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Report to: |
Lead Member for Adult Social Care and Health |
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Date of meeting: |
21 November 2023 |
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By: |
Director of Adult Social Care and Health |
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Title: |
Public Health Local Service Agreements with GP Practices and Community Pharmacies |
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Purpose: |
To seek approval for the direct award of contracts to GP Practices for the provision of Public Health services. |
The Lead Member is recommended to agree to waive procurement standing orders to allow a Direct Award of Public Health Local Service Agreements to General Practitioner (GP) Practices for delivery of the mandated Public Health services (NHS Health Checks and Sexual Health Services).
1.1 In 2013, when responsibility for public health services transferred to East Sussex County Council (ESCC), a number of contracts for services were provided by GPs as Locally Enhanced Services (LES). These were sub elements of the General Medical / Pharmaceutical services (GMS/GPS) contract. These contracts were initially held by NHS England (as local authorities are not legally entitled to hold LES agreements with General Practices), before transferring to ESCC and being renamed as Public Health Local Service Agreement (PHLSA) contracts.
1.2 Five-year waivers have been in place to cover commissioning arrangements which are due to expire in March 2024. This report seeks approval to agree arrangements for a further five years.
The PHLSA services
2.1 The PHLSA services with significant sums attached are NHS Health Checks and Sexual health services which are delivered by GP Practices. A smaller amount of activity is attributed to smoking cessation services and some sexual health services provided by community pharmacies as PHLSA contracts.
2.2 The NHS Health Check is a systematic vascular risk assessment and management programme to help prevent cardiovascular diseases (CVD) including heart disease, stroke, diabetes, dementia and kidney disease. The eligible cohort is people between 40 and 74 years of age who (i) have no previous diagnosis of CVD and (ii) are not currently taking statins. The NHS Health Check programme is a mandated public health service for all local authorities. Local authorities are required to offer all eligible patients aged between 40 and 74 an NHS Health Check once every five years, such that 20% of eligible patients are offered a check each year and the results of the check should be recorded on the patient’s GP records. Following the NHS Health Check, patients should be offered lifestyle advice to reduce their risk of disease and those meeting specific clinical thresholds should be offered additional tests or services by their GP (additional services are provided under the practices General Medical Service contract with NHS England, and not funded by ESCC). Of the 51 GP Practices in East Sussex, 48 are currently signed up to provide the NHS Health Check PHLSA.
2.3 The PHLSA GP sexual health services cover Intra-uterine Contraceptive Device/System (IUCD/S) and Subdermal Contraceptive Implants (SDCI). These services ensure a full range of contraceptive options are provided by GP Practices to patients. These services reduce both unintended pregnancy and abortions/termination of pregnancy. Sexual health services are a mandated public health service for all local authorities. Of the 51 GP Practices in East Sussex, 39 are signed up to deliver at least one sexual health service under a PHLSA.
The rationale for a five year waiver
2.4 GP Practices have a unique infrastructure helping to target service users and promote health and healthy choices where the opportunity is presented. GP Practices are contracted by NHS England to provide primary care to patients and are the only organisations that hold a comprehensive healthcare record for people registered with them. NHS primary care is a niche market. There are no similar alternative organisations providing these health care services to members of the public in similar numbers and locations across the county. The vast majority of East Sussex residents are registered with a General Practice, and therefore GPs are in a unique position for the provision of these services.
2.5 Through the PHLSA, General Practices are offered the opportunity to provide targeted public health services at a specified price (set by the commissioner of the service). This is funded through the Public Health grant. Each General Practice is an independent business, and a separate legal entity which may choose whether or not to engage in the provision of these services. It is not desirable or cost effective to seek a quotation for price from each individual General Practice, as this could lead to significant variations in price and inconsistency across the County. Instead, the Council takes a standardised approach to pricing which is considered to offer best value.
2.6 Best value is achieved through annual review of:
· modelled costs based on expected time and other elements of providing services using information compiled by the Personal Social Services Research Unit (PSSRU) (a partnership between the University of Kent, University of Manchester and the London School of Economics (2017)) which calculates and annually publishes the unit costs of health and social care services by different staff groups/settings). This approach represents a nationally recognised micro costed financial model; and
· benchmarking, i.e. prices paid for similar services from GPs in other areas across the South East region.
2.7 Prices are also reviewed annually, direct with the provider, to ensure the desired level of activity is achieved.
The value of the GP PHLSA services
2.8 Total spend, across all GP Practices, in 2022/23 is detailed in the table below:
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2023/23 spend |
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NHS Health Checks* |
£323,261 |
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Sexual Health services: |
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(i) fitting intra-uterine contraceptive coils /systems (IUCD/S) |
£175,685 |
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(ii) subdermal contraceptive implants (SDCI) |
£109,212 |
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Total |
£608,158 |
*There is also a fixed cost (applicable only to GP Practices using Point of Care Testing (POCT) of £874 (subject to change based on the cost of consumables) per POCT machine per annum for Internal Quality Control (IQC) testing to ensure the quality of the machines used within the programme.
2.9 The GP Practice with the highest level of NHS Health Checks activity during 2022/23 has been modelled with a 5% annual increase. The total modelled spend over five years is £353,640. The GP Practice with the highest level of sexual health services (IUCD & SDCI) activity during 2022/23 has been modelled with a 5% annual increase. The total modelled spend over five years is £138,141.
PHLSA Terms and Conditions
2.10 The GP Practices have to sign up to ESCC’s Sign-up Terms and Conditions which will be reviewed at regular intervals over the next 5 years to ensure they remain fit for purpose and in compliance with relevant legislation.
3 Conclusion and reasons for recommendations
MARK STAINTON
Director of Adult Social Care and Health
Contact Officer: Tracey Houston, Business Manager, Public Health
Email: Tracey.Houston@eastsussex.gov.uk
LOCAL MEMBERS
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BACKGROUND DOCUMENTS
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