Agenda item

Alison Blair, Chief Officer Islington CCG,  Dr.David Davies, GP and clinical lead for the NHS 111 and out of hours re-procurement, Islington CCG, Samit Shah, Clinical lead for the NHS 111 and out of hours re-procurement for North Central London CCG’s. Rebecca Kingsnorth, Head of Service Transformation, Islington CCG and Dr.Robbie Bunt, GP and Chair of the Local Medical Committee.

The Chair had also invited Dr. Nick Mann, a Hackney GP to talk to the Committee about the recent successful bid for the out of hours service in Hackney that had been tendered for successfully by a consortium of Hackney GP’s

Sue Richards of Keep Our NHS Public campaign was also present.

Dr. Davies made a presentation to the Committee, a copy of which is interleaved, and during discussion of the presentation the following main points were made –

·         Following the takeover of the GP Out of Hours service by Care UK in 2012  and in April 2013 LCW, not for profit, commenced contract to provide 111 for C&I

·         2013 October: Primary Care Foundation review of Harmoni/Care UK Out of Hours service. The review found the service was clinically safe and provided good care

·         2014 March: Urgent Care Review Camden and Islington

·         There had been community engagement on the urgent care review

·         The community wanted smooth and efficient links between NHS 111 and the OOH and a service that is easy and accessible, staff operating NHS 111 have the right knowledge and skills, easy referral into the necessary services, everyone in the community will find the service easy to use and more local knowledge of NHS 111 and OOH

·         The urgent review conclusions recommend that the 111 service is commissioned across all North Central London and a combined NHS 111, GP Out of Hours service as a single whole system model, but not necessarily a single provider

·         The features of the new re-procurement include – NHS 111 across five boroughs, as now, NHS 111 and GP out of hours services integrated although not necessarily under a single provider for both services, NHS 111 in line with the nationally mandated model, with local influence where possible and with GP out of hours services still providing telephone support, face to face visits, and home visits

·         NHS England require a robust re-procurement process, with evidence

·         Primary care will see significant other changes in the next 1-5 years

·         Flexibility will be built into the new model to ensure that the service can be adapted to further change

·         Related primary care developments include the funding of additional capacity in general practice- 65 additional hours per week pan Islington from2014/15, Pan Islington service under development intended to provide general practice 8 – 8, 7 days per week

·         Angel Medical services contract renewed – 7 day extended access to GP appointments and agreement from all practices to develop pan Islington federation

·         What is possible – one governance structure, improved response by joining NHS 111 and GP out of hours service, prescriptions via pharmacist available for earlier entry into the pathway, quicker access to help for dental problems, earlier input into the 111 pathway from health care professionals, integrated IT and direct booking of ‘in hours’ appointments.

·         There will be public engagement on the re-procurement process from January to March and further community meetings are planned with a wide range of groups and comments on the clinical model and procurement process will be fed into the specification

·         Feedback so far has been a positive experience of the use of NHS 111 and GP out of hours services, support for combining NHS 111 and out of hours services, support for NHS111 being able to book appointments directly with the patients GP, support for information sharing between services with safeguards, the suggestion that call handlers – advisors and clinicians- have training in mental health and support for GP’s and other clinicians being involved earlier in the pathway

·         There are a number of questions received and there will be continued engagement until April when the service specification will be finalised and the tendering process commences for the new service to start in April 2016

·         Nick Mann stated that the Hackney consortium consisted of roughly a third of local GP’s, a third TUPE’d across from the previous contractor HARMONI, and a third locum GP’s who built up a knowledge of the area

·         The CCG in Hackney had initially assisted the GP consortium bid, however the consortium had eventually had to form a company and this was a not for profit company run as a social enterprise and any monies accruing went back into patient care. The Hackney consortium is popular with patients and worked well and was focused on quality rather than cost. In addition the time commitment from local GP’s in providing the out of hours service was not excessive and if GP’s did not want to be involved they did not have to do so

·         There were concerns about the 111 service which was operated by operator staff dealing with patients from a ‘crib’ sheet who were not medically trained and appeared to add to the costs involved

·         The Keep NHS Public campaign stated that residents wanted a local GP out of hours service rather than a private company seeking to make a profit

·         The view was expressed that the demands on GP’s had grown significantly in previous years and that there appeared at present to be little enthusiasm for a GP led consortium to bid for the out of hours service in Islington

·         Dr. Blunt stated that GP’s in Islington felt overstretched and even if a  local consortium was established it would not guarantee that the GP’s servicing it would all be local. In his view it was necessary to focus on the parts of the model that could be changed effectively to deliver a better service for Islington residents. He added that central Government had directed that GP surgeries needed to open 8-8 and it was difficult enough for GP’s to seek to manage this and that the Hackney model was he felt different to that which could be achieved in Islington

·         Samit Shah expressed the view that there had not been an increase in the overall A&E attendance figures since the introduction of the 111 service and in fact he felt that it had assisted in coping with the recent problems with A&E attendance. In addition the call operators at 111 all received a 12 week training course and had to take 2 exams and operators followed an algorithm for assessing patients which was designed by the Royal College of GP’s and there was a strong governance framework to audit calls

·         A Member expressed concern at a recent press article from the CCG that appeared to preclude a bid for the out of hours service from Islington GP’s and queried whether this was the case. It was stated that the contracts were coming up for re-procurement and if there was a locally led GP consortium that would be willing to tender this would be welcomed, however with the current focus on extending opening hours adding to the pressure on GP’s this was felt to be not likely

·         The view was expressed that it was feasible to have a bid from a group of organisations, one providing the 111 service and the other providing out of hours service, as long as they could work effectively together

·         The challenge was to make the 111 service as effective as possible within the system procured for the out of hours service

·         Members were informed that the CCG were committed to the NHS ethos and understood the desire for a locally operated GP out of hours service

·         In response to a question the CCG stated that they were holding an event in February for possible providers to offer facilitation in forming partnerships in the re-procurement process but they could not favour any particular bidder in the process

·         The Keep NHS Public campaign stated that they felt that there should be a public consultation to listen to residents views and that as the NHS was not for profit it should be the most cost effective provider and residents should be asked if they wanted GP’s or a private company running the out of hours service. The question should still be asked even if local GP’s did not come forward to tender for the service

·         The CCG stated that they were in the process of consulting and if residents had proposals/ideas they felt should be considered these could be put forward and other events could be considered to hear residents views. In addition the views of patient participation groups would be taken into account through GP practices

·         The Chair indicated that it would be useful if the Committee were shown a draft of the service specification for the re-procurement of the service and an indication of the possible providers who may bid for the service

RESOLVED:

That the draft service specification for the re-procurement of the 111 and out of hours service be submitted to a future meeting of the Committee, together with details of possible interested parties in procuring the contracts that attended the provider event

The Chair thanked those who had contributed to the presentation and ensuing discussion for attending