Primary Care Commissioning Committee Public Meeting To be ... · the roll out of electronic referrals (e-RS) or GP2GP. The Committee fedback positively on the work completed by the

Primary Care Commissioning Committee Public Meeting

To be held on Thursday 9th November 2017 Commencing at 12.30pm – 2.30pm

In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Lead Enc

1. Apologies for Absence Chair 2. Declarations of Interest Chair

3. Minutes of the meeting held on 12 October 2017 Chair Enc A

4. Matters Arising not on the Agenda, including progressing the action tracker

Chair Enc B

5. Finance:

5.1 Full Quarterly Report Mrs Tingle Enc C

6. Quality:

6.1 Full Quarterly Report Mrs Cookson Enc D

7. Commissioning:

7.1 GPFV Update

a) General Update Mrs Ogle Enc E

7.2 Primary Care Delivery Plan Mrs Wastnage / Mr Empson

Tabled

7.3 ACS Primary Care Steering Board Minutes and Action Log

Mrs Ogle Enc G1 &G2

7.4 CCG Primary Care Delivery Group Report Mrs Ogle Enc H

7.5 Governing Body Annual Report Chair Verbal

8. Potential Risks Chair Verbal

9. Any Other Urgent Business Chair Verbal

10. Date and Time of Next Meeting Thursday 14th December 2017, Boardroom, Sovereign House at 12.30pm

Chair

To resolve that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

1

Minutes of the Primary Care Commissioning Committee Held on Thursday 12 October 2017 commencing at 12.30pm

In the Boardroom, Sovereign House

Voting Members Present:

Non-Voting Members Present:

Mrs Linda Tully – Lay Member (Chair) Mrs Sarah Whittle – Lay Member Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mr Anthony Fitzgerald – Director of Strategy & Delivery

Dr Khaimraj Singh – Locality Lead, South East Locality Dr Niki Seddon – Locality Lead, North West Locality Mrs Carolyn Ogle – NHS England Representative

Formal attendees present (non- voting):

Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term Conditions Mrs Debbie Hilditch - Health watch Doncaster Representative Mrs Kayleigh Wastnage - Primary Care Support Manager Dr Nicholas Leigh- Hunt – Public Health Representative

In attendance:

Miss Emma Ross - Primary Care Support Officer - (Taking Minutes) Mr Ian Carpenter - Head of Communications & Engagement Chris Empson – Informatics Programme Manager Gemma Sessions – Senior Data and Systems Analyst

ACTION

1. Apologies for Absence

Apologies were received from:

• Mrs Suzannah Cookson – Deputy Chief Nurse

Mrs Tully took the opportunity to welcome both Dr Singh and Dr Leigh-Hunt to the Committee and a round of introductions were made.

2. Declarations of Interest

The Chair reminded Committee members of their obligations to declare any interest they may have on any issues arising at Committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.

Declarations declared by members of the Committee are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following

2

link www.doncasterccg.nhs.uk

The meeting was noted as quorate.

Declarations of interest from sub-Committee/working groups:

None declared.

Declarations of interest from today’s meeting:

None declared

3. Minutes of the Previous Meeting held on 14 September 2017

The minutes of the meeting held on 14 September were agreed as an accurate record.

4. Matters Arising

Carcroft Doctors Group and Princess Medical Centre Mrs Wastnage confirmed the Primary Care Web Tool extract for practice boundaries has been received from NHSE and would be used in a future merger meeting with the practices.

The Primary Care Commissioning Committee reviewed and updated the Action Tracker.

5. Finance

5.1 Interim Exception Update Mrs Tingle updated the Committee on the current financial position commenting the CCG is currently achieving the delegated budget. Some additional costs were GP indemnity of approximately £145k. The CCG is in a position to meet this additional cost however it would mean less flexibility in the already tight finances. Mrs Whittle questioned why the CCG is not aware of this cost pressure and Mrs Tingle explained this had been part of the 17/18 GP Contract changes which have previously been unclear in confirming if NHSE or CCGs would be responsible for funding. Maternity and sickness payments are currently not causing any issues but the CCG is keeping a close eye on this for the remainder of the financial year.

The Primary Care Local Enhanced Services are on track financially, once activity was moving out of the Trust there would be an increase in spend which would be monitored.

5.2 Update on LIFT costs and non-Payment of practice reimbursements Mrs Tingle reminded the Committee of the commitment the CCG has made to facilitate discussions with CHP and practices. It was agreed the LMC would facilitate these discussions and feedback to the CCG. The CCG needed to be assured that any practices that have

http://www.doncasterccg.nhs.uk/

3

accumulated debts with CHP have this money set aside. Dr Seddon queried how the CCG would approach a practice that had not set this money to one side. Mrs Tingle confirmed the CCG needed to have further discussions internally on how they would follow up with practices if this was the case.

The Committee thanked Mrs Tingle for the update.

6. Quality 6.1 Interim Exception Update Apologies from Mrs Cookson had been received meaning this item would be deferred to the next meeting.

6.2 Primary Care Quality Dashboard Mr Empson and Miss Sessions attended the meeting to update the Committee on the Primary Care Matrix, the original concept for this and the workings of this within the monthly Primary Care Matrix Evaluation Group (PCMEG).

Mr Empson gave a detailed description of the data sources and how they were used to form discussions with practices around a number of both positive and negative impacts individual practices have on the wider system.

The PCMEG was still in its infancy with new members such as Dr Alsindi invited to attend and input into these discussions. A more recent agreement from the Primary Care Delivery Group has been for the Group to focus on both the variation between practices but also any Doncaster wide messages which need supporting, such as the roll out of electronic referrals (e-RS) or GP2GP.

The Committee fedback positively on the work completed by the PCMEG and requested an evaluation is completed in order to see how this has impacted practices.

A question was raised by Mrs Hilditch regarding how demographics were taken into account as not only was there a variance within Doncaster but also within practices. Mr Empson acknowledged this and confirmed deprivation is taken from the Public Health Observatory which is publically available.

Additionally Mrs Hilditch enquired if patient experience data outside of GP survey, Family Friends Test and Complaints were included. Mr Empson commented that although soft intelligence around practices is used it is difficult to gather useful qualitative data. Mrs Hilditch offered to meet with Mr Empson and Miss Sessions to aid gathering this information. The Committee thanked Chris and Gemma for their attendance and requested an annual report come to the Committee on progress. Mrs Tully requested this is added to the forward planner.

Mr Empson/Miss Sessions

Mrs Hilditch/Mr Empson/Miss Sessions

Mrs Wastnage

4

7. Commissioning 7.1Primary Care Charter Mrs Ogle discussed enclosure D with the Committee commenting this had been an amalgamation of the ACS GPFV plans and should contain no surprises to the Committee. Mrs Ogle commented the plans needed refreshing from a Doncaster perspective.

Mrs Ogle discussed the key priorities which were implementing the GPFV, Local Care Networks development and discussion around how this would work in Doncaster, and also interoperability between IT systems.

Mrs Ogle informed the Committee there would soon be money devolved through the ACS to support Local Care Networks of £1 per patient population non recurrent funding. It was not clear currently how this money would be accessed but the Committee would be updated in due course.

The Committee discussed the eagerness to learn the ACS approach to primary care and requested the minutes and action planner are added to the standing items of business.

A discussion on why the document was referred to as a charter as the group did not feel this document was a charter. Mrs Ogle agreed to feed this back in the ACS meeting which would take place at the end of October.

The Committee agreed it would be useful to compare the CCGs plans against the charter. Mrs Ogle and Mrs Wastnage were tasked with undertaking this assessment.

Mrs Hilditch expressed her disappointment on the level of communication and engagement work shown in the charter.

Mrs Tully thanked the Committee for the discussion and requested any comments to be sent to Mrs Ogle and Mrs Wastnage by Friday 20th October.

7.2Extended Primary Care: Revised Tier 2 Local Enhanced Services Dr Alsindi presented enclosure E to the Committee and requested members take note of the changes highlighted in red. The GPs went on to discuss the ring pessary requirements to keep a stock of sizes, it was agreed this was not the ideal but Dr Alsindi and Dr Eggitt were unable to find a work around and asked for support from their clinical colleagues. The GPs agreed to take this discussion out of the meeting and the Committee agreed to agree the request with the expectation the issues would be resolved.

Mrs Wastnage

Mrs Ogle

Mrs Ogle/Mrs Wastnage


Dr Alsindi/Dr Eggitt/Dr Seddon/Dr Singh

5

7.3 Acquisition of the Phoenix Medical Practice by the Flying Scotsman Health Centre

Mrs Ogle explained that a merger request had been considered at the previous meeting in the confidential session and a request had been made for legal advice to be sought on the request. This advice had now been received and was set out in the paper. The advice made it clear that it was not a merger that was requested but an acquisition and there was no precedent in the country for a PMS contractor to join an APMS contractor in this way. However the advice clarified that the risk of challenge under the procurement rules was relatively low due to the safe harbours provisions.

The Committee noted that the request would provide the CCG with a significant financial pressure due to the out of hours contract held by the Flying Scotsman which is paid on number of registered patients.

There was a risk connected with the premises at the Phoenix practice as there was no lease in place. Mrs Tingle explained that a section 21 notice would need to be issued to evict from the premises and there would be two months grace period. Alternative premises options were also discussed. Following discussion it was agreed that a comprehensive option appraisal with risk assessment be completed for the November meeting of the Committee.

7.4 The Ransome Practice Branch Closure

Mrs Wastnage presented the final paper outlining the steps The Ransome Practice has completed through the patient consultation. The Committee agreed the branch closure and agreed further discussion outside the meeting with the estates group to decide how to dispose of the property.


8. Any Other Urgent Business

No other business discussed.

9. Date and Time of Next Meeting

Thursday 9 November, Boardroom, Sovereign House at 12.30pm

6

Date of Meeting Agenda Item Action Action by Action due Update Status

13 July 2017 Application to Close List - Thorne

Moor Medical Practice

CCG to facilitate exploration of available space within the

building for the practice to expand into.

Hayley Tingle August

Committee

CCG liaising with CHP. To date no action

has taken place

Outstanding

13 July 2017

Application to Close List - Dunsville

Medical Centre Update

PC Team to continue to support the Practice and update

the committee on a monthly basis.

PC Team

Update

required at

each

Committee

On-going

Action

10 August 2017

Work and Health Trial

Carolyn Ogle to update the Committee of progress with

the work programme

Carolyn Ogle

Update

required at

each

Committee

On-going

Action

12 October 2017

Primary Care Quality Dashboard

Chris Empson and Gemma Sessions to evaluation the

outcomes from the PCMEG and present at a future

Committee meeting

Chris Empson

/ Gemma

Sessions

In due

course

On-going

Action

12 October 2017

Primary Care Quality Dashboard Debbie Hilditch and Chris Empson to meet and discuss

use of qualitative data within the PC Matrix and

Chris Empson

/ Debbie

In due

course On-going

Action

12 October 2017

Primary Care Quality Dashboard

Chris Empson and Gemma Sessions to draft an annual

report of findings / working undertaken and present at a

future Committee meeting

Chris Empson

/ Gemma

Sessions

In due

course

On-going

Action

12 October 2017

Primary Care Charter Carolyn Ogle to feedback to the ACS comments from the

Committee

Carolyn Ogle In due

course On-going

Action

12 October 2017

Primary Care Charter

Carolyn Ogle and Kayleigh Wastnage to collate

Committee comments on the Charter, update it and

compare it to the CCG's Primary Care and Place Plan

Strategies

Carolyn Ogle /

Kayleigh

Wastnage

In due

course

On-going

Action

12 October 2017

Extended Primary Care - Revised

Tier 2 LES

The Committee GP's will discuss the ring pessary fit

requirements outside of the Committee and feedback at

the next meeting

All Committee

GP's

November

Committee

Nabeel Alsindi will lead these discussions.

On-going

Action

12 October 2017

Acquisition of The Phoenix Medical

Practice by The Flying Scotsman

Health Centre

A comprehensive options paper will be drafted and

presented to the next Committee

Carolyn Ogle

November

Committee

On-going

Action

12 October 2017 Branch Closure Update - Ransome

Practice

Letter of approval to be sent to the practice Kayleigh

Wastnage

November

Committee On-going

Action

12 October 2017 Branch Closure Update - Ransome

Practice

Consideration of disposal of the building to be presented

to the Strategic Estates Group

Kayleigh

Wastnage

In due

course

The next SEG is 15.11.17 On-going

Action

Meeting name Primary Care Committee

Meeting date 9th November 2017

Title of paper

Delegated Primary Care 2017/18 Financial Position – Quarter 2 2017/18

Executive /

Clinical Lead(s) Hayley Tingle

Chief Finance Officer

Author(s) Genna Miller

Finance Manager

Purpose of Paper - Executive Summary

This report outlines the 2017/18 financial position as at 30th September 2017 Primary Care Delegated Co-Commissioning (GP Contracts).

Recommendation(s)

Members are asked to receive the report and note the position and highlighted financial risks.

Impact analysis

Quality impact

None identified

Equality impact

None identified

Sustainability impact

Nil

Financial implications

As highlighted within the report

Legal implications

None identified

Management of Conflicts of Interest

None Identified

Consultation

N/A

/ Engagement

(internal departments,

clinical, stakeholder

& public/patient

)

Report previously

presented at

None

Risk analysis

Assurance Framework

1.2, 1.4, 2.4, 3.1, 3.2, 6.2

NHS DONCASTER CCG

2017/18 PRIMARY CARE DELEGATED CO-COMMISSIONING (GP CONTRACTS) QUARTER 2 2017/18 FINANCIAL POSITION

1. Introduction

NHS Doncaster CCG assumed responsibility for managing the Primary Medical Care Budget from NHS England with effect from 1st April 2016, adding to the current CCG responsibility for Enhanced Services, Out of Hours Contract, Oxygen and GP IT.

2. Quarter 2 2017/18 (July/September) Financial Position

The total 2017/18 Primary Care Delegated Co-Commissioning GP Contract annual budget is £42,036,558, an increase of £45k from Q1 2017/18 relating to a national allocation linked to NHSPS premises . As at Quarter 2 2017/18 we are forecasting an underspend of £271k with a number of highlighted risk, as detailed below, where we are awaiting further information to order to calculate the associated financial risk.

YTD

Budget YTD

Actual YTD

Variance Annual Budget

Forecast Outturn

Variance

£’000 £’000 £’000 £’000 £’000 £’000

General Practice – GMS

10,975 10,993 18 21,950 21,968 18

General Practice – PMS

3,019 2,753 -266 6,038 6,038 0

General Practice – APMS

394 686 292 787 802 15

Premises 2,915 2,876 -40 5,845 5,891 47

Enhanced Services

591 581 -11 1,193 1,234 41

QOF 1,565 1,434 -131 4,471 4,276 -195

Other – GP Services

876 609 -267 1,753 1,557 -196

TOTAL – DELEGATED MEDICAL CONTRACTS

20,335 19,931 -405 42,037 41,766 -271

Areas of concern relate to;

• Premises - LIFT premises reimbursement has been realigned to 2017/18 charges, but these have since been realigned a number of times by CHP. NHS England are working with CHP to understand why the charges are changing on a regular basis during the year (and to set a clear process on what version we are reimbursing) and the on-going national issue relating to management allowance reimbursement (for information – management allowance was a non reimbursable cost in 2016/17 i.e. practice cost. CHP have discovered that a number of leases do not include the management allowance in the documentation, therefore they cannot recharge the

practices. CHP have now stated that this is a reimbursable cost i.e. NHS cost. This is not covered in the premises directions, therefore NHS England are working with CHP to agree a national stance). This impact is not included in the Q2 position. Notional/actual rent reviews are being checked against the NHS England premises database to understand potential increases in rent reimbursement. This is not included in the Q2 position. NHS England are working on information relating to the GL Hearn rates review, and are to confirm the amount of funds available to NHS Doncaster CCG to reclaim. This is not currently in the Q2 position.

• Enhanced Services – Component 2&3 of the Avoiding Unplanned Admissions DES for 2016/17 is yet to be approved in CQRS and paid to practices. This should be covered by the 2016/17 accrual but until final figures are known, this could cause a financial cost pressure.

• QOF – The current QOF achievement forecast outturn is based on 30% of the CQRS aspiration calculation (based on 2016/17 actual point achievement at 2017/18 price per point). This has been offset against the 2016/17 final year end accrual position. Potential for overperformance linked to the 2016/17 position due to increased points performance and changes to practice prevalence (recent external practice training event to help practices understand how to maximize their prevalence levels against national) which will impact on the overall spend.

• Other – changes to the locum sickness cover became mandatory from 1st April 2017, therefore any sickness claims are a cost pressure to the CCG as there was no expenditure in 2016/17 therefore no allocated budget. Costs will be unknown until a claim is submitted. Current sickness claims - year to date £45k, forecast £53k.

3. Conclusion and Recommendations

Members are asked to:

Receive and note the Quarter 2 2017/18 (July/September 2017) financial position for Primary Care Delegated Co-Commissioning GP Contracts with associated risks.

Page 1 of 6

Committee

Meeting name Quality and Patient Safety

Meeting date 2 November 2017

Title of paper

Primary Care Quality Report

Executive / Clinical Lead

Suzannah Cookson Deputy Chief Nurse

Author Suzannah Cookson


The purpose of the Primary Care Quality Report is to provide the Quality and Patient Safety Committee with an update of the recent activity and progress made by the NHS Doncaster CCG Quality Team in relation to Primary Care.

Recommendation(s)

The group are asked to receive and note the progress made during this time period.

Impact analysis

Quality impact As detailed in the report

Equality impact

None


Positive, supporting sustainability of general practice.


None

Legal implications

None

Management of Conflicts of

Interest

None

Consultation / Engagement


clinical, stakeholder & public/patient)

Engagement with member practices is on-going.

Report previously

presented at

None

Risk analysis

There are no risks to report at this time.

Assurance Framework

1.2, 1.3, 2.1, 2.2, 4.3, 5.1

Page 2 of 6

Primary Care Quality Report

1. Introduction

The purpose of this paper is to provide an overview of the quality and patient safety issues in relation to Primary Care, this is a developmental process. This paper refers to the information submitted since the last meeting.

2. Delegated Authority

The Primary Care Committee is meeting regularly and there is a regular agenda item for quality.

3. Primary Care Quality Support

In this reporting period there has been reduced capacity in available quality support proactively offered to practices as part of the assurance visits. The primary care team with the wider quality team have provided support as required.

The additional update around quality and patient safety themes to the GP bulletin due to commence last month will be available as soon as capacity is back to establishment for primary care quality.

4. National Reporting and Learning System

To date there have been upwards of 30 reports submitted with no patterns or trends identified. Conversations have been held with practices and secondary care providers and some processes have been changed to improve quality and patient safety. Many practices have embraced this way of sharing and reporting of incidents and have shared their learning.

5. Primary Care Matrix Evaluation Group (PCMEG)

The PCMEG have recently expanded its remit, following approval by the Primary Care Delivery Group. The PCMEG will now also incorporate the CCG’s priority areas in its discussions identifying practices. The first two areas to be focused on are use of eRS and the referral process and use of the new clinical thresholds for Procedures of Limited Clinical Value.

6. Primary Care Transformation

Doncaster’s new GP Federation Primary Care Doncaster (PCD) has been established. The election process for their Board has concluded and each neighbourhood has 2 representatives sitting on the Board.

The Proactive Coordinated Care Quarter 3 reports are being collated and a verbal update was presented to the Primary Care Commissioning Committee in August with a formal summary following at September’s Committee.

Page 3 of 6

7. Care Navigation

Care Navigation went live on the 13th October 2017. The CCG will be monitoring practices via a new care navigation dashboard which is in development. The dashboard will provide details such as when practices are care navigating i.e. time of day, the patient rejection rate and the services care navigated to.

The Primary Care Delivery Group will be discussing expansion of the programme and will look to develop a forward plan for 2018 at its November meeting.

8. Workforce

No update this reporting period.

9. Case Conference Reporting / Attendance

9.1 Reports requested for initial child protection conferences

Month

Initial child protection conference [total]

GP Reports Received

Percentage in relation to number invited too %

January 2017 28 8 35%

February 2017 28 9 33%

March 2017 30 18 64%

April 2017 23 10 43%

May 2017 18 4 25%

June 2017 26 9 45%

July 2017 22 7 32%

August 2017 24 9 38%

September 2017 25 10 10%

The number of reports submitted by GPs for initial child protection conferences is still fluctuating. There was a large increase in GP reports being sent to initial conference in March 2017 that was attributed to the TARGET training provided. This reduced consecutively in April and May.

June saw an increase to 45% this follows the introduction in April of all GP surgeries receiving a letter of thanks for their contribution and percentage data of meetings that received a report. Several practices have asked if these letters can be more practice specific, giving individual percentages, Doncaster Children’s Trust have said they will look into this and see if this is possible. This letter is now sent out every month to act as a prompt.

The Deputy Designated Nurse for Children’s Safeguarding & LAC and the Lead Nurse for Quality in Primary Care met with staff members from Doncaster Children’s Trust with a view to how we support practices to increase the number of reports submitted.

The main issue raised was the delay between the date the Social Worker sends the initial booking request form and the date that the Safeguarding team obtain GP details.

Page 4 of 6

The business support team at Doncaster Children’s Trust is now able to obtain GP details directly from Single Point Of Access (SPOC) and it is anticipated that in future GP’s will have more time to write and submit a report resulting in further increases in the number of reports submitted.

The LMC has also met with safeguarding leads to understand some of the issues and challenges, A regular meeting has been established between CCG safeguarding leads, LMC and DCST to develop relationships and look at some solutions for reporting.

The LMC, CCG and DSCT have also reviewed the GP Case Conference Reporting template to ensure that it is fit for purpose. The revised template is currently being finalised and will be shared with GP practice shortly.

9.2 Reports required for review child protection conferences

Month

Review child protection conference

GP Reports Received

Percentage in relation to number invited too %

January 2017 59 9 15%

February 2017 39 14 36%

March 2017 62 24 39%

April 2017 43 13 30%

May 2017 52 25 49%

June 2017 53 24 46%

July 2017 49 19 40%

August 2017 31 10 32%

September 2017 59 31 53%

In January 2017 business support began sending invites eight weeks in advance to all review conferences which has seen the reports submitted increasing month on month. GP’s now have 6 weeks’ notice to submit the report to RCPC which appears more achievable than the tight timescales for ICPC’s.

10. Care Quality Commission

Carys Murray-Cook, who is the Care Quality Commission’s lead inspector for Doncaster, will be attending a practice manager meeting following the publication of the new inspection methodology. She will be giving a short presentation around the new way of regulating and inspecting and will then open for questions.

11. Primary Care CQC Reports Published

Mexborough Health Centre

Mexborough Health Centre was inspected by the Care Quality Commission on 18 September 2017 and the report was published on 20th October 2017. This was an announced focused inspection to review that the practice had carried out the actions identified in the previous CQC inspection on 16 March 2017.

Overall the practice was rated as Requires Improvement.

Page 5 of 6

Safe Effective Caring Responsive Well Led Overall Rating

RI Good RI Requires Improvement

12. Public Health England Screening Quality Assurance Visit report

A Fourth QA visit was undertaken at Carcroft Health Centre on July 21st with the report published September 11th. Two immediate concerns had been identified at the time of the review and these were actioned by the practice straight away. Twenty – Three recommendations were highlighted in the report, with a month timeframe for the majority of the recommendations. A meeting has been set to review progress made together with PHE as joint commissioners of this service.

Page 6 of 6

Meeting name Primary Care Commissioning Committee

Meeting date 12th October 2017

Title of paper

GP Forward View Update

Executive /

Clinical Lead(s) Anthony Fitzgerald, Chief of Strategy and Delivery

Author(s) Carolyn Ogle, Associate Director Primary Care


To update the Primary Care Commissioning Committee on the implementation of the GP Forward View further to the report presented in August 2017

Recommendation(s)

Primary Care Commissioning Committee members are asked to: - Note the contents of the enclosed paper - Advise on any further action to be taken by the Primary Care Team

Impact analysis

Quality impact

Quality will be monitored through the Primary Care Quality Strategy and Quality Dashboard. The aim of the GPFV plan is to increase quality of general practice across the board.

Equality impact

EIAs will be done as part of the service specifications and other work-up


The aim is to invest in primary care to sustain services into the future


As per the paper

Legal implications

Procurement regulations will be complied with as services are commissioned

Management of Conflicts of Interest

Will be preserved through the PCCC’s Constitution

Consultation, Engagement

(internal depts,

clinical, stakeholder

public/patient

An ongoing process for each of the workstreams

Report previously

presented at

Previous update presented to August Primary Care Commissioning Committee

Risk analysis

As per paper

Assurance Framework

1.2, 2.3

GP Forward View Update

Introduction

The General Practice Forward View published in April 2016 commits to an extra £2.4billion per year to support general practice services by 2020/21. This paper serves to provide an update of progress made/activities having taken place since the last update in August 2017.

1. Workforce – expand and support GPs and wider primary care staffing

The Local Workforce Advisory Board to the ACS (LWAB) has developed a proposal for investment to build a multi-professional primary care workforce for general practice across South Yorkshire and Bassetlaw. The proposal describes the investment required for the regional realisation of the NHS Five Year Forward View and a route to a sustainable plan for transforming health care services across the region that allows patients to be looked after in the most appropriate place by the most appropriate people. It describes the current headcount, the changing shape of primary care and estimates the number of additional posts required each year from 2017 to 20121 across SYB. Further work is required on the plan and clarity around the potential for funding streams to support this.

Primary Care Doncaster is undertaking a workforce survey to gather data from all practices on their existing workforce, including skill-mix, age, qualifications, training needs etc. This will provide a baseline across Doncaster to show where the particular workforce gaps are, and identify where funding to pump-prime different roles, or ways of working may be developed.

The Federation is also providing support for practice manager development and training and developing a physician associate preceptorship. They attended the careers fair on 4th October to promote this and four practices have expressed an interest in hosting these posts. Primary Care Doncaster is also considering submitting an application for the Clinical Pharmacist Programme. Further discussions are ongoing within the ACS about whether there is appetite to pursue international recruitment. The next step is to learn from other areas about their approach where significant numbers of GPs have been recruited.

As reported in August a workshop on mental health therapists is being held in Leeds on 31 October 2017. Any feedback from this workshop will be made verbally at the Committee.

Care navigation training has completed for the first wave of services to be rolled out and has been very well received. The Delivery Group at its meeting on 3 November 2017 will be considering the roll out of phase two.

2. Workload

• Managing demand Releasing time for care development programme event launched on 12 October 2017 in Doncaster, very well received. Dates for two days fundamentals programme and collaborative workshops for practices being organised for January/February 2018. Primary Care Doncaster supported

practices to attend by funding cover. Support is also being provided by NHS England’s national team to provide marketing and promotion of the programme.

• Building practice resilience All practices put forward for funding received £5,000 for organisational development or recruitment support. Additional practice also identified for support received funding from slippage.

3. Practice Infrastructure

• The five CCGs across South Yorkshire & Bassetlaw have agreed to take a collective approach to the implementation of GP Wifi. Project management support has been secured from Sheffield Health and Social Care Trust combining the shared resources allocated by NHS Digital for this purpose in order to achieve economies of scale. Procurement is taking place using the support of the Crown Procurement Service which has been one of a number of routes to market explored. The potential opportunity to progress without procurement with our existing supplier was rejected given the decision to progress at scale across the SYB footprint – the five CCGs do not receive IT support from the same single supplier. Given the development of the ACS it was felt that a common approach would support future inoperability and technology developments better as well as ensure confidence that the supplier offered acceptable and market tested rates for the implementation of Wi-fi. It is envisaged that wifi will be in place in practices by the end of March 2018.

• Online consultation system

Guidance on this has been delayed but is expected in advance of the PCCC and therefore details will be shared at the meeting.

4. Care Redesign

• Extended access A survey has been developed for patients to respond on the times they would wish to access extended primary care and the method by which they would prefer to access (online, group consultations, telephone etc) and data is being gathered by practice on the use of the Same Day Health Centre. Discussions are ongoing about the links between the urgent treatment centre and extended access. Further guidance is expected on a model specification and procurement. It has been clarified that the expectation for delivery in 2018/19 is mid year.

The Committee is asked to note this update report and consider any further action required by the Primary Care Team.

1

Wednesday 6 September 2017, 3:00-5:00pm,

Boardroom, 722 Prince of Wales Road, Darnall, Sheffield, S9 4EU

Meeting of the South Yorkshire and Bassetlaw ACS Primary Care Work Stream Steering Board

Minutes

Attendees: Name Role Initials

Maddy Ruff

Dr Tim Moorhead Karen Curran Victoria Lindon Louise Nunn Dr Nabeel Alsindi

Dr Anthony Gore Tom Bisset Jacqui Tuffnell Victoria McGregor- Riley Dr Avanti Gunasekera Jackie Holdich

Dr Mehrban Ghani Dr Alistair Dixon Raheel Baig

ACS Primary Care SRO, Accountable Officer, Sheffield CCG Chair, Sheffield CCG (Meeting Chair) ACS Primary Care Programme Lead , NHS England Senior Primary Care Manager, NHS England ACS Senior Finance Manager, NHS England Clinical Lead for Primary Care and Long Term Conditions, Doncaster CCG Clinical Lead for Out of Hospital Care, Sheffield CCG Secretary, Barnsley LPC Head of Co-commissioning, Rotherham CCG Executive Lead for Primary Care, Bassetlaw CCG

Strategic Executive Lead GP for Primary Care, Rotherham CCG Head of Delivery (Integrated Primary and Out of Hospital Care) Medical Director, Barnsley CCG

SY&B GPFV Transformation Manager

MR

TM KCu VL LN NA

AG TB JT VMR

AGu

JH

MG

RB

Apologies: Name Role Initials

Katrina Cleary Carolyn Ogle

Garry Charlesworth Penny Brooks Dr Eric Kelly Dr Ben Jackson Lisa Simonite

Programme Director Primary Care, Sheffield CCG KC Chief of Partnerships and Primary Care & CO Senior Primary Care Manager, NHS England Senior Primary Care Manager, NHS England GC Chief Nurse, Sheffield CCG PB Clinical Lead, Bassetlaw CCG EK Health Education England BJ Support Officer, GPFV Transformation Team LS

In attendance Name

Louise Berwick

Role

Project Manager, Health Education England

Initials

LB

Andrea Fitzgerald

Senior Programme Manager, Sheffield City Region AF

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Item Title Action 1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting.

Apologies received from Katrina Cleary, Carolyn Ogle, Garry Charlesworth, Penny Brooks, Dr Eric Kelly, Dr Ben Jackson and Lisa Simonite.

It was noted that a representative from the South Yorkshire and Bassetlaw LMCs was not present at the meeting.

ACTION: Ensure LMC representative is confirmed and invited to future meetings.

Kate Woods

2. Review of Minutes and Actions from 3 August 2017

The minutes of the previous meeting were agreed as an accurate record. It was noted that there were a number of updates required to the Action Log.

ACTION: Action Log to be updated.

In particular it was noted that funding will be available through the ACS Transformation

Funds. MR and TM were at a meeting yesterday (5th September) where it was confirmed that the ACS has received is Transformation Funds allocation. However, work is ongoing to identify the funding available specifically for the development of Primary Care.

ACTION: Continue to analyse the ACS Transformation Funds allocation, to identify the funding available for Primary Care Development.

MR and KCu have undertaken some work in preparation for the additional funding to support Primary Care Networks. KCu explained that at a regional meeting this morning, it was confirmed that currently this funding remains within the national budget and will be made available to Primary Care Networks. KCu also noted the requirement that by 2021, 18% of ACS Transformation Funds is to be spent on Primary Care.

MR informed the group that she has asked NAPC to attend a future meeting to share lessons learnt from the Primary Care Home Programme and next steps.

JT informed the group that the ACS Estates Group now has representation from each CCG.

VL

MR, KCu and LN

3. International Recruitment JH presented an update to the group about how the programme is being expanded and explained that further guidance is expected shortly. It was noted that if a bid is put forward, it will need to focus on the areas of need within the ACS area, including the specific requirements of the individual practices and the support arrangements. It is understood that the funding for each individual recruitment will be between £26,000 and £36,000. The South Yorkshire and Bassetlaw Workforce Strategy identifies a need for an additional 112 GPs by 2020.

NA asked if there was any further clarity on the funding arrangements. KCu confirmed

3

that there is a national PMO in place and there needs to be agreement reached about the split of funding for the PMO team and the local resource. It was agreed that it would be helpful to learn from other areas who have successfully undertaken international recruitment.

ACTION: KCu to invite colleagues from Leicester to attend a future meeting of the group to share their lessons learnt from undertaking international recruitment.

AG noted that international recruitment may be useful to address current vacancies but further clarity is needed about how it aligns with the strategic plan to increase the overall workforce.

AGu and NA noted concerns about the long-term sustainability of this programme. MG noted that international recruitment had previously been undertaken in Barnsley but none of the GPs recruited remain in post.

JT noted that Rotherham CCG are keen to move forward with the new model of General Practice workforce, whereby there is a broader skill-mix.

VMR suggested that it would be useful to further explore the potential of the programme to enable an informed decision to be made about whether to submit a bid and that it may be a useful approach to address current gaps, whilst the new workforce model is developed and embedded.

KCu

4. GP Access KCu explained that discussions are ongoing with both regional and national colleagues within NHS England. The requirements for access during core hours and for the Extended Access service are clear. However, further clarity is required around the link between the access arrangements during core hours and the eligibility of practices to provide the Extended Hours DES.

KCu is awaiting a response from colleagues within the regional NHS England team, following further discussions today and queries raised about how the approach outlined by the national NHS England team aligns with the development of Primary Care Networks.

ACTION: KCu to confirm to MR once a response is received from the regional NHS England team.

KCu

5. Workforce Strategy

LB presented a progress report to the group about the work of the South Yorkshire and Bassetlaw Primary Care Workforce Group (SYBPCWG) and a proposal for investment to transform the Primary Care workforce.

MR explained that she will be joining the SYBPCWG, chaired by Ben Jackson.

NA asked if the ACS has funding available to resource the investment proposal and TM confirmed that the ACS had not identified funding for this.

KCu noted that the workforce numbers included in the proposal are based on the current model and that there is a need to understand the requirements of the new model. LB suggested that investment is required to train and build capacity, to enable the availability of a workforce to fulfil the new model requirements.

4

KCu also noted the importance of ensuring that the workforce requirements of each ACS workstream are reflected in the workforce plan. TM explained that further clarity is needed as to how the SYBPCWG is being included within each ACS workstream.

MR noted the importance of ensuring GPs have input into the ACS Hospital Service Review and confirmed that an invite has been sent to each CCG to enable them to input.

TB highlighted the risks to delivery of the Clinical Pharmacists Plan, including whether there are Pharmacists available to take up these roles and how they will be trained to meet the requirements of the role.

It was agreed that clarity is required on the funding available to support the Workforce Plan. LN explained that the ACS Transformation Funding is committed for Years 1 and 2 but is yet to be committed for Years 3 and 4.

ACTION: MR to meet with Kevan Taylor and Mike Curtis to confirm how the ACS Workforce Group is linked to each of the other ACS workstreams.

MR

6. Sheffield City Region Health Led Employment Trial AF presented details of the trial to the group, which is due to commence in December and will run for two years. The trial is aimed at providing support for patients with mild to moderate mental health needs, both employed and unemployed. The aim is that there will be a number of referral routes to the trial, including the IAPT service.

The trial is due to be approved at the Medical Ethics Committee on 19th September. The procurement of the service provider is being led by Sheffield CCG and is currently at PQQ stage. AF confirmed that there will be a national evaluation of the service, which will determine next steps.

MR asked how General Practice can be engaged in the trial to ensure it is effective and requested clear information about how patients can be referred by their GP.

ACTION: AF to provide service details that can be sent on to GP Practices.

AG suggested that it would be useful to advise practices of a read code to be used for these referrals, to assist in the audit and evaluation of the service.

TB noted the importance of having clear service information, which doesn’t just refer to Sheffield City Region as this may result in a perception that it isn’t available to other areas and of the need to remove acronyms from any information for patients.

JH noted that there is a significant issue with an increasing number of requests for GPs to provide sicknotes in relation to mental health conditions. AF confirmed that a key element of the service relates to working with employers to enable them to support their employees.

NA suggested that the referral process should be as straight forward as possible and should mirror the self-referral process.

AF confirmed that the ‘control group’ within the trial will receive the current support service, rather than not receive a service.

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7. Primary Care Charter The group discussed the latest draft of the Primary Care Charter that had been circulated with the meeting papers. Feedback from the group was positive. It was agreed that each CCG representative(s) present would take the charter back into their respective CCGs for discussion and also to discuss areas where there are any gaps in information regarding plans or progress.

ACTION: CCG representative(s) provide feedback to KCu.

The group agreed that the Charter would remain a live document.

KCu proposed that sub-groups to this Board are established, which are structured around the key workstream areas of Development of Primary Care at Scale, Increasing the Primary Care Workforce, Building Resilient General Practice, Extending Access to Primary Care, Increasing Investment in Primary Care, Addressing the Wider Determinants of Health Prevention, Integrated Out of Hospital Services and Development of Wider Primary Care.

CCG repre(s)

8. Workstream Highlight Report KCu explained that the North Region NHS England Team had produced an STP PC Delivery Plan Template and that KCu had clarified with Region that SY&B would not be producing a separate plan using the template, but would incorporate the relevant narrative into the SYB ACS PC Charter and would also utilise the same templates for reporting progress including milestones and forward plans in each of the 6 areas included in the NHS England STP PC plan template.

It was agreed that the PC/Transformation Teams in NHS England would populate much of the templates/narrative going forward on behalf of the CCGs.

9. AOB There were no items.

10. DATE AND TIME OF NEXT MEETING Wednesday 11 October 2017, 10.30am – 12.30pm. Venue to be confirmed

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1

SY&B ACS Primary Care Steering Board

Meeting Action Log – 06 September 2017

Date Log No. Action Owner Due Date Status

27/04 1.5 Invite CHP to future meeting Maddy Ruff Outstanding

06/09 1.33 Action log to be updated Victoria Lindon 06/09 1.34 Ensure LMC representative is confirmed and invited to

future meetings. Kate Woods Before meeting on 11

October KW contacted Sheffield LMC with meeting dates. LMC agreed to send rep to mtgs.

06/09 1.35 Continue to analyse the ACS Transformation Funds allocation, to identify the funding available for Primary Care Development.

Karen Curran and Louise Nunn

Meeting arranged with NHS E finance colleagues, 11/10/17

06/09 1.36 Colleagues from Leicester to be invited to attend a future meeting of the group to share their lessons learnt from undertaking international recruitment.

D

RA

Karen Curran

FT

Future meeting – to be confirmed

To be arranged for December Board

06/09 1.37 KCu to confirm to MR once a response is received from the regional NHS England team to clarify the requirements for the access arrangements during core hours and the eligibility of practices to provide the Extended Hours DES.

Karen Curran

06/09 1.38 MR to meet with Kevan Taylor and Mike Curtis to confirm how the ACS Workforce Group is linked to each of the other ACS workstreams.

Maddy Ruff

06/09 1.39 AF to provide service details of the Health Led Employment Trial that can be sent on to GP Practices.

Andrea Fitzgerald Prior to commencement of the trial

06/09 1.40 CCG representative(s) to provide feedback on PC Charter to KCu.

CCG repre(s)

2

DRAFT

Meeting name Primary Care Commissioning Committee

Meeting date 9 November 2017

Title of paper

Update from the Primary Care Delivery Group –October 2017

Executive / Clinical Lead(s)

Anthony Fitzgerald, Chief of Strategy and Delivery

Author(s) Carolyn Ogle Associate Director of Primary Care


This paper summarises the discussions from the Primary Care Delivery Group’s meeting on 6 October 2017.

Recommendation(s)

Primary Care Commissioning Committee members are asked to:

• Note the report

Impact analysis

Quality Impact Quality report provided to Delivery Group each month

Equality impact

No equality issues


No sustainability issues


As stated in the paper

Legal implications

None

Management of Conflicts of

Interest

Conflicts of interest are recorded in the minutes

Consultation / Engagement


clinical, stakeholder &

public/patient)

The Delivery Group brings all internal depts. with an interest in

primary care together

Report Previously

Presented at

PCCC has previously had minutes from these meetings it has been decided to produce a report in future

Risk Analysis -

Assurance Framework

4.1, 4.2

Primary Care Commissioning Committee

9 November 2017

Update from the Primary Delivery Group – October 2017 Introduction The Primary Care Delivery Group minutes have routinely been circulated to the Primary Care Commissioning Committee. The last minutes were those from 1 September 2017. As the majority of the business is discussions around the work plan for the delivery group it was felt it would be more useful to do an update report to this meeting of the Committee.

Core Hours Access It has been agreed that the primary care team undertake a review of core hours provision in practices. Dean Eggitt had agreed to facilitate communications with practices by giving them a heads up at an appropriate time.

Extended Access It was reported that there would be a market engagement exercise which would help develop the service specification. The Strategy and Organisational Development Forum within the CCG will have a discussion on 2 November 2017 about the links between extended access and urgent treatment centres

Minor Eye Care Service The Group was reminded that funding had been made available through the care navigation programme to develop a minor eye care scheme which had been identified as a priority for active signposting. It was noted that there was a service in Doncaster already providing some of these services through the AQP GOS 18 triage service and it had just been agreed to extend this service. The Delivery Group agreed that further work needed to be done to not only align the service to care navigation by enabling self referral but also to look at secondary care activity so that any service development could directly impact on referrals to secondary care.

ACS Primary Care Charter The Group received the draft charter and were asked to submit any comments. The minutes of ACS Primary Care Steering Board meetings in June, July and August were also to be received.

Wider impact on primary care

The Delivery Group noted that task and finish groups had been set up around Gastrology, to review the referral process around irritable bowel syndrome and inflammatory bowel disease; and ENT where a business case is being developed for micro-suction

It was noted that in relation to Cancer there has been an expansion in the number of Colposcopies since the roll out of HCVP. The cancer alliance board is looking at the potential increase in local activity. Modelling is expected to be completed by the end of November 2017.

Work Plan Updates were provided on the development of local enhanced services and work around the thyroid register. An update was given around the Bentley Estates Planning Group which is working on an accommodation schedule which will need to go through Local Authority and CCG governance processes. There is an issue in the North with practices refusing patients in CAP beds and the practices involved are being reminded of their responsibilities. Feedback from locality meetings includes Consultant Connect, Care Home Strategy, Electronic Referral Service, Federation updates, Clinical Thresholds and Rapid Response.

Primary Care Commissioning Committee Public Meeting To be ... · the roll out of electronic referrals (e-RS) or GP2GP. The Committee fedback positively on the work completed by the

Documents