Thank you Lesley, Vijay and Ian has confirmed each PCN is entitled to half of the £7.46 for this year. In Ealing this has been an area of contention, good to get it in writing.
Suk Get Outlook for iOS<https://aka.ms/o0ukef> ________________________________ From: Lesley Williams via Nwl_cd <[email protected]> Sent: Wednesday, May 18, 2022 5:09:46 PM To: [email protected] <[email protected]> Cc: WINFIELD, Cathy (NHS NORTH WEST LONDON CCG) <[email protected]>; PARK, Paul (NHS NORTH WEST LONDON CCG) <[email protected]>; Asiya Yunus <[email protected]>; ILLIAMS, Lesley (NHS NORTH WEST LONDON CCG) <[email protected]> Subject: [Nwl_cd] FW: Enhanced Access Pack for PCN CDs and practices This message originated from outside of NHSmail. Please do not click links or open attachments unless you recognise the sender and know the content is safe. Dear all Please find below the LMC concerns re the enhanced access pack and covering letter that you may have received from Julie Sands. We hope this is helpful and would welcome your views and concerns. 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From: Cathy Winfield <[email protected]> Sent: 18 May 2022 16:25 To: SANDS, Julie (NHS NORTH WEST LONDON CCG) <[email protected]> Cc: SEHGAL, Javina (NHS NORTH WEST LONDON CCG) <[email protected]>; MCGALE, Joe (NHS NORTH WEST LONDON CCG) <[email protected]>; TAILOR, Vijay (NHS NORTH WEST LONDON CCG) <[email protected]>; GOODMAN, Ian (MOUNTWOOD SURGERY) <[email protected]>; Lesley Williams <[email protected]>; Paul Park <[email protected]>; Asiya Yunus <[email protected]> Subject: RE: Enhanced Access Pack for PCN CDs and practices Importance: High Dear both, Thanks for this further information on Enhanced Access. We had already prepared a response following Joe’s presentation to CDs last week. We have added some comments in relation to the information Julie has sent. We fully appreciate the challenge that the London ICSs face with the national DES representing a shortfall in current provision for London. Our understanding is that London Region have escalated this to NHSE and it has been raised with DH. There may be a different solution for London with regards to this issue. However, we are clear that the DES only mandates PCNs to deliver the stated Network Contract hours. Whilst there is some flexibility on when these hours can be delivered the provision still falls short of the current level. The funding for the DES comprises the £1.44 plus the £6.00 that CCGs have previously used to commission extended access. The total sum goes to PCNs as part of their allocation. We note that the letter to CDs and practices refers to £3.76 – please can you explain the shortfall in funding? It was helpful to see the utilisation data but it would be useful to look at this data specifically for the periods not covered by the DES e.g. 5.00 – 8.00 pm on Saturdays and Sundays. This would indicate how much of an impact reducing the capacity to the DES spec would have. As far as we understand it the activity of the hubs has largely been about demand on the day, whereas the emphasis of the DES in on pre bookable appointments. As the system moves back to increasing numbers of pre bookable appointments we may well see less demand on the day at week ends from people who have not been able to book routine appointments mid week. In North Central they reported that pre Covid they had a lot of unused capacity at week ends but this changed during Covid when the access to general practice changed. What was the pattern in NWL and do we need to plan week end capacity based on the pre Covid model as we restore services? We are concerned about some of the statements on slide 26 in Joe’s presentation: * The proposed model from 1st October should not see a reduction in overall access. Unfortunately there will be a reduction in access as Sundays are not mandatory in this scheme and the NHSE Q and A make this clear. This statement may confuse practices and lead them to think they will have to provide Sat and Sun 8-8 to avoid a reduction in access from within the DES funding envelope. This is not the case. * PCNs to consider provision of EA on Sundays and BH. PCNs could provide appointments on Sundays and BH, if local engagement suggested that this was warranted, but they would then need to reduce the hours on Saturday or mid week to achieve this. It might be that PCNs flex appointments over the year to provide additional cover at peak periods or over 4 day BHs but they cannot provide hours beyond those set out in the DES within the funding envelope. * Ensure IT interoperability This is a critical part of the DES but it is an area where the CCG will need to support as it is not entirely within the gift of PCNs to deliver – who is the Digital lead for this? * Make agreed number of pre booked 111 slots available 1 per 1.5 hours This is not part of the DES which simply requires PCNs to make unused appointments available to 111 but does not specify a number. The emphasis of the DES is on pre bookable appointments and routine primary care. There is a wider question about the appropriateness of 111 dispositions to primary care and plenty of examples of 111 driving inappropriate demand in primary care (and ED). It would be wrong to invest in capacity to meet this type of demand and it may be more appropriate to invest in an effective CAS in 111 so that they can close more cases and reduce dispositions to primary care and ED. * We agree that patient engagement is going to be critical. However, it will be important for people to understand that PCNs are charged with implementing a national specification so the focus of the engagement will need to be on how it is implemented rather than what. There are 14.5 additional hours being commissioned through the DES and the question to patients is when these are best delivered. It is also going to be important to frame the discussion around need and not wants within a cash and capacity constrained system. The discussion could be informed by the activity analysis we have suggested above. We are also concerned that your guidance to PCNs to have a minimum of 4 meetings and the channels to be used is overly prescriptive. You mentioned that the CCG intends to support the engagement work but on the timeline this sits with PCNs and the support seems to be limited to drafting the patient survey. May is nearly over and until PCNs have the opportunity to think about how they intend to implement the DES it is difficult to commence engagement. We are particularly concerned by the comms material and patient survey which states that the current provision of 8-8 and Sundays will continue. We do not think the activity analysis has yet been done to support this requirement and we are unclear how the ICS will fund this, given the current budget transfers to PCNs and the CCG has a financial deficit. Has a business case been agreed to support the ongoing commissioning of current levels of provision? We would be worried about making statements in the public domain that cannot subsequently be supported. * We are pleased to see the role of Borough teams set out and their support is going to be critical. They could support with Comms, patient and partner engagement and the EQIA, for example. In other areas the ICSs are stating their intention to take a collaborative and supportive approach and giving clear instruction to PCNs to submit plans that meet the DES requirement and do not go beyond this. We are aware of proposals for a CD workshop, for example, that will be led by the ICS and cover: * PCN challenges * Links to the Fuller Review * Patient engagement * Role of the ICS * Feedback from PCNs on current thinking * Pt views – from HW and PPG reps * Break out sessions on: 111, engagement, digital, and costing approaches supported by subject matter experts. * It would be really helpful if NWL could consider running a similar workshop – perhaps at Borough, or groups of Borough level, given your size. We would be very happy to support any such workshops. I think you mentioned a Task and Finish Group for EA had been established and we would like to be part of this please. It would also be helpful to ensure read across to the wider Access Task and Finish Group. We hope these comments are helpful and we can work with you to support our PCNs to deliver this challenging agenda. Cathy Winfield Director of Primary Care Londonwide LMCs Mobile: 07458 144381 Email: [email protected]<mailto:[email protected]> Diary management: [email protected]<mailto:[email protected]> From: SANDS, Julie (NHS NORTH WEST LONDON CCG) <[email protected]<mailto:[email protected]>> Sent: 18 May 2022 10:02 To: Cathy Winfield <[email protected]<mailto:[email protected]>> Cc: SEHGAL, Javina (NHS NORTH WEST LONDON CCG) <[email protected]<mailto:[email protected]>> Subject: Enhanced Access Pack for PCN CDs and practices Hi Cathy, please find attached the pack and cover letters going to PCN CDs and practices today to support their thinking and preparation of their plans for enhanced access from 1st October 2022. The pack includes: 1. A slide pack which provides an overview of National Enhanced Access requirements and sets out the NWL Enhanced Access Engagement & Development Principles and the key timelines 2. A supplementary pack with baseline information on existing service provision and utilisation data (further data will be provided by your borough team) 3. A checklist of areas for PCN consideration when developing Enhanced Access plans 4. A communications pack and tools to support engagement incl. NWL Patient Survey, Equalities Impact Assessment template The online patient survey that was developed with patients and leads is being offered to PCNs to collect feedback from their patients is going live shortly so it is ready for any PCNs to use to direct patients to. Happy to talk this through if you’d find that helpful. 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