Agenda item

Jessica Arnold (Head of Primary and Community Care, Bromley CCG) submitted a report to the HWB. The title of the report was ‘Primary Care Commissioning, Access and Resilience’.

The report was presented to the HWB for information, comment and discussion, and the Board was briefed on the report by Dr Bhan.

The report outlined the key updates relating to the primary care function of Bromley CCG, these were:

·  Moving from the co-commissioning of general practice with NHS England towards fully delegated commissioning from 1^st April 2017.

·  Recent improvements to primary care access, in particular during evenings and weekends

·  Investments into general practice planned as part of the GP Forward View programme.

The Board was updated concerning Level 3 full delegation of Primary Care Commissioning, and the advantages and possible disadvantages of delegated commissioning were outlined. Bromley CCG had submitted their plans for fully delegated commissioning to NHS England in December 2016, and a decision was expected in mid-February 2017. If approval was received, then the transition process would commence on 1^st April 2017.

If approval was given, a new Primary Care Commissioning Committee would be established. This would function as the highest level of governance for primary care matters and would replace the former SEL Joint Committee. It was expected that all six SEL CCGs would be approved for fully delegated commissioning from April 2017.

The Board was updated concerning the GP Forward View, and the development and implementation of the Forward View Plan. It was noted that the General Practice Forward View (GPFV) was launched in April 2016. This was a plan that was designed to stabilise and transform general practice backed by a multi-billion pound investment to redress historic underinvestment in the service. The GPFV stated that if general practice failed, then the NHS would also fail.

Dr Bhan mentioned some of the GPFV investments for Bromley:

·  £185,000 for vulnerable practices

·  £89,000 for online consultations

·  £1.1m for improving access

The GPFV investments in Bromley were noted. The Board was appraised that Bromley CCG was currently in the process of developing a detailed prioritisation and action plan for the resilience and workforce elements of the local GPFV plan. Once the Plan had been approved, it could be published and implemented swiftly.

The Board was appraised concerning Primary Care Access Hubs which had been set up since 1^st December 2015 to offer additional GP appointments. A third Hub had been established since December 2016, and further expansion was planned for the future. The Board was appraised that the Hub service was being provided by the Bromley GP Alliance, and that a new contract had recently been agreed. The new contract would mean that the service would continue to be provided by the Bromley GP Alliance up to 31^st March 2018. In the interim, Bromley CCG would be undertaking a competitive procurement process in line with statutory obligations. It was hoped that a new GP Access Hub could be sited in the centre of Bromley.

The Board noted the current position relating to the review of PMS contracts, and of the GMS equalisation process. The investment made into general practice under the PMS contract and planned GMS equalisation would be £12.26 per weighted patient—totalling £3.5m per annum. The plan was that going forward; all practices would provide the same levels of service. This would include improved screening rates, increasing the uptake of the flu vaccine, and more online consultations. This would also help to support GPs to transition to the ICN structure. 

Dr Bhan updated the Board concerning the Integrated Case Management Local Improvement Scheme. The scheme had been operating since 1^st December 2016 and was regarded as a significant step forward in the implementation of Integrated Care Networks in Bromley. The good news was that currently 37 of Bromley’s 45 practices were participating in Integrated Case Management.

It was noted that funding had been received by Bromley CCG for the development of a Health and Wellbeing Centre. The plans and business case for this were in an early stage of development.

The Board heard that the Care Quality Commission (CQC) were currently in the process of inspecting all London GP practices. The outcomes for Bromley at the time of writing the report were as follows:

·  1 practice was rated as outstanding

·  18 practices were rated as good

·  3 practices ‘required improvement’

·  23 had not been inspected

The CCG was working closely with those practices that required improvement.

The Vice Chairman enquired how investment would be shifted from the acute sector to primary care. Dr Bhan stated that some of the money would come from the GPFV. The shifting of resources would be a longer term plan. It was also intended not to increase money going into hospitals, but to divert money so that more complex patients could be looked after in the community.

Cllr Evans referred to the possible disadvantages of delegated authority for commissioning mentioned in the report. He asked what level of monitoring of interventions would take place, and if there would be uniformity. He also referred to any improvement plans that may be recommended by the CQC, and if the CCG would be involved in overseeing the improvement plans.

Dr Bhan responded that the CQC ratings were a useful measure of quality that could aid the CCG with scrutiny, and that these indicators, combined with patient feedback were useful. The CCG had set up a Primary Care Team to improve General Practice, and that a Primary Care Needs Assessment was being developed.

Cllr Evans asked if the CCG would have sufficient funding for proper intervention and monitoring. Dr Bhan clarified that no extra funding had been provided to date. However, some people had been brought back to south east London to assist.

Harvey Guntrip expressed the view that full delegation should result in a more open process as control would then be local.

RESOLVED that the report be noted and that Dr Bhan email the Committee Clerk to advise of the outcome of the full delegation application for commissioning.