Report to the Board October 27 2010 School House Practice – GP Led Health Centre 1.
The purpose of this paper is to: • • • • 2.
Report on the performance of the School House Practice Note the proposed changes to the School House Practice to enable the contract to be managed within the contracted financial envelope Consider the implications of the changes to the wider urgent care agenda Note that discussion has taken place with the LMC and practice based commissioners, who are supportive of the proposed actions set out in this report. Background
The School House Practice opened on the 1st March 2009. The service offers a GP Service for registered patients and non-registered patients and is open 8.00am to 8.00pm seven days a week, every day of the year. The current list size is (1st July 2010) 948. 3.
Year 1 Position
The contract is an activity based contract, with the provider being paid an agreed price for each registered patient and a different agreed price for each walk in attendance. In year one the level of non registered activity was significantly in excess of the planned levels (more than double). Registered list size was 80% of that planned. This resulted in a significant financial pressure of c£350k and necessitated an arbitration process to achieve resolution. If we do nothing to manage non registered activity and allow the registered list size to grow to the planned level from year 2 this will result in a significant financial pressure. This could be between £300k to £500k in each of the remaining 4 years of the contract.
Current and Future Years – Revised Proposal
The provider has submitted proposals to manage within the contracted financial envelope. Importantly this moves the contract from an activity based one to a fixed price contract with an agreed level of capacity. This capacity can then be used to provide a mix of registered and walk in patient appointments. These proposals are based on reducing the levels of non registered patients and growing the list size in such a way as to balance the overall numbers of appointments within the available capacity funded by the contract. The reductions in walk in activity are achieved by: • •
Reducing opening hours progressively over the remainder of the contract such that they ultimately complement existing GP access. The PCT and Provider working together to manage demand for walk in services by highlighting heavy users (either patients or practices) and addressing underlying issues for this.
Following discussions between NHS Kirklees and the provider (Local Care Direct), it is proposed that for the current year (20010/11 – year 2 of the contract), opening hours are reduced to 12:00 to 20:00 between Monday – Friday, with the opening hours of 8am – 8pm remaining for weekends and bank holidays. The impact of this change would be monitored closely for the rest of the year and a decision then made as to arrangements for future years. In addition to the change affecting non-registered patients, it is proposed that the registered list size would grow to 2,700 over the remaining 4 years of the contract compared with the initial commissioning intention of 3,000. This means that the revised proposal substantially delivers the commissioned levels of walk in and registered patient activity, but does so by reducing the opening hours of the walk in element of the service. To support this, the provider is also asking: a. To vary the target for the length of time that patients can wait for a walk in appointment which currently is specified as 30 minutes. b. To agree protocols for categorising non urgent patients, and how these will be handled and possibly turned away. c. To agree a revised approach to the KPIs within the contract to reduce the administrative burden of collecting information. d. To remove the ‘no detriment clause’ in the contract and allowing the provider to encourage the registration of patients who attend as walk in patients.
The requirement to commission a GP Led Health Centre was a policy of the previous Government, however we are aware of other PCTs around the country who are looking to change the contract terms to reduce opening hours or decommission the service. Any changes may have implications for local practices, patients, urgent care work and future GP Consortia and ongoing work is required to understand these and monitor the impact of the changes (for example on A&E attendances). 6.
It is recommended that the Board: • • • •
Supports the move to a fixed price contract for years 2 to 5 of the contract. Agrees the principle of reducing opening hours in year 2 of the contract as set out in the paper, and the agreement of bullet points a, b, c, and d in section 4 to support this. Supports ongoing work to monitor the impact of these changes. Notes the content of the Equality Impact Assessment in Appendix 1.