Issue - meetings

Report and presentation attached.

The review of the Primary Medical Services (PMS) contract for GPs had been initiated by NHS England in 2014. Following a pause, CCGs had been asked by NHS England to restart the review in November 2016, on the basis of only a local offer with no London-wide offer. Any agreement reached would not be to the detriment of patients. Governance of the contract negotiations was the responsibility of the Primary Care Commissioning Committee which included representation from local Councils.

Around one third of Practices across Barking & Dagenham, Havering and Redbridge were subject to the PMS contract. Any proposals by the CCGs needed to be affordable and existing PMS contracts were being investigated to see if any further revenue could be derived from them. Discussions would be held shortly with NHS England in order to establish the best option in terms of affordability. The new contract was required to be in place by the end of October 2017 and officers accepted this was a tight timescale.

All local GP Practices had now been inspected by the CQC although the outcomes of inspections were still awaited for approximately 25% of cases. Six local GP practices had been placed in special measures with around 30 receiving a rating of ‘requires improvement’. All Practices in this position were offered support to revise procedures as well as on-line training being made available for Practice staff.

GP networks were being established across Barking & Dagenham, Havering and Redbridge which would be vehicles for collaborative working between Practices. Work between Practices on areas such as quality improvement for diabetes services was already under way.

Some sanctions were available for poorly performing Practices. Officers would consider the position if the Practice of a member of the CCG governing body was itself placed in special measures. Officers accepted that there were significant problems facing primary care in North East London including workforce issues and concerns that there would not be sufficient capacity to cope with the rising population in the area.

The review did not specifically cover the issue of health inequalities but it was anticipated that this would be covered by the work of the GP networks. The Committee agreed that health inequalities should be covered by the PMS review, as should workforce and capacity issues.

Whilst there was a small positive correlation nationally between GP list size and quality, it was accepted that single practices often also recorded better scores for patient experience. GP practices were encouraged to share services such as Practice nurses and back office functions although Practices remained private businesses. Several Members added that GPs were now often reluctant to become partners due to the added workload and preferred to stay as salaried GPs or locums.

It was AGREED that a letter should be sent on behalf of the Committee summarising its concerns that issues such as workforce, capacity and health inequalities should be included within the PMS contract review.