Agenda and Papers for the. West Kent Primary Care Commissioning Committee on

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1 Agenda and Papers for the West Kent Primary Care Commissioning Committee on Tuesday 6 th September 2016 at 4.00pm-6.00pm at Hadlow Manor Hotel, Maidstone Road, Tonbridge, Kent, TN11 0JH

2 Meeting of the Primary Care Commissioning Committee To be held on 6 th September Hadlow Manor Hotel, Maidstone Road, Tonbridge, Kent, TN9 1RE A G E N D A Chair is Alistair Smith Time Agenda no. Agenda Item Lead Required Action? 4.00pm 1 Welcomes and Introductions Chair TO NOTE 4.05pm 2 Apologies for Absence Chair TO NOTE 4.10pm 4.15pm 4.25pm 3 Quorum and Declaration of Interests Committee to receive Register of Interests 4 i). Terms of Reference, Purpose of Committee & Remit ii). Appointment of Vice Chair 5 Overview of Primary Medical Services Contracts Chair Chair Richard Woolterton TO NOTE TO NOTE TO NOTE 4.40pm 6 Proposed scheme for Delegation and Reservation Richard Segall Jones FOR APPROVAL 4.55pm 7 Memorandum of Understanding Papers Louise Matthews FOR APPROVAL 5.10pm 8 Criteria for consideration of Section Gail Arnold FOR APPROVAL 106 & Community Infrastructure Levy Grants 5.25pm 9 Finance Report Yin Yau TO NOTE 5.40pm 10 Primary Care COG Report including Louise Matthews TO NOTE Premises/Estates Matters & Partnership Issues 5.55pm 11 Q&A from the public Chair TO NOTE Date of the next meeting (as previously circulated): 1 st November 2016 at pm at Hadlow Manor Hotel, Tonbridge

3 Register of Interests Primary Care Commissioning Committee September 2016 May 201S6

4 Register of Interest NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee members as at 6 th Sept Name Practice/Organisation Declaration of Interest Ian Ayres WK CCG Chief Officer None. Alistair Smith Caroline Becher Chair of the Primary Care Commissioning Committee / Lay Member Independent Nurse on Governing Body Lay member for Governance at South Kent Coast CCG (member of Governing Body) Directorships: o HRSS (HR Specialist Services) Ltd (Reg Office 14 Orchard Drive TN28 8SE)* o SCI La Guiraude non healthcare sector (Reg office: Beauteville France). *Note; HR Specialist Services Ltd is a subcontractor to Foresight Centre for Governance part of GE Finnamore which works across the Health Service. *Note; Spouse (Janine P Smith) is joint owner of HRSS Ltd Management and Nursing Freelance Consultant Director, Marnock Place, Tunbridge Wells Director, 3 St James Road, Tunbridge Wells Consultant Member of IMD Mentor and Interviewer for the Florence Nightingale Foundation Member Royal College of Nursing Public Member Medway NHS Foundation Trust Public Member Queen Victoria NHS Foundation Trust Public Member Sussex Community NHS Trust Trustee for the Scotts Project Trust West Kent CCG Register of Interests 2

5 Name Practice/Organisation Declaration of Interest Dr Nick Cheales Mr Nic Goodger Winterton Surgery, Westerham/ GP Governing Body Member Independent Member (secondary care doctor) GMS contract holder GP Principal at Winterton Surgery, Westerham, Kent Health Education, Kent Surrey and Sussex (HE KSS) GP Tutor 1 session per week Wife is an employee at West Kent CCG Divisional Medical Director of East Kent Hospitals University NHS Foundation Trust Private medical practice based at the Chaucer Hospital in Canterbury and Spencer Wing, East Kent Hospitals University NHS Foundation Trust Clinical Director of the South East Coast Strategic Clinical Network for Cancer Director of East Kent Medical Services Reg Middleton WK CCG Chief Finance Officer Partner is an employee of Eastbourne District General Hospital Brother-in-law, Mark Moorton, is a Director of HR at Specsavers. West Kent CCG Register of Interests 3

6 Name Practice/Organisation Declaration of Interest Dr Sanjay Singh Snodland Medical Practice/ GP Governing Body Member GMS contract holder, Snodland Medical Practice GPSI cardiologist GP Trainer Susan Southon Lay Member None West Kent CCG Register of Interests 4

7 Other members of the Executive Management Team who are not Primary Care Commissioning Committee members: Name Practice/Organisation Declaration of Interest Gail Arnold Chief Operating Officer Undertakes occasional personal and professional development consultancy for ESP Ltd. Richard Segall Jones Company Secretary and Head of Corporate Services Director, Cavendish Health Care Consultancy Limited Partner, Conducting Business Shareholder, Tune Into Care Ltd. (trading arm of the charity Sing For Your Life) Member of the Guy s & St Thomas NHS Foundation Trust Wife, Veronika Segall Jones: o is a lay member on NHS England South (South East) Area Team panels considering GPwSI accreditation or the general regulation and performance management of GPs, GDPs and optometrists; o is a Patient and Public Voice Representative for GP Revalidation & Appraisal for NHS England South (South East); o undertakes voluntary project work for HealthWatch Kent West Kent CCG Register of Interests 5

8 Name Practice/Organisation Declaration of Interest Dr Mike Parks Andrew Hayes Local Medical Committee Kent Representative Healthwatch Kent Representative Wife is a Consultant Paediatrician who works for EKHUFT None. Councillor Pat Bosley Health & Wellbeing Board Representative None. Richard Woolterton NHS England Representative None. David Selling NHS England Representative None. West Kent CCG Register of Interests

9 PRIMARY CARE COMMISSIONING COMMITTEE Terms of Reference 1. Introduction 1.1 The Committee is established as a committee of the Governing Body of the CCG in accordance with the NHS Act 2006 (as amended by the Health and Social Care Act 2012). 1.2 The Committee has been established to oversee the procurement, review, planning and strategic development of primary care services in the Group area under delegated authority from NHS England. 1.3 The Committee is authorised by the Governing Body to act within its terms of reference. All Members and employees of the Group are directed to co-operate with any request made by the Committee. 2. Membership 2.1 The Committee shall be appointed by the Group as set out in the Group's Constitution and may include individuals who are not on the Governing Body. 2.2 The membership of the Committee shall consist of: One existing Lay Member of the Governing Body (but not the Audit Committee Chair); Two additional Lay Members, one of whom shall be the Chair of the Committee; The two Independent Members of Governing Body (secondary care and nursing); Two GP members of the Governing Body, one from each practice federation area; One of the Chief Officer or Deputy Chief Officer but not both (i.e. only one may vote); Chief Finance Officer; Company Secretary;

10 2.3 The following will also be invited to attend but will not have voting rights: Deputy Chief Officer/Chief Operating Officer (if not deputising for the Chief Officer); Local Medical Committee representative; HealthWatch Kent representative; Health and Wellbeing Board representative; NHS England representative. 3. Secretary 3.1 The Company Secretary shall be the secretary to the Committee and will provide administrative support and advice. In this, (s)he may be supported by the Corporate Services team. The duties of the secretary in this regard include but are not limited to: agreement of the agenda with the chair of the Committee and attendees together with the collation of connected papers; taking the minutes and keeping a record of matters arising and issues to be carried forward; and advising the Committee as appropriate on best practice, national guidance and other relevant documents. 4. Quorum 4.1. A quorum shall be five (5) members which must include at least one Lay Member, one Independent Member and one Officer. 5. Frequency and notice of meetings 5.1. Meetings shall be held at least every two (2) months Meetings of the Committee must be open to the public unless the Committee (on advice from the Company Secretary) resolves that the public be excluded from the meeting, whether for the whole or part of the proceedings on the grounds that publicity would be prejudicial to the public interest, or the interests of the CCG, by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of the business to be transacted or the proceedings Notice of any Committee meeting must indicate: its proposed date and time, which must be at least seven (7) days after the date of the notice, except where a meeting to discuss an urgent issue is

11 required (in which case as much notice as reasonably practicable in the circumstances should be given); where it is to take place; an agenda of the items to be discussed at the meeting and any supporting papers; and if it anticipated that members of the Committee participating in the meeting will not be in the same place, how it is proposed that they should communicate with each other during the meeting Notice of a Committee meeting must be given to each member of the Committee in writing Failure to effectively serve notice on all members of the Committee does not affect the validity of the meeting, or of any business conducted at it. 6. Remit and responsibilities of the Committee 6.1. NHS England has delegated to the Group authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. The Committee is subject to any directions made by NHS England or by the Secretary of State. The Committee shall exercise the management of its functions in accordance with the agreement entered into between NHS England and the CCG, which will sit alongside the delegation and terms of reference The Committee shall ensure the effective management of the following activities: The planning, including needs assessment, for primary medical care services in the Group area, including the development and retention of the primary [medical] care workforce Reviews of primary medical care services in the Group area; The coordination of a common approach to the commissioning of primary care services generally; and The management of the budget for commissioning of primary medical care services in the Group area The Committee will oversee the management of functions relating to the procurement, review, planning and strategic development of primary medical services under section 83 of the NHS Act This includes the following: GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); Newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services );

12 Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF); Decision making on whether to establish new GP practices in an area; Approving practice mergers; and Making decisions on discretionary payment (e.g., returner/retainer schemes) The functions of the Committee are undertaken in the context of a desire to promote co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. 7. Relationship with the Governing Body 7.1. Although the Committee may have delegated decision-making authority from Governing Body, the Committee will nonetheless report to the Governing Body after each Committee meeting. 8. Policy and best practice 8.1. The Committee is authorised by the Governing Body to instruct professional advisors and request the attendance of individuals and authorities from outside the Group with relevant experience and expertise if it considers this necessary for or expedient to the exercise its functions The Committee is authorised to obtain such internal information as is necessary and expedient to the fulfilment of its functions The Committee is authorised to establish such sub-committees as the Committee deems appropriate in order to assist the committee in discharging its responsibilities 9. Conduct of the Committee 9.1. There must be transparency and clear accountability of the Committee. Members must declare any interests and /or conflicts of interest at the start of the meeting. Where matters on conflicts of interest may arise, the Chair will have the powers to request that members withdraw from any discussion/voting until concluded All declared items / conflicts of interest will be recorded in a members register in accordance with Standards of Business Conduct guidance and the CCG s Declaration and Conflicts of Interest Policy The Chair will reserve the right to refer a decision to the Governing Body should an item or issue arise where it is judged that Governing Body approval would secure

13 essential good corporate governance and decision making. 10. Approval of Terms of Reference The terms of reference of the Committee will be reviewed at least annually and approved by Governing Body and the CCG Membership and will form part of the CCG s Standing Orders which form an annex to the CCG s Constitution.

14 Primary Care Commissioning Committee This paper is for: Noting Recommendation: Overview of Primary Medical Services contracts For further information or for any enquiries relating to this report please contact: David Selling Date: 6 th September 2016 Reporting Officer: David Selling Agenda Item: 5 Lead Director: Alistair Smith, Chair Version: Final Report Summary: Please see document detailed overleaf, received from NHS England. FOI status: This paper is disclosable under FOI. Strategic objectives links: Board Assurance Framework links: Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: All strategic objectives are served by the work of the Primary Care Commissioning Committee. The work of the Primary Care Commissioning Committee links to all BAF components. N/A N/A N/A N/A N/A N/A DATE NHS West Kent CCG Page 1 of 1

15 A meeting of the Primary Care Commissioning Committee of West Kent CCG Date of meeting: 06 September 2016 Title of report: Overview of Primary Medical Services contracts Recommendation: The Committee is recommended to note the report Summary: This report provides the Committee with an overview of the contractual relationship with GP practices, the types of contract that are in existence, the main requirements of the contract for primary medical services, funding flows to GP practices and a summary of the levers within and outside the contract which are available to the CCG to address issues of contractual concern. Committee sponsor: Author(s): David Selling Senior Contract Manager, NHS England South (South East) Review by other committees: N/A Date of report: 26/08/16 Health impact: [short note of any or why there are none] Financial implications: There are no financial implications associated with this report as the item is for information only. Legal or compliance implications: There are no legal or compliance implications associated with this report as the item is for information only. Link to key objective and/or principal risks: [Specify key objective and/or assurance framework reference. You may find it useful to refer to the ISOP] How has the patient and public engagement informed this work: [What was the engagement and what was the impact of the engagement (e.g. how did it inform the strategy, commissioning activity, etc.?)] Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact No Impact Not required for report Privacy Impact Assessment (PIA) outcome: No personal data used Data processes sufficient Actions required NHS West Kent Clinical Commissioning Group

16 1. Introduction An Overview of Primary Medical Services Contracts This paper provides the Committee with an overview of the contractual relationship with GP practices, the types of contract that are in existence, the main requirements of the contract for primary medical services, funding flows to GP practices, and a summary of the levers within and outside the contract which are available to the CCG to address issues of contractual concern. 2. NHS contracts for primary medical services Primary medical services is the term used to describe the provision of GP or family doctor services. Primary medical services are provided by a number of organisations across England including sole practitioner contractors, (otherwise referred to as single handers ), partnerships of GPs, (which may also include nursing and managerial partners), Community Interest Companies, Limited Liability Companies and Public Limited Companies. Many GP practices have been established for decades with the vast majority holding contracts that run in-perpetuity and which grant the contractor considerable flexibilities with regards to making variations to the contracts they hold. Over the years the rules and regulations governing market entry have changed significantly and this history explains why we have a mixed economy of contractors as well as different types of contract platform in use. The primary medical service needs of the registered populations of West Kent CCG are met by a number of contractors, all of whom hold contracts for service with NHS England. The total number of practices in the CCG is shown in Table 1 below along with the type of contract in place. Table1: GP Practices Contract Type* General Medical Services Personal Medical Services Alternate Provider Medical Services Practices within West Kent CCG * As at 25 th August 2016 and subject to PMS review 2.1. Types of Contractual platforms There are only three contractual platforms that NHS England and CCGs acting under delegated authority can use to commission primary medical services for their NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 1

17 populations. These are: 2.2. General Medical Services (GMS) contract This is a nationally directed contract between NHS England and a practice. The new GMS contract was introduced in April This is the most common form of contract for primary medical services. Currently, more than 60 per cent of practices across England are on GMS contracts Personal Medical Services (PMS) contract This is a local contract agreed between NHS England and the practice, together with its funding arrangements. The GMS contract has a strong influence on the content and scope of this contract. Approximately 35% of practices across England hold PMS contracts. These contracts have been subject to a nationally mandated review in order to support the move towards equitable funding for the same services Alternative Provider Medical Services (APMS) contracts This type of contract was introduced in 2006 and is the least common form of contract platform. However, APMS is considered to be the only type of contract that should be used when awarding a new contract for GP services. This is because APMS contracts can be held by any form of organisational entity and consequently are seen as being non-discriminatory insofar as procurement law, rules and principals are concerned. APMS contracts are for defined fixed-term periods and their specifications and pricing are subject to local agreement. The contract for Staplehurst Health Centre services is managed under an APMS contract. 3. Contractual Requirements The current definitions of what are and are not primary medical services are contained within the GMS Regulations and the GMS contract. These Regulations define the services that those delivering primary care within the NHS are obliged to provide. The definitions of primary medical services include: Essential Services Additional services Enhanced services, and; Emergency services NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 2

18 3.1. Essential services, core hours and opening times, and appointment availability The GMS contract, (and virtually all PMS contracts), requires GP practices to provide all essential services throughout core hours as appropriate to meet the reasonable needs of its patients. Essential services are defined as services required for the management of a practice s registered patients and temporary residents who are, or believe themselves to be ill, with conditions from which recovery is generally expected; terminally ill; or suffering from chronic disease, delivered in the manner determined by the practice in discussion with the patient. Although individual patients are entitled to be consulted about the way in which general medical services are provided to them, the final decision about the manner in which services should be provided, (including the location at which the services should be provided), rests with the GP. In terms of further definitions, the Regulations define management as including; offering consultation and, where appropriate, physical examination for the purpose of identifying the need, if any, for treatment or further investigation; and the making available of such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services and liaison with other health care professionals involved in the patient's treatment and care. Core hours are defined as the period beginning at 8am and ending at 6.30pm on any day from Monday to Friday. This excludes Good Friday, Christmas Day or bank holidays. The contract does not require the practice to make a GP available in person to provide routine services to patients throughout core hours. Therefore, a GP practice is not necessarily in breach of its contract if it is closed for some time during core hours. If GP practice premises are closed at any point during the core hours, the GP practice either must provide a means for patients to be able to access one of the practice GPs throughout that period or make arrangements (sub-contract) with an out of hours provider to provide emergency GP services to patients during that period. It is important to note that there are no set surgery hours within the GMS GP contract but the opening hours need to be sufficient to meet the reasonable needs of its patients. GP practices which fail to provide a sufficient number of surgery appointments to meet the reasonable needs of their patient populations may be acting in breach of the contractual requirement to provide services to meet the reasonable needs of its patients. In such situations the commissioner could consider serving a Remedial Notice on the contractor that requires them to extend the number of surgery appointments. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 3

19 3.2. Additional Services Essential services are the range of services that GP practices are obliged to provide as a minimum to their practice patients and temporary residents. However, GP practices can also provide extra services to patients and thus avoid the need for the GP practice to refer patients who need such services elsewhere. Services which are extra to essential services are classified as additional services and enhanced services. GP practices are not obliged to provide additional services which are individually funded within the value of Global Sum. Should a practice decide to not provide any or all of the additional services then a deduction is made to their value of their Global Sum payment. The list of additional services is outlined below and the specifications for these services can be found within the GMS contract. Additional services means one or more of: (a) cervical screening services; (b) contraceptive services; (c) vaccines and immunisations; (d) childhood vaccines and immunisations; (e) child health surveillance services; (f) maternity medical services; and (g) minor surgery 3.3. Enhanced Services GP practices can also agree to provide a number of Directed Enhanced Services. While Directed Enhanced Services create an obligation on the part of the commissioner to make these services available to their populations, GP practices are not under a contractual obligation to provide them, but MUST be offered the opportunity to provide services. The Primary Medical Services (Directed Enhanced Services) Directions 2016 issued on behalf of the Secretary of State list the range of Directed Enhanced Services that the commissioner is required to make available to their populations as below: - Extended Hours Access Scheme - Learning Disabilities Health Check Scheme - Childhood Immunisation Scheme - Influenza and Pneumococcal Immunisation Scheme - Violent Patients Scheme - Minor Surgery Scheme - Avoiding Unplanned Admissions and Proactive Case Management Scheme NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 4

20 In addition, GP practices can also agree to provide a range of locally commissioned services, (previously known as Local Enhanced Services), that are commissioned by their CCG and local authority public health directorates Emergency services The GMS Regulations provide that GP practices must provide a limited range of emergency services and to specifically have in place arrangements for its patients to access such services throughout the core hours in case of emergency. The GMS Regulations also require the contractor to provide primary medical services in core hours for the immediately necessary treatment of any person to whom the contractor has been requested to provide treatment owing to an accident or emergency at any place in its practice area Other services that GP practices are obliged to provide The GMS Regulations provide a list of other services that all GMS practices must provide to their patients. There is a similar list in the PMS Regulations. The following paragraphs summarise a number of the key requirements: 3.6. Premises The contract provides that the contractor shall ensure that the premises used for the provision of services under the contract are suitable for the delivery of those services; and sufficient to meet the reasonable needs of the contractor's patients. A schedule within the contract documents the sites and designation(s) of the premises that are to be used by the contractor in delivering services to patients Telephone lines NHS GP practices are prohibited from using premium rate telephone numbers which start with the digits 087, 090 or 091 or consists of a personal number, unless the service is provided free to the caller. There are also provisions to prevent NHS GP practices using other types of premium rate telephone services Storage of vaccines GP practices must ensure that all vaccines are stored in accordance with the manufacturer's instructions and that all refrigerators in which vaccines are stored have a maximum/minimum thermometer and that readings are taken on all working days Infection control Each GP practice must ensure that it has appropriate arrangements for infection control and decontamination. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 5

21 3.10. Duty of Co-operation Paragraph 12 of Schedule 6 to the GMS Regulations provides that GP practices which do not provide additional services, enhanced services or OOH services must co-operate with those providers who do deliver those services for NHS patients 4. Funding for GMS practices GP practices receive their funding from a number of streams and are outlined within The General Medical Services Statement of Financial Entitlements Directions 2013 (as amended) (Known as the SFE) Global Sum This funds practices for delivering essential and additional services to its registered list of patients. The funding formula (Carr-Hill Formula) within the Statement of Financial Entitlements adjusts each practice s actual list into a weighted patient list taking account of a range of factors (principally age) that affect workload. The value of each practice s Global Sum is adjusted each quarter to reflect changes in its weighted list and is paid monthly. 2016/17 Global Sum rate per raw (actual) patient = per annum 4.2. Minimum Practice Income Guarantee (MPIG) MPIG is a financial protection scheme, (also referred to as correction factor payments) which many practices receive additional income from. It was introduced when the contract payment structure changed in From 2014/15 funding to general practice moved towards equitable funding over a seven year period during which time MPIG payments will gradually be phased out, with its value being reinvested into an increased Global Sum payment Quality and Outcomes Framework (QOF) The QOF is a voluntary scheme that provides funding to support aspiration to and achievement of a range of quality standards, by rewarding practices for the volume and quality of care delivered to their patients. It measures practice achievement against evidence based clinical, public health, quality, productivity and patient experience indicators. Practices score points according to their levels of achievement, payments are calculated on the points the practices achieve which depend on passing certain thresholds, disease prevalence (against a register) and a list size adjustment. Although voluntary, the vast majority of practices participate in the scheme, which has reduced from 1,000 points to 559 points, with QOF funding being reinvested into an increased Global Sum payment. QOF has seen evidence based indicators achieved by almost every GP practice in the UK to a very high level. The QOF has delivered benefits to patients through the improved monitoring and treatment of acute and chronic health problems. The NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 6

22 coordinated and comprehensive care patterns supported by the QOF have also helped to reduce inequalities across the UK. Domains QOF Points Clinical 435 Public Health 124 Total 559 The national average practice population figure for the 2016/17 QOF year is taken from the Calculating Quality Reporting Service (CQRS) on 1 January 2016 and is 7,460. The unadjusted price per QOF point is currently at Directed Enhanced Services These provide practices with additional resources to deliver specific services (e.g.: Minor Surgery, Violent Patient Scheme) Other payments The Statement of Financial Entitlement (SFE) lists other payments contractors are able to claim such as payments for: - Maternity, Paternity and Adoption Leave - Locum payments for GP Sickness - Locum payments for to cover suspended Doctors (from the Medical Performers List) - Prolonged Study Leave - Seniority Pay (being phased out) - GP Retainers and Returners Scheme - Dispensing Services (those practices authorised under the Pharmacy Regulations) - Dispensing Services Quality Scheme (DSQS) 4.6. Payments for Premises Many GP practices own their premises and make these available to the NHS for patient care. GPs borrow the capital to build the premises and there are schemes that compensate the practice for this, for example borrowing costs (formerly known as cost rent) or notional rent reimbursement. Payments to contractors are calculated on the amount of rent the practice would pay if renting the premises and this is agreed with the District Valuer (DV). Other contractors rent their premises, in which case they receive rent reimbursement for actual leasehold rent. The level of reimbursement is calculated by the DV in relation to local current market rents (CMR), this may differ from actual rent paid. Practices are entitled to claim reimbursement for practice running costs covering; Business Rates, Water and Sewerage charges, Clinical Waste disposal. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 7

23 Premises payments are governed by the NHS GMS - Premises Costs Directions 2013 which are expected to be revised and published from October Table 2: Practice List sizes at July 2016 PRACTICE NAME QUARTER NORMALISED WEIGHTED LIST SIZE RAW PRACTICE LIST SIZE AMHERST MEDICAL 01/07/ PRACTICE KINGSWOOD SURGERY 01/07/ ALBION PLACE MEDICAL 01/07/ CENTRE EDENBRIDGE MEDICAL 01/07/ GREGGS WOOD MEDICAL 01/07/ CENTRE STOCKETT LANE SURGERY 01/07/ CLANRICARDE MEDICAL 01/07/ CENTRE BOWER MOUNT MEDICAL 01/07/ PRACTICE HILDENBOROUGH MEDICAL 01/07/ GROUP GROSVENOR MEDICAL 01/07/ CENTRE TONBRIDGE MEDICAL 01/07/ GROUP NORTH RIDGE MEDICAL 01/07/ PRACTICE AYLESFORD MEDICAL 01/07/ CENTRE WARDERS 01/07/ GROVE PARK SURGERY 01/07/ BEARSTED MEDICAL 01/07/ PRACTICE ST JAMES MEDICAL 01/07/ CENTRE THE MOTE MEDICAL 01/07/ PRACTICE THORNHILLS MEDICAL 01/07/ PRACTICE SNODLAND MEDICAL 01/07/ PRACTICE BREWER STREET SURGERY 01/07/ WINTERTON SURGERY 01/07/ LEN VALLEY PRACTICE 01/07/ BLACKTHORN MEDICAL 01/07/ NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 8

24 CENTRE THE COLLEGE PRACTICE 01/07/ ABBEY COURT MEDICAL 01/07/ CENTRE ALLINGTON CLINIC 01/07/ TOWN MEDICAL CENTRE 01/07/ HEADCORN SURGERY 01/07/ WOODLANDS HEALTH 01/07/ CENTRE BOROUGH GREEN MEDICAL 01/07/ PRACTICE THE OTFORD MEDICAL 01/07/ CENTRE WEST MALLING GROUP 01/07/ PRACTICE ST ANDREWS MEDICAL 01/07/ CENTRE YALDING SURGERY 01/07/ RUSTHALL MEDICAL 01/07/ CENTRE WATERFIELD HOUSE 01/07/ SURGERY HOWELL SURGERY 01/07/ THE VINE MEDICAL 01/07/ CENTRE LAMBERHURST SURGERY 01/07/ WATERINGBURY SURGERY 01/07/ ST JOHN'S MEDICAL PR 01/07/ MARDEN MEDICAL CENTRE 01/07/ OLD PARSONAGE SURGERY 01/07/ SUTTON VALENCE 01/07/ SURGERY PHOENIX MEDICAL 01/07/ PRACTICE OLD SCHOOL SURGERY 01/07/ NORTHUMBERLAND COURT 01/07/ THE CRANE SURGERY 01/07/ THE SURGERY 01/07/ DR WORTHLEY P 01/07/ MALLING HEALTH FOUR 01/07/ THE ORCHARD SURGERY 01/07/ ROWAN TREE SURGERY 01/07/ WISH VALLEY SURGERY 01/07/ ORCHARD END SURGERY 01/07/ THE ORCHARD MEDICAL CENTRE 01/07/ NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 9

25 THE MEDICAL CENTRE HADLOW LONSDALE MEDICAL CENTRE COBTREE MEDICAL PRACTICE ALLINGTON PARK SURGERY SOUTH PARK MEDICAL PRACTICE 01/07/ /07/ /07/ /07/ /07/ Registration requirements with Care Quality Commission All GP contractors are required to be registered with the Care Quality Commission (CQC). CQC is the independent regulator of health and adult social care services and aims to ensure that health and social care services provide people with safe, effective, compassionate, high-quality care. CQC monitors, inspects and regulates services to make sure they meet fundamental standards of quality and safety, with findings being published, including performance ratings to help people choose care. CQC inspects and rates GP practices by using published Key Lines of Enquiry (KLOE) and rating characteristics to determine: whether each GP practice is well-led and providing care that is safe, effective, caring and responsive, and; a rating status for each practice practices will be categorised as either being outstanding, good, requires improvement or inadequate. There are a number of areas where there are similarities in the issues that CQC look at in their inspections and the requirements placed on GP practices through their contracts: one of these is access to appointments. In this respect, it should be noted that the role of CQC is not to monitor GP practices to ensure they meet the requirements of their contract. When CQC inspects a GP practice it considers the following questions and issues as part of a Key Line of Enquiry for being responsive: Can people access care and treatment in a timely way? Do people have timely access to appointments for an initial assessment, for diagnosis and for treatment or ongoing management of chronic conditions? Is the appointments system easy to use and does it support people to access appointments? NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 10

26 Can people access care and treatment at a time to suit them? Does the service prioritise people with the most urgent needs, including through triage? Do services run on time, and are people kept informed about disruption? To be considered good CQC expect to see evidence that: people can access the right care at the right time access to appointments is managed to take account of people s needs, including those with urgent needs waiting times, delays and cancellations should be minimal and managed appropriately services should run on time and people kept informed of any disruption to their care or treatment. Where practices are not open during all of the core hours yet there is evidence that patients can continue to access appointments and services, (both when the practice is open and when it is closed), then being closed for some part of the core hours will not lead to a poor rating for responsiveness. The important issue is whether patients can access the care they need. If there is evidence that patients: are frequently and consistently not able to access appointments and services in a timely way, or experience unacceptable waits for some appointments and services then the practice is likely to be judged as being inadequate by CQC in terms of responsiveness. This may apply in situations both where a practice is open during all of the core hours as well as cases where the practice is closed for some of the core hours. If a GP practice is closed during its core hours and does not make arrangements for patients to access care, should they need it, then CQC will consider this to be poor practice which potentially puts patients at risk. The important point is the impact on people who are using the GP practice and whether they are able to access appointments and services when they need them. If a GP practice is closed during core hours and does not make arrangements for patients to access care, should they need it, then this is considered to be poor practice which potentially puts patients at risk. The practice is very likely to be in breach of its contract and this may also affect their CQC rating. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 11

27 There are, however, no set hours for appointments within the GMS contract but the opening hours need to be sufficient to meet the reasonable needs of its patients as part of the contractor s responsibility to deliver essential services. Table 3: CQC Ratings in West Kent CCG (as of 25/7/16) Inspection Rating Practices Inspected Outstanding 1 5.2% Good % Requires improvement % Inadequate 0 0% 19 Inspected Row Label Link to CQC Report Overall Caring Effective Responsive Safe Well-led G Outstanding Good Good Good Outstanding Outstanding G Good Good Good Good Good Good G Good Good Good Good Good Good G Good Outstanding Good Good Good Good G Good Good Good Good Good Good G Req. Imp. Good Good Req. Imp. Req. Imp. Good G Good Good Good Good Good Good G Good Good Good Good Good Good G Good Good Good Good Req. Imp. Good G Good Good Good Good Good Good G Good Good Good Good Good Good G Good Good Good Good Good Good G Req. Imp. Good Good Good Req. Imp. Req. Imp. G Good Good Good Good Good Good G Good Good Good Good Good Good G Good Good Good Good Req. Imp. Good G Good Good Good Good Good Good G Good Good Good Good Good Good G Good Good Good Good Good Good 6. Contract Breaches, Sanctions and Termination The NHS England Policy Book for Primary Medical Services (Gateway January 2016) details the context, information and tools to safely commission and contract manage primary medical care contracts. This policy document supersedes any guidance detailed below. The contract contains provisions under which the responsible commissioner can take contractual action where the contractor is failing to meet the terms of their contract. In many situations it is first important to establish the evidence and matters of fact. In addition, it is also important to understand the perspective of the contractor and to invite them to clarify and comment on the issue of concern. In this respect the NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 12

28 contract also makes provisions that allow the commissioner to ask for specific relevant information from the contractor which places a contractual obligation on the contractor to respond within a specified time period, (which usually is a minimum of 28 days but can be less by agreement). Failure by the contractor to respond to such requests is a breach of contract. In many situations issues can be resolved through timely and open dialogue. In this respect the Local Medical Committee can play a helpful role in terms of liaison between the practice and Commissioner. In addition, CCGs may find peer review processes helpful in identifying and addressing areas of concern. The CCGs should also work closely with colleagues at CQC and consider appropriate ways of working with the regulator to address any issues of concern about the member practice especially where they relate to patient safety. However, the specific provisions within the contracts can and should also be used to address issues of contract failure. The Commissioner should ideally seek legal advice in the case of a contract termination decision it may take. Delegated CCG s as the decision maker must obtain their own legal advice Contract Breaches and Termination Given that any decision to issue a Breach or Remedial Notice, apply sanctions or terminate a contract or agreement can be challenged by the contractor under appeal, it is essential that the Commissioner follows, and can demonstrate that it has followed, due process in investigating, communicating and implementing actions in this respect and that the Commissioner has acted fairly and reasonably throughout. It is also essential that the Commissioner maintains thorough and accurate records of all communications and discussions in respect of all notices under this policy Contract Breaches Where the Commissioner considers that a breach has occurred, there are a number of options on how to proceed. The Commissioner can: take no action; agree an action with the contractor; issue a Remedial Notice; issue a Breach Notice; apply a Contract Sanction; or terminate the contract. Doing nothing and agreeing an action with the contractor are options that are always available to the Commissioner. The remaining options may only be applied in specific situations as envisaged by the contract. The Commissioner must ensure that, when issuing a Remedial or Breach Notice, applying a Contract Sanction or terminating a contract, it follows the proper internal NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 13

29 processes around approval of the action, compliance with any standing orders and due consideration of all relevant factors in the decision making process Remedial Notices and Breach Notices The GMS Regulations, the PMS Regulations and the APMS Directions make a clear distinction between the process to be followed where a breach is capable of remedy and the process where a breach is not capable of remedy. For GMS and PMS contracts - Where a breach is capable of remedy, a Remedial Notice must be issued before the Commissioner takes any other action under the contract, (such as termination except where the breach relates to specific right to terminate). Where a breach is not capable of remedy, a Breach Notice must be issued before the Commissioner takes any other action under the contract. For APMS contracts - Contracts are not required to contain provisions relating to Remedial or Breach Notices. The NHS England Standard Alternative Provider Medical Services Contract 2014/15 does, however, contain these provisions. It is therefore important to review the actual wording of the contract to ensure the right process is followed. If, following the issue of a Breach Notice, a contractor either repeats a breach that was the subject of a Breach Notice or otherwise breaches the contract that results in a further Remedial Notice or a Breach Notice, then the Commissioner has the right to terminate the contract by serving notice on the contractor. This right to terminate can only be used however, where the Commissioner is satisfied that the cumulative effect of the breaches is such that the Commissioner considers that to allow the contract to continue would be prejudicial to the efficiency of the services to be provided under the contract. If the contractor is in breach of any obligation and a Breach Notice has been issued, the Commissioner may withhold or deduct monies which would otherwise be payable under the contract in respect of that obligation Contract Sanctions Contract Sanctions must not be applied to a contract unless the Commissioner is in a position to move to terminate. Where Contract Sanctions are applied, this is an alternative to terminating the contract. The Commissioner cannot therefore apply Contract Sanctions and later decide to terminate the contract in the same circumstances. Furthermore, Contract Sanctions must not be applied if they terminate or suspend any obligation that relates to essential services. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 14

30 Contract Sanctions may involve the termination of specified reciprocal obligations; the suspension of specified reciprocal obligations for a period of up to six months; or withholding or deducting monies otherwise payable under the contract. The choice of which Contract Sanction to use would ordinarily depend on the nature of the breach, or cumulative effect, and what is felt to be the most appropriate and proportionate action in those circumstances. For example, if the breaches have occurred in relation to a specific service element under the contract, it might be most appropriate to move to terminate that specific service, such as an additional service Termination of the Contract Termination is a very significant action to take both on the part of the Commissioner and the contractor and is an area of high risk for both parties in respect of financial impact and continuity of services. Legal advice is always advisable. Whenever a primary medical service contract comes to an end the Commissioner is then faced with making an important commissioning and procurement decision. Specifically the Commissioner need to determine how it will ensure that the patients registered at the practice whose contract is to terminate will be able to continue to access GP services. Primary medical service contracts may be terminated in the following circumstances: (see table next page) NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 15

31 Table 4: Termination scenarios GMS PMS APMS Death of the contractor Death of the contractor Death of the contractor Contractor serving notice: 3 months singlehanded 6 months partnership (Last calendar day) Contractor serving notice 6 months notice Contractor serving notice * depends on contract form Late payment Late payment Late payment Provision of untrue information Fitness to practice issues Provision of untrue information Fitness to practice issues Provision of untrue information Fitness to practice issues Patient safety Patient safety Patient safety Material financial loss Material financial loss Material financial loss Unlawful sub-contracting Unlawful subcontracting Unlawful subcontracting Remedial Notices and Breach Notices Remedial Notices and Breach Notices Carrying on business detrimental to the contrac Breach of Regulation 4 (Conditions relating solely to medical practitioners) of the GMS Regulations; and Certain partnership matters. Carrying on business detrimental to the contract Commissioner serving notice Contractor's exercise of the right to a GMS contract Remedial Notices and Breach Notices * depends on contract form Contract reaches its cessation date NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 16

32 7. Typical contractual matters & issues Issue Decision / Note Note Contract Variations Changes due to legislation Note Contractor consent not usually required Changes due to the contracting party (partnership, company change, retirement, novation, merger, splits, death of a contractor) Note & Decision* *Merger & Split requires a decision. 24 hour retirement for individual contractor is an issue. CQC Registration impact. Changes to services Decision Commissioner notify patients Changes to payment Decision arrangements Partnership dispute dissolution of partnership and partner nomination NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee Decision (on eligible person) Failure to nominate a former partner means the contract will terminate. Closed Lists Decision Follow contractual process decision within 21 days of receipt, 3-12 months period. Comments from neighbouring practices required. Boundary Changes Decision Consider impact on local practices/patients follow process Premises relocation Decision Significant changes engage with patients/stakeholders Branch closure Decision Significant changes engage with patients/stakeholders Opt-out of services additional or out of hours Contract Breaches Quality issues Eg CQC Inadequate rating Special Measures Premises Statutory & Minimum standards (Premises Costs Directions Schedule 1) Telephone number 0844 etc Failure to provide information/reports List capping Premises Costs Directions applications. Note Decision Decision Decision Decision Discussion with practices Decision Commissioner to commission from alternative source Remedial breach to meet contractual requirements Await NHSE policy through Gateway process NHSE Premises Group meets to consider applications CCG decision 17

33 8. GMS Contract Changes 2016/ Background NHS Employers and the British Medical Association s General Practitioner Committee (GPC) announced changes to the General Medical Services (GMS) contract for 2016/17 on 19 February The contract for 2016/17 will see investment, aimed at alleviating some of the pressures in general practice and working to improve access to services for patients. In addition, there have been a number of other key changes including further development of data collection to drive patient care and changes that build upon online services. There is a commitment to ensure that the changes agreed in GMS contracts are consistently and equitably applied through Personal Medical Services and Alternative Provider Medical Services contracts. CCGs with delegated authority will need to work to amend local contracts and implement the subsequent changes at the earliest possible opportunity. NHS England will be working with NHS Employers and the GPC to develop detailed guidance on all the agreed changes, including supporting documents that underpin contracting and delivery of these changes. It is envisaged that the Regulations underpinning the GMS contract will be amended by July Following this, standard contract variations to GMS contractors will need to be served. The changes that have been agreed to the GMS contract for 2016/17 form part of a wider approach which aims to stabilise, support and transform primary medical services Summary of key changes for 2016/ Contract Uplift and Expenses An investment of 220 million in the contract for 2016/17. This investment will uplift the contract and take into account increasing expenses, covering: a pay uplift of 1 percent an increase in the item of service fee for vaccinations and immunisations to 9.80 changes in the value of QOF points funding to cover increased business expenses (including additional Care Quality Commission costs) Agreement has also been reached on undertaking work in 2016/17 that seeks to determine an agreed methodology for expenses, which all parties might use for the future. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 18

34 8.4. Quality Outcomes Framework (QOF) For 2016/17, there will be no changes to the number of QOF points available, the clinical or public health domains or QOF thresholds. The Contractor Population Index (CPI) will be adjusted to reflect changes on list size and growth in the overall registered population for one year, from 1 January 2015 to 1 January The adjustment to CPI will inform an increase to the value of a QOF point for 2016/17. The national average list size as of 1 January 2016 is 7,460 and the value of a QOF point for 2016/17 will be NHS Employers and GPC have agreed to explore during 2017/18 negotiations, amongst other possibilities, the ending of QOF Enhanced Services It has been agreed to end the directed enhanced service on dementia at 31 March The rationale for this is that it is felt that clinical guidelines and current QOF indicators for dementia are sufficient to ensure appropriate care for patients. The 42 million funding that supported the previous directed enhanced service will be transferred into the value of global sum (with no out of hours deduction being applied to this element). The Avoiding Unplanned Admissions Directed Enhanced Service (DES) will continue for a further year with minor changes to clarify the timeframe for care plan reviews. All other directed enhanced services will continue unchanged for a further year Vaccinations and Immunisations These programmes, which are reserved functions within the CCGs Delegation Agreements, are to continue in 2016/17 with the exception of: the removal of the infant dose of meningococcal C vaccination minor changes to the meningococcal B vaccination programme to withdraw the catch-up element of the programme and the delivery of paracetamol minor changes to the meningococcal ACWY 18 years programme to allow for the opportunistic vaccination of year olds non-freshers who self-present for vaccination Patient Online Services A number of changes to patient online access and information technology have been agreed. These changes are non-contractual, except where specific changes to the GMS Regulations are set out to support the use of the Electronic Prescription Service, the Summary Care Record and GP2GP. They focus on using digital technology to provide more efficient services underpinning general practice, and greater flexibility and choice for patients and practices. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 19

35 The GP Systems of Choice (GPSoC) programme is the process by which the nationally approved and funded systems necessary to provide the patient online facilities will be made available to practices by NHS England. Electronic prescriptions GP practices will be encouraged to transmit prescriptions electronically using Electronic Prescribing Service Release 2, unless the patient asks for a paper prescription or the necessary legislative or technical enablers are not in place. It agreed to aim for at least 80 percent of repeat prescriptions to be transmitted electronically by 31 March Electronic referrals GP practices will be encouraged to make referrals electronically using the NHS e- Referral Service. It has been agreed to aim for at least 80 percent of elective referrals to be made electronically usinmg the NHS e-referral Service by 31 March Summary Care Record NHS England and the GPC will jointly consider ways in which GP practices can be resourced to offer patients the opportunity to add additional information to their Summary Care Record (SCR). Separately, the GMS regulations will be amended to say SCR will be enabled on an ongoing rather than daily basis. GP2GP GP2GP compliant practices will continue to utilise the GP2GP facility for the transfer of all patient records between practices, when a patient registers or deregisters (not for temporary registration). The GMS regulations will be amended so that GP practices are no longer required to seek permission from NHS England not to print out the electronic record where patient records successfully transfer to a new practice using GP2GP. Access to online services Practices will aim for at least 10% of registered patients to be using one or more online services by 31 March Apps for patients to access services GP practices will receive guidance on signposting the availability of apps to patients to allow them to book online appointments, order repeat prescriptions and access their GP record. Apps will be clinically and technically validated during 2016/17 before being made available to patients. Technical support for patients in using the Apps will be provided by the App suppliers. Online access to clinical correspondence GP practices will provide patients with online access to clinical correspondence such as discharge summaries, outpatient appointment letters, and referral letters unless specific requirements of the Data Protection Act 1998 apply to restrict this. Hospitals and other secondary care providers will be expected to copy patients into correspondence as standard, and patients should be enabled to have dialogue with the provider as the primary route to discuss such correspondence. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 20

36 GP practices will have the facility to make available online only those letters received from a chosen prospective date which will be no later than March Information sharing agreements between practices NHS England and GPC will jointly develop a national template data sharing agreement, to facilitate information sharing between practices locally for direct care purposes. This will allow formal sharing agreements to be put place where practices choose to work collaboratively in providing care. Shared discharge summaries and event posting To support the increased use of interoperable records, the NHS Standard Contract requires providers to send their discharge summaries electronically to GP practices from 1 October From April 2016, GP practices will be required to receive all discharge summaries and subsequent post-event messages, electronically. Cyber security NHS England and GPC will continue to promote the completion of the Health and Social Care Information Centre (HSCIC) information governance toolkit, including adherence to the requirements outlined within it. GP practices will also continue under the GMS regulations to nominate a person with responsibility for practices and procedures relating to the confidentiality of personal data Data Collection Named GP NHS England will discuss with GPC during 2016/17 how appropriate and meaningful data relating to the named accountable GP can be made available at practice level through automatic extraction. This will be particularly relevant for patients being case managed and also those aged 75 and over. The data would be shared internally within practices and used for peer review and quality improvement. It is recognised that there are a number of system issues to overcome before this can be implemented. Access survey GP practices will be contractually required to record data on patient access to GP services and allow it to be extracted or manually reported. The data required and the form in which it is to be collected will be discussed between GPC and NHS England. It will be used to inform NHS England of the availability of evening and weekend opening for routine appointments and is to be collected until 2020/21. The data will be collected every six months. This data collection will go through the appropriate corporate governance channels once details have been firmed up Locum GPs In line with other areas of healthcare, where the use of agency staff attracts high fees, NHS England propose setting a maximum indicative rate based on a set of NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 21

37 rates (which may have some degree of regional variation) for locum doctors pay. NHS England will amend the electronic declaration system to include recording on the number of instances where a practice pays a locum doctor more than the maximum indicative rate Access to Healthcare GPC agree to work with DH and NHS England to develop arrangements for identifying patients with European Health Insurance Card (EHIC) and S1 and S2, through patient self-declaration at the point of registration and recording their details with the aim of implementation in December Discussions will consider how to address any additional workload for GP practices Further Work NHS England and GPC have committed to take forward discussions in the coming months on a national approach to reducing bureaucracy and workload management in general practice, a national promotion of self-care and appropriate use of GP services, SFE arrangements for sickness payments and approach to expenses. On expenses, we have also agreed to undertake work in 2016/17 that seeks to determine an agreed methodology that all parties might use. Following the Prime Minister s announcement about plans for an alternative contract, we are clear that the GMS contract will remain available to those practices who wish to continue with it for the foreseeable future Summary of key GMS contract changes in recent years Contract changes 2015/16 On 30 September 2014, NHS Employers and the BMA's General Practitioner's Committee announced changes to the GMS contract in England for 2015/16. The changes included: a named accountable GP, publication of earnings, establishment of a patient participation group, adjustment of QOF point value, extension of; Avoiding Unplanned Admissions, extended hours and learning disabilities directed enhanced services for a further year, and a further commitment to expand and improve the provision of online services for patients. In addition, the alcohol enhanced service and patient participation enhanced service will cease with the associated funding reinvested in global sum Contract changes 2014/15 Changes included a new enhanced service to care for patients who may be at risk of an unplanned admission to hospital, reducing the QOF by 341 points, changes to seniority payments, and a named, accountable GP for patients over 75. NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 22

38 8.15. Contract changes 2013/14 Changes included an increase in global sum of 1.47%, the phasing out of the Minimum Protection Income Guarantee over a seven year period, changes to QOF, vaccination and immunisation and four new enhanced services. END NHS West Kent Clinical Commissioning Group Primary Care Commissioning Committee 23

39 PROPOSED DELEGATION OF AUTHORITY FROM PRIMARY CARE COMMISSIONING COMMITTEE This paper is for: Recommendation: Approval The Primary Care Commissioning Committee is asked to approve the proposed schedule of delegation and reservation of authority to enable operational decisions to be made on its behalf between meetings. For further information or for any enquiries relating to this report please contact: * richard.segall-jones@nhs.net or ( Date: 6 th Sept 2016 Reporting Officer: Richard Segall Jones Agenda Item: 6 Lead Director: Ian Ayres Version: Final Report Summary: This paper sets out a schedule of proposed areas of delegation and reservation of the Committee s authority. The intention is to enable the smooth operation of commissioning and contracting for primary medical care services whilst ensuring that major and strategic decision-making remains with the Committee. Note that the proposal is to vest authority in a small group of senior officers rather than to establish a sub-committee of the Primary Care Commissioning Committee (albeit that those senior officers may choose to be be advised by the work of the Primary Care Operational Group). FOI status: This paper is disclosable under the FOI Act Strategic objectives links: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities Having a robust primary care sector will contribute to improved health outcomes and reduced health inequalities and be in inaugural part of developing the new models of primary care a key strand of the mapping the future blueprint. September 2016 NHS West Kent CCG

40 Board Assurance Framework links: Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: F: Robust governance: In order to demonstrate appropriate governance arrangements are in place as a delegated commissioner of primary care, the CCG needs to be able to evidence how it is applying robust corporate governance arrangements in the execution of its delegated responsibilities. Without a suitable scheme of delegation, all relevant decisions would need to come before the bi-monthly meetings of the Primary Care Commissioning Committee. It is envisaged that this would make the operational management of day-to-day commissioning and contracting unworkable. Thus a scheme of delegation is necessary but should be reviewed periodically to ensure it continues to satisfy the Committee and meet all necessary governance requirements. No additional resources will be required to implement the scheme of delegation. No legal implications identified. Equality Assessment to be completed. None. Proposed scheme of delegation and reservation. If the Primary Care Commissioning Committee approves the scheme of delegation and reservation it will be implemented immediately. September 2016 NHS West Kent CCG

41 PROPOSED DELEGATION OF AUTHORITY FROM PRIMARY CARE COMMISSIONING COMMITTEE May be delegated In line with agreed NHS England Standard Operating Policies and Procedures for Primary Medical Services, to take action on the following items: Urgent* partnership issues including 24 hour retirements, partnerships becoming sole contractors Urgent* contractual changes including practice and contract mergers, boundary changes, branch closures/openings, contract variations, list closures, remedial and breach notices Quality issues urgent* action relating to matters including serious incidents, CQC inspections, cold chain events Premises including initial scrutiny of Project Initiation Documents (PIDs) for premises developments and minor improvement grants, rent reviews sale and leaseback To whom - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies - Chief Nurse plus AO or COO - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies - GP Information Management and Technology operational issues (i.e. not investment decisions) - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies Correspondence with practices on the above issues, to ensure decisions are made with the fullest possible information and to communicate back to practices clearly and promptly - AO, Chief Operating Officer and Chief Finance Officer or Chief Nurse or deputies (as appropriate) Urgent* or minor discretionary payments < 25k - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies Other urgent* operational issues - Chief Operating Officer Working with NHS England, the practice(s) and South East Commissioning Support Unit to manage any likely media impact of primary medical care co-commissioning decisions - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies

42 May be delegated Taking necessary urgent* contractual action such as issuing branch/remedial notices and removing a contract * Urgent = where time constraints will not allow for deliberation at PCCC To whom - Two of Accountable Officer, Chief Operating Officer or Chief Finance Officer or nominated deputies RESERVED TO PCCC Decisions on the following: General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Providers of Medical Services (APMS) contracts (including the design of PMS and APMS contracts taking routine contractual action (such as issuing breach/remedial notices and removing a contract) approving practice mergers newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services ) design approval of local incentive schemes and any alternative to the Quality Outcomes Framework (QOF) Approve estates strategy; approve commissioning new GP practices in an area planning new primary care estate business Cases for premises developments approving discretionary payments > 25k major investment decisions arising from CCG Governing Body decisions relating to primary care (e.g. IT systems) > 25k year-end sign-off of the Quality and Outcomes Framework (QOF) [move to delegation CFO or nominated deputy] review and approve broader strategic Primary Care developments as they arise, including Locally Commissioned Services other strategic items, as required.

43 This paper is for: Recommendation: Memorandum of Understanding Approval The Primary Care Co-commissioning Committee is requested to approve the request for tier 3 level support for NHS West Kent CCG and tier 4 level support as required as outlined in the attached Memorandum of Understanding (MOU) and to encourage CCG officers to feedback any specific queries to NHS England. For further information or for any enquiries relating to this report please contact: Louise Matthews louise.matthews5@nhs.net, ( Date: 6 th September 2016 Reporting Officer: Louise Matthews Agenda Item: 7 Lead Director: Gail Arnold Version: Final Report Summary: (A précis of the contents of the report) The MOU offers four tiers of support (see pages 6-8 of the MOU). Tier 1 Core Support (provided to all CCGs) Tier 2 Priority Support (applicable to all CCGs) Tier 3 Standard Support (optional to delegated CCGs) Tier 4 Extended Support (may be available to delegated CCGs on request) The CCG are being asked to confirm 1. details of our named signatory (see on page 16 of the MOU) 2. contact details for the CCG as set out in Appendix 2 Table 3 (page 19 of the MOU). 3. the Tiers of Support that the CCG wish to take up from NHS England South East with regards to GP contracting support (page 20 of the MOU) FOI status: This paper is disclosable under the FOI Act; Strategic objectives links: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities Having a robust primary care sector will contribute to improved health outcomes and reduced health inequalities and be in inaugural part of developing the new models of primary care a key strand of the mapping the future blueprint. 6 September 2016 NHS West Kent CCG Page 1 of 2

44 Board Assurance Framework links: Identified risks & risk management actions: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities In order to demonstrate appropriate governance arrangements are in place as a delegated commissioner of primary care the CCG needs to be able to evidence how it is applying the relevant policy, guidance and standard operating procedures that relate to primary care commissioning. If the CCG does not accept the MOU support offered it may have difficulty meeting its obligations as a delegated co-commissioner. Resource implications: Legal implications including equality and diversity assessment There is no financial cost to the CCG for accepting the tiers of support outlined in the MOU, it does have implications for how the Primary Care Team (CCG) and the GP Team (NHS England South East) work together The Policy Book for Primary Medical Services ( aims to support a consistent and compliant approach to primary care commissioning across England. It is essentional that any decisions relating to primary care confirm to this guide and other statutory regulations and standard operating procedures that are in force. Report history: Not considered previously by this committee. Appendices 1 The MOU which contains appendices 1-3 (Appendix 1 List of Delegated Functions, Appendix 2 List of Contacts, Appendix 3 CCG by CCG support requirements from NHS E GP Contracts Team) 2 Appendix 4 - Staffing structure of GP contracts team 3 Appendix 5 - NHS E South East GP Contracts Team Governance structure 4 Annex A - finance 5 Annex B nursing and quality 6 Annex C - communications Next steps: To approve the level of support requested by the CCG and to encourage CCG officers to feedback any specific queries to NHS England. 6 September 2016 NHS West Kent CCG Page 2 of 2

45 Memorandum of Understanding Between Ashford CCG, Canterbury & Coastal CCG, Coastal West Sussex CCG, Dartford, Gravesham & Swanley CCG, Eastbourne, Hailsham & Seaford CCG, Hastings & Rother CCG, High Weald, Lewes & Havens CCG, North West Surrey CCG, Swale CCG, West Kent CCG & NHS England South (South East) for Primary Medical Services Commissioning and Contracting Support Version 2 NHS E South East - Page 1 of 22 27/06/2016

46 1. Introduction This Memorandum of Understanding (MoU) sets out the working arrangements and responsibilities for the delivery of primary medical services co-commissioning in NHS England South East (NHS E South East) under delegated commissioning (Level 3) from 01 April 2016 to 31 March 2017, between NHS E South East and the following 10 Clinical Commissioning Groups. Ashford CCG Canterbury & Coastal CCG Coastal West Sussex CCG Dartford, Gravesham & Swanley CCG Eastbourne, Hailsham & Seaford CCG Hastings & Rother CCG High Weald, Lewes & Havens CCG North West Surrey CCG Swale CCG West Kent CCG 2. Background Co-commissioning enables CCGs to have greater influence on decisions relating to primary medical services and enables an integrated approach to improving health care locally, providing opportunities for a more collaborative approach to designing local solutions to support delivery of CCG primary care strategies as well as the wider strategic aims of CCGs. Fully delegated co-commissioning status (Level 3) empowers CCGs to take decisions in accordance with the Delegation that exists between them and NHS England. The table below identifies the current co-commissioning status of each of the 20 CCGs across NHS E South East as of 01 April CCG Status as of 01 April 2016 Ashford Fully delegated (Level 3) Brighton & Hove Greater involvement (Level 1) Canterbury & Coastal Fully delegated (Level 3) Crawley Greater involvement (Level 1) Coastal West Sussex Fully delegated (Level 3) Dartford, Gravesham & Swanley Fully delegated (Level 3) Eastbourne, Hailsham & Seaford Fully delegated (Level 3) wef 01/04/15 East Surrey Greater involvement (Level 1) Guildford & Waverley Greater involvement (Level 1) Hastings & Rother Fully delegated (Level 3) High Weald, Lewes & Havens Fully delegated (Level 3) wef 01/04/15 Horsham & Mid Sussex Greater involvement (Level 1) Medway Greater involvement (Level 1) North West Surrey Fully delegated (Level 3) South Kent Coast Greater involvement (Level 1) Surrey Downs Greater involvement (Level 1) Surrey Heath Greater involvement (Level 1) Swale Fully delegated (Level 3) Thanet Greater involvement (Level 1) West Kent Fully delegated (Level 3) Version 2 NHS E South East - Page 2 of 22 27/06/2016

47 NHS E South East will continue to commission primary medical services for the 10 CCGs that have retained their Level 1 (Greater Involvement) status as well as for community pharmacy, dental and optometric services across the entirety of NHS E South East. Individual CCG Delegation Agreements identify three models of staff deployment to support CCGs with their delegated commissioning responsibilities. These are: Assignment of NHS England staff to support CCGs Secondment of NHS England staff to a CCG or CCGs Direct employment of staff by the CCG. CCGs were required to set out their approach to staffing and mobilisation within their Delegation Agreement submissions. In this respect it is possible for CCGs to utilise a hybrid approach of the above models. Across the CCGs that are to be signatories to this MoU a hybrid approach is to be adopted comprising of assignment and CCG directly employed staffing. These arrangements are set out within each CCGs Delegation Agreement submission (specifically within Schedule 7 of the Delegation Agreement). The hybrid approach seeks to ensure that CCGs have the benefit of support from a range of NHS E South East staff. The approach recognises that staff capacity is limited and that the staff resources historically deployed to deliver the majority of functions associated with commissioning, procurement and management of primary medical services contracts remain within NHS England. 3. Purpose The purpose of this MoU is to set out how various parties will contribute to the delivery of primary medical services contracting and commissioning functions across the respective CCGs operating under delegated co-commissioning arrangements. In doing so NHS England and CCGs need to ensure they are able to share expertise and knowledge to enhance strategy, policy development and decision making by working in an integrated way. The MoU provides a framework through which CCGs will be supported by NHS E South Eaast in delivering their delegated functions. The MoU needs to be read and understood in the broader context of the Delegations held by CCGs. For the avoidance of doubt this MoU does not replace or supersede the requirements of CCGs Delegations. In this respect the Delegation clarifies the commissioning functions that CCGs are responsible for, and these are listed as set out in the Delegation, in Appendix Key Principles The CCGs that are subject to this MoU and NHS E SE agree that: The provisions contained within the MoU are not legally binding. There is no associated financial value to the MoU and nor does the MoU require any financial transaction to be made between the CCGs and NHS E in respect of the described and agreed areas of functional support that are to be made available to CCGs by NHS E South East (although there will be some cross-charging to CCGs in respect of specific service contracts that will continue to be held and managed by NHS E South East). Version 2 NHS E South East - Page 3 of 22 27/06/2016

48 The delivery of core functions is essential this includes payment processes for practices. Significant expertise and knowledge to deliver these functions resides within the GP Contracts Team at NHS E South East. The service offer outlined within this MoU describes support by way of functions. NHS E South East staff responsible for the delivery of MoU support functions will neither be assigned nor dedicated to individual CCGs as they have responsibilities that span numerous CCGs and may also hold wider responsibility for other functions. Some staff within the GP Contracts Team at NHS E South East have been designated to support a number of individual delegated CCGs and will act as key points of contact and liaison with these CCGs. The existing GP Contracts Team need to agree practical and effective working relationships with all CCGs in 2016/17. Delegated CCGs wish to operate in different ways and are at differing stages of development and face different challenges. Consequently this MoU attempts to offer a more bespoke level of support to CCGs since a one-size fits all approach was not considered to be helpful. 5. Objectives The objectives of this document are to outline the agreed working arrangements for the delivery of primary medical services commissioning in respect of: CCGs already holding or taking on full delegation having access to a share of the GP contracts team staffing resource to enable delivery of their commissioning responsibilities. NHS E South East having sufficient operational capacity to deliver all its ongoing primary care commissioning responsibilities both for those CCGs operating at level 1 and to deliver on-going primary care responsibilities in relation to those other areas of primary care commissioning (dental, pharmacy and optometry) which are not currently included in co-commissioning. 6. Points of Agreement All parties agree that the smooth transition of functions associated with the commissioning, procurement and management of primary medical services contracts is paramount. The aim is to avoid any interruption to the effective delivery of these contracts and therefore safeguard: access to primary medical services for local people; the quality and outcomes of primary medical services; practice payment and reimbursement systems and processes. NHS E South East and Level 3 CCGs agree that decisions, functions and associated tasks being delegated to CCGs will be managed in accordance with the Delegation, the relevant Regulations and Directions relating to primary medical services, and the CCG s standing orders and internal governance arrangements. Specifically the following overarching operating points of agreement are agreed: CCGs should be the initial point of contact for their member practices with regard to all GP commissioning and contracting issues. Version 2 NHS E South East - Page 4 of 22 27/06/2016

49 CCGs will take responsibility for decision making for all GP commissioning and contracting issues (apart from those that are Reserved Functions or are as otherwise agreed). CCGs will establish and administer the necessary and required governance arrangements which enable decisions to be made in accordance with NHS England policy and guidance in a timely way. NHS E South East will support CCGs in carrying out designated tasks and will provide information, advice and guidance related to the delegated functions. Section 7 of the MoU sets out the detail of this support. CCGs operating under delegated co-commissioning arrangements understand that NHS E SE also needs to support those practices and CCGs operating at Greater Involvement. 7. Functional Support from NHS E South East The support that is to be provided from NHS E South East will cover the following six areas: Resources and networks Commissioning and contracting GP Practice Premises Finance Nursing & Quality Communications and engagement 7.1 Resources and networks (available to all delegated CCGs) One-off payment of 30K which each CCG can use at its discretion to facilitate transition. Standard CCG subscription to Primary Care Commissioning paid for by NHS E South East. This will provide each CCG with access to a helpdesk and to training events. The creation of primary care contracting networks for delegated CCGs to participate in, facilitated through NHS E South East own subscription to Primary Care Commissioning. Access to masterclasses and shared learning/training events that will be delivered with NHS E South East and provided by Primary Care Commissioning. A designated strategic lead officer and a designated operational support officer who will act as the principal points of contact with each delegated CCG. Senior representation at CCG PCCC meetings. Monthly liaison meeting with the GP contracts Team designated Contracts Officer The NHS E Policy Book for Primary Medical Services (see hyperlink below) which provides commissioners with the context, information and tools to safely commission and contract mange primary medical care contracts. Electronic copies of all GP contracts within the CCG, copies of relevant correspondence relating to live issues, and a summary document relating to existing GP practice premises. NHS E South East development and sharing of a GP practice quality dashboard by October Version 2 NHS E South East - Page 5 of 22 27/06/2016

50 A list of key contacts across NHS E South East and delegated CCGs is attached as Appendix Commissioning and Contracting Support (GP Contracts Team) NHS E South East will offer the following Tiers of GP contracting support to CCGs delivered principally through its GP Contracts Team. Appendix 2 confirms, on a CCG by CCG basis, the respective functional support requirements of each delegated CCG. Tier 1 - Core Support (this will be provided to all CCGs): Definition: The core support relates to the following specific functions that NHS E will undertake or make available across all CCGs irrespective of their delegation status: Service support from Primary Care Support England in line with the national contract Management and coordination of those national programs that are not delegable Managing the processes in relation to Improvement Grants and other capital programs Managing the contracts for various interpreting service and for cross charging CCGs* Managing the contracts for clinical waste services and for cross charging CCGs* Management and coordination of the DoHs Central Alerting Service for the cascade of patient safety alerts Managing the contracts for GP occupational health services and for cross-charging CCGs* Coordination and liaison role in managing those complaints about GP services and practices within the CCG that are submitted to NHS England Management and coordination of other Reserved Functions as outlined in Delegation. *The cross-charging arrangements will need to be agreed between the respective finance teams of the CCGs and NHS E South East. Tier 2 Priority Support (applicable to all CCGs) Intensive support in the event of crisis situations (e.g.: death of a single-hander, multiple contract terminations, sudden closure of a practice following CQC decision to revoke or suspend a contractor s registration) that require the urgent collective effort of suitably experienced personnel across the CCG and NHS E South East. It is understood that the need to provide and make available Tier 2 support, may mitigate the ability of NHS E South East to provide all of the functions described in Tiers 3 and 4. Tier 3 - Standard Support (optional to delegated CCGs) Definition: The Standard Support Offer relates to the following specific functions that the NHS E South East would routinely provide to those delegated CCGs that require this support. Version 2 NHS E South East - Page 6 of 22 27/06/2016

51 Attendance at CCG PCOG meetings. Issuing mandatory and statutory contract variations Processing the contract variation paperwork for routine contract variations (e.g.: partnership changes) which can be processed in accordance with the Regulations, and which do not require a decision, and where the correct instruction has been received from the contractor via the CCG. Processing the contract variation paperwork for those contract changes that do require a CCG commissioning and contracting decision following a decision being taken by the CCG and receipt of the correct instruction and documentation from the contractor and CCG (e.g.: contract mergers, list closure, branch surgery closure, boundary changes). For managing patient allocations and for providing monthly reports about the volume and distribution of patient allocations For managing the allocation of patients onto the Violent Patient Scheme (NB: delegated CCGs would be responsible for the commissioning and contracting arrangements for this Directed Enhanced Service in accordance with the Delegation). For assessing and calculating payments for CCG approval under the SFE in relation to maternity/paternity leave and sickness. NHS E South East Premises Group to provide oversight and assurance role over GP contractor premises development proposals in advance of CCG decision making. Instructing an appointed surveyor (e.g.: the District Valuer) to undertake 3 yearly rent reviews in line with the obligations set out in the 2013 Premises Directions. To provide advice to CCGs in those areas where a CCG decision, judgment or interpretation of the Regulations is required (i.e.: practice mergers, branch surgery closure applications, list closure applications). Provision of advice in relation to the CCGs management of poor contractor performance and service delivery. Attendance at meetings with contractors to support the CCG as part of an agreed escalation process. Management of CQRS in line with CCGs declared position with HSCIC Development, roll-out and maintenance of a GP practice quality benchmarking tool For assisting with, and providing advice on, procurement processes for the award of new APMS contracts. Tier 4 Extended Support (support that may be available to delegated CCGs on request) Definition: Extended Support relates to the following specific functions that may be requested by a delegated CCG, from time to time, and where the request will be considered by NHS E South East. NHS E South East would aim to provide the support requested (or elements of the support requested) but would need to be cognisant of other pressures in determining whether or not it was able to provide the support asked for. Extended Support List of Functions: Advising the CCG in relation to its development of business cases and options appraisals following notice being served by a contractor(s) to terminate their GMS/PMS/APMS contract. Version 2 NHS E South East - Page 7 of 22 27/06/2016

52 Advising the CCG with the development of Committee papers in relation to a decision about whether or not to issue breach/remedial notices or termination notices Providing advice on the CCGs drafting of breach and remedial notices. Providing advice on the CCGs drafting of termination notices. The majority of the support described in the Tiers of Support above will be provided by NHS E South East s GP Contracts Team. Appendix 4 sets out the existing establishment of the GP Contracts Team. 7.3 GP practice premises and technology NHS England agrees to support the CCGs by providing support and advice on premises issues. Initially, and until agreement by both NHS England and the CCG, all significant premises issues in the CCG area will be brought to the monthly NHS England Premises Group for consideration. A CCG representative will join the meeting for these agenda items. The Premises Group will make recommendations only in respect of those GP practice premises issues within delegated CCGs. These recommendations can then be presented to the CCGs Primary Care Operational Group and/or CCG Primary Care Commissioning Committee for decision. Through the Estates and Technology Transformation Fund (ETTF), CCGs will lead on the development of commissioning plans, including producing Local Estates Strategies and Digital Plans that will make clear their specific priorities for investment. The support for the development of primary care under the ETTF will continue to be a regionally managed process whereby CCGs will submit new scheme developments as and when ready and necessary. This will allow each region to maximise the investment available. 7.4 Finance The arrangements for finance and payments are set out in Annex A. 7.5 Nursing and Quality The support that is to be made available to CCGs from NHS E South East Nursing & Quality directorate is set out in Annex B. 7.6 Communications and Engagement A protocol for the management of communications is attached as Annex C. 8. Other functions and further work 8.1 Reserved Functions Schedule 3 of the Delegation between NHS England and CCGs sets out the specific Reserved Functions that are to remain with NHS England. The Reserved Functions are as follows: Version 2 NHS E South East - Page 8 of 22 27/06/2016

53 management of the national performers list; management of the revalidation and appraisal process; administration of payments in circumstances where a performer is suspended and related performers list management activities; Capital Expenditure Functions; Section 7A Functions; functions in relation to complaints management; decisions in relation to the Prime Minister s Challenge Fund (now known as the GP Access Fund ); and such other ancillary activities that are necessary in order to exercise the Reserved Functions. 8.2 Complaints As per the delegation agreement complaints are a reserved NHS England function. A quarterly report will be provided by the NHS E complaints team. 8.3 Section 7A Section 7A functions are acknowledged by NHS England and CCGs to be part of the reserved functions and no funds in respect of amounts payable in relation to Section 7A functions are included under delegated funds. This is regardless of whether arrangements are included in or under primary medical services contracts or not. NHS England remains responsible and accountable for the discharge of the Section 7A functions. 8.4 Information Governance As per section E of the Delegation Agreement 8.5 Incident Reporting Current arrangements for incident reporting will continue and STEIS reporting shall continue to be managed by the Nursing & Quality Team of NHS E South East. 8.6 Further work It is recognised that there are a number of areas where more detail is required to underpin specific elements of the operational support provided under this MoU. NHS E South East will lead on the development of flowcharts/protocols/guidance notes, as appropriate, on the following areas: Violent patient scheme Cross charging arrangements Responding to Care Quality Commission reports and interventions Whistleblowing Version 2 NHS E South East - Page 9 of 22 27/06/2016

54 9. Governance 9.1 NHS England South East Appendix 5 shows the proposed governance structure that will be managed by NHS England South East that specifically relates to commissioning and contracting of primary medical services. 9.2 CCGs The governance arrangements for delegated commissioning are articulated in each CCGs constitution and in the Terms of Reference for its Primary Care Commissioning Committee. It is anticipated that CCGs will hold monthly Primary Care Operational Groups which will routinely be attended by members of the GP Contracts Team. 9.3 Relationship and Points of Contact The GP Contracts Team will work across all CCGs but in addition each CCG will have direct access to a GP Contracts Team Contracts Manager and Contracts Officer through named leads. A Senior Manager from NHS E South East will be designated to attend each CCG Primary Care Commissioning Committee during 2016/17. The ongoing need for this representation will be assessed during Q4 of 16/17. The two Primary Care Leads will lead the GP Contracts Team on a day to day basis The two Primary Care Leads will oversee the operational business interface with each individual CCG and coordinate matrix working across teams within NHS E South East. 9.4 Supporting Transition NHS England will arrange to meet with each CCG to provide a summary of all transitional issues currently being dealt with by NHS England that will need to be managed via delegated commissioning arrangements. The GP Contracts Team will also provide a brief document summarising all transitional issues currently being dealt with by NHS England that will need to be managed via these new arrangements. 9.5 Review of the MoU A review of the MoU will be undertaken during Quarter 3 of 2016/17 led by the Director of Commissioning and through a process that will engage both Level 1 and Level 3 CCGs and other directorates within NHS E South East. The review will seek to assess what has worked well and less well from a number of perspectives and the operation delivery of the MoU in terms of providing effective and timely support to CCGs such that they are able to manage their delegated responsibilities. The review will outline recommendations in respect of the following: Operational changes that are needed to the existing MoU provisions Substantive changes to the level and nature of support provided by NHS E South East in the remainder of 16/17 and which would need to be subsequently agreed by all parties to the MoU. The content of the MoU to support co-commissioning arrangements for 2017/18 Version 2 NHS E South East - Page 10 of 22 27/06/2016

55 10. Variations to the Memorandum of Understanding Either party is able to request a variation to the Memorandum of Understanding at any point in time. Any requests to vary the Memoranda should be raised with the Director of Commissioning within NHS E South East. If both parties agree to the changes, this will be confirmed through an amendment to the existing Memorandum of Agreement. 11. Service Sustainability NHS E South East s ability to deliver this MoU is subject to: Delegated CCGs agreeing to a standardised approach deviation away from this may result in a decreased level of service delivery. CCGs agreeing not to fragment the existing staffing resource as this will limit the ability of NHS E South East to deliver the support outlined. CCGs agree risk share and collective consistent approach to commissioning arrangements where appropriate. 12. Terms of the Agreement As this is an evolving document, quarterly reviews will be undertaken and any amendments signed off by the CCGs and NHS England at an operational level. These arrangements will be reviewed during the period with a view to either agreeing a continuation of the model into future years or its cessation and movement to a new arrangement. 13. Signatories 13.1 On behalf of NHS England South East Signature Name and Designation.. Date Version 2 NHS E South East - Page 11 of 22 27/06/2016

56 13.2 On behalf of Ashford CCG Signature. Name and Designation Date 13.3 On behalf of Canterbury & Coastal CCG Signature. Name and Designation Date Version 2 NHS E South East - Page 12 of 22 27/06/2016

57 13.4 On behalf of Coastal West Sussex CCG Signature. Name and Designation Date 13.5 On behalf of Dartford, Gravesham & Swanley CCG Signature. Name and Designation Date Version 2 NHS E South East - Page 13 of 22 27/06/2016

58 13.6 On behalf of Eastbourne, Hailsham & Seaford CCG Signature. Name and Designation Date 13.7 On behalf of Hastings & Rother CCG Signature. Name and Designation Date Version 2 NHS E South East - Page 14 of 22 27/06/2016

59 13.8 On behalf of High Weald, Lewes & Havens CCG Signature. Name and Designation Date 13.9 On behalf of North West Surrey CCG Signature. Name and Designation Date Version 2 NHS E South East - Page 15 of 22 27/06/2016

60 13.10 On behalf of Swale CCG Signature. Name and Designation Date On behalf of West Kent CCG.. Signature Ian Ayres, Accountable Officer.. Name and Designation. Date Version 2 NHS E South East - Page 16 of 22 27/06/2016

61 Appendix 1 List of Delegated Functions 1.1. The role of the CCG will be to exercise the Delegated Functions in the Area The Delegated Functions are the functions set out in Schedule 1of the Delegation and being: decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities: decisions in relation to Enhanced Services; decisions in relation to Local Incentive Schemes (including the design of such schemes); decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; decisions about discretionary payments; decisions about commissioning urgent care (including home visits as required) for out of area registered patients; the approval of practice mergers; planning primary medical care services in the Area, including carrying out needs assessments; undertaking reviews of primary medical care services in the Area; decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list); management of the Delegated Funds in the Area; Premises Costs Directions Functions; co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and such other ancillary activities that are necessary in order to exercise the Delegated Functions Schedule 2 (Delegated Functions) sets out further detail in relation to the Delegated Functions and the exercise of such Delegated Functions. Version 2 NHS E South East - Page 17 of 22 27/06/2016

62 1.4. The CCG agrees that it must perform the Delegated Functions in accordance with: the Delegation; the terms of this Agreement; all applicable Law; the CCG s constitution; Statutory Guidance; and Good Practice. 6.4A The CCG must have due regard to Guidance and Contractual Notices Without prejudice to clause 6.4, the CCG agrees that it must perform the Delegated Functions in such a manner as to ensure NHS England s compliance with NHS England s statutory duties in respect of the Delegated Functions and to enable NHS England to fulfil its Reserved Functions When performing the Delegated Functions, the CCG will not do anything, take any step or make any decision outside of its delegated authority as set out in the Delegation Without prejudice to any other provision in this Agreement, the CCG must comply with the NHS England central finance team s operational process (as such process is updated from time to time) for the reporting and accounting of the Delegated Funds. In particular, the CCG will be required to permit the NHS England central finance team and/or their agents and contractors authorised by them to have the ability to access the CCG ledger to provide the services required to deliver financial support and assistance to the CCG necessary to enable them to manage the Delegated Funds and exercise the Delegated Functions. NHS England and the CCG will agree any accruals to be made including any adjustments related to the relevant Financial Year expenditure to ensure no net financial impact or gain on the CCG The decisions of the CCG in exercising the Delegated Functions will be binding on the CCG and NHS England. Version 2 NHS E South East - Page 18 of 22 27/06/2016

63 Appendix 2: List of contacts Table 1: NHS England points of contact GP contracts team CCG Strategic Lead Contract Manager Contract Support Ashford Richard Woolterton/David Valerie Gibson Vacancy Selling Canterbury & Coastal Richard Woolterton/David Valerie Gibson Vacancy Selling Coastal West Sussex Stephen Ingram/Kirsty Monica Cox Marian Ryland Lewis Dartford, Gravesend & Richard Woolterton/David Sam Harris Vacancy Swanley Selling Eastbourne, Hailsham & Stephen Ingram/Kirsty Jas Kumari Tina Afiryie Seaford Lewis (Interim) Hastings & Rother Stephen Ingram/Kirsty Jas Kumari Tina Afiryie Lewis (Interim) High Weald Lewes & Stephen Ingram/Kirsty Jas Kumari Tina Afiryie Havens Lewis (Interim) North West Surrey Stephen Ingram/Kirsty Lewis Siobhan Cambridge Suzanne Case- Green Swale Richard Woolterton/David Sam Harris Vacancy Selling West Kent Richard Woolterton/David Selling Cheryl Turner Vacancy Table 2: NHS E points of contact Finance, nursing & quality and communications teams CCG Finance Nursing & Quality Communications Ashford Andrew Wills Bonnie Wyatt Sarah Whitehead Canterbury & Coastal Andrew Wills Bonnie Wyatt Sarah Whitehead Coastal West Sussex Jeevan Mahesan Alison Walton Sarah Whitehead Dartford, Gravesend & Swanley Andrew Wills Bonnie Wyatt Sarah Whitehead Eastbourne, Hailsham & Seaford Jeevan Mahesan Alison Walton Sarah Whitehead Hastings & Rother Jeevan Mahesan Alison Walton Sarah Whitehead High Weald Lewes & Havens Jeevan Mahesan Alison Walton Sarah Whitehead North West Surrey Jeevan Mahesan Alison Walton Sarah Whitehead Swale Andrew Wills Bonnie Wyatt Sarah Whitehead West Kent Andrew Wills Bonnie Wyatt Sarah Whitehead Table 3: CCG points of contact CCG Primary care Finance Nursing & Quality contract liaison Ashford Wendy Malkinson Canterbury & Coastal Wendy Malkinson Coastal West Sussex Laura Wade Dartford, Gravesend & Swanley Eastbourne, Hailsham & Seaford Nic Hone Fiona Kellet Alison Cannon Hastings & Rother Nic Hone Fiona Kellet Alison Cannon High Weald Lewes & Havens Elizabeth Tinley North West Surrey Helen Snelling Swale Jim Loftus West Kent Jo Louise Matthews/ 8b post holder Reg Middleton/ Yin Yau Alison Brett/ Debbie Dunn Version 2 NHS E South East - Page 19 of 22 27/06/2016

64 Appendix 3: CCG by CCG support requirements from NHS E GP Contracts Team CCG Tier 1 Tier 2 Tier 3 Tier 4 Ashford YES YES TBC TBC Canterbury & Coastal YES YES TBC TBC Coastal West Sussex YES YES TBC TBC Dartford, Gravesend & Swanley YES YES TBC TBC Eastbourne, Hailsham & Seaford YES YES TBC TBC Hastings & Rother YES YES TBC TBC High Weald Lewes & Havens YES YES TBC TBC North West Surrey YES YES TBC TBC Swale YES YES TBC TBC West Kent YES YES TBCYES TBCYES as required Version 2 NHS E South East - Page 20 of 22 27/06/2016

65 Appendix 4: Staffing structure of GP contracts team Please see attached document. Version 2 NHS E South East - Page 21 of 22 27/06/2016

66 Appendix 5: NHS E South East GP Contracts Team Governance structure Please see attached document. Version 2 NHS E South East - Page 22 of 22 27/06/2016

67 South East Commissioning (GP Team) Structure June 2016 Primary Care Lead (8d) RICHARD WOOLTERTON 1 WTE Primary Care Lead (8d) STEPHEN INGRAM 1 WTE Senior Contract Manager - GP (8c) DAVID SELLING 1 WTE Business Support (Snr.Team) (4) ALEX WILLIAMS 1 WTE Senior Contract Manager GP (8c) KIRSTY LEWIS 1 WTE Contract Officer GP (8a) SAM HARRIS 1 WTE Contract Officer - GP (8a) CHERYL TURNER 1 WTE Contract Officer - GP (8a) VALERIE GIBSON 1 WTE Contract Officer GP (8a) VANESSA DOSHI 1 WTE Mat. Lve. Oct.16 Contract Officer - GP (8a) VACANT 1WTE Contract Officer GP (8a) SIOBHAN CAMBRIDGE 1 WTE Contract Officer GP (8a) MONICA COX 1 WTE Primary Care Commissioning Support (7) XANTEN BROOKER 1 WTE Mat. Lve. April- Dec 16 LINDA TODMAN ACTING-UP Primary Care Commissioning Assistant (6) VACANT 1 WTE Primary Care Commissioning Assistant (6) MAT LEAVE COVER DEBBIE HARDING 1 WTE Primary Care Commissioning Assistant (6) VACANT 1 WTE Primary Care Commissioning Assistant (6) TINA AFIRYIE 1 WTE Primary Care Commissioning Assistant (6) SUZANNE CASE-GREEN 1 WTE Primary Care Commissioning Assistant (6) MARIAN RYLAND 1 WTE ** Business Support Administrator (4) JOSIE WALLACE 1 WTE Business Support Administrator (4) JOANNE ALLEN 1 WTE Business Support Administrator (4) JANET MITCHELSON 0.8 WTE Business Support Assistant (3) VACANT 1 WTE Business Support Assistant (3) ASHLEIGH COPPING 1 WTE Business Support Assistant (3) BEN? 1 WTE Business Support Assistant (3) ANNA FOWLER 1 WTE Business Support Assistant (3) PATRICIA WALTON 1 WTE Business Support Assist. (3) AMARJEET KAUR 1 WTE 1

68 GP team split over STP footprints May DG&S/Swale/West Kent/Ashford /Canterbury 1 North West Surrey* 4 EH&S/H&R/HWL&H/ Coastal West Sussex 3 Medway/Thanet /South Kent Coast Kent & Medway STP c. 260 GP Cont. 3 Surrey Downs Guildford & Wav. Surrey Heath (Frimley STP) Surrey Heartlands STP c. 105 GP Cont. 4 Crawley/Horsham & Mid- Sussex/Brighton & Hove/East Surrey Surrey & Sussex STP c. 225 GP Cont. Richard Woolterton David Selling Senior Lead Sam Harris Valerie Gibson Cheryl Turner Deputy Lead Operational Leads (attend CCG Ops. Groups) Strategic Leads (attend CCG Committees) Siobhan Cambridge Stephen Ingram Kirsty Lewis Senior Lead Deputy Lead Alex Williams (Snr. Team Support) Monica Cox Jas Kumari (interim cover) Vanessa Doshi (ML) Linda Todman Xan Brooker (ML) GP CONTRACTING HUB Vacancy B Vacancy B6 1.00? Suzanne Case-Green Tina Afiryie Marian Ryland Janet Mitchelson Joanne Allen Josie Wallace Ben? Vacancy B3 x 2 Tricia Walton Anna Fowler Amarjeet Kaur Lead Areas: MOU/Premises Group/ Contract Panel / P.C.Oversight Group/Regulations/Directions /APMS/PMS/OH & Clin. Waste / PCTF/PMCF Planning / CQC & Quality/Vulnerable Pract./ Enh.Servs &CQRS/Capita PCS/ National Programmes / Risk Register /Corporate issues 2

69 STP CCG Co-Comm Status Contract Officer- Operational Lead (Designated) Commissioning Assistant Senior Contract Manager Primary Care Lead Kent & Med. Dartford, Grav. & Swanley L3 deleg. Sam Harris Vacant David Selling Richard Woolterton Kent & Med. Swale L3 deleg. Sam Harris Vacant David Selling Richard Woolterton Kent & Med. Medway L1 Sam Harris Vacant David Selling Richard Woolterton Kent & Med. West Kent L3 deleg. Cheryl Turner Vacant David Selling Richard Woolterton Kent & Med. Thanet L1 Cheryl Turner Vacant David Selling Richard Woolterton Kent & Med. South Kent Coast L1 Cheryl Turner Vacant David Selling Richard Woolterton Kent & Med. Ashford L3 deleg. Valerie Gibson Vacant David Selling Richard Woolterton Kent & Med. Canterbury & Coastal L3 deleg. Valerie Gibson Vacant David Selling Richard Woolterton Surrey Heartlands North West Surrey L3 deleg. Siobhan Cambridge Suzanne Case-Green Kirsty Lewis Stephen Ingram Surrey Heartlands Surrey Downs L1 Siobhan Cambridge Suzanne Case-Green Kirsty Lewis Stephen Ingram Surrey Heartlands Guildford & Waverley L1 Siobhan Cambridge Suzanne Case-Green Kirsty Lewis Stephen Ingram Frimley Surrey Heath L1 Siobhan Cambridge Suzanne Case-Green Kirsty Lewis Stephen Ingram Surrey & Sussex Eastbourne, Hail.& S ford L3 deleg. Jas Kumari (interim) Surrey & Sussex Hastings & Rother L3 deleg. Jas Kumari (interim) Surrey & Sussex High Weald, Lew. & Hav. L3 deleg. Jas Kumari (interim) Surrey & Sussex Brighton & Hove L1 Jas Kumari (interim) Tina Afiryie Kirsty Lewis Stephen Ingram Tina Afiryie Kirsty Lewis Stephen Ingram Tina Afiryie Kirsty Lewis Stephen Ingram Tina Afiryie Kirsty Lewis Stephen Ingram Surrey & Sussex Coastal West Sussex L3 deleg. Monica Cox Marian Ryland Kirsty Lewis Stephen Ingram Surrey & Sussex Crawley L1 Monica Cox Marian Ryland Kirsty Lewis Stephen Ingram Surrey & Sussex Horsham & Mid-Sussex L1 Monica Cox Marian Ryland Kirsty Lewis Stephen Ingram Surrey & Sussex East Surrey L1 Vanessa Doshi (ML) Vacancy Kirsty Lewis Stephen Ingram 3

70 Appendix 5 CCG Primary Care Committees (Delegated) x 10 (Quarterly/Bi-Monthly) QSG x 2 CCG Primary Care Shadow Committees (non-delegated) x 10? FC Chair SE MTM SE Primary Care Development Oversight Group (PCDOG) Strategic Planning/National Programmes/Operational Risk Management RW/SI Co- Chair SE GP Contract Panel (6 weekly) SM Chair FC Chair SE GP Commissioning Recommendation Panel SM Chair SE Procurement Programme Group (SEPPG) SE Pharmacy Reg. C ttee PSRC SE Ophthalmic Contract Panel SE Dental Contract Panel Local Professional Networks (LPNs) SM Chair CCG Primary Care Operational Groups (PCOGs) (Delegated) x 10 (6 weekly) Internal Commissioning Led Internal Other Directorate Led External SE Led External attendance - Commissioning Led External CCG Led SE GP Quality Working Group Nursing Chair DT Chair SE Premises Group (Level 1 & 3 CCGs) Operational & Strategic issues (6 weekly) SE PCTF Working Group National Progs. Working Groups APMS Procurement Working Group Dental Procurement Working Group Clinical Waste Framework Working Group Public Health Procurement Working Group Community Services Procurement Working Group Occup. Health Procurement Working Group 1

71 ANNEX A NHS England (South East) Memorandum of Understanding Delegated Co-Commissioning CCGs Finance 1. Introduction This Finance MOU supplements the Commissioner MOU, and sets out the roles and responsibilities of the Finance Teams in both the Local Office and CCGs. 2. Duration and Scope This MOU sets out where the responsibility for financial processes lies. This includes both the payment processes and reporting of expenditure. The MOU will run for a year alongside the Commissioning MOU and applies to both 1 st Wave and 2 nd Wave applicants. 3. Overview The allocation of responsibilities follows standard governance rules. CCGs are statutorily responsible for their expenditure and remaining within their financial allocations. The Co- Commissioning allocation forms part of a CCGs financial allocation, and it therefore follows that Co-Commissioning CCGs should be responsible for reporting this expenditure and for remaining within their overall financial allocation. From this, it also follows that CCGs should be responsible for preparing their monthly expenditure reports, and raising all necessary accruals and budget and expenditure adjustments for the production of these expenditure reports. This is equally true for the end of year annual accounts. It also follows from this that CCGs should be responsible for authorising any expenditure relating to Co-Commissioning expenditure and the submission of payment requests to PCSE and SBS. This includes expenditure generated from intermediate systems, such as CQRS, where, although the Local Office Commissioning Hub may be performing the role of validating the claims, the final financial sign-off should rest with CCGs. The Local Office will be available to help and advise in any of these areas, but it is expected that, over time, CCGs will become better acquainted with the systems and processes, and thus become more self-sufficient. However, it is acknowledged that preparation of annual accounts present their own issues, and this may be a time of greater liaison with the Local Office. 1 P age

72 4. Local Office Finance Team s Roles and Responsibilities The following lists the roles and responsibilities of the Local Office Finance Team. The list may not be exhaustive, but covers most of the activities. Where an activity is not listed, the Overview above will provide a guide as to where the responsibility lies. a. The Local Office has had three years experience of managing the GP budgets, and as such, has the knowledge and information to prepare budgets for each practice. These will be prepared and circulated to CCGs before 30 th June b. These budgets will include all services with the exception of the following: i. Revalidation ii. Revenue GPIT for Local Office residual responsibilities - Registration Authority Support Services, NHS Mail Administration, Clinical Safety Officer Support and IG Support for Primary Care Contractors as outlined in the GP IT Operating Model, Securing Excellence in GP IT 2014/16 c. These budgets will include all other costs. For clarity, it will include Named GP, Interpreting Services, Syringes and Occupational Health, alongside the more obvious costs such as Global Sum, MPIG, PMS, APMS, QOF, Premises (including Clinical Waste and rent reviews), Seniority Payments, Locum Payments (for maternity / paternity / adoption leave, sickness leave, and to cover suspended GPs: note, it does not cover vacancy absence which is the responsibility of the practice), Personally Administered (PADM)and Dispensed items Dispensing Fees and GP retainers. FP10 income for dispensing GPs is deducted from budgets. In addition, the budgets will include 0.5% Contingency and 1.0% Non-Recurrent reserve; however, the Local Office will retain prior year surpluses since this forms part of the national requirement to replicate the previous year s surplus, and Co-Commissioning CCGs are not required to make a 1% surplus on the Co-Commissioning element of the CCG s allocations. d. The Local Office will prepare a schedule of payments for 2016/17 for practices under the PMS Review, reflecting any transitional payments to these practices that will reduce over time under the transition to new GMS or PMS contracts. The schedule will be passed to the CCG to include on a payment schedule. e. The Local Office will also prepare a separate schedule to identify the quantum of reinvestment of the PMS Premium. The CCG will be responsible for identifying how the reinvestment will be made. f. Payments in the 2016/17 ledgers for CCGs will include some expenditure relating to 2015/16. The Local Office will prepare a schedule once Month 3, Month 6 and Month 9 has closed, identifying payments relating to 2015/16. The CCG will be asked to check the schedule, and once agreed, can recharge these amounts to the Local Office. It is assumed that all creditors would have been settled by Month 9, and no further adjustment will be required. This cut-off will help stabalise CCG and Local Office finance positions for Deep Dive and year end forecasts. Should 2 P age

73 subsequently a significant additional creditor arise, then the CCG should discuss this with the Local Office. g. Where advance payments have been made by NHSE in 2015/2016 relating to future accounting periods, NHSE will recharge these amounts to the CCG. The Local Office will prepare a schedule for the CCG to check, and once agreed, these amounts will be invoiced by the Local Office to the CCG. h. Payments for MPIG and Seniority are reducing over the next few years, with the funding recirculated to other parts of the GP budgets. The budgets prepared by the Local Office include the recirculated monies allocated to the relevant service line as appropriate. i. The Prime Minister s Challenge Fund will continue to be managed by the Local Office. The budgets transferred to CCGs to do not include these funds. j. The Local Office will be happy to respond to queries and provide assistance as required. It is expected that these requests will diminish over time as CCGs become more accustomed to the processes. Responses to queries may be delayed whilst Local Office staff are preparing their monthly finance reports, or during periods of annual leave. 5. CCG Finance Team s Roles and Responsibilities The following lists the roles and responsibilities of the CCG Finance Team. The list may not be exhaustive, but covers most of the activities. Where an activity is not listed, the Overview above will provide a guide as to where the responsibility lies. a. Although the Local Office has prepared budgets for 2016/17, the CCG will be responsible for preparing Plans and Budgets for 2017/18 onwards. b. The CCG will be responsible for preparing and processing all journal and budget adjustments required for monthly reporting and annual accounts, and for preparing and inputting forecast outturns. c. The CCG will be responsible for signing off payments on the CQRS system. d. The CCG will be responsible for submitting payment requests to SBS and PCSE. e. The CCG will be responsible for paying over pension contributions to the Pensions Agency by the 19 th of each month. f. The CCG will be responsible for deducting LMC levies and paying them over to the LMC. g. The CCG will be responsible for reimbursing GP practices for reimbursable property charges. This is usually restricted to rent, rates, clinical waste and water rates. h. The CCG will be responsible for meeting the additional cost of any rent increases arising from premises developments, and all other costs associated with premises developments however funded. The CCG has received a Premises Other allocation which can be used for this purpose. i. The CCG will be responsible for meeting the additional cost of any rent reviews arising through the three-yearly rent reviews and for costs associated with changes to lease contracts and terms such as the regularisation and change to Market Rents for NHSPS and CHP premises. The CCG has received a Rent Review Reserve 3 P age

74 allocation within the overall Rent budget which can be used for this purpose. The CCG should also receive additional non-recurrent funding from Central NHS England in 2016/17 to help meet the cost of the introduction of Market Rents. j. Any savings arising through estate rationalisation, such as closure of branch surgeries, will be available for the CCG to reinvest in primary care. k. The CCG will be responsible for funding any short-term transitional payments to GP practices undergoing changes, for example, merging or absorbing patients from other practices nearby which are closing. The Contingency reserve can be used for these purposes; there are no pre-existing claims on these reserves. l. The CCG is responsible through the PCSE for reimbursing the rates incurred by practices upon production of receipted rates bills. However, the payments made historically were at a higher level than the charges should be from 2016/17 following a legal case. The budgets reflect the old, higher, charges, and there is no intention to reclaim any of this funding. m. The budgets do not reflect any QIPP schemes. If a CCG wishes to implement any QIPP schemes, the savings generated are available for the CCG to re-use on primary care services. n. It is expected that GP practices will be able to submit a claim for a GP Improvement Grant in 2016/17. CCGs will be responsible for prioritising and scoring the schemes submitted. 4 P age

75 Nursing and Quality s Primary Care Support Offer to South East CCGs ANNEX B Overall Aim Peoples' treatment in Primary Care will be of higher quality, with less variation and reduced inequalities. Nursing and Quality Offer 1. To offer specialist Nursing and Quality input to support desired outcomes for primary care (general medical services) through: provision of clinical and professional advice to the CCG; provision of advisors and/or support on quality system escalation such as Special Measures, single item QSG or equivalent. 2. Promote the delivery and implementation of national priorities aligned to primary care (general medical services) that: keep people well; ensure that when people need support and care as much as possible is delivered in their homes, local surgeries and communities; support GPs to evolve new care models to support better outcomes for patients. 3. Promote the quality of complaints handling and support system wide learning through: clinical and safeguarding oversight of GP complaints, ensuring timely liaison with CCGs as appropriate; enabling CCGs access to NHS England primary care (general medical services) complaints activity data at CCG level (subject to final IG authorisation); enabling access to NHS England primary care (general medical services) complaints themes and trends data at CCG level (subject to final IG authorisation); oversight by the Primary Care Quality Group (to include CCG membership) to promote early warning and shared intelligence of CCGs member practices risks and issues; escalating single provider issues identified from complaints to QSG that are of significant concern or that relate to other known quality issues. 4. Support Safeguarding learning and development through: raise adult and child safeguarding awareness through NHSE s promotional DVD package; promotion and access to the Virtual College safeguarding total training package; monitoring and reporting of Virtual College training take up at CCG level; targeted training awareness aligned to local priorities. 5. Support and shared learning from Serious Incidents (SIs) through: workshop event to support SI and RCA skills development and clarification of PH, CCG and NHSE roles and responsibilities; enabling a standardised approach to the investigation and reporting of incidents; ensuring learning from primary care SIs is shared at scale and, where appropriate, at pace; providing specialist support/advice to vulnerable practices (as identified by CCGs and NHSE); within an advisory capacity, responding to ad hoc requests to support/investigate quality concerns. 6. Support development of a Primary Care Scorecard through: scoping of current primary care (general medical services) quality frameworks; feasibility review of adaption to/adoption of single dashboard for use across the South East CCGs; input of standard quality metrics to include; GP survey, complaints, SIs, FFT and CQC outcomes. Nursing & Quality Offer 1 July 2016

76 Annex C Communications and Engagement Protocol: Managing local GP service issues which are subject to delegated commissioning arrangements NHS England (South) Communications and Engagement Team 1

77 Background Primary care co-commissioning is one of a series of changes set out in the NHS Five Year Forward View. Co-commissioning aims to support the development of integrated out-of-hospital services based around the needs of local people. It is part of a wider strategy to join up care in and out of hospital. There has been a strong response to co-commissioning and in 2015/16 nearly three quarters of CCGs took on an increased role in the commissioning of GP services with 63 CCGs taking on full delegated responsibility. In December 2015, a further 52 CCGs were authorised to take on delegated commissioning of GP services and will be able to operate under these arrangements from 1 April This means that over half of CCGs will have delegated responsibility in 2016/17. While day-to-day commissioning responsibilities for GP services pass to CCGs when they are approved for delegated commissioning, NHS England retains ultimate legal responsibility for the commissioning of these services in all cases. As such, NHS England needs to be assured that appropriate local delegated commissioning arrangements are in place on an ongoing basis and through the CCG assurance process. This includes ensuring appropriate communications and engagement activity takes place in regards to the commissioning and provision of local GP services, so that both patients and other local stakeholders are kept appropriately informed and involved in the development of services and in line with any legal requirements. Aims of this protocol This protocol is designed to provide clarity about the communications and engagement responsibilities of different partners where delegated commissioning arrangements for local GP services are in place within the South of England The protocol applies to the work of local NHS England communications and engagement teams, CCG communication and engagement teams (including CSUs where they are providing this function for a CCG) and GP providers within the South region It is particularly aimed at ensuring effective communication with local patients, the public and stakeholders in line with the Health and Social Care Act and NHS Constitution (set out in section 1). This means having effective systems in place for information sharing and a collaborative relationship between all partners. This will help ensure join up and clarity across the local healthcare system, for the benefit of both patients and other stakeholders. While this protocol is designed to provide clarity and consistency, it is recognised that a single model will not work in every situation and it is not designed to be prescriptive. Examples of communications materials that have previously been used when managing different local GP service issues are contained in the appendices. These can be used as a reference tool/starting point for CCG communications teams working under delegated commissioning arrangements, but materials will need to be adapted and tailored for local use as appropriate and at the discretion of CCG communications colleagues in response to issues as they arise. This protocol will be kept under review and kept updated over time as needed. 2

78 For further information/guidance CCG/CSU colleagues can contact their local NHS England Communications and Engagement Team: South Central Andrea Collins Head of Communications and Engagement Annie Tysom Senior Communications and Engagement Manager Natalie McEwan Communications and Engagement Manager Toni Adenle Communications and Engagement Officer South East Stuart Green Head of Communications and Engagement Linda Gregory Senior Communications and Engagement Manager Sarah Whitehead Communications and Engagement Manager Nicola Hawdon Communications and Engagement Manager Sally Lissenburgh Communications and Engagement Manager South West Glen Everton Head of Communications and Engagement Peter Bramwell Senior Communications and Engagement Manager Jodie Fulton Communications and Engagement Manager Elizabeth Kulh Communications and Engagement Officer Wessex Carol Wood Head of Communications and Engagement Graham Groves Senior Communications and Engagement Manager Emily Grainger Communications and Engagement Officer

79 Contents 1. NHS responsibilities for communications and engagement Communications responsibilities of partners Managing contractual and operational scenarios: key principles List of key local stakeholders for engagement Potential resources to consider Implementing this protocol...12 Appendices: Examples of different communications scenarios...13 Appendix 1: GP provider retires/gives notice...13 Appendix 2: List dispersal...16 Appendix 3: Practice put in special measures...19 Appendix 4: Immediate practice closure by CQC...21 Appendix 5: Practice merger...25 Appendix 6: GP suspended due to performance concerns...25 Appendix 7: GP charged with criminal offence...27 Appendix 8: Patient recall due to incorrect vaccine storage...28 Appendix 9: Incident causing immediate loss of premises...30 Appendix 10: Death of single-handed GP

80 1. NHS responsibilities for communications and engagement 1.1 The NHS has a statutory responsibility to effectively communicate and engage with people who use its services. The Health and Social Care Act 2012 introduced two legal duties, requiring Clinical Commissioning Groups (CCGs) and commissioners in NHS England to enable: Patients and carers to participate in planning, managing and making decisions about their care and treatment, through the services they commission; The effective participation of the public in the commissioning process itself, so that services provided reflect the needs of local people. Guidance and resources on patient participation are available on the NHS England website. 1.2 On involvement in healthcare in the NHS the NHS Constitution states the following in regards to the rights of patients: You have the right to be involved in planning and making decisions about your health and care with your care provider or providers, including your end of life care, and to be given information and support to enable you to do this. Where appropriate, this right includes your family and carers. This includes being given the chance to manage your own care and treatment, if appropriate. You have the right to an open and transparent relationship with the organisation providing your care. You must be told about any safety incident relating to your care which, in the opinion of a healthcare professional, has caused, or could still cause, significant harm or death. You must be given the facts, an apology, and any reasonable support you need. You have the right to be involved, directly or through representatives, in the planning of healthcare services commissioned by NHS bodies, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. The NHS commits to provide you with the information and support you need to influence and scrutinise the planning and delivery of NHS services (pledge); to work in partnership with you, your family, carers and representatives (pledge); to involve you in discussions about planning your care and to offer you a written record of what is agreed if you want one (pledge); and to encourage and welcome feedback on your health and care experiences and use this to use this to improve services (pledge). 1.3 Effective communication and engagement means: Patients are well informed, involved and provided with all they need to know and are not needlessly alarmed. Staff are put in the best possible position to handle any issues. Stakeholders are informed and understand the context of any potential changes. There is a clear process for the sharing of information, areas of responsibility and for approval of materials. The reputation of the NHS is not damaged through poor communication. 5

81 There is contractual robustness and the NHS continues to work well locally. 1.4 There are different forms and degrees of engagement, as listed below: Informing, i.e using communication channels to provide communities and individuals with balanced and objective information to assist them in understanding problems, alternatives, opportunities and solutions. Consulting, i.e obtaining community and individual feedback on analysis, alternatives and / or decisions, for example, surveys, door knocking, citizens panels and focus groups Involving patients by working directly with them Collaborating in partnership with patients and the public Devolving decision making to the patient. NHS England has developed a bite size guide on planning for participation which includes a ladder of engagement. While this protocol touches on areas where aspects of consultation may be considered, both in terms of informing the development of a service and in meeting legal obligations, the predominant scope of the guidance is around effective use of communications channels to ensure patients, the public and stakeholders are well informed. Guidance is also available in NHS England s new national Patient and Public Participation policy and guidance available at: 2. Communications responsibilities of partners It is important that each organisation is clear on its role in any given situation and works effectively with all other involved parties, particularly around information sharing, in order to ensure clear and consistent communications for patients and the public. This section summarises the key operational responsibilities of fully delegated CCGs, NHS England and local GP providers and how this links to communications handling. 2.1 Fully delegated CCGs CCGs that have fully delegated responsibility for commissioning GP services are now responsible for commissioner-related communications for GP services in their areas This in line with the following functions that have been delegated to these CCGs: - Managing General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action, such as issuing breach/remedial notices, and removing a contract) - Newly designed enhanced services ( Local Enhanced Services (LES) and Directed Enhanced Services (DES) 6

82 - Design of local incentive schemes as an alternative to the Quality and Outcomes Framework (QOF) - The ability to establish new GP practices in an area - Approving practice mergers - Making decisions on any local discretionary payments (e.g. returner/retainer schemes). - Premises Costs Directions functions will be delegated to CCGs to give CCGs maximum flexibility and responsibility for the use of health spending in their geographic area. The premises functions include: making payments in relation to recurring premises costs (such as rent) and premises developments or improvements. Delegated CCG communications teams will also need to provide communications and engagement advice to GP providers on practice communications as necessary (see section 2.3) Ultimate legal responsibility for these services still lies with NHS England. NHS England also has an assurance role for ensuring that any communication and engagement in relation to the commissioning of these services is appropriate and effective, both on an ongoing basis and as part of CCG assurance process. While delegated CCGs are the lead for commissioner-related GP communications, there should be ongoing information sharing between the CCG, NHS England and the GP provider as appropriate given NHS England s ultimate legal responsibility for services. The CCG communications lead/s should copy any relevant information/communications relating to local GP services to the NHS England local communications lead/s for information, particularly around key reputational issues and media enquiries. NHS England local communications leads will in turn share this information with local operational colleagues as appropriate and also highlight any significant issues with the national NHS England communications team. Where the issue relates to one of the statutory functions retained by NHS England (such as oversight in regard to individual GP performance issues or public health functions) the CCG communications must agree with the local NHS England communications team to agree lines. For significant reputational issues which may have national implications, the CCG communications team should also discuss communications handling with the local NHS England communications team Where a GP service provides services to a number of patients who live outside the immediate local CCG area then delegated CCG communications teams will need to liaise with CCG communications teams in other affected areas/nhs England NHS England is able to offer communications advice and guidance to CCG communications teams where delegated commissioning applies, particularly in the early days while these arrangements are bedding in. This includes providing examples of previous communications handling on different issues (as in the examples given in the appendices). 7

83 2.2 NHS England Regardless of the commissioning status of any individual CCG, NHS England retains certain functions associated with the commissioning and provision of GP services. These include: - Management of the national performers list and related activities (GPs must be on the national list to provide NHS GP services and NHS England s role includes liaison with the General Medical Council and other bodies in relation to the individual performance of GPs) - Administration of payments to a GP in circumstances where the GP is suspended - Management of the revalidation and appraisal process for GPs - Capital Expenditure Functions (NHS England retains responsibility for the allocation of funds for premises improvements under the Primary Care Transformation Fund) - Section 7a (Public Health) Functions (such as the commissioning of screening and immunisation services from local GP practices). - Functions in relation to complaints management regarding GP services - Decisions in relation to the Prime Minister s GP Access Fund. Local CCG communications teams therefore need to work closely with the local NHS England communications and engagement team when managing any issues that relate to functions retained by NHS England. The local NHS England communications team will share with CCG communications leads details of any key national announcements relating to the provision of GP services, so as to inform their local handling of such announcements. NHS England retains responsibility for national policy decisions relating to the provision of GP services. For example in relation to the national funding arrangements for services. Delegated CCG communications colleagues should discuss any individual enquiries on these issues with the local NHS England communications team to determine handling as appropriate in each case. 2.3 GP providers roles and responsibilities As independent contractors, GPs are responsible for their own communication and engagement activity. As the commissioners of GP services, NHS England/delegated commissioning CCGs are not responsible for communicating and engaging for GP practices. It could constitute a conflict of interest if one organisation delivered for provider as well as commissioner related communications. 8

84 However, it is fully recognised that the majority of GP providers do not have dedicated resources to deliver such communications activity. NHS England/delegated CCGs can therefore provide advice and guidance to practices about their communications. In certain cases, for example where there is a major reputational issue, NHS England/the delegated CCG communications team may lead any necessary communications and engagement as commissioners (for example in any case concerning potential criminal activity). It should also be noted that in relevant cases, GPs may be able to source additional support for communication and engagement from their Local Medical Committee (LMC), the Royal College of GPs (RCGP) or Medical Defence Union. As commissioners, NHS England/or the delegated CCG do have an assurance role in helping to ensure that any significant patient/stakeholder communications from GP practices are effective and accurate. While they should not communicate and engage for the GP practice, they should provide practice staff with advice on the best practice approach for communications and engagement. Communications teams working for CCGs who have delegated commissioning should provide this advice to practices in their areas. 3. Managing contractual and operational scenarios: key principles 3.1 In regards to the provision of GP services, there are a range of contractual and operational scenarios that may require communications and engagement support, which may be the responsibility of the commissioner or the GP provider in any given instance. 3.2 A local commissioner of services (either the delegated CCG or NHS England) would generally be responsible for leading any communications activity relating to the following scenarios (although this is not an exhaustive list) : - Communicating a planned or unexpected contractual change e.g. GP provider gives early notice on a contract/a single-handed GP retires therefore bringing the existing practice contract to an end - Communicating when a GP provider is no longer able to deliver on the contract - Caretaker provider put in place by commissioner, due to performance issues - Re-procurement of services, due to the contract coming to an end - Dispersal of a patient list where a contract is ending and no new provider can be found, or the decision is taken by the commissioner not to re-procure a service Service change due to commissioner-led changes to the contract - Communicating the outcome of a CQC inspection to key local stakeholders where needed (eg local councillors, Healthwatch, local MP). - In the event of a serious incident or investigation the commissioner will take the lead for communication and engagement activity, in partnership with the GP provider. 9

85 3.3 On matters of national policy that require a commissioner-led communications response, delegated CCG communications teams should contact the local NHS England communications team for advice on handling. 3.4 GP provider communications responsibilities include: - Communicating a GP provider-led change e.g. moving premises, refurbishment of premises, merger with another practice - Changes to staff, e.g. staff leaving, staff retiring, new starters (unless the departure of a GP/GPs from the practice would mean the providers contract coming to an end as in the case of a single-handed GP retiring, in which case this would fall to the commissioners to communicate next steps to patients/stakeholders) - Decision by the GP provider to make amendments to the services available (eg changes to opening times/clinic times) - Communicating a service disruption such as a faulty phone line/flood affecting part of the building - Communicating the outcome of a CQC inspection to practice staff and to patients 3.5 Where a commissioner is leading the communications and engagement process, in response to any given circumstances, then the GP provider should support the use of these communications in order to ensure a clear message and joined up approach for patients. The GP practice should not produce separate communications for patients, local stakeholders and the media, in order to avoid confusion for patients. 3.6 Examples of communications materials are in the attached appendices. These cover give a range of scenarios and describe the responsibilities of the commissioner and the GP provider in each case, along with example communications materials that CCG commissioners may wish to consider. These can be used as guidance for other situations, but any materials will need to be tailored according to the particular local circumstances. 3.7 In all scenarios, consideration should be given as to whether affected patients have any particular communications needs (eg if individual patients require information in another language or in an easy read format). A statement such as the following could be added to any local communications materials: This information can be made available in formats such as easy read, or large print and maybe available in alternative languages on request. Please contact xxxx. 4. List of key local stakeholders for engagement 4.1 When a significant issue affecting GP services occurs then as well as informing patients, it is also best practice to inform and engage with other key local stakeholders. This is to ensure they are reassured about any action being taken to ensure the continued delivery of safe, quality care to affected patients in any given circumstances. Other local stakeholders can also help ensure patients get accurate information provided by the NHS about the provision of services, particularly people like local MPs/councillors and Healthwatch who may receive enquiries from local patients in response to a particular incident/issue affecting a GP surgery. 10

86 4.2 When managing communications around a particular issue, delegated CCG communications teams should consider whether the following local individuals/agencies need to be involved or informed and as appropriate to the circumstances. The list if not exhaustive and those stakeholders contacted will need to be determined in relation to each individual issue: - The practice Patient Participation Group - Healthwatch (who may be able to provide help getting information out to patients by posting information on their website or helping to manage general enquiries) - Chair of the local Health Overview and Scrutiny Committee - Chair of the local Health and Wellbeing Board - Local MPs - Local district/borough councillors in the area affected - Other local GP practices (particularly if they are affected by the issue, as in the case of a list dispersal as they will also need to support affected patients in such circumstances) - Local Medical Committee - Other local health care providers who may be affected by the issue/receive enquiries from patients - Neighbouring CCGs/NHS England if GP practices in surrounding areas will be affected 5. Potential resources to consider 5.1 There are a range of different potential communications tools that could be used as appropriate to any given circumstances and delegated CCG communications teams will be best placed to determine what is most appropriate in each case. Some communications methods that could be considered are: Reactive or proactive media statement Letter to patients (note it may take a few days for letters to reach patients and best practice would be for patients to receive information direct as opposed to reading news about any key changes at their GP practice in the media first) Q&A for patients which could be posted on the practice website/given out at the practice or a Q&A to support practice staff/ccg colleagues manage any enquiries they receive from patients Use of social media to get messages out to patients/the wider community if needed Poster for surgery premises Phone line for managing patient enquiries (might be necessary if large number of patient enquiries are expected, for example in the case of a sudden practice closure) Stakeholder letter 11

87 Individual discussions between senior CCG staff and local HOSC chair/mp/healthwatch/local patient groups etc as needed Note to related healthcare services (including other local practices as needed) 6. Implementing this protocol 6.1 Communications teams for delegated CCGs and their primary care colleagues should be aware of this protocol and the general principles in it. 6.2 Delegated CCG communications teams are responsible for working with their primary care colleagues to ensure that local GP practices are aware of their general responsibilities in regards to communications and engagement as providers, as described in this protocol. CCGs should achieve this as they see appropriate. 12

88 Appendices: Examples of different communications scenarios Attached are example materials that have previously been used to describe changes to local CCG services in various different scenarios and which delegated CCG communications colleagues may find useful. CCG communications colleagues will need to use their discretion/experience to adapt and tailor materials to individual scenarios that arise. CCG branding should be used on any commissioner-led communications materials that are produced but NHS branding has been used here for illustrative purposes. Appendix 1 Scenario: Example communications where a contract is ending because the provider has given notice on their contract (which might include the retirement of a single-handed GP). In this scenario, the commissioner would be responsible for leading communications with patients and local stakeholders due to the need to make a commissioning decision about the future provision of services for affected patients. In circumstances where the contract is coming to an end and a commissioning decision is required about the future of the service then it is advisable to take patient/stakeholder feedback and experience into account in determining future care arrangements, where possible/applicable. For example, commissioners could invite feedback from patients/stakeholders before reaching a commissioning decision. Key responsibilities for communication and engagement Commissioner Briefing stakeholders (for example HOSC, local councillors, Healthwatch, local MPs, the practice s Patient Participation Group) on plans for engagement with registered patients Managing the media pro-active and reactive Engagement with patients including letters to patients, information for the practice website and a Q&A to support practice staff in managing enquiries as needed, posters for the practice (the exact type of engagement will be determined by the type of change and level of impact on patients). GP Provider Posting any patient information provided by commissioners on the practice website Making any engagement material provided by commissioners available in the practice, including putting up any posters Briefing practice staff (including making sure they are aware of commissioner s communications to help manage patient enquiries) Responding to any key patient enquiries made to the practice (supported by materials from commissioners) Notify NHS Choices of any changes to practice information on the site Points of note: In these circumstances where the commissioner is leading communications, the GP provider is asked not to issue any communications to patients/stakeholders or respond to media enquires independently/without the knowledge of the commissioner as this could cause confusion amongst patients and it is important to ensure they are provided with consistent information about their care. 13

89 Should a GP/provider wish to deliver any personal message to patients before they retire/end their contract this should be done in conjunction with commissioner-led communications to ensure join up If a GP provider is approached for comment by the local media/stakeholders about why they have chosen to end their contract then they are asked to liaise with the commissioner communications team to ensure join up on any communications. Example patient letter inviting feedback on future care where provider has given notice Dear Sir/Madam, Re: Changes affecting your care at The Acres Surgery, 19 Church Lane, Smithtown, SM11 1PJ I am writing to inform you of planned changes at The Acres Surgery. The healthcare group [insert name of provider] has informed NHS Smithtown CCG that they wish to bring their contract to provide GP services at the practice to an end. This means that [insert name of provider] will stop providing your care at the practice on 26 February Our priority is to guarantee that you have continued access to a full range of GP services and care after this date and we are working to identify the available options to achieve this. However it is possible that we may need to ask you to register with a new GP practice in order to guarantee your ongoing access to care. You will be given as much notice and support to register at a new practice if this is the case. The purpose of this letter is to invite you to provide us with any feedback you wish to give about arrangements for your future care, including any specific concerns you may have about registering with a new GP practice. All feedback will be considered by NHS Smithtown CCG in reaching a final decision about how to ensure your ongoing access to care. Please contact us with any feedback by writing to the postal address above, or by ing xxxxx by xxxxx so we can ensure this is considered as part of the final decision making process. You can also call the telephone number above. Please note that you do not have to take any action at this point. The Acres Surgery will continue to provide services to you at the current time. We will write to you again as soon as we have taken into account all patient feedback and options and have made a final decision about how to ensure your continued access to local GP services. We understand this may be an uncertain time for you and that you may be concerned about your future care. Please be assured that NHS Smithstown CCG is continuing to explore all options to ensure arrangements for your ongoing care and we will continue to update you as information becomes available. 14

90 In the meantime if you have any queries about the process, you can contact us using the contact details above. If you have any queries about your individual care, please contact The Acres Surgery direct. Yours sincerely, Example poster to put up in the practice inviting patient feedback (can be printed on A3 paper in large arial font and given to the practice to put up in reception area) Give your views about your future care [insert name of provider] has decided to end their contract to provide your care at The Acres Surgery. Their contract to provide services at the surgery will therefore end on 26 February We may need to ask you to register with another local GP surgery in order to guarantee your ongoing care after this date, but no final decision has been made about this and you do not need to take any action at this point. A letter has been sent to all patients advising you of the current situation and we will update you as soon as possible about future arrangements for your care. If you want to give your views about this please XXXXXX or write to: Primary Care Team, NHS Smithstown CCG, xxxxx by xxxxx. You can also call xxxx Example media statement Our priority is to ensure all patients from The Acres Surgery have ongoing access to local GP services following the decision by [insert name of healthcare provider] to end their contract to provide services at the practice. We have written to the surgery s patients to reassure them that we are working to secure alternative arrangements for their care after 26 February 2016, which is the last day [insert name of healthcare provider] will be providing appointments at the practice. All patient feedback will be taken into account in reaching a final decision about how to guarantee their future care and we will update patients about this as soon as we can. 15

91 Appendix 2 Scenario: Commissioning decision has been made that patients will need to register with another GP practice This could be the potential outcome of scenario 1 if a decision is made that it is not feasible to re-procure the contract for services for affected patients or to appoint an alternative provider of care. In this scenario, the commissioner would be responsible for leading communications with patients and local stakeholders due to the need to explain the commissioning decision and next steps for patients. Key responsibilities for communication and engagement Commissioner Updating patients (including letters to patients detailing other local practices and how to register with them, information for the practice website, Q&As to support practice staff in managing enquiries as needed, posters for the practice) Producing any communications to advertise any bespoke patient registration sessions held Briefing stakeholders (for example HOSC, local councillors, Healthwatch, local MPs, the practice s Patient Participation Group) on plans for engagement with registered patients Managing the media pro-active and reactive Briefing other local practices and providing them with copies of the letter so they know what patients have been told and can be as helpful as possible in helping them to re-register GP Provider Posting any patient information provided by commissioners on the practice website Making any engagement material provided by commissioners available in the practice, including putting up any posters/making spare copies of patient letter available to patients on request Briefing practice staff (including making sure they are aware of commissioner s communications to help manage patient enquiries) Responding to any key patient enquiries made to the practice (supported by materials from commissioners) Notify NHS Choices of any changes to practice information on the site Working with primary care team to make sure other local healthcare providers are informed 16

92 Example patient letter IMPORTANT INFORMATION REGARDING YOUR GP SURGERY YOU NEED TO TAKE ACTION - PLEASE READ CAREFULLY Dear Sir/Madam, Re: Closure of The Acres Surgery, 19 Church Lane, Smithstown, SM11 1PJ I am writing to tell you that The Acres GP Surgery will be closing on Friday 26 February You will need to register with a new GP practice in order to ensure your ongoing access to care after this date. This letter explains how you can do this. Why The Acres Surgery is closing We wrote to you on XXX to explain that Dr Bloggs is retiring and that her contract to provide services at The Acres Surgery will therefore end on Friday 26 February. The priority of NHS England is to ensure you can continue to access GP services and we have been working to determine how we can guarantee your ongoing care. We have reviewed all options and taken into account feedback from patients and other stakeholders. As a result, we have now taken the difficult decision that is it not feasible for another provider to deliver care to patients from The Acres Surgery and that we will need to ask you to register with an alternative local GP practice. How to register with a new GP practice You need to register with a new GP practice of your choice in order to make sure you have access to GP services after The Acres Surgery closes. There are 12 other GP practices within a 1 mile radius of The Acres Surgery which are ready to register new patients and these practices are listed in the attached sheet. Additional information about GP practices is also available on the NHS Choices website at You can choose the GP practice that is most suitable for you and according to where you live. The GP practice will need to check that you live within their registration boundary before you are able to register. This information should be available on their website, or you can check this with their reception staff. In order to register with a new GP practice you will need to complete the registration form GMS1, which is enclosed with this letter. Additional copies will be available from the practice of your choice. Please note that you may be requested to provide proof of address by your chosen GP practice as part of the registration process and therefore it may be helpful to bring this with you when you register at a new practice. Once you have registered, your medical records will transfer automatically to your new surgery. If you are currently receiving hospital care, it is important that you confirm details of your new GP practice to the hospital so that they keep your records updated. 17

93 NHS Smithstown CCG is hosting two patient drop-in sessions at The Acres Surgery to which representatives from other local GP practices have also been invited to attend. These will be held on: XXXXX You do not need to book to attend the session, which may help you in choosing a new practice and completing the forms for registration. If you need any support in registering with a new GP practice, or identifying other GP practices where you live, you can contact XXXXXX We appreciate this may be an unsettling time for you, but please be assured that we will be working closely with staff from The Acres Surgery and other local GP surgeries to support patients through the process of registering with another GP practice. Yours sincerely, Example poster to put up in practice reception area (can be printed on A3 paper in large arial font) The Acres Surgery is Closing The Acres Surgery is closing on Friday 26 February 2016 You will need to re-register with a new GP practice as soon as possible. You have been sent a letter with more details including, how to re-register with another GP practice. If you have not received this letter, please speak to reception staff. If you need help or have questions: - See our reception staff - Call the NHS Smithstown CCG registration line on xxxxx - Visit our patient drop-in sessions: Smithstown Library: The Acres Surgery: [insert dates and times] Example media statement Our priority is to ensure that all patients from The Acres Surgery have ongoing access to local GP services after 26 February, when Dr Bloggs retires. We have now written to the surgery s patients to explain they will need to re-register with one of the other local GP practices that are able to welcome new patients. This includes 12 other GP practices within a 1 mile radius of The Acres Surgery. We will continue to work with staff from The Acres Surgery to support patients through this process. 18

94 Appendix 3 Scenario: GP practice is rated inadequate by the Care Quality Commission (CQC) and placed in special measures Following the inspection of a GP practice, the CQC allocates the practice a rating of either outstanding, good, requires improvement, or inadequate. Those rated inadequate are placed in special measures and are re-inspected within six months to check they have improved. The CQC usually only issues press releases about individual local practices where they are rated as outstanding, or inadequate and going into special measures, but it publishes all inspection reports whatever the rating on the CQC website. When a practice is placed into special measures it is important that the GP practice is supported to understand the challenges this may produce in terms of their reputation and patient confidence, when placed into special measures. In such circumstances it is recommended that the delegated CCG communications team liaises with the GP practice once the practice is made aware of the CQC rating, to check that they are prepared for the publication of the report. The CCG communications team should not however issue communications on behalf of the practice, as this would undermine their role as the commissioner of services in this scenario. Responsibilities for communication and engagement Commissioner Offering guidance to GP practice around communications Briefing stakeholders (for example HOSC, Healthwatch, local MPs) if appropriate Developing commissioner press line. GP Provider Publishing a link to the CQC report on their website Making information available for patients to reassure them how the practice is responding to the report. This could include making a statement/q&a for patients available on the practice website and in the surgery reception area Briefing practice staff (advised to verbally brief staff and to make sure that they have communications materials so they are clear on how to respond to enquiries) Liaison with Patient Participation Group Responding to media requests seeking comment from the practice (as GP practices don t have dedicated communications resource they could place a media statement on their website and point patients there) Need to share any practice statements/media enquiries received with CCG communications colleagues to ensure join up Brief patients/staff on any updates (eg outcome of any CQC re-inspections where improvements have been made) 19

95 Example commissioner media statement These inspections are about ensuring that every patient, anywhere across the country, receives consistently high quality services by identifying issues so improvements can be made. The Acres Surgery has confirmed its commitment to making the necessary improvements set out by the Care Quality Commission (CQC). NHS Smithstown Clinical Commissioning Group (CCG) is working to support the practice to take the action needed to make sure it has the right processes in place to support the delivery of safe, high quality care to all its patients. Example GP practice statement The Acres Surgery is disappointed at the decision by the Care Quality Commission to place the practice into special measures, following a practice inspection in March The CQC inspection report highlighted areas where the surgery was delivering a good service, which reflects the commitment of all practice staff to high quality patient care, but also identifies areas that we need to improve. We take the safety and welfare of our patients very seriously and have already started addressing each of the CQC concerns through a robust action plan. We are committed to making all necessary improvements for all of our patients and the practice is confident that the outcome of any future CQC inspection will reflect this. 20

96 Appendix 4 Scenario: CQC takes action which results in the immediate suspension/end of services at a practice on the grounds of patient safety In this instance, the CCG commissioner would need to lead communications (with the support of any staff on site at the practice in helping to make sure patients had the advice they needed about how to immediately access any care they needed). There would also need to be close liaison between the CCG communications and CQC communications team to ensure a joined-up approach to communications handling, given the action taken by the CQC and the need for the CCG to respond to this as a commissioner by ensuring alternative services are available for patients. Responsibilities for communication and engagement Commissioner Ensuring patients have information they need about what has happened and how to immediately access alternative services (g through patient letters, a patient Q&A which can be made available on the practice website/at the premises if they haven t closed, arranging an answerphone message for the practice and making sure any remaining practice staff and partners (like Healthwatch) have the patient Q&A to support responses to patient enquiries GP Provider To make any commissioner communications materials for patients available on the practice website/at the practice if the reception area remains open To place any commissioned notices up at the practice as requested To put any commissioner-led answerphone message on the practice phone lines as appropriate Ensuring local stakeholders (eg HOSC, MPs, Health and Wellbeing Board, Healthwatch, Patient Participation Group) are briefed and informed how they can help ensure accurate information in response to any patient enquiries Ensuring other local healthcare services (including other local practices, 111 service, acute, mental health and community services, out of hours GP services) are aware of what has happened how they now need to manage any operational issues as a result Confirming longer term arrangements for patient care Liaising closely with the CQC communications team to co-ordinate comms handling Managing any media/stakeholder/patient enquiries about how patients will be able to continue accessing services 21

97 Example patient letter IMPORTANT INFORMATION REGARDING YOUR GP SURGERY PLEASE READ CAREFULLY Dear Sir or Madam, Re: Immediate end of services at The Acres Surgery, 19 Church Lane, Smithstown, SM11 1PJ It is with regret that we have to inform you that The Acres Surgery is unable to provide clinical services to patients with immediate effect from Tuesday 9 June This follows urgent action taken by the Care Quality Commission (CQC) to protect the safety and welfare of patients. Our priority is now to make sure you have ongoing access to local GP services. This letter explains how you can access care from a doctor at the immediate time and the action we are taking to guarantee your access to care in the longer term. Why the practice is unable to provide clinical services The Care Quality Commission (CQC) is the independent regulator of health and social care in England. The CQC s role is to check that GPs, dentists, hospitals and other care services provide safe, effective and good quality care that meet national standards. Following discussions with NHS Smithstown Clinical Commissioning Group (CCG), the Care Quality Commission (CQC) inspected The Acres Surgery due to concerns that the practice was failing to provide essential services to patients. The CQC s investigations confirmed concerns that the practice was not providing an acceptable level of service to patients and was not meeting the necessary standards to ensure you were provided with the appropriate care and treatment. As a result, the CQC determined that immediate action was necessary to stop The Acres Surgery from providing clinical care to patients, to protect their safety and welfare How you can now access care In the immediate period, if you need to see a GP or a nurse you can attend the Station Road Health Centre, which can provide treatment for a range of minor injuries and illnesses as necessary. Station Road Health Centre is open from 8am to 8pm, seven days a week, and includes a walk-in service for patients who are not registered there. No appointment is needed to access the walk-in service. The health centre is located at: Station Road Health Centre 9 Station Road Smithstown SM11 PRG Telephone: XXXXX If you need urgent medical help or advice but it's not a life-threatening situation you can also call the NHS 111 service by dialling 111. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. For immediate, life-threatening 22

98 emergencies, you should call 999. NHS Smithstown CCG is currently working to ensure the provision of alternative services and will keep you informed of the situation. As soon as further information becomes available, we will write to you again. If you have any general queries related to your individual healthcare at the immediate time, you can contact NHS Smithstown CCG on XXXX from 9am to 5pm Monday to Friday. Yours sincerely, Example stakeholder letter Dear colleague, Re; The Acres Surgery, 19 Church Lane, Smithstown It is with regret that we have to inform you that The Acres Surgery in Smithstown is unable to provide clinical services to patients with immediate effect. This follows urgent action taken by the Care Quality Commission (CQC) to cancel the practice s CQC registration, in order to protect the safety and welfare of patients. Our priority is now to make sure that all the patients currently registered with The Acres Surgery have ongoing access to local GP services. We have sent them the attached letter to confirm how they can access services at the immediate time, while we work to urgently secure the provision of alternative GP services that will meet their needs. This letter includes a number they can call if they have any queries about their individual care needs. Why the practice is unable to provide clinical services NHS Smithstown Clinical Commissioning Group (CCG) and the Care Quality Commission (CQC) shared concerns that the practice was failing to provide essential services to its patients. The CQC subsequently undertook an unannounced inspection of the practice due to the collective concerns that had been raised. The practice was inspected on Thursday 4 June. The CQC s investigations confirmed the collective concerns that the practice was not providing an acceptable service to patients. As a result, the CQC determined that an urgent cancellation of the practice s CQC registration was necessary in order to protect the safety and welfare of patients. The CQC therefore applied to the courts to withdraw the practice s registration with the CQC with instant effect. Without this registration, the practice does not have the authorisation to deliver clinical care to its patients and therefore patients cannot currently be treated at The Acres Surgery. As such, the practice will be unable to meet the terms of its contract to provide core services to patients. NHS Smithstown CCG will therefore need to end the contract in order to make alternative arrangements that will guarantee patients ongoing access to patient care. Action we are taking to maintain patient care There are currently around 5,000 patients registered at The Acres Surgery and we are taking urgent action to make sure they have access to the full range of GP services as swiftly as possible. We will write to you as soon as possible with further details about this but are currently looking to issue a contract to another provider in the short term to ensure that all 23

99 patients have access to ongoing care. In the immediate period, patients who need to see a GP or a nurse can attend the Station Road Health Centre, which can provide treatment for a range of minor injuries and illnesses as necessary. We will write again to patients imminently to explain the action we have taken to secure their access to local GP services in the longer term. If you have any queries at this stage, do feel free to contact me. Yours sincerely, Example media statement Following urgent action by the CQC to close The Acres Surgery to protect the safety and welfare of patients, NHS Smithstown CCG s priority is to make sure patients continue to access local GP services. Patients who need to see a GP can attend the Station Road Health Centre, which can provide treatment. Patients can also get medical help or advice by calling NHS 111. For immediate, life-threatening emergencies, patients should continue to call 999. NHS Smithstown CCG is taking urgent action to ensure patients have access to safe, high quality care in the longer term. We will be writing to all affected patients imminently to explain the necessary closure of The Acres Surgery in order to guarantee patient safety and how they will be able to continue to access local GP services. Example poster The Acres Surgery It is with regret that we have to inform you that The Acres Surgery is unable to provide clinical services with immediate effect from 9 June This follows urgent action by the Care Quality Commission (CQC) to protect the safety and welfare of patients. NHS Smithstown CCG is taking urgent action to guarantee your ongoing access to care and a letter will be sent to all affected patients about this imminently. If you need to see a GP or nurse immediately you can attend Station Road Health Centre, which provides a walk-in service from 8am to 8pm seven days a week. This is located at: Station Road Health Centre 9 Station Road Smithsville SM11 9PQ Tel: xxxx If you need urgent medical help or advice but it's not a life-threatening situation you can call the NHS 111 service by dialling 111. For life threatening medical emergencies please dial

100 Appendix 5 Scenario: Two practices negotiate a merger, which will see the practices move into a new building As a practice-led change, the GP provider would need to lead communications in this instance (overseen by the CCG commissioner) Responsibilities for communication and engagement Commissioner Assurance of the practice s communication and engagement plan and development of a supportive commissioner media line GP Provider Liaison with Patient Participation Group in regard to proposed engagement with patients Promotional information/materials for patients in the GP practice/on the website and distributed to other local venues as appropriate, explaining the proposed changes and inviting feedback Develop and deliver the communication and engagement plan Brief stakeholders (for example HOSC, Healthwatch, local MPs) on plans for consultation with registered patients and to explain the reasons for the proposed change and the benefits Engagement with the CCG commissioner (who would need to approve the plans) Engagement with other local providers and stakeholders as appropriate (other local GP practices, pharmacies, acute providers, ambulance service, social care, Local Medical Committee) Briefing practice staff Notify NHS Choices of any changes Assurance of the practice s communication and engagement plan and development of a commissioner media line Example media statement We supported the plans by xxx and xxx to come together to share clinical experience and resources for the benefit of their patients, having reviewed the proposals to make sure the practices plans will provide the best possible care, as well as continued and sustainable access to services at both surgeries 25

101 Appendix 6 Scenario: Single-handed GP suspended due to performance concerns In this scenario, the CCG communications team and affected practice would need to liaise with the local NHS England communications team (given that NHS England retains responsibility for the oversight of individual GP performance issues). This includes where a GP has been suspended from the NHS England national performers list (which they have to be on to provide NHS GP services). NHS England also liaises with the General Medical Council (GMC) where a GP has been suspended from the GMC s register of doctors, or has had conditions placed upon their practice by the GMC (with these decisions taken via the Medical Practitioners Tribunal Service (MPTS). The handling of such issues will vary according to individual circumstances, but should be handled sensitively and recognising the confidential nature of an individual GP s employment record. However, this should also be balanced against information that is placed into the public domain/mpts about the status of individual GPs on the GMC register and the needs of patients. All communications in such circumstances must be signed off by the local NHS England team (via their communications team) given their responsibility for the operational oversight of individual GP performance. Responsibilities for communication and engagement Commissioner Responsible for liaising with the NHS England local communications team (who will in turn liaise with their medical directorate colleagues and MPTS) to agree any reactive lines that can be used in response to patient, media and stakeholder enquiries Responsible for reactive media handling (in conjunction with NHS England local communications team) GP Provider Responsible for liaising with CCG communications team/nhs England local communications team on how to respond reactively to any patient enquiries Responsible for referring any media/stakeholder enquiries on to NHS England/the CCG communications team as instructed Responsible for leading communications handling where any patient recall is necessary due to performance concerns (in liaison with local NHS England communications team) Example media statement The General Medical Council (GMC) is currently carrying out a review into Dr Bloggs professional practice. While this investigation is being carried out, he is suspended by the GMC, meaning he/she is not currently treating patients. NHS Smithstown CCG is working closely with staff from Dr Bloggs surgery to ensure patients can continue to access care and treatment from other GPs. If pressed: We are unable to provide any further information whilst the GMC investigation is ongoing." 26

102 Appendix 7 Scenario: A member of staff in a GP practice has been charged with a criminal offence Where there is a serious issue regarding an individual member of staff, such as a serious allegation being made or if they are facing criminal charges, it is likely that the GP practice will need greater support on communications handling. Where significant reputational issues are involved and the individual s conduct as a health professional is in question, the local NHS England communications team and the CCG communications team will both need to be involved. They will need to discuss and agree the NHS communications handling arrangements, in liaison with colleagues and appropriate GP practice staff. In cases where any criminal charges have been brought/may be brought, the local NHS England/CCG communications team will also need to liaise closely with press offices of the lead communications agency (eg Police or NHS Protect) to agree handling. Where there is an ongoing investigation/legal case then the NHS will need to respect this and will be limited in what can be said in response to any media/patient/stakeholder enquiries. In cases where alleged criminal activity has had a potential impact on patient care, then commissioners will also need to oversee any necessary proactive communications with patients about this in liaison with the police (for example the recall of patients where an individual has falsified qualifications etc). Responsibilities for communication and engagement Commissioner Responsible for liaising with the NHS England local communications team, police/nhs Protect to agree management of any patient enquiries Responsible for reactive NHS media handling (in conjunction with NHS England local communications team/police/nhs Protect) Responsible for leading communications handling where any patient recall is necessary due to performance concerns about an individual GP and in liaison with local NHS England communications team/police GP Provider Responsible for liaising with CCG communications team/nhs England local communications team on how to respond reactively to any patient enquiries Responsible for referring any media/stakeholder enquiries on to NHS England/the CCG communications team as instructed Responsible for ensuring practice staff are clear on how to respond to any patient/media enquiries (based on agreement with commissioners) and that they are aware of the importance of not compromising any ongoing legal investigation Example media statement We are aware of the charges that have been brought against Dr Bloggs. Dr Bloggs was suspended from practice by the General Medical Council (GMC) in October 2015, and has not seen patients since that time. Alternative arrangements have been put in place to ensure ongoing access to services for her patients. If any patients have concerns about treatment they have received they can call the NHS helpline on xxx (open from 0800 to 1800 Monday to Friday). We are unable to comment further while legal proceedings are ongoing." 27

103 Appendix 8 Scenario: A GP practice has to recall patients due to concerns that vaccinations have been improperly stored In these circumstances, the practice/ccg communications team would need to liaise with the local NHS England communications team on handling. This is because NHS England commissions screening and immunisation services from local GP practices and public health staff embedded within local NHS England teams would need to provide expert advice on communications lines/handling. Responsibilities for communication and engagement Commissioner Responsible for liaising with the NHS England local communications team/public health staff to agree lines regarding the management of any patient enquiries Responsible for reactive NHS media handling (in conjunction with NHS England local communications team/public health staff) Responsible for advising on communications handling where any patient recall is necessary, in liaison with local NHS England communications team/public health staff GP Provider Responsible for liaising with CCG communications team/nhs England local communications team on how to respond reactively to any patient enquiries Responsible for liaising with NHS England/the CCG communications team on how to respond to any media/stakeholder enquiries Responsible for ensuring practice staff are clear on how to respond to any patient/media enquiries (based on agreement with commissioners) Responsible for facilitating any necessary patient recall, in liaison with commissioners/nhs England/local public health staff Example media statement (any lines would have to be signed off by local public health experts at NHS England on the individual circumstances) Patients have been recalled as a precautionary measure there is no danger from having an immunisation that has been stored above the recommended temperature, but it might not provide all the protection the patient would expect, so it is safest to have the vaccination again. If you had an immunisation at the surgery but haven t been contacted there is no need to worry. The surgery has investigated the matter thoroughly and has contacted anyone who might have been affected. There is no danger in having a second dose of an immunisation even if the first one was effective although there is an increased chance of some soreness at the site of the injection. 28

104 If no recall is required but matter becomes public: A thorough investigation was carried out which determined that there was no risk to patients, and there is no need for anyone to be revaccinated. In the small number of cases where patients may have received jabs that had been stored outside the optimum temperature range, it has been established that this would not have affected the vaccination s effectiveness. If you or your child was vaccinated during the sessions possibly affected, there is no need to worry or book another vaccination. We are confident that everything that should have been done to protect patient safety has been done, but we will work with the provider to identify any lessons that can be learned to prevent future events of this nature. 29

105 Appendix 9 Scenario: Practice premises are put out of use with immediate effect due to fire/flooding/other damage Responsibilities for communication and engagement Commissioner Can support practice by helping to manage any immediate media/stakehholder interest if the impact on services is significant (eg in terms of helping the practice to get messages out via the local media/social media about alternative access to services) GP Provider Responsible for communicating with its own patients about alternative arrangements that have been made for care (possible message on practice website, on practice phone line and patient letters if impact will be longer term) This may include the need to advise patients on any immediate implications for their care (eg whether only urgent patients can be seen/whether the practice is unable to honour pre-booked routine appointments, whether there are alternative premises the practice will need to work from) Example media statement Due to a [Insert details of incident] at the The Acres Surgery in Smithstown today, the practice will be unable to treat patients there for the immediate future. The Acres Surgery has put arrangements in place to ensure that patients with urgent health needs can be treated at an alternative site over the next week. NHS Smithstown CCG is supporting the practice so that longer-term arrangements can be made as soon as possible to recommence routine appointments for patients while The Acres Surgery is unable to access their premises. The surgery will be providing regular updates for patients on their website about the current situation and how they can access services. Further information will be made available to affected patients as soon as possible. 30

106 Appendix 10 Scenario: Death of a single-handed GP Parliamentary regulations associated with the General Medical Services (GMS) contract state that in the event of the death of a single-handed GP, then the contract the NHS holds with them for services at their practice must come to an end within 35 days. In such circumstances it is therefore necessary to ensure a swift commissioning decision to make future arrangements for the care of patients. In engaging with patients and local community representatives about this a fair and proportionate approach will need to be taken. Given the urgency of the situation and the need to maintain continuity of care, the timescales may not allow commissioners the opportunity to seek the views of all patients from the practice about any changes to services. In such circumstances, commissioners could however seek to engage the views of patient and public representatives (eg Healthwatch, Patient Participation Group, Health and Wellbeing Board, HOSC). Responsibilities for communication and engagement Commissioner Develop communication and engagement plan, to cover engagement with key patient representatives on future plans for care (eg PPG, Healthwatch, Health and Wellbeing Board, HOSC) Develop communication materials for patients (including initial information to place within the practice/support practice staff respond to patient enquiries, a patient letter to explain next steps for their care once determined, a poster for the practice GP Provider Make any communications materials provided by the commissioner for patients on the practice website Manage any patient enquiries, in line with information provided by commissioners Management of any media enquiries about the future care of patients Example media statement We extend our condolences to Dr Bloggs family and are aware of the high esteem in which she was held by her patients, which has been borne out by the passion shown by local people for The Acres Surgery. Following careful consideration we have determined the only way we can ensure the healthcare needs of patients continue to be met is to ask them to register with a different GP practice of their choice nearby. We know this will be a disappointment to a number of people but our priority has to be to guarantee that everyone registered at The Acres Surgery can continue to access the full range of GP services. We are now writing out to all affected patients with further information about how they can register with one of the local practices that are ready to welcome new patients. We are extremely grateful to the staff from The Acres Surgery for the services they have provided to patients and their support in helping to ensure a smooth transition for them following the unavoidable closure of the practice. 31

107 Background information All households with patients registered at The Acres Surgery are being sent a letter with further information about the unavoidable closure of the practice and confirming how they can register with a new local GP surgery of their choice. Patients can also find details of other practices close to where they live on the NHS Choices website at Alternatively they can contact the Registration Helpline on xxxxx for help registering with a new practice. A patient registration drop-in session is being held on Wednesday 7 September between 2pm and 3pm at xxxxx to provide further advice for patients about choosing a new surgery We are bound by parliamentary regulations that state that in the event of the death of a single-handed GP, then the contract the NHS holds with them for services at their practice must come to an end within 35 days. The 9 September marks the end of this statutory period at The Acres Surgery and we have been working throughout the limited time available to secure an alternative arrangement for patients. We have also been advised that the current building will no longer be available to use as a surgery. Example patient letter To: Every household with a patient or patients registered at The Acres Surgery Dear Sir/Madam, Re; Closure of The Acres Surgery It is with regret that we have to inform you that The Acres Surgery will be closing on Friday 9 September This follows the sad and sudden death of Dr Maria Bloggs. NHS Smithstown Clinical Commissioning Group (CCG) is responsible for ensuring that you continue to receive access to a full range of local GP services. This remains our priority. We have reviewed what alternative local GP services are already in place that patients currently registered with The Acres Surgery could access. This review has shown that there are a number of GP practices within close proximity of The Acres Surgery which are ready to register new patients. A list of these practices is attached, providing information of addresses and contact details. NHS Smithstown CCG recommends you register with another practice as soon as possible in order to ensure you can continue to access the full range of GP services when you need them. Please take steps now to register with your chosen GP surgery. How to register with a new practice There are 12 other GP practices within a 1 mile radius of The Acres Surgery which are ready to register new patients and these practices are listed in the attached sheet. Additional information about GP practices is also available on the NHS Choices website at 32

108 You can choose the GP practice that is most suitable for you and according to where you live. The GP practice will need to check that you live within their registration boundary before you are able to register. This information should be available on their website, or you can check this with their reception staff. In order to register with a new GP practice you will need to complete the registration form GMS1, which is enclosed with this letter. Additional copies will be available from the practice of your choice. Please note that you may be requested to provide proof of address by your chosen GP practice as part of the registration process and therefore it may be helpful to bring this with you when you register at a new practice. Once you have registered, your medical records will transfer automatically to your new surgery. If you are currently receiving hospital care, it is important that you confirm details of your new GP practice to the hospital so that they keep your records updated. NHS Smithstown CCG is hosting two patient drop-in sessions at The Acres Surgery to which representatives from other local GP practices have also been invited to attend. These will be held on: XXXXX You do not need to book to attend the session, which may help you in choosing a new practice and completing the forms for registration. If you need any support in registering with a new GP practice, or identifying other GP practices where you live, you can also contact XXXXXX We appreciate this may be an unsettling time for you, but please be assured that we will be working closely with staff from The Acres Surgery and other local GP surgeries to support patients through the process of registering with another GP practice. The attached question and answer sheet contains additional information that you may find useful. Yours sincerely, 33

109 Section 106 Monies & Community Infrastructure Levy Funding This paper is for: Recommendation: Approval The Primary Care Commissioning Committee is asked to approve the proposed criteria for considering applications for, and spending of, s106 and CIL grants. These have been approved by Governing Body with a particular view to confirming that the criteria align appropriately with the CCG s strategic vision and plans for out of hospital care in west Kent. The Primary Care Commissioning Committee is asked to approve the criteria in respect of the transactional issues relating to the CCG s Member Practices where there may be conflicts of interest. For further information or for any enquiries relating to this report please contact: * gail.arnold@nhs.net or ( Date: 6 th Sept 2016 Reporting Officer: Gail Arnold Agenda Item: 8 Lead Director: Gail Arnold Version: Final Report Summary: This paper gives an overview of Section 106 planning obligations and the Community Infrastructure Levy, highlights the importance of the CCG engaging with District/Borough Councils to ensure health infrastructure needs are taken into account by fulfilling its responsibilities as a named body to be consulted in local plans and recommends criteria for the allocation of health infrastructure monies that come through both S106 and CIL funding routes. FOI status: This paper is disclosable under the FOI Act Strategic objectives links: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities Having a robust primary care sector will contribute to improved health outcomes and reduced health inequalities and be in inaugural part of developing the new models of primary care a key strand of the mapping the future blueprint. September 2016 NHS West Kent CCG

110 Board Assurance Framework links: Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities In order to demonstrate appropriate governance arrangements are in place as a delegated commissioner of primary care the CCG needs to be able to evidence how it is applying the relevant policy, guidance and standard operating procedures that relate to primary care commissioning. Planning consultations need to be responded to in a timely manner. Without a clear set of criteria for drawing down s106/cil funding the CCG may not benefit from funding that is available for the improvement of health facilities in West Kent Staffing resources within the Primary Care Team to retain an oversight of the bids and to respond to the planning consultations. No legal implications identified at this stage. Equality Assessment to be completed. Previously considered and approved by Governing Body. Report If the Primary Care Commissioning Committee approves the criteria in respect of the transactional issues relating to the CCG s Member Practices, the criteria will be used with immediate effect in confirming the CCG s applications for s106 and CIL funding going forward. September 2016 NHS West Kent CCG

111 Section 106 Monies & Community Infrastructure Levy Funding Date 22 August 2016 Patient focused, providing quality, improving outcomes

112 Section 106 Monies & Community Infrastructure Levy 1 Introduction 1.1 This paper gives an overview of Section 106 planning obligations and the Community Infrastructure Levy, highlights the importance of the CCG engaging with District/Borough Councils to ensure health infrastructure needs are taken into account by fulfilling its responsibilities as a named body to be consulted in local plans and recommends criteria for the allocation of health infrastructure monies that come through both S106 and CIL funding routes. 2 Background 2.1 The link between planning and health is long established. The planning system has an important role in creating healthy communities; it provides a means both to address the wider determinants of health and to improve health services and infrastructure to meet changing healthcare needs. Consultation between Local Planning Authorities (LPAs), public health and health organisations is a crucial part of this process. 2.2 LPAs vary across England, in two-tier local authorities areas (such as Kent County Council area), the relevant LPA is the district or borough council, except for applications involving minerals and waste development which are made to the county council. Clinical Commissioning Groups (CCGs) and NHS England (NHS E) are named bodies to be consulted in Local Plans. 2.3 The power of a LPA to enter into a Planning Obligation with anyone having an interest in land in their area is contained in Section 106 of the Town and Country Planning Act 1990 (as amended by Section 12 of the Planning and Compensation Act 1991). Their main service areas where monies are received through the use of S106 obligations are: Local Economy; Community or Town Centre use; Highways/Traffic; Education; Health; Land; Affordable; and Other (which records payments for any other contributions which do not fall into one of the above categories). 2.4 It is important to note that S106 monies may only be spent on facilities where the new development has, at least in part, contributed to the need for the facilities. S106 funding is available for capital projects only. Revenue funding towards on-going running costs is not available. 2.5 Following concerns that S106 obligations were not transparent, ineffective in providing for major infrastructure, had a disproportionate effect on major developments, and that most development did not pay. The 2008 Planning Act, introduced the Community Infrastructure Levy (CIL) the purpose of which is to raise funds from developers who are undertaking new building projects, to help pay for infrastructure that is needed to support new development. CIL is an optional tariff based system of collecting money to pay for all or part of the cost of providing infrastructure to support development. It will replace Section 106 planning obligations for many forms of infrastructure, although Section 106 agreements can still be used for site-specific mitigation measures and for affordable housing provision. LPAs will determine what infrastructure is required Page 2 of 8

113 and can use the money to provide, improve or operate facilities. It can be used to fund a wide variety of infrastructure including: transport schemes flood defences schools, hospitals and other health and social care facilities parks, green spaces and leisure centres. 2.6 CIL is now becoming the preferred method for collecting pooled developer contributions to fund infrastructure and all LPAs are expected to move to CIL as a priority. In West Kent, only Sevenoaks District Council has adopted a Community Infrastructure Levy 3 Developing a Community Infrastructure Levy (CIL) 3.1 LPAs are allowed to raise funds from developers through a CIL to help to deliver infrastructure needed to support development requirements within their wider administrative areas: A CIL Charging Schedule must be prepared, and this sets out the types of development that will be liable to pay CIL and the methods by which it will be calculated. This could apply to new NHS premises. This entire process is subject to public consultation and examination by an independent examiner; CIL is a standard charge on all liable new buildings and extensions that occur within a council s administrative area; LPAs must prepare a regulation 123 list which sets out the type of infrastructure that may be funded by CIL in an area (for example, health facilities and transport infrastructure). The Infrastructure Plan (or similar) sets out what infrastructure is required to serve the planned growth in an area, and this is where public health, CCGs and NHS E, in conjunction with Foundation Trusts and Trusts, need to engage with LPAs; There will be a high level of competing needs for infrastructure funding from a wide variety of projects. As CIL is intended to supplement other sources of funding for local infrastructure, not all projects will receive funding through this levy. The apportionment of CIL to projects will be determined by the LPA as the charging authority in relation to local infrastructure priorities. It is important that the CCG engages with it s District/Borough Councils to ensure health infrastructure needs are taken into account in the development of CIL charging schedules by fulfilling its responsibilities as a named body to be consulted in local plans. 4 Releasing Section 106 Monies 4.1 In general terms, most S106 agreements allow the following improvements to health facilities: The expansion of health premises to provide additional facilities and services to meet increased patient or user numbers; New health premises or services at the local level; Any new facility required to compensate for the loss of a health facility caused by the development. 4.2 Historically the processes for allocating Section 106 health funding was via the Primary Care Trust (PCT) who were responsible for maintaining an Estates Strategy and would manage any health allocation as a contribution to delivering against that strategy. The process for securing healthcare contributions was based on a simple formula applied to the number of dwellings proposed in each planning application. Page 3 of 8

114 4.3 In April 2013, PCTs were disbanded and Clinical Commissioning Groups (CCG) were established, the responsibility for estate management for health provision was split. NHS England South as a regional body was made accountable for primary care whilst the CCGs retained responsibility for acute and community care. NHS Property Services (PropCo) took over all PCTs and Strategic Health authorities estates interests. Where PCT properties were classed as critical clinical infrastructure and a Foundation Trust or another NHS provider was the majority occupier ownership was offered to those NHS bodies initially rather than PropCo. 4.4 As at 1 April 2016, NHS West Kent Clinical Commissioning Group took on delegated cocommissioning of primary care services and it also inherited the responsibility to produce an Estates Strategy for its area. In June 2016, Governing Body agreed both a primary care development strategy and a local Estates Strategy framework. 4.6 The CCG needs to be able to exercise its responsibility to make recommendations on the allocation of health related s106 and CIL monies in a way that is: strategic financially robust meeting need in a particular area Supported by the relevant Council, the CCG Members and relevant healthcare organisations in CCG area Able to allow the CCG and district/borough councils to align their relevant investment strategies in order to enable the development of a holistic approach to investment in the broad healthcare estate 4.7 To ensure all consultations are responded to in a timely manner and that a log of CCG responses is maintained. All consultations on planning applications received by the CCG will be routed through a single inbox wkccg.notifications@nhs.net. 4.8 NHS Property Services has advised that historically the need for a health facility or the sum to be requested in West Kent for health under S106 was estimated based on a calculation consisting of occupancy x number of units in the development x 360. Size of Unit Occupancy Assumptions Based Health Need/Sum Requested per unit on Size of Unit 1 bed unit 1.4 persons 504 per 1 bed unit 2 bed unit 2.0 persons 720 per 2 bed unit 3 bed unit 2.8 persons 1008 per 3 bed unit 4 bed unit 3.5 persons 1260 per 4 bed unit 5 bed unit 4.8 persons 1728 per 5 bed unit 4.9 NHS Property Services also advised that if the planning application doesn t specify the unit sizes in the proposed development, the average occupancy of 2.8 persons is used in the initial health calculation until such time as the size of the dwelling units are confirmed at which point the final costs/health calculation would be confirmed. For example if the proposal was for a 400 dwelling development the initial calculation would be 2.8 persons x 400 dwelling units x 360 = 403, NHS Property services also advised on the indicative square meterage calculations historically used to determine the core GMS space required for a practice patient population. Details are set out in the table below and don't take into account any co-location of secondary care services just core GMS services. Further advice will be sought in respect of practices with populations of under 20,000 patients. Page 4 of 8

115 Practice patient population size CORE GMS square meterage 20,000 patients 1278 sqm 22,000 patients 1378 sqm 24,000 patients 1478 sqm 25,000 patients just over 1500 sqm 4.11 West Kent Local Planning Authorities (Maidstone Borough Council, Sevenoaks District Council, Tonbridge & Malling Borough Council and Tunbridge Wells Borough Council) are holding funds from a number of Section 106/CIL agreements that need to be committed to health estate improvements. The legal S106 agreement itself for a particular development will state where the funds should be spent and on the specific project to reflect the initial S106 request Most s106 agreements also include a time limit for spending the contribution, usually 5 years from when it has been received. If a contribution is not used for the intended purpose or not spent within the time specified in the agreement, the funds are required to be returned to the developer In terms of allocating the s106 contributions for primary healthcare facilities, the CCG will need to submit to the Council appropriate specific schemes which it is committed to deliver, with timescales for their implementation. It should be noted that the Council cannot release s106 contributions to enable the feasibility work to be carried out without an appropriate business case and information The CCG now needs to establish fair and transparent criteria to allow access and draw down of any s106 and future CIL funding to ensure that the maximum health benefit is realised from any available funding. Page 5 of 8

116 Draft Criteria Criteria 1. For the purpose of S106/CIL funding allocations where a particular practice is cited as a potential recipient the CCG interpretation will be to allocate the monies for services delivered in the particular practice or services that are provided outside of the practice but support the practices registered patient population 2. Any s106/cil monies will be used for the purpose provided for in the relevant agreement. 3. Any s106/cil monies will be used in the location provided for in the relevant agreement 4. Any s106/cil monies not spent within the time limits prescribed in those agreements, will be returned to the payee. 5. When the CCG is formally consulted on planning applications it will consider strategic fit with strategic commissioning plans and the estates framework and recommend the funding is allocated in support of specific premises schemes or for specific practice developments. 6. When the CCG is formally consulted on planning applications it will apply the occupancy estimates set out in paragraphs 4.8 and 4.9 above to reach a value of health need/sum requested from S106/CIL agreements 7. When the CCG receives formal bids to release funds from practices, each proposed scheme will require a business case to be submitted which will highlight how the proposed schemes will improve access to healthcare for the local patients and demonstrate strategic fit and support for identified CCG priorities 8. When the CCG receives formal bids to release funds, each proposed scheme will be assessed against these criteria by the Primary Care Co-commissioning Operational Group, with a recommendation made to the Primary Care Co-commissioning Committee prior to submission to the LPA in order for the monies to be released The CCG will not support any business case/proposal where a contract for works has already been entered into, work has been commenced or that contract or work has not been subject to prior agreement with the CCG. 10. Where the value of formal bids from practices exceeds the s106/cil monies available the CCG will be guided by Rationale To ensure that the investment supports delivery of the primary care development strategy, strategic commissioning plans and future commissioning intentions for West Kent and to enable the development of a holistic approach to investment in the broad healthcare estate Spend needs to comply with the purpose outlined in the s106/cil agreement or CCG will not be able to draw down funds Spend needs to be in the location outlined in the s106/cil agreement or CCG will not be able to draw down funds Spend needs to be in the time period outlined in the s106/cil agreement or CCG will not be able to draw down funds To ensure that the investment supports strategic commissioning plans and future commissioning intentions for West Kent and to enable the development of a holistic approach to investment in the broad healthcare estate To ensure there is a consistency and objectivity to calculations used across the West Kent area To ensure that the access to healthcare will be improved for patients in the affected locations and to ensure the proposed investment supports strategic commissioning plans and future commissioning intentions for West Kent To ensure that the access to healthcare will be improved for patients in the affected locations and to ensure the proposed investment supports strategic commissioning plans and future commissioning intentions for West Kent To ensure that the access to healthcare will be improved for patients in the affected locations and to ensure the proposed investment supports strategic commissioning plans and future commissioning intentions for West Kent To ensure there is a consistency and objectivity to calculations used across the West Kent area. 1 To support decision making and to ensure maximum fairness the Primary Care Co-commissioning Committee will be provided with details of any other grants, administered by the CCG or NHS England, that the practice bidding for S106/CIL monies has received in the previous 12 months. Page 6 of 8

117 the Premises Costs Directions 2013 in particular sections 8 and 9 (see Appendix 1) as to projects that may or may not be funded. 11. Where any schemes are approved the s106/cil contribution will be not less than 33% or more than 66% of the total cost of the premises improvement, plus any Value Added Tax for which the contractor cannot claim a refund. 12. The CCG will aim to utilise 100% of the s106/cil funding available for primary community healthcare facilities in its area. 13. The CCG will not support a business case for S106/CIL funding that would lead to the space allocated for core GMS exceeding the square meterage calculation that of the space required to deliver core GMS for the patient population under consideration (see paragraph 4.10 above) 14. Where a practice receives s106/cil monies that contributes to the cost of building or refurbishment work done in the practice premises and the capital was not borrowed by or provided by the contractor the notional rent payable is respect of those payments is to be abated in line with directions 43 and 45 and schedule 3 of the Premises Costs Directions 2013 S106 funding is available for capital projects only. Revenue funding towards on-going running costs is not available. To ensure there is a consistency and objectivity to calculations used across the West Kent area and To maximise the s106/cil resources available to the CCG To ensure minimise the additional cost pressures that may arise for the CCG as a result of allocating S106/CIL capital monies To secure best value for money for the provision of GMS services through the named practice. Recommendation Governing Body is asked to approve the proposed criteria for considering applications for, and spending of, s106 and CIL grants, particularly confirming that these align appropriately with the CCG s strategic vision and plans for out of hospital care in the future. Page 7 of 8

118 Appendix 1 - Extract from NHS Premises Costs Directions 2013 Projects that may be funded with premises improvement grants 8. The types of premises improvement projects that may be the subject of a premises improvement grant include- (a) improvements to practice premises in the form of building an extension to the premises, bringing into use rooms not previously used to support delivery of primary medical services or the enlargement of existing rooms; (b) improving physical access to and within practice premises, and alterations or additions made necessary by the Equality Act 2010(a); (c) improving lighting, ventilation and heating installations (including replacement of other forms of heating by central heating) of practice premises; (d) the reasonable extension of telephone facilities within practice premises (but not the initial purchase or replacement of telephone systems); (e) the provision 'of car parking required for patient and staff use, subject to the number of parking spaces being agreed by the Board (access to and egress from each parking space must be undertaken without the need to move other vehicles); (f) the provision of suitable accommodation at the practice premises to meet the needs of children and elderly or infirm people; (g) fabric improvements to practice premises such as double glazing, security systems and work required for fire precautions and other statutory building requirements; (h) refurbishment of a building not previously used for the _ provision of primary medical services but which is to be used as practice premises on a temporary basis; (i) improvements which are necessary in connection with emergency planning, such as the provision of electronic storage facilities at a location remote from the practice premises or the installation of a connection for an emergency generator; (j) improvements which are necessary to meet infection control or decontamination requirements at practice premises, including the installation of specialist floor covering in areas used for the treatment of patients; and (k) the installation of a water meter. Projects that must not be funded with premises improvement grants 9. The Board must not agree to fund the following expenditure with a premises improvement grant- (a) any cost elements in respect of which a tax allowance is being claimed; (b) the cost of acquiring land, existing buildings or constructing new buildings; (c) the repair or maintenance of premises, or the purchase, repair or maintenance of furniture, furnishings, floor covering (with the exception of the specialist floor covering referred to in direction 80)) and equipment; (d) restoration work in respect of structural damage or deterioration; (e) any work in connection with the domestic quarters or the residential accommodation of practitioners, caretakers or practice staff, whether or not it is a direct consequence of work on surgery accommodation; (f) any extension not attached to the main building by at least a covered passage way; (g) improvements designed solely to reduce the environmental impact of premises, such as the installation of solar energy systems, air conditioning, or replacement windows, doors or facades; and (h) any work made necessary as a result of fair wear and tear. Page 8 of 8

119 2016/17 Month 4 (Month ended Primary Care Cocommissioning This paper is for: Information Recommendation: The committee is required to note the financial position of the PCC budget. The committee should be aware that there are financial risks which may crystallise in the future from PCC providers ensuring their registered patient population are receiving high quality care. For further information or for any enquiries relating to this report please contact: Reg Middleton, Chief Finance Officer Date: 6 th September 2016 Reporting Officer: Yin Yau, Deputy Chief Finance Officer Agenda Item: 9 Lead Director: Reg Middleton, Chief Finance Officer Version: Final Report Summary: The report is a high level summary of the current financial performance of the Primary Care Co-commissioning budget (PCC). The report provides 2016/17 PPC budget details Month /17 forecast financial position The impact of uncrystallised financial risk relating to PCC expenditure Links to PCC information regarding aspects of detailed operation FOI status: This paper is disclosable under the FOI Act Strategic objectives links: E: Sustainable Finances September 2016 NHS West Kent CCG

120 Board Assurance Framework links: This paper supports the mitigation of the following strategic risk: E Loss of control over provider activity and system finances could result in the CCG being unable to invest in service development and ultimately breaching its statutory duties. Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: N/A N/A N/A N/A Appendices included in report N/A September 2016 NHS West Kent CCG

121 [Type text] Introduction The purpose of this report is to provide an overview to the committee regarding financial performance for Primary Care Co-commissioning activities. Financial Background to Primary Care Co-commissioning (PCC) Activities Financial resources are provided to GP practices to provide primary care services under 5 key headings: 1. GP contracts of which there are 3 types that operate in WKCCG GMS, PMS & APMS (Annex A) 2. Enhanced Services (Annex A) 3. Quality and Outcomes Framework (Annex A) 4. Premises (Annex A) 5. Additional Practice Payments (Annex A) 2016/17 WKCCG allocation for Primary Care Co-commissioning Activities WKCCG received the following initial allocation to provide for PCC m m Initial allocation Less: PCC contribution to 1% headroom (0.588) PPC contribution to 0.5% contingency (0.298) Add: Allocation for IMT & dispensing doctors Less: Return of allocation for management of Primary Care Co-Commissioning activities by NHS England Revalidation of co commissioning (0.414) GP IT (0.082) Current Operational Primary Care Co-commissioning budget

122 [Type text] 2016/17 PCC key budgets GP Contracts, 38,117,715 Enhanced Services, 3,218, % contingency, 298,000 1% Headroom, 588,000 Additional practice payments, 3,424,189 Premises, 7,505,290 Quality & Outcomes Framework, 5,597,481 Financial performance of Primary Care Co-commissioning budget A high level overview indicates that the CCG is forecasting a 60,000 over expenditure against budget in premises and a significant 530,000 under expenditure against budget in other practice payments. This is based on projections from the financial information that is interfaced from the Exeter system administered by Capita. 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000,000 0 Primary Care Co-commisioning Expenditure 2016/17 APRIL MAY JUNE JULY Budget FOT ADDITIONAL PRACTICE PAYMENTS PREMISES QUALITY and OUTCOMES FRAMEWORK ENHANCED SERVICES GP CONTRACTS 2

123 [Type text] Potential financial risks The PCC budget is exposed to various risks in the key areas and an early assessment at M4 indicates that should all the risks crystallise the PCC budget would be reporting an over expenditure against budget which would require mitigation from the CCG s overall financial position. Summary Although the performance of the PCC budget is currently being reported at Month 4 as 490,000 under expenditure against budget, there are significant financial risks that could potentially change this position to circa 275,000 over expenditure. The CCG in managing PCC contracts has no placed no restrictions on providers of services and encourages the development of PCC related services and seeks to manage the financial impact of recurrent and non-recurrent claims and entitlements within the overall budget available. A key financial pressure that the CCG has to manage is the longer term recurrent investment in new infrastructure and premises to provide the most suitable environment for registered patients. More clarity and assurance of the financial forecast will be provided when the final settlement with NHS England is known regarding the net recharge to fully mitigate the impact of prior year costs from the CGGs expenditure position. Currently the CCG is making best assumptions with regards to mitigating such costs. 3

124 [Type text] Annex A Primary Care Co-commissioning financial headings GP contracts General Medical Services contract The General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities. Personal Medical Services contract Personal Medical Services (PMS) agreements are locally agreed contracts between NHS England and GP practices. PMS contracts offer local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and the provider structure (who can hold a contract) Alternative Provider Medical Services Alternative Provider Medical Services (APMS) is a contracting route available to enable PCOs to commission or provide primary medical services within their area to the extent that they consider it necessary to meet all reasonable requirements. APMS contracts are provided under Directions of the Secretary of State for Health and provide the opportunity for locally negotiated contracts. They allow PCOs to contract with non-nhs bodies, such as voluntary or commercial sector providers, (or with GMS/PMS practices) to supply enhanced and additional primary medical services. PCOs can enter into APMS contracts with any individual or organisation to meet local needs, as long as core NHS values are fully protected and secured. Enhanced Services Information for Enhanced services are detailed here: Quality and Outcomes framework (QOF) Information for QOF are detailed here: Premises Information for premises payments to practices are governed under NHS (GMS-premises Costs) Directions 2013 under statute re National Health Service Act General_Medical_Services_-_Premises_Costs Directions_2013.pdf 4

125 [Type text] Other practice Payments Information for other practice payments are governed by the General Medical Services Statement of Financial Entitlements Directions med_servs_statement_financial_entitlements_directions_2013_acc.pdf This is subsequently updated every year with appropriate amendments. All publications and amendments relating to Primary Medical services can be found here Examples of other general practice payments include: PAYMENTS FOR LOCUMS COVERING MATERNITY, PATERNITY AND ADOPTION LEAVE PAYMENTS FOR LOCUMS COVERING SICKNESS LEAVE PAYMENTS FOR LOCUMS TO COVER FOR SUSPENDED DOCTORS PAYMENTS IN RESPECT OF PROLONGED STUDY LEAVE SENIORITY PAYMENTS DOCTORS RETAINER SCHEME RETURNERS SCHEME FLEXIBLE CAREERS SCHEME DISPENSING DISPENSARY SERVICES QUALITY SCHEME Specific details are in the Statement of Financial Entitlements 5

126 This paper is for: Recommendation: Primary Care Update Information and Decision The Primary Care Co-commissioning Committee is asked to Ratify the decision on the Clanricarde Medical Centre and Rowan Tree Surgery merger. Approve the Marden Medical Centre s boundary changes Note the contractual changes listed. Delegate responsibility to COO/AO/CFO for responding to the GP Resilience proposals on behalf of the CCG. For further information or for any enquiries relating to this report please contact: Louise Matthews louise.matthews5@nhs.net, ( Date: 6 th September 2016 Reporting Officer: Louise Matthews Agenda Item: 10 Lead Director: Gail Arnold Version: Final Report Summary: This report provides an update on primary care activities. FOI status: This paper is disclosable under the FOI Act; Strategic objectives links: Board Assurance Framework links: A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities Having a robust primary care sector will contribute to improved health outcomes and reduced health inequalities and be in inaugural part of developing the new models of primary care a key strand of the mapping the future blueprint. A: Implementation of Mapping the Future Blueprint. C: Improved health outcomes and reduced health inequalities In order to demonstrate appropriate governance arrangements are in place as a delegated commissioner of primary care the CCG needs to be able to evidence how it is applying the relevant policy, guidance and standard operating procedures that relate to primary care commissioning. 6 th September 2016 NHS West Kent CCG Page 1 of 2

127 Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: None identified None identified The Policy Book for Primary Medical Services ( aims to support a consistent and compliant approach to primary care commissioning across England. It is essential that any decisions relating to primary care confirm to this guide and other statutory regulations and standard operating procedures that are in force. Not considered previously by this committee. N/A N/A 6 th September 2016 NHS West Kent CCG Page 2 of 2

128 Primary Care Update 6 September 2016 Patient focused, providing quality, improving outcomes