Agenda item

Briefing note of Jenni Northcote, Coventry and Rugby Clinical Commissioning Group (CCG), who has been invited to the meeting for the consideration of this item

The Board considered a briefing note of Jenni Northcote, Coventry and Rugby Clinical Commissioning Group (CCG), which outlined the processes in place and approach taken by NHS Coventry and Rugby CCG in relation to the four APMS (Alternative Provider of Medical Services) contracts in Coventry which were due to expire on 31st March 2020. The briefing note also provided assurance that the CCG was seeking to commission appropriate service provision to meet the needs of registered patients along with assurance that the CCG had appropriately discharged its duties in respect to commissioning primary medical services and undertaken appropriate engagement with patients and key stakeholders. Jenni Northcote and Rose Uwins, Coventry and Rugby CCG attended the meeting for the consideration of this item.

The briefing note set out the background to the introduction of APMS contracts. In 2014/15 NHS England invited CCGs to take on greater responsibility for general practice commissioning through one of three models. In 2015 Coventry and Rugby CCG took on delegated commissioning responsibility operating under the terms of a Delegated Agreement with NHS England. This agreement set out the terms and conditions on how delegated primary medical care functions were to be exercised. CCGs were subject to an annual audit in this area. The report detailed the responsibilities of the CCGS under a delegated agreement. The Board were informed that primary medical services were delivered to registered patients through two types of contracts:

General Medical Services Contracts (GMS) – these contracts covered core medical services and were held by a gp or gp partnership and were in perpetuity (not time limited).

Alternative Provider Medical Services Contracts (APMS) – these contracts were provided under directions of the Secretary of State for Health and provided the opportunity for locally negotiated contracts. Primary Care Organisations (PCOS) could contract with non-NHS bodies to supply enhanced and additional medical services. PCOs could enter into contracts with any individual or organisation to meet local needs, as long as core NHS values were fully protected and secured. APMS contracts were time limited, usually 5 years.

The CCG currently had 4 practices in Coventry and 1 practice in Rugby operating under time limited APMS contracts. The Coventry practice contracts were due to expire on 31st March 2020. The practices concerned were Stoke Aldermoor Surgery;   Foleshill Surgery; Broad Lane Surgery and City of Coventry Centre Practice.

The Board were informed that the CCG had followed a due diligence process to consider the most appropriate commissioning response in respect of each of these contracts, within the existing legislative and procurement framework, taking account of existing service provision, future demand for primary medical care including demographic growth, housing growth projections and the anticipated increase in student population.

There were two options available to the CCG which were considered by the CCG’s Primary Care Committee in June: list dispersal (allowing the existing contracts to expire and supporting patients to register at existing local practices) or to undertake market engagement to explore provider interest in securing APMS contracts for the registered patient lists associated with the 4 practices.

The briefing note set out the decision making and patient engagement processes undertaken by the CCG to determine the most appropriate commissioning and contracting response. Appendices to the briefing note detailed the patient and stakeholder engagement and the market engagement with 12 providers who had expressed an interest in one or more of the contracts. Liaison was also carried out with local practices to understand the impact on neighbouring practices within a one to two mile radius. Having considered all the evidence, it was decided to go out to market engagement. The CCG also took the decision to procure contracts for five years plus a two years extension.   

Attention was drawn to the timetable which highlighted the next steps and timelines for taking forward the CCG commissioning and contracting obligations. Patient engagement would continue throughout the procurement process.

The Board questioned the representatives on a number of issues and responses were provided, matters raised included:

·  Whether it was possible to extend the existing contracts

·  Concerns at the overall position, particularly since patients could be faced with having a new doctor when patients valued continuity of care

·  Concerns about gp patient numbers being below the 3,500 practice threshold and who determines this number

·  An acknowledgement that some doctors preferred the option of having a salaried position rather than becoming a part owner in a gp practice

·  Clarification that with the different types of contracts, the tax payer was getting value for money, particularly in light of the funding incentives with the APMS contracts

·  A request for members to be provided with information about the value of the contracts and was it difficult for other providers to put in a bid

·  Further information about the consultation undertaken with patients at the four practices

·  Further information about the questions on the questionnaire since all the issues set out would be important to patients

·  What were the views of patients, were they accepting of the situation or resisting potential change

·  In light of the low level of feedback received to the consultation, a suggestion to use citivision to get information out to patients. 

RESOLVED that:

(1) The content of the report be noted.

(2) The link to the tender documents be circulated to members when the documents are made available to the public.