Overview Under sections 13Q of the NHS Act 2006, NHS England has a statutory duty to ‘make arrangements’ to involve the public in the commissioning services for NHS patients. (This duty is also placed directly on to CCGs under section 14Z2.) Section 13Q applies to: the planning of commissioning arrangements the development and consideration of any proposals that would impact on the manner in which services are delivered to individuals or the range of services available to them decisions that would impact on the manner in which services are delivered to individuals or the range of services available to them The section 13Q duty only applies to plans, proposals and decisions about services that are directly commissioned by NHS England. This includes GP, dental, ophthalmic and pharmaceutical services. However, under the Delegation Agreement CCGs must act in a way that enables NHS England to comply with the 13Q requirements. (The section 14Z2 duty applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a CCG in the exercise of the CCG's own functions i.e. commissioning of secondary care.) The commissioners' arrangements for public involvement The statutory duty to ‘make arrangements’ under section 13Q of the NHS Act 2006 is essentially a requirement to make plans and preparations for public involvement. NHS England has set out its plans as to how it intends to involve the public in the following publications: These publications set out and explain the arrangements NHS England has in place: Corporate infrastructure – how public involvement is embedded in the way that NHS England is constituted and carries out its business Involvement initiatives – initiatives designed to involve the public in strategic planning and the development of policy or other aspects of NHS England’s
GMS Contract PMS Agreement APMS Contract Who can hold the contract? Individual medical practitioner Two or more individuals practising in partnership where: at least one partner is a medical practitioner, and any other partner is either an NHS employee; or an individual eligible under s88 of the NHS Act A company limited by shares The above is a summary only. Please refer to Annex 1 for more detail. Medical practitioner NHS employee Health care professional Individuals already providing services under a GMS, or GDS contract or equivalent (UK) Individuals eligible under s93 of the NHS Act Qualifying body (which is a company limited by shares with restrictions on share ownership) NHS trust or foundation trust The above is a summary only. Please refer to Annex 2 for more detail. The APMS Directions do not state who can hold a contract. Instead it states that particular types of persons cannot hold a contract if they are not eligible. Please refer to Annex 3 for more detail.
Must the contractor provide essential services? Yes No No Is there a standard form contract? Yes Yes Yes Does the standard form contract contain KPIs? No No No Can KPIs be added? KPIs can be agreed between the parties in relation to supplementary quality based services Yes Yes Payment arrangements GMS SFE As agreed by the parties and contained within the agreement – there may be reference to the GMS SFE As agreed by the parties and contained within the contract
“Article 15B employee” means an individual who, in connection with the provision of services in accordance with Article 15B arrangements, is employed by a person providing or performing those services, “health care professional” means a person who is a member of a profession regulated by a body mentioned (at the time the agreement in question is made) in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002 (c. 17), “NHS employee” means an individual who, in connection with the provision of services in the health service, the Scottish health service or the Northern Ireland health service, is employed by– (a) an NHS trust, an NHS foundation trust or (in Northern Ireland) a Health and Social Services Trust, (b) a Local Health Board, (c) a person who is providing services under a general medical services contract or a general dental services contract or a Welsh general medical services contract or a Welsh general dental services contract, (d) an individual who is providing services as specified in subsection (1)(d)(iii), “the Northern Ireland health service” means the health service within the meaning of the Health and Personal Social Services (Northern Ireland) Order 1972, “qualifying body” means a company which is limited by shares all of which are both legally and beneficially owned by persons falling within paragraph (a), (b), (c), (d), or (e) of subsection (1) , “the Scottish health service” means the health service within the meaning of the National Health Service (Scotland) Act 1978, “section 17C arrangements” means arrangements for the provision of services made under section 17C of the 1978 Act, “section 17C employee” means an individual who, in connection with the provision of services in accordance with section 17C arrangements, is employed by a person providing or performing those services,
Examples of the cases referred to above would include any incident in which the patient has: struck, grabbed or punched a GP, member of staff or other individuals, either within the practice premises, or if elsewhere, if in a targeted attack thrown an inanimate object at a GP, member of staff either within the practice premises or elsewhere, if in a targeted attack struck, grabbed, punched or thrown an inanimate object at another patient(s) within the practice premises wielded a weapon, or used an object as one, in an actual or intended assault or in a manner intended to intimidate or terrorise staff, patients or other persons on the practice premises threatened to assault or physically harm a primary care worker threatened to damage property or to ‘seek revenge’ in a menacing way caused damage to property with an intention to intimidate or cause harm. This list is not exhaustive What behaviour this scheme does not ordinarily cover? Below are some examples of the types of behaviours that would not ordinarily fall within the scope of the Regulations covered by this guidance. These are only intended to be used as a guide and therefore the list is not exhaustive. Any person felt threatened or fearful of their own safety, should still report the incident. These removal regulations cover all persons on the practice premises.
liaising with patient representative groups, such as local Healthwatch or the practices' patient participation group. The timing of public involvement is again a matter of broad discretion for the Commissioner. However, any involvement should be meaningful. As such, the Commissioner should involve patients at the time proposals are developed and considered. Overall, it is helpful to bear in mind the "Gunning" principles (these are used to judge whether or not a consultation exercise has been "fair" but are useful when making arrangements for patient and public involvement), as follows: Involvement should take place when the proposal is still at a formative stage; Sufficient information regarding the proposals should be provided, to allow meaningful involvement; Adequate time should be given for consideration of the information provided and for response; The product of the involvement should be conscientiously taken into account by the decision-maker. Separately, bearing in mind the Commissioner's equalities responsibilities, the Commissioner should consider carrying out an Equality Impact Assessment, to check whether any specific groups of people require specific or enhanced forms of involvement. Competition A key question in relation to whether a practice merger raises any competition issues is whether the GP practices cease to be distinct, since for merger control purposes, this means they have to be brought under some form of common ownership or common control. This could happen under certain types of merger model (for example, via a corporate structure), but by no means all. If no one party has a sufficient degree of ownership or control over the practice merger (usually via a shareholding exceeding 25%) then the whole arrangement would remain a contractual one. However, if a party has a 25% or more shareholding, a "relevant merger situation" could be created, meaning that the Competition and Markets Authority ("CMA") would then have the right to examine the practice merger, and whether it poses the risk of a substantial lessening of competition in any market in the UK. There are few recent
Co-commissioning - delegated commissioning arrangements A CCG that has delegated commissioning arrangements will have entered into a Delegation Agreement with NHS England setting out the scope of those arrangements. The Delegation Agreement includes a section on approving GP practice mergers and closures. When carrying out such actions, the CCG is required to act in accordance with the Delegation Agreement which includes but is not limited to: undertaking all necessary consultation when taking any decision in relation to GP practice mergers or GP practice closures, including those set out under section 14Z2 of the NHS Act (duty for public involvement and consultation). The consultation undertaken must be appropriate and proportionate in the circumstances and should include consulting with the LMC; prior to making any decision, clearly demonstrating the grounds for such a decision and fully considering any impact on the GP practice’s registered population and that of surrounding practices. The CCG must be able to clearly demonstrate that it has considered other options and has entered into dialogue with the GP contractor as to how any closure or merger will be managed; and in making any decisions, taking account of the CCG's obligations as set out in the Delegation Agreement in relation to procurement, where applicable. Annex A - Template Business Case for Practice Merger 1. Explanation of the practice merger Practices should provide an overview below of how the practices are merging. Paragraph 11.4 of the Contract Variations chapter provides common models of practice mergers and may be helpful here but practices should recognise that mergers are not restricted to one of the models listed and proposed mergers may adopt elements of more than one model or may adopt an entirely different approach.
It is essential that the Commissioner ensures continued communication with contractors throughout the stages to enable them to have a clear understanding of the processes, expectations and obligations. Outlined in Annexes 1 and 2 are guides to communications with contractors and a proposed checklist for documentation recording. In each of the stages below there are a range of activities that may need to be undertaken, depending on the Commissioner’s preferred route, and the Commissioner may usually discuss with the appropriate LMC throughout. Summary of Key Stages There are three key stages: Stage 1 – minimum 9 to 15 months before contract end (all essential): Needs assessment; Impact; and Engagement proposal. Stage 2 – 12 months before contract end: Notice period – exit plan; Commence procurement and either: Begin negotiations for continuation with contractor; and Begin exit arrangements of incumbent provider and mobilisation of any new provider. Stage 3 – at contract end: Contract end – possible dispersal of patient list: Variation to contract/extension: and Commencement of new provider. Stage 1 – 9 – 15 Months before Contract End The considerations that should be given when completing each action are provided below. This list is not exhaustive but does provide a platform for commissioners to fully assess the existing and future service needs of its population. Commissioners should ensure that all appropriate stakeholders are given the opportunity to input into the needs assessment for their population, including but not limited to public health. Needs assessment
19 Number of patients per WTE GP Understand GP access Patients/GP XXXX patients/WTE GP 20 Total no. of clinical (GP & Qualified Nursing) hours offered per week (incl. concurrent hours) Understand total clinical access a) GP hrs/week b) Nurse hrs/week c) Other state e.g. Pharmacist hours/week Total hrs/week 21 Has the practice received any contract breaches since 1 April 2013? Potential marker of poorer quality practice Yes No Details not required 22 Are any of the GP performers being investigated by NHS England Medical Directorate or GMC? Potential marker of poorer quality practice Yes No Details not required 23 What was the Practices published CQC overall rating? Understanding of practice quality issues Please state Outstanding / Good / Requires Improvement / Inadequate? 24 Has the practice applied for a formal list closure at any point since 1 April 2013? Marker of demand/practice issues Yes No Details not required 24b If yes, was this granted? Yes No 24c If application was approved how long was the list closed in total? Please state 3 months / 6 months / 9 months / 12 months 25 Number of practices within a 1-mile radius of practice insert number To be completed by Commissioner - NHS England Local Context Information NHS England complete NHS England complete
Termination due to late payment The contractor may give notice in writing to the Commissioner if the Commissioner has failed to make any payment due to the contractor under the contract. If the Commissioner has failed to make any such payment within 28 days of the notice, the contractor may terminate the contract by a further written notice. Where the NHS dispute resolution procedure has been invoked by the Commissioner, within 28 days of the initial notice, the contractor may not terminate the contract until either the NHS dispute resolution determination allows termination or the Commissioner ceases to pursue the NHS dispute resolution process. For further information on the NHS dispute resolution process, please refer to the chapter on managing disputes. NHS England's general duties may be triggered by termination in these circumstances. For further information, refer to paragraph 1.6.12 of this chapter and also the full chapter on General Duties of NHS England. Termination for provision of untrue information The Commissioner may serve notice to terminate the contract immediately (or from any date set out in the notice) if, after the contract has been entered into, it comes to the attention of the Commissioner that written information provided to the Commissioner: before the contract was entered into; or for GMS contracts, pursuant to paragraph 85(2) or (3) or 86(2) of Schedule 6 of the GMS Regulations; or for PMS agreements, pursuant to paragraph 80(2) or (3) of Schedule 5 of the PMS Regulations, in relation to: for GMS contracts, Regulations 4 and 5 of the GMS Regulations for PMS agreements, Regulation 5 of the PMS Regulations; and for APMS contracts, Direction 4 of the APMS Directions, was, when given, untrue or inaccurate in a material respect.
Details of GP performer taking leave Surname: ………………………………………. First Name: ……………………………. Claim period: ………………………………….. Number of weeks: …………………….. Number of clinical sessions worked……………………………. Reason for claim (delete as appropriate): MATERNITY / PATERNITY / ADOPTION / SICKNESS Declaration of GP performer taking leave I ………………………………………………………………………………….. certify that: (Full name in capitals) The information shown on the reverse side of this form provides an explanation of how the practice intends to cover my period of absence. ……………………………………………………………………