Southwark Primary Care Commissioning Committee Primary...KMB explained that the Brid Nicholson, the infection control nurse for Southwark and Lambeth was leaving the CCG but that the

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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 25 September 2018

Part 1 – 1.00 – 3.00pm

Cambridge House, 1 Addington Square, London SE5 0HF

Item Time Item ENC Lead

Part One

Introductory items

1 13:00 Welcome, introductions, apologies and declarations of interest - Chair / All

2 13:05 Minutes and Actions of last meeting: July 2018 A Chair

3 13:10 Public Open Space - Chair

Standing items

4 13:20 Primary Care Finance Report: Month 5 2018-2019 B Malcolm Hines

5 13:30 Contract Action Log D Jill Webb

6 13:40

Primary Care Commissioning Committee Decisions for reporting a) Dr Aru Partnership b) Sir John Kirk Close Surgery Remedial Notice c) Camberwell Green Surgery Additional Funding

E Jean Young

Items for decision

7 13:55 Remedial and breach notice considerations following CQC inspection outcomes

a) Dr Aru, Lister Primary Care Centre

F Jill Webb

8 14:10 Sir John Kirk Close APMS Contract decision G Caroline Gilmartin

Chair: Dr Jonty Heaversedge 2 Chief Officer: Andrew Bland The best possible health outcomes for Southwark people

Item Time Item ENC Lead

Items for information / discussion

9 14:25

Procurement updates a) APMS Tranche 6 – contract award

a. Lister Primary Care Centre b. Falmouth Road Group Practice

b) Dulwich Health Centre

Verbal

H

Jean Young Jean Young

10 14:40 Quality Improvement Report C For information

11 14:45 AOB Chair

12 14:50 Public Open Space Chair

13 15:00 Close Chair

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NHS Southwark Clinical Commissioning Group (CCG) Primary Care Commissioning Committee

Tuesday 24 July 2018, 1pm – 2.30pm Cambridge House, 1 Addington Square, London SE5 0HF

MINUTES

Present:

Robert Park (Chair) Lay Member, Southwark CCG (SCCG) RP

Caroline Gilmartin Director of Integrated Commissioning, SCCG CG

Ross Greaves Managing Director, SCCG RGr

Richard Gibbs Lay Member, SCCG Conflict of Interest Guardian RGi

Jean Young Head of Primary Care Commissioning, SCCG JY

Andrew Nebel Lay Member, SCCG AN

Jill Webb Head of Primary Care, South East London Primary Care

team

JW

Dr Penny Ackland Southwark Local Medical Committee PA

Kate Moriarty-Baker Director of Quality and Chief Nurse KMB

Malcolm Hines Chief Finance Officer, SCCG MH

Rachel Doherty

(notes)

Primary Care Commissioning Manager, SCCG RDo

Catherine Negus Southwark Healthwatch Manager CN

Apologies:

Dr Emily Gibbs Clinical Lead, Primary Care, SCCG EG

Dr Rob Davidson Clinical Lead, Primary Care, SCCG RDa

Joy Ellery Lay Member, SCCG JE

Ami David Registered Nurse Member AD

Stephen Whittle Southwark Healthwatch SW

1.0 Introduction

Introductions and apologies were noted as above.

1.1 Declarations of Interest

The 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 or conflicts.

2.0 Minutes from the last meeting

The minutes were agreed as an accurate record. PA asked for an update in relation to the LMC’s

query at the last meeting regarding the quoracy of the Committee. RG confirmed that a letter had

been sent to Jane Cliffe with the relevant information and that PA could contact him with any

other queries.

2.1 Actions from the last meeting

The actions were discussed as follows:

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Date of

Meeting

Action

number

Action Point Lead Status

23.01.18 4 To create a principles document

for mergers

RD On-going, to be brought

to next meeting

22.05.18 3.1 To inform Christine Andrews on

local mental health service

related meetings

CG RD emailed the patient

and put in contact with

mental health

commissioning

colleagues to advise of

mental health related

meetings. Closed.

22.05.18 4.1 To confirm the London conflict of

interest guidance for GP

delegated commissioning to the

LMC

RG Complete. Closed.

22.05.18 8.1 To feed back all of the PCCC

comments to NHS England

NL Complete. Closed.

3.0 Public Open Space

RP welcomed members of the public.

Martin Dadswell asked if the utilisation of the extended primary care services was increasing. JY

confirmed that utilisation of the service had increased.

4.0 Primary Care Finance Report: Month 3 2018-19

MH explained that the report included delegated and local primary care budgets. It was noted

that the short fall in delegated funding had been met by the CCG. It was noted that there was no

significant variances at month 3.

MH explained that the report format had changed following comments from the Committee. The

Committee thanked MH for the changes made.

AN noted the variation in the prescribing budget and asked if the CCG was confident that the

overspend could be mitigated. MH confirmed that the medicines optimisation team would be

working with practices to mitigate an overspend in this area. It was noted that the budget is

significant and therefore a minor change in prescribing can increase expenditure against the

budget.

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It was noted that the SELDOC budget had increased as the number of APMS caretaking

contracts had increased but that it was expected the budget would break even. It was explained

all APMS contracts are opted out of providing out of hours services.

5.0 Quality Improvement Report

KMB presented the paper. KMB explained that 4 practices have had CQC reports published

since the last Committee. It was noted that the Hurley Group who have been caretaking Dr

Hossain’s former practice were not assigned a rating due to the short time they had been

managing the practice, but that the CQC recognised systems and processes at the practice have

improved.

KMB explained that the Brid Nicholson, the infection control nurse for Southwark and Lambeth

was leaving the CCG but that the CCG had appointed to the post. It was explained that the post

holder will work with practices, the commissioning support unit and primary care commissioning

to identify practices that require support.

It was noted that the south-east London general practice nurse strategy group had been set up to

support the delivery of the general practice nurse 10 point plan. It was noted a successful bid to

Health Education England was submitted to support delivery in south-east London and that the

group is in the process of recruiting to a practice educator role. It was explained that Southwark

had recruited to a preceptorship nurse role to support mentorship of new nurses in Southwark.

KMB explained that the CCG was working across south-east London to support the raising

awareness of sepsis. It was confirmed all practices have a sepsis lead.

It was also explained that the CCG had revised the significant event template which includes

guidance on how to develop SMART actions is being promoted alongside the quality alert

process.

PA noted that infection control inspections of general practice services needed to be in line with

standards that relate to general practice. JW confirmed that the south-east London team has

engaged with Londonwide LMC over the development of the infection control audit tool.

JY noted that it was good that Falmouth Road Group Practice and Acorn and Gaumont Surgery

had now been rated as ‘good’ by the CQC and noted the turnaround made at Falmouth Road

Group Practice by the caretaker provider, AT Medics. The Committee noted the new presentation

of CQC ratings was helpful.

JW confirmed that she would share the evaluation of the infection control audits completed

across London and the sepsis audit tool with KMB.

Date of

Meeting

Action

number


24.07.18 1 To share the evaluation of the infection control JW New

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audits completed across London and the

sepsis audit tool with KMB.

6.0 Contract Action Log

JW presented the paper. It was noted that there were 5 open cases and that action in relation to

Lordship Lane Surgery would be discussed later in the meeting.

PA noted that it would be helpful to include in the report what support the practice had been

provided. It was confirmed that this information is included in the quality report.

7.0 Primary Care Commissioning Committee decisions for reporting

It was explained that the Committee has the ability to make urgent decisions in between public

meeting. JY noted that the Primary Care Commissioning Committee had made two urgent

decisions in between the public meetings.

The first was an urgent unplanned decision to close Camberwell Green’s Surgery list to new

patient registrations. JY explained that this excludes family members of patients currently

registered with the practice. It was noted that this decision was taken urgently to support the

practice’s resilience. CN asked if the practice was the only practice in Southwark with a closed

patient list and if the other practices engaged with prior to the decision had any objections. JY

confirmed that all other practices in Southwark had lists that are open to new patient registrations

and that the surrounding practices to Camberwell Green had supported the temporary closure to

support the resilience of the practice.

JY also noted that the Committee made an urgent planned decision to issue the Bermondsey

Spa practice with 3 remedial breach notices in line with the CCG’s contract management

framework.

8.0 Lordship Lane Surgery Breach and Remedial Notice

JW explained that the situation in relation to this practice was highly unusual. In fact, it was noted

that this scenario was not covered by the Requires Improvement London standard operating

procedure, although the considerations that are included in the SOP had been applied.

It was explained that as well as the evidence obtained from the 3 CQC visits and desk top

review, the practice had, on numerous specified occasions, failed to provide sufficient

information to officers that they had addressed all areas included in their remedial breach notices

following previous CQC inspections. It was noted that the CQC had now rated the practice as

‘good’ overall, with one area rated as requires improvement, following its third inspection visit on

12 March 2018. Whilst the PCCC could gain some assurance from the improvements that the

practice had made, officers were not in a position to provide full assurance to the PCCC that all

compliance issues had been addressed satisfactorily. Where there were outstanding actions

relating to breach notices that had been assessed as now compliant by the CQC, officers had

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confirmed to the practice that they would not be seeking further separate evidence of

compliance.

It was noted that there were a number of outstanding areas where the practice had not provided

sufficient assurance to the CCG that the required actions had been taken. JW summarised the

areas that were included in the report. It was noted that there were outstanding areas of non-

compliance, despite the practice receiving support from the Londonwide LMC support team.

JW confirmed that the recommendation to the Committee was that the practice was issued with a

fourth remedial breach notice in order to require the practice to remedy outstanding compliance

issues within a 28 day period.

JY advised that she had spoken to the lead GP at the practice and advised the Committee that

he took the situation very seriously.

RP noted that the outstanding areas seemed to be areas which could be addressed quickly by

the practice, although it was also noted that there were matters outstanding, such as the

practice’s repeat prescribing policy, that required clinical input. It was noted that the management

capability of practices to provide assurance to commissioners was vital in this process.

The Committee were satisfied that contract levers were needed to be utilised to seek assurance

about the quality of general practice services and agreed the issuing of the fourth remedial

breach notice.

Date of

Meeting

Action

number


24.07.18 2 To issue a remedial breach notice to Lordship

Lane Surgery.

JW New

9.0 Procurement Update – extended primary care services to residents in residential and

nursing homes

JY reported in public that Quay Health Solutions Community Interest Company was the

successful bidder following a procurement for the extended primary care service to residents of

residential and nursing homes. It was noted the service for nursing home residents started on 1

July 2018 and that the service for residential patients will be mobilised over the summer.

10.0 Silverlock Relocation Update

RD reported in public that the Silverlock Medical Centre had relocated to the Health Centre on

Verney Way from 2 July 2018. It was noted that the relocation had enabled the practice to

provide services from a purpose built premises with capacity for the list size. It was explained that

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the CCG had been successful in getting capital funding to increase the number of consultation

rooms at the premises.

RP suggested that the CCG reviewed the outcomes of the relocation at a Committee in the future

to include data regarding patient registrations, patient experience to identify if any lessons could

be learnt.

Date of

Meeting

Action

number


24.07.18 3 To present a review of the relocation of

Silverlock at a future Committee.

RD New

11.0 GP Forward View Resilience Funding

RD explained report was being presented to the Committee following an action from the last

meeting. RD summarised the areas which practices used the funding for in 17/18 to support with

their resilience. It was noted that outcomes all practices who had received funding improved in

terms of their CQC ratings and that practices had been able to demonstrate improvements in

relation to patient outcomes, experience and recruitment of staff. It was discussed that the

resilience funding has supported practices with their management capacity but also enabled lead

GPs time to work on improvement plans to support the practice’s resilience.

It was noted that NHS England was leading evaluations of resilience funding and that many case

studies had noted improvements as a results of funding.

RD explained that the CCG would work with the LMC to prioritise practices for 18/19.

12.0 AOB

RP noted that the meeting was PA’s last as Chair of the LMC. RP thanked PA for her

contributions to the Committee and wished her luck for the future. PA thanked the Committee for

the opportunity.

13.0 Public Open Space

No questions were raised.

Meeting closed 2.30pm

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Southwark CCG Committee Report

ITEM FOR DISCUSSION / ASSURANCE

CCG Committee

Primary Care Commissioning Board

Month September Year 2018

Item title: Primary Care Finance Report: Month 5 2018-19

Enclosure number:

B

Any know conflict of interest

No

2



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

Discussion ☐

Assurance ✓

Report Author Responsible Director

Name Julian Westcott Name Malcolm Hines

Job title Head of Finance Job title Director of Finance

Directorate Finance & Business Directorate Finance & Business

Email [email protected] Email [email protected]

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

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 2018/19 financial year to date.

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

Delegated Primary Care As at Month 5, Delegated Primary Care is showing a breakeven position for the 2018/19 financial year. For 2018/19, there continues to be a funding gap between the allocation received by the CCG and

3



the expenditure budget required for Primary Care. To mitigate this shortfall, the CCG has not set aside a 0.5% contingency within the Delegated Primary Care budgets and has added a further £1.3m of non-delegated primary care allocation to ensure that adequate budget is set aside for Primary Care. There are no significant variances to report as at Month 5. The format of the report has been updated this month to show the spend by expenditure category rather than by contract type. The change is intended to aid understanding of over- and under-spends and to make the financial performance more transparent.

4



5



Other Primary Care Health Services

Other Primary Care Health Services are mainly operating in line with budget with the exception of Prescribing. Prescribing spend is showing favourable at this point of the year based on 3 months of information. It is important to note that at this stage it is difficult to accurately report prescribing spend due to the fact that the information is received 2 months in arrears. This is in line with the national timescales for information. Based on the Month 3 report from NHS BSA, the prescribing spend is lower than expected at this point and is forecast to continue to remain below plan for the remainder of the financial year. This is a change compared to the information received covering Month 2 activity and this change has been seen at other South East London CCGs in the Month 3 data. The Month 4 data, when it becomes available, will be closely scrutinised to identify any ongoing issues or underlying emerging trends. Interpreting is slightly underspent at this point in the year, due to lower activity than planned. The £35k favourable showing on “Other” is due to underspends on computer contracts and minor

6



ailments and residential homes costs.

3. What stakeholder engagement has taken place?

N/A

Supporting information / documents

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

Appendix # Name of document

Date paper completed

Friday, 14 September 2018

1





CCG Committee

Primary Care Commissioning Committee


Item title: Contract Action Log

Enclosure number:

D


No

2




Discussion ☐

Assurance ✓


Name Nick Langford Name Caroline Gilmartin

Job title Assistant Head of Primary Care

Job title Director of Integrated Commissioning

Directorate N/A Directorate Integrated Commissioning



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.


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

mailto:[email protected]


3



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.


n/a




i Contract Action Log


Monday, 17 September 2018

Primary Care Remedial/Action Plan Tracker

No. Practice Name Code CQC inspection date CQC report publication

Date considered by the Committee

Outcome ReasonDate sent to practice

Date response received

Status Comments

12 Lordship Lane Surgery G85681 19/05/2016 26/07/2016 Dec-16Remedial breach notice

RI SOP - first inspection

24/02/2017 21/03/2017 OpenPractice was not compliant, as a result a second breach notices was issued to the practice on 26 July 2017. See line 16.

16 Lordship Lane Surgery G85681 19/05/2016 26/07/2016 Jun-17Remedial breach notice

Failure to respond to 1st breach

26/07/2017 24/08/2017 Open Practice is not fully compliant. 4 actions are not fully completed. See line 17.

17 Lordship Lane Surgery G85681 23/01/2017 13/04/2017 Jun-17Remedial breach notice

RI SOP 24/08/2017 22/09/2017 Open

Practice sent the same action plan they sent for the second breach notice. Reviewed action plan against latest "Good" CQC report. There are four outstanding actions to be closed off and six new and reopened issues arising. The CCG has met with the practice and has asked the contractor to complete all outstanding actions, reopened and new issues. These are in relation to infection control and practice procedures. Once these actions are completed, all B&R notices will be completed and letters will be sent.* CCG contacted practice on 20/4/18 to request meeting. Completed action plan has been reviewed but it is not suffiently comprehensive. Meeting with the practice on 16/05/2018 to discuss final actions required and improvement plan as part of the contract. Following meeting with practice and LMC, the practice was provided 4 weeks to provide further evidence in relation to the outstanding issues, which was due on 15.06.2018. Evidence was received by SEL team on 18.06.2018 which has been reviewed and the practice remains non-compliant in relation to carrying out an adequate risk assessment, not providing a fire safety log and lack of a robust system for carrying out recruitment checks. There are 2 areas awaiting confirmation which are compliance with infection control and policy of uncollected prescriptions. The practice sent evidence of MDT meetings, however, despite being advise not to, the practice sent PID as part of their evidence and therefore these could not be reviewed. At the PCCC of July 2018 the issuing of a further remedial notice was approved and this will be issued subject to legal advice.

26 New Mill Street Surgery G85705 09/11/2017 28/12/2017 27 February 2018Issue breach and remedial notice

CQC overall inadequate

09/04/2018 04/05/2018 Open

The CCG and SEL PC team met with the practice on 16 January 2018 to discuss the practice's action plan and seek assurance the practice was making the required improvements to remedy the issue outlined in the breach notice. In accordance with PCCC decision, breach and remedial notice was issued on 9.04.2018. The response has been reviewed by officers and CCG clinical lead, which was not fully compliant in some areas - contacted practice to provide suplementary evidence by 29th June. Further evidence received on 02.07.2018 and reviewed on 17.07 2018. The practice is compliant subject to completion of risk assessment actions.

27 Camberwell Green Surgery G85013 23/01/2018 26/03/2018 25/04/2018Remedial 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 has been requested at a meeting held between commissioners and the practice on 5/09/2018.

28 Sir John Kirk Close G85050 09/05/2018 12/07/2018 Aug-18 Remedial notice CQC overall RI TBC TBC Open

CQC inspection 09.05.2018. Warning notice issued 12.06.2018. Areas for improvement include Governance, Recruitment, Equiptment,Risk Management, Infection control, emergency medicines and vaccine management. Practice is required to be compliant by 31.08.2018. Final report published on 12 July 2018 - Rated Good for Effective, Caring and Responsive. Rated Requires Improvement for Well-Led and Inadequate for Safe. A remedial notice and action plan will be prepared and sent to the practice

29 Bermondsey Spa G85623 10/07/2018 18/09/2018 TBC TBC TBC TBC TBC Open

New - Following CQC inspection on 10.7.2018, minor surgery services were suspended WEF 16.07.2018 for a period of 3 - 6 months. The CQC has issued two warning notices for reg 12 (safe care + treatment) and reg 17 (governance). This means the practice will go in to special measures.The CQC made an unannounced visit to the practice on 3/9/2018 in relation to the warning notices.

30Dr Aru - Lister Health Centre CQC 3rd Inspection

G85134 10/05/2018 16/07/2018 25/09/2018 TBC TBC TBC TBC OpenOverall Requires Improvement. Paper has been prepared and will be considered by PCCC in September 18

31 New Mill Street Surgery G85705 26/06/2018 03/09/2018 TBC TBC TBC TBC TBC OpenOverall Requires Improvement. Paper will prepated to be considered by PCCC in October 18

1




CCG Committee



Item title: Primary Care Commissioning Committee Decisions for reporting

Enclosure number:

E


No

2



Discussion ☐ Assurance ✓


Name Rachel Doherty Name Caroline Gilmartin

Job title Primary Care Commissioning Manager


Directorate Integrated Commissioning Directorate Integrated Commissioning



The purpose of this paper is to report in public decisions taken by the Primary Care Commissioning Committee in between the Committee’s held in public.


The Primary Care Commissioning Committee (PCCC) is held every other month in public. The Primary Care Commissioning Board meets in the month that public meeting is not held. This is made up of members of the Primary Care Commissioning Committee and can make urgent planned PCCC decisions if required. Where ever possible, decisions are made in public. However on occasions, decisions, either planned or unplanned, will need to be made before the next public meeting. The actions detailed in this report are being reported following the:

• Primary Care Commissioning Committee decision made at the Primary Care Commissioning Board on Tuesday 26 June 2018 which was not reported at the July PCCC

• Primary Care Commissioning Committee decision made at the Primary Care Commissioning Board on Tuesday 28 August 2018.

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Stakeholders were engaged with prior to decisions being made. The appendix provides a summary.




i Summary of the decisions taken by the Primary Care Commissioning Committee (PCCC) voting members prior to the public Primary Care Commissioning Committee.



1

Chair: Dr Jonty Heaversedge Accountable Officer: Andrew Bland Managing Director: Ross Graves The best possible health outcomes for Southwark people

Summary of the decisions taken by the Primary Care Commissioning Committee (PCCC) voting members prior to the public Primary Care Commissioning Committee. The following decisions are reported below:

No. Committee name Meeting date Agenda item Action taken under delegation by the committee

1 Primary Care Commissioning Committee

26.06.18 Dr Aru (Lister PCCC) Partnership Change

The Committee approved the practice’s application to add a new GP Partner, Dr Wilson, to their PMS contract and a quality improvement plan with the practice focused on the management of long term conditions.


28.08.18

Sir John Kirk Close Surgery Remedial Notice

The Committee agreed the to issue a remedial notice to the Sir John Kirk Close Surgery as the practice was rated overall as ‘requires improvement’ by CQC following an inspection on 9 May 2018. The decision was made in line with the London standard operating procedure for practice’s that are rated as ‘requires improvement’ by the CQC.


28.08.18

Camberwell Green Surgery Additional Funding

The Committee agreed to provide Camberwell Green Surgery with additional funding to support the practice lead a change management programme focused on the practice’s sustainability, development of a stable workforce and implementing effective and efficient processes. An MOU will be agreed with the practice as part of this funding.

Primary Care Commissioning Committee papers are available on request.

1




ITEM FOR DECISION

CCG Committee



Item title: Dr P Arumugaraasah’s & Partners Review of need for contractual action following inspection by the CQC on 10 May 2018

Enclosure number:

F

Any known conflict of interest

No


Name Miren Querejeta-Lopez Name Caroline Gilmartin

Job title Commissioning Manager Job title Director of Integrated Commissioning


Email [email protected]

Email [email protected]


2



Process followed for development of this paper:

Followed agreed CCG process in full ✓ Urgent paper ☐

For urgent papers only: explain the reason for urgency

Click here to enter text.

Have you described the below impacts as part of this proposal?

Have you considered either of the below to be relevant to this proposal?

Impact on patients / service users

Financial impact

Impact on

providers

Estates impact

Workforce impact

Equalities legislation

OSC involvement

Yes ✓ ☐ ☐ ☐ ☐ ☐ ☐

N/A ☐ ✓ ✓ ✓ ✓ ✓ ✓

Does the recommendation align with the CCG’s objectives and responsibilities?

Deliver IAF improvement

Improve patient

outcomes

Improve quality / safety

Secure financial

sustainability

Support integration

Address health

inequalities / parity of esteem

Enable the delivery of

care coordination

Promote early action

☐ ✓ ✓ ☐ ☐ ☐ ☐ ☐

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1. Purpose of the paper

The purpose of this report is to seek approval from the Primary Care Commissioning

Committee, for the recommendation, that Dr P Arumugaraasah’s & Partners be issued

with a contractual remedial notice and a breach notice following the CQC inspection on 10

May 2018.

This recommendation is in line with the London Standard Operating Procedure (SOP) for

practices rated as Requires Improvement and the NHS Personal Medical Services

contractual requirements.

2. Describe the issue being presented to the committee

The Care Quality Commission (CQC) carried out a re-inspection of Dr P Arumugaraasah's & Partners on 10 May 2018. The CQC report was published on 16 July 2018.

The overall rating is ‘Requires Improvement’ with ‘Good’ in relation to ‘Are services safe?’ and ‘Are Services Responsive?’; ‘‘Requires Improvement’ in relation to ‘Are Services Effective‘, ‘Are Services Responsive?’ and ‘Are Services Well-Led’. A copy of the report can be found here http://www.cqc.org.uk/location/1-574806176/reports

There are repeated matters of non-compliance that have been raised in the latest report which were raised in the previous CQC report, published 11 August 2016, of which the practice received a breach and remedial notice, such as management of patients with diabetes, and management of feedback from patients.

The latest CQC report also states that “the Patient Participation Group was not active at

the time of the inspection but had been relaunched following a previous group having

been dissolved with a first meeting schedule.”

Southwark Primary Care Joint Committee (PCJC) previously approved the London region Standard Operating Procedure for Primary Medical contracts: A consistent approach to responding to Care Quality Commission ‘Requires Improvement’ ratings. The considerations within this have been used to determine what formal contractual actions, if any, commissioners may recommend to the Southwark PCCC, as a result of Dr P Arumugaraasah’s & Partners receiving a ‘Requires Improvement’ rating. The considerations have included:

• Should contractual action be considered? When a contractor is in receipt of a CQC report indicating that they ‘Require improvement’, they have immediately breached their contract as ‘The Contractor shall comply with all relevant legislation and have regard to all relevant guidance issued by the Board or the Secretary of State or Local Authorities in respect of the exercise of their functions under the 2006 Act.’ It is therefore proportionate for commissioners to consider further contractual action.

• Should a breach and/or remedial notice be issued based on CQC visit report

http://www.cqc.org.uk/location/1-574806176/reports

4



evidence? As the most recent report lists repeated matters of non-compliance that have been raised in the previous CQC inspections dated 4 May 2016 and 31 January 2017, then a breach and/or remedial notice can be considered.

• What is the Contractor’s track record/contractual history? Commissioners conclude that taking into account the full contractual history (set out below) of this contractor and discussions that the CCG have held with the practice, further contractual sanctions are deemed reasonable.

• Is it a proportionate response to issue a breach and/or remedial notice?

• In relation to the consideration for the issuing of remedial notices, the CQC report indicates that the Contractor has previously breached its contract in relation to the repeated matters of non-compliance which have appeared in previous inspection reports, dated 4 May 2016 and 31 January 2017 and therefore can be taken into account. In addition, there are new repeated matters of non-compliance in the most recent report that also need to be addressed.

• In relation to the consideration for the issuing of breach notices, the Contractor’s non-compliance with the PMS contractual requirement to establish and maintain a Patient Participation Group can be taken into account.

A brief resume of the relevant contractual history is as follows:

• The contractor was previously inspected on 4 May 2016. At that inspection the rating for the practice was ‘Inadequate’ overall and was placed under special measures for a period of six months. The practice was rated ‘Inadequate’ in two domains, ‘Effective’, ‘Well-led’ and all six population groups.

• The contractor was served a notice under Section 29 of the Health and Social Care Act 2008 following its first inspection on 4 May 2016.

• NHS Southwark CCG and SELPCT met with the practice on 7 September 2016 to discuss and comment on the practice’s action plan as well as to seek assurance that the practice had an action plan in place which would support the practice to make the required improvements.

• NHS England issued the contractor with a remedial notice after the first inspection. The Contractor completed and submitted a copy of the action plan to address the remedial notice.

• NHS Southwark CCG and SELPCT met with the practice on 18 January 2017 to discuss the progress made towards the action plan and address the concerns raised by CQC report.

• A second inspection was carried out on 31 January 2017. The practice was rated as ‘Requires Improvement’ and was removed from special measures. The practice was rated ‘Requires Improvement’ in all areas except ‘Responsiveness’ where it was rated ‘Good’. The Section 29 notice was lifted following the outcome of the second inspection.

• NHS Southwark CCG and SELPCT met with the practice on 6 May 2017 to discuss the remedial notice action plan and the progress the contractor had made to address the concern raised in the CQC report.

5



• It was agreed at the meeting that the Contractor had addressed the majority of actions relating to the breach notice. At the meeting the Contractor was asked to send a copy of the action plan to officers for the second inspection addressing the repeated matters of non-compliance identified in the CQC report and subsequently the Contractor sent the action plan to officers.

• A request for the evidence to validate the action plan was sent to the Contractor on 14 August 2017. The contractor provided the evidence on 16 August 2017. The action plan and evidence showed how the contractor had addressed the issues highlighted on the CQC second inspection report.

• Whilst the Contractor was in breach of the regulations, commissioner concluded that it was not proportionate at the time to issue a remedial notice.

• NHS Southwark CCG and SELPCT met with the practice on 16 May 2018 and agreed to close the formal action plan in response to the second CQC inspection following the information submitted by the practice on 27 December 2017.

• A third inspection was carried out by the CQC on 10 May 2018. The report was published on 16 July 2018 with the finding that the contractor’s overall rating is ‘Requires Improvement’ for the quality of care provided. The practice was rated as ‘Requires Improvement’ for the domains ‘Are services Effective, Caring and Well-led’ and population groups ‘People with long-term conditions’ and ‘Working age people’.

• At a previous inspection held on 31 January 2017 the practice was rated as ‘Requires Improvement’ for providing caring services and the practice was required to seek and act on the views of people who use the service, however at the most recent inspection on 10 May 2018 it was found that the practice had not acted on feedback from patients and had not improved the performance for patient with diabetes and was rated as ‘Requires Improvement’ for providing care.

• NHS Southwark CCG will be meeting with the practice at a date to be arranged to discuss the progress the practice has made to address the issues raised at the most recent CQC inspection on 10 May 2018.

• The Contractor is in breach of regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Part 28 of Schedule 5 of the NHS Personal Medical Services contract;

It is therefore considered proportionate to issue further breach and/or remedial notices in relation to the repeated and new matters of non-compliance highlighted in the report of 16 July 2018 that have not been subsequently addressed by the Contractor. As the Contractor did not have a PPG at the time of the CQC inspection then the Contractor has breached the contract and a breach and remedial notice should be issued.

3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?).

6



Commissioners recommend that formal contractual action is pursued on this occasion. The Standard Operating procedures in relation to ‘Requires Improvement’ CQC reports provides that ‘when provided with a full contractual history of the practice, contractual sanctions may be deemed reasonable’. The Requires Improvement PCCC decision making flowchart (attached to this paper) also confirms that where similar concerns are raised within a two year period, a breach and/or remedial notice should be approved to address the concerns that remain unresolved. The Contractor provides Essential Services under a PMS contract and as part of its obligations the Contractor must establish and maintain a Patient Participation Group comprising of some of its registered patients. As this was not in place at the time of the recent CQC inspection, the Contractor is in breach of its contractual obligations. Commissioners therefore recommend the following two actions as a proportionate response to the most CQC inspection report:

1. to issue a remedial notice in relation to the repeated and new matters of non-compliance; and

2. to issue a breach notice in relation to the PPG not being active.




i GP Practice: Requires Improvement: Contractual Implications Flowchart



7



Appendix 1

1




ITEM FOR DECISION

CCG Committee



Item title: Sir John Kirk Close Surgery Registered Patient List

Enclosure number:

G

Any known conflict of interest

Yes


Name Rachel Doherty Name Caroline Gilmartin

Job title Primary Care Commissioning Manager


Directorate N/A Directorate Integrated Commissioning




2



Process followed for development of this paper:

Followed agreed CCG process in full ✓ Urgent paper ☐

For urgent papers only: explain the reason for urgency

Click here to enter text.

Have you described the below impacts as part of this proposal?

Have you considered either of the below to be relevant to this proposal?

Impact on patients / service users

Financial impact

Impact on

providers

Estates impact

Workforce impact

Equalities legislation

OSC involvement

Yes ✓ ✓ ✓ ✓ ✓ ✓ ✓

N/A ☐ ☐ ☐ ☐ ☐ ☐ ☐

Does the recommendation align with the CCG’s objectives and responsibilities?

Deliver IAF improvement

Improve patient

outcomes

Improve quality / safety

Secure financial

sustainability

Support integration

Address health

inequalities / parity of esteem

Enable the delivery of

care coordination

Promote early action

☐ ✓ ✓ ✓ ☐ ✓ ✓ ☐

3



1. Purpose of the paper

The Sir John Kirk Close (SJKC) Surgery Alterative Provider Medical Services (APMS) contract is due to expire on 30 April 2019 and the Primary Care Commissioning Committee (PCCC) is required to decide on the future of this contract. The PCCC is asked to agree to the recommendation to ask patients registered at SJKC Surgery to register with a practice of their choice, that has a catchment area covering the patient’s address. The decision is subject to:

• The CCG being assured that there is sufficient capacity for patients to register at alternative practice, which will include looking at estates solutions, following the completion of a full capacity audit of local practices including premises

• Patient and stakeholder engagement.

2. Describe the issue being presented to the committee

The PCCC is asked to agree to the proposal to ask patients registered with SJKC Surgery to register with a practice of their choice, providing the patient lives within the practice’s catchment area as:

• Previous market engagement has informed commissioners that a list of fewer than 6,000 patients is not attractive to the market or sustainable in terms of providing primary care medical services. SJKC Surgery had 4,015 patients registered at 1 April 2018.

• Performance of local practices indicates that patients would be able to access general practice service of the same or higher quality.

• Local practices report that they have capacity to register additional patients. However, the CCG wishes to explore premises solutions in the locality with local practices to support future sustainability and ensure patients have appropriate local access. Specifically, the CCG wishes to explore whether the SJKC premises, which are fit for purpose premises, may continue to be utilised for patient care by one of the local practices. Whist there will be a reduction in GP contracts, the CCG may retain this premises for the local resident’s access.

The attached Appendix i Strategic Review document sets out the options available to commissioners and the issues which needed to be considered to enable the patients to register with another practice of their choice. The outcome of the review of 16 local practices capacity and quality is:

• 15 of the 16 local practices have open lists to register new patients.

• The three practices located within 0.5 miles have reported that combined they could register up to 6,700 patients

• All, but one, of the practices within a 1.2 mile radius of SJKC Surgery are rated as ‘good’ by the CQC. SJKC Surgery is currently registered as ‘requires improvement’.

• SJKC Surgery performs highly when looking at patient outcomes compared to surrounding practices. For example the practice scored 98.7% of QOF points in 2016/17 which was higher than the three closest practices. However, it should be noted that SJKC Surgery also had a higher exception rate than these practices.

• In March 2018 all the surrounding practices reported using the national Friends and Family Test levels of patient satisfaction higher than Sir John Kirk Close Surgery

• 6 out of the 11 local practices are rated lower than the practice and 5 are rated better than the practice for ratings on NHS Choices.

• 11 of the 15 local practices perform better than the practice for “Patients that would not recommend the practice” under the patient survey.

4



This demonstrates that there is capacity of an acceptable quality in local practice, for current SJKC patients to register with. As SJKC Surgery is located in a purpose built premises and there is a shortage of modern general practice premises in Southwark. The CCG wants to complete a more in depth audit of local practices capacity, including premises in the Newington area to ensure that we have a full understanding of the options to support the sustainability of services in the future. We will also explore and consider opportunities for the premises to continue to be utilised by another local GP practice as an alternative to their current site. This work will include the CCG, local practices and NHS Property Services (NHSPS) which hold the lease on the building.

The NHS PS lease for the premises expires in 2022. If the conclusion of the work between the CCG, NHSPS and local practices is that there is no requirement to utilise the building the CCG may be liable for rental costs for up to the point of the lease expiring.

The annual rental costs for the site is £126,000 per annum.

The estimated cost savings of the proposal to disperse the SJKC list are £20k per annum due to the additional APMS contract payments for this registered list. Should other premises be released through the estates work, the ongoing rental costs will be a potential savings.

The estimated cost of patient engagement is approximately £5k.

3. What is your recommendation to the committee (i.e. what course of action do you suggest is taken?).

The PCCC recommendation is to ask patients currently registered with SJKC Surgery to register with another practice of their choice at the end of April 2019, subject to;

• Patient engagement relating to the decision, to address any concerns, the results of which will be provided to the Committee when completed.

• Stakeholder engagement

• Completion of a full capacity audit of local practices including premises by the CCG working with NHSPS including consideration of SJKC premises to be secured for future use by a local practice

The PCCC should note that the contract has a further 6 months extension available which CCG officers will use to complete the estates work if required and will keep the Committee updated. This contract is within the 19/20 budget and therefore there will be no cost pressure for extending this contract further.

5






i Sir John Kirk Close Surgery APMS Strategic Review



Page 1 of 13

GP Contract Strategic Review

To be completed for an expiring GP contract

The purpose of this form is to support commissioners in determining future options for an expiring GP

contract and to provide evidence for any decisions made.

STP Area: South East London

CCG: Southwark CCG Commissioning Level: 3

Practice Name: Sir John Kirk Close Surgery

Practice Code: G85050

Raw/Registered List Size at April/2018: 4015 Weighted List Size at April/2018: 4213.22

Current Provider: Nexus Health Group Current Contract Expiry Date: 30 April 2019 Current Contract Type: APMS

Reason for Contract Expiry: The contract was procured under an APMS contract which commenced on 1 May 2009 with The Walworth Partnership. As part of the merger of The Walworth Partnership in to Nexus Health Group in August 2016 it was agreed that Nexus Health Group would become the responsible provider for the delivery of services under the contract. The contract was extended from 13 February 2017 until 30 April 2019 with a further provision to extend until 31 October 2019.

Name of NHS England Commissioner Completing this Form: Christine Lancaster/Nick Langford

Name of CCG Commissioner Consulted about Completing this Form: Rachel Doherty

Date Form Completed:

Contract Extension: 1. Has this contract already been extended beyond its natural term?

Yes If so, for how long? 2 years and 2 months

2. Is there provision within the current contract to extend (further)? Yes

If so, for how long? 6 months until 31 October 2019, commencing on the day after the Expiry Date of the contract variation.

3. Will an extension be required? (e.g. to allow for consultation / procurement) If any procurement process extends past 31 October 2019.

4. Will any required extension fall within the allowable timescale in 2 above? Yes, if the award of the contract under the procurement process extends past 31 October 2019.

Page 2 of 13

Background to this Practice

This practice is an APMS contract run by Nexus Health Group, following the merger of the Walworth Partnership with 3 other GP practices in August 2016. The contract has come to its natural end and can only be extended until 31 October 2019. Nexus Health Group also hold one PMS contract for the delivery of services to approximately 70,000 patients across 8 sites in north Southwark.

Current Practice Performance

Current Provider Contract Performance:

There are no historical issues in relation to contractual performance of the practice.

• CQC

• Patient Experience o Friends and Family Test o GP Patient Survey o NHS Choices

• Quality Outcomes Framework 2016/2017

CQC

The practice was inspected by the CQC in May 2018 and the report has not been published. Patient Experience

Patient experience

The table below outlines the practice performance in relation to patient experience. 74% of patients at the practice in March 2018 reported that they would recommend the practice to their Friends and Family. This was based on 53 patients completing the FFT survey in March 2018. The Southwark average was 85%. In March 2018 all the surrounding practices report levels of patient satisfaction higher than Sir John Kirk Close Surgery, however samples are small. For example Penrose Surgery reported 100% satisfaction but only 9 patients completed the survey.

Survey results for the Friends and Family Test also vary each month, for example Sir John Kirk Close Surgery had 64% and 54% of patients in October and November 2017 reporting that they would recommend the practice to their friends and family. The samples of these scores were more representative of the patients with 259 and 113 patients being sampled. This shows that when more patients are surveyed the satisfaction results decrease for the practice.

In relation to the GP Patient Survey the practice performs better than the Southwark average. 15% of patients reported in July 2017 that they did not find it easy to get through on the phone compared to a Southwark average of 27%. 80% of patients said that they would recommend the practice compared to a Southwark average of 73%.

On NHS Choice website the practice had a 2.5 star rating, following 14 responses. Other practices range from 2 – 4.5 stars. The practice has responded to patients were concerns have been raised.

Indicators Achievement CCG average

FFT (May 2018) 74% would recommend 85%

GPPS July 2017 82% of patients said their overall experience was ‘good’

79%

GPPS July 2017 15% Not easy getting through by phone

26%

GPPS July 2017 29% Not able to get an appointment to see or speak to someone

18%

NHS Choices Star rating: 2.5 out of possible 5 (14 responses) (GPPS data source: http://gp-patient.co.uk/practices-search, July 2017) (FFT data source: GP Sustainability and Resilience, May 2018)

http://gp-patient.co.uk/practices-search

Page 3 of 13

QOF The practice performs highly when looking at patient outcomes. The practice scored 98.7% of QoF points in 2016/17. The practice’s exception rate was 7.5%.

List Size Considerations

The practice has a list size of 4216 weighted patients. Please note that a list of 6,000 patients or more is generally considered viable under the standard terms of the London APMS contract. A decision to procure a list of fewer than 6,000 patients is likely to attract fewer bidders and cost more per patient. It is important, therefore, to evidence list size considerations carefully. Analysis of the list size overtime shows that this has not increased significantly. The list size has only includes by approximately 200 patients over a three year period.

List size movement over time:

Date Raw List Size Weighted List Size

Date of most recent list – April 2018 4015 4216.93

Either one year or one quarter earlier – whichever is most appropriate for this contract – April 2017

3882 4091.07

Either two years or two quarters earlier - whichever is most appropriate for this contract – April 2016

3850

4067.10

Either three years or three quarters earlier - whichever is most appropriate for this contract – April 2015

3832 4064.89

Potential for List Growth:

The practice is located in Newington Ward. There is a small projected population increase of approximately 1400 patients by 2035. In Camberwell Green ward to the south of the practice there is a projected population increase of 2300 patients by 2035. It is expected that Parkside Medical Centre has capacity to register these patients.

The CCG does not have population growth data for Lambeth and therefore Lambeth CCG will need to be engaged as the practice is close to the boroughs border.

Premises Considerations

Address of Current Premises: 3 Sir John Kirk Close, London SE5 0BB.

Name of Landlord or Holder of Head Lease: NHSPS

Expiry Date of Current Lease/Sub Lease: 2022

Are the Premises Statutorily and Contractually Compliant?

Yes

Will the Premises be available for GP Services following the Expiry of the current Contract?

Yes, NHS England and NHS Southwark CCG have instructed NHSPS to continue with the Headlease until the expiry of the lease agreement in 2022.

Patient Choice Considerations

Summary of Appendix 1, Table 1.

As at April 2018, the practice list size is 4015 which is under the number of registered patients

required to make a practice viable and attractive to the market. There are sixteen surrounding

practices within 1.2miles that would be affected if the list was dispersed. Fourteen of the

surrounding practices are PMS practices and one is GMS.

Three of these practices, Maddock Way Surgery, Minet Green (Lambeth_ and Akerman Practice

Page 4 of 13

(Lambeth) are within 0.3 miles and have said that combined they could register 6,700 patients. It

should be taken in to account that Maddock Way Surgery has said they cold register 3,700 of these

patients.

All, but one, local practices have no known issues in relation to accepting patients. Camberwell

Green has a closed list to new patient registrations until 26 December 2018 and does not have

capacity to register additional patients currently.

The practice was inspected by the CQC in May 2018, and rated as requires improvement overall.

All, but one, of the practices within a 1 mile radius, all are rated as “Good” following their CQC

inspection except one. (see table 1 appendix 1)

The practice performs highly when looking at patient outcomes compared to surrounding practices. For example the practice scored 98.7% of QoF points in 2016/17 which was better than the three closest practices. However it should be noted that the practice also had a higher exception rate than these practices.

74% of patients at the practice in March 2018 reported that they would recommend the practice to their Friends and Family. This was based on 53 patients completing the FFT survey in March 2018. The Southwark average was 85%. In March 2018 all of the surrounding practices report levels of patient satisfaction higher than Sir John Kirk Close Surgery. This indicates that patients would have access to surrounding practices with higher levels of satisfaction, although it is noted that FFT results are varied due to different sample sizes. For example Penrose Surgery reported 100% satisfaction but only 9 patients completed the survey.

In relation to the GP Patient Survey the practice performs better than the Southwark average (27%) but worse than two of the three practices located within 0.3 miles of the practice. 15% of patients reported in July 2017 that they did not find it easy to get through on the phone compared to 8% of Maddock Way patients and 17% of Minet Green patients (Lambeth).

On NHS Choice website the practice had a 2.5 star rating, following 14 responses. Other practices range from 2 – 4.5 stars. The practice has responded to patients were concerns have been raised.

Based on the list above, is there capacity of acceptable quality locally to disperse this list?

Yes, Appendix 2, Map 1 shows the density of patients in relation to the practice, which demonstrates that the majority of patients are located within the immediate area of the practice. There are 16 practices within 1.2 miles of the practice. There are also two practices within 5 minutes’ walk and 14 practices within 20 minutes’ walk of the practice. The three practices within 0.5 miles of Sir John Kirk Close could register 3,700 patients (see appendix 1)

Performance and capacity information shows that patients would have access to a comparable or higher standard of general practice if they were to register with other local practices.

It should be taken in to account that Maddock Way Surgery reported that they could register 3,700 of these patients. Appendix 2, Map 1 shows the density of patients in relation to the practice, which demonstrates that the majority of patients are located within the immediate area of the practice. There are 16 practices within the current practice catchment area.

Appendix 2, Map 2 shows the number of practices within walking distance of the practice.

A scattergram is attached at Appendix 2, Map 1.

Demographic Considerations

- Demographics – there is a mostly even split of males/females with a high proportion of pa-

tients aged 25-39. (Source: Public Health England) - 4.6% of patients are 75+ (Source: Public Health England)

Page 5 of 13

Wider Strategic Considerations

Sir John Kirk Close Surgery is a purpose built premises with a co-located pharmacy and residential dwellings on top. NHS PS holds the head lease for the premises until 2022. The nearest practice to Sir John Kirk Close Surgery is Maddock Way Surgery, which is located on a parade of shops and had 3 consultation rooms.

There is a shortage of modern general practice premises in Southwark. The premise of Sir John Kirk Close Surgery was built within the last 20 years and is part of a mixed construction estate which adjoins to a pharmacy.

Camberwell Green Surgery is located 0.6miles from Sir John Kirk Close Surgery. Camberwell Green Surgery has approx. 12,000 registered patients. The CCG is currently providing support to the practice in relation to their resilience, which includes agreeing for the practice to close their list, following significant changes in the partnership and workforce which is impacting on its sustainability. The list closure was agreed in June 2018 and therefore the impact on this on other local practices resilience at the moment is not known, however local practices were engaged with as part of the agreement and they did not raise any concerns about the impact of this on their resilience.

Do any of these strategic considerations impact upon the timescales dictated by the contractual constraints noted on page 1?

No

Equality and Health Inequalities

The recommendation would be subject to an EHI being completed.

Patient Engagement

There is a standard patient engagement process associated with re-procuring existing APMS contracts following the initial commissioning decision. Will any of the options listed below require additional patient engagement or consultation prior to a decision being made?

Yes, a recommendation would be subject to patient engagement

Options

Taking into account the evidence above, the following are the options for the future of this patient list.

Option 1: Re-procurement of a new contract from the expiry date

Option 2: Ask patients to register with another practice, providing the patient is within its catchment area.

Option 3: Ask patients to register with another practice and for the CCG to explore premises options and opportunities in the Newington Ward area.

Recommended Option

Recommendation: Option 3 - to ask patients to register at other local practices.

Rationale: The recommendation is being made for the following reasons:

• The patient list size is under 6000 patients. Market engagement has indicated that a patient list size of less than 6000 patients is not an attractive for viable practice to the market.

• Performance of local practices indicates that patients would be able to access general practice services of the same or higher quality

• Local practices report that they have capacity to register patients. The three practices within 0.5 miles of Sir John Kirk Close could register 3,700 patients (see appendix 1)

• There is a shortage of modern general practice premises in Southwark. The premise of Sir

Page 6 of 13

John Kirk Close Surgery was built within the last 20 years and is part of a mixed construction estate which adjoins to a pharmacy.

This recommendation is being made subject to:

• Patient and stakeholder engagement

• Engagement with Lambeth CCG

• An equality health impact assessment being completed.

Practical Considerations:

It should be noted that NHS PS lease for the premises expires in 2022. The CCG may be liable for rental costs for this time for void space even if the building is not used for the delivery of services. The annual rental costs for the site is £126,000 per annum.

6 of the local practices to Sir John Kirk are in Lambeth and therefore the CCG will have to engage with Lambeth CCG.

Page 7 of 13

Approval Approval is sought for the recommended course of action detailed above

Decision of Primary Care Commissioning Committee Support Recommendation / Reject Recommendation (if rejecting recommendation, please reference alternative proposals in comments below) Tuesday 25 September 2018

Page 8 of 13

Page 9 of 13

APPENDIX 1

Table 1 data for practices within a mile of St John Kirk Close

Name

Sir John Kirk G85050

Maddock Way Sur-gery (Dr Sinha) G85082

Minet Green Health Practice G85135

Akerman Medical Practice G85695

Concor-dia Parkside G85030

Vassall Medical Centre Drs Patel and Part-ner G85073

Camber-well Green Surgery G85013

Penrose Surgery G85084

Nexus Health Group – 1 Manor Place-Branch G85034

The Villa Street Medical Centre G85632

The Cor-ner Sur-gery G85127

St Giles

Surgery

(Dr

Roseman

) G85726

St Giles

Medical

PracticeG

85042

Nexus Health Group - Ayles-bury Partner-ship G85034

Hurley Clinic – Ebenezer House G85053

Herne Hill Road Medical Practice G85016

East Street - Dr Brad-ford’s Practice G85721

CCG Area Southwark Southwark Lambeth Lambeth Southwark Lambeth Southwark Southwark Southwark Southwark Lambeth Southwark Southwark Southwark Lambeth Lambeth Southwark

Distance n/a 0.4 miles 0.5miles 0.5miles 0.6 miles 0.6 miles 0.6 miles 0.8 miles 0.9 miles 0.8 miles 1 mile 1 mile 1 mile 1.2 miles 1.2 miles 1.2 miles 1.2 miles

Contract Type APMS

PMS PMS APMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS PMS

Contract End Date *N/A (not applicable)

30.04.18

N/A N/A TBC N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Raw List Size 4015 3188 11999 5418 5659 8008 11224 7974 72215 7651 5922 4760 6984 72215 12632 6725 8292

Known Capacity is-sues

No No No No No No Yes – closed list to new registra-tions

No No No No No No No No No No

How many patients can they take on with-in current capacity resources (total max-imum)

3,700 2,000 1,000 500 200 - 400 None – list

closed to

be new

patient

registratio

ns

1000-

5000

Could not

give an

exact

figure as

they

manage

numerous

sites as

the Nexus

Health

Group.

100-200

per

quarter

up to

7,000

500 -

1,000

500 -

1,000

Could not

give an

exact

figure as

they

manage

numerous

sites as

the Nexus

Health

Group.

200 100 500

Total Achieved Clinical results Clinical Exception rate QOF 2016/2017

98.7% 98.5% 7.5%

96.5% 96.7% 2.8%

94.1% 93.8% 5.8%

92.5% 95.8% 5.2%

98.1% 98.5% 9.3%

92.2% 92.4% 5.1%

95.5% 94.3% 4.9%

99.3% 99.3% 7.1%

99.0% 99.3% 6.5%

96.1% 95.7% 8.8%

98.2% 98.9% 10.1%

96.7% 96.3% 7.3%

96.5% 95.5% 7.6%

99.0% 99.3% 6.5%

95.4% 94.5% 8.6%

88.8% 85.9% 5.0%

94.2% 93.7% 4.3%

Selected for resilience programme support?

No No Unknown Unknown No No Yes No No No Unknown No No No Unknown Unknown No

CQC rating Requires Improve-ment

Good Good Good Good Good Requires Improve-ment

Good Good Good Good Good Good Good Good Good Good

FFT rating (would rec-ommend practice) (CCG Average 85%)

74% No Data No Data No Data 82% 93% 91% 100% 83% 98% 88% 98% 91% 83% No Data 91% 93%

NHS Choices star rat-ing (full ratings is 5)

2.5 (14 re-views )

2 (10 re-views )

2.5 (27 re-views)

3 (26 re-views)

2.5 (18 re-views)

4.5 (13 re-views)

3 (32 re-views)

4.5 (31 re-views)

2.5 (10 re-views)

3.5 (19 re-views)

2.5 (12 re-views)

4 (4 re-views)

3 (2 re-views)

3 (5 re-views)

3 (51 re-views)

3.5 (12 re-views)

4.5 (18 re-views)

Overall Experience rated as good CCG average (79%)

82% 88% 85% 70% 68% 93% 85% 87% 85% 92% 81% 83% 90% 85% 78% 92% 82%

Page 10 of 13

Not easy getting through on phone (CCG Average 26)

25% 8% 27% 31% 37% 6% 22% 12% 18% 5% 16% 20% 14% 18% 40% 27% 12%

Not able to get ap-pointment (CCG Aver-age 18%)

29% 19% 24% 31% 27% 10% 14% 16% 16% 14% 24% 16% 10% 16% 21% 9% 12%

Page 11 of 13

APPENDIX 2 Map 1 G85050 – Sir John Kirk Close Surgery – Scatter/Heat map and boundary with surrounding practices within 1 mile

Page 12 of 13

APPENDIX 2 Map 2 G85050 – Sir John Kirk Close Surgery – Scatter/Heat map with surrounding practices within 20 minutes walking distance

Page 13 of 13

1





CCG Committee



Item title: Dulwich procurement – outcome of engagement

Enclosure number:

H


No

2






Name Jean Young Name Caroline Gilmartin

Job title Head of Primary Care Commissioning





The purpose of this paper is to remind the Primary Care Commissioning Committee of the market and patient engagement on the Dulwich GP contract decision and endorse the outcome of this engagement on the procurement decision. The PCCC is being asked to consider the outcome of the engagement and endorse the decision to change the contract model to be commissioned from Dulwich Health Centre when it opens in spring 2020 based on our market and patient engagement.


The decision regarding the procurement of primary care services in Dulwich first came to the PCCC in December, prior to the engagement process. As we are required to re-procure that GP services that formed part of the proposal the decision to move forward with market and public engagement was made in part 2 of the PCCC.

The PCCC agreed the proposed model and the relating affordability issues to procure both the Hambleden Clinic and Melbourne Grove Medical Practice as a combined registered list size and include in that contract provision of the south Extended Primary Care Service (EPCS). It was expected that the EPCS would also maintain a presence at the Lister Primary Care Centre in Peckham. There was also consideration of the GP services to Barry House residents, but this was later removed due to external unrelated factors. This PCCC decision was made pending market, patient and stakeholder engagement.

The conclusion from the market engagement is the EPCS contract does not need to be within the GP services APMS contract to enable co-location of the EPCS at Dulwich Health Centre. The

3



CCG can work with the provider of EPCS and other general practice service providers to ensure that patients receive a seamless general practice service at Dulwich 7 days a week.

In addition, consideration has had to be given to the implications of a decision to recommissioning of the EPCS does not fit with the CCG’s commissioning decision for the EPCS across the borough, of which there are 2 contracts; one for south Southwark and one for north Southwark. To bundle the south Southwark EPCS into a core GP practice contract will restrict the flexibility of the current service contract to respond demands of both patient needs and the wider NHS agenda.

The EPCS was originally commissioned to provide on the day/next day demand and enable Southwark practices to free up appointments for patients with complex needs and who required continuity of care. Whilst it has not been considered as an urgent care service i.e. a direct like for like replacement for emergency department care, it has been used to direct patients away from these services to receive on the day care. If the CCG commissions this service as part of a 5 + 5 year contract separate to the north Southwark provision of EPCS, this will restrict the CCG’s ability to commission this service in line with the urgent care strategy including the Integrated Urgent Care (IUC) Service due to start in October 2018. It will mean that decisions relating to these services may be different for north and south Southwark due to the contracting arrangement which may cause variability in service delivery across the borough.

The PCCC, having provided further scrutiny of the implications of combining the EPCS service into an APMS contract for registered patients, has since recommended to extend the EPCS contracts by 2 years. The Governing Body has endorsed this decision.

The APMS contract procurement process will need to start in October 2018 subject to the contract model proposed by NHS England (which remains the contracting authority.) This decision will be made on 25th September and the procurement will go live following this agreement. One APMS contract with the combined registered list of Hambleden Clinic and Melbourne Grove Medical Practice will be procured for a combined registered list of approx. 12,200 patients with the capacity to increase the registered list size as the contract will:

A. Attractive range of services for potential bidders B. Provides 7 days a week 8 to 8 services for patients registered in South Southwark C. Provide comprehensive access to primary care for patients registered in Dulwich practices D. Provide an viable increased registered list size and associated income for the provider E. Access for an increased list size to the facilities of Dulwich health centre F. Ability of these services to build relationship and MOU with the out of hours services to

maximise use of Dulwich Health Centre during the out of hours period. To ensure that patients can still access extended primary care service in the Peckham and Camberwell area the provider would be expected to maintain an extended primary care service at the Lister Primary Care Centre as well as provision at the Dulwich. The current EPCS contract has a clause which can be enacted to relocate giving sufficient notice, at least 12 months.


Full patient, stakeholder and market engagement has taken place. The market engagement does support this recommendation to remove the EPCS from this contracting decision. The patient engagement report can be found in the appendices. 221 patients of Melbourne Grove and Hambleden Clinic completed a patient engagement survey. Out of 109 people who lived in the SE5 postcode area, 58 people (53%) said that they would find it difficult to get to Dulwich if

4



their GP practice relocated to the Dulwich Health Centre. Although of all the patients that completed the survey only 35 patients (16%) said that they would register if a new practice if their GP practice was to move. The majority of patients living in SE22, SE15 and SE24 said that it would be easy for them to get to the new Health Centre site. 43% of patients said that would want the extended primary care service located at the Dulwich Health Centre as it was closer to their homes, but 18% said they would like the service to be located at both Dulwich and the Lister as this would make the service more convenient for all patients in south Southwark. The enclosed patient engagement also includes information regarding what services patients valued which can be reviewed when developing a service specification.




i Patient engagement report


Wednesday, 19 September 2018

Extended Primary Care Centre Patient Engagement Report

July 2018

NHS Southwark CCG – Dulwich Health Centre – Melbourne Grove and Hambleden Patient Engagement Report

Page 2

Version Date Details/provenance/comments Author Sent to

1 July 2018 Version for PCCC Rachel Doherty

PCCC

Purpose

The purpose of this report is to provide details of feedback from patients and other stakeholders on the proposals put forward by NHS Southwark Clinical Commissioning Group (CCG) for the future provision of general practice services at the new Dulwich Health Centre, and to outline how this feedback will affect the proposal plans.

Background

In February 2018 the CCG’s Primary Care Commissioning Committee (PCCC) agreed for the CCG to engage on a service model for general practice services at the new Dulwich Health Centre. The PCCC agreed that the CCG would engage with patients and stakeholders on the proposal to relocate the Extended Primary Care Service (the 8 – 8 service), currently provided from the Lister Primary Care Centre in Peckham, to the Dulwich Health Centre in 2020 as part of a combined contract with the registered patient lists of Melbourne Grove Medical Practice and the Hambleden Clinic.

The purpose of the patient engagement was to find out what patients thought about the proposed relocation of the service to the new Dulwich Health Centre and the type of workforce at the service.

How We Collected Your Views

The CCG organised two patient engagement meeting::

• Wednesday 21 March 2018, 6.30 pm at Lister Primary Care Centre about the proposals regarding the 8 – 8 service.

• Thursday 22 March 2018, 6.30 pm at Dulwich Hospital aimed primarily for patients from Melbourne Grove and the Hambleden but open to all patients.

Two patients attended the meeting on 21 March 2018. Approx. 25 patients attended the open meeting on 22 March (including 17 from Melbourne Grove and 3 from the Hambleden Clinic). A poster advertising the meeting on 21 March was sent to the current provider of the 8 – 8 service on 6 March to advertise the meeting to people who attended the service. The meetings were also advertised at


Page 3

the South Southwark PPG on 13 March (attended by seven patients). An email and poster was sent to the south Southwark PPG and to the staff supporting PPGs in the south practices on 15 March asking them to display the poster.

The survey was published on 17 May 2018 and the CCG sent the link out to the South Southwark PPG mailing list asking people to fill it in (apart from those patients registered at the two surgeries as their practices were to text the link out to a different survey). The CCG also advertised the survey via twitter, linking to east Dulwich and other local on-line forums and the stakeholder bulletin and asked south surgeries to display copies and send out link to their PPGs. In early June the CCG noted that the online survey had the question regarding the location of the extended primary care service was missing on the online survey. When this was highlighted the CCG informed NHS England and the question was added to the online survey and a separate standalone survey was also created with the missing question. Patients that had completed the survey were asked to complete this question. 92 patients had completed the survey without this question. 18 of these patients have subsequently completed the missing question. 30 patients completed the online survey once this question was included. Paper copies of the survey included the question. The survey was extended until 6 July and this was highlighted at the south Southwark PPG on 3 July and via email to the south PPG mailing list on 4 July and at the South locality meeting on 28 June.

What You Told Us

135 people completed the online or paper survey. Patients were asked if they had been offered an appointment at the extended primary care centre before. 43 patients (32%) said that they had been offered an appointment and that they had attended the service. 31 of these patients (23%) reported that the service was convenient if an urgent appointment was required and that it was useful to be able to get appointments in the evenings or at weekends. One patient noted that they were able to get a same day appointment despite contacting their practice at 3pm. Patients were asked if they attended the service what could be improved. Where people gave suggestions these included:

- Service running to time

- Car parking for patients

- Improved signage

- Improved waiting area with more space

- More regular staff, local to Southwark

- A pharmacy open at the same time as the service

- More services should be provided e.g. diagnostics


Page 4

Patients from the following postcode areas completed the survey

- SE5, 9 patients (7%)





12 patients (9%) said that they had been offered an appointment at the service, but did not attend. 9 of these patients (75%) said this was because the location was not convenient. 2 patients (16%) said they preferred to wait for an appointment at their GP surgery and one patient said the time of the appointment was not convenient for them.

Patients were asked which location they would prefer the Extended Primary Care Service to be provided from. 100 people did not answer this question (see above) We know that 92 people had completed the survey when we notified NHS England that the question was missing from the online version. Out of the 53 people (36%) that did:

- 30 people (57%) said Dulwich as it was more convenient for where these patients lived

- 18 patients (34%) said Lister and Dulwich to provide a better geographical coverage and more options for patients

- 5 patients (9%) said the Lister as this was more accessible via public transport.

59 people (44%) said that that had not been offered an appointment at the service. 3 people (2%) were not sure.

46 people (34%) said that they would be happy to see a nurse at the service if this was for appropriate issues. A theme was the 36 people (27%) that said they would not be happy to see a nurse also was that a nurse would only be appropriate for certain appointments.

What We Will Do With This Information

The CCG will share this report with the Primary Care Commissioning Committee to review to inform decisions regarding the proposals for the procurement of the extended primary care service.

The report will be published on the CCG’s website and will be presented to the south Southwark patient participation group meeting. The report will also be shared with the current provider of the extended primary care service, Improving Health Limited and south Southwark practices will also be asked to share and discuss the reports with their patient participation groups.


Page 5


Page 6

ANNEX 1 (Statistics)

Practice Name:

Extended Primary Care Service

Practice Code:

N/A List Size:

NA

Date Engagement Commenced: 21.03.18

Date Engagement Completed:06.07.18

Date of Report: July 2018 Report Written By: Rachel Doherty

Written Communications

Link emailed to south Southwak PPG mailing list

17.05.18

Twitter Throughout engagement

Links on east Dulwich and other local on-line forums

May 2018

Stakeholder bulletin May 2018

The CCG requested south Southwark practices to make available paper copies and send to PPGs

May 2018

Meetings

Date Time Venue No. of

Attendees

Patient Engagement 1

21.03.18 6.30pm Lister Primary Care Centre 2

Patient Engagement 2

22.03.18 6.30pm Dulwich Hospital 25

Patient Survey

Date Survey launched: 17.05.18

Date Survey closed: 06.07.18

No. of Responses:135

Issues / Themes Arising from engagement


Page 7

Theme: Not all patients had used the service. Of those that had it was reported the service was convient for urgent appointments or is patients needed appointments in the evening or at weekends.

Theme: Of the patients that had said they had been offered an appointment at the service but did not attend, 75% said this was because the current location was not convienet to get to.

Theme: The majority of patients said they would like the service to be provided from Duwlich in the the future although 34% said that if the service was provided both from the Lister and Dulwich this would provide more options for patients and better geographical coverage

Theme: Patients reported they would be happy to see a nurse for certain reasons.

1





CCG Committee Primary Care Commissioning Committee


Item title: Quality Report

Enclosure number:

C


No



2




Name Harpinder Priest Name Kate Moriarty-Baker

Job title Quality Manager Job title Director of Quality and Chief Nurse

Directorate Quality & Nursing Directorate Quality & Nursing



The purpose of this paper is to provide an update on quality issues relating to primary care.


CQC Inspection reports and actions taken The CQC inspection process is a national programme. Southwark’s 37 GP practices have now been inspected and had their reports published; their ratings are summarised in Appendix 1 and full reports are available on the CQC website http://www.cqc.org.uk/ NHS Southwark CCG continues to engage with patients on the quality of general practice services in Southwark through workshops, via the Engagement and Patient Experience Committee (EPEC) and through locality patient participation group meetings (PPGs). Since the last Committee meeting report in July 2018 three practices had their CQC inspection report published; table 1 below, summarizes the results:

• Dr Bhatt, Park Medical Centre

• Dr Alan Campion, The New Mill Street Surgery

• Dr P Arumugaraasah’s & Partners, Lister Primary Care Centre




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

3



Table 1 – results of Southwark CCG CQC inspection reports published since May 2018:

Practice Date of inspection

Date report

published

Overall rating

Safe Effective Caring Responsive Well-led

Dr Bhatt Park Medical

10/05/2018 18/07/2018 Good Good Good Good Good Good

Dr Campion New Mill Street

20/06/2018 03/09/2018 Requires

Improvement Requires

Improvement Good Good

Requires Improvement


Dr Arumugaraasah’s

Lister PCC 10/05/2018 16/07/2018


Good Requires

Improvement Requires

Improvement Good


• Dr Bhatt – Park Medical Centre – Overall rating Good The practice was previously inspected in October 2017 when it was rated as Requires Improvement overall and in the areas of being Safe and Effective, at that time it was rated Inadequate for being Well-Led. The latest inspection, carried out in May 2018, found that the practice had addressed the concerns raised at previous CQC inspections and noted the continued to work to improve standards of care. This resulted in the practice achieving a rating of Good in all domains and Good overall. The practice was found to have clear systems to manage risk so that safety incidents were less likely to happen and that when incidents happened, learning had been identified and shared. It was also found to routinely review the effectiveness and appropriateness of the care it provided and ensure that care was delivered according to evidence based guidelines. Staff were noted as treating patients with compassion, kindness, dignity and respect and most patient found the appointment system easy to use. Areas noted for additional improvement can be found in the inspection report via the CQC website. The CCG Primary Care and Quality Team and the South East London Primary Care Team have been available to provide support and guidance to the practice during the inspections.

• Dr Alan Campion – The New Mill Street Surgery – Overall rating Requires Improvement The practice was previously inspected in November 2017 and rated as Inadequate overall and placed in Special Measures. The recent inspection carried out in June 2018 found the practice had made improvements and was rated Good in the domains of Effective and Caring. It was rated as Requires Improvement overall and in the areas of being Safe, Responsive and Well-led. The recent inspection found that the practice had established systems to manage most of its risks around safety incidents so that they were less likely to occur. There was evidence that the practice learned from incidents. Further processes were required in relation to staff being aware how to report significant events. The practice had produced a comprehensive action plan around clinical performance and targets which showed that improvements had been made. The inspection found that the practice could evidence quality improvement activity and performance and most systems and process in management of medicines were effective and safe. Areas noted for improvement include a review of methods for advertising support for bereaved patients, a review of clinical time for meeting with the needs of local population, systems to support and

4



identify patients with caring responsibilities. Full details about the inspection and its report can be found on the CQC website. The CCG Primary Care and Quality Teams and the South East London Primary Care Team have been available to provide support and guidance to the practice during the inspections.

• Dr Arumugaraasah – Lister Primary Care Centre – Overall rating Requires Improvement The CQC previously inspected this practice on the 31 January 2017 when it was rated as Requires Improvement overall and in the areas of being Safe, Effective, Caring and Well-led, it was rated as Good in being Responsive. The lasts inspection found the practice to be Requires Improvement overall. It had achieved a rating of Good in the areas being Safe and Responsive, other areas were rated as Requires Improvement. The recent inspection found that the practice had clear systems to manage risk so that safety incidents were less like to happen, it had also ensured that staff were aware of current evidence-based guidance and that they had been trained with skills and knowledge to deliver effective care. The practice had ensured that information was available to patients on how to complain about services and there was a strong focus on continuous learning and improvement at all levels. The inspection identified areas for improvement which include to ensure systems and process of good governance are in place, to ensure that patient outcomes are continually reviewed throughout the year and that views of people using the service are regularly sought. The full inspection report can be found on the CQC website. The CCG Primary Care and Quality Teams and the South East London Primary Care Team have been available to provide support and guidance to the practice during the inspections. Docman NHS England recently issued a national CAS alert to all General Practices following information coming to light regarding an area within DOCMAN (software which holds patient related documents). Actions need to be taken by practices relating to management of an ‘Unprocessed Folder’ in DOCMAN. Practices are currently reviewing documents within this folder against patient records and, if any harm is identified from unprocessed documentation, completing risk assessments. Practices are working to a timetable of staged data submissions to the CCG, which the CCG is feeding back to NHSE. The final data submission to NHSE Primary Care teams is 26 September. NHS Southwark CCG are currently working closely with practices and providing support to ensure risks are identified and submissions are timely, however it should be noted that this has caused considerable additional work to some practices. There are over 36,000 unique files on Southwark which require checking. By 19 September 17 practices had completed their review and found no harm.

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CCG Medicines Optimisation Team shortlisted for HSJ Award

NHS Southwark CCG has been shortlisted for the prestigious Health Service Journal (HSJ) awards in the Medicines Optimisation category with two submissions:

• Multi-factorial approach to Antimicrobial Stewardship - Southwark CCG has supported GP

practices to improve appropriate antibiotic prescribing locally. The multifactorial approach has contributed to making Southwark the best prescribing borough in London in a number of antibiotics, which ultimately safeguards antibiotics – and so patient safety - for future generations. The project has also promoted self-care and strengthened relationships with secondary care and the local community.

• Pharmacist led virtual clinic to improve rates of anti-coag for Atrial Fibrillation in General

Practice (joint – Lambeth CCG, Southwark CCG and KCH). AF virtual clinics have delivered a

substantial increase in the rate of anticoagulation detection locally, and reduced the number of AF-related strokes. The model is currently being considered by NHS England for national rollout.

The Meds Op team will present to a judging panel in October and the winner will be announced in November

CCG Practice Quality Improvement Visits

The CCG undertook its first visit focused on quality improvement in September 2018 to a neighbourhood of five practices in Walworth (Old Kent Road, Villa St, Aylesbury, East Street, Trafalgar Road, plus QHS federation reps). The meeting was well attended by clinicians and practice managers, and well received.

The group discussed the CCG’s quality improvement dashboard and were interested in benchmarking information and how they were delivering against other practices. The meeting also discussed the primary care sepsis initiative, and sharing learning from incidents and significant events. The visit would have benefited from more time however learning from this pilot can be applied for future visits.

It should be noted that it has been very challenging to arrange group visits due to availability necessary from multiple organisations, and their individual focus on other initiatives such as CQC visits, mergers, etc. The CCG has worked with the federations to make use of existing meetings to maximise diaries however these federation cluster meetings are not yet established across the borough.

The CCG is now reflecting on findings from the first visit and reviewing how to go forward with the remainder of practices in the cluster format, noting the challenge of availability for the meetings experienced so far.


6



The CQC inspection process is a national programme. NHS Southwark CCG continues to engage with patients on the quality of general practice service in Southwark through engagement workshops, via the Engagement and Patient Experience Committee and locality patient participation group meetings.




1 CQC Inspection update table and ratings

Date paper completed Wednesday, 19 September 2018

7



Appendix 1 CQC Outcomes

The following chart illustrates the current position of CQC overall ratings for Southwark General

Practices the rating for each domain. Data is correct as at 14 September 2018.

Note: Hurley Group Caretaking at the Lister has not been assigned a rating for ‘Caring & Responsive

domains’’ and are not assigned an overall rating due to being registered for a limited time as a new provider,

32

4

1

Overall CQC Ratings for Southwark Practices

Good RequiresImprovement

Not yetAssigned

8



33

34

31

35

33

3

3

5

1

3

0 5 10 15 20 25 30 35 40

Safe

Effective

Caring

Responsive

Well-Led

Rating for Each CQC Domain

Good Requires Imrovement Inadequate Not yet rated

9



Overall

CQC

Rating

GP Practice

Name

Inspection

Date

Publication

Date

Safe? Effectiv

e?

Caring? Respon

sive?

Well-

led?

RI Dr Alan M

Campion

26/06/2018 03/09/2018 RI G G RI RI

RI Lister

Dr P

Arumugaraasah'

s &

10/05/2018 16/07/2018 G RI RI G RI

RI Dr R S Durston

& Partners

23/01/2018 26/03/2018 RI G RI G I

RI Sir John Kirk

Close

09/05/2018 12/07/2018 I G G G RI

G Lordship Lane

Dr SAKM Doha's

Practice

12/09/2017 20/10/2017 RI G G G G

G Forest Hill Group

Practice

08/02/2018 29/03/2018 G RI G G G

G Concordia

Parkside Medical

Centre

22/06/2017 15/08/2017 G G RI G G

G Concordia

Melbourne Grove

08/09/2016 12/01/2017 G G RI G G

G The Acorn&

Gaumont

Surgery

12/04/2018 22/06/2018 G G RI G G

G The Trafalgar

Surgery

30/01/2018 04/04/2018 G G G G G

G Falmouth Road

Group Practice

26/04/2018 15/06/2018 G G G G G

G Dr Bhatt – Park

Medical Centre

17/05/2018 18/07/2018 G G G G G

G Elm Lodge

Surgery

10/04/2017 26/05/2017 G G G G G

G Silverlock

Medical centre

10/05/2017 05/06/2017 G G G G G

G Sternhall Lane

Surgery

14/03/2018 26/04/2018 G G G G G

G Nunhead

Surgery

20/09/2016 30/01/2017 G G G G G

G Dulwich Medical

Centre

11/08/2016 14/12/2016 G G G G G

G The Garden's

Surgery 05/08/2016 03/11/2016

G G G G G

G Dr Kaushal

Kishore Misra

22/10/2015 18/06/2015 G G G G G

G Dr Ramesh

Sharma

15/10/2015 10/12/2015 G G G G G

G Dr Shivraj

Chudha

29/04/2015 06/08/2015 G G G G G

G Penrose Surgery 22/06/2016 01/08/2016 G G G G G

G Albion Street

Practice

15/12/2015 03/03/2016 G G G G G

G Dr Mahreen

Chawdery 306

Medical Centre

26/05/2016 15/08/2016 G G G G G

G Lister

Hurley Group

Practice

12/04/2016 26/08/2016 G G G G G

G Hambledon 09/06/2016 20/06/2016 G G G G G

G St Giles Surgery

Dr Virji/Begley

23/08/2016 04/11/2016 G G G G G

G St Giles Surgery

Roseman/Vasan

t

18/08/2016 04/11/2016 G G G G G

G DMC Healthcare 29/09/2016 21/12/2016 G G G G G

G Old Kent road

Surgery

22/06/2016 23/01/2017 G G G G G

G The Surgery

301 East Street

27/11/2017 01/02/2018 G G G G G

G Dr Shabir Bhatti 25/10/2017 07/12/2017 G G G G G

G Villa Street

Medical Centre

08/12/2016 30/03/2017 G G G G G

Bermondsey

&Landsdown

Medical Mission

(inc Artesian HC

22/04/2015 30/07/2015 G G G G G

Princess St

Practice

22/04/2015 13/08/2015 G G G G G

Aylesbury

Medical

CentreThurlow

Street/Dun

14/01/2016 06/04/2016 G G G G G

Surrey Docks

Health Centre

18/08/2016 12/01/2017 RI G G G G

Manor Place Not

inspected

now merged

into NEXUS

G G G G G

G Maddock Way

Surgery

14/03/2017 14/05/2017 G G G G G

G Queens Road

Surgery

01/08/2017 08/09/2017 G G G G G

No rating

assigned

Hurley Group

Caretaking

(formerly Dr

Hossain)

01/05/2018 12/07/2018 G RI Not

assigned

Not

assigned

G

G

Documents

Southwark Primary Care Commissioning Committee Primary...KMB explained that the Brid Nicholson, the infection control nurse for Southwark and Lambeth was leaving the CCG but that the