

Corporate Objective To commission integrated, safe, high quality service in the right place at the right time.

Risks

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n/a


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Clinical Leadership Comments n/a


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Equality Analysis

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n/a

Communication Plan n/a


n/a

Reputational Issues

Need to ensure the best possible GP services to patients registered with this practice – adverse CQC reports could potentially erode confidence in services in this practice.

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Recommendation The Primary Care Commissioning Committee is asked to note the attached reviews of the 2019 GP Patient Survey. SW London Primary Care Team [email protected] 26th February 2020

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GP Patient Survey 2019

Croydon CCG

Summary Report

SWL Primary Care Team

October 2019

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Contents

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No. Section Slide no.

1 Introduction 3

2 Background to GP patient Survey 4

3 Section1: CCG results 5

4 Section 2: Practice achievement against SWL and England averages 6 – 16

5 Section 3: Practice rankings 17 – 18

6 Summary 19

7 Further information 20

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Introduction

The 2019 GP Patient Safety results were published in July 2019. This summary report provides some further detail and comparable results to help inform the CCG for planning work with practices to address any concerns and to develop action plans in order to improve patient satisfaction.

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Background to the GP Patient Survey

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices.

Ipsos MORI administers the survey on behalf of NHS England.

This slide pack presents some of the key results for NHS Croydon CCG.

The data in this slide pack are based on the July 2019 GPPS publication. In contrast to previous years when the survey was carried out across two

waves, the GPPS now consists of a single wave of fieldwork carried out annually, from January 2019 to March 2019. However, the sample size

has remained similar, continuing to provide practice-level data.

In NHS Croydon CCG, 19,992 questionnaires were sent out, and 5,481 were returned completed. This represents a response rate of 27% (-0.6%

from the previous year).

Prior to 2015 these slide packs presented Area Team averages for each CCG. These are no longer included following the integration of Area Teams

into the four existing Regional Teams. However, CCGs can still see how their results compare to those of other local CCGs.

The GP Patient Survey measures patients’ experiences across a range of topics.

The GP Patient Survey provides data at practice level using a consistent methodology, which means it is comparable across organisations and over

time.

The survey has limitations:

Some of the questions were changed following the 2017 survey. This 2019 summary report provides a sample of the questions, with

comparisons to the 2018 survey results.

Sample sizes at practice level are relatively small.

The survey does not include qualitative data which limits the detail provided by the results.

The data are provided once a year rather than in real time.

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Section 1: CCG results

5

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Overall experience of GPSurgery

Ease of getting through toGP surgery

How satisfied are you withthe general practice

appointment times thatare available to you?

Overall experience ofmaking an appointment

How long after yourappointment did you wait

to see or speak to thehealthcare professional (15

mins or less)

Did you have confidenceand trust in the healthcare

professional you saw orspoke to?

In the past 12 months haveyou contacted an NHS

service when you wantedto see a GP but your GP

practice was closed?

How helpful do you findthe receptionists at your

GP practice

Croydon CCG 2019 achievement comparison against SWL and England averages

Croydon 2019 SWL 2019 England 2019

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Section 2: Practice achievement against SWL and England averages

• The following slides provide a comparison against the 2018 and 2019 practice achievement, against 2019 SWL and England averages, for the following eight questions of the GP Patient Survey:

• Overall experience of GP surgery

• Ease of getting through to GP surgery

• How satisfied are you with the general practice appointment times that are available to you?

• Overall experience of making an appointment

• How long after your appointment did you wait to see or speak to the healthcare professional (15 minutes or less)

• Did you have confidence and trust in the healthcare professional you saw or spoke to?

• In the past 12 months have you contacted an NHS service when you wanted to see a GP but your GP practice was closed?

• How helpful do you find the receptionists at your GP practice?

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7

Practice code Practice name Overall experience of GP Surgery Ease of getting through to GP surgery

How satisfied are you with the general practice appointment

times that are available to you? Overall experience of making an appointment

2018 CCG England 2019 CCG England 2018 CCG England 2019CCG England 2018 CCG England 2019 CCG England 2018CCG England 2019CCG England

H83001 PORTLAND MEDICAL CENTRE 72% 83% 84% 64% 82% 83% 46% 71% 70% 36% 72% 68% 51% 67% 66% 55% 67% 65% 41% 71% 69% 44% 70% 67%

H83004 THE FARLEY ROAD MEDICAL PRACTICE 92% 83% 84% 92% 82% 83% 91% 71% 70% 94% 72% 68% 82% 67% 66% 85% 67% 65% 90% 71% 69% 93% 70% 67%

H83005 UPPER NORWOOD GROUP PRACTICE 93% 83% 84% 92% 82% 83% 93% 71% 70% 92% 72% 68% 88% 67% 66% 85% 67% 65% 96% 71% 69% 92% 70% 67%

H83006 PARKWAY HEALTH CENTRE (02) 77% 83% 84% 83% 82% 83% 76% 71% 70% 78% 72% 68% 78% 67% 66% 80% 67% 65% 74% 71% 69% 80% 70% 67%

H83007 VIOLET LANE MEDICAL PRACTICE 83% 83% 84% 80% 82% 83% 66% 71% 70% 76% 72% 68% 62% 67% 66% 72% 67% 65% 69% 71% 69% 73% 70% 67%

H83008 THE ADDISCOMBE SURGERY 84% 83% 84% 83% 82% 83% 84% 71% 70% 82% 72% 68% 61% 67% 66% 75% 67% 65% 68% 71% 69% 72% 70% 67%

H83009 NORBURY HEALTH CENTRE (02) 82% 83% 84% 78% 82% 83% 72% 71% 70% 69% 72% 68% 68% 67% 66% 70% 67% 65% 69% 71% 69% 72% 70% 67%

H83010 SOUTH NORWOOD HILL MEDICAL CENTRE 95% 83% 84% 84% 82% 83% 89% 71% 70% 66% 72% 68% 50% 67% 66% 59% 67% 65% 72% 71% 69% 49% 70% 67%

H83011 NORTH CROYDON MEDICAL CENTRE 65% 83% 84% 73% 82% 83% 43% 71% 70% 61% 72% 68% 37% 67% 66% 66% 67% 65% 36% 71% 69% 61% 70% 67%

H83012 ST.JAMES'S MEDICAL CENTRE 82% 83% 84% 74% 82% 83% 74% 71% 70% 70% 72% 68% 67% 67% 66% 53% 67% 65% 74% 71% 69% 56% 70% 67%

H83013 OLD COULSDON MEDICAL PRACTICE 95% 83% 84% 95% 82% 83% 90% 71% 70% 78% 72% 68% 80% 67% 66% 82% 67% 65% 93% 71% 69% 80% 70% 67%

H83014 QUEENHILL MEDICAL PRACTICE 95% 83% 84% 97% 82% 83% 95% 71% 70% 96% 72% 68% 80% 67% 66% 94% 67% 65% 90% 71% 69% 96% 70% 67%

H83015 PARKSIDE GROUP PRACTICE 93% 83% 84% 97% 82% 83% 74% 71% 70% 89% 72% 68% 69% 67% 66% 85% 67% 65% 75% 71% 69% 82% 70% 67%

H83016 KESTON MEDICAL PRACTICE 80% 83% 84% 81% 82% 83% 55% 71% 70% 52% 72% 68% 62% 67% 66% 68% 67% 65% 60% 71% 69% 55% 70% 67%

H83017 BRIGSTOCK & SOUTH NORWOOD PARTNERSHIP 82% 83% 84% 74% 82% 83% 65% 71% 70% 64% 72% 68% 74% 67% 66% 64% 67% 65% 71% 71% 69% 68% 70% 67%

H83018 SELSDON PARK MEDICAL PRACTICE 94% 83% 84% 95% 82% 83% 90% 71% 70% 91% 72% 68% 87% 67% 66% 94% 67% 65% 90% 71% 69% 90% 70% 67%

H83019 FRIENDS ROAD MEDICAL PRACTICE 77% 83% 84% 78% 82% 83% 80% 71% 70% 79% 72% 68% 63% 67% 66% 61% 67% 65% 60% 71% 69% 62% 70% 67%

H83020 EVERSLEY MEDICAL CENTRE 74% 83% 84% 76% 82% 83% 53% 71% 70% 54% 72% 68% 51% 67% 66% 68% 67% 65% 60% 71% 69% 62% 70% 67%

H83021 LONDON ROAD MEDICAL PRACTICE 75% 83% 84% 80% 82% 83% 73% 71% 70% 82% 72% 68% 50% 67% 66% 62% 67% 65% 57% 71% 69% 67% 70% 67%

H83022 THORNTON HEATH HEALTH CENTRE 82% 83% 84% 82% 82% 83% 68% 71% 70% 64% 72% 68% 61% 67% 66% 73% 67% 65% 64% 71% 69% 71% 70% 67%

H83023 MORLAND ROAD SURGERY 86% 83% 84% 80% 82% 83% 65% 71% 70% 64% 72% 68% 57% 67% 66% 70% 67% 65% 59% 71% 69% 62% 70% 67%

H83024 WOODCOTE MEDICAL 82% 83% 84% 78% 82% 83% 75% 71% 70% 72% 72% 68% 62% 67% 66% 68% 67% 65% 71% 71% 69% 61% 70% 67%


H83028 ADDINGTON MEDICAL PRACTICE 92% 83% 84% 98% 82% 83% 99% 71% 70% 97% 72% 68% 79% 67% 66% 85% 67% 65% 88% 71% 69% 94% 70% 67%

H83029 HARTLAND WAY SURGERY 85% 83% 84% 87% 82% 83% 85% 71% 70% 81% 72% 68% 67% 67% 66% 81% 67% 65% 73% 71% 69% 75% 70% 67%

H83030 BROOM ROAD MEDICAL PRACTICE 76% 83% 84% 85% 82% 83% 80% 71% 70% 84% 72% 68% 57% 67% 66% 75% 67% 65% 80% 71% 69% 74% 70% 67%

H83031 THE HALING PARK PARTNERSHIP 76% 83% 84% 85% 82% 83% 82% 71% 70% 77% 72% 68% 60% 67% 66% 69% 67% 65% 58% 71% 69% 69% 70% 67%

H83033 ASHBURTON PARK MEDICAL CENTRE 84% 83% 84% 89% 82% 83% 77% 71% 70% 74% 72% 68% 71% 67% 66% 80% 67% 65% 75% 71% 69% 80% 70% 67%

H83034 THE WHITEHORSE PRACTICE 74% 83% 84% 62% 82% 83% 66% 71% 70% 53% 72% 68% 57% 67% 66% 51% 67% 65% 57% 71% 69% 57% 70% 67%

H83037 AUCKLAND SURGERY 97% 83% 84% 93% 82% 83% 93% 71% 70% 94% 72% 68% 74% 67% 66% 84% 67% 65% 81% 71% 69% 81% 70% 67%

H83039 STOVELL HOUSE SURGERY 93% 83% 84% 94% 82% 83% 95% 71% 70% 90% 72% 68% 89% 67% 66% 83% 67% 65% 84% 71% 69% 83% 70% 67%

H83040 MITCHLEY AVENUE SURGERY 99% 83% 84% 99% 82% 83% 95% 71% 70% 92% 72% 68% 95% 67% 66% 99% 67% 65% 92% 71% 69% 96% 70% 67%

H83042 LEANDER ROAD SURGERY 83% 83% 84% 85% 82% 83% 54% 71% 70% 51% 72% 68% 58% 67% 66% 71% 67% 65% 55% 71% 69% 60% 70% 67%

H83043 SHIRLEY MEDICAL CENTRE 84% 83% 84% 81% 82% 83% 95% 71% 70% 84% 72% 68% 76% 67% 66% 74% 67% 65% 68% 71% 69% 69% 70% 67%

H83044 EAST CROYDON MEDICAL CENTRE 81% 83% 84% 77% 82% 83% 80% 71% 70% 57% 72% 68% 52% 67% 66% 66% 67% 65% 67% 71% 69% 59% 70% 67%

H83049 HEADLEY DRIVE SURGERY 91% 83% 84% 88% 82% 83% 83% 71% 70% 90% 72% 68% 86% 67% 66% 93% 67% 65% 87% 71% 69% 91% 70% 67%

H83050 THE MOORINGS MEDICAL PRACTICE 94% 83% 84% 94% 82% 83% 93% 71% 70% 87% 72% 68% 71% 67% 66% 86% 67% 65% 88% 71% 69% 81% 70% 67%

H83051 THORNTON & VALLEY PARK SURGERY 93% 83% 84% 83% 82% 83% 82% 71% 70% 84% 72% 68% 82% 67% 66% 71% 67% 65% 80% 71% 69% 71% 70% 67%

H83052 BRAMLEY AVENUE SURGERY 98% 83% 84% 94% 82% 83% 98% 71% 70% 92% 72% 68% 85% 67% 66% 77% 67% 65% 95% 71% 69% 80% 70% 67%

H83053 PARCHMORE MEDICAL CENTRE 70% 83% 84% 81% 82% 83% 38% 71% 70% 48% 72% 68% 61% 67% 66% 73% 67% 65% 57% 71% 69% 55% 70% 67%

H83608 BRIGSTOCK FAMILY PRACTICE 84% 83% 84% 61% 82% 83% 68% 71% 70% 45% 72% 68% 55% 67% 66% 63% 67% 65% 64% 71% 69% 48% 70% 67%

H83609 MERSHAM MEDICAL CENTRE 98% 83% 84% 96% 82% 83% 90% 71% 70% 89% 72% 68% 75% 67% 66% 83% 67% 65% 88% 71% 69% 82% 70% 67%

H83611 SELHURST MEDICAL PRACTICE 89% 83% 84% 88% 82% 83% 89% 71% 70% 94% 72% 68% 76% 67% 66% 84% 67% 65% 75% 71% 69% 84% 70% 67%

H83624 FAIRVIEW MEDICAL CENTRE 87% 83% 84% 88% 82% 83% 91% 71% 70% 94% 72% 68% 77% 67% 66% 88% 67% 65% 82% 71% 69% 82% 70% 67%

H83625 BROUGHTON CORNER MEDICAL CENTRE 59% 83% 84% 67% 82% 83% 36% 71% 70% 46% 72% 68% 48% 67% 66% 56% 67% 65% 34% 71% 69% 49% 70% 67%

H83627 BIRDHURST MEDICAL PRACTICE 94% 83% 84% 87% 82% 83% 93% 71% 70% 91% 72% 68% 70% 67% 66% 75% 67% 65% 77% 71% 69% 79% 70% 67%

H83631 GREENSIDE MEDICAL PRACTICE 76% 83% 84% 74% 82% 83% 64% 71% 70% 62% 72% 68% 55% 67% 66% 68% 67% 65% 57% 71% 69% 53% 70% 67%

Y02962 THE PRACTICE SURGERIES LTD 60% 83% 84% 43% 82% 83% 34% 71% 70% 18% 72% 68% 65% 67% 66% 43% 67% 65% 43% 71% 69% 29% 70% 67%

Y05317 COUNTRY PARK PRACTICE 73% 83% 84% 77% 82% 83% 54% 71% 70% 55% 72% 68% 59% 67% 66% 61% 67% 65% 60% 71% 69% 57% 70% 67%

Y05318 DENMARK ROAD SURGERY 77% 83% 84% 85% 82% 83% 53% 71% 70% 62% 72% 68% 58% 67% 66% 81% 67% 65% 58% 71% 69% 70% 70% 67%

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Practice code Practice name

How long after your appointment did you wait to see or speak

to the healthcare professional (15 mins or less)

Did you have confidence and trust in the healthcare professional

you saw or spoke to?

In the past 12 months have you contacted an NHS service

when you wanted to see a GP but your GP practice was

closed? How helpful do you find the receptionists at your GP practice

2018CCG England 2019CCG England 2018CCG England 2019CCG England 2018CCG England 2019CCG England 2018CCG England 2019CCG England

H83001 PORTLAND MEDICAL CENTRE 43% 57% 69% 40% 68% 69% 90% 92% 96% 87% 94% 95% 26% 22% 23% 22% 23% 23% 82% 86% 90% 75% 89% 89%

H83004 THE FARLEY ROAD MEDICAL PRACTICE 81% 57% 69% 89% 68% 69% 96% 92% 96% 95% 94% 95% 14% 22% 23% 18% 23% 23% 98% 86% 90% 98% 89% 89%

H83005 UPPER NORWOOD GROUP PRACTICE 77% 57% 69% 80% 68% 69% 96% 92% 96% 96% 94% 95% 7% 22% 23% 16% 23% 23% 97% 86% 90% 95% 89% 89%


H83007 VIOLET LANE MEDICAL PRACTICE 84% 57% 69% 80% 68% 69% 96% 92% 96% 94% 94% 95% 23% 22% 23% 25% 23% 23% 80% 86% 90% 92% 89% 89%

H83008 THE ADDISCOMBE SURGERY 68% 57% 69% 67% 68% 69% 94% 92% 96% 96% 94% 95% 22% 22% 23% 25% 23% 23% 86% 86% 90% 91% 89% 89%

H83009 NORBURY HEALTH CENTRE (02) 68% 57% 69% 65% 68% 69% 95% 92% 96% 88% 94% 95% 20% 22% 23% 28% 23% 23% 94% 86% 90% 94% 89% 89%

H83010 SOUTH NORWOOD HILL MEDICAL CENTRE 58% 57% 69% 54% 68% 69% 100% 92% 96% 100% 94% 95% 18% 22% 23% 22% 23% 23% 94% 86% 90% 90% 89% 89%

H83011 NORTH CROYDON MEDICAL CENTRE 33% 57% 69% 35% 68% 69% 87% 92% 96% 96% 94% 95% 21% 22% 23% 19% 23% 23% 62% 86% 90% 88% 89% 89%

H83012 ST.JAMES'S MEDICAL CENTRE 69% 57% 69% 57% 68% 69% 98% 92% 96% 89% 94% 95% 26% 22% 23% 21% 23% 23% 95% 86% 90% 91% 89% 89%

H83013 OLD COULSDON MEDICAL PRACTICE 78% 57% 69% 68% 68% 69% 97% 92% 96% 98% 94% 95% 16% 22% 23% 21% 23% 23% 98% 86% 90% 99% 89% 89%

H83014 QUEENHILL MEDICAL PRACTICE 86% 57% 69% 89% 68% 69% 99% 92% 96% 98% 94% 95% 12% 22% 23% 19% 23% 23% 97% 86% 90% 99% 89% 89%

H83015 PARKSIDE GROUP PRACTICE 77% 57% 69% 78% 68% 69% 99% 92% 96% 99% 94% 95% 23% 22% 23% 29% 23% 23% 95% 86% 90% 95% 89% 89%

H83016 KESTON MEDICAL PRACTICE 69% 57% 69% 82% 68% 69% 93% 92% 96% 96% 94% 95% 19% 22% 23% 25% 23% 23% 87% 86% 90% 87% 89% 89%

H83017 BRIGSTOCK & SOUTH NORWOOD PARTNERSHIP 66% 57% 69% 75% 68% 69% 93% 92% 96% 88% 94% 95% 23% 22% 23% 12% 23% 23% 81% 86% 90% 85% 89% 89%

H83018 SELSDON PARK MEDICAL PRACTICE 71% 57% 69% 79% 68% 69% 97% 92% 96% 98% 94% 95% 13% 22% 23% 16% 23% 23% 98% 86% 90% 98% 89% 89%

H83019 FRIENDS ROAD MEDICAL PRACTICE 72% 57% 69% 72% 68% 69% 95% 92% 96% 93% 94% 95% 27% 22% 23% 28% 23% 23% 89% 86% 90% 83% 89% 89%

H83020 EVERSLEY MEDICAL CENTRE 55% 57% 69% 65% 68% 69% 91% 92% 96% 94% 94% 95% 28% 22% 23% 33% 23% 23% 85% 86% 90% 85% 89% 89%

H83021 LONDON ROAD MEDICAL PRACTICE 52% 57% 69% 57% 68% 69% 92% 92% 96% 94% 94% 95% 29% 22% 23% 25% 23% 23% 71% 86% 90% 78% 89% 89%

H83022 THORNTON HEATH HEALTH CENTRE 69% 57% 69% 79% 68% 69% 97% 92% 96% 97% 94% 95% 20% 22% 23% 22% 23% 23% 83% 86% 90% 86% 89% 89%

H83023 MORLAND ROAD SURGERY 53% 57% 69% 58% 68% 69% 98% 92% 96% 100% 94% 95% 25% 22% 23% 32% 23% 23% 87% 86% 90% 80% 89% 89%

H83024 WOODCOTE MEDICAL 47% 57% 69% 64% 68% 69% 97% 92% 96% 90% 94% 95% 19% 22% 23% 20% 23% 23% 87% 86% 90% 89% 89% 89%


H83028 ADDINGTON MEDICAL PRACTICE 80% 57% 69% 83% 68% 69% 98% 92% 96% 99% 94% 95% 18% 22% 23% 22% 23% 23% 97% 86% 90% 93% 89% 89%

H83029 HARTLAND WAY SURGERY 79% 57% 69% 78% 68% 69% 93% 92% 96% 98% 94% 95% 19% 22% 23% 19% 23% 23% 91% 86% 90% 95% 89% 89%

H83030 BROOM ROAD MEDICAL PRACTICE 54% 57% 69% 56% 68% 69% 92% 92% 96% 95% 94% 95% 23% 22% 23% 21% 23% 23% 87% 86% 90% 89% 89% 89%

H83031 THE HALING PARK PARTNERSHIP 66% 57% 69% 75% 68% 69% 92% 92% 96% 98% 94% 95% 24% 22% 23% 21% 23% 23% 84% 86% 90% 85% 89% 89%

H83033 ASHBURTON PARK MEDICAL CENTRE 57% 57% 69% 77% 68% 69% 98% 92% 96% 97% 94% 95% 24% 22% 23% 19% 23% 23% 86% 86% 90% 95% 89% 89%

H83034 THE WHITEHORSE PRACTICE 56% 57% 69% 63% 68% 69% 92% 92% 96% 91% 94% 95% 27% 22% 23% 34% 23% 23% 86% 86% 90% 81% 89% 89%

H83037 AUCKLAND SURGERY 83% 57% 69% 90% 68% 69% 93% 92% 96% 96% 94% 95% 16% 22% 23% 19% 23% 23% 96% 86% 90% 95% 89% 89%

H83039 STOVELL HOUSE SURGERY 71% 57% 69% 73% 68% 69% 93% 92% 96% 94% 94% 95% 17% 22% 23% 16% 23% 23% 95% 86% 90% 96% 89% 89%

H83040 MITCHLEY AVENUE SURGERY 84% 57% 69% 86% 68% 69% 98% 92% 96% 99% 94% 95% 10% 22% 23% 21% 23% 23% 99% 86% 90% 100% 89% 89%

H83042 LEANDER ROAD SURGERY 43% 57% 69% 43% 68% 69% 90% 92% 96% 98% 94% 95% 33% 22% 23% 26% 23% 23% 89% 86% 90% 89% 89% 89%

H83043 SHIRLEY MEDICAL CENTRE 56% 57% 69% 48% 68% 69% 90% 92% 96% 93% 94% 95% 19% 22% 23% 28% 23% 23% 96% 86% 90% 89% 89% 89%

H83044 EAST CROYDON MEDICAL CENTRE 71% 57% 69% 75% 68% 69% 97% 92% 96% 96% 94% 95% 29% 22% 23% 30% 23% 23% 89% 86% 90% 78% 89% 89%

H83049 HEADLEY DRIVE SURGERY 87% 57% 69% 83% 68% 69% 95% 92% 96% 90% 94% 95% 21% 22% 23% 20% 23% 23% 92% 86% 90% 95% 89% 89%

H83050 THE MOORINGS MEDICAL PRACTICE 79% 57% 69% 78% 68% 69% 93% 92% 96% 98% 94% 95% 13% 22% 23% 33% 23% 23% 92% 86% 90% 94% 89% 89%

H83051 THORNTON & VALLEY PARK SURGERY 60% 57% 69% 65% 68% 69% 95% 92% 96% 93% 94% 95% 19% 22% 23% 30% 23% 23% 93% 86% 90% 91% 89% 89%

H83052 BRAMLEY AVENUE SURGERY 81% 57% 69% 84% 68% 69% 99% 92% 96% 99% 94% 95% 28% 22% 23% 36% 23% 23% 97% 86% 90% 93% 89% 89%

H83053 PARCHMORE MEDICAL CENTRE 51% 57% 69% 49% 68% 69% 94% 92% 96% 96% 94% 95% 21% 22% 23% 19% 23% 23% 78% 86% 90% 76% 89% 89%

H83608 BRIGSTOCK FAMILY PRACTICE 62% 57% 69% 61% 68% 69% 95% 92% 96% 90% 94% 95% 19% 22% 23% 24% 23% 23% 91% 86% 90% 77% 89% 89%

H83609 MERSHAM MEDICAL CENTRE 76% 57% 69% 81% 68% 69% 100% 92% 96% 99% 94% 95% 22% 22% 23% 28% 23% 23% 98% 86% 90% 91% 89% 89%

H83611 SELHURST MEDICAL PRACTICE 60% 57% 69% 68% 68% 69% 99% 92% 96% 98% 94% 95% 13% 22% 23% 15% 23% 23% 94% 86% 90% 94% 89% 89%

H83624 FAIRVIEW MEDICAL CENTRE 68% 57% 69% 72% 68% 69% 91% 92% 96% 91% 94% 95% 22% 22% 23% 26% 23% 23% 87% 86% 90% 90% 89% 89%

H83625 BROUGHTON CORNER MEDICAL CENTRE 48% 57% 69% 76% 68% 69% 95% 92% 96% 93% 94% 95% 25% 22% 23% 27% 23% 23% 60% 86% 90% 87% 89% 89%

H83627 BIRDHURST MEDICAL PRACTICE 89% 57% 69% 83% 68% 69% 100% 92% 96% 99% 94% 95% 21% 22% 23% 15% 23% 23% 87% 86% 90% 94% 89% 89%

H83631 GREENSIDE MEDICAL PRACTICE 63% 57% 69% 56% 68% 69% 93% 92% 96% 91% 94% 95% 28% 22% 23% 17% 23% 23% 83% 86% 90% 76% 89% 89%

Y02962 THE PRACTICE SURGERIES LTD 54% 57% 69% 44% 68% 69% 83% 92% 96% 86% 94% 95% 31% 22% 23% 40% 23% 23% 76% 86% 90% 58% 89% 89%

Y05317 COUNTRY PARK PRACTICE 48% 57% 69% 51% 68% 69% 99% 92% 96% 91% 94% 95% 24% 22% 23% 30% 23% 23% 73% 86% 90% 95% 89% 89%

Y05318 DENMARK ROAD SURGERY 45% 57% 69% 53% 68% 69% 95% 92% 96% 96% 94% 95% 27% 22% 23% 29% 23% 23% 82% 86% 90% 95% 89% 89%

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

40%

50%

60%

70%

80%

90%

100%

PO

RTL

AN

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CEN

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AL

PR

AC

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FAIR

VIE

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AL

CEN

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BR

OU

GH

TON

CO

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AL

CEN

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BIR

DH

UR

ST M

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AL

PR

AC

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GR

EEN

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EDIC

AL

PR

AC

TIC

E

THE

PR

AC

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E SU

RG

ERIE

S LT

D

CO

UN

TRY

PA

RK

PR

AC

TIC

E

DEN

MA

RK

RO

AD

SU

RG

ERY

Overall experience of GP Surgery

2018 2019 CCG England

9

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ease of getting through to GP surgery


10

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

30%

40%

50%

60%

70%

80%

90%

100%

How satisfied are you with the general practice appointment times that are available to you?


11

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Overall experience of making an appointment


12

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

30%

40%

50%

60%

70%

80%

90%

100%

PO

RTL

AN

D M

EDIC

AL

CEN

TRE

THE

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MED

ICA

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RC

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BR

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PR

AC

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MER

SHA

M M

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AL

CEN

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SELH

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PR

AC

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FAIR

VIE

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CEN

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BR

OU

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DEN

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ERY

How long after your appointment did you wait to see or speak to the healthcare professional (15 minutes or less)


13

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

75%

80%

85%

90%

95%

100%

Did you have confidence and trust in the healthcare professional you saw or spoke to?


14

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

PO

RTL

AN

D M

EDIC

AL

CEN

TRE

THE

FAR

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AD

MED

ICA

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ALL

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PA

RC

HM

OR

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AL

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BR

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OC

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AM

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PR

AC

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MER

SHA

M M

EDIC

AL

CEN

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SELH

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AL

PR

AC

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E

FAIR

VIE

W M

EDIC

AL

CEN

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BR

OU

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TON

CO

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CEN

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BIR

DH

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PR

AC

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AL

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AC

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DEN

MA

RK

RO

AD

SU

RG

ERY

In the past 12 months have you contacted an NHS service when you wanted to see a GP but your GP practice was closed?


15

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

PO

RTL

AN

D M

EDIC

AL

CEN

TRE

THE

FAR

LEY

RO

AD

MED

ICA

L P

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PR

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RG

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NO

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SOU

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L C

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CR

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MED

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L C

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Y D

RIV

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RG

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THE

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OR

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S M

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AL

PR

AC

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THO

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TON

& V

ALL

EY P

AR

K S

UR

GER

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BR

AM

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AV

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E SU

RG

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PA

RC

HM

OR

E M

EDIC

AL

CEN

TRE

BR

IGST

OC

K F

AM

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PR

AC

TIC

E

MER

SHA

M M

EDIC

AL

CEN

TRE

SELH

UR

ST M

EDIC

AL

PR

AC

TIC

E

FAIR

VIE

W M

EDIC

AL

CEN

TRE

BR

OU

GH

TON

CO

RN

ER M

EDIC

AL

CEN

TRE

BIR

DH

UR

ST M

EDIC

AL

PR

AC

TIC

E

GR

EEN

SID

E M

EDIC

AL

PR

AC

TIC

E

THE

PR

AC

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E SU

RG

ERIE

S LT

D

CO

UN

TRY

PA

RK

PR

AC

TIC

E

DEN

MA

RK

RO

AD

SU

RG

ERY

How helpful do you find the receptionists at your GP practice


16

Enc

6 A

p1a

2019

Cro

ydon

Pt s

umm

ary

of 233

Section 3: Practice rankings

17

Five lowest ranking practices Top five ranking practices

Data collection - 2019 survey Lowest 2nd 3rd 4th 5th 5th highest 4th 3rd 2nd Highest

Overall experience of GP Surgery

Y02962

Edridge Road

H83608 Brigstock

Family

H83034

Whitehorse

H83001

Portland

H83625

Broughton

Corner

H83609

Mersham

H83015

Parkside

H83014

Queenhill

H83028

Addington

H83040

Mitchley

Avenue

Ease of getting through to GP surgery

Y02962

Edridge Road H83001 Portland

H83608

Brigstock

Family

H83625

Broughton

Corner

H83053

Parchmore

H83611

Selhurst

H83624

Fairview

H83027

Parkway

H83014

Queenhill

H83028

Addington

How satisfied are you with the general practice

appointment times that are available to you?

Y02962

Edridge Road

H83034

Whitehorse

H83012 St

James

H83001

Portland

H83625

Broughton

Corner

H83624

Fairview

H83049

Headley

H83018

Selsdon

H83014

Queenhill

H83040

Mitchley

Avenue


Y02962


H83608

Brigstock

Family

H83625

Broughton

Corner

H83010 South

Norwood

H83005 Upper

Norwood

H83004

Farley Road

H83028

Addington

H83014

Queenhill

H83040

Mitchley

Avenue

How long after your appointment did you wait to see

or speak to the healthcare professional (15 mins or

less)

H83011 North

Croydon H83001 Portland

H83042

Leander

Y02962

Edridge Road

H83043

Shirley

H83052

Bramley

H83040

Mitchley

Avenue

H83004 Farley

Road

H83014

Queenhill

H83037

Auckland

Did you have confidence and trust in the healthcare

professional you saw or spoke to?

Y02962


H83009

Norbury

H83017

Brigstock

South

Norwood

H83012 St

James

H83052

Bramley

H83609

Mersham

H83627

Birdhurst

H83010 South

Norwood

H83023

Morland

In the past 12 months have you contacted an NHS

service when you wanted to see a GP but your GP

practice was closed?

Y02962

Edridge Road H83052 Bramley

H83034

Whitehorse

H83020

Eversley

H83050

Moorings

H83005 Upper

Norwood

H83006

Parkway

H83627

Birdhurst

H83611

Selhurst

H83017

Brigstock

South

Norwood

How helpful do you find the receptionists at your GP

practice

Y02962


H83053

Parchmore

H83631

Greenside

H83608

Brigstock

Family

H83018

Selsdon

H83004

Farley Road

H83014

Queenhill

H83013 Old

Coulsdon

H83040

Mitchley

Avenue

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Practices in bottom five (no. of times) No. Practices in top five (no. of times) No.

Edridge Road Community Health Centre 8 Queenhill Medical Practice 6

Portland Medical Centre 7 Mitchley Avenue Surgery 5

Brigstock Family Practice 4 The Farley Road Surgery 3

Broughton Corner Medical Centre 4 Addington Medical Practice 3

The Whitehorse Practice 3 Upper Norwood Group Practice 2

St James' Medical Practice 2 The Selsdon Park Medical Practice 2

Parchmore Medical Centre 2 Bramley Avenue Surgery 2

Norbury Health Centre 1 Mersham Medical Centre 2

South Norwood Hill Medical Centre 1 Selhurst Medical Centre 2

North Croydon Medical Centre 1 Fairview Medical Centre 2

Brigstock and South Norwood Medical Partnership 1 The Birdhurst Medical Practice 2

Eversley Medical Practice 1 New Addington Group Practice 1

Leander Road Primary Care Centre 1 South Norwood Hill Medical Centre 1

Shirley Medical Centre 1 Old Coulsdon Medical Practice 1

The Moorings Medical Practice 1 Parkside Group Practice 1

Bramley Avenue Surgery 1 Brigstock and South Norwood Medical Partnership 1

Greenside Group Practice 1 Morland Road Surgery 1

Parkway Health Centre 1

Auckland Surgery 1

Headley Drive Surgery 1

Practices rated in the top/ bottom 5 rated practices (2019 Patient survey)

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Summary• Croydon CCG averages are below 2019 SWL average for seven out of the eight questions, and the same as the SWL average for patients who have contacted an

NHS Service in the last 12 months to see a GP but their practice was closed. However, they are above the 2019 England average for three out of the eight questions.

• Croydon CCG 2019 averages improved against the previous year for the following:

• Ease of getting through to GP surgery

• Length of time (15 minutes or less) at waiting to see or speak to the healthcare professional

• Confidence and trust in the healthcare professional they saw or spoke to

• Helpfulness of receptionists

• In the last 12 months had contacted an NHS Service when they wanted to see a GP but their GP practice was closed

• Two practices appear the most in the bottom five ranked practices - Edridge Road Community Health Centre (8 times) and Portland Medical Centre (7 times).

• Two practices appear most in the five top ranked practices – Queenhill Medical Practice (6 times) and Mitchley Avenue Surgery (5 times).

• Overall experience of GP Surgery: 22 practices achieved below CCG and England averages for 2019. 18 of these also achieved below average in 2018.

• Ease of getting through to the surgery: 18 practices achieved below CCG and England averages for 2019. 15 of these also achieved below average in 2018.

• Satisfaction with the general practice appointment times: 11 practices achieved below CCG and England averages for 2019. Eight of these also achieved below average in 2018.

• Overall experience of making an appointment: 18 practices achieved below CCG and England averages for 2019. 15 of these also achieved below average in 2018.

• Appointment wait time (15 minutes or less): 22 practices achieved below CCG and England averages for 2019. 14 of these also achieved below average in 2018.

• Confidence and trust: Two practices achieved 100% (three had achieved this in 2018). 18 practices achieved below CCG and England averages for 2019. Five of these also achieved below average for 2018.

• Practice was closed: 24 practices achieved above CCG and England averages for 2019. 12 of these also achieved above average in 2018.

• Helpfulness of receptionist: One practice achieved 100%. 17 practices achieved below CCG and England averages for 2019. 11 of these also achieved below average in 2018.

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Further information

The published data is available here on the NHS GP Patient Survey website:

https://www.gp-patient.co.uk/analysistool?trend=0

A copy of the Croydon CCG results slide pack has also been included with this summary report.

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2

Contents

Background, introduction and guidance

Overall experience of GP practice

Local GP services

Access to online services

Making an appointment

Perceptions of care at patients’ last appointment

Managing health conditions

Satisfaction with general practice appointment times

Services when GP practice is closed

Statistical reliability

Want to know more?

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3


Background, introduction

and guidance

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4

Background information about the survey

• The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level

data about patients’ experiences of their GP practices.

• Ipsos MORI administers the survey on behalf of NHS England.

• For more information about the survey please refer to the end of this slide pack or visit

https://gp-patient.co.uk/.

• This slide pack presents some of the key results for NHS CROYDON CCG.

• The data in this slide pack are based on the July 2019 GPPS publication.

• In NHS CROYDON CCG, 19,992 questionnaires were sent out, and 5,481 were

returned completed. This represents a response rate of 27%.

• In 2018 the questionnaire was redeveloped in response to significant changes to

primary care services as set out in the GP Forward View, and to provide a better

understanding of how local care services are supporting patients to live well, particularly

those with long-term care needs. The questionnaire (and past versions) can be found

here: https://gp-patient.co.uk/surveysandreports.

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5

Introduction

• The GP Patient Survey measures patients’ experiences across a range of topics, including:

- Your local GP services

- Making an appointment

- Your last appointment

- Overall experience

- Your health

- When your GP practice is closed

- NHS Dentistry

- Some questions about you

• The GP Patient Survey provides data at practice level using a consistent methodology, which means it is comparable across organisations.

• The survey has limitations:

- Sample sizes at practice level are relatively small.

- The survey does not include qualitative data which limits the detail provided by the results.

• The data provide a snapshot of patient experience at a given time, and are updated annually.

• Given the consistency of the survey across organisations, GPPS can be used as one element of evidence.

• It can be triangulated with other sources of feedback, such as feedback from Patient Participation Groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient journeys.

• This slide pack is intended to assist this triangulation of data. It aims to highlight where there may be a need for further exploration.

• Practices and CCGs can then discuss the findings further and triangulate them with other data – in order to identify potential improvements and highlight best practice.

• The following slide suggests ideas for how the data can be used to improve services.

• This pack includes trend data, beginning in 2018. Following the extensive changes to the questionnaire in 2018, all questions at CCG and practice level are not comparable prior to this year.

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6

Guidance on how to use the data

• Comparison of a CCG’s results against

the national average: this allows

benchmarking of the results to identify

whether the CCG is performing well,

poorly, or in line with others. The CCG may

wish to focus on areas where it compares

less favourably.

• Considering questions where there is a

larger range in responses among

practices or CCGs: this highlights areas

in which greater improvements may be

possible, as some CCGs or practices are

performing significantly better than others

nearby. The CCG may wish to focus on

areas with a larger range in the results.

• Comparison of practices’ results within

a CCG: this can identify practices within a

CCG that seem to be over-performing or

under-performing compared with others.

The CCG may wish to work with individual

practices: those that are performing

particularly well may be able to highlight

best practice, while those performing less

well may be able to improve their

performance.

The following suggest ideas for how the data in this slide pack can be used and interpreted to

improve GP services:

*Images used in this slide are for example purposes only

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Interpreting the results

• The number of participants answering (the base size) is stated for each question. The total

number of responses is shown at the bottom of each chart.

• All comparisons are indicative only. Differences may not be statistically significant

– particularly when comparing practices due to low numbers of responses.

• For guidance on statistical reliability, or for details of where you can get more information

about the survey, please refer to the end of this slide pack.

• Maps: CCG and practice-level results are also displayed on maps, with results split across

5 bands (or ‘quintiles’) in order to have a fairly even distribution at the national level of

CCGs/practices across each band.

• Trends:

- Latest / 2019: refers to the July 2019 publication (fieldwork January to March 2019)

- 2018: refers to the August 2018 publication (fieldwork January to March 2018)

• For further information on using the data please refer to the end of this slide pack.

*More than 0% but less than 0.5%

100%Where results do not sum to

100%, or where individual

responses (e.g. fairly good;

very good) do not sum to

combined responses

(e.g. very/fairly good) this is

due to rounding, or cases

where multiple responses

are allowed.

When fewer than 10 patients respond

In cases where fewer than 10

patients have answered a

question, the data have been

suppressed and results will

not appear within the charts.

This is to prevent individuals

and their responses being

identifiable in the data.

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8



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9

83%

7%


44%

38%

11%

4% Very good

Fairly good

Neither good nor poor

Fairly poor

Very poor

Q31. Overall, how would you describe your experience of your GP practice?

National

6%

Good

Poor

%Good = %Very good + %Fairly good

%Poor = %Very poor + %Fairly poor

Base: All those completing a questionnaire: National (760,037); CCG 2019 (5,393); CCG 2018 (5,628); Practice bases range from 68 to 136; CCG bases

range from 2,377 to 8,129

CCG’s results Comparison of results

82%Good

Poor

CCG

83 82

7 70

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor

CCG’s results over time

Practice range in CCG – % Good Local CCG range – % Good

Lowest

Performing

Highest

Performing

43% 99%

Lowest

Performing

Highest

Performing

74% 88%

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Overall experience:

how the CCG’s results compare to other local CCGs

Comparisons are indicative only: differences may not be statistically significant

74%

88%

Percentage of patients saying ‘good’

Base: All those completing a questionnaire: CCG bases range from 2,377 to 8,129 %Good = %Very good + %Fairly good


The CCG represented by this pack is highlighted in red

Results range from

to

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11

Overall experience:

how the CCG’s practices compare


Base: All those completing a questionnaire: Practice bases range from 68 to 136



Results range from

to

43%

99%


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Overall experience:


Percentage of patients saying ‘good’ CCGPractices National

Base: All those completing a questionnaire: National (760,037); CCG 2019 (5,393); Practice bases range from 68 to 136


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Overall experience:


Percentage of patients saying ‘good’ CCGPractices National



0%

10%

20%

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40%

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70%

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100%

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Local GP services

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25%

48%

18%

10%

Very easy

Fairly easy

Not very easy

Not at all easy

68%

28%

Ease of getting through to GP practice on the phone

Q1. Generally, how easy is it to get through to someone at your GP practice on the phone?

32%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (742,537); CCG 2019 (5,288); CCG 2018 (5,453); Practice bases range

from 64 to 137; CCG bases range from 2,324 to 7,930

72%Easy

Not easy

75 72

25 28

0

10

20

30

40

50

60

70

80

90

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2018 2019

% Easy % Not easy

%Easy = %Very easy + %Fairly easy

%Not easy = %Not very easy + %Not at all easy

Practice range in CCG – % Easy Local CCG range – % Easy

Lowest

Performing

Highest

Performing

18% 97%

Lowest

Performing

Highest

Performing

52% 83%

CCG’s results Comparison of resultsCCG’s results over time

NationalCCG

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Ease of getting through to GP practice on the phone:


Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Base: All those completing a questionnaire excluding ‘Haven’t tried’: National (742,537); CCG 2019 (5,288); Practice bases range from 64 to 137 %Easy = %Very easy + %Fairly easy



CCGPractices National

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0%

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ND

SU

RG

ER

Y

SE

LH

UR

ST

ME

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PR

AC

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E

FA

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IEW

ME

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CE

NT

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NH

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ON

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PR

AC

TIC

E



Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Base: All those completing a questionnaire excluding ‘Haven’t tried’: National (742,537); CCG 2019 (5,288); Practice bases range from 64 to 137 %Easy = %Very easy + %Fairly easy




Enc

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18

42%

46%

8%3%

Very helpful

Fairly helpful

Not very helpful

Not at all helpful

89%

11%

Helpfulness of receptionists at GP practice

Q2. How helpful do you find the receptionists at your GP practice?

11%

Helpful

Not helpful

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (5,349); CCG 2018 (5,543); Practice bases range


89%Helpful

Not helpful

89 89

11 110

10

20

30

40

50

60

70

80

90

100

2018 2019

% Helpful % Not helpful

%Helpful = %Very helpful + %Fairly helpful

%Not helpful = %Not very helpful + %Not at all helpful

Practice range in CCG – % Helpful Local CCG range – % Helpful

Lowest

Performing

Highest

Performing

58% 100%

Lowest

Performing

Highest

Performing

81% 92%


NationalCCG

Enc

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0%

10%

20%

30%

40%

50%

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Helpfulness of receptionists at GP practice:


Percentage of patients saying receptionists at the GP practice are ‘helpful’

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (5,349); Practice bases range from 66 to 136 %Helpful = %Very helpful + %Fairly helpful




Enc

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20

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DE

NM

AR

K R

OA

D S

UR

GE

RY

ST

OV

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US

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UR

GE

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TH

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QU

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NH

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MIT

CH

LE

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NU

E S

UR

GE

RY



Percentage of patients saying receptionists at the GP practice are ‘helpful’

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); CCG 2019 (5,349); Practice bases range from 66 to 136 %Helpful = %Very helpful + %Fairly helpful




Enc

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Enc

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49%

39%

16%

9%

34%

44%41%

15%

7%

40%

0

10

20

30

40

50

60

70

80

90

100

Bookingappointmentsonline

Ordering repeatprescriptionsonline

Accessing mymedical recordsonline

None of these Don't know

CCG

National

Awareness of online services


Pe

rce

nta

ge a

wa

re o

f o

nlin

e s

erv

ice

s o

ffe

red b

y

GP

pra

ctice


Q4. As far as you know, which of the following online services does your GP practice offer?

Practice range

within CCG

Enc

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Online service use

19%

13%

4%

74%

15% 16%

4%

76%

0

10

20

30

40

50

60

70

80

90

100

Booking appointmentsonline

Ordering repeatprescriptions online

Accessing my medicalrecords online

None of these

CCG

National

Pe

rce

nta

ge u

se

d o

nlin

e s

erv

ice

s in

pa

st 1

2 m

on

ths

Practice range

within CCG


Q5. Which of the following general practice online services have you used in the past 12 months?


Enc

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77%

23%

Ease of use of online services

Q6. How easy is it to use your GP practice’s website to look for information or access services?*

23%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (259,817); CCG 2019 (1,909); CCG 2018 (1,799); Practice bases range

from 17 to 72; CCG bases range from 929 to 3,006

77%Easy

Not easy



Practice range in CCG – % Easy Local CCG range – % Easy

Lowest

Performing

Highest

Performing

44% 97%

Lowest

Performing

Highest

Performing

66% 79%

26%

51%

15%

8%

Very easy

Fairly easy

Not very easy

Not at all easy

74 77

26 23

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Easy % Not easy

*Those who say ‘Haven’t tried’ (60%) have been excluded from these results.


NationalCCG

Enc

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0%

10%

20%

30%

40%

50%

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ICE

Ease of use of online services:


Percentage of patients saying it is ‘easy’ to use their GP practice’s website

%Easy = %Very easy + %Fairly easy Base: All those completing a questionnaire excluding 'Haven't tried': National (259,817); CCG 2019 (1,909); Practice bases range from 17 to 72

Q6. How easy is it to use your GP practice’s website to look for information or access services?



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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UP

PE

R N

OR

WO

OD

GR

OU

P P

RA

CT

ICE

HA

RT

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SE

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ICA

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CT

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Percentage of patients saying it is ‘easy’ to use their GP practice’s website

%Easy = %Very easy + %Fairly easy Base: All those completing a questionnaire excluding 'Haven't tried': National (259,817); CCG 2019 (1,909); Practice bases range from 17 to 72




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14%

58%

10%

34%

Yes, a choice of place

Yes, a choice of time orday

Yes, a choice ofhealthcare professional

No, I was not offered achoice of appointment

62%

34%

Choice of appointment

38%

Yes

No

Base: All who tried to make an appointment since being registered excluding ‘Can’t remember’ and ‘Doesn't apply’: National (593,075); CCG 2019

(4,182); CCG 2018 (4,331); Practice bases range from 57 to 109; CCG bases range from 1,902 to 6,085

66%Yes

No

66 66

34 34

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q16. On this occasion (when you last tried to make a general practice appointment), were you

offered a choice of appointment?

Practice range in CCG – % Yes Local CCG range – % Yes

Lowest

Performing

Highest

Performing

38% 94%

Lowest

Performing

Highest

Performing

57% 74%

%Yes = ‘a choice of place’ and/or ‘a choice of time or

day’ and/or ‘a choice of healthcare professional’


NationalCCG

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Choice of appointment:


Percentage of patients saying ‘yes’ they were offered a choice of appointment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PO

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NH

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DO

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AD

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PR

AC

TIC

E

Base: All who tried to make an appointment since being registered excluding ‘Can't remember’ and ‘Doesn’t apply’: National (593,075); CCG 2019

(4,182); Practice bases range from 57 to 109







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Percentage of patients saying ‘yes’ they were offered a choice of appointment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ME

RS

HA

M M

ED

ICA

L C

EN

TR

E

NE

W A

DD

ING

TO

N G

RO

UP

PR

AC

TIC

E

BIR

DH

UR

ST

ME

DIC

AL

PR

AC

TIC

E

UP

PE

R N

OR

WO

OD

GR

OU

P P

RA

CT

ICE

HE

AD

LE

Y D

RIV

E S

UR

GE

RY

TH

E F

AR

LE

Y R

OA

D M

ED

ICA

LP

RA

CT

ICE

MIT

CH

LE

Y A

VE

NU

E S

UR

GE

RY

Base: All who tried to make an appointment since being registered excluding ‘Can't remember’ and ‘Doesn’t apply’: National (593,075); CCG 2019

(4,182); Practice bases range from 57 to 109







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73% 74%

73%

20%

7%

Yes, and I accepted anappointment

No, but I still took anappointment

No, and I did not takean appointment

Satisfaction with appointment offered


Lowest

Performing

Highest

Performing

43% 99%

Lowest

Performing

Highest

Performing

62% 77%

Base: All who tried to make an appointment since being registered: National (711,867); CCG 2019 (5,039); CCG 2018 (5,227); Practice bases range


73 73

27 27

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q17. Were you satisfied with the type of appointment (or appointments) you were offered?

6%

20%

7%

No, took appt

20%

Yes, took appt

No, took appt

Yes, took appt

No, didn’t take apptNo, didn’t take appt

%No = %No, but I still took an appointment +

%No, and I did not take an appointment


NationalCCG

Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

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of 233


32

Satisfaction with appointment offered:


Percentage of patients saying ‘yes’ they were satisfied with the appointment offered

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TH

E P

RA

CT

ICE

SU

RG

ER

IES

LT

D

TH

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EH

OR

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PR

AC

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E

ST

. JA

ME

S'S

ME

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EN

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PO

RT

LA

ND

ME

DIC

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EN

TR

E

BR

OU

GH

TO

N C

OR

NE

R M

ED

ICA

LC

EN

TR

ES

OU

TH

NO

RW

OO

D H

ILL M

ED

ICA

LC

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DS

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ME

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TH

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NO

RB

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LT

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02

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MO

RL

AN

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OA

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GE

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LE

AN

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OA

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GE

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TH

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ON

& V

ALL

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PA

RK

SU

RG

ER

Y

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T L

AN

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L P

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CC

G

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ON

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AT

H H

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LT

H C

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TR

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ICA

L C

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IRL

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TH

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ISC

OM

BE

SU

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BR

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M R

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ICA

L P

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BIR

DH

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ME

DIC

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PR

AC

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BR

AM

LE

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NU

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UR

GE

RY

PA

RK

WA

Y H

EA

LT

H C

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TR

E (

01

)

NE

W A

DD

ING

TO

N G

RO

UP

PR

AC

TIC

E

AS

HB

UR

TO

N P

AR

K M

ED

ICA

L C

EN

TR

E

HA

RT

LA

ND

WA

Y S

UR

GE

RY

DE

NM

AR

K R

OA

D S

UR

GE

RY

OL

D C

OU

LS

DO

N M

ED

ICA

L P

RA

CT

ICE

ST

OV

ELL

HO

US

E S

UR

GE

RY

ME

RS

HA

M M

ED

ICA

L C

EN

TR

E

AU

CK

LA

ND

SU

RG

ER

Y

SE

LH

UR

ST

ME

DIC

AL

PR

AC

TIC

E

TH

E F

AR

LE

Y R

OA

D M

ED

ICA

LP

RA

CT

ICE

UP

PE

R N

OR

WO

OD

GR

OU

P P

RA

CT

ICE

PA

RK

SID

E G

RO

UP

PR

AC

TIC

E

Base: All who tried to make an appointment since being registered: National (711,867); CCG 2019 (5,039); Practice bases range from 63 to 133




Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


33



Percentage of patients saying ‘yes’ they were satisfied with the appointment offered

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

AD

DIN

GT

ON

ME

DIC

AL

PR

AC

TIC

E

TH

E M

OO

RIN

GS

ME

DIC

AL

PR

AC

TIC

E

FA

IRV

IEW

ME

DIC

AL

CE

NT

RE

HE

AD

LE

Y D

RIV

E S

UR

GE

RY

QU

EE

NH

ILL

ME

DIC

AL P

RA

CT

ICE

SE

LS

DO

N P

AR

K M

ED

ICA

L P

RA

CT

ICE

MIT

CH

LE

Y A

VE

NU

E S

UR

GE

RY





Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


34

12%9%

12% 12% 13%16%

11%7%

30%

14%

8%12% 10% 10%

21%

12% 11%

29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Got anappointment fora different day

Called an NHShelpline, suchas NHS 111

Went to A&E Spoke to apharmacist

Went to orcontacted

another NHSservice

Decided tocontact my

practice anothertime

Looked forinformation

online

Spoke to afriend or family

member

Didn’t see or speak to anyone

CCG

National

What patients do when they are not satisfied with the

appointment offered and do not take itO

f th

ose

wh

o d

eclin

ed

an

app

oin

tme

nt,

perc

enta

ge

wh

o w

ent

on to

do s

om

eth

ing

els

e

Base: All who did not take the appointment offered (excluding those who haven't tried to make one): National (34,350); CCG 2019 (270)

Q19. What did you do when you did not take the appointment you were offered?


Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


35

67%

14%


30%

39%

16%

9%6% Very good

Fairly good


Fairly poor

Very poor

Q22. Overall, how would you describe your experience of making an appointment?

Practice range in CCG – % Good Local CCG range – % Good

16%

Good

Poor

Lowest

Performing

Highest

Performing

29% 96%

Lowest

Performing

Highest

Performing

57% 75%



Base: All who tried to make an appointment since being registered: National (705,310); CCG 2019 (5,018); CCG 2018 (5,183); Practice bases range


70%Good

Poor

71 70

14 140

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor


NationalCCG

Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


36

Overall experience of making an appointment:


Percentage of patients saying they had a ‘good’ experience of making an appointment


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TH

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RA

CT

ICE

SU

RG

ER

IES

LT

D

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LA

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ME

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BR

IGS

TO

CK

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H N

OR

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HIL

L M

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LC

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EB

RO

UG

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ME

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CE

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GR

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NS

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ME

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ON

ME

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PA

RC

HM

OR

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L C

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AC

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L P

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AS

HB

UR

TO

N P

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K M

ED

ICA

L C

EN

TR

E

BR

AM

LE

Y A

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NU

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UR

GE

RY

AU

CK

LA

ND

SU

RG

ER

Y

TH

E M

OO

RIN

GS

ME

DIC

AL

PR

AC

TIC

E

PA

RK

SID

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UP

PR

AC

TIC

E

ME

RS

HA

M M

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ICA

L C

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TR

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FA

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ME

DIC

AL

CE

NT

RE

ST

OV

ELL

HO

US

E S

UR

GE

RY

SE

LH

UR

ST

ME

DIC

AL

PR

AC

TIC

E





Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


37



Percentage of patients saying they had a ‘good’ experience of making an appointment


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SE

LS

DO

N P

AR

K M

ED

ICA

L P

RA

CT

ICE

HE

AD

LE

Y D

RIV

E S

UR

GE

RY

UP

PE

R N

OR

WO

OD

GR

OU

P P

RA

CT

ICE

TH

E F

AR

LE

Y R

OA

D M

ED

ICA

LP

RA

CT

ICE

AD

DIN

GT

ON

ME

DIC

AL

PR

AC

TIC

E

QU

EE

NH

ILL

ME

DIC

AL P

RA

CT

ICE

MIT

CH

LE

Y A

VE

NU

E S

UR

GE

RY





Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


38


Perceptions of care at patients’

last appointment

Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


39

Perceptions of care at patients’ last appointment with a

healthcare professional

Base: All who had an appointment since being registered with current GP practice excluding 'Doesn't apply': National (717,030; 715,282; 717,062); CCG

2019 (5,062; 5,063; 5,073)

CCG’s results

Nationl results %

Poor (total)

CCG results

% Poor (total)

%Poor (total) = %Very poor + %Poor

Q26. Last time you had a general practice appointment, how good was the healthcare professional

at each of the following

44% 49% 49%

41%39% 37%

11% 8% 10%3% 3% 3%

Giving you enough time Listening to you Treating you with care and concern

Very good Good Neither good nor poor Poor Very poor

National results

% ‘Poor’ (total)

CCG results


Very poor

Very good

4% 4% 4%

4% 4% 4%


Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


40



Base: All who had an appointment since being registered with current GP practice excluding ‘Don’t know / doesn’t apply’ or ‘Don’t know / can’t say’:

National (637,385; 705,397; 706,338); CCG 2019 (4,467; 4,958; 4,957)

CCG’s results

Nationl results %

Poor (total)

CCG results

% Poor (total)

Q28-30. During your last general practice appointment…

58%66% 60%

35%29% 34%

8% 6% 6%

Felt involved in decisions about care andtreatment

Had confidence and trust in thehealthcare professional

Felt their needs were met

Yes, definitely Yes, to some extent No, not at all

National results

% ‘No, not at all’

CCG results


No, not at all

Yes, definitely

7% 5% 6%

8% 6% 6%

Felt involved in decisions about care

and treatment Had confidence and trust in the



Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


41

49%

34%

17%

Yes, definitely

Yes, to some extent

No, not at all

86%

17%

Mental health needs recognised and understood

14%

Yes

No

Base: All who had an appointment since being registered with current GP practice excluding ‘I did not have any mental health needs’ and ‘Did not apply to my

last appointment’: National (284,999); CCG 2019 (2,039); CCG 2018 (2,146); Practice bases range from 22 to 61; CCG bases range from 852 to 3,542

83%Yes

No

83 83

17 17

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q27. During your last general practice appointment, did you feel that the healthcare professional

recognised and/or understood any mental health needs that you might have had?

%Yes = %Yes, definitely + %Yes, to some extent


Lowest

Performing

Highest

Performing

52% 100%

Lowest

Performing

Highest

Performing

76% 89%


NationalCCG

Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


42



Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

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43

38%

36%

27%

Yes, definitely

Yes, to some extent

No, not at all

78%

27%

Support with managing health conditions

22%

Yes

No

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,939); CCG 2018

(2,028); Practice bases range from 22 to 54; CCG bases range from 773 to 2,655

73%Yes

No

Q38. In the last 12 months, have you had enough support from local services or organisations to

help you to manage your condition (or conditions)?


Lowest

Performing

Highest

Performing

36% 95%

Lowest

Performing

Highest

Performing

67% 82%

73 73

27 27

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No



NationalCCG

Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


44

Percentage of patients saying ‘yes’ they have had enough support to manage their condition(s)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TH

OR

NT

ON

& V

ALL

EY

PA

RK

SU

RG

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RO

UG

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ON

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ME

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NT

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AN

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. JA

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L P

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AU

CK

LA

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SU

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UT

H N

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HIL

L M

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LC

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CC

G

PO

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LA

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ME

DIC

AL C

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AD

DIN

GT

ON

ME

DIC

AL

PR

AC

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NO

RB

UR

Y H

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LT

H C

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02

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SE

LS

DO

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ICA

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NH

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ME

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BR

IGS

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& S

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TH

NO

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DP

AR

TN

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SH

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BR

AM

LE

Y A

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NU

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UR

GE

RY

CO

UN

TR

Y P

AR

K P

RA

CT

ICE

EA

ST

CR

OY

DO

N M

ED

ICA

L C

EN

TR

E

DE

NM

AR

K R

OA

D S

UR

GE

RY

TH

E A

DD

ISC

OM

BE

SU

RG

ER

Y

UP

PE

R N

OR

WO

OD

GR

OU

P P

RA

CT

ICE

AS

HB

UR

TO

N P

AR

K M

ED

ICA

L C

EN

TR

E

SH

IRL

EY

ME

DIC

AL C

EN

TR

E

TH

E M

OO

RIN

GS

ME

DIC

AL

PR

AC

TIC

E

TH

E H

ALIN

G P

AR

K P

AR

TN

ER

SH

IP

KE

ST

ON

ME

DIC

AL P

RA

CT

ICE

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,939); Practice

bases range from 22 to 54



Support with managing long-term health conditions:





Enc

6 A

p1b

2019

Cro

ydon

Pt s

urve

y

of 233


45

Percentage of patients saying ‘yes’ they have had enough support to manage their condition(s)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SE

LH

UR

ST

ME

DIC

AL

PR

AC

TIC

E

FA

IRV

IEW

ME

DIC

AL

CE

NT

RE

PA

RK

SID

E G

RO

UP

PR

AC

TIC

E

TH

E F

AR

LE

Y R

OA

D M

ED

ICA

LP

RA

CT

ICE

MIT

CH

LE

Y A

VE

NU

E S

UR

GE

RY

NE

W A

DD

ING

TO

N G

RO

UP

PR

AC

TIC

E

BIR

DH

UR

ST

ME

DIC

AL

PR

AC

TIC

E

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); CCG 2019 (1,939); Practice

bases range from 22 to 54



Support with managing long-term health conditions:





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Satisfaction with general

practice appointment times

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25%

42%

16%

10%

7%Very satisfied

Fairly satisfied

Neither satisfied nordissatisfied

Fairly dissatisfied

Very dissatisfied

65%

17%

Satisfaction with appointment times

18%

Satisfied

Dissatisfied

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (5,021); CCG 2018

(5,247); Practice bases range from 62 to 127; CCG bases range from 2,254 to 7,543

67%Satisfied

Dissatisfied

68 67

16 17

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Satisfied % Dissatisfied

Q8. How satisfied are you with the general practice appointment times that are available to you?*

%Satisfied = %Very satisfied + %Fairly satisfied

%Dissatisfied = %Very dissatisfied + %Fairly dissatisfied

Practice range in CCG – % Satisfied Local CCG range – % Satisfied

Lowest

Performing

Highest

Performing

41% 97%

Lowest

Performing

Highest

Performing

58% 72%

*Those who say ‘I’m not sure when I can get an appointment’ (1%) have been excluded from these results.


NationalCCG

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Satisfaction with appointment times:


Percentage of patients saying they are ‘satisfied’ with the appointment times available

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (5,021);

Practice bases range from 62 to 127

0%

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Q8. How satisfied are you with the general practice appointment times that are available to you?



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Percentage of patients saying they are ‘satisfied’ with the appointment times available

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); CCG 2019 (5,021);

Practice bases range from 62 to 127

0%

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• The services when GP practice is closed questions are only asked of those who have recently used an NHS service when they wanted to see

a GP but their GP practice was closed. As such, the base size is often too small to make meaningful comparisons at practice level; practice

range within CCG has therefore not been included for these questions.

• Please note that patients cannot always distinguish between out-of-hours services and extended access appointments. Please view the results

in this section with the configuration of your local services in mind.

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58%

20%

3%

43%

15%

12%

19%

4%

63%

25%

5%

37%

12%

8%

17%

5%

I contacted an NHS service by telephone

A healthcare professional called me back

A healthcare professional visited me at home

I went to A&E

I saw a pharmacist

I went to another general practice service

I went to another NHS service

Can't remember

CCG National

Use of services when GP practice is closed

Base: All those who have contacted an NHS service when GP practice closed in past 12 months: National (139,476); CCG 2019 (1,035)

Q45. Considering all of the services you contacted, which of the following happened on that

occasion?

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62%

38%It was about right

It took too long

38%

Time taken to receive care or advice when GP practice is closed

66%

34%

About right

Took too long

Local CCG range – % About right

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / doesn’t apply’: National

(130,757); CCG 2019 (981); CCG 2018 (929); CCG bases range from 382 to 1,433

Lowest

Performing

Highest

Performing

52% 74%

62%About right

Took too long

Q46. How do you feel about how quickly you received care or advice on that occasion?

57 62

43 38

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% About right % Took too long


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40%

50%

10%

Yes, definitely

Yes, to some extent

No, not at all 10%

Confidence and trust in staff providing services when GP

practice is closed

91%

9%

Yes

No

Local CCG range – % Yes

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / can't say’: National (134,437);

CCG 2019 (1,015); CCG 2018 (959); CCG bases range from 398 to 1,487

Lowest

Performing

Highest

Performing

86% 95%

90%Yes

No

90 90

10 100

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

%Yes = %Yes, definitely + % Yes, to some extent

Q47. Considering all of the people that you saw or spoke to on that occasion, did you have

confidence and trust in them?


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29%

36%

19%

9%

7%Very good

Fairly good


Fairly poor

Very poor

16%

Overall experience of services when GP practice is closed

69%

15%

Good

Poor

Local CCG range – % Good


CCG 2019 (1,011); CCG 2018 (968); CCG bases range from 395 to 1,501

Lowest

Performing

Highest

Performing

56% 77%

65%Good

Poor

62 65

19 16

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor


%Poor = %Fairly poor + %Very poor

Q48. Overall, how would you describe your last experience of NHS services when you wanted to

see a GP but your GP practice was closed?


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Participants in a survey such as GPPS represent only a sample of the total population of interest – this means we cannot be certain that the results of

a question are exactly the same as if everybody within that population had taken part (“true values”). However, we can predict the variation between

the results of a question and the true value by using the size of the sample on which results are based and the number of times a particular answer is

given. The confidence with which we make this prediction is usually chosen to be 95% – that is, the chances are 95 in 100 that the true value will fall

within a specified range (the “95% confidence interval”).

The table below gives examples of what the confidence intervals look like for an ‘average’ practice and CCG, as well as the confidence intervals at

the national level.

Average sample size on

which results are based

Approximate confidence intervals for percentages at or near

these levels (expressed in percentage points)

Level 1:

10% or 90%

Level 2:

30% or 70%

Level 3:

50%

+/- +/- +/-

National 770,512 0.10 0.15 0.16

CCG 4,034 1.29 1.96 2.14

Practice 110 6.83 10.06 10.92

An example of confidence intervals (at national, CCG and practice level) based on the average number of responses to the question

“Overall, how would you describe your experience of your GP practice?”

For example, taking a CCG where 4,034 people responded and where 30% answered ‘Very good’ in response to ‘Overall, how would you describe

your experience of making an appointment’, there is a 95% likelihood that the true value (which would have been obtained if the whole population had

been interviewed) will fall within the range of +/-1.96 percentage points from that question’s result (i.e. between 28.04% and 31.96%).

When results are compared between separate groups within a sample, the difference may be “real” or it may occur by chance (because not everyone

in the population has been interviewed). Confidence intervals will be wider when comparing groups, especially where there are small numbers e.g.

practices where 100 patients or fewer responded to a question. These findings should be regarded as indicative rather than robust.

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Want to know more?

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Further background information about the survey

• The survey was sent to c.2.3 million adult patients registered with a GP practice.

• Participants are sent a postal questionnaire, also with the option of completing the

survey online or via telephone.

• Past results dating back to 2007 are available for every practice in the UK. From 2017

the survey has been annual; previously it ran twice a year (June 2011 – July 2016), on a

quarterly basis (April 2009 – March 2011) and annually (January 2007 – March 2009).

• For more information about the survey please visit https://gp-patient.co.uk/.

• The overall response rate to the survey is 33.1%, based on 770,512 completed surveys.

• Weights have been applied to adjust the data to account for potential age and gender

differences between the profile of all eligible patients in a practice and the patients who

actually complete a questionnaire. Since the first wave of the 2011-2012 survey the

weighting also takes into account neighbourhood statistics, such as levels of deprivation,

in order to further improve the reliability of the findings.

• Further information on the survey including questionnaire design, sampling,

communication with patients and practices, data collection, data analysis, response

rates and reporting can be found in the technical annex for each survey year, available


770,512Completed surveys in the July 2019 publication

c.2.3mSurveys to adults registered with an English GP practice

33.1% National response rate

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Where to go to do further analysis …

• For reports which show the National results broken down by CCG and Practice, go to

https://gp-patient.co.uk/surveysandreports - you can also see previous years’ results here.

• To look at this year’s survey data at a national, CCG or practice level, and filter on a specific participant group

(e.g. by age), break down the survey results by survey question, or to create and compare different participant

‘subgroups’, go to https://gp-patient.co.uk/analysistool/2019.

• To look at results over time, and filter on a specific participant group, go to https://gp-

patient.co.uk/analysistool/trends.

• For general FAQs about the GP Patient Survey, go to https://gp-patient.co.uk/faq.

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For further information about the GP Patient Survey, please

get in touch with the GPPS team at Ipsos MORI at

[email protected]

We would be interested to hear any feedback you have on

this slide pack, so we can make improvements for the next

publication.

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19-043068-01 GPPS STP Slidepacks | Version 1 | Public© Ipsos MORI 19-043068-01 GPPS STP Slidepacks | Version 1 | Public

South West London Health & Care

Partnership STP

Latest survey results2019 publication

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19-043068-01 GPPS STP Slidepacks | Version 1 | Public

Contents

Background, introduction and guidance


Local GP services



Perceptions of care at patients’ last appointment


Satisfaction with general practice appointment times



Want to know more?

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Background information about the survey

• The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level

data about patients’ experiences of their GP practices.

• Ipsos MORI administers the survey on behalf of NHS England.

• For more information about the survey please refer to the end of this slide pack or visit

https://gp-patient.co.uk/.

• This slide pack presents some of the key results for South West London Health &

Care Partnership STP (Sustainability and Transformation Partnership).

• The data in this slide pack are based on the July 2019 GPPS publication.

• In South West London Health & Care Partnership STP, 70,694 questionnaires were

sent out, and 20,474 were returned completed. This represents a response rate of 29%.

• In 2018 the questionnaire was redeveloped in response to significant changes to

primary care services as set out in the GP Forward View, and to provide a better

understanding of how local care services are supporting patients to live well, particularly

those with long-term care needs. The questionnaire (and past versions) can be found


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Additional publication – CCG slide packs

• Individual slide packs for each CCG, providing more detail about local services,

including performance of individual practices can be found here:

https://www.gp-patient.co.uk/Slidepacks2019

• Slide packs for each CCG in South West London Health & Care

Partnership STP can be found here:

NHS CROYDON CCG

NHS RICHMOND CCG

NHS KINGSTON CCG

NHS WANDSWORTH CCG

NHS SUTTON CCG

NHS MERTON CCG

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Introduction

• The GP Patient Survey measures patients’ experiences across a range of topics, including:

- Your local GP services

- Making an appointment

- Your last appointment

- Overall experience

- Your health

- When your GP practice is closed

- NHS Dentistry

- Some questions about you

• The GP Patient Survey provides data at practice level using a consistent methodology, which means it is comparable across organisations.

• The survey has limitations:

- Sample sizes at practice level are relatively small.

- The survey does not include qualitative data which limits the detail provided by the results.

• The data provide a snapshot of patient experience at a given time, and are updated annually.

• Given the consistency of the survey across organisations, GPPS can be used as one element of evidence.

• It can be triangulated with other sources of feedback, such as feedback from Patient Participation Groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient journeys.

• This slide pack is intended to assist this triangulation of data. It aims to highlight where there may be a need for further exploration.

• STP teams, CCGs and practices can then discuss the findings further and triangulate them with other data –in order to identify potential improvements and highlight best practice.

• The following slide suggests ideas for how the data can be used to improve services.

• This pack includes trend data, beginning in 2018. Following the extensive changes to the questionnaire in 2018, all questions at STP, CCG and practice level are not comparable prior to this year.

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Guidance on how to use the data

• Comparison of an STP’s results against

the national average: this allows

benchmarking of the results to identify

whether STPs are performing well, poorly,

or in line with the national picture.

• Analysing trends in an STP’s results

over time: this provides a sense of the

direction of the STP’s performance over

time. NHS England teams may wish to

focus on areas where an STP has seen

decline over time.

• Comparison of CCGs’ results within an

STP’s area and over time: this can

identify CCGs in an area that seem to be

over-performing or under-performing

compared with others, and provide a sense

of the direction of the CCGs’ performance

over time. NHS England teams may wish

to work with individual CCGs: those that

are performing particularly well may be

able to highlight best practice, while those

performing less well may be able to

improve their performance.

The following suggest ideas for how the data in this slide pack can be used and interpreted to

improve GP services:

*Images used in this slide are for example purposes only

*

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Interpreting the results

• The number of participants answering (the base size) is stated for each question. The total

number of responses is shown at the bottom of each chart.

• All comparisons are indicative only – differences may not be statistically

significant.

• For guidance on statistical reliability, or for details of where you can get more information

about the survey, please refer to the end of this slide pack.

• Maps: STP and CCG level results are also displayed on maps, with results split across 5

bands (or ‘quintiles’) in order to have a fairly even distribution at the national level of

STPs/CCGs across each band.

• Trends:

- Latest / 2019: refers to the July 2019 publication (fieldwork January to March 2019)

- 2018: refers to the August 2018 publication (fieldwork January to March 2018)

• For further information on using the data please refer to the end of this slide pack.

*More than 0% but less than 0.5%

100%Where results do not sum to

100%, or where individual

responses (e.g. fairly good;

very good) do not sum to

combined responses

(e.g. very/fairly good) this is

due to rounding, or cases

where multiple responses

are allowed.

When fewer than 10 patients respond

In cases where fewer than 10

patients have answered a

question, the data have been

suppressed and results will

not appear within the charts.

This is to prevent individuals

and their responses being

identifiable in the data.

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83%

5%


46%

39%

10%

4% Very good

Fairly good

Neither good norpoor

Fairly poor

Very poor


National

6%

Good

Poor



Base: All those completing a questionnaire: National (760,037); STP 2019 (20,166); STP 2018 (19,583)

STP’s results Comparison of results

85%Good

Poor

STP

85 85

5 50

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor

STP’s results over time

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Overall experience:

how the STP’s results compare to other STPs

STP results range from

to


77%

88%




The STP represented by this pack is highlighted in red

Base: All those completing a questionnaire: STP bases range from 6,760 to 48,016

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Overall experience:

how the STP’s CCGs compare


Base: All those completing a questionnaire: CCG bases range from 2,377 to 5,393



CCG results range from

to

81%

88%


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Overall experience: current performance and change

over time

Base: All those completing a questionnaire: National 2019 (760,037); 2018 (746,847); STP 2019 (20,166); 2018 (19,583); CCG bases range from: 2,377 to 5,393

(2019); 2,174 to 5,628 (2018)




83%

85%

88%

87%

87%

84%

82%

81%

National-level

South West London Health & Care Partnership STP

NHS RICHMOND CCG

NHS WANDSWORTH CCG

NHS SUTTON CCG

NHS KINGSTON CCG

NHS CROYDON CCG

NHS MERTON CCG

2019 2018

83% q 1 84%

85% ---- 85%

88% p 1 87%

87% ---- 87%

87% ---- 87%

84% q 1 85%

82% q 1 83%

81% q 1 82%

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25%

50%

18%

8%

Very easy

Fairly easy

Not very easy

Not at all easy

68%

26%

Ease of getting through to GP practice on the phone


32%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (742,537); STP 2019 (19,686); STP 2018 (18,992)

74%Easy

Not easy

75 74

25 26

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Easy % Not easy



STP’s results Comparison of resultsSTP’s results over time

NationalSTP

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how the CCGs within the STP compare

Base: All those completing a questionnaire: National 2019 (742,537); 2018 (729,884); STP 2019 (19,686); 2018 (18,992); CCG bases range from: 2,324

to 5,288 (2019); 2,127 to 5,453 (2018) %Easy = %Very easy + %Fairly easy



68%

74%

82%

78%

77%

72%

70%

64%

National-level


NHS RICHMOND CCG

NHS WANDSWORTH CCG

NHS SUTTON CCG

NHS CROYDON CCG

NHS KINGSTON CCG

NHS MERTON CCG

2019 2018

68% q 2 70%

74% q 1 75%

82% p 1 81%

78% q 2 80%

77% q 1 78%

72% q 3 75%

70% p 1 69%

64% q 1 65%

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44%

46%

8%

Very helpful

Fairly helpful

Not very helpful

Not at all helpful

89%

10%

Helpfulness of receptionists at GP practice


11%Helpful

Not helpful

Base: All those completing a questionnaire excluding ‘Don’t know’: National (751,111); STP 2019 (20,007); STP 2018 (19,339)

90%Helpful

Not helpful

90 90

10 100

10

20

30

40

50

60

70

80

90

100

2018 2019

% Helpful % Not helpful

%Helpful = %Very helpful + %Fairly helpful

%Not helpful = %Not very helpful + %Not at all helpful


NationalSTP

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to 5,349 (2019); 2,155 to 5,543 (2018) %Helpful = %Very helpful + %Fairly helpful



89%

90%

92%

91%

91%

90%

89%

89%

National-level


NHS SUTTON CCG

NHS KINGSTON CCG

NHS RICHMOND CCG

NHS WANDSWORTH CCG

NHS CROYDON CCG

NHS MERTON CCG

2019 2018

89% q 1 90%

90% ---- 90%

92% ---- 92%

91% ---- 91%

91% p 1 90%

90% q 1 91%

89% ---- 89%

89% p 2 87%

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53%

42%

19%

7%

33%

44%41%

15%

7%

40%

0

10

20

30

40

50

60

70

80

90

100

Bookingappointmentsonline


Accessing mymedical recordsonline

None of these Don't know

STP

National

Awareness of online services


Percentage aware of online services offered by GP practice

Base: All those completing a questionnaire: National (746,334); STP (19,779)

Q4. As far as you know, which of the following online services does your GP practice offer? Enc

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Online service use

Percentage used online services in past 12 months

Base: All those completing a questionnaire: National (754,767); STP (20,076)

Q5. Which of the following general practice online services have you used in the past 12 months?


22%

13%

5%

71%

15% 16%

4%

76%

0

10

20

30

40

50

60

70

80

90

100

Booking appointmentsonline


Accessing my medicalrecordsonline

None of these

STP

National

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77%

23%

Ease of use of online services

Q6. How easy is it to use your GP practice’s website to look for information or access services?*

23%

Easy

Not easy

Base: All those completing a questionnaire excluding 'Haven't tried': National (259,817); STP 2019 (7,907); STP 2018 (7,103)

77%Easy

Not easy



25%

52%

17%

6%

Very easy

Fairly easy

Not very easy

Not at all easy

79 77

21 23

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Easy % Not easy

*Those who say ‘Haven’t tried’ (55%) have been excluded from these results.


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%Easy = %Very easy + %Fairly easy Base: All those completing a questionnaire: National 2019 (259,817); 2018 (234,144); STP 2019 (7,907); 2018 (7,103); CCG bases range from: 975 to

1,909 (2019); 871 to 1,799 (2018)



77%

77%

79%

78%

77%

77%

77%

74%

National-level


NHS SUTTON CCG

NHS RICHMOND CCG

NHS WANDSWORTH CCG

NHS KINGSTON CCG

NHS CROYDON CCG

NHS MERTON CCG

2019 2018

77% q 1 78%

77% q 2 79%

79% q 1 80%

78% p 1 77%

77% q 5 82%

77% q 1 78%

77% p 3 74%

74% q 5 79%

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12%

61%

12%

31%

Yes, a choice of place

Yes, a choice of time orday

Yes, a choice ofhealthcare professional

No, I was not offered achoice of appointment

62%

31%

Choice of appointment

38%

Yes

No

Base: All who tried to make an appointment since being registered excluding ‘Can’t remember’ and ‘Doesn't apply’: National (593,075); STP 2019

(15,885); STP 2018 (15,391)

69%Yes

No

68 69

32 31

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No






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to 4,182 (2019); 1,750 to 4,331 (2018)






62%

69%

73%

71%

68%

68%

67%

66%

National-level


NHS WANDSWORTH CCG

NHS RICHMOND CCG

NHS SUTTON CCG

NHS KINGSTON CCG

NHS MERTON CCG

NHS CROYDON CCG

2019 2018

62% ---- 62%

69% p 1 68%

73% ---- 73%

71% p 2 69%

68% q 2 70%

68% p 4 64%

67% p 1 66%

66% ---- 66%

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76% 74%

76%

19%

6%Yes, and Iaccepted anappointment

No, but I still tookan appointment

No, and I did nottake anappointment

Satisfaction with appointment offered

Base: All who tried to make an appointment since being registered: National (711,867); STP 2019 (19,005); STP 2018 (18,351)

75 76

25 24

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No


6%

19%

6%

No, took appt

20%

Yes, took appt

No, took appt

Yes, took appt

No, didn’t take apptNo, didn’t take appt

%No = %No, but I still took an appointment +

%No, and I did not take an appointment


NationalSTP

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to 5,039 (2019); 2,074 to 5,227 (2018)



74%

76%

77%

77%

77%

76%

74%

73%

National-level


NHS SUTTON CCG

NHS RICHMOND CCG

NHS KINGSTON CCG

NHS WANDSWORTH CCG

NHS MERTON CCG

NHS CROYDON CCG

2019 2018

74% ---- 74%

76% p 1 75%

77% q 1 78%

77% ---- 77%

77% p 2 75%

76% p 1 75%

74% p 1 73%

73% ---- 73%

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13%9%

14%9% 11%

19%14%

11%

26%

14%

8%12% 10% 10%

21%

12% 11%

29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Got anappointment fora different day

Called an NHShelpline, suchas NHS 111

Went to A&E Spoke to apharmacist

Went to orcontacted

another NHSservice

Decided tocontact my

practice anothertime

Looked forinformation

online

Spoke to afriend or family

member

Didn’t see or speak to anyone

STP

National

What patients do when they are not satisfied with the

appointment offered and do not take it

Of those who declined an appointment, percentage who went on to do something else

Base: All who did not take the appointment offered (excluding those who haven't tried to make one): National (34,350); STP (861)

Q19. What did you do when you did not take the appointment you were offered?


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67%

12%


31%

41%

16%

8%4%

Very good

Fairly good


Fairly poor

Very poor


16%

Good

Poor



Base: All who tried to make an appointment since being registered: National (705,310); STP 2019 (18,877); STP 2018 (18,203)

72%Good

Poor

72 72

12 120

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor


NationalSTP

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to 5,018 (2019); 2,062 to 5,183 (2018) %Good = %Very good + %Fairly good



67%

72%

75%

74%

74%

73%

70%

69%

National-level


NHS SUTTON CCG

NHS WANDSWORTH CCG

NHS RICHMOND CCG

NHS KINGSTON CCG

NHS CROYDON CCG

NHS MERTON CCG

2019 2018

67% q 2 69%

72% ---- 72%

75% q 1 76%

74% q 1 75%

74% ---- 74%

73% p 2 71%

70% q 1 71%

69% p 2 67%

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Perceptions of care at patients’

last appointment

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Base: All who had an appointment since being registered with current GP practice excluding 'Doesn't apply': National (717,030; 715,282; 717,062); STP

(19,050; 19,027; 19,065)

STP’s results

National results

% Poor (total)

CCG results

% Poor (total)

%Poor (total) = %Very poor + %Poor

Q26. Last time you had a general practice appointment, how good was the healthcare professional

at each of the following

47% 52% 52%

39%37% 35%

10% 7% 9%3%


Very good Good Neither good nor poor Poor Very poor

National results


STP results


Very poor

Very good

4% 4% 4%

4% 4% 4%


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Base: All who had an appointment since being registered with current GP practice excluding ‘Don’t know / doesn’t apply’ or ‘Don’t know / can’t say’:

National (637,385; 705,397; 706,338); STP (16,916; 18,710; 18,724)

STP’s results

National results

% Poor (total)

CCG results

% Poor (total)

Q28-30. During your last general practice appointment…

60%68% 62%

34%28% 33%

7% 5% 6%

Felt involved in decisions about care andtreatment

Had confidence and trust in thehealthcare professional


Yes, definitely Yes, to some extent No, not at all

National results


STP results


No, not at all

Yes, definitely

7% 5% 6%

7% 5% 6%

Felt involved in decisions about care

and treatment Had confidence and trust in the



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52%

33%

15% Yes,definitely

Yes, to someextent

No, not at all

86%

15%

Mental health needs recognised and understood

14%

Yes

No

Base: All who had an appointment since being registered with current GP practice excluding ‘I did not have any mental health needs’ and ‘Did not apply to my

last appointment’: National (284,999); STP 2019 (7,527); STP 2018 (7,382)

85%Yes

No

85 85

15 15

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

Q27. During your last general practice appointment, did you feel that the healthcare professional

recognised and/or understood any mental health needs that you might have had?



NationalSTP

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40%

37%

23%Yes,definitely

Yes, tosome extent

No, not at all

78%

23%

Support with managing health conditions

22%

Yes

No

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (292,168); STP 2019 (6,767); STP 2018

(6,585)

77%Yes

No



78 77

22 23

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No



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Base: All those completing a questionnaire: National 2019 (292,168); 2018 (284,887); STP 2019 (6,767); 2018 (6,585); CCG bases range from: 773 to

1,939 (2019); 704 to 2,028 (2018)



Support with managing health conditions:




78%

77%

82%

81%

79%

78%

73%

73%

National-level


NHS SUTTON CCG

NHS RICHMOND CCG

NHS KINGSTON CCG

NHS WANDSWORTH CCG

NHS MERTON CCG

NHS CROYDON CCG

2019 2018

78% q 1 79%

77% q 1 78%

82% p 3 79%

81% q 3 84%

79% q 1 80%

78% q 1 79%

73% q 1 74%

73% ---- 73%

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Satisfaction with general

practice appointment times

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26%

43%

16%

10%5%

Very satisfied

Fairly satisfied

Neither satisfiednor dissatisfied

Fairly dissatisfied

Very dissatisfied

65%

15%

Satisfaction with appointment times

18%

Satisfied

Dissatisfied

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (696,898); STP 2019 (18,927); STP 2018

(18,310)

69%Satisfied

Dissatisfied

69 69

15 15

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Satisfied % Dissatisfied

Q8. How satisfied are you with the general practice appointment times that are available to you?*


%Dissatisfied = %Very dissatisfied + %Fairly dissatisfied

*Those who say ‘I’m not sure when I can get an appointment’ (1%) have been excluded from these results.


NationalSTP

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to 5,021 (2019); 2,055 to 5,247 (2018) %Satisfied = %Very satisfied + %Fairly satisfied



65%

69%

72%

71%

68%

68%

67%

67%

National-level


NHS WANDSWORTH CCG

NHS SUTTON CCG

NHS KINGSTON CCG

NHS RICHMOND CCG

NHS CROYDON CCG

NHS MERTON CCG

2019 2018

65% q 1 66%

69% ---- 69%

72% p 1 71%

71% ---- 71%

68% q 1 69%

68% p 3 65%

67% q 1 68%

67% ---- 67%

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• The services when GP practice is closed questions are only asked of those who have recently used an NHS service when they wanted to see

a GP but their GP practice was closed.

• Please note that patients cannot always distinguish between out-of-hours services and extended access appointments. Please view the results

in this section with the configuration of your local services in mind.

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59%

19%

3%

41%

13%

12%

15%

6%

63%

25%

5%

37%

12%

8%

17%

5%

I contacted an NHS service by telephone

A healthcare professional called me back

A healthcare professional visited me at home

I went to A&E

I saw a pharmacist

I went to another general practice service

I went to another NHS service

Can't remember

STP National

Use of services when GP practice is closed

Base: All those who have contacted an NHS service when GP practice closed in past 12 months: National (139,476); STP (3,784)

Q45. Considering all of the services you contacted, which of the following happened on that

occasion? Enc

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66%

34%It was aboutright

It took too long

34%

Time taken to receive care or advice when GP practice is closed

66%

34%

About right

Took too long

Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months excluding ‘Don’t know / doesn’t apply’: National

(130,757); STP 2019 (3,550); STP 2018 (3,405)

66%About right

Took too long

Q46. How do you feel about how quickly you received care or advice on that occasion?

62 66

38 34

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% About right % Took too long


NationalSTP

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46%

46%

8%Yes, definitely

Yes, to someextent

No, not at all 8%

Confidence and trust in staff providing services when GP

practice is closed

91%

9%

Yes

No


STP 2019 (3,645); STP 2018 (3,488)

92%Yes

No

92 92

8 80

10

20

30

40

50

60

70

80

90

100

2018 2019

% Yes % No

%Yes = %Yes, definitely + % Yes, to some extent

Q47. Considering all of the people that you saw or spoke to on that occasion, did you have

confidence and trust in them?


NationalSTP

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30%

39%

17%

9%5%

Very good

Fairly good


Fairly poor

Very poor

15%

Overall experience of services when GP practice is closed

69%

15%

Good

Poor


STP 2019 (3,638); STP 2018 (3,521)

69%Good

Poor

67 69

16 15

0

10

20

30

40

50

60

70

80

90

100

2018 2019

% Good % Poor


%Poor = %Fairly poor + %Very poor

Q48. Overall, how would you describe your last experience of NHS services when you wanted to

see a GP but your GP practice was closed?


NationalSTP

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Participants in a survey such as GPPS represent only a sample of the total population of interest – this means we cannot be certain that the results of

a question are exactly the same as if everybody within that population had taken part (“true values”). However, we can predict the variation between

the results of a question and the true value by using the size of the sample on which results are based and the number of times a particular answer is

given. The confidence with which we make this prediction is usually chosen to be 95% – that is, the chances are 95 in 100 that the true value will fall

within a specified range (the “95% confidence interval”).

The table below gives examples of what the confidence intervals look like for an ‘average’ practice and CCG, as well as the confidence intervals at

the national level.

Average sample size on

which results are based

Approximate confidence intervals for percentages at or near

these levels (expressed in percentage points)

Level 1:

10% or 90%

Level 2:

30% or 70%

Level 3:

50%

+/- +/- +/-

National 770,512 0.10 0.15 0.16

STP 18,000 0.61 0.93 1.02

CCG 4,034 1.29 1.96 2.14

An example of confidence intervals (at national, CCG and practice level) based on the average number of responses to the question

“Overall, how would you describe your experience of your GP practice?”

For example, taking a CCG where 4,034 people responded and where 30% answered ‘Very good’ in response to ‘Overall, how would you describe

your experience of making an appointment’, there is a 95% likelihood that the true value (which would have been obtained if the whole population had

been interviewed) will fall within the range of +/-1.96 percentage points from that question’s result (i.e. between 28.04% and 31.96%).

When results are compared between separate groups within a sample, the difference may be “real” or it may occur by chance (because not everyone

in the population has been interviewed). Confidence intervals will be wider when comparing groups, especially where there are small numbers e.g.

practices where 100 patients or fewer responded to a question. These findings should be regarded as indicative rather than robust.

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Further background information about the survey

• The survey was sent to c.2.3 million adult patients registered with a GP practice.

• Participants are sent a postal questionnaire, also with the option of completing the

survey online or via telephone.

• Past results dating back to 2007 are available for every practice in the UK. From 2017

the survey has been annual; previously it ran twice a year (June 2011 – July 2016), on a

quarterly basis (April 2009 – March 2011) and annually (January 2007 – March 2009).

• For more information about the survey please visit https://gp-patient.co.uk/.

• The overall response rate to the survey is 33.1%, based on 770,512 completed surveys.

• Weights have been applied to adjust the data to account for potential age and gender

differences between the profile of all eligible patients in a practice and the patients who

actually complete a questionnaire. Since the first wave of the 2011-2012 survey the

weighting also takes into account neighbourhood statistics, such as levels of deprivation,

in order to further improve the reliability of the findings.

• Further information on the survey including questionnaire design, sampling,

communication with patients and practices, data collection, data analysis, response

rates and reporting can be found in the technical annex for each survey year, available


770,512Completed surveys in the July 2019 publication

c.2.3mSurveys to adults registered with an English GP practice

33.1%National response rate

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Where to go to do further analysis …

• For reports which show the National results broken down by CCG and Practice, go to

https://gp-patient.co.uk/surveysandreports - you can also see previous years’ results here.

• To look at this year’s survey data at a national, CCG or practice level, and filter on a specific participant group

(e.g. by age), break down the survey results by survey question, or to create and compare different participant

‘subgroups’, go to https://gp-patient.co.uk/analysistool/2019.

• To look at results over time, and filter on a specific participant group, go to https://gp-

patient.co.uk/analysistool/trends.

• For general FAQs about the GP Patient Survey, go to https://gp-patient.co.uk/faq.

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For further information about the GP Patient Survey, please

get in touch with the GPPS team at Ipsos MORI at

[email protected]

We would be interested to hear any feedback you have on

this slide pack, so we can make improvements for the next

publication.

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3 March 2020

Title of Paper: Medicines Shortages Update

Lead Director Josh Potter Joint Director of Strategy and Transformation

Report Author Louise Coughlan Joint Chief Pharmacist

Committees which have previously discussed/agreed the report

Primary Care Commissioning Working Group



Purpose of Report For Information

Recommendation:

The Primary Care Commissioning Committee is asked to: ▪ Note the current medication shortage issues that are affecting both clinical care and

finance and the actions put in place to minimise risk

Background:

Shortages of medicines are becoming increasingly frequent, and have an impact on pharmacy teams in both primary and secondary care to issue/dispense medicines in a timely manner. So far, no shortages have been attributed directly to EU exit. There is also an impact on patient experience, as in some cases, medication is switched to an unfamiliar alternative product (eg HRT) or in extreme cases cannot be supplied at all. The CCG Medicines Optimisation team works closely with GPs and community pharmacists to ensure disruption is kept to a minimum, making use of local intelligence, and national resources such as the Specialist Pharmacy Service website. The Department for Health and Social Security publishes a monthly newsletter, providing information and advice on new and ongoing shortages. There are currently 75 items on this list. Most notable are: Ranitidine - withdrawn due to unacceptable levels of a potentially toxic substance, alternative agents need to be used that has required significant pharmacy resource. Fluoxetine - serious shortage protocol enacted that allowed community pharmacists to swap between strengths. Digoxin injection - manufacturing issue, prioritisation of stock required should stocks and alternatives run out. Alternative product is unlicensed and significantly more expensive.

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Phenytoin 100mg capsules – Expected to be out of stock until May 2020, alternative product may require extra monitoring. Hormone replacement therapy – significant ongoing shortages across multiple products that has caused distress for many women. We are informed of which products are in stock and recommendations for alternatives for those currently out of stock. Information for GPs are published either via a monthly newsletter, or if urgent, a memo will be distributed.

Key Issues:

• Impact on quality of care our residents receive if their regular medication cannot be supplied

• Resource issues as prescribers and pharmacists need to prescribe/source/advise alternatives

• Impact on finance as alternative products are often more costly. In Croydon, this is estimated to produce a cost pressure of approximately £1.7m for 19/20 just in primary care

• The Medicines Optimisation Team work closely with other healthcare colleagues across the system and utilises all available resources to ensure clinicians are made aware of shortages and how to manage them in order to minimise disruption to the Croydon residents.

Governance:

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Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care

Risks Poor patient experience and care if shortages are unable to be managed.

Clinical Leaders comments where appropriate

Financial Implications Negative

Conflicts of Interest Nil

Implications for other CCGs Implication same for whole of UK

Equality Analysis N/A

Patient and Public Involvement N/A

Communication Plan Via relevant newsletters/memos

Information Governance Issues Nil

Reputational Issues Lack of access to medication

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3 March 2020

Title of Paper: Primary Care Quality and CQC visits/ratings report

Lead Director Josh Potter Director of Strategy and Transformation

Report Author Helen Goodrum Primary Care Commissioning and Quality Lead


Primary Care Commissioning Working Group


Primary Care Commissioning Committee Quality Committee

Purpose of Report For noting Recommendations:


▪ Note the on-going and developmental work to deliver the CCG’s statutory duties in regards to ensuring quality in General Practice

▪ Discuss, comment and support the continued proactive approach to understanding and improving quality in General Practice

▪ Note the CQC status of practices in Croydon and the CCG input and actions to support practices

Background:

A high quality and safe healthcare system is at the heart of the CCG’s ambition as delegated commissioners of General Practice and as a clinically led organisation actively supports providers to go beyond national standards towards safe care on the ground. The CCG’s role is to be assured of the care quality of its providers but more importantly lead their improvement. Croydon CCG has established a number of measures and support mechanisms which are outlined in this report, together with details of future work planned to monitor quality, safety and performance and ensure that commissioned services deliver the best health outcomes for Croydon residents. The GP Clinical Quality Review Group (CQRG) discusses and monitors clinical issues, quality of care and performance.

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General Practice Clinical Quality Review Group (GP CQRG) report This report is a summary of the contents of the CQRG meeting on 29 January 2020. Learning Disability Health Checks

An improved number of LD Health Check has been noted in Q3 2019-20 (558) compared

to Q3 2018-19 (410). Total number of Health Checks completed year to date, with a count

of 1049, compared to 901 previously. The rolling 12 month total is 1642, which currently

forecasts a >75% of the number of patients on QOF LD register 2018-19 (all ages), if Q4

2019-20 is equal to or greater than 2018-19. However caution should be exercised when

considering this forecast, since some practices have made changes to when they recall

people, attempting to administer the influenza immunisation to this group of eligible

patients in the autumn, rather than waiting to the early months of the year.

The GP dashboard is being used to help identify and address individual practices where

variation is seen. A 2.5 hour training session on Learning Disability review for Practice

Nurses is planned on 12th February 2020.

Cervical Screening

Improvement initiative making appointments available to patients in the Extended Access

Services, as well as a CGPC run initiative is planned to follow up and recall patients

offering appointments in the EAS. NHSE/I are relaunching the cervical screening text

reminder project across London region. The six-month pilot was highly effective and

resulted in a 5% increase in the uptake of cervical cancer screening. More detail on the

results is available here.

In early January 2020 we were informed only half of the Croydon practices had signed up,

at the end of January, following support from the variation team, there are two practices

who are outstanding and being chased up.

Childhood immunisations

The GP dashboard is being updated with data quarterly, the latest available is Q2 2019-20.

A Quality improvement project has commenced with Primary Care North Croydon PCN to

understand barriers and improve processes focusing on childhood immunisations.

Learning will be shared.

The CCG attend and contribute to the Croydon Council Immunisation Steering group and

the associated improvement plans for immunisations.

Changes to the GP contract agreement 2020/21 - 2023/2 recently announced include

implementing over the next two years the findings of the vaccinations and immunisations

review. The payment model will be overhauled to support improved vaccination coverage.

Vaccinations and immunisations will become an essential service in 2020. New contractual

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core standards will be introduced. Item of service payments will be introduced and

standardised across all routine programmes over the next two years. This will begin with

Measles Mumps and Rubella (MMR) in 2020/21 and extend to other vaccines from April

2021.

Elective transformation

Now at 95% Blue button usage, compared to ~35% in April 2020.

SMI Health Checks

As a CCG Croydon has 5.1% achievement in 12 months to end of September 2019. (total

percentage to get full check). London mean is 33.5%. A new LCS was launched in the

autumn 2019 supporting this, which will be promoted at the January GP open meeting. We

are awaiting details of broken down by practices to further address variation.

GP online access

Nearly 25% of the Croydon population is registered for GP Online services (appointment

bookings or prescription services). There is variation between practices, which is

highlighted on the GP dashboard. One practice is being looked into as published data is

showing zero for both services. Another practice is showing zero for number of patients

registered to book appointments online, however this is an artefact due to how they are

using Doctorlink, which is a digital software application which allows online appointments,

for example video appointments.

Diabetes – National Diabetes Audit

NDA for Jan18-Mar19 was published in December 2019. Type 1: all eight went up from

35% to 45% - taking Croydon from ‘as expected’ to ‘higher than expected’ (England is at

41%).

Type 2: all eight went up from 52% to 60% - also taking Croydon from ‘as expected’ to

‘higher than expected’ (England is at 54%). Variation between practices from 3% to 96%,

but the majority of practices are now over 50% for the completion of checks for people with

type 2 diabetes. See separate report for full details.

Diabetes - National Diabetes Prevention Programme

The CCG continues to exceed targets for the National Diabetes Prevention Programme

(NDPP); 111 were referred in December 2019, the total number of Croydon residents now

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referred to the programme exceeds 2000. Improvements have been made by the provider

aimed at increasing access to the services, a digital offering is now available and also

population specific cohorts, such as a men only group.

NRLS Incidents reporting

There have been 68 medicine related incidents reported on The National Reporting and

Learning System (NRLS). Data is also shared with CHS and the Primary Care Prescribing

Committee to allow for improved shared learning. The reports this year have been rated

as low or no harm, a theme regarding errors as a result of a lack of or incorrect coding of

allergies has been seen, learning has been shared regarding this via the Medicines

Optimisation Newsletter.

Ursula Madine (interim head of Quality Assurance) is developing a comprehensive NRLS

incident reporting plan to engage, train and support GP practices.

Influenza immunisation 2019-20 update

The GP CQRG received the influenza immunisation uptake data for the period 1st

September to w/c 5th January 2019. Uptake amongst over 65s and pregnant women is

the same /higher than this time last year, however the uptake amongst at risk groups and

is marginally lower than last year.

There continues to be some data extraction issues in December which impacted two

Croydon practices. This had been reported to the national team but in the interim they were

being supported with their manual submissions.

Practices have been reminded that the final flu activity submission for 2019/20 on

ImmForm will be 12th February 2020.

Planning for 2020-21 season is underway, practices have been advised regarding placing

orders for supplies, and an immunisation update training event for practice nursing staff

has been arranged for 5th August 2020.

Comparison of percentage uptake of flu immunisation 1st Sept-w/c 5th

Jan

2019-20 2018-19

Over 65s 62.8% 61.0%

At risk groups 36.8% 40.4%

Pregnant woman 38.0% 38.6%

Safeguarding update

The CCG Safeguarding Team continue to work to implement changes as part of the

Croydon CCG and Local Authority CQC action plan.

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Elective Transformation: Blue Button

The Variation team continues to support the Elective Transformation work.

The latest data now shows that around 90% of referrals are being managed via the Blue

Button Booking service which offers choice of provider to patients, compared to less than

35% going by this route in April 2019.

Care Quality Commission (CQC) Visits/Ratings report The CQC are the independent regulator of health and social care in England and inspect

General Practices on a three yearly cycle or whenever ‘alert’ is received.

There are currently no practices within the Croydon Borough who the CQC have rated as

‘Inadequate’ overall. There are five practices/providers who the CQC have rated as

‘Requires Improvement’ overall which impacts seven of the fifty GP contracts:

1. Denmark Road 2. East Croydon Medical Centre / Edridge Road 3. The Greenwood Group - Greenside Road / Country Park Practice. 4. Mitchley Avenue Surgery 5. Hartland Way Surgery

Whilst the remaining GP Practices within Croydon Borough are rated as “Good” overall,

some practices are rated as “Requires Improvement” in one of the CQC’s Quality Domains:

1. Addington Medical Centre - “Safe” domain; 2. Brigstock and South Norwood Partnership - “Safe” domain;

Two practices have been rated as “Outstanding” in one of the CQCs Quality Domains:

1. Friends Road Medical Centre – “Well Led” 2. Selhurst Medical Centre – “Responsive”

The table below shows details of inspections undertaken by the CQC as part of their scheduled programme, return visits, other changes or where we are awaiting publications of reports since the previous at the December PCCC meeting. Appendix 1 reflects the position of all the practices at the end of Q3, presented to the Primary Care Working group meeting on 16th January 2020.

Location Type Date of

CQC visit

Date

report

published

Current

Overall

Rating

Change to last

visit

Denmark Road

Surgery

Comprehensive 23/10/2019 10/12/2019 Requires Improvement.

Remains RI. RI in

safe, effective and

well-led domains

East Croydon Medical Centre /

Comprehensive 6/11/2019 08/01/2020 Requires Improvement.

Remains RI. RI in

safe, effective,

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▪ A number of themes emerge from the CQC report findings regarding practices’ shortcomings, these include;

• Medicines Optimisation processes

• QOF / Clinical Care

• HR / Employment processes

• Estates / risk assessments

• Complaints / Incidents / sharing learning CQC Reports Published since December 2019 Denmark Road Surgery – Overall Rating: Requires Improvement The CQC inspected the practice on 23rd October 2019, and published the report on 10th December 2019. It is rated as “Requires Improvement” overall, having previously been placed in special measures in October 2018. It has been rated as a “Requires Improvement” in the CQC’s Quality Domains of “safe”, “effective” and “wed-led” The CQC determined that the provider “Must” make improvements in the following areas:

• Ensure that care and treatment is provided in a safe way

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The CQC determined that the practice “Should” make improvements in the following areas:

• Review antibiotic prescribing

• Review procedures in place to demonstrate improved outcomes for patients

• Consider ways to improve uptake for childhood immunisations, bowel cancer screening and cervical screening.

East Croydon Medical Centre – Overall Rating: Requires Improvement The CQC inspected the practice on 6th November 2019, and published the report on 8th January 2020. It is rated as “Requires Improvement” overall, having previously been rated as “Requires Improvement” following an inspection in September 2018. It has been rated as a “Requires Improvement” in the CQC’s Quality Domains of “safe”, “effective”, “responsive” and “wed-led” The CQC determined that the provider “Must” make improvements in the following areas:

Edridge Road

responsive and

well-led domains

Hartland Way

Surgery

ARR triggered 13/11/2019 07/01/2020 Requires Improvement

Previously Good. RI in safe, effective

and well-led domain

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• Review procedures in place for appropriate coding of medicine reviews

• Consider ways to improve uptake for childhood immunisations and cervical screening

• Review procedures to improve organisation of recruitment and training records to enable monitoring

• Review service procedures to improve low scoring areas in the national GP patient survey to improve patient satisfaction

Hartland Way Surgery – Overall Rating: Requires Improvement The CQC inspected the practice on 13th November 2019, and published the report on 7th January 2020. It is rated as “Requires Improvement” overall, having previously been rated as “Good”. It has been rated as a “Requires Improvement” in the CQC’s Quality Domains of “safe”, “effective” and “wed-led”. The CQC determined that the provider “Must” make improvements in the following areas:




• Review procedures in place to demonstrate improved outcomes for patients

• Consider providing equality and diversity training for staff

• Review procedures in place for appropriately code medicine reviews in the patient management system.

• Consider ways to improve uptake for cervical screening and childhood immunisations

• Review reception and clinical staffing levels in response to staff feedback Future CQC Visits and Quality Assurance The CQC have introduced annual regulatory reviews (ARR) to monitor practices rated as

good and outstanding. This includes all GP practices rated good or outstanding being sent

an email explaining that annual regulatory reviews were being rolled out and that the next

step will be a phone call from an inspector, to set a date four weeks later. Further details

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on the process can be found here: https://www.cqc.org.uk/guidance-providers/gps/how-we-

monitor-gp-practices

It is anticipated that the CQC will continue to undertake return visits for practices rated as “Requires Improvement” within the next 3-6 months. The CQC are in regular contact with Croydon CCG Primary Care Team and have been invited to attend a future General Practice CQRG meetings. Croydon CCG Primary Care, Variation and Medicines Optimisation teams are working actively to support Practices who are not rated as “Good” by the CQC. Regular supportive visits are undertaken by CCG representatives, including Clinical Leads, to understand the progress against their action plans and to assess and provide support to manage any risks. As well as supporting those practices rated as “Requires Improvement”, Croydon CCG are keen to see practices rated as “Good” move to ‘Outstanding’. The GP Quality Dashboard, designed by Croydon CCG, captures various quality data for all Croydon GP practice including CQC results. The Dashboard is presented at the bimonthly Primary Care CQRG meeting and has been designed to assess overall quality within Practices and Localities.

Governance:

Corporate Objective To develop as a mature membership organisation

To commission integrated, safe, high quality service in the right place at the right time.

To have collaborative relationships to ensure integrated approach

To achieve financial balance over five years

Risks

Risk relate to assuring consistent clinical services to the patient population


Financial costs in line with allocation.


Conflicts of Interest have been managed where appropriate as per the Conflicts of Interest policy.

Clinical Leadership Comments This document has been discussed at Clinical


N/A

Equality Analysis

N/A


Patient and Public involvement will be sought where appropriate.

Communication Plan The new arrangements for monitoring quality will be communicated to Practices through a number of channels.

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Discussions around specific quality issues will be undertaken within the boundaries of the CCG’s Information Governance policy.

Reputational Issues

Failure of the CCG to have oversight of the quality of care in General Practice could have an adverse effect on the reputation of the CCG.

Appendix below

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Summary of CQC end Quarter 3 - 2019/20

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NHS CROYDON CCG PRIMARY CARE COMMISSIONING …...Mark Creelman Interim Project Director Enclosure 3...

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Transcript of NHS CROYDON CCG PRIMARY CARE COMMISSIONING …...Mark Creelman Interim Project Director Enclosure 3...