Primary Care Performance and Quality Report

July 2018 Author: Sue Gunner, Analyst - Planning & Performance

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ENCLOSURE 7

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Contents

Page Number

Introduction 3

Friends & Family Test (FFT) 4

GP Patient Survey – Out of hours services 7

Primary Care – Narrative Update 14

CQC Ratings 15

Appendix 1 – FFT Data Table 17

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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 will be predominantly driven by data that is published nationally, but will be 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.

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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 April 2018. It should be noted that 18 practices did not submit data:

South View Partnership, Dysart Surgery, Derry Downs Surgery, Summercroft Surgery, Station Road Surgery, Cornerways Surgery, Charterhouse Surgery, Elm House Surgery, St James' Practice, Robin Hood Surgery, Ballater Surgery, Gillmans Road Surgery, Highland Road Surgery, Wickham Park Surgery, Bank House Surgery, Cross Hall Surgery, Crescent Surgery and Cator Medical Centre.

Additionally two practices submitted data but the number of responses was less than five so the results were supressed:

Manor Road Surgery and Bromley Common Practice.

Note: Detailed FFT data is included as appendix 1 (page 17)

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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. It is more than three years since the two-year rollout of the FFT across NHS-funded services was completed. Since then patients have consistently been contributing about 1.2 million pieces of feedback every month, demonstrating the appetite of members of the public to tell staff what they are doing well and where improvements can be made, particularly where they give comments on their experience in addition to their rating. Stakeholder surveys NHS England are inviting providers, commissioners and FFT suppliers to complete a survey to tell us how they currently use the FFT and how they might be impacted by any changes to the current guidance. Individuals are welcome to complete this as we have not restricted it to one response per organisation. We understand it may be used and experienced differently by different professionals and it is useful to have a range of perspectives. Responses will provide vital information to the project team to help shape decision-making. The surveys are open until 31 July and the Commissioners Survey can be accessed here https://www.engage.england.nhs.uk/survey/2018-fft-development-project-commissioners/

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Friends & Family Test (3 of 3)

Notes: The highest number of responses for an individual practice was 239 (Chislehurst Medical Practice).

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

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients’ experiences of their GP practices. The survey is run by Ipsos MORI on behalf of NHS England. The data in this report is based on the July 2017 GPPS publication. This combines two waves of fieldwork, from January to March 2017, providing practice-level data. The survey is sent out annually in January on behalf of NHS England. 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 following data represents some of the key results for Bromley CCG. In Bromley CCG 12,321 questionnaires were sent out and 4,937 were returned completed. This represents a response rate of 40%. The 2018 GP Patient Survey data will be available in early August 2018 . The resesult for

GP Survey (1 of 7)

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GP Survey (2 of 7) The GP Patient Survey measures patients’ experiences across a range of topics, including:

Making appointments Perceptions of care at appointments Waiting times Practice opening hours Out-of-hours services

This month’s report will focus on ‘Out of hours services’

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 %

18 to 24 years 374 8

25 to 34 years 773 16

35 to 44 years 915 19

45 to 54 years 950 20

55 to 64 years 727 15

65 to 74 years 591 12

75 to 84 years 372 8

85+ years 169 3

GP Survey (3 of 7)

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The out-of-hours service questions are only asked of those who have recently used an NHS service when they wanted to see a GP but their GP surgery was closed. As such, the base size is often too small to make meaningful comparisons at practice level; practice range within CCG has therefore not been included for these questions. (Ipsos MORI Social Research Institute)

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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GP Survey (7 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

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

Bromley CCG has the highest OP utilisation rate in south east London

CCG November December January February March

Bexley CCG 75.9% 62% 73.6% 77.4% 77.3%

Bromley CCG 89.2% 78% 85.2% 84.1% 82.0%

Greenwich CCG 56.4% 53% 67.1% 72.0% 72.1%

Lambeth CCG 46.5% 44% 52.9% 55.6% 58.9%

Lewisham CCG 49.4% 61% 67.2% 75.7% 79.5%

Southwark CCG 43.0% 42% 54.1% 57.6% 59.6%

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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 (2 of 2)

Practice Name Overall CQC RatingDate 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 16/03/2016Poverest 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 26/02/2018Sundridge 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 25/11/2016Wickham Park Surgery Good 29/09/2016

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

Forge Close Surgery Good 04/04/2016Highland Medical Practice

Requires Improvement 19/12/2017

Gillmans Road Good 19/08/2016 Manor Road SurgeryRequires

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 SurgeryNew Premises - Not

yet assessedService 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

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Appendix 1 – FFT Data Table – April 2018 England ######## 266,373 90% 6% 189,602 49,433 8,915 6,224 9,329 2,870 37,183 2,494 6,864 189,951 10,725 2,328

Selection (excluding supressed data) 349,028 1,413 89% 5% 805 453 75 47 25 6 193 0 0 1,123 8 1G84001 SOUTH VIEW PARTNERSHIP SOUTH VIE BR1 3DR 13,340 no data no dataG84002 DYSART SURGERY 13 RAVENS BR1 1HN 11,699 no data no dataG84003 LINKS MEDICAL PRACTICE THE LINKS BR1 4PX 10,896 163 87% 8% 84 58 8 6 7 0 0 0 0 163 0 0G84004 STOCK HILL SURGERY THE SURGE TN16 3TJ 10,487 42 79% 12% 16 17 4 3 2 - - - - 42 - -G84005 DERRY DOWNS SURGERY 29 DERRY D BR5 4DU 5,181 no data no dataG84006 SUMMERCROFT SURGERY STARTS HI BR6 7AR 10,870 no data no dataG84007 POVEREST MEDICAL CENTRE 42 POVERE BR5 2DQ 8,988 13 46% 8% 3 3 4 1 0 2 12 0 0 0 0 1

G84008 MANOR ROAD SURGERY THE SURGE BR3 5LE 5,732 1 Less than 5 responses * * * * * * * * * * * * *

G84009 FAMILY SURGERY THE FAMIL BR6 6BG 3,920 12 92% 0% 6 5 1 0 0 0 12 0 0 0 0 0G84010 CHISLEHURST MEDICAL PRACTICE THE CHISL BR7 5AQ 15,122 239 90% 4% 148 68 14 7 2 0 1 0 0 238 0 0G84011 EDEN PARK SURGERY 194 CROYD BR3 4DQ 8,607 11 91% 0% 8 2 1 0 0 0 10 0 0 0 1 0G84013 ST MARY CRAY PRACTICE 322 HIGH S BR5 4AR 2,617 12 92% 0% 7 4 1 0 0 0 12 0 0 0 0 0G84015 STATION ROAD SURGERY 74 STATIO BR4 0PU 12,098 no data no dataG84016 LONDON LANE CLINIC THE LOND BR1 4HB 15,125 43 86% 9% 22 15 2 2 2 0 41 0 0 0 2 0G84017 ADDINGTON ROAD SURGERY 77 ADDING BR4 9BG 9,671 115 85% 8% 55 43 8 8 1 0 0 0 0 102 0 0G84018 CORNERWAYS SURGERY 50 MANOR BR3 5LG 8,684 no data no dataG84019 BROOMWOOD ROAD SURGERY BROOMW BR5 2JP 10,352 180 84% 9% 96 56 9 10 6 3 0 0 0 180 0 0G84020 CHELSFIELD SURGERY 62 WINDSO BR6 6HD 8,159 111 100% 0% 76 35 - - - - - - - 111 - -G84021 CHARTERHOUSE SURGERY THE CHART BR6 9JN 6,921 no data no dataG84022 TRINITY MEDICAL CENTRE 33 CROYDO SE20 7TJ 5,078 10 80% 0% 4 4 2 0 0 0 10 - - - - -G84023 SOUTHBOROUGH LANE SURGERY CROWN M BR2 9GT 10,985 29 93% 3% 18 9 1 0 1 0 27 0 0 0 2 0

G84024 BROMLEY COMMON PRACTICE CROWN M BR2 9GT 9,542 1 Less than 5 responses * * * * * * * * * * * * *

G84025 THE PARK PRACTICE OAKS PAR SE20 8QA 7,578 68 88% 4% 37 23 4 2 1 1 0 0 0 0 0 0G84027 ELM HOUSE SURGERY BECKENHA BR3 3FD 18,562 no data no dataG84028 ST JAMES' PRACTICE ST.JAMES' BR3 4DG 6,525 no data no dataG84029 ROBIN HOOD SURGERY 94 CROYDO SE20 7AB 4,656 no data no dataG84030 FORGE CLOSE SURGERY 1 FORGE C BR2 7LL 6,701 6 100% 0% 5 1 0 0 0 0 5 0 0 0 1 0G84032 KNOLL MEDICAL PRACTICE 64 SEVENO BR6 9JL 8,882 98 93% 3% 55 36 4 3 0 0 0 0 0 98 0 0G84033 PICKHURST SURGERY 56 PICKHU BR2 7JF 7,378 92 93% 4% 64 22 2 3 1 0 0 0 0 92 0 0G84035 TUDOR WAY SURGERY THE TUDO BR5 1LH 7,491 42 90% 2% 15 23 3 1 0 0 34 0 0 8 0 0G84039 NORHEADS LANE SURGERY 14A NORH TN16 3XS 3,092 34 94% 3% 26 6 1 1 0 0 2 0 0 34 0 0G84040 BALLATER SURGERY 108 CHISLE BR6 0DP 9,854 no data no dataG84041 GILLMANS ROAD SURGERY 1 GILLMAN BR5 4LA 3,177 no data no dataG84604 HIGHLAND ROAD SURGERY 10 HIGHLA BR1 4AD 3,996 no data no dataG84607 WICKHAM PARK SURGERY 2 MANOR BR4 9PS 5,281 no data no dataG84609 BANK HOUSE SURGERY BANK HOU BR6 7BA 3,083 no data no dataG84621 WHITEHOUSE SURGERY 123 TOWN BR5 1EL 3,561 5 100% 0% 3 2 0 0 0 0 5 0 0 0 0 0G84624 ANERLEY SURGERY 224 ANERL SE20 8TJ 2,539 12 100% 0% 7 5 0 0 0 0 12 0 0 0 0 0G84625 OAKFIELD SURGERY 17 OAKFIE SE20 8QA 3,964 6 100% 0% 6 0 0 0 0 0 6 0 0 0 0 0G84627 GREEN STREET GREEN MED CT 21-21A HIG BR6 6BG 7,381 20 80% 5% 12 4 3 0 1 0 2 0 0 18 0 0G84628 CROSS HALL SURGERY 31 HIGH ST BR5 3NL 3,312 no data no dataG84629 SUNDRIDGE MEDICAL CENTRE SUNDRIDG BR1 4HE 5,369 7 86% 0% 6 0 1 0 0 0 0 0 0 0 0 0G84630 CRESCENT SURGERY THE CRESC BR5 2DD 2,315 no data no dataY00542 WOODLANDS PRACTICE THE WOOD BR7 6DB 9,783 41 93% 2% 26 12 2 0 1 0 2 0 0 37 2 0Y02811 CATOR MEDICAL CENTRE BECKENHA BR3 3FD 10,474 no data no data

Primary Care Overview PMS Premium Services. Practice Development Plans for both wave 1 and 2 practices are being reviewed by the PDP Panel each month, which

includes CCG and LMC representation. To date, 39 practices have submitted plans; four are outstanding; and two practices have opted out of providing the PMS Premium. The deadline for all plans is 30th June 2018. A reflection piece on this element of Bromley CCG PMS commissioning together with analysis of themes across the plans will commence from June and learnings will be shared with the PCSG/PCCC, SEL colleagues, LMC and feed into the PCNA

Primary Care Needs Assessment. Dr Agnes Marossy is continuing her work on the Bromley Primary Care Needs Assessment. A Workforce

Clinical Reference Group was held on 27th February with GP practice staff and CCG colleagues to discuss the workforce issues facing general practice and how best to address them. A follow up CRG is planned for 26th June to report back on the action plan from the first meeting and further develop implementation plans. Data gathering for the second annual workforce survey is now complete from 100% of practices. And has shown that GP vacancies have increased since last year. Other deep dive work is ongoing around practice DNA rates.

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: 78% of practices were visited in June-Sept 2017 91% of practices were visited in Oct-Dec 2017 89% of practices were visited in Jan-Mar 2018

A reflection piece on GP practice visits and wider engagement by the primary care team has gone to the PCSG in April 2018 for discussion. This will also go to the LMC and PCCC in July.

Review of medical support to care homes (Visiting Medical Officer scheme). The existing Visiting Medical Officer (VMO) contract was due to cease on 31 March 2018 and the service specification and remuneration rates have not been refreshed since 2010. There has been a lack of overarching strategic direction around care homes in recent years, and a lack of joint working between the CCG and the council as the two main commissioners of care home placements. Despite several reviews, this has made it difficult for the VMO scheme to be refreshed to align with an overall vision of health and social care in a more effective commissioner/provider context. We are now remedying this by: Extending the existing VMO arrangements to 31st March 2019 Developing joint care homes strategic and operational groups with the council, that will deliver change plans Robustly engaging with local VMOs, care homes, patients, commissioners and partners (e.g. St Christopher’s), and learning from good

practice in other areas Implementing a new commissioning model for enhanced support to care homes. Through engagement at GP cluster meetings, with

Bromley LMC and at the CCG’s CEG and PCCC meetings, we have now selected an APMS contract model Aiming to invest funding from the Better Care Fund to top up CCG budgets to provide this support Improving the contribution of the wider health system towards care of care home residents Commencing market engagement in early summer 2018 and procurement by August, ahead of a ‘go live’ start date of 1st April 2019 18

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 submitted two bids for the £2m SCF funding allocated to SEL. 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 An assurance process has taken place to assure NHSE that SEL projects are sound and ready for implementation in 2018/19, and we are waiting to receive formal feedback. Funding should be released in June 2018, following which the CCG (and CEPN for project 2) will discuss with local practices, the LMC and other stakeholders their priorities for investment.

Winter resilience schemes for 2017/18: In lieu of the GP Home Visiting service, additional support within the BHC rapid response service has been in place since 26th December. This

is being extended until the end of May 2018 Additional appointments (10%) in the access hubs have been in place since 1st October and utilisation remains high A review of the housebound flu vaccination programme has taken place, and 2018/19 planning meetings are being arranged with Bromley

Healthcare, LMC, GP and Practice Manager representatives and the CCG from May ‘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

The 2017/18 Referral Optimisation Local Improvement Scheme has been evaluated. 37/45 practices signed up to the LIS There has been good attendance at the education sessions and the Action Learning Meetings. A survey has gone out to participating

practices to seek their feedback on these elements of the scheme EMIS Resource Publisher is still not yet in place – the risks have been escalated and are being picked up with EMIS with urgency Referrals are still increasing steadily compared to the 16/17, although there was a reduction in referrals in November 2017 compared to the

November 2016. Over September to November 2017 (since the ALMs) , referrals in general have reduced or stayed the same. The Primary Care Steering Group approved recommendations to continue an amended version of Referral Optimisation LIS in 2018/19

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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 (97% utilisation rate in December 2017) and 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. The contract with the GP Alliance for the Access Hubs has been extended to 30th September 2018, as the CCG is undertaking a review

of urgent care services, which the Access Hubs interface with through Urgent Care Centre booking into hub slots. 22 people attended a patient engagement event in January 2018 to seek public views on the current Access Hub provision and how it

can be improved. The feedback captured will be reflected on and considered for future service developments, in particular better communication about what the Access Hubs offer and other healthcare services that are available to better educate patients on accessing the right care at the right time

Bromley’s current Out of Hours 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)

Primary Care (4 of 4)

Primary Care Overview cont.

E-Referrals – Outpatient Utilisation

The table below sets out Bromley’s outpatient e-referral utilisation rates over the course of 2017/18. Bromley CCG has the highest OP utilisation rates in South East London – March data is not final and is provisional from NHS Digital weekly reports.

Numbers are draft until published in NHS Englands quarterly IAF reports.

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CCG Name Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

NHS BEXLEY CCG 60.0% 55.4% 58.8% 61.7% 62.1% 67.3% 63.6% 69.0% 63.3% 73.6% 77.3% 85.2% NHS BROMLEY CCG 60.6% 66.2% 71.4% 66.8% 68.0% 77.4% 86.3% 89.7% 84.8% 85.2% 84.0% 87.4% NHS GREENWICH CCG 46.8% 49.2% 49.0% 53.0% 49.5% 50.2% 45.7% 55.6% 55.5% 67.1% 72.0% 73.9% NHS LAMBETH CCG 23.2% 21.7% 23.9% 26.3% 30.3% 43.9% 45.2% 48.9% 49.2% 52.9% 55.5% 60.2% NHS LEWISHAM CCG 49.9% 50.8% 50.8% 49.0% 49.9% 47.9% 49.8% 50.6% 55.7% 67.2% 75.7% 77.2% NHS SOUTHWARK CCG 26.4% 28.7% 29.9% 30.6% 32.5% 41.5% 45.4% 47.1% 49.9% 54.1% 57.6% 61.4%

40.00%

60.00%

80.00%

100.00%

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

NHS BROMLEY CCG

NHS BROMLEY CCG