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Date Version Revision Comment Author / Editor
10/10/2013 Draft 1 Dr Margaret Chirgwin
20/11/2013 Draft 2 Dr Margaret Chirgwin
20/12/2013 Consultation Draft 3 Dr Margaret Chirgwin
April 2014 Final Dr Margaret Chirgwin
Document approval
Date Version Revision Role of approver Approver
24/04/2014 Final CCG Board
Newham CCG Primary Health
Care Strategy 2014-18
Dr Margaret Chirgwin
Final approved by Newham CCG Board on 24th April 2014
Note: Data/information in the Strategy was the most up to date available for the Consultation Draft of 20th December 2013 and has not been updated in this final version.
URGENT
CARE
STRATEGY
INTEGRATED CARE
STRATEGY SELF CARE
STRATEGY
IM&T
STRATEGY
ESTATES STRATEGY
PRIMARY HEALTH
CARE STRATEGY
WORKFORCE DEVELOPMENT
STRATEGY
1
Contents
1. GLOSSARY .........................................................................................................................................3
2. Executive Summary ...........................................................................................................................6
3. Introduction ......................................................................................................................................9
3.1. A definition of Primary Health Care ........................................................................... 9
3.2. General Practice ....................................................................................................... 9
3.3. Why does Newham CCG need a Primary Health Care Strategy? ........................... 10
3.4. This strategy states: ................................................................................................ 12
4. Our Vision for Primary Health Care Services in Newham ................................................................... 12
4.1. Outputs/outcomes from this strategy ....................................................................... 14
5. Our Health Environment .................................................................................................................. 16
5.1. The Population ........................................................................................................ 16
5.2. The Primary Health Care Provider Landscape ........................................................ 29
5.3. Activity and Finance ................................................................................................ 39
5.3.1. Activity .................................................................................................................. 39
5.3.2. Finance ................................................................................................................. 40
5.4. The Outcomes......................................................................................................... 44
5.4.1. Health Outcomes .................................................................................................. 44
5.4.2. Newham CCG Outcome Framework 2013/14 ....................................................... 49
5.5. What our population says about their local health services ..................................... 53
5.5.1. National NHS Surveys........................................................................................... 53
5.5.2. Local NHS Surveys ............................................................................................... 55
5.5.3. LBN Surveys ......................................................................................................... 56
5.5.4. The population’s local service development priorities ............................................ 60
6. High Quality Primary Care Providers ................................................................................................. 61
6.1. Primary Medical Services (PMS,GMS, APMS) ........................................................ 61
6.2. Extended Primary Care Providers – practices, clusters, networks and federations .. 62
6.3. The support the CCG will provide to General Practices and Groups of General Practices ............................................................................................................................. 63
6.4. Non-General Practice/List-based provider extended primary care providers (including specialist outreach services) ............................................................................................... 65
7. Enablers .......................................................................................................................................... 66
7.1. IT infrastructure and capabilities .............................................................................. 66
7.2. Workforce Development .......................................................................................... 67
7.3. Estates .................................................................................................................... 69
8. Treating People in the Community ................................................................................................... 71
8.1. Self-care.................................................................................................................. 72
8.2. Primary Medical Services ........................................................................................ 72
8.3. Extended Primary Care Services ............................................................................ 73
8.4. Secondary (specialist) care to be provided in a primary care setting ....................... 73
9. Development of Clusters as Commissioners ...................................................................................... 74
10. Procurement and contract management .......................................................................................... 77
10.1. Newham CCG Procurement Strategy and Policy .................................................... 77
2
10.2. Procurement Process and Annual Procurement Plan .............................................. 77
10.3. Use of the NHS Standard Contract .......................................................................... 78
10.4. Quality Performance Management Processes......................................................... 79
10.5. Activity and Quality Reports .................................................................................... 81
11. Working with our Stakeholders ........................................................................................................ 82
11.1. Our population......................................................................................................... 82
11.2. Health and Well-being Board ................................................................................... 82
11.3. NHSE and LBN ....................................................................................................... 82
12. Implementation Plan ....................................................................................................................... 84
13. Investment Plan .............................................................................................................................. 94
Appendices .................................................................................................................................................. 96
Appendix A. Newham Practices ...................................................................................... 96
Appendix B. PMS Contracts KPI Performance Summary ........................................... 109
Appendix C. General Practice High Level Indicators .................................................. 113
Appendix D. Public Health Outcome Framework Indication ....................................... 114
Appendix E. ELFT Community Health Service Specifications .................................... 117
Appendix F. Contracting and Procurement Work Plan for 2013/14 ............................ 118
Appendix G. Activity Trends ......................................................................................... 122
Appendix H. Details from Report on Newham Health Debate 2010/11 ....................... 132
Appendix I. August 2013 Community Reference Group – Feedback Notes .............. 140
Appendix J. LBN Survey Results .................................................................................. 142
Appendix K. Draft Terms of Reference Information Management and Technology and Working Group ................................................................................................................ 144
Appendix L. Draft Terms of Reference Newham Education and Training Academy Board Draft 1 ................................................................................................................... 147
Appendix M. NHS England – Commissioning GP Premises – October 2013 Group . 149
Appendix N. Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013 + update for 14/15 ...................................................................... 157
Appendix O. List of Outreach Services presently contracted by Newham CCG from Barts Health 158
Appendix P. Cluster Member Practices, Representatives, and Leads ....................... 159
Appendix Q. Draft Terms of Reference for Cluster Development Working Group .... 161
Appendix R. Newham CCG Procurement Strategy ...................................................... 163
Appendix S. Newham CCG Procurement Policy 2014 ................................................. 165
Appendix T. Contracting and Procurement Group Draft TOR .................................... 196
Appendix U. Impact Table ............................................................................................. 199
Appendix V. Code of Conduct Template to be completed when GPs have a financial interest in possible provider .......................................................................................... 200
3
1. GLOSSARY
A&E Accident and Emergency CSU Clinical Support Unit
ACS Ambulatory Care Sensitive CVD Cardiovascular Disease
ADQ Average Daily Quantities CYANA Cancer charity
AF Atrial Fibrillation DC Day case
APMS Alternative Provider Medical Services
DES Directly Enhanced Scheme
AQP Any Qualified Provider DIPs Data Improvement Plans
BME Black and Ethnic Minority DSR Directly Standardised rate
BMI Body Mass Index ECG Electrocardiogram
BP Blood Pressure ELFT East London Foundation Trust
BPAS British Pregnancy Advisory Service EMIS Egton Medical Information Systems
C2C Consultant to consultant ENT Ear Nose and Throat
CAPI Computer-Assisted Personal Interviewing
EOLC End of Life Care
CBT Cognitive Behavioural Therapy EPCS Extended Primary Care Services
CCG Clinical Commissioning Group EU European Union
CEG Clinical Effectiveness Group FACET Survey
Combination of 6 surveys
CHD Coronary Heart Disease FM Facilities Maintenance
CHN Community Health Newham FTE Full Time Equivalent
CHP/LIFTCo Community Health Partnership GLA Greater London Authority
Co-op Cooperative (not for profit) GMS General Medical Services
COPD Chronic Obstructive Pulmonary Disease
GP General Practitioner
CQUINs Commissioning for Quality and Innovation
GPwSI General Practitioner with a Special Interest
CSP Commissioning Strategic Plan HbA1C Glycerated Haemoglobin
HCA Health Care Assistant LIFT Local Improvement Finance Trust
Hib Haemophilus b LSOA Local Super Output Area
4
HIV Human immunodeficiency virus LTCs Long term Conditions
HMRC Her Majesty's Revenue & Customs Ltd Limited (for profit)
HPV Human papilloma virus MH Mental Health
ICT Information and communications technology
MRI Magnetic resonance imaging
IFCC International Federation of Clinical Chemistry
MRSA Meticillin-Resistant Staphylococcus Aureusis
IM&T Information Management and Technology
MSK Musculoskeletal
IMD Index of Multiple Deprivation NCB National Commissioning Board
IP In Patient NCCG
Newham Clinical Commissioning Group
IT Information Technology NCMP
National Child Measurement Programme
IV Intravenous NELCSU
North East London Commissioning Support Unit
JSNA Joint Strategic Needs Assessment NELIE
KPI Key Performance Indicators NELs Non-Electives
LA Local Authority NETA Newham Education and Training Academy
LAS London Ambulance Survey NHS National Health Service
LAT Local Area Team NHSE National Health Service England
LBN London Borough of Newham NHSPS NHS Property Services
LBW Low Birth Weight NICE National Insitute for Clinical Excellence
LES Local Enhanced Scheme NSAID Non-steroidal Anti-Inflammatory Drugs
LETB Local Education and Training Board
OBC Outline Business Case
OCUs Opiate/Crack Users SLA Service Level Agreement
ONS Office for National Statistics SMI Severe Mental Illness
OOH Out of Hours SOM Single Operating Model
5
OP Out Patient Star-PU Specific Therapeutic group Age-sex Related Prescribing Units
OPD Out Patient Department TB Tuberculosis
PCT Primary Care Trust tbc to be confirmed
PMS Personal Medical Services TOPs Termination of pregnancy
PPV Pneumococcal Polysaccharide Vaccine
TOR Terms of Reference
PROMS Patient Reported Outcome Measures
UCC Urgent Care Centre
QIPP Quality Innovation Productivity and Prevention
UK United Kingdom
QOF Quality Outcome Framework VTS Vocational Training Scheme
SDIPs Service Development and Improvement Plans
6
2. Executive Summary
Why do we need a Primary Health Care Strategy? (pages 10-12) - health knowledge and
technology is changing; the people we serve are changing; demands are changing and the workforce
and buildings are not fit for purpose.
Our Vision for Primary Health Care in Newham (pages 12-15) - to deliver universally accessible high
quality out of hospital services that:
• promote the health and wellbeing of our local community
• ensure that our population receive the right treatment at the right time and in the right place
• reduce early death and improve the quality of life of those living with long term conditions; and
• reduce health inequalities
High Quality Primary Health Care Providers
Primary Medical Services (pages 61-62) – the CCG will work closely with our population, NHSE and
LBN Public Health to ensure practices are supported to develop new ways of working and all patients
have equal access to the services they need.
General Practices/List-based providers and Groups of General Practices/List-based providers
providing Extended Primary Care (pages 62-63) – the CCG will support the development of local
General Practices/List-based providers and Groups of General Practices/List-based providers to
provide a wide range of services as close as possible to the patient. We will support Clusters of GP
Practices/List-based providers to achieve activity and access targets for their populations. We will
purchase Extended Primary Care Services from General Practices/List-based providers using the
National Standard Contract which allows sub-contracting of service provision to other providers. All
practices will be expected to provide access for their patients to all EPCSs if they sign a contract with
the CCG.
The support the CCG will provide to General Practices/List-based providers and Groups of General
Practices/List-based providers (pages 63-65) - the CCG will provide quality performance data and
facilitate Clusters of General Practices/List-based providers as providers to discuss and agree what
they need to do as individual providers to reduce any validated quality variations and to develop and
manage sub-contracting within the cluster and to other providers. We will continue to provide
prescribing, PPG development and safeguarding support as well as support with IT, workforce and
estates.
Other Extended Primary Care Providers (pages 64-65) – the CCG will work to integrate service
provision of all NHS out of hospital health service providers (GP, optician, community pharmacy,
dentist, Bart’s outreach, etc.), LBN and the voluntary sector.
Enablers
IT Infrastructure and capabilities (pages 66-67) – the CCG at present manages a delegated IT budget
from NHSE to support IT for core GMS/PMS/APMS service provision. The CCG will identify an
additional IT budget which in combination with the NHSE budget will provide training, software
(including on-going development of searches to support practices to achieve best practice) and
hardware. The CCG will have an IM&T Strategy which will continue to focus on supporting all
primary care and out of hospital health service providers to effectively use fully compatible health
records systems that will allow all providers to share all relevant live records with the patient’s
7
explicit consent. Within the life of this strategy the intention is to ensure that this ability to share
electronic records will include key parts of our local acute provider (those who share the care of
those with long term conditions), London Ambulance Service and relevant LBN staff subject to
patient consultation.
Workforce development (pages 67-69) - the CCG will support the development of Newham
Education and Training Academy (NETA) as the body that will understand our workforce needs and
support on-going professional development with a focus on accrediting training for Extended
Primary Care Services and developing programmes to attract and retain all health professions in
Newham. This will include the development of research capacity within a number of Newham
practices. The aim will be for NETA to become independent of the CCG by 2018.
Estates development (pages 69-70) – the CCG will work with NHSE to ensure all estate meets all
basic requirements and to develop capacity for the extended services. The focus will be on providing
the necessary facilities to ensure we can provide the right services to the right patient in the right
place and as much as possible ensuring that geographic access is equally good across all of Newham.
We therefore support a dispersed model of service provision that gives greatest possible access to
the largest population. We will support all practices to provide extended services when appropriate
and the largest number of provision sites that is financially viable where the service cannot be
provided within all practices. We plan to undertake a FACET survey of all General Practice Estate and
will include mapping of practice populations and isochrones. This will be used to prioritise estates
improvements and where necessary new developments. We will establish an Estates Working Group
that will include NHSE, all NHS bodies with estate in Newham, and LBN to develop a comprehensive
10 year Estates Strategy.
Treating Patients in the Community (pages 71-74) - from 2013-2018 the CCG will prioritise
developing:
Self-Care Aware General Practices
A joint Self-care and prevention strategy with Public Health (LBN)
Access to a range of standard primary medical services 8am to 8 pm 7 days a week through a
combination of GP practice, Extended Hours and Out of Hours Services provision with full
access to a patient’s notes irrespective of how or where access occurs. This will include use
of technology to develop a number of non-face-to-face consultations including emails and
telephone triage of the majority of appointment requests
GPs able to consult consultants using emails/texts/phone/advice and guidance/Skype
Outreach of elderly care specialist services in the primary care setting including a patient’s
home and local nursing homes
Outreach of cardiology specialist services in the primary care setting including a patient’s
home and local nursing homes (this is already in place for diabetes)
Outreach of respiratory specialist services in the primary care setting including a patient’s
home and local nursing homes
8
A range of health and social care services that will support an individual to be treated at
home or in a nursing home when previously they would have been treated in a hospital. This
will include provision of IVs in the community – antibiotics and chemo therapy; and rapid
access to a named clinician for those with complex health and social care needs
A full range of support services to allow all those who wish to die at home to do so.
Development of Clusters as Commissioners (pages 74-77) - the CCG will invest in the development
of the skills necessary in both its GP member practices and the CCG support staff to allow a
maximum of 8 clusters (all Newham practices being members of one of these clusters) to hold and
commission with a budget. The level and nature of the delegation to be agreed by April 2015.
Procurement of Extended Primary Care and Specialist Outreach from the acute setting (pages77-
79) - the CCG’s procurement strategy will focus on achieving the best services for the patients and
for most services this will mean that integration and proximity/access (so long as the quality meets
the required standard) will drive the choice of procurement route.
Contract and Performance Management (pages 79-81) - the CCG will use the National Standard
Contract with all out-of-hospital service providers including General Practices/List-based providers
and Groups of General Practices/List-based providers. All service specifications will clearly state the
staff skills and equipment requirements that must be met to provide the service. Pricing will
explicitly include cost of the estate and support staff. Subcontracting to another Newham General
Practice/List-based provider or Group of General Practices/List-based providers or when appropriate
another provider will be allowed as long as there is full access to the patient notes. A performance
management system will be put in place following the processes defined in the National Standard
Contract. This performance management process with our local General Practices will be shared
with NHSE and LBN, as key commissioners of services from these providers, through performance
management pre-meets and joint meetings with CCG Clusters as providers.
Working with our Stakeholder (pages 82-83) – the CCG has developed key outcomes of this strategy
with members of local PPGs and the voluntary sector. We will report regularly against these to all
the participation forums. Patients will be represented in the process to develop new out of hospital
care pathways that the Strategy supports. The CCG will establish with NHSE and LBN quarterly
General Practice quality review meetings at cluster level including a pre-meet to discuss issues on
performance and provider developments including planned training, investments and service
developments. The CCG will work closely with other local health service providers (opticians,
pharmacists, dentists, ELFT, Bart’s etc.) to develop new and improved services.
Implementation Plan (pages 84-93) – this shows key Strategy deliverables over the 5 years.
Investment Plan (pages 94-95) – this will support implementation of the strategy.
9
3. Introduction
3.1. A definition of Primary Health Care
The World Health Organization (WHO) Alma-Ata declaration of 1978 defined primary health care
as:
Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.1
Though written over 30 years ago this remains a good definition of Primary Health Care.
For the purposes of this Primary Health Care Strategy Primary Health Care will include all non-
specialist health care provided outside of hospitals but not those health services in the
community that are commissioned by other parts of the system and for which the CCG has no
responsibility. In particular: community pharmacists, opticians and dentists but also those
services purchased by LBN Public Health and NHSE that are not purchased from General
Practices.
3.2. General Practice
The European Definition of General Practice/Family Medicine was used to develop the
competences that the RCGP 2006 General Practitioner curriculum develops and as such is the
best available definition of General Practice in the UK. The contracts that GPs hold with the NHS
all rely on these competencies but are regularly changing and themselves cannot be used as a
definition of General Practice. In England General Practice:
is available to all the English population through registration at a practice which means that
the individual becomes part of the practice list. The services an individual receives directly
from the practice are therefore often referred to as “list based” services. As General
Practices develop and form new structures they will continue to hold lists. For clarity,
1 World Health Organization, 1978. Declaration of Alma Ata, International conference on PHC, Alma-Ata, USSR,
6-12 September, available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf (accessed June 2009).
10
throughout this document any new grouping of practices providing Extended Primary Care
Services to those on their lists will be called Groups of General Practices/List-based
providers.
is normally the point of first medical contact within the healthcare system, providing open
and unlimited access to its users, dealing with all health problems regardless of the age, sex,
or any other characteristic of the person concerned
makes efficient use of healthcare resources through co-ordinating care, working with other
professionals in the primary care setting, and by managing the interface with other
specialities. It also means taking on an advocacy role for the patient when needed
develops a person-centred approach, orientated to individuals, their family, and their
community
has a unique consultation process, which establishes a relationship over time through
effective communication between doctor and patient
is responsible for the provision of longitudinal continuity of care as determined by the
needs of the patient
has a specific decision-making process determined by the prevalence and incidence of
illness in the community
manages simultaneously both the acute and chronic health problems of individual patients
manages illness which presents in an undifferentiated way at an early stage in its
development, some of which may require urgent intervention
promotes health and well-being by both appropriate and effective intervention
has a specific responsibility for the health of the community
deals with health problems in their physical, psychological, social, cultural and existential
dimensions.
3.3. Why does Newham CCG need a Primary Health Care Strategy?
In general terms the NHS in England needs to change in response to a number of factors:
Changes in health knowledge and technology
– So much more can now be done than when the NHS was established. The structure
and function of the different parts of the NHS system was set up in a very different
technological age without computers, transplantation, clot busting drugs and the pill
Changes in the people the NHS serves
– The age profile of the population of England is changing with a projected massive
increase in the percentage of the population over the age of 65, 75 and 85 in the
next 30 years
11
– Increasing levels of obesity, lack of exercise and alcohol but less smoking
– Patterns of disease are changing with less infections and more time spent living with
a disease such as diabetes or high blood pressure
Changes in demand
– Individual expectations are changing with most patients expecting more
involvement in decisions about their health and more understanding of their options
– Patients wish to have a choice about when and where they are treated and about
who will provide their care (this is not universally the case. Its importance varies
with the kind of care being provided. For some kinds of care it is not important if
quality is guaranteed)
– How individuals want to use the service is changing with a greater demand for
immediate access to services and increasing expectations that access may not need
to be face to face. Thus increasing use of texts, email, phone and on line
Workforce and buildings are not fit for purpose
- The workforce was developed for a service which was structured differently and
functioned very differently. Many are approaching retirement whilst the new
generation has a different expectation of how they will work (a reduction in GP
partners and an increase in salaried GPs of particular note)
– Many GP premises were developed from residential housing and are simply unable
to expand any further.
Newham has its own local mix of these national issues requiring a Newham specific response.
The vibrant, diverse, multicultural community established across Newham has one of the
youngest growing populations in Europe coupled with a relatively high turnover of people who
arrive from other countries and who have not used the NHS before and bring expectations and
health service understanding from very different systems.
Therefore we need a health service that can fully support both the established population and
the transient one - so that when people leave Newham they have an awareness of how to use
health and social services appropriately and so that people choose to stay in Newham partly
because its health services are understood and experienced as exceptional.
We need a 21st century healthcare system that provides accessible flexible care and takes a
strong approach to educating people on how and when to self-care with local communities and
the voluntary sector supporting the services and population.
12
As one of the largest regeneration areas in Europe we have a unique opportunity to develop
state of the art facilities particularly in the Docks and Canning Town developments and with the
Olympic legacy in Stratford.
3.4. This strategy states:
1. Our Vision for Primary Health Care Services in Newham and the planned outputs we
expect from implementing this strategy over the next 5 years
2. What we will do to support the development of our General Practices/List-based
providers and other extended primary care providers
3. The Services we plan to develop over the next 5 years to provide treatment in the
community
4. How we will develop our Clusters as Commissioners
5. How we will procure services to provide treatment in the community
6. How we will contract and performance manage these services
7. How we will work with key stakeholder: our population, NHSE, LBN and local providers to
develop and manage providers and develop new services.
4. Our Vision for Primary Health Care Services in Newham
To deliver universally accessible high quality out of hospital services that:
• promote the health and wellbeing of our local community
• ensure that our population receive the right treatment at the right time and in the right
place
• reduce early death and improve the quality of life of those living with long term
conditions; and
• reduce health inequalities.
It is envisaged that General Practices/List-based providers, as providers (core and extended
together), will be:
Providing a cradle to grave prevention (primary, secondary and tertiary) and treatment
service with the GP as the named and accountable clinician for his or her patients i.e.
the GP will be the key to the effective integration of an individual’s care
Ensuring continuity of an individual’s care
Providing access to essential services 7 days a week
13
Working in an equal partnership with patients, their families and carers with each
contact empowering the patient and their family and carers to manage their health and
make informed choices about their care
Accessing a wide variety of other skilled workers to support the GPs in providing holistic
and integrated care to their patients
Directly employing or contracting the majority of the generally skilled workers
Proactively identifying those at risk of ill-health
Diagnosing and managing the risk factors for long term conditions and the long term
conditions over the patient’s life time and through the course of the disease with
support from secondary care experts
Managing as much ill-health as possible outside of hospital and using technology where
appropriate to facilitate this
Accessing the secondary care expertise to support a patient’s care without needing the
patient to visit the hospital except when this is the best place for the care to be provided
Working in collaboration with social care and the voluntary sector
Using a single patient record and, with the patient’s consent, sharing relevant parts of
this record with all local health and social care providers who will be able to add
information directly to the patient record
We aim to:
Reduce the years of life lost from causes amenable to health care by 2018:
o To the England average for men; and
o To less than 10% above the average (was 17% in 2011) for women
Reduce the gap in life expectancy between wards:
o For men from 11.5 years (2008-20010) to less than 10 in 2015/16 and less than
8 in 201 7/18
o For women from13.5 years (2008-10) to less than 12 years in 2015/16 and less
than 10 years in 17/18.
Increase the levels of satisfaction with the service
o Improve the overall satisfaction with the GP service to the England Av by
2015/16
14
o Improve the overall satisfaction with the Out of Hours service to the England Av
by 2015/16
The health outcome measures will not be available until 2 or more years after the period
measured so are not useful for measuring the implementation of the Strategy however the
satisfaction measures will be available within 12 months.
4.1. Outputs/outcomes from this strategy
The following are more specific service outputs/outcomes the strategy plans to achieve.
Outcome measure Baseline 2014
By March 2015
By March 2016
By March 2018
Access
1 % of Newham practice population able to speak with a GP by phone within 4 hours 5 days a week
Baseline to be set during 2014/15
2 % of Newham practice population able to see a doctor or nurse (as requested) within 48 hours
Baseline to be set during 2014/15
3 % of Newham practice population able to book an appointment 5 days in advance with a doctor of their choice
Baseline to be set during 2014/15
Quality
4 Outcome Framework measure: Proportion of people feeling supported to manage their condition
55.45 (Jan-Sept 2012)
65% England Average
England Average
5 a) Number of practices (without a valid non- clinical quality reason) with Trigger Point 2 against 1 or more GP High Level Indicators
b) Number of practices (without a valid non- clinical quality reason) with Trigger Point 1 against 1 or more GP High Level Indicators
27
61
10
40
0
20
0
10
6 a) Percentage who die who are on the Palliative Care Register
b) Percentage of those on the Palliative Care Register who die where wish to die
14%
13% 2013/14 Q1 and 2
20%
20%
40%
40%
50%
60%
7 Number of referrals made by General Practices to alternative(non-NHS) support services
Baseline to be set during 14/15
15
Enablers
8 Percentage of CCG budget spent on out of hospital services (including ELFT community and mental health; GP prescribing; reimbursement schemes where this is funding practice to provide extended services and another mechanisms developed to fund this; any outreach services provided by an acute provider or an AQP or other form of contract out in the community; ? money transferred to LBN but being spent on services provided by health professionals)
36% .40% 43% 45%
9 Number of providers using a patient records system for recording all patient contact activity, which is interoperable with the GP clinical record with a live view of patient information and the ability to import coded data from the GP systems and for the GPs to be able to import coded data from the ELFT patient record, with a clinical governance compliant patient consent control system.
All GP Practices/List-based providers OOH
All Community Services with mobile access
Diabetic OPD
All OPD at NUH
LAS
Relevant SS teams (adult and children)
10 a) NETA facilitating access to a full range of training opportunities to all primary care clinical and non-clinical staff
b) NETA funding from CCG
None
Minimal support
GP
HCA
Practice Nurses
Management
All
50% of management support rest paid for by Practices
All
Fully funded by those using the services
11 FTE GPs/capita
FTE Practice nurses/capita
FTE HCAs/capita
1800/GP
Baseline to be set during 2014/15
1,700/GP 1,600/GP 1,500/GP
12 a) Number of Surgeries in lowest category for facilities (need to agree what this is but from previous survey there were 12 practices in this group)
b) Number of surgeries in the middle category (need to define -there were 44 practices in this category. I would prefer to be more specific with this picking off only a portion of these)
12
44
6
40
0
30
0
20
16
5. Our Health Environment
5.1. The Population2
5.1.1. Our Population
The 2011 National Census estimates that the total population of Newham is 308,000 which is a
significant increase from previous estimates. However there are 371,000 individuals registered
with Newham GPs (from the Exeter system) and it is this figure that is now being used by NHS
England as the raw CCG population.
Population age sex profile
The borough has an unusually young age profile in comparison to the age profile for England.
Newham has a larger than average proportion of people aged under 10 years, and aged 20 to 39
years, with a correspondingly smaller than average proportion aged 40 and above.
People aged 65 and over make up a relatively small proportion of the Newham population in
2 Information in this section from NEWHAM JOINT STRATEGIC NEEDS ASSESSMENT 2011/12 September 2012 Update
17
comparison to London and England as a whole. In 2011 just 6.7% of Newham’s population was
estimated to be aged 65 and over (around 20,700)2 compared to 16.5% nationally.
52% of the borough’s population are males, a higher proportion than the national average of
49.2%.
Ward Level Age Profiles
There is marked variation in age profile between different wards. The proportion of people aged
over 65 living in each ward ranges from 4.1% (Beckton) to 10.9% (Plaistow South). The
proportion of people aged under 18 living in each ward ranges from 23.7% (Plaistow South) to
36.5% (East Ham South).
Table 1: Population age profile by ward
Area Name Under 18 18 - 64 65 plus
ENGLAND 21.1 62.4 16.5
LONDON 23.0 66.0 11.0
NEWHAM 26.8 66.1 7.1
Beckton 22.7 73.2 4.1
Boleyn 28.3 63.3 8.4
Canning Town North 29.5 63.6 7.00
Canning Town South 28.1 63.4 8.5
Custom House 27.6 64.0 8.4
East Ham Central 28.5 64.6 6.9
East Ham North 30.5 63.7 5.8
East Ham South 33.5 58.4 8.1
Forest Gate North 25.1 68.0 7.0
18
Forest Gate South 23.3 71.4 5.3
Green Street East 28.9 64.3 6.8
Green Street West 26.8 65.6 7.7
Little Ilford 31.0 62.5 6.5
Manor Park 26.4 64.6 9.0
Plaistow North 27.3 64.9 7.87
Plaistow South 20.2 68.9 10.9
Royal Docks 22.1 72.8 5.1
Stratford and New Town 21.8 72.2 6.00
Wall End 30.4 63.3 6.3
West Ham 27.8 64.7 7.6
Source: GLA Round 2011 Population Projection SHLAA - PUBLISHED APR 2012
Birth Rates
Newham has the highest birth rate in England (113.9 live births per 1,000 female population of
reproductive age) compared to the London average (72.1); and this in turn is higher than the
England average (65.5). In 2010 there were 6,262 live births to Newham residents.
In 2010, over 76% of these babies were born to mothers who themselves were born outside the
UK. The largest percentage was from Asia & the Middle East (49%), followed by Africa (25%) and
the EU (20%).
Newham has the second highest proportion of new-borns with low birth weight (less than
2500g) in London.
19
Graph 1: Percentage of live births that are Low Birth Weight
Source: Health and Social Care Information Centre
Population Growth
The total population of Newham increased from approximately 244,000 in the 2001 Census to
308,000 in the 2011 Census. Some of that increase may be explained by improved census
completion in 2011, but the increase also reflects increasing regeneration in the past decade and
migration into the borough. Housing development and regeneration will accelerate during the
next decade across several areas of Newham, which is likely to result in continued population
growth.
Local modelling, taking account of housing development as well as migration, birth and deaths,
predicts a population increase of over 30,000 people between 2011 and 2016, an increase of
around 10%. The largest growth is expected in Stratford and New Town and Canning Town South
(around 11,000 and 5,000 people in each, a 55.8% and 34% increase respectively).
Population Turnover
High population churn impacts on local services and areas in a number of ways. An area with
high churn will generally be a greater burden on local services even though the population may
be identical. If the population is unchanged in size but the already resident population were all
replaced by new people, the churn index would take a value of 100%. Population turnover
measures the magnitude of flows into and out of an area. For example, the population of an
area may be unchanged, but the people that live there may be completely different from those
at a previous snapshot. If an area retained exactly the same people between two points in time,
then the turnover is defined as zero.
20
In Newham 6.9% of the population was born between 2007 and 2011. In this same time period
the total population grew by 10.7%, 31.6% of residents were new to Newham and 7.7% had
moved their address. Within this broad picture there was more substantial variation by ward
driven in large part by re-generation - in some areas of Newham there has been a 50%+
turnover of people.
Table 2: Population Turnover
Borough Population in 2011
% change since 2007
% of 2011 stock born since 2007
% of 2011 stock new to borough by in-migration
% of 2011 stock due to internal movement
% of 2011 stock unchanged since 2007
Newham 298,916 10.7 6.9 31.6 7.7 53.9
Map 1: Population Turnover
Source: Comparative analysis of the resident population of the six Olympic host boroughs -sources and uses of locally owned administrative data. Dr Les Mayhew; Gillian Harper; Sam Waples. 2011
Regeneration
The regeneration plans for Newham, will have a significant impact on the level of population and
the boroughs infrastructure.
Geographically, the areas of concentrated regeneration are located along the east and west
sides of the Borough as well as along the borders of the river Thames. This land is mostly former
industrial or dockside land which is currently underutilised. New technologies of land
21
reclamation mean that this land now represents "an arc of opportunity" for redeveloping
Newham. Maps of land use or road systems highlight how this ground is currently relatively
empty when compared to the interior of Newham Borough.
Map 2: Areas of Redevelopment
From the figures submitted for planned new-builds we are able to determine the extent and
timing of the regeneration-driven growth at the Community Forum level.
Graph 2: Population Growth Projections
From 2011 onwards, Stratford & West Ham, the Royal Docks and Custom House & Canning
Town Forums will experience fast and significant growth.
22
By 2019, Stratford & West Ham and Custom House & Canning Town Community Forums will
have surpassed any other Community Forum in the Borough by 10,000 habitants. This is a
significant pace and scale of this change.
Ethnicity Profile
Until further information becomes available from the 2011 Census, the best available estimates
of the ethnicity profile for Newham come from GLA 2010 ethnic group projections. These
projections reflect the considerable ethnic diversity of Newham.
GLA Ethnic Breakdown
Table 3: Ethnic Breakdown
GLA Aggregated ethnic
Group
2011 %
White 80,107 29.8
Black Caribbean 17,833 6.6
Black African 42,863 15.9
Black Other 8,246 3.1
Indian 31,066 11.6
Pakistani 28,808 10.7
Bangladeshi 28,495 10.6
Chinese 4,365 1.6
Other Asian 12,933 4.8
Other 14,137 5.3
Source: GLA 2010 Round Ethnic Group Projections – SHLAA
The population of Newham, in terms of ethnic group, varies substantially by age group. Of
people aged under 20 years, 20.7% of the population are black African and 16.5% are
Bangladeshi. Of people aged 20-64 years, 15% of the population are black African and 8.7% are
23
Bangladeshi. In contrast, 16% of the under 20s age range population are white, rising to 33% of
the 20-64 age range population and 55% of 65 years and over population.
5.1.1. Socio-economic determinants of health
As the Marmot Review restated, socioeconomic status is an important predictor of health
status. The exact relationship between the ‘wider determinants of health’ (for example, income,
housing quality, education) and individual health outcomes is complex, but has a profound
impact on health. Socioeconomic status is a useful predictor of health outcome, particularly at a
population level, but does not, on its own, explain any one individual’s health outcomes.
Deprivation
Based on the Index of Multiple Deprivation (IMD), Newham is the 3rd most deprived local
authority area in the country. In 2010, all (20 out of 20) of Newham wards were ranked in the
20% most deprived in the country and 8 were ranked in the 5% most deprived.
Graph 3: Deprivation by quintiles – Newham compared to national quintiles
Source: Public Health England Newham Health Profile September 2013
The figure below shows variation in deprivation within Newham based on the IMD. The chart
divides Local Super Output Areas into quintiles based on deprivation index score. The higher the
IMD score, the more deprived an area is so that the areas shaded dark blue are more deprived
than those in lighter shades.
Map 3: Deprivation by quintiles – quintiles within Newham
24
Source: Public Health England Newham Health Profile September 2013
Employment
According to the Office for National Statistics (ONS) Annual Population Survey, in Apr 2011-Mar
2012 Newham had an unemployment rate of 14.6% (the highest in London) compared to 13.0%
in Tower Hamlets (2nd highest), 12.5% in Enfield (3rd highest) and 9.3% in London.
Housing
London has a higher percentage of local authority homes not meeting the decent homes
standard than other parts of the country (25% local authority stock homes in London are non-
decent compared to 16% in England in 2010). The proportion of non-decent homes in Newham
is higher than the London average, with 27% not meeting the decent homes standard. The
highest rates are reported in Havering with 57% and Tower Hamlets with 56%.
Newham has a high proportion of households living in fuel poverty, the 4th highest in London
and the 2nd highest proportion of unfit dwellings.
25
Recent data suggest that Newham has the highest proportion of housing classified as
‘overcrowded’ in London. In 2010, 17.9% of homes in Newham were defined as overcrowded
compared to 7.5% in London.
In Newham there were 2, 710 households living in temporary accommodation in Quarter 1 of
2011, the number of households living in temporary accommodation in Quarter 1 of 2010 was
3,873.
Homelessness
Although homelessness has a significant impact on the health of the local population, the
problem is not extensive in Newham. In the period between April 2010 and March 2011,
Newham had 97 households reported as being homeless and in priority need. This equates to a
rate of 1.05 homeless households and in priority need, compared to a London average of 3.14
per 1000 households. Although the number of households reported as being homeless and in
priority need in Newham is below the London average, the proportion of households in
temporary accommodation is higher. Newham has a rate of 19.24 per 1000 households in
temporary accommodation compared to a London average of 11.05.
Crime
Violent crime impacts on health both directly and through its impact on the community. Rates of
violent crime in Newham (31 offences per 1,000 population) are considerably higher than the
London average (23 per 1,000). 48% of residents in Newham perceive anti-social behaviour to be
a problem in the local area (the highest percentage of all London boroughs).
Road Traffic Incidents
Although levels of car ownership in Newham are low relative to the London average, in 2011 74
people were killed or seriously injured on Newham’s roads.
26
Child Poverty
The HMRC define poverty as: “The proportion of children living in families in receipt of out of
work (means-tested) benefits or in receipt of tax credits where their reported income is less
than 60 per cent of median income.”. In Newham, the proportion of children (age under 16
years) in poverty in 2009 was 38.2%. The London average, by comparison was 29.7% and the
England average was 21.9%.
Map 4: Relative Levels of Child Poverty (Newham highlighted in red)
Source: Newham Child Health Profile 2012, Children and Maternal Health Observatory
Disabilities
The Newham Disabled Children and Young People’s Service caseload numbers (on a week by
week basis) nearly halved in two years, from 788 in September 2009 to 377 in December 2011.
5.1.2. Individual life style determinants of health
Lifestyle factors may have a direct impact on individual health outcomes. For individuals who
smoke, are inactive, have a poor diet, or abuse drugs or alcohol, lifestyle changes can have a
significant impact on their health.
Smoking
Smoking remains the single biggest preventable cause of ill health and premature mortality in
England. Data from the Local Tobacco Control Profiles for England indicate that the proportion
of adults who smoke in Newham is close to the national average – 21%. However, the impact
of smoking on health in Newham is disproportionate, with the proportion of death that can be
27
attributed to smoking being significantly worse than the national average. In contrast, the rates
of smoking amongst women giving birth are significantly better than the national average.
Within the Newham population there is considerable variation in rates of smoking between
different ethnic groups, and between men and women within ethnic groups. Highest rates of
smoking are found in white British men and women, east Europeans and Bangladeshi and
Pakistani men. The lowest rates are amongst Pakistani and Bangladeshi women.
Obesity
Using modelled estimates from the Health Survey for England, it is estimated that 25.3% of the
adult population in Newham are classified as obese. This is higher than England (24.2%) and
higher than London (20.7%).
Physical Activity
Two sources of data are available describing physical activity levels in Newham. The Sport
England Active People Survey report for April 2012 states that 27.8% of Newham adults engage
in moderately intense activity of 30 minutes at least once a week, one of the lowest
participation rates in England. However, the Active People Survey focuses on sport
participation as opposed to overall physical activity.
The Newham Household Panel Survey Wave 6 report found that 73% of residents took part in
only one physical activity in previous 4 weeks. Physically active housework and brisk walking
were the most commonly identified activities.
Healthy Diet
National guidance recommends that individuals eat at least 5 portions of different fruit and
vegetables a day. The Newham Household Panel Survey Wave 6 reported that 40% of Newham
residents eat 5 A Day on at least 5 days a week.
Substance Misuse
Drug Misuse
In 2009/10 there were an estimated 2,049 Opiate/Crack Users (OCUs) in Newham. This is lower
than the previous year’s estimate of 2,590 (This is a difference of 541, or 21% lower). There are
an estimated 571 Opiate/Crack Users not known to treatment, or ‘treatment naïve’, or 28% of
OCUs. Whereas, the previous year’s estimate stated that there were 1138 treatment naïve and
therefore a much higher prevalence at 44%.
Alcohol
The crude rate of alcohol-specific hospitals stays aged under-18 years is significantly lower than
28
the England average. In Newham 25.3 people aged under-18 per 100,000 were admitted to
hospital due to alcohol-specific conditions in 2007/08 to 2009/10 (pooled), compared with 61.8
per 100,000 in England17. However, the age and sex standardised rate of admission to hospital
for alcohol related harm per 100,000 population in 2010/11 for the whole of the Newham
population was significantly worse than the England average. In Newham the rate was 2760
per 100,000 population and the England average was 1895 per 100,000.
The proportion of the population estimated to fall into the category of “increasing and higher
risk drinking” in Newham is 15.7%, which is lower than, but not significantly different to, the
England average of 22.3%17. This suggests, therefore, that whilst Newham has a similar
proportion of increasing and higher risk drinkers, those that do use alcohol are more likely to
require admission to hospital for alcohol-related harm.
There were a total of 265 alcohol-related deaths in 2006-2010, of which, 86 were specific to
alcohol. 70% of the alcohol-specific deaths were male and 33% of people were aged 45 to 54.
The majority of people were born in the UK (55%). The second most common area of birth was
Eastern Europe (14%).
Childhood Oral Health
There have been significant improvements in the oral health of five year-old children over the
past eight years. However dental decay remains much higher than the London and national
average with Newham having the second highest rates of dental decay in London in this age
group.
Childhood Obesity
The National Child Measurement Programme (NCMP) measures the height and weight of
children in Reception Class and in Year 6 and calculates their BMI by comparison to the 1990
UK growth charts. As these growth charts are based on a largely White British sample there is
some criticism that they may not accurately reflect the overall obesity risk to individuals from
other ethnic groups, which comprise over 90% of the Newham school age population. Advice
from the National Obesity Observatory is that the charts may understate the risk to children
from South Asian ethnic groups, including Bangladeshi, Indian and Pakistani, but overstate the
risk to children from Black African and Black Caribbean groups. As children from the south
Asian groups form a greater proportion of the local school age population the overall impact
for Newham at population level may therefore be to understate the risk from obesity for
Newham children.
29
Based on 2011 NCMP data, 12.9% of Reception Class children in Newham were obese,
the 5th highest in England. The rate for boys was 14.6% (5th highest) and for girls was
11.3% (8th highest)
Based on 2011 NCMP data, 24.7% of Year 6 children in Newham were obese, the 10th
highest in England. The rate for boys was 26.9% (10th highest) and for girls was 22.3%
(13th highest)
5.2. The Primary Health Care Provider Landscape
5.2.1. The General Practices
We have 61practices - 32 PMS, 26 GMS and 3 APMS. The list of practices with their contract
type and population size can be found in Appendix A.
A legacy of NHS development is these different types of contract for primary care providers
which makes it difficult to ensure financial resources are deployed evenly, on a per-patient
basis, within a defined geography. GMS contracts are negotiated nationally. PMS are locally
negotiated contracts designed to reflect local conditions and objectives. This has led to
significantly different levels of funding to practices. Although during 12/13 there was review
and re-negotiation of the PMS contract in Newham there remains a significant discrepancy in
spend per head across PMS practices. Appendix B PMS Contract KPI Performance Summary
shows the additional services expected to be provided by the 32 PMS practices. There is more
detail on financial aspects of this issue in the finance section below.
The CCG does not hold these contracts so does not have the full data available on practices. In
particular we do not have data on how practices are functioning in terms of opening hours,
number of appointments/capita the use of telephone triage, the use of call and recall systems.
It appears likely that our practices are providing a higher level of appointments than the
England and London average in order to service this population and achieve the secondary care
activity level noted in section 5.3.1 below.
30
Table 4: Summary of Newham practices compared to the National average.
Source: www.primarcare.nhs.uk
Of note Newham practices have smaller than average practice populations, higher list turnover
and very high levels of Black and Ethnic Minority (BME) patients. When comparing Practice level
achievements the CCG will seek CCGs with a similar profile (Tower Hamlets, Brent and City and
Hackney are the most similar).
31
Map 5: Practice Distribution
Source: www.primarcare.nhs.uk
General Practice High Level Indicators
NHSE has developed 38 general Practice High Level Indicator (Appendix C is the CCG average
achievement of these Indicators is compared to the national average) to monitor the activity and
quality of General practices. Practices are plotted on a National Funnel Plot. This shows that
Newham Practices are practicing very similarly to all England practices with no significant
statistically valid variation between practices. For many indicators all practices are within the
England funnel, and behaving and achieving very similarly to each other.
Of the 61 practices some are “outliers” against particular indicators. Below are listed those
indicators with 9 or more outliers:
32
Table 5: GP High Level Indicator with high numbers of outlier practices
Indicator Number of
Outlier
Practices
1 Emergency Cancer admissions per 100 population 13
2 Emergency Asthma admissions per 100 patients on disease register 10
3 Percentage of patients aged 25 -64 whose notes record a cervical
smear performed in last 5 years
9
4 Percentage of patients with diabetes in whom the last IFCC – HbA1c
is 64 mmol/ml
11
5 The percentage of patients with diabetes who have a record of
retinal screening in the previous 15 months
15
6 AF Prevalence ratio 10
7 Asthma Prevalence ratio 10
8 Diabetes Prevalence ratio 21
9 Overall experience of GP surgery 10
Source: www.primarycare.nhs.uk
The high prevalence of diabetes in Newham due to the ethnic makeup of the population means
the prevalence ratio outliers are to be expected.
Public Health Outcome Framework Indicators – details can be found in Appendix D
Wider determinants of health
Newham has high levels of deprivation and a high proportion of children in poverty and families
living in temporary accommodation. Hospital admissions for violence, and violent offences were
high and there were high numbers of first time entrants to the youth justice system. However,
there was less social isolation and less sickness absence than average for England.
Health improvement
33
Smoking prevalence in adults is 18.8% compared with England average of 20% and of over 4000
Newham residents annually who use smoking cessation services over half succeeded in giving up
smoking. Only 5.5% mothers are smokers at the time of their delivery compared with England
13.2%. Breast feeding is initiated by 88.7% mothers in Newham compared with 74% in England.
There were fewer births to Newham under 18s (teenage pregnancies) than would be expected
from national rates.
Fewer adults are physically active than in England as a whole and around 7% are recorded to
have diabetes compared with 5.8% nationally. High levels of obesity in 10 year old children
(39.8% overweight compared with 33.9% in England), if not tackled, will lead to earlier onset of
diabetes in middle age or earlier.
Uptake of NHS health checks is higher in Newham, but with large variations between practices,
and there is low uptake of cancer screening for breast and cervical cancer and for screening for
diabetic retinopathy.
Self-reported satisfaction score, worthwhile score and happiness score were lower and anxiety
was higher in Newham than in England. However the suicide rate was around average for
England.
Health protection
The child immunisation programme indicators show low uptake of all child vaccines, typically
under 90% which may be partly due to incomplete recording, but measles, mumps and rubella
(MMR) immunisation is even lower at under 80%. Influenza immunisation has average uptake in
over 65s and higher uptake for adults at risk. Coverage of pneumococcal vaccine in over 65s is
much lower than flu coverage in Newham whereas in England most over 65s have had both flu
and pneumococcal vaccination.
The programme to offer secondary school children HPV vaccine to prevent cervical cancer has
been successful with 91.2% uptake compared with 86.8% for England.
Newham has a high proportion of HIV being diagnosed at late stage suggesting a need for earlier
diagnosis through improved access to testing particularly for at risk groups.
Newham has highest incidence of tuberculosis in England but treatment completion is just
higher than the average for England.
34
Health care and premature mortality
Newham has high premature (before aged 75) death rates from cardiovascular disease. Some of
this is preventable through maintaining a healthy weight, taking exercise and not smoking. Early
intervention to control diabetes and raised blood pressure can lengthen lives and prevent heart
attacks and strokes. Diabetic eye disease contributes to higher rates of blindness which may be
preventable if identified and treated. Premature mortality from cancer was average but deaths
form respiratory disease and liver disease were higher than expected from national rates.
Emergency readmissions within 30 days were lower in Newham than in England but that may
reflect the younger population.
Finance
As noted above a legacy of NHS development is that the different types of contract for primary
care providers which makes it difficult to ensure financial resources are deployed evenly, on a
per-patient basis, within a defined geography. GMS contracts negotiated nationally and PMS
negotiated locally has led to significantly different levels of funding to practices. Most recent
data available is 2011/12
Average spend per weighted capita GMS contract in Newham = £115.30
Average spend per weighted capita GMS nationally = £122.19
Average spend per weighted capita PMS contract in Newham = £140.29
Average spend per weighted capita GMS contract nationally = £131.07
Appendix A is the list of CCG practices with type of contract and spend per patient.
IT – hardware, software and utilisation
Since April 2013 all practices in Newham are now using EMIS web, previously all were on older
versions of EMIS. There is an on-going rolling programme of training supporting the practices
during this implementation phase. The benefits to patient care of being able to share records
with OOH, the UCC and each other are acknowledged but there are still significant teething
problems for practices and a need to develop practices skills to use the power of the new
system.
All practices have similar computing hardware but expertise within practices is varied and
utilisation is not yet optimal.
35
Workforce
At this time we do not have up-to-date information on practice staffing and vacancies. A
baseline survey is in process. Below is the information available at this time.
We have significantly less than the average GPs/capita than the England and the London
average. We believe this is also the case for practice nurses and health care assistants. Once we
have the baseline we will be able to assess our shortfalls.
Graph 4: GP FTE’s per 100,000 unified weighted population, London PCT’s 2011
36
Graph 5: Increase/decrease in FTE GP’s per 100,000 patients 2006-2011
The table below showing patients per full time GP is based on practice numbers in November
2012 and data on GPs available to the PCT at that time. These are presented at the level of LBN
Community Forums. There are ten Community Forums covering the entire borough, and anyone
who lives or works in Newham is encouraged to get involved. The Forums have been set up to
enable local residents and stakeholders to agree priorities for their local areas and provide
feedback on the performance of the local area strategies. They also provide an opportunity for
the whole community to have their say, to get involved and to influence what happens in their
area. They are functional communities within the Borough and as such looking at service
distribution at this level makes sense.
37
Table 6: Full Time Equivalent (FTE) per capita 2012
Community Forum Population FTE GPs Patients/FTE GPs
Beckton 24,645 14 1,760
Customs House and
Canning Town
36,859 16 2,303
East Ham 31,873 16 1,992
Forest Gate 13,999 8 1,750
Green Street 89,458 42 2,130
Manor Park 73,120 42 1,740
Plaistow 34,653 20 1,732
Royal Docks 5,384 2 2,629
Stratford & West Ham 43,613 29 1,504
Grand Total 353,604 188 1,880
Table 7: Age and gender profile of GPs 2012
• 37% GPs over 60 yrs
• Gender balance GPs - 70% male, 30% female
• 38% single handed (cf. 15% Hackney)
38
Estates
A significant number of practices are in premises that have been developed from residential
housing and are limited in their capacity for further development to provide a wider range of
services with a number being barely fit for purpose for basic GMS/PMS service provision.
At present there are significant inconsistencies in condition, statutory compliance, space
utilisation, functional suitability, quality and accessibility across GP Estate in Newham. A 6 Facet
survey was last commissioned in 2005 by which provided detailed analysis of all the points
above but the information is too out of date to be the basis for a detailed implementable Estates
Strategy. Therefore the CCG will seek support from NHSE to undertake a new FACET survey
looking at the suitability of the GP Practice estate for the present population it serves and the 5-
10 year suitability based on projected local population growth and likely facility requirements for
provision of an increased range of services in the community.
5.2.2. Out of Hours (OOH)
We have 54 practices still opted in to provide 24/7 services with their out of hours service
(OOH) being provided by a not-for-profit GP Co-op. This service is also contracted by the CCG to
provide OOH services to those practices that have opted out of providing services 24/7. The GP
Co-op also provides extended hours and a group PPG for 26 practices at 10 sites across
Newham.
5.2.3. Other out of hospital providers
There is one main community provider, East London Foundation Trust (ELFT). The list of the
services they provide at present can be found in Appendix E
There are a small number of mainly GP owned other providers of services out in the
community:
Dr Sen
iHealth
Patient First
Dr Bhasi
Dr Nasralla
Dr Gopinathan
Dr Madipalli
St Joseph’s Hospice
39
BPAS
In Health Ltd
Hestia Housing and Support
Mind in Tower Hamlets and Newham
CYANA
Newham Forum for Health and Wellbeing
A number of these services are provided by GPs with a special interest (GPwSI) or hospital
consultants. The list of services they were providing in April 2013 can be found in Appendix F.
These are in the process of being reviewed and either decommissioned or re-commissioned using
the National Standard Contract.
There are 69 community pharmacists and 26 community opticians in the Borough whose main
contracts are held by NHs England.
The CCG holds three contracts with community pharmacists:
Anticoagulation LES;
Directly Observed Treatment Of TB Scheme with community pharmacists; and
Minor Ailments Service LES with local pharmacists.
The CCG holds one contract with the community opticians:
Direct Cataract Referral Scheme LES with opticians.
The strategy does not cover the development of these providers because their main contracts are
with NHSE. However it may be the case that in implementing this strategy the CCG will develop
new contracts with these among other potential local providers.
5.3. Activity and Finance
5.3.1. Activity
Our practices are achieving secondary care planned and unplanned activity levels very similar to
the rest of England and London and in some cases significantly lower than the average and
these results compare very well to those CCGs that serve similarly populations - Tower Hamlets,
City and Hackney and Brent.
Appendix G provides activity trends over the last 3 years and London and England comparative
data for 12/13 for:
A&E + UCC activity;
40
Planned and unscheduled admissions;
First Outpatient attendances;
Planned inpatient, day-case and outpatient procedures; and
Prescribing.
Table 8: Health Service Activity Trends
What Trend Compared to national rates
A&E + UCC 13/14 above 11/12 but probably below 12/13.
Approx. same as England and London average (same)
Unscheduled admissions
Basically flat. Possible slight downward trend.
Approx. England average and above London average
Outpatients 13/14 GP firsts below 12/13, about same as 11/12
Follow ups approx. 2.5 times firsts. Activity levels flat
GP firsts significantly below London average and slightly below England average
First to follow up ratio highest in London and well above both London and England averages
Planned procedures/ admissions
Inpatient and outpatient procedures flat with sudden doubling of OPD procedures since March 2012 now looks flat
IP+DC rates well below England and London averages – 6th lowest in London
Investigations Not enough information to comment
Prescribing Total prescribing budget increased by £3.8 million (11%) over 8 years giving an annual growth of 1.6%
Costs/1,000 well below England and London averages – 6th lowest in London
This activity data suggests that despite population growth and high levels of deprivation
Newham GP Practices/List-based providers are containing the increasing demand from the
population though it also may indicate that there are areas where there may be under activity
particularly in planned care and prescribing.
5.3.2. Finance
The Financial Picture
The bulk of primary care funding was disaggregated to NHSE Primary Care Commissioning as
part of the re-organisation of the NHS arising from 2012 Health and Social Care Act.
41
Spend in 2012/13 on Primary Care Commissioning is summarised as follows:
Table 9: 2012/13 Primary Care Spend
Description £’000
GP Contracts (GMS/PMS/APMS) 31,169
Primary Care Premises 4,073
QOF and Enhanced Services 8,646
Other development and support 4,692
Total GP Practice Support 48,580
Community Pharmacy 10,016
Community Dental 15,018
Community Ophthalmic services 3,679
Total 77,293
In addition prescribing costs totalled £37,524,107.
In Newham approximately £74.4million was transferred to NHSE for Primary Care as part of the
2012/13 disaggregation with balances for Walk in Centres (£565,000), Out of Hours Support
(£590,000) and Local Enhanced Services (£981,000) being retained within the CCG allocation in
13/14.
Other funding was disaggregated to the Local Authority and Public Health England.
The CCG no longer commissions the disaggregated element and is not funded to support
activities that should be provided as part of the core GMS/PMS/APMS contracts or
commissioned by any other Commissioner.
However, the CCG does currently budget for a number of primary care programmes as follows:
Table 10: Other 2012/13 Primary Care Spend
Programme £’000
42
GP Local Enhanced Schemes rolled over £1,130
Out of Hours £590
Walk In Centre £850
GP IT (Delegated from NHSE) £1,319
Total £3,889
In addition approximately £37,670,000 is held as a prescribing budget and £500,000 to support
the Community Pharmacy Minor Ailments Scheme giving a total budget of £42,059,000.
A number of contracts are held by consortia or companies in which Newham GPs are directors
and services are also provided by Newham GPs with Special Interests.
As part of the preparation for CCG Authorisation a number of practice remunerations schemes
totalling approximately £750,000 were undertaken in 2012/13. In 2013/14 the Board agreed
remuneration initiatives of a similar amount to support the introduction of the Integrated Care
initiative.
The Financial Challenge
Newham faces a significant financial challenge over the next three years, driven by rapid
population increase, low or zero increases in revenue allocation and the requirement to redress
unmet health need and unequal access to health provision in a deprived and transient
population.
43
Graph 6: Forward health service cost projections 13/14 – 16/17
The main financial pressures are:
Demographic Growth – with an anticipated additional 6,000 residents per year
coming into the Borough and significant growth in specific developments such as the
Olympic Park.
Low or zero increases in the revenue allocation – Under the new allocations formula
Newham is currently funded above target. The CCG is anticipating a 0.5% uplift in
2014/15 and 2016/17 and zero uplift in 2015/16.
Integrated Care – The implementation of integrated care to reduce the pressure of
the increasing demand on the acute sector will require additional investment from
the pooled Better Care Fund (identified from within current CCG resources) to
develop capacity for both NHS and Borough led provision.
As a result the CCG will be seeking to identify cumulative Quality, Innovation, Productivity and
Prevention (QIPP) savings totalling approximately £62 million or 9% of total revenue over the
period to ensure the necessary services and capacity to meet the additional demand can be
met.
The CCG currently splits it’s funding across the main sectors of health provision as shown in the
table below. This is compared to the proportional provision in two similar CCGs, Tower Hamlets
and Brent.
Present financing of out of hospital services as percentage of total commissioning spend
340,000,000
360,000,000
380,000,000
400,000,000
420,000,000
440,000,000
460,000,000
480,000,000
2013/14 2014/15 2015/16 2016/17
£'s
Newham CCG Summary - 'do nothing' costs against revenue
Anticipated Revenue Do Nothing Cost
44
Table 11: 12/13 Total health spend by sector
Type of spend Newham 12/13
%
GMS/PMS £50m 10%
Prescribing £38m 8%
Community Services £53m 11%
OTHER Out of Hospital £21m 4%
Continuing Care £9m 2.8%
TOTAL out of hospital £171m 36%
CCG Acute Spend £261m 55%
CCG Mental Health Services £46m 10%
Grand Total £478m 100%
As the CCG does not commission primary care contracted services directly detailed and
comparative data is not readily available. However, the anticipated spend by the NHSE primary
care teams for these services is approximately £75 million. To this can be added a further
allocations for specialised commissioning, services now commissioned by the local authority
and those commissioned by NHSE.
In total additional NHS services commissioned by authorities other than the CCG total
approximately £200m.
Integrate care and the plan to move care from secondary care to primary care settings are at
the centre of the CCG’s plans to live within the allocated budget.
5.4. The Outcomes
5.4.1. Health Outcomes
High levels of socioeconomic deprivation combined with unhealthy lifestyles are likely to have a
negative impact on local health outcomes. This section covers some of the key health outcome
indicators for Newham.
45
Life expectancy
Life expectancy describes the average number of years that people can expect to live; the graph
below demonstrates that life expectancy has been increasing in England, in London and in
Newham. Life expectancy gap between Newham and London/England has narrowed for women
however it has increased for men.
Female life expectancy in Newham is 81.1 years, one and a half years less than the England
average of 82.6 (2008-10). Male life expectancy in Newham is 76.2 years, nearly two and a half
years less than the England average of 78.6 years (2008-10).
Graph 7: Trend of life expectancy at birth for males and females in Newham, London and
England, 1991-1993 to 2008-2010
Source: The NHS Information Centre for health and social care
Gap in Average Life Expectancy in Newham
Men in Little Ilford have an average life expectancy of 71.6 years- this is 11.5 years less than
men in Green Street East, who have an average male life expectancy of 83.1. Women in Canning
Town North have an average life expectancy of 76.6 years, which is 13.5 years less than the
women within Royal Docks who have an average female life expectancy of 90.2 years.
The gap in life expectancy within Newham increased markedly between 2007-2009 and 2008-
10. The life expectancy gap for 2007-2009 was 10.2 years for men and 10.6 years for women.
46
Table 12: Life Expectancy Gap between Newham wards 2008-10 by Sex
Source: The NHS Information Centre for Health and Social Care
Mortality Rates
Overall the mortality rate in Newham for the total population is the highest in London and
significantly higher than the national average. The directly standardised rate (DSR) for men is
the highest in London, 749 per 100,000 in Newham (compared to 656 per 100,000 in England).
For women the DSR is the 2nd highest in London (533 per 100,000 compared to the London
average of 438).
Newham has the highest directly standardised rate in London for mortality from all causes
amenable to healthcare in ages under 75 (141 per 100,000 compared to a London average of
94).
However there is good news:
Over the 10 years 2001-2010 there has been a significant reduction in mortality
for both Newham and England
Mortality has fallen faster for both men and women in Newham than the average
for England thus reducing health inequalities (25% vs 21% drop for men and 15%
vs 13.6% for women)
In Newham early death (under 75) rates from cancer are now below the England
Average
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In Newham early death in now as likely to be from cardio-vascular disease as
cancer.
Graph 8: All age, all-cause mortality
Source: Newham Health Profile Published by NHS England on 24th September 2013
There is more detailed information on this in the Public Health Outcome Indicators in Appendix
D.
Infant Mortality
Infant mortality rate reflects the number of deaths under one year of age for every 1,000 live
births. The infant mortality rate in Newham in 2010 was 5.3 per 1,000 live births, compared
with the England average of 4.6 and the London average of 4.5.
Causes of Death (at all ages)
The main causes of death in Newham are cardiovascular disease, cancer and respiratory
disease.
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Graph 9: Causes of Death in Newham – Male and Female
Source: Office for National Statistics, 2011
Circulatory (cardiovascular) disease
Newham has the highest cardiovascular disease (CVD) mortality rate in the capital. The ratio of
observed prevalence of coronary heart disease in Newham (based on GP QOF disease registers
in 2010/11) to estimated prevalence in 2011 (based on modelling that takes into account the
age, gender and ethnic make-up of the population) is lower than the England average at 0.35,
compared with 0.5923. The ratio of observed (in 2010/11) to estimated prevalence of
hypertension (in 2011) is also lower than the England average, the ratio in Newham is 0.38
compared with 0.44 in England. This suggests that a large proportion of people with coronary
heart disease (CHD) and hypertension in the Newham population are not receiving appropriate
management in primary care. Emergency admission rates for CHD and stroke in Newham are
significantly higher than the national rate.
Graph 10: Early death rates from heart disease and stroke
Source: Newham Health Profile Published by NHS England on 24th September 2013
Cancers
49
Newham has the 5th highest Directly Standardised mortality rate for all cancers across London.
Recently published figures show that Newham has the second worst one-year survival rate for
cancer in England. The main factors affecting one-year survival are late presentation by the
patient and delayed referral by the GP.
Graph 11: Early death rates from cancer
Source: Newham Health Profile Published by NHS England on 24th September 2013
Respiratory disease
Newham has the 6th highest mortality from Chronic Obstructive Pulmonary Disease (COPD) in
London (a standardised mortality ratio of 139 compared to a London average of 97), which is
probably due to higher smoking rates in some population groups.
Tuberculosis (TB)
Newham has historically had highest TB rates in England, with rates of disease approximately 8
times higher than the national average and 3 times higher than the London average. Over 90%
of Newham residents notified with TB during 2011 were born outside the UK, with 50% having
arrived in the UK in the past 5 years. During 2011 TB notifications for Newham residents
increased by 77 cases to 381 representing an increase of 25% from the previous year and of
40% since 2006.
5.4.2. Newham CCG Outcome Framework 2013/14
NHSE will be using the framework below as part of the CCG Balanced Score Card to assess how
well the CCG is performing compared to national averaged.
50
Outliers of note:
Female potential years of life lost from causes amenable to health care is
significantly higher than the England average
Male potential years of life lost from causes amenable to health care is
significantly higher than the England average but not as bad as significantly high
as for females
Under 75 mortality from cardiovascular disease is significantly worse than
England
Portion of people feeling supported to manage their condition is significantly
worse than England
Patient experience of GP services (overall experience of GP surgery) is
significantly worse than England
Patient experience of Out of Hours services is significantly worse than England
Patient experience of inpatient care is significantly worse than England
Patient experience of outpatient services is significantly worse than England
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Table 13: Newham CCG 2013/14 Outcome Framework
Domain 1: Preventing people from dying prematurely Reporting period Current performance England average
Female potential years of life lost from causes amenable to health care 2012 2387 2061
Male potential years of life lost from causes amenable to health care 2012 2576 2232
Under 75 mortality from cardiovascular disease 2012 90.9 65.5
Under 75 mortality from respiratory disease 2012 37.6 27.4
Under 75 mortality from liver disease 2012 15.1 15.4
Under 75 mortality from cancer 2012 102.0 122.3
People with severe mental illness who have received a list of physical checks 2012/13 97.3% ?
Antenatal assessments < 13 weeks Q2 12/13 63.9% 90% national target, 86.2% England Average
Maternal smoking a delivery Q2 12/13 4.5% 12.7%
Breastfeeding prevalence at 6-8 weeks Q2 12/13 67.9% 46.8%
Domain 2: Enhancing quality of life for people living with long-term conditions Reporting period Current performance England average
Dementia diagnosis rates (prevalence – QOF data) Q4 2012 61.6% 46%
Proportion of people feeling supported to manage their condition Jan-Sept 2012 53.7% 68.5%
Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)
per 100,000 of population (indirectly standardised)
2012/2013 481.8 795.1
Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s per
100,000 of population (indirectly standardised)
2012/2013 218.4 326.2
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Domain 3: Helping people to recover from episodes of ill health or following
injury
Reporting period Current performance England average
Emergency admissions for acute conditions that should not usually require hospital
admission per 100,000 of population (indirectly standardised)
2012/13 482 1018
Emergency readmissions within 30 days of discharge from hospital 2010/2011 9.4 11.9
Patient Reported Outcomes Measures (PROMS) for elective procedures: i) Hip
Replacement, ii) Knee Replacement, iii) Groin Hernia, iv) Varicose veins
2011/2012 i) 0.41 ii) 0.218 iii) 0.090 iv) N/A
i) 0.411 ii) 0.299 iii) 0.087 iv) 0.094
Emergency admissions for children with lower respiratory tract infections per
100,000 of population (indirectly standardised)
2012/13 137.6 397.3
Domain 4: Ensuring that people have a positive experience of care Reporting period Current performance England average
Patient experience of GP services (overall experience of GP surgery) Jul 2012 – March 2013 78.3% 86.7%
Patient experience of Out of Hours services Jul 2012 – March 2013 63.1% 70.2%
Patient experience of inpatient care 2011/2012 70% 76%
Patient experience of outpatient services 2011/2012 73% 80%
Patient experience of community mental health services
Domain 5: Treating and caring for people in a safe environment and protecting them
from avoidable harm
Reporting period Current performance 2013/14 Plan
Incidence of healthcare associated infection: MRSA 10/2011 – 09/2012 2.69 0
Incidence of health care associated infection: C. difficile 04/12 – 03/13 9.7 10.4
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5.5. What our population says about their local health services
The local population has expressed its opinions about its health services through a variety of routes.
There are standardised NHS patient satisfaction surveys, there are local surveys and other forums
where the PCT and now the CCG have collected data and there is information collected by LBN in the
regular surveys it undertakes.
5.5.1. National NHS Surveys
Graph 12: Comparing CCGs for 17) Satisfaction (Quality) a-g
Graph 13: Comparing CCGs for 18) Satisfaction (Overall Care) a-b
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Graph 14: Comparing CCGs for 20) Patient Experience
Graph 15: Comparing CCGs for 21) Satisfaction (Access) a-c
These clearly indicate that the CCG and practices need to work with our population to improve these
national results.
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5.5.2. Local NHS Surveys
BMG Research was commissioned in January 2011 by Newham NHS to analyse and report upon the
results from the 2010/2011 “Newham Health Debate” conducted from November 26th 2010 through to
February 28th 2011. This is the third consecutive year in which this programme of research has been
conducted. The report presents the results of the 2010/2011 Health Debate, with comparisons made
against available results from previous years (2008 and 2009). Key variations in opinion among resident
groups are highlighted.
The Newham Health Debate survey was delivered as an insert in the Newham Mag to 105,400
households across the borough. To ensure a community based approach to the campaign, additional
surveys and posters encouraging residents to complete a survey were also distributed to all NHS health
centres in the borough, public sites managed by the London Borough of Newham including libraries,
leisure centres, local service centres, the Town Hall and to the 55 community centres across the
borough.
The survey was also hosted electronically on the NHS Newham website for the duration of the
campaign, which ran from 26th November 2010 to 28th February 2011. A total of 1137 paper surveys
and 350 online responses were received.
To ensure responses reflected the diverse makeup of Newham’s total population, the campaign also
incorporated a strong community engagement component. Over the period of the campaign, a series of
face to face presentations were delivered across many different community spaces including to young
people, BME groups and older people. A borough wide Health Fair was also held to further promote the
campaign’s objective to encourage dialogue.
Results relevant to this Strategy:
How Newham NHS can help to improve the health of its residents When asked how NHS Newham can help improve the health of its residents a broad range of responses were given, the most common of which were: Promote / encourage exercise / healthy living (e.g. walking, swimming) (19%); Educate the public / promote health events / provide information e.g. health, exercise (14%); and, Promote / encourage healthy eating (12%). How Newham NHS can improve health services for its residents The most common suggestions respondents made regarding how health services in Newham could be improved were: Improve access generally (i.e. waiting times, extended hours) (24%); Employ more staff / medical staff (6%); Improve customer service (inc. better staff training) (5%); and, Information / advice / advertise on services available (5%).
More detailed responses can be found in Appendix H.
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In August 2013 Newham Community Reference Group met and was asked to address 3 questions:
1. Would you agree that the Action Plan areas from the annual DES survey would improve
primary care or are there any other issues that we should also consider?
2. Given the range of services available how can commissioners promote use of these as an
alternative to A&E?
3. People between 20 – 29 (22.4%) are more likely to use A & E, what are your ideas on
how we might change this?
The detailed feedback can be found in Appendix I. But in general the DES Annual Feedback Survey
results were supported. In the DES survey patients identified key actions to improve satisfaction with
the surgeries was to:
• Provide more information about extended hours and other services
• Keep patients informed about progress to changes at the surgery
• Provide an alternative for on-line booking and repeat prescriptions
• Liaise more with pharmacies with regard to blood testing, repeat prescriptions and
minor ailments
• Keep patients informed about waiting times and if possibly say why they are running late
• Text appointment reminders to all patients
Graph 16: Access DES Annual Feedback Survey Results
5.5.3. LBN Surveys
A number of surveys are undertaken regularly by LBN. Below are key points on methodology and
results. Details can be found in Appendix J.
68% 50%
27% 9% 14% 9%
0%20%40%60%80%
57
LBN Liveability Survey 2011
Methodology
• Face to face, household (CAPI) in August – October 2011
• Random probability sampling, using sampling points (10 interviews per point)
• Targets set by total sample, CFA and ward (with +/-5% tolerance level)
• Targets by age, gender, economic status and ethnicity within ward
• Boost in regeneration areas
• 3,992 interviews completed in total. +/-1.6% confidence on an observed statistic of 50%
Results
Graph 17: LBN Liveability Survey 2011 Results: Trust – GPs come out on top
58
Graph 18: LBN Liveability Survey 2011 Results: Satisfaction with doctors and pharmacists is high
Graph 19: LBN Liveability Survey 2011 Results: Since 2010 satisfaction with health services has
improved
LBN Annual Residents Survey
Methodology
• 1,258 adults & 251 young people interviewed in home and on the door step using CAPI
• Fieldwork conducted from 30th October – 30th November 2012
• Random location sampling with quotas on age, gender, ethnicity, tenure & working status
59
Graph 20: LBN Annual Residents Survey 2012: Results
Graph 21: LBN Annual Residents Survey 2012: Q18. What is your opinion of...?
60
Newham residents are predominantly more positive about Council services than Londoners as a
whole (including health services)
Table 14: LBN Annual Residents Survey 2012 Results compared with London Averages
Graph 22: LBN Annual Residents Survey 2012 Q60. I would like to ask you about services in this area.
What is your opinion of…? Respondents 12-17 years old
5.5.4. The population’s local service development priorities
A meeting was held with local PPG members and members of Health Watch and a number of other
third sector organisations to discuss access, quality and continuity of care as these are the three areas
61
that have been highlighted by previous surveys of local priorities. The group prioritised the 7 outcome
indicators below.
Table 15: Local Priorities for the Outcomes from implementation of this Strategy
Access
1 % of Newham practice population able to speak with a GP by phone within 4 hours 5 days a week
2 % of Newham practice population able to see a doctor or nurse (as requested) within 48 hours
3 % of Newham practice population able to book an appointment 5 days in advance with a doctor of their choice
Quality
4 Proportion of people feeling supported to manage their condition (CCG Outcome Framework measure)
5 The number of practices (without a valid non- clinical quality reason) with Trigger Points 1 and 2 against the GP High Level Indicators
6 a) Increased the percentage of those who die who are on the Palliative Care Register – i.e. we will be recognising those that are likely to die in the next 12 months and have actively supported them and their family and carers through the process
b) Increased percentage of those on Palliative Care Register who die where they wish to die
7 Increased number of referrals made by General Practices to alternative(non-NHS) support services
6. High Quality Primary Care Providers
6.1. Primary Medical Services (PMS, GMS, APMS)
As the CCG does not hold these contracts there is no formal contracting management role for the CCG
however these practices are our Members and they are our Members by virtue of holding a GMS, PMS
or APMS contract. The CCG has a role to support our Members. One of the key aims of the CCG is to
reduce any validated (real) quality variation. Also, as the CCG will be holding contracts with these
providers for Extended Primary Care Services, improvements in the core services will increase the
quality of these providers. Hence the CCG is committed to supporting practices to transform their core
services and achieve best practice in the management of their patients particularly with respect to
those with long term conditions.
Although during 12/13 there was review and re-negotiation of the PMS contract in Newham there
remains a significant discrepancy in spend per head across PMS practices. Recognising the reasons for
these contract differences, the CCG wishes to develop an environment of transparency and support the
movement over three years to standardising PMS contracts at £97.50 per patient and to ensure that all
62
patients have the same access to services whether they are registered with a PMS, GMS or APMS
service. At present the average spend per patient in a GMS practice is £25 less than a PMS practice. The
CCG will seek to recognise, and where necessary correct, the disparity in service provision to patients
with equal need and will work closely with NHSE on how this should be funded.
NHSE and LBN have equal interest in the capacity, capability and quality of these providers and the CCG
will work closely to ensure that the supports provided to practices are coordinated and do not put
unacceptable levels of stress on our Members.
6.2. Extended Primary Care Providers – practices, clusters, networks and federations
There will be legally enforceable contracts between the CCG as the commissioner and these providers.
The service specification will clearly define the quality and activity requirements of the contract.
Performance against these will be monitored by the contracting team and actions taken as defined in
the contract if the provider is failing to provide the agreed service in terms of quality and or quantity
see Section 9 below.
There are two possible kinds of list based providers of Extended Primary Care Services: GP Practices or
groupings of GP Practices into clusters, networks or federations. In this document clusters, networks or
federations will all be referred to as Groups of General Practices/List-based providers. There is much on-
going debate as to what is the ideal model for these groupings of practices and national and local
evidence is lacking as to which structure works best. It is probably true that we will never have a clear
evidence base for what is “best” and “best” is likely to be different in different situation.
GP Practices/List-based providers themselves come in a number of forms and with great variation in size
with the smallest in Newham having 1,609 patients and the largest 16,213 with the average practice
having 5,589 patients. What is clear is that the pressure on practices is ever increasing and that small
practices will have much greater difficulty providing long opening hours such as the suggested 8-8 7
days a week even if in all other respects they are providing a very high quality service to their patients.
Likewise the Extended Primary Care Services that the CCG is intending to purchase from GP
Practice/List-based provider or Groups of GP Practices/List-based providers will require specific training
and expertise of the practice staff and again a small practice will have more difficulty in meeting these
prerequisites across a large number of service specifications.
Therefore the CCG will support practices to work together to share capacity, specialist skills and
facilities to ensure all services are universally available to patients on every practice’s list. However the
CCG does not believe that there is one right way for this sharing to happen. We believe that there are
flexibilities within the Standard National Contract that will allow us to purchase all Extended Primary
Care Services from all GP Practices/List-based providers with some or all of these practices agreeing to
sub-contract activity to other local practices within a network of their choice so long as the CCG is able
63
to audit the sub-contract and assure ourselves that the sub-contractor has the necessary skills. See
Section 9.3 below for more details of how this will work.
The CCG plans to have a Quarterly Quality Review meeting with each Cluster as a cluster of providers,
we will also be supporting the development of clusters as commissioners (see Section 8 below) and we
will incentivise clusters to achieve particular priority quality and activity metrics. This will tend to
support practices within clusters to sub-contract Extended Primary Care Services to practices within
their geographic cluster but this will not be a necessity if a practice is part of an alternative network.
6.3. The support the CCG will provide to General Practices and Groups of General
Practices
The CCG has in place a Cluster Support Team that has supported the Clusters to develop a 13/14 Cluster
Work Plan that includes joint working to support PMS/GMS/APMS contract requirements such as QOF,
QP and flu vaccination coverage.
The Cluster Work Plans include demand management work that is required to support the Cluster as
Commissioners. As noted in Section 8 below the CCG will work with the Clusters to develop their role as
commissioners and the Cluster Support Team will increasingly be focussed on this work but will
continue to facilitate Clusters in their provider roles and through practice visits will assist the practices
as providers to transform the way they provide core services as agreed by the cluster and to develop
their capacity to sub-contract to each other and other local providers. The CCG will consider providing
non-recurrent financial assistance to practices and clusters to facilitate the adoption of new ways of
working within the core contract and to develop their sub-contract development and management
skills. The CCG will work closely with NHSE and LBN to ensure that this is not complementary to their
priorities for transformation.
As noted on pages 31 and 32, NHSE has identified a range of General Practice High Level Outcome
Indicators (Appendix C) which measure how well a practice is performing compared to all other
practices in England. Being an outlier is not always a negative and the CCG considers there are 4 that
cannot be seen as negative – Diabetes Prevalence Ratio (high), Anti-depressants ADQ/Star PU (low),
Antibacterial Items/Star PU (low) and NSAIDs Ibuprofen & Naproxen % Items (high). When these are
removed from the list of practices in Newham with 5 or more outliers the CCG has 7 practices with 5 or
more outliers.
A further indicator on Retinal Screening is being targeted by an extension of the present ELFT service
and we expect this to ensure that all practices are meeting the national norm. If this occurs there will
only be 4 practices with 5 or more outliers and these have a collective population of 25,645 patients (7%
of our population).
64
One of the aims of this strategy is to reduce the number of practice outliers against the indicators that
have no clinically valid reason for being outliers. The CCG staff will work with each practice to decide
which outliers have clinically valid explanations and to develop strategies to reduce those without valid
explanation.
More generally there are 3 key enablers for improvements in the quantity and quality of services
provided by General Practices. These are:
IT Infrastructure and capabilities;
Workforce Development; and
Estates
Each is covered in more detail in Section 6 below.
In addition the CCG will:
Provide regular and timely, cluster reports of activity and performance data:
o that use high quality validated data streams with 100% GP identifiers (no attribution of
activity to a practice without );
o which provide where possible national and local statistically valid comparisons (i.e. that
recognise age and sex differences and when available deprivation and ethnicity
differences in prevalences and behaviours – this is often done by comparing with CCGs
with similar ethnicity and or deprivation profiles);
o that are easy to interpret; and
o whose key messages in terms of variation between practices, clusters and CCGs is of
statistical significance.
Support regular cluster meetings to:
o discuss the above reports and agree what can be done to reduce any validated
significant negative variations in the quality of service provision
o these same reports can be used from a commissioner perspective to manage contracts
and to allow the clusters to monitor implementation of agreed new pathways or to
prioritise commissioning of new services etc.
Provide prescribing support including regular pharmacist visits to the practice and regular
practice specific reports with recommendations on areas for quality improvement and
assistance to implement changes. Also we will continue to provide Script switch to facilitate
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change in practice and will work with the clusters to develop a rolling programme of work
using this resource
Provide briefings including recommendations to the Practice Council or clusters on new NICE
Guidance and the consequences for practices as service providers if these are to be
implemented
Provide support to practice to ensure they are meeting their responsibilities for both Child
and Adult Safeguarding.
Provide support to practices and the cluster to develop sub-contracting processes including
suitable legally binding contracts and contract performance management tools.
6.4. Non-General Practice/List-based provider extended primary care providers
(including specialist outreach services)
As with General Practices there will be legally enforceable contracts between the CCG as the
commissioner and these providers. The service specification will clearly define the quality and activity
requirements of the contract. Performance against these will be monitored by the contracting team and
actions taken as defined in the contract if the provider is failing to provide the agreed service in terms of
quality and or quantity see Section 9 below.
Possible providers would be:
pharmacists
opticians
the local acute
the community provider
third sector organisations
networks/federations of providers
others
The 3 key enablers (IT infrastructure and capabilities; Workforce Development and Estates) will be
relevant to these alternative providers. As stated in Section 9 of this document:
All service specifications within these contracts will include a clear statement of the staff
qualifications and equipment and facilities required to provide a service. Providers will have
to provide evidence that they meet these requirements to be able to tender and claim
against a service specification or make a case for why an alternative approach will provide an
equally good or better service to the patient.
66
During at least the first 3 years of this strategy the business cases for new extended primary
care services will include the training budget required to up-skill present staff. New providers
will have access to this training budget as will the present providers. During the contracting
process it will be agreed if the training budget will be held on behalf of the provider or the
provider will receive the budget and organise the necessary up-skilling. As the Newham
Education and Training Academy (see Section 6 above) develops and becomes independent
from the CCG the need for this financial support for training should be reduced as extended
primary care providers develop their capacity to up skill staff to meet new service
specification requirements without external support.
The payment structure and local tariff will be developed based on actual local cost to provide
the service and will always include a clear element for the full cost of the facilities (facilities +
soft and hard facility maintenance (FM)) and administrative support staff.
These alternative providers may therefore take full responsibility for all IT, workforce and estates issues
or these may be supported by the CCG as for General Practices. This would be negotiated at the time of
agreeing the final terms of a contract.
7. Enablers
7.1. IT infrastructure and capabilities
Newham practices have been at the forefront of practice IT systems development and the development
of the wider IT environment. This has been led by an IT Committee which developed an IT
Commissioning Vision and Strategy for Newham 2013 – 2018 under the PCT. This committee continues
to meet and is now established as the IM&T Committee reporting to the Primary Care Strategy
Transformation Programme. The draft Terms of Reference of this Committee are attached as Appendix
K The purpose of the committee is to ensure that a coordinated approach to IM&T strategy,
commissioning and procurement is developed across the CCG and in conjunction with relevant provider
organisations with the aim of enhancing patient care via seamless integrated and/or compatible IT
systems. The Committee also has a responsibility for supporting and promoting IM&T as an enabler for
primary care development.
All Newham Practices are now on EMIS web as is the newly commissioned UCC and OOH provider. ELFT
CHN is in the process of adopting this patient record system as is the Diabetic Out Patient Department
at Barts. The CCG’s main IT priority is to continue to support all primary care and out of hospital health
service providers to effectively use fully compatible health records systems that will allow all providers
to share all relevant live records with the patient’s explicit consent. Within the life of this strategy the
intention is to ensure that this ability to share electronic records will include key parts of our local acute
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provider (those who share the care of those with long term conditions), London Ambulance Service and
relevant LBN staff subject to patient consultation.
The committee has responsibility for:
1. Developing and implementing an IM&T strategy and work plan for Newham that is in synergy
with our main local providers and supports reducing health inequalities and improving patient
access
2. Managing by way of devolved responsibility the Newham CCG annual ICT budget and assessing
and agreeing IT spending priorities in-year. *The Governance and Risk Manager shall be the
NCCG budget holder for the non-core element of the Primary Care ICT budget
3. Working in partnership with other NCCG Commissioning Committees, Transformation
Programmes and other partners as required to support relevant IM&T developments and
priorities pertinent to the work of the committees
4. Supporting equity of IM&T development, infrastructure and training within primary care
5. Acting as the primary forum for discussion and communication between Newham CCG and the
NELIE project team regarding future strategic developments for the NELIE system from a
Newham perspective.
6. Supporting improved patient access by using IT to provide online access to patient care records,
appointments and repeat prescription ordering
7. Supporting national programmes of working towards a paperless NHS
The CCG at present has a delegated IT budget from NHSE to support practice IT systems. This is topped
up with CCG funds. This model works well as this ensures no duplication of effort between the CCG and
NHSE. However this will only be the case if NHSE continues to fund the IT infrastructure and training at
an adequate level.
7.2. Workforce Development
NHS Workforce planning and development has a difficult job ensuring the right clinicians with the right
skills are available in the right quantity in the right place as there is a long lag time between starting
training and having a fully qualified clinician. As highlighted in Section 4 of this strategy it is likely that
Newham is short of all types of health care professionals. It is not entirely clear why this is the case but
this is likely to be partly because of the heavy workload and the lack of high quality premises which
means that staff do not experience working in Newham in a positive way. For specific professional
groups the issues will be different.
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We are in the process of undertaking a baseline survey of all practice staff including age, plans for
retirement and present vacancies. Once this baseline is established it will be necessary to collect further
data on the issues for particular professional groups so the CCG can develop a package to attract
individuals to come to work in Newham and to stay beyond the initial contract period.
There are a number of NHS bodies that have responsibilities and resources for on-going professional
development as well as the initial training of different health cadre and the CCG is already supporting a
variety of educational activities for a range of workers and in particular employ a full time practice nurse
to provide training to practice nurses.
The CCG is supporting the development of Newham Education and Training Academy (NETA) as the
body that will understand our workforce needs and support on-going professional development with a
focus on accrediting training for Extended Primary Care Services and developing programmes to attract
and retain all health professions in Newham. NETA is established as a Working Group of the Primary
Care Strategy Transformation Programme and its draft Terms of Reference are attached as Appendix L.
The committee has responsibility for:
1. Developing and implementing multi-professional workforce planning, education and training
strategy for Newham CCG
2. Support clinical leads and cluster leads and other primary shapers in spreading good practice
3. Running an accreditation scheme to accredit educational events, particularly small group and
practice based work to develop good educational practice
4. Support professional appraisal
5. Oversee Friday educational events
6. To develop a portfolio of educational events and partner providers
7. To support GP VTS as the GP School changes
8. To work with practices and clusters to create a working environment that encourages trainees
(GPs, nurses and other staff groups) to stay in Newham after their training is completed and to
attract qualified professionals to Newham
9. Support the development of research capacity within Primary Care in Newham.
At present there is no formal educational budget within the CCG. Resources are found from a number of
different places. Working is on-going to see if this can be brought together in one budget that will be
managed by NETA. All new Extended Primary Care Services commissioned by the CCG will include a staff
development budget which will either be retained by NETA who will provide the necessary training on
behalf of the provider or the budget will be allocated to the provider to undertake the necessary
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training. Much of NETAs work will be coordinating and facilitating access to training funded by other
NHS bodies such as the LET B. NETA will work with NHSE and LBN to ensure that training they require is
also covered by its programme of work.
Ultimately the development of the workforce is the responsibility of each provider but the CCG believes
that in collaboration with NHSE and LBN it has a significant role to play, particularly in the next few
years, to support the development of Primary Care providers that have high quality HR policies and
practice and particularly with a focus on the on-going professional development and professional
support for the development of all employees from admin to practice managers, HCAs, practice nurses,
nursing and allied professionals through to GPs.
In 5 years’ time we would expect the Primary Care providers to be purchasing this kind of workforce
development support rather than receiving it from the CCG, NHS and LBN.
7.3. Estates
NHS England is responsible for commissioning GP premises and have recently released a short
document “Commissioning GP Premises” which can be found in Appendix M. NHS England as a national
body is expected to work from national single operating models (SOM) and therefore is in the process of
developing an SOM for GP premises arrangements. A suite of documents have been developed by
Primary Care Premises Expert Advisory group to support Area Teams with decisions. These are currently
in the final stages of development and will hopefully be available from late 2013 alongside an NHSE
Premises Policy. In the absence of the completion of the national SOM London Region of NHSE has set
in place a standardised interim process. This process clearly states that the CCG will be asked for a view
as to whether it supports a proposed development at both the Project Initiation Document and business
case stages and there are some criteria that will be used until the national prioritisation matrix is
released. It is likely that the new national process will not be very different from the interim process.
Newham is one of the largest regeneration areas in Europe and there are opportunities within this to
house new state-of-the-art healthcare facilities particularly in the Docks and Canning Town
developments and at the Olympic legacy site in Stratford.
With the growing population of Newham and the CCG vision of bringing increasing numbers of services
out of the hospital setting there is a need to ensure that the estate has the capability to meet the
increasing demand.
Aside from the scale of change, there is a risk of Newham generating a two-tier health system within
the borough. If new General Practices are to be commissioned for the new populations there will be an
increase in high quality estate in the regeneration areas while the population in the centre of Newham
continues to receive services provided in old estate. When developing and implementing the Estates
Strategy we must maintain a balance between the centre of Newham and outer areas of regeneration.
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To assist potential providers of Extended Primary Care Services to develop facilities to provide these
services the price of all Extended Primary Care Services will have a clearly identified component to pay
for the facilities (space, equipment and hard and soft FM) required to provide the service and the CCG
will work with NHSE on how this should be paid if the service uses space that is already paid for by the
GMS/PMS contract or are within other premises already owned and paid for within other NHS
contracts.
To develop a comprehensive Health Estates Strategy for Newham we will need to engage with all health
partners with estate interests across Newham, to include NHSE, Barts Health, East London Foundation
Trust, NHS Property Services, Community Health Partnerships and LBN. With a joint working approach
we can identify fit for purpose vacant estate which will assist in ensuring health estate as a whole is
effectively managed and utilised. This will also highlight where investment would be needed and/or
disposal of assets that are no longer fit for purpose.
At present there are significant inconsistencies to condition, statutory compliance, space utilisation,
functional suitability, quality and accessibility across GP Estate in Newham and there are other NHS and
Borough Estate that is not fully utilised. Our Strategy will seek the most cost effective utilisation of all
existing estate as long as this does not compromise quality and accessibility.
A 6 Facet survey was last commissioned in 2005 by Oakleaf which provided detailed analysis of all the
points above but the information is too out of date to be the basis for a detailed implementable Estates
Strategy. Therefore the CCG will seek support from NHSE to undertake a new FACET survey looking at
the suitability of the GP Practice estate for the present population it serves and the 5-10 year suitability
based on projected local population growth and likely facility requirements for provision of an increased
range of services in the community. The focus will be on ensuring that geographic access is equally good
across all of Newham so the survey will include mapping of practice populations and populations within
5, 10 and 15 minute isochrones (a line on a map or diagram connecting places from which it takes the
same time to travel to a certain point).
When this survey is completed we will establish an Estates Working Group that will be used to develop
and implement, with our partners, a detailed Estate Strategy to prioritise estates improvements and
new developments. The CCG recognises that premises for provision of the GP core contract are
ultimately the responsibility of NHSE and in this context the role of the CCG is to facilitate our practices’
engagement with all relevant stakeholders including NHSE and LBN to ensure the necessary local
premises are developed in a timely fashion.
When considering applications for GMS/PMS estates development
The CCG will support applications to NHSE initially for any practices that in some way “fail” the FACET
survey and then the rest but always prioritising those with a lower FACET score over higher. We will
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only support significant practice estates development if the practice or practices jointly serve a
population of 8,000 patients or more or based on the catchment (isochrones to 10 minutes and
population growth in this zone) is likely to serve at least this population by 2018 and there is no suitable
health estate that does not increase the average journey time for the practice population by more than
5 minutes.
Guiding principles when considering estates developments which will include significant provision of
space for Extended Primary Care Services
The CCG will:
1) Support such estates developments where there is a minimum population of 20,000 within the
10 minutes isochrone.
2) Support a dispersed network able to provide similar levels of Extended Primary Care Services
across the whole of Newham
3) Seek to use the most cost effective type of estate development (work is required to ascertain
what route is most cost effective – LIFT is seen as an expensive option but when all the real costs
of estate development and maintenance is included it is not clear whether NHS Property
Services estate, acute hospital, community provider or privately owned estate is the most cost
effective over the life time of the estate’s use for heath service prevision).
8. Treating People in the Community
Implementation of this strategy will ensure the building blocks are in place to allow the provision of high
quality accessible primary medical services, extended primary care and secondary care provided in a
primary care setting. The sections below give an idea of the kind of services that we expect to be
providing outside the hospital setting by 2018. The building blocks (physical infrastructure, provider
organisations and commissioning and provider skills and expertise) will take time to develop and the
movement of services from their present setting into new provider organisations or at least
commissioned by the CCG using new contracting options will be progressive. No big bang is planned.
The CCG will encourage and support natural growth of the types of providers we believe are needed.
Services may be provided by:
individual General Practices/List-based providers
Groups of General Practices/List-based providers
a Grouping of all General Practices/List-based providers in Newham
pharmacists
opticians
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the local acute
the community provider
third sector organisations
networks/federations of providers
others
Appendix F: Contracting and Procurement Work Plan for 2013/14, Appendix E: ELFT Community Health
Services and Appendix N: Information provided to Newham CCG on Local Enhanced Services (LES) in
January 2013 + update for 14/15 and Appendix O: List of Outreach Services presently contract by
Newham CCG from Barts Health in addition to the 32 PMS, 26 GMS and 3 APMS contracts constitute the
present range of service being provided outside the hospital setting.
Clearly Newham already has an extensive range of services helping our population to stay out of
hospital and a number of strategies to transform the sector, in particular our Urgent Care Strategy and
our Integrated Care Strategy both of which are supported by CCG Transformation Programmes that
report to the CCG board. The Primary Health Care Strategy therefore supports the implementation of
these Strategies with a focus on the Primary Care developments required to support system
transformation.
8.1. Self-care
Our Vision for Self-Care is an empowered population equipped with the knowledge and motivation to
self-care. A population with greater confidence to look after themselves: knowing when it’s safe to self-
care, when professional help is needed and where is should be sought.
Self-care includes: primal, primary, secondary and tertiary prevention; management of minor illness and
injury; and self-care following discharge from hospital.
2014-18 the CCG will support practices to become Self Care Aware practices and develop and
implement a joint Self-care Strategy with LBN Public Health. Implementation will be phased over the 5
years with the focus being on having a balanced and coordinated portfolio of self-care interventions
across the CCG and LBN.
Success of the Self-care Strategy will be monitored through improvements in a set of Outcome
Framework measures, a decrease in health inequalities and a decrease in the growth of NELs for LTCs,
A&E and UCC activity.
8.2. Primary Medical Services
Access to a full range of standard primary medical services 8am to 8 pm 7 days a week through a
combination of GP practice, Extended Hours and Out of Hours Services provision with full access to a
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patient’s notes irrespective of how or where access occurs. This will include development of a range of
non-face-to-face consultations (including emails) and telephone triage of the majority of appointment
requests.
The intention is to ensure that a full range of services is available to all patients irrespective of whether
they are registered with a PMS, GMS or APMS practice. This will require close working with NHSE on the
best way to achieve this in contractual terms but will probably involve the development of Extended
Primary Care Service Specifications for the GMS practices for those additional services that PMS
practices are funded to provide. The GMS practices could provide these services themselves or could
sub-contract the extended services through other local practices.
8.3. Extended Primary Care Services
During 2014-18 we will develop business cases and seek to fund extended primary care services that:
Enable GPs to consult hospital consultants using emails/texts/phone/advice and
guidance/Skype with or without the patient present
Support an individual to be treated at home or in a nursing home when previously they
would have been treated in a hospital. This may include increasing rapid access to
investigations to avoid the admission. This will include provision of IVs in the community –
antibiotics and possibly chemo therapy.
Increase the palliative care services available to those who wish to die at home
Provide rapid access to a named clinician for those with complex health and social care
needs
Optimise the health and social care of people with the following long term conditions:
o diabetes (already well developed but further development of the service
specification will be required),
o CVD (AF diagnosis and warfarinisation, hypertension, heart failure and stroke,
cardiac rehab following MI)
o COPD
Optimise the health and social care of the frail elderly.
8.4. Secondary (specialist) care to be provided in a primary care setting
There are already significant on-going development in this area using both consultants and GPwSI and
other clinicians with a special interest. Appendix E Contracting and Procurement Work Plan 13/14 has a
list of those provided outside the main contracts a number of which are in the process of being re-
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tendered. Appendix E: ELFT Community Health Services is the full list of services provided by CHN a
number of which are provided by specialist clinicians and Appendix O: List of Outreach Services
presently contract by Newham CCG from Barts Health. These together show the range of specialist
services at present provided in the community.
There is a need to review the present services as there is some level of duplication of services
provided by the hospital and the community provider. A single pathway with the fewest possible
interfaces between providers will be commissioned for each long -term condition.
The priorities for 2014-18 will be:
Outreach of elderly care specialist services in the primary care setting including a patient’s
home and local nursing homes
Outreach of cardiology specialist services in the primary care setting including a patient’s
home and local nursing homes (this is already in place for diabetes)
Outreach of respiratory specialist services in the primary care setting including a patient’s
home and local nursing homes
9. Development of Clusters as Commissioners
Clinical commissioning groups are established under the Health and Social Care Act 2012 (“the 2012
Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of
the health service in England and are treated as NHS bodies for the purposes of the National Health
Service Act 2006 (“the 2006 Act”). The duties of clinical commissioning groups to commission certain
health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and
the regulations made under that provision.
Clinical commissioning groups are clinically led membership organisations made up of general practices.
The members of the clinical commissioning group are responsible for determining the governing
arrangements for their organisations, which they are required to set out in a constitution.
To be a member the organisation must hold a GMS, PMS or APMS contract with NHS England.
Paragraph 3.3.3 of the Newham CCG Constitution states:
Practice Clusters
The practice clusters will meet to review success, to learn, and to problem solve. They will develop
local shared service solutions and over time, these are anticipated to be formalised into cluster based
“contracts” with the CCG for the delivery of specific services. Cluster meetings are an important
element of the CCG governance structure as practices act as the “powerhouse” to generate solutions
to improve patient care and health outcomes. Local intelligence is communicated to inform wider
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commissioning intentions within the commissioning cycle. They collectively assess the local quality of
care achievement against CCG standards and best practice.
Since the Newham Constitution was signed by all Newham GP Practices in December 2012 the CCG
has come into legal existence and much has changed. In particular the new organisational structure
has changed significantly and the constitution has been updated. 11 geographically based clusters of
GP Practices of roughly equal population size have a GP representing them on the CCG Board. In
addition 8 of these clusters have identified Cluster Leads as a mechanism to develop future leaders
and to spread the CCG work load. The 11 clusters have begun to group together and there are 7
active clusters where all practices in all 11 clusters are represented.
The 7 clusters are:
Cluster Population
1 Central 1 & 2 68,364 (27,019 + 41,345)
2 South 1 & 2 54,440 (32,649 + 21,791)
3 Central 3 and South 3 66,651 (43,571 + 23,080)
4 North West 1 51,072
5 North West 2 47,623
6 North East 1 30,624
7 North East 2 & 3 56,427 (29,324 + 27,103)
Clusters have now been meeting regularly for more than a year and have developed 13/14 Work Plans
and are in the process of implementing this plan. At present their role as a group of primary care
providers and as commissioners are not clearly separated and much of their work has been on
improving their performance as providers and to start to work together as a geographically based group
of providers. Section 4 above addresses the issues of developing the GP Practices/List-based providers
and others as extended primary care providers in Newham. Appendix P provides the details of cluster
practice membership and representation.
Clusters as commissioners need to understand and be involved with all commissioning functions of the
CCG if they are, as stated in the constitution, to be the power house to generate solutions. Over time
they need to develop an understanding of and involvement with:
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NHS budgeting and financial cycle including risk management
Agreeing the budget allocation methodology and how risk will be managed between
practices and between clusters
Monitoring of activity and spend against plan by contract and responding as required to
ensure the CCG and cluster live within budget
Using all the clauses of the National Standard Contract to full effect to increase the quality
and cost effectiveness of all CCG held contracts and thus reduce risk
The commissioning/contracting cycle
o Commissioning Strategic Planning (CSP)
o Commissioning Intentions
o Scoping papers and full business cases
o Service Development and Improvement Plans (SDIPs)
o Key performance Indicators (KPIs); and
o Commissioning for Quality and Innovation (CQUINs) for the main contracts and for
GP Practices/List-based providers as extended primary care providers
o Development of the Local Incentive Scheme and other schedules of the National
Standard Contract for Extended Primary Care Services contracts Contract
management processes
The development of the Plan on a Page ,QIPP Plan, Quality Premium, Annual Operating Plan
etc. as required by NHSE.
As the clusters develop their understanding and capacity they will increasingly be involved in the
decision making processes of the CCG. The CCG will invest in the development of the skills necessary in
both its GP member practices and the CCG support staff to allow a maximum of 8 clusters to hold and
commission with a full delegated budget. During 2014/15 the clusters will work with indicative budgets
and during the year agree what level of delegation of budget to the clusters will benefit the population
of Newham the most and thereafter will review the level of delegation annually throughout the life of
this strategy.
The CCG has established a Cluster Development Working Group that will report to the Primary Care
Strategy Transformation Programme. The Draft Terms of Reference for this group is attached as
Appendix Q. The initial work will be to review the Terms of Reference for the Clusters, Cluster Leads
Meeting and the job descriptions of the Cluster Leads and the Cluster Leads meeting Chair. These will be
taken the CCG Board for discussion, approval and thus inclusion in the Constitution. The Working group
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will then develop and oversee the implementation of a Cluster development programme to ensure that
the Clusters are capable of managing a shadow budget from April 2014 and a fully delegated budget by
April 2015.
The staffing support required by the clusters to support them to fulfil their approved Terms of
Reference will be assessed and agreed by the CCG Executive.
The staffing support required by the clusters to support them to fulfil their approved Terms of
Reference will be assessed and agreed by the CCG Executive.
10. Procurement and contract management
10.1. Newham CCG Procurement Strategy and Policy
As noted above to keep more people out of hospital we will need to procure new services and/or need
to transform present service provision. This will require the transformation of our present local
providers so that they are capable of providing the new services and when necessary attracting new
providers to Newham or developing new local providers to fill capacity/skills gaps, to increase choice
and when necessary to increase quality.
Newham CCGs long term Vision is to develop extraordinary levels of community cohesion, buy-in and
commitment which will unlock great health benefits for Newham by ensuring that we have a focus on
three strategic priorities: integrated care, health inequalities, and robust patient and public
engagement.
Our Procurement Strategy and Policy have been developed to support this vision and our need for new
services.
Appendix R is Newham CCG Procurement Strategy and Appendix S is the Newham CCG Procurement
Policy. It sets out the CCG’s approach to procurement and is not a procedural manual setting out in
great detail the operational process of running procurements but provides the framework in which we
will act.
The developing landscape for procurement of NHS funded healthcare services requires a consistent but
flexible approach rather than a rigid application of any particular procedure, the policy has been written
with this in mind and to ensure that the CCG’s statutory and regulatory duties and obligations are clear
and complied with.
10.2. Procurement Process and Annual Procurement Plan
The CCG has established a Contracting and Procurement Group (Draft TOR can be found in Appendix T)
which reports directly to the CCG Executive Committee and then to the Board. They will be responsible
for developing and implementing an Annual Procurement Plan.
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The Contracting and Procurement Group will play a core role by ensuring that procurement activities
are planned and coordinated across the CCG, are properly authorised, follow the correct process and
paperwork is to the agreed standard. The role of the group is also to ensure that there is documentation
of the decision to go to the market and then to enter a contractual agreement with a provider or to
enter into contracts with our General Practices (a form of single tender action) or to accept another
single tender action instead of going to market.
The Impact Table in Appendix U will be completed for all investments in new services before the route
for a particular service development is agreed.
In addition, when the services are likely to be provided from local General Practices/List-based
providers or other organisations in which GPs have a financial interest the NHS England document:
Code of Conduct: Managing conflicts of interest where GP Practices are potential providers of CCG-
commissioned services first published by the NHS Commissioning Board Authority in June 2012 and by
the NHS Commissioning Board in October 2012 (or any document that replaces it) will be followed and
the Template in Appendix V completed.
Appendix F: Contracting and Procurement Work Plan for 13/14 is the list of small out of hospital service
contracts that were transferred to the CCG from the PCT in April 2013. There is an on-going process to
get all these contracts onto the National Standard Contract through a legally sound procurement
process. This will continue in 2014/15. The intention is this should be completed by end of March 2015.
Appendix N: Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013 +
update for 14/15 is a list of the enhanced services that GP Practices/List-based providers were providing
in 12/13 and shows whose responsibility these became in April 2014 and the present intention for these
in 14/15. There is an on-going process to review those that became the responsibility of the CCG and
get those that it is agreed should continue onto the National Standard Contract either through an AQP
process or a form of single tender waiver. This process will be completed by April 2014.
10.3. Use of the NHS Standard Contract
From April 2014 for all providers the CCG will use the NHS National Standard Contract including for all
services purchased from our GP Practices/List-based providers and other extended primary care service
providers.
This will include any Local Enhanced Services that the PCT held with Practices that the CCG decides to
continue with.
New services will need to be clearly specified as additional services that the CCG is purchasing above the
PMS/GMS/APMS contract a practice holds or a contract that another provider holds.
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If there is significant overlap with a present service then the transformation process will require either a
Service Development and Improvement Programme (SDIP) with the current provider or
decommissioning and re-commissioning.
The new service specifications may include pathways that include increased access to investigations.
The normal contracting cycle (including issuing of 6 month commissioning intentions letters to practices
on 30th September each year), and contract levers including: KPIs, Service Development and
Improvement Plans (SDIPs), Data Improvement Plans (DIPs). Local Incentive Schemes (LISs) and CQUINs,
will be used.
Performance against these contracts will be monitored by the contracting team and actions taken as
defined in the contract if the provider is failing to provide the agreed service in terms of quality and or
quantity.
10.4. Quality Performance Management Processes
As with all CCG contracts we will follow Newham CCG’s Approach to Commissioning for Quality 2013 –
2014 to develop the quality performance processes for these contracts.
Figure 1: Newham Quality Framework
The Quality Performance Management processes will be standardised by size of provider as these
should be proportionate to the value of the contract held with any particular provider. All will include at
least a quarterly quality review meeting. A system of these will be established with each CCG Cluster as
a group of GP Extended Primary Care Service providers. This will be overseen by the CCG Quality
Committee which will also establish an Amber Alert System for GP Practices/List-based providers as CCG
provider contractors and practices will be included in a performance quality database that the Quality
Committee is developing.
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From the 13/14 NHS contract guidance: there are a number of stages to the contract management
process if there are concerns. These can be summarised as follows:
issue of contract query;
excusing notice (where relevant);
meet to discuss the contract query;
implement a remedial action plan and/ or joint investigation;
withhold funding in the event of failure to agree a remedial action plan;
issue an exception report where there is a breach in the remedial action plan
which remains un-remedied and withholding of funding;
issue a second exception report to the boards where there is a breach of
time scales for remedy identified in the first exception report and permanently retain
withheld funding.
When GP Practices/List-based providers will be the Extended Primary Care provider the CCG will work
closely with NHS England and LBN to support practices with performance issues before it becomes
necessary to enter the formal contract performance management process and issue a contract query.
NHS England has defined 28 GP High Level Indicators and has identified Achievement Categories for
each practice. Practices are stratified depending on the number of level 1 and level 2 triggers associated
with the Practices' achievements against each Indicator. Sometimes these data are out-of-date or
incorrect and therefore the trigger levels and achievement levels are a guide to the achievement of a
Practice, not a rule. The categories are assigned based on the achievement of the practices compared to
the London average for the standards. There are 40 standards in total, although not every practice will
have recorded data for every standard. Details on the standards can be found on the NHS England
website: www.primarycare.nhs.uk.
Higher Achieving Practices have less than four triggers in total, and have no level 2 triggers.
It is expected that only around 10-20% of practices will be in this group
Achieving Practices have between four and six triggers in total and no more than 1 level 2
trigger. It is expected that around 40-60% of London practices will be in this category
Approaching Review Practices have up to eight triggers in total, and no more than 2 level 2
triggers. These practices are not identified as having problems with achievement, but have
more than an average number of triggers. It is expected that around 10-20% of London
practices will be in this group.
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Review Identified suggests that there is a need to review a Practices’ data to ensure the
recorded values are accurate. This group includes those with more than 11 triggers in total,
and all who have three or more level 2 triggers. It is expected that less than 10% of London
practices will be in this group.
The CCG will add any information on the achievements against the KPIs in the Extended Primary Care
Services contract to this to identify CCG Review Identified practices who will be offered support to put
in place strategies to reduce the number of triggers identified.
10.5. Activity and Quality Reports
Standardised activity and quality reporting using EMIS web templates and searches will be used where
the provider uses EMIS web and there is an intention for as many of our current out of hospital service
providers as possible to be on a fully read and write compatible system by 2018. New health service
providers wishing to enter the Newham health economy will have to have such an EMIS web
compatible system in place to win a contract.
All Service specifications within these contracts will include a clear statement of the staff qualifications
and equipment and facilities required to provide a service. Providers will have to provide evidence that
they meet these requirements to be able to claim against a service specification or make a case for why
an alternative approach will provide an equally good or better service to the patient.
During at least the first 3 years of this strategy the business cases for new extended primary care
services will include the training budget required to up-skill present staff. New providers will have
access to this training budget as will the present providers. During the contracting process it will be
agreed if the training budget will be held on behalf of the provider or the provider will receive the
budget and organise the necessary up-skilling. As the Newham Education and Training Academy (see
Section 6 above) develops and becomes independent from the CCG the need for this financial support
for training should be reduced as extended primary care providers develop their capacity to up skill staff
to meet new service specification requirements without external support.
The payment structure and local tariff will be developed based on actual local cost to provide the
service and will always include a clear element for the full cost of the facilities (facilities + soft and hard
facility maintenance (FM)) and administrative support staff.
When General Practices/List-based providers are the preferred route for procurement subcontracting to
another Newham General Practice/List-based provider or another approved provider that meets the
staffing and facilities requirements will be allowed as long as there is full access to the patient notes,
physical access for the patient will not be significantly affected, and it is clearly stated within the
practice’s contract with the CCG. Payment of the sub-contractor will be the responsibility of the list
holding practice.
82
11. Working with our Stakeholders
11.1. Our population
During the development of this strategy Patient Participation Groups (PPGs) and local voluntary
organisations have helped to set the out-comes this strategy seeks to achieve.
The Newham CCG Communication and Engagement Strategy 2013-2014 provides details of how the
CCG plans to work with our population. Newham Clinical Commissioning Group (CCG) knows how
important patient engagement and communications is to improve and enhance local health services. A
key part of our vision for an improved and more responsive health services is to see patients at the
centre of all that we commission and do.
The stakeholder landscape is complex and challenging in Newham but we have already established
thriving patient engagement structures including a Patient Forum, Community Reference Group and a
Health and Social Care Network. Through these structures we have engaged hundreds of people,
involving patients in developing our commissioning intentions, redesign of services and in the tendering
of new services.
During the implementation of this Strategy we will report regularly to these forums on progress. In
addition the Strategy envisages the development or modification of a number of services bringing them
out of the hospital when possible. Patients, carers, patient groups and the population in Newham more
generally will be involved in the development of these new pathways to ensure that they are
responding to our patient’s needs and recognise their ideas of quality not just those of clinicians and
managers.
11.2. Health and Well-being Board
The CCG is a full member of the Newham Health and Well-being Board (HWBB) and is fully committed
to the Health and Well-being Strategy (HWBS). Therefore the Primary Health Care Strategy is one of the
ways the CCG will implement the health service elements of the HWBS. The HWBB will be regularly
briefed on the implementation of the Primary Health Care Strategy and as the HWBB develops new
streams of work the Strategy will implement those elements that need to occur in a primary care
setting.
11.3. NHSE and LBN
NHS England and LBN will be holding contracts with many of the same providers as the CCG (the GP
Practices/List-based providers in particular but also with community pharmacists, opticians and others)
and therefore we need to work closely together as commissioners and in contract management.
83
In terms of procurement it will be important to be fully aware of each other’s procurement plans to
ensure that there is sufficient capacity in the providers to fulfil all contracts or to jointly prioritise which
contracts should use the limited resources and to develop the provider’s capacity in terms of IT,
workforce and estates. Details of the CCG strategies in these areas are covered in Section 6 of this
document. Where possible we should pool resources for IT, Workforce and Estates development.
It is proposed to ensure coordination and to share these plans the CCG Extended Primary Care
Commissioners should meet quarterly with NHSE and LBN to discuss issues they have with their GP
Practice/List-based provider and Groups of General Practices/List-based providers. This would be a pre-
meet before meeting with the providers.
To ensure that the performance of these providers is of an acceptable standard for all commissioners it
is proposed that LBN and NHSE should participate in the quarterly performance management meetings
with each cluster as a group of providers and that we share our soft and hard intelligence about each
provider. It is proposed that we develop a joint process to identify and manage those GP Practices/List-
based providers and other extended primary care providers we have quality and or performance
concerns about as early as possible to avoid where possible entry into the more formal performance
management processes that would ultimately lead to removing a contract.
84
12. Implementation Plan
This will be a developing element of the strategy – detail developing as implementation proceeds
Date Clusters as
Commissioners
development
Extended Primary
Care Services
development and
contract
management
GP Practices/List -
based providers as
providers
development
Estates Working
Group IM&T Working
Group NETA Working
Group
March 2014
Board Agrees number of clusters and initial distribution of practices to the clusters Draft TORs for Clusters and Cluster Leads Meeting and JDs for cluster leads discussed at cluster leads meeting and support needed to fulfil these roles recommended by Cluster Leads Meeting developed Development programme for clusters and cluster leads developed and costed.
Develop and finalise all the service specs Agree pricing methodology for GP provided EPCSs Negotiate and agree 14/15 prices with LMC, LOC, LPC Develop contract management process. Develop support/training plan. Present all above to practices and other providers. Begin training for all new EPCSs. All to sign 14/15 EPCS contracts
Joint LMC/CCG meeting on contracting and HR options for working more closely together Offer support package to groups of practices wishing to work more closely together as providers:
Legal – a group of practices with 20,000 practice pop or more able to draw down 8 hours of legal time + 1 contract drawn up (maximum cost to CCG per grouping £10,000)
HR – same groupings up to maximum of 5 days HR advice (maximum cost to CCG per group
TOR approved by Primary Care Strategy TP Establishment of Newham Health Estates Working Group (membership across NHSE, LBN, Barts, ELFT, NHSPC and CHP) Survey commenced:
6 Facet Survey
CQC Audit
Disabled Access Review
Reception privacy
Mapping of isochrones
Detailed Space Utilisation Study
IM&T WG meeting IM&T Strategy approved by Board 14/15 work plan agreed including agreement on levels of clinical input HIE view of summary care record shared between acute and primary care (live in all practices) MIG interoperability project for information sharing between Adastra OOH and Primary Care operational and live for all practices Procurement of a single view only integration engine to support
TOR approved by Board Establish functional NETA Working group – include agreement on levels of clinical input NETA development and investment plan for 14/15 Staff support for 14/15 approved by Board Staff recruitment commenced (NETA and CEPN) Workforce baseline data collate and analysed All present GP practice and extended primary care service related staff training (including admin and reception
85
£3,000)
Management support – same groupings but to a maximum size of 50,000. Matched funding by CCG up to a max of £1/capita. Agreed outputs from this management resource (practice plans including workforce)
implementation of integrated care across WELC boroughs Cyberlabs. To be procured and installed live in all Newham GP Practices/List-based providers T-Quest. To be procured and installed live in all Newham GP Practices/List-based providers
staff) and development resources coming into Newham identified Gap analysis completed Training plan for 2014/15 End of year funded training (admin and HCA) undertaken
April 2014
Draft TORs, JDs and staff support and development programme to Board for discussion and approval Accountability framework for clusters developed Develop process for practice moving from one cluster to another? Constitution changes developed to support agreed roles and responsibilities and processes
Ongoing support and training programme for the EPCSs Practices start to provide new EPCSs. First pre-meet with LBN and NHSE to discuss quality and activity issues with GP practice providers.
Establish quarterly providers meetings supported by: Estates, IM&T and NETA working groups reporting on support provided over previous quarter and discuss what offered next 3 months. Providers groups draw down on support offering Develop Practice Plans to implement EPCSs and reduce outliers for GPHLI (trigger 1s and 2s)
Newham Health Estates WR meeting Survey results received Based on survey report develop draft Estates Strategy with recommendations for CCG Board and proposed letter to NHSE re: present condition of primary care estate
IM&T WG meeting Implementation of IM&T work plan DSX – referral support under development Roll out of digital messaging service to all Newham practices EPS 2 – live in all practices Summary care record activated in all Newham practices
NETA WR meeting Staff recruited and in place (NETA and CEPN) Planning for first CEPN event Regular training programme running smoothly Workforce development planning with practices
86
13/14 Spend by cluster available
May 2014
Development programme implementation Agree shadow risk sharing arrangements between clusters and methodology for budget allocation to clusters 14/15 cluster budgets available
First Quarterly Contract Performance Meeting Ongoing training and support
Providers groups draw down on support offering Implementation of practice plans
Newham Health Estates WR meeting Report, strategy and letter/approach to NHSE approved by Board Development of work plan including investment if funding available
IM&T WG meeting Implementation of IM&T work plan Focus on development of DSX materials
NETA WG meeting Regular training programme running smoothly First CEPN meeting
June 2014
Development programme implementation First Quarterly meeting as Commissioners First Report of spend against budget available Cluster profile available Discuss commissioning cycle
Ongoing training and support.
Providers groups draw down on support offering Implementation of practice plans
Implementation of work plan
IM&T WG meeting Implementation of IM&T work plan Focus on rollout of DSX to all practices
NETA WG meeting Regular training programme running smoothly First CEPN meeting
July 2014
Development programme implementation ongoing. Particularly
Ongoing training and support. Second contract
Providers groups draw down on support offering
Newham Health Estates WR meeting Implementation of
IM&T WG meeting Implementation of IM&T work plan
NETA WG meeting Regular training programme running
87
refining of quarterly cluster finance and activity reporting and effective mechanisms for practices and clusters to feedback information on contract performance to contract management teams
management meeting. Audit process begins.
Implementation of practice plans
work plan
Focus on rollout of DSX to all practices
smoothly
Aug 2014
Implementation ongoing
Ongoing training and support. Audit process continues.
Quarterly providers meeting Providers groups draw down on support offering Implementation of practice plans
Implementation of work plan
Implementation of IM&T work plan All practices with active DSX to practices
NETA WG meeting Regular training programme running smoothly Planning for first CEPN event
Sept 2014
Second quarterly Commissioning Meeting Development of Cluster Commissioning Plan for 2015/16 discussed at practice meeting in Sept 2014 Agree 15/16 Cluster Commissioning intentions to feed into CCG CI letters to providers
Ongoing training and support. Audit process continues September 30th Commissioning Intentions Letter issued to all providers
Providers groups draw down on support offering Implementation of practice plans
Newham Health Estates WR meeting Implementation of work plan
IM&T WG meeting Implementation of IM&T work plan Now into maintenance of DSX
NETA WG meeting Regular training programme running smoothly Second CEPN meeting
88
October 2014
Clusters involved in developing Business cases for 15/16 Clusters continuing involved in contract management principally through feeding back information to the contract management teams on quality and quantity issues within present contracts
3rd contract management meetings in the clusters Ongoing training and support Audit process continues
Providers groups draw down on support offering
Implementation of work plan
Bi monthly IM&T WG meeting Video conferencing Activation of EMIS online access for appointments booking and online records access for all Newham Practices Self-care and self-monitoring through mobile technology E-consultation Maintenance of DSX
Monthly NETA WG meeting Regular training programme running smoothly Following issuing of Commissioning Intentions Letter to practices – review training needs for second 6 months
Nov 2014
Clusters continue to be involved in contract management and forward planning Cluster involvement in development of Service Development and Improvement Plans, Data Quality Plans and CQUINs for all providers
Ongoing training and support with focus on those practices not providing all EPCS service specs Audit process continues
Providers groups draw down on support offering Quarterly providers meeting – November review commissioning intentions letter Review implementation of practice plans and refocus as necessary
Newham Health Estates WR meeting Implementation of work plan
IM&T WG meeting Implementation of IM&T work plan
Monthly NETA WG meeting Regular training programme running smoothly Third CEPN meeting
Dec 2014
3rd meeting December Contract performance – activity and quality
Ongoing training and support with focus on those practices not providing all EPCS
Providers groups draw down on support offering
Implementation of work plan
IM&T WG meeting Implementation of IM&T work plan
Monthly NETA WG meeting Regular training
89
report at CCG, cluster and practice level easy to use – business intelligence highlighted areas of concern for the cluster Focus of meeting on financial forecast for end of year and plans for 15/16. In particular CCG and cluster level budgeting for 2015/16 Agree exposure of cluster members to the contracting round as part of knowledge and skills development
service specs and those where there are any quality issues identified Audit process continues
programme running smoothly
January 2015
Ongoing clusters as commissioners development plan implementation Cluster Commissioning Plan for 2015/16 approved by practice by end January 2015
4th contract management meetings in the clusters Ongoing training and support with focus on those practices with low activity against some/all EPCS service specs and those where there are any quality issues identified Audit process continues Revision of service specs underway and
Providers groups draw down on support offering During last quarter of 2014/15 the groups of practices will make a presentation to the PCSTP on plans achievements in 14/15, including achievement against the measures of success above, and the groups OD plan for 2015/16. If the PCSTP approves the 2015/16 OD plan the funds will
Newham Health Estates WR meeting Review progress and agree future of working group and possible funding options for 2015/16
IM&T WG meeting Implementation of IM&T work plan Review of IM&T Strategy and develop work plan for 15/16
Monthly NETA WG meeting Regular training programme running smoothly Review NETA and CEPN achievements and agreed on going development plan leading to CEPN as independent organisation in 15/16 and NETA outcomes for 15/16
90
new service specs in development – negotiations with LMC re: service specs, prices and content of the LIS
be released for 2015/16
Feb 2015
Ongoing clusters as commissioners development plan implementation Development of Cluster Commissioning Plan work plan for 15/16
Ongoing training and support with focus on those practices with low activity against some/all EPCS service specs and those where there are any quality issues identified Audit process continues All new service specs agreed and training plan in development Contract practices and value agreed in line with government time table (28/02/2015)
Implementation of work plan
IM&T WG meeting Implementation of IM&T work plan
Monthly NETA WG meeting Regular training programme running smoothly Forth CEPN meeting
March 2015
4th meeting March Meeting focused on end of year finances and contract values and QIPP savings and investments for 2015/16 Cluster approves
Ongoing training and support with focus on those practices that the CCG is not clear should be offered a 15/16 contract for quality reasons Audit process continues
Newham Health Estates WR meeting – if to continue agree work plan for 15/16
IM&T WG meeting Implementation of IM&T work plan
First NETA Annual report to practices in development including collection of evaluation of effectiveness from practices Monthly NETA WG meeting
91
15/16 work plan All contracts signed for 15/16 with arrangements in place for all practices that have not taken up a contract
Regular training programme running smoothly
April 2015 – March 2016
Commissioning cluster meetings May, June, September, November, December, February and March Implementation of 15/16 work plan and development and approval of Cluster 16/17 Commissioning Intentions, Commissioning Plan and work plan Full and effective role in commissioning and contract management processes now in place
Contract management meetings April, July, October and January Ongoing training and support Audit process continues September 30th CI letter identifies intended changes New/changed specs available February 2016 Negotiations completed by 28th Feb All new contracts signed by end march 2016
Funding will increasingly be from the practices and meetings will now be entirely at the discretion of the groups without CCG involvement. Reports will be quarterly. End of year evaluation of impact on agreed quality outcome measures and viability of groupings of provider organisations within Newham
Work plan will be agreed for each year in March of previous year
IM&T WG meetings Implementation of IM&T work plan Review of IM&T Strategy and develop work plan for 16/17
Monthly NETA WG meetings Regular training programme running smoothly Development of NETA towards independence a priority in year 2 with a focus on the development of a business model that seeks to fund the core staffing and functionality independent from the CCG End of year report to Practice including feedback from practices and assessment of impact of NETA on workforce recruitment and retention at end of year 2
92
April 2016 – Mach 2017
Commissioning cluster meetings May, June, September, November, December, February and March Implementation of 15/16 work plan and development and approval of Cluster 16/17 Commissioning Intentions, Commissioning Plan and work plan Full and effective role in commissioning and contract management processes now in place
Contract management meetings April, July, October and January Ongoing training and support Audit process continues September 30th CI letter identifies intended changes New/changed specs available February 2017 Negotiations completed by 28th Feb All new contracts signed by end march 2017
Work plan will be agreed for each year in March of previous year
IM&T WG meeting Implementation of IM&T work plan Review of IM&T Strategy and develop work plan for 17/18
Monthly NETA WG meetings Regular training programme running smoothly Development of NETA towards independence on going with diversification of funding of core functions expected during year 3 End of year report to Practice including feedback from practices and assessment of impact of NETA on workforce recruitment and retention at end of year 3
April 2017 – March 2018
Commissioning cluster meetings May, June, September, November, December, February and March Implementation of 15/16 work plan and development and approval of Cluster 16/17 Commissioning Intentions, Commissioning Plan
Contract management meetings April, July, October and January Ongoing training and support Audit process continues September 30th CI letter identifies intended changes
Work plan will be agreed for each year in March of previous year
IM&T WG meeting Implementation of IM&T work plan Review of IM&T Strategy and develop work plan for 18/19
Monthly NETA WG or Board meetings Regular training programme running smoothly Creation of NETA as an independent organisation is the aim of this year but still with significant levels of core funding from
93
and work plan Full and effective role in commissioning and contract management processes now in place
New/changed specs available February 2018 Negotiations completed by 28th Feb All new contracts signed by end march 2018
the CCG. End of year report to Practice including feedback from practices and assessment of impact of NETA on workforce recruitment and retention at end of year 4
April 2018 – March 2019
Commissioning cluster meetings May, June, September, November, December, February and March Implementation of 15/16 work plan and development and approval of Cluster 16/17 Commissioning Intentions, Commissioning Plan and work plan Full and effective role in commissioning and contract management processes now in place
Contract management meetings April, July, October and January Ongoing training and support Audit process continues September 30th CI letter identifies intended changes New/changed specs available February 2019 Negotiations completed by 28th Feb All new contracts signed by end march 2019
Work plan will be agreed for each year in March of previous year
IM&T WG meeting Implementation of IM&T work plan Review of IM&T Strategy and develop work plan for 19/20
CCG Core functionality funding less than 50% of total. CCG funding training related to EPCS service specs.
94
13. Investment Plan
As with the Implementation Plan the Investment Plan will develop over the life of the Strategy and will depend on the financial situation the CCG faces
annually. This Plan was approved by the Board at its meeting of 28th April 2013.
Clusters as
Commissioners
development
Extended
Primary Care
Services
development
and contract
management
GP
Practices/List-
based providers
as providers
development
Estates
Working Group
IM&T Working
Group
NETA Working
Group
Prescribing
Working Group
TOTAL
2014/15
£400,000 for
development of
Cluster
Commissioning
£1,566,000 new
for EPCS service
specs
£400,000 for
Organisational
Development
support package
£0 – role is to
facilitate access to
other resources
£500,000 within IC
budget
£400,000 Uplift of
prescribing budget
yet to be agreed
£3,266,000
2015/16
£0 new - continue
as above
EPCS services –
size of increase will
depend on freeing
up of resources
Reduction in OD
investment
£0 £0 £0 - continue as
above
Annual increase
will be include
normal cost
pressures +
element to
support
prescribing
increases
associated with
the EPCS contract
£0
95
2016/17
£0 new - continue
as above
EPCS services –
size of increase will
depend on freeing
up of resources
Review need for
ongoing
investment in
supporting OD
development of
Groups of
practices as
providers
£0 £0 Reduction in
financial support
to NETA
Annual increase £0
2017/18
£0 new - continue
as above
EPCS services –
size of increase will
depend on freeing
up of resources
Unknown at this
time
£0 £0 Further reduction
in financial support
to NETA
Annual increase £0
2018/19
£0 new - continue
as above
EPCS services –
size of increase will
depend on freeing
up of resources
Unknown at this
time
£0 £0 Continued funding
for training related
to EPCS
specifications only
Annual increase £0
96
Appendices
Appendix A. Newham Practices
GP Code GMS/ PMS/ APMS
Practice Name
List Size as of 31/3/11
2011/12 NHS income per weighted patient
2011/12 NHS income per actual patient
Address Phone Principal GP Salaried GPs & Other Types of GPs
Partnership/ Single hander
1 F84004 PMS Market Street Health Group
11815 £144 £141 52 Market Street, East Ham E2 2RA
020 8548 2200 Dr Robert Waugh Dr Adekola Orimoloye Dr Gillian Hall Dr Olufemi Daramola
Dr Jane Obasi Dr Tamara Hibbert Dr Chetty (Registrar) Dr Ambrozie (Registrar)
Partnership
2 F84006 PMS Shrewbury Road Surgery
12011 £139 £132 The Shrewsbury Centre, Shrewsbury Road , Forest Gate, E7 8QP
020 8586 5111 Dr Sri-Ganeshan Dr Anita Bhasi Dr Girija Purushothaman Dr Navan Navaneetharaja Dr C Sunath
Dr N Kumar Dr Bapu Kunhipurayil Sathyajith Dr R Bhuvenandra (Associated Psychiatrist)
Partnership
3 F84009 PMS Stratford Village Practice
8717 £138 £136 50C Romford Road, Stratford, E15 4BZ
020 8534 4133 Dr Ashwin Mukand Shah Dr Sudha Shah
Dr Islam Majid Dr Shashi Prasad Dr Ruchika Khanna Dr Joyce Fernandes Dr Ahmed Hamza
Partnership
97
4 F84010 PMS St Bartholomew's Surgery
8647 £128 £127 292A Barking Road, East Ham, E6 3BA
020 8472 0669/1077
Dr Fola Ajanlekoko Dr Hasmukh Patel Dr Jonathan Ojukwu Dr Trevor Adrian Powell Dr S Chellappan
Dr Sabul Hussain
Partnership
5 F84014 PMS Upton Lane Medical Centre
7093 £145 £142 75/77 Upton Lane, Forest gate, E7 9PB
020 8471 6912 Dr Baljeet Saluja
Partnership
Dr Gauri Shanker
Dr Rajendra Bishnoi
Dr Ravinder Kumar Khajuria
Dr Rowshan Begum
6 F84017 PMS Star Lane Medical Centre
12234 £135 £146 121 Star Lane, Canning Town, E16 4QH
020 7476 4862 Bharat Kumar Dr Bharat Patel Dr Carolyn Fang Dr Henry Edung Dr Ini Smith
Caroline Fang and Dr A Ekundayo Dr Bhavini Shantilal Lad
Partnership
98
7 F84022 PMS Stratford Health Centre
6104 £118 £117 121-123 The Grove, Stratford, E15 1EN
08443 878 019 Dr Mathew Khai Laing Chang
Dr W Naing (Permanent Locum) Dr Adetokunbo Osokoya (Salaried) Dr Mubeen Ali Dr T T Lwin (Permanent Locum) Dr M Mookerjee (Permanent Locum)
Single Hander - With Salaried
8 F84032 GMS Dr Inayatullah' Surgery
3263 £128 £119 34 Barking Road, East Ham, E6 3BP
020 8472 1347 Dr Inayat Inayatullah
Dr I Aboh (Locum)
Single Hander - With Salaried
F84032 GMS Dr Inayatullah' Surgery
£128 £119 154 High St South, East Ham E6 3RW
020 8472 9260 Dr Inayat Inayatullah
9 F84047 PMS Custom House Teaching & Training Medical Practice
12856 £136 £141 16 Freemasons Road, Custom House E16 2NA
020 7476 2255 Dr Alem Tsegaye Dr Eleanor Shore Dr Faiez Al-Shawk Dr Zuhair Zarifa
Dr Shabela Begum
Partnership
10 F84050 PMS Boleyn Medical Centre
9204 £136 £119 Ground Floor, 152 Barking Road, East Ham, E6 3BD
020 8475 8500 Dr Mohammed Khan Dr Nejat Chalabi
Dr Shani Bhaskaran Dr Imran Sheikh Dr Ali Ahmed-Shuaib Dr Abdul Nasir Khan
Partnership
99
11 F84052 PMS Essex Lodge 7409 £167 £181 94 Greengate Street, Plaistow E13 0AS
020 8472 4888 Dr Abu Khan Dr Anne Pauleau Dr Hardip Nandra Dr Ray Higgins
Dr Rupom Chatterjee Dr T Ali (Registrar) Dr A Noona (Registrar) Dr N Chung (SHO)
Partnership
12 F84053 PMS Greengate Medical Centre
7474 £141 £138 497 Barking Road, Plaistow, E13 8PS
020 8471 7160 Dr A Gopinathan Dr Shahab Din Kalhoro
Dr Soomro Humairah Dr Haleem Bhatti Dr Debasis Roy-Choudhury
Partnership
13 F84070 GMS Lathom Road Medical Centre
5032 £102 £94 2A Lathom Road, East Ham E6 2DU
020 8548 5640 Dr Reena Patel Dr Niranjan R Patel Dr Pratap Rai Dubal
Partnership
14 F84074 PMS Wordsworth Health Centre
11444 £169 £161 19 Wordsworth Avenue, Manor Park, E12 6SU
020 8548 5960 Dr Abdul Husain Kadhim Nasralla Dr Andrew Robert Pople Dr Jaqueline Buscombe Dr Pulickal Raghavan Sajilal
Dr Sophie Brandon Dr Lise Hertel Dr Elizabeth Ann Goodyear Dr Hussain (Registrar)
Partnership
15 F84077 GMS Dr Samuel & Dr Khan Surgery
6237 £89 £93 Vicarage Lane Health Centre, Stratford, E15 4ES
020 8536 2266 Dr Shahzada Khan Dr Roseline Samuel
Dr Jeyaseelan Selvarajah
Partnership
100
16 F84086 GMS Dr Driver & Partners
6742 £101 £105 Lord Lister Health Centre, 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7513 Dr Cathy Friel Dr Leung Ting Lam Kin Teng Dr Nowshir Driver
Dr Radhika Acharya
Partnership
17 F84088 GMS Plashet Road Medical Centre
3935 £105 £105 152 Plashet Road, Plaistow, E13 0QT
020 8472 0473 Dr Akram Qureshi Dr Thebo
Dr Zulfiqar Ali Thebo
Partnership
18 F84089 PMS Manor Park Medical Centre
1,636 £192 £220 688 Romford Road, Manor Park, E12 5AJ
020 8478 5355 Dr S Dhariwal Dr. Karam Vir Kapur
Single Hander
19 F84091 GMS The Surgery - Dr C P Raina & Dr A Arshad
4486 £99 £95 57 Gladstone Avenue, Manor Park, E12 6NR
020 8471 4764 Dr Arslan Arshad Dr Chander Raina
Partnership
20 F84092 PMS Glen Road Medical Centre
5463 £131 £128 1 - 9 Glen Road, Plaistow, E13 8RU
020 7476 3434 Dr Venkateswara Madipalli Rao Dr Sudha Madipalli
Dr Shazia Jabeen Ali
Partnership
21 F84093 PMS Tollgate Medical Centre
15451 £119 £118 220 Tollgate Road, Beckton, E6 5JS
020 7473 9399 Dr Chander Kiran Sikka Dr David Erickson Watt Dr Gillian Lesley Goose Dr Kenneth James Cochran Dr Laura Ruhi Scott Dr Patricia T Rijsenburg Dr Stuart Sutton
Dr Saila Chatakondu Dr M Sahemey
Partnership
101
Dr Vasos Vrachimi Dr S Sutton
22 F84097 PMS Claremont Clinic
8746 £144 £139 459-463 Romford Road, Forest Gate, E7 8AB
02085220222/0333
Dr Atmaji Manam Dr Ciaran Seamus Joyce Dr Hiran De Silva Dr Kiran Sinha Dr Sarah A Wood
Dr Annie Mireille Mackela Dr Hiran Gavin A Desilva
Partnership
23 F84111 GMS Abbey Road Medical Practice
7297 £130 £125 28A Abbey Road, Stratford E15 3LT
020 8534 2515 Dr Subir Sen Dr Kenny Uzoka
Dr Helen Yates Dr Gurvinder Singh Saluja Dr Sobhoshini Kugaprassad Dr Yser Abdul-Amir (Registrar)
Partnership
24 F84121 PMS E12 Health Centre
10224 £133 £134 The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7440 Dr Bhupinder Kohli
Dr Clare Thormod Dr Nusrat Jabeen Dr Kavita Gaur Dr Shanaz Husain Dr Preeti Bakshi Dr Abrar Hussain Dr Suparna Chakrabarti
Single Hander - With Salaried
102
25 F84124 PMS The Project Surgery
4274 £190 £178 10 Lettsom Walk, Plaistow E13 0LN
020 8472 5234 Dr Farzana Hussain Dr Sairah Ali
Dr Anya Leiva (GPR ST3) Dr Alexis Ahmedi (GPR ST1)
Partnership
26 F84631 PMS Dr Abiola Lord Lister Health Centre
3577 £105 £106 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7550 Dr Philip Abiola Dr Fatai Salau Single Hander - With Salaried
Dr Kareem Magoub (F2 Doctors)
27 F84641 PMS Birchdale Road Medical Centre
3771 £147 £140 2 Birchdale Road, Forest Gate, E7 8AR
020 8472 1600 Dr B K Sinha Dr A Dawoodjee Dr B Mandavia Dr A sheth
Single Hander - With Salaried
28 F84642 GMS Sinha Medical Teaching Practice
5846 £103 £89 1A Lucas Avenue, Plaistow, E13 0QP
020 8471 7239 Dr Anurag Sinha Dr B K Sinha
Partnership
29 F84654 PMS Roding Medical Practice
2,171 £139 £149 997 Romford Road, Manor Park, E12 5JR
020 8478 2711 Dr Chandra Prakash Dr Manjaya Shetty
Dr Edward Adeyemi Abimbola
Single Hander
30 F84657 PMS Cumberland Medical Centre
2,756 £131 £150 179 Cumberland Road, Plaistow, E13 8LS
020 7476 1029 Dr Ramnik Gonsai
Single Hander
31 F84658 PMS Sangam Surgery
4371 £135 £122 31A Snowshill Road, Manor Park, E12 6BE
020 8911 8378 Dr Prakash Chandra Dr Chandra Gowda
Dr Sheetal Shah Partnership
32 F84660 GMS Dr C M Patel 2,186 £131 £104 2 Jephson Road, Forest Gate, E7 8LZ
020 8470 6429 Dr Chandrakant Patel
Single Hander
103
33 F84661 PMS West Ham Medical Centre
2458 £144 £145 401 Corporation Street, Stratford, E15 3DJ
020 8555 0428 Dr Prasanta Bhowmik
Dr Jagadis Chandra Ray Dr A Asalkhou
Single Hander - With Salaried
34 F84666 GMS The Ruiz Medical Practice
2368 £106 £112 2 St. Luke's Square, Tarling Road, E16 1HT
020 7366 6440 Dr Encarnacion Ruiz-Gutierrez
Dr Joarder
35 F84669 PMS Newham Medical Centre
4634 £142 £133 576 Green Street, Plaistow, E13 9DA
0844 499 6992 Dr A U Ahmed
Edward Abimbola Dr Hadeel Hameed-Nasrat
Single Hander - With Salaried
36 F84670 GMS Westbury Road Medical Practice
4768 £114 £97 45 Westbury Road, Forest Gate, E7 8BU
020 8472 4123 Dr Alauddin Ahmed Dr Kabir Mahmud Dr Saidur Rahman
Partnership
37 F84671 GMS Katherine Road Medical Centre
1,809 £159 £136 511 Katherine Road, Forest Gate, E7 8DR
020 8472 7029 Dr Govind Bapna
Single Hander
38 F84672 GMS Leytonstone Road Medical Centre
2,291 £118 £108 157 Leytonstone Road, Stratford, E15 1LH
020 8534 1026 Dr Abdul Qadri Single Hander
39 F84673 GMS Esk Road Medical Centre
2,650 £148 £119 12 Esk Road, Plaistow, E13 8LJ
020 7474 9002 Dr Rama Venugopal
Single Hander
40 F84677 PMS East End Medical Centre
5011 £138 £133 61 Plashet Road, Plaistow, E13 0QA
020 8470 8186 Dr Ila Basu Dr Suniti Kumar Basu
Dr H Hameed-Nasrat Dr S Savla Dr Ashwin Balabhadra
Partnership
104
41 F84679 GMS The Upper Road Medical Centre
3646 £108 £102 50 Upper Road, Plaistow, E13 0DH
020 8552 2129 Dr Abul Zakaria Single Hander
42 F84681 PMS Balaam Street Practice
6343 £111 £112 113 Balaam Street, Plaistow, E13 8AR
020 8472 1238 Dr Barry Sullman Dr Ghassan Al-Mudallal
Dr Jeevarani Shantini Navaratnam
Partnership
43 F84699 GMS Stratford Medical Centre
2,190 £112 £120 60 Leytonstone Road, Stratford, E15 1SQ
020 8534 1533 Dr A Q Brohi Single Hander
44 F84700 GMS DMC Health Care 1
1778 £112 £91 10 Vicarage Lane, Stratford, E15 4ES
020 8536 2277 Dr Ravi Gupta Dr Jane Muir-Taylor
Partnership
45 F84706 GMS Dr S K Swedan
3,063 £111 £104 121 Woodgrange Road, Forest Gate, E7 0EP
020 8250 7530 Dr S K Swedan Dr Fernandes
Partnership
46 F84707 PSU PSU - St. Luke's Health Centre
2478 na na 2 St. Luke's Square, Tarling Road, E16 1HT
020 7366 6430 Dr Clare Davison
Dr D Malik Dr A Seresht Dr A Ali Dr Atul Kumar
PCT Practice
47 F84708 PMS Dr Lwin's Surgery
4,273 £117 £108 343 Prince Regent Lane, Custom House, E16 3JL
020 7511 2980 Dr Tun Lwin Dr Win Naing Single Hander – With Salaried
48 F84713 GMS East Ham Medical Centre
3623 £164 £142 1 Clements Road, East Ham, E6 2DS
020 8472 0603 Dr Prabha Shukla Dr Samuel Mandavilli
Partnership
105
49 F84717 PMS Royal Docks Medical Practice
9141 £129 £119 21 East Ham Manor Way, Beckton, E6 5NA
020 7511 4466 Dr Jim Lawrie
Dr S Nandakumar Dr Aung Kyi MYINT Dr Alpa Patel Dr Amjad Izmeth Dr Ophelia Cheng (salaried) Dr D Satananyana
Single Hander - With Salaried
50 F84724 PMS Woodgrange Medical Practice
11268 £146 £128 40 Woodgrange Road, Forest Gate, E7 0QH
0208 221 3100 Dr Sanjay Parmar Dr Yusuf Patel
Dr Muhammad Waqqas Naqvi Dr Tathagata Sadhu Dr Amber Ghaznavi Dr Anusha Durairatnam Dr Jagdeep Kaur Burdi Dr Bhavini Lad Dr Thana Shanamugadan Dr Timothy Carroll Dr Shoaib Patel Christina Linvell
Partnership
51 F84727 GMS Dr Qureshi's Surgery
2181 £120 £124 17 Stopford Road, Plaistow, E13 0LY
020 8552 6858 Dr S Qureshi Single Hander
52 F84729 PMS Dr N Bhadra’s Surgery
4,072 £153 £132 778 Romford Road, Manor Park, E12 5JG
020 8478 7005 Dr Nirode Badra
Dr Arun Sarkar Single Hander
106
53 F84730 GMS Dr P Knight 3945 £108 £107 10 Vicarage Lane, Stratford, E15 4HG
0208 536 2244 Dr Pakalapati Knight
Dr Praveen Vangala
Single Hander
54 F84734 GMS Boleyn Road Practice (Dr S Rafiq)
9461 £110 £89 162 Boleyn Road, Forest Gate, E7 9QJ
020 8503 5656 Dr Saeeda Sultana Rafiq
Single Hander
55 F84735 GMS The Azad Practice
8168 £98 £91 1st floor Boleyn Medical Centre, 152 Barking Road, East Ham, E6 3BD
020 8475 8550 Dr Ajith Azad Dr Sajith Azad Dr Mohamed Faiz
Partnership
56 F84736 PSU PSU - Church Road
3812 £147 £116 The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7475 Dr Clare Davison
Dr Anwar Syed Dr Lise Hertel Dr Rajesh Chadda Dr Nazia Ali
PCT Practice
57 F84739 PMS Dr Kugapala's Practice
5,278 £98 £91 243 High Street North, Manor Park, E12 6SJ
020 8470 2500 Dr Girija Kugapala
Single hander
58 F84740 APMS Newham Transitional Primary Care Team
4,620 ? ? The Centre, 30 Church Rd, Manor Park, E12 6AQ
020 8553 7460 Dr Duncan Trathen
APMS
59 F84741 GMS Dr Krishnamurthy Practice
2,978 £147 £116 East Ham Memorial Hospital, Shrewsbury Road, Forest Gate, E7 8QR
020 8586 6555 Dr Thyagaraja Krishnamurthy
Single Hander
107
60 F84742 GMS The Summit Practice
2312 £103 £91 Old East Ham Memorial Hosp, Shrewsbury Road, Forest Gate, E7 8QR
020 8552 2299 Dr Aminu Yesufu Chukwuma Amayo
Partnership
61 F84749 PSU PSU - Carpenter's Road Medical Practice
1934 ? ? 17 Doran Walk, Stratford, E15 2LJ
020 8534 8057 Dr Clare Davison
Dr Rajesh Chadda Dr Dinesh Malik
PCT Practice
62 Y00225 APMS Vicarage lane Transitional Team
4041 ? ? 10 Vicarage Lane, Stratford, E15 4ES
0208 536 2255 Dr E Kensah Dr Daniela Dinca
APMS
63 Y02823 APMS DMC Vicarage Lane
2842 ? ? 10 Vicarage Lane, Stratford, E15 4ES
020 8536 2080
Dr Daniel Yevu Dr Chukwuma Amayo Dr G Ademiluyi Dr Iman Ismail Dr Oluwalogbon Rasheed Dr Eloho Veronica Odu Dr Jonathan W Turner
APMS
64 Y02928 APMS The Practice Albert Road
5171 ? ? 76 Albert Road, North Woolwich, E16 2DY
020 8104 2222 Dr S Choudhury Dr Nazir Dr Mukherjee
APMS
108
65 Y02928 APMS The Practice Britannia Village
5171 ? ? 12a Wesley Avenue, North Woolwich, E16 2RZ
020 3040 0100 Dr Mousumi Mukherjee (Clinical Lead) [email protected];
Dr Shahidur Choudhury Dr Neeru Garg
APMS
109
Appendix B. PMS Contracts KPI Performance Summary
Ref. No
KPI Description Annual
Measure Performance
Band Payment
Band Weighting
QOF/CE
G/ Practice A B C A B C
1 Access 41 1.01 GP
appointments
The contractor must make available to patients a number of hours of GP appointments per week per 1000 patients. These clinical appointments can be delivered by either a GP, Registrar or suitably qualified nurse or approved HCA* (these hours can include telephone consultations verifiable as appointments on the clinical system and home visits) *HCA must meet an agreed training standard as agreed between the PCT and provider.
≥16.8 ≥14 <12 100% 66% 33%
19 1.02 Consultation
times A minimum of either one early session (starting at or before 8:30am) and one late session (last appointment at or after 6:20pm) or two early starts or two late finishes (excludes any Extended Hours provision).
Achieved Not
Achieved
100% 0% 0%
6 1.03 Practice
Opening Hours
The practice is open 8.00 am to 6.30 pm Monday to Friday (excluding Bank Holidays). That is, patients can access the premises, and have face to face access with a receptionist for a minimum of 52.5 hours per week.
≥52.5 ≥45 <45 100% 66% 33%
16
110
2 Training & Prescribing 3
2.01 Repeat Prescribing Procedure
Practices must have a robust written and communicated procedure in place to deal with repeat prescribing requests ensuring quality, safety and timely issue of repeat prescriptions in 28-day intervals (see the 'Repeat Prescribing Policy' on the Medicines and Prescribing intranet site.)
≥70% 60-
69.9% <60% 100% 66% 33%
3
3 Service Delivery 41
3.01 Cervical
Screening
Percentage of eligible patients aged from 25 to 64 whose notes record that a cervical smear has been performed in the last five years (as a % using National Screening data).
≥80% 73-
79.9% <73% 100% 66% 33%
3
3.02 Breast
Screening
Percentage of eligible patients screened. National target - 70% of eligible women screened / average for Newham Qtr 2 20010/11 - 64.8%
≥70% 60-
69.9% <60% 100% 66% 33%
2
3.03
Childhood immunisations and preschool
boosters
Percentage of patients aged below 5 whose notes record that all childhood immunisation, childhood pneumococcal and preschool boosters have been given in accordance with the Green Book (National target - 90%). Source Cover Data.
≥92% ≥90% <90% 100% 66% 33%
3
3.04 Influenza
immunisations
Percentage of patients aged over 65 whose notes record that the influenza immunisation has been given (as a %)
≥73% ≥70% <70% 100% 66% 33%
2
3.05 Influenza
immunisations
Percentage of patients within 'at risk' clinical groups whose notes record that influenza immunisation has been given (as a %)
≥65% 55-
64.9%%
<55% 100% 66% 33%
2
111
3.06 CHD Maximise the %age of CHD patients with normal blood pressure (150/90)
≥75% ≥71% <71% 100% 66% 33%
3
3.07 Maximise the %age of CHD patients with cholesterol of 5mmol/l or less
≥75% ≥71% <71% 100% 66% 33%
3
3.08 At least 90% of CHD register has a smoking status recorded.
≥95% ≥90% <90% 100% 66% 33% 3
3.09
At least 90% of smokers on the CHD register have been offered advice and/or referral for smoking cessation.
≥90% ≥75% <75% 100% 66% 33%
3
3.10
Obesity The % of patients on either of the following disease registers, Diabetes, CHD and Hypertension, or new patients aged 25 & over, whose BMI has been recorded in the last 15 months ≥70% ≥60% <60%
100% 66% 33%
3
3.11
The % of new patients aged 25 & over or patients on either of the CHD or Hypertension registers with a BMI > 30 checked for diabetes using fasting glucose testing ≥70% ≥60% <60%
100% 66% 33%
3
3.12
Diabetes Practices should achieve the standard for management of diabetic patients, with the aim of achieving 70% of diabetic patients with HbA1c of 8 or less.
≥75% ≥70% <70% 100% 66% 33%
3
3.13
Practices should achieve the standard for management of diabetic patients, with the aim of achieving 50% of diabetic patients with HbA1c of 7.5 or less.
≥52% ≥50% <50% 100% 66% 33%
3
112
3.14
Hypertension Practices should achieve the standard for management of hypertensive patients, with the aim of achieving 75% of patients with a normal blood pressure (150/90).
≥75% ≥70% <70% 100% 66% 33%
3
3.15
Infant feeding Using the CEG Child Health Surveillance template used at the 6-8 week check, practices should record infant feeding status (i.e. breastfed or artificial feeding), as % of total CHS 6-8 week checks.
98% ≥90% <90% 100% 66% 33%
2
4 Practice Specific 15
4.1
Objective 1: Local
The practice develops a proposal for a service which includes the rationale, which the service is for, how the target group will be identified and the outcomes sought. Where possible an evidence base will be provided to support the benefits along with a proposed means of measurement. A proposed price per patient along with proposed levels of uptake expected and associated expense for provision of the service with a reasonable margin
100% 66% 33%
4.2
Objective 2: Mild to moderate depression
All patients on the mild to moderate depression register will be offered treatment in line with NICE guidance (medication/CBT) and be assessed using an appropriate tool on a minimum of a quarterly basis
100 ≥90 <90 100% 66% 33%
4.3 Objective 3: ECG service
100% 66% 33%
4.4 Objective 4; Spirometry
100% 66% 33%
4.5 Objective 5: Urgent care
100% 66% 33% The provider will not be penalised for failure to deliver on a KPI if they can provide evidence to the PCT that they have made every endeavour to achieve the target. This includes but is not limited to, the application of best practice or gold standards, taking the advice of peers and the PCT (and or its advisers).
113
Appendix C. General Practice High Level Indicators
114
Appendix D. Public Health Outcome Framework Indication
Health Improvement – England and Newham (coloured)
Negatives of Note:
High number LBW babies Excess weight in 10-11 year olds
115
High percentage inactive adults High percentage recorded diabetes Low percentage for breast, cervical and retinal screening High percentage of people with low satisfaction/ low worthwhile and low happiness scores High percentage with high anxiety scores High number of injuries from falls 65-79 years old
Health protection – England and Newham (coloured)
Negatives of Note: High level of Chlamydia diagnosis High % presenting with HIV at late stage Extremely high TB incidence compared to England Low childhood imms coverage
116
Health Care and Premature Mortality - England and Newham (coloured)
Negatives of Note:
High mortality rate from preventable causes High mortality rate CVD High preventable mortality rate CVD High mortality rate liver disease (not high for preventable liver disease) High mortality rate respiratory disease
117
Appendix E. ELFT Community Health Service Specifications
Adults Services 1. Adult Speech and Language Therapy Service
2. Cardiac Rehabilitation
3. Continence Service
4. Continuing Care And Respite Care (In-patient Wards)
5. Continuing Care Liaison Team
6. Day Hospital (for people over 60) and Falls Prevention
7. Diabetes Specialist Nursing Service
8. Diabetic Retinal Screening Service
9. Extended Primary Care Team and Virtual Wards
10. Foot Health Service
11. Health Advocacy Service
12. Learning Disability Service
13. Community Neuro Service
14. Patient Appliances
15. Phlebotomy
16. Physiotherapy
17. Pulmonary Rehabilitation
18. Sexual Health and Reproductive Health
19. Tissue Viability Service
20. New Entrant Screening
21. Urgent Care Centre
22. Wheelchair Service
Children’s and Young People’s Services 1. Audiology
2. Child Development Centre
3. Child Health Admin Team
4. Children’s Therapy Service
5. Community Children’s Nursing Service
6. Community Paediatrics
7. Development Advisory Clinic
8. Health Visiting
9. Immunisation Team
10. Looked After Children
11. Safeguarding Children’s Team
12. School Nursing
13. Sickle Cell & Thalassemia Service
118
Appendix F. Contracting and Procurement Work Plan for 2013/14
CONTRACTS EXPECTED TO REQUIRE TENDERING (WELC POD - NEWHAM): 2013/14 As at October 2013
Recommended Route to Market: ST = Single Tender, CT = Competitive Tender, AQP = Any Qualified Provider, TQ = Three Quotes, T = Terminate Contract
Contract Management Details Contract Particulars
SERVICE TYPE Service Provider
name
Service Commencement Date
Contract end date
Contract Term
Contract Notice period
Rec. Route
to Market
Notes
PRACTICE BASED SERVICE
Cardiology Dr Sen 01/01/2013 30/09/2013 9 Months tbc T Retendering of activities to identify new providers for contracts which
are coming to an end.
Competitive tender is recommended for services that will
continue in a similar form but where the CCG has an obligation to re-tender for these services at the
Contract end dates.
Termination is recommended for contracts which will be retendered as part of QIPP initiatives (i.e. the new services may be significantly
different from the current services) or where a change in the contract
or provider has been recommended.
PRACTICE BASED SERVICE
Chronic Pain* iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Dermatology Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Diabetes* Dr Bhasi 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Headache Clinic*
Dr Nasralla 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Minor Surgery Dr Gopinathan 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
MSK (op) Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Ophthalmology Service
Dr Madipalli 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Physiotherapy Patient First 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Physiotherapy iHealth 01/01/2013 30/09/2013 9 Months tbc T
119
PRACTICE BASED SERVICE
Rheumatology iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Trauma & Orthopaedics
iHealth 01/01/2013 30/09/2013 9 Months tbc T
PRACTICE BASED SERVICE
Chronic Pain n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Diabetes n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Headache Clinic n/a 01/10/2013 n/a tbc tbc CT
PRACTICE BASED SERVICE
Specialist Palliative Care
St Joseph's Hospice
01/04/2013 31/03/2014 1 YEAR tbc CT
PRACTICE BASED SERVICE
Termination of Pregnancy Service (TOPS)
BPAS 01/04/2013 31/03/2014 1 YEAR tbc CT
QIPP/REFERRALS MANAGEMENT
Gynaecology n/a 01/11/2013 n/a tbc tbc CT
Projects to move services from acute setting into the community.
These CTs are important for the
delivery of QIPP savings.
Cardiology, Dermatology and Minor Surgery are currently provided as practice based
services.
QIPP/REFERRALS MANAGEMENT
MSK n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Cardiology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
ENT n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Ophthalmology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Dermatology n/a 01/11/2013 n/a tbc tbc CT
QIPP/REFERRALS MANAGEMENT
Minor Surgery n/a 01/11/2013 n/a tbc tbc CT
120
DIAGNOSTIC SERVICES
MRI In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
Retendering of the LDS contract which is coming to an end. NB. Contract Values are for
Newham CCG 2012/13; because of local referral patterns the type of
services procured using AQP tender and Terminated
(redistributed to other contracted providers) will vary for other NEL
CCGs.
DIAGNOSTIC SERVICES
ULTRASOUND In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
BP+ECG In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
ENDOSCOPY In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
Audiology In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months AQP
DIAGNOSTIC SERVICES
DEXA Scan In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months T
DIAGNOSTIC SERVICES
X RAY In Health Ltd 01/04/2007 31/03/2014 7 Year 3 months T
URGENT CARE CENTRE
Urgent Care Centre
n/a unknown 30/11/2013 unknown notice served
CT CT already underway; UCC
Contract expected to complete contract mobilisation by Nov2013
MENTAL HEALTH Mental Health Service User Involvement
Hestia Housing & Support
01/04/2013 31/03/2014 1 YEAR 12
months CT Retender because contract is
ending. CT is recommended as the services
cannot easily be redistributed between other contracted
providers.
MENTAL HEALTH Mental health advocacy
Mind in Tower Hamlets & Newham
01/04/2013 31/03/2014 1 YEAR 12
months CT
MENTAL HEALTH
RAID (Rapid Assessment Interface and Discharge) Pilot
Pilot Project 01/07/2013 n/a 9
MONTHS none ST
New Enhanced Psychiatric Liaison Service Pilot
COMMUNITY SERVICES
End of Life Care tbc tbc 31/03/2014 tbc tbc CT Retendering of existing services
NB status of 13/14 contract is to be confirmed
121
COMMUNITY SERVICES
Cancer Support CYANA 01/01/2013 31/03/2014 9
MONTHS tbc ST
Contract has expired, single tender waiver to be signed to allow for
extension covering the period until a competitive tender can be
completed
COMMUNITY SERVICES
Diabetes Education
n/a 01/12/2013 n/a tbc tbc TQ Project to enhance Diabetes
services
COMMUNITY SERVICES
GP Cover for Nursing Homes
GPs (6-7 in Newham)
01/04/2014 n/a 1 year n/a CT Previous a LES. Services will be reviewed and then re-procured
based on the outcome.
CONTINING HEALTHCARE
Domiciliary Care
tbc 01/12/2013 tbc tbc tbc AQP
AQP started and process being agreed with DH. Procurement managed by Supply 2 Health with support from Shaju Jose.
PATIENT AND PUBLIC ENGAGEMENT
Forum for Health and Wellbeing
01/01/2013 31/03/2013 9
MONTHS n/a ST
Contract has expired, single tender waiver to be signed to allow for extension covering the period until a competitive tender can be completed
122
Appendix G. Activity Trends
123
124
125
126
0
1000
2000
3000
4000
5000
6000
7000
April May June July August September October November December January February March
Atte
nd
an
ce
s
First OP Attendances
Gp First Attendances 11/12
Gp First Attendances 12/13
GP First Attendances 13/14
C2C First 11/12
C2C First 12/13
C2C First 13/14
Any Other 11/12
Any Other 12/13
Any Other 13/14
127
128
129
130
131
132
Appendix H. Details from Report on Newham Health Debate 2010/11
6.1.20 Improve the health services generally More GP's, more District Nurses and also improve Newham General Hospital.
The single important thing is to help people in Newham is to improve the health service.
Keep trying to improve.
To be more helpful in A.E. I attended this department on 26th November 2010 and felt I was a trouble to them, they then sent me to Whipps Cross and that was "very good".
In my point of view more staff may need for an Accident and Emergency Department and Maternity (labour) ward.
A good GP.
It is important that the NHS service has more responsibility and provides good treatment for all of the Newham residents.
Give accessible and reliable health service.
Better NHS service.
We need good NHS doctors. We need to get rid of GPs like Doctor Ahmed in Westbury Terrace in Forest Gate.
Improve NHS to be equal to private health care.
We need more hospitals and more ambulance services.
By improving the cleaning standards of the hospitals and making medication cheaper to buy.
Build more hospitals and more GPs. 6.1.21 Provide quicker / set up appointments at earlier date Parents could reach a doctor instantly and quickly.
Improve GP appointments as it is very hard to get an appointment, all you get is an answering machine.
Waiting time for hospital appointment is too long.
Speed of consultations and treatment.
Fast appointment
We need more change in the GP appointments system.
Make it possible to book a doctor's appointment when you need one.
Able to get an appointment within four weeks of contacting them.
Reduce A&E waiting times.
Make it possible to get a GP appointment within a week. Newham Health Debate: 2010/2011 58 The staff at the hospital should improve the long waiting times.
Waiting time for appointments is too long. My husband has been waiting for 14 months for his catheter problem to be sorted out.
Foster relationships between doctors and patients, so that it is not just about treatment. Also, quicker treatment of people when there is something wrong with them. I have had health issues for nearly a year, which could have been sorted in 6 months if the waiting list was not so long! 6.1.22 Put facilities in local parks By have aerobic sessions in local parks available for the local residents and encourage the youth as well as the old to come along every morning.
Make parks more accessible to families e.g. more toilets, sitting down areas and play areas.
Improve local parks, install more fitness machines
Put basic gym equipment in parks.
133
6.1.23 Improve customer service in health service Make staff respectful as if they are doing you a favour.
Better access to GPs i.e. clear information from them and less condescension from General Practitioners.
Offer a friendly service so people are not reluctant to visit G.P.
Treat people as equals, especially the mentally ill.
Be more respect of patient’s needs.
We need more qualified staff that care and are polite. Also, more rights for patients. 6.1.24 Improve access to services (i.e. waiting time, opening times) Make it easy to get an appointment with the doctor as well as with the hospital.
To be able to see a doctor in less than a week. I made an appointment on the 9th and the date they gave me was to see the GP was the 21st.
Easier access to doctors and not G.P.
Open market street health centre, so that I can access a G.P without having to take time off work.
Good GP's needed and surgeries should be open longer with good doctors giving appointments.
Improve response times e.g. physiotherapy, scans and consultant appointments, this following an accidental fall on 28/08/10. The response times for serious injury have not been responsive to the patient’s needs.
I am studying in Newham and would like to be able to use the facilities here.
Easy access to drop in centres.
Make appointment easy access.
Get rid of the GPs that have low availability of appointments and get more Doctor Practices like DMC.
The walk in centre is difficult to access. Reduce the queues when people visit the hospital.
Keep the chemists open during Thursday and Saturday afternoons.
Access to GPs opening times and closing times should be 8.00am - 8.00pm (Monday - Sunday).
Employ more staff and improve the training, so that the waiting time will be reduced.
Able to see the GP Whenever possible. See the one who is most familiar with your history.
Reduce waiting times.
Longer opening times for GP and chemists.
Better access for appointments at GP surgeries.
GP to be opened on Saturday, as its quite difficult for people who work to get a day off to see a doctor.
Make seeing a doctor easier. The surgery appointment system is useless; usually you can't get an appointment for days. Thus, have to book in as an emergency patient.
In Newham we should introduce a 24 hour pharmacy service as it would be very helpful. The pharmacy we have now closes early, so if someone becomes ill and is in desperate need for medicine they are unable to buy as the shop is closed. If we had a 24 hour pharmacy people could easily get medicine at any time and this would make a massive improvement with everyone's general health.
Build more hospitals.
Hospital access for children from first born to 18 years old.
Reduce waiting time for GPs and hospital appointments.
Improve access to General Practice; the lack of access at convenient times for people who work is a scandal. This would also take pressure off other sources of primary care e.g. the urgent care centre.
Good access to health services when required
Improve access to GPs
134
More walk-in facilities (e.g. sexual health clinics for over 25's) More surgeries and better opening hours i.e. weekends 6.1.25 Encourage people to improve communication / listen Talk and listen to them as communication is so important, yet I feel there is a lack as listening is becoming less common.
Supervise GPs and tell them to take an interest in patients and not the time.
Listen.
Take time to listen and don't rush us in case we have forgotten something.
Listen and give more time.
To listen to the people's concerns.
6.2 Improving health services 6.2.1 Improve access generally (i.e. waiting times, hours) Reduce waiting times.
Less waiting times in A & E Newham. Do not book in 20 patients at 9.30am for clinics and then doctors do not turn up until 11.00am and then to be told why the delay, so if you have another appointment you do not miss it (this happens time after time). Cut down staff at clinics that spend their day walking about with a file or paper in their hands and just chatting amongst themselves.
Reduce waiting time to see a GP and reduce waiting time to see someone in a Walk-In-Clinic.
Cut waiting times.
Easier accessibility to GPs.
As a Newham resident, I do not use Newham based health facilities because of the poorer health outcomes. The Primary Care Trust (PCT) and Newham University Hospital should improve their reputation by raising their standards and raising the health standards of residents in line with those from more affluent areas.
Less waiting time in Accident and Emergency Department.
Making sure appointments are not cancelled at hospitals.
Dentists are too expensive and we wait too long for appointments.
When I had the flu I was very weak. I called the doctor and the receptionist said to call the next day as all the appointments were booked. The thing I didn't like was that they never gave me any medicine and just gave me paracetamol. I tried all the cold remedies but they never worked.
Improve waiting time for appointments at my GP.
Calling up for appointments should be improved, it should be improved to provide more appointments. There should be more confidentiality with the receptionist, as I think some details should only be discussed with your doctor.
It is hard to get an appointment with the dentist even when my children need to see the dentist.
Reduce waiting times and educate people.
I cannot get an appointment straightaway.
Provide more GP's and more flexible opening times.
Improve A&E waiting times to a minimum and not 24 hours or 36 hours in some cases.
The waiting time in Newham hospital is too long, so I go to King George Hospital to get seen to quicker.
I am always contacting the dentist to make an appointment but all I get is the voicemail.
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More service for GPs and an out of hours service.
Make more GP's available during the weekend. The GP should try to help when one has a cold and not only to be sent home with paracetamol. Organise more fitness events for families to promote healthy lifestyle.
To see a GP in seven days or less because it seems it is taking longer to see a GP.
Instant appointments for mediation and consultation.
Doctor's surgeries should open on Saturdays or late evening once a week.
Improve the way the public have access to their GPs and other doctors as well as hospital services.
Opening times of surgeries.
Better cleanliness and improve parking for A&E at night as I am a single disabled person.
Services to be more readily accessible in times of emergencies, without a lot of waiting time.
Improve customer services and waiting time in hospitals.
I think we can do a lot to improve health services in hospitals and G.Ps.
Open services on Saturdays and two hours on Sundays. Have advice centres about health within your surgery and don't ignore patients when they are talking about their health.
Better time keeping in hospitals. For example, if the appointment time is 10.00am then make sure the doctor, nurse or technician are there on time.
Quicker blood test results.
To make appointments quicker.
Keep to your time at the A&E and blood testing.
To get an appointment with your GP as soon as you need it. To make home visits for those unable to visit the doctor i.e. the elderly. Also to provide information on health care for those people in the community.
Reduce waiting time to see a consultant.
Personally, I had a few problems to get appointments to see the G.P (serious cases). Maybe provide more research about local surgeries and local G.P's. It is a good way to improve services or change some aspects.
We need more doctors and nurses to cut some of the waiting times in hospitals.
The A&E waiting time is very long. When people arrive they need to see somebody. The waiting time has to be improved. Also, improve time to see specialists in hospitals and waiting time for ultrasound and MRI CT scan.
Cut down on waiting time.
Reduce waiting time in hospital and GP surgeries. Ensure correct medication is given to patients.
Maintaining appointment times.
Improve access to GP surgeries.
G.P appointment days and times of availability.
Reduce waiting times with GP's and hospitals.
Make health services seamless. I had a baby 16 months ago and had to take him to the Vicarage Lane Clinic to have him weighed and take him to the doctor's to be measured, a waste of my time
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and the GP's resources. Make the services and times more flexible as it is difficult to get appointments when you work.
G.P's should stick to the appointment times and not make us wait.
GP's should allow more than 5 minutes per patient as they can accurately know how much time each patient requires. We need G.P's and doctors to address the patients as soon as possible. The long waiting list makes patients depressed.
As soon as possible make an appointment.
To be able to see the GP more quickly.
The response times, especially physiotherapy.
Maintain the positive attitude that is currently in people being able to contact their GP. Maintain health checks and discussions between nurses and the general public.
Make access to GP's better as at the moment as it is not always possible to get through to a GP when you call. The advance booking is not always helpful.
Increase efficiently by investing in improved management framework (e.g. better computerised systems etc.)
GP surgery waiting time be curtailed, same day access to GP.
In emergency wards is needed so that the staff actually realise that it is an emergency. I was with one of my friends in an emergency and it took us three hours for someone to see me.
Improve waiting time at the health centre and hospital.
Telephone response to GP's surgery quicker than at present. Access to A&E quicker if needed after surgery hours.
Improve waiting times at hospital.
Easier access to GP if needed after my own GP is contacted after normal surgery hours.
Quicker appointment.
The doctor's surgery needs more information and advice. Doctor's should care more about patients.
More time available for working parents to see their GP when required.
Receptionists need to be improved. Doctor’s appointments are very bad.
I like to have quicker appointments, dentist has a long waiting list and also elderly people should have eye tests once a year.
Shorter time for appointments.
Improve waiting time at hospitals and also improve the appointment process at GP surgeries as you have to wait too long.
Waiting time.
Improve waiting time in hospital. We need more GPs in the area.
Improve appointments at GP surgery.
Reduce the waiting time as I was waiting less than three weeks to see a doctor and waiting less time at hospital. I went to hospital with a broken wrist and waited four hours before I was even looked at.
Try to extend longer hours during the week and weekend for medical services for people who are at work all day.
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Make it easier to see your own doctor. I had appendicitis and I couldn't see him so in the end I saw another doctor and at that point I was in agony and scared. I am 75 and I live alone. I rarely go to the doctors unless they send me an appointment.
Reduce waiting time hospitals.
More flexibility to GP appointments for full time employed residents.
Ensure emergency appointments at the GP are available for children. There is never an appointment available the same or next day and it is always for the following week that is not good enough!
Don't make hospital appointments from 9:00 am when the doctors and some nursing staff don't get there till 10:00 am. The local blood test clinic on Appleby Road used to have one person taking blood from 7:30 am - 4:00 pm now we have two people taking blood from 7:30 am - 11:00 am, but some people cannot get there at that time. It hasn't improved the service as we are there a lot longer waiting to be seen to. Reduce hospital waiting lists.
Less waiting time.
Less waiting times for appointments and doctors.
People have to wait too long at A&E and at their doctor's surgery.
To have shorter queues and more doctors to be there.
According to my knowledge the GPs are treating the symptoms, but they should treat the cause of the illness, they probably could prevent the most dangerous diseases.
Better hygiene and friendly staff.
By making doctors to be available during the weekend.
GP, hospital and more access for emergency appointments at GPs.
Easier access to GP because when you phone you either cannot get through or all the appointments are booked and you have to call another day.
Make the staff work more efficiently because half of the time in hospitals they are always chatting and don't seem to be working, yet there are people queuing up. Most of the time it's irrelevant chatting.
Better A&E waiting time and services.
Continue to make accessible by extending time/days-for GP's, clinics etc. Continue to make accessible by extending time/days for GPs and clinics.
GP waiting time needs to be improved.
Make appointments quicker.
Easier access to GPs for people that go to work i.e. late nights and Saturday surgeries. Quicker appointments after referral to hospital.
Cut waiting times and referrals.
Make appointments at the GP easier to make and not have to wait two weeks to see the doctor.
Better access to GP as it takes too long to wait for an appointment.
Improve hospitals waiting times.
Make it easier to get a doctor’s appointment (two weeks waiting).
It takes too long to get an appointment to see a GP, why can't they make it easier?
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Reduce waiting time for appointments.
Reduce waiting time.
Open more hours.
Better access to GP.
Appointment and waiting times.
Cut down on waiting time for access to GP and hospital appointments.
Flexible appointments for working people. Cleaner rooms.
Waiting times.
Reduce waiting time in hospitals.
Easier access to GPs.
Reduce waiting times.
Waiting time for hospital appointments take too long. Supply transport for patients going there and back.
Improve waiting times.
Improve waiting times both in hospital and GP settings as the waiting time in Newham Hospital is far too long.
Improve waiting time GP surgeries.
In Newham Hospital, the A&E Department waiting times to see the nurses take long to see even if you are in a serious condition. Have a time slot to see patients with health conditions, emergency or accidents.
To improve appointment times e.g. to be seen sooner.
Reduce A&E waiting times.
Increase GP surgeries working hours from 8.00am to 8.00pm.
Reduce waiting time of GP surgeries.
It takes too long to wait for appointments.
We need shorter waiting lists, quicker appointments (less than 2 months). This is because too many cancellations are made by services due to lack of care/not friendly towards patients.
Make sure that when we have an appointment (at a certain time), then we get served at the right time, as we wait far too long to get served.
Easier to access GP'S.
Have weekend opening for GP's and blood taking centres.
Stop hospital waiting.
Improve waiting times at the GP'S surgery and have more time with GP's.
Improve waiting times in GP surgeries.
Improve appointment times.
Shorter waiting times for outpatient appointment
Shorter waiting list for outpatient appointments.
Improve waiting times in hospitals.
Improve hospital waiting times.
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Advertise more health campaigns such as blood testing, sugar level testing, Cholera tests and many more. Allow patients to access the health centre to check on their health.
The GP should employ more people to answer the phones at peak times. Ensure all GP surgeries have internet appointments/repeat prescriptions.
Improve the surgery waiting times. Allow, 15 minutes with the doctor, as most people need this time without feeling rushed.
Make it accessible to make an appointment with your preferred GP when you really need him/her. Make hospital referral appointments quicker than the normal 2-3 months.
I still find it almost impossible to see my GP. It has to be 'an emergency' to get a quick appointment. Its first come first served and I can never get them on the phone. I work full time and have to drop everything for a non-urgent consultation, it's so frustrating.
Quick access to specialist doctors, as needed e.g... Children to be seen by a pediatrician rather than only by GP's.
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Appendix I. August 2013 Community Reference Group – Feedback Notes
1) Improving primary care The wider issues
Reality is we are under doctored in Newham, so we would struggle to meet demand even if we can make services accessible. CCG can’t recruit doctors because of conflict of interest but can work with NHS England.
Blockages to GP access are concentrated at certain times rather than evenly across the week, and we may actually have more capacity than appears at first site, but not at the times we are offering it. Are there ways of addressing this e.g. by working with national bodies to remove the requirement for offering appointments within 48 hours, or by offering people an option for more flexibility if they agree to wait longer?
Confidence in joined-up nature of care in community.
Appointments Walk-ins get better than booking via making appointment.
Wordsworth Practice – have call back / phone triage (much better).
Do people get given alternatives to GP appointments?
Online booking stopped in some GPs.
Automated booking system.
Telephone access is a problem but more resources needed in the system.
Internet bookings – what proportion of the population would / could use it? It is currently a cumbersome system, with no message about what’s happening or how the queue’s progressing (this may be linked to the PFI agreement).
We need to consider how to make patients understand cost of DNAs (name and shame), DNAs at appointments is 10-11%.
Answer phone for small hours of the night, even if it’s not reasonable or financially viable to have a human receptionist at that time.
different phone systems in doctor’s surgeries. Can we research to identify the best practice and then stream-line, perhaps by using the cluster system and / or working with NHS England commissioners.
Education and information Information about what alternatives there are to A&E e.g. Urgent Care ‘get people going to
the right place’: paper leaflets, Newham Mag, radio debates, press stories, Ads, Facebook.
Churn – population turnover – can we do anything to ensure people moving into the borough know about the local NHS culture.
Customer service and experience Receptionists: customer service training, triaging – not clear about training / right to do this.
Text reminders: great, well under way (for people with mobile phones).
Blood tests Could these be done at GP surgeries, would this save money and can CCG investigate?
Can CCG reduce duplication of tests by GPs and in hospital?
2) How can commissioners promote use of the range of
services in the community as an alternative to A&E? Information and education
Information leaflets about minor ailment services available at Pharmacy.
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Make sure all the different communities in Newham understand the NHS system.
Information to employers in Newham about alternative services to A&E.
Prioritise information and communication for maximum impact.
Vital information gets hidden in all the other leaflets.
Media and communications – get the message out about what services are appropriate for what.
Link with Darren as Healthwatch Newham and Migrants Right Network.
Commissioning decisions Commissioners need to go with the best and competent providers.
Ambulances being used unnecessarily – it’s usually older people with ambulance crews being unwilling to risk waiting for a doctor. There was an experiment in Kent and in Newham, we can already provide, for example, the Rapid Response Team. We also have new facilities for ambulance crews to consultant with GPs for urgent advice. We would need research to know if this is cost effective.
Ambulance – send out nursing care than taking into hospital.
3) Ideas for reducing emergency admissions for people aged 20-29 Story behind the data
Why and when are they going?
Need the real story behind the data – more information about this group of patients (who are they, what is their background, what are they going to A&E for etc.).
How can we find out about why so many young people attend A&E – can we work with Schools, use University research teams, build a better website to find out who they are?
Work related – 29 year olds usually under pressure to be back at work – GP practices lots of waiting
time for appointments so this might be why this group go to A&E.
Employers might also think it’s more serious if the employee goes to A&E.
Often it just might be a one off visit so it’s much easier to just go to A&E.
Information about alternatives to A&E Need more practices like Vicarage Lane Surgery in the borough.
Does this age group know about Vicarage Lane Surgery – we should ask them if they use / prefer this type of service.
Check numbers of people aged 20-29 using Vicarage Lane.
More use of minor aliment scheme to free up capacity.
Ideas for promoting alternatives to A&E Texting information and new technology.
Those not registered with a GP – know about need to register.
Target education to your audience.
More information available e.g. – use prescriptions to give messages.
Encourage self-care.
Life skills classes in secondary schools to education about use of A&E.
Healthwatch also wants to engage young people so we can work together – use the Young Mayor.
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Appendix J. LBN Survey Results
Newham Annual Resident’s Survey 2012
Content:
• Methodology
• Sample profile
• Areas of personal concern
• Local area
• Community cohesion
• The Council and service delivery
• Civic engagement
• Immigration
• Housing
• Olympics 2012
• Young people’s survey
Methodology:
• LBN is dedicated to hearing its residents’ views on the council & the borough as a place to live
• It has undertaken an annual survey of residents since 1991, which aims to:
• Find out residents’ personal concerns in relation to crime, health & other social issues
• Rate residents’ perceived image of the council
• Measure residents’ satisfaction with local services
• Gauge opinion on other important issues such as community cohesion & anti-social behaviour
• The results are used to help monitor the council’s & its partner agencies’ performance, as well as to
inform service planning & the assessment of council priorities
• The findings are compared with those of Londoners generally, using the annual Survey of Londoners
which contains the same ‘core’ questions. The Survey of Londoners was carried out using the same
methodology in October/November 2012.
Results Summary: Areas for Improvement
• Fewer residents regard street robbery and intimidating behaviour as something that bothers them
• Satisfaction with the local area continues to rise since 2010
• Satisfaction with the Council has increased significantly since 2011
• Residents are also significantly more likely to feel that LB Newham provides value for money and
would be more likely to speak highly of the Council since 2011
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• Satisfaction with most Council services has increased since 2011, especially parking services, refuse
collection, the housing benefit service, and the Council Tax benefit service
• Users of Council services are more likely to be positive about the service
• There is increased awareness of the name of the Mayor of Newham since 2011, and fewer say they
do not know about what the Mayor is doing for Newham
Results Summary: Areas for Consideration
• Crime and litter are bigger concerns for Newham residents than Londoners generally, and these are
increasing as concerns
• Crime is increasing as a concern
• A low level of crime, clean streets and job prospects are priorities for Newham residents
• Far fewer residents feel they can influence decisions affecting their local area, especially in Royal
Docks and East Ham
• Fewer residents feel informed about various aspects of the Council, including how well they are
performing
• There has been an increase in the proportion who find it difficult to get through to the Council on
the phone
• Satisfaction with the Council Tax collection service has decreased since 2011 and is far lower than
found across London as a whole
• Fewer residents feel immigration is good for Newham than in 2011
• There has been a reduction in residents believing there will be long term benefits from the Olympics
since 2011
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Appendix K. Draft Terms of Reference Information Management and Technology and Working Group
NHS Newham Clinical Commissioning Group Information Management and Technology Working Group
Terms of Reference
(As Adopted on ● ● 2013)
1) Introduction
The IM&T Commissioning Committee is established in accordance with Newham Clinical Commissioning Group’s constitution, standing orders and scheme of delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the clinical commissioning group’s constitution and standing orders
2) Membership
The committee shall comprise the following members:
Core Committee (voting) members
1) The NCCG Clinical Lead with responsibility for IT Commissioning, who shall be Chair
2) NCCG Head of Performance and Information, who shall be Deputy Chair
3) NCCG Governance and Risk Manager
4) NCCG Primary Care Development Lead
5) NCCG Localities Lead
6) NCCG Integrated Care Programme Lead
7) NCCG Finance team representative
Attending (non-voting members)
8) NELCSU Newham ICT Lead (or nominated representative)
9) NELCSU NELIE Project team Lead (or nominated representative)
10) Barts Health NHS Trust ICT Lead (or nominated representative)
11) East London Foundation Trust ICT Lead (or nominated representative)
12) London Borough of Newham ICT Lead (or nominated representative)
13) A minimum of two clinical or managerial representatives from Newham Primary Care GP Practices/List based providers
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These shall be the permanent members of the committee. Other Clinical Leads, CCG officers, members of NELCSU, Clinical Effectiveness Group (CEG), Emis and other relevant officers or provider representatives may attend by invitation and according to the agenda.
3) Secretary
The Head of Governance and Engagement will nominate a deputy to provide secretarial support to the committee. The secretary will be responsible for supporting the Chair and Deputy Chair in planning agendas, distributing papers in advance of the meeting, taking minutes and following up meetings with a summary of actions. They will also be responsible for advising the committee on terms of reference and operating procedures in accordance with best practice, the provisions of the constitution and external regulations.
4) Quorum
The quorum sufficient for conduct of business will be four members at least two of whom should be voting members and one of whom shall be the Chair or Deputy Chair.
5) Frequency and notice of meetings
The meetings shall be held monthly on a schedule to be agreed by the Chair in consultation with the Secretary. The schedule of meetings shall be agreed for the financial year and to fit with other key committees or groups to whom the Committee reports and/or has a close working relationship.
Special meetings can be called outside of the schedule by the Chair and Deputy Chair and with at least 48 hours’ notice.
6) Remit and responsibilities of the committee
The purpose of the committee is to ensure that a coordinated approach to IT strategy, commissioning and procurement is developed across the CCG and in conjunction with relevant provider organisations with the aim of enhancing patient care via seamless integrated and/or compatible IT systems. The group also has a responsibility for supporting and promoting IT as an enabler for primary care development.
The committee has responsibility for:
1) Developing and implementing an IM&T strategy and work plan for Newham that is in synergy with our main local providers and supports reducing health inequalities and improving patient access
2) Managing by way of devolved responsibility the Newham CCG annual ICT budget and assessing and agreeing IT spending priorities in-year. *The Governance and Risk Manager shall be the NCCG budget holder for the non-core element of the Primary Care ICT budget
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3) Working in partnership with other NCCG Commissioning Committees, Transformation Programmes and other partners as required to support relevant IM&T developments and priorities pertinent to the work of the committees
4) Supporting equity of IM&T development, infrastructure and training within primary care
5) Acting as the primary forum for discussion and communication between Newham CCG and the NELIE project team regarding future strategic developments for the NELIE system from a Newham perspective.
6) Supporting improved patient access by using IT to provide online access to patient care records, appointments and repeat prescription ordering
7) Supporting national programmes of working towards a paperless NHS
7) Reporting Relationship
The Committee reports to the Primary Care Transformation Programme. It will provide a monthly written report summarising actions taken and recommendations made by the Committee.
The Committee will also make available these reports to the Executive Committee via the Primary Care Transformation Programme.
The committee will review these reporting arrangements every six months to ensure that they remain in line with wider CCG objectives and governance arrangements.
8) Policy, best practice and conduct of meetings
The Committee will ensure that papers are provided 4 working days in advance of meetings and that minutes and follow up actions are available within 3 working days after the meeting.
The Committee shall act in accordance with the principles of good governance as set out in the CCG’s constitution and behave in accordance with the Staff Charter as agreed in July 2013.
The Committee shall develop an annual work plan that will be updated as required.
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Appendix L. Draft Terms of Reference Newham Education and Training Academy Board Draft 1
NETA Background
NETA is the educational arm of Newham CCG. It is an umbrella group bringing together all primary care educational stakeholders to ensure a co-ordinated multi-professional strategy is developed and implemented.
There are 8 key work streams in NTEA
1. Developing and implementing multi-professional workforce planning, education and training strategy for Newham CCG
2. Support clinical leads and cluster leads and other primary shapers in spreading good practice
3. Running an accreditation scheme to accredit educational events, particularly small group and practice based work to develop good educational practice
4. Support professional appraisal 5. Oversee Friday educational events 6. To develop a portfolio of educational events and partner providers 7. To support GP VTS as the GP School changes
8. To work with practices and clusters to create a working environment that encourages trainees (GPs, nurses and other staff groups) to stay in Newham after their training is completed and to attract qualified professionals to Newham.
Role of Board
Responsibility for developing an effective educational strategy covering all professional groups within Newham CCG.
Responsible for ensuring strategy is implemented
Responsible for monitoring and tracking strategy
Supervision of the work of the NETA core group
Membership
Chair, CCG Education and training lead
Vice Chair
LETB primary care forum reps, CCG educational support manager, CCG nurse education lead, practice management rep, VTS programme director, Appraisal lead, Primary care strategy lead,
Quorum
One third of the membership
Frequency of meetings
The Board will meet 3 times per year . Extraordinary meetings may be called by the chair or CCG support manager
Notice of meetings
A yearly calendar of meetings will be produced to allow members to plan their time effectively. Agendas and papers will be circulated 1 weeks before a meeting.
Reporting responsibilities
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The NETA board will report to (The Primary Care Strategy Transformation Programme
Authority
We need to agree if there will be an education and training budget (including staffing costs) managed by this Working group.
(To be completed by XXXX)
Sub committee
The NETA core group is a sub-committee of the Board and will meet every 1-2 months as required to take operational responsibility for strategy implementation and will comprise of the CCG Education Lead (Chair), Primary care forum reps, CCG support manager and nurse educational lead.
The core group will be responsible to the NETA board.
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Appendix M. NHS England – Commissioning GP Premises – October 2013 Group
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Appendix N. Information provided to Newham CCG on Local Enhanced Services (LES) in January 2013 + update for 14/15
Primary Care Trusts (PCT) will cease to exist from the 31st March 2013. Under the terms of the Health and Social Care Act (HSCA) 2012, the responsibility of these agreements will transfer to the following organisations from the 1st April 2013:
o The Clinical Commissioning Groups (CCG) o The Local Authorities (LA) o The National Commissioning Board (NCB)
The extension letter you received from the PCT today will mean that the new organisations have instructed the PCT to extend the service from 1st April 2013 to 31st March 2014 (with a 6 month review). The new organisations will therefore be legally responsible for the operation and payment of invoices from 1st April 2013 onwards.
Below is a table showing the various services GP Practices/List-based providers and pharmacies have agreed to provide in Newham in 2012/13. This table will explain who the new responsible organisation will be for each service and whether this service has been extended by the PCT for 2013/14. For services not extended by the PCT via this communication, the new organisations will be in contact with you in due course.
Note: DES and NES agreements included here for information purposes. These agreements are the responsibility of the NCB from 1st April 2013.
No. Name of Service
Who is the new receiver
organisation from 1st April
2013?
Was the service
operational in 2012/13
within PCT area?
Has the 2013/14
extension been
completed by the PCT via
this extension letter?
Who will communicate
2013/14 intensions to the provider?
2014/15 CCG update
Local Enhanced Services (LES)
1 Anticoagulation LES with community pharmacists
CCG YES YES PCT - Done To continue
2 Chlamydia screening LES LA YES NO LA NA
3 Contraceptive Implants LES LA YES NO LA NA
4 Diabetes LES CCG YES NO CCG
To continue with further
developments
5 Direct Cataract Referral Scheme LES with opticians
CCG YES YES PCT - Done To continue
6 Directly Observed Treatment
Of TB Scheme with community pharmacists
CCG YES YES PCT - Done To continue
7 IUCD LES LA YES NO LA NA
8 Management of Problem Drug Use (Shared Care) LES
LA YES NO LA NA
9 Minor Ailments Service LES with local pharmacists
CCG??? YES YES PCT - Done To continue
10 Needle Exchange LES LA YES NO LA NA
11 NHS Health Check LES LA YES NO LA NA
12 Palliative Care Services LES CCG NO NO CCG ?
13 Sexual Health LES LA YES NO LA NA
14 SMI-DEPOT LES CCG YES YES PCT - Done To continue
15 Smoking Cessation LES LA YES NO LA NA
16 Supervised Consumption LES LA YES NO LA NA
Directed Enhanced Services (DES)
17 Alcohol DES NCB YES NO NCB NA
18 Childhood Immunisations
DES NCB YES NO NCB NA
19 Extended Hours DES NCB YES NO NCB NA
20 FLU DES NCB YES NO NCB NA
21 Minor Surgery DES NCB YES NO NCB NA
22 Patient Participation DES NCB YES NO NCB NA
23 Violent Patients DES NCB YES NO NCB NA
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Appendix O. List of Outreach Services presently contracted by Newham CCG from Barts Health
Not available at this time.
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Appendix P. Cluster Member Practices, Representatives, and Leads
Cluster meeting takes place 1st Thursday of every other month @1pm, Market Street Health
Centre.
Cluster Lead: Rotational Chair as no nominations
Cluster meeting takes place 4rth Tuesday of every month @1:00 pm WKH.
Cluster Lead: Dr Barry Sullman & Dr Stuart Sutton
Code Central 3 & South 3 F84052 Essex Lodge (Dr Higgins)
F84681 Balaam Street (Dr Al-Mudallal)
F84679 Upper Road Medical Centre (Dr Zakaria) F84727 Dr S.Qureshi's Practice (Dr Qureshi)
F84734 Boleyn Road Practice ( Dr Rafiq)
F84641 Birchdale Road Medical ( Dr BK Sinha)
F84642 Sinha Medical Centre & Teaching Practice (Dr AK Sinha)
F84032 Barking Road Medical Practice (Dr Inayatullah)
Y02928 The Practice - Albert Road (Dr Mukherjee)
F84093 Tollgate Health Centre (Dr Watt)
F84700 DMC Health Care 1 (Dr Jane Muir Taylor)
Cluster meeting takes place 4th Thursday of every month @1pm, Room F54, Vicarage Lane Health
Centre
Cluster Lead: Dr Prasanta Bhowmik
Code North West 1 Y02823 DMC Vicarage Lane (Dr Jane Muir Taylor)
F84699 Stratford Medical (Dr Brohi)
Y00225 Vicarage Transitional Team (Dr Kensah)
F84009 Stratford Village Surgery (Dr Shah)
F84077 Dr Samuel & Dr Khan's Practice
F84730 Dr PCL Knight's Practice
F84661 West Ham Medical Practice (Dr Bhowmik)
F84111 Abbey Road Medical Practice (Dr Yates)
F84022 Stratford Health Centre (Dr Chang)
F84672 Leytonstone Medical Practice (Dr A Qadri)
Code Central 1&2 F84050 Boleyn Medical Centre ( Dr Chalabi)
F84735 The Azad Practice (Dr Azad)
F84750 The Project Surgery (Dr Jones)
F84669 Newham Medical Centre (Dr Ahmed)
F84010 St Bartholomew Surgery (Barking Road, Dr Patel)
F84004 Market Street (Dr Waugh)
F84053 Greengate Medical Practice (Dr Kalhoro)
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Cluster meeting takes place 2nd Thursday of every month @1pm, Claremont Clinic
Cluster Lead: Mohammad Naqvi
Code North West 2 F84706 Lord Lister Health Centre (Dr Swedan)
F84086 Lord Lister Health Centre (Dr Driver)
F84631 Lord Lister Health Centre (Dr Abiola)
F84097 Claremont Clinic (Dr Wood)
F84742 The Summit Practice (Dr Yesufu)
F84724 Woodgrange Medical Practice (Dr Y Patel)
F84736 Church Road PSU (Dr Davison)
F84707 St Luke's Health Centre (Dr Davison)
F84749 Carpenters Lane (Dr Davison)
Cluster meeting takes place 3rd Monday of every month @7pm, East Ham Care Centre
Cluster Lead: Dr Saidur Rahman
Code North East 1 F84658 Dr Chandra
F84671 Katherine Road (Dr Bapna)
F84660 Dr CM Patel
F84088 Plashet Road (Dr Umrani)
F84670 Westbury Road (Dr A.Ahmed)
F84091 Dr Raina Surgery
F84654 Roding Medical Centre (Dr Shetty)
F84713 East Ham Medical Centre (Dr Mandavilli)
F84729 Dr Bhadra
Cluster meeting takes place 3rd Wednesday of every month @1pm, Wordsworth Health Centre
Cluster Lead: Dr Nusrat Jabeen & Dr Bapu Sathyajith
Code North East 2 & 3 F84121 E12 Health Centre (Dr Kohli)
F84089 Manor Park (Dr Dhariwal)
F84739 Dr Kugapala
F84014 Upton Lane (Dr Shanker)
F84006 The Shrewsbury (Dr Sri-Ganeshan)
F84074 Wordsworth (Dr Nasralla)
F84741 Dr Krishnamurthy
F84070 Dr Dubal
F84740 Newham Transitional Team (Dr Duncan Trathen)
Cluster meeting takes place 3rd Thursday of every month @1pm, Star Lane
Cluster Lead: Dr Jim Lawrie
Code South 1&2 F84708 Dr Lwin
F84047 Custom House Surgery (Dr Zarifa)
F84666 Dr Ruiz
F84677 East End Medical (Dr Basu)
F84657 Cumberland Medical Centre (Dr Gonsai)
F84092 Glen Road Medical Centre (Dr Rao)
F84673 Esk Road (Dr Venugopal)
F84717 Royal Docks Medical Centre (Dr Lawrie)
F84017 Star Lane Medical Centre (Dr Patel)
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Appendix Q. Draft Terms of Reference for Cluster Development Working Group
Background/Context
The Cluster Development Working Group is established in line with the agreed governance structure
of the Primary Care Transformation Programme.
These Terms of Reference (ToR) set out the role, responsibilities, membership and reporting
arrangements of the working group.
Role and Function
Responsibilities
Develop a work plan for the development of clusters
Oversee the implementation of the plan
To develop the Reimbursement Scheme for 14/15 and ensure this is embedded in the yearly commissioning intention cycle
Ensure that clusters are engaged in the development of QIPP especially those relevant to primary care
Ensure the development of reports/reporting formats for all data to be used at cluster and practice level
To ensure that practice indicative budget statements are developed and rolled out to clusters
Develop an accountability framework for clusters
Ensure that QIPP are represented in cluster plans for 2014/15
Develop a yearly planning template to incorporate the cluster priorities for the year 2014/15
Develop a process where practices are identified for high intensity support
General
Membership and Accountabilities
Membership of the Cluster Development Working Group will include the following roles outline
below however additional members will be co-opted when required
Core Membership:
CCG Deputy Director of Delivery
CCG Clinical Cluster Leads chair
CCG Localities Manager
CCG Primary Care
CCG Programme Director-Primary care Strategy
CCG Senior commissioning manager
CCG Finance Manager
CSU Senior Manager
Accountabilities
The Cluster Development working group reports to the Primary Care Transformation Programme
The TOR and work plan of the cluster development working group are subject to the approval of the Primary Care Transformation Programme
Convenor/Chair
The Cluster Development working group will be chaired by the cluster lead chair
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Secretary
The administrative support for the Cluster Development working group will be delegated to practice
facilitators who provide the administrative function for clusters.
Frequency & Quorum of Meetings
Schedule to meet monthly.
Quorum:
Work Plan
The Cluster Development working group will develop a work plan that represent the delivery of its
responsibility outline in 2. This plan will be reviewed monthly at meetings and progress summarised
for the Primary Care Transformation Programme.
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Appendix R. Newham CCG Procurement Strategy
When making a decision about which contracting/procurement route we will use for
developing and procuring a particular service the CCG will take into account 4 key principles:
Quality
Access
Integration; and
Value for money
To enable Newham CCG to demonstrate compliance with the principles of good
procurement practice we will also ensure adherence to the following:
Transparency
Proportionality
Non-discrimination; and
Equality of treatment
Quality
The first consideration will always be the quality of service - all service
development/procurement decisions will consider the impact of the
contracting/procurement choice on the likely quality of all services that will be impacted by
the choice made.
For instance: if an increase in quality can be achieved, but how it is likely to be provided
using a particular procurement route is likely to have a negative impact on the quality of
another service, this must be included in the procurement decision making process. During
the process of deciding on the procurement route the CCG will undertake analysis of this
wider impact and this will be included in the criteria for evaluation if a competitive process is
used. The highest total quality option for all services will get the highest score. We will also
use a concept of “good enough” quality, rather than driving for absolute quality
improvements, to allow us to consider all service development procurement options that
will be acceptable under this criteria.
These considerations may well lead the CCG to choose to purchase a new service from a
local provider rather than developing the market and encouraging providers from outside
the geographical area because reducing the services provided by our main provider(s) may
reduce the viability of that provider or at least negatively impact on their ability to provide
other services.
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Access
The second most important driver for our decisions with respect to service specification and
therefore the appropriate procurement route for a service is the likely impact a service
specification will have on access to the service. Quality overrides access up to some point
but if the decreased access means that our population will use the service less than the
optimum amount then the increase in quality ceases to be more important than access.
As a general rule the more complex and acute a service the further people will travel for it.
The evidence is that for prevention services/activities individuals and their families and
carers are not willing to travel far – access/the right choice – needs to be as easy as possible.
The impact of difficult access on use of services increases with social deprivation. Thus
increasing the difficulty of access will increase health inequalities.
Therefore the CCG will seek to procure the provision of all kinds of prevention services
including management of long term conditions as close to our population as possible (ie at
multiple sites) to reduce the likelihood of increasing health inequalities. This may require the
development of more local providers of some services and the CCG will structure
procurement of prevention and management of long term conditions services to encourage
the development of local providers if this will improve the local access.
Integration
The integration of services to ensure we provide a seamless service to those with complex
illness is a priority for the CCG. Thus, when considering the route to procurement, we will
prioritise NOT increasing the number of interfaces between providers and where possible
aim to decrease the number of providers along any particular pathway of care.
In addition we recognise that generalists (e.g. GPs, practice nurses and district nurses)
provide and should continue to provide much of care outside of hospital and that these
generalists are key workers in multiple pathways. Thus when procuring new services we will
not seek to procure individual pathways of care from different providers - rather seek
providers willing and capable of providing all key pathways and able to grow the skills and
capacities of available generalist staff.
Value for Money
This also is a key driver for the CCG but we will assess the impact on using the cheapest
provider on access and integration and will be willing to pay a higher tariff where there is
significant evidence that either of these will be compromised by the cheapest provider
winning a tender. Clearly any provider that does not meet the “good enough” quality will
not be considered.
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Appendix S. Newham CCG Procurement Policy 2014
Approved June 2014 with effective date 1/04/2014
Draft Version V3
CONTENTS 1. INTRODUCTION .......................................................................................................................... 5
2. ASSOCIATED POLICIES AND PROCEDURES.......................................... 5
3. AIMS AND OBJECTIVES ............................................................................ 6
4. SCOPE OF THE POLICY ............................................................................ 6
5. ACCOUNTABILITIES & RESPONSIBILITIES.............................................. 6
6. GUIDING PRINCIPLES ............................................................................... 7
7. PUBLIC PROCUREMENT OBLIGATIONS................................................... 8
8. CONFLICTS OF INTEREST.......................................................................... 9
9. PROCUREMENT .......................................................................................... 9
10. PATIENT ENGAGEMENT IN PROCUREMENT..........................................10
11. PROCUREMENT APPROACH FOR NON-CLINICAL SUPPLY AND
SERVICE CONTRACTS.....................................................................................11
12. PROCUREMENT APPROACH FOR HEALTHCARE AND SOCIAL SERVICE CONTRACTS ………………………………………………………………………. 11
13. APPROACH TO MARKET ...........................................................................13
14. TENDERING PROCESS..............................................................................15
15. FINANCIAL AND QUALITY ASSURANCE CHECKS ..................................16
16. PRINCIPLES OF GOOD PROCUREMENT.................................................16
17. CONTRACT FORM......................................................................................18
18. SUSTAINABLE PROCUREMENT................................................................18
19. PUBLIC SERVICES (SOCIAL VALUE) ACT 2012........................................18
20. USE OF INFORMATION TECHNOLOGY ....................................................18
21. DECOMMISSIONING SERVICES.................................................................19
22. TRANSFER OF UNDERTAKINGS AND PROTECTION OF EMPLOYMENT REGULATIONS (TUPE).......................................................................................19
23. EQUALITY IMPACT ASSESSMENT.............................................................19
24. TRAINING NEEDS ANALYSIS......................................................................20
25. MONITORING COMPLIANCE WITH THIS STRATEGY / PROCEDURE....20
REFERENCES........................................................................................21 Appendices
A List of Part B Health and social services 22
B Procurement Options Brief 23
C Template to be used when commissioning services that may potentially be provided by GP practices 24
D Procurement Approach – schematic 26 E Aspects to be considered when deciding whether competitive tender is appropriate 28 F Equality Impact Assessment for this Policy 30
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1. INTRODUCTION
1.1 Procurement is central to driving quality and value. It describes a whole life-cycle process of acquisition of goods, works and services; it starts with identification of need and ends with the end of a contract or the end of useful life of an asset, including performance management. Procurement encompasses everything from repeat, low-value orders through to complex healthcare service solutions developed through partnership arrangements.
1.2 There are a range of procurement approaches available which include working with existing providers, non-competitive and competitive tenders, multi-provider models such as Any Qualified Provider (AQP) and frameworks.
1.3 Newham CCG’s approach to procurement is to operate within legal and policy frameworks and actively to use procurement as one of the system management tools available to strengthen commissioning outcomes. It can do this by:
• Increasing market capacity and meeting CCG demand requirements;
• Using competitive tension to facilitate improvements in choice, quality, efficiency, and access and responsiveness;
• Stimulating innovation.
2. ASSOCIATED POLICIES AND PROCEDURES
2.1 This policy and any procedures derived from it should be read in accordance with the following policies, procedures and guidance.
• Newham Clinical Commissioning Group Constitution
• Code of Business Conduct
• Newham Standing Orders and Prime Financial Instruction
• WELC CCG Collaborative agreement
2.2 Other legislation and guidance affecting procurement include:
• Procurement Guide for commissioners of NHS-funded services (DH, 30 July 2010)
• The Principles and Rules for Cooperation and Competition (PRCC, July 2010)
• Framework for Managing Choice, Co–Operation and Competition (May 2008)
• The Equality Act 2010 (section 149)
• The Public Services (Social Value) Act 2012
• Procurement of healthcare (clinical) services, briefings 1-4 (NHS Commissioning Board, September 2012).
• The NHS (Procurement, Patient Choice and Competition) Regulations 2013 which support interpretation of section 75 of the Health and Social Care Act 2012 (11.03.13)
• Managing conflicts of interests: Guidance for clinical commissioning groups (NHS England, March 2013)
• Section 11 of the Health and Social Care Act, 2001 requires commissioners of healthcare services to ensure patients and their representatives are involved in and are consulted on planning of healthcare services
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• Section 242 of the Health and Social Care Act, 2006 provides that commissioners of healthcare services have, in relation to health services for which they are responsible, a legal duty to consult patients and the public, directly or through representatives on service planning, the development and consideration of service changes and decisions that affect service operation.
Section 75 of the Health and Social Care Act and Section 75 of the Health and Social Care Act and Statutory Instrument National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 places requirements on commissioners to ensure that they adhere to good practice in relation to procurement, do not engage in anti-competitive behaviour and promote the right of patients to make choices about their healthcare.
• Monitor Briefing Note – Substantive Guidance on the Procurement, Patient Choice and Competition Regulations, December 2013.
3. AIMS AND OBJECTIVES
3.1 To set out the approach for facilitating open and fair, robust and enforceable contracts that provide value for money and deliver required quality standards and outcomes, with effective performance measures and contractual levers.
3.2 To describe the transparent and proportional process by which the CCG will determine whether health and social services are to be commissioned through existing contracts with providers, competitive tenders, via an AQP or framework approach or through a non-competitive process.
3.3 To enable early determination of whether, and how, services are to be opened to the market, to facilitate open and fair discussion with existing and potential providers and thereby to facilitate good working relationships.
3.4 To set out how we will meet statutory procurement requirements primarily the National Health Service (Procurement, Patient Choice and Competition) Regulations 2013
3.5 To enable Newham CCG to demonstrate compliance with the principles of good procurement practice:
• Transparency
• Proportionality
• Non-discrimination
• Equality of treatment
4. SCOPE OF THE POLICY
4.1 As far as it is relevant, this Policy applies to all Newham CCG procurements (clinical and non-clinical). However, it is particularly relevant to procurement of goods and services that support the delivery of healthcare and certain sections relate only to procurement of health and social services.
4.2 This Policy must be followed by all Newham CCG employees and staff on temporary or honorary contracts, representatives acting on behalf of Newham CCG including staff from member practices, and any external organisations acting on behalf of the CCG including other CCGs and the North East London Commissioning Support Unit (NELCSU).
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5. ACCOUNTABILITIES & RESPONSIBILITIES
5.1 Lead Manager
5.1.1 Overall accountability for procurement rests with the Chief Financial Officer.
5.2 Procurement support
5.2.1 Where it is required and considered appropriate procurement support will be provided by the North East London Commissioning Support Unit and in the case of collaborative projects by another CCG. The CCG will have systems in place to assure itself that the NELCSU’s or relevant CCG’s business processes are robust and enable the CCG to meet its duties in relation to procurement.
5.3 Authority
5.3.1 The CCG will remain directly responsible for:
• Approving procurement route;
• Signing off specifications and evaluation criteria;
• Signing off decisions on which providers to invite to tender;
• Making final decisions on the selection of the provider.
5.4 Arrangements for delegation of authority to officers are set out in the relevant Standing Financial Instructions. In the event of any discrepancy between this Procurement Policy and the SOs/SFIs, the SOs/SFIs will take precedence.
6.6. GUIDING PRINCIPLES
6.1 When procuring health care services, the CCG is required to act with a view to:
• Securing the needs of the people who use the services,
• Improving the quality of the services, and
• Improving efficiency in the provision of the services
6.2 The CCG is required and committed to:
• Act in a transparent and proportionate way
• Treat providers equally and in a non-discriminatory way, including by not treating a provider, or type of provider, more favourably than any other provider, in particular on the basis of ownership
6.3 The CCG is required and committed to procuring services from one or more providers that:
• Are most capable of meeting the needs, quality and efficiency required
• Provide the best value for money in doing so
6.4 The CCG is required and committed to act with a view to improving quality and efficiency in the provision of services, the means of doing so will include:
• The services being provided in an integrated way (including with other health care services, health related services, or social care services)
• Enabling providers to compete to provide the services
• Allowing patients a choice of provider of the services
Whilst ensuring that quality, access and efficiency are not adversely affected.
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6.5 The CCG is committed to act with a view to understanding the impact of its procurement and contracting actions on provider market(s), particularly in respect of the development and sustainability of existing providers as well as the future maturity and plurality of providers within such market(s).
6.6 Potential conflicts of interest will be managed appropriately to protect the integrity of the CCG’s contract award decision making processes and the wider NHS commissioning system.
7.7. PUBLIC PROCUREMENT OBLIGATIONS
7.1 The Public Contracts Regulations 2006 which transpose European Directives place legal requirements and procedures for awarding contracts above a certain threshold amount.
7.2 Within the EU Procurement rules, services contracts are currently divided into two categories:
• Part A - to which the full regime of EU rules apply; and
• Part B - where only some of the EU procurement rules apply.
7.3 “Health and social services” are categorised as a “Part B” service. There is a specific list of services that qualify as “Health and social services” and these are, in broad terms, services delivered by healthcare professionals (See Appendix A).
7.4 There is a statutory requirement to follow the full EU Procurement rules, where legally-enforceable contracts are to be awarded, for supply of goods and/or services with an estimated full-life value above the nationally defined value, see Appendix B, other than those specifically listed as Part B services.
7.5 Where legally-enforceable contracts are to be awarded for Part B services with estimated full-life value above the nationally defined value, see Appendix B, there is a limited statutory requirement to apply some of the EU procurement rules.
7.6 The EU Treaty principles of non-discrimination, equal treatment, transparency, mutual recognition and proportionality apply to all procurements, whether they are for Part A or Part B services. The CCG’s approach to fulfilling these requirements is described in section 15.
7.7 There is no statutory requirement to tender Health and Social services and no general policy requirement for Health and Social services to be subject to formal procurement processes. The Tendering and Contracting sections of Standing Orders and Standing Financial Instructions apply where the CCG elects to invite competitive and non-competitive bids for the supply of Health and Social services.
7.8 EU Procurement rules changed in January 2014 when the European Parliament passed the EU Directive on Procurement 2013. The key change is the abolition of the current Part A/B services distinction, leading to a requirement for all services above a €750,000 threshold to advertise in the OJEU. Failure to comply with this, such as in case of a direct award, could trigger the application of the public procurement remedies regime with the risk of the contract being declared ineffective. Newham CCG’s Procurement Policy will be updated once the UK Government enacts this in UK law, probably in September to December 2014.
8.8. CONFLICTS OF INTEREST
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8.1 Managing potential conflicts of interest appropriately is needed to protect the integrity of the wider NHS commissioning system and protect CCGs and GP practices from any perceptions of wrong-doing.3
8.2 General arrangements for managing conflicts of interest are set out in the Newham CCG Constitution. This section describes additional safeguards that Newham CCG will put in place when commissioning services that could potentially be provided by GP practices.
8.3 The template included at Appendix D will be completed as part of the planning process for all services that may potentially be provided by GP practices (either as a successful bidder in a competitive procurement process, as one of several qualified providers through an AQP approach, or via a non-competitive process from GP practices). The completed templates will be used to provide assurance to the CCG Audit Committee that proposed services meet local needs and priorities and that robust processes have been followed in selecting the appropriate procurement route and in addressing potential conflicts. It is intended that completed templates will be made publicly available via the CCG website.
8.4 Where any practice representative on a decision-making body has a material interest in a procurement decision, those practice representatives will be excluded from the decision-making process (but not discussion about the proposed decision). This includes where all practice representatives have a material interest, for example where the CCG is considering commissioning services on a single tender basis from all GP practices in the area. Rules relating to quoracy in these and other circumstances are set out in the CCG constitution.
8.5 Details of all contracts, including the value of the contracts, will be published on the CCG website shortly after contracts are signed.
9.9. PROCUREMENT PLANNING
9.1 A procurement plan will be maintained that will list all current and future procurements. The procurement plan will be reviewed on a regular basis taking into account local and national priorities; the CCG’s commissioning intentions; requirements of “Everyone Counts” (and subsequent iterations); and nationally mandated procurements. In addition it will take into account the impact of completed and on-going procurements.
9.2 The plan will highlight the priority, timescale, risk and resource requirement for each potential procurement. Not every priority on the procurement plan will result in procurement, but the plan indicates the CCG’s intention to review the service or activity which may result in procurement.
9.3 The plan will be developed as a key element to provide communication between the CCG, its membership and potential providers. Through transparent and open processes the CCG will actively encourage provider engagement.
9.4 Procurement Governance
The CCG’s Procurement Group will undertake procurement planning and have oversight of all procurement decisions based on advice from the CCG’s Commissioning Committees and Transformation Programme Groups. These decisions will be made based on the information completed in the Procurement Options Brief, see form in Appendix C, which will be completed by the procurement project lead and clinical lead.
33 ode of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioned services.
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9.5 All Procurement decisions will be approved and minuted by the CCG Procurement Group which reports to the Newham CCG Board.
10. PATIENT ENGAGEMENT IN PROCUREMENT
10.1 Newham CCG is committed to putting patient engagement at the heart of the procurement process. We value patients as equal partners and will put in place processes in place to ensure this happens. The CCG ambition is to embed patient engagement across the commissioning cycle.
10.2 Prior to designing any procurement process we are committed to working with patients and Healthwatch Newham to determine the extent and the best way to involve patients; this can include any of the following:
• Evaluation Panel Member
• Input into specification
• Patient feedback on current or proposed pathway particularly service redesign
• Interview Panel Member with equal voting rights
• Development of patient experience KPIs and indicators in contracts
• Development of engagement offer in monitoring of contracts
10.3 The CCG will also use different engagement structures to involve patients and the public, this can include:
• Community Reference Group
• Patient Forum
• Healthwatch Newham
• Patient Participation Groups
• Service Users
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10.4 The CCG will also strive to take into account guidelines issued by the Patient and Public Voice team at NHS England on involving patient representatives in the procurement process as well as the development of a PPE Procurement Charter by patient and public groups in collaboration with the CCG.
11. PROCUREMENT APPROACH FOR NON-CLINICAL SUPPLY AND SERVICE CONTRACTS
11.1. The CCG and/or its agents will follow EU public procurement rules and Standing Orders/Standing Financial Instructions as appropriate.
12. PROCUREMENT APPROACH FOR HEALTHCARE AND SOCIAL SERVICE CONTRACTS
12.1 The emerging Monitor guidance on Choice, Competition and Conflicts of Interest which for the most part replace the previous Department of Health Principles and Rules for Cooperation and Competition, provide a set of rules that govern system management within the NHS. They recognise that the service is no longer a system based on tight controls of the means of provision, but largely an open system with a defined purchaser/ provider split, which commissioners need actively to manage.
12.2 Newham CCG will conduct health and social service procurements, as one part of market management and development, according to priorities established in its strategic plans.
12.3 Decisions of whether to tender will be driven by the need to commission services from the providers who are best placed to meet the needs of our patients and population.
12.4 The decision-making process will vary depending on whether or not the service is an existing one, new or significantly changed.
12.5 Existing Services
12.5.1 For an existing service (i.e. one that is not new or significantly changed) that is not at the end of a fixed-term procured via competitive tender, where the service is fit for purpose, offers best value for money and continues to fit with the strategic direction of the CCG, the existing provider will normally be retained as long as it is appropriate to do so. The process is shown diagrammatically in Appendix E.
12.5.2 Where the provider of an existing service was selected for a fixed period via a competitive tender exercise and the fixed period (including any options for contract extension) is due to end, a new competitive tender exercise will normally be conducted to select the future provider of the service.
12.5.3 Where an existing service is provided by several providers, the CCG will consider whether there are advantages in continuing with several providers (or indeed increasing further the number of providers), or whether there are advantages in consolidation to a single service provider.
12.5.4 Procuring several providers or increasing the number of providers can be achieved either through use of a framework or through the use of the AQP model (see section 12.1). The practicability of implementation of the framework or AQP model will take account of:
• Value of improving choice and contestability;
• Level of market interest and capability;
• Complexity of accreditation requirements and associated cost;
• The appropriateness of the framework or AQP model to the service concerned
• Impact on increased service fragmentation and complexity of pathway choice
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• Viability of service providers if multiple providers are awarded contracts
12.5.5 The requirement for consolidation into a single provider would be the default position when there are no requirements to increase choice and contestability. Additionally, a single provider would be desirable where there was a need for pathway integration with other providers and use of multiple providers would result in pathway inefficiencies.
12.6 New or significantly changed services
12.6.1 The CCG’s approach to secure services will in overall terms be the following:
• To determine whether the service can be accommodated through existing contracts with providers through future variations to those contracts, assuming that this is possible without contravening procurement rules and guidance, and that quality, patient safety and value for money can be demonstrated.
• To determine whether there are demonstrable grounds to identify a specific provider or group of providers without competition, these include: o When the provider having full access to the patient’s healthcare record is deemed essential or will beyond reasonable doubt demonstrably increase the quality or cost effectiveness of the service provided e.g. where a call and re-call system is required.
o Where knowledge that can only be secured through real-time access to the patient record of other health problems will make a material difference to the choices made or reduce the likelihood of sub-optimal treatment or side effects occurring, or increase the consultation time because clinical information needs to be collected from the patient and hence reducing the quality of the patient experience, (see section 8.3).
o When the provider or group of providers will provide higher levels of patient access or integration of services for the Newham population than alternative providers could.
o Where the service is of minimal value (less than £20,000 pa)
In these cases the CCG will consider procuring on a non-competitive basis.
• Determine whether for technical reasons, or for reasons connected with the protection of exclusive rights, the contract may be awarded to only that provider i.e. there is only one provider that can meet the CCG’s requirements.
• Determine whether for reasons of extreme urgency, outside the control of the CCG, it is not possible to award a contract to another provider in the time available.
• Where there is a requirement to broaden the choice of provider available to patients then the CCG’s approach where applicable and appropriate will be the AQP model (see section 12).
• If the AQP model is not appropriate, the service is not of minimal value, the CCG’s expectation is that the service will normally be subject to competitive tender for a single or limited number of providers, but all such cases will be subject to a review of whether a competitive tender process is appropriate on the grounds of demonstrating best value, market maturity, maintaining competitive tension and complying with the EU procurement rules. Appendix F provides an indication of the aspects to be considered when deciding whether competitive tender is appropriate.
12.6.2 The proposed approach for New or Significantly changed Healthcare and Social services is shown in a flow diagram in Appendix E.
13. APPROACH TO MARKET
13.1 Any Qualified Provider
13.1.1 With the AQP model, for a prescribed range of services, any provider that meets criteria for entering a market can compete for business within that market without constraint by a
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commissioner organisation. Under AQP there are no guarantees of volume or payment, and competition is encouraged within a range of services rather than for sole provision of them.
• The AQP model will not be appropriate, for example where the number of providers needs to be constrained, e.g. o Where the level of activity can only support one provider;
o Where clinical pathways dictate a restricted number of providers;
• Value for money cannot be demonstrated without formal market testing (e.g. to determine the price the CCG will offer for provision of the services);
• Innovation is required from the market and cannot be achieved collaboratively;
• There is no effective method of selecting from amongst qualified providers for delivery of specific units of activity;
Overall costs would be increased through multiple provider provision because of unavoidable duplication of resources.
13.1.2 The AQP model promotes choice and contestability, and sustained competition on the basis of quality rather than cost. Any service that is contracted through the AQP model does not need to be tendered, although it will be advertised if appropriate and potential service providers will need to be qualified.
13.1.3 A standard NHS contract amended as per the provision in 16.2, will be awarded to all providers that meet:
• Minimum standards of clinical care (implying qualification/accreditation requirement);
• The price the CCG will pay;
• Relevant regulatory standards.
13.1.4 The CCG will have regard at all times to the EU Treaty principles of non- discrimination, equal treatment, transparency, mutual recognition and proportionality when applying the AQP procedure.
13.2 Competitive Tendering
13.2.1 It is anticipated that an increasing number of services will be subject to competitive tendering in order to demonstrate the application of the principles of transparency, openness, equitability and obtaining and delivering value for money. Whilst there is no “checklist” that will definitively determine the appropriate use of competitive tendering, Appendix F provides an indication of the aspects to be considered when deciding whether competitive tender is appropriate.
13.3 Non-Competitive process
13.3.1 Competition may be waived in circumstances where the CCG is satisfied that the services to which the contract relates are capable of being provided only by that provider or there where service provider integration is paramount. In these circumstances the procedures set out within the CCG’s Standing Orders and Standing Financial Instructions must be followed.
13.3.2 Where it is decided not to competitively tender for new services or where services are significantly changed, CCG Board approval must be obtained following any recommendation to follow this approach.
13.4 Provider Partnership Arrangements
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13.4.1 Where collaboration and coordination is considered essential, for example in developing new integrated pathways, enabling sustainability of services, ensuring smooth patient handover, coordination etc. the CCG may wish to continue with existing “partnership” arrangements. These “Partnership” arrangements must be formalised using the appropriate contract form and must provide:
• Transparency particularly with provision of information sharing good and bad practice
• A contribution to service re-design
• Timely provision of information and performance reporting
• Evidence of improved patient experience year on year
• Evidence of value for money
13.4.2 Partnership status must not be used as a reason to avoid competition and should only be used appropriately and be regularly monitored.
13.4.3 For partnership services the CCG may choose to commission the service from a partner but may also choose to tender for provision of the service, for example where the partner cannot meet the service model requirements or costs cannot be agreed.
13.5 Spot Purchasing
13.5.1 There will be the need to spot purchase contracts for particular individual patient needs or for urgency of placements requirements at various times. At these times, a competitive process may be waived. It will be expected that these contracts will undergo best value reviews to ensure the CCG is getting value from the contract. In all cases the CCG should ensure that the provider is fit for purpose to provide the particular service.
13.6 Framework Agreements
13.6.1 The CCG is able to use other public sector organisations framework agreements if a provision has been made in the framework agreement to allow this (that is the by the holder of the framework agreement, such as the Government Procurement Service). The EU rules state that framework agreements should be for no longer than four years in duration.
13.6.2 Where it is allowed for in the framework agreements there may be an option for running mini competitions. Here all providers on the framework who can meet requirements are invited to submit a bid, these are then evaluated and a contract awarded following the same processes as for tenders. Any contract awarded can run beyond the framework agreement period but the length of the contract extension must be reasonable.
13.7 Grants
13.7.1 In certain circumstances the CCG may elect to provide a grant payable to third sector organisations. However there should be no preferential treatment for third sector organisations. Use of grants can be considered where:
• Funding is provided for development or strategic purposes
• The provider market is not well developed
• Innovative or experimental services are being developed
• Funding is non-contestable (i.e. only one provider)
13.7.2 Grants should not be used to avoid competition where it is appropriate for a
formal procurement to be undertaken.
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14. TENDERING PROCESS
14.1 If a decision is taken to pursue a competitive tender process, there are a range of further issues that will be taken into account in the design of the process to be followed; see appendix F, these are not considered in detail in this Policy but which include:
• Market analysis (e.g. structure, competition, capacity, interest);
• Tender routes;
• Procurement timescales;
• Affordability;
Impact on service stability;
• Procurement resource, including responsibilities and accountabilities;
• Consultation and Engagement requirements;
• Outcome-based specifications;
• Existing related contractual arrangements;
• Contract management;
• Provider development.
• Value for money
15. FINANCIAL AND QUALITY ASSURANCE CHECKS
15.1 The CCG will require assurance about potential providers. Where this is not achieved through a formal tender process, the following financial and quality assurance checks of the provider will be expected to be undertaken before entering into a contract:
• Financial viability;
• Economic standing;
• Corporate social responsibility
• Clinical capacity and capability;
• Clinical governance;
• Quality/Accreditation.
16. PRINCIPLES OF GOOD PROCUREMENT
16.1 The key principles of good procurement are:
• Transparency:
• Proportionality:
• Non-discrimination:
• Equality of treatment
Making commissioning intent clear to the market place, including the use of sufficient and appropriate advertising of tenders, transparency in making decisions not to tender, and the declaration and separation of conflicts of interest;
Making procurement processes proportionate to the value, complexity and risk of the services contracted, and critically not excluding potential providers through overly bureaucratic or burdensome procedures;
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Having specifications that do not favour one or more providers. Ensuring consistency of procurement rules, transparency on timescale and criteria for shortlist and award; and
Ensuring that all providers and sectors have equal opportunity to compete where appropriate; that financial and due diligence checks apply equally and are proportionate; and that pricing and payment regimes are transparent and fair.
16.2 The CCG will ensure compliance with these principles in the following ways.
16.2.1. Transparency
• The CCG will commission services from the providers who are best placed to meet the service needs of our patients and population.
• The CCG will procure general goods and services using processes and from suppliers that offer best value for money.
• The CCG will maintain on its website for public view a record of contracts held and information about what services are to be procured and when they will be presented to the market
• The CCG will determine as early as practicable whether and how services are to be opened to the market and will share this information with existing and potential providers.
• The CCG will use the most appropriate media in which to advertise tenders or opportunities to provide services.
• The CCG will robustly manage potential conflicts of interest and ensure that these do not prejudice fair and transparent procurement processes.
• The CCG will ensure that all referring clinicians tell their patients and the commissioner about any financial or commercial interest in an organisation to which they plan to refer a patient for treatment or investigation.
• The CCG will provide feedback to all unsuccessful bidders.
• The CCG will not contract with providers whose pricing strategy constitutes predatory pricing.
16.2.2.Proportionality
• The CCG will ensure that procurement processes are proportionate to the value, complexity and risk of the products to be procured.
• The CCG will define and document procurement routes, including any streamlined processes for low value/local goods and services, taking into account available guidance.
16.2.3 Non-discrimination
• The CCG will ensure that tender documents are written in a non-discriminatory fashion e.g. generic terms will be used rather than trade names for products.
• The CCG will inform all participants of the applicable rules in advance and ensure that the rules are applied equally to all. Reasonable timescales will be determined and applied across the whole process.
• The CCG will ensure that shortlist criteria are neither discriminatory nor particularly favour one potential provider.
16.2.4 Equality of Treatment
• The CCG will ensure that no sector of the provider market is given any unfair advantage during a procurement process.
• The CCG will ensure that basic financial and quality assurance checks apply equally to all
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types of providers.
• The CCG will ensure that all pricing and payment regimes are transparent and fair (according to the DH Principles and Rules Document).
• The CCG will retain an auditable documentation trail regarding all key decisions.
• The CCG will hold all providers to account, in a proportionate manner, through contractual agreements, for the quality of their services.
17. CONTRACT FORM
17.1 The CCG will ensure that the NHS Standard Contract or where appropriate a NHS Standard Deed of Variation will be used for all contracts for NHS funded health and social care services commissioned by the CCG. In exceptional circumstances, such as where a joint contracting arrangement is led by local authority, the CCG may agree to be party to a different form of contract.
17.2 All contracts issued by the CCG will include a requirement for providers to clearly inform clinicians and potential patients about their organisational status including Company ownership and whether they are a public, voluntary or privately owned provider. This will include digital and physical communication including signage.
17.3 The CCG will ensure that a standard Grant Agreement document will be used to record the provision of grants to third parties which will contain the provisions upon which the grant is made.
18. SUSTAINABLE PROCUREMENT
18.1 The NHS is a major employer and economic force both in Newham. The CCG recognises the impact of its purchasing and procurement decisions on the regional economy and the positive contribution it can make to economic and social regeneration.
18.2 The CCG is committed to the development of innovative local and regional solutions, and will deliver a range of activities as part of its market development plan to support this commitment.
18.3 Wherever it is possible, and does not contradict or contravene the CCG’s procurement principles or the provisions allowable under the Public Services (Social Value) Act 2012, the CCG will work to develop and support a sustainable local health economy.
19. PUBLIC SERVICES (SOCIAL VALUE) ACT 2012
19.1 This Act that came into force on 31st
January 2013, will require commissioners at the pre-procurement stage to consider how what is to be procured may improve social, environmental, and economic well-being of the relevant area, how they might secure any such improvement and to consider the need to consult.
19.2 Although the Act only applies to certain public services contracts and framework agreements to which the Public Contract Regulations apply, the CCG intends, as a matter of good practice to consider how what is proposed to be procured might improve economic, social and environmental well-being in order to maximise value for money. The considered application of the provisions of this Act will provide the CCG with the means to broaden evaluation criteria to include impact on the local economy.
20. USE OF INFORMATION TECHNOLOGY
20.1 Wherever possible appropriate information technology systems i.e. e- procurement and e-evaluation methods will be used. These are intended to assist in streamlining our procurement processes whilst at the same time providing a robust audit trail. E-Tendering and E-evaluation solutions provide a secure and efficient means for managing tendering
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activity particularly for large complex procurements. They offer efficiencies to both purchasers and providers by reducing time and costs in issuing and completing tenders, and particularly to purchasers in respect of evaluating responses to tenders.
21. DECOMMISSIONING SERVICES
21.1 The need to decommission contracts can arise through:
• Termination of the contract due to performance against the contract not delivering the expected outcomes. This can be mitigated by appropriate contract monitoring and management and by involving the provider in this. The contract terms will allow for remedial action to be taken to resolve any problems. Should this not resolve the issues, then the contract will contain appropriate termination provisions;
• The contract expires; and/or
• Services are no longer required
21.2 Before a service is decommissioned full regard will need to be considered to the potential costs of decommissioning.
21.3 Where services are decommissioned, the CCG will ensure where necessary that contingency plans are developed to maintain patient care. Where decommissioning involves Human Resource issues, such as TUPE issues, then providers will be expected to cooperate with all legal TUPE obligations, to consult with effected staff, and to co-operate fully with the new service provider.
22. TRANSFER OF UNDERTAKINGS AND PROTECTION OF EMPLOYMENT REGULATIONS (TUPE)
22.1 These regulations arose as a consequence of the 1977 EU Acquired Rights Directive and were updated in 2006. They apply when there are transfers of staff from one legal entity to another as a consequence of a change in employer. This is a complex area of law which is continually evolving.
22.2 Commissioners need to be aware of these and the need to engage HR support and possibly legal advice if there is likely to be a TUPE issue. Additionally, NHS Bodies must follow Government guidance contained within the “Cabinet Office Statement of Practice 2000/72 and associated Code of Practice 2004 when transferring staff to the Private Sector” also known as “COSOP”.
22.3 It is the position of the CCG to advise potential bidders that whilst not categorically stating TUPE will apply it is recommended that they assume that TUPE will apply when preparing their bids, and ensure that adequate time is built into procurement timelines where it is anticipated that TUPE may apply.
23. EQUALITY IMPACT ASSESSMENT
23.1 All public bodies have statutory duties under the Equality Act 2010. The CCG aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others.
23.2 In order to support these requirements, a single equality impact assessment is used to assess all the CCG’s policies/guidelines and practices. This Procurement Policy was found to be compliant with this philosophy (see Appendix G).
24. TRAINING NEEDS ANALYSIS
24.1 All CCG staff and others working with the CCG will need to be aware of this policy and its implications. It is not intended that staff generally will develop procurement expertise, but they will need to know when and how to seek further support. The most urgent requirement is that all commissioning staff throughout the CCG should know enough about procurement
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to know to seek help when they encounter related issues; they must also be able to give clear and consistent messages to providers and potential providers about the CCG’s procurement intentions in relation to individual service developments.
24.2 Awareness of procurement issues is being raised through organisational development and training sessions for clinical and non-clinical members of the CCG.
25. MONITORING COMPLIANCE WITH THIS STRATEGY / PROCEDURE.
25.1 This Policy will be reviewed every three years.
25.2 In addition it will be kept under informal review in the light of emerging guidance, experience and supporting work. Given the changing environment it is likely that this Policy will need to be updated within a relatively short timescale. 25.3 Effectiveness in ensuring that all procurements comply with this Policy will primarily is achieved through “business as usual” review by the relevant Head of Service within the CCG.
26. REFERENCES
Legislation
Directive 2004/18/EC on the coordination of procedures for the award of public works contracts, public supply contracts and public service contracts. Mar 2004.
The Public Contracts Regulations 2006; SI 2006 no.5. Jan 2006. Equality Act 2012
NHS Policy
Principles and rules for Cooperation and Competition. July 2010. DH. (Gateway Ref: 14611).
Procurement Guide for commissioners of NHS-funded services; May 2008; DH (Gateway Ref: 9915).
Framework for Managing Choice, Cooperation and Competition. May 2008.DH. (Gateway Ref: 9914).
NHS Procurement. Raising our game; May 2012; DH (Gateway Ref 17646).
Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioned services; July 2012; NHS Commissioning Board.
Towards establishment: Creating responsive and accountable CCGs; February 2012; NHS Commissioning Board.
National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013; February 2013
Monitor Briefing Note – Substantive Guidance on the Procurement, Patient Choice and Competition Regulations, December 2013
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Appendix A. List of Part B Health and Social Services
Health and social work services.
Company health services
Health services. Medical analysis services
Hospital and related services. Pharmacy services
Hospital services. Medical imaging services Optician services
Surgical hospital services. Acupuncture and chiropractor services
Medical hospital services. Chiropractor services
Gynaecological hospital services. Veterinary services
In-vitro fertilisation services. Domestic animal nurseries
Obstetrical hospital services. Social work and related services
Rehabilitation hospital services. Welfare services for the elderly
Psychiatric hospital services. Welfare services for the handicapped
Orthotic services. Welfare services for children and young people
Oxygen-therapy services. Social work services without accommodation
Pathology services. Day-care services and Child day-care services
Blood analysis services. Day-care services for handicapped children and young people
Bacteriological analysis services. Medical practice services.
Hospital dialysis services. General-practitioner services.
Hospital-bedding services. Medical specialist services.
Outpatient care services. Gynaecologic or obstetric services.
Medical practice and related services. Nephrology or nervous system specialist services.
Geriatric services. Cardiology services
Psychiatrist or psychologist services. Pulmonary specialists’ services.
Home for the psychologically disturbed services ENT or audiologist services.
Ophthalmologist Gastroenterologist and geriatric services.
Dermatology Medical practice services.
Orthopaedics services. Advisory services provided by nurses
Paediatric or urologist services. Paramedical services
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Paediatric services. Physiotherapy services
Urologist services. Homeopathic services Hygiene services
Surgical specialist services. Home delivery of incontinence products
Community Dental practice and related services. Ambulance services
Dental practice services. Residential health facilities services
Orthodontic services. Residential nursing care services
Orthodontic-surgery services. Services provided by medical laboratories
Miscellaneous health services. Services provided by blood banks
Services provided by medical personnel Home delivery of provisions
Services provided by midwives Guidance and counselling services
Services provided by nurses Family services
Home medical treatment services Welfare services not delivered through residential institutions
Dialysis home medical treatment services Rehabilitation services
Services provided by sperm banks Vocational rehabilitation services
Services provided by transplant organ banks Social services
Community health services
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Appendix B – Financial Limits Applying To EU Procurement Rules
There is a statutory requirement to follow the full EU Procurement rules, where legally-enforceable contracts are to be awarded, for supply of goods and/or services with an estimated full-life value above £116,676, (as of May 2014) other than those specifically listed as Part B services. Where legally-enforceable contracts are to be awarded for Part B services with estimated full-life value above £172,514, (as of May 2014) there is a limited statutory requirement to apply some of the EU procurement rules.
These financial limits are amended annually and will be revised as such with an amendment to this document.
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Appendix C - Procurement Options Brief
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Appendix D: Template to be used when commissioning services that may potentially be provided
by GP practices
NHS Newham Clinical Commissioning Group
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Appendix E - Procurement Approach - Approach for Existing Health Services
AQP suitability:
•Where patient choice is a high priority
•Pathway integration NOT required
•Sufficient patient numbers to support multiple providers
Contract rules: •<10% of existing contract value, or •Service lines in an Acute contract
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Approach for New or significantly changed Health Service
AQP suitability:
Where patient choice is a high priority
Pathway integration NOT required
Sufficient patient numbers to support multiple providers
Contract
rules:
<10% of existing
contract value, or
Service lines in an
Acute contract
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Appendix F: Aspects to be considered when deciding whether competitive tender is appropriate
In addition the following, potentially-overriding, considerations will be taken into account:
• Is a specific provider required to protect essential public services? (e.g. A&E)
• Are services protected by monopoly rights? (e.g. in accordance with a legal or administrative instrument)
• Are there any procurement constraints linked to partnership funding? (e.g. if the CCG is not a joint signatory to a contract)
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Appendix G. Equality Impact Assessment for this Policy Newham CCG - Equality Impact Assessment 2011
Fostering good relations involves tackling prejudice and promoting understanding between people who share a protected characteristic and others.
Following a recent judicial review (costing Birmingham City Council a reported £600k) due regard was described as ‘creating a decision making process that links the policy design, macro or micro, with the details of the impact of policy on individuals’. Before making policy decisions, even Newham level decisions about allocation of resources, an organisation must understand the potential impact of its decision on individuals (not necessarily named individuals, but a suitable range of typical service users) and ensure that this is explicitly factored into its decision-making.
This assessment process therefore aims to ensure we have;
• evidence of consultation and other engagement activities that elicit sufficient information to enable it to identify the impact of a proposed decision on individuals;
• informed the decision-makers of the potential impact and expressly considered how this can be reconciled with the organisations equalities duties;
• informed decision-makers how adverse impacts of a decision in Newham be mitigated and whether there are alternatives to the proposed decision that could be taken that would avoid or reduce adverse impact.
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Appendix T. Contracting and Procurement Group Draft TOR
Contracting & Procurement Group
Terms of Reference (Draft)
Background
From April 2013, Newham CCG is responsible for the procurement of award of contracts for health care in Newham. There are several contracts which are due to expire in 2013/14 and decisions need to made on their route to the market (e.g. to AQP, open competition, single provider) and awards of contract. The Newham QIPP plan also outlines many new services or changes to patient pathways which require identification of new service providers and contracts.
Newham CCG governance is currently under review. Although the responsibility for contract management and procurement sit with the programme boards, the process for monitoring and ensuring programme level procurements is not clear. Therefore a due diligence process is required to ensure that procurements are properly authorised, delivered on time and are run in accordance with the CCG commissioning strategic plan. A formal procurement governance structure of the CCG is important for evidencing transparency of the procurement decisions and provides first defence to challenges of anti-competitive commissioning.
Structure and process
The Contracting and Procurement Group will play this core role by ensuring that procurement activities are planned and coordinated across the CCG, are properly authorised, follow the correct process and paperwork is to an agreed standard. The role of the group is also to ensure that there is documentation of the decision to go to market, to enter a contractual agreement with a provider and when to accept single tender action instead of going to market.
There is a duty on the CCG Board to ensure that procurement decisions are made with due regard to the Principles of Co-operation Choice and competition published by the Department of Health. (Section 75 of the Health and Social Care Act ‘Requirements as to procurement, patient choice and competition’)
Programme Boards are required to generate new business cases for procurement activities, show how the procurement activity fits with CCG strategy, how it will improve patient experience and be cost effective. Service specification development and the detail of tender process design can be done at Programme Board level then be reported back to the CCG Exec.
The CCG Exec would receive final reports of procurements authorised by the Contracting and Procurement Group and give final authorisation for the CCG enter into contract with the successful bidder (unless the contract value required escalation to the CCG Board for authorisation). Any single tender waivers or procurement business cases not previously reviewed at the C&P group would need to be reviewed by the CCG Exec meeting.
Contracting and
Procurement group
CCG Exec NCCG Board
Review and accept
Procurement plans /
business cases
Ensures procurement
is in motion and
progress monitored
Acknowledges all
procurement activity
and decisions Pu
rpo
se
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Purpose of Contract & Procurement Group
The role of the Contracting & Procurement Group (NCCG C&PG) is to assess the most appropriate route for procuring a service, whether through an existing provider or through market testing. To approve plans for reviewing the progress and reaching the desired outcome of each procurement process and to provide assurance to the NCCG Executive and Board that the process of deciding on the preferred bidder has followed best practice and meets the requirements of CCG Standing Financial Instructions.
assess the most appropriate route for procuring a service (as defined by a business case submitted by the relevant programme board) and then to review the outcome of each procurement process to provide assurance to the Board that the process of deciding on the preferred bidder has followed best practice
ensure a balance between the need to stimulate the market and encourage plurality, and innovation in the health care market
ensure partnerships with existing providers who provide high quality care and best value for money
ensure there is full engagement of relevant CCG Board Members, Clinical Leads and other key stakeholders relevant to the procurements under discussion.
provides assurance to the CCG Board that the process and outcome has been fair. The process of decision-making must be transparent and robust. Clear management of potential conflicts of interest and consistency are required throughout
Membership
Dr Zuhair Zarifa CCG Chair (Proposed chair of C&PG)
Dr Ashwin Shah Clinical Lead (proposed vice chair of C&PG)
Steve Gilvin CCG Accountable Officer
Scott Hamilton CCG Director of Delivery
Chad Whitton CCG Director of Finance
Chetan Vyas CCG Associate Director of Quality
Nicholas Garforth CSU Procurement (provides procurement expertise)
Lee Walker CSU Contracting (provides contracting expertise)
Carl Edmonds CSU Commissioning Support (supports and track delivery)
Reporting Structure
The Group will be sub-group of the CCG Executive Committee. Contract and procurement leads (who will be members of the relevant programme board) will supply reports to the Executive committee. Minutes of the group will be recorded and sent to the CCG Executive.
Quorate
Freq
D
ecis
ion
s
Route to market
To enter contract
Tender waivers
For £200k+ value
Route to market
To enter contract
Approve new
business cases /
tender waivers
Ad hoc Monthly Monthly
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The chair or vice and 2 other CCG members.
Accountability
Chair: Dr Zuhair Zarifa? Administration: CCG
Frequency
This is an ad hoc and meetings will be organise with a minimum notice period of two weeks (papers supplied one week before the meeting).
Review
The terms of reference of the contracting and procurement group will be reviewed on an annual basis. The next review will take place on XXXXXXXXXXXXXXXXX
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Appendix U. Impact Table
Procurement or Contracting Option
Quality Access Integration VFM
Contract Variation
Contract Management
Waivers
Single Tender Action
(NHS Procurement, Patient Choice & Competition) Regulations 2013)
Competitive Dialogue
Negotiated Procedure
Framework Agreement Call-off
AQP
(Any Qualified Provider)
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Appendix V. Code of Conduct Template to be completed when GPs have a financial interest in possible provider
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