Agenda item

Brent CCG: Commissioning Intentions

The Health Partnerships Overview and Scrutiny Committee will be aware that from April 2013, Brent Clinical Commissioning Group is responsible for the commissioning of health services in Brent.  In view of this the CCG has been asked to provide details of its general approach to commissioning and its immediate commissioning intentions.


Sarah Mansuralli, Brent CCG informed the Committee that the report set out the work plan for 2013/14, objectives and approach, providing an overview of how budgets would be allocated.  The report highlighted quality innovation and productivity plans as well as the way health services were commissioned and how the decision to procure services was taken.  It was explained that there were three ways in which health services could be procured; rolling and varying existing contracts, “any qualified provider” and through a traditional tendering process.  Under the NHS reforms, transactional support would be provided in terms of managing contract performance, business intelligence and supporting decisions to enable implementation by the CSU (Commissioning Support Unit).  It was explained that there was a new interface of working with the CSU and although a few teething problems these were overcome through good governance and working relationship with the CSU.


Rob Larkman, CCG highlighted that the commissioning process was cyclical, where priorities were formed through consultation with public providers and the local authority and services commissioned to meet the needs of residents.


During discussion, members queried how the requirement to consult on commissioning decisions had been fulfilled.  Rob Larkman informed the Committee that previous contracts such as out patient services were brought to the Committee for consultation.  He clarified that the contracts for cardiology and ophthalmology were currently at the preferred provider stage and therefore some information was not available as it was commercially sensitive.  Members queried the reliance on GPs to carry out additional cardiology and ophthalmology services.  It was clarified that the bids were from secondary care providers moving into the community.  Members highlighted that the contract specification appeared generic and appeared to suggest that there would be fewer first and second appointments for cardiology and ophthalmology and whether this represented a cut in the service.  Ethie Kong clarified that the service would be complemented by those provided in primary care, resulting in the patient being able to receive greater services such as diagnostics and ECGs at a surgery rather than needing to be referred to hospital.  Investment in cardiology equipment was taking place to offer an enhanced primary care service.  In response to queried regarding other enhanced services provided, Ethie Kong explained that some GPs offered diabetes clinics with individual cases being supported and managed where appropriate.  Enhanced services for ophthalmology included enhanced diagnostic checks through tracking high blood pressure rather than following the tradition route of referring to a hospital for basic checks.  Ethie Kong highlighted in response to questions that she did not have specific data relating to the number of patients who had been referred to hospitals for ECGs but agreed to provide the Committee with a copy of the recent CCG investment study.  Following queries in relation to the recent GP survey results and the lack of access to detailed data through the survey website, Ian Winstanley agreed to provide full data for Brent CCG and Brent GP practices broken down and analysed in a similar way to the survey received by the Committee several years ago.  It was agreed that this information would be passed to the Committee, as the basis for an agenda item on G.P access at the next meeting.  Ethie Kong informed the Committee that all 67 GP surgeries in Brent had signed up to receive investment and therefore all surgeries should have the same equipment to enable GPs to carry out service beyond the original contract.  Following queries on how much had been invested, it was agreed that this information would be provided.  In response to queries when all surgeries would have the ECG machines, it was confirmed that all machines had been ordered however they would not be used until GPs had received appropriate training and if members had any specific surgeries they had queries on then specific information could be provided outside the meeting.  Members queried how they intended surgery extended operating hours to work.  It was explained that the extended operating hours linked to the GP locality service where each locality would have an extended practice in which GPs had a share.  It was agreed that a detailed report would be brought to a future meeting for the Committee to explore GP access further.  In response to queries regarding enhanced ophthalmology it was explained that all bids would include the ability for GPs to consult an optometrist prior to referring a patient and being able to refer directly as well as be supported by consultants to manage patients.  Ian Winstanley felt it would be suitable for the providers once appointed to present the enhanced service offered to the Committee.  Members queried diabetic retina screening and it was confirmed that this was the commissioning responsibility of NHS England and therefore CCG representatives would not have detailed information available for the Committee. 


Members drew the CCG representative’s attention to concern that stakeholders and residents had not been adequately consulted on the proposed commissioning arrangements.  Sarah Mansuralli informed the panel that the CCG regularly consulted the public and patients and the commissioning arrangements specifically required that consultation took place.  It was clarified that the procurement process required a statutory consultation with patients, the residents and patient representation on procurement panelsFwave, with the EDEN Committee ensuring that the CCG fulfilled its statutory consultation duties.  In response to queries regarding rolling over existing contracts, it was clarified that following the establishment of the JSNA needs assessment and priorities, three waves of commissioning were agreed, with the next wave not commencing until the previous wave was completed.  Wave 1 was the commissioning of cardiology/ophthalmology services; wave 2 is musculoskeletal/ rheumatology /trauma and orthopaedics/gynaecology; wave 3 is any other remaining services. It was explained that the majority of contracts were rolled over in line with NHS England Planning guidance with adjustments for QIPP embedded into contracts and budgets where possible.  Contracts that required adjustment were negotiated early in the commissioning cycle to enable acute contract activity and investment.  Sarah Mansuralli informed the Committee that procurement often took place due to poor provider performance, opportunity to commission innovative models of care, opportunity to provide services closer to home and potential to achieve better value for money.  Ian Winstanley informed the Committee medical consultants were worked with to ensure best practice was sought and consulted as part of the process as well as undertaking the statutory consultation process.  Rob Larkman clarified that consultation was embedded within the commissioning governance arrangements and consulted partners and stakeholders as well as the EDEN consultation group, going beyond the required statutory consultation.  Rob Larkman agreed to provide the Committee with a list of consultees for cardiology and ophthalmology procurements.  The Committee queried the provider for services where a reprocurement exercise had taken place and whether these services were suitable.  It was confirmed that the existing service provider had received the decommissioning notices and continued to provide service until an appointment was made.  It was explained that the current service provider had reapplied for the contract and audits had been carried out to ensure there had been no impact on service delivery and to ensure patient safety.  It was explained that the decision to reprocure occurred after the current service provider were unsure whether they would be able to meet the needs of the CCG following dialogue so it was agreed to test the market.  It was clarified that a competitive dialogue was required to ensure that the CCG delivered the best service in terms of changes to technology and efficiencies.  Rob Larkman informed the Committee that the service currently provided did not support patients close to home and was to be reoccurred to improve the service to individuals through the quality received and improved access.  Members queried whether the improvements to service were based on GPs taking on additional work and whether this was feasible.  It was clarified that this was dependent on the model procured from the competitive dialogue but GPs were to be looked at within the process.  In response to queries regarding the improved health outcomes priority, it was explained that £13m will be invested into services through the assistance of QIPP to improve services such as dementia and learning disabilities, with a large quantity of the investment being released in 2013/14.  In relation to the shaping healthier futures initiative, it was felt that the investment proposals supported the scheme due to the shift of providing out of hospital care enabling a safer sustainable service in hospitals.  It was clarified that the investment was in line to support out of hospital services and to comply with legal standards, testing the market was required.




(i)            That the report be noted

(ii)          That a copy of the CCG investment study be provided

(iii)         Information be provided regarding the level of investment in GP surgeries’

(iv)         Information on Brent CCG and Brent GP practices broken down and analysed to be sent to the Committee based on the latest survey results

(v)          A report be provided on the extended opening hours of GP surgeries

(vi)         A list of consultees be provided to the Committee


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