Doctors in Peterborough seeing higher than average numbers of patients

The Cambridgeshire and Peterborough Clinical Commissioning Group (CPCCG) has held its latest online strategy meeting this week (September 8)

Chairman, Dr Gary Howsam, told the governing body of the CPCCG: “The amount of non-coronavirus related appointments being seen by GPs is not only above average, but considerably higher than at this time last year.

“Despite conflicting reports in the media, GPs have been seeing higher and higher referral appointments throughout the year and this has been so since the beginning of the Covid-19 pandemic in March.”

The current contracts in place for the delivery of the CPCCG commissioned ‘Extended Access Service’ all expire on September 30, 2020.

The CPCCG has been waiting for confirmation of funding at a rate £6 per patient to support the commissioning of the Extended Access Service for 2020-21.

While NHS England and NHS Improvement (NHSE&I) confirmed in writing on July 30 that funding for an Extended Access Service for 2020/21 would be on the same basis as it was in 2019/20, uplifted for population increases, discussing the report at their online meeting, Dr Howsam said: “At the time of writing this paper, the CPCCG is still waiting for the actual weighted population figures to be advised.

“Currently, the CCG Extended Access Service is commissioned based on national core requirements issued by NHSE&I.

“The service delivers pre-bookable and same day appointments 365 days a year, with a weekly capacity requirement of 30 mins/per 1000 weighted population.

“Providers had to deliver a 75 per cent utilisation target by March 31, 2020 and be able to evidence that their services are advertised and available to 100 per cent of patients in practices and the wider community.

“The CPCCG currently commissions Extended Access Services from our GP Federations, Granta Medical Practices, and an Alternative Provider Medical Services (APMS) contract.

“Overall, the four providers are: Greater Peterborough Network (GPN) who provide services to Peterborough and Wisbech practices; West Cambs GP Federation (WCGPF) who provide services to Huntingdon and Fenland practices; Cambridge GP Network (CGPN) who provide services to Cambridge and Ely practices; and Granta Medical Practices (GMP) who provide this service to their c.43,000 patients.

“During the COVID-19 pandemic, the GP Federations have stepped in to support practices and Primary Care Networks (PCNs) around resilience and back-office support.

“They directly provided primary care services for patients of Waterbeach Practice when COVID-19 forced a shutdown in March for 48 hours, and Nightingale Medical Centre when nursing capacity was reduced due to the need for staff self-isolation.

“In addition, they’ve supported the wider health system by providing clinical capacity to support the HUC COVID-19 call queue, sourcing and delivering Personal Protective Equipment (PPE), undertaking the daily sitreps calls with GP practices as well as various asks from the CCG around Test and Trace, setting up hot/cold sites and supporting primary care in business continuity planning.

“One condition of the contract extension to 30 September 2020 was the agreement by all Providers to the inclusion of a COVID-19 Pandemic clause into the service specification, which allows the CCG to repurpose any available capacity to support the wider system at times of need.

“This flexibility around the use of commissioned capacity is now contractually in place and would be carried over with any future contract extensions”.

Dr Howsam added: “As I see it, there are two issues for the Governing Body to consider in relation to these contracts.

“Firstly, there is the looming expiry of the GP Federation and Granta contracts on 30 September 2020, and the significant risk this poses to the continued delivery of the service should key staff working in the GP Federations be given notice in line with the September 30 date.

“Clinical rotas are filled up to two/three months in advance, and there could be serious disruptions to service provision beyond September 2020.

“This loss of capacity would hit this system just as the CCG needs to prepare for winter pressures and the possible resurgence of COVID-19.

“Secondly, the five-year framework for GP contract reform issued in January 2019, has always signalled that the funding and responsibility for providing the current CCG-commissioned Enhanced Access Services would transfer to the Network Contract Directed Enhanced Service (DES) by April 2021 at the latest.

“This will fund a single, combined access offer as an integral part of the Network Contract DES, delivered to 100% of patients.

“The guidance also encourages local Integrated Care Systems and their PCNs to move ahead of this date if there is appetite to do so.

“Lakeside Healthcare have signalled that they wish St Neots PCN to begin delivering the extended access service themselves from October 1, 2020. This would be in line with the referenced guidance.

“The recommendation to the Governing Body is to approve the Extended Access contracts for the Cambridge and Peterborough Federations by a further six months with the contract expiry date moving to March 31 2021.

“The core requirements would be unchanged, including the inclusion of the Pandemic repurposing clause.

“The contracts would be funded based on the weighted populations attributed to the GP practices within the Cambridge/Ely, Peterborough and Wisbech.

“Also, we should extend the Extended Access contracts for Granta Medical Practices by a further six months with the contract expiry date moving to March 31 2021.

“Again, the core requirements would be unchanged, including the inclusion of the Pandemic repurposing clause. The contracts would be funded based on the weighted populations attributed Granta Medical Practices.

“Extend the Extended Access contracts for the West Cambridge Federation by a further six months with the contract expiry date moving to March 31, 2021.

“Once more, the core requirements would be unchanged, including the inclusion of the Pandemic repurposing clause. The contracts would be funded based on the weighted populations attributed to the GP practices within Huntingdon and Fenland excluding the practices aligned with St Neots PCN.

“As PCNs cannot hold contracts, we should approve an offer of a 6-month contract to Lakeside Healthcare to deliver Extended Access on behalf of St Neots PCN. The contract would be aligned with the core requirements, including the inclusion of the Pandemic repurposing clause. The contracts would be funded based on the weighted populations of the GP practices within St Neots PCN.
The Governing Body approved the recommendations to extend the contracts to March 31, 2021.