Table of Contents Document Page 7 06.1 MCCG … PCCC...Table of Contents Document Page 1 01 PT1 PCCC...

Table of Contents

Document Page

1 01 PT1 PCCC October 2018 AGENDA 32 02 MPCCC Register of Interest 2018-19 August 2018 53 03.1 PT1 PCCC June 2018 minutes 114 03.2 PMCPG_Executive summary 155 05.1 PART 1 Integrated Primary Care Commissioning Update 216 05.2 M5 Merton Primary Care Committee Finance Update 297 06.1 MCCG PCC GP Pt Survey 2018 378 06.2 08R - NHS MERTON CCG GP Survey 479 07.1 Merton Primary Care Committee Estates Update_cover 9910 07.2 Merton CCG_PCCC_ Estates Update.docx 101

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1

MERTON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE

Tuesday 2rd October 2018

13.00 – 14:00

Rm. 6.2, 6th Floor. 120 The Broadway, Wimbledon, SW19 1RH

Part 1

Questions from the public are received at the discretion of the Chair.

Closure of Part 1 To resolve that the public now be excluded from the meeting, on the basis that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be conducted in the second part of the agenda.

Chair: Clare Gummett

No. Item Description Lead For Att./

Verbal

1 Welcome and Apologies CG Note Verbal

2 Conflicts of Interest All Note Att 1

3 Minutes of Part 1 of the Primary Care Commissioning Committee 05.06.18

All Approval Att 2

4 Matters Arising All Note Verbal

5 Integrated Primary Care Commissioning Update inc. Finance Report

KS & NM

Information Att 3

6 GP Patient Survey Report EG Note

7 Primary Care Estates Update LL Note

8 Any Other Business All Note Verbal

3 of 104

Name

Current position (s) held in the

CCG i.e. Governing Body

member; Committee member;

Member practice; CCG employee

or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest

(Name of the organisation and nature of business)

Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

Dr Andrew Murray Clinical Chair of MCCG

Chair of Governing Body

Joint Chair Clinical Oversight Group

Member of Remuneration Committee

Member of Executive Management

Team

Member of Finance Committee in

Common

Member (non-voting) of Primary Care

Commissioning Committee

Chair of South West London Clinical

Senate

Chair of Merton Planned Care

Programme Board

Co-Chair Integrated Governance and

Quality Committee

Y

1. GP Partner in The Nelson Medical Practice operating out of the Nelson

Health Centre.

2. Chair of Executive Management Team at Nelson.

3. Wife helped establish Merton Against Trafficking (local anti-people

trafficking) for which I have done some volunteer work.

4. A close friend set up Chapel Street (Charity) – this runs some services

for NHS, but not in Merton.

5. Same friend also set up “For Refugees” – a national initiative aimed at

supporting refugees moving to UK.

6. Regular attendee of Raynes Park Community Church, a member of

Merton Citizens, a community movement whose campaign areas include

mental health services for children and young.

1

6

3

4

5

1. Apr 2015

2. Apr 2015

3. Sept 2008

4. 2010

5. 2016

4. March

2017

Adherence to COI

policy

James Blythe Managing Director

Governing Body Member


Team

Member of Primary Care



Common

Member of Integrated Governance

Quality Committee

Y

1. Wife is an employee of St George's University Hospitals NHS

Foundation Trust and has a specialist training number with HEE South

London

1 1. May 2017 1. I am not present

at specific

discussions relating

to the relevant

service.

Register of Interests 2018/19 (updated September 2018)

5 of 104

Name





or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest


Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

Clare Gummett Governing Body Lay Member for

Patient & Public Engagement

Member of Integrated Governance and

Quality Committee

Chair of Primary Care Commissioning

Committee

Member of Audit & Governance

Committee

Member of Remuneration Committee

Member of Sutton & Merton CCGs

Charitable Trust

Member of Patient Engagement Group

Member of Merton Equality & Diversity

Group

Y

1. Age UK Merton – Chair of Trustees 1. Jan 2014 Adherence to COI

policy

Andrew Leigh Governing Body Lay Member for Audit

& Governance

Chair of Audit & Governance

Committee

Member of Governing Body

Member of Remuneraton committee




Quality Committee

Y

1. Director of Maynard Leigh Associates (MLA), and Chair of Leadership

Team. MLA runs training courses; NHS employees occasionally attend.

2. Manage a non for profit web site called Ethical Leadership.

3. Wife is Deputy Chair of Sustainable Merton

1

2?

3

1. Nov 2017

2. Nov 2017

3. Current

all ongoing 1. Avoid voting on

items about

Leadership Training

contracts for which

Maynard Leigh

might bid.

2. A not-for profit

site; does not trade

commercially.

6 of 104

Name





or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest


Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

Dr Tim Hodgson GP Governing Body Member

Joint West Merton Locality Lead


Quality Committee


Common

Member of Clinical Oversight Group


Commissioning CommitteeY

1. GP Partner – Wimbledon Village Surgery (Member of Merton

Federation)

1 Apr-17 Apr-19 Adherence to COI

policy

Dr Karen

Worthington

GP Governing Body Member



Quality Committee


Common

Clinical Director for transforming

Primary care

Member of Merton Health and

Wellbeing board

Y

1. Part time salaried GP at Central Medical Centre. 2 days per week

2. Part time staff bank member-clinical support to clinical harm review

at St Georges Hospital. Training undertaken but no work done.

1.

2.

1.12/06/16

2. 24/4/17 2. 24/04/18

Adherence to COI

policy

Dr Mike Greenberg Governing Body Secondary Care

Member




Committee

Y

1. Medical Director of Barnet Hospital (part of Royal Free London Group)

2. Member of Wellington Diagnostics and Outpatient Centre LLP

3. Wife is a GP in Barnet and a Board member of Barnet Federation of

GPs.

2

1

3

1. 01/04/2018

2. 01/04/2018

3. 01/04/2018

Adherence to COI

policy

7 of 104

Name





or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest


Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

Dagmar Zeuner Director of Public Health (LBM)


Director for Preventative and Proactive

Care


Member of CCG Clinical Cabinet

Member of Primary Care Committee Y

1. Director of Public Health, LBM

In this role potential / perceived conflict of interest re any decision

about future of St Helier’s Hospital.

2. Partner is owner of ZG publishing (publishes the magazine: “Outdoor

Swimmer”).

3. Honorary senior lecturer at the London School of Hygiene and

Tropical Medicine.

4. Research advisor (occasional) for University of London/Institute of

Child Health.

1

3

2

1. Feb 2016

2. Feb 2011

3. Apr 2006

4. Apr 2010

1. Not being a

member of the CIC,

being excluded

from any decision

making on the

future of St Helier,

which includes

circulation of

related

unpublished

papers.

Neil McDowell Director of Finance


Member of Finance Committee


Committee




Committee


Quality Committee

Y

1. Spouse employed by Guildford and Waverley CCG as CFO Adherence to COI

policy

Julie Hesketh Director of Quality and Corporate

Governance



Committee


Quality Committee

Member of Audit and Governance

Committee

Y

1. Personal involvement in Richmond Education Network (not for profit

organisation). This is done outside of CCG hours.

Adherence to COI

policy

Katharine Denton Director of Primary Care

Transformation

N

No interests declared Adherence to COI

policy

8 of 104

Name





or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest


Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

John Atherton Director of Performance Improvement





Quality Committee


Committee

N


policy

Josh Potter Director of Commissioning Member

of Governing Body


Committee




and Quality Committee

N


policy

Dr Marek

Jarzembowski

Local Medical Committee

Representative

Chair of Merton Local Medical

Committee

Y

1. Partner in the Nelson Medical Practice partnership, operating from

the Nelson Health Centre.

2. Member of Merton Health Ltd (Federation) by dint of being a partner

in the Nelson Medical Practice.

3. Member of the Board of Directors of Londonwide LMCs.

4. Chair of Merton Local Medical Committee.

1 1. April 2015

3. March 2015

4. 2016

Adherence to COI

policy

9 of 104

Name





or other

Do you

have any

interests

to

declare?

(Y or N)

Declared Interest


Fin

an

cia

l In

tere

st

No

n-F

ina

nc

ial

pro

fes

sio

na

l

Inte

res

t

No

n-F

ina

nc

ial

Pe

rso

na

l In

tere

st

Ind

ire

ct

Inte

res

t

Nature of Interest

From To

Action taken to

mitigate risk

10 of 104

of 4

Minutes of the Merton Clinical Commissioning Group

Primary Care Commissioning Committee Meeting

Tuesday 5th June 2018, 120, The Broadway, Wimbledon, SW19 1RH

Chair: Clare Gummett

Members:

Clare Gummett (CG) Chair, Governing Body Lay Member for PPI

Neil McDowell (NM) Director of Finance

Andrew Leigh (AL) Governing Body Lay Member for Audit & Governance

Andy McMylor (AMc) Director of Primary Care Transformation

Julie Hesketh (JH) Director of Quality & Governance

Dr Mike Greenberg (MG) Secondary Care Governing Body Member

Attendees:

Dr Dagmar Zeuner (DZ) Director of Public Health

Dr Tim Hodgson (TH) Clinical Locality Lead, West Merton

Dr Marek Jarzembowski (MJ) Chair, Merton Local Medical Committee

Dr Andrew Murray (AM) Chair of the Governing Body

Nora Simon (NS) Deputy Head of Primary Care Commissioning, NHSE

Rebecca Blackburn (RB)

Lucy Lewis (LL) Head of Estates, Merton and Wandsworth CCGs

Apologies:

James Blythe (JB) Managing Director

Kate Symons (KS) Acting Head of Delegated Primary Care Commissioning

Officer in Attendance:

Tony Foote (TF) NELCSU

Muna Ahmed (MA) Interim Governance Officer

11 of 104

of 4

No. Item Action

1.

Welcome and Apologies

CG welcomed all and noted the apologies as above. The meeting was quorate. CG thanked TF for all his hard work in managing the committee and introduced MA, who will be taking this role on from TF.

2. Conflicts of Interest

DZ declared that she works for Merton Council and would be conflicted if there were any decisions to be made regarding Epsom and St Helier.

3. Notes of Meeting on 24th April 2018

The minutes of 24th April 2018 were APPROVED as a full and accurate record, subject to the attendees list being updated to include DZ, who was in attendance.

4. Matters Arising and Action Log

There were no matters arising from the minutes. Action log Action 5 – AMc confirmed that as part of the Primary Care at Scale, there will be practice support teams. The overarching contract will now include complaints.

5. Integrated Primary Care Commissioning Update including Finance Report

Rowans Surgery CQC report The Rowans Surgery was inspected by the CQC on 27th February 2018. The current provider Streatham Common Practice had only been in place for four months. Four of the five key domains were identified as “Requires improvement”. It was acknowledged that there were legacy issues with the practice. The domain “Effective” was rated as “Good”. The practice has since recruited 2.6 WTE GPs and has a good medicines management system in place. CCG and NHSE team will visit the practice to address quality areas of concern. A follow up inspection is usually carried out after 6 months and is likely to be a desktop inspection. The practice will develop an improvement action plan which is monitored at the Primary Care Quality Committee. DZ advised the committee to ensure participation of the local authority is included in the action plan, for assurance around safeguarding. JH confirmed an update on safeguarding goes to the Safeguarding Committee. Updates to the NHS England Primary Care Policy Guidance Manual (PGM) NS provided a brief summary of the PGM and explained that existing policies were pulled together into one document. NS highlighted what is in the manual:

- NHS England’s responsibilities

- CCG delegated commissioning responsibilities

12 of 104

of 4

- Contract Management

- Assurance Framework

- Issuing breach notices

- Local payments and reimbursements

There was a discussion about the new chapter on discretionary payments. NS explained that this relates to the section 96 payment. Sickness and maternity leave is no longer discretionary and will be an entitlement. Joint Primary Care Quality Review Group (PCQRG) Update There was a review on how the joint PCQRG is going. There was general consensus that it is a helpful and useful forum to discuss how we communicate with the membership, provided input and made changes to “Make a difference”, contract management and going forward, formulate which areas to target in quality. It was felt that there is scope for learning from Wandsworth. AMc added that it is useful to review the CQC inspections with the expertise in the meeting. With the quality contract starting, AMc would like to invite the Federation to the meetings. Learning events for Merton will be held over the summer. There was a discussion about a dashboard for quality in Primary Care. The CSU has been asked to develop a dashboard for primary care which incorporates practice variation and quality contracts. The aim is to have data in one place. Primary Care contracting decisions NS highlighted an error in the paper, as the contract variations are for the whole of 2017/18 and not for quarter 1, as stated.

Action: An executive summary of the NHS England Primary Care Policy Guidance Manual to be circulated to the committee.

The Committee NOTED the Integrated Primary Care Commissioning Paper.

Finance Report NM presented this report and highlighted the following points:

- The end of year 2017/18 position for primary care was an under spend of

£1m.

- The primary care budget has been approved by the Board.

- James O’Riordan practice transfer with Sutton is ongoing. 1st July is the

official move date.

- Month 12 position is similar to month 11. Prescribing performed well

overall with an under spend of £704k, despite the “No Cheaper Stock”

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of 4

(NCSO) issue. MJ advised that a reduction in cost for prescribing should

not mean a reduction in the quality of prescribing.

- Out of hours had an unusual under spend. NM will look into why this is

the case. AMu queried whether the under spend in out of hours is due to

the GP Access Hubs. AMc will ask STP to provide more information on

this.

- There has been an increase in locum fees and will be a cost pressure in

2018/19.

MJ queried the over spend of £102k in Quality and Outcomes Framework (QOF) payments. It was explained that there was temporary protection for Rowans and also the QOF final achievement is based on the list size, as it is on 1st January.

2018/19 budget report:

- Going forward, NM will make a distinction in the report between

transformation funding and business as usual funding.

- NM asked for feedback on how the finance report can be improved and

what the committee would like to see that is different from Board finance

report. A committee member asked for the “Other” category in the

finance report to be broken down, for transparency and clarity.

The Committee NOTED the Finance Report on the Primary Care Budgets. -

6. Any Other Business

There was a discussion about how the committee is publicised to the public. It was queried whether this meeting should be filmed, like the Governing Body. There was no additional business for consideration. CG thanked all present for their input and declared Part 1 of the meeting closed.

Date of Next Meeting: Tuesday 2nd October 2018, 1-3pm

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Executive summary - Primary Medical Care Policy and

Guidance Manual (PGM) This policy and guidance manual has been updated to reflect the changing landscape in

primary care co-commissioning.

In 2016, the ‘Policy Book’ for Primary Medical Services was published (Gateway Ref 04171),

which provided commissioners of GP services with the context, information and tools to

commission and manage GP contracts.

As part of the co-commissioning strategy, as at 1 April 2017, 176 Clinical Commissioning

Groups (CCGs) have responsibility for commissioning and contract monitoring GP services in

their locality, with NHS England maintaining overall accountability. Local Offices of NHS

England retain responsibility for commissioning and monitoring the performance of GP

services for the remaining CCGs.

Recognising the need to strengthen guidance for CCG commissioners, NHS England

reviewed its Policy Book and the feedback received since its first publication and has made

the following additions and amendments and published herewith in this ‘Primary Medical Care

Policy and Guidance Manual (PGM).

The PGM has been divided into 4 parts (A-D). The language throughout has been amended

to cover all commissioners, recognising 85% of CCGs are now operating under fully delegated

authority or joint arrangements. Reflecting feedback, templates have been embedded as

extractable documents for easier onward use.

Part A – Excellent Commissioning and Partnership Working 1 Introduction – providing some background information to updated policy

2 Abbreviations and Acronyms – List of abbreviations and acronyms used throughout

the document

3 Commissioning Described – in this section co-commissioning and delegated

commissioning arrangements are explained

4 General Duties of NHS England (including addressing health inequalities) This chapter

outlines the general duties that NHS England must comply with that are likely to affect

the decisions it takes regarding the provision of primary care. CCGs carrying out co-

commissioning under delegated authority do so on behalf of NHS England. Such

CCGs need to comply with NHS England's legal duties when doing this – this is set

out in the co-commissioning Delegation Agreement. Therefore, this chapter is also

relevant to co-commissioning CCGs.

Summary of duties covered by this chapter

Equality and Health Inequalities duties

a) Equality Act 2010

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b) NHS Act 2006

Other non-equality and health inequalities related duties

The "Regard Duties"

The "View To Duties"

The "Promote Duties"

The "Involvement Duty"

Duty to act fairly & reasonably

Duty to "obtain appropriate advice"

Duty to exercise functions effectively

Duty not to prefer one type of provider

Equality and Health Inequalities duties

a) Equality Act 2010 b) NHS Act 2006 (as amended by the Health and Social Care Act

2012)

5 Working Together – Commissioning and Regulating – This chapter is intended to

inform commissioners of existing and ongoing work to establish a robust and practical

joint working framework by CQC and NHS England, with wider clinical commissioners,

in light of CCGs taking on full delegation and as CQC moves to its next phase of

inspection process.

Part B – General Contract Management 1 Contracts Described – This chapter includes a comparison of the various contracting

models and the list of eligibility requirements for persons entering the GMS/PMS and

APMS contract.

2 Assurance Framework Contract Review – Commissioners of Primary Medical Care are

responsible for the quality, safety and performance of services delivered by providers,

within their area of responsibility. This chapter outlines the approach to be taken by

commissioners when overseeing primary medical care contracts to ensure compliance

with quality and safety standards and replaces the Primary Medical Services

Assurance Management Framework guidance and policy documents first published

April 2013.

3 Managing Patient Lists – This chapter explains practice and commissioner’s

responsibility with regards to managing patient lists (open/closed/patient assignments)

and the process of list maintenance. It also describes the Primary Care Support (PCS)

Services delivered nationally through Primary Care Support England (PCSE).

4 GP Patient Registration Standard Operating Principles for Primary Medical Care – A

new chapter in the PGM, but which updates existing registration guidance published

by NHS England in November 2015 (Gateway Ref 04448). There has not been any

change in national policy in respect of patient registration for primary medical care

services – this guidance clarifies the rights of patients and the responsibilities of

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providers in registering with a GP practice. It also clarifies the contractual rules in

respect of patient registration for patients, practices, CCGs and NHS England’s

regional teams.

5 Temporary suspension to patient registration – These guidelines for commissioners,

describe the process for closing the practice list and the circumstances where a

temporary suspension by the contractor of patient registration may be appropriate and

the conditions that should govern that decision such that the roles and responsibilities

of both parties are not compromised.

6 Special Allocation Scheme (SAS) – This chapter provides guidance to Commissioners

and providers of essential primary medical care services in relation to the removal of

patients who are violent from their practice list and the Special Allocation Schemes

(SAS) intended to ensure such patients receive primary care services. Provision for

SAS is set out in the GMS Regulations and the PMS Regulations (together, the

Regulations). This guidance focuses on a number of key themes, such as

commissioning the service, provider and service requirements, eligibility criteria and

the process of requesting immediate removal of a patient, which are intended to

support implementation of, and commissioning and monitoring of a SAS.

7 Contract Variations - This policy describes the process to determine any contract

variation, whether by mutual agreement or required by regulatory amendments, to

ensure that any changes reflect and comply with legislation so as to maintain robust

contracts. An existing chapter that has been strengthened and refined by the Legal

team and provides increased guidance in relation to Practice Mergers.

8 Managing a PMS Contractor’s Right to a GMS Contract – A contractor holding a PMS

agreement which is providing essential services, has the right to a GMS contract in

accordance with Regulation 19 of the PMS Regulations. This policy sets out the

decision-making process that the Commissioner will follow, together with refusal

(where eligibility is not satisfied), appeal processes and discussions regarding any

actions that are required.

9 Practice Closedown (Planned / Scheduled) - This chapter outlines the approach to be

taken when a time-limited primary medical services contract is coming to an end.

10 Discretionary Payments (made under Section 96) – this section does not cover locum

payments. A new chapter drafted jointly with NHS England’s Legal and Finance

Teams. Section 96 of the NHS Act (2006) (as amended) makes provisions for

commissioners to provide assistance and support to primary medical services

contractors, including financial support. S.96 exceptional discretionary funding is

intended to be used to safeguard patients’ interests by providing additional funding to

support practices facing a crisis situation.

Part C – When things go wrong 1 Contract Breaches, Sanctions and Terminations – This policy chapter outlines the

approach to be taken by the Commissioner when a contract is considered to have

been breached. The GMS Regulations, the PMS Regulations and the APMS Directions

make a clear distinction between the process to be followed where a breach is capable

of remedy and the process where a breach is not capable of remedy. The chapter also

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describes the circumstances where the commissioner may apply contract sanctions.

The third part of this chapter deals with contract terminations.

2 Unplanned / Unscheduled and Unavoidable Practice Closedown – When a GP

Practice closes at short notice, it is important that commissioners respond and act in a

timely way. Such closures may be as result of actions by the CQC, for example

voluntary closure in response to an adverse inspection or cancellation of the practice’s

registration, or due to the sudden inability of a provider to continue providing a service

for some other reason such as bankruptcy. This guidance clarifies the role of the

commissioner and the engagement required with patients and any partner

organisations (e.g. NHS England or CQC).

3 Death of a Contractor (excluding single handers – see adverse events) – The aim of

this policy is to provide consistency when dealing with the death of a contractor,

whether they are a single-handed contractor, in a partnership or a corporate

organisation and includes consideration of GMS, PMS, APMS and where appropriate

MCP/PACS contracts. This policy outlines the procedure to follow when the death of a

contractor occurs. This is a rare occurrence, but there are certain steps to follow within

agreed timescales that are laid down in legislation.

4 Managing Disputes – This policy describes the process to determine the action

required when a contractor has requested to follow the NHS dispute resolution process

or where the Commissioner elects to follow the NHS dispute resolution procedure.

5 Adverse Events (e.g. flood fire) – Adverse incidents are dealt with in the force majeure

provisions of the standard GMS, PMS, APMS and where appropriate MCP/PACS

contracts. Although these provisions are not required by the GMS Regulations, the

PMS Regulations or the APMS Directions, the majority of GMS, PMS, APMS and

where appropriate MCP/PACS contracts will include them. A force majeure event is

one which is caused by circumstances beyond the reasonable control of either the

Commissioner or the contractor that could not have been avoided or mitigated with

reasonable care and where the event has had a material effect on the fulfilment of the

contract. All contractors will likely be obliged under the terms of their contracts to

promptly notify the Commissioner of a force majeure event, detailing the cause or

event, what service provision is being delayed or prevented and what action(s) within

their power they are taking in order to comply with the terms of the contract as fully

and promptly as possible.

Part D – General 1 GP IT Operating Model: Data and Cyber Security Arrangements – A new chapter

drafted by the GPIT team. This chapter provides an overview of GP IT Operating

Arrangements, as outlined in the GP IT Operating Model, ‘Securing Excellence in GP

IT Services’ 2016/18, published by NHS England. Particular reference is made to data

and cyber security arrangements, following the publication of the National Data

Guardian Review in July 2016 which included key recommendations and proposed ten

data security standards.

2 Protocol in respect of locum cover or GP performer payments for parental and sickness

leave – A new chapter in the PGM but previously published in April 2017 with Gateway

Ref 06791. The General Medical Services Contracts Statement of Financial

Entitlement Directions 2013 (SFE) as amended in the SFE (amendment) Directions

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2017 set out the provisions, conditions and payments relating to reimbursement to GP

practices for GP performers covering parental leave and sickness leave. This protocol

applies only to GMS practices, but commissioners should ensure they treat Primary

Medical Services (PMS) practices equitably.

3 Guidance Note: GP Practices serving Atypical Populations – A new chapter in the PGM

but previously published in December 2016 with Gateway Ref 06265). The General

Medical Services (GMS) funding formula (Carr-Hill formula) is an attempt to fund

practice workload, regardless of the population they serve. It is applicable to the vast

majority of the UK, but there are some practice populations that are so significantly

atypical that using the GMS funding formula would not ensure the delivery of an

adequate general practice service. This working group has looked at three such

atypical populations: unavoidably small and isolated; university practices and; those

with a high ratio of patients who do not speak English.

This document was produced to assist NHS England and delegated Clinical

Commissioning Group (CCG) commissioners of 3 such atypical ‘populations’ by

detailing the particular challenges faced by providers and offering examples of either

provider or commissioner reports that may help either articulate or address these

pressures. The chapter also talks about the GMS funding formula review.

NHS England recognises the scale and pace of change in Primary Medical Care

commissioning, service delivery and redesign. As such it is committed to reviewing this policy

and guidance regularly, to ensure it supports the commitments set out in the General Practice

Forward View, the Five Year Forward View and with changes in legislation and regulation.

References NHS England. (2017, November 15). Primary Medical Care Policy and Guidance Manual

(PGM) . Retrieved from NHS England: https://www.england.nhs.uk/publication/primary-

medical-care-policy-and-guidance-manual-pgm/

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General Purpose – Integrated Primary Care

Commissioning Paper Author: Kate Symons & Emma Gillgrass Sponsor: Katie Denton Date: October 2018

Executive Summary

Context

This is report provides the Primary Care Committee with an update on how delegated

Primary Care commissioning is being managed in Merton; providing an update on some of

the key programmes of work.

Question(s)/ topics this paper addresses 1. Monitoring PMS KPIs

2. Ravensbury Park Update

3. Joint Primary Care Quality Review Group (PCQRG) Update

4. What general contracting decisions have been made in the last quarter?

Conclusion 1. The Committee are asked to note the proposals for monitoring the PMS KPIs in Merton,

including the development of a PMS KPI Review Group.

2. Ravensbury Park Practice have recently been respected by the CQC and we are

awaiting the outcome.

3. The PCQRG update focussed specifically on the Quality, Support and Education

contract and the GP Resilience Funding update.

4. The Committee are asked to note the decisions taken over the last quarter.

Input Sought The Committee are asked to note the detail included within this paper, and the progress

made under delegate commissioning arrangements.

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The Report

A N A L Y S I S

1. Monitoring the PMS KPIs

In 2016/17 the CCG undertook a review of the PMS Premium indicators in Merton as part

of a nationally directed review process. As part of this process we had the opportunity to

review the old PMS indicators and engage clinicians in the development of new service

specification requirements that were clinically appropriate and strategically important, whilst

also ensuring that we continued to support sustainability across practices in Merton.

A PMS Working Group was established and regular meetings took place with the Local

Medical Council (LMC) in order to develop and refine our approach; as well as agreeing

what we will be included in our local PMS Premium Offer. We utilised the opportunity

afforded to us under delegated primary care commissioning to look at the quality of the

previous indicators and work in a more broader sense to ensure that the new indicators are

fit for purpose, provide value for money, and clinical appropriate for the population of Merton.

In total there are 22 Practices in Merton; 20 of which are PMS Practices, with 1 GMS and 1

APMS Practice.

We rolled out the developed PMS Premium indicators to all our PMS practices during the

end of 2017, early 2018 with all PMS Practices signing up to the new PMS Contract and

local Premium. One practice decided to revert back to a GMS Contract, although agreed to

sign up to the PMS Premium indicators.

As part of our delegated commissioning responsibility the CCG is responsible for the

oversight of the PMS KPIs and the performance management of practices achieving these

indicators.

As such we are now in a position to begin to review these locally developed indicators as

part of the process of continuous improvement, review and reflection of the suitability of

each of those implemented.

What are the PMS Premium Indicators in Merton?

The Merton PMS Premium Indicators are made up of the following:

Improving access for Carers

Opening Hours, Appointment Numbers and facilitations of access to Local Access Hubs

Working with the CCGs Medicines Optimisation Team

Medicines Management Uptake of Electronic Prescribing System (EPS)

Uptake and utilisation of advice and guidance tool (kinesis)

Peer review for referrals

Reducing unscheduled admissions for mild to moderate frailty

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Diabetes exception reporting

Ten High Impact Actions

Prevention – Bowel cancer screening

Prevention – Improve uptake of childhood immunisations

Prevention – Improve uptake of Influenza Vaccinations in Primary Care

Wound Care

Administering non-contraceptive hormonal implants or injections

What about the GMS Practices?

As part of the PMS Review Process one Merton Practice reverted back to a GMS practice;

although signed up to delivering the PMS premium indicators and therefore aligned with the

other PMS practices in relation to the services now offered.

How do we propose to monitor these indicators?

A standardised data collection template has been designed by the SWL Primary Care

Contracting Team, as they will be collecting the data on our behalf. This template details

the reporting requirements for each indicator, and as well as the format for reporting on

action planning, or where further performance feedback on the indicator is required.

It is the monitoring of areas that the SWL Team require input in from a local perspective; in

terms of the content on the action or implementation plans, and deciding on the best way to

follow up these area where required.

The Area’s that will be monitored via an Action or implementation Plan include:

Reviewing the uptake of EPC and documenting any valid factors that have impacted on

progress

Evidencing how peer reviews have been undertaken

Annual 360 degree feedback template for the reducing unplanned admissions KPI

Annual Diabetes Action Plan to improve rates of exception reporting

Annual report detailing the changes implemented as a result of the Dementia Friends

Training

Annual report of how non responders to the bowel cancer screening invite will be

identified and the methods used to contact them

Sharing learning from these reports will also be an important way of adding value to the

PMS Indicators. It may be through local review that examples of good practice are identified,

or learning can be shared where practices have made significant progress in increasing

certain rates, i.e bowel screening uptake. Ensuring that we have a local intelligence when

reviewing the data will provide a more robust review of these data returns, allowing for local

context where appropriate.

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Who will review the indicators? It is proposed that a local PMS KPI Review Group will be established to look at the KPI

returns, on a quarterly and annual basis as required by the specific indicator. This group

will include;

SWL primary care team lead

Locality Manager

Head of Primary Care Quality

Locality clinicians as appropriate

Head of delegated commissioning

Where zero returns are made, or practices report a reduction towards meeting a target then

the group can review this data in light of any other local intelligence and agree whether there

should be any follow-up support provided to the practice. Conversely, where practice may

show significant improvements then the group can agree an approach to sharing good

practice/learning.

It is anticipated that the initial review meetings will focus on the baseline returns and any

action plans, as well as ensuring the practice are able to provide the required information.

This will give an initial review as to the suitability of the KPIs as well as the use of the

searches and templates by each practice.

Subsequent review of the returns will enable the review of the suitability of the KPI indicators,

to ensure that we are getting full value and realising the anticipated benefits of each

indicator.

How do we plan to share the learning? It is anticipated that learning will be shared more widely on an annual basis, as practice may

choose to implement improvements in a staged approach and therefore the full impact

and/or benefit of the indicators will not be realised until the full year.

We will however be mindful where early feedback indicators that certain KPIs may not be

appropriate or suitable to monito, or where searches do not provide the appropriate data i.e

regular zero returns.

Learning from reviewing the KPI indicators will be reported into both the Primary Care

Quality Review Group and well as the Primary Care Ops group as appropriate, with the final

oversight of performance undertaken by the Primary Care Committee. Where areas of good

and even poor practice can be identified, then these groups can agree the best approach to

share this learning more widely.

Working with the LMC One of the key success points of the PMS Review in Merton was the engagement with our

local LMC colleagues to develop locally driven, fit for purpose indicators. With this is mind

the CCG aims to continue this engagement with the LMC in the review of the KPIs on an

annual basis to ensure that we continuously review the suitability of each indicator. Local

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LMC colleagues will be asked to feed into the review process and where indicators may be

retired or refreshed, engage with the CCG in the development of alternative replacements.

The LMC will also be asked to contribute to the process in particular where early indicators

identify a particular issue or concern with a specific KPI.

2. Ravensbury Park Update

The Committee will be aware of previous updates made in relation to the CQC Inadequate

Rating given to the Practice, and the work undertaken over the last 12 months as a result of

the Practice being placed into ‘Special Measures’. The practice have been supported by

both the CCG, NHS England and a local practice (through a new partnership arrangement)

in order to implement the required improvements at the practice. The Practice received a

further CQC inspection on the 18th September; and we are awaiting the formal outcome and

rating.

3. Joint Primary Care Quality Review Group (PCQRG) Update

The Joint Merton and Wandsworth Primary Care Quality Review Group (PCQRG) is a

clinically led group with responsibility for overseeing the quality of services provided by GP

practices across both boroughs through the core GP contracts. It reviews a range of data

and information in order to seek assurance on the quality of services and also identify any

areas, or individual practices that may require support. The PCQRG then identifies what

support is available, what further work may be required and monitors progress.

The PCQRG monitors national and local quality standards as well as holding Providers to

account for any contractual requirements relating to clinical quality and safety of the

services. This group review a range of areas such as patient experience and clinical

indicators to direct areas of focus and inform decisions about practices, as well as identifying

support for practices where required.

Quality, Support, Education Contract

A Quality, Support and Education contract has recently been agreed with Merton Health Ltd.

(the Merton GP Federation). As part of this contact a Primary Care Support Team be

established to support practices with quality improvement, reducing variation and

developing resilience.

The team will facilitate discussion within practices, to identify areas of good practice and

also areas where improvements could be made. This will be tailored to each individual

practice. The team will then be able to support the practice implement actions for

improvement. This may include linking in with other teams or services which will be able to

provide expert advice and support. The team will also provide direct support to the practices.

A key area for support will be in ensuring practices are CQC compliant, and responding to

requests for support ahead of inspections or where areas of improvement are identified by

the CQC.

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GP Resilience Funding

In 2017-18 12 Merton practices were identified as part of the resilience scheme and received

support which included practice management and back office support, and I.T. support and

training.

2018-19 is now the third year of GP Resilience funding and as in 2017-18, due to the small

amount of funding available (approximately £170,000 for SWL) it has been agreed to

manage this at a South West London level.

A heat map for SWL was produced which included data around Quality and safety,

Workforce, Patient Experience and Efficiency for all practice. This was used as the basis for

local discussions as to which practices should be put forward for the 2018-19 scheme. In

Merton this was through the Primary Care Quality Review Group. Using the heat map and

other local data and knowledge a list of 7 Merton practices was agreed to be put forward for

the scheme.

Practices were also offered the opportunity to self-nominate for the 2018-19 scheme and 1

practices put themselves forward, which had already been identified by the CCG.

The process for identifying and agreeing the specific packages for support is being managed

across all the SWL resilience practices and CCGs will be provided with regular update

reports.

4. What general Primary Care Contracting decisions have been made in the last quarter?

The following details the primary care contracting decision made to date; under business as

usual arrangements. Where the contractual changes are detailed these decision would

have been made through the usual governance arrangements; and therefore taken at

Committee level.

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C O N C L U S I O N

The Committee are asked to note the ongoing work that has been jointly implemented

across Primary Care under delegated commissioning arrangements.

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Primary Care Finance Report

Produced by Finance

August 2018 (2018/19 Month 5)

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Contents

1. Month 5 Background & Overview

2. Month 5 Primary Care Overall Position

3. Primary Care Narrative

4. Recommendations

August 2018


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1. Month 5 Background & Overview• Background

Primary Care Delegated Commissioning was introduced on 1st April 2016.

The financial accounting for this area is done with NHS England staff working exclusively for South West London

CCGs.

This paper reflects information available to the CCG to support the financial position for the five months ended

31st August 2018.

For prescribing we are relying on 3 months’ data for forecasting purposes.

It should be noted that this position includes general primary care commissioning that has always been the

responsibility of the CCG as well as picking up other areas of primary care expenditure which have always been

under the responsibility of their CCG from its programme allocation.

• Overview

Primary care expenditure overall had an underspend of £81k year to date.

This is the net impact of a prescribing overspend of £46k and an overspend in Local Enhanced Services of £106k,

offset by an underspend in Primary Care Delegated Budgets of £25k, and an underspend of £206k relating to

other primary care expenditure.

We are currently reporting a forecast net overspend of £77k which includes risk of £256k for NCSO, but there are

significant risks to prescribing for category M drugs (£500k) and further NCSO risk (£100k) which are not currently

reflected in the reported forecast outturn.

The following slides give more detail behind these numbers.

August 2018


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2. Primary Care Position

August 2018


Full Year

Budget

Budget to

Date

Actual to

Date

Variance to

Date

Forecast

Actual

Forecast

Variance

£000's £000's £000's £000's £000's £000's

PRESCRIBING 21,694 9,039 9,083 -44 21,800 -105

MEDICINES OPTIMISATION 75 31 28 3 67 8

CENTRAL DRUGS 669 279 283 -5 680 -12

Total Prescribing 22,438 9,349 9,395 -46 22,547 -109

HOME OXYGEN SERVICE 220 92 88 4 220 0

TB PROJECT 30 13 13 0 30 0

TOTAL LONG TERM CONDITIONS 250 104 100 4 250 0

PRIMARY CARE CONTRACT VALUE AND KPI'S 21,295 7,052 7,065 -13 21,493 -198

PRIMARY CARE OTHER DELEGATED BUDGET 7,791 4,879 4,841 39 7,561 230

Total Primary Care Delegated Budgets 29,086 11,931 11,906 25 29,054 32

Total Local Enhanced Services 531 221 327 -106 531 0

Total Out Of Hours 1,808 753 756 -3 1,808 -0

GP - STATUTORY MEDICAL FEES 108 45 75 -29 108 0

QUALITY PREMIUM 0 0 0 0 0 0

GPSI'S COMMISSIONING - MINOR SURGERY 77 32 0 32 77 0

OPHTHALMOLOGY (LOW VISION SERVICE) 9 4 0 4 9 0

GPFV GP DEV RECEPTION & CLERICAL TRAINING (S1017) 38 16 16 0 38 0

GPFV ONLINE CONSULT SOFTWARE SYSTEMS (S1018) 75 31 31 0 75 0

GPFV IMPROVED GP ACCESS INIT SCHEME (S1019) 948 395 395 0 948 0

PRIMARY CARE TRANSFORMATION FUND 0 -0 -0 -0 0 -0

PRIMARY CARE INVESTMENTS 157 65 69 -3 157 0

PRIMARY CARE OTHER 1,938 808 754 54 1,938 0

Access Local Incentive Scheme 1,180 492 342 149 1,180 0

WALK IN CENTRE (UNREGISTERED PATIENTS) 0 0 0 0 0 0

Total Primary Care Other 4,530 1,888 1,681 206 4,530 0

TOTAL PRIMARY CARE 58,643 24,247 24,166 81 58,720 -77

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3. Primary Care Narrative – Delegated Budgets• On the delegated Primary Care budget, five months results to 31st August are showing an under-spend of

£25k on the revised budget, a position which is carried forward to the forecast variance at year-end.

• Essential and Additional services are £122k over budget, the main diver of this overspend is the

announcement of the increase in the Global Sum value to further fund GP and practice staff salaries, which is

£82k of the overspend in the year to date whilst the forecast includes a £198k overspend to reflect this. The

PMS and GMS core contract costs also include £40k for an extension of the “old” Minor Surgery PMS

payment into the new year for the ten Practices signed up to deliver it previously, however the £138k to fund

the scheme is currently reflected in the CCG “excess resource allocation over committed budget” awaiting

finalisation of the numbers of practices signing up, leaving a forecast saving of £100k on this unallocated

budget.

• DES costs are currently £16k below budget as a result of claw-backs to be made for performance in Quarter

1, the forecast for DES payments still has a breakeven position, which will allow for additional payments for

Health Checks for patients with Learning Disabilities over and above the budget as last year’s payments

breached the accrual value on which the budget was based.

• Seniority costs are £5k below budget and this is forecast to continue for the year and a forecast overspend of

£11k is included in the outturn. Personally administered Drugs costs are £22k below budget, but this is

general for this period of the year, are will be eroded when the winter flu scheme activity is undertaken. There

is a credit generated from the finalisation of the 2017/18 payments for enhanced services and QOF, as costs

were not as much as accruals raised. This £112k is shown as a saving in the year to date and forecast. The

overall forecast is a saving on budget of £32k.

August 2018


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3. Primary Care Narrative – Prescribing

• Currently only three months of prescribing data is available. Expenditure at Merton CCG for

the first three months is slightly higher than that of last year.

• There is an additional risk to the position relating to Category M reimbursement prices which

are due to increase from August 2018. This is a national issue due to the Department of

Health and Social Care agreeing to cease a £15 million per month reduction in prices that had

been in place to recover estimated excess margin delivered to pharmacies in 2015/16 and

2016/17. This decision was a result of negotiations with PSNC (Pharmaceutical Services

Negotiating Committee) in which concerns were raised about the impact of price reductions on

contractors’ cash flow.

• We expect this issue to translate locally into a cost pressure of approximately £75k per month

for the CCG, which if this continues for the rest of the year from August, could mean an over-

spend of around £600k by year end. We will continue to monitor the situation as the actual

data comes through in ePACT and start to recognise this risk in the forecast position as we

gain greater certainty over its value and likelihood.

August 2018 6


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The Primary Care Committee are asked to note the financial position as

reported in this paper for the four months ended 31st August 2018.

August 2018


4. Recommendations

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M E R T O N C C G P A G E 1 O F 9

Strictly Confidential Board Intelligence Hub template

GP Patient Survey 2018 Author: Emma Gillgrass Sponsor: Katie Denton Date: 10/2018

Executive Summary

Context

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data

about patients’ experiences of their GP practices. Ipsos MORI administer the survey on

behalf of NHS England.

The most recent data, reviewed in this report was collected in the survey period January –

March 2018.

Question(s) this paper addresses

1. What does the survey show about GP practices in Merton?

2. What areas need further work?

Conclusion

1. The survey shows the variation in services between GP practices, however overall

there is a high level of satisfaction with GP practices in Merton.

2. The areas with the lowest results, and widest variation between practices which may

need further consideration are linked to making appointments.

Input Sought

The Primary Care Committee is asked to review and note the survey results.

M E R T O N C C G

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The Report

F U R T H E R C O N T E X T

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data

about patients’ experiences of their GP practices. Ipsos MORI administer the survey on

behalf of NHS England.

The most recent data, reviewed in this report was collected in the survey period January –

March 2018. Full results and CCG level packs can also be accessed at: https://www.gp-

patient.co.uk/surveysandreports

(Please note the Merton CCG slide pack includes data on the GP Led Health Centre which

has now closed and James O’Riordan Medical Centre which now comes under Sutton CCG)

Survey questions come under a number of headings:

Your local GP service

Making an appointment

Your last appointment

Overall experience

Your health

When your GP practice is closed

Some questions about you

The sample sizes for individual practices are very small so this should be taken into account when analysing the data.

Within Merton 3.8% of the registered list was sent a survey. The response rate was 27.9%

in Merton which equates to 1% of the total registered list sizes.

Population (May 2018)

Forms distributed

Completed forms

returned

% Pop. sent form

Response

rate (%)

%

Response

Total Pop.

Merton 226,482 8,687 2,422 3.8% 27.9% 1.1%

Wandsworth 404,441 15,779 3,818 3.9% 24.2% 0.9%

SW London 1,665,262 68,606 19,845 4.1% 28.9% 1.2%

London 9,863,204 485,814 125,270 4.9% 25.8% 1.3%

England 59,085,088 2,221,068 758,165 3.8% 34.1% 1.3%

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https://www.gp-patient.co.uk/surveysandreports

https://www.gp-patient.co.uk/surveysandreports



A N A L Y S I S

1) What does the survey show about GP practices in Merton?

1.1) 2018 Results – Borough level

In 2018 82% of patients in Merton rated their experience of their GP practice as Good.

The table below highlight some of the key questions from the survey and provides

comparisons for Merton with South West London (SWL), London and England. In general

Merton is in line with the London average.

2018 – Averages Merton

CCG

South West

London London England

Overall how would you describe your experience of your GP surgery? (% Good)

82% 85% 81% 84%

Generally how easy is it to get through to someone at your GP surgery on the phone? (% Easy)

65% 75% 70% 70%

How helpful do you find the receptionists at your GP surgery? (% Helpful)

87% 90% 88% 90%

Overall how would you describe your experience of making an appointment? (% Good)

67% 72% 66% 69%

How easy is it to use your GP practice’s website to look for information or access services? (% easy)

79% 78% 73% 78%

During last general practice appointment did you have confidence and trust in the healthcare professional (% yes)

94% 95% 94% 96%

How satisfied are you with the general practice appointment times that are available to you? (% satisfied)

67% 69% 65% 66%

1.2) Trends – Borough level

Many of the questions in the 2018 survey had changes to previous surveys so trends could

not be seen. The table below sets out some questions that had not changed to show trends

over the last few years at borough and national level, and two questions where there was a

slight change in the wording so both the previous questions and the new question are

shown. For the majority of questions Merton has seen improvements since the 2017 survey.

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Jun-13 Jul-14 Jul-15 Jul-16 Jul-17 Aug-18

Change from Jul-17 to Aug-18

Overall how would you describe your experience of your GP surgery? (% Good)

MCCG 82% 79% 79% 80% 80% 82%

England 85% 85% 84%

Generally how easy is it to get through to someone at your GP surgery on the phone? (% Easy)

MCCG 66% 61% 57% 60% 60% 65%

England 70% 68% 70%

How helpful do you find the receptionists at your GP surgery? (% Helpful)

MCCG 86% 84% 84% 85% 84% 87%

England 87% 87% 90%

Overall how would you describe your experience of making an appointment? (% Good)

MCCG 70% 66% 66% 67% 66% 67%

England 73% 73% 69%

How satisfied are you with the hours that your GP surgery is open? (% Satisfied)

MCCG 76% 74% 70% 73% 75%

England 76% 76%

How satisfied are you with the appointment times that are available to you? (% Satisfied)

MCCG 67%

England 66%

Did you have confidence and trust in the GP you saw or spoke to? (% Yes)

MCCG 94% 94% 95% 94% 94%

England 95% 95%

Did you have confidence and trust in the nurse you saw or spoke to? (% Yes)

MCCG 96% 96% 96% 95% 96%

England 97% 97%

During your last general practice appointment did you have confidence and trust in the healthcare professional? (%yes)

MCCG 94%

England 96%

1.3) Practice Level Results

Results for the survey are also available at practice level, although again the small sample

size needs to be taken in to consideration. The number of completed surveys per practice

ranged from 83 to 132, reflecting an average of 1% of the practice population.

Friends and Family Test (FFT)

The GP Patient survey is just one way in which patient experience is captured. Another route

that all practices are expected to engage with is the Friends and Family Test. As with the

patient survey the FT often had small numbers of responses which needs to be considered

when analysing the results.

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The Friends and Family Test question is “How likely are you to recommend our service to

friends and family if they needed similar care or treatment?”

When the results of the Overall Experience GP Patient Survey Question and the FFT

question are compared, most practices are rated fairly similarly across both question,

although the majority have a slightly higher scores for their most recent Friends and Family

Test (June 2018 data), where data was submitted.

Practice Level Charts – Appendix 1

The charts below show for each practice:

Overall experience: – Overall how would you describe your experience of your GP

surgery? (% Good)

Use of Services: Practice level results across 9 questions

GP Patient Survey: Overall Experience compared to Friends and Family Test (June

2018) results

2) What areas need further work?

Merton generally rates similarly to the London average. There are still areas for

improvement, and areas where there is significant variation between practices.

The questions with the lowest results:

How easy is it to get through to someone on the phone

Offered choice of appointment

Satisfied with the general practice appointment times that are available

Over all experience of making an appointment

Questions with the widest variation between practices:

How easy is it to get through to someone on the phone

Offered choice of appointment

Over all experience of making an appointment

Satisfied with the general practice appointment times that are available

3) Next Steps

The survey results are being reviewed by the Primary Care Quality Review Group where

practices requiring additional support will be identified as well as areas across the borough

where improvement can be made. The PCQRG will also look to identify what support can

be provided in order to make improvements.

C O N C L U S I O N

The Primary Care Committee are asked to review and note the survey results.

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Appendix 1

Merton Practice Level Data: Overall how would you describe your experience of your GP surgery? (% Good)

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Merton Practice Level Data: Use of services

Practice Name List Size

Overall

experience

Over all

experience of

making an

appointment

How satisfied

are you with

the general

practice

appointment

times that are

available to

you?

How easy is it

to get through

to someone on

the phone

How helpful do

you find the

receptionists

Offered choice

of appointment

Satisfied with

type of

appointments

offered

How easy is it

to use your GP

practice’s

website to look

for information

or access

services?

During your last

general practice

appointment

did you have

confidence and

trust in the

healthcare

professional

Jun-18 % Good % Good % Satisfied % Easy % Helpful % Yes % Satisfied % Easy % Yes

E Rowans Surgery 7,220 53% 40% 43% 32% 68% 48% 60% 60% 83%

E Tamworth House Medical Centre 9,345 68% 51% 56% 41% 79% 42% 53% 52% 85%

E Mitcham Family Practice 3,608 70% 74% 64% 78% 90% 71% 64% 81% 88%

E The Mitcham Medical Centre 9,040 77% 48% 49% 36% 82% 53% 58% 76% 87%

E Figges Marsh Surgery 7,989 80% 60% 68% 60% 90% 78% 76% 76% 91%

W Morden Hall Medical Centre 14,524 80% 64% 74% 57% 88% 81% 73% 83% 92%

E Ravensbury Park Medical Centre 5,336 80% 74% 67% 71% 88% 69% 74% 88% 93%

W Grand Drive Surgery 8,850 81% 70% 66% 88% 92% 65% 69% 90% 96%

W Lambton Road Medical Practice 17,646 81% 68% 67% 58% 85% 63% 70% 85% 92%

E Colliers Wood Surgery 10,546 82% 75% 72% 72% 85% 61% 78% 51% 93%

W The Nelson Medical Practice 28,975 82% 61% 70% 68% 87% 66% 63% 81% 100%

E Wide Way Medical Centre 9,196 83% 72% 77% 76% 91% 69% 80% 91% 87%

E Cricket Green Medical Practice 11,605 85% 66% 64% 49% 87% 54% 81% 71% 94%

W The Merton Medical Practice 8,007 85% 78% 76% 86% 88% 70% 82% 79% 89%

W The Vineyard Hill Road Surgery 4,210 85% 82% 73% 94% 91% 80% 85% 72% 93%

W Stonecot Surgery 8,481 87% 69% 70% 42% 90% 67% 79% 90% 94%

W Princes Road Surgery 9,448 87% 76% 68% 77% 93% 65% 81% 80% 98%

W Central Medical Centre 8,740 87% 72% 74% 64% 73% 75% 80% 65% 96%

W Francis Grove Surgery 13,436 87% 70% 65% 67% 94% 67% 70% 81% 96%

W Wimbledon Village Practice 12,177 89% 81% 63% 89% 95% 68% 80% 86% 97%

W Alexandra Surgery 5,536 90% 71% 83% 75% 94% 86% 86% 72% 100%

W Riverhouse Medical Practice 5,819 91% 78% 73% 89% 83% 85% 87% 90% 100%

Range: Minimum 40% 43% 32% 68% 42% 53% 51% 83%

Range: Maximum 82% 83% 94% 95% 86% 87% 91% 100%

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Merton Practice Level Data: GP Patient survey Overall Experience Compared to Friends and Family Results

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For Reference Edit as appropriate:

1. The following were considered when preparing this report:

The long-term implications [Yes]

The risks [Not applicable]

Impact on our reputation [Yes]

Impact on our patients [Yes]

Impact on our providers [Yes]

Impact on our finances [Not applicable]

Equality impact assessment [Not applicable]

Patient and public involvement [Yes]

2. This paper relates to the following corporate objectives:

Commission high quality services which improve outcomes and reduce

inequalities [Yes]

Make the best use of resources, continually improve performance and deliver

statutory responsibilities [Not applicable]

Continually improve delivery by listening to and collaborating with our patients,

members, stakeholders and communities [Yes]

Transform models of care to improve access, ensuring that the right model of care

is delivered in the right setting [Yes]

Develop the CCG as a continuously improving and effective commissioning

organisation [Yes]

3. Executive Summaries should not exceed 1 page. [My paper does comply]

4. Papers should not ordinarily exceed 10 pages including appendices.

[My paper does comply]

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17-043177-06 Version 1 | Public© Ipsos MORI

1

Version 1| Public


NHS MERTON CCG

Latest survey resultsAugust 2018 publication

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2

Contents

This slide pack provides results for the following topic areas:

Background, introduction and guidance …………………………….……………………………………….. Slide 3

Overall experience of GP practice ………………………………………………………………..…..……….. Slide 8

Local GP services ………………………………………………………………………………………………... Slide 13

Access to online services ………………………………………………………………………………………. Slide 18

Making an appointment …………………………………………………………………………………………. Slide 23

Perceptions of care at patients’ last appointment …………………………………………….……………. Slide 31

Managing health conditions …………………………………………………………………………….............Slide 35

Satisfaction with general practice appointment times …………………………………………………….. Slide 38

Services when GP practice is closed ……….………………………………………………………………… Slide 41

Statistical reliability ………………………………………………………………………………………………. Slide 46

Want to know more? …………………………………………………………………………………………...... Slide 48

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Background, introduction

and guidance

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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 NHS MERTON CCG.

• The data in this slide pack are based on the August 2018 GPPS publication.

• In NHS MERTON CCG, 8,687 questionnaires were sent out, and 2,422 were returned

completed. This represents a response rate of 28%.

• 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 questionnaire has been redeveloped for 2018 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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https://gp-patient.co.uk/

https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

https://gp-patient.co.uk/surveysandreports


5

Introduction

• The GP Patient Survey measures patients’ experiences across a range of topics, including:

- Making appointments

- Perceptions of care at appointments

- Managing health conditions

- Practice opening hours

- Services when GP practices are closed

• 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 is provided once a year rather than in real time.

• However, 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.

• Given the extensive changes to the questionnaire in 2018, this pack does not include trends over time.

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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:

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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.

• All data is taken from the latest / 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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Overall experience of GP practice

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84%

7%

Overall experience of GP practice

42%

40%

11%

5%Very good

Fairly good

Neither good nor poor

Fairly poor

Very poor

Q31. Overall, how would you describe your experience of your GP practice?

Practice range in CCG – % Good Local CCG range – % Good

National

6%

Good

Poor

Lowest

Performing

Highest

Performing

39% 93%

Lowest

Performing

Highest

Performing

74% 87%

%Good = %Very good + %Fairly good

%Poor = %Very poor + %Fairly poor

Base: All those completing a questionnaire: National (746,847); CCG (2,396);

Practice bases range from 24 to 131; CCG bases range from 2,174 to 7,142

CCG’s results Comparison of results

82%Good

Poor

CCG

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Results range from

to

Overall experience:

how the CCG’s results compare to other local CCGs

Comparisons are indicative only: differences may not be statistically significant

74%

87%

Percentage of patients saying ‘good’

Base: All those completing a questionnaire: CCG bases range from 2,174 to 7,142 %Good = %Very good + %Fairly good


The CCG represented by this pack is highlighted in red

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Overall experience: how the CCG’s practices compare

Percentage of patients saying ‘good’

Base: All those completing a questionnaire: Practice bases range from 24 to 131 %Good = %Very good + %Fairly good



Results range from

to

39%

93%

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Overall experience: how the CCG’s practices compare

Percentage of patients saying ‘good’ CCGPractices National average

Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses


Practice bases range from 24 to 131



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Local GP services

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35%

70%65%

Not easy

Easy

Ease of getting through to GP practice on the phone

18%

47%

23%

12% Very easy

Fairly easy

Not very easy

Not at all easy

Easy

Practice range in CCG - % Easy Local CCG range - % Easy

Lowest

Performing

Highest

Performing

32% 94%

Lowest

Performing

Highest

Performing

52% 86%

%Easy = %Very easy + %Fairly easy

%Not easy = %Not very easy + %Not at all easyBase: All those completing a questionnaire excluding ‘Haven’t tried’: National (729,884); CCG (2,313);


CCG

Q1. Generally, how easy is it to get through to someone at your GP practice on the phone?*

National

30%

*Those who say ‘Haven't tried’ have been excluded from these results.


Not easy

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Ease of getting through to GP practice on the phone:

how the CCG’s practices compare

Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to lower numbers of responses

Base: All those completing a questionnaire excluding ‘Haven’t tried’: National (729,884); CCG (2,313);

Practice bases range from 20 to 129%Easy = %Very easy + %Fairly easy

Q1. Generally, how easy is it to get through to someone at your GP practice on the phone?

CCGPractices National average

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Not helpful

Helpfulness of receptionists at GP practice

39%

49%

10%3% Very helpful

Fairly helpful

Not very helpful

Not at all helpful

Practice range in CCG - % Helpful Local CCG range - % Helpful

National

Not helpful

90%

10%

Helpful

Lowest

Performing

Highest

Performing

68% 95%

Lowest

Performing

Highest

Performing

81% 92%

%Helpful = %Very helpful + %Fairly helpful

%Not helpful = %Not very helpful + %Not at all helpful

Base: All those completing a questionnaire excluding ‘Don’t know’: National (738,543); CCG (2,352);


87%

13%

Helpful

CCG

Q2. How helpful do you find the receptionists at your GP practice?*

*Those who say ‘Don't know’ have been excluded from these results.


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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 (738,543); CCG (2,352);

Practice bases range from 22 to 127%Helpful = %Very helpful + %Fairly helpful

Q2. How helpful do you find the receptionists at your GP practice?


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Access to online services

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Awareness of online services

52%

37%

16%

9%

34%

41%38%

13%8%

42%

0

10

20

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60

70

80

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100

Bookingappointmentsonline

Ordering repeatprescriptionsonline

Accessing mymedical recordsonline

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Q4. As far as you know, which of the following online services does your GP practice offer?

Practice range

within CCG

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Online service use

20%

10%6%

74%

13% 14%

3%

79%

0

10

20

30

40

50

60

70

80

90

100

Booking appointmentsonline

Ordering repeatprescriptions online

Accessing my medicalrecords online

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Q5. Which of the following general practice online services have you used in the past 12 months?

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78%

22%

79%

21%

Base: All those completing a questionnaire excluding 'Haven't tried': National (234,144); CCG (893);

Practice bases range from 22 to 64; CCG bases range from 871 to 2,390

Ease of use of online services

24%

55%

14%

7% Very easy

Fairly easy

Not very easy

Not at all easy

Practice range in CCG - % Easy Local CCG range - % Easy

National

Easy

Not easy

Lowest

Performing

Highest

Performing

51% 91%

Lowest

Performing

Highest

Performing

66% 82%

CCG

Easy

Not easy

Q6. How easy is it to use your GP practice’s website to look for information or access services?*

%Easy = %Very easy + %Fairly easy

%Not easy = %Not very easy + %Not at all easy

*Those who say ‘Haven’t tried’ have been excluded from these results.


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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 (234,144); CCG (893);


Q6. How easy is it to use your GP practice’s website to look for information or access services?


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Making an appointment

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62%

38%

66%

34%

*Those who say ‘Doesn’t apply’ or ‘Can’t remember’ have been excluded from these results. The ‘Yes’ options are multi-code and so the summation of the three ‘Yes’ options does not equal the combined

‘Yes’ offered a choice statistic.

Choice of appointment

Practice range in CCG - % Yes Local CCG range - % Yes

National

Yes

No

Lowest

Performing

Highest

Performing

42% 86%

Lowest

Performing

Highest

Performing

57% 73%

CCG

Yes

No

Q16. On this occasion (when you last tried to make a general practice appointment), were you

offered a choice of appointment?*

%Yes = either offered a ‘Choice of place’, a ‘Choice of time or day’

or a ‘Choice of healthcare professional’

Base: All tried to make an appointment since being registered excluding ‘Doesn’t apply’ and ‘Can’t remember’: National (586,602); CCG (1,868);


9%

59%

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


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Choice of appointment

Percentage of patients saying ‘yes’ they were offered a choice of appointment


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EN

HA

LL M

ED

ICA

L C

EN

TR

E

RIV

ER

HO

US

E M

ED

ICA

L P

RA

CT

ICE

ALE

XA

ND

RA

SU

RG

ER

Y

Base: All tried to make an appointment since being registered excluding ‘Doesn’t apply’ and ‘Can’t remember’: National (586,602); CCG (1,868);


Q16. On this occasion (when you last tried to make a general practice appointment), were you

offered a choice of appointment?

%Yes = %Choice of place + %Choice of time or day

+ %Choice of healthcare professional


71 of 104


26

6%

21%

7%

74%

20%

73%

No, took appt

Base: All tried to make an appointment since being registered: National (701,961); CCG (2,230);


Satisfaction with appointment offered

73%

21%

7% Yes, and I accepted anappointment

No, but I still took anappointment

No, and I did not take anappointment


National

Yes, took appt

No, took appt

Lowest

Performing

Highest

Performing

48% 87%

Lowest

Performing

Highest

Performing

63% 78%

CCG

Yes, took appt

Q17. Were you satisfied with the type of appointment (or appointments) you were offered?

No, didn’t take apptNo, didn’t take appt


72 of 104


27

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%

GP

LE

D H

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L P

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TH

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INE

YA

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US

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ICA

L P

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ICE



Q17. Were you satisfied with the type of appointment (or appointments) you were offered?


73 of 104


28

14%

6%

17%

4%

12% 14%

6%11%

34%

14%

7%11% 10% 11%

22%

11% 11%

28%

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 it


Perc

enta

ge

wh

o w

ent

on to

do s

om

eth

ing

els

e w

hen

did

not ta

ke the a

ppoin

tment off

ere

d

Base: All who did not take the appointment offered (excluding those who haven't tried to make one): National (32,326); CCG (121)

Q19. What did you do when you did not take the appointment you were offered?

74 of 104


29

69%

15%

67%

15%Poor

Overall experience of making an appointment

26%

41%

18%

9%5% Very good

Fairly good


Fairly poor

Very poor

Practice range in CCG - % Good Local CCG range - % Good

National

Good

Poor

Lowest

Performing

Highest

Performing

40% 82%

Lowest

Performing

Highest

Performing

58% 76%


%Poor = %Fairly poor + %Very poor



CCG

Q22. Overall, how would you describe your experience of making an appointment?


Good

75 of 104


30

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%

RO

WA

NS

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GP

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TH

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DO

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ILLA

GE

PR

AC

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INE

YA

RD

HIL

L R

OA

D S

UR

GE

RY


Q22. Overall, how would you describe your experience of making an appointment?


76 of 104


31


Perceptions of care at patients’

last appointment

77 of 104


32

Perceptions of care at patients’ last appointment with a

healthcare professional

Base: All had an appointment since being registered with current GP practice excluding 'Doesn't apply’:

National (706,895; 705,167; 706,882); CCG (2,239; 2,236; 2,236)

CCG’s results

*Those who say ‘Doesn’t apply’ have been excluded from these 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*

41% 47% 45%

42%40% 38%

12% 9% 12%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

% ‘Poor’ (total)

Very poor

Very good

4% 3% 4%

5% 4% 5%

Giving you enough time Listening to you Treating you with care and concern

78 of 104


33

Perceptions of care at patients’ last appointment with a


Base: All had an appointment since being registered with current GP practice excluding 'Doesn't apply’:

National (628,938; 695,421; 696,267); CCG (1,987; 2,190; 2,190)

CCG’s results

Nationl results %

Poor (total)

CCG results

% Poor (total)

Q28-30. During your last general practice appointment…*

55%64% 60%

36%29% 34%

9% 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’

No, not at all

Yes, definitely

*Those who say ‘Don’t know / doesn’t apply’ or ‘Don’t know / can’t say’ have been excluded from these results.

7% 4% 5%

9% 6% 6%

Felt involved in decisions about care

and treatment Had confidence and trust in the


Felt their needs were met

79 of 104


34

87%

13%18%

82%

Mental health needs recognised and understood

50%

32%

18% Yes, definitely

Yes, to some extent

No, not at all


National

Yes

No

Lowest

Performing

Highest

Performing

54% 94%

Lowest

Performing

Highest

Performing

76% 89%

%Yes = %Yes, definitely + %Yes, to some extentBase: All had an appointment since being registered with current GP practice excluding ‘I did not have any mental health needs’ or ‘Did not apply

to my last appointment’: National (277,497); CCG (905); Practice bases range from 11 to 56; CCG bases range from 817 to 3,013

*Those who say ‘I did not have any mental health needs’ or ‘Did not apply to my last appointment’ have been excluded from these results.

No

CCG

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

80 of 104


35


Managing health conditions

81 of 104


36

79%

21%

74%

26%

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (284,887); CCG (776);

Practice bases range from 25 to 46; CCG bases range from 704 to 2,286

Support with managing long-term health conditions

38%

36%

26%Yes, definitely

Yes, to some extent

No


National

Yes

No

Lowest

Performing

Highest

Performing

61% 93%

Lowest

Performing

Highest

Performing

64% 84%

CCG

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)?*

%Yes = %Yes, definitely + %Yes, to some extent

*Those who say ‘I haven’t needed support’ and ‘Don’t know / can’t say’ have been excluded from these results.


82 of 104


37

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%

MO

RD

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ST

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AM

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ICE

FR

AN

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UR

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ER

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TH

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ITC

HA

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ED

ICA

L C

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TR

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CR

ICK

ET

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ED

ICA

L P

RA

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ICE

WID

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AY

ME

DIC

AL

CE

NT

RE

LA

MB

TO

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OA

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ED

ICA

L P

RA

CT

ICE

JA

ME

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RD

AN

ME

DIC

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CE

NT

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CE

NT

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ICA

L C

EN

TR

E

Base: All with a long-term condition excluding ‘I haven’t needed support’ and ‘Don’t know / can’t say’: National (284,887); CCG (776);


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)?

%Yes = %Yes, definitely + %Yes, to some extent

Support with managing long-term health conditions


83 of 104


38


Satisfaction with general

practice appointment times

84 of 104


39

66%

17%

67%

16%Dissatisfied

Satisfaction with appointment times

22%

46%

17%

10%

6%Very satisfied

Fairly satisfied

Neither satisfied nordissatisfied

Fairly dissatisfied

Very dissatisfied

Practice range in CCG - % Satisfied Local CCG range - % Satisfied

National

Satisfied

Dissatisfied

Lowest

Performing

Highest

Performing

34% 83%

Lowest

Performing

Highest

Performing

58% 73%

Base: All those completing a questionnaire excluding ‘I’m not sure when I can get an appointment’: National (689,659); CCG (2,209);


%Satisfied = %Very satisfied + %Fairly satisfied

%Dissatisfied = %Very dissatisfied + %Fairly dissatisfied

Satisfied

CCG

Q8. How satisfied are you with the general practice appointment times that are available to you?*

*Those who say ‘I’m not sure when I can get an appointment’ have been excluded from these results.


85 of 104


40

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 (689,659); CCG (2,209);


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

GP

LE

D H

EA

LT

H C

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JA

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S M

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SU

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ER

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TH

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ELS

ON

ME

DIC

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RA

CT

ICE

ST

ON

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SU

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CO

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RS

WO

OD

SU

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US

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ICA

L P

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ICE

TH

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INE

YA

RD

HIL

L R

OA

D S

UR

GE

RY

MO

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EN

HA

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ED

ICA

L C

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TR

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CE

NT

RA

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ED

ICA

L C

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TR

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TH

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ER

TO

N M

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ICA

L P

RA

CT

ICE

WID

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AY

ME

DIC

AL

CE

NT

RE

ALE

XA

ND

RA

SU

RG

ER

Y

%Satisfied = %Very satisfied + %Fairly satisfied

Q8. How satisfied are you with the general practice appointment times that are available to you?


86 of 104


41


Services when GP practice is closed

• 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.

87 of 104


42

62%

21%

6%

44%

12%

11%

2%

6%

62%

25%

5%

36%

12%

18%

5%

8%

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 (138,025); CCG (461)

Q45. Considering all of the services you contacted, which of the following happened on that

occasion?

88 of 104


43

36%

65%

35%

64%

64%

36%It was about right

It took too long

Time taken to receive care or advice when GP practice is closed

About right

Took too long

Local CCG range – % About right

Base: All those who have contacted an NHS service when GP practice closed in past 12 months excluding ‘Don’t know / doesn’t apply’:

National (129,429); CCG (430); CCG bases range from 394 to 1,182

Lowest

Performing

Highest

Performing

50% 69%

NationalCCG

About right

Took too long

Q46. How do you feel about how quickly you received care or advice on that occasion?*

*Those who say ‘Don’t know / doesn’t apply’ have been excluded from these results.


89 of 104


44

8%

91%

9%

92%

47%

45%

8% Yes, definitely

Yes, to some extent

No, not at all

Confidence and trust in staff providing services when GP

practice is closed

%Yes = %Yes, definitely + % Yes, to some extent

Yes

No

Local CCG range – % Yes

*Those who say ‘Don’t know / can’t say’ have been excluded from these results.

Lowest

Performing

Highest

Performing

86% 94%

NationalCCG

Yes

No

Q47. Considering all of the people that you saw or spoke to on that occasion, did you have

confidence and trust in them?*

Base: All those who have contacted an NHS service when GP practice closed in past 12 months excluding 'Don't know / can't say’:



90 of 104


45

19%

69%

15%

69%27%

42%

13%

11%

7%Very good

Fairly good


Fairly poor

Very poor

Overall experience of services when GP practice is closed


%Poor = %Fairly poor + %Very poor

Base: All those who have contacted an NHS service when GP practice closed in past 12 months excluding 'Don't know / can't say:


Good

Poor

Local CCG range - % Good

Lowest

Performing

Highest

Performing

54% 70%

Good

Poor

NationalCCG

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?*

*Those who say ‘Don’t know / can’t say’ have been excluded from these results.


91 of 104


46


Statistical reliability

92 of 104


47

Statistical reliability

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

Level 1:

10% or 90%

Level 2:

30% or 70%

Level 3:

50%

+/- +/- +/-

National 758,165 0.09 0.15 0.16

CCG 4,000 1.32 2.02 2.20

Practice 100 6.93 10.21 11.08

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 4,000 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 +/-2.02 percentage points from that question’s result (i.e. between 27.98% and 32.02%).

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.

93 of 104


48


Want to know more?

94 of 104


49

Further background information about the survey

• The survey was sent to c.2.2 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 34.1%, based on 758,165 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

here: https://gp-patient.co.uk/surveysandreports.

758,165Completed surveys in

the August 2018

publication

c.2.2mSurveys to adults

registered with an

English GP practice

34.1% National response

rate

95 of 104

https://gp-patient.co.uk/



50

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 the 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

• For general FAQs about the GP Patient Survey, go to https://gp-patient.co.uk/faq

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https://gp-patient.co.uk/analysistool

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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Cover Sheet Template for Committee Meetings Final Version 1.2 July 2018 Page 1 of 2

Merton Primary Care Commissioning Committee Date Tuesday, 02 October 2018

Document Title Estates Update

Lead Director (Name and Role)

Neil McDowell, Director of Finance

Clinical Sponsor (Name and Role)

N/A

Author(s) (Name and Role)

Lucy Lewis, Head of Estates

Agenda Item No. Attachment No.

Purpose (Tick as Required) Approve Discuss Note

Executive Summary Background: Merton CCG has four improvement schemes underway. These projects have been in the pipeline for some years and are now if the planning and delivery phase. Schemes are being funded through Estates and Transformation Technology Funding, Section 106 and Local Improvement Finance Trust (LIFT) respectively. In addition the CCG has 8 practices who have applied for Improvement Grant funding 2019/20. The report provides the committee with a high level update on progress to date and next steps. Purpose: Note Reason for Committee Review: Regular update to the committee

Key Issues: 1. The delay to the Wilson project 2. The delivery of Patrick Doody scheme in November 3. The progress with the Colliers Wood and Rowan Park schemes

Conflicts of Interest: N/A.

Mitigations: N/A

Recommendation: The Committee is asked to: Note the report and feedback any comments or areas of concern.

XX

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Cover Sheet Template for Committee Meetings Final Version 1.2 July 2018 Page 2 of 2

Corporate Objectives This document will impact on the following CCG Objectives:

Under delegated commissioning the CCG needs to be assured that practices are providing services to patients from safe and suitable premises that are fit for purpose. Meets objectives of the STP as part of wider SWL estates strategy and feeds into London Capital Estates project reporting via that forum.

Risks This document links to the following CCG risks:

N/A

Mitigations Actions taken to reduce any risks identified:

N/A

Financial/Resource/ QIPP Implications

Financial impacts have been explored and approved through CCG’s internal financial governance processes. No further details required for this update.

Has an Equality Impact Assessment (EIA) been completed?

Yes relevant to each individual project.

Are there any known implications for equalities? If so, what are the mitigations?

None known

Patient and Public Engagement and Communication

Relevant to each individual project.

Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:

Committee/Group Name: Date Discussed:

Outcome:

Click here to enter a date.



Supporting Documents

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Merton CCG Estates Update

1. Patrick Doody Estates & Technology Transformation Fund (ETTF) Scheme

Background

An NHS England ETTF scheme to refurbish the ground floor and part first floor of

Patrick Doody Clinic 79 Pelham Road, London SW19 1NX for occupation by

Princes Road Surgery. The new site is 0.2 mile from the current premises at 51

Princes Road. Patients and staff are supportive of the refurbishment which will

provide additional ground floor consulting and treatment rooms, and dedicated

staff breakout and office space on the first floor.

The CCG approved the scheme in 2016 because the current premises, a

converted end terrace house was no longer fit for purpose for a growing list size,

and the scheme met ETTF requirements for transformation of primary care. The

CCG has taken a number of business cases through internal and external

governance to enable the scheme to be completed in 2018/19 financial year and

worked with the ETTF Programme Management Office (PMO) and NHS England

Director of Finance on obtaining 100% allocation of funds direct to NHS Property

Services for the cost of the works required.

Position to date

NHS Property Services (NHSPS) are in possession of the allocation of funds

for the works and have raised the purchase order for the contractor;

A Project Manager has been engaged by NHS Property Services to manage

the works and the move;

Primary Care colleagues are working to ensure the project plan for the move

is implemented. This is being monitored via MCCG’s Primary Care

Commissioning Operations Group (PCCOG);

The building contractor started on site Monday 24th September and has

confirmed completion of works by 24th November 2018.

Next steps

A letter will be sent to all Princes Road Surgery patients informing them of

the move date.

And update will be shared with the Wimbledon Community Forum.

Information will be shared on practice website and notice board;

CCG Estates and finance lead continue to remain actively involved in

oversight of the scheme until, and beyond completion.

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2. Rowan Park – Section 106 Scheme

Background

Between 2012 and 2014 the former Rowan High School site, Rowan Road

Mitcham was redeveloped as part of a joint project with the Homes and

Communities Agency (HCA), Crest Nicholson Homes and Merton Council. At the

time a Section 106 (S106) agreement was put in place for a scout hall and

community facility, new medical centre and pharmacy. Rowan Park development

has been complete since 2014 however the medical centre and community

facilities are yet to be built.

Rowans Surgery plans to relocate to the new site from their existing site in Stirling

Close, Mitcham which is 0.5 miles from Rowan Park. The CCG supports the

scheme because the existing surgery premises is no longer fit for purpose and

cannot support further growth and meets our obligations to improve primary care

estate

The scheme is a high profile scheme in Mitcham with interest from local residents,

ward councillor and MP.

Position to date

The CCG approved a business case to proceed in 2016/17. Since then we have

been meeting regularly with the Council, Crest Nicholson and their delivery

partner, CMS Developments to ensure the scheme meets all the local stakeholder

requirements and remains deliverable.

Next Steps

Crest have recently put forward a series of options which are currently being

considered by all partners, this includes some further value engineering to the

medical centre specification and the addition of two residential units on the site.

We have committed to review all available options by end November 2018.

3. Colliers Wood Estates & Technology Transformation (ETTF) Scheme

Background

An ETTF Scheme to the value of £1.01m to consolidate two current outdated

separate Colliers Wood Surgery premises into one new, purpose built facility at

the current Merton Vision site at 67, Clarendon Road, Colliers Wood, SW19 2DX.

The GP practice is working with third party developer, Octopus Health and Merton

Vision’s board of trustees on the design and planning for the new building which

includes a two storey GP surgery and 200 square metres of additional clinical

space for out of hospital services.

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The outline business case for the scheme was submitted to ETTF Programme

Management Office in August 2017. Approval on revenue implications and rent

from MCCG Finance Committee was obtained on 28th March. The CCG, GP

Partners, Merton Vision Trustees and Octopus Health hosted an event for local

councillors earlier in 2018 and followed up by sharing the outcome of the

discussion and a Q&A.

Position to date

In 2018 Octopus Healthcare focussed on engagement with Ward Councillors,

London Borough of Merton as Planning Authority and landowner, along with

engagement with Colliers Wood Residents’ Association in order to prepare the

scheme for the planning process:

As a result of successful stakeholder activity the scheme now has a set of

proposals which are in principle supported by Ward Councillors and the Residents’

Association, are capable of getting planning permission and in principle fit with the

Council’s legal framework for the site.

Next Steps

The planning application is planned to be submitted later this year with a

construction commencement date of April 2019 (subject to planning).

4. The Wilson Health & Wellbeing Campus – Local Improvement Finance

Trust (LIFT) Scheme

Background

Following an economic appraisal in 2015 it was decided that a new build on the

Wilson Hospital site was the preferred option for providing the estate to support

the delivery of new models of care. The chosen procurement route for the delivery

of the scheme is NHS LIFT (Local Improvement Finance Trust).

The Wilson will become a Health & Wellbeing Campus, addressing particular

needs of residents in the east of the borough, but available for all residents of

Merton. The Wilson will be deliberately different from a traditional health centre.

The space will support residents to stay healthy and develop stronger links with

their community, as well as deliver local wellbeing services that support people to

lead healthier lives.

Position to date

At the time of writing the CCG has reported a delay to the opening date for the

redeveloped Wilson Health and Wellbeing Campus due to discussions at a

national level between HM Treasury and Department of Health and Social Care

about policy change. As is the case for all other similar projects across England,

we must now wait for the outcome of these discussions as they will have an impact

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on the plans and agreements we make with the developers of the Wilson. Until

then, we are unable progress with the building design and planning element of the

project with the developers. In addition, the estimated construction period for the

scheme was 20 months, however developers have further information about the

site and construction resulting in a revision of this time to 24 months.

Despite delays, our service development work and community engagement

activity is continuing as planned. Over the summer CCG colleagues attended a

range of community events and meetings to talk to people about developing the

campus. We also asked for feedback to inform the initial design for the site. A

report on the feedback we heard this summer and is being factored into the design

brief to be published in the coming weeks.

Next steps

Wilson Community Reference Group (WCRG), made up of local residents and

community organisations, to support and advise us throughout the programme’s

lifetime. We hope to hold the first meeting in early November.

A Social Enterprise will be set up that will have oversight of the wellbeing services

and we plan this to be in place by the end of March 2019.

Merton CCG’s Wilson Service Design & Commissioning Group continues to work

on the detailed design of the services and commissioning model for the campus.

5. Improvement Grant Funding

Merton has 8 applications pending approval by NHS England’s Improvement

Grant (IG) funding programme management office. Funding can be applied for a

wide variety of practice improvements from large extensions to replacement doors.

All applications must meet the criteria set out by the IG team and practices will be

required to contribute 34% towards the cost of the works.

Practices will receive notification of whether or not their scheme has been

approved from January 2019 onwards following a process of prioritisation across

the STP.

Last year Wide Way Medical Centre and Central Medical Centre both successfully

used IG funding to improve and extend their current premises.

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