Agenda item

This report was written by Jessica Arnold, the Head of the Primary and Community Care Commissioning Directorate from the CCG. The update to the Board on the day was provided by Dr Bhan, and by Dr Andrew Parson.

The report outlined the review and commissioning intentions of NHS Bromley CCG for the GP PMS contract from 2016/17, and plans for the equalisation of the GP GMS contract.

The report was brought to the attention of the Board as changes to the GP PMS contract would have an impact on primary care and would improve services, sustainability, and the integrated working of GP practices within the wider health and social care system. The HWB were being asked to note the contents of the report and to give their comments about the proposed commissioning intentions of the CCG for GP contracts.

It was explained to the Board that the PMS contracts required the delivery of extra services for which a premium would be paid. Most contracts in south east London were PMS contracts. However, in Bromley, there was a greater mix of contracts. PMS contracts were paid £11.00 to £12.00 more per patient. Dr Bhan briefed the Board concerning the two elements of the PMS contract that were current.

Dr Bhan outlined the new offer for Bromley PMS contracts. It was noted that there was a “London Offer” and a “Local Offer” that together formed Bromley CCG’s commissioning intentions. The “Local Offer” had been developed subsequent to a wide range of engagement activities. 

The “London Offer” was sub divided into two sections, namely KPI’s and the “Additional use of Technology”. The “Local Offer” was subdivided into two main sections which were “Local Priorities” and “Transformational Priorities”. Dr Bhan informed the Board that under the umbrella of the “additional use of technology”, the target would be that 50% of appointments would be available and cancellable online by 1^st April 2017. This was considered a reasonable target and allowed for older people not being able to access IT. Dr Bhan spoke about the possibility of GP Practices offering electronic consultations. She acknowledged that there were issues around this, not least concerns around the privacy of personal data. 

The Board noted that part of the local offer was for GP’s to carry out bowel screening and suture removal, both of which would reduce the number of people going into hospitals. Dr Bhan acknowledged that GP practices were under severe pressure and that they would require resources to cope so that the ICN strategy could be developed. The detail of the new contracts was being worked through, and practices would have to deliver on all aspects of the new contracts.

It was explained to the Board that roughly 40% of the contracts were GMS contracts; therefore an “equalisation” process was required. 

Linda Gabriel noted the reference to KPIs and “Patient Voice” which was part of the London Offer on the new contracts. She encouraged engagement with the Voluntary Sector and with Healthwatch to develop this. Dr Bhan referenced the previous report submitted by Healthwatch to the CCG on GP access. She made the point that GP Hubs had been put in place to improve GP access, but that further joint work would be undertaken in this area between the CCG and Healthwatch. 

Cllr William Huntington Thresher put forward the view that improving GP access should not just focus on developing core hours, but should also encourage the development of flexible working. Dr Bhan responded that GP’s were already working flexible hours. Dr Parson made the point that any consideration of increasing core hours would need to allow for the employment of other staff members in addition to GP’s at the same time—this would be staff such as receptionists and nurses. Other enabling forces would need to be factored in such as the GP Alliance; all delivery models would present challenges.

Dr Bhan referred to the Local Offer concerning bowel screening and acknowledged that not all practices may wish to take this up. In these cases, it may be the case that the GP Alliance or the Federation of GP’s could assist. 

The Chairman asked Dr Bhan how outcomes would be measured. Dr Bhan explained that there were a variety of ways that measurement could take place:

·  More patient contact

·  More vaccinations

·  Reduced incidence of the late diagnosis of bowel cancer

·  Reduced mortality

·  A better and interactive service

Cllr Tunnicliffe asked why there was still such a high percentage of GMS contracts in Bromley compared with other London Boroughs. The answer to this was uncertain. Cllr Tunnicliffe asked why it was expected that GMS Practices would change to PMS contracts now. Dr Bhan suggested a number of reasons why GMS practices would now consider changing to the new contracts:

·  Newer GP Practices were more open to change

·  Some practices would have transferred over previously if able

·  Practices may previously have been concerned about the workload

·  Now mores resources and support were available

·  A different environment and approach now existed

Dr Parson felt that what was required was the removal of variability, which was made easier by a better understanding of the challenges facing GPs. GMS Practices were now keen to deliver. He expressed the view that in many cases the reality was that there was not much difference between many PMS practices and GMS practices.

Ian Dallaway referred to the potential cost of £1.5m that would be incurred if there was a 100% take up of PMS contracts, and asked where this money was coming from. Dr Bhan responded that this was new money to the CCG from the NHS.

The HBW noted the report, and the Chairman welcomed the initiative.

RESOLVED that the report be noted, and the initiatives around the development of the new PMS contracts be endorsed.