MERTON CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE Date of Meeting: 25 th May 2017 Agenda No: 4 Attachment: 3 Title of Document: Primary Care Commissioning Update Purpose of Report: Information Report Authors: Lead Director: Nora Simons & Kate Symons Andrew McMylor Executive Summary: This is report provides the Primary Care Committee with an update on how delegated Primary Care commissioning is being managed in Merton; providing an update on some of the key programmes of work. Key sections for particular note (paragraph/page), areas of concern etc: The Committee are asked to note specific updates on The Rowans Surgery Procurement, and how we are managing the Ravensbury Park CQC rating of Inadequate. Recommendation(s): The Committee are asked to note the detail included within this paper, and the progress made under delegate commissioning arrangements. Committees which have previously discussed/agreed the report: None Financial Implications: None Implications for CCG Governing Body: None How has the Patient voice been considered in development of this paper: N/A Other Implications: N/A Equality Assessment: N/A Information Privacy Issues: N/A Communication Plan: (including any implications under the Freedom of Information Act or NHS Constitution) N/A 1
General Purpose Integrated Primary Care Commissioning Paper Author: Nora Simon & Kate Symons Sponsor: Andrew McMylor & William Cunningham-Davis Date: 25 th May 2017 Executive Summary Context This is report provides the Primary Care Committee with an update on how delegated Primary Care commissioning is being managed in Merton; providing an update on some of the key programmes of work. Question(s) this paper addresses 1. What Primary Care Commissioning Practice Specific Updates do the Committee need to note? 2. How have our General Practices performed in recent CQC inspections? 3. What General Contracting Decisions have been taken for the Committee to note? Conclusion 1. The Committee are asked to note specific updates on The Rowans Surgery Procurement, and how we are managing the Ravensbury Park CQC rating of Inadequate. 2. All practice in Merton have received a CQC visit; with 91% rated as Good. There is a process for managing a Requires rating and NHS England and the CCG are working together on implementing this. We will be issuing appropriate contractual breaches in the areas identified. 3. The Committee should note the contract variations or decisions have been taken under delegated commissioning. Input Sought The Committee are asked to note the detail included within this paper, and the progress made under delegate commissioning arrangements.
The Report A N A L Y S I S 1. What Primary Care Commissioning Practice Specific Updates do the Committee need to note? Rowan s Surgery Procurement Update The Rowans Surgery, 1 Windermere Road, London SW16 5HF is currently providing primary medical services under an Alternative Personal Medical Services (APMS) caretaking contract which was due to expire 31st May 2017. The contract has now been extended by 1 month to align with the pan London procurement process and will expire on 1st June 2017. Merton Clinical Commissioning Group (CCG) agreed to re-procure the service to ensure on-going primary medical service provision in the area. The Rowans Surgery contract is within the London T5 procurement programme. A decision was made at an extra-ordinary Primary Care Committee Meeting on the 27 th May; to approved the procurement process that had been undertaken and as such the award of the contract to the preferred bidder. On the 16 th May the CCG were formally notified that the contract had been awarded to AT Medics. We now begin the mobilisation process; with the formal contract commencing on the 1 st July. Ravensbury Park Inadequate CQC Report - Progress Update Ravensbury Park Medical Centre was inspected by the CQC on 11 January 2017. The CQC s findings from the inspection were presented in a final report published on 30 March 2017. The practice was given an overall rating of Inadequate and placed in Special Measures. The overall rating was determined by the performance found in the following five domains: Overall Rating Inadequate Caring Effective Responsive Safe Well-led Requires Inadequate Inadequate Inadequate Inadequate The CQC raised a number of areas of concern for each of the domains where the practice must make improvements. A further inspection will take place within 6 months. If insufficient improvements have been made that result in a rating of inadequate for any population group, key question or overall, the CQC will take action in line with their enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if there is no improvement. The CQC found the practice to be in breach of the following regulations within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
Regulation 13 HSCA (RA) Regulations 2014 Safeguarding service users from abuse and improper treatment Regulation 16 HSCA (RA) Regulations 2014 Receiving and acting on complaints The practice is now working to an Essential Standards Action Plan issued by the CQC to remedy these regulatory breaches. Actions in place: Royal College of General Practitioners (RCGP) Practices placed in Special Measures by the CQC can participate in the RCGP Practice Support Programme which is, from April 2017, funded by NHS England. The RCGP is now providing support to the practice by way of a Memorandum of Understanding (MOU) jointly signed with NHS England. The RCGP team has drawn up a Special Measures Action Plan with the practice and is scheduling a series of meetings over the six month period including CCG and NHS England representation to support the practice staff as they work through the necessary actions. Merton CCG The East Merton Locality Clinical Lead, Dr Karen Worthington, has met with Dr Keyamo and offered ongoing clinical support to the practice. NHS England Representatives from NHS England and Merton CCG have met with the Senior Partner and the practice manager do discuss the outcome of the report and the actions required. The practice was also advised that the issues identified by the CQC also constitute breaches of their PMS contract and that the serving of a contract breach remedial notice was under consideration in the areas identified. We will be issuing a remedial breach notice which will be supported by the submission of the Practice action plan. One of the key areas would be the completion of work carried out recommended by the RCGP team and development of an Action Plan. This will save duplication and lessen the bureaucracy for the practice. There will be a follow up visit from NHS England and the CCG to monitor the progress and to review their plans. 2. How have our General Practices performed in recent CQC inspections? As of 15 th May 2017, all but the Rowan Surgery have received a CQC inspection under the new inspection regime, introduced in October 2014. The CQC aimed to have inspected all General Practices in England by April 2017. As part of this process practices receive an overall rating and then additional ratings across five areas: Are services safe? Are services effective? Are services caring? Are services responsive to people s needs? Are services well led? Ratings are also given to care for specific groups of people: Older people; People with long term conditions; Families, children and young people; Working age people; People
whose circumstances may make them vulnerable; and People experiencing poor mental health (including people with dementia). The data below shows how the Merton GP practices have been rated across these five key areas. The majority of practices, 91%, have been rated as Good overall, with just one practice rated as inadequate, and one with Requires. Date of CQC Overall CARING EFFECTIVE Responsive Practice Name SAFE Rating WELL-LED inspection visit: Rating Rating Rating Rating Rating The Nelson Medical Practice 12/10/2016 Good Good Good Good Good Good Mitcham Medical Centre 31/08/2016 Good Good Good Good Good Good Mitcham Medical Centre 31/08/2016 Good Good Good Good Good Good Francis Grove Surgery 19/11/2015 Good Good Good Outstanding Good Good Wimbledon Village Surgery 18/10/2016 Good Good Good Good Good Good Princes Road Surgery 09/12/2015 Good Good Good Good Good Good Wide Way Medical Centre 08/10/2015 Good Good Good Good Good Good Tamworth House Medical Centre 04/10/2016 Good Good Good Good Requires Rowans Surgery Morden Hall Medical Centre 05/11/2015 Good Good Good Good Good Good Cricket Green Medical Practice 18/12/2015 Good Good Good Good Good Outstanding Lambton Road Medical Practice 14/12/2016 Good Good Good Good Requires Good Central Medical Centre 10/11/2015 Good Good Good Outstanding Good Good James O'Riordan Medical Centre 27/10/2015 Good Good Good Good Good Good Stonecot Surgery 10/01/2017 Good Good Good Good Good Good Mitcham Family Practice 21/06/2016 Good Good Good Good Good Requires Figges Marsh Surgery 18/01/2016 Good Good Good Good Good Good Riverhouse Medical Practice 17/08/2016 Good Good Good Good Good Good Grand Drive Surgery 10/01/2017 Good Good Good Good Requires Good Ravensbury Park Medical Centre 11/01/2017 Inadequate Requires Inadequate Inadequate Inadequate Inadequate Vineyard Hill Road Surgery 31/01/2017 Good Good Good Good Good Good Merton Medical Practice 23/02/2016 Good Good Good Good Good Good Colliers Wood Surgery - Main 58 24/11/2016 Requires Good Good Requires Requires Good High Street Colliers Wood Surgery - Branch - 24/11/2016 Requires Good Good Requires Requires Good 182 Western Road Alexandra Road Surgery 01/12/2015 Good Good Good Good Good Good Good The Wilson Health Centre - GP Surgery and Walk-in Clinic 01/11/2016 Good Good Good Good Good Good 3. What General Contracting Decisions have been taken for the Committee to note? Below details the contract variations that have been made under delegated commissioning arrangements. Many of these decisions should be considered business as usual and have been actioned by NHS England Team in conversation with the CCG. Where more complex contract variations have taken place i.e. Termination; the Committee will have been involved in taking these decisions.
C O N C L U S I O N The Committee are asked to note the ongoing work that has been jointly implemented across Primary Care under delegated commissioning arrangements.