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Proposal for the transfer of the Community Health Centre Practice

Patient List from the Primary Care Trust into Primary Care and the
establishment of an Enhanced Service for Hard to Reach Groups

1.0 Background

1.1 The Community Health Centre Personal Medical Services Pilot was
initially set up to address the needs of marginalized communities,
including hard-to-reach groups such as refugees, asylum seekers and
the homeless, offering temporary registration before moving them on
into mainstream primary care. The initial proposal was submitted to
the former Department Of Health Regional Office by the former
Walthamstow, Leyton and Leytonstone PCT in March 2002.

1.2 Establishing the new practice proved to be a lengthy process and the
Community Health Centre (CHC) Practice finally became established
and registering patients in November 2004.

1.3 However, during the intervening years, international political change,

associated asylum and EU legislation, together with the new General
Medical Services contract have meant that the overwhelming
anticipated demand in relation to the identified target client group has
not materialised. In January 2005, it was agreed that the practice
would accept registration from all Waltham Forest residents and
registration would be permanent. The current list size is 962 patients.
A significant proportion of these are from the hard to reach client
group and patients whose first language is not English. 60% are
resident in Leyton/Leytonstone and 33% are resident in Walthamstow.

2.0 The current position

2.1 The new General Medical Services Contract places an obligation on

practices to register any resident living within their catchment area.
Although it is recognised that some patients still have problems
registering with a GP and that the CHC Practice itself has made a
significant contribution to patient registration, it has become much
easier for many patients to register with a GP than it was in previous
years and there were only 15 allocations throughout the Borough in the
second quarter of 2005/06. A significant number of practices are
actively increasing their list sizes and during the next three years, the
PCT is committed to supporting local practices to grow and develop
into larger practices and Primary Care Businesses. The PCT is also in
the process of delivering an ambitious premises transformation
programme, with six major premises schemes opening in 2005/06.
This will allow practices the physical capacity to further expand their
 lists, a factor which had previously held many practices back from
expanding.

2.2 One of the key aspects of the proposal to establish the CHC Practice
was that longer appointment times could be offered, compared to
mainstream general practice. However, there has been significant
improvements in the length of appointment times offered by general
practice over the past year or so. Practices are significantly
incentivised under the Quality and Outcomes Framework to offer
appointment times over 10 minutes and vast majority of practices offer
this. Many practices now offer extended opening hours, particularly the
8.00am till 8.00pm Pilots, and these practices are now routinely in a
position to offer appointment slots of over 15 minutes.

2.3 The Department Of Health document Commissioning a patient Led-

NHS, published in July 2005, outlined the proposal that PCTs become
more patient-led and commissioning-led organisations with their role in
provision reduced to a minimum and required to PCTs to assess what
services should move away from direct PCT provision and at what
pace. The document also requires PCTs to make at least 15%
reduction in management and administrative costs.

2.3 The Primary and Interface Care Directorate as a whole is facing

serious financial risks in 2005/06 and as such, all aspects of the budget
need to be reviewed urgently.

3.0 Recommendations

3.1 The primary care climate and local demographic situation has changed
significantly since the pilot was first proposed in 2001. Although the
contribution the practice has made to patients registration problems is
acknowledged, a significant number of practices are now in a stronger
position to increase their list sizes and are keen to do this. The
practice is an expensive service for the PCT to maintain, as the PCT
has to bear the whole infrastructure costs. Were the PCT to allocate
this list to a local practice, it would only bear the marginal costs of the
extra patients. This would be in line with the Department Of Healths
proposals for PCTs to become commissioning organisations and move
away for the provision of services and due to the financial pressures on
the PCT we would look to do this as soon as possible.

3.2 The proposal is to advertise the list to GP practices early in 2006.

Payment would take the form of an additional sum of money added to
their existing funding based on the number of patients registered at the
CHC Practice. Due to the fact that the list is split between
Leyton/Leytonstone and Walthamstow residents, we propose that two
practices divide the list between them, ideally one from each locality.
This would enable patients to have care delivered nearer to their home.
3.3 In order to ensure that the successful practices were able to continue
to deliver the high standard of care established by the CHC Practice
and commit to continuing the registration of hard to register groups,
we would look to package the list as an enhanced service.

3.4 In addition to a standard payment for the patients, each practice would
receive an additional payment to reflect the greater workload
associated with the patient list and to enable them to offer an
appropriate level of service for this client group. In order to ensure a
high level of access to primary care for these patients, we would
require each practice to offer primary care services to patients from
8.00am till 8.00pm 5 days a week in addition to the provision of
services on a Saturday. This would mean an enhanced level of access
for those patients currently registered with the CHC Practice, compared
to the level currently offered. Services are currently offered at the CHC
practices from 9.30am 5.00pm, with a half day on a Thursday. The
successful practices would also be required to commit to registering
any unregistered patient resident within Waltham Forest and accept
referrals for registration from the Walk In Centre and relevant agencies.
This would enable the significant role taken by the CHC Practice in the
registration of hard to reach groups to continue. A detailed service
specification would be drawn up emphasising the delivery of a quality
service to meet the needs of the client group, and the practices
providing the services would be expected to demonstrate that they
meet this specification.

3.5 Details of the list would be circulated and primary care providers would
be invited to apply for the list as an enhanced service, demonstrating
that they would be able to meet the criteria laid out in the defined
service specification. The successful practice would be required to
accommodate the additional patients within their own premises.

3.6 This proposal impacts on staff employed at the PCTs CHC Practice as
they would then be placed at risk. Details of the staff affected are
outlined in Appendix A.

3.7 The paper is part of the formal consultation process and the timetable
for consultation is outlined in Appendix B. It is anticipated that if it is
agreed that the list transfers to a primary care provider as an enhanced
service, this would take place in March 2006.

3.8 Plans will be made around the future integration of other elements of
the Community Health Centres services over the coming months. For
example, this is likely to involve the African Well Women being
integrated into Womens and Sexual Health Services and the
counselling team combining with the Primary Care Mental Health
Team.
Appendix A

Consultation process timetable

Presented to the Patient and Public Involvement 7 Nov 05

Forum
Initial discussion at Joint Management and Staff side 8 Nov 05
Consultative Committee
30 day consultation period for affected staff Commenced 9 Nov
05
Meeting held with affected staff 10 Nov 05
Consultation with relevant stakeholders and 21 Nov 05
community groups
Paper presented to Waltham Forest Adults and Older 30 Nov 05
People Overview Scrutiny Committee
Paper presented to PEC 2 Dec 05
Paper presented to PCT Board 24 Jan 06
Appendix B

Staff working at the Community Health Centre Practice

Post WTE Postholder

Nurse Practitioner 1WTE Keely McSweeney
Practice Nurse 1WTE Annick Mallen
Practice Manager 1WTE Eka Inyangudor
Community Health Advocate 1WTE Nihad Fathi
Practice Administrator 1WTE Abiola Sobodu
Practice Administrator 0.7WTE Housna Essop
Practice Administrator 0.8WTE Debbie Bronka

Note: The staffing establishment includes a full-time GP. There is no post-

holder currently in post.