Primary care commissioning

NHS Surrey Heartlands is responsible for ensuring that our registered and resident populations have access to a range of primary, community and secondary care health and wellbeing services that meet their health needs. This includes the ability to register with a GP.

NHS Surrey Heartlands Integrated Care Board (ICB) holds delegated responsibility from NHS England for the commissioning and oversight of Primary Medical Services (more commonly known as GP services or primary care).

The commissioning process

The process of commissioning is a continual cycle requiring Surrey Heartlands to identify and prioritise the needs of our population so that we can design and secure services to meet those needs within a defined budget.

Ordinarily the need for additional NHS GP capacity arises due to an increase in population, for example, as a result of a new housing development and/or a change in the provision of existing contracts such as the termination or closure for another reason.

Review and evaluate the current provision

Review and evaluation of those services forms part of this cycle and helps to identify unmet needs and any issues with the performance or quality of these services. This in turn enables us to consider whether additional or alternative services need to be commissioned or whether some services are no longer needed.

Poor performance of a service provider is not dealt with by way of adding additional capacity but rather through support and where necessary, contractual action.

Should we conclude that additional GP capacity is potentially needed, we will consider the development and delivery of actions as described in the NHS England Commissioning cycle.

Commissioning additional services

In the event that additional capacity is required via the award of a new Alternative Provider Medical Services Contract (APMS) contract, the ICB is required to act in accordance with relevant legislation by advertising the opportunity via a competitive process.

Every individual or partnership of GPs must hold an NHS GP contract to run an NHS-commissioned general practice. These set out mandatory requirements and services for all general practices, as well making provisions for several types of other services that practices may also provide, if they so choose.

The APMS contract allows organisations (such as private companies or third sector providers) other than general practitioners/partnerships of GPs to provide primary care services. APMS contracts can also be used to commission other types of primary care service, beyond that of ‘core’ general practice. For example, a social enterprise could be contracted to provide primary health care to people who are homeless or asylum seekers.

Commissioning example

Assessing the nature and capacity of existing GP services in the local area

  1. Explore and understand why additional capacity may be required
    • Is there a new housing development leading to an increase in the local population that would need a GP?
  2. Review and forecast the additional capacity required
    • What might a potential list size (the number of patients registered at a GP practice) of any new practice be?
    • Can surrounding practices provide the GP services required in an effective, safe and viable way?
  3. Work with local people and communities to understand any unmet needs
    • Are additional GP services required?
  4. Review local access and transport provision.
  5. Assess the local and wider, competitive market and consider the risks and unintended consequences of new contract arrangements
    • Is there enough provider appetite (interested parties) to provide additional services?
    • Can any new service be provided within financial sustainability limits?
    • Will any other local services experience any destabilisation?  
  6. Assess the availability of estates (buildings) from which services could operate.
    • Are the available buildings appropriate?
    • Are there any accessibility issues?
    • Can the service afford the costs?
  7. Engage patients and stakeholders at different stages of these actions, including consideration of proposals and next steps.
  8. Consider our responsibilities under the Public Contract Regulations and Procurement, patient choice and competition regulations 2013 and any other legislation and or guidance that may apply.

Primary care commissioning committee

All recommendations regarding the commissioning and delivery of Primary Medical Care provision are subject to approval via our Primary Care Commissioning Committee, which oversees the effective and appropriate use of delegated funding and ensures that NHS Surrey Heartlands fulfils its commissioning responsibilities.  

The above information relates to the establishment and oversight of NHS Primary Medical Care Contracts. It is possible that a GP surgery may operate outside of the NHS. Such a practice would qualify as a private practice and would need to be established in accordance with relevant business and trading laws and registered with the CQC.