Provision of Primary Medical Care Services at Mayfield Medical Centre

Concepts

• health services
• mayfield medical centre
• aldershot
• provision of primary medical care services
• delivery of primary medical care services
• salus medical services limited
• primary care provision
• primary care
• primary reasons
• primary care federations

Location

Hampshire and Isle of Wight:

Description

1.1. It is the Contracting Authorities preference to enter into a new contract with the incumbent provider Salus Medical Services Limited (effectively extending the current arrangements) for the Provision of Primary Medical Care Services at Mayfield Medical Centre, for the reasons detailed in this notice.

Total Quantity or Scope

Background 2. Introduction 2.1. This document has been drawn up to provide a full explanation and justification for the direct award of a maximum 5 years and 10 month contract to Salus Medical Services Limited (referred to as Salus within this document) for the delivery of primary medical care services to the population registered at Mayfield Medical Centre, Farnborough. 2.2. The contract term will be 5 years and 10 months to align with the remaining term of the lease in place at the practice premises. 2.3. The period covered by this direct award is from 1st January 2023 to 30th September 2028. 2.4. The reasons for the proposal of this direct award are: • To provide consistency in delivery of primary medical care services to the population registered at Mayfield Medical Centre - recognising the positive impacts on patient outcomes and primary care provision that have been realised to date through the caretaking arrangement currently in place with Salus; and • To recognise the contribution made by primary care federations in relation to the development and resilience of primary care provision; and • To recognise the vital importance of local leadership in the development, mobilisation and success of the current caretaking arrangement. 2.5. The justification relating to the direct award of this contract will cover three key areas: patient need, quality improvement, and contract efficiency, with the primary reasons being linked to the complexity of the population being served and the positive improvements achieved through the existing caretaking arrangement. 3. Salus Medical Services 3.1. Frimley Clinical Commissioning Group (CCG) recognise Salus as the General Practice Federation that represents primary care within its geographical area, and that delivers services both pan CCG wide and within specific primary care networks (PCNs). 3.2. Salus have well established links with General Practice and other local providers in the North East Hampshire and Farnham area. Now employing over 250 individuals they are able to draw on the required managerial and clinical workforce along with digital capability to provide the primary care services required for the population registered at Mayfield Medical Centre. 3.3. Salus have experience of working within the local geography and understand the demographic makeup of the population. They have established links into specific communities such as the Nepali community and employ Nepalese members of staff who can communicate fluently with patients, understanding the cultural and religious factors that may understand their view of healthcare. This understanding of local cultures is vital in order to provide a responsive and flexible services to the patients registered at Mayfield Medical Centre. 3.4. There is a list of enhanced primary care services also delivered by this provider in Appendix A. These services are closely integrated with provision of primary medical care services at Mayfield Medical Centre. 4. Background to the situation 4.1. In January 2020 the partners at Mayfield Medical Centre issued immediate notice to the CCG on their GMS contract and a contract was awarded to Salus for delivery of primary medical care services under an APMS contract. Notification to the market of award of this contract has been issued. 4.2. The contract was initially designed to be a short-term two-year caretaking arrangement that would address known issues with regards to recruitment, workforce models, patient outcomes and access. The intention was that following improvements in these areas, a long-term local provider for the GP practice would be sought through a practice merger. Within a few weeks of the contract commencing the effects of the Covid-19 pandemic began to be felt and a change of focus for the provider was required. 4.3. Of prime concern to North East Hampshire and Farnham place and Farnborough Primary Care Network is securing a long term provider that is invested in maintaining the success that has been achieved at Mayfield Medical Centre (MMC) and is one that will foster and continue to improve good local working relationships. 5. Practice profile 5.1. Mayfield Medical Centre is located in the Cherrywood ward of Rushmoor; in the north eastern part of Farnborough town. Image 1 - Mayfield Medical Centre GP practice inner boundary January 2019 5.2. The current list size is 9,634 with a weighted list size of 9,200. 5.3. The practice population is distributed across and outside of the inner boundary. 76% of the population are registered within the inner boundary and 24% are outside of the inner boundary. 5.4. Demographic data as at January 2019 demonstrates the patient population of Mayfield Medical Centre as broadly equally divided by gender. The practice registered population is similar to the CCG and England patient profile with the exception of the 25-29 and 30-34 age brackets where Mayfield Medical Centre have more patients in these categories. 5.5. National statistics indicate that patients in areas of extreme social deprivation can have up to 30% more long-term conditions and appointments than patients registered in areas of affluence, with continuity of care highlighted as a key factor in patient assurance and support. 5.6. There are several factors about the Mayfield Medical Centre registered population that have resulted in high levels of demand at the practice. 5.6.1. Deprivation - The Cherrywood ward in Rushmoor has higher levels of deprivation than many areas in the CCG geography. Elements of the Cherrywood ward rank amongst the 20% most deprived areas in England. The IMD Score for Mayfield Medical Centre is 21.5 whereas the CCG score is 9.9 . 5.6.2. Ethnicity - Over 35% of the registered patients are identified as being from a black or ethnic minority group. Many families from Nepal are registered with Mayfield Medical Centre and are reported to arrive with complex and undiagnosed medical conditions with little or no understanding of the healthcare system. 5.6.3. Care homes - 1.1% of the patient population is coded as residing in a nursing home. 5.6.4. Serious and enduring mental health illness - Demand from this patient cohort is high and the complex nature of their conditions makes holistic provision of their care a challenge 6. Rationale for the direct contract award 6.1. Patient need and quality improvement 6.1.1. The three key aims of the APMS contract with Salus were to achieve: • Enhanced clinical and managerial leadership • An amended same day access model to have immediate but also lasting positive effects on the level of demand from patients • The introduction of a new skill mix with strong, consistent GP leadership 6.1.2. Salus were only 2 months into the delivery of the contract at Mayfield Medical Centre when the COVID-19 pandemic started significantly affecting primary medical care services. Much of the business as usual and transformational projects that had been planned were subsequently reprioritised as the need to focus on responding to the pandemic became clear. Despite these challenges significant improvements have been achieved by Salus and the team at Mayfield. Many of these have only been achieved due to the good working relationships in place between Salus and the MMC leadership along with the relationships within Farnborough Primary Care Network. 6.1.3. From a commissioning perspective these achievements include:  Successful recruitment to and expansion of practice team including GPs (testing a new model of employed GPs with funded management responsibilities), Clinical Pharmacists, a Paramedic and Mental Health Support Workers  Establishment of a new appointment system and the re-introduction of routine capacity  Optimisation of administrative functions  Long term condition recall system improvements  Introduction of and use of eConsult to improve access for patients  Premises improvements 6.1.4. Agreed performance improvement trajectories have been achieved in the following areas:  Introduction of eConsult  Improved dementia diagnosis rate Improvement in overall score in GP practice survey 6.1.5. Improved patient experience and clinical outcomes have also been achieved by focusing on the quality indicators included in the APMS contract schedules. These include:  Continued delivery of essential, additional and locally commissioned services  Improved scores in the GP practice survey  Maintenance of QOF scores within the thresholds agreed in the support package  Participation in the Medicines Management Optimisation Scheme  Improved Dementia Diagnosis rates, increase of learning disability healthchecks, cervical smear screening, vaccinations and immunisations uptake  Increased use of patient online systems  Introduction of e-Consult  Network Directed Enhanced Service participation  Introduction of a new atypical population service 6.1.6. It is recognised that more work is needed in several areas. Where appropriate actions plans are in place to address these. Areas for particular focus include:  Learning disability healthcheck uptake  Childhood vaccination and immunisation uptake  Fully implementing a year of care system for patients with long term conditions  Optimise extended hours and improved access services  Increase cervical smears uptake  Reinstating Mayfield as a training practice

CPV Codes

• 85100000 - Health services

Other Information

1.2. The proposed contract is for a period of 5 years and 10 months commencing 1st January 2023. If, however, there are expressions of interest to compete to deliver the requirements, it should be noted that the Authority will undertake a competition process in accordance with Public Contracts Regulations 2015, for a new contract to commence for service delivery for this period. 1.3. If no expressions of interest are received, the Authority will enter into a contract with the above-named provider relying upon a Regulation 32 exemption of no response/no requests to participate have been submitted in response to this notice. 1.4. If you wish to express an interest or should you wish to discuss the content of this PIN further, please contact South of England Procurement Services via the Intend e-Tendering portal. Please note that an Expression of Interest Form will require completion, please read the instructions detailed on the Form noting that if you access the documents but do not wish to formally express an interest, you are required to provide confirmation. ** PREVIEW NOTICE, please check Find a Tender for full details. **