Primary Care Performance

and Quality Report August 2018

Author: Sue Gunner, Analyst - Planning & Performance

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ENCLOSURE 6

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Contents

Page Number

Introduction 3

Friends & Family Test (FFT) 4

GP Patient Survey – Overall experience of GP Practice

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Primary Care – eRS Referrals Utilisation 13

CQC Ratings 14

Primary Care overview 16

Appendix 1 – FFT Data Table 20

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Introduction

This purpose of this report is to give the Primary Care Commissioning Committee a brief overview of the quality of Primary Care services in Bromley. A plethora of performance information relating to Primary Care is available and the frequency of publication varies depending on the data source and collection regimes. Therefore, the content of the report is predominantly driven by data that is published nationally, supplemented with local intelligence where appropriate. The content of each Primary Care Quality Report will vary depending on what information has been most recently published at the time of writing. The content, data and information presented has been collected from a number of sources including; NHS England, NHS Digital, Public Health England (PHE) and the Care Quality Commission (CQC). This report should not be looked at in isolation but considered alongside other sources of information, both hard and soft, pertaining to Primary Care service provision in Bromley. The July 2017 report was the first Primary Care Quality Report produced by the CCG and the format/content of the report has changed over the months as feedback from the Committee is received and, where possible, incorporated into the document. This report is currently being looked at for possible changes by the Audit Committee, a task and finish group has been set in place.

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Friends & Family Test (1 of 3)

The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience.

It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. This feedback is vital in transforming NHS services and supporting patient choice.

Whilst a useful tool to measure patient satisfaction/experience when the response numbers are very low this can skew the results at individual practice level.

The chart that follows details FFT data for June 2018. It should be noted that 7 practices did not submit data:

South View Partnership, London Lane Clinic, Charterhouse Surgery, Gillmans Road Surgery, Wickham Park Surgery, Bank House Surgery and Cross Hall Surgery.

Additionally one practice submitted data but the number of responses was less than five so the results were suppressed:

Manor Road Surgery .

Note: Detailed FFT data is included as appendix 1 (page 20)

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Friends & Family Test (2 of 3)

Friends and Family Test development project 2018-19 NHS England is carrying out a project to improve some areas of the way the Friends and Family Test works across the country. The work will result in publications of refreshed FFT Guidance by April 2019. Outline proposals for the work were given the green light by Chief Executive Simon Stevens in the autumn and also supported by the Department of Health. The ambition is to ensure the FFT can be a more effective tool in gathering patient feedback that helps to drive local improvements in healthcare services. So far, the FFT has produced more than 48 million pieces of feedback – and the total rises by around 1.2 million more every month – making it the biggest source of patient opinion in the world. Scores so far have told us that at least nine out of ten patients would recommend the NHS services they used to their loved ones. Patient comments also identify areas where improvements can be made so that providers can make care and treatment better for everyone. Improvements are being made to the part of the Calculating Quality Reporting Service (CQRS) system that GP practices use to submit their monthly Friends and Family data. Practices had fed back over the past few months that they wanted to be able to go back into the system before the submission deadline to amend any incorrect data entries, which is not currently possible. Some practices had also accidentally filled in data in the fields for 2016 months rather than 2015, locking in the information, and were requesting these fields be cleared. NHS England has listened to these requests and worked with HSCIC, who own the system, to facilitate improvements. After the deadline for October data submissions, which is on 17 November, the system will be disabled for several days.

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Friends & Family Test (3 of 3)

Notes: The highest number of responses for an individual practice was 362 (Chelsfield Surgery).

Practices reporting higher response numbers are using Handwritten Forms and SMS/Text Messages as the method of collection

Changes to the GPPS (GP Practice Survey) -

The GPPS is a large-scale England-wide survey funded by NHS England and currently administered by Ipsos MORI. It provides practice-level data about patients’ experiences of their GP practices, which is comparable across organisations (for practices and CCGs, for example) and over time. The findings are published online (at www.gp-patient.co.uk) and can be used by GP practices and other organisations to inform decisions about local health services. The survey produces Official Statistics that feed into domains of the NHS Outcomes Framework, CCG Improvement and Assessment Framework and is used by the Care Quality Commission in their Insight Model. More generally, the data are used to measure how well GP services are serving patients. In this way, the survey provides invaluable insight to assist with improvement and accountability, and also gives patients information to help them make choices about which GP service they use.

The GPPS needed to change as “Primary care services in England are currently undergoing significant change, as set out in the GP Forward View, which outlines NHS England’s vision for primary care. These changes include providing extended access to appointments including in the evening and at weekends, as well as introducing new ways for people to contact their GP surgery and make appointments. New services are also rolling out across practices, such as access to general practice pharmacists, mental health professionals and other practitioners. “ GP Patient Survey Questionnaire redevelopment, NHS England and Ipsos Mori, July 2018.

GP Survey (1 of 7)

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The data in this report are based on the August 2018 GPPS publication. This combines two waves of fieldwork, from January to March 2018, providing practice-level data. The survey is sent out annually in January on behalf of NHS England. Participants are sent a postal questionnaire, also with the option of completing the survey online or via telephone.

Weighting has been applied to adjust the data to account for potential age and gender differences between the profile of all eligible patients in a practice and the patients who actually complete a questionnaire. Since the first wave of the 2011-2012 survey the weighting also takes into account neighbourhood statistics, such as levels of deprivation, in order to further improve the reliability of the findings.

The questionnaire has been redeveloped for 2018 in response to significant changes to primary care services as set out in the GP Forward View, and to provide a better understanding of how local care services are supporting patients to live well, particularly those with long-term care needs.

The following data represents some of the key results for Bromley CCG:

In Bromley CCG 13,523 questionnaires were sent out and 4,677 were returned completed. This represents a response rate of 35%.

For the first time 16 and 17 year olds were able to participate in the Survey, previously the age had been 18 years plus.

GP Survey (2 of 7)

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GP Survey (3 of 7)

The GP Patient Survey measures patients’ experiences across a range of topics, including:

Making appointments

Perceptions of care at appointments

Managing health conditions

Practice opening hours

Services when GP practices are closed

This report will focus on ‘Overall experience of GP Practice’

It is useful to understand who has responded to the survey and what their contact has been with their surgery. The table below details the age breakdown of respondents to the survey. The pie chart alongside sets out when survey respondents’ last saw or spoke to a GP.

Age Band Number of Respondents %

16 to 24 years 402 9

25 to 34 years 650 15

35 to 44 years 822 18

45 to 54 years 872 19

55 to 64 years 721 16

65 to 74 years 533 12

75 to 84 years 327 7

85+ years 154 3

GP Survey (4 of 7)

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GP Survey (5 of 7)

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GP Survey (6 of 7)

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Primary Care (1 of 1) Primary Care Overview

E-Referrals – Outpatient Utilisation

The table below sets out Bromley’s outpatient e-referral utilisation rates over recent months Apr-2017

May -2017

Jun -2017

Jul -2017

Aug - 2017

Sept - 2017

Oct – 2017

Nov – 2017

Dec – 2017

Jan – 2018

Feb –2018

Mar - 2018

Apr– 2018

May - 2018

Jun - 2018

64.6% 73.0% 71.8% 67.7% 69.3% 75.0% 87.8% 89.2% 78.3% 85.2% 84.1% 82.0% 72.5% 72.2% 74.9%

Bromley CCG has the fourth highest OP utilisation rate in south east London – June 2018

CCG Nov Dec January February March April May June

Bexley CCG 75.9% 62% 73.6% 77.4% 77.3% 82.8% 88.5% 91.2%

Bromley CCG

89.2% 78.3% 85.2% 84.1% 82.0% 72.5% 72.2% 74.9%

Greenwich CCG

56.4% 53% 67.1% 72.0% 72.1% 72.3% 76.6% 82.2%

Lambeth CCG

46.5% 44% 52.9% 55.6% 58.9% 63.9% 62.0% 63.3%

Lewisham CCG

49.4% 61% 67.2% 75.7% 79.5% 80.2% 82.2% 83.8%

Southwark CCG

43.0% 42% 54.1% 57.6% 59.6% 63.9% 62.0% 65.0%

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The Care Quality Commission (CQC) inspects practices to assess how they provide primary care services to six particular population groups:

Older people People with long-term conditions Families, children and young people Working age people People whose circumstances may make them vulnerable People experiencing poor mental health

The CQC assess whether the service provided for these groups are; safe, effective, well-led, responsive and caring. The following table categorises Bromley practices under the four CQC ratings:- Outstanding, Good, Requires Improvement and Inadequate.

CQC Ratings (1 of 2)

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CQC Ratings – Updated 16th August 2018 (2 of 2)

Practice Name Overall CQC Rating Date of CQC Inspection

Practice Name Overall CQC Rating Date of CQC Inspection

Dysart Surgery Outstanding 23/07/2015 Park Group Practice Good 29/12/2016

Addington Road Surgery Good 06/12/2016 Pickhurst Surgery Good 12/12/2016

Ballater Surgery Good 16/03/2016 Poverest Medical Centre Good 18/06/2018

Bank House Good 11/01/2017 Robin Hood Surgery Good 03/10/2016

Bromley Common Practice Good 22/04/2016 South View Partnership Good 06/04/2016

Broomwood Surgery Good 31/05/2018

Southborough Lane Surgery - Crown Medical Centre

Good 05/01/2017

Cator Medical Centre Good 01/11/2016 St James' Practice Good 30/04/2015

Chelsfield Surgery Good 18/09/2017 Station Road Surgery Good 12/12/2016

Chislehurst Medical Practice

Good 22/09/2016

Stock Hill Surgery Good 04/04/2016

Cornerways Surgery Good 27/04/2016 Summercroft Surgery Good 09/01/2018

Crescent Surgery Good 26/02/2018 Sundridge Medical Centre Good 09/11/2017

Cross Hall Surgery Good 15/03/2018 Trinity Medical Centre Good 03/06/2016

Derry Downs Surgery Good 26/05/2017 Tudor Way Surgery Good 20/10/2016

Eden Park Surgery Good 02/03/2018 Whitehouse Surgery Good 15/09/2017

Elm House Surgery Good 25/11/2016 Wickham Park Surgery Good 29/09/2016

Family Surgery Good 08/07/2016 Woodlands Practice Good 16/11/2016

Forge Close Surgery Good 04/04/2016 Highland Medical Practice Requires Improvement 19/12/2017

Gillmans Road Good 19/08/2016 Manor Road Surgery Requires Improvement 29/12/2017

Green St Green Medical Centre

Good 01/12/2016

Charterhouse Surgery New inspection Service taken over by new providers

Knoll Medical Centre Good 31/05/2016

Anerley Surgery New inspection Service Registered by CQC on 01/11/2017

Links Medical Practice Good 31/05/2016

Oakfield Surgery New Premises - Not yet

assessed Service Registered by CQC on 19/11/2017

London Lane Clinic Good 11/01/2017

St Mary Cray Practice New inspection Service Registered by CQC on 23/02/2018

Norheads Lane Surgery Good 13/09/2017

Primary Care Overview

PMS Premium Services. Practice Development Plans for both wave 1 and 2 practices have been reviewed by the PDP Panel (with CCG and LMC representation) each month between Nov 17 and Aug 18. In total, 43 practices have submitted plans; noting that two practices have opted out of providing the PMS Premium. All but two plans are now approved and the final two are being followed up by the end of September

A reflection piece on the practice development plans together with analysis of themes across the plans commenced in June and learnings have been shared with the PCSG and will later go to the PCCC, SEL colleagues, LMC and feed into the PCNA from September 2018

Primary Care Needs Assessment and Strategy. Dr Agnes Marossy is continuing her work on the Bromley Primary Care Needs Assessment.

The Clinical Reference Group met on 27th Feb and 26th June with GP practice staff and CCG colleagues to discuss the workforce issues facing general practice and how best to address them, and how workload impacts profoundly on resilience. Data gathering for the second annual workforce survey is now complete from 100% of practices and findings have been presented to the PCSG. This has shown that the numbers of GPs have decreased since last year; and a quarter of salaried GP posts are vacant. Other deep dive work is ongoing around DNA rates.

The PCNA is now moving towards an implementation stage, working with two collaborations of practices (Penge and Crays; five practices from each) and working across Bromley on new role skill mix and workload filtering

A Primary Care Strategy is being developed that will set out how we use the PCNA to guide the CCG work programme, GPFV spending and primary care decision-making in coming years

Practice engagement. The Primary Care team has a named team member for each practice as the first point of contact for that practice and

to undertake quarterly practice visits. Progress with practice visits over the past year has been: 91% of practices were visited in Oct-Dec 2017 89% of practices were visited in Jan-Mar 2018 96% of practices were visited in April–July 2018

A reflection on GP practice visits and wider engagement by the primary care team went to PCSG in April 2018 and IGC in July for discussion

Review of medical support to care homes (Visiting Medical Officer scheme). Following an extensive engagement process with all local stakeholders, we are now implementing long term, improve commissioning arrangements under an APMS contract by:

Extending the existing VMO arrangements to 31st March 2019 Investing funding from the GP enhanced service budget; primary care delegated budget and Better Care Fund to provide the required

level of support Completed a provider market engagement event on 13th July 2018 The procurement was launched on 13th August, to run until 1st October 2018, after which time the bids will be evaluated and a

successful bidder selected ahead of mobilisation during January-March 2019 and a ‘go live’ start date of 1st April 2019 16

Primary Care (1 of 4)

Primary Care Overview cont.

GP Forward View: Following a local and south east London engagement and development process against short timescales, Bromley CCG has had our two bids for the £2m SCF funding approved. The purpose of this funding is to increase at scale working across general practice to improve resilience, and to promote integration with the wider health system through partnership working. Bromley's bids were: 1. Improving collaboration of practices within localities, supporting practice mergers where there is the appetite and developing Primary

Care Homes by integrating community, voluntary and other services into general practices 2. Increase the pace, scale and depth of a Primary Care Academy for Bromley, building on early developments to include new ways of

working, portfolio opportunities and workforce training Funding has been partially released in August 2018 with the rest to follow in September. The CCG (and CEPN for project 2) are developing the programme for investing this funding, working with local practices, the LMC and other stakeholders on their priorities for investment. A delivery structure is also being put into place. Resilience funding of £44,000 was recently released and two collaborations of practices in Penge and the Crays have put in expressions

of interest for this funding. The CCG working with LWLMCs have digested and approved the initial EoIs and will be working with the collaborations on early investment (noting the longer term strategy noted on page 1)

Winter resilience schemes for 2017/18:

The primary care winter resilience additional schemes for 2018/19 will be additional appointments in the GP access hubs, and additional ANP home visits. We are working with providers to mobilise these services, and the details of numbers and spread of appointments and general practice/patient access to these will be finalised in September 2018 for a 1st October start

These will link with the wider winter resilience plans being put into place by the Urgent Care team, including the Hospital at Home model

The housebound flu vaccination programme for 2018/19: Planning meetings are being arranged with Bromley Healthcare, LMC, GP and Practice Manager representatives and the CCG from May up to winter

‘Liaison GPs’ have been recruited to the Discharge to Assess team at the PRUH. They are undertaking ‘discharge optimisation’ ward rounds pre-discharge and visiting patients placed in interim care home beds soon after discharge to provide general medical support for the patient

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Primary Care (2 of 4)

Primary Care Overview cont.

Out of Hours Primary Medical Services

Primary care access hubs continue 4pm-8pm opening on weekdays and 8am-8pm opening at weekends (therefore, 8-8, 7/7 has been in place since late January 2017)

Utilisation rates remain high (95% utilisation rate in August 2018) and we are actively tackling the 10% DNA rate with the implementation of text message reminders, which we anticipate will have a particular impact on the weekend appointments.

Utilisation of weekend appointments has grown significantly in recent months, with Saturday utilisation at 97% (Jan-June 2018) and Sunday utilisation at 96%.

The contract with the GP Alliance for the Access Hubs has been extended to 30th September 2019, as the CCG is undertaking a review of all urgent care services, including Access Hubs, Urgent Care Centre's and 111

Bromley’s current Out of Hours GP service runs from 6.30 pm to 8 am, with 24 hour cover at weekends and bank holidays, to ensure

access to Primary Care is available

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Primary Care (3 of 4)

GP Referrals 2018/19

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Following a significant increase in GP-made referrals into secondary care outpatients across SEL in the first quarter of 2018/19, Bromley has developed and commenced implementation of an action plan for improving the quality of referrals and preventing inappropriate referrals by Bromley GPs. This will include a range of measures, working with Bromley practices and the GP Alliance, covering action learning, peer review, clinical support tools, community service information and improved data for practices. This will be supported by a second year of the CCG’s Referral Optimisation LIS, due to launch in mid September.

Bromley’s recovery plan will contribute to the SEL recovery plan for referral growth that has been requested by NHSE and will give assurance up the line to the SEL Exec, as well as improving patient experience as unnecessary outpatient appointments (and waits) are avoided

0

2000

4000

6000

8000

10000

12000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Bromley CCG MAR GP Referrals

2016/17 2017/18 2018/19 YTD 2018/19 Plan

Financial

Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Grand Total

2016/17 8471 8025 8414 7851 8296 8037 8331 8361 7104 8056 8198 9470 98614

2017/18 7300 8743 8365 8070 8509 8111 8868 8652 6958 8791 8185 8859 99411

2018/19

YTD 8577 9944 8947 27468

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Appendix 1 – FFT Data Table – June 2018