PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC SESSION

Transcription

1 PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC SESSION Thursday 21 December 2017, 10.30am 11.15am Robert Robinson Room, Scarsdale, Chesterfield, Derbyshire A G E N D A Item Enclosure Presenter Duration 1. Welcome, introductions, and apologies Verbal Gary Apsley 2. Declaration of Interests Primary Care Co-Commissioning Committee Members to declare interest in items on the Agenda To receive and note any changes to the Register of Primary Care Co-Commissioning Committee Members interests 3. Minutes from the Primary Care Co- Commissioning Committee of 30 November To Approve 4. Matters arising from the Primary Care Co- Commissioning Committee of 30 November Action Log Decision Log to note 5. The Grange Family Health Centre/Royal Primary Care Update Paper A Paper B Verbal Paper C Paper D Paper E Gary Apsley Gary Apsley Gary Apsley Hannah Belcher 6. Avenue House & Hasland Partnership Paper F David Knight Contractual Merger with Hasland Medical Centre 7. NHS England Annual Complaints Report Paper G Marie Scouse 8. Any Other Business Verbal All 9. Date, time and venue of the next meeting: Thursday 25 January 2018, in the Robert Robinson Room, Scarsdale, Chesterfield, Derbyshire at 10.30am Verbal Gary Apsley

2 Financial Interest Non Financial Professional Interest Non-Financial Personal Interest NHS NORTH DERBYSHIRE CCG REGISTER OF INTEREST DECEMBER 2017 Type of Interest Date of Interest Name Current Position(s) held in CCG i.e. Governing Body member, Committee member, Member Practice, CCG Employee or other Declared Interest (Including direct/ indirect Interest) Direct or Indirect Interest From To Action taken to mitigate risk Milton, Ben Chair Sessional (locum) GP in North Derbyshire CCG Practices P Direct Oct-16 On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Governing Body Member, Primary Care Co Commissioning Committee Former Partner at Darley Dale Medical Centre P Direct Oct-03 Sep-16 As above Darley Dale Surgery is a member of the Primary Care Research Finance and Performance Committee Member, Clinical Commissioning Committee Member Network and is funded to carry out research projects accordingly P Indirect Apr-13 On going As above Unpaid support to the Medical & Health Coaching Academy P Indirect Apr-13 On going As above Clayton, Chris Taylor, Vikki Derbyshire CCG Chief Executive Officer Governing Body Member, Audit Committee Member, Primary Care Co Commissioning Committee Member Finance and Performance Committee Member, Clinical Commissioning Committee Member Locality Director NHS England Spouse is a Director at PWC. No relevant interest No spouse with relevant interest Indirect 2001 On going As per conflicts of interest policy. Cawley, Michael Interim Chief Finance Officer Governing Body Member, Finance and Performance Committee Member, Audit Committee Member, Primary Care Co Commissioning Committee Member, Clinical Commissioning Committee Member No relevant interests May-17 On going Bainbridge, Louise Chief Finance Officer, Governing Body Member, Finance and Performance Committee Member, Audit Committee Member, Primary Care Co Commissioning Committee No relevant interests Nov-17 On going Member, Clinical Commissioning Committee Member Gibbard, Ian Audit Committee Chair No relevant interests Apr-13 On going Finance and Performance Committee Member No spouse with relevant interests Miller, Roger Local Authority Representative, Governing Body Assistant Director Derbyshire Adult Care Mar-16 On going No spouse with relevant interests Assistant Chief Finance Officer, Primary Care Co Green, Darran Commissioning Member No relevant interests Apr-13 On going No spouse with relevant interests

3 Stringfellow, Jayne Chief Nurse Officer Governing Body Member, Primary Care Co Commissioning Member Finance and Performance Committee Member, Clinical Commissioning Committee Member Partner Governor Chesterfield Royal Hospital Foundation Trust Interim Chief Nurse and Director of Quality for Southern Derbyshire CCG from 1 January 2017 Interim Chief Nurse and Director of Quality for Erewash CCG from 3 July 2017 P Direct Apr-13 On going No action required P Direct Jan-17 On going No action required P Direct Jul-17 On going No action required Rutter, Eleanor Braithwaite, Bruce Austin, Debbie Public Health Specialist Local Authority, Governing Body Member, Clinical Commissioning Committee Member Specialist Secondary Care Doctor Governing Body Member, Clinical Commissioning Committee Member Deputy Clinical Chair, Governing Body GP Primary Care Co Commissioning Committee Member, Clinical Commissioning Committee Member Spouse is an employee of Mansfield and Ashfield CCG P Indirect Jun-17 On going No action required Spouse is Trustee of Carers Trust East Midlands P Indirect Apr-12 On going No action required Interim Chief Nurse and Director of Quality for Hardwick CCG from 1 September 2017 P Direct Sep-17 On going No action required Consultant in Public Health Derbyshire County Council P Indirect Jan-17 On going No action required Director of Operations, Alliance Surgical PLC P Indirect Apr-13 On going No action required Director BD Braithwaite Ltd P Indirect Apr-13 On going No action required Director Veincare Ltd P Indirect Apr-13 On going No action required No spouse with relevant interests School Governor Taxal and Fernilee Primary School, Whaley Bridge P Indirect On going On going No action required Spouse is Employee of DCHS, Associate Director of Transformation P Indirect On going On going No action required Locum GP P Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Lay Member Patient and Public Involvement Governing Body Member, Chair Primary Care Co Commissioning No relevant interests Apr-13 On going Apsley, Gary Committee, Audit Committee Member Finance and Performance Committee Member No spouse with relevant interests Spooner, Anne-Marie Governing Body GP Member GP Partner at Hasland Medical Centre P Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Hasland Medical Centre is a member of the North Derbyshire Clinical Commissioning Committee member GP Federation. P Direct On going On going No action required Hasland Medical Centre is a member of the Chesterfield GP Federation. P Direct On going On going No action required No spouse with relevant interests Stone, Isabella Alla, Praveen Lay Member Patient and Public Involvement Governing Body Member, Deputy Chair Primary Care Co Commissioning Committee, Audit Committee Member, Finance and Performance Committee Member No relevant interests On going On going No spouse with relevant interests Governing Body GP Member, Finance & Performance Committee Member Clinical Commissioning Committee Member GP Partner at Welbeck Road Health Centre P Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair

4 Welbeck Road Health Centre is a member of the North Derbyshire GP Federation P Direct On going On going No action required Shearer, Carolin Primary Care Co Commissioning Member Board member of Healthwatch Derbyshire P Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Soultana, Lisa Primary Care Co Commissioning Member Alexin Healthcare Ltd Non-Executive Director P Direct On going On going No action required No spouse with relevant interests Lunn, Joe Primary Care Co Commissioning Member Scouse, Marie Assistant Chief Nurse Officer Primary Care No relevant interests Belcher, Hannah Head of Primary Care No relevant Interests No spouse with relevant interests Woods, Kerrie Primary Care Co Commissioning Member No relevant Interests No spouse with relevant interests Knight, David Primary Care Manager NHS England No relevant Interests No spouse with relevant interests Phillip, Tracey Primary Care Support Officer NHS England No relevant Interests No spouse with relevant interests Markus, Kath Primary Care Co Commissioning Member Chief Executive, DERBY and Derbyshire LMC GP Partner at Calow and Brimington Practice Harvey, Chris Member of the Clinical Commissioning Committee Locality Lead for High Peak GP Partner Stewart Medical Centre, Buxton Derbyshire OOH Sessional GP GP Appraiser Jordon, Louise Clinical Commissioning Committee Member GP Partner at Baslow Health Centre P Indirect On going No action required P Direct On going On going Aug-09 On going 2012 On going Dec-15 On going P Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Chair of the Dales Community Meeting Chair of the Board of Trustees for Helen's Trust P Indirect 2001 On going To be mindful of the conflict of interest Withdraw from all discussion and P Direct On going On going voting if organisation Is potential provider unless otherwise agreed by Butler, Richard Clinical Commissioning Committee Member GP Partner at The Valleys Medical Partnership the meeting chair The Valleys Medical Partnership is a member of the North P Derbyshire GP Federation Direct On going on going No action required Linfoot, Amanda Clinical Commissioning Committee Member Member of ND CCG Lay Reference Group P Direct May-16 On going No action required Street, Jocelyn Clinical Commissioning Committee Member Member of NDCCG Lay Reference Group ND CCG Clinical Commissioning Committee Member of DCHS Lessons Learned Committee Tideswell Surgery PRG Dales PLACE Group Cross Reference Group ND CCG Equalities Committee On going On going Twibey, Carl Head of Financial Management Chapel-en-le-Frith Parish Councillor Partner is employed by Derbyshire Community Health Care Services NHS Trust P On going On going P Indirect On going On going No action required

5 No relevant interest Pickering, Suzanne Head of Governance No spouse with relevant interest Clarey, Richard Member of Prescribing Sub Committee No relevant interests Richards, Jean Hardwick CCG employee, member of Prescribing Sub Group No relevant interests On going On going Gregory, Helen Medicines Management Technician No relevant interests On going On going Assistant Chief Quality Officer Medicines Management, Member of Senior Leadership Team NDCCG. Member of Director/ Secretary (10% Shareholder) of Hollowmoor P Indirect On going On going No action required Needham, Kate Prescribing Sub Committee Consultancy Ltd North, Maxine Lead Medicines Management Pharmacist Member of Prescribing Sub Group No relevant interests Parkin, Tim Dr Member of Prescribing Sub Committee P Direct On going On going Owner/Partner Blackwell Pharmacy, Gloves Lane, Blackwell Derbyshire. Partner Limes Medical Centre, Blackwell.Blackwell Medical Centre, Village Surgery (Pinxton & South Normanton) Member of Hardwick CCG, Prescribing Lead, Learning Disabilities Lead and Research Lead. P P Direct Direct On going Ongoing On going Ongoing Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Monck, Kelly Member of Prescribing Sub Committee No relevant interests On going On going Riches, Elizabeth Dr Member of Prescribing Sub Committee Partner of GP Practice at Chatsworth Road Medical Centre GP Partner NDCCG Chatsworth Road Medical Centre is a member of North Derbyshire GP Federation P P Direct Direct On going On going On going On going Shepherd, Martin Member of Prescribing Sub Committee No relevant interests Wooster, Lorraine Dr Member of Prescribing Sub Committee Partner to be at Stubley Medical Centre P Direct On going On going Stubley Medical Centre is s member of North Derbyshire GP P Federation Direct On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Emslie, Carolyn Dr Member of Prescribing Sub Committee Practice member of NDCCG Partner at Springs Health Centre, Clowne Springs Health Centre is part of North Derbyshire GP Federation P P Direct Direct On going On going On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Fitzsimons, Diane Dr Member of Prescribing Sub Committee Director of Darley Private Healthcare Partner at Darley Dale Medical Centre Darley Dale Medical Practice is a member of North Derbyshire GP Federation P P Direct Direct On going On going On going On going Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Shaw, Denise Medicines Management Technician No relevant interests On going On going Autherst, Adam Head of Planning and Performance, Member of Senior Leadership Team NDCCG No relevant interest No spouse with relevant interest On going On going Gillott, Aaron Assistant Chief Finance Officer, Member of Senior Leadership Team NDCCG No relevant interest no spouse with relevant interest On going On going Moore, Laura Assistant Chief Nurse and Quality Officer No relevant interest No spouse with relevant interest On going On going

6 Fleming, Isobel Service Director Countywide Commissioning Director of Child Outcomes Research Consortium (CORC). CORC is a not for profit organisation. The Director position is not paid. Member of National Group. NHS England Measuring Children and Young People s Mental Health Outcomes Group. Whitworth, Michael Interim Director for Contracting and Performance Owner and Director of Michael Whitworth Consultancy Development Limited Ennis, Adrian Turnaround Director No relevant interests Carter, Sarah Efficiency & Programme Director Bhatia, Upendra Clinical Commissioning Committee Member GP Partner at Newbold Surgery, Chesterfield P P P P Direct Direct Current Current On going On going Jul-16 On going Direct 2009 On going Should CORC tender for contracts any interests to be clearly declared and may result in Isobel Fleming withdrawing from involvement in the process. Should CORC tender for contracts any interests to be clearly declared and may result in Isobel Fleming withdrawing from involvement in the process. Withdraw from all discussion and voting if organisation Is potential provider unless otherwise agreed by the meeting chair Merriman, Louise Clinical Commissioning Committee Member GP Practice part of Chesterfield Health Provider Company P Direct 2009 On going No action required GP Consultancy advice P Direct 2016 On going No action required Withdraw from all discussion and GP P Direct On going On going voting if organisation Is potential provider unless otherwise agreed by the meeting chair Lead GP for Cancer On going On going Member of Pathology liaison group On going On going G2 locality lead GP On going On going

7 NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper B NORTH DERBYSHIRE CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE Robert Robinson Room, Scarsdale Thursday 30 November 2017 MINUTES Present Gary Apsley (Chair) Lay Member (Patient and Public Engagement) Isabella Stone Lay Member (Patient and Public Engagement) Ian Gibbard Lay Member (Audit) Ben Milton CCG Chair and Clinical Lead, GP Jayne Stringfellow Chief Nurse & Quality Officer Executive Lead for Primary Care Marie Scouse Assistant Chief Nurse Hannah Belcher Head of Primary Care Commissioning Debbie Austin GP (High Peak and Dales Locality) Carolin Shearer HealthWatch Representative Joe Lunn Head of Primary Care (North Midlands), NHS England David Knight GP Contract Manager, NHS England Kathryn Markus LMC Representative, GP Apologies Eleanor Rutter Public Health Consultant Louise Bainbridge Chief Finance Officer Minute- Taker Rosalind Combes PA to Director of Chief Nurse & Quality Officer Opening of Business PCC The Chair welcomed Primary Care Co-Commissioning Committee Members; introductions were not required. PCC Apologies for Absence Apologies for absence were received as noted. It was recognised that, in the absence of a second substantive executive, the Committee was not quorate. The CCG s governance lead Mrs Suzanne Pickering was consulted and it was confirmed that Mr Darran Green (Assistant Chief Finance Officer) could act as deputy for Ms Bainbridge should quoracy be required for decision-making purposes. NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 28 September 2017 Page 1 of 4

8 PCC NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper B Declaration of Interests It was noted in the interests of complete transparency that Dr Austin was working at Thornbrook Surgery under winter pressures funding. It was reported for the avoidance of doubt Dr Austin had been approached by the practice to undertake locum work. Dr Austin agreed to withdraw from discussions should it be deemed appropriate by the Chair, but no such need was foreseen as there was no conflict of interests against any item on the agenda. No further declarations were made. PCC Minutes of the Primary Care Co-Commissioning Committee meeting of 26 October 2017 The minutes were agreed as an accurate record of the meeting, and were signed by the Chair. PCC Matters Arising from the Primary Care Co-Commissioning Committee Meeting of 26 October/Action Log PCC SBS Report re Missing Patient Information The item did not appear in the action log as it had been included in the original meeting agenda; a late stage amendment to the agenda had resulted in its removal. Ms Lunn had obtained confirmation that 9 CCG practices were still to act. The Committee was asked to decide a way forward. The Committee was reminded that neither the CCG nor the local NHS England team had been involved in the matter and that it had been handled at national level. Consideration was given to deadlines for practices to claim compensation. Mrs Scouse confirmed that the matter would be addressed internally and LMC support requested if necessary. It was agreed that a report should be presented to the confidential session of the December Committee meeting. Mr Knight PCC Financial Update The item appeared on the main agenda but was addressed as a matter arising. A meeting had taken place with NHS England but some details remained outstanding; the matter would be addressed further in financial reports. The Decision Log was NOTED. PCC The Grange Family Health Centre/Royal Primary Care Update Lengthy discussion took place around the inclusion of the item in NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 28 September 2017 Page 2 of 4

9 NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper B the agenda. Post-meeting note: the Committee is reminded that a standing agenda item was created for this matter in August 2017 during discussion around the CQC report, in order both to ensure that the Committee remained sighted on issues concerning this practice and to provide assurance of the same to the public. It was noted that the matter was also to be addressed during confidential session. Post-meeting note: the Committee is reminded that it was agreed that discussions should take place in both sessions to facilitate the consideration of sensitive information in confidential session and retain the provision of assurance to the public in public session. It was confirmed that an update had been included in the Primary Care Quality and Performance Assurance Report. The Primary Care team had not met with the practice since the Committee meeting in October 2017, but an update would be provided to the next meeting. The Committee NOTED the update. PCC Feedback from Co-Commissioning Budget Discussions The item had been addressed as a matter arising. PCC Primary Care Co-Commissioning Quality And Performance Assurance Report Mrs Scouse presented the paper, which included a greater level of detail than previous iterations as per the Committee s request. Mrs Scouse advised that the report had been presented to the Primary Care Quality and Performance Review Committee, and the lay representatives had expressed concerns around the level of data and suggested that the paper did not feel public-facing. Ms Stone and Drs Austin and Milton concurred that the paper had been written for use by the Committee and that while it was available for public review, the public was not its target audience. It was noted that these considerations could apply to all papers presented to public sessions of all CCG Committee meetings, and the role of the Patient Experience team was recognised. Dr Milton noted a discrepancy between versions of the practice summary table contained in the public session report and the confidential session report relating to the CQC; Mrs Scouse agreed to correct the version contained in the public session report for the purposes of the CCG website. Mrs Scouse It was confirmed that the Committee was happy with the format for the report. The Committee was reminded that the Primary Care Co- NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 28 September 2017 Page 3 of 4

10 NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper B Commissioning Quality and Performance Assurance Report was a quarterly paper and would therefore next be presented in February Mrs Scouse advised that a county-wide format would be adopted in due course, after the development and implementation of new structures; it was not possible to estimate timelines. The Committee NOTED the report. PCC Any Other Business No further business was transacted. Date and time of next meeting: Thursday 21 December 2017 in the Robert Robinson Room, Scarsdale, Chesterfield, Derbyshire at 10.30am. Signed by:. (Chairman) Dated: NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 28 September 2017 Page 4 of 4

11 ACTION LOG MASTER Action Log (Public and Confidential sheets) Project Title: NDCCG Primary Care Co-Commissioning Committee - Public Session Action Log Closed issues are hidden Meeting Action Date PCC SBS Update - Missing Patient Information Report to be presented to Confidential Session in December PCC Primary Care Co-Commissioning Committee Quality and Performance Assurance Report Responsible Officer Target Date Completed Comments David Knight Item added to agenda for Confidential Session to take place on Marie Scouse An error had been noted in the Practice Summary table on the second page of the report; it was agreed that a corrected version should replace the incorrect version included in the papers uploaded to the CCG website.

12 Primary Care Co-Commissioning Committee - PUBLIC Session Items more than six months old are HIDDEN Decision Log Number Detail - refer to meeting minutes for full information Date Captured 1 Record decisions made. These will usually be in a Project Group, but depending on the project, may be decisions made in other settings Record date of decision (usually a meeting date) 12 NORTH DERBYSHIRE CCG PRIMARY CARE QUALITY AND PERFORMANCE REVIEW COMMITTEE ASSURANCE FRAMEWORK The framework was approved for use. 13 CLINICAL PEER REVIEW OF REFERRALS The Committee AGREED: To write to practices indicating that work on the scheme was suspended; To present a further paper in October; Not to roll the scheme out any further for the time being, and to accept any consequences from NHS England arising from this decision which practices were expected to support; To await the outcome of the LMC s discussions with NHS England during the first week of October; To seek NHS England s further guidance.

13 ND CCG Primary Care Co-Commissioning Committee December 2017 Paper E NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP PRIMARY CARE CO-COMMISSIONING COMMITTEE 21 st December 2017 Report Title: Purpose: Royal Primary Update to Primary Care Co Item No: 5 Commissioning Committee. The purpose of this report is to provide Primary Care Co Commissioning Committee (PCCCC) members with an update on: Progress against the CQC action plan developed in response to areas of concern highlighted within the CQC report published on the 10 th August Provide a general update as contained within the CRHFT Executive Summary and Briefing paper submitted to the Board of Directors on the 27 th November Objective: To provide assurance to Primary Care Co Commissioning Committee members that North Derbyshire Clinical Commissioning Group (NDCCG) Is fulfilling its responsibility under delegated authority to monitor and support primary care quality and performance. 1. Background and context Chesterfield Royal Hospital NHS Foundation Trust signed the contract with NHS England and NHS North Derbyshire Clinical Commissioning Group to be fully accountable for the delivery of the Alternative Provider of Medical Services contract for Royal Primary Care on the 17 th July The Care Quality Commission (CQC) carried out an announced comprehensive inspection at The Grange Family Health Centre on 24 May This was the first inspection of Royal Primary Care at this location as the new provider of this service. The Care Quality Commission Quality Report was published on the 10 th of August Overall Rating for the service Inadequate Domain Are services safe? Are services effective? Are services caring? Are services responsive to people s needs? Are services well-led? Rating Inadequate Inadequate Requires Improvement Inadequate Requires Improvement On the basis of the ratings highlighted above the practice has been placed into special measures. This will be for a period of six months. CQC will inspect the practice again in six months (follow up visit planned for January 2018) to consider whether sufficient improvements have been made. If CQC find that the provider has not made adequate improvements at this visit, the CQC can cancel its registration which would result in an alternative provider needing to be found. The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 1

14 ND CCG Primary Care Co-Commissioning Committee December 2017 Paper E 2. Key matters for consideration Progress against CQC action plan Royal Primary Care has submitted a detailed action plan and timescales for completion of actions to the Care Quality Commission. The Quality Team are meeting with Royal Primary Care Senior Leadership Team monthly to review the action plan and gain assurance as to progress towards achievement of actions outlined. The attached CRH Summary and Briefing paper contains a Royal Primary Care CQC Assurance Update to the CRH Board of Directors. The majority of actions are now complete and throughout November and December assurance testing is taking place. The three outstanding actions will be implemented by the end of December in readiness for the inspection date. Outstanding actions include: Policy/ Process for Serious Event Audits, review of NICE guidance, process for clinical audit and review of decision making process. High Staff turnover and vacancies Staff turnover remains high % in November with an annual rolling turnover rate of 51.5%. There has been an increase in turnover following the CQC inspection and publication of report and rating. Recruitment via NHS jobs proved unsuccessful for primary care where recruitment historically has been through word of mouth. The recruitment and retention plan was therefore amended and an advert via social media was made, we also asked staff to reach out to suitable contacts. As a result approx 70 people attended the open day on October 17 where all but 3wte receptionist s posts were recruited to. Financial pressures The main cause of the overspend is locum GP spend, which is 540k above budget YTD due to the current number of GP vacancies, with substantive GP staff underspent by 165k. GP recruitment is on-going but in the short term locum expenditure continues to increase. Reducing Patient List Size Since May 2015, 1880 patients have left RPC1. Data suggests that the net loss is about 90 patients on average per month. The majority of patients have left The Grange Surgery with 72% of the total being allocated to this site. No patients have left Inkersall surgery and 28% have left Rectory Road. Patient experience information (The Family and Friend Test) indicates that patients seem satisfied with the Grange, However the Grange is situated in an area where patients have more choice of GP practices and as such move between them when not satisfied. Each patient on the list equates to approx. 120 therefore the income lost over the time period is 225,600 or averaging 10k per month. To reduce the flow of patients leaving the practice the communication plan will focus heavily on advising patients of improved performance. Phone System and Responsiveness The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 2

15 ND CCG Primary Care Co-Commissioning Committee December 2017 Paper E Royal Primary Care telephony technical issues have been resolved and any problems encountered recently have been resolved promptly. The telephone reports for RPC over the last three months have proven reliable and data has been analysed. 48% of all calls were picked up, with a number being lost due to patients putting the phone down before the handler could get to the call. Of those calls picked up 99% are picked up within 30 minutes and 90% within 20 minutes. Further analysis of the data has been requested to understand how long callers wait before putting the phone down. The CCG has contacted the practice on a number of occasions over the past month to review the time taken to pick up a call, length of time to speak to someone has varied from 2.58 minutes to 27 minutes. A recent capacity and demand study, based on the reports available, demonstrated that 9 call handlers were required in the morning and 7 in the afternoon. RPC currently have 20 trained staff and a further six new recruits being trained in the next 4 weeks to boost the numbers available to take calls. The most recent patient survey (July-Aug 17) indicates that 85% of the 65 patients indicated that access via the phone system was difficult. A number of comments received relate to it being easier to go in person for example - "I sometimes go in person to avoid despair trying to book by phone". A further study of those attending in person is being undertaken in December to understand if contact via telephone had been made prior to visiting the practice and why they had opted to attend in person. 3. Financial Impact and Analysis of risk On the basis of the ratings highlighted in section 2 the practice has been placed into special measures. This will be for a period of six months. CQC will inspect the practice again in six months to consider whether sufficient improvements have been made. If CQC find that the provider has not made adequate improvements, the CQC can cancel its registration which would result in an alternative provider needing to be found. 4. Equality Impact The Clinical Commissioning Group has a statutory obligation to support the quality of services delivered through Primary Care. 5. Recommendations The Primary Care Co Commissioning Committee is asked to: Author: Sponsor: Receive this update report as to progress against action plan and general update. Date: 11/12/2017 Judy Derricott Head of Primary Care Quality Marie Scouse Assistant Chief Nurse Primary care The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 3

16 CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST BOARD OF DIRECTORS 27 November 2017 EXECUTIVE SUMMARY AND BRIEFING PAPER Agenda item: Royal Primary Care Update Board lead(s): Tony Campbell, Chief Operating Officer Reason for the item The purpose of this paper is to provide the Board with insight into the performance of Royal Primary Care and progress against the transformational and CQC plan. Briefing on the item - RPC remains challenged in a number of key areas including high staff turnover. The risk of staff leaving the practice following the publication of a rating of inadequate was described as a risk on the risk register. We anticipate turnover to reduce after December as new starters settle in and the preparation for CQC settles. - The high staff turnover has directly impacted upon some of the operational functions such as call handling, management of referrals, workflow and subsequent tasks and daily monitoring and juggling of resources is ensuring that no backlogs are created. However, additional resources are being utilised whilst new staff are training and the skill sets can be increased to a normal level. This is anticipated to be in place by the end of January The financial position is as predicted for month 7, with locum spend being the highest expenditure. The establishment and competitive pay rates have been calculated and are awaiting financial approval. - RPC1 CQC action plan is progressing, however additional support has been necessary to assess against all of the Fundamental Standards and key lines of enquiry. The consideration of including RPC2 in the inspection has increased the workload and pressure to those co-ordinating but plans are being put in place to maximise effort and streamline. - The transformation plan which was presented to the Board last month has now been presented to staff at the last QUEST. Although each work stream is not particularly difficult the number of them added to the operational pressures and CQC preparation is daunting and regular internal communications are being developed to keep staff focused and motivated. The management team are being kept on track by daily operational teleconference calls, and through the internal meeting structure. Recommendation: The Board are asked to receive the update, and consider progress against the action plans. RPC Update Report update November 2017 Page 1 of 22

17 Related strategic outcome(s): 1: To be rated as outstanding by the CQC 2: To have a solid foundation of core acute services meeting all national standards 3: To have effective partnerships locally through more integrated care and regionally through networked clinical service models 4: To be in the top 20% of all NHS employers for staff experience as measured by the national staff survey and our own Your Voice survey 5: To have from NHS Improvement a financial sustainability risk rating of 4 and a green governance rating, and to be deemed well-led by NHS Improvement 6: To be in the top 20% of NHS providers for PLACE scores and to reduce CO 2 emissions from 11,298 tonnes to 10,634 tonnes (2% per year); to have an IM&T capability that is fit for purpose for 2018 and beyond Board Assurance Framework (BAF) risks relating to this item: BAF 1.1 Other risks relating to this item: Risk 2227 (rating 16) Financial impact: None Equality impact: None Environmental impact: None Partnership working: NA RPC Update Report update November 2017 Page 2 of 22

18 Royal Primary Care -Update Report 14 November Background This paper provides a general update on the performance of Royal Primary Care including progress against the Transformation plan and the CQC actions and readiness. 2. Key Challenges There are currently four key challenges that the Board should be aware of and be assured that remedial actions are being taken. a) High Staff turnover and vacancies Staff turnover for both practices remains high with RPC1 being 7.14% this month with an annual rolling turnover rate of 51.5%. There has been an increase in turnover following the CQC inspection and publication of report and rating. In November we received a further three resignations with staff leaving before the end of January RPC 2 staff turnover rate is normally low but saw an increase last month with four staff leaving the practice (annual turnover rate of 12%). These posts have been recruited to and training underway. The combined impact of staff leaving has resulted in some organisation memory loss and a reduction in skill sets. However, during the recruitment drive a few highly experienced people were interviewed and secured. A competitive salary was required to secure these people and as the transition from current structure to future structure takes place they will fit in to the establishment and budget. RPC Update Report update November 2017 Page 3 of 22

19 Gaps in establishment occurred between Sept and October with 13 wte receptionist vacancies and 2.6 nursing. This has placed additional pressure on the remaining staff resulting in low morale. The significant gap in establishment was due to unsuccessful recruitment, and recruitment checks taking longer than the short notice period. It became evident that some of the older contracts retained original notice periods rather than those described in the newer ones. A review of all old contracts will be undertaken to align notice periods to prevent similar situations occurring. Recruitment via NHS jobs proved unsuccessful for primary care where recruitment historically has been through word of mouth. The recruitment and retention plan was therefore amended and an advert via social media was made, we also asked staff to reach out to suitable contacts. As a result approx 70 people attended the open day in October 17 where all but 3wte receptionist s posts were recruited to. The new recruits have been brought in quickly with support from HR. An induction and training programme has been developed with identified trainers for staff new to primary care. Key Actions Underway Review all contracts to align notice periods before the end of January 18 Get approved the new structure and competitive pay scales and implement Implement Induction policy and new induction programmes before December 17 Implement new appraisal process which aims at better supporting staff before the end of Jan 18 b) Financial position behind plan The financial position for the Division at the end of October 17 is 418k behind plan. The expenditure budget is overspent by 450k with an over-recovery on income of 32k. RPC1 YTD Apr 17 - Oct 17 Budget Budget Actual Variance FY YTD YTD (Fav)/Adv '000 '000 '000 '000 Income (3,814) (2,225) (2,279) -54 Expenditure 3,814 2,225 2, Net I&E Position RPC2 Income (1,628) (950) (927) 22 Expenditure 1, , Net I&E Position RPC Total I&E Position Work around the forecast is ongoing, taking into account some of the pressures around admin team and ongoing locum expenditure the forecast position is expected to be 650k- 700k behind plan at year end. For RPC1 the over-recovery on income relates to the main contract income being higher than planned, this is a result of an increased rate per patient and other ad hoc income adjustments. Income levels could have been significantly higher but for the reduction in registered patients which has now stabilised. Additional funding is available within primary care e.g. out of hours provision but further work is required to assess any associated cost implications. RPC Update Report update November 2017 Page 4 of 22

20 The main cause of the overspend is locum GP spend, which is 540k above budget YTD due to the current number of GP vacancies, with substantive GP staff underspent by 165k. GP recruitment is ongoing but in the short term locum expenditure continues to increase. For RPC2 the current position is slightly behind plan; there are a number of enhanced service claims outstanding which are currently being resolved which should improve the position in month 8. Expenditure is currently 70k overspent which relates to premiums paid on locum expenditure, there are also some non-recurrent costs associated with the ALO implementation included within the position. Key Actions Underway Finalise proposed clinical workforce model and implement to reduce premium locum costs. Review of all income opportunities and develop a proposed action plan. Stop loss of patient population and encourage new registrations. Review opportunities for economies of scale through closer primary/secondary care working. c) Reducing Patient List Size at RPC1 Since May 2015, 1880 patients have left RPC1. Data suggests that the net loss is about 90 patients on average per month. The graph below highlights that the majority of patients have left The Grange Surgery with 72% of the total being allocated to this site. No patients have left Inkersall surgery and 28% have left Rectory Road. Patient experience information (The Family and Friend Test) indicates that patients seem satisfied with the Grange, However the Grange is situated in an area where patients have more choice of GP practices and as such move between them when not satisfied. Each patient on the list equates to approx. 120 therefore the income lost over the time period is 225,600 or averaging 10k per month. To reduce the flow of patients leaving the practice the communication plan will focus heavily on advising patients of the improved performance. RPC Update Report update November 2017 Page 5 of 22

21 A campaign to attract new patients to our practices is being thought through with particular focus on the Chesterfield area where we know that a new developed is being built. RPC2 list size is stable at approx. 10,500 registered patients. Key Actions Underway A patient and Public Communications strategy has been developed and material id being created maximising the Trusts social media profiles. d) Phone System and Responsiveness As reported previously RPC1 telephony technical issues have been resolved and any problems encountered recently have been resolved promptly. RPC2 phone system, although mainly reliable did go down for 2 consecutive days in November. The Business Continuity plan was enacted. The telephone reports for RPC1 over the last three months have proven reliable and we have been able to analyse the data. 48% of all calls were picked up, with a number being lost due to patients putting the phone down before the handler could get to the call. Of those calls picked up 99% are picked up within 30 minutes and 90% within 20 minutes. Further analysis of the data has been requested to understand how long callers wait before putting the phone down. Last 21 Days Data (Oct - Nov 2017) Calls received Calls Answered % In 30 Mins % The most recent patient survey (July-Aug 17) indicates that 85% of the 65 patients indicated that access via the phone system was difficult. A number of comments received relate to it being easier to go in person for example - "I sometimes go in person to avoid despair trying to book by phone". A further study of those attending in person is being undertaken in December to understand if contact via telephone had been made prior to visiting the practice and why they had opted to attend in person. The North Derbyshire CCG have been undertaking mystery shopper calls and have reported a general improvement in call responsiveness ranging from seconds to 20 minutes wait. A recent capacity and demand study, based on the reports available, demonstrated that 9 call handlers were required in the morning and 7 in the afternoon. We currently have 20 trained staff and a further six new recruits being trained in the next 4 weeks to boost the numbers available to take calls Key Actions Underway Train all new staff in call handling over next 6 weeks Increase the number of call handlers on the rota each two weeks Receive and analyse report regarding lost calls Patient Communication to include recent completed actions 3. Transformational Plan The transformational plan has been updated since reporting at the previous Board meeting (see appendix 1) RPC Update Report update November 2017 Page 6 of 22

22 There are four actions where slippage has occurred and six of the seven actions due for completion this month have been finalised. Action 7 Good progress has been made in reducing the burden for GPs around workflow management (Documents), there is currently no back log to report. The risk has been reduced on the Risk register. Action 8 The Job Description and expression of interest has been developed and will be sent out shortly. Action 16 the escalation SOP has been delayed due to consideration and alignment of RPC2. This will be in place by the end of December 17. Action 23 the patient survey has been sent out and returned for RPC1 and results shared with the PPG. The patient survey for RPC2 has been sent out and we await the returns. This will be complete by mid-january Completed actions Action 11 Recruitment has taken place and all staff recruited will be in post by the end of December 17. Action 24 a schedule of monthly assurance meetings has been arranged. Action 34 The vision, values and behaviours for RPC has been drafted and shared with all staff at the November QUEST Action 35 The Communications advisor is now in post and beginning to develop some of the material required. The intention is to actively promote the work and the achievements of RPC staff and services across a range of channels including social media, on-line magazines, local media and national trades Action 49 Monthly meetings with the CCG have been taking place and are scheduled into the New Year. The Transformation plan is monitored at the Performance and Quality Board (PQB). 4. CQC Action Plan Actions are being tracked locally through RPC PQB which then reports into the Trust s Quality and Delivery Group. The updated action plan can be found as appendix 2. The majority of actions are now complete and throughout November and December assurance testing is taking place. The Head of Quality Governance is assisting in this task and providing feedback on additional evidence required. The outstanding actions will be implemented by the end of December in readiness for the inspection date. A CQC task group has been established to ensure that all fundamental standards are being adhered too and a gap analysis over both practices is being completed with required actions being developed and evidence collated. The group meet weekly and the intention is to progress actions promptly. The newly launched Keyline of Enquiry (November 17) are being reviewed to assess the implications of changes and these will be built into the gap analysis and action plan. The General Manager and communications lead are developing a suite of information sheets for staff outlining the key areas of focus within each of the five domains. This material will assist in their deeper understanding, how they might respond to some of the questions asked and where to direct inspectors if they are unable to answer any questions. The relationship meetings continue with the CQC lead and updates are being provided to the Director of Nursing. RPC Update Report update November 2017 Page 7 of 22

23 6. Conclusion RPC remains challenged on a number of key areas including high staff turnover. The risk of staff leaving the practice following the publication of a rating of inadequate was described as a risk on the risk register. We anticipate turnover to reduce after December as new starters settle in and the preparation for CQC settles. The high staff turnover has directly impacted upon operational functions such as call handling, management of referrals, workflow and subsequent tasks and daily monitoring and juggling of resources is ensuring that no backlogs are created. However, additional resources are being utilised whilst new staff are training and the skill sets can be increased to a normal level. This is anticipated to be in place by the end of January The financial position is as predicted for month 7, with locum spend being the highest expenditure. The establishment and competitive pay rates have been calculated and are awaiting financial approval. RPC1 CQC action plan is progressing, however additional support has been necessary to assess against all of the Fundamental Standards and key lines of enquiry. The consideration of including RPC2 in the inspection has increased the workload and pressure to those coordinating but plans are being put in place to maximise effort and streamline. The transformation plan which was presented to the Board last month has now been presented to staff at the last QUEST. Although each work stream is not particularly difficult the number of them added to the operational pressures and CQC preparation is daunting and regular internal communications are being developed to kept staff focused and motivated. The management team are being kept on track by daily operational teleconference calls, and through the internal meeting structure. 7. Recommendation The Board are asked to receive the update, and consider progress against the action plans. Mrs Joanne Lacey, General Manager (RPC) RPC Update Report update November 2017 Page 8 of 22

24 Provide High Quality, safe, person centred care Support and Develop our staff Deliver sustainable, High performing services Objective Target Month Completed Overdue On plan ROYAL PRIMARY CARE TRANSFORMATION PLAN 2017/18 Themes May-17 June July Aug Sept Oct Nov Dec Jan-18 Feb Mar Monitoring Operational 1Resolve telephony technical issues IPR 2Develop staff rota to cover all duties (including Phones)ODG 3Discharge PPM - Safe Environment - water / fire / securitynew target Risk Register Improve Recall system - QOF IPR 90% Medicine review complete IPR Enact delapidation repair programme Risk Register 7Track and maintain control of work flow managament IPR Workforce 8Appoint Divisional Director (agreed / in place)jd Advert Recruit Induct Assurance 9Agree establishment for all staff groupsvp Yes Assurance Appoint deputy Practice Manager x2 Advert Recruit Induct Assurance Recruit to Admin vacancy (13wte) NHS Jobs Open day Induct Risk Register Recruit to GP vacancy (2.5 wte) Risk Register Recruit to Lead nurse for RPC JD Induct Assurance Recruit to Nursing vacancy (2.2wte) Advert Recruit Induct Assurance Introduction of values based appraisals Intel Create consult Cascade Assurance Models of Care Develop a clinical alert process and esclation Develop SOP Consult Launch Assurance Undertake demand measurement throughout winter review IPR Review and adjust capacity/clinical input per site per population review plan Assurance Review clinical model review plan Assurance Identify frequent users of service and support with care plan List Contact Assurance Review use of Inkersall Surgery - introduce well being centre concept Plan Plan Consult Assurance Improve service / environment from patient feedback (survey) Survey Results Change Change IPR Introduce Patient Engagement (PPG) mini survey / PPG surgery Discuss Arrange IPR RPC Update Report update November 2017 Page 9 of 22

25 Manage Money wisely Build on existing partnerships and create new ones Support and develop our staff Provide and infrastructure to support delivery Governance Developed clear line of sight to CRH (Assurance meeting monthly) Prep Assurance Describe Governance system - Link with CRH system Assurance Define and describe the RPC aligned meeting structure Structure ToRef Consult Assurance Develop and monitor Performance Metrics (IPR) Define Consult Assurance Policy alignment for both practices Jul-18 Risk Register CQC readiness (actions discharged) Assurance Board Incorporate new CQC KLOE into readiness plan Launch Review Action Board IG Toolkit actions discharged and submitted Review Collate Collate Populate Populate Risk Register Review and refresh induction package for all staff groups PQB Define quality improvement programme (Audit / NICE / Alerts) Process Look back Look back Assurance Risk Register Leadership and Culture Define and share with staff vision, values and behaviours Intel develop launch Assurance Define and deliver 'I am team RPC' (whisper campaign) Assurance Introduce to Deputy Practice Manager and above - Leading the Chesterfield way Assurance Trimurivate Leadership programme (request) PQB Customer Service training (AND PARTNERSHIP) PQB Competency based training in place and recorded Assurance Launch and deliver Listening into Action (LiA) Assurance Define mandatory Training programme - 12 month plan IPR Introduce Fair Flexible working arrangements in place (Staff survey) Assurance Communication Develop internal communication procedure for staff PQB Re-introduce pool meeting, staff huddle to share comms PQB Communication person appointed Advert Recruit Induct PQB Develop Newsletter, website and TV screens Assurance Create RPC brand PQB Partnership working with federation e.g 8/8 Risk Register Contract meeting with CCG Assurance Strengthened relationship with LMC PQB Finance Review home visiting service and bring in house Assurance Review Physio service and link with CRH Assurance Develop more attractive GP package - loyalty bonus per year IPR RPC Update Report update November 2017 Page 10 of 22

26 CQC/ /001 Feedback Unique ref no Source Rec Action plan status Assurance status CQC ACTION PLAN Created / last Update: Green Amber Red Action achieved/on plan Not on plan, agreed recovery plan Off plan Full assurance found Partial assurance found No assurance found/not tested Recommendation Action Responsible person Start date Finish date (RAG rated) Progress Assurance SAFE DOMAIN RPC Update Report update November 2017 SAE policy / process needs strengthening Update Policy, include flow chart and report form Provide investigation training to key staff, including access to Human factors training. (clinical and non clinical) Formalise SAE meeting to ensure it is facilitated to capture learning General Manager General Manager SAE Chair Current Policy in place - user friendly version being drafted, additional input from Governance GP in Sept - To be reviewed at Dec Governance meeting and ratified at PQB. Trust RCA training shared with relevant people at RPC - 2 clinicians booked and the next session Ratification of Policy at Performance & Quality Board, Training Data, Feedback that investigations are of a good standard Quality Assurance Toolkit, Safety Workaround's - staff can describe last few SAE and outcomes. Page 11 of 22

27 CQC/ /003 Feedback CQC/ /002 Feedback Agree how and where a note is to be recorded on EMIS Safeguarding Lead Now added to the DNA template for staff 9/06/17 Quality Assurance Toolkit, Check of EMIS records Communicate to staff Business Services Officer (Assurance - run report) Ensure actions following safeguarding discussions are captured in patient records EMIS Add monitoring as standing agenda item at Safeguarding meeting Business Services Officer This meeting occurs monthly and has a standard agenda in which the monitoring of safeguarding notifications will be discussed. Create reports to monitor 'Did not bring' for child in records Scope the costing replacement of all bins to pedal bins, present to PQB Performance and Quality Manager Operational Service Manager Report compiled and being discussed at the Safeguarding meeting 67 per bin and require 13 The Grange, 8 each and Rectory Road and Inkersall = Bins in place IPC audits, Quality Assurance Toolkit Staff aware of who leads are Discharge actions from IPC audits Develop and implement safety walk around sheet, which includes removal of clutter and cleanliness check Re-evaluate use and frequency of each room to refresh cleaning schedules and renegotiate contract. Lead Nurse Operational Service Manager Template designed and approved at August Quality Meeting. Contract meeting arranged - New cleaning schedules in place. (IPC re-audit undertaken and actions to implement) Schedule quarterly meeting with cleaning company and ensure minuted General Manager RPC Update Report update November 2017 Page 12 of 22

28 CQC/ /005 Feedback CQC/ /004 Feedback Create and Circulate to staff laminated poster identifying IPC lead and link nurses including contact details Business Services Manager Poster designed and going to all sites - week ending 23/06 Quote for replacement of carpets are Rectory Road Operational Service Manager Quote completed - CCG approved, awaiting funds to be received. Work to be scheduled Dec/Jan Liaise with CCG regarding contribution towards replacement Provide interim risk analysis to CQC and copy in the folder General Manager General Manager CCG agreed at contract meeting to pay for as part of refurbishment of Rectory Road and conversion of upstairs admin rooms into clinical Monitoring at Water safety Meeting, Governance Meeting Ensure Water safety risk assessments are current Ensure MHRA alerts are robustly monitored and actioned Risk Assessment for each site to be completed Remedial work to be agreed by the Associate Director of Facilities and included in the Planned and Preventative Maintenance program Allocate officer responsible Operational Service Manager General Manager Primary Care Manager Risk assessments undertaken at all three sites - report received and actions being undertaken DCHS procured to undertake PPM and Immediate works required. Awaiting Contract This has been added to the responsibilities of the Business Service Officer Monitoring at PQB. Quality Assurance Toolkit. RPC Update Report update November 2017 Page 13 of 22

29 CQC/ /010 Feedback Undertake look back of alerts over last 6 months Performance and Quality Manager alerts identified and search run / actions undertaken. To be discussed are Prescribing Committee (Assurance test scheduled November 2017) Develop tracking sheet and associated SOP Business service Officer Tracking sheet developed, SOP ratified on 23 Aug Governance Meeting (to include both practices) Ensure standing agenda item on Clinical Meeting (prescribing Committee) Business Service Officer From Sept two meeting per month are scheduled to ensure reviews are taking place which will then feed into the Prescribing Committee. Ensure recall process for HbA1Cs is robust Identify key leads for reviewing and actioining alert recommendations Allocate responsible person within data team to create and run search on EMIS Business Services Officer This has been allocated to the Prescribing GP Lead who has been given leadership time to complete. Performance and Quality Manager patients to contact for recall Monitor at PQB, Dashboard (Assurance Test Nov 2017) Contact recall patients Performance and Quality Manager This is underway and being tracked. RPC Update Report update November 2017 Page 14 of 22

30 CQC/ /012 Feedback Update SOP for LTC recall including escalation of key challenges at Operational Delivery Group (ODG) Performance and Quality Manager Recovery plan agreed and discussed at Sept PQB. Alignement of recalls and QOF being undertaken to reduce duplication of vists and DNA. Gradual change annual reviews to anniversary of birth dates. Consider introduction of nebuliser with 02 within the practice for life threatening situation Develop IPR - include recall data as part of Key performance metrics / dashboard Discuss issue at the next prescribing Committee to understand background and way forward. General Manager Lead Nurse Draft developed- final agreed at August PQB. (Assurance test Nov 2017) Review latest NICE Guidance Lead Nurse RPC Update Report update November 2017 Page 15 of 22

31 CQC/ /013 Feedback Contact CCG to understand current advice against NICE Guideline Lead Nurse Chaperone system is working effectively; the policy needs revising to reflect where to stand and record the chaperone was present Introduce Nebulisers as an Emergency Measure in accordance with guideline (develop simple flow chart for staff to follow) and communicate to all clinical staff. Review and update Policy Lead Nurse Introduced into practice - 19 June 2017 Clinical Lead Reviewed and amended - ratified at June PQB, feedback to staff at QUEST July Ratification of Policy at Governance Meeting RPC Update Report update November 2017 Page 16 of 22

32 CQC/ /006 Feedback CQC / /015 Feedback CQC/ /014 feedback Medicines Management good records on Intradoc with the process for internal distribution needing tightening and clearer documentation High Risk medications generally good process however needs greater control and checks on reporting process and task management Track and monitor distribution of medicines management and include as agenda item on prescribing agenda Performance and Quality Manager and Prescribing Lead System has been checked and the case identified by CQC was a lone issue. All other High risk meds tracked and no issue identified. This has been addressed with particular clinician. Leadership responsibility has been strengthened with allocated time to review prescribing given each week. Non-compliance oversight process to be created as a SOP to improve governance. Review of prescribing meeting minutes at Governance Committee. IPR metric under development (Peer review to schedule in Dec) Review project at PQB, staff feedback Staffing levels the work to recruit GPs and the workforce was recognised however GP numbers and their availability was having an impact on nurses having access to GPs, their working hours and ability to take adequate breaks Review and introduce an appraisal tool that supports staff Review agreed establishment to ensure that adequate ratio of GP / GPE is in place Adapt Trust tool for RPC General Manager / Clinical Lead WELL LED CCG working with Practice to assess required capacity / establishment / appointment ratio (Routine / urgent) and ability to provide clinical leadership. Information required has been worked up and being sent to CCG. Recruitment and Retention plan developed. Estalishment agreed on place. Patient Population under review to assess function of Inkersall with CCG HR adviser Trust tool in use as of June 2017 Monitoring at PQB via Key Performance Metrics RPC Update Report update November 2017 Page 17 of 22

33 CQC/ /007 Feedback understanding the vision and values Test tool Original tool amended to ensure it fits with RPC however Trust launched new tool and in use. HR Adviser New tool launched at Nov QUEST. NEW - Launch tool at QUEST along with vision and values and Pay award process HR adviser Complete and shared at QUEST Monitoring as part of IPR - 90% of staff appraised with new tool over the next 12 months Allocate responsible officer and clinical lead. Operational Service Manager EFFECTIVE Primary Care Manager Metric included in IPR and remaining at 90% This has been assigned responsibility of the Business Services Officer Monitor NICE compliance at PQB, Quality Assurance Toolkit. Ensure NICE Guidance is robustly monitored and actioned Review function of Data team and appoint to Data Lead post Develop tracking tool and associated SOP Performance and Quality Manager Performance and Quality Manager Position of data Officer has been agreed and vacancy control panel. To go out to recruitment, interviews scheduled end of July 17. NICE Policy agreed at August Governance Meeting - to be ratified at PQB. Governance Lead GP accountable (Test - review tracker at each Governance Meeting) Ensure EMIS queries developed to audit compliance Performance and Quality Manager Start process in AUG RPC Update Report update November 2017 Page 18 of 22

34 CQC/ /008 Feedback Ensure retrospective NICE guidance reviewed Governance Lead GP Governance GP is reviewing Provide feedback to lead GP to ensure actions and learning captured at clinical meeting - check process is working and report to PQB Performance and Quality Manager New Governance GP and ANP appointed in July. Position statement required for PQB Facilitate the development of 2017/18 clinical audit plan Performance and Quality Manager To be presented at August PQB - audit plan aligned to RPC2. Complete Discussed at PQB, formal plan and other practices plans have been obtained - to cross reference to ensure completeness. Ensure Clinical audit programme is develop and executed over 2017/18 Review function of Data team and appoint to Data Lead post Performance and Quality Manager Post approved at Vacancy Control - Individual appointed - likely start date is October 17. Data team relocated to RR, establishment review has identified another individual required. Vacancy review Ensure Clinical audit is an agenda item on the clinical meeting Performance and Quality Manager Added to rolling agenda - assurance check required NEW - Clinical audit Training required for nursing staff General Manager Session requested from Clinical Effeciveness Team Monitor Clinical Audits at PQB. Quality Assurance Toolkit RPC Update Report update November 2017 Page 19 of 22

35 CQC/ /009 Feedback NEW - project forms to be created to ensure clinical audit resources are appopriatley used and staff given time to undertake General Manager Forms designed and shared - for approval at clinical meeting Report required as part of performance update at PQB Understand the telephony configuration and initiate a group to look at improving Performance and Quality Manager To provide report December 2017 RESPONSIVE Primary Care Manager Discussed at June QUEST - mapping exercise undertaken to understand issues and capture staff solutions. Phone message amended to provide quicker decisions and clarity. Metrics agreed and monitored via IPR at PQB Ensure that telephony system is fit for purpose and access is improved. (listening into action) Telephony issues - drop call after 50 minutes, queue jumping, to be resolved with company General Manager Weekly meeting established with HBT, calls being drop cannot be changed from 50 minutes however calls should be answered before this time. Queue jumping has been resolved, new message for patients recorded as system has been reconfigured and simplified. Process map to redesign handling of calls - develop metrics to show improvement Report is now configured and accurate. Primary Care Manager Training for 6 super users has been delayed until new starters in place. RPC Update Report update November 2017 Page 20 of 22

36 CQC/ /011 Feedback Undertake a review of establishment Primary Care Manager Escalation process in place to prevent patients waiting more than 30 minutes in place. New staff in place and being trained currently. Capacity and demand work complete and indicates the number of call handlers required. Plan to increase number of call handlers with each batch of trainees deemed competent. Implement both plans and monitor calls / wait times / impact - feedback monthly at PQB Primary Care Manager Monitored on IPR Create document management tracker Identify additional support from within in team to remove back log Operational Services Officer This has been amended to a daily tracker General Manager Ensure Document Management is consistently up to date Establish a service Improvement plan to stream documents to reduce GP burden and manage documents Primary Care Manager Discussed at June QUEST - mapping exercise undertaken to understand issues and capture staff solutions. LiA - led by General Manager Review responsibilities of data team and train in coding Performance and Quality Manager Complete RPC Update Report update November 2017 Page 21 of 22

37 CQC / /016 Feedback Development of SOP Test then launch new way of working Primary Care Manager Primary Care Manager SOP to be finalised when remedial actions complete and process refined and finalised. Launched end of Sept. Nov updated - document management reduced, plan in place until end of Dec The signposting algorithm system with the reception staff is a good process suggesting RPC should take the opportunity to review the decision making process for clarity Undertake active signposting project to ensure that primary care team are utilised appropriately (high Impact Area) Primary Care Manager Mapping session undertaken, this is available on the clinical system on the F12 key. This needs adding to staff desktop as unable to access via key when in EMIS. Refresh SOP to ensure and clarify decision making process Primary Care Manager GP Resilience funding of 8K secured to develop staff training / competency and signposting. Training scheduled for December 2017 RPC Update Report update November 2017 Page 22 of 22

38 ND CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper F NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC SESSION 13 December 2017 Report Title: Item No: 6 Contractual merger of Avenue House and Hasland Partnership and Hasland Medical Centre Purpose: To inform the committee of the progress to date of the contractual merger between Avenue House and Hasland Partnership, and Hasland Medical Centre particularly regarding the engagement and stakeholder process. Objective: To ensure access and provision of sustainable and quality primary medical services. Confidentiality Information is in the public domain following extensive Rationale: patient engagement process 1. Background and context This paper is to inform the committee of the progress to date of the contractual merger between Avenue House and Hasland Partnership, and Hasland Medical Centre particularly regarding the engagement and stakeholder process. The Committee supported the practice s application to undertake a full contractual merger subject to them undertaking patient and stakeholder engagement. Furthermore, it was requested that the Committee be presented with evidence of this process prior to the merger being finally agreed by the Committee. A report was submitted to the Committee on 30 November 2017 which provided assurance and evidence that appropriate patient and stakeholder engagement has taken place with no significant concerns highlighted. Final approval for the practices to continue with the full contractual merger was therefore given at the Committee meeting. 2. Key matters for consideration The practice confirmed that there have been no significant concerns raised by either patients or staff and concerns raised were mainly regarding practicality and access which the practice has already considered as part of due process. As communicated previously, existing premises will be retained and both practices have submitted schemes under the Estates Transformation and Technology Fund to make improvements to their existing premises. The full contractual merger process will continue to be supported and monitored by both the CCG and NHS England s representatives. There have been no changes to the timeline for the merger of the two practices with 1 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours

39 ND CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper F the full contractual merger expected to be completed from 1 April 2017 A further report will be submitted to the committee following completion and 6 months after the full contractual merger. 3. Financial Impact IT/clinical systems; the practices have informed IT regarding the merger of clinical systems and there are no cost implications identified of the clinical merger from GEMCSU and TPP for review. Premises; the practices propose to retain existing premises and services and therefore there are no identified financial savings. Contract; both practices are on a PMS contract and therefore there are no contractual financial implications as each practice is reimbursed at the same price per weighted registered patient. There is no PMS premium for either practice. 4. Analysis of Risk There is no financial risk to the CCG as both practices are on a PMS contract which attracts the same price per weighted registered patient. Provisional discussions have taken place between the practices and the CCG regarding the clinical system merger. Confirmation will be required to ensure that the practices are working closely with GEMCSU and TPP to ensure that the effective date of the 1 April 2018 for the clinical merger is achieved. 5. Equality Impact Better health outcomes for all; to ensure the population benefits from an improved stability of service offer through a larger organisation Improved patient access and experience; patients will benefit from increased flexibility and appointments being available from both sites. Empowered, engaged and well-supported staff; North Derbyshire CCG to support staff to facilitate the successful implementation of the practice merger. Inclusive leadership at all levels; a combination of current employed managers and assistant manager at each site to form a new management team to develop shared management expertise. 6. Recommendations To note the progress to date of the full contractual merger between Avenue House and Hasland Partnership and Hasland Medical Centre. To note that a report will be presented to the Committee in October 2018, 6 months after completion of the merger updating the Committee on any issues, lessons learned or patient concerns following the merger. Author: Sponsor: Julia Wong, Senior Primary Care Support Officer, Primary Care Hub Hannah Belcher, Head of Primary Care Commissioning, North Derbyshire CCG Date: 12 December 2017 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 2

40 ND CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper G NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC SESSION December 2017 Report Title: Purpose: Objective: NHS England North Midlands, Complaints Annual Report 2016/17 Item No: 7 To provide an update to the Primary Care Co Commissioning Committee To update the Primary Care Co Commissioning Committee re: NHS England North Midlands Complaints Annual Report 2016/17 1. Background and context The NHS England North Midlands Complaints Team has responsibility for coordinating and responding to complaints in relation to NHS Primary Care Services; specifically those which relate to GP and Dental practices, Pharmacies and Optometrists. The team is also responsible for Health and Justice (H&J) Complaints regarding healthcare provision commissioned by NHS England in prisons. The report attached provides an overview of the complaint activity, performance, and themes for the NHS England North Midlands Complaints Team for 2016/17. The Customer Contact Centre is the central point of contact responsible for the receipt and coordination of NHS England complaints. All complaints are investigated in line with the NHS England Complaints Policy and the NHS England Quality Framework. During 2016/17 NHS England has focused on ensuring they deliver against our key performance indicators (KPI) whilst ensuring organisational consistency and a balance between timeliness and quality. 2. Key matters for consideration GP complaints continue to form the largest proportion of the complaint case load for the NHS England North Midlands team. This has to be taken into the context of the number of GP practices exceeds the other providers. The trends and themes are shared with the CCG s on a monthly basis therefore sharing findings throughout the year to inform the wider quality discussions. GP Complaint Activity NDCCG In 2016/17 there were 26 complaints raised for GP practices within North Derbyshire CCG, which accounts for 36% of the total of County Complaints. Of these 8 were upheld. 1 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours

41 ND CCG Primary Care Co-Commissioning Committee 21 December 2017 Paper G North Derbyshire CCG had one of the highest percentages of GP complaints upheld across North Midlands. It is important to highlight that there are a number of variables e.g. patient list size; therefore it is difficult to draw direct comparisons when considering the attached data. The common themes for complaints are, Unhappy with the quality of care, Appointment availability/length, Communications, Misdiagnosis, Prescription issues, Delay in treatment and Staff attitude and behaviour. In North Derbyshire CCG one surgery had three upheld complaints, two with a theme around access to appointments and the other around staff attitude and behaviour. The data for North Derbyshire has been aggregated and therefore not available at Practice Level. 3. Financial Impact Possible financial impact upon outcome of complaint process 4. Analysis of Risk Reputational risk 5. Equality Impact This report provides the Primary Care Co Commissioning Committee with an overview of the Complaints received by NHS England North Midlands Team. 6. Recommendations To receive the paper for information Author: Sponsor: Clair Wood Clinical Quality Facilitator Judy Derricott Head of Primary Care Quality Date: 4 th December 2017 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 2

42 OFFICIAL NHS England North Midlands Complaints Annual Report 2016/17 1

43 OFFICIAL 1.0 Introduction NHS England North Midlands Complaint Performance 2.1 Acknowledgement within 3 working days 2.2 Response within 40 working days 3.0 NHS England North Midlands Activity by Provider 3.1 GP Complaint Activity 3.2 Dental Complaint Activity 3.3 Pharmacy Complaint Activity 3.4 Health & Justice Complaint Activity 4.0 Themes 4.1 GP Themes 4.2 Dental Themes 4.3 Pharmacy Themes 4.4 Health & Justice Themes 4.5 Themes Summary Re-opened Complaints Parliamentary and Health Service Ombudsman (PHSO) Feedback 7.1 From Complainants 7.2 From CCGs and Providers Areas of Focus 2017/ Appendix

44 OFFICIAL 1.0 Introduction The NHS England North Midlands Complaints Team has responsibility for coordinating and responding to complaints in relation to NHS Primary Care Services; specifically those which relate to GP and Dental practices, Pharmacies and Optometrists. The team is also responsible for Health and Justice (H&J) Complaints regarding healthcare provision commissioned by NHS England in prisons. This report provides an overview of this work undertaken between 1 April 2016 and 31 March The Customer Contact Centre is the central point of contact responsible for the receipt and coordination of NHS England complaints. All complaints are investigated in line with the NHS England Complaints Policy and the NHS England Quality Framework. During 2016/17 NHS England has focused on ensuring we deliver against our key performance indicators (KPI) whilst ensuring organisational consistency and a balance between timeliness and quality. Going forward the national team is working in partnership with local advocacy providers and Healthwatch to review complaint handling across the country with a view to identify good practise and ensure continuous improvement. This report provides an overview of the complaint activity, performance, and themes for the NHS England North Midlands Complaints Team. Concerns, including those from local Members of Parliament, also make up part of the complaint team s workload, however for the purpose of this report are not included. 2.0 NHS England North Midlands Complaint Performance 2.1 Acknowledgement within 3 working days Table 1 demonstrates the monthly position in relation to the achievement of the 3 day acknowledgement. NHS England s key performance (KPI) indicator requires that that 100% of complaints are acknowledged within 3 working days from receipt. Table 1 Complaints ack 3 wkg days April May June July August September October November December January FYTD No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % Midlands and East % % % % % % % % % % 1,973 98% Derbyshire and Nottinghamshire % % 27 96% % 33 97% % 36 97% % % % % Shropshire and Staffordshire % % % % 23 96% 27 93% 13 87% % 16 94% % % North Midlands % % 49 98% % 56 97% 57 97% 49 94% % 40 98% % % Leicestershire and Lincolnshire % % 34 97% 29 97% % 26 87% 35 92% % 32 97% 28 93% % Hertfordshire and The South Midlan 10 77% % % 17 94% 19 95% % % % % % % Central Midlands 34 92% % 53 98% 46 96% 47 98% 46 92% 62 95% % 49 98% 45 96% % Arden % % % 8 100% % % 8 100% % % 7 88% % Birmingham 28 93% % % 40 98% % 41 93% 45 96% 45 98% % 29 94% % West Midlands 39 95% % % 48 98% % 58 95% 53 96% 62 98% % 36 92% % East Anglia 24 92% 24 96% 31 97% 27 96% % % % % % % % Essex 23 96% 27 93% % % % % % 35 97% % 23 96% % East 47 94% 51 94% 57 98% 58 98% % % % 62 98% % 46 98% % Across the year the team averaged acknowledgement of 99% of all complaints within 3 working days. 2.2 Response within 40 working days Table 2 demonstrates the monthly position in terms of achievement of the 40 day investigation response target. NHS England s KPI requires that 90% of all complaints are responded to within 40 working days. 3

45 OFFICIAL Table 2 Complaints res 40 wkg days April May June July August September October November December January February March FYTD No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % Midlands and East % % % % % % % % 91 54% % % % 1,553 66% Derbyshire and Nottinghamshire 16 76% 13 68% 24 86% 30 88% 30 88% 25 83% 32 86% 25 96% 17 71% 19 86% 18 90% 26 96% % Shropshire and Staffordshire 24 80% 13 65% 18 78% 17 77% 22 92% 27 93% 14 93% 22 96% 13 76% 18 90% % 17 89% % North Midlands 40 78% 26 67% 42 82% 47 84% 52 90% 52 88% 46 88% 47 96% 30 73% 37 88% 30 94% 43 93% % Leicestershire and Lincolnshire 23 96% 22 65% 17 49% 18 60% 11 41% 18 62% 14 37% 16 47% 15 45% 21 68% 15 48% 9 35% % Hertfordshire and The South Midla 5 38% 4 24% 9 47% 6 33% 5 25% 6 30% 10 37% 4 24% 5 28% 8 42% 7 35% 4 21% 73 32% Central Midlands 28 76% 26 51% 26 48% 24 50% 16 34% 24 49% 24 37% 20 39% 20 39% 29 58% 22 43% 13 29% % Arden 9 82% 9 90% 11 79% 4 50% 9 69% 12 71% 3 38% 3 18% 2 18% 6 75% 7 78% 10 83% 85 62% Birmingham 19 63% 29 81% 35 78% 31 76% 20 53% 26 59% 21 46% 14 30% 9 38% 19 61% 32 91% % % West Midlands 28 68% 38 83% 46 78% 35 71% 29 57% 38 62% 24 44% 17 27% 11 31% 25 64% 39 89% 39 95% % East Anglia 19 73% 20 80% 23 72% 19 68% 23 82% 19 68% 16 73% 19 70% 18 90% 16 70% 13 93% 10 67% % Essex 15 63% 22 76% 16 62% 22 71% 22 71% 12 57% 14 64% 25 69% 12 55% 21 88% 18 78% 6 38% % East 34 68% 42 78% 39 67% 41 69% 45 76% 31 63% 30 68% 44 70% 30 71% 37 79% 31 84% 16 52% % In relation to 2016/17 activity, overall there has been a 31% reduction in the number of formal complaints received by the team. Whilst the reasons for this reduction are uncertain the impact of increased informal resolution of concerns by the Customer Contact Centre is likely to have been significant. Achievement against the KPI of 90% during 2015/16 required improvement therefore local recovery and improvement plans was put in place. The North Midlands KPI Recovery Action Plan was established including set trajectories. A Complaint Improvement & Sustainability Plan was created (whereby team members were engaged in informing and monitoring process improvements). In addition Daily Situation Reports (Sit Reps) were introduced ensuring caseload and capacity oversight and appropriate resource distribution. During the year these improvement initiatives were successful and as illustrated in the above table, the North Midlands team is achieving the best performance in the Region, whilst receiving the greatest number of complaints. 84% of all complaints were responded to within 40 working days. 3.0 NHS England North Midlands Activity by Provider Group Table 3 details the numbers of complaints received for each of the provider groups. Currently Clinical Commissioning Groups (CCG) receives a monthly breakdown of open cases. Table 3 Provider GP Dental H&J Pharmacy Other No of Practices No of Complaints GP complaints continue to form the largest proportion of the complaint case load, however is the largest provider group; whereas Health & Justice have a high number of often more complex complaints in relation to their relatively low number of providers. 3.1 GP Complaint Activity Table 4 illustrates the GP complaints in CCG context, which gives a proportionate picture, particularly in relation to the percentage of the CCGs complaints which have been upheld. 4

46 OFFICIAL Table 4 CCG Breakdown No. of Practices per CCG No. GP Complaints Received % of total County Complaints No. Upheld % of GP Complaints Upheld per CCG Nottinghamshire & Derbyshire NHS Erewash % 0 0% NHS Hardwick % 1 33% NHS North Derbyshire % 8 31% NHS Southern Derbyshire % 7 18% Total Derbyshire % NHS Mansfield & Ashfield % 10 42% NHS Newark & Sherwood % 1 10% NHS Nottingham City % 13 22% NHS Nottingham North & East % 5 33% NHS Nottingham West % 1 10% NHS Rushcliffe % 2 20% Total Nottinghamshire % Staffordshire & Shropshire NHS Cannock Chase % 5 24% NHS East Staffs % 3 16% NHS North Staffordshire % 5 23% NHS SE Staffordshire % 2 13% NHS Stafford & Surrounds % 2 11% NHS Stoke on Trent % 12 18% Total Staffordshire % NHS Shropshire % 5 38% NHS Telford & Wrekin % 6 27% Total Shropshire % It is important to highlight that there are a number of variables e.g. patient list size; therefore it is difficult to draw direct comparisons when considering the data above. It is evident that Nottingham City CCG and Southern Derbyshire CCG both have the largest number of practices and the largest proportion of complaints and likewise in Staffordshire with Stoke on Trent CCG. However there is a notable difference in Shropshire & Telford and Wrekin where this is not a similar trend. Section 4 of this report will further consider the themes of complaints providing additional insights into the nature of the complaints being received. CCGs with the highest percentage of GP complaints upheld across the North Midlands include North Derbyshire, Mansfield & Ashfield, Nottingham North & East, and Shropshire CCGs. With regards to trends, in Mansfield & Ashfield one surgery had two upheld complaints with a similar theme inappropriate care; in North Derbyshire one surgery had three upheld complaints; two with a theme around access to appointments and the other around staff attitude and behaviour; and in Nottingham North and East one surgery had two upheld complaints; one around staff attitude and behaviour, the other around inappropriate care. In Shropshire one surgery had two upheld complaints; one around staff attitude and behaviour, the other around prescription issues. Trends and themes are shared with CCG s on a monthly basis therefore sharing findings throughout the year to inform the wider quality discussions. 5

47 OFFICIAL 3.2 Dental Complaint Activity Although the commissioning of dental services remains with NHS England, confirming dental complaints in their CCG context again gives a proportionate picture of patient experience. As above the percentage of those upheld is detailed. Table 5 details the dental complaints received. Table 5 CCG Breakdown No. of Practices per CCG No. Dental Complaints Received % of total County Complaints No. Upheld % of Dental Complaints Upheld per CCG Derbyshire & Nottinghamshire NHS Erewash 8 2 9% 0 0% NHS Hardwick 6 2 9% 0 0% NHS North Derbyshire % 0 0% NHS South Derbyshire % 5 45% NHS Mansfield & Ashfield % 2 67% Total Derbyshire % NHS Newark & Sherwood % 2 67% NHS Nottingham City % 5 36% NHS Nottingham North & East % 1 17% NHS Nottingham West % 0 0% NHS Rushcliffe % 1 50% Total Nottinghamshire % Staffordshire & Shropshire NHS Cannock Chase % 1 100% NHS East Staffs % 0 0% NHS North Staffordshire % 0 0% NHS SE Staffordshire % 1 50% NHS Stafford & Surrounds % 0 0% NHS Stoke on Trent % 2 22% Total Staffordshire % NHS Telford & Wrekin % 1 50% NHS Shropshire % 0 0% Total Shropshire 80 5 As previously mentioned, it is important to highlight that there are a number of variables therefore direct comparisons should not be drawn when considering the data above, in addition numbers of complaints are low in some cases. It is evident that the highest number of dental complaints was within Nottingham City and Southern Derbyshire CCGs, and in Stoke-on-Trent CCG had the greatest number in Staffordshire with complaints in Telford and Wrekin greatest in Shropshire. CCGs with the highest percentage of dental complaints upheld across the North Midlands include Southern Derbyshire, Nottingham City, and Stoke on Trent CCGs. With regards to trends, in Nottingham City one practice had two upheld complaints; one around inappropriate care and the other around delay in making a referral. Trends and themes are shared with primary care contracting teams on a regular basis therefore sharing findings throughout the year to inform the wider quality discussions. 6

48 OFFICIAL 3.3 Pharmacy Complaint Activity Table 6 details the pharmacy complaints received. Table 6 CCG Breakdown No. of Practices per CCG No. Pharmacy Complaints Received No. Upheld % of Pharmacy Complaints Upheld per CCG NHS Erewash % NHS Hardwick % NHS North Derbyshire % NHS South Derbyshire % NHS Mansfield & Ashfield % NHS Newark & Sherwood % NHS Nottingham City % NHS Nottingham North & East % NHS Nottingham West % NHS Rushcliffe % NHS Cannock Chase % NHS East Staffs % NHS North Staffordshire % NHS SE Staffordshire % NHS Stafford & Surrounds % NHS Stoke on Trent % NHS Shropshire % NHS Telford & Wrekin % Across the whole of the North Midlands a total of 20 complaints were received with no single CCG receiving more than three complaints. Pharmacies historically have received low complaint numbers through to the commissioners; local resolution and complaints procedures regularly address concerns at the point of occurrence. Contracting teams ensure that complaints procedures within the practices are aligned to NHS Complaints procedures including signposting to the Customer Contact Centre. 3.4 Health & Justice Complaint Activity NHS England North Midlands has responsibility for the investigation of healthcare complaints in a total of 28 health and justice establishments nationally. In relation to those establishments a total of 61 Health & Justice complaints were received and investigated through to resolution, 22 (36%) of which were upheld. The prisons with the highest number of complaints received are HMP Rye Hill (15), HMP Oakwood (10) and HMP Stafford and Stoke Health (5 each). Table 7 details the health & justice complaints received. Table 7 Provider No. Complaints No. Complaints Upheld HMP Rye Hill 15 4 HMP Oakwood 10 3 HMP Stafford 5 2 HMP Stoke Heath 5 0 HMP Dovegate 4 2 HMP Gartree 4 3 HMP IRC Morton Hall 3 0 HMP Birmingham 1 1 7

49 OFFICIAL HMP Drake Hall 1 0 HMP Featherstone 1 0 HMP Hewell 1 1 HMP Leicester 1 0 HMP Lincoln 1 1 HMP Long Lartin 1 1 HMP Lowdham Grange 1 0 HMP North Sea Camp 1 0 HMP Ranby 1 0 HMP Stocken 1 0 HMP Whatton 1 1 HMP YOI Werrington Themes In 2016/17 the codes used in the K041 data collection was amended, this altered the subjects and subsubjects by which complaints are themed. This has therefore made it challenging to draw informed comparisons. The top themes for all North Midland GPs and North Midland Dental complaints received in 2015/16 and 2016/17 are outlined below. Although the coding may have changed since last year the quality of care provided remains the most common theme for GP, Dental and Health and Justice Complaints. Complaint themes by CCG are detailed in Appendix GP Complaint Themes 2016/17 Unhappy with quality of care 14% 20% 12% 22% 32% Staff attitude/behaviour Delay in treatment Appointment availability/length Inappropriate treatment 8

50 OFFICIAL 4.2 Dental Complaint Themes 4.3 Pharmacy Themes 13 complaints (65%) were upheld and the most common complaint theme was Prescription Issues (70%) followed by Communications (15%). 4.4 H&J Complaint Themes 4.5 Themes Summary Complainants reporting that they are unhappy with the care received is the top reported concern followed by staff attitude and delays in care. Charging/costs is also a theme for dentistry. Changes to the way themes are reported will enable future reporting to include better analyse of these themes in terms of the numbers of these complaints which are upheld and are related to particular issues within the specific provider groups. During the period 1 April March (33%) complaints were shared with the Fitness to Practice team for consideration. Complaints are shared following immediate risk assessment of the concern being raised (i.e. where serious harm has occurred), or following the outcome of an independent clinical review. The team review and consider whether further investigation is required by the Performers 9