Agenda item

Report to follow.

Vanessa Piper, Assistant Director of Primary Care Contracts and Commissioning for NCL, provided an overview on quality and performance monitoring of GP practices. The NCL Integrated Care Board (ICB) had responsibility for monitoring the contracts of 180 GP practices in the NCL area in line with national primary care regulations and policy guidance produced by NHS England.

Vanessa Piper explained that there were clear processes in place for any quality or performance issues that were identified and the ICB’s Primary Care Contracts team and Quality team worked together to respond to any trigger indicating quality concerns or underperformance. This could include from a patient complaint, infection control issue or an adverse rating from the CQC. While CQC reports were carefully scrutinised, any ICB investigation was carried out independently from the CQC and examined a range of quality data over three or four financial years. They would also then speak to the Practice about any specific concerns or challenges that they may be facing. The ICB Primary Care Contracts team meets with the CQC and the NHS England Medical Directorate on a fortnightly basis to discuss cases and share relevant information. Recommendations are then taken to the Primary Care Contracts Committee which meets on a bi-monthly basis and is attended by HealthWatch, local councillors and community representatives. The recommendations can include improvement action plans for individual practices or more formal contractual action.

Vanessa Piper then addressed concerns that had previously been raised by the Committee relating to reporting by the BBC Panorama programme about physician associates and the GP/patient ratio at a London GP practice. Although this practice was not in the NCL area, the ICB had started to scrutinise GP FTE workforce ratios in NCL. The current figures indicated that the ratio was too low in some practices, but it was also the case that a number of practices had not recently logged onto the National Workforce Reporting System meaning that the data was not accurate in some cases. The primary care team was therefore working with practices to improve reporting. They would also work closely with practices over the supervision and training of physician associates through the core primary care contract. In addition, the CQC looked at employment and training records through its regulatory inspections.

Vanessa Piper then responded to questions from the Committee:

• Cllr Connor referred to the concerns about the GP practice in south London that was covered by the BBC Panorama programme and asked how the monitoring practices in the NCL area would prevent a similar issue from occurring. Vanessa Piper noted that the detail of the GP practice would not be known until the CQC report was published. She added that, while ICBs had monitoring processes in place, some practices could get into a pressured position which could lead to quality and performance concerns. On top of the process described in the report there was also an annual contract review process on all primary care contracts which included questions on clinical governance and issues of protocol that practices should have in place.
• Cllr Bevan asked whether the monitoring process checked whether practices had patient participation groups established and whether these were effective. Vanessa Piper said that the ICB would survey the groups if there were any contractual changes. In addition, if there were any specific concerns triggered with a practice, the ICB would review how effectively the practice was engaging with its patient population.
• Cllr Bevan described a GP practice on Tottenham High Road which was covered in graffiti and asked whether issues such as the condition of the buildings used were included in the monitoring process. Vanessa Piper explained that an Estates Strategy was produced for the NCL area and each borough. The ICB had recently commissioned an audit of primary care estates which would consider the condition of buildings as well as issues such as infection control. There was also an NCL Estates team which looked at the condition of premises and at what additional primary care capacity was required.
• Asked by Cllr Cohen for details on the number of occasions when concerns about practices had been raised and how information about specific concerns was reported to the public, Vanessa Piper said that information was available through the Primary Care Commissioning Committee’s dashboard which included performance data, including CQC ratings, for the 180 GP practices in the NCL area. The Committee had also recently committed to provide a summary including detail of the concerns relating to a specific practice and of what action was being taken as a result. This information would be provided to the public part of the Committee’s meeting and would therefore be published on the ICB’s website.
• Asked by Cllr Revah how patients know where and how to complain, Vanessa Piper explained that all practices should operate a complaints procedure. Alternatively, patients could go to the NHS England complaints team or the ICB’s complaints team who could ask the practice to respond to the complaint.
• Cllr Connor noted the previous comments that a number of practices had not recently logged onto the National Workforce Reporting System meaning that data on the GP FTE workforce ratio was not always accurate. She asked what assurances could be given that this would be enforced in future. Vanessa Piper suggested that further guidance on this could be provided to practices in future including clarity on the roles of the workforce and of supervision and training for staff. There was some existing guidance under the Primary Care Network directives which could be shared with practices.

The Committee then proposed recommendations based on the information that they had heard:

• The Committee recommended that the reporting from GP practices on the GP FTE workforce ratio onto the National Workforce Reporting System should be a requirement that was enforced.
• While Members of the Committee welcomed the publication of concerns relating to a specific practice on the ICB website, they felt that most patients would not necessarily know where to find this information. The Committee recommended that there should be greater clarity on how this information would be communicated to patients and suggested that this could include a link to the relevant information on the website of the GP practice concerned. (ACTION)