Primary Care Performance

and Quality Report May 2018

Author: Sue Gunner, Analyst - Planning & Performance

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ENCLOSURE 5

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Contents

Page Number

Introduction 3

Friends & Family Test (FFT) 4

GP Patient Survey – Satisfaction with the Practices Opening Hours

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Primary Care – Narrative Update 10

CQC Ratings 11

Appendix 1 – FFT Data Table 13

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Introduction This purpose of this report is to give the Primary Care Commissioning Committee a brief overview of the quality of Primary Care services in Bromley. A plethora of performance information relating to Primary Care is available and the frequency of publication varies depending on the data source and collection regimes. Therefore, the content of the report will be predominantly driven by data that is published nationally, but will be supplemented with local intelligence where appropriate. The content of each Primary Care Quality Report will vary depending on what information has been most recently published at the time of writing. The content, data and information presented has been collected from a number of sources including; NHS England, NHS Digital, Public Health England (PHE) and the Care Quality Commission (CQC). This report should not be looked at in isolation but considered alongside other sources of information, both hard and soft, pertaining to Primary Care service provision in Bromley. The format/content of the report has changed over the months as feedback from the Committee is received and, where possible, incorporated into the document.

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Friends & Family Test (1 of 2)

The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. This feedback is vital in transforming NHS services and supporting patient choice. Whilst a useful tool to measure patient satisfaction/experience the response numbers are very low so this can skew the results at individual practice level. The chart that follows details FFT data for March 2018. It should be noted that four practices did not submit data:

Charterhouse Surgery, Elm House Surgery, Wickham Park Surgery and Cator Medical Centre,

Additionally three practices submitted data but the number of responses was less than five so the results were supressed:

South View Partnership, Manor Road Surgery and Bromley Common Practice.

Note: Detailed FFT data is included as appendix 1 (page 13)

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Friends & Family Test (2 of 2)

Notes: The highest number of responses for an individual practice was 349 (Summercroft Surgery).

Practices reporting higher response numbers are using Smartphone App/Online as the method of collection

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. The survey is run by Ipsos MORI on behalf of NHS England. The data in this report is based on the July 2017 GPPS publication. This combines two waves of fieldwork, from January to March 2017, providing practice-level data. The survey is sent out annually in January. Weighting has 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. The following data represents some of the key results for Bromley CCG. In Bromley CCG 12,321 questionnaires were sent out and 4,937 were returned completed. This represents a response rate of 40%.

GP Survey (1 of 4)

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GP Survey (2 of 4) The GP Patient Survey measures patients’ experiences across a range of topics, including:

Making appointments Perceptions of care at appointments Waiting times Practice opening hours Out-of-hours services

This month’s report will focus on ‘Satisfaction with the practices opening times’

It is useful to understand who has responded to the survey and what their contact has been with their surgery. The table below details the age breakdown of respondents to the survey. The pie chart alongside sets out when survey respondents’ last saw or spoke to a GP.

Age Band Number of Respondents %

18 to 24 years 374 8

25 to 34 years 773 16

35 to 44 years 915 19

45 to 54 years 950 20

55 to 64 years 727 15

65 to 74 years 591 12

75 to 84 years 372 8

85+ years 169 3

GP Survey (3 of 4)

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GP Survey (4 of 4)

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Primary Care (1 of 1) Primary Care Overview

E-Referrals – Outpatient Utilisation

The table below sets out Bromley’s outpatient e-referral utilisation rates over recent months Apr-2017

May -2017

Jun -2017

Jul -2017

Aug - 2017

Sept – 2017

Oct – 2017

Nov – 2017

Dec – 2017

Jan – 2018

Feb – 2018

Mar - 2018

64.6% 73.0% 71.8% 67.7% 69.3% 75.0% 87.8% 89.2% 78.3% 85.2% 84.1%

Bromley CCG has the highest OP utilisation rate in south east London

CCG November December January February

Bexley CCG 75.9% 62% 73.6% 77.4%

Bromley CCG 89.2% 78% 85.2% 84.1%

Greenwich CCG 56.4% 53% 67.1% 72.0%

Lambeth CCG 46.5% 44% 52.9% 55.6%

Lewisham CCG 49.4% 61% 67.2% 75.7%

Southwark CCG 43.0% 42% 54.1% 57.6%

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The Care Quality Commission (CQC) inspects practices to assess how they provide primary care services to six particular population groups:

Older people People with long-term conditions Families, children and young people Working age people People whose circumstances may make them vulnerable People experiencing poor mental health

The CQC assess whether the service provided for these groups are; safe, effective, well-led, responsive and caring. The following table categorises Bromley practices under the four CQC ratings:- Outstanding, Good, Requires Improvement and Inadequate.

CQC Ratings (1 of 2)

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CQC Ratings (2 of 2)

Practice Name Overall CQC RatingDate of CQC Inspection Practice Name Overall CQC Rating

Date of CQC Inspection

Dysart Surgery Outstanding 23/07/2015 Pickhurst Surgery Good 12/12/2016

Addington Road Surgery Good 06/12/2016

Poverest Medical Centre Good 18/06/2015

Ballater Surgery Good 16/03/2016 Robin Hood Surgery Good 03/10/2016

Bank House Good 11/01/2017 South View Lodge Good 06/04/2016

Bromley Common Practice Good 22/04/2016 Southborough Lane Surgery

- Crown Medical Centre Good 05/01/2017

Cator Medical Centre Good 01/11/2016 St James' Practice Good 30/04/2015

Chelsfield Surgery Good 18/09/2017 Station Road Surgery Good 12/12/2016

Chislehurst Medical Practice Good 22/09/2016 Stock Hill Surgery Good 04/04/2016

Cornerways Surgery Good 27/04/2016 Summercroft Surgery Good 09/01/2018

Crescent Surgery Good 26/02/2018Sundridge Medical Centre Good 09/11/2017

Cross Hall Surgery Good 15/03/2018 Trinity Medical Centre Good 03/06/2016

Derry Downs Surgery Good 26/05/2017 Tudor Way Surgery Good 20/10/2016

Eden Park Surgery Good 02/03/2018 Whitehouse Surgery Good 15/09/2017

Elm House Surgery Good 25/11/2016Wickham Park Surgery Good 29/09/2016

Family Surgery Good 08/07/2016 Woodlands Practice Good 16/11/2016

Forge Close Surgery Good 04/04/2016 Broomwood SurgeryRequires

Improvement 04/09/2017

Gillmans Road Good 19/08/2016Highland Medical Practice

Requires Improvement 19/12/2017

Green St Green Medical Centre Good 01/12/2016 Manor Road Surgery

Requires Improvement 29/12/2017

Knoll Medical Centre Good 31/05/2016 Charterhouse Surgery New inspection Service taken over by new providers

Links Medical Practice Good 31/05/2016 Anerley Surgery New inspection Service Registered by CQC on 01/11/2017

London Lane Clinic Good 11/01/2017 Oakfield SurgeryNew Premises - Not

yet assessedService Registered by CQC on 19/11/2017

Norheads Lane Surgery Good 13/09/2017 St Mary Cray Practice New inspection

Service Registered by CQC on 23/02/2018

Park Group Practice Good 29/12/2016

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Appendix 1 – FFT Data Table – March 2018

Primary Care Overview PMS Premium Services. The PMS Premium Services are now in place 44 out of 45 practices following Wave 1 implementation from October 2017

and Wave 2 implementation from January 2018. We are working with the remaining GMS practice to mobilise delivery to their patient populations from June. Bromley CCG is currently pulling together performance reporting for the first quarter of delivery amongst wave 1 practices. Although the first

quarter is a ‘grace period’ exempt from performance management for practices, pulling together the data and a report provides a good opportunity for practices and the CCG to become familiar with the monitoring arrangements required each quarter.

Practice Development Plans for both wave 1 and 2 practices are being reviewed by the PDP Panel each month, which includes CCG and LMC representation

Primary Care Needs Assessment. Dr Agnes Marossy is continuing her work on the Bromley Primary Care Needs Assessment. A Workforce Clinical Reference Group was held on 27th February with GP practice staff and CCG colleagues to discuss the workforce issues facing general practice and how best to address them. Data gathering for the second annual workforce survey is now complete from 100% of practices. Other deep dive work is ongoing around practice DNA rates.

Practice engagement. The Primary Care team has a named team member for each practice as the first point of contact for that practice and to

undertake quarterly practice visits. Progress with practice visits over the past year has been: 53% of practices were visited in Feb-May 2017 (the drop off was due to staff leaving and competing PMS priorities) 78% of practices were visited in June-Sept 2017 91% of practices were visited in Oct-Dec 2017 89% of practices were visited in Jan-Mar 2018

A reflection piece on GP practice visits and wider engagement by the primary care team is going to the CEG and PCSG in April 2018 for discussion

Review of medical support to care homes (Visiting Medical Officer scheme). The existing Visiting Medical Officer (VMO) contract was due to cease on 31 March 2018 and the service specification and remuneration rates have not been refreshed since 2010. There has been a lack of overarching strategic direction around care homes in recent years, and a lack of joint working between the CCG and the council as the two main commissioners of care home placements. Despite several reviews, this has made it difficult for the VMO scheme to be refreshed to align with an overall vision of health and social care in a more effective commissioner/provider context. We are now remedying this by: Extending the existing VMO arrangements to 31st March 2019 Developing joint care homes strategic and operational groups with the council, that will deliver change plans Robustly engaging with local VMOs, care homes, patients, commissioners and partners (e.g. St Christopher’s), and learning from good practice

in other areas Exploring new commissioning models for enhanced support to care home. Through engagement at GP cluster meetings, with Bromley LMC and

at the CCG’s CEG and PCCC meetings, we have now selected an APMS contract model Aiming to invest funding from the Better Care Fund to top up CCG budgets to provide this support Improving the contribution of the wider health system towards care of care home residents 14

Primary Care (1 of 3)

Primary Care Overview cont.

GP Forward View: Practice resilience, workforce and sustainability plans are now being implemented using the £185,000 of 2016/17 funding from the GP Forward

View monies, plus a further £41,000 for resilience in 2017/18 These focus on practice nursing, new roles in primary care including clinical pharmacists, staffing solutions, vulnerable practice support and

care navigation Bromley are supporting 13 practices in 2017/18. Practices were identified using a rigorous assessment process using London-supplied and

local intelligence and followed by collaborative action planning and evaluation with the selected practices NHS England has allocated £45 million over the next three years to support the implementation of online consultation systems by practices. This

equates to £87,000 for Bromley for 2017/18. Following extensive patient and practice engagement, and in line with NHS England guidance on what type of products we can implement, we are proposing to pilot online video consultations and an online triage system that allows patients to consult with a GP from their practice via a confidential online platform. This was approved at the March 2018 meeting of the PCSG

Winter resilience schemes for 2017/18: In lieu of the GP Home Visiting service, additional support within the BHC rapid response service has been in place since 26th December. This is

being extended until the end of May 2018 Additional appointments (10%) in the access hubs have been in place since 1st October and utilisation remains high A review of the housebound flu vaccination programme has taken place, and 2018/19 planning meetings are being arranged with Bromley

Healthcare, LMC, GP and Practice Manager representatives and the CCG from May ‘Liaison GPs’ have been recruited to the Discharge to Assess team at the PRUH. They are undertaking ‘discharge optimisation’ ward rounds pre-

discharge and visiting patients placed in interim care home beds soon after discharge to provide general medical support for the patient.

The 2017/18 Referral Optimisation Local Improvement Scheme has been evaluated. 37/45 practices signed up to the LIS There has been good attendance at the education sessions and the Action Learning Meetings. A survey has gone out to participating practices to

seek their feedback on these elements of the scheme EMIS Resource Publisher is still not yet in place – the risks have been escalated and are being picked up with EMIS with urgency Referrals are still increasing steadily compared to the 16/17, although there was a reduction in referrals in November 2017 compared to the

November 2016. Over September to November 2017 (since the ALMs) , referrals in general have reduced or stayed the same. The Primary Care Steering Group has approved recommendations to continue an amended version of Referral Optimisation LIS into 2018/19

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Primary Care (2 of 3)

Primary Care Overview cont.

Out of Hours Primary Medical Services

Primary care access hubs continue 4pm-8pm opening on weekdays and 8am-8pm opening at weekends (therefore, 8-8, 7/7 has been in place since late January 2017). Utilisation rates remain high (97% utilisation rate in December 2017) and are actively tackling the 10% DNA rate with the implementation of text message reminders, which we anticipate will have a particular impact on the weekend appointments. The contract with the GP Alliance for the Access Hubs has been extended to 30th September 2018, as the CCG is undertaking a review of

urgent care services, which the Access Hubs interface with through Urgent Care Centre booking into hub slots. 22 people attended a patient engagement event in January 2018 to seek public views on the current Access Hub provision and how it can

be improved. The feedback captured will be reflected on and considered for future service developments, in particular better communication about what the Access Hubs offer and other healthcare services that are available to better educate patients on accessing the right care at the right time

Bromley’s current Out of Hours service runs from 6.30 pm to 8 am, with 24 hour cover at weekends and bank holidays, to ensure access to Primary Care is available

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Primary Care (3 of 3)