Dear all FYI Kind regards Lesley Lesley Williams Assistant Director Primary Care Strategy Londonwide LMCs and Londonwide Enterprise Ltd Tel: 020 7387 2034 ext *221 Direct Dial: 020 3818 6221 Mobile: 07768 109690 Email: [email protected]<mailto:[email protected]> Web: www.lmc.org.uk<http://www.lmc.org.uk/> Twitter: @LondonwideLMCs
From: Londonwide LMCs <[email protected]<mailto:[email protected]>> Sent: Thursday, February 23, 2023 11:01 AM To: Subject: NWL enhanced services contract offer, update 1 - 23 February 2023 To view this email as a web page, go here.<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fview.email.lmc.org.uk%2F%3Fqs%3D187179349c511b784e9dde88f110b8aaae830cef2b7e4080b587f7d3a9b39dbd0141e6604011da976e35e8dceb3b3d3b24ea8affcb446e2e4b429ab52def4fac6d43cae640fe8581&data=05%7C01%7CLesley.Williams%40lmc.org.uk%7Ceb671006993646910f8308db15950b6a%7C5670c82635004dfd9a7fc45939b3c53f%7C0%7C0%7C638127502118310860%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=J%2Fub8Uz8W0DBxnVV14MxtVgw39a4W89oeG4AkjZzqrY%3D&reserved=0> [Londonwide Logo] [https://image.s6.sfmc-content.com/lib/ffcf14/m/1/spacer.gif] Thursday 23 February 2023 Dear practices, NWL enhanced services contract offer, update 1 - 23 February 2023 We are writing with a further update regarding the NWL enhanced services contract offer, following discussions with borough LMCs, CDs and PCN member practices. To recap, the two most significant changes involved in the proposed approach are: * Firstly, that the member practices of each PCN will collectively be responsible for ensuring the delivery of all the local enhanced services in the single contract to their combined patient population, rather than each practice being able to select individual services to deliver to its own registered patients. * Secondly, a large volume of work traditionally undertaken by commissioners will shift from ICB to PCN level, requiring additional capacity and, in most cases, new skills and expertise to be brought in. Many of these services are currently being delivered effectively at a practice or borough level, however delivery of these enhanced service specifications will be new to many practices or boroughs and there is limited allowance for training, set up and management costs. We remain immensely concerned that the timeframes available prior to the proposed rollout date do not provide enough time or flexibility for the majority of practices to put in place arrangements for delivery of the contract as proposed, or to provide alternative subcontracting arrangements. While there are a minority of PCNs who tell us they feel in a position to deliver the contract, the majority have fed back they still have outstanding reservations and concerns which need addressing. All or nothing contract The proposed all-or-nothing PCN level contract will need to be signed by a lead practice on behalf of the PCN, or the PCN as a legal entity if they are incorporated. While delivery of services or components of contract management can be subcontracted, responsibility for the population coverage, delivery and monitoring of the contract sits with the contract signatory with the associated potential legal and clinical implications. Nationally PCNs are required to deliver components of the PCN DES contract only, and the NWL proposed contractual model for delivery of additional services is not commonplace; in fact we are not aware of this model in place elsewhere in London or the country. Workload and resource commitments The decision to sign up needs to be made on an individual PCN level, taking into consideration multiple factors including, but not limited to: 1. Operational Planning, Management and Oversight - PCNs will be responsible for ensuring sufficient capacity is in place (sessions) to meet indicative activity for each service line. Where practices choose not to deliver a service directly, the PCN must ensure that their patients have equitable access to this service, for example through delivery by another practice within the PCN, or by subcontracting to another provider such as a neighbouring PCN or a federation. 2. Financial Management - the PCN lead practice will receive ES payments directly from NWL ICB. The PCN Lead Practice will have to take on the responsibility of distributing funds directly to individual practices in the PCN or to a selected sub-contracted provider, e.g. a GP Federation, based on the activity undertaken during that period. NWL ICB are proposing they will not send funding directly to individual practices. 3. Workload implications - for practices/ PCNs for delivery and management of the contract. The contract signatory will also need to monitor delivery of the contract, manage the performance of appointed subcontracted providers, as well as undertake data reporting and all relevant financial management and payment functions. 4. Training and upskilling requirements for practices/ PCNs - PCNs will need to ensure workforce are sufficiently trained, qualified. 5. Workforce availability for practices/PCNs - PCNs will be required to ensure there is sufficient appropriate available workforce within the PCN grouping to carry out all of the enhanced services in the contract, or to ensure subcontracted organisations have sufficient workforce availability to meet indicative activity. 6. Level of remuneration for services - PCNs need to consider impact on practice bottom-line finances and workforce and whether this can be delivered within the proposed financial envelope and, where subcontracted, that providers are willing to deliver within the funding available. There may also be significant costs associated with managing the contract. 7. Governance and regulatory compliance - PCNs will have to nominate and provide leads for various roles e.g. Infection Prevention Lead, Accountable Emergency Officer and other roles outlined in the contract. It will be the responsibility of PCNs to ensure these roles are fulfilled by appropriately qualified and trained individuals, and provide this information to the ICB. 8. Clinical Governance - PCNs will need to ensure it has the appropriate Clinical Governance oversight arrangements for all services delivered under the contract. 9. Dispute management processes - PCNs need to consider the potential for dispute within PCNs regarding contract delivery, or clawback of finances. Mechanisms need to be in place, either via the Alliance Agreement or main contract to have a clear and agreed internal dispute resolution process. 10. Premises - will need to be available for delivery of services and to accommodate required workforce, in addition to practices' core contract and PCN DES requirements. It is important that every practice is aware of all implications and feels able to make an informed decision when it comes to deciding whether to sign up to this Enhanced Services contract. Existing model There are currently a number of contractual models in place for delivery of enhanced services in NWL, many of which are working well for practices and patients. Given the immense pressures on practices, which are particularly severe in NWL given the perilous workforce numbers, we have strongly encouraged commissioners to adopt processes and contracts that minimise needless bureaucracy. However, commissioners seemingly do not wish to continue to contract directly with multiple different providers to deliver these services, and wish PCNs to determine who is best placed to deliver each service and at what scale. Whilst this may appear to offer opportunity to PCNs, this also has many implications for, and risks to, practices that PCNs must consider. Available and outstanding documents The LMC continues to raise these concerns with ICB leads from the enhanced services delivery programme, and are currently reviewing the information provided to date: 1. Draft NHS Standard Contract (incomplete) 2. Draft Alliance Agreement (incomplete) 3. Service specifications: * ABPM * Anticoagulation * Draft DESS Level 1 * Draft DESS NDH * Draft DESS Rewind * ECG * LTBI * Medicines Management * Near Patient Testing * Phlebotomy * Spirometry * Wound Care * Ring Pessary N.B. the Mental health spec remains outstanding as of 22 February 2023. Please continue to feed back on the contractual model, individual specifications and the contract/ alliance documentation via borough leads and the LMC via: [email protected]<mailto:[email protected]>. This feedback shapes our response and discussions with the ICB and will help us convey outstanding concerns so they can be addressed in a timely manner. We will continue to engage with commissioners on your behalf, and update you to support your practice and PCN's decision making. Kind regards, Jamie Wright, Director of Primary Care, North West London Dr Hannah Theodorou, Medical Director, North West London Dr Asiya Yunus, Medical Director, North West London Londonwide LMCs and Londonwide Enterprise Ltd Tel: 020 7387 2034 Fax: 020 7383 7442 Email: [email protected]<mailto:[email protected]> Web: www.lmc.org.uk<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fclick.email.lmc.org.uk%2F%3Fqs%3Dae6eea08bd59b821a3c9c8c79f81bab7fdf95932cc2b066940dec8684c16abf6038839648b0b1bc95122d066bfaf8c77&data=05%7C01%7CLesley.Williams%40lmc.org.uk%7Ceb671006993646910f8308db15950b6a%7C5670c82635004dfd9a7fc45939b3c53f%7C0%7C0%7C638127502118310860%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=ahJ4NQ0rCGHhnwHu%2Bads%2BzI6avs%2FMPAs22WP9vfpPhs%3D&reserved=0> Twitter:@LondonwideLMCs<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fclick.email.lmc.org.uk%2F%3Fqs%3Dae6eea08bd59b82192a33f531d024741801423d7a1ad0320d280c88433daa89c6bd5eb0a19b0db76c63cd512d2161546&data=05%7C01%7CLesley.Williams%40lmc.org.uk%7Ceb671006993646910f8308db15950b6a%7C5670c82635004dfd9a7fc45939b3c53f%7C0%7C0%7C638127502118310860%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=tbmHBN%2Fmlnaln6sGY%2FipZvET9wcxLFTP0E2vkmYgxIQ%3D&reserved=0> Facebook: www.facebook.com/LondonwideLMCs<https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fclick.email.lmc.org.uk%2F%3Fqs%3Dae6eea08bd59b821d5f5baf99ee54a594548f196612eb4b37741b6197ad2cc563cbad378ad18549fcd5c5b3d8b06eaea&data=05%7C01%7CLesley.Williams%40lmc.org.uk%7Ceb671006993646910f8308db15950b6a%7C5670c82635004dfd9a7fc45939b3c53f%7C0%7C0%7C638127502118310860%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=3ZaRPP%2F7Y%2FbGeQo%2BwhcdmpXdtpYbaMD865TWUHxlsFo%3D&reserved=0> PS: Make sure that you add us to your 'safe senders' list so that these emails do not go to your Junk email box. 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