Agenda item

To consider an update on primary care co-commissioning.

5.1       Chris Neill (Interim Deputy Managing Director, NHS Central London

Clinical Commissioning Group) presented the report which included providing an update on NHS Central London CCG’s current situation with regard to moving from joint commissioning to delegated commissioning of primary medical services in Westminster. Chris Neill advised that NHS England had requested that all CCGs consider proposals to move to full delegation of commissioning of primary care from 1 April 2017. NHS Central London CCG was currently consulting and in discussion with its’ GPs on the proposals and the benefits and risks of the proposals were under consideration. Chris Neill advised that the risks of fully delegated commissioning included issues such as the costs of the CCGs’ estates, including rents. He confirmed that the voting process for Westminster GPs had commenced and would continue over a two week period, with voting closing on 14 February.

5.2       Louise Proctor (Managing Director, NHS West London Clinical Commissioning Group) advised that NHS West London CCG was also holding a ballot with its’ GPs on the delegated commissioning proposals and this would take place on 7 February, with advanced voting available for GPs who were unavailable to vote on that date. She added that the views on the proposals from the CCG’s GPs had been mixed. The other North West London CCGs were also discussing the proposals and it was possible that views amongst the CCGs would vary quite widely.

5.3       Councillor Robathan asked what were the main risks associated with the proposals and was there a consistent trend amongst GPs that would determine what their views would be.

5.4       In reply, Dr Philip Mackney (NHS West London Clinical Commissioning Group) stated that it was difficult to identify whether the size of a practice would be more likely to determine whether it was in favour of the proposals or not, however a number of GPs within his CCG had expressed concerns with regard to governance

5.5       Dr Neville Purssell (NHS Central London Clinical Commissioning Group) advised that the main risks perceived amongst his CCGs’ GPs were their concerns about being responsible for rents and rates and that their practices would be unviable if they were not reimbursed in timely manner. He felt that this was due to the way the NHS system worked as opposed specifically to the proposals for delegation. The advantages of the proposals included increasing the ability to align commissioning of primary care with secondary and community care and ensuring the same direction of travel with the STP.

5.6       Dr Mona Vaidya (NHS Central London Clinical Commissioning Group) stated that GP practices felt they were exposed to rents being determined by landlords and GPs wanted clarity from NHS England on the matter, including what would happen in respect of rates. Staff, including doctors and nurses, were also discouraged by high commuting costs to central London and partner organisations needed to work closer together to find a solution.

5.7       A Member commented that estates had been an issue for a long time and landlords had consistently raised costs, whilst costs of land in Westminster would continue to rise. There was also a need for more GPs in Westminster and in general and he stated that the NHS England representative should be attending Board meetings and making suggestions to help the CCGs. The Member felt that all partner organisations should be involved in helping resolve the issue of estates and costs, including housing and he suggested that sports and leisure could also play a role. Another Member emphasised the importance of ensuring that primary care co-commissioning and the Health and Wellbeing Strategy were aligned and that consideration be given as to how the Board could support this piece of work.

5.8       Councillor Robathan advised that the Council had undertaken a significant piece of work in primary care modelling and emphasised the need for joined-up working amongst partner organisations. She stated that joint estate mapping would need to feed into delegated primary care commissioning if this went ahead, whilst there also needed to be further consideration as to how health and wellbeing centres and the work of hubs could be linked better with primary care commission to move forward.