BUSINESS CASE
FOR
PROPOSED MERGER
OLD FORGE SURGERY (A89020)
AND
EDEN TERRACE (A89611)
Contents
1 Introduction 3
2 Background 3
3 QOF and Performance issues 4
3.1 QOF Data 4
3.2 Cervical Cytology 5
3.3 Childhood Vaccinations and Immunisations 6
3.4 GP Survey 6
3.5 CQC Actions 7
4 Premises 7
5 IT 8
5.1 Current IT Systems 8
5.1.1 Clinical systems 8
5.1.2 Non-clinical systems 8
5.2 Plans for merging the IT Clinical System 8
6 Staffing following the merger 9
6.1 GP Interests 9
6.2 Nurse clinical areas 9
7 Engagement 9
7.1 Engagement Plan 9
7.2 Outcome of Engagement Period 10
7.3 Response to Engagement Report and Actions that will be taken 11
8 Summary Details of the Practices Proposal 14
Appendix 1 – QOF Data 2014/15 17
Appendix 2 – GP Patient Survey 19
Appendix 3 - Practice Boundaries 20
Appendix 4 - Services Delivered 21
Appendix 5 - Enhanced Services Delivered 22
1 Introduction
This business case sets out a proposal for Old Forge and Eden Terrace to fully merge. This merger will include the closure of Eden Terrace, where they will move into Old Forge Surgery which is located in the Pallion Area of Sunderland and provides services from purpose built premises, which were built in August 1995 and is approximately 5 miles away from Eden Terrace Surgery. The Eden Terrace contract will terminate and the proposed date for the merger would be 1 October 2016.
Both Practices deliver primary medical services with Eden Terrace being under a PMS Contract (currently moving over to GMS) and Old Forge under a GMS Contract.
2 Background
Two practices in Sunderland have applied to merge into one practice to ensure their future sustainability to deliver high quality and safe primary health care to their patients.
Eden Terrace Surgery and Old Forge Surgery would like to merge their practices together, with Eden Terrace services moving into the Old Forge Surgery site. The main reasons for this is that Eden Terrace Surgery premises have extremely poor facilities, with no disability access or disabled toilets, and this is not the environment that is best to deliver modern healthcare. Eden Terrace only has one consulting room and is unable to provide additional access for patients to meet the ever increasing demand. During the 6 facet survey undertaken in Sunderland it was noted that Eden Terrace premises were the only premises across the city that did not come up to standard and with no ability to modernise. This coupled with the difficulties being faced across the country with GP recruitment, has prompted the discussions between the two practices about how they can secure services to their patients and make them fit for the future. Eden Terrace Surgery has not had their CQC visit as yet.
Old Forge Surgery offers more modern facilities with room to accommodate all Eden Terrace Staff. Old Forge Surgery following a CQC inspection in April 2015 was rated as inadequate which was subsequently regraded as ‘requires improvement’ in some specific areas. With support from the CCG Primary Care Advisors an improvement plan is in place which is being actioned by the practice.
Old Forge Surgery has tried to recruit 1 WTE GP without success and is subsequently using expensive locums which do not deliver consistent care for patients. The recruitment crisis in Sunderland has added to this. The practice wants continuity for their patients and feels a merger is the right approach to support sustainability within both practices and to ensure safe, effective clinical care for patients. Should the merger be successful the practice is hoping that recruitment of a new full time GP will be more attractive and will bring continuity to the existing old forge patients.
In addition Old Forge have applied and been successful in obtaining the Supporting Vulnerable Practice Funding from NHS England which when match funded by the practice gives resource for specialist advice and training support to enable the two practices to look at how they can work together as a team, identify any gaps and produce a practice plan which will allow the team to develop and the practice to become sustainable going forward.
Both practice are keen to emphasise that the proposed merger will not lead to the withdrawal of any services to patients, will not affect patient access to the practice and will not lead to the removal of any patients.
Old Forge practice has 7,700 patients with 2.5 WTE GPs although the .5 GP is currently on long term sick leave and Eden Terrace has 3,000 patients with 1.5 WTE GPs, although due to accommodation issues where there is only 1 consulting room only 1 GP can be seeing patients at any one time. With a combined list of 10,000 patients It is envisage that the proposed merger will greatly benefit all levels of staff who work within the proposed premises of Old Forge (GP’s, Nursing, Management and Administrational staff) by reducing current workloads and allow potential for increased efficiency and therefore offer patients an even higher level of patient satisfaction than is currently offered.
There will be a separate mobilisation plan should this Business Case be approved which the Practice will be happy to share.
3 QOF and Performance issues
3.1 QOF Data
The latest QOF data available nationally is from 2014/15, this was published in October 2015 on the HSCIC website http://www.hscic.gov.uk/
A full breakdown of the practices achievement can be found in Appendix 1
A summary is given in the table below
Old Forge / Eden TerraceOverall achievement / 83.69% / 88.03%
Exception Rate / 8.40% / 7%
Less than full achievement / · CHD
· PAD
· Stroke/TIA
· COPD
· Cancer
· CKD
· Diabetes
· Dementia
· Mental Health
· RA
· BP
· Smoking
· Contraception
· Cervical Screening / · PAD
· Asthma
· COPD
· CKD
· Diabetes
· Dementia
· Mental Health
· Osteoporosis (no patients applicable for this indicator)
· BP
· CVD-PP (no patients applicable for this indicator)
· Smoking
To ensure this high standard is maintained when practice’ merge they will agree to have a dedicated administrator who will organise bimonthly QOF meetings with nurses and GPs to focus on areas where performance is low, develop a practice action plan where the admin will monitor and ensure delivery. The newly formed practice intends to improve nursing capacity by employing an additional nurse.
3.2 Cervical Cytology
Both practices are active participants within the Cervical Cytology Screening Service,
Their achievement is summarised in the table below:-
Old Forge / Eden TerraceAchievement / 80% / 99.16%
Inadequate smears / Monitored quarterly / Annual review of smear takers
Both practices are within the higher target for cervical cytology. Flexible appointments will continue, dedicated admin oversee the Exeter and ensure higher targets are maintained. The practice nurse will lead this, in particular around the non-attenders and ensure there is a mechanism in place to chase up patients and find out why they have not attended.
3.3 Childhood Vaccinations and Immunisations
Both practices are active participants within the Childhood Vaccination Immunisation Programme. Their achievement is summarised in the table below:-
Old Forge / Eden TerraceAchievement / 90% / 90%
Currently the Practice Manager at Eden Terrace spends time maintaining the recall system. This will change with the merger as this will be organised and managed by a dedicated administrator who will liaise with a nurse which in turn will free up valuable time for the Practice Manager
3.4 GP Survey
The latest GP survey data available nationally was published on 7 January 2016 on the GP patient survey website https://gp-patient.co.uk/.
A full breakdown of the practices performance in the survey is given in Appendix 2.
The table below gives an overview of where differences between the practices are:-
Similar Outcome / Difference - Old Forge more positive outcome / Difference - Eden Terrace more positive outcomePatients who find the receptionist at the surgery helpful / Patients who say that the last appointment they got was convenient / Patients who find it easy to get through to this surgery by phone
Patients who say the last GP they saw or spoke to was good at giving them enough time / Patients who say the last nurse they saw or spoke to was good at giving them enough time / Patients who usually get to see or speak to their preferred GP
Patients who say the last GP they saw or spoke to was good at listening to them / Patients who say the last nurse they saw or spoke to was good at listening to them / Patients who were able to get an appointment to see or speak to someone the last time they tried
Patients who say the last GP that they saw was good at explaining tests and treatments / Patients who say the last nurse they saw or spoke to was good at explaining tests and treatments / Patients who describe their experience of making an appointment as good
Patients who say the last GP they saw or spoke to was good at treating them with care and concern / Patients who say the last nurse they saw or spoke to was good at involving them in decisions about their care / Patients who usually wait 15 minutes or less after their appointment time to be seen
Patients who have confidence and trust in the last GP they saw or spoke to / Patients who say the last nurse they saw or spoke to was good at treating them with care and concern / Patients who feel they don’t normally have to wait too long to be seen
Patients who had confidence and trust in the last nurse they saw or spoke to / Patients who say the last GP they saw or spoke to was good at involving them in decisions about their care
Patients who are satisfied with the surgeries opening hours / Patients who would recommend this surgery to someone new in the areas
Patients who describe their overall experience of this surgery as good
Currently Eden Terrace, although they do have an appointment system, can only have one GP on duty at any one time due to room availability i.e. they only have 1 GP Consulting Room. This means that if patients need to be seen they continually add on patients at the end of their surgery. Following the merger there will be more consistent availability and there will be an increase in structured appointments due to additional GPs and increase in appointments.
Old Forge currently use locums who see patients but do not complete the vast majority of paperwork e.g. read hospital letters and take appropriate action, complete insurance forms, carry out medicals etc. Using locums means that the permanent GPs have more paperwork and consequently 4 appointments per day have to be taken out of consultations to allow paperwork to be completed. Following merger these appointments can be released as the workload will be appropriately shared.
3.5 CQC Actions
Eden Terrace is yet to be visited by CQC officially but did have a pilot visit in September 2014 which did not have a rating against them
Old forge have had two official CQC visits with the latest visit upgrading them from Inadequate to requires improvement.
The improvement plan is almost complete and includes all recommended improvements by end of June and the surgery will have another visit in due course
4 Premises
Eden Terrace Surgery premises are a Victorian terrace with no ability to modernise, they have extremely poor facilities, with no disability access or disabled toilets and this is not the environment that is best to deliver modern healthcare. There is only 1 consulting room meaning that only 1 GP can see patients at any one time. The premises are owned by a previous GP who rents the building to the existing partners. The recent 6 facet survey which was carried out across Sunderland showed that Eden Terrace was the only practice which did not reach the standard including the issue with disability access. There are no lease implications.
Old Forge Surgery offers more modern facilities with room to accommodate all Eden Terrace staff and patients. Old Forge Surgery is owned by the GP Partners with no lease implications. The square footage of Old Forge is not changing therefore there will be no rent reimbursement issues.
Distances by bus and metro from Eden Terrace Surgery to Old Forge Surgery is:-
· By Car 1.2 miles
· Time to Walk 1.1 miles (22 minutes)
· Bus numbers 8,10,11,18,20,99,700
· Pallion metro 0.6 miles 11 minutes to walk
· Millfield metro station 0.5 miles 11 minutes to walk
5 IT
5.1 Current IT Systems
5.1.1 Clinical systems
Both practices use the EMIS web clinical system. The city hospital Meditech system is also used by the practices. The Docman document management system is used for all clinical mail coming into the practice.
5.1.2 Non-clinical systems
Old forge uses the IRIS payroll system which will be extended to Eden Terrace
Old Forge use IQ toolkit for CQC Compliance Manager and will continue to use this following merger, updating any policies and procedures to include the additional practice
5.2 Plans for merging the IT Clinical System
The merging of the two IT Clinical Systems will be carried out by NECS and the CCG. The costs will be met by Sunderland CCG. The data merge will potentially happen after the 1 October once the practices have merged but the physical move would happen before should this proposal be approved. It will be possible for Eden Terrace Emis Web System to be accessed from The Old Forge but staff will need to switch between screens in particular when accessing SPINE services.