Discussion with Sarah see, Primary Care Director, Havering Clinical Commissioning Group on Primary Care issues in Havering.
Minutes:
The Director of Primary Care Transformation, Havering Clinical Commissioning Group (CCG) explained that there were three types of GP contact:
General Medical Services (GMS) – a national contract that could not be changed locally. This mainly covered traditional GP services along with some additional services such as influenza treatment and maternity services.
Personal Medical Services (PMS) – Local GP contracts of higher value that could be commissioned locally. It was these contracts that were currently being reviewed by the CCG. These contracts could only be held by a GP practice.
Alternative Provider of Medical Services (APMS) – Whilst still being provided by GPs, these contracts could be held by any suitable organisation.
It was noted that, in addition to whichever contract was held, the Council also commissioned some services from GPs e.g. smoking cessation services.
The review of PMS contracts locally had to be completed by March 2016 and it was possible that this could lead to changes in some GP services but officers agreed to return to update the Sub-Committee once further details were known, probably in January/February 2016.
Contracts included a number of performance indicators that providers were expected to meet in areas such as patient satisfaction. Indicators within the London Primary Care Framework also applied for areas such as on-line patient access (including to records) and the target of Saturday opening for all practices.
It was noted that CCGs were required to meet a gap in Government funding for PMS contracts and these types of contracts were therefore a cost pressure for the CCG. The CCG was therefore currently trying to complete a financial analysis of the new contract package and what services were currently being commissioned. In addition to completion of the financial modelling, discussions on the revised PMS contracts would take place with the Local Medical Committee. Discussions would also take place with the Council and with Healthwatch and a final decision on the PMS contracts would be taken by the Primary Care Committee.
A working group on PMS contracts had also been established across the Barking & Dagenham, Havering and Redbridge area, supported by NHS England and the North East London Commissioning Support Unit. The Local Medical Committee and clinical leads for Primary Care were also represented. Briefings on the new PMS contracts would be circulated, once details had been confirmed.
It was confirmed that there were a total of 15 Havering GP practices with PMS contracts although it was uncertain if there were PMS contract practices within each GP cluster. The PMS practices within Havering tended to be those that were higher performing.
It was also clarified that patients within a practice area had to be allowed to be allowed to register with a local GP, providing that practice’s list was open. The target was to have 1,800 patients to each GP but there was no maximum patient number.
The issue of GPs moving to larger premises to allow them to provide e.g. minor surgery was not part of the PMS review but was covered in the CCG’s programme of transformation work. A total of £1 billion Government funding for GP premises had been announced from 2015/16 although this had not been released as yet. The funding would be managed by NHS England although it was clarified that associated revenue costs would have to be met by the CCGs. The CCG officer felt that this was deliverable but that a clear policy was needed re premises investment.
It was accepted that there were a lot of single-handed GPs in Havering as well as many GPs approaching retirement age. It was not possible to reclaim from patients the cost of primary care; this was only possible with hospital treatment.
The King’s Park surgery in Harold Wood was under an APMS contract, currently held by the Hurley Group. This contract was coming to an end and a procurement exercise was therefore currently under way with patient engagement and provider events planned. Contract procurement was at an early stage and a new contract would be in place by 1 August 2016.
The walk-in service formerly based at Orchard Village had moved to South Hornchurch clinic. The CCG also planned to introduce a GP practice for the Orchard Village estate although a funding route for this would be need to be agreed with NHS England. The contract for walk-in services at South Hornchurch was also currently held by the Hurley Group. The walk-in service would become part of the CCG’s Vanguard work and would hence be a different contract from the Orchard Village GP surgery.
The Sub-Committee NOTED the updates.