Agenda item - Personal Medical Services GP Contract Review

Report of the Chief Operating Officer of the Clinical Commissioning Group (copy attached).

Please note this report was written prior to the announcement that the Practice Group would be withdrawing from the 5 surgeries highlighted in the report.

A presentation will be provided to the Board by NHS England and the CCG to ensure the Board has the latest information.

Also attached to the report are copies of the Stakeholder Letter and Patient Letter that have been sent out from NHS England.

 53.1   The Board had a report from the Interim Chief Operating Officer of the Clinical Commissioning Group. Since this report was provided the practice group which provides services under the Personal Medical Services (PMS) contract had announced they were intending to withdraw from the contract. Mr S Ingram (Head of Primary Care NHS England South) and Ms S MacDonald (Director of Commissioning NHS England South) presented the up to date situation on the PMS contract and the slides would form part of the minutes.

53.2    The presentation summarised the key findings emerging from a review of all General Practice Personal Medial Services (PMS) across England undertaken by NHS England during February 2014 and March 2016. In Brighton and Hove there were five GP Practices which operated under a PMS contract. All the practices in the city with a PMS contract were managed by The Practice PLC. PMS contracts were negotiated locally as opposed to the nationally negotiated General Medical Services (GMS) contracts. NHS England had written to the practices operating under a PMS contract outlining the approach to the review in accordance with the national guidance. Those reviews need to be completed and any proposals implemented by March 2016. The aim of the review was to ensure that any extra funding above and beyond what an equivalent GMS contract would receive was linked to providing extra services.

53.3    The Board were advised that The Practice PLC had given notice to NHS England that they would be bringing their PMS contract to an end. There was a requirement to give six months notice of a decision to end a contract, and NHS England were in discussions with the company to ensure that as much time as possible could be given to secure ongoing care arrangements for patients who would be affected. Patients and stakeholders had been informed and NHS England was working with NHS Brighton & Hove Clinical Commissioning Group (CCG) to identify alternative options. At this time patients did not need to take any action and would continue to receive care at their surgery as normal. Patients would be updated as soon as it was possible.

53.4    The Board were asked to note that paragraph 5.1 of the CCG report should read that the PMS agreements were introduced in ‘1998’ and not ‘2008’.

53.5    Dr C Beesley said that she worked as a GP in one of the Practice Group PLC surgeries. The percentage of NHS spend on general practices had gone down, which had resulted in practices being underfunded. A number of practices were financially vulnerable and there needed to be a change to the way practices worked. Brighton and Hove was a good place to work, but there was a problem with the retainment of general practitioners. Many young doctors did not want to become partners in practices, and that could be a problem as 60% of GP’s in the city were due to retire in the next five years. The possible closure of five surgeries needed to be managed correctly as the dispersal of so many patients with the city could be disastrous.

53.6    Ms F McCabe agreed that the closures needed to be managed correctly, and continuity of care was important. Doctors needed to be encouraged to move to the city and join local practices. This was a difficult time, but with the right model there could be positive changes which would benefit patients.

53.5    Ms C Holloway said that lessons had been learnt from the recent closure of two other practices, and patients affected would be given independent advice and there would be a managed process to closing the surgeries.

53.6    Councillor Mac Cafferty was concerned at why The Practice PLC had withdrawn so suddenly from the contract, and hoped that the reasons were addressed to ensure that any issues were not repeated. He noted that six months notice had to be given to withdraw from a contract and suggested that that could be extended in future. The Commissioning & Performance Manager said that the six month period would end in June 2016, and that negotiations were taking place to try to stagger the closure of the surgeries over a longer period of time. Sometimes the closure of a surgery could create opportunities to improve the service, and it was hoped that a sustainable solution to the problems could be found.

53.7    Councillor G Theobald asked how vacancies in GP surgeries were advertised and asked if there was a list of all positions available in the city. Mr Ingram said all posts were advertised and there was no shortage of opportunities for doctors. The Director of Public Health said that it may be useful to look at the way posts were advertised and a more structured way could be used. The Director of Commissioning suggested that the Board may wish to invite Heath Education England to attend a meeting, as they worked to encourage doctors to become general practitioners.

53.8    The Chair thanked Mr Ingram and Ms MacDonald for their presentation and asked if they could attend the next meeting of the Board to provide an update on the closure of the five surgeries.

53.9    RESOLVED: That the report be noted.