The Health Authority should give an opinion as to whether it recommends that the proposal be approved and whether the proposal is consistent with local primary care objectives.

The proposal from Drs Bhatt, Bulger, Andrews and Side of Woodhall Farm Surgery, Archway Surgery, Red & White House Surgery and The Old Forge Surgery respectively is for a combined PMS only pilot with central growth monies for 1.25 WTE GP’s (MPC approval required) and a WTE nurse practitioner (MPC approval not required). They are interested in being a PMS plus pilot for the purposes of the services they provide under the monies from the PCG.

The Health Authority submitted an application to the MPC for the additional GP time during the three-week consultation period. The MPC confirmed that would comment upon receipt of the final documentation that included comments from all organisations consulted. As such the MPC has received a copy of this completed document at the same time that it has been sent to the Regional Office.

The pilot aims to address four key areas:

• Enhanced IHD management (requiring growth monies for a nurse practitioner);
• Improved communication and co-operative working amongst the four single-handed practices including peer review
• Improved health for travellers within the A41 patch
• Production of a single negotiating unit within the PCT

These objectives fit the criteria to become a PMS pilot, fit the objectives of the NHS Plan with respect to single-handed practices, and are consistent with local primary care objectives.

The proposal is supported by the PCG subject to the pilot securing the central growth monies to employ the 1.25 GPs and nurse practitioner. The LMC support the application and trust that the growth monies will be available.

The Health Authority supports this application for the four single-handed practices to become a PMS pilot effective April 2001 subject to clarification of the funding required.

Dacorum PCG has confirmed that the proposal meets the PCG’s criteria for support provided that the required central growth monies are made available.

The PCG is supportive of this proposal to enable the four practices to better deliver the HimP, Clinical Governance agenda and improve rapid access to healthcare for patients.

Support is given conditional upon the following points:

• Central growth monies for the nurse practitioner is secured
• MPC approval for the 1.25 WTE GPs and growth monies to support this
• Clarification as to the status of the pilot – one pilot or four working closely
• Clear protocols to co-ordinate the drug issues throughout the PCG including links with the mental health service and local drug and alcohol agencies
• PCG and pilot working to develop a robust management structure to administer the pilot

LMC

Acknowledged the four main areas of work that the pilot wishes to concentrate on.

LMC actively supports single-handed practices and welcomes this example of an innovative plan to maintain the key features of a single-handed practice, whilst providing a framework for high quality services taking forward national and local priorities.

The LMC hoped that the identified £12K from the PCG for the designated PMS plus services is realistic in view of the increased workload that will be required to achieve the aims.

The LMC was mindful that the outcome of the MPC’s consideration would not be known till later in the consultation period. It supported the proposal and hoped that it would be successful in securing the additional finance to employ the required staff.

CHC

No comments received to date

The following individuals were consulted - no comments have been received:

• Director of Housing and Health, Dacorum Borough Council
• Director of Social Services, Hertfordshire County Council
• Director of Education, Hertfordshire County Council
• District Manager, Social Services

Trusts:

Stoke Mandeville Hospital NHS Trust:

Commented that they were unable to assess whether there would be any material affect on the contractual relationship between the Trust and the PCG. They registered their interest in discussing any resulting changes re: activity, finance or service flow, pending further detail being available.

Confirmed they had no comment on the application

Expressed many concerns including the general lack of understanding of the nurse practitioner role. Did not agree that it would be easy to recruit from those clinical areas where recruitment is already a serious problem, nor that the operational issue of finding a nurse to work between the practices would be realistic. Concern about implications for the University of Hertfordshire funding the post, and the perceived view of the pilot that their relationship with the Consortium would change if they were to become a pilot.

Richard Page MP confirmed his desire for the application to be considered favourably and registered his support for the proposed enhanced services that he believed the pilot would provide. He acknowledged there were advantages and disadvantages for single handed practices to deliver care, and the real improvement if the pilot were to secure the additional staff proposed.

Broadly welcomed the initiative. Recognised the benefits in terms of peer review and audit of services and practice, whilst preserving the benefits of the more personal nature of the sole practitioner service without the enhancement in terms of access, services and OOH cover.

The Council welcomed the planned increase in resources to be allocated, but expressed some concern at the geographical spread of the participating practices who are spread over a six-mile radius.

The Council approved of the service developments proposed especially the emphasis on the prevention of IHD, enhanced care for the isolated elderly, and work in preventing teenage pregnancy.

The Council responded directly to the pilot proposers, commenting on their understanding of the proposal and raising questions for consideration.

Generally the issues revolved around the status of the proposed additional GP and the relationship of this postholder to the pilot were the pilot to become permanent. Clarification was sought with respect to the confidentiality of patient records with the proposed pilot and the effect this would have upon the access to individual GPs.

In addition to the above, the following agencies / individuals were consulted - no response was received:

• GP practices in Dacorum PCG
• West Herts Hospitals NHS Trust
• Aylesbury Vale NHS Trust
• Beds & Herts. Ambulance & Paramedic Service NHS Trust
• Local Dental Committee
• Local Optometric Committee
• Watford CVS
• District Co-ordinating Groups
• Unison, MSF, BMA, RCN, CPHVA
• Hertfordshire Health Promotion Service