1. Prime Minister’s Challenge Fund Harrow LMC Briefing Meeting

2. PM Challenge Fund Voluntary scheme, to look at options of access including 8-8 opening, use of IT etc Scheme worth £50m across England – non recurrent NWL joint bid awarded £5m Harrow’s share non-recurrent funding of £960k for one year only Matched funding of £500 from Harrow CCG In future years will cost CCG £500k annually with no additional resource Application from practices Statement of CCG support

3. Harrow PMCF application Letter sent to practices from CCG on 24/1/14 advising them that the CCG was submitting an EOI in obtaining a share of the PMCF Letter explained that all practices had been opted in by the CCG but could opt out if they wished by 31/1/14 No specifics re details of the EOI Letter stated only: ‘There is no specific entry requirement over and above a willingness to participate - this does NOT mean practices are signing up to open 7 days a week at this stage. The funding isn't to pay practices to open but to fund time to participate in the development of plans and assess what this will mean.’ ‘PLEASE NOTE: This letter is for an expression of interest only, to take part in initial discussions around formulating the 7 day working plan – it DOES NOT commit any Harrow Practices to open for any additional extended time at this stage’

4. Harrow PMCF Application Practice Commitments GPs to work in multi-disciplinary networks Routine non- urgent appointment within 48hrs Patients with non-urgent needs offered choice of an appointment at their own practice. Email/ video calling and telephone consultations. Electronic Prescription service - online ordering of repeat prescriptions All Harrow practices open 8:00 a.m. to 6:30 p.m. (contractual obligation is to be available –not open - in these hours) Urgent care needs absorbed as much as possible in hours by a patient’s local practice, before shifting care up into networks Patient online access to summary care records. Patient online access to full records. Named care co-ordinator for all patients with complex needs. Patient online appointment booking – NHSE Contract requirement from the 1 st April 2014 Baseline no. of consultations per 1000 patients – efficiency marker

5. Harrow PMCF practice commitments continued - appointments “All practices to meet the ‘BMA’ benchmark of - 72 GP patient consultations per 1000 registered patients per week - 33 nurse consultations per 1000 registered patients per week” BMA does not have any benchmark as above

6. Harrow GP Access Survey July 2014 PMCF online survey monkey to determine current service levels Practices told it was required – paid £1000 Harrow practice visits Results compare Harrow practices re GP and Nurse consultation rate per 1000 patients – face to face/telephone/visits/residential home visits Practices are identifiable under appendix A Raw figures - no recognition of different GMS & PMS funding between practices

7. Harrow PMCF Application Network commitments Access to General Practice 8-8 (Mon-Fri) and additional 6hrs/day during weekend. Patients with urgent care needs provided with a timed appointment within 4hrs. Patients with non-urgent needs offered choice of an appointment within 24hrs. Access to GP consultation in a time and manner convenient to the patient.

8. Payment Gateways Gateway 1 £1000 for attending a PMCF briefing and completing PMCF survey. Gateway 2 10% of the total PMCF money to practices signing and agreeing the MOU and setting out how it plans to use this 10 % of money. Gateway 3 quick wins:-  Patient online appointment booking – NHSE Contract requirement from the 1st April 2014.  Online patient ordering of repeat prescriptions.  Patient online access to summary care records.  Email/ video calling and telephone consultations.  Electronic Prescription service.  All practices to meet the BMA benchmark of 72 GP patient consultations per 1000 registered patients per week Gateway 4 implementation of the entire package

10. Questions re Practice commitments Do practices have any obligation to agree to the EOI PMCF outcomes given the original letter of 24/1/14 did not specify these details to practices? What if practices are not able to or do not wish to participate in some access outcomes What will be the resources given to practices to achieve these outcomes? How will delivery of normal core services be affected?

11. Questions re Federating Models What models of federations are there? What are the legal liabilities/implications for practices of the proposed CIC? Should an alternative model be considered? Conflicts of Interest COI: Should the CCG as a commissioning body be developing the network rather than practices? COI: Should CCG board members who will be commissioning some GP services, be on the governing board of the provider federation/network?

12. Questions re Federating continued:- Practice Liability Can a practice be part of the network but not agree to specific PMCF outcomes, e.g. 48 hour routine appointments, baseline no. of appointments? (slides 4 - 5) What is a practice’s liability for non-delivery of the specific PMCF outcomes? What is practice’s liability for non-delivery of the additional provider network’s outcomes e.g. routine appointments within 24 hours and access in a time and manner convenient to the patient? (slide 7) Practicing Outside of a network How can a practice leave the federation/network? Can a practice survive outside of the federation/network?