Report for the Royal Borough of Kingston Health Overview Panel (HOP) on GP Provision in Kingston.

 
Report for the Royal Borough of Kingston Health Overview Panel (HOP) on GP Provision in Kingston.
Report for the Royal Borough of Kingston Health
Overview Panel (HOP) on GP Provision in Kingston.

Author: Kathryn MacDermott, Director Primary Care & Planning, Kingston & Richmond CCGs

Contact: Kathryn.macdermott@kingstonccg.nhs.uk

Contributions from and thank you to:

      KCCG Primary Care Team
      KCCG Performance & Information Team
      SWL Primary Care Contacting Team

                                                                                     1
Contents
1.      GP Provision in Kingston - background...........................................................................................4
2.      Kingston Medical Services – the local primary care strategy .........................................................4
     2.1 Quality in Primary Care – local engagement in Kingston Medical Services ..................................5
3.      The GP Forward View .....................................................................................................................6
     3.1 Investment....................................................................................................................................7
     3.2 Workforce.....................................................................................................................................7
     3.3 Work load .....................................................................................................................................7
     3.4 Infrastructure................................................................................................................................8
     3.5        Care redesign ..........................................................................................................................8
4.      The South West London STP...........................................................................................................9
5.      Services provided by GP Practices in Kingston ...............................................................................9
     5.1 Contract by contract type...........................................................................................................10
     5.2 Core primary care medical services............................................................................................11
     5.3 Locally Commissioned Services ..................................................................................................11
     5.4 National Directed Enhanced services .........................................................................................12
     5.5 Kingston Medical Services – local KPIs........................................................................................13
     5.6 GPs with Specialist Interest ........................................................................................................14
6.      Access to general practices...........................................................................................................15
7.      Extended Primary Care Services ...................................................................................................17
     7.1 Weekend additional capacity .....................................................................................................17
     7.2 National DES extended hours .....................................................................................................17
8.      Urgent Primary Care services .......................................................................................................21
     8.1 Urgent Treatment Centres..........................................................................................................21
     8.2 GP Out of Hours Services............................................................................................................22
     8.3 NHS 111 ......................................................................................................................................22
9.      Primary Care data .........................................................................................................................23
     9.1 Numbers and ages of registered patients ..................................................................................23
     9.2 Deprivation by practice ..............................................................................................................25
     9.3        Ethnicity by practice .............................................................................................................26
     9.4 Usage of GP appointments .........................................................................................................27
10.         General practice workforce ......................................................................................................29
     10.1 Kingston primary care workforce as of March 2016: ...............................................................29

                                                                                                                                                       2
10.2      Patient to GP Ratio ...............................................................................................................30
  10.3 Total Health Care professionals per practice FTE .....................................................................31
  10.4 GPs by Age Band .......................................................................................................................32
11.      The GP Patient Survey ..............................................................................................................33
  11.1 Overall experience of GP surgeries...........................................................................................33
  11.2 Patient experience of telephone access ...................................................................................34
  11.3 Success in getting an appointment...........................................................................................34
  11.4 Waiting time at the GP surgery ................................................................................................35
  11.5 Patient perception of care ........................................................................................................36
  11.6 Patient satisfaction with opening hours ...................................................................................36
12.      Care Quality Commission (CQC) ratings ...................................................................................37
13.      Primary Care Governance.........................................................................................................39

                                                                                                                                               3
1. GP Provision in Kingston - background

There are currently 22 practices listed as members of Kingston CCG. One practice whilst a
member of Kingston CCG is geographically located in the borough of Merton. At this point in
time three practices also have branch surgeries. This means that in Kingston there are 26
locations at which patients can see a GP. In addition to the individual GP practices Kingston
also provides three extended primary care services that offer 8 to 8, 7 day a week access to
a GP and/or nurse appointment.

   2. Kingston Medical Services – the local primary care strategy

The local primary care strategy covers delivery of the GP Forward View transformation of
primary care whilst aiming to provide the same services across all practices in Kingston. To
achieve this KCCG is investing additional money into Kingston general practices through a
range of locally developed services known as KPIs. In 2016/17 the additional investment was
£1m. In 2017/18 the additional investment is £1.5m. The intent is to be able to invest an
additional £2m in 2018/19 to achieve the transformation and equalisation of services.
However, this level of additional investment is only sustainable if we can change the flow of
patients into hospitals, change patient behaviours and move money around the local
healthcare system.

The local Kingston Medical Services strategy invests in a range of additional services
including extended primary care services, primary care mental health, paediatric same day
appointments, supports practices to make informed referral decisions, supports practices
identify vulnerable patients that require additional care and/or referral to Kingston
Coordinated Care, audiology services, respiratory services, and supports practices set a
minimum number of GP appointments based on list size (not currently stipulated in the
GMS contract). The local strategy is in the middle of being rolled out and the GMS practices
are already delivering a range of the local KPIs. The PMS practices will be moving from their
existing PMS KPIs to the new Kingston Medical Services local KPIs for the 1st April 2018. The
table below sets out the current pattern of delivery for the new KPIs:

                                                                                                4
Weekend Additional
                                                                              Paediatric Same Day

                                                                                                    Primary Care Access
                                                         Early intervention

                                                                                                                                       Respitatory (new)

                                                                                                                                                           Risk Stratification
                                                          Mental Health &

                                                                                                      Standard (new)

                                                                                                                          Management
                                            GPFV (new)
                                Audiology

                                                                                                                                                                                     Capacity
                                                                                                                            Referral
                                                                                     appts.
          Practice

     Berrylands Surgery
      Brunswick Surgery
  Canbury Medical Centre
        Central Surgery
 Chessington Park Surgery
       (Merrick Centre)
  Churchill Medical Centre
 Claremont Medical Centre
  Fairhill Medical Practice
   Groves Medical Centre
 Holmwood Corner Surgery
Hook Surgery (Merrick centre)
   Kingston Health Centre
  Langley Medical Practice
Manor Drive Medical Centre
       Orchard Practice
       Red Lion Surgery
      (Mediventure Ltd)
      Roselawn Surgery
 St Alban’s Medical Centre
        Sunray Surgery
        Village Surgery
    West Barnes Surgery

2.1 Quality in Primary Care – local engagement in Kingston Medical Services

Kingston CCG launched a public engagement programme at its AGM in September. The aim
is to have a public conversation about the quality of locally provided general practice and
community pharmacy across Kingston & Richmond CCGs.
It has been 18 months since Kingston CCG took on the responsibility for commissioning
primary care medical services and we included a commitment in our commissioning
intentions to actively engage the local population in the design of local services.

Kingston CCG completed an engagement programme in primary care in 2015. The feedback
from this programme helped inform the primary care strategy – Kingston Medical Services.
We wish to build on what local people have already told us about local GP practices and
pharmacies, and develop a set of quality pledges for primary care. To do this we will be

                                                                                                                                                                                                      5
talking to patients, carers, local people, clinicians and staff, to understand what good quality
looks like. Over the next four months KCCG will be talking to people across Kingston and
asking ‘what matters most to you when visiting your GP and/or local pharmacy?

We also want the perspective of clinicians and staff working in local GP practices and
pharmacies about what good quality primary care looks like and what matters most to them
about the services they deliver.

   3. The GP Forward View

Kingston Medical Services sits alongside the General Practice Forward View (GPFV)
published in April 2016 by NHS England, with support from Royal College of GPs (RCGP) and
Health Education England. The GPFV sets out a substantial 5 year package of investment and
transformation that aim to support practices respond to the changing environment. It sets
out a plan to stabilise and transform general practice, improving services for patients and
investing in new ways of providing primary care. The key actions set out in the plan include:
accelerated funding of primary care; expanding and supporting GP and wider primary care
staffing; reducing the burden on practices to help release time for patient care; develop the
primary care estate and invest in better technology and a major programme of
improvement support to practices.

The illustration below attempts to illustrate how the delivery of the GP Forward View
intends to impact on general practice, patients and the wider healthcare system.

 Strengthening General
        Practice                  Community          Collective
                                   Services
                                                      Working
                                                                            Access Hub

     Demand Management                                                        Standard
     • Self-help e.g. nhs.uk                                                  Contract
     • Better sign posting            •       Stabilise practices
          o Minor Ailments            •       Support for stressed GPs
          o Social prescribing        •       Resilience programme
     • Enhanced remote care           •       Development programme
     • Care Planning Approach         •       Workforce expansion
     • Reformed 111/Urgent Care                                                Greater
                                      •       Streamlined processes           Specialist
                                                                               Support

                                             Proportionate regulation
                                          Streamlined payment systems
                                      Review of requirements e.g. QOF/AUA

                                                                                               6
The GP Forward View is structured into five sections:

   1)   Investment
   2)   Workforce
   3)   Workload
   4)   Practice infrastructure
   5)   Care redesign

3.1 Investment

The GP Forward View states “by 2020/21 recurrent funding to be increased by an estimated
£2.4 billion a year, decisively growing the share of spend on general practice services”. This
is clearly positive news and taken with Kingston CCGs strategy to invest in Kingston Medical
Services represents a unique opportunity in Kingston to general practices to support the
significant redesign of care pathways and patient flows.

The new funding formulae for general practices (to replace the existing Carr-Hill formulae) is
proposed and being worked by up NHSE with the BMA and is designed to take into account
‘atypical’ population lists, i.e. practice lists with significant older populations, high rates of
students, black and minority ethnic communities etc. This work is expected to be completed
in the summer of next year.

3.2 Workforce

The GP Forward View recognises that there is a significant workforce challenge for primary
care and refers to new incentives for training, recruitment, retention and return to practice.
The ambition is to double the workforce and ongoing work across London to understand
how this could be achieved.

There are a number of positive initiatives proposed including the health & wellbeing of GPs,
training ‘hubs’, practice nurse development, leadership development, and piloting clinical
pharmacists in general practice. Across SWL the CCGs are collaborating on the development
and delivery of a shared workforce strategy.

3.3 Work load

“Releasing Time for Patients” is a development programme to support general practice
‘release time’ by enabling the care of patients to be provided by the appropriate
professional, at the right time, in the right place. This refers predominantly to the care and
self-management of people living with long term conditions.

                                                                                                 7
The GP Forward View suggests that CCGs look to local community pharmacy to help with
patients with long term conditions and minor ailments. This is a key element within the
Kingston plan, included in the extended primary care services communications materials
and a key question in the current quality in primary care engagement programme.

3.4 Infrastructure

The infrastructure section covers both estates and technology. The GPFV signalled a change
in the way CCGs could apply for capital funding for estates bids, establishing the Estates and
Technology Transformation Fund (ETTF). Kingston CCG currently has a proposal in the ETTF
‘round; for a new primary care centre on the Kingston Hospital site.

Most of the focus on infrastructure within the GPFV focusses on changing the way people
can access general practice through technology. This includes:

      Technology that enables self-care and self-management for patients
      Helps to reduce workload in practices
      Helps practices who want to work together to operate at scale
      Supports greater efficiency across the whole system
      Support uptake of online consultation systems
      Digital Primary Care Maturity Index – sets out the support general practice can
       expect from IT services

3.5 Care redesign

Care redesign focusses on enhanced primary care access (8 to 8, 7 days a week), and the
integration of core general practice with out of hours and urgent care services. This element
has been recently expanded on in the Urgent Care Guidance, and is informing the extended
primary care services commissioning intentions for 2018/19 onwards.

The GPFV lists 10 high impact actions supporting care redesign and releasing capacity for
practices. These include:

      Active signposting
      New consultation types
      Reduce DNAs (did not attends)
      Develop the team
      Productive workflows
      Personal productivity
      Partnership working
      Social prescribing
      Support self-care
      Develop Quality Improvement expertise (QI)

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4. The South West London STP

The South West London (SWL) Sustainability & Transformation plan includes a chapter on
general practice and sets out the plan to integrate primary care and community services.
However primary care is threaded throughout the strategy and is the bedrock of the out of
hospital transformation of care.

The framework of the SWL STP chapter on general practice is currently structured around
the 17 London specifications (Access, Coordinated & Proactive). This framework overlaps in
a number of ways with the delivery of Kingston Coordinated Care.

   5. Services provided by GP Practices in Kingston

Nationally there are three types of contracts that a general practice can sign up to. There
are two contract types in place for general practices in Kingston, GMS & PMS.

The GMS contract covers the delivery of general medical services (GMS). It is the nationally
set NHS contract between NHSE and a practice, not the individual GP. This came into force
on 1st April 2004. Services in the GMS contract are split into three groups: essential,
additional and enhanced.

Essential services are mandatory. Practices must provide essential services for people who
are sick or perceive themselves to be sick with conditions from which recovery is expected,
chronic disease management and general management of terminally ill patients.

Additional services are ‘expected’ under the GMS contract but Practices have the option to
opt out. Additional services include cervical screening, contraceptive services, vaccination
and immunisation, child health surveillance, maternity services (including intra partum care)
and some minor surgery procedures.

Enhanced services can be either essential or additional services that are delivered to a
higher standard, or extra/additional, specialised services, such as minor surgery or extended
hours. These are known as Directed Enhanced Services (DES). Directed Enhanced Services
are voluntary and NHSE commissions the national Directed Enhanced Services (on behalf of
the CCGs).

Directed Enhanced Services are NHSE defined and funded services that practices can opt to
provide. An example is the extended hours DES which a number of Kingston practices
provide. Additionally, Kingston CCG commissions Locally Commissioned Services (LCS) that
are designed and funded locally to meet local population needs.

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PMS contracts build on the GMS contract. A practice with a PMS contract has contractually
agreed to provide additional services as part of their core contract.

GMS and PMS contracts were introduced in 2004 as part of The NHS Plan. The intention was
to move away from simply paying practices on the number of registered patients by
introducing a number of quality indicators. The basic principle is that high quality practices
receive additional resources to support continuation of quality services.

5.1 Contract by contract type

Kingston CCG is made up of a number of practices, some of which include branch surgeries.
These are listed below by contract type as requested:

                          Practice                                  Branch              GMS
                     Brunswick Surgery                                                  GMS
                  Canbury Medical Centre                           Berrylands           GMS
                Claremont Medical Centre                                                GMS
                  Groves Medical Centre                                                 GMS
               Hook Surgery (Merrick centre)                                            GMS
                  Kingston Health Centre                                                GMS
                Manor Drive Medical Centre                                              GMS
                      Orchard Practice                      Part of Churchill Medical   GMS
                 St Alban’s Medical Centre                                              GMS
                    West Barnes Surgery                                                 GMS

                          Practice                                                      PMS
                      Central Surgery                                                   PMS
         Chessington Park Surgery (Merrick Centre)                                      PMS
                 Churchill Medical Centre                    Surbiton & Tudor Drive     PMS
                 Fairhill Medical Practice                    Fairfield & University    PMS
                Holmwood Corner Surgery                                                 PMS
                 Langley Medical Practice                                               PMS
            Red Lion Surgery (Mediventure Ltd)                                          PMS
                    Roselawn Surgery                                                    PMS
                      Sunray Surgery                                                    PMS
                      Village Surgery                                                   PMS

                                                                                            10
5.2 Core primary care medical services

All Kingston general practices provide the essential GMS services. In addition half of
Kingston practices also provide additional services as part of the PMS contract. The
additional services provided by a PMS practices includes:

   1) A stretch target (i.e. higher than the GMS target) for childhood immunisation target.
      PMS practices are expected to achieve 95% coverage of all childhood immunisations
      DTP, MMR, Hib, Men C, PCV, etc.
   2) Stretch target on QOF (Quality Outcomes Framework). PMS practices are expected
      to achieve greater than 950 QOF points.
   3) Stretch target on cervical cytology (screening). PMS practices are expected to
      achieve 85% or more coverage of women aged between25-64 years of age.
   4) Stretch target on flu & pneumococcal vaccination for patients aged 65 and over.
      PMS practices are expected to achieve 75% coverage of flu vaccination cover for
      patients who meet the DH criteria for flu immunisation.
   5) Mental Health: PMS practices are expected to achieve 65% of patients diagnosed
      with dementia provided with an annual physical check-up including a regular review
      of any antipsychotic medication prescribed.
   6) Obesity: The practice will offer a health check for 95% of new registrations over age
      18 to include waist, weight and height measurements and offer referral to local
      weight management and exercise referral schemes where higher risks are identified
      and schemes are available e.g. Weigh-to-Go, Rosemary Conley, Get Active, Walk-4-
      Life and Cyle-4-Life.
   7) Choose and Book: PMS practices are required to continue to deliver Choose and
      Book.
   8) Carers: Have a carer’s register, routinely identify carer’s, have a ‘carer’s liaison
      officer’.
   9) PMS practices are required to provide data on the delivery of any of the DH Vital
      Signs Targets (limit up to 3). The data is fed back to child health for reporting
      coverage to the DH for public health information

5.3 Locally Commissioned Services

Kingston CCG also invests in locally commissioned services, which all practices can opt into
delivering. These local services are designed to meet the needs of the local population and
can be different across different boroughs. The range of locally commissioned services
provided by Kingston practices are illustrated in the table below:

                                                                                           11
Kingston Locally Commissioned Services

                                Alcohol (PH LCS)

                                                                                  Complex Wound

                                                                                                                                                                              Misuse (PH LCS)
                                                                 Leg Ulcer Care

                                                                                                                                                              Sexual Health
                                                   ABPM (blood

                                                                                                                                  Phlebotomy

                                                                                                                                               Ring Pessary
                                                                                                  Shared Care
                                                   monitoring)

                                                                                                  Prescribing

                                                                                                                                                                                Substance
                                                                                                                       Diabetes
                                                     pressure

                                                                                                                                                                (PH LCS)

                                                                                                                                                                                                Vascular
                                                                                                                COPD
                                                                                      Care
          Practice

      Berrylands Surgery
       Brunswick Surgery
   Canbury Medical Centre
         Central Surgery
  Chessington Park Surgery
        (Merrick Centre)
   Churchill Medical Centre
  Claremont Medical Centre
   Fairhill Medical Practice
   Groves Medical Centre
  Holmwood Corner Surgery
Hook Surgery (Merrick centre)
    Kingston Health Centre
  Langley Medical Practice
 Manor Drive Medical Centre
       Orchard Practice
Red Lion Surgery (Mediventure
               Ltd)
       Roselawn Surgery
  St Alban’s Medical Centre
         Sunray Surgery
         Village Surgery
     West Barnes Surgery

5.4 National Directed Enhanced services

In addition to locally commissioned services, that are developed and paid for locally, there
are a range of nationally developed enhanced services that are managed by NHSE. Kingston
practices also deliver a range of the nationally directed enhanced services illustrated below.
Further detail on directed enhanced services can be found in section 6.2:

                                                                                                                                                                                                           12
National Directed Enhanced Services

                                                                     Out of Area
                                                      Patient with

                                                                     Registration
                                                       Difficulty
                                 Extended

                                                        Learning
                                            Surgery
                                   Hours

                                             Minor
           Practice

                                             With
      Berrylands Surgery                    Canbury
      Brunswick Surgery
   Canbury Medical Centre
        Central Surgery
  Chessington Park Surgery
       (Merrick Centre)
  Churchill Medical Centre
 Claremont Medical Centre
   Fairhill Medical Practice
   Groves Medical Centre
  Holmwood Corner Surgery
Hook Surgery (Merrick centre)
   Kingston Health Centre
  Langley Medical Practice
 Manor Drive Medical Centre
       Orchard Practice
       Red Lion Surgery
      (Mediventure Ltd)
      Roselawn Surgery
  St Alban’s Medical Centre
        Sunray Surgery
        Village Surgery
     West Barnes Surgery

5.5 Kingston Medical Services – local KPIs

Unique to Kingston is the investment that KCCG is putting into primary care through
Kingston Medical Services. This new investment is enabling the roll out a suite of new
services to all practices. Kingston Medical Services will ensure that all practices are able to
offer the same range of services to their patients regardless of the type of national contract
the practice holds with NHSE (i.e. GMS or PMS).

Kingston Medical Services has to demonstrate that it can achieve a shift in patient activity to
enable the non-recurrent investment currently underpinning Kingston Medical Services to
become recurrent.

                                                                                             13
GMS            PMS
                 Practice                    Essential     Additional     LCS      KPIs
                                             Services       Services
          Berrylands Surgery
           Brunswick Surgery
       Canbury Medical Centre
            Central Surgery
  Chessington Park Surgery (Merrick
                Centre)
       Churchill Medical Centre
      Claremont Medical Centre
       Fairhill Medical Practice
        Groves Medical Centre
      Holmwood Corner Surgery
    Hook Surgery (Merrick centre)
        Kingston Health Centre
       Langley Medical Practice
     Manor Drive Medical Centre
           Orchard Practice
  Red Lion Surgery (Mediventure Ltd)
           Roselawn Surgery
      St Alban’s Medical Centre
            Sunray Surgery
            Village Surgery
         West Barnes Surgery

5.6 GPs with Specialist Interest

Kingston has a number of GPs trained in specialised areas. These are known as GPs with a specialist
interest (GPwSI). We currently have eight GPwSI and a number of them are specialist in more than
one area.

Specialist GP advice is available on:

       Dermatology
       Dementia
       Neurology
       Urology
       Vasectomy
       Minor Surgery

                                                                                                  14
GPs with a specialist interest provide this additional service through a number of clinics that a
patients GP can refer a patient to.

    6. Access to general practices

The GMS contract describes core general practice hours as 8am to 6.30pm. However the
GMS contract does not stipulate that the practice must be open for all core hours only that practices
must provide essential services to meet the 'reasonable needs' of their patients.

The table below illustrates the current opening hours of practices in Kingston and illustrates
the range of hours available. This range is due to a number of factors:

       The extended hours provided under the national extended hours enhanced service
       If the practice has chosen to deliver the Kingston Weekend Additional Capacity KPI
        that provides for Saturday morning appointments.
       If a practice closes for lunch
       If a practices closes to allow for staff training time

There has been recent national attention paid to the contractual requirement to be open for
the full core hours and future revisions to the GMS contract may clarify this point.

                                                                                                    15
Kingston GP Hours

                                                                                              Practice provides cover outside of core opening
           Practice                        Hours (core hours are 8.00 to 18.30)                                                                       GP practices open on Saturdays       Online services
                                                                                                           times (8am - 18.30pm)

      Berrylands Surgery                          Extended hours Mon & Fri only                        Yes. Extended hours Mon & Fri only                           Yes                          Yes
       Brunswick Surgery               7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed         Yes. 7.30am - 18.30 Mon to Fri, 7.30am to 19.30 Wed                   No                           Yes
   Canbury Medical Centre                        Extended hours Mon & Tues only                         Extended hours Mon & Tues only                              Yes                          Yes
        Central Surgery                7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri        Yes. 7.30am - 20.00 Mon to Thur, 7.30am to 18.00 Fri                  No                           Yes
   Chessington Park Surgery
                       8am - 13.00 Mon to Fri, 14.00 to 18.30 Mon, Tues, Fri, 14.00 to 20.00 Wed 7 Thur                No                                    Every 2nd Sat am                    No
  Churchill Medical Centre,
                                                    8.00am - 20.00 Mon to Fri                               8.00am - 20.00 Mon to Fri                         8.30am - 11.10                     Yes
            Kingston
  Churchill Medical Centre,        8.30am - 12.00, 16.00 - 18.00 Mon, Tues, Thur, Fri. Wed
                                                                                                                Wed eve to 20.00                                    No                 Repeat Prescribtions only
             Surbiton                     8.30am - 12.00, 15.00 - 17.00, 18.00 - 20.00
Churchill Medical Centre, Tudor
                                    8.30am - 12.00 Mon to Fri. 16.00 - 18.00 Mon to Thur.                              No                                           No                 Repeat Prescribtions only
                Br
                                    8.30am to 13.00 Mon, Tues, Thur, Fri. Wed 8.30 am to
  Claremont Medical Centre                                                                    Wed eve to 19.50. Thur eve to 19.20. Fri eve to 18.50                Yes                           Yes
                                           19.50. Thur 14.10 - 19.20. Fri 14.10 - 18.50
   Fairhill Medical Practice                        8.00am - 18.30 Mon to Fri                                          No                                          No                            Yes
         Fairhill Branch                            8.00am - 18.30 Mon to Fri                                          No                                          No                            Yes
   Fairhill University Branch                       8.00am - 17.30 Mon to Fri                                          No                                          No                            Yes
    Groves Medical Centre                   8.30am - 13.00, 14.00 - 18.30 Mon to Fri               7.00am on Tues & Thurs. 20.00 on Wed eve                        Yes                 Repeat Prescribtions only
                                 8.50am to 11.30, Mon, Thur & Fri, 8.30am to 11.30 Tues &
  Holmwood Corner Surgery        wed. 16.00 - 18.00 Mon. 15.00 - 19.30 Tues & Thur. 14.00 -                Tues & Thurs eve to 19.30.                          9.00 - 10.30                      Yes
                                              17.30 Wed eve. 15.00 - 18.00 Fri eve.
          Hook Surgery                      8.00am - 13.00, 14.00 - 19.00 Mon to Fri                              Eves to 19.00                        Every 2nd Sat am 8.30 - 10.30             Yes
    Kingston Health Centre         8.00am - 18.30 Tues to Thur, 7.15am - 18.30 Mon & Fri.                    Mon & Fri 7.15 am start                                Yes                          Yes
   Langley Medical Practice                         8.00am to 18.30 Mon to Fri                                         No                                           No                           Yes
                                  9.00 - 11.00 Mon to Fri, 15.30 - 18.00 Mon, Tues, Thur &
 Manor Drive Medical Centre                                                                                     Mon eve to 20.00                                   Yes                           Yes
                                           Fri, 17.00 on Wed, 18.30 - 20.00 Mon eve.
                                   8.30 - 11.30 Mon & Thur, 9.00 - 11.30 Tues, 9.30 - 11.30
Red Lion Surgery (Mediventure
                                   Wed, 8.30 - 10.30 Fri, 16.30 - 18.30 Mon & Wed, 16.30 -        Tues eve, 18.30 - 19.30, Fri eve 18.30 - 19.00                    No                 Repeat Prescribtions only
               Ltd)
                                                   19.30 Tues, 16.30 - 19.00 Fri.
        Orchard Practice            7.30 - 18.30 Mon, Wed & Fri, 7.30 - 20.00 Tues & Thur               7.30 am, Tues & Thur eve to 20.00                          Yes                           Yes
                                  8.30 - 13.00 Mon to Fri, 14.00 - 19.30 Mon, 14.00 - 19.00
       Roselawn Surgery                                                                             Mon, Tues, wed & Fri extended eve hours.                        No                           Yes
                                                         Tues, Wed & Fri.
  St Alban’s Medical Centre              7.30 - 18.00 Mon to Fri, closed 12.00 - 13.30.                                No                                           No                           Yes
         Sunray Surgery                       8.00 - 13.00, 15.00 to 18.30 Mon - Fri                             Mon eve 20.00                                      No                           No
        Village Surgery                   8.30 - 18.30 Mon to Fri, 19.30 Wed & Thur.                        Wed & Thur eve to 19.30.                                No                 Repeat Prescribtions only
                                                                                                To 19.00 Mon to Fri, Wed am 7.30 to 8.00, Fri eve
     West Barnes Surgery                               8.00 - 19.00 Mon - fri                                                                                      Yes                           Yes
                                                                                                                 18.30 to 19.40.

                                                                                                                                                                                                                   16
7. Extended Primary Care Services

Kingston has three extended primary care services across Kingston that provides access to GP
and/or Nurse Appointments, 8 to 8, 7 days a week.

The three services are based at:

      Surbiton Health Centre
      Kingston Health Centre
      Merritt Health Centre

Access to the weekday appointments are made by the patients GP through their clinical
system. The appointments for each week (Monday to Friday) are available to be booked
from Monday morning.

For access to weekend appointments patients can book via a single shared phone number.
All callers will have access to the appointment available in all three extended primary care
services, providing an element of patient choice. The weekend extended services is not
advertised as a walk-in service. Where patients do walk-in they are allocated the next free
appointment slot.

The extended primary care services and all Kingston practices are on the same clinical
system (EMIS). This ensures that no matter where a patient is seen the clinician will be able
to access their clinical records.

7.1 Weekend additional capacity

Weekend Additional Capacity is the name given to one of the local KPIs in the Kingston
Medical Services contract. This KPI requires a practice to be open on a Saturday morning
with a minimum number of appointments available (based on list size). There are two
options for delivery of the Weekend Additional Capacity KPI. One requires that practices
offers booked appointments, up to 5 days in advance. The second option requires practices
to offer both booked in advance and same day appointments. Practices can choose which
option best meets the needs of their local population.

7.2 National DES extended hours

The national DES (directed enhanced services) extended hours is commissioned and
managed by NHSE. For Kingston CCG as a level 3 commissioners we would want to ensure
that the extended provision provided through the national DES, local KPIs and the extended
primary care services formed a holistic and seamless approach to extended hours that did
not duplicate or create gaps in service provision for Kingston residents.

                                                                                               17
The next two tables are drawn from NHSE information on Kingston practices that have
signed up to provide DES extended services. The detail provides a clear illustration of the
extended hours provided and the clinical professional providing the services:

                                                                                              18
Monday -                                             Tuesday -                                            Tuesday -
                               Monday -     Monday                                                            Monday                                               Tuesday                                              Tuesday
                                                                                                    Extended                                             Extended                                             Extended
                               Extended     Extended                                                          Extended                                             Extended                                             Extended
                                                                                                    Hours                                                Hours                                                Hours
 Practice Name                 Hours        Hours 1 GP     2 GPs   3 GPs   1 Nurse 2 Nurses HCA               Hours 1 GP   2 GPs   3 GPs   1 Nurse HCA             Hours 1 GP   2 GPs   1 Nurse HCA     Other           Hours 1 GP    2 GPs   1 Nurse
                                                                                                    Evening -                                            Morning -                                            Evening -
                               Morning -    Morning -                                                         Evening -                                            Morning -                                            Evening -
                                                                                                     start                                                start                                                start
                               start time   end time                                                          end time                                             end time                                             end time
                                                                                                    time                                                 time                                                 time

Canbury Medical Centre                                                                                                                                   07:00   08:00   1 GP                     HCA   Advanced Nurse Practitioner
Brunswick Surgery             07:00         08:00                  3 GPs   1 Nurse                                                                                                                               18:30 19:00 1 GP
The Groves Medical Centre                                                                                                                                07:00   08:00   1 GP           1 Nurse HCA              18:30 19:30 1 GP
Fairhill Medical Practice                                                                           18:30   20:00          2 GPs                                                                                 18:30 20:00          2 GPs
Hook Surgery                                                                                        18:30   19:00          2 GPs
Churchill Medical Centre                                                                            18:30   20:00          2 GPs                                                                               18:30   20:00   1 GP
St Alban's Medical Centre     07:30         08:00          2 GPs                     2 Nurses HCA                                                        07:30   08:00          2 GPs   1 Nurse
The Orchard Practice          07:30         08:00   1 GP                                                                                                                                                       18:30   20:00   1 GP
Holmwood Corner Surgery                                                                                                                                                                                        18:30   20:15   1 GP
Chessington Park Surgery
Roselawn Surgery                                                                                    18:30   19:30          2 GPs                                                                               18:30   19:00          2 GPs
Berrylands Surgery            07:30         08:00          2 GPs
Red Lion Road Surgery (Mediventure Ltd)                                                                                                                  06:30   07:30   1 GP                                  18:30   19:30   1 GP
Kingston Health Centre        07:00         08:00   1 GP                   1 Nurse           HCA
Langley Medical Practice      07:00         08:00   1 GP                   1 Nurse                                                                       07:30   08:00                  1 Nurse                18:30   20:00   1 GP
Sunray Surgery                                                                                                                                           07:30   08:00   1 GP                     HCA          18:30   20:00   1 GP           1 Nurse
Claremont Medical Centre                                                                            18:30   20:00                  3 GPs                                                                       18:30   19:00                  1 Nurse
The Village Surgery
Manor Drive Medical Centre                                                                          18:30   20:30          2 GPs           1 Nurse HCA
West Barnes Surgery                                                                                 18:30   19:00   1 GP                   1 Nurse                                                             18:30   19:00          2 GPs

                                                                                                                                                                                                                                                   19
Wednes                                                      Wednes
                                         Wednes                                                      Wednes                            Thursday -                                 Thursday -                             Friday -                                    Friday -               Saturday -
                               day -                                                       day -                                                  Thursday                                   Thursday                              Friday                                      Friday                  Saturday
                                         day                                                         day                               Extended                                   Extended                               Extended                                    Extended               Extended
                               Extended                                                    Extended                                               Extended                                   Extended                              Extended                                    Extended                Extended
                                         Extended                                                    Extended                          Hours                                      Hours                                  Hours                                       Hours                  Hours
 Practice Name                 Hours               1 GP 2 GPs 1 Nurse 2 Nurses HCA   Other Hours               1 GP 2 GPs 1 Nurse                 Hours 1 GP 2 GPs 1 Nurse HCA               Hours 1 GP 2 GPs 1 Nurse              Hours 1 GP 1 Nurse 2 Nurses HCA             Hours 1 GP              Hours 1 GP 1 Nurse
                                         Hours                                                       Hours                             Morning -                                  Evening -                              Morning -                                   Evening -              Morning -
                               Morning -                                                   Evening -                                              Morning -                                  Evening -                             Morning -                                   Evening -               Morning -
                                         Morning -                                                   Evening -                          start                                      start                                  start                                       start                  start
                                start                                                       start                                                 end time                                   end time                              end time                                    end time                end time
                                         end time                                                    end time                          time                                       time                                   time                                        time                   time
                               time                                                        time
Canbury Medical Centre         07:00 08:00              2 GPs                  HCA
Brunswick Surgery                                                                              18:30      19:45 1 GP                                                                                                     07:30 08:00 1 GP
The Groves Medical Centre 07:30           08:00               1 Nurse                          18:30      20:00      2 GPs             07:00 08:00          2 GPs
Fairhill Medical Practice                                                                      18:30      20:00 1 GP                                                              18:30 20:00 1 GP                       07:30 08:00 1 GP                                                   08:00 11:30 1 GP
Hook Surgery                  07:30       08:00                                      Nurse Practitioner                                                                           18:30 19:30      2 GPs
Churchill Medical Centre                                                                       18:30      20:00 1 GP                                                              18:30 20:00 1 GP                                                                   18:30 20:00 1 GP
St Alban's Medical Centre 07:30           08:00        2 GPs 1 Nurse          HCA                                                      07:15 08:00      2 GPs 1 Nurse HCA                                                07:30 08:00 1 GP 1 Nurse
The Orchard Practice                                                                           18:30 20:00 1 GP                        07:30 08:00 1 GP                           18:30 20:00 1 GP
Holmwood Corner Surgery                                                                                                                                                           18:30 20:15 1 GP                                                                                          09:00 11:45 1 GP
Chessington Park Surgery                                                                       18:30 20:00 1 GP              1 Nurse                                              18:30 20:00 1 GP
Roselawn Surgery
Berrylands Surgery                                                                                                                     07:00 08:00 1 GP
Red Lion Road Surgery (Mediventure Ltd)                                                                                                                                                                                                                              18:30 19:00 1 GP
Kingston Health Centre        07:00       08:00 1 GP          1 Nurse         HCA                                                      07:00 08:00 1 GP             1 Nurse HCA                                          07:00 08:00           1 Nurse        HCA
Langley Medical Practice 07:00            08:00 1 GP          1 Nurse
Sunray Surgery
Claremont Medical Centre                                                                                                                                                          18:30 19:30      2 GPs 1 Nurse                                                                            08:30 11:30 1 GP
The Village Surgery                                                                            18:30 19:45 1 GP                                                                   18:30 19:45 1 GP
Manor Drive Medical Centre
West Barnes Surgery           07:30       08:00 1 GP          1 Nurse         HCA                                                                                                 18:30 18:45                  1 Nurse                                               18:30 19:00 1 GP 08:30 11:15                  1 Nurse

                                                                                                                                                                                                                                                                                                                       20
8. Urgent Primary Care services

8.1 Urgent Treatment Centres

National guidance on Urgent Treatment Centres was published recently. It includes the
definition of an Urgent Treatment Centres (UTC) as:

“Urgent treatment centres (UTCs) are community and primary care facilities providing
access to urgent care for a local population. They encompass current Walk-in Centres, Minor
Injuries Units, GP-led Health Centres and all other similar facilities, including the majority of
those currently designated as “Type 3 and Type 4 A&E Departments”. Urgent treatment
centres will usually be led by general practitioners, and are ideally co-located with primary
care facilities, including GP extended hours / GP Access Hubs or Integrated Urgent Care
Clinical Assessment Services (formerly known as “GP out of hours” services)”.

The guidance sets out clear ‘minimum standards by which UTCs should operate. These
include:

   •   Urgent treatment centres should be open for at least 12 hours a day seven days a
       week, including bank holidays. Typically this will be an 8-8 service
   •   Urgent treatment centres must include minor illness and injury in adults and children
       of any age:
           • including wound closure, removal of superficial foreign bodies and the
                management of minor head and eye injuries.
   •   Access to investigations including:
           • swabs, pregnancy tests and urine dipstick and culture. Near patient blood
                testing, such as glucose, haemoglobin, d-dimer and electrolytes should be
                available. Electrocardiograms (ECG) should be available, and in some urgent
                treatment centres near-patient troponin testing could also be considered.
   •   Bedside diagnostics and plain x-ray facilities, particularly of the chest and limbs, are
       desirable and considerably increase the assessment capability of an urgent
       treatment centre, particularly where not co-located with A&E.
           • Where these facilities are not available on site, clear access protocols should
                be in place.
   •   Provide both pre-booked, same day and “walk-in” appointments
   •   Apply an effective and consistent approach to the primary prioritisation (triage) of
       pre-booked appointments and “walk-in” appointments, and the allocation of pre-
       booked routine and same day appointment slots (ratio)
   •   Ability to book an appointment in the urgent treatment centre by a single phone call
       to NHS 111; patients should be encouraged to use NHS 111 as the primary route to
       access an appointment at an urgent treatment centre.
   •   Patients who have a pre-booked appointment made by NHS 111 should be seen and
       treated within 30 minutes of their appointment time

                                                                                              21
•   Patients who have a pre-booked appointment made by their GP should be seen and
       treated within 30 minutes of their appointment time
   •   Patients who “walk-in” to an urgent treatment centre should be clinically assessed
       within 15 minutes of arrival
           • but should only be prioritised for treatment, over pre-booked appointments,
                where this is clinically necessary.
   •   Following clinical assessment, walk in patients will be given an appointment slot,
       which will not be more than two hours after the time of arrival.
   •   Be able to issue prescriptions, including repeat prescriptions and e-prescriptions
   •   Access to the electronic (up to date) patient care record
   •   Ability for other services (e.g. NHS 111) to electronically book appointments directly

Kingston Hospital is currently developing a UTC for the front end of Kingston A&E. The
current KHFT plans include the triage of patients, and could include redirection of patients
to the extended primary care services. The current contract with Kingston GP Chambers for
extended primary care services includes the provision for the extended primary care service
to be able to provide appointments for redirected patients. The contract for the Teddington
walk in centre that many Kingston residents use is being updated for 2018/19 to include the
ability to provide appointments for Richmond patients that are redirected.

8.2 GP Out of Hours Services

GP out of hours services are provided from 6.30pm to 8am on weekdays and all day at
weekends and on bank holidays. For Kingston residents this service is provided by a
partnership of Vocare and SELDOC. Sutton CCG manages this contract on behalf of Kingston
CCG and four of the other five SWL CCGs.

8.3 NHS 111

NHS 111 is a national telephone based service that helps callers identify the most
appropriate service for them to use. The intention is to integrate NHS 111 with the GP OOH
services and enable 111 to book directly into the extended primary care services/hubs,
enabling a seamless transfer for a patient calling the service.

                                                                                           22
9. Primary Care data

9.1 Numbers and ages of registered patients

As of 1st April 2017 there were 204,821 patients registered with a Kingston CCG practice. The number of patients registered per practice as of
1st April 2017 is set out below, by age band:

                                      e
                       de            m
                     Co            Na
              tic
                 e
                            tic
                               e
                                               04             09             14             19             24             29             34             39             44         l   49             54             59             64             69             74             79             84             89             94
            ac            ac              to             to             to             to             to             to             to             to             to        +    to
                                                                                                                                                                                ta      P       to             to             to             to             to             to             to             to             to
         P r           P r                  0       05             10             15             20             25             30             35             40             45
                                                                                                                                                                          95 To       W    50             55             60             65             70             75             80             85             90
      H84053    Berrylands Surgery           263    247    211    159    231    298    304    361    302    315    273    255   216   215   177   124   102    71    36   8   4,168   4,013
      H84015    Brunswick Surgery            554    501    410    345    362    530    729    756    648    619    545    419   331   286   215   151   114    81    38 22    7,656   6,725
      H84010    Canbury Medical Centre       598    707    619    550    489    598    671    817    807    841    726    664   536   478   343   209   150    98    49 24    9,974   8,821
      H84030    Central Surgery              788    783    687    564    533    789 1,033 1,135 1,113       980    903    696   580   580   490   361   272   198   102 44 12,631 11,588
      H84050    Chessington Park Surgery 480        459    389    447    422    481    457    469    478    475    537    421   392   339   303   168   156    90    41 13    7,017   6,647
      H84027    Churchill Medical Centre 1,471 1,460 1,044        743    922 1,426 1,795 1,881 1,800 1,449 1,121          905   680   600   531   331   226   149    63 25 18,622 16,137
      H84619    Claremont Medical Centre 860        626    462    356    400    875 1,338 1,505 1,213       946    626    463   301   247   214   143   100    63    24   8 10,770    8,624
      H84020    Fairhill Medical Practice    892    920    751 1,406 6,559 3,043 1,653 1,409 1,262 1,014           872    637   524   455   398   254   170   121    59 17 22,416 18,772
      H84042    Holmwood Corner Surgery 818         824    709    688    730    851    992 1,078 1,049      968    883    682   549   546   415   323   277   198    83 30 12,693 11,192
      H84025    Hook Surgery                 518    509    414    355    401    491    604    582    539    534    446    385   313   274   252   178   139    90    42 15    7,081   6,693
      H84058    Kingsdowne Surgery           172    168    179    205    209    280    309    296    283    272    278    225   242   228   188   143   109    64    29 11    3,890   3,786
      H84062    Langley Medical Practice 511        458    378    316    381    567    642    678    635    623    556    455   346   336   301   195   159   105    29 12    7,683   7,091
      H84635    Manor Drive Surgery          966    866    719    646    613    808    985 1,164 1,132      927    902    791   665   600   551   367   277   162    76 22 13,239 11,755
      H84054    Red Lion Road Surgery        146    172    163    179    174    216    259    254    240    239    192    164   128   125    98    76    69    33    16 14    2,957   2,610
      H84061    Kingston Health Centre       746    707    630    501    735    945 1,064 1,109      976    870    688    385   302   290   189   102    81    48    27   6 10,401    8,513
      H84051    Roselawn                     352    345    404    374    368    477    487    451    508    482    457    323   238   219   180   111    95    64    26 11    5,972   5,087
      H84033    St Albans Medical Centre 410        508    498    434    313    341    345    480    560    582    615    504   387   362   311   218   166   103    54 16    7,207   6,624
      H84618    Sunray Surgery               236    330    308    272    242    289    348    360    315    290    307    256   202   152   115    59    48    26     8   2   4,165   3,379
      H84016    The Groves Medical Centre 780 1,071 1,093         962    742    912    929 1,185 1,204 1,254 1,166        972   784   704   529   415   315   267   149 52 15,485 13,916
      H84034    The Orchard Practice         450    519    520    479    485    571    577    639    566    594    665    534   422   427   345   244   166   141    45 19    8,408   8,286
      H84629    Village Surgery              217    296    304    288    307    478    462    385    442    413    344    301   221   170   167   102    56    34     8   1   4,996   4,090
      H85055    West Barnes Surgery          331    424    409    431    436    473    475    600    566    582    546    509   415   376   292   222   142    93    48 20    7,390   6,247
                KCCG                      12,559 12,900 11,301 10,700 16,054 15,739 16,458 17,594 16,638 15,269 13,648 10,946 8,774 8,009 6,604 4,496 3,389 2,299 1,052 392 204,821 180,598

                                                                                                                                                                                                                                                                                                                                  23
The illustrations below allow you to see how the age bands by sex are spread across the Kingston registered population.

Age Band          Male    Female             Male       Female              Kingston CCG Practice List Size Apr 2017
0 to 04             6,433 6,126                  -6433 6,126
05 to 09            6,506 6,394                   95+
                                                 -6506    6,394
10 to 14            5,657 5,644             90 to-5657
                                                   94     5,644
15 to 19            5,115 5,585             85 to-5115
                                                   89     5,585
20 to 24            6,965 9,089             80 to-6965
                                                   84     9,089
25 to 29            7,605 8,134                  -7605
                                            75 to 79      8,134
30 to 34            8,111 8,347                  -8111
                                            70 to 74      8,347
35 to 39            9,053 8,541                  -9053
                                            65 to 69      8,541
40 to 44            8,744 7,894                  -8744 7,894
                                            60 to 64
45 to 49            8,219 7,050                  -8219 7,050
                                            55 to 59
50 to 54            7,219 6,429                  -7219 6,429
                                            50 to 54
55 to 59            5,691 5,255                  -5691 5,255
60 to 64            4,386 4,388             45 to-4386
                                                   49     4,388
65 to 69            3,946 4,063             40 to-3946
                                                   44     4,063
70 to 74            3,226 3,378             35 to-3226
                                                   39     3,378
75 to 79            2,050 2,446             30 to-2050
                                                   34     2,446
80 to 84            1,505 1,884             25 to-1505
                                                   29     1,884
85 to 89              881 1,418                    -881
                                            20 to 24      1,418
90 to 94              335     717                  -335
                                            15 to 19        717
95+                   102     290                  -102
                                            10 to 14        290
                  101,749 103,072           05 to 09
                                             0 to 04

                                                   10000      8000   6000    4000      2000       0       2000     4000   6000   8000   10000

                                                                                          Male   Female

                                                                                                                                                24
9.2 Deprivation by practice

Kingston is a relatively affluent borough with deprivation scores well below the England
average. There is however variation across Kingston with all of the practices in the two
localities of Chessington and New Malden with a score over the CCG average.

                                                                                           25
9.3 Ethnicity by practice

The population in Kingston, like most London boroughs, is made up of a range of people from differing ethnic backgrounds. The practices in New Malden
have the greatest mix of ethnicity with Chessington the least.

                                                                                                                                                        26
9.4 Usage of GP appointments

In the last year in Kingston there have been over 800,000 GP appointments. That roughly equates to an average of 4 appointments per patient.
27% of these GP appointments could have been seen by a community pharmacist or nurse. Each and every GP in Kingston has more than 8
appointments a week missed. This does not include appointments where a patient has contacted the practice and cancelled, this is where a
patient simply does not turn up for a booked appointment. This adds to the pressure on appointments that could be avoided.

Appointments Not Attended                                            Column Labels
Row Labels                                                             2008/09                2009/10    2010/11    2011/12    2012/13    2013/14    2014/15    2015/16    2016/17    2017/18 Grand Total
2 - Appointment Cancelled By, Or On Behalf Of, The Patient                            7,449     13,194     26,900     14,103     16,169     31,590     31,146     34,072     38,369     13,276    226,268
3 - Did Not Attend - No Advance Warning Given                                        15,799     18,251     20,786     18,688     19,333     16,915     19,098     20,061     20,863      6,031    175,825
4 - Appointment Cancelled Or Postponed By The Health Care Provider                    4,421     14,140     27,123     13,984     12,634     30,832     37,187     41,563     45,317     15,376    242,577
Grand Total                                                                          27,669     45,585     74,809     46,775     48,136     79,337     87,431     95,696    104,549     34,683    644,670

In Kingston we have three extended primary care services that also offer GP appointments. The take-up of these appointments during the
week is high and the service is well used. However the weekday appointments also have a high level of ‘did not attend’ (averaging over 10%).

The weekend appointments have a low utilisation with only 50% of available appointments booked on a Saturday and even less on a Sunday.
Saturday and Sunday also have high levels of ‘did not attend’. Kingston CCG is currently working with the provider Kingston GP Chambers to
maximise the use of the service / redesign to better meet patient’s needs.

                                                                                                                                                                                                      27
28
10. General practice workforce

The general primary care workforce is made up of GPs (as partners and salaried members of the practice), Registrars, Nurses, Allied Health
Professionals, Medical Secretaries, Trainee Nurses, Health Care Assistants, and Practice Managers. General practices can also employ
therapists, pharmacists, pharmacy support staff, and physician associates amongst other roles.

10.1 Kingston primary care workforce as of March 2016:

GPs                      N=       fte        Male / female        Over / under 55 years
Partners                 65       54.57      42 Male 23 Female    19 over 55
Salaried GP              1        0.32       Male                 Over
Registrar (ST3/4)        3        1.81       1 Male 2 Female      Under
GP Registrar             1        0.8        Male                 Under

Nursing staff            N=       fte        Male / female        Over / under 55 years
Advanced Nurse           12       8.43       All female           5 aged 55 and over
Practitioner
Health Care Assistants   22       14.41      All female           7 aged 55 and over
Nurse specialist         1        0.15       Female               Over
Practice Nurse           49       27.23      All female           16 aged 55 and over

Admin/non-clinical       N=       fte        Male / female        Over / under 55 years
Practice Manager /       32       25.43      28 Female 4 Male     7 aged 55 and over
management
Receptionist             138      82.18      133 Female 5 Male    44 aged 55 and over
Medical Secretary        28       18.53      All female           14 aged 55 and over
Admin / estates /        30       21.41      28 Female 2 Male         12 ged 55 and over
ancillary

                                                                                                                                             29
10.2   Patient to GP Ratio

                                                 Patient to GP
Practice Name                Patients   GP FTE                          Note
                                                     Ratio
BERRYLANDS SURGERY            4139      4.67          887
BRUNSWICK SURGERY             7538      3.85         1956
CANBURY MEDICAL CENTRE        9937      4.89         2033
CENTRAL SURGERY               12561     0.00           0         Data not available
CHESSINGTON PARK SURGERY      6849      4.56         1502
CHURCHILL MEDICAL CENTRE      18440     11.37        1621
CLAREMONT MEDICAL CENTRE      10994     4.50         2444
FAIRHILL MEDICAL PRACTICE     21920     0.00           0         Data not available
GOSBURY HILL GP CLINIC         801      0.00           0         Data not available
GRAY'S MEDICAL CENTRE          766      0.00           0         Data not available
HOLMWOOD CORNER SURGERY       12522     7.09         1767
HOOK SURGERY                  6813      3.61         1888
KINGSDOWNE SURGERY            3794      0.00           0         Data not available
KINGSTON HEALTH CENTRE        9842      0.00           0         Data not available
LANGLEY MEDICAL PRACTICE      7432      4.16         1787
MANOR DRIVE MEDICAL CENTRE    13066     5.73         2279
RED LION ROAD SURGERY         2925      0.00           0         Data not available
ROSELAWN                      5867      3.56         1648
ST ALBANS MEDICAL CENTRE      7149      4.27         1676
SUNRAY SURGERY                3926      2.53         1550
THE GROVES MEDICAL CENTRE     15544     0.00           0         Data not available
THE ORCHARD PRACTICE          8080      4.53         1782
VILLAGE SURGERY               4848      2.93         1653
WEST BARNES SURGERY           7397      3.12         2371

                             203150     75.38        2695

                                                                                      30
10.3 Total Health Care professionals per practice FTE

Practice Name                GPS        Other Doctors Senior Partners Provisional Partners Nurses           Dental Practitioners   Total Health Professionals
BERRYLANDS SURGERY               4.67               4.67            0.89                 2.22        1.23                        0                          13.68
BRUNSWICK SURGERY                3.85               3.85               1                 2.43        1.61                        0                          12.74
CANBURY MEDICAL CENTRE           4.89               4.89            0.89                 1.56        3.03                     0.91                          16.17
CENTRAL SURGERY                     0                  0               0                    0        4.27                     1.77                            6.04
CHESSINGTON PARK SURGERY         4.56               4.56            1.07                 1.07        1.68                     0.51                          13.45
CHURCHILL MEDICAL CENTRE        11.37             11.37             0.87                 1.13        3.25                     2.17                          30.16
CLAREMONT MEDICAL CENTRE          4.5                4.5            0.67                 2.13        1.08                        0                          12.88
FAIRHILL MEDICAL PRACTICE           0                  0               0                    0        1.65                        1                            2.65
GOSBURY HILL GP CLINIC              0                  0               0                    0           0                        0                               0
GRAY'S MEDICAL CENTRE               0                  0               0                    0           0                        0                               0
HOLMWOOD CORNER SURGERY          7.09               7.09             0.7                  5.8        3.03                      1.4                          25.11
HOOK SURGERY                     3.61               3.61            1.09                 1.09        1.37                      0.8                          11.57
KINGSDOWNE SURGERY                  0                  0               0                    0        0.48                     0.32                             0.8
KINGSTON HEALTH CENTRE              0                  0               0                    0        1.27                     1.81                            3.08
LANGLEY MEDICAL PRACTICE         4.16               4.16            0.53                 2.13        1.29                        0                          12.27
MANOR DRIVE MEDICAL CENTRE       5.73               5.73             1.2                  2.4        1.71                     0.53                            17.3
RED LION ROAD SURGERY               0                  0               0                    0        0.32                        0                            0.32
ROSELAWN                         3.56               3.56               1                    2        1.01                     0.83                          11.96
ST ALBANS MEDICAL CENTRE         4.27               4.27            0.67                 2.13        1.76                        1                            14.1
SUNRAY SURGERY                   2.53                2.4             0.8                  1.6        0.45                        0                            7.78
THE GROVES MEDICAL CENTRE           0                  0               0                    0        4.81                     3.55                            8.36
THE ORCHARD PRACTICE             4.53               4.53            0.13                 0.88           1                     1.21                          12.28
VILLAGE SURGERY                  2.93               2.93             1.2                  1.2        0.96                        0                            9.22
WEST BARNES SURGERY              3.12               3.12            0.53                 2.59        0.91                     0.93                            11.2
                                                                                                                                                                 0
                                75.37            75.24           13.24               32.36          38.17                    18.74                         253.12

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10.4 GPs by Age Band

                              GPs     GPs        GPs                                                                                                   GPs 60 And
                                                         GPs Between GPs Between GPs Between GPs Between GPs Between GPs Between 65   GPs 70 and
                             UNDER Between 30 Between 35                                                                                                 Above
                                                          40 AND 44   45 AND 49   50 AND 54   55 AND 59   60 AND 64      AND 69         Above
Practice Name                  30    AND 34     AND 39                                                                                                  (overall)
BERRYLANDS SURGERY                0         1          1            2           2           0           0           0             0                0                0
BRUNSWICK SURGERY                 0         0          0            5           0           0           0           0             0                0                0
CANBURY MEDICAL CENTRE            0         2          1            2           1           0           0           0             0                0                0
CENTRAL SURGERY                   0         0          0            0           0           0           0           0             0                0                0
CHESSINGTON PARK SURGERY          0         0          1            2           1           1           1           0             0                0                0
CHURCHILL MEDICAL CENTRE          0         3          5            3           1           3           1           0             0                0                0
CLAREMONT MEDICAL CENTRE          0         1          1            2           3           0           0           0             1                0                1
FAIRHILL MEDICAL PRACTICE         0         0          0            0           0           0           0           0             0                0                0
GOSBURY HILL GP CLINIC            0         0          0            0           0           0           0           0             0                0                0
GRAY'S MEDICAL CENTRE             0         0          0            0           0           0           0           0             0                0                0
HOLMWOOD CORNER SURGERY           0         3          1            1           1           0           2           0             0                0                0
HOOK SURGERY                      0         0          1            2           1           0           1           0             0                0                0
KINGSDOWNE SURGERY                0         0          0            0           0           0           0           0             0                0                0
KINGSTON HEALTH CENTRE            0         0          0            0           0           0           0           0             0                0                0
LANGLEY MEDICAL PRACTICE          0         2          1            1           0           1           0           0             0                0                0
MANOR DRIVE MEDICAL CENTRE        0         0          3            0           1           1           0           0             0                0                0
RED LION ROAD SURGERY             0         0          0            0           0           0           0           0             0                0                0
ROSELAWN                          0         0          1            0           1           0           0           1             1                0                2
ST ALBANS MEDICAL CENTRE          1         0          0            0           0           0           2           0             1                1                2
SUNRAY SURGERY                    0         0          2            1           0           1           0           0             1                0                1
THE GROVES MEDICAL CENTRE         0         0          0            0           0           0           0           0             0                0                0
THE ORCHARD PRACTICE              0         2          2            1           1           2           1           0             0                0                0
VILLAGE SURGERY                   0         0          0            0           1           0           0           1             0                1                2
WEST BARNES SURGERY               0         0          1            0           0           3           0           0             0                0                0

                                  1        14         21          22           14          12           8           2             4                2                8

                                                                                                                                                                32
11. The GP Patient Survey

The GP Patient Survey is an England wide survey commissioned by NHSE provided by ipsos
MORI. The information below is taken from the July 2017 Patient Survey.

The results published are based on 2,491 responses to the 7,112 questionnaires were sent
out; a response rate of 35%. ipsos MORI acknowledge that the survey has limitations:

      Sample sizes at practice level are relatively small
      The survey does not include qualitative data which limits the detail provided by the
       results
      The data are provided once a year rather than in real time

However Kingston CCG through its Primary Care Commissioning Committee and Primary
Care Patient Forum recognises the feedback on telephone access to practices and has
collaborated with Kingston GP Chambers to secure investment to roll out a new, pan
practice integrated telephone system that we believe will address the telephony issues
currently being experience by Kingston patients.

11.1 Overall experience of GP surgeries

Kingston practices score 83% ‘Good’ against a national average of 85%. The ‘Good’
experience across practices ranged from 73% to 87%.

Results from the GP Patient Survey on overall experience are illustrated below:

                                          Very good
              4%
        12%
                                          Fairly good
                        38%
                                          Neither good nor poor

                                          Fairly poor

        45%                               Very poor

                                                                                           33
11.2 Patient experience of telephone access

Kingston practices achieve a score of 63% on the ease of getting through to the surgery on
the phone, against a national average of 68%.

Results from the GP Patient Survey on telephone access are illustrated below:

                 4%                           Very easy
           11%        16%
                                              Fairly easy

                                              Not very easy
     22%
                                              Not at all easy

                                              Haven't tried
                       47%

Kingston CCG in partnership with Kingston GP Chambers submitted a bid to the Estates &
Technology Transformation Fund (ETTF) to provide investment to introduce a new,
integrated across practices telephony system. Kingston GP Chambers is in the process of
rolling VOIP out across the Kingston practices.

11.3 Success in getting an appointment

Kingston practices score 85% ‘Yes’ against a national average of 84% on the question ‘Last
time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to
get an appointment to see or speak to someone?.

Results from the GP Patient Survey on getting an appointment are illustrated below:

                                                                                             34
Yes
                4%
          11%
                                        Yes, but I had to call
                                        back closer to or on the
    17%
                                        day
                                        No
                      68%

                                        Can't remember

11.4 Waiting time at the GP surgery

Kingston practices score 61% ‘Don’t wait too long’ against a national average of 58% on the
question ‘How do you feel about how long you normally have to wait to be seen?

Results from the GP Patient Survey on waiting times are illustrated below:

                8%                    I don't normally have to wait
           7%                         too long
                                      I have to wait a bit too long

                                      I have to wait far too long
     25%
                          61%
                                      No opinion/doesn't apply

                                                                                          35
11.5 Patient perception of care

       Kingston practices score 95% on the question ‘Did you have confidence and trust in
        the GP you saw or spoke to?’ in line with the national average of 95%.
       Kingston practices score 97% on the question ‘Did you have confidence and trust in
        the nurse you saw or spoke to?’ in line with the national average of 97%.

11.6 Patient satisfaction with opening hours

Kingston practices score 75% on the question ‘How satisfied are you with the hours that
your GP surgery is open?’ against a national average of 76%.

Results from the GP Patient Survey on opening hours are illustrated below:

                                       Very satisfied
                  3%4%
             7%
                                       Fairly satisfied
                         34%
       11%
                                       Neither satisfied nor
                                       dissatisfied
                                       Fairly dissatisfied

                  41%                  Very dissatisfied

                                       I'm not sure when my GP
                                       surgery is open

                                                                                          36
12. Care Quality Commission (CQC) ratings

The CQC inspects and regulates health and social care services. The role of the CQC is to regulate
through registration and continuously monitor the quality of the services provided through
inspections. The inspection of a GP service covers five key areas:

Safe              Is the patient protected from abuse and avoidable harm
Effective         Does the care, treatment and support achieve good outcomes, helping patients to
                  maintain quality of life and is based on the best available evidence
Caring            Do the staff involve and treat patients with compassion, kindness, dignity and
                  respect
Responsive        Are services organised so that they meet patients’ needs
Well led          Is the leadership, management and governance of the organisation making sure
                  that it is providing high-quality care that's based around patient individual needs,
                  that it encourages learning and innovation, and that it promotes an open and fair
                  culture

A summary of the CQC findings for Kingston practices is below:

    •    Overall quality of care in Kingston is good
    •    All of the 22 practices in Kingston have been inspected and had reports

Practices that have received ‘requires improvement’ or ‘inadequate’ ratings work towards
addressing the issues within a set timeframe. This is overseen by KCCG Primary Care Quality &
Development Group (PCQDG) which reports to the Primary Care Commissioning Committee.

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