Agenda item

Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) was in attendance.

(1)       The Chair welcomed Mr Perks to the Committee. Mr Perks began by assuring the Committee that the East Kent CCGs were working closely with the provider Primecare; a robust plan to address the issues identified by the CQC had been developed and was being monitored by the CCGs. The CQC would be reviewing the three warning notices covering safe care and treatment, good governance and staffing during the following week. He stated that there had been some difficulties with contract which the CCGs were seeking to resolve with Primecare. He confirmed that Primecare would be leaving the contract early on 7 July 2018.

(2)       In response to a specific question about the CCG’s oversight of the provider, Mr Perks stated that he took personal responsibility for overseeing the provider and its improvement plan; he was confident that the plan was achievable. He explained that regular contract management had identified concerns prior to the CQC inspection which had resulted in a performance notice being issued. He noted that a review of the procurement was also being undertaken. The CCGs were one of the first to combine 111 and care navigation services and there had not been a national specification at the time of procurement; the navigation service element of the contract had never been mobilised. He explained that the CCGs had worked closely with Primecare during mobilisation and there had been a phased implementation of the 111 service. He reported that Primecare was committed to addressing the concerns and he was confident that the actions being taken would resolve these; he anticipated that the CQC would confirm this at its next meeting.

(3)       Members enquired about financial sanctions and staffing. Mr Perks explained that whilst it was possible to apply financial sanctions, in this instance, it would prevent the provider in making the necessary changes due to resourcing challenges. Mr Perks stated that there had been problems with the management during the mobilisation and Primecare had not engaged with local GPs as the previous provider had done. He reported that Primecare had subsequently appointed a medical director to build relationships with local GPs. The CCGs were monitoring the level of staff cover being provided; if the 111 or out-of-hours service did not work effectively, it could have implications on the wider system such as increased A&E attendance.

(4)       A Member asked about the potential of bringing the service in house. Mr Perks stated that consideration was being given to out-of-hours services becoming part of seven day working in primary care but it required significant GP resource which was not currently available. The provider had been contracted to integrate 111, out-of-hours and care navigation services but had not been able to make the partnership arrangement required to do this; partnership working would be a focus of a future contract award.  Mr Perks reported that a joint procurement of a Kent & Medway 111 service, to go live in April 2019, had been agreed. The East Kent CCGs were developing interim arrangements between the Primecare contract ending in July 2018 and the start of the new contract.

(5)       A number of comments were made about performance. Mr Perks explained that 111 service was subject to local and national performance standards such as the percentage of calls addressed by clinicians. He stated that the contract required doctors to be on call but the provider had struggled with its fill rate; there had been a number of hours at the weekend where out-of-hours doctors had not been in place. He stressed the importance of the provider improving its relationship with local GPs so they could work in partnership to improve the service.

(6)       RESOLVED that:

(a)       the report be noted;

(b)       the East Kent CCGs be requested to provide a written update to the Committee in November and a verbal update in January;

(c)        the Committee receives a report about the joint procurement of the Kent & Medway 111 service at its January meeting.