Southwark Primary Care Commissioning Committee...KMB presented the report. It was noted that both GP Federations as providers of the extended primary care services in Southwark had

1

Chair: Dr Jonty Heaversedge Accountable Officer: Andrew Bland Managing Director: Ross Graves

The best possible health outcomes for Southwark people

Southwark Primary Care Commissioning Committee

Tuesday 24 September 2019, 14.00 - 16.00

Cambridge House, 1 Addington Square, London SE5 0HF

Item Time Item ENC Lead

Part One

Introductory items

1 14.00 Welcome, introductions, apologies and declarations of interest - Chair / All

2 14.05 Minutes and Actions of last meeting: May 2019 A Chair

3 14.10 Open Public Space Chair

Standing items

4 14.20 Contract Action Log B Nick Langford

514.30 Finance Report C Malcolm Hines

6 14.40 Quality Report D Kate Moriarty Baker

7 14.50

Urgent planned PCCC decisions for reporting

- SAS procurement Verbal Jean Young

Items for discussion

8 15.00Penrose Surgery Premises Plans Paper (not for decision) TO FOLLOW

E Gerry Owen/Jean Young

Items for Information

9 15.20 Dr Aru Improvement Plan F Jean Young

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1 of 47Primary Care Commissioning Committee - 24 September 2019-24/09/19

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Item Time Item ENC Lead

10 15.30Primary Care Network Update (change of IHL CDs and update on QHS recruitment and extended access changes)

Verbal Sam Hepplewhite

Closing items

11 15.50 AOB - Chair

12 15.50 Public Open Space - Chair

13 16.00 Close

1 Agenda

2 of 47 Primary Care Commissioning Committee - 24 September 2019-24/09/19

NHS Southwark Clinical Commissioning Group (CCG)Primary Care Commissioning Committee – PART 1

Tuesday 23 July 2019, 2pmCambridge House, 1 Addington Square, London, SE5 0HF

MINUTES

Present:Robert Park (Chair) Lay Member, Southwark CCG (SCCG) RPAndrew Nebel Lay Member, SCCG ANSam Hepplewhite Director of Integrated Commissioning, SCCG SHMalcolm Hines Chief Finance Officer, SCCG MHRichard Gibbs Lay Member, SCCG Conflict of Interest Guardian RGKate Moriarty-Baker Director of Quality, SCCG KMBCllr Evelyn Okoto Health and Wellbeing Board Representative EOStephen Whittle Southwark Healthwatch SWNick Langford Assistant Head of Primary Care, South East London Primary

Care teamNL

Ami David Registered Nurse Member, SCCG ADRachel Doherty (notes)

Primary Care Commissioning Manager, SCCG RDo

Apologies:Ross Graves Managing Director, SCCG RGrJill Webb Head of Primary Care, South East London Primary Care team JWDr Rob Davidson Clinical Lead, Primary Care, SCCG RDaDr Emily Gibbs Clinical Lead, Primary Care, SCCG EGJean Young Head of Primary Care Commissioning, SCCG JYDr Kishor Vasant Southwark Local Medical Committee KV

1.0 IntroductionIntroductions and apologies were noted as above.

1.1 Declarations of InterestThe group were asked to declare if there had been changes to their interests and if they had a conflict with an agenda item. All members confirmed no changes to their declarations.

2.0 Minutes from the last meeting The minutes were agreed as an accurate record. There were no outstanding actions from the previous meetings.

3.0 Public Open Space

No members of the public attended the meeting.

4.0 Contract Action Log

NL presented the paper. SW asked what areas the CCG have requested more information from Nexus in response to their remedial notice. It was summarised that Nexus have provided a significant amount of information to the CCG to demonstrate that they are addressing the issues raised by the CQC. It was noted that an area where more information has been requested relates to the mandatory training of staff and the process in place to ensure this is kept up to date. SH noted that the CCG will ask Nexus to provide more

A Minutes


information to patients and Healthwatch about the work they are progressing to address the CQC report.

5.0 Finance Report

MH presented the finance report.

6.0 Quality Report

KMB presented the report. It was noted that both GP Federations as providers of the extended primary care services in Southwark had been inspected by the CQC and rated as good overall. The Committee noted that this was very positive and congratulated the GP federations. AN also noted the significant improvements in practice ratings compared to the previous year and recognised the amount of work completed by practices and the CCG teams to improve ratings.

It was noted that the infection control audit tool for practices had now been shared. It was also explained that the CCG is continuing to support practices with duty of candour and root cause analysis.

7.0 System Reform

SH explained that the paper was coming to the Committee to note the GB decision on 11th

July to merge in to one CCG across south-east London and to note the implications this would have for the Primary Care Commissioning Committee. It was noted that when there is one CCG across south-east London the function of delegated general practice commissioning can’t be double delegated to individual boroughs and therefore there will be one Primary Care Commissioning Committee working across south-east London. It was noted that the detail of ensuring a balance between local and south-east London is being worked through.

Members of the Committee raised the importance of still having local influence and local relationships. It was noted that where possible decisions will be made in line with a policy by boroughs.

8.0 Healthwatch access report – Action Plan Update

RD presented the paper, noting the progress that the CCG, practices and GP Federation had made against the Healthwatch recommendations which were produced following enter and view visits which reviewed GP practice appointment systems.

SW thanked the CCG for providing the update proactively. It was agreed a summary will be sent to the Committee as the paper had not formatted correctly. It was discussed that Healthwatch will be invited to the access working with practices in September.

9.0 GP Patient Survey Results

SH explained the GP Patient Survey results were published in July 2019. It was noted the part provides a comparison of some of the results against Lambeth and Lewisham and the national average. It was noted that the results indicated that there were still some issues with access in Southwark. It was explained that the CCG will contact the practices with the lowest results to agree action plans with them to support improvements in access for patients.

The Committee noted the report was useful. The Committee noted the issues patients raise in relation to access to councillors and that this is shared with the CCG. It was explained that patient complaints is responded to following the NHS complaints procedure. It was noted

A Minutes


that the CCG is supporting practice review access as noted in the Healthwatch access paper.

10.0 AOB

None declared

11.0 Public Open Space

No public attended the Committee.

12.0 Meeting closed.

A Minutes


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Southwark CCG Committee Report

ITEM FOR DISCUSSION /ASSURANCE

CCG Committee

Primary Care Commissioning Committee

Month September Year 2019

Item title: Contract Action Log

Enclosure number:

B

Any knownconflict of interest

No

B Contract Action Log


2


The item is being presented to the committee for (select only one):

Discussion Assurance ¸

Report Author Responsible Director

Name Nick Langford Name Sam Hepplewhite

Job titleAssistant Head of Primary Care Job title

Director of Integrated Commissioning

Directorate N/A Directorate Integrated Commissioning

Email [email protected] Email [email protected]

1. Purpose of the paper (why does the committee need to discuss / receive assurance?)

The purpose of this paper is to provide information to the Committee as to when breach and/or remedial notices and requests for action plans have been sent to practices following PCCC decisions.

The paper provides details when practice’s responses have provided sufficient information to assure commissioners that all the required improvements have been addressed.

2. Describe the issue being presented to the committee for discussion or assurance

Decisions to issue practices with breach and/or remedial notices following poor contract performance are made by the Primary Care Commissioning Committee.

London developed a standard operating procedure (SOP) to enable borough Committees to take a consistent approach to issuing breach and/or remedial notices in response to Care Quality Commission ‘requires improvement’ reports. Decisions where practices have been rated as inadequate and placed in special measures are made in line with a national SOP.

This paper provides information to the Committee on the status of the remedial and/or breach notices and confirms if the practices response has provided commissioners with satisfactory information to demonstrate that the required improvements have been made.

3. What stakeholder engagement has taken place?



3


N/A

4. What equality and diversity considerations have been highlighted in the Equality Analysis and how have they been addressed?

N/A

Supporting information / documents

Please append any relevant documents including detailed reports; options appraisals; background documents; national guidance etc.

Appendix # Name of document

i Southwark CCG CQC Contract Action Log (September)

Date paper completed

12 September 2019



NHS Southwark CCG - CQC Contract Action Log September 2019

No. Practice Name CodeCQC inspection date

CQC report publication

Date considered by the Committee

Outcome ReasonDate sent to practice

Date response received

Status Comments

27 Camberwell Green Surgery G85013 1/23/2018 26/03/2018 4/25/2018Remedial breach notice

CQC overall RI 21/05/2018 15/06/2018 Open

CQC inspection visit on 23 Jan 2018, puplished on 26 March 2018. PCCC decision made on 25/4/2018 to issue Breach and Remedial Notice and Action plan by 9 May 2018. There has been a short delay in sending to the practice as officers had been unable to speak to the practice regarding the meeting to discuss the B&R notice. Meeting was held with practice on 05.06.2018 and the practice submitted action plan requirements on 15.06.2018. Submission has been reviewed by officers and further evidence has been requested by 1/08/2018. The further evidence was requested at a meeting held between commissioners and the practice on 5/09/2018 and an extension to submit the evidence was agreed with the practice until 28th September which was met by the practice.CCG and SEL PCT reviewed the evidence and are assured the practice has taken actions to address all areas in the remedial notice, with the exception of infection control. The practice is in the process of updating the carpeted areas in consultation rooms. The CCG will not be taking any further action, however this will remain open and monitored until the practice completes the actions in relation to the carpeted consultation rooms.

32 Nexus - CQC inadequate G8503401/11/2019 - 28/11/2019

26/02/2019 3/26/2019 Remedial Notice CQC-Inadequate 26/04/2019 24/05/2019 Closed

The report was published on 26 February 2019 and was rated 'Inadequate' overall with 'Inadequate' in 'Safe' and 'Well-led' and 'Requires Improvement' in 'Effective' and 'Responsive'. A paper was taken to the March Committee where it was agreed that the practice be issued with breach and remedial notices. Remedial notice was issued on 24.04.2019 and the response from the practice is due on 22 May 2019. The practice has submitted a response to the remedial notice. A meeting with the practice is taking place on 16 July 2019, where the evidence will be reviewed by officers. A verbal update will be provided to the Committee.Officers have reviewed the response from the contractor and supplementary evidence and are satisfied that all the requirements have been met. A compliance letter was sent to Nexus on 12/09/2019.

B C

ontract Action Log

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Chair: Dr Jonty Heaversedge 1 Chief Officer: Andrew Bland




CCG Committee



Item title: Primary Care Finance Report: Month 5 2019-20

Enclosure number:

C

Any known conflict of interest

No


Discussion ☐ Assurance ¸

C Finance Report





Name Vincent Kelly Name Malcolm Hines

Job title Acting Head of Finance Job title Director of Finance

Directorate Finance & Business Directorate Finance & Business



This report provides the Primary Care Commissioning Committee with assurance and information with regard to the financial performance of the Primary Care budgets for the 2019/20 financial year to date.


Delegated Primary Care

As at Month 5, Delegated Primary Care is showing a £76k underspend for the 2019/20 financial yearand is expected to underspend by £197k by year end. The underspend is due to PCN expenditure not being as high as planned.

C Finance Report




C Finance Report




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Other Primary Care Health Services

Other Primary Care Health Services are forecast to overspend by £1.6 million. This is due to factors: Prescribing which is forecast to overspend by £500k, this is due to volume increases and also Primary Care Programmes which are forecast to overspend by £1.1 million.

The 111 contract is now reported in the Acute Directorate.

Other than that, all other areas are showing break-even or near break-even.

C Finance Report





N/A




i None

Date paper completed Tuesday, 17 September 2019

C Finance Report


1




CCG Committee



Item title: Quality Report

Enclosure number:

D


No

D Quality Report


2



Discussion ☐ Assurance ¸


Name Jacquie Foster Name Kate Moriarty-Baker

Job title Head of Quality Job titleDirector of Quality and Chief Nurse

Directorate Quality & Nursing Directorate Quality & Nursing

Email [email protected] [email protected]


The purpose of this paper is to provide an update on quality in relation to primary care.


1. Care Quality Commission inspection reports

The CQC inspection process is a national programme. Current ratings for Southwark CCG are summarised in Appendix 1 and full reports are available on the CQC website http://www.cqc.org.uk/

The CCG has 36 practices of which 33 are rated Good overall. In addition there are two practices rated Requires Improvement and one rated Inadequate (the Nexus group is also rated Inadequate).The Southwark practices are generally improving – 15 practices have improved their ratings – yet 3 practices have ratings which have worsened over time. And Southwark does not have a single practice or domain rated as Outstanding.

In 2017 NHS Southwark CCG created and promoted a Learning Resource document to support practices with preparing for their CQC inspections. This is available on the website and had been promoted in the GP bulletins.

The CCG has attended various for a including practice nurse and practice managers to promote the Learning Resource, advise what the CCG has available, and, if practices request support, co-ordinated specialists to work with them (safeguarding, Meds Op team, Infection Prevention and Control, etc).

The Quality team at the CCG work in partnership with the Primary Care team and have visited practices regarding CQC Action Plans and targeted support. The CCG engages with the local population through locality Patient Participation Groups (PPGs) on issues which may relate to quality.

D Quality Report


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

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a. New CQC results in Southwark

Since the last Committee meeting in July 2019, the CQC have published the inspection report for Dr Arumugaraasah (Aru’s) practice.

Table 1 – results of Southwark CCG CQC inspection reports published since July 2019:

Site Inspection date

Report publication

date

Overall rating

Safe Effective Caring Responsive Well-led

Dr Aru 9/7/2019 29/8/2019 Good Good Good Good Good Good

Dr Aru’s surgery was inspected by the CQC in July 2019 and has been rated Good in all 5 domains. The practice had been inspected each year in 2016, 2017, 2018 and again in 2019 and continued improvement has been seen each time. In 2016 the practice was Requires Improvement overall with two domains rated as Inadequate. The practice has improved each time and are to be commended to having achieved Good in all domains.

The CQC noted that the practice had reviewed the needs of the population and responded accordingly. Feedback from patients had influenced a new telephone system being installed, and complaints were responded to appropriately and within the practice’s timeframe. Shared care agreements with secondary care regarding medications were in place to ensure patient treatment was coordinated.

The CQC recommended the practice continue to take steps to improve childhood immunisation uptake (a problem noted in Southwark) and review ways to better engage patients diagnosed with long-term conditions with treatment offers.

The full inspection report can be accessed via:https://www.cqc.org.uk/sites/default/files/new_reports/AAAJ5534.pdf

2. Infection Prevention and Control (IPC) in Primary Care Update

The nine practices in Southwark nominated for audited have had this carried out by the NEL IPCteam, in accordance with the London-wide approved arrangements for NHS England’s primary care IPC audit process. In addition, a further two Southwark practices have received follow up visits to provide ongoing support for audits undertaken during last year’s programme. The audit reports and any required action plans have not yet been received by the CCG however the CCG IPC Nurse Lead expects to review them for quality assurance in due course.

The CQC expects practices to undertake their own IPC audits annually, led by nominated practice IPC leads. An approved IPC audit tool has been sent to all practices by the CCG, with the recommendation that it be used as to self-assess and so assist with meeting CQC requirements. An IPC primary care resource and guidance pack commissioned by the CCG is also available for practice use.

Ongoing IPC support and advice continues to be provided to practices both on request and as required by the CCG, including those practices requiring contract management.

D Quality Report


https://www.cqc.org.uk/sites/default/files/new_reports/AAAJ5534.pdf

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3. Medicines Optimisation update

a. Medicines Optimisation Practice Pharmacist EventThe Medicines Optimisation Team at Southwark CCG recently held a training event for pharmacists employed by General Practice. The event provided an opportunity for practice pharmacists to meet the CCG’s Medicine Optimisation Team (MOT) pharmacists and share ideas for good practices and quality improvement. The MOT provided resources to equip the GP based pharmacist to support their practices deliver 2019/20 Prescribing Improvement Scheme. Training pharmacists to help practices demonstrate the safe use of medicine – a key area during a CQC inspection was also covered.

Incident reporting, working within scope of practice (for non-medical prescribers) and responding effectively to queries were some of the areas covered. The event was well attended and the feedback very positive.

b. Patient Group Direction (PGD) for the supply of varenicline by authorised community pharmacists

The MOT has updated this PGD in line with current evidence to ensure it safe for use by community pharmacists providing smoking cessation services. The MOT also provided training for pharmacists working in selected community pharmacies (contracted by Southwark Local Authority) to provide smoking cessation support for Southwark registered patients. An additional ‘catch up’ session has been arranged for community pharmacists who could not attend the event.

c. Prescribing Review VisitFollowing on from the Medicines Optimisation PLT in May 2019, nearly every practice in the Southwark has had a visit from their MOT Prescribing Advisor. The visits were to inform practices of the medicines optimisation’s priorities for 2019/20, provide them with general and clinical updates, key resources to support quality and safety prescribing, and respond to specific queries/concerns.

d. Direct Oral Anticoagulants (DOAC) & Low Molecular Weight Heparin (LMWH) Quality Improvement Review

Members of the MOT and sessional anticoagulant pharmacists (seconded from the Acute trusts) are currently visiting practices and collecting data to help address issues relating to the safe prescribing of DOAC and LMWH. Approximately 1,050 records for patients prescribed a DOAC/LMWH have been reviewed to date with approximately 1,200 records to finished shortly. An education event to address learning from the audit to improve safe prescribing of DOAC/LMWH is planned for Autumn.

e. Pre- Registration Pharmacist TrainingNHS Southwark CCG is recognised as a pre-registration training site by the General Pharmaceutical Society. Our 2018/19 trainee has successfully passed his pre-registration exams and we are looking forward to welcoming our new trainee in October 2019.

4. Learning, Development and Nursing in General Practice

The CCG is providing ongoing support for core and update training for nurses, HCAs and pharmacists both groups and individual requests for training. Areas such as Immunisation, mentoring, non-medical prescribing, Cytology, Sexual health, STIF course and Contraception updates, core skills andCare Certificate for HCAs.

In addition the CCG runs monthly Practice Nurse, HCAs forums and PLT events, and promotes courses commissioned by other organisations and training hubs. The CCG has also offered the following specific opportunities:

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a. Trainee Nursing Associate Programme – the CCG are actively working with practices to consider supporting current HCAs and others interested to enrol into TNA programme. As part of the work of the task and finish group in the SEL STP area and TNA team at HEE, we are working on organising events to promote the Nursing Associate role and promote the uptake.

b. Nursing Student Placements - Working with South East London Practice Educators and placements coordinator, we expect the number of pre-registration nursing placements will increase this year. Training of mentors and nurses to comply with the new standards of supervision and assessors is ongoing.

c. Preceptorship Programme - We continue to support the preceptorship programme in Southwark, working in collaboration with preceptor leads across SE London

d. Clinical Supervision – There are clinical supervision groups for nursing staff developing across Southwark, the CCG support Practice Nurse leads in this work.

e. Southwark Sessional GP Forum - The forum will have a lot more impact this year – regular email updates, quarterly events and social platforms are used and developed to provide support and information for sessional GP. Two main areas of development identified: a digital platform to be used by the group and creating a regular peer review structured meeting. Regular communications with the group will also enable better uptake of training and other opportunities to encourage professional development and promote vacancies in Southwark.

f. RCA and Incident awareness – the CCG has run 2 of the 3 sessions booked for practice clinicians, with about 10 people attended or expected on each date. Attendees asked to be put in touch by email to continue discussions from the day, feedback from trainers suggested more in-depth training on the subject would be welcomed.

a. What stakeholder engagement has taken place?

NHS Southwark CCG continues to engage with patients on the quality of general practice service in Southwark through engagement workshops, via the locality patient participation group meetings.

b. What equality and diversity considerations have been highlighted in the Equality Analysis and how have they been addressed?

None highlighted.




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1 CQC Inspection update table and ratings

Date paper completed Wednesday, 11 September 2019

D Quality Report


7


Appendix 1 CQC Outcomes

The following charts illustrate the current position of CQC overall ratings for Southwark General Practices the rating for each domain.

Overall CQC Ratings for Southwark Practices

30

32

31

32

30

4

3

4

2

3

1

0

0

1

2

1

1

1

1

1

0 5 10 15 20 25 30 35 40

Safe

Effective

Caring

Responsive

Well-Led

Total rating for each CQC Domain

Good Requires Improvement Inadequate Not yet inspected

2

30

31

Inadequate Good RequiresImprovement

Not yet inspected

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Overall CQC Rating

GP Practice Name

Safe? Effective? Caring? Responsive? Well-led?

Inadequate Special Measures

Bermondsey Spa RI RI RI I I

I I I I I

G G G G G

RI G G G G

I I RI I I

Inadequate (Special Measures)

Nexus I RI G RI I

Requires Improvement

Borough Med Centre - Dr Misra

RI G G G RI

G G G G G

Requires Improvement

New Mill Street RI G G RI RI

I RI RI RI I

G G G G G

Good Lister Dr P Aru

G G G G G

G RI RI G RI

RI RI RI G RI

RI I RI RI I

Good Sir John Kirk Close

G G G G G

Good Camberwell Green

G G G G RI

RI G RI G I

RI RI G G RI

Good Acorn & Gaumont Surgery

G G RI G G

G RI RI G G

Good Sternhall Lane Surgery

G G G G G

I RI G G RI

RI G G G RI

Good Lordship Lane Dr Doha

RI G G G G

RI RI RI G RI

I RI RI RI RI

Good Parkside Medical Centre

G G RI G G

RI RI G G RI

Good Elm Lodge Surgery

G G G G G

RI G G G G

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9


Good East Street Surgery

G G G G G

G RI G G G

Good Maddock Way Surgery

G G G G G

RI RI G G RI

Good Trafalgar Surgery G G G G G

I RI G RI I

Good Forest Hill Group Practice

G RI G G G

I RI G G I

RI RI G G RI

Good Falmouth Road Group Practice

G G G G G

I G RI G RI

I RI I I I

RI RI RI RI I

Good Park Medical Centre

G G G G G

RI RI G G I

RI G G G RI

Good Melbourne Grove G G RI G G

Good Silverlock Medical centre

G G G G G

Good Queens Road Surgery

G G G G G

Good Nunhead Surgery G G G G G

Good Dulwich Medical Centre

G G G G G

Good The Gardens Surgery

G G G G G

Good Borough Med Centre - Dr Sharma

G G G G G

Good Blackfriars Medical Centre

G G G G G

Good Penrose Surgery G G G G G

Good Albion Street Practice

G G G G G

Good 306 Medical Centre

G G G G G

Good Hambledon G G G G G

Good St Giles SurgeryDr Virji/Begley

G G G G G

Good St Giles Roseman/ Vasant

G G G G G

Good DMC Healthcare G G G G G

Good Old Kent Road Surgery

G G G G G

Good Villa Street Medical Centre

G G G G G

Not inspected yet

The Lister Practice (AT Medics)

Not rated yet

Not rated yet Not rated yet

Not rated yet Not rated yet

D Quality Report


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D Quality Report


1



ITEM FOR DISCUSSION / ASSURANCE

CCG Committee



Item title: Penrose Surgery Plans Paper

Enclosure number:

E

Any known conflict of interest

No

E Penrose Surgery


2



Discussion Assurance ☐


Name Gerry Owen Name Malcolm Hines

Job title Estates Programme Director

Job title Finance Director

Directorate Finance & Business Directorate Finance & Business



Penrose practice wishes to advise the primary care committee of its proposed premises redevelopment. If the project proceeds, a legal letter will be drawn up, co-signed by the commissioner and provider, that confirms the basis of ongoing premises costs reimbursement.


Penrose practice is keen to develop a larger purpose-designed premises. The population in the area has been growing and the existing premises are now slightly below requirement and a previous plan to infill the courtyard is not practical. A plan has been drawn up and discussions held with Southwark Council to develop a new facility at the base of a residential development. This practice development is not identified as a strategic aim in the borough in the approved Estates Strategy, and significant local population growth is intended to be supported from a community hub located close to Elephant and Castle. The committee is invited to note the practice proposal and that it presents a requirement for additional NHS resources only for a single additional room as detailed in unsuccessful bids for ETTF and IG funds.


The paper states the following: The Practice has an active patient participation group (PPG) and they have been consulted and will be kept involved in the scheme as it progresses. The PPG are extremely keen for a new premises to enable better access for patients. The Manor Terrace Development has been widely consulted amongst the local community. The

E Penrose Surgery


3


Council and the local community including residents of the Walworth Society and Friends of Pasley Park are keen for Penrose Surgery to be included within this development alongside retail units and residential flats above.

4. What equality and diversity considerations have been highlighted in the Equality Analysis and how have they been addressed?

The practice has undertaken an initial equality analysis to assess the impact of the proposed relocation on patient and staff equality groups, from which it is considered that the impact of the proposed relocation is neutral or indeed positive.




i

BUSINESS CASE Proposed Practice re-location to purpose built premises at Manor Terrace, Kennington, London SE17 Rev. 07

Date paper completed

Monday, 16 September 2019

E Penrose Surgery


Page 1 of 12

BUSINESS CASE

Proposed Practice re-location to purpose built premises

at Manor Terrace, Kennington, London SE17 Rev. 07

Date: 19th September 2019

Penrose Surgery

Current address: 33 Penrose Street, London SE17 3DW

New Manor Terrace Development sketch

Key Contact(s) & contact details: Dr. Sarah Hawxwell - [email protected]

Mr. Sunil Gupta - [email protected] Telephone: 0207 703 3367 and 02073586440

E Penrose Surgery


mailto:[email protected]

mailto:[email protected]

Page 2 of 12

Contents 1 Executive Summary 2 Proposal 3 Practice Information 4 5

Case for Change Project Plan

6 Financial implications of the Proposal – Recurrent and Fixed

7 Comments / Issues

E Penrose Surgery


Page 3 of 12

1. Executive Summary

The Practice is currently located in a converted detached Georgian House and holds a PMS contract. The current premises are insufficient in a number of ways (despite regular investment and refurbishment) and as a result, the Practice has been looking for alternative premises solutions for a number of years now. Southwark Council is developing a residential led, mixed use scheme c.300 metres from the current premises called Manor Terrace. The scheme gained planning consent in January 2018 (Ref.17/AP/0907). The Practice’s patient group, the Council and the local community - including members of the Walworth Society and Friends of Pasley Park - are keen for Penrose Surgery to be included within this development alongside retail units and residential flats above. The Council has offered the unit to the partners on an off-market basis. The shell unit will then be fitted out in accordance with NHS Premises Standards and Directions to create an environment that is more suitable and higher quality for patients and staff alike. The CCG has advised the Practice that there are no NHS capital funds available currently to support the relocation and that any rent reimbursement at the new site would need to be pegged to the level that would otherwise be reimbursed at the existing site. The Practice is prepared to proceed on this basis at this time and so is seeking the CCG’s acknowledgement of the Practice’s intentions and to gain the CCG support albeit without the need for any additional financial support other than as noted.

2. Proposal

This Business Case has been prepared by Penrose Surgery to set out and support its case to relocate to new, purpose built nearby premises that are being developed by London Borough of Southwark under the development title of Manor Terrace.

3. Practice Information

The Penrose Surgery is currently based in a converted Grade 2 listed Georgian building originally constructed in the mid-1800s at 33 Penrose Street, London SE17 3DW. The premises are located just off Walworth Road south of Elephant & Castle. The premises are owned by the Practice. The Practice holds a PMS contract. The premises currently consist of 3 Consulting Rooms and 1 Treatment Room. Additionally, there are 2 small flexible use rooms on the ground floor (<14m2) and a waiting area / reception. The premises were classified as compliant in the NIFES premises audit of 2012.

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The current premises are laid out below :

E Penrose Surgery


Page 5 of 12

The Practices current and proposed premises location is shown below together with the location of neighbouring GP Practices.

Proposed site at Manor Terrace Existing Penrose Surgery The Practice has been based at the current 33 Penrose Street building for over 40 years. According to the latest EMIS registered patient list, the Practice has a list size of c. 9,700 (as at September 2019). The Practice list continues to grow – net growth over the last twelve months was 14.1% or c.1,200 patients. The average growth over the last 5 years has been 12.4% annually, with over 4,000 patients being added in that time frame. Given the practices excellent service delivery record (see below), consistent growth pattern and the anticipated rise in the local population, the Practice expects its patient list to continue to grow at similar rates (i.e. 1,000-1,500 patients per year). The Practice has a good patient satisfaction rating – 4 and 1/2 out of 5 stars on independent online platform NHS choices with currently 89% of patient participating in the Friends and Family test said they would recommend the practice. See http://www.nhs.uk/Services/GP/Overview/DefaultView.aspx?id=44195 The Practice latest Quality Outcome Framework score is 558.27 out of 559 = 99.9% and is currently rated Good by the Care Quality Commission. The Practice covers a wide area to the south of Elephant & Castle in South East London. The patient boundary map is included below :

E Penrose Surgery


http://www.nhs.uk/Services/GP/Overview/DefaultView.aspx?id=44195

Page 6 of 12

The Practice currently has the following staff:

• 4 GPs • 1 Practice Nurses • 1 HCA (& Phlebotomist) • 1 Paramedic • 1 Clinical Pharmacist • 1 Mental Health Nurse • 7 reception and clinical admin • Back office management (located off-site due to lack of space)

Penrose Surgery is open Monday to Saturday and offers the following services:

• GP same day and routine appointments • Nurse and HCA same day and routine appointments • Post-natal checks • Cervical smears and sexual health • Contraception • Smoking cessation • Spirometry • In-house Pharmacist • Well person clinic • Diabetic/asthma • Travel vaccines • Baby clinic • Ear irrigation • Blood Tests • Electronic prescription service to patient nominated pharmacy • Care plan clinics • Home visits • Medical Student training • Yellow Fever Centre

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4. Case for Change

Strategic local context – Penrose Surgery is located in Newington Ward with a catchment area covering parts of East Walworth, Faraday and South Camberwell. Mayor of London’s Draft 2019 London Plan indicates the Elephant and Castle / Walworth Road area to be of High Residential Growth Potential with Camberwell indicated as an area of Medium Residential Growth Potential. 5,000 minimum new homes and 10,000 indicative jobs in Elephant and Castle as per London Plan. Options appraisal – The Practice has considered its options as follows ; 1) Do Nothing – it is considered this option does not rectify the current premises problems nor does

it support the Practice’s short- or long-term aspirations and will constrain the Practice’s ability to grow both in terms of list size and services it offers. This option does not serve the needs of the growing local population and has therefore has been dismissed.

2) Extend at existing premises – listed building consent has previously been granted to extend into the external courtyard to create additional waiting area space and an additional consulting room and w/c (c. 50m2). Whilst this would improve the current accommodation it does not significantly improve capacity and retains many of the existing shortcomings of the space. Construction in the confined space available would also be costly and disruptive – worsening the short term burden on the Practice and team. Consequently this plan was deemed to not meet the Practice’s current needs or projected future needs. Since planning permission for this scheme was granted, the list has grown by 49% or c.3,200 patients. Given the nature of the property and its location, any extension plans on the existing site would have to be limited in scale and therefore further plans have not been pursued.

3) Re-locate to new premises at Manor Terrace – this is the Practice’s preferred option. It is a unique opportunity to secure alternative, compliant, high quality premises in an inner city area where it has proven very difficult to identify and secure affordable opportunities that are effectively an ‘off-market’ transaction. This is a truly transformational option for the Practice, its patients and for the CCG to improve health delivery in this rapidly growing area of Southwark. It will give the Practice the opportunity to meet the demands of an increasing patient list and also offer improved service with increased clinical capacity, wider skill mix (e.g. physicians assistants, physiotherapists, triage specialists), and space for PCN based services.

The Council led Manor Terrace development was granted planning consent in January 2018 (Ref. 17/AP/0907). It includes space allocated at Ground Floor for an 85m2 pharmacy (or retail) unit as well as a unit of 745m2 with consent for either B1 (Office) or D1 (GP Surgery) use. By reference to the PID space planner toolkit, the Practice ought to be seeking 720m2 based on a projected list of 12,000 patients (achieved within 18 months at current rates). It also suggests the need for 7 consulting rooms and 3 Treatment Rooms. It should be noted that at the current list size of c.9,700 patients the toolkit indicates the need for 5 consulting rooms and 2 treatment rooms and a GIA of 649m2. Note: The current premises are 196m2 and consists of 3 No. Consulting rooms and 1 No. Treatment Rooms. An indicative proposed layout plan for the ground floor of Manor Terrace is included below. It offers up to 9 clinical rooms plus a counselling room and associated utility and w/c rooms as well as a meeting room and multi-purpose room. The size of clinical rooms will be mostly at 14m2 with some at 16m2.

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Indicative layout plan for Ground Floor of Manor Terrace development Objectives and benefits - the objectives of the proposal are two-fold. Firstly, to provide the practice with accommodation that could allow it to meet the needs of its current and future projected list size and that also meets NHS premises standards. Secondly, to facilitate a transformational change in the way the Practice is able to delivers improved care to patients by allowing more room for increased clinical capacity, wider skill mix (e.g. physicians assistants, physiotherapists, triage specialists), and space for PCN based services. Justification for the scheme, including strategic drivers, local need, demographic information, premises issues etc. The population of London is projected to increase substantially over the next ten years and Southwark is no exception. The headline numbers as identified by London Borough of Southwark are set out overleaf. Equality Analysis An initial equality analysis has been undertaken to assess the impact of the proposed relocation on patient and staff equality groups such as age, disability, gender, race, religion and sex. In all instances it is considered that the impact of the proposed relocation is neutral or indeed positive. In no instances, is it considered that the relocation will have a negative or discriminative impact on any equality group therefore no remedial or other measures need to be put in place at this time. The analysis will be repeated at key stages of the project including following relocation. If this results in any negative impact - even very low – then suitable measures will be put in place to remedy.

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The resident population across Southwark is expected to grow by over 47,000 by 2025 i.e. an increase of 15%. North Southwark, especially the area around Elephant and Castle is expected to show the largest increase.

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Populations in Elephant and Castle and Camberwell specifically are expected to grow substantially. The Elephant and Castle / Walworth Road area is of High Residential Growth Potential and Camberwell is indicated as an area of Medium Residential Growth Potential in the Mayor of London’s London Plan. This document also indicates a minimum of 5,000 new homes and 10,000 indicative jobs to be created in the area. The below map indicates the new homes and developments that have recently been completed or are currently being built. That does not include planned further developments to come over the next 5 years.

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New homes and developments in the Penrose Surgery catchment area (Source: Rightmove) By relocating to bespoke premises the Practice will be better placed to cope with its list size, offer better access and also more appointments to meet patients demands. This will help reduce pressure on local Urgent Care Centre and A&E Depts. Consultation - The Practice has an active patient participation group (PPG) and they have been consulted and will be kept involved in the scheme as it progresses. The PPG are extremely keen for a new premises to enable better access for patients. The Manor Terrace Development has been widely consulted amongst the local community. The Council and the local community including residents of the Walworth Society and Friends of Pasley Park are keen for Penrose Surgery to be included within this development alongside retail units and residential flats above.

5. Project Plan

The Council intend to complete construction of the development by the end of 2021. The Practice envisage completing the fit out at the same time with occupation in January 2022. Final terms are due to be agreed with the Council by mid-October 2019 so that solicitors can be instructed. By the time that the long leasehold interest is legally ready to be completed, the Practice will need to have finalised the fit out design and costs so as to ensure that the scheme remains viable.

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6. Financial impacts of the Proposal – Recurrent and Fixed

The current rent reimbursement at Penrose Surgery is £38,555 per annum. The CCG has advised that any rent reimbursement at the new site would need to be pegged to the level that would otherwise be reimbursed at the existing site. The CCG has also advised the Practice that there are currently no NHS capital funds available to support the relocation and that all such costs will need to be met by the Practice. The Practice is prepared to proceed on this basis at this time.

7. Comments / Issues:

Procurement of fit out works – The Council will be the developers working alongside their selected development partner. The Council will construct the shell unit and let it to the Practice on a long lease in return for an agreed premium. The Council has prepared Heads of terms for the sale and matters are due to be finalised by mid October 2019. The Practice currently has two procurement options for the fit out, namely:

1. The Councils Building Contractor framework Partner for the overall scheme, Durkan Ltd. are appointed by the Practice to undertake the fit out following a negotiated contract.

2. The Practice lets the fit out work contract to a suitably qualified builder following competitive tendering (that may include Durkan Ltd. on the tender list)

Key risks associated with the project - The key risks to the Practice will be :

1. Agreeing acceptable terms with the Council 2. Ensuring that the scheme remains fundable and financially viable and affordable

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CCG Committee



Item title: Dr Aru and Partners Improvement Plan Update

Enclosure number:

F


No

F Dr Aru Improvement Plan


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Discussion ¸ Assurance ¸


Name Rachel Doherty Name Sam Hepplewhite

Job titlePrimary Care Commissioning Manager

Job titleDirector of Integrated Commissioning

Directorate Integrated Commissioning Directorate Integrated Commissioning



In June 2018 the Primary Care Commissioning Committee agreed for Dr Aru to take on an additional GP Partner, Dr Wilson Onyeka, to his Personal Medical Services (PMS) contract. As part of this process an improvement plan was agreed with the practice.

This paper provides an update on the progress the practice has made in the areas included within the improvement plan.


The agreed improvement plan with the practice is attached at appendix 1.

A summary of achievements to date are:

∑ An increase in 7% points of patients with diabetes that have a HbA1c ≤ 58mmol/mol.

∑ An increase in 31% points of patients with diabetes that a blood pressure ≤ 140/80 mmHg, which is also now above the south Southwark average.



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∑ An increase in 28% points of patients with diabetes with Cholesterol < 5mmol/l, which is also now above the south Southwark average.

∑ 83% of diabetic patient with all completed 8 care processes, above the south Southwark average.

∑ 93% of patients with learning disabilities receiving a health check, above the south Southwark average.

∑ 83% of patients with a diagnosis of COPD being confirmed by spirometry, an increase of approx. 50% points.

∑ The practice has completed one local patient survey and identified areas of improvements. This has been discussed with the PPG and includes increasing nursing access. The practice is proposing to the primary care network to increase their nursing extended hours capacity. The practice is planning on completing a second patient survey following the results of the national survey published in July 2019 to enable them to gather more in-depth information and enable comparison.

∑ The practice is working towards the 2019/20 target of having 30% of patients signed up to use online services. It is expected to increase further with the introduction of the NHS App.

The data shows the practice has delivered the areas of the improvement plan, improving outcomes for patients in these areas.

The practice has improved performance significantly in all areas. There are three areas where the practice has improved significantly from 2017/18 to 2018/2019 but three areas where the revised south Southwark average has not quite been met. The practice has confirmed they will continue to work to meet the south Southwark average in these areas.

The CCG will continue to review the practices performance in line with the agreed contract management process for all practices in Southwark.

In addition to the improvement plan agreed with the CCG, following a CQC inspection on 9th

July 2019 the practice has now been rated as good in all areas and overall by the CQC. Previously the practice was rated as ‘requires improvement overall’ and prior to that was in special measures and rated as inadequate in 2016.


N/A




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i Improvement Plan Outcomes

ii

iii

iv

v

Date paper completed Friday, 30 August 2019



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Area Practice Baseline 2017/2018

South Southwark Average Baseline 2017/2018

Improvement Outcome 31 March 2019



2018/2019 achievement

Diabetes -HbA1c ≤ 58mmol/mol

% of patients on the diabetes register with HbA1c ≤ 58mmol/mol

51% 58% 5% improvement on 17/18 data

5% improvement on 18/19 data

To meet the south Southwark average as of 31 March 2021.

58%

South Southwark average 61%.

PART ACHIEVED

Diabetes - BP ≤ 140/80 mmHg

% of patients on the diabetes register with BP ≤ 140/80 mmHg




90%

South Southwark average 79%

ACHIEVED

Diabetes -Cholesterol < 5mmol/l

% of patients on the diabetes register with Cholesterol < 5mmol/l




90%


ACHIEVED

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Diabetes – All 8 Care Processes Completed

% of patients on the diabetes register that have completed all 8 care processes on an annual basis




82%

South Southwark average 65.5%

ACHIEVED

LD Healthchecks

% of patients on the Learning Disabilities register that have received a healthcheck on an annual basis in line with the directed enhanced service.

47% 71% -Southwark average

To meet the Southwark average

To meet the Southwark average


93%. 14 of 16 patients.

Southwark Southwark average 81%.

ACHIEVED

COPD –diagnosis confirmed with spirometry

% of patients with a diagnosis of COPD that has been confirmed by the presence of a post bronchodilator ratio ( FEV1 / FVC or VC) less than 0.7 and more than 0.2




83%,


PART ACHIEVED

Patient Experience

The practice will conduct an annual local patient experience

n/a n/a n/a n/a n/a Completed and ongoing. See cover

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survey and review results against the national survey. If the local survey identifies areas for improvement the practice will develop an action plan to implement these.

sheet for detail.

Patient Online -% of patients with accounts Feb 2018

% of patients that have enabled online accounts to book appointments, view medical records and order repeat prescriptions

20% 30% -national target 18/19

To meet the 30% national target

To agree dependent on national targets

To agree dependent on national targets

24.5%

Average 28%.

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Documents

Southwark Primary Care Commissioning Committee...KMB presented the report. It was noted that both GP Federations as providers of the extended primary care services in Southwark had