Agenda item

To consider the report on Primary Care Co-Commissioning.

6.1       Matthew Bazeley presented this item and explained that the latest update on primary care co-commissioning provided more details of co-commissioning to date as well as on processes which previous reports had focused on. He advised that the Central London CCG Joint Co-Commissioning Committee and the West London CCG Joint Co-Commissioning Committee had each met three times, in common with the other six North West London CCG Joint Co-Commissioning Committees. The nomination of a Board representative on the Central London CCG and West London Joint Co-Commissioning Committees was welcomed.

6.2       Matthew Bazeley advised that the Co-Commissioning Joint Committees had discussed the review of Personal Medical Services (PMS) contracts led by NHS England at their June and September meetings. The review sought to ensure that the PMS contracts in place were providing effective services. A PMS Review Steering Group had been set up by the North West London CCGs to undertake the work of the eight Joint Committees and to make recommendations to them about a North West London wide strategic approach to the review. Matthew Bazeley also advised Central London, West London and North West London CCGs were developing a new model of primary care that would draw from the output of the PMS review. The Board heard that the Joint Committees had no appetite at the moment to create a fully delegated commissioning model.

6.3       Dr Neville Purssell (NHS Central London Clinical Commissioning Group) advised that work was to be undertaken in terms of the outcome of the PMS review. Consideration also needed to be given as to how work on the Whole Systems Integrated Care would feed into developing a new model of primary care. Dr Neville Purssell added that providing equality of access was a major objective both in terms of the PMS review and in a future model of primary care.

6.4       The Board sought further details on what differences would patients see as a result of the PMS review and the new model of primary care. Members asked what mechanisms would be place to ensure that GP practices raised standards where they were seen to be lacking and would the changes mean more work for GPs. Another Member asked if conflict of interest was an issue, particularly where a member of a CCG Joint Co-Commissioning Committee may be awarding contracts to providers who they were familiar or friendly with, or even related to. A Member emphasised the need for Healthwatch representation and input on the local Joint Co-Commissioning Committees.

6.5       In reply to issues raised by the Board, Dr Neville Purssell advised that the outcome of the PMS review and the development of a new model of primary care may result in some GP practices benefitting, whilst others may experience the reverse. Some practices were appreciably better funded than others and the quality of care for less well funded practices may be affected. Defining quality of care through the new primary care model would help provide for more equal quality of care for all patients. Dr Neville Purssell explained that some practices were having to provide more for less, particularly where they wanted to qualify for the premium, however during the changes, transitional funding would be made available to practices. He stated that access to out of hospital services for patients was presently determined by postcode, however the new model of primary care would put an end to this and patients would be able to access their local GP provider or the closest GP provider that offered the service they required. Dr Philip Mackney (NHS West London Clinical Commissioning Group) concurred that there was a significant difference in funding amongst GP practices and careful consideration needed to be given as to what to expect from them, including looking at what services could be done more simply.

6.6       Matthew Bazeley advised that awarding of contracts was also subject to authorisation of the Investment Committee that considered matters such as conflict of interest. He added that Healthwatch representation on the local Joint Co-Commissioning Committees would be discussed further and he acknowledged that it was essential to have wider representation and support when making decisions.

6.7       Members emphasised the need to continue to receive updates on primary care co-commissioning. Members agreed that Chris Neill represent the Board as its’ Member on the Central London CCG and West London CCG Joint Co-Commissioning Committees, with Meenara Islam as the Deputy Member.