Primary Care Commissioning Committee – Part 1 and...10.00 Welcome and Introductions & Apologies...

Primary Care Commissioning Committee – Part 1

Date: Wednesday 20 September 2017 Time: 10.00 – 12.00 Venue: The Gallery,The Woolwich Centre, 35 Wellington Street, Woolwich

SE18 6HQ, Chair: Richard Rice

Time Item Papers Presented by

1. 10.00 Welcome and Introductions & Apologies for Absence

Chair

2. 10.03 Conflicts of interest a. To note declared interests b. To add new interests c. To identify potential conflicts of

interest with the business on the agenda

Note Declare

Chair

3 10.05 Questions from members of the public previously submitted to the CCG

4 10.10 Minutes of Previous Meeting held on 26 July Matters Arising Not on the Agenda

a) Update on Clinical Pharmacists in General Practice

Enc A for approval Enc B

Chair Simon James

5 10.30 Urgent Business To consider any items not already on the agenda

a) Conway Partnership Proposal

Enc C For approval

Chair Jan Matthews

6. 10.50 2017-18 Primary Care Budget Allocations and Presentation

To note Enc D

David Maloney

7 11.00 Quality & Performance Dashboard Enc E Irene Grayson

8 11.20 Highlight Reports i. GP 5 Year Forward View

Enc F Irene Grayson

ii. Primary Care Executive

9 11.30 Any Other Business: CCG Response to Healthwatch Report on Access 2017

Enc G

Irene Grayson

10 Future Meetings 29 November 2017 10-12.00 at The Woolwich Centre

12.00 CLOSE

Chair: Dr Ellen Wright Chief Officer: Joanne Murfitt

Enc. A

PRIMARY CARE COMMISSIONING COMMITTEE DRAFT

26 July 2017

The Gallery, The Woolwich Centre

PRESENT: Richard Rice (RR) CHAIR, Governing Body lay member

David Maloney (DM) Chief Finance Officer Ellen Wright (EW) GCCG Clinical Chair Irene Grayson (IG) AD Primary Care Jan Matthews (Jan M) Primary Care Delivery Manager Jill Webb (JW) Head of Primary Care, NHS England Joanne Murfitt (Jo M) Chief Officer Maggie Buckell (MB) Lay Member Rikki Garcia (RG) Healthwatch Dr Sabah Salman (SS) GP Executive Simon James (SJ) Primary Care Delivery Manager Steve Whiteman (SW) Director of Public Health, Royal Borough

of Greenwich Tuan Tran (TT) Local Care Networks (LCN) Chair Vanessa Fowler (VF) Deputy Director of Commissioning

IN ATTENDANCE: Toni Meyers Business Manager (Minutes) APOLOGIES: Jill Prescott (JP) Commissioning Manager Primary Care

Liz James Director of Commissioning

Item Action

2. Conflicts of interest No new conflicts were declared.

4. Minutes of previous meeting on 31 May 2017 The minutes were agreed as an accurate record.

4. Matters arising PCCC Terms of reference & Governance map Agreed subject to minor amendments. Primary Care Executive Group (PCEG) The PCCC received this paper and heard that pending the South East London (SEL)–wide reorganisation this was still under development and the terms of reference were likely to change. IG confirmed that although

allocations come from NHS England (NHSE), the decision about how to deploy funds was still taken locally, with the PCEG acting as an advisory group for example in contractual matters such as the special allocation scheme. The decision on how to commission services remains with Greenwich PCCC. RR suggested that this be added to the Terms of reference as an addendum. Business Continuity Plans IG noted that this work was ongoing and that the Greenwich IT Group had asked the practices for updates.

5 Urgent business Clover subcontract with Grabadoc Jan M presented this item. She noted that from 1 September 2017 when the previous provider contract expires, Clover will enact a subcontract with Grabadoc to provide an innovative nurse-led service to patients in care homes. Jo M noted that prior to securing Grabadoc every practice in Greenwich had been offered the opportunity to take on this service to care homes. Jan M confirmed that stakeholder engagement activities had begun and were to continue, and that she expected the new service to deliver care which is as good if not better than that which would have been provided under the previous arrangements. The Primary Care Commissioning Committee APPROVED this proposal.

6. 2017-18 Primary Care Budget DM presented this item. He noted his intention to bring a report on month 3 onwards to the PCCC. He reported that the Primary Care budget had a break even position at the first quarter 17-18 with a slight overspend of £6k. The monthly run rate did not exceed the budget. DM mentioned that he submitted a return to NHSE on a monthly basis on risks not on the ledger and that the SEL Chief Finance Officers had asked NHSE for monthly reports from month 3 onwards.

7. Quality & Performance report JW presented this item. She noted that 4 out of the six SEL CCGs have developed their own quality reporting and Jo M queried which ones had involved patients in that process. JW noted the trend for using CQC indicators in CCG reporting. ACTION: To consult with Bexley who are considering collating their own local quality reporting to discover if any useful templates or learning can be gained. JW noted NHSE intention of recommending an operating model to the September PCCC. JW pointed out that Greenwich scored well on the Friends & Family Test, was behind the London average on CQC inspection ‘Requires Improvement’ and relatively high for contractual

JP / Jan M

breaches, though this may be affected by the percentage of single-hander GP practices in the borough which is higher than the national average. Overall average satisfaction levels within Greenwich are similar to the London average. SW suggested that QOF and clinical data would be useful. RR suggested that, local capacity permitting, that a similar report be produced using local data to be read alongside the Quality and Performance report. He also suggested to JW some improvement in presentation for the QP report. Clinical Pharmacists IG mentioned the successful bid for clinical pharmacists to be placed within General Practice. ACTION: To add an update on the clinical pharmacist bid to agenda for next meeting.

IG

8. Review of CQC Action Plan – Progress for Trinity PMS Jan M presented this update. She noted that Trinity have addressed the concerns raised with an action plan, and she was confident the CQC would be satisfied with this upon their expected return visit. No breach notice would be issued.

9. Strategy Review on Local Care Networks IG presented this item. She noted the national requirement for an Accountable Care System (ACS) but she and VF stressed Greenwich CCG’s intention to work with providers, patients and stakeholders to craft a relevant way of working which supported practices at every stage. VF leads on this work and although noted that although it was in very early exploratory stages, described her aspiration to engage practices and patients as fully as possible. No timescales have yet been set. TT mentioned his concern about this process possibly adding to practices workloads – Jo M assured him that the outcome was intended to support and assist practices and that Greenwich CCG would proceed thoughtfully. DM made the point that budgets had been fixed and as no further increases were expected CCGs must find different ways of working within finite resources.

10. Any other business None

Questions from the public.

Members of the public raised the following concerns: 1. Would Greenwich CCG be engaging with patients in its work,

particularly on ACS? Greenwich CCG response: Yes, an extensive programme of patient engagement was intended.

2. Concern over ACS in America, uncertain if it was appropriate for NHS? Greenwich CCG response: We have been mandated to design an ACS from scratch. We intend to proceed carefully and thoughtfully, consulting with as many stakeholders as possible. The ACS which GCCG designs is very likely to differ from similarly-named arrangements abroad.

3. What are your thoughts on the STP? Greenwich CCG response: We have been mandated to work within the STP and believe we are doing so successfully.

Next meeting: Primary Care Commissioning Committee – 20 September 2017

ACTIONS FROM PRIMARY CARE COMMISSIONING COMMITTEE

Date 20 September 2017

No. Item/ref date

Action Action owner To be completed by

Comments

ACTIONS BROUGHT FORWARD

2 10b 31/5/17

Cyber attacks LCN to ask their members to check whether their business continuity plans are fit for purpose.

Caroline Hollingworth /

Tuan Tran

12 July 2017 TT to chase

4 10d 31/5/17

Cyber attacks Add business continuity plans to risk register and via that means to consider at GCCG Finance Quality & Performance Committee for additional assurance.

Yvonne Leese 12 July 2017

7 7 12/7/17

NHSE Quality & Performance report To consult with Bexley who are considering collating their own local quality reporting to discover if any useful templates or learning can be gained.

Jill Prescott Jan Matthews

31 August 17

9 11 12/7/17

Primary Care Executive Highlight report Remove mention of Mark Easton ‘new’ appointment as it is no longer new.

Irene Grayson 26 July 2017

ACTIONS FROM THIS MEETING

10 7 26/7/16

Clinical Pharmacists in Primary Care To add an update on the clinical pharmacist bid to the agenda for the next PCCC meeting.

Irene Grayson 20 Sept 2017

CLOSED ACTIONS

No. Item ref Date of mtg

Action Owner Date closed Comments

1 6 31/5/17

Terms of reference To add governance map/diagram to ToR for information


3 10c 31/5/17

Cyber attacks Greenwich IT Group to consider the Greenwich CCG business continuity plan in conjunction with the plans from practices and Lewisham & Greenwich Trust and report on suitability to GEG.

Ranil Perera 26 July 2017 RP has contacted LGT re lessons learnt

5 11 31/5/17

LCN Transformation Group Strategy review on Local Care Networks Transformation Group to be presented to next meeting of Primary Care Commissioning Committee.


6 12 31/5/17

Primary Care Statistics To add primary care statistics as an agenda item for next Primary Care Commissioning Committee meeting.

Irene Grayson 26 July 2017 Jo M suggests devising a timetable for expected data dissemination

8 10 12/7/17

Progress for Trinity PMS To add evidence cited and verified to the action plan

Jan Matthews 26 July 2017

: It

Item 4 Enc B

Primary Care Commissioning Committee

DATE OF MEETING: 20 September 2017

Title: Update On Clinical Pharmacy Bid

AUTHOR: Irene Grayson Associate Director Primary Care Background NHS England launched in 2015 a pilot scheme to support clinical pharmacists working in general practice in patient facing roles. Funding was made available to support more than 450 clinical pharmacists in 650 practices across 90 pilot sites. The General Practice Forward View (GPFV) includes a commitment to deliver an additional 5,000 clinical and non-clinical staff in general practice, of which the aim is to have ‘’a pharmacist per 30,000 of the population… leading to a further 1,500 pharmacists in general practice by 2020’’. Through a national bidding process in summer 2017, Greenwich Health Ltd, on behalf of Greenwich general practice and GP its constituent GP Federations, successfully received funding to recruit clinical pharmacists to be trained and employed in Greenwich. This is a joint programme with Lewisham and Greenwich NHS Trust and is actively supported by the Trust’s chief pharmacist. The funding contributes to the costs of recruitment, employment, training of twelve clinical pharmacists. These pharmacists will expected to work half-time within the Trust and half-time in the practices, so will in total bring six whole-time equivalent (WTE) staff into general practice. Twenty-eight Greenwich practices are signed up to receive clinical pharmacist capacity from the scheme, planned on the basis of one session (usually 3.5 hours) per 4,000 registered patients. Once employment arrangements and recruitment are completed, the pharmacists will begin training and deployment into general practice. This will augment a small number of clinical pharmacists who have previously been employed directly by Greenwich general practices and are working in a similar role. To note, the role of the clinical pharmacists is to work in general practice as part of a multi-disciplinary team to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas. They are (or will train to be) prescribers who can take responsibility for patients with chronic diseases and undertake clinical medication reviews. This means they can proactively manage people with complex polypharmacy (e.g. older people, people in care homes and those with multiple co-morbidities), improving adherence and providing medication advice directly to the patient. They can also support practices with training and advice and help shift workload appropriately from GP and nurse to within their competencies and remit.

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Recommendation

The committee is asked to Note the Update on the Clinical Pharmacy bid and scheme implementation.

NHS Greenwich CCG CONTACT: Name: Irene Grayson – AD Primary Care

E-Mail: [email protected]

mailto:[email protected]

Item: 5 Enc: C

Primary Care Commissioning Committee Urgent Unplanned/Planned Decision

Title of paper:

Conway Medical Centre (G83633) – Request for Contract Variation to Add Partner

Date paper to be considered: 20th September 2017

Presented by: Jan Matthews Title: Primary care Contracting and Performanace Manager & email contact: [email protected]

Corporate Objective addressed by this paper (please select one or more with an X):

1. To commission sustainable high quality services to meet the health needs of the population of Greenwich and reduce health inequalities.

X

2. To ensure the CCG financial position recovers to meet all statutory financial duties.

3. To continue to ensure that the CCG is a clinically driven organisation.

4. To ensure diverse patient and public voices are fully considered.

Purpose of the report: To inform the committee’s decision regarding a request by the Conway Medical Centre for a new partner to be added to the practice PMS contract.

Previous committee involvement: None

Recommendations to the Committee: The Primary Care Commissioning Committee is asked to support the commissioner’s recommendation that:

1. A contract variation should be implemented to add an additional partner to the Conway Medical Centre PMS contract

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Background:

The Care Quality Commission (CQC) undertook a comprehensive inspection of Conway Medical Centre on 2nd February 2016. The inspection report was published on 27th May 2016 and indicated an overall rating of ‘inadequate’. Within this overall rating the safety; the responsive and the well led domains were judged ‘inadequate’ with the effective and the caring domains judged to be requiring improvement. The practice was put into special measures by the CQC. NHS England and Greenwich CCG then arranged a joint contractual compliance visit which took place on 13th June 2016. At that visit, the practice advised that it had challenged a number of aspects of the CQC report which was subsequently withdrawn for review. An updated CQC report was published on 29th September 2016 but this report did not differ significantly from the original version. The CQC carried out a follow up inspection on 13th December 2016. Subsequently, on 30th December 2016 the CQC issued a warning notice that the PMS contract holder remained in breach of Regulation 17 (good governance) and that it was required to act to achieve compliance by 30th March 2017. The report of the December inspection was published on 15th April 2017 and showed the practice had been inadequate in all 5 domains i.e. the practice performance as against the CQC criteria had deteriorated since the original inspection. The report stated “we1 are taking action in line with our 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 they do not improve. The service will be kept under review and if needed, could be escalated to urgent enforcement action”. Such action could include the issue of a notice of deregistration. A key statement in the CQC report was …” we found the partners were largely absent from the practice and the leadership arrangements did not support the delivery of high quality care”. Request for Contract Variation to Add Partner

The current Conway Medical Centre PMS contract is currently held by a GP (Dr. J Bajwa) and a pharmacist (Mr S Gulsin). The practice employs a long term locum Dr R. Perera. In March 2017, the practice submitted a request for the addition of Dr Perera to the contract. It is normal practice not to implement contract variations where there are, as in this case, significant concerns about practice performance. In order to discuss the concerns and agree how they might best be resolved, a meeting between the practice partners; Dr Perera; CQC; Greenwich CCG and NHS England was

1 i.e. the Care Quality Commission

3

proposed. Unfortunately getting all parties to a meeting has proved to be difficult until now; a meeting took place mid-August 2017. As referred to above, the CQC report stated that the partners were largely absent from the practice and the leadership arrangements did not, in the CQC’s view, support the delivery of high quality care. The practice application to add Dr Perera to the contract is its response to putting in place the provider level clinical leadership required. Dr Perera will lead on Clinical Governance areas at the practice and in particular: Business plans to demonstrate that the practice strategy was delivered,

monitored and reviewed to address or improve areas where performance and patient outcomes were below average.

Provide the presence required at the practice and the leadership arrangements to support the delivery of high quality care.

Carry out reviews for at risk groups and ensure arrangements are in place for managing risks and ongoing monitoring.

Admin/clinical staff training and engagement, sharing vision and values and responsibilities in relation to each individual.

Review policies and procedures that govern activity, and bring up to date and amend to reflect current practice.

Although as already discussed, a contract variation would not normally be approved where a practice is in CQC special measures, in these particular circumstances, the PCCC is asked to agree that the addition of Dr Perera should be agreed in order to improve governance arrangements within Conway Medical Centre. KEY ISSUES:

Following a CQC comprehensive inspection in February 2016, Conway PMS was put under CQC Special Measures in May 2016 on publication of the inspection report.

The original report findings were appealed by the practice but the appeal was not upheld.

A second comprehensive inspection was carried out in December 2016 and, as a result, the CQC issued a formal warning notice to the practice that, unless it became compliant with CQC governance requirements by March 30th 2017, the CQC might take enforcement action.

A key finding of the CQC was that the existing partners (one GP and one pharmacist) were largely absent from the practice and the leadership arrangements did not support the delivery of high quality care.

The practice wishes to add another GP Dr Perera to the contract.

Contract variations are not normally agreed where commissioners have reason for significant concerns about a practice performance.

The addition of a further GP partner to the contract may be considered to be a logical approach to improving governance arrangements and clinical leadership at the practice.

In these exceptional circumstances, given that a significant element of the

4

performance concerns are linked to governance and leadership arrangements it is proposed that the request for this contract variation to be implemented be agreed.

RECOMMENDATION:

The Primary Care Commissioning Committee is asked to support the commissioner’s

recommendation that:

A contract variation should be implemented asap to add an additional partner to the

Conway Medical Centre PMS contract

Author CONTACT:

Name: Harry Goldingay



:

Item 6 Enc.D



Title: Financial Reports – 4 Months to 31st July 2017. South East London Primary Medical Services

AUTHOR: NHSE Finance Team

1. Overview: The year to date reported financial position for South East London Primary Medical services is an overspend of £253k against total year to date (ytd) allocations of £82,781k. 2. 2017/18 Budgets: The total primary care medical services allocation for South East London STP for 17/18 is £248,232. After allowing for forecast population growth, anticipated increases in premises costs, 1% non-recurrent headroom and 0.5% contingency there is an underlying deficit of £2,707k for the STP, releasing the headroom and contingency reserves changes this to an STP surplus of £1,018k. The deficits and surpluses do not fall evenly across CCGs and are shown in the table below:

17/18

Allocations

Surplus/(Gap) before release of Headroom and contingency

Surplus/(Gap) after release of Headroom and contingency

£ £ £

Bexley 28,652 -532 -103

Bromley 40,558 974 1,607

Greenwich 37,127 -482 76

Lambeth 54,671 -1,396 -584

Lewisham 41,908 567 1,213

Southwark 44,398 -1,838 -1,190

Sub-total SEL 247,315 -2,707 1,018

3. Primary Medical Services Expenditure Summary

2

The expenditure summary for South East London for the current month is set out in Table 1 below with a break down at CCG level in Appendix A. Table 1

SEL Total

Service

Annual Budget

YTD Budget

YTD Actual Expenditure

YTD Variance

YTD

Variance %

£000's £000's £000's £000's

%

PMS 204,090 68,028 67,881 (146)

-0.2%

GMS 23,075 7,691 7,710 19

0.2%

APMS 18,424 6,141 6,215 74

1.2%

Other Medical Services 2,744 921 1,227 307

33.3%

Total Primary Care Medical Services 248,332 82,781 83,034 253

0.3%

Bexley CCG

PMS 24,935 8,311 8,322 10

0.1%

GMS 2,341 780 789 9

1.2%

APMS 621 207 211 4

1.7%

Other Medical Services 651 217 217 0

0.0%

Total Primary Care Medical 28,548 9,515 9,538 23

0.2%

Bromley CCG

PMS 24,916 8,305 8,305 0

0.0%

GMS 13,697 4,565 4,568 2

0.0%

APMS 1,789 596 597 1

0.1%

Other Medical Services 1,763 61 61 0

0.0%


0.0%

Greenwich CCG

PMS 34,175 11,391 11,355 (36)

-0.3%

GMS 267 89 88 (1)

-0.6%

APMS 2,548 849 905 56

6.6%

Other Medical Services 214 71 51 (20)

-27.9%

Total Primary Care Medical 37,203 12,400 12,399 (0)

0.0%

Lambeth CCG

PMS 44,204 14,734 14,617 (117)

-0.8%

GMS 2,616 872 903 31

3.6%

APMS 7,549 2,516 2,515 (1)

0.0%

Other Medical Services (282) (94) 225 319

-339.0%


1.3%

3

Lewisham CCG

PMS 38,434 12,812 12,807 (5)

0.0%

GMS 2,363 788 782 (6)

-0.8%

APMS 932 311 316 5

1.6%

Other Medical Services 1,392 464 464 0

0.0%

Total Primary Care Medical 43,121 14,374 14,367 (6)

0.0%

Southwark CCG

PMS 37,425 12,475 12,476 2

0.0%

GMS 1,791 597 580 (17)

-2.8%

APMS 4,985 1,662 1,671 9

0.6%

Other Medical Services (993) 203 210 7

3.5%


0.0% Brackets denote underspend

Medical services are showing a ytd overspend of £253k. The only material variances from budget reported at Month 4 is for Lambeth CCG and reflects the gap between their allocation and budgets after releasing the headroom reserve and contingency into the position. 4 Capitation Report There was year on year growth of 2.1% in South East London’s weighted population from April 2016 to April 2017. Demographic growth reserve budgets have been funded differentially at CCG level in London for 2017/18 based on the ONS predicted population growth figures. Figures by CCG, including growth between April 17 and July 17 are shown in Table 2 below. Table 2

CCG

Normalised weighted list as at

01/04/2016

Normalised weighted list as at

01/04/2017

Year on Year %

Movement

Normalised weighted list

as at 01/07/2017

April to July %

Movement

ONS % 16_17

ONS % 17_18

Bexley 219,428 223,645 1.92% 223,789 0.06% 1.00% 1.00%

Bromley 320,947 323,703 0.86% 324,499 0.25% 1.10% 1.10%

Greenwich 277,556 288,440 3.92% 288,660 0.08% 1.20% 1.10%

Lambeth 376,673 385,999 2.48% 388,270 0.59% 1.20% 1.10%

Lewisham 306,819 311,924 1.66% 312,859 0.30% 1.50% 1.40%

Southwark 313,341 319,177 1.86% 320,526 0.42% 1.50% 1.30%

Total SEL 1,814,765 1,852,888 2.10% 1,858,603 0.31%

Overall, in absolute terms South East London saw an increase of 38,123 in the normalised weighted population between April 16 and April 17 and a further 5,715 (0.31%) to July 17. 5. Appendix A details each CCG’s current financial performance. 5.1 Bexley The primary care medical budget calculated for this CCG leaves a net deficit position of £103k against the 17/18 allocation of £28,549k. It is expected that this deficit will be managed within the population growth reserve following low levels of list increase in Q2.

4

The reported ytd position is an overspend of £14k (0.2%), the majority relating to seniority, it is not certain that this overspend position will continue to year end. The CCG weighted practice list size has increased by 1.9% year on year from April 2016 to April 2017 and a further 0.06% to July 17. The primary care medical services allocation increased by 2.7%. 5.2 Bromley The primary care medical budget calculated for this CCG leaves a surplus position of £1,607k (inclusive of headroom reserve and contingency) against the 17/18 allocation of £42,165k. The reported ytd position is an overspend of £3k (0.02%), it is not certain that this overspend position will continue to year end. The CCG weighted practice list size has increased by 0.9% year on year from April 2016 to April 2017 and a further 0.25% to July 17. The primary care medical services allocation increased by 7.6%. 5.3 Greenwich The primary care medical budgets calculated for this CCG leaves a surplus position of £76k (the headroom and contingency reserves released into the position) against the 17/18 allocation of £37,203k. The reported ytd position is to break-even. The CCG weighted practice list size has increased by 3.9% year on year from April 2016 to April 2017 and a further 0.08% to July 17. The primary care medical services allocation increased by 4.4%. 5.4 Lambeth The primary care medical budget calculated for this CCG leaves a net deficit position of £584k against the 17/18 allocation of £54,087k. The reported ytd position is an over spend of £232k reflecting the release into the position of the net deficit. The CCG weighted practice list size has increased by 2.5% year on year from April 2016 to April 2017 and a further 0.59% to July 17. The primary care medical services allocation increased by 2.2%. 5.5 Lewisham The primary care medical budget calculated for this CCG leaves a surplus position of £1,213k (inclusive of headroom and contingency reserves) against the 17/18 allocation of £43,121k. The reported ytd position is an underspend of £6k (0.04%), the surplus has not been factored into the ytd position. The CCG weighted practice list size has increased by 1.7% year on year from April 2016 to April 2017 and a further 0.3% to July 17. The primary care medical services allocation increased by 6.3%.

5.6 Southwark The primary care medical budget calculated for this CCG leaves a net deficit position of £1,190k against the 17/18 allocation of £43,208k.

5

The reported ytd position is an overspend of £2k (0.01%), it is not certain that this overspend position will continue to year end. The CCG weighted practice list size has increased by 1.9% year on year from April 2016 to April 2017 and a further 0.42% to July 17. The primary care medical services allocation increased by 2.5%.

: It

Item 7 Enc E



Title: Greenwich primary care quality dashboard

AUTHOR: Simon James Primary Care Delivery Manager Current Position Greenwich CCG currently does not have a formally agreed quality dashboard which provides accessible and meaningful data on primary care in the borough. A quality report from the South East London primary care commissioning team has previously been provided for the Primary Care Commissioning Committee, but this is not perceived as being either comprehensive or current enough to afford an objective assessment of the quality of Greenwich primary care services. The London Operating Model is currently being finalised and will be presented to PCCCs in November/December 2017. To support the Operating Model, NHSE will be looking to develop a new Quality Report that will provide comparative data on agreed indicators. In the meantime, CCGs are developing their own bespoke Quality Reports until such time the NHSE reports will be available. The Dashboard The proposed Greenwich dashboard is based on a review of other local CCGs’ examples where available and exemplars from other parts of England. The core indicators are similar to those used by Bromley CCG and there is an indication that other South East London CCGs are interested in adopting a similar approach. This is likely to be an initial stage in development, as implementation of the new PMS/GMS contracts will eventually give the CCG a source of monitoring data that can be incorporated into a more comprehensive dashboard. Within the report, there is a summary of how this version has been developed and potential indicators which could be added to future iterations.

The report to the September 2017 PCCC draws on available data sets that are as current and meaningful in terms of core primary care service delivery and patient feedback. This includes: - GP Patient Survey (published July 2017) - Friends and Family Test returns - Quality & Outcomes Framework (2016/17 outcome summary by practice); and - CQC ratings (from www.cqc.org.uk as of August 2017);

http://www.cqc.org.uk/

2

In addition, CCG level data for child immunisations for the period January-to-March 2017. This compares Greenwich to other South London CCGs, rather than practice-level rates. Workforce data focuses on GPs for this report, referring to baseline assessments of GP numbers, nationally-collected workforce data and a local survey of the primary care workforce carried out in June 2017. A summary of GP contractual variations in September 2017 are also included in this report, drawing on

information collated by the Medical Directorate and Contract teams at NHS England. Data on practice list size growth and a map of Greenwich general practice are included for contextual information. Explanatory text about these indicators is included within the dashboard report and .

Recommendation

The committee is asked to consider and review the dashboard and comments are invited on how it may

be developed and improved.

NHS Greenwich CCG CONTACT: Name: Simon James, Primary Care Delivery Manager E-Mail: [email protected]


Greenwich Primary Care Quality Report

Irene Grayson

Associate Director, Primary Care NHS Greenwich CCG

Contents Item Page Number

Introduction 3

Developing the Primary Care Dashboard 4

Greenwich Practices 5

Contract Indicators 6

Practice List Size Growth 7

Friends and Family Test 8

QOF Performance 11

CQC Ratings 13

Immunisations, Children 14

Primary Care Workforce: GPs 16

GP Patient Survey 2017: Access and Experience 19

Introduction The purpose of this report is to give the Primary Care Committee and

the Greenwich public an overview of the quality of primary care

services in Greenwich.

The report is designed to present data that is current and meaningful to practices, professionals and patients and is based, as much as

possible, on nationally-collected data.

This is, however, a work-in-progress and further development and

enhancement of the report is anticipated (for example, assessing progress in using digital services). The contents will also change

through the year to ensure it reflects the activity and reporting cycle of

primary care.

Explanatory information about the data sources and the indicators is included in the pack and can be seen in red text boxes. Actions are

shown in blue boxes.

Developing the Greenwich Primary Care Quality Dashboard

Greenwich Dashboard

• Friends and Family Test

• GP-Patient Survey (selected indicators)

• CQC ratings

• QOF performance

• List Growth

• Workforce

Contract indicators

• Retirements

• Partnership changes

• Mergers

• List Closures

• Breaches

• Performer Issues

• New PMS contract Key Performance Indicators (2018-)

Add. Quality indicators

• Patient Online

• Digital inclusion

• Access hub appointments

• A&E attendances

• Vacccination and Immunisations

• Dementia

• Cervical Screening

• Learning Disability health checks

• Diabetes

Principles for Dashboard

• Constructive and developmental

• Fair and meaningful

• Accurate and objective

• Timely and reflecting

Structure

• A core dashboard that reflects monitoring standards in rest of South East London

• Additional summary of contract indicators to mirror former SE London NHS England team Quality Report

• Future addition of new contract KPIs when it goes live in Greenwich

• Addition of local quality indicators to assess clinical, access, workforce and digital performance

Gaps

• Estates

• Public engagement & complaints

• Outpatient referrals / Electronic Referral System use

• GP Forward View impact and progress assessment

• Proactive Care indicators

• Coordinated Care indicators (e.g. progress in developing at-scale integrated care at network/borough level)

4

Greenwich practices Serial

No

Syndicate Serial

No

Surgery Name

1 Network 30 Manor Brook Medical Centre

2 Excel 31 New Eltham Medical Practice

3 Excel 32 Nightingale Surgery (Branch)

4 Eltham 33 Plumbridge Medical Centre

5 Excel 34 Plumstead Health Centre

6 Excel 35 Rochester Way Surgery (Branch)

7 Eltham 36 Royal Arsenal PMS

8 Blackheath_Charlton 37 Samuel Street Surgery (Branch)

9 Eltham 38 Sherard Road Medical Centre

10 Blackheath_Charlton 39 Shooters Hill Medical Centre

(Branch)11 Blackheath_Charlton 40 South St Medical Centre

12 Excel 41 St Marks Medical Centre

13 Network 42 Thamesmead NHS Health Centre

14 Eltham 43 The Fairfield Centre

15 Excel 44 The Hill Surgery-Dr Baksh (Branch)

16 Eltham 45 The Hill Surgery-Dr S Ratsnewaren

(Branch)17 Eltham 46 The Mound Medical Centre

18 Eltham 47 The Slade Surgery

19 Eltham 48 The Trinity Medical Centre

20 Eltham 49 The Waverley Practice

21 Network 50 Triveni PMS

22 Network 51 Triveni PMS Branch (Branch)

23 Network 52 Tudway Road (Branch)

24 Excel 53 Vanbrugh Health Centre

25 Excel 54 Wallace Centre (Branch)

26 Blackheath_Charlton 55 Westmount Surgery

27 Eltham 56 Wickam Lane Surgery (Branch)

28 Eltham 57 Wickham Street (Branch)

29 Network 58 Woodland Walk Surgery

Henley Cross Medical Practice Excel

Henley Cross Medical Practice

Branch

Excel

Heronsgate Medical Centre (Branch) Blackheath_Charlton

Garland Road Health Centre

(Branch)

Blackheath_Charlton

Glyndon Medical Centre Blackheath_Charlton

Greenwich Peninsula Practice Eltham

Ferryview Health Centre Excel

Frances Street Surgery (Branch) Excel

Gallions Reach Health Centre Eltham

Eltham Medical Practice Branch Excel

Eltham Palace Surgery Network

Eltham Park Surgery Excel

Dr Mostafa PMS Eltham

Dr S Ratneswaren Surgery Eltham

Eltham Medical Practice Eltham

Clover Health Centre Network

Conway PMS Network

Dr M Baksh The Coldharbour

Surgery

Blackheath_Charlton

Briset Corner Surgery Eltham

Burney Street Practice Network

Charlton Road Surgery (Branch) Blackheath_Charlton

Eltham

Blackfen Road (Branch) Network

Blackheath Standard Surgery Excel

Surgery Name Syndicate

7 Day Healthcare (Bramch) Blackheath_Charlton

Abbeywood Surgery Eltham

All Saints Medical Centre Network

Avery Hill Surgery (Branch) Blackheath_Charlton

Bannockburn Surgery Excel

Basildon Road Surgery

5

This map shows practices (main and branch surgeries) by syndicate area as at the start of 2017

Contract indicators: September 2017

Indicator Number this quarter

Retirements 0

Partnership changes 1

Mergers 0

List Closures 0

Breaches 0

Performance Issues 0

The partnership change is to Abbeyslade PMS who have a new partner, Dr Jyoti Chand. She

joined the Contract from 26/5/17 and this is now finalised through a contractual variation.

Practice List Size Growth PRACTICE

CODE PRACTICE NAME

Raw list size

1.4.2016

Raw list size

1.4.2017 Increase % Increase

G83628 DR J LAL'S PRACTICE 6892 8445 1553 22.5

Y03296 CLOVER HEALTH CENTRE 5089 5747 658 12.9

G83021 VANBRUGH GROUP PRACTICE 11891 13419 1528 12.9

Y02974 AT MEDICS 6526 7322 796 12.2

G83016 ROYAL ARSENAL MEDICAL CENTRE 8225 9100 875 10.6

Y03755 GREENWICH PNINSULA 7740 8561 821 10.6

G83015 ELTHAM PALACE PMS 4808 5308 500 10.4

G83673 PRIMECARE PMS (COLDHARBOUR) 4379 4771 392 9.0

G83680 ELTHAM MEDICAL PRACTICE 13887 15019 1132 8.2

G83019 PLUMSTEAD HEALTH CENTRE PMS 10550 11290 740 7.0

G83027 SHERARD ROAD MEDICAL CENTRE 10103 10801 698 6.9

G83003 DR M BAKSH'S PRACTICE 4223 4500 277 6.6

G83663 BRISET CORNER SURGERY 2172 2302 130 6.0

G83651 WOODLANDS SURGERY 5587 5921 334 6.0

G83641 Plumbridge MC 2264 2395 131 5.8

Y02222 THE TRINITY MEDICAL CENTRE 3230 3411 181 5.6

G83039 ST MARKS PMS 7774 8188 414 5.3

G83065 BURNEY STREET PMS 15332 16035 703 4.6

G83044 FAIRFIELD PMS 10447 10865 418 4.0

G83647 MOSTAFA PMS 6212 6449 237 3.8

G83026 TRIVENI PMS 7338 7613 275 3.7

G83013 BLACKHEATH STANDARD PMS 6474 6700 226 3.5

G83001 MANOR BROOK PMS 12450 12881 431 3.5

G83034 ELTHAM PARK SURGERY 4775 4930 155 3.2

G83030 ALL SAINTS MEDICAL CENTRE PMS 5094 5231 137 2.7

G83022 DR V SANDRASAGRAS PRACTICE 2339 2401 62 2.7

G83058 PRIMECARE PMS (SOUTH STREET) 8281 8472 191 2.3

G83654 BANNOCKBURN SURGERY 5408 5504 96 1.8

G83631 ABBEYSLADE PMS (DR CHAND) 4568 4616 48 1.1

G83031 ABBEY WOOD SURGERY 7691 7763 72 0.9

G83060 GLYNDON PMS 6836 6894 58 0.8

G83633 CONWAY PMS 4226 4439 13 0.3

G83067 VALENTINE HEALTH PARTNERSHIP 25444 25502 58 0.2

G83635 WAVERLEY PMS 4753 4643 110 -2.3

G83012 GALLIONS REACH HEALTH CENTRE 16859 15490 1369 -8.1

G83017 HENLEY CROSS MEDICAL PRACTICE 4529 3727

G83063 DR B P C PEIRIS' PRACTICE 2801 673

G83655 DR V AGARWAL'S PRACTICE 1616 1037

G83668 THE SLADE SURGERY 3673 2129

Year-on-year to April 2017, seven

practices had 10% plus list size growth.

Individual list size growth has resulted from:

Practices taking on additional

patients due to practice

closures Population growth generated

through new housing developments

7

Greenwich is monitoring list size

by practice and is using this as a key indicator for its use of GP Forward View resilience funding in

2017/18.

Friends and Family Test The Friends and Family Test (FFT) is an important feedback tool that supports the

fundamental principle that people who use NHS services should have the opportunity

to provide feedback on their experience.

It asks people if they would recommend the services they have used and offers a

range of responses. When combined with supplementary follow-up questions, the

FFT provides a mechanism to highlight both good and poor patient experience. The

feedback is vital in transforming NHS services and supporting patient choice.

Whilst a useful tool to measure patient satisfaction/experience the response numbers

are very low so this can skew the results at individual practice level.

The chart that follows details FFT data for June 2017. It should be noted that these

practices did not submit data:

Royal Arsenal Medical Centre

Burney Street PMS

Clover Health Centre

Plumbridge Medical Centre

Friends and Family Test

The highest number of responses for an individual practice

was 164 (Abbey Wood Surgery) and the lowest was 8 (Dr V

Sandrasagra practice).

The SMS/Text message returns account for 91% of the

response collection type. 9

Practices are supported by the CCG and

Greenwich Healthcare GP Federation by funding

the i-Plato friends and family test function, so

patients can quickly and electronically register

their opinions.

Friends and Family test: data table

10

Quality and Outcomes Framework The Quality and Outcomes Framework (QOF) is the annual reward and incentive programme

detailing GP practice achievement results. It rewards practices for the provision of quality care and helps standardise improvement in the

delivery of primary medical services.

It is a voluntary process for all surgeries in England and was introduced as part of the GP contract in 2004. The indicators for the QOF change annually, with the introduction of new measures and some indicators are retired.

The QOF contains three domains (Clinical, Public Health and Public Health - Additional services) with

each domain consists of a set of achievement measures, known as indicators, against which practices score points according to their level of achievement.

The QOF measures achievement against these indicators with practices scored points on the basis of achievement against these indicators, up to a maximum of 559 points.

The QOF gives an indication of the overall achievement of a surgery through a points based system. Practices aim to deliver high quality care across a range of areas for which they score points.

The next slide sets out the overall achievement for all Greenwich practices. The latest published data

is 2015/16, so the 2016-17 & 2017/18 scores is yet to be published. 2016/17 QOF data is due to be published in October 2017.

Quality and Outcomes Framework

12

CQC Ratings Practice

codeLocation Name Location Street Address Postcode Latest Rating Publication Date

G83001 Manor Brook PMS Manor Brook Medical Centre SE3 0EN Good 22/09/2016

G83003 DR M BAKSH'S PRACTICE Coldharbour Surgery SE9 3JD Good 10/12/2015

G83012 Thamesmead Medical Associates - PMS Gallions Reach Health Centre SE28 8BE Good 25/04/2017

G83013 Blackheath Standard PMS Blackheath Surgery, SE3 7HB Good 29/09/2016

G83015 Eltham Palace PMS 30 Passey Place SE9 5DQ Not visited on new site

G83016 Royal Arsenal Medical Centre 21 Arsenal Way SE18 6TE Good 26/04/2017

G83019 Plumstead Health Centre PMS Tewson Road SE18 1BH Good 11/01/2017

G83021 Vanbrugh Group Practice Lambarde Square SE10 9GB Not visited on new site

G83022 Dr Vasanti Sandrasagra 191 Westmount Road SE9 1XY Good 26/07/2016

G83026 Triveni PMS Escreet Grove Surgery SE18 5TE Good 27/03/2017

G83027 Sherards Road Medical Centre 71 Sherard Road SE9 6ER Requires improvement 06/07/2017

G83030 All Saints Medical Centre PMS 13a Ripon Road SE18 3PS Good 11/08/2016

G83031 Abbey Wood Surgery 9 Godstow Road SE2 9AT Good 19/02/2015

G83034 Eltham Park Surgery 46 Westmount Road SE9 1JE Good 17/03/2016

G83039 St Marks PMS St Marks Medical Centre SE18 3EP Good 04/11/2016

G83044 Fairfield PMS The Fairfield Centre SE7 8TX Good 23/08/2016

G83058 Primecare PMS (South Street) 71A Greenwich South Street SE10 8NT Good 22/12/2016

G83060 Glyndon PMS Glyndon Medical Centre SE18 7LU Requires improvement 22/02/2017

G83065 Burney Street PMS Burney Street Practice, SE10 8EX Good 23/03/2016

G83067 Ferryview Health Centre GP Surgery 25 John Wilson Street SE18 6PZ Good 16/11/2016

G83628 New Eltham Medical Centre 52 Thaxted Road SE9 3PT Requires improvement 28/01/2016

G83631 Abbeyslade PMS - Dr Chand 111 Basildon Road SE2 0ER Good 22/03/2016

G83633 Conway PMS Conway Medical Centre SE18 1AH Inadequate 05/04/2017

G83635 Waverley PMS The Waverley Practice SE18 7QU Good 17/12/2015

G83641 Plumbridge MC 32-33 Plumbridge Street SE10 8PA New provider, to be visited

G83647 Mostafa PMS 141 Plumstead High Street SE18 1SE Good 16/02/2017

G83651 Woodlands Surgery Woodland Surgery, Woodland Walk SE10 9UB Good 29/09/2016

G83654 Bannockburn PMS 20-22 Bannockburn Road SE18 1ES Good 18/08/2016

G83663 Briset Corner Surgery Briset Corner, SE9 6JX Good 24/02/2017

G83673 Primecare PMS (Coldharbour) 79 William Barefoot Drive SE9 3JD Good 09/04/2015

G83680 Eltham Medical Practice 30 Passey Place SE9 5DQ Good 20/07/2017

Y02222 Trinity Medical Centre 2 Garland Road SE18 2AE Requires improvement 14/12/2016

Y02974 AT MEDICS Thamesmead Health Centre SE28 0NY New provider, to be visited

Y03296 Clover Health Centre Equitable House, 10 Woolwich New RoaDSE18 6AB Good 09/04/2015

Y03755 Greenwich Peninsula Practice Millenium Village Health Centre SE10 0QN Good 09/05/2016 13

Several practices

require re-visits to new premises or providers of their

service. Their reports are

archived by CQC and are not available to report

here.

Our single lowest

rated practice has received RCGP support to improve

and proposal to improve clinical

leadership is before the PCCC.

Their CQC revisit took place on 13

September 2017.

Immunisation Programmes: Children

Latest period 16-17 Q4 Latest period 16-17 Q4 Latest period 16-17 Q4 Latest period 16-17 Q4

Lower threshold 90.0% Lower threshold 90.0% Lower threshold 90.0% Lower threshold 90.0%

Standard 95.0% Standard 95.0% Standard 95.0% Standard 95.0%

Richmond upon Thames 77.0% 1 Lewisham 83.8% 1 Richmond upon Thames 75.0% 1 Richmond upon Thames 75.3%

Croydon 85.3% 2 Croydon 84.8% 2 Croydon 86.3% 2 Croydon 86.4%

Lambeth 85.7% 3 Richmond upon Thames 85.2% 3 Lambeth 88.4% 3 Bromley 88.7%

Bromley 87.5% 4 Lambeth 85.6% 4 Bromley 88.7% 4 Lambeth 88.7%

Southwark 88.2% 5 Bexley 87.9% 5 Greenwich 89.6% 5 Greenwich 89.3%

Wandsworth 89.1% 6 Bromley 88.4% 6 Wandsworth 90.3% 6 Wandsworth 90.8%

Merton 92.3% 7 Southwark 88.5% 7 Lewisham 91.1% 7 Lewisham 91.4%

Sutton 92.4% 8 Greenwich 92.2% 8 Southwark 91.9% 8 Southwark 91.9%

Greenwich 92.8% 9 Kingston upon Thames 93.3% 9 Bexley 92.7% 9 Bexley 92.3%

Kingston upon Thames 93.3% 10 Merton 98.0% 10 Merton 93.2% 10 Merton 93.6%

Lewisham 93.4% 11 Sutton 98.0% 11 Sutton 93.4% 11 Sutton 93.6%

Bexley 96.0% 12 Wandsworth No data 12 Kingston upon Thames 95.3% 12 Kingston upon Thames 95.2%

Rotavirus coverage (two dose, 12 mths) Men B coverage (12 mths) Dtap / IPV / Hib coverage (12 mths) PCV coverage (12 mths)

Latest period 16-17 Q4 Latest period 16-17 Q4 Latest period 16-17 Q4

Lower threshold 90.0% Lower threshold 90.0% Lower threshold 90.0%

Standard 95.0% Standard 95.0% Standard 95.0%

Richmond upon Thames 82.9% 1 Richmond upon Thames 73.3% 1 Richmond upon Thames 72.4%

Croydon 90.1% 2 Croydon 80.3% 2 Croydon 80.2%

Bromley 90.3% 3 Bromley 81.7% 3 Lewisham 81.0%

Wandsworth 90.7% 4 Greenwich 82.8% 4 Bromley 81.3%

Greenwich 91.0% 5 Lambeth 83.4% 5 Greenwich 82.4%

Lambeth 91.5% 6 Wandsworth 83.5% 6 Lambeth 83.3%

Lewisham 92.8% 7 Lewisham 85.0% 7 Wandsworth 83.5%

Southwark 93.7% 8 Bexley 87.5% 8 Bexley 88.4%

Merton 94.1% 9 Southwark 88.3% 9 Merton 88.6%

Sutton 94.3% 10 Merton 88.8% 10 Sutton 88.7%

Bexley 94.5% 11 Sutton 88.8% 11 Southwark 89.3%

Kingston upon Thames 95.4% 12 Kingston upon Thames 90.5% 12 Kingston upon Thames 89.9%

Dtap / IPV / Hib coverage (2 years old) MMR for one dose coverage (2 years old) Hib/Men C booster coverage (2 years old)

14

Immunisations data covers a wide-range of services provided, primarily, in general practice (e.g. flu, cancer, shingles). Data for January-March 2017 is available for child immunisations by CCG is available, and the following shows Greenwich as a whole in comparison to the rest of South London. However, there are campaigns – like flu – which are seasonal and for which data will now be a year out-of-date. This performance is best reported at a spring PCCC.

Immunisation Programmes: Children

15




Richmond upon Thames 73.5% 1 Richmond upon Thames 84.5% 1 Richmond upon Thames 86.7%

Croydon 80.8% 2 Croydon 84.7% 2 Croydon 88.2%

Bromley 80.8% 3 Lewisham 86.0% 3 Greenwich 89.0%

Greenwich 82.5% 4 Greenwich 86.2% 4 Merton 89.7%

Lambeth 83.2% 5 Wandsworth 87.8% 5 Southwark 89.7%

Wandsworth 83.5% 6 Merton 88.1% 6 Wandsworth 89.7%

Lewisham 84.0% 7 Sutton 88.2% 7 Sutton 89.7%

Bexley 88.2% 8 Southwark 88.3% 8 Lewisham 90.8%

Merton 88.5% 9 Kingston upon Thames 90.2% 9 Lambeth 91.0%

Sutton 88.7% 10 Lambeth 90.2% 10 Kingston upon Thames 93.4%

Southwark 89.2% 11 Bexley 92.7% 11 Bexley 94.1%

Kingston upon Thames 89.9% 12 Bromley 93.4% 12 Bromley 95.2%

MMR for one dose coverage (5 years old)PCV booster coverage (2 years old) Hib / Men C booster coverage (5 years old)




Richmond upon Thames 65.8% 1 Croydon 90.4% 1 Richmond upon Thames 31.8%

Croydon 71.3% 2 Richmond upon Thames 91.8% 2 Wandsworth 68.2%

Bromley 77.4% 3 Greenwich 91.9% 3 Croydon 70.7%

Merton 79.7% 4 Southwark 92.2% 4 Greenwich 73.9%

Sutton 79.7% 5 Merton 92.7% 5 Bexley 74.7%

Bexley 82.2% 6 Sutton 92.8% 6 Bromley 76.8%

Kingston upon Thames 82.5% 7 Wandsworth 93.4% 7 Merton 76.9%

Wandsworth 83.2% 8 Lewisham 93.9% 8 Lambeth 76.9%

Greenwich 84.1% 9 Lambeth 94.2% 9 Sutton 77.1%

Lambeth 85.3% 10 Kingston upon Thames 95.6% 10 Lewisham 77.4%

Lewisham 86.2% 11 Bexley 95.6% 11 Southwark 77.5%

Southwark 86.4% 12 Bromley 96.3% 12 Kingston upon Thames 82.8%

MMR for two doses coverage (5 years old) DTaP/IPV/Hib coverage (5 years old) DTaP/IPV booster coverage (5 years old)

Primary Care Workforce: GPs To assist primary care workforce planning for CCGs

as part of the GP Forward View implementation,

Healthy London Partnership projected GP supply and

demand by CCG in 2016.

GP numbers in Greenwich were running behind

demand in 2016 and projected to show a similar gap

by 2021 – if no action taken to improve recruitment

and retention.

Much of the gap will be based on retirement – 1/3rd of

Greenwich GPs are over 55 years’ of age and 22%

over 60 (the 5th highest in London).

132

157 157

186

0

50

100

150

200

2016 2017 2018 2019 2020 2021

GP Supply vs demand WTE

GP Supply GP Demand

Reference: www.healthylondon.org/workforce/workforce-modelling/primary-care

The CCG carried out a survey of Greenwich practices in June 2017. this was designed to augment nationally-collected

workforce data (reported as of March 2017) and assess local recruitment need across all primary care professionals and

staff. The data also contributed towards a SE London bid against the new NHS International Recruitment programme. This

was successful and, with three other CCGs, 45 overseas GPs are expected to be recruited into the area from 2018.

https://www.healthylondon.org/workforce/workforce-modelling/primary-care





Greenwich primary care workforce survey

A total of 115.6 whole-time equivalent (WTE)

GPs were in post, with a declared vacancy

total of 22.7 WTE GPs – this approximately

16% of the total complement.

Practices reported a high level of GP

partnership vacancies in practices – 8 WTEs

in total. From the reported baseline of GP

partners in post plus vacancies, this gave a

reported vacancy rate of 12.5%.

Practices also reported high levels of

vacancies for salaried GPs in Greenwich,

equivalent to 18.4 WTE.

GPs identified as locums covering the

combined gap of partners and salaried were

reported as 40.9 WTE.

There were 10 practices reporting they had

11 GPs who were expecting to retire in the

next two years.

Ten training practices reported a total of

19.25 WTEs Year 3 GP Registrars (i.e. GPs

in training).

Of the practices, 24 had an interest in help

to recruit GPs and expressed this against

the international recruitment programme. Of

those, 17 of these had GP vacancies now

equivalent to 20.8 WTEs in total.

Of these, 14 practices were for at least 1

full-time GP.

For General Practitioners, the results were for the 29 practices that responded:

17

Comparative data: GPs

Geography

Total GP WTE (excluding registrars)

Total GP Partner and Salaried

Ratio of Total GP / Patient

Ratio of GP Partner and Salaried / Patient

List Size

National* 29,937 29,336 1:1912 1:1952 57,254,188

London* 4,701 4,521 1:1995 1:2074 9,377,393

Greenwich 120.9 111.5 1:2270 1:2461 274,443** * National data taken from the General and Personal Medical Services, England September to March 2016, Provisional

Experimental statistics (NHS Digital)

** Total practice list size, March 2017

This table shows a top-down summary of GP numbers and a comparison against London and England data.

Combining this nationally-reported primary care workforce data with reported GP numbers from the local survey

(excluding GP Registrars) would give Greenwich an estimated total of 120.9 WTE GPs.

Other reported data seems to back up the overall message that Greenwich is under-doctored compared to the rest

of London. Health Education England analysis for London from 2016 also showed

GP Patient Survey 2017 • The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data

about patients’ experiences of their GP practices.

• Ipsos MORI administers the survey on behalf of NHS England.

• The survey measures patients’ experiences across a range of topics, including:

– Making appointments

– Waiting times

– Perceptions of care at appointments

– Practice opening hours

– Out-of-hours services

• The data in this slide pack are based on the July 2017 GPPS publication from a single wave of fieldwork carried out annually, from January 2017 to March 2017.

• In NHS Greenwich CCG, 13,826 questionnaires were sent out, and 4,055 were returned completed. This represents a response rate of 29%.

• A selection of graphs from the Greenwich CCG published pack are included in this report, focusing on Access and Patient Experience.

19

Note that several of the practices in these slides have since merged or closed.

15-080216-01 Version 1 | Public © Ipsos MORI

20

Success in getting an appointment:

how the CCG’s practices compare

Percentage of patients who said they were able to get an appointment last time they tried to see or speak to a GP or nurse

CCG Practices National average

Q12. Last time you wanted to see or speak to a GP or nurse from your GP surgery,

were you able to get an appointment to see or speak to someone?

Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses

Base: All those completing a questionnaire: National (772,293); CCG (3,854); Practice bases range from 21 to 128

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%Yes = %Yes + %Yes, but I had to call back closer to or on the

day


21

Ease of getting through to GP surgery on the

phone: how the CCG’s practices compare

Percentage of patients saying it is ‘easy’ to get through to someone on the phone

Q3. Generally, how easy is it to get through to someone at your GP surgery on the

phone?




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%Easy = %Very easy + %Fairly easy


22

Overall experience of making an appointment:


Percentage of patients saying they had a ‘good’ experience of making an appointment

Q18. Overall, how would you describe your experience of making an appointment?




0%

10%

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23

Waiting times at the GP surgery:


Percentage of patients saying they ‘don’t normally have to wait too long’


Q20. How do you feel about how long you normally have to wait to be seen?



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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24

Satisfaction with opening hours:


Percentage of patients saying they are ‘satisfied’ with the hours their GP surgery is open

Q25. How satisfied are you with the hours that your GP surgery is open?




0%

10%

20%

30%

40%

50%

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25

Overall experience: how the CCG’s practices

compare

Percentage of patients saying good CCG Practices National average

Q28. Overall, how would you describe your experience of your GP surgery?


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Base: All those completing a questionnaire: National (794,704); CCG (3,987); Practice bases range from 24 to 131 %Good = %Very good + %Fairly good


26

Overall experience of GP surgery

35%

46%

12%

5%

Very good

Fairly good

Neither good nor poor

Fairly poor

Very poor

Q28. Overall, how would you describe your experience of your GP surgery?

Practice range in CCG – % Good Local CCG range – % Good

CCG’s results over

time National

85%

5%

Good

Poor

Lowest Performing

Highest Performing

54% 94%

Lowest Performing

Highest Performing

73% 87%

%Good = %Very good + %Fairly good

%Poor = %Very poor + %Fairly poor

Base: All those completing a questionnaire: National (794,704); CCG 2017 (3,987); CCG 2016 (4,108); CCG 2015 (4,426); CCG 2014

(4,590); CCG 2013 (5,201); Practice bases range from 24 to 131; CCG bases range from 2,464 to 7,689

84 83 81 82 81

5 5 7 6 7 0

10

20

30

40

50

60

70

80

90

100

June2013

July2014

July2015

July2016

July2017

% Good % Poor

CCG’s results Comparison of results

81%

7%

Good

Poor

CCG

: It

Item 8 Enc F



Title: Primary Care Highlight Reports

AUTHOR: Irene Grayson Associate Director Primary Care Background Currently there are 3 main meetings that take place which report on primary care activity.

SE London Primary Care Executive Board

Greenwich GP Forward View Programme Board

Greenwich Primary Care Commissioning Committee Each of these meetings have a different function;

SE London Primary Care Executive Board meets monthly with senior representatives from the 6 CCGs and is chaired by the Programme Director for SE London for Community Based Care. The remit of this Board is to ensure a fair and equitable approach to decisions made regarding primary care funding initiatives, sharing best practice and collectively working together to develop the primary care delivery plan for South East London STP.

Greenwich GP Forward View Programme Board meets bi-monthly and is responsible for approving decisions at a local level associated with financial allocations that are discussed at the SE London Executive Board. The Board will also escalate issues of concern up to the SEL Executive Board

Greenwich Primary Care Commissioning Committee (PCCC) is corporate decision-making body for the management of primary care delegated functions and meets quarterly in public

The Highlight Reports It is important that the PCCC receives highlight reports from these groups and that these reports are shared across the Greenwich Boards and Committees to enable collaborative working and avoid duplication. The work of these Boards should complement the overall primary care strategy for Greenwich Recommendation

The committee is asked to Note the Highlight Reports attached.

2

NHS Greenwich CCG CONTACT: Name: Irene Grayson – AD Primary Care



GP FORWARD VIEW - Highlight Report September 2017 No 7

Item 10

Encl F

Board GP Forward View Programme Board

Frequency Bi-monthly

Reporting Frequency Quarterly

Author Irene Grayson

Executive Lead Vanessa Fowler

Clinical Lead Dr Ellen Wright & Dr Ranil Perera

General

Healthy London Partnerships is setting up a new GPFV assurance regime on behalf of SEL STP. CCGs will be required to submit regular update reports as part of this assurance process.

Progress

1. Access Hubs

Our GP Access Hubs based at Eltham and Thamesmead are now operating from 9am – 5pm Saturdays, 9am – 1pm Sundays and 4pm – 8pm Monday to Friday. The extension of opening hours on Saturdays and Sundays from 8am – 8pm will be completed during Quarter 2 2017/18. Patients will then have access to primary care services in Greenwich 7 days a week from 8am to 8pm. July Data

Hub utilisation per day

Day # appts available # appts booked # DNAs

Monday 184 184 0

Tuesday 184 162 19

Wednesday 184 119 23

Thursday 184 162 35

Friday 184 184 35

Saturday 738 334 54

Sunday 190 117 54

Total this month

1848 1262 220

There has been a drop in utilisation, particularly at weekends, which could be due to the holiday period and will continue to be monitored closely. The hubs have sufficient capacity to take 111 bookings but the interoperability between the Hubs and 111 is still not available, therefore the bookings are completed by phone. The hubs are also working on setting up SMS messaging in order to reduce the DNA rate which remains high. Greenwich Health Ltd have developed their communication plan to GP Practices and patient facing leaflets have been produced which were distributed at the Great Get Together on 24 June 2017. Sign posting posters and leaflets have been developed for the Urgent Care Centre (UCC) and the Patient Champion in the UCC will also be signposting patients to primary care services.

2. Resilience Plans – Heat Maps

Healthy London Partnerships are managing the resilience funding process for 2017 and have produced a heat map identifying practices across SEL which would automatically meet the criteria for support based on performance against a set of indicators. However all practices have been written to with the option to self-nominate for practice support using a template developed by HLP. CCGs were required to add local intelligence to the heat maps and to encourage practices to nominate themselves as appropriate. A SEL panel is being set up to review and agree those nominations that meet a set scoring criteria. SEL have allocated its funding to individual CCGs based on a weighted allocation of which Greenwich has been allocated circa £36k. HLP have sent out information on the number of self-nominations by CCG. No Greenwich practice nominations

GP FORWARD VIEW - Highlight Report September 2017 No 7

have been received. The CCG will now be seeking clarification on whether it can allocate the £36k to locally agreed resilience schemes. The 2016/17 resilience plan which provides access to education and training for practice managers and practice nurses is in implementation stage. The workflow management programme is due to start late November 2017.

3. General Practice Workforce

As part of a combined South East London proposal, Greenwich has been successful in its bid to the new NHS International Recruitment Programme. This is a major GP Forward View initiative to recruit qualified GPs from overseas and our bid with colleagues from Bromley, Bexley and Lewisham CCGs. It will see 45 GPs coming into our four CCGs’ local primary care system over the next twelve months and, via direct negotiation with general practices, they will commit to contracts to work as general practitioners in Greenwich for a minimum of three years. Our bid included a wide range of local partners, both educational and provider organisations, and we feel confident that this will support successful delivery.

The CCG Commissioning Project Lead for Workforce, Dr Eugenia Lee, is writing to the 24 general practices that both completed our recent primary care workforce survey and indicated an interest in participating in the scheme. This will hopefully begin the process of establishing the current and emerging level of their GP vacancies and firmer interest in potentially sourcing new clinicians via this scheme.

NHS England are coordinating an initial meeting with all the successful bidders for the scheme, together with phase 1 pilot sites, on 14 September and the four South East London CCGs will be represented by OHSEL workforce project manager, Rebekah Middleton, and Simon James from Greenwich CCG.

A meeting is taking place on 5 September with key stakeholders regarding the successful bid for clinical pharmacists in General Practice. The meeting will be planning next steps in implementing the project plan that was submitted.

4. Patient On-Line and e-consultations

Patient On-Line: The latest figures which include Iplato show a significant increase over that short space of time for Greenwich. EMIS data should be ready by the end of this month which should confirm the continual progress that has been made in Greenwich since March 2017. However the CCG recognises that when benchmarked against other SEL CCGs our percentages which range between just under 10% - 30% are low and more work needs to be done to increase uptake. E-Consultations: The necessity of making progress towards commissioning an e-consultation package to meet the requirements of the GP Forward View and release 2017/18 funding is clear and work has taken place in the summer to review other South East London CCGs’ progress and a desktop review of the market. Further consultative work with end users (i.e. patients) in collaboration with Healthwatch, and primary care staff who would need to integrate an e-consultation package into their day-to-day work and organisational processes of their practices, is planned for September. This should enable Greenwich to finalise its preference in terms of functionality and initiate commissioning of an e-consultation package for 2017/18.

5. Estates

A Gallions Reach reconfiguration group is meeting monthly to oversee progress on site and Essentia are continuing to work on the Outline Business Case. The expectation is that this is received in November and finalised during December 2017. Subject to approval by all parties, Essentia will then move to develop the Full Business Case in early 2018. Kidbrooke Village: an agreed design for the health centre facility within Berkeley Homes’ Kidbrook Village development was submitted to RBG Planning Committee in August as part of the overall next implementation stage. This was agreed and development of a section 106 agreement will start the next phase of the project, working through the expectations of both parties, the general practice and other service providers prior to the build phase.

SEL PRIMARY CARE EXECUTIVE BOARD - Highlight Report No 2

Enc

Item 8 Encl Fii Board SEL PRIMARY CARE EXECUTIVE BOARD

Date of Last Meeting 15 August 2017

Reporting Frequency Monthly

Author Jessica Arnold (Bromley) Tom Bunting (Southwark)

Executive Lead Andrew Bland

1. London Operating Model SEL CCG leads are advised to keep their Primary Care Working Groups (or equivalent local name) sighted on the development of the London Operating Model between now and the 13 October meeting of the Primary Care Management Board, after which time the final Operating Model will go to PCCCs (across London) for approval during November and December. This board will aim to reach a commonality of approach and recommendations via SEL CCG leads to their working groups/PCCCs on the development and finalising of the Operating Model. 2. FYFV Primary Care STP Delivery Plan – feedback from NHSE and next steps

The SE London Delivery Plan has been broadly well-received by NHSE. There were a number of development areas across the sections on Workforce and ETTF, with minor feedback on Access also. However, the general response was positive. Healthy London Partnership has not asked for a resubmission of the primary care delivery plan, but that SE London will need to have actions progressed and be in a position to demonstrate how these are being tracked before the end of August. Circulated amongst the meeting papers were (i) the FYFV Primary Care plan submitted on 30 June, (ii) the feedback received from TPMO/NHSE on 28 July, (iii) the SE London internal draft response to the main points in the feedback (put together by JA and Paul White). To further develop the response, SEL CCG leads were asked to consider the following questions:

1. What workforce planning and modeling have you/partners undertaken within your borough; how has this informed your actions; and how frequently has/will this be updated?

2. What nurse training are you offering/commissioning; how will this increase the numbers of nurses working in your practices; and how will you monitor this?

3. What work are you doing on productivity; and how will this be assessed/monitored to articulate the benefits?

4. How are your recruitment and retention programmes being monitored and assessed? (any information in addition to the above)

5. Are you doing any work locally to link in with HEE and the Local Workforce Advisory Board? CCG leads were asked to send further responses to JA, TB and Paul White by 23 August to inform the response to the feedback. (this has been progressed further since the meeting and Mark Edginton is now taking a lead on this since he commenced in his role as CBC Programme Director).

3. PMS Review

A summary of feedback from Londonwide LMCs (LWLMCs) was tabled, who had identified some contractual issues within SE London PMS Contract Offer Pack that had been received very recently. It was noted that the comments included in it were provided by LWLMC Officers who had not been present at the meetings with each CCG. The PMS Support Team would shortly be reviewing this feedback to identify the items within it that might potentially be resolved relatively quickly and simply (as well as the correction of any factual errors included in it), and to identify the more fundamental issues. A discussion took place on the potential implications of this feedback across SE London. It was agreed that a follow-up call with CCG leads would be scheduled for next week to update and gather further local views in response and to agree next steps.

SEL PRIMARY CARE EXECUTIVE BOARD - Highlight Report No 2

Enc

4. SE London potential APMS re procurements There are 15 APMS contracts due to expire within SE London between now and end of March 2018. The immediate priority is to procure those contracts that expire in the early part of this timeframe. To determine what needs to be procured, strategic commissioning intentions must be finalised by the end of September. The SE London Primary Care team will support CCGs in taking the commissioning intentions to Primary Care Commissioning Committee (PCCC) part 2 meetings for timely approval. It was noted that, in instances where PCCC meetings fell outside of this timeframe, that urgent planned decisions would be enacted as appropriate and in line with PCCC ToRs. A London APMS work stream has been established. Jill Webb is currently overseeing a review of the process that will establish whether the ‘Once for London’ arrangements for procuring/reprocuring APMS contracts, based on a single price, performance framework and KPI/performance management arrangements were sustainable in light of the PMS equalisation agenda and the increasing focus on STP working. An extraordinary PCMB meeting has been scheduled for early September to enable NHSE London and STP PC leads to focus specifically on the recommendations of the review. 5. Quality & Performance report – consider data requirements and frequency for SE London The Primary Care SE London CCG leads agreed that there is a need to collectively identify what data would be helpful to PCCCs within this report, and to work with the SE London STP primary care team to prioritise the ongoing offer of performance information to CCGs. A view will also be taken on any potential additional borough-level information (e.g. held by CCGs) to be added to each local report. The CCG leads made it clear that they wanted to see the current provision of reporting maintained in the meantime whilst these potential changes were being developed. 6. Escalation of issue of concern re Primary Care Support England

At a recent meeting of this Board, several CCGs had highlighted serious concerns, including the loss of up to 700 patient records by the provider and multiple failures to make patient records available to practices in a timely manner for patient care, as well as the extent to which this issue has been taken seriously by the provider and the commissioner. CCGs have generally been told to escalate their problems directly with the provider, rather than the commissioner of the services, agreeing to take up serious concerns through contract management mechanisms. However, generic email addresses and telephones numbers are the only contact details available and there have been no or delayed responses to serious problems. It was noted that this this matter should be escalated to NHSE as the contract holder (lead contact Karen Wheeler). It was also escalated by SE London at the PCMB meeting on 4 August. A separate related matter regarding the annual Service Audit Review (SAR; a national document) was raised. Jill Webb said that a number of the SE London PCCCs had requested sight of the SAR and that this request would be passed to NHSE’s national team in order to obtain and issue it in SE London. It was agreed that this Board should review the SAR in order to consider consistent recommendations being made about it to each CCG, with particular regard to potential direct and indirect consequences of its findings, for CCGs. The SE London CCG leads on this Board will also need to determine whether the SAR should be reviewed by their respective PCCC or Audit Committee. Once the identified committee in each borough has considered the Board’s recommendations relating to the SAR, each will need to consider whether further assurance is required (ie whether its recommendations go far enough) and feedback to NHSE accordingly. An update on this will come to the next meeting on 19 September. 7. Next Meeting The next meeting of this board is scheduled to take place on 19 September. Mark Edginton (new CBC Programme Director) will attend for the first time since his appointment.

:

Item: 9 Enc: G



Title: Greenwich Clinical Commissioning Group - Response to Healthwatch Report on GP Access 2017

AUTHOR: Irene Grayson – Associate Director Primary Care

BACKGROUND The impetus for this project was generated from the outreach work Healthwatch Greenwich undertakes with Greenwich Migrant Hub. The Migrant Hub provides advice and legal support to people who have Nil Recourse to Public Funds (NRPF). Healthwatch provides advice on health services, as well as engaging with local people to obtain their views and experiences on the health and social care services. Healthwatch had obtained initial data which indicated a rise in the number of families that were experiencing difficulties registering with a GP, especially those who were homeless or in emergency accommodation. The main message was that to register, GP practices were requesting, in some cases, passports/photo ID as well as 2 proofs of address. If the patient was unable to provide these documents then they were not able to register. These registration requirements do not comply with NHS England guidance as highlighted here: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf. The attached report highlights the outcomes of an audit carried out between January and March 2017 by Greenwich Healthwatch. Please note that the number of practices sited in the report as 48 is inaccurate – during the stated period, there were 37 GP practices and 18 branch surgeries. The CCG is assuming that some of the practices contacted were the branch surgeries. The CCG was invited to comment on the recommendations made on page 19 of the report and this paper outlines the CCG’s formal response to this report. Initial Response

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf


2

Identifying barriers to registration and promoting registration is a key priority for the CCG and we welcome the report produced by Healthwatch. Those patients registered with a GP will ensure that they get timely access to health services and that they access the right service at the right time. Patients will also benefit from the various preventative initiatives within primary care that will help to keep them healthy and well. Our primary care budgets are based on financial allocations in accordance with how many patients are registered with a Greenwich GP, therefore it is in the CCG’s interest to ensure that as many of local Greenwich residents are registered in order for the CCG budget allocations to adequately meet the growing health needs of our population. In Greenwich our population is changing, attracting a younger and more transient population. It is predicted that by 2026 the population of Greenwich will increase by around 67,000 to 322,000. Greenwich is also an ethnically diverse borough with around 38% of the population coming from a non-white ethnic group (Greenwich Joint Strategic Needs Assessment – Greenwich Profile). The recommendations set out in the Healthwatch report provides a good platform for discussion and action planning, recognising the issues raised in the report go beyond the barriers highlighted in the report, for example language and cultural barriers. Healthwatch Recommendations – Formal Response Recommendation 1: All Greenwich GP practices should undertake an urgent review of their own patient registration requirements and ensure they are compliant.

The CCG will support Practices in this by providing further training at the Practice Managers meeting in October 2017. This will be supplemented through discussion with practice staff during primary care Protected Learning Time Events. The CCG will review practices’ arrangements for registering patients as part of our contract management process and use the data in Appendix 2 to help inform where to target our resources. Practices will be reminded of the “Once for London” registration guidance through key messages being delivered from the CCG to primary care.

Recommendation 2: In collaboration with the CCG, Greenwich GPs should arrange training for front line practice staff to update them on the NHS England Patient Registration guidance (2016).

The CCG will include training for front line staff as part of the Protected Learning Time training events. See above

Recommendation 3: The CCG should provide further written guidance for GPs on their patient registration practice and procedures.

The “Once for London guidance and the new Homelessness resource pack issued by NHSE will be distributed to Practices and discussed at the Practice Managers meeting. The information

3

will also be made available at the Greenwich Wide Forum – a quarterly meeting of GP practices. Guidance will also be uploaded onto the Greenwich Intranet – an internal website which all GP practice staff can access.

Recommendation 4: The CCG should work with statutory and voluntary community groups, in particular BME groups, to provide and distribute the Healthy London Partnership ‘health care cards’ to Greenwich residents and patients.

The CCG is in the process of updating its leaflet ‘Is everyone in your household registered with a Greenwich GP’ and will include signposting to ‘My Right to Access Healthcare’. The CCG will also include references to this initiative when training practices on registration guidelines.

The CCG has commissioned Goundswell, a homeless health peer advocacy service, to support homeless people by improving their access to services through volunteers engaging and accompanying people to health care appointments. Patient education via this service will help to increase knowledge, confidence and motivation of homeless people to better manage their own healthcare as well as supporting patients to access the right services in the right place.

Recommendation 5: The CCG should provide and require appropriate posters to be displayed in prominent places in practices, setting out clearly the registration requirements for vulnerable people, focusing on those who are unlikely to have documentation, as set out in the Patient Registration guidance.

As a result of this recommendation, the CCG is sourcing this material to put into practices. We will ask members of our Patient Reference Group to check when they visit local surgeries that the posters are being appropriately displayed.

Recommendation 6: The CCG should, where possible, ensure that adherence to NHS England patient registration guidance is monitored as part of the GP contract, with robust performance monitoring indicators. In addition, in consultation with patient representatives, the CCG should develop a policy on what to do with non-compliance with the registration guidance by practices.

See Recommendation 1. The issue of non-compliance is very much reliant on patients contacting NHSE through the complaints procedure – complaints is a function that still sits with NHS England and not the CCG. The CCG will aim to empower patients through education and ensuring that appropriate information is made available via its Communication and Patient Engagement Team.

Recommendation 7: In conjunction with NHS England, the CCG should consider incorporation on the GSM1 information (patient registration form); information on what is required to register.

This would involve a national change in process as GMS1 is a national form. The CCG will feed this back to NHS England and ask for a written response.

Recommendation 8: GP practices should ensure that accurate and up to date patient information is readily available to potential new registrants, including information on practice

4

website and a link to a patient reference document or “fact sheet” on registration.

The CCG will work with Practices and the GP Federation to produce some generic guidance that will be consistent across all Practice web sites. The leaflet highlighted in Recommendation 4 can also be added as a link on practice websites.

Recommendation 9: The CCG should consider the possibility of providing a local appeals process for patients who have been de-registered by the GPs against their will (either via the ghost patient process or any other reason). Patients can already appeal via the NHS England complaints process. Complaints of this nature have not been delegated to the CCG as highlighted under Recommendations 6. However, we are mindful that some de-registration issues are often a result of a break down in relationships between the patient and the practice. The CCG has a role to play in supporting patients to register elsewhere.

Recommendation

The CCG will formally respond to the recommendations in the Healthwatch Report and will wait to receive feedback before drawing up a final action plan with timelines which will be monitored as part of the quality improvement work of the primary care team within the CCG.

NHS Greenwich CCG CONTACT: Name: Irene Grayson – Associated Director Primary Care E-mail: [email protected]

Greenwich GP Access Report 2017

Healthwatch Greenwich 2

We know that you want local services that work for you, your friends and family. That’s why we want you to share your experiences of using health

and care services with us – both good and bad. We use your voice to encourage those who run services to act on what matters to you.

We are uniquely placed as a national network, with a local Healthwatch in every local authority area in England.

We confirm that we are using the Healthwatch Trademark (which covers the logo and

Healthwatch brand) when undertaking work on our statutory activities as covered by the

licence agreement.

© Copyright Healthwatch Greenwich 2017


Contents

Contents .................................................................................................. 3

1 Introduction ............................................................................................ 4

1.1. Acknowledgements .............................................................................. 4

1.2. Disclaimer ......................................................................................... 4

1.3. Context ............................................................................................ 4

1.4. Strategic drivers .................................................................................. 6

2 GP Access Audit ....................................................................................... 9

2.1. Methodology ...................................................................................... 9

2.2. Summary of findings ............................................................................. 9

2.3. Charts ............................................................................................ 10

3 NHS Regulations and Guidance ................................................................... 12

3.1. NHS regulations ................................................................................ 12

3.2. GP Contracts .................................................................................... 12

3.3. Care Quality Commission – Standards of care .............................................. 12

3.4. Greenwich CCG Commissioned Report – Staff Attitudes ................................. 13

3.5. ‘My Right to Access Healthcare’ cards ...................................................... 14

4 Conclusions .......................................................................................... 16

4.1. Access to GP services – GP registration ..................................................... 16

4.2. De-registration ................................................................................. 17

4.3. GSM 1 Form – Patient Registration Form ................................................... 18

5 Recommendations .................................................................................. 19

6 Service provider responses ....................................................................... 20

7 References ........................................................................................... 21

Appendix 1: HWG phone audit form ............................................................... 22

GP access phone audit .............................................................................. 22

Introduction: ......................................................................................... 22

Questions: ............................................................................................ 22

Appendix 2: Phone audit raw data................................................................. 24

Contact us .............................................................................................. 30


1 Introduction

1.1. Acknowledgements

Healthwatch Greenwich would like to thank the GP practices, service users, and staff for their

contribution to the work programme of Healthwatch Greenwich.

1.2. Disclaimer

Please note that this report relates to findings observed on the specific date(s) stated. Our

report is not a representative portrayal of the experiences of all service users and staff, only

an account of what was observed and contributed at the time.

1.3. Context

The impetus for this project was generated from the outreach work Healthwatch Greenwich

undertakes with Greenwich Migrant Hub. The Migrant Hub provides advice and legal support to

people that have Nil Recourse to Public Funds (NRPF). Healthwatch provides advice on health

services, as well as engaging with the clients to obtain their views and experiences on the

health and social care services.

Initial data indicated a rise in the number of families that were experiencing difficulties

registering with a GP, especially those who were homeless or in emergency accommodation.

The main message was that to register, the GP practices were requesting, in some cases,

passports/photo ID as well as 2 proofs of address. If the patient was unable to provide these

documents then they were not able to register. These registration requirements do not comply

with NHS England guidance1.

In 2015, Greenwich Clinical Commissioning Group (GCCG) ran a GP registration campaign

which produced a leaflet “Is everyone in your household registered with a GP’. This leaflet

provided advice on how to register. Included on the leaflet, in bold, was the statement that

your “immigration status does not affect your right to register with a GP, in fact you shouldn’t

even be asked.” This information was incorporated into the leaflet following concerns by

GCCG that some black and minority ethnic (BME) residents were reluctant to register because

of their immigration status.


In October 2016, Greenwich’s GP walk-in centres were closed and replaced by a GP Access

Hub. The Access Hub provides weekend appointments (9am to 5pm on Saturdays and 9am to

1pm on Sundays), accessed via a Greenwich GP or by calling the NHS111 service. However, to

be able to use the Access Hub service, a patient needs to be already registered with a

Greenwich GP, in part so that their medical details could be accessed.

Some of the key strategic drivers for the action by NHS England, and the campaign by GCCG,

was to improve access to GP services, reduce the number of unregistered patients attending

Accident and Emergency, and to ensure that the most vulnerable people would be able to

access health care services.

In addition, there was concern that patients could be at risk of being de-registered from a GP

list if they were identified as “ghosts”. “Ghost” patients are people that have not used their

GP practice for 5 years. The aim being to “cleanse” the GP patient list of any patients that

could have died, moved away, or left the country.

The accuracy of the patient list is vital as it is directly related to the funding the practice

receives. The GP practice has a duty to provide this list to NHS England, who have

commissioned a private contractor (Capita) to contact the patient. A key component of

confirming registration details is providing an address. For people who have become homeless,

don’t have ID or are in emergency housing this can be very difficult. In addition to this, once a

GP has asked for the removal of a patient from their list, there is no way for the patient to

stop, suspend or appeal against removal. We are concerned about the lack of checks and

balances in this process and will make comments to this effect in our recommendations

Healthwatch Greenwich decided to carry out an audit of the registration process of all GP

practices. Undertaking the audit, combined with various bits of feedback from local patients,

has given us valuable insight into the GP patient registration and de-registration processes.

With GCCG now taking on responsibility for commissioning primary care services, including the

management of the GP contract, this report’s recommendations are intended to help both

them and local GPs to improve the patient registration process (and potentially reduce the

pressure on the Accident and Emergency and Urgent Care Centre).


1.4. Strategic drivers

GP patient registration is fundamental in ensuring that patients can exercise their right to

access to primary care services. The role of primary care is pivotal in achieving this, acting as

gatekeeper to the health system and the main point of contact for the patient. Registration is

the first step in the journey.

NHSE Patient Registration Standard Operating Principles for Primary Medical Care (General

Practice)1

In December 2016, the NHS England updated its registration guidance. It stated:

“The reason for issuing this guidance now is evidence of an increasing number of patients

finding it difficult to register with some GP practices. This is because they cannot

provide documentation to the practice in support of who they are or where they live and

the subsequent problems they have in accessing health care. The guidance is designed to

clarify the position for all patients, in particular though this issue is affecting migrants

and asylum seekers who do not have ready access to documents”.

The Guidance goes on to say that:

“If a patient cannot produce any supportive documentation but states that they reside

within the practice boundary then practices should accept the registration.

“Where necessary, (e.g. homeless patients), the practice may use the practice address

to register them if they wish. If possible, practices should try to ensure they have a way

of contacting the patient if they need to (for example provide test results). “

(NHS England – Sec 1 -Policy Statement)

The Guidance also provides examples of people who are legitimately unable to produce any of

the listed documentation. These include;

• People fleeing domestic violence staying with friends or family,

• People living on a boat, in unstable accommodation or street homeless,

• People staying long term with friends but who aren’t receiving bills,

• People working in exploitative situations whose employer has taken their

documents,


• People who have submitted their documents to the Home Office as part of an

application,

• People trafficked into the country who had their documents taken on arrival,

• Children born in the UK to parents without documentation.

NHS England are expecting GP Practices to act reasonably and that the individual be

registered with sensitivity to their situation.

Greenwich Clinical Commissioning Group

Recent research conducted by the Royal Borough of Greenwich (RBG) estimated that those not

registered with a GP was between 1.2% and 5.4% of the Greenwich population2. The research

suggested that specific groups were more likely to be unregistered than others. The Picker

Institute was commissioned to undertake research with some of these groups, to better

understand the unregistered population and identify barriers they may face in registering with

a GP3.

Building on research by RBG and GCCG2, the Picker Institute focused on exploring these issues

with specific communities identified as being more likely to be unregistered with a GP

practice. These communities included the:

• Somali

• Nepali

• Vietnamese

Although there were no specific recommendations the research identified three key barriers3:

• Language

• Lack of information

• Lack of confidence

In response to the report suggestions, GCCG printed the leaflet “Is everyone in your household

registered with a GP” to encourage and increase the numbers of patients registering. The

leaflet focused on an individual’s rights to register, and aimed to give confidence to people

from BME communities to register, by stating that proof of immigration status is not required

to register and that GP practices should not be asking.


This was followed in December 2015, by a workshop on advice and guidance concerning

patient registration at a GCCG protected learning time event. This workshop was aimed

primarily at GP practice staff. NHS England and Public Health gave presentations.

The participatory workshop was led by the Picker Institute who also presented their findings

from research into the unregistered population in Greenwich, looking at the barriers patients

face, and some of the difficulties encountered by practices in registering patients3. The aim

was to ensure that practice staff understood the registration guidance better, how best to

implement it, and how to ensure that GP registration is ”easy, equitable and safe to both

patients and practices.”

The report from this workshop with the staff (GP Registration – Staff Attitudes)4 is discussed

further in section 3.4


2 GP Access Audit

2.1. Methodology

We conducted this audit between January and March 2017. We developed a call audit form

(Appendix 1) that was used to illicit the information required. We phoned each GP practice

and asking the receptionist what information is needed for registration. The calls were carried

out by our Staff and Authorised Representatives (volunteers of Healthwatch Greenwich).

We also carried out an audit of the web-site of each practice, to identify what, if any, advice

and guidance was provided on registration.

2.2. Summary of findings

All 48 GP practices in Greenwich were contacted, including branch practices. Key findings

included:

• All the GP practices requested some form of registration documentation, ranging from

passport identification to two forms of proof of address.

• 32 practices requested proof of identity (e.g. drivers licence or passport).

• 18 practices requested two proofs of address.

• 17 practices requested one proof of address.

• Three practices requested the patients NHS number.

• Six practices stated that they would not register a patient who did not have any

documents.

• One practice requested the NHS number, two proofs of address and proof of ID (i.e.

passport) with at least six months remaining until the expiration date.

• Although most practices had a link on their website to download the registration form,

none of the practices had any information about patient’s rights to registering without

documents, or immigration status not being required.

• Although no practices requested immigration status documents to register, 32 of the

practices did request passports or photo ID. Although there was no evidence that

administrative staff were making decisions to register on their status in their passport,

this requirement could act as a significant deterrent to many people.


2.3. Charts

Figure 1 sets out the percentage responses to the survey question “What documentation do

you ask for from a registering patient.”

Figure 1: GP Practices requesting documents to register.

Figure 2 sets out the responses to the question: “If a person registering does not have a proof

of address, is homeless or in temporary accommodation can you still register them?”

Fig 2 – Can a person register without documentation

Proof of identity46%

1 proof of address24%

2 proof of address26%

NHS number4%

Unsure0%

Proof of Uk residency

0%

GP REQUESTING DOCUMENTS TO REGISTER

Unsure27%

Yes25%

Yes, if practice manager agrees

31%

No13%

N/A4%

REGISTERING WITH NO DOCUMENTATION


Of the 48 practices/branches:

• 58% of the respondents were either unsure or would refer to the practice manager.

The responses varied from “I would get a letter from Healthwatch” to “I don’t know,

never had to deal with this situation before.” The overwhelming impression is that

staff are unsure what to do as this situation does not frequently occur. Many were of

the view that the practice manager had a separate process for these applications.

• 31% of the practices stated they could register patients without any proof of address

or form of identification, only after referring to the practice manager, with the

majority unsure of what to do in such circumstances.

• One practice stated that an address “is not required for registration” but prefaced

the response by firstly asking for proof of address.

• One practice positively stated to this question that they “can and must register...and

would never turn anyone away”.

• Four practices correctly stated that a homeless person or a person without

documentation would be able to register at the practice address.

• The GSM1 (patient registration form) which is used by all GP practices does not

provide any guidance on registering without proof of documents or if homeless.


3 NHS regulations and guidance

3.1. NHS regulations

Registering without proof of identity and address

There is no contractual duty to seek evidence of identity or immigration status or proof of

address. Therefore, practices should not refuse registration on the grounds that a patient is

unable to produce such evidence1.

Anyone in England is entitled to receive NHS primary medical services at a GP practice and

applications for registration for any patient in England must be considered in exactly the same

way, regardless of country of residence.

Registering homeless patients

People who are homeless have particular health needs and often suffer some of the worst

outcomes. Both the British Medical Association (BMA) and NHS England are committed to

ensuring homeless patients receive the same level of care as those with permanent addresses.

The same obligation on practices regarding identity and proof of address applies to homeless

patients as a population group. Homeless patients are entitled to register with a GP using a

temporary address which may be a friend's address or a day centre. The practice may also use

the practice address to register them.

3.2. GP Contracts

The General Medical Services Contracts Regulations (2004)5 state that

“practices may only refuse an application to go on their list if they have reasonable

grounds for doing so which do not relate to the applicant’s race, gender, social class,

age, religion, sexual orientation, appearance, disability or medical condition.”

3.3. Care Quality Commission – Standards of care

Expected standards of care

The Care Quality Commission (CQC) expects practices to:


“register people who are homeless, people with no fixed abode, or those legitimately

unable to provide documentation living within their catchment area who wish to register

with them. Homeless patients are entitled to register with a GP using a temporary

address which may be a friend's address or a day centre. The practice may also use the

practice address to register them. Practices should try to ensure they have a way of

contacting the patient if they need to (for example with test results). Some areas will

have special services for homeless patients and practices may refer homeless patients

into those services in line with local arrangements where it is in the best interests and

with the agreement of the patient.”

3.4. Greenwich CCG Commissioned Report – Staff Attitudes

The report, GP Registration – Practice Staff (Picker, 2015)4 is key in gathering insight into the

views and attitudes of practice staff for patient registration administration, and provides

evidence of what is happening in the practices.

The report identified many issues influencing practice staff attitudes and behaviours towards

patient registration. Although intertwined, the researchers were able to group them at

different levels of influence: national, local, and personal influences.

A key finding by Picker:

“was the strength of personal views about patient registration that emerged;

specifically, about who should be entitled to receive NHS primary care. These were

primarily associated with concerns about protecting NHS resources from those who

attempt to abuse the system, either through fraud or simply because they are considered

undeserving. Several receptionists saw themselves as conscientiously defending the NHS

from people who try to defraud it and similarly, receptionists expressed concerns about

people coming from overseas specifically to take advantage of ‘free’ NHS healthcare.

This was seen as a ‘waste’ of NHS resources and something they had a responsibility to

prevent.”

The report went on to state that:

"a combination of these influences on registration behaviour means that simply clarifying

the national guidance to frontline staff may not be sufficient”.


The report suggested that due to the strength of practice level influences, the focus should be

on:

“supporting practices as a whole to understand the guidance and helping them to

translate this into practice-level processes. That means engaging with primary care staff

at all levels – receptionists, practice managers, GPs – to clarify the guidance and what

this means for day-to-day practice, and also outline any implications of non-

compliance.”

3.5. ‘My Right to Access Healthcare’ cards

Front (left) and back (right) design of the ‘My right to access healthcare’ cards available to

download or can be ordered via the website6.

Healthy London Partnership and Groundswell have produced ‘My Right to Access Healthcare’

cards to help people who are homeless to register and receive treatment at GP practices in

London. If those who are homeless, or have concerns about their immigration status, are more

able to access primary care this could lead to fewer people presenting at A&E with health

concerns. The plastic cards are designed to be carried by people who are homeless across

London, including people who sleep rough, live in hostels, sleep on family and friend's sofas,

or who are chronically insecurely housed.

They can be used to remind GP receptionists and other practice staff of the national patient

registration guidance from NHS England5. This states that:

• people do not need a fixed address or identification to register or access treatment at GP

practices


• where necessary, the practice may use the practice's address to register the patient if they

wish.

Training for receptionists is available via Healthy London Partnership7. They have developed

an online training, featuring actors from Cardboard Citizens who have experience of

homelessness, aiming to support GP receptionists and practice managers to ensure anyone

experiencing homelessness can get the care they need.


4 Conclusions

4.1. Access to GP services – GP registration

Greenwich CCG has recognised the importance of patient registration, and the effect it can

have on reducing urgent care centre and accident and emergency attendance. They have

made strident efforts to work with practice staff to ensure that the patient registration

guidelines are being adhered to and what it means for the practice.

However, the report findings indicate that despite these efforts, many Greenwich GP

practices are still not adhering to the patient registration guidance provided by the NHS, CQC

and other professional bodies.

At least one GP practice stated they would refer unregistered patients to the urgent care

centre (UCC). Lack of documentation is not an appropriate use of the UCC and could directly

contribute to increased pressure on an already stretched service.

Several GP practices will register patients with no ID, but many of these would only do so

through the practice manager. There is a risk that this may create an extra block to people in

need of primary healthcare services. It would be preferable for receptionists to have clear

direction on how and when to do this, without the need to refer to the practice manager.

A key obstacle to the registration process appears to be related to the attitudes and views of

the practice staff that administer the process.

The Picker report stated that some practice staff:

“…saw themselves as conscientiously defending the NHS from people who try to defraud

it and similarly, from overseas specifically, to take advantage of ‘free’ NHS healthcare”.

Where this is the case, further work may be needed to help practice staff understand both the

rights of individuals to access primary health care, and the importance of relieving pressure on

Accident and Emergency and the urgent care centre for routine health care.


Incorrect perceptions should be rectified through the appropriate staff training and

development, and should been seen as an urgent action for the CCG. The Picker Institute

advice in 2015 was that GCCG should be:

“engaging with primary care staff at all levels – receptionists, practice managers, GPs –

to clarify the guidance and what this means for day-to-day practice, and also outline

any implications of non-compliance.”

To date we are unable to locate any guidance that the GCCG or NHS England have put into

place to respond to “any implications of non-compliance” to the registration guidelines. With

GCCG now becoming responsible for GP contracts and performance monitoring, this may be

the time to consider a new approach.

4.2. De-registration

As mentioned, we were able to gain an insight into the ghost patients and the GP de-

registration process. Some of the ghost patients that have been removed from GP practice

patient lists are amongst the most vulnerable. This process has been criticised by GP’s and

patient’s groups, as they believe that ghost patients are being removed inappropriately and

patients are being penalised for not visiting their doctor.

GPs can also remove or de-register a patient from their patient list. The British Medical

Association – General Practitioners Council states (May 2017)7 that a patient must be warned

that they are at risk of removal, together with an explanation of the reasons for this, within

the period of 12 months before the date of the request to the Primary Care Organisation.

Whilst warnings do not have to be in writing it is good practice for them to be so as this allows

for carefully considered reasons to be given. The process does not give the patient much

choice, especially if they are making reasonable requests, if the GP wishes to proceed. We

have recently dealt with a case where a patient was de-registered by the practice following a

request for a copy of their patient records and a subsequent disagreement about the accuracy

of their records. The patient had been with the same GP practice for several decades and was

very concerned with being forced to change, However, once a GP has requested a removal via

Primary Care Support England (PCSE), who manage the lists on behalf of the NHS, there is no

right of appeal and no means to stop or reverse a decision.


4.3. GSM 1 Form – Patient Registration Form

The first section of the form requires the patient’s personal details i.e. name, DOB, as well as

the NI number. It provides no information on what action to take if a person does not have a

permanent address or they are homeless. The word ‘optional’ could be placed next to

address, with a short explanation if no permanent address is available.


5 Recommendations

Based on our investigation, we are proposing the following recommendations:

• Recommendation 1: All Greenwich GP practices should undertake an urgent review

of their own patient registration requirements and ensure they are compliant.

• Recommendation 2: In collaboration with the CCG, Greenwich GPs should arrange

training for front line practice staff to update them on the NHS England Patient

Registration guidance (2016).

• Recommendation 3: The CCG should provide further written guidance for GP’s on

their patient registration practice and procedures.

• Recommendation 4: The CCG should work with statutory and voluntary community

groups, in particular BME groups, to provide and distribute the Healthy London

Partnership ‘health care cards’ to Greenwich residents and patients.

• Recommendation 5: The CCG should provide and require appropriate posters to be

displayed in prominent places in practices, setting out clearly the registration

requirements for vulnerable people, focusing on those who are unlikely to have

documentation, as set out in the Patient Registration guidance.

• Recommendation 6: The CCG should, where possible, ensure that adherence to

NHS England patient registration guidance is monitored as part of the GP contract,

with robust performance monitoring indicators. In addition, in consultation with

patient representatives, the CCG should develop a policy on what to do with non-

compliance with the registration guidance by practices.

• Recommendation 7: In conjunction with NHS England, the CCG should consider

incorporation on the GSM1 information (patient registration form), information on

what is required to register.

• Recommendation 8: GP practices should ensure that accurate and up to date

patient information is readily available to potential new registrants, including

information on practice website and a link to a patient reference document or “fact

sheet” on registration.

• Recommendation 9: The CCG should consider the possibility of providing a local

appeals process for patients who have been de-registered by the GPs against their

will (either via the ghost patient process or any other reason).


6 Service provider responses

TBC


7 References

1 NHS England – Patient Registration (Reviewed Dec 2016). https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf 2 “Estimating the Unregistered Population within Greenwich” (RB Greenwich, Nov 2014);

“Right care, first time” consultation (NHS Greenwich CCG, Nov 2013)

3 GP registration in Greenwich- Understanding Barriers to registration - Helen Bohan, Alice

Coulter, Tamara van Doorn (March 2015)

4 GP Registration – Staff Attitudes (March 2015), Picker Institute

5 The General Medical Services Contracts Regulations (2004). https://www.england.nhs.uk/wp-content/uploads/2014/05/gms-contract-04-14.pdf

6 https://www.healthylondon.org/homeless/access-gp-practices

7 https://www.myhealth.london.nhs.uk/healthy-london/latest/news/supporting-gp-

receptionists-help-people-who-are-homeless



https://www.england.nhs.uk/wp-content/uploads/2014/05/gms-contract-04-14.pdf

https://www.healthylondon.org/homeless/access-gp-practices

https://www.myhealth.london.nhs.uk/healthy-london/latest/news/supporting-gp-%20%20%20%20%20%20%20receptionists-help-people-who-are-homeless

https://www.myhealth.london.nhs.uk/healthy-london/latest/news/supporting-gp-%20%20%20%20%20%20%20receptionists-help-people-who-are-homeless


Appendix 1: HWG phone audit form

GP access phone audit

Please complete for each audit and save the document with the practice name.

Complete:

Name of GP surgery:

_______________________________________________________________________

Date: ____________________ Time: ________________

Completed by: _______________________________________________

Introduction:

Hello, I’m calling from Healthwatch Greenwich. We’re an organisation that collects patient’s experience of using health & social care services in Greenwich.

We’ve had an enquiry from a resident who was concerned about GP registration.

Could I ask you a few quick questions about your registration process for new patients?

Questions:

Upon registration, what documentation do you ask for from a registering patient?

☐ Proof of identification (Passport, driving license)

☐ 1x Proof of address (bank statement, utility bill)

☐ 2x Proof of address (bank statement, utility bill)

☐ Proof of UK residency

☐ Their NHS number

☐ Unsure


Other (please specify): ____________________________________________________________ If the person registering does not have proof of address, is homeless or in temporary accommodation can you still register them?

☐ Yes ☐ No ☐ Unsure

If yes, how can they register with the practice? _____________________________________________________________ If no, what advice is given to the person registering? _____________________________________________________________

Thank you for your time!

Appendix 2: Phone audit raw data

Surgery Practice Manager

Upon registration, what documentation do you ask for from a registering patient?

Comment If no proof of address, or in homeless or

temp. housing, can

you still register them?

Comment

Proof of ID (passport, driving licence, etc...)

1x Proof of address (bank statement, utility bill, etc...)

2x Proof of address (bank statement, utility bill, etc...)

Proof of UK residency

NHS no.

Unsure

New Eltham Surgery

Nayana Patel Yes Yes Need to be in the catchment area (very busy practice so has to keep limit on numbers)

Unsure Understands situation, needs circumstances before being told. Can register online or collect form from the receptionist. Refer to the practice manager.

Blackfen Medical Centre

Yes Caretaker practice - no documentation required.

Unsure Never had to deal with this but would refer to the Practice Manager.

Nightingale Surgery

Sue Raphael (Karen Powell & Samuel Wahba)

Yes Yes Photo ID and proof of address within 3months

Unsure Speak to Practice Manager for advice. She would phone on behalf of patient (if on doorstep).


St Marks Medical Centre

Yes Yes Dated in the lasted 3 months. NHS number not essential.

Yes, but only through Practice Manager

Bring whatever documents they have and speak with the Practice Manager. The Practice Manager would still register them and ask for name and DOB. Always try to help and never turn anyone away.

Briset Corner Surgery

Eva Meloni Yes Yes Yes, but only through Practice Manager

Temporary accommodation address & NHS number. Advice would be given.

Bannockburn Surgery

Heather Mustafa

Yes Yes Form from the surgery Unsure Letter from Healthwatch Greenwich. Some proof of temporary accommodation or I.D.

All Saints Medical Centre

Mr Aravamuthan Suresh

Yes Yes Yes, but only through Practice Manager

Letter from temporary address or someone to vouch for them. Would have to go through the Practice Manager.

Abbey Wood Surgery

Tara Bolton Yes Yes Yes Yes, but only through Practice Manager

Go through the Practice Manager. SE2 & SE28 postcodes only.

Conway Health Centre

Robert Sweeney

Yes Yes But will be referred to the Practice Manager if not all documentation available.


Will be up to the Practice Manager.

Welling Medical Surgery

Yes Yes Yes Ask for proof of address but isn't need for registration. Can still be registered. Practice Manager.


Dr Chand, Basildon Road

Pauline Clelland

Yes Yes Passport for foreign individuals. Home address in last 3 months.


Only through the Practice Manager. Can be seen immediately if necessary.

Eltham Medical Practice, 180 Well Hall Rd

Dr Sarbjit Chauhan


A process is available via the Practice Manager.

Eltham Medical Practice, Passey Place


Ferryview Health Centre, Valentine Health Partnership

Mr Rok Ziherl (Business and Facilities)


There is a process to go through the Practice Manager.

Holborne Road, Valentine Health Partnership

Mrs Laura Snow (IT)


Eltham Park Surgery

Terri Livingstone


Via the Practice Manager.

Eltham Palace Surgery, Eltham Community Hospital

Johanne Gilby Yes Yes Dated in the lasted 3 months.


Through a process with the Practice Manager.

Gallions Reach Health Centre

Tinashe Magwenzi

Yes Yes Registration between 11:30-14:30


New guidelines though the Practice Manager.

Heronsgate Medical Centre

34 Plumstead Common Road, Triveni PMS

Jane Whithall Yes Not meant to ask for details but like 1 proof of address.

Unsure But must be in their postcode area.

Escreet Grove Surgery, Triveni PMS

Unsure


Burney Street Practice @48 Burney Street

Jennifer Peters

Yes Yes Unsure They will do their best depending on details given. Advice will be given for help needed.

Burney Street Practice @ Wallace Health Centre

Yes Yes Yes Fill out forms but should keep them while in the area.

Dr Ratneswaren Practice

Bridgette Gallaway-Meyer

Yes ID asked for but not necessary.

Yes If homeless they can register with the GP address

The Coldharbour Hill Surgery (DR BAKSH)


Through the Practice Manager.

Clover Health Centre

Mike Konche Yes Yes Yes, but only through Practice Manager

Through the Practice Manager.

Royal Arsenal Medical Centre

Kevin Ryan Yes Yes No Would need proof of address, or a relative or friends address, to register.

Thamesmead Health Centre

Sue Pinkerton Yes GHM1 form No Would need some proof of address. .

The Fairfield Practice

Karen James / Wendy Davenport (Assistant Practice Manager)

Yes Yes Yes ID with over 6 months till date of expiry. Registration Mon-Fri.

No SE7 residents only. Would need proof of address.

Vanburgh Group Practice

Christine Benford

None; do not ask for any documentation just to complete a form.

Yes Will register anyone regardless of location or residence. Even register outside of Greenwich; no catchment area.


South Street Medical Centre

Minnaaz Wijegoonawardena

Yes Don't need to ask for proof of address.

Yes Can and must register. Would register them as temporary. Would never turn anyone away.

Sherard Road Medical Centre

Helen Oakley Yes Yes Unsure Speak to Practice Manager for advice.

Tudway Road (Branch Surgery)

Unsure

Plumbridge Medical Centre

Thamina Sharmeen

Yes Yes Anything with photo ID. Online registration possible.

Unsure Not come across this yet. If family member is registering will consider.

Dr Sandrasagra, Westmount Surgery

Debra Bodycombe

Yes Yes Yes If necessary & in area; register under GP address.

Dr Gera & Partner, 123 Samuel Street (Branch Surgery)

Gina Reed Yes Yes Unsure Would refer to the Practice Manager.

Dr Gera & Partner, Glyndon Medical Centre, 188 Ann Street

Unsure

Greenwich Peninsula Practice

Johanna Randall

Yes Yes Dated in the lasted 3 months.

No Run by a private company so won't but may do under extreme circumstances.

Dr Sabat, Plumstead Health Centre

Anita Raipal Yes Yes But other forms could be used if necessary.

Yes Under GP address.

Garland Road Clinic

Yes Yes Dated in the lasted 3 months.

Unsure If in temporary accommodation some letter of householder.

Dr Ratnarajan, Woodland Walk Surgery

Ahila Sithamparappillai

Yes Yes Passport needed for foreign individuals.

No Not on national register then cannot help.


Charlton Road Surgery, 67 Charlton Rd

Dr Patel, The Blackheath Standard Surgery

Jackie Hobson Forms but no proof needed anymore

Yes As long as they are in the area.

Dr Mostafa, 141 Plumstead High Street

Nicole Mostafa (Practice Manager)

Yes No ID needed Yes Would be registered under GP address but contact details needed for follow up.

Dr Mostafa, 253 Wickham Lane

Lucy Page Haines (Assistant Practice Manager)

Yes

Dr Gupta, The Waverly Practice

Janet Riches Yes Yes But if not available Janet the Practice Manager will help.

Yes Patient will have GP address but they will need contact details i.e. phone number. Dr Gupta, 209

Wickham Street (Branch Surgery)

Yes

Dr Coutinho, The Trinity Medical Centre

Donna Walker Yes Yes Previous GP details No Will be sent to Queen Elizabeth Hospital Urgent Care Centre

Manor Brook Medical Centre

Dorothea Sanger

Closing on 31st March 2017 so not taking on new registrations.

N/A

Avery Hill Medical Practice, Campus Medical Centre

For University of Greenwich students only.

N/A

Contact us

Address: Gunnery House, Gunnery Terrace, Woolwich, London SE18 6SW

Phone number: 020 8301 8340

Email: [email protected]

Website: www.healthwatchgreenwich.co.uk

Twitter: @HWGreenwich

If you require this report in an alternative format please contact us at the address above.

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