BRIEFING PAPER FOR GPs
AND OTHER PARTNER ORGANISATIONS

BOLTON PRIMARY CARE TRUST
GP Workforce Growth
Procurement Process for a New Practice in Bolton

Why do we want to increase the current level of GP services?

PCTs have a duty of care to secure the provision of primary medical services. PCTs must commission or provide primary medical services to “the extent that they consider it necessary to meet all reasonable requirements of their population”.
Compared to national average figures Bolton is considered as ‘under-doctored’
In addition, the age profile of the GP workforce shows that there is a potential risk of losing up to 7% of the workforce over the next five years.
The PCT has made a commitment in its Manifesto to increase GP workforce in Bolton.

In which part of Bolton would we want to see growth?

The PCT has been undertaking work to analyse the spread of primary care workforce in Bolton to identify areas at risk owing to under-provision. This has been mapped against health needs.

This has shown:

• Analysis of the spread of Bolton GP workforce (including Nurse Practitioner roles) demonstrates under-provision concentrated in the central; and south east parts of the borough
• These statistics overlaid with potential GP retirements over the next five years identifies 6 areas at greatest risk:
  Daubhill; Derby; Burnden; Little Lever; Halliwell and Central
• Public health data identifies the correlation of these areas with high levels of deprivation (IMD score); hospitalised prevalence of COPD; Diabetes; CHD and emergency admissions and in these ward areas are poor primary care premises and high numbers of smaller practices

What does the PCT plan to do to improve under-provision in these areas?

A series of initiatives are planned, these include:

• • Going out to tender to secure a new GP Practice located in one of the targeted areas (listed above)
• • Offering existing practices the opportunity to bid for additional GP (or equivalent) growth where this will allow demonstrable and measurable improvements in patient care, eg to support extended opening times
•  Initiation of a service improvement scheme to support practices through a development programme based on achievement of quality standards
• • Development of a PCT Peripatetic Service to support practices in self-assessment and development of care for patients with respiratory and cardio vascular disease.

What are the benefits of introducing a new practice into Bolton?

New contracting options offer PCTs flexibility to offer alternative methods (beyond GMS and PMS) to secure medical services. One of these is APMS ie Alternative Provider of Medical Services. This allows certain benefits when wanting to deliver a service to a targeted population.
APMS allows:

• PCTs to define specific requirements for the design of medical services to meet the needs of a target population – ie the contract can specify mandatory requirements that a GMS or PMS contract would not allow
• the development of contract performance measures linked more appropriately to health improvement – ie PCTs can decide on the contract measures that will determine the success of the service in meeting the health improvement needs of the population

APMS contracts allows a wide range of providers including:

Existing GP Practices
Foundation Trusts
PCTs
NHS Trusts
Voluntary Sector
Commercial Sector

The new practice will be secured under an APMS contract.

What are the timescales?

Timescales are as follows:

Scheme outline approved by PCT Board – 11th April 07
Advertisement placed – May 07
Expressions of Interest and pre qualifying questionnaires - June 07
Invitation to tender – July 07, tenders returned end Sept 07
Financial Close – December 07
Earliest service commencement date – December 2007

What services will the new practice deliver?

As well as the minimum services required under GMS/PMS (essential, additional and directed enhanced services) the new practice will:

• Provide a specialist role in induction and integration of refugees and asylum seekers into Bolton
• Provide services in extended hours – Saturday and Sunday morning
• Be a training practice for GP registrars; Foundation Year students; nurses and advanced practitioners etc..
• Provide access to services through a multi-disciplinary team taking account of patient needs (cultural; language etc as well as health) and patient preferences considering health screening; promotion and education though outreach services
• Provide enhanced services including: minor injury; anti-coagulation; near patient testing; drug and alcohol services; minor surgery and primary prevention
• Participate in existing organisational requirements such as Choose and Book; IM&T programmes and emerging programmes such as social prescribing; gold standard framework for end of life care

As a ’green-field development’ the practice will not have a ready-made practice list – it is expected that the practice will grow over a 5 year contract period resourced to reach a list size of 6,000 patients over this time.

Who is being consulted about this development?

We are keen to consult widely on the proposals and we have a consultation plan posted on the PCT website. Those to be consulted include:

Local GP Practices in the target areas
Local Representative Committees (Medical; Pharmaceutical; Dental and Optometrist)
Patient and Public Involvement Forum
Patients and the Public through local press/public meetings and practices
The Health Overview and Scrutiny Committee of the Local Authority
Bolton Hospitals NHS Trust
Greater Manchester West Mental Health NHS Foundation Trust

Timescales for consultation are May to July 2007.

Where do I send Comments?

Please return all comments to:

Joan Leonard
Asst Dir Commissioning
c/o Mandy Bishop
1st Floor
Bolton PCT
St Peters House
Silverwell St
Bolton BL1 1PP