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									 SERVICE SPECIFICATION
          FOR
  REPROVISION OF PMS
PRIMARY CARE SERVICES




       21st February 2008 5th Version
                                                    INDEX
1 Key considerations ......................................................................................... 3
2 Core Requirements ........................................................................................ 4
3 Primary Medical Services ............................................................................... 4
4 Core Services ................................................................................................. 4
5 Directed Enhanced Services (DES) ............................................................... 5
6 Local Enhanced Services (LES) ..................................................................... 6
7 Access ............................................................................................................ 6
8 Continuity of Care ........................................................................................... 7
9 Child and Vulnerable Adult Protection ............................................................ 7
10 Smoking cessation ........................................................................................... 8
11 Wound management and suture removal ........................................................ 8
12 Sexual health ................................................................................................... 8
13 Resuscitation ................................................................................................... 8
14 Self care and self management ....................................................................... 8
15 Preventative Care ............................................................................................ 9
16 Vaccinations during outbreak, flu pandemic or major incident ......................... 9
17 In Hours Home Visiting Service ....................................................................... 9
18 Out of Hours (OOH) Service ............................................................................ 9
19 Non-registered patients.................................................................................. 10
20 Medicines Management ................................................................................. 10
  20.1 Repeat Prescriptions ............................................................................... 10
  20.2 Quality & cost-effective prescribing.......................................................... 10
  20.3 Controlled Drugs ...................................................................................... 11
21 Supporting Services ....................................................................................... 11
  21.1 Environmental considerations .................................................................. 11
  21.2 Information Technology & Information Governance ................................ 11
22 Relationships with Other Providers ................................................................ 12
  22.1 Relationships with other Primary Care Contractors ................................. 13
  22.2 Relationships with Secondary Care and Mental Health Services ............ 13
  22.3 Relationships with Community Services .................................................. 13
  22.4 Relationships with Patients, Carers & Service Users............................... 13
23 Quality ............................................................................................................ 14
  23.1 Quality Indicators ..................................................................................... 14
  23.2 Health Care Commission “Standards for Better Health” .......................... 15
24 Practice Based Commissioning and Demand Management .......................... 15
25 Monitoring & Review ...................................................................................... 16
  25.1 Monitoring, information and accountability ............................................... 16
  25.2 Requirements for contract review meetings ............................................. 16
26 Training practice status/learning practice environment .................................. 16
27 Conflict of Interest .......................................................................................... 17
28 Clinical Governance, Standards and Inspection ............................................ 17
29 Additional Requirement. A&E attendance, PPI, Workforce…………..….……17


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07/05/2011 – Version 5                                    -2-                   Mike Nelson/Neil Hamer Lewisham PCT
                         Service Specification
1 Overview
This service specification has been developed by Lewisham PCT in response to
the proposal to tender for the provision of services to patients of the 42 Gellatly
Road practice (which is currently managed by the PCT). It is expected to be
tendered out under an APMS or PMS contract. The main aim is to ensure that
any successful bidder provides services that are patient centred, clinically
effective, high quality and offer value for money.

1.1 Service Commencement:
The successful bidder or consortium must be able to deliver services from
approximately August 2008

1.2 Contract duration.
 It is intended that the provider/s will enter into a 10 year contract with an option
for both parties to apply a break clause at 5 years with an annual review.

1.3 Reviews:
 It is intended that there will be regular annual reviews of key performance
indicators the exact details of which will be finalised when a preferred provider
has been selected. These elements will form part of the contract negotiation

1.4 Premises
 The current Gellatly Road premises are no longer considered suitable for the
provision of the services tendered. Providers will be expected to be able to
accommodate patients either immediately in an existing building or provide an
acceptable transition plan (which vacates the existing premises as soon as is
practical) into new or existing premises suitable for delivery of the primary care
services identified in this service specification. The PCT will consider practical
variant bids which take account of existing patients. The PCT expect to
reimburse rent and rates as per the prevailing GMS regulations.

There are a number of key considerations which Providers are required to take
into account in their response to the overall requirements of this Output Based
Specification.

at http://www.lewishampct.nhs.uk/index.php?PID=0000000095 see
Commissioning Strategy plan

Future Providers will be expected to build on the achievements in Lewisham. For
example,


07/05/2011 – Version 5                    -3-            Mike Nelson/Neil Hamer Lewisham PCT
2 Core Requirements
The core requirements are categorised as follows:

                         An output requirement which the PCT considers to be
Obligatory               essential and of particular importance and is treated as
                         mandatory.
                         Providers will be required to demonstrate they can fully
                         satisfy requirements
                         An output requirement which the PCT considers to be
Desirable                desirable and which may, as appropriate, (but will not
                         necessarily) result in being treated as non-mandatory

3 Primary Medical Services
The provider is required to provide primary care medical services as laid out and
defined in the general medical services contract (2004 and revisions 2006)

This is set out in the national General Medical Services Contract (2004),
Investing in General Practice and revisions to the GMS contract 2006/7,
Delivering Investment in General Practice. The provision of primary medical
services have been categorised into:


        Essential Services
        Additional Services
        Enhanced Services.

The definitions of these services may change from time to time, subject to
developments in national and local priorities, best practice and legislation
requirements.

4 Core Services
Obligatory
Providers are required to deliver all Essential Services to registered and
temporary patients:
     i. management of patients who are ill or believe themselves to be ill, with
        conditions from which recovery is generally expected, for the duration of
        that condition, including relevant health promotion advice and referral as
        appropriate, reflecting patient choice wherever practicable
    ii. general management of patients who are terminally ill
   iii. management of chronic conditions in the manner determined by the
        healthcare professional in discussion with the patient. The provider will be




07/05/2011 – Version 5                       -4-           Mike Nelson/Neil Hamer Lewisham PCT
       expected to establish dedicated CDM clinics such as diabetes and asthma
       to reflect local needs.
   iv. Note summarisation (patient records)
.
Home visits when clinically required in line with the GMS regulations All home visits
requested for registered patients should be clinically assessed within one hour of practice
being alerted.

   v. If clinically appropriate home visits must be undertaken by practice staff
       within 6 hours of practice being alerted
   vi. Immediate/necessary/emergency treatment to non registered patients
       (during core hours)

Providers are required to deliver all Additional Services as defined by the GMS
Contract (2004 & Revisions in 2006) Investing in General Practice:

     i.cervical screening
    ii.contraceptive services
   iii.vaccinations and immunisations
   iv. child health screening & surveillance
    v. maternity services – excluding intra partum care (which can be an
       Enhanced Service)
   vi. minor surgery procedures of curettage, cautery, cryocautery of warts and
       verrucae, and other skin lesions

5 Directed Enhanced Services (DES)
Providers are required to deliver the Obligatory services and indicate which of the
Desirable DES they are able to provide. These services are as defined by the
GMS Contract (2004 & revisions 2006) Investing in General Practice:

Obligatory
    i. Improved Access to general practice services
   ii. IM&T
  iii. Childhood Immunisations and vaccinations
  iv. Influenza Immunisation for those in the 65 and over and other at-risk
       groups
   v. Choose and Book

Providers are required to deliver new DES as they are announced by the DoH.
Enhanced services may be withdrawn in line with national precedents.

Desirable
   i. Minor Surgery
  ii. Near patient testing




07/05/2011 – Version 5                     -5-              Mike Nelson/Neil Hamer Lewisham PCT
6 Local Enhanced Services (LES)
Obligatory

Providers are required to deliver the following services.

     i.   In-house Phlebotomy
    ii.   Practice based commissioning
   iii.   Partnership working
   iv.    Additional Imms
    v.    Provision of Near Patient Testing
   vi.    Alcohol brief intervention
  vii.    Depression awareness
  viii.   IUD fitting – by accreditation
   ix.    Minor injuries reporting
    x.    Miscellaneous basket

Specifications for all the above Local Enhanced Schemes are available on the
Lewisham PCT website – click on “Gellatly Road GP Consultation” On the
bottom left hand side of the home page then go to the bottom of the page.

http://www.lewishampct.nhs.uk/index.php?PID=247


Providers will be expected to increase the portfolio of LES delivered as the
enhanced services are developed.

7 Access
Access is a critical issue and providers are expected to demonstrate how they
will deliver a range of improvements and set this out in an Access Plan

Obligatory

     i. Providers are required to ensure 100% of patients who wish to do so can
        consult with a primary healthcare professional within one practice working
        day and a GP within two practice working days.
    ii. No embargoed appointments
   iii. Patients are able to book appointments more than 48 hours in advance
        and up to 4 weeks in advance.
   iv. Premises will be open and reception staffed for face to face contact and
        telephone access (not voicemail) to the practice between 8 am till 6.30pm
        Monday to Friday
    v. Providers are required to ensure patients have an opportunity to be seen
        by a practitioner of preference
   vi. Providers are required to follow GMS regulations on list closure and
        patient allocation.



07/05/2011 – Version 5                    -6-          Mike Nelson/Neil Hamer Lewisham PCT
  vii. Providers are required to participate in the monthly Primary Care Access
        Survey (PCAS) and any other / additional surveys implemented by the
        DoH
  viii. Providers are able to offer flexible ways of making an appointment ( e.g.
        E-mail, fax, phone, visit to practice reception)
   ix. Providers are able to offer telephone consultations as well as face to face
        consultations

Providers should demonstrate how they will ensure services are accessible to the
full range of patients including those with varying language and communication
needs and housebound patients.

Desirable
The PCT encourages providers to consider how they would deliver a service
offering extended availability (over and above 8am to 6.30pm Monday-Friday) for
both reception and clinical services to deal with specific needs of patients who
find it difficult to access appointments or require flexible access. Consideration
should be made of how to utilise practice skill mix and clinical rooms effectively.
This should be set out in an access plan.

These requirements may change in line with the specification of access targets
set out in GMS, revisions and enhanced services

8 Continuity of Care
Obligatory
Providers should demonstrate how they will achieve continuity of care for
patients and carers through stability and permanence of the practice team and
how this is balanced with access. Providers will be asked for plans to minimise
locum usage and maximise staff continuity and quality.

Desirable
Providers should have a system to identify patients with complex needs and
assign a named health care professional to co-ordinate care for each patient.

9 Child and Vulnerable Adult Protection
Obligatory
The provider will make sure it has in place systems to effectively manage cases
requiring child or adult protection and will be expected to follow Lewisham PCT
Child Protection Policies & Procedures Each practice should have a named
health care professional for child and vulnerable adult protection.
The funding of any training for practice staff to attend child protection awareness
courses or case conferences for children registered at the practice should be
included in the contract price

For a copy of Lewisham PCT Child Protection Policies


07/05/2011 – Version 5                  -7-            Mike Nelson/Neil Hamer Lewisham PCT
                          LPCT Child Protection
                           policy Jan 2008.pdf
& Procedures click here

10 Stop Smoking
Obligatory
Providers will be expected to actively refer patients who smoke to the stop
smoking service or demonstrate how they provide an appropriate level of service
within the practice. Systems should be in place to record smoking status for all
patients (broader than QoF parameters).The PCT will agree with the provider
specific annual targets to be achieved

11 Wound management and suture removal
Obligatory
The provider will be expected to provide a basic wound management and suture
removal service for all eligible patients without referral to any other NHS provider
(including NHS Trusts, Walk-in Centres or PCT clinics) unless the patient‟s
clinical condition is such that it would be inappropriate for the service to be
carried out by the practice. Procedures to be covered include:
      i. Sutures and skin clip removal from post operative and traumatic wounds
     ii. Re-dressing or simple packing of post operative and traumatic wounds
    iii. Wound review if requested by the hospital – post operative and traumatic

12 Sexual health
Obligatory
Providers are required to demonstrate how they will provide Level 1 sexual
health care in terms of skills, access and standards as set out in the national
sexual health strategy (DoH 2001). The practice should actively participate in the
Chlamydia screening programme. The availability and scope of the services
should be well advertised.

13 Resuscitation
The provider is expected to comply with the UK Resuscitation Council
recommendations regarding the equipment that practices should have.
In addition relevant staff should be trained at appropriate intervals to ensure
competence.

14 Self care and self management
Obligatory




07/05/2011 – Version 5                       -8-        Mike Nelson/Neil Hamer Lewisham PCT
Providers should demonstrate what systems & initiatives are in place to facilitate
self-care of minor ailments & self-limiting conditions and how they support
patients with chronic / long-term conditions in self-management.
Providers are requested to describe how they will work to develop partnerships
between health care professionals and the public to ensure a joint approach to
enhanced patient self care.

15 Preventative Care
Obligatory
Providers should demonstrate how they will support preventative care and
promote health in the practice population. The Provider will be required to deliver a
service that is focused heavily on health promotion and disease prevention. Provider will
need to ensure that it has effective strategies for health promotion and disease
prevention in place to tackle lifestyle issues that underlie diseases such as long-term
conditions like diabetes, cancers and sexually transmitted disease. Strategies such as;

    1. Primary prevention targets around the management of hypertension, cholesterol
       etc
    2. Smoking Cessation
    3. Obesity Management
    4. Sexual Health
    5. Older People Issues especially falls
    6. Positive Mental Health especially children and young people




16 Vaccinations during outbreak, flu pandemic or major incident
The provider will be expected to engage in managing a flu pandemic, disease
outbreak or major incident situation and have a practice flu plan in place.

17 In Hours Home Visiting Service
Obligatory
Providers are required to conduct home visits when clinically required. Providers
should demonstrate how this will be audited.

The criteria for determining when home visits are necessary should be effectively
communicated to patients and also included in the practice leaflet

18 Out of Hours (OOH) Service
The out-of-hours period is defined as from 6.30 pm to 8.00 am on weekdays, and
the whole of weekends, Bank Holidays and Public Holidays, and at other times
as arranged between the PCT and Out of Hours provider.




07/05/2011 – Version 5                    -9-             Mike Nelson/Neil Hamer Lewisham PCT
Providers wishing to opt of out of hours services will be included in the PCT
contract for out of hours service provision with SELDOC. Providers wishing to
opt in to providing OOH services must comply with the national OOH quality
requirements. Providers should clearly state how OOH services will be provided.

19 Non-registered patients
Obligatory
The provider is required to provide immediate/necessary/emergency treatment
and treatment to temporary residents.

20 Medicines Management
Obligatory
The PCT expects all prescribers to adhere to both legal and good practice
guidance on prescribing and medicines management in line with the Medicines
Act and/or any other national/local guidance. Guidance has been collated by the
Royal College of General Practitioners at:
http://www.rcgp.org.uk/default.aspx?page=3111&groupid=59
As well as the standard level of service provision required when prescribing,
reviewing and educating patients about medicines, the following is obligatory:

20.1 Repeat Prescriptions
    There should be a clear prescription request process that ensures a turn
      around of requests within 48 hours or less (excluding weekends and bank
      holidays)
    Providers are required to provide a range of prescription request
      mechanisms ( e-mail, fax, person)
    Providers should actively offer patients a choice to receive repeatable
      prescriptions for Repeat Dispensing when assessed as clinically
      appropriate
    Medication reviews are undertaken by the provider at clinically appropriate
      time intervals and recorded in the patient‟s medical notes. Providers
      should demonstrate how they will undertake medication reviews for
      housebound patients. A minimum annual medication review should be
      offered to all patients receiving regular repeat medication.

20.2 Quality & cost-effective prescribing

Obligatory
The provider is expected to engage in improving the quality, cost effectiveness
and affordability of prescribing in the context of overall use of NHS resources.
This is good professional practice.
Providers are expected to participate in the annual PCT Prescribing Incentive
       Scheme and undertake the audits which form part of the scheme.




07/05/2011 – Version 5                 - 10 -         Mike Nelson/Neil Hamer Lewisham PCT
20.3 Controlled Drugs

Obligatory
The practice and all prescribers must comply with the statutory regulatory
requirements relating to the safe and secure management of controlled drugs.
Providers will be required to complete a self assessment and declaration on
whether and how they use controlled drugs. This is a national requirement.
21 Supporting Services
Underpinning the delivery of primary medical services, there are a number of
supporting services which providers are required to deliver.

21.1 Environmental considerations

Providers are required to meet relevant health and safety requirements.
In particular this relates to: disposal of clinical waste, sharps, compliance with
2007 decontamination regulations, safe and effective storage of medicines, aids
& appliances and those substances which may be necessary to undertake minor
surgery procedures. There should be a named lead clinician responsible for
infection control.

Providers are required to ensure that they are compliant with the Disability
Discrimination Act (DDA).

21.2 Information Technology & Information Governance
The National Programme for IT is an essential element in delivering the NHS
Plan. The Agency responsible for delivering this programme is Connecting for
Health (CfH). The local service provider for London is BT CCA, who offer a
number of different developments

Providers are required to fully comply with Connecting for Health requirements.

Providers are required to actively implement key national initiatives

Providers are required to use a compliant GP system with the proven ability to
support the required standards in the areas of security, information governance,
Choose & Book, Electronic Transfer of Prescriptions and GP2GP functionality.

The systems offered by the provider should be compatible with the PCT‟s current
systems and the NHS IT infrastructure development programme. Any plan to
migrate from the existing GP clinical system should be documented in the early
submissions and should comply with the rules / guidelines established by CfH.

Providers are required to ensure that all practice staff, clinical and non-clinical,
receive adequate training to equip them to adopt new methods and systems; and
that staff receive sufficient skills development to ensure that the practice can
function effectively.


07/05/2011 – Version 5                  - 11 -         Mike Nelson/Neil Hamer Lewisham PCT
Providers are required to have actively managed disease registers.

Providers should aim to have an integrated IT system working on a paperless
basis. Providers are required to ensure accreditation of their computer systems
used for the electronic record keeping.

Providers are expected to use the national NHS e-mail service.

Providers are required to liaise with the PCT and Local Service Provider (LSP)
for their area to agree an implementation strategy.

Providers will be expected to ensure appropriate data back-up procedures are in
place.

Providers must have systems that are compliant with the Data Protection Act
1998, Freedom of Information Act 2000, Access to Health Records Act 1990, and
Clinical Governance requirements and will need procedures detailing how they
will comply with these requirements.

Providers are required to have an identified Caldicott Guardian in each practice.

For further information:

http://www.connectingforhealth.nhs.uk/publications/nhs_cfh_factsheet.pdf

http://www.connectingforhealth.nhs.uk

22 Relationships with Other Providers
The Provider will be expected to:

    1. Have effective processes to deal with on-site clinical emergencies, basic
       resuscitation, urgent and emergency referrals to off-site providers of A&E and
       inpatient services as may be required.
    2. Use robust protocols for internal and external referrals, agreed with local trusts
       that include a basis for prioritisation
    3. Routinely collect data about the appropriateness of their referrals.
    4. Implement national referral advice including Referral Guidelines for Suspected
       Cancer and NICE guidance e.g. ensure urgent suspected cancer referrals are
       received by the relevant trust within 24 hours.
    5. Implement and operate choose and book at point of referral for specialist
       services, and provide a booking facility (in accordance with the national Booking
       and Choice Programme)
    6. Adhere to agreed care pathways that are being developed and implemented
       across the PCT. As part of the contract demonstrate on a yearly basis as a
       result of audit how these pathways are being implemented. It is anticipated that
       by April 2008 this practice along with all other in the PCT will participate in a



07/05/2011 – Version 5                    - 12 -          Mike Nelson/Neil Hamer Lewisham PCT
         Clinical Assessment Service model of triage via a peer review system. The
         Provider will be required to participate in this system.




Providers are required to demonstrate their added value to the local health
economy.

22.1 Relationships with other Primary Care Contractors

Providers are required to develop working relationships with other local general
practices, community pharmacists, dentists, optometrists and to link to any
proposed new service developments with the opportunities afforded by new
contracting routes and practice based commissioning. The LMC, LPC, LDC and
LOC may be able to assist with this.

22.2 Relationships with Secondary Care and Mental Health Services

Providers are required to work to clinical guidelines, shared care protocols and
via the clinician to clinician forum to develop and work within the care pathways
agreed for secondary to primary care shift.

22.3 Relationships with Community Services & Social Care

Providers are required to effectively use systems that allow timely communication
on patient care, for example informing community staff when patients are known
to have been admitted to secondary care or communication where child
protection or domestic violence may be an issue.

Providers are required to provide feedback to community staff on their
effectiveness & responsiveness.

Providers are required to work with community staff to develop protocols and
pathways for delivering effective modernised community based care, supporting
hospital discharge and preventing hospital admission. This will be achieved by
working with community staff to pioneer and evaluate new ways of working
Providers are required to support the community management of Very High
Intensity Users (VHIU) of services.


22.4 Relationships with Patients, Carers & Service Users

Section 11 of the Health and Social Care Act 2001 places a duty on strategic
health authorities (SHA's), PCT‟s and NHS Trusts, to make arrangements to
involve and consult patients and the public in planning services, developing and
considering service changes and in decisions which affect how services operate.



07/05/2011 – Version 5                  - 13 -         Mike Nelson/Neil Hamer Lewisham PCT
The Provider will be required to work with patients in ways that foster
partnerships and include:

    1.   Patient Participation Groups
    2.   Comments and Suggestion Boxes
    3.   Work with the local Patient Advice and Liaison Service (PALS)
    4.   Local Complaints Process and Annual Review
    5.   Patient Surveys
    6.   Promoting self care

The Provider will be required to establish a Patient Participation Group to further
engage patients, carers and the local community with the PCT and the Patients &
Public Involvement Forum (PPIF) (or successor bodies) for Lewisham PCT.

In providing better access and additional capacity, the Provider will need to
identify in its tender application any additional staff that will be employed to
deliver the primary medical care services.
.
Providers should make readily available a variety of appropriate practice
information
Providers are required to outline how they will work with social services, housing
and education to address the practice population‟s requirements.

23 Quality
23.1 Quality Indicators

Obligatory
Providers are required to achieve 95% minimum attainment levels for GMS
Quality & Outcomes Framework (QOF) i.e. 950 QOF points
[Providers should produce a plan of how they will have achieved this standard by
March 2010].

Providers are required to comply with existing and any new recommendations
from the National Institute for Clinical Excellence (NICE) and the publication of
further National Service Frameworks (NSFs) and other relevant national and
local public service documents.

Providers are required to comply with clinical governance, Health Care
Commission and risk management processes and any other statutory obligations
e.g. Data Protection Act, Children‟s Act; Freedom of Information Act

Desirable
Providers are encouraged to participate in any other quality programmes for
example the RCGP programme “Quality team development” or any collaboration
between the Healthcare Commission (HCC) and the RCGP.



07/05/2011 – Version 5                  - 14 -         Mike Nelson/Neil Hamer Lewisham PCT
23.2 Health Care Commission “Standards for Better Health”
The provider is required to be compliant against the set of 24 essential or „core‟
standards that all healthcare organisations in England that treat NHS patients
should be achieving now, and 13 developmental standards that they should be
aiming to achieve in the future. The Provider is required to demonstrate
compliance with documented evidence. In cases where compliance is failing or at
risk an action plan must be developed to rectify the situation.

The provider is required to make and sustain progress; this will include taking
part in any HCC Improvement reviews during the year. These reviews may
require information on a particular area under tight timescales.

The Provider is required to support the PCT with delivery of both the New and
Existing targets/performance indicators (outlined below). The provider will be
required to achieve explicit performance indicators [to be agreed] which relate
solely to primary care at general practice level.

        New national target indicators for primary care trusts

http://ratings2006.healthcarecommission.org.uk/Indicators_2006Nat/Downloads/
PCTList.doc

        Existing national target indicators for primary care trusts (PCT’s)

http://ratings2007.healthcarecommission.org.uk/Downloads/PCTList.doc

24 Practice Based Commissioning and Demand Management
Providers are required to make all bookings via Choose & Book technology
where possible and appropriate. This will be achieved through staged targets to
be agreed with the provider.

It is essential that providers are actively involved in Practice based
commissioning in Lewisham and are shaping clinical pathway redesign schemes
and demand management initiatives; providers are required to be active
members of recognised Lewisham PCT Practice based Commissioning cluster 1
and so help deliver PbC plans for 2008-09 and onwards.

Providers must show how they will actively participate in any PBC commissioning
plan for their cluster. This must fully meet the terms of the PCT‟s PBC enhanced
scheme. Consideration should be made of the following areas of PCT focus:

        Diabetes
        CHD
        Heart failure
        dermatology



07/05/2011 – Version 5                 - 15 -          Mike Nelson/Neil Hamer Lewisham PCT
        musculoskeletal care and orthopaedics
        ophthalmology
        ear, nose and throat services (ENT)
        respiratory care including chronic obstructive pulmonary disease (COPD)
        sexual health
        long term conditions
        A&E attendances
        short stay emergency admissions



25 Monitoring & Review
25.1 Monitoring, information and accountability

The Provider will submit to the PCT any information requested by the PCT for
the collation of national and/or local statistics and other such relevant
information, as soon as reasonably practicable upon request. The provider is
required to have systems in place to ensure effective contract monitoring can
take place.

The Provider will ensure that all data used to monitor performance is of high
quality, robust and timely. The Provider must put the necessary actions in place
to bring about improvement on any data especially where either the Provider of
the PCT has concerns.

The Provider will act upon any new or amended Regulations or Directions that
relate to the Providers‟ responsibilities under this contract.

25.2 Requirements for contract review meetings
The Provider is required to meet with the PCT at 3 and 6 months after the start of
the contract and then 6 monthly thereafter to review performance against the
contract.

The PCT envisages using its established contract review teams to facilitate these
meetings in order to ensure a consistent approach to contract management
across all of its practitioners.

26 Staff Training & Development possible
The Provider will be expected to have a comprehensive plan for the development
of both clinical and administrative staff to ensure, through appropriate audit,
training and continuing professional development that all staff involved in treating
NHS patients are and remain qualified and competent to do so.




07/05/2011 – Version 5                  - 16 -         Mike Nelson/Neil Hamer Lewisham PCT
A proposal to become a training practice in the future will be considered for
support by the PCT. More information is available at: www.londongpvts.org.uk

The Provider is required to demonstrate evidence of involvement in continuing
professional development as recommended by the Royal College of General
Practitioners.

The Provider is required to provide evidence of participation in a PCT
professional appraisal scheme and evidence of personal development plans as
part of the appraisal process

The Provider is expected to be interested in mentoring either as mentee, mentor
or both

27 Conflict of Interest
The provider must ensure that where any clinical staff work in both the NHS and
outside of the NHS:
    i. There must be no conflict of interest with their NHS commitments; and
   ii. The interest of NHS patients is not prejudiced

28 Clinical Governance, Standards and Inspection
The Provider will be expected to have in place an effective system of Clinical
Governance and should nominate a person who will have responsibility for
ensuring its monitoring and operation.

29 Additional Requirement. A&E attendance, PPI, Workforce,

A&E Attendance

The Provider must have a mechanism in place for regularly reviewing patient
attendance at A&E both in and out of hours and for minimising the use of A&E for
primary medical services throughout the term of the contract. The PCT will
provide the practice with quarterly A&E attendance data to assist in this process.

Annex a - Lewisham Population Projections

Ward pop. projn.xls


Annex B Contractual & Statutory Requirements




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   Cont & Stat Req
    AnnexB.pdf




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