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Report to the Sutton Clinical Commissioning Group Governing Body

Date of Meeting: 4th June 2014 Agenda No: 5.2 Attachment: 07 Title of Document: : Sutton GP Engagement Scheme for 2014/15

Purpose of Report: For approval

Report Authors: Dr. Jeff Croucher, Clinical Lead Sutton and Cheam locality Dr. Farhan Rabbani, Clinical Lead , Wallington locality Dr. Ash Mirza, clinical lead, Carshalton locality Carolyn Reynolds- Locality manager, Sutton CCG

Lead Director: Susan Roostan, Director of Commissioning & Planning

Executive Summary: The purpose of the 2014/15 Sutton Engagement Scheme (SES) is to support Sutton GP Practices and their Localities to actively engage in high quality, cost effective clinically-led commissioning and service redesign. The scheme financially compensates Practices for the input required to achieve measurable quality and cost effective outcomes. The initial agreement to the GP Engagement Scheme was discussed and agreed at the Executive on 29th January 2014. In March 2014 The Executive Committee Members were asked to agree the outputs required of the Sutton GP Engagement Scheme for 2014/15 as detailed and to support the paper and its implementation for 14/15. Given the membership of the Executive committee and recognising there are conflicts of interests when making decisions relating to this proposal, the Executive Committee were instead asked to express a view regarding the approach. It was agreed that the decision to approve will be taken by the CCG Board where conflicts of interests can be managed. Key sections for particular note (paragraph/page), areas of concern etc: Recommendation(s): The Governing body is asked to agree the outputs required of the Sutton GP Engagement Scheme for 2014/15 as detailed. It is asked to support the paper and its implementation for 14/15. Committees which have previously discussed/agreed the report: Executive Committee – January and March 2014

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Financial Implications: This proposal also represents part of the CCGs response to the expectation that every CCG should identify £5 per patient from its allocation for 2014/15 and use this to support practice plans for improving services for older people. The remainder of this support is covered by new and additional services in the community, such as the additional investment in community provision of admission teams and designated locality based district nursing.

Other Implications:

Equality Impact Assessment: Information Privacy Issues:

Communication Plan:

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1 Purpose:

The purpose of the 2014/15 Sutton Engagement Scheme (SES) is to support Sutton GP Practices and their Localities to actively engage in high quality, cost effective clinically-led commissioning and service redesign by financially compensating Practices for the input required to achieve measurable quality and cost effective outcomes. 2 Background:

This Scheme has been developed by the three GP Locality Leads, Locality Manager, Head of Performance, Director of Commissioning & Planning and Assistant Director for Commissioning Children & Community Services for the Sutton Clinical Commissioning Group to ensure that this incorporates CCG commissioning priorities. 3 Achievement in 2013/14

The Sutton Engagement Scheme for 2013/14 has been very well received and supported and 26 out of the 27 practices signed up for this. Practice visits were made to all practices by the GP Locality Leads during October/November. Engagement from GPs attending locality meetings and Practice Managers and Practice Nurses attending monthly forums has been excellent. Annual Reports from each practice have indicated that practices have found the monthly locality meetings helpful in terms of sharing performance reports and good practice. Practice representation at the Patient Reference Group has been variable, with some practices unable to encourage attendance by their patients. At the practice visits, practices demonstrated referral management processes with variable degrees of success. Overall, first out patient referrals have increased compared with 2012/13. (Appendix A). The uptake in the use of Scriptswitch has been consistently above the target of 17% across most practices (Appendix B). The childhood immunisation data that practices have been monitored against is the national quarterly data and, as yet, we have only received this for quarter 1. Practices have therefore provided the CCG with their practice figures due to the poor quality of the national data and the time delays in its publication (Appendix C). The criteria in terms of long term conditions required the practices to work with the CCG and localities with an aim to achieve a reduction in emergency admissions. The plan was also for the CCG to provide practices with a risk stratification tool, but unfortunately, this has only become available to practices at the end of 2013/14. There has therefore been no significant reduction in emergency admissions from 2012/13 that can be attributed to use of risk stratification.

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4. Assessment of Achievement for 2013/14 Achievement against all criteria within the Engagement Scheme will not be available until May 2014. A panel consisting of the following personnel will be reviewing and agreeing final practice achievement on 28th May 2014, however note that the GP Locality Leads will not be involved in the assessment of their own achievements: Paul Sarfaty – Board Lay Member, Chair of panel Dr. Jeff Croucher – GP Locality Lead – Sutton & Cheam Dr. Farhan Rabanni – GP Locality Lead – Wallington Dr. Ash Mirza – GP Locality Lead – Carshalton Sian Hopkinson – Head of Performance Carolyn Reynolds – Locality Manager Due to the timing of this paper for the Board, the final achievement for 2013/14 had not been approved. 5 Proposal for 2014/15 Practices are required to sign up to Part 1 and Part 2 of the Engagement Scheme

Part 1 - Engagement with Locality meetings, Practice Manager and Practice Nurse Forums, etc.

1. Practices will be expected to have GP representation at Locality meetings. Locality meetings will be a minimum of two hours in duration. Practices’ Members will be required to attend all meetings. A deputy clinician or managerial representative can attend with prior notification to the Chair, as can additional members of practice teams

2. Practice attendance and participation at quarterly plenaries, and relay

information and action points to the Practice’s clinical and managerial team.

3. Practice Manager or practice representative at monthly Practice Manager Forums and sharing of information with the team.

4. Practice Nurse, Nurse Practitioner or Health Care Assistant attendance at

monthly forum and sharing of information. 5. Supply monthly referral data to the CCG

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6. Timely response to audit requests, e.g. immunisation rate requests. 7. Improved patient engagement in Patient Reference Group forum (each

practice to send at least one representative, and ideally two.) • An Annual Report will be submitted in accordance with the requirement (See

section 8) This proposal also represents part of the CCGs response to the expectation that every CCG should identify £5 per patient from its allocation for 2014/15 and use this to support practice plans for improving services for older people. The remainder of this support is covered by new and additional services in the community, such as the additional investment in community provision of admission teams and designated locality based district nursing. Part 2 - Practice Based Engagement - Outcomes:

Criteria No. Description

1

Prescribing

Practices will be required to ensure that their prescribing spend keeps within the threshold described in Appendix D. Support pharmacists will be allocated to spend more time with those practices that have the largest reductions to achieve. Spend against budget will continue to be monitored monthly at the Locality Meetings.

2

Referrals Reduction in out-patient referrals, with variable targets depending on current referral rates, (see attached Appendix E) will continue to be monitored monthly at the Locality meetings.

3

Emergency admissions Variable percentage reduction in “Avoidable” Emergency admission rates (see attached Appendix F), as defined in the 2014/15 Quality Premium indicator (see http://www.england.nhs.uk/wp-content/uploads/2014/03/qual-prem-guid-1415-rev.pdf). This will be monitored monthly at the Locality Meetings.

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5 Weighting/Reward Proposal Based on £1 per head of weighted capitation: the funding will be split across Part 1 and Part 2 as follows: 34p for the engagement aspect 66p for the outcomes section (22p for each criteria 1, 2, 3) The cost of this scheme, based on the latest weighted list sizes at the time of this report is £176,172 The outcomes will be monitored on a monthly basis and targeted visits will be made to practices according to progress with the Scheme. These visits will be made by the GP Locality Lead, supported by the Prescribing Lead and Head of Performance as necessary. All practices will be visited at least once per annum and Action Plans generated as part of this review. Practices will submit a written report of achievement by the middle of April 2015. Achievement will be assessed by a member of the Board of the CCG together with the GP Locality Leads and Head of Performance. 6 Recommendation The Governing body is asked to agree the outputs required of the Sutton GP Engagement Scheme for 2014/15 as detailed. It is asked to support the paper and its implementation for 14/15. Dr. Jeff Croucher Locality Lead for Sutton & Cheam Dr. Farhan Rabbani Locality Lead for Wallington Dr. Ash Mirza Locality Lead for Carshalton May 2014

Appendix A

Actual numberRate per 1000

of population% change

1st OP

rate

Total

expected

1st OP

1st OP

rate

Cumulative

number of

1st OP

% Performance

Value against

year end target

H85019 - GP Centre (Longley Jm) 1807 356 98.0% 6% 335 1693 379 1917 113.3%

H85063 - GP Centre (Brennan Cam) 1505 297 90.9% 6% 279 1425 300 1530 107.4%

H85023 - Bishopsford Road Surgery 1139 281 114.2% 6% 264 1074 252 1025 95.4%

H85054 - GP Centre (Muktar) 1318 259 90.1% 5% 246 1251 251 1273 101.8%

H85022 - Park Road Medical Centre 1061 258 107.6% 5% 245 988 263 1061 107.4%

H85662 - Beeches Surgery 1445 257 102.4% 5% 245 1381 243 1370 99.2%

H85653 - Wallington Family Practice* 3202 248 106.0% 5% 236 3090 265 3472 112.4%

H85105 - Cheam Family Practice 2984 247 98.3% 5% 235 2876 242 2968 103.2%

H85030 - Dr Grice & Partners 3045 233 104.8% 4% 224 2858 213 2718 95.1%

H85031 - Benhill & Belmont Practice 2566 229 96.1% 4% 220 2473 230 2589 104.7%

H85053 - Sutton Medical Centre 981 228 110.6% 4% 219 941 198 849 90.3%

H85018 - Mulgrave Road Surgery 1982 224 99.5% 3% 217 1882 230 1991 105.8%

H85693 - Green Wrythe Surgery 2416 222 107.0% 3% 215 2156 219 2197 101.9%

H85025 - Wrythe Green Surgery 2864 220 94.5% 3% 213 2840 213 2841 100.1%

H85683 - Faccini House Surgery 1428 217 91.6% 3% 210 1342 221 1409 105.0%

H85113 - Maldon Road Surgery 776 212 107.9% 2% 208 762 202 743 97.5%

H85021 - Chesser Practice 1439 211 98.6% 2% 207 1407 216 1469 104.4%

H85103 - Hackbridge Medical Centre 770 209 84.8% 1% 207 778 205 770 98.9%

H85116 - Manor Practice 1775 208 98.8% 1% 206 1778 231 1995 112.2%

H85115 - Shotfield Medical Practice 2105 208 104.3% 1% 206 2155 217 2277 105.6%

H85032 - Carshalton Fields Surgery 666 208 101.3% 1% 206 678 211 696 102.7%

H85674 - Beddington Medical Centre 791 203 87.4% 1% 201 770 288 1099 142.8%

H85095 - Robin Hood Lane (Seyan Rsa) 1896 195 99.7% 0% 195 1993 193 1968 98.7%

H85686 - Grove Road Surgery 1546 182 100.7% 0% 182 1571 190 1642 104.5%

H85618 - Well Court Surgery 355 178 90.8% 0% 178 358 187 375 104.7%

H85086 - Wandle Valley Health Centre 355 176 95.0% 0% 176 346 201 393 113.7%

H85665 - Wallington Medical Centre 409 176 120.4% 0% 176 412 174 408 99.0%

Sutton CCG 42626 229 99.4% -3.3% 221 41285 231 43045 104.3%

SW London 328622 213 97.1%

Sutton CCG: First outpatient attendances following GP referral

GP Practice

Last year (2012/13) Performance Current year (2013/14) Performance

First Outpatient Attendance Rate

direction:

12/13 vs

11/12

Target Actual Performance (M12: Mar - 14)

Appendix BSurgery Acceptance Rate Repea MinDate MaxDateBEDDINGTON MEDICAL CENTRE 8% 02/04/2013 31/12/2013BENHILL & BELMONT PRACTICE 35% 02/04/2013 31/12/2013BISHOPSFORD ROAD PRACTICE 34% 02/04/2013 31/12/2013CARSHALTON FIELDS SURGERY 34% 02/04/2013 31/12/2013CHEAM FAMILY PRACTICE 48% 02/04/2013 31/12/2013FACCINI HOUSE SURGERY 15% 02/04/2013 31/12/2013GREEN WRYTHE SURGERY 29% 02/04/2013 31/12/2013HACKBRIDGE MEDICAL CENTRE 15% 02/04/2013 31/12/2013LEGHARI & MUKTAR PRACTICE 29% 02/04/2013 31/12/2013MALDON ROAD SURGERY 26% 02/04/2013 31/12/2013MANOR PRACTICE 20% 02/04/2013 31/12/2013MULGRAVE ROAD SURGERY 28% 02/04/2013 31/12/2013PARK ROAD MEDICAL CENTRE 20% 02/04/2013 31/12/2013SHOTFIELD MEDICAL PRACTICE 47% 02/04/2013 31/12/2013SUTTON MEDICAL PRACTICE 24% 02/04/2013 27/12/2013THE CHESSER SURGERY 35% 02/04/2013 31/12/2013THE GROVE ROAD PRACTICE 34% 01/04/2013 31/12/2013THE HEALTH CENTRE (ROBIN HOOD LANE) 38% 02/04/2013 31/12/2013THE OLD COURT HOUSE SURGERY 24% 02/04/2013 31/12/2013THE WRYTHE GREEN SURGERY 34% 02/04/2013 31/12/2013WALLINGTON FAMILY PRACTICE 41% 02/04/2013 31/12/2013WALLINGTON MEDICAL CENTRE 17% 02/04/2013 31/12/2013WANDLE VALLEY HEALTH CENTRE 21% 02/04/2013 31/12/2013WELL COURT PRACTICE 20% 02/04/2013 31/12/2013

29% -- --

Appendix C

Immunisations of 2 year olds 2013/14

Average rate across all immunisations

Cohort Avg

Imms %

BEDDINGTON MEDICAL CENTRE 42 41 96.4%

BEECHES SURGERY 56 55 98.1%

BENHILL & BELMONT PRACTICE 167 160 96.2%

BISHOPSFORD ROAD SURGERY 60 56 94.4%

CARSHALTON FIELDS SURGERY 32 29 90.6%

CHEAM FAMILY PRACTICE 165 156 94.5%

CHESSER PRACTICE 80 78 97.5%

DR GRICE & PARTNERS 172 166 96.7%

FACCINI HOUSE SURGERY 98 94 96.0%

GP CENTRE (BRENNAN) 173 171 98.7%

GP CENTRE (LONGLEY) 173 171 98.7%

GP CENTRE (MUKTAR) 173 171 98.7%

GREEN WRYTHE SURGERY 203 194 95.3%

GROVE ROAD SURGERY 103 101 97.8%

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Tel: 020 3668 1200

HACKBRIDGE MEDICAL CENTRE 19 18 96.5%

MALDON ROAD SURGERY 39 38 98.3%

MANOR PRACTICE 137 130 94.5%

MULGRAVE ROAD SURGERY 131 123 94.1%

PARK ROAD MEDICAL CENTRE 66 61 92.1%

ROBIN HOOD LANE (SEYAN RSA) 208 197 94.6%

SHOTFIELD MEDICAL PRACTICE 158 144 91.1%

SUTTON MEDICAL CENTRE 61 57 92.5%

WALLINGTON FAMILY PRACTICE 190 180 94.8%

WALLINGTON MEDICAL CENTRE 22 20 93.9%

WANDLE VALLEY HEALTH CENTRE 37 36 99.1%

WELL COURT SURGERY 28 27 98.8%

WRYTHE GREEN SURGERY 203 196 96.7%

CCG average 2993 2869 95.8%

Medicines Management Plan – Appendix D

1st OP Attendances – Appendix E

Avoidable emergency admissions – Appendix F