Primary Care Commissioning Committee

Transcription

1 Primary Care Commissioning Committee To be held on Thursday 13 th April 2017 from 12.30pm until 2.30pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ

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3 Primary Care Commissioning Committee To be held on Thursday 13 April 2017 Commencing at 12.30pm 2.30pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ PUBLIC AGENDA Presenter Enc Action required 1. Welcome and Introductions Chair 2. Apologies Chair 3. Declarations of Interest Chair 4. Minutes of the previous meeting held on 9 March 2017 Chair Enc A Noting Primary Care Commissioning Committee Action Tracker 5. Matters Arising Chair Strategy & Development 6 Primary Care Estates planning Mrs Sherburn/ Mrs Tingle Presentation Discussion 7 GPFV Implementation Plan progress update Mrs Sherburn Enc B Noting 8 Doncaster-wide June event: agenda planning Laura Sherburn Verbal Discussion Business Items 9 Application for list closure; Dunsville practice Mrs Wastnage Enc C For approval 10. Rent Reimbursement: Burns Practice Mrs Wastnage Enc D For approval 11. GMS Contract Changes Mrs Tingle Enc E Noting

4 12. Financial Planning Primary Care budgets Presenter Enc Action required Mrs Tingle Enc F Noting 13 PCCC forward planner Mrs Sherburn Quality & Performance 14. Quality Update Mrs Cookson Enc G Enc H Noting Noting 15. Receipt of Minutes Receipt of minutes from: Chair Enc I Noting Primary Care Delivery Group Draft Minutes of the meeting held on 10 March 2017 Provider Engagement Group Draft Minutes of the meeting held on 22 February 2017 & 16 March Any Other Business Chair Verbal Noting 17. Date & Time of next meeting Chair Verbal Noting Thursday 13 April 2017 at 12.30pm To resolve that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act Chair

5 Minutes of the Primary Care Commissioning Committee Held on Thursday 9 March 2017 commencing at 12.30pm In the Boardroom, Sovereign House Voting Members Present: Non-voting Members present: Formal attendees present (nonvoting): Mrs Linda Tully Lay Member (Chair) Mrs Sarah Whittle Lay Member (Vice Chair) Mrs Hayley Tingle Chief Finance Officer Mrs Laura Sherburn Chief of Partnerships Commissioning and Primary Care Mrs Jackie Pederson Chief Officer Dr Niki Seddon Locality Lead, North West Locality Mrs Carolyn Ogle Primary Care Contract Manager, NHS England Dr Nabeel Alsindi Clinical Lead for Primary Care and Long Term Conditions Mrs Debbie Hilditch, Health Watch Doncaster Representative Mrs Kayleigh Wastnage Primary Care Support Manager Mrs Suzannah Cookson Deputy Chief Nurse In attendance: Ms Rhona McCleery Corporate Services Officer - (Taking Minutes) Dr Robin Carlisle Lay Member, Rotherham CCG Mr David Gibbons - Liaison Officer, Deputising for Dr Dean Eggitt Doncaster Local Medical Committee ACTION 1. Welcome and Introductions Mrs Tully welcomed everyone to the Primary Care Commissioning Committee meeting. There were 2 members of the public in attendance at the meeting and 3 members of NHS Doncaster CCG staff observing the meeting. 2. Apologies Apologies were received from: Dr Dean Eggitt Medical Secretary, Doncaster Local Medical Committee Dr Rupert Suckling Director of Public Health Mr Ian Carpenter, Head of Communications & Engagement 1

6 Dr Pat Barbour Locality Lead, South East Locality 3. Declarations of Interest The Chair reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group. Declarations declared by members of the committee are listed in the CCG s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link The meeting was noted as quorate. Declarations of interest from sub-committee/working groups: None declared. Declarations of interest from today s meeting: Item 7 - National Primary Care Transformation Fund (Capital Infrastructure & IT) Dr Seddon declared a Financial interest in the National Primary Care Transformation Fund (Capital Infrastructure & IT) Update as a bid had been submitted from her practice. As this item provided an update only, Dr Seddon remained in the meeting. Item 10 Extended Primary Care Pillar Tiered Framework Dr Seddon declared a Financial Interest in the Extended Primary Care Pillar Tiered Framework as Dr Seddon provides a Colposcopy service. As this item provided an update only, Dr Seddon remained in the meeting. 4. Minutes of the Previous Meeting held on 9 th February 2017 The minutes of the meeting held on 9 th February 2017 were agreed as an accurate record with one amendment to be noted: Mrs Hilditch had declared an interest in item 10 (Practice Merger Business Case Proposal) on the basis that Healthwatch had been asked to engage with the practices concerned. Mrs Hilditch left the meeting when the agenda item was discussed and returned directly after. 5. Matters Arising Proactive Co-ordinated Primary Care Specification Update on Practice Readiness Recommendations 2

7 Dr Eggitt and Mrs Sherburn continue to hold discussions to find a solution and this item will remain open on the Action Tracker National Primary Care Transformation Fund (Capital infrastructure & IT) update This has been added to the agenda for today s meeting and will be discussed in item 7. Keeping Well Pillar of the Primary Care Strategic Model Dr Alsindi confirmed that further discussions with Dr Eggitt and Mrs Sherburn were needed. This remains on the Action Tracker. Practice Merger Business Case Proposal Mrs Sherburn fed back to Practices and assurances have been received from all. This action can be closed. Any Other Business QOF Mrs Sherburn confirmed that the request to suspend QOF for the remainder of the year was denied by NHSE. This action can be closed. 6. Review of Terms of Reference Mrs Tully stated that the Terms of Reference were to be revised and this is an opportunity for members to comment on whether the meeting is working effectively or if any of the Terms of Reference need amending. Amendments to be noted and implemented are: Page 3 No member of Quality Team listed as per page 8. Page 3 LMC representation not listed as per page 8. Page 8 Lay member (Vice Chair) to be amended to reflect Mrs Whittle s position as Vice Chair remove Miss Morris. Mrs Tully asked members to consider, that given the experience of the previous 2 meetings where Mrs Wastnage is frequently asked for information and advice whilst sitting in the Public Gallery, and given the work she is involved with, that her role be added as an official attendee. This was agreed and is to be added. A public question section is listed at the end of the agendas for meetings in other CCGs and noted within Terms of Reference - this will be given consideration for inclusion outside of this meeting. Amend Dr Nabeel s title to CCG Clinical Lead for Primary Care not General Practice. Mrs Cookson s job title to be changed to Deputy Chief Nurse. Mrs Tully to make the amendments listed. Mrs Tully 3

8 7. National Primary Care Transformation Fund (Capital Infrastructure & IT) Update Mrs Sherburn commented that following on from the conversation had at the previous meeting where it was agreed to continue support to practices that were in cohort 2 and assist in working up their PIDs, 2 PIDs were submitted by the end of February. A stocktake of the detail within these is now being done and an assessment around revenue impact is being carried out. Mrs Ogle confirmed that 3 IT Schemes in cohort 1 are at the invoicing stage. The Premises ones are finalising due diligence processes. Some of those have taken longer than expected and where the funds will not be spent in 16-17, the schemes will roll forward into 2017/18 and this will have an impact on Cohort 2 schemes. The national team have confirmed that there are twice as many bids as can be funded from the overall national fund. Open, frank and honest discussions for the cohort 2 bids are needed, to assess whether delivery can actually take place by March Mrs Sherburn confirmed that conversations were had with the Cohort 2 practices in January where bids and viability were fully discussed. It may be necessary to reiterate some of these conversations. Mrs Wastnage confirmed that 2 practices have dropped out and some have not moved forward as they are worried the time, effort and money involved would be prohibitive. Some have asked for confirmation that they are still in the process, but without further details, have informed the CCG that they wouldn t be doing any further work-up of their bids. No action is required from the committee at this point. Primary Care Commissioning Committee noted the update. 8. GPFV Implementation Plan progress update Mrs Sherburn provided a verbal update only on this occasion but will bring a paper to the next meeting once all conversations have concluded. There are dates in place to commence Care Navigation Training and also Managing Medical Correspondence training for staff. Invoices are coming through now for the funds. The other tranche of funding for 17/18 via GP Forward View is the 3 per head transformational monies; conversations are now underway with the emerging federation in Doncaster to understand how this could be best deployed. There is a growing consensus that by pooling the 3 per head into a collective fund means that there would be far more benefit gained than deploying it at practice level. This has been shared with the LMC and a conversation was had at the 4

9 Primary Care Engagement Group about some of the areas. It was also discussed at the Strategy and Development meeting in Dec A federated model is being developed for Doncaster and this is to be a single legal entity. What it looks like is yet to be determined but the work will be underpinned by the practices aligned to the 4 neighbourhoods as per the Place Plan. A work plan will be developed for the implementation of this model. Other areas for deployment of the 3 per head are proposed as: Practices will be required to work together at neighbourhood level to deliver change projects against the HIAs most relevant to their need. Part of the GP Forward View offer is the opportunity for practices to engage with a more Productive General Practice and other CCGs have taken this up. Discussions will be had with emerging federation as to how to take this forward. NHS England wish to test out a GP Workforce tool to enable better understanding of who does what, with what type of patients, and what impact; consistently across the patch. This will be subsidised but there will be a cost to practices. We will need to prepare for Extended Access. New ways of working will need to be piloted in this coming year to get us ready for the requirements in readiness for April This means that the 5 main areas to be concentrated on are: Federation, Change Projects, Productive General Practice, Understanding Workforce & Workload and Preparing for Extended Access this will be where the 3 per head will be deployed. The Primary Care Commissioning Committee noted the update. 9. Proactive Co-ordinated Primary Care Service Quarter 1 Report Dr Alsindi gave an update on the first pillar on the Strategy that was commissioned and started in practices on the 1 st October The first set of reports has now been received from most of the practices. 1 practice is still outstanding but is being followed up on. There is no baseline to compare at this point but emerging themes can be picked out. Capacity has been noted as one of these themes and it was recognised that recruitment has been a problem in some practices. One thing that was different to the Transforming Primary Care was building on the MDTs. Some practices have forged ahead with this, engaging with other wider health and social care colleagues. It is hoped that Qtr 2 will show more universal progress. Enriched Summary Care Record there is quite a lot of variation between practices in how many patients have agreed to share ESCR. It is not known whether this is down to operational reasons or variation in 5

10 practice s understanding about how to implement. Further conversations will be had to follow this up. From 1 st April 2017 the Avoidable Unplanned Admissions Direct Enhanced Service is to be rolled into the global contract sum, and will not have any dedicated reporting mechanisms in place. This was anticipated when designing the PCPC specification, so for a lot of practices, the fact that we encouraged the overlap with the AUA register should mitigate against no longer having that contractual requirement to deliver the service for those patients. There is a feeling of progress and encouragement. Reporting is much improved, still variable in receipt and contents, but some have included feedback from patients and families. The outcomes in Qtr 2 will show if improvement has taken place. Mrs Whittle noted that the report was based on process, and asked if a full evaluation of outcomes was running at the same time? Dr Alsindi noted that the outcomes from the collaborative working and the wider MDTs could take years to show effect. It would be preferable to show year on year results rather than just quarterly. Mrs Sherburn commented that the measurable things we have are very much proxy indicators for outcomes, as it is difficult to prove that any outcomes are a direct result of this service. One of the things that will be measured globally will be the impact of reduction on acute care. Mrs Tully queried how we can ensure consistency of information if practices have tweaked the template to suit? Dr Alsindi said that no real meaningful changes had been made to the template and practices will be followed up with if any specific pieces of data are lacking. Mrs Tully also queried the compliance with the deadline. The deadline was 31 st January and most responses weren t received until the end of February, will this be stricter going forward? Dr Alsindi confirmed that the performance-related elements of the payment are based on full engagement with the reporting process; therefore practices that continue not to engage/report on time will not be eligible for these payments. The update was noted. 10. Extended Primary Care Pillar Tier 1 & 2; Practice responses Mrs Sherburn provided a brief update. Practices have been asked to indicate to the CCG which local enhanced services they will be providing from April The local enhanced services have been divided into 3 Tiers as part of the implementation of the Extended Primary Care Pillar. 6

11 All practices must provide all of the Tier 1 services if not directly, then by agreement with another provider. Tier 2 services can be offered to non-registered patients. This aspect of the services will be trialled and tested throughout 2017/18. As of the 8 th March 39 Practices have responded and this gives good coverage across Doncaster for Tier 1 services. For the Tier 2 services particular skills are needed to invest in delivery of these. Interests have been received back from the practices and it has been a very encouraging response. There is at least 1 practice in each of the 5 commissioning localities that has expressed interest in providing all of the Tier 2 services, to registered and non-registered patients. In this sense, it is possible to see that potential hubs are emerging but a lot more work is still to be done; however early indications are really encouraging. Responses have been received for the changes to the Treatment Room LES. Last year, which services from the list were provided was at the discretion of the practice but going forward it is to be delivery of all or none. Again positive responses were received. A little more work is to be done around the pricing, but the top-up fees for non-registered patients have supported the positive response. The update was noted. Tier 3 Colposcopy Service Dr Alsindi gave an update to the Committee. Last month the framework for how we would commission or expand the LES was approved and was due to be brought back here as a business case. Key issues were highlighted: The CCG is making assumptions on other potential providers of a community based colposcopy service that haven t been formally tested via expressions of interest to a Prior Information Notice. The potential contract value in a service that isn t reliant on holding a patient list would leave a decision made by the Committee open to challenge. Testing of a market for other providers has the potential to lead to a Doncaster-wide community colposcopy service which would be more equitable for the population rather than the partial expansion outlined in the business case. If there were no additional interested providers then this information would allow the CCG to make a more informed commissioning decision regarding a partial expansion of the service. Some of the information required in this and future business cases for the Committee to have a fully formed discussion will be 7

12 commercially sensitive and not already in the public domain, which has led to discussion on how best to balance transparency with confidentiality. Where a member(s) of the Committee has a direct financial interest in a proposal that comes to the committee, as would be the case here, there are various options to minimize the conflict of interest. These include redacting sections of the papers circulated to that individual where there is commercially sensitive information and, after presenting the case as a provider, the member leaving the room for the commissioning part of the discussion and decision-making process. As a result of the advice on the above issues, it has been agreed with Mrs Tully, Chair of the Primary Committee, to: Not bring the current business case to the Committee at this stage. Work will be done with Claire Burns, Head of Procurement and Business Support, around testing the market for potential providers of a community based colposcopy service. For future business cases to be discussed in the Confidential section of the Committee. A summary of the Business Case, not containing any information that may be commercially sensitive, along with the decision taken by the Committee in the confidential meeting will go to the next public Committee meeting for noting. Take the above approach to minimize conflicts of interest as appropriate. Mrs Tully commented that the service being provided in the community at present is of good quality and there is no doubt it should continue and expand. There is, however, the need to make sure that this is done within a fair and equitable process. Dr Alsindi Dr Alsindi will meet and discuss with Claire Burns, the next steps needed to move forward. The Committee noted the update. 11. Application for Ransome Practice Branch Closure Mrs Wastnage provided an update to the Committee. Mrs Sherburn and Mrs Wastnage visited the Ransome Practice to discuss the closure at the end of February For sustainability reasons they wish to close the Scawthorpe branch site. The practice currently operate over 3 sites: 1. Main Branch The Health Centre, Askern Road, Bentley 2. Branch Site Woodside Surgery, Woodside Road, Woodlands 3. Branch Site The Clinic, Amersall Road, Scawthorpe There are another 4/5 practices within a mile or 2 radius of the Scawthorpe Branch Site. 8

13 Dr Alsindi declared an interest at this point, as he is a salaried GP at 1 of the nearby practices. It was agreed that Dr Alsindi could remain in the meeting as he is not a voting member. The practice is passionate about doing the right thing for their patients and the decision to close has not been purely a financial one. 1 partner has recently retired and the 2 remaining partners would struggle to provide cover to this branch site. The application form sets out all the considerations that they have looked at so far. Patient consultation has not yet begun and this will need to be completed before formal approval can be given. Mrs Hilditch confirmed that she had met with the Practice Manager and raised the question of whether it was actually a consultation or not. There is a fundamental difference between consulting patients about whether they will move across to a different branch and whether they will have a say on the actual closure. There needs to be careful wording of the letter and assistance has been given with this. A copy has been sent to the LMC and Mrs Wastnage for approval of wording. Mrs Hilditch also recommended that a Equality Impact Assessment should be carried out. Mrs Ogle queried if the proposal had gone to the Overview and Scrutiny Committee yet? She cited the case of a practice that requested to close a branch in 2013 and they were made to jump through a number of hoops when seeking permission and were subsequently turned down. NHSE have not yet been consulted on the closure of the site and Pharmacies are missing off the list of stakeholders in the area. Mrs Ogle also noted that this doesn t strictly follow the NHSE policy of holding discussions about keeping the branch open and the application shouldn t come forward until the outcome of all discussions is available. There is also the need to be mindful of Vulnerable patients and whether there are Care Homes affected by the closure. The premises are owned by NHS Property Services have the lease options been considered? Mrs Tully commented that it must be difficult for 2 GPs to cover 3 sites and that patient safety should ultimately be taken into consideration. Mrs Tully agreed with Mrs Wastnage that this should be taken forward with NHSE and any gaps looked at. Whilst the process can t be rushed the need for patient safety should be high on the list of considerations. A brief discussion on the public consultation took place. Dr Seddon felt that without a quick decision there is a high chance that the practice will fail. While all the correct procedures should be and need to be followed, a speedy resolution is also important. The GPs in the area around the practice will give full support. Recruitment has been a difficult task those being recruited don t stay for any particular length of time. Mrs Tingle picked up on the comment around the premises and financial 9

14 issues. These issues may not go away. There is a lot of beaurocracy linked to NHS Property Services and the Practice needs to fully understand what their liabilities are. Mrs Wastnage confirmed that NHSE hadn t been consulted up to now at the request of the practice. It was agreed that it is the recommendation of this committee to now begin that consultation process. The Committee cannot approve in principle at this point although they do want to support the practice in doing what is best for them. The recommendation is for the practice to work with the CCG and NHSE and follow due process, the first step of which is to have an urgent meeting with representatives from NHS Property Services, the CCG and NHSE to discuss the implications of their proposal. Mrs Wastnage to take this back to the practice for further discussion. Mrs Wastnage 12. Outcome of the 2017/18 GMS Contract Negotiations Mrs Tingle said that as we don t yet know the financial impact of 2017/18 GMS contract negotiations, this has delayed calculating the budget for next year. A full paper will be brought to the next Primary Care Committee meeting in April. Mrs Tingle Mrs Tingle spoke through the key points: A letter came out on 7 th February 2017, notifying CCGs, Primary Care, and NHSE etc. of the GMS contract negotiations. Contract Uplift and Expenses An investment of 238.7m has been agreed for 2017/18 which reflects cost pressures arising from o Pay Inflation o Indemnity Costs o Changes to the Quality and Outcomes Framework (QOF) Values o A change to the Learning Disabilities Health Check Scheme payment fee. This is the totality of funding for 17/18. Carr-Hill Formula negotiations are due to start but implementation isn t due to be until 2018 at the earliest. QOF In 2017/18 there will be no change to the number of QOF points available however the QOF point price will be adjusted. Directed Enhanced Services Payment for the Learning Disabilities Health Check Scheme will increase from 116 to 140 reflecting a 20.7% increase. The financial impact of this is calculated to be 10,000. The Extended Hour Access DES will continue unchanged until 30 th September The Avoidable Unplanned Admissions DES will cease at 31 st March 2017, the funding will transfer into global sum to fund the new contractual requirement relating to identification and management for patients with Frailty. 10

15 A number of other changes will also be put in place. The Primary Care Commissioning Committee noted the update. 13. Quality Update Primary Care Dashboard Mrs Cookson commented that this paper had also been to the Quality and Safety Committee and is here for noting. Mrs Zara Head, Primary Care Quality Nurse has now been to all but 1 practice. Practices have been very welcoming and are using the visits as a quality and learning opportunity. There has been a real passion for quality improvement seen. Work is on-going to look at how practice nurse training is supported and this platform can be used to build a general practice nurse support network, or forum. Case Conference Reporting: work will continue with practices to identify barriers to reporting. This was also discussed at the recent TARGET meeting. Issues have been and will continue to be raised with the Children s Trust. The Quality Dashboard has been very well received by practices in Doncaster. They look at it positively and in the spirit with which it is intended. The Primary Care Commissioning Committee noted the update. 14. Receipt of Minutes The following minutes were received and noted by the Primary Care Commissioning Committee: Primary Care Delivery Group Draft minutes from the meeting held on 10 February Provider Engagement Group The Draft minutes from the meeting held on 22 February 2017 were not yet available and will be presented in the next meeting in April Any Other Business Mrs Whittle spoke of a regular agenda item that is featured in other meetings, especially the Audit Committee, and this is Risks Raised/Highlighted. Mrs Whittle asked if it could be added as a regular 11

16 item on the agenda for this Committee to feed back to the Audit Committee. She noted that examples of these today were the practice branch closure and the Estates and Transformation Plan. Only those that don t already appear on the Risk Register would be escalated. Items for escalation would be noted and this committee would decide the appropriate route for escalation. This proposal was agreed and Mrs Satterthwaite to add as a regular item on the Agenda for future meetings of this Committee. Mrs Tully spoke of her request at the previous meeting about ensuring that papers were submitted in time for inclusion on the Agenda of this Committee. Further to that, Mrs Tully now asked that, especially given that this is a public meeting and what is discussed needs to be clearly seen, lengthy verbal reports are avoided. If lengthy reports are given, especially containing complicated information, this can make the information hard to digest. Therefore, whilst it is acceptable to have a verbal presentation, these should be kept brief. If any complex information is to be presented, a short synopsis should be made available also. Mrs Satterthw aite 16. Date and Time of Next Meeting Thursday 13 th April 2017, Boardroom, Sovereign House at 12.30pm 12

17 PRIMARY CARE COMMISSIONING COMMITTEE ACTION TRACKER Date of Meeting Action Action by Action due Update Date Completed 27 Apr 16 Forward future dates of the meeting to Mrs Hilditch for the Healthwatch information bulletin. Mrs Satterthwaite 4 May 16 Dates forwarded 3 May 16 3 May 16 Presentation of the Governance Structure at next meeting. Mrs Satterthwaite/Mrs Atkins Whatley 24 May 16 The Governance structure was presented at the meeting held on 24 May May 16 Pro-active specification to be shared with practices. Circulation of the RightCare Report Mrs Sherburn 24 May 16 Pro-active specification was an agenda item at the meeting on 24 May 16 Mrs Sherburn 4 May 16 The RightCare Report has been circulated 24 May 16 4 May 16 National Primary Care Transformation Fund (Capital Infrastructure & IT) to be an agenda item on forward planner Mrs Satterthwaite 4 May 16 National Primary Care Transformation Fund (Capital Infrastructure & IT) has been placed on forward planner 4 May May 16 Hyper link to website did not seem to work Mrs Satterthwaite 25 May 16 Hyper link checked and was working 25 May 16 Mrs Tingle to liaise with Mrs Miller re PMS Contract Uplift 2016/17 and Dementia LES Mrs Tingle 16 Jun 16 Mrs Tingle liaised with Mrs Miller and an explanation relating to the PMS Contract 16 Jun 16

18 Stakeholder Engagement Plan PCCC to forward any comments to Mr Carpenter re the plan then Mr Carpenter take this to the Engagement & Experience Committee Uplift 2016/17 and the Dementia LES was given Mr Tingle 16 Jun 16 The Stakeholder Engagement Plan is an agenda item at the Engagement & Experience Committee meeting on 7 Jul Jun Jun 16 Mrs Tingle to circulate the information relating to the affected practices to the Committee regarding the PMS Uplift Mrs Tingle 14 Jul July Jul 16 Dr Seddon offered her support to the Medicines Management Team regarding the Prescribing Gain Share Scheme. Dr Seddon 11 Aug Aug 16 Dr Barbour and Mrs Sherburn to discuss the details around the Risk Stratification Tool options outside of the meeting. Dr Barbour/Mrs Sherburn 11 Aug 16 Miss Morris requested that clarification be sought from Mrs Tingle if the Primary Care Commissioning Committee has Mrs Sherburn 11 Aug Aug 16

19 authority to approve the payment schedule in accordance with Standing Financial Instructions. Dr Barbour requested that the Quality Dashboard be circulated to Governing Body GPs. Miss Morris suggested that a deadline for presentation of the report be established. Mrs Cookson agreed to circulate the practice profiles, Public Health tool and the practice Web Tool. Mrs Cookson 11 Aug Aug 16 Mrs Cookson 11 Aug Aug Aug 16 Mrs Sherburn and Mrs Ogle to bring an Update on the National Primary Care Transformation Fund (Capital Infrastructure & IT) to the October Meeting Mrs Cookson and Mrs Sherburn agreed to speak with Dr Eggitt to discuss the title of the Quality Strategy Mrs Ogle and Mrs Sherburn Mrs Cookson, Mrs Sherburn & Dr Eggitt 13 October Oct September Sept 16 Forward planner to be developed for future agenda items Mrs Satterthwaite asap 13 Oct 16

20 The Committee agreed the basis of the payment proposal with the proviso that any monies remaining at the end of the year be ring-fenced for the population and used within Primary Care. Mrs Tingle 13 Oct 16 ETTF - Mrs Sherburn to issue communications to Cohort 2 practices in the next few days. Mrs Sherburn 21 Oct Nov Nov 16 Proactive Co-ordinated Primary Care Specification - Update on Practice Readiness Dr Alsindi to forward the report to attendees. Quality Update Mr Empson to produce specification sheets to explain what sits under each and what the data criteria is. Executive summaries will also be produced Draft Contingency Planning Document for the event of contract termination in general practice - Mrs Sherburn to make the link to Primary Care Quality Strategy should be made more Dr Alsindi asap 8 Dec 16 Mr Empson asap Mrs Sherburn asap The final amendments have been made. Mrs Sherburn to circulate the plan.

21 explicit within the Contingency plan. 8 Dec 16 Proactive Co-ordinated Primary Care Specification. Mrs Sherburn and Dr Eggitt to investigate whether any tools/levers are available to secure the service from another provider to the practice s patient population. (This item to remain on the Action Tracker) Mrs Sherburn/Dr Eggitt asap Oakflower Merger Business Case Mr Carpenter and Mrs Hilditch to contact practices to understand more about patient consultation and what questions were being asked. PCCC Summary report to Governing Body Mrs Ogle and Mrs Satterthwaite to liaise how NHS England has sight of the report Mr Carpenter/ Mrs Hilditch Mrs Ogle/ Mrs Satterthwaite asap asap 21 Dec 16 PCCC Forward Programme Mrs Satterthwaite to add GPFV and Oakwood/Mayflower Mrs Satterthwaite asap 16 Jan 17

22 merger to PCCC Forward Programme. PCCC Forward Programme Dr Seddon highlighted that Colposcopy should be part of the Extended Primary Care Pillar Mrs Sherburn to add PCCC Forward Programme Mrs Tingle to investigate if the Pharmacy LES should be added to the forward programme. Mrs Sherburn asap 9 Feb 17 Mrs Tingle asap 9 Feb 17 9 Feb 17 Mrs Ogle to query when funding for those practices in Cohort 1 will be received. Dr Eggitt requested that there was further clinical input on the relevant aspects prior to finalising the specification. It was agreed that Dr Alsindi, Mrs Sherburn and Dr Eggitt would meet to review these aspects. Extended Primary Care Pillar Tiered Framework to be included as a standing agenda item going forward. Practice Merger Business Case proposal - Mrs Sherburn to check with the practices is there is equity for patients to access a Mrs Ogle asap Dr Alsindi, Mrs Sherburn and Dr Eggitt asap Mrs Satterthwaite asap Mrs Sherburn asap

23 single service and there is adequate assurance for the provision of home visits. Mrs Sherburn to write to practices to communicate the Committee s decision. QOF Preparation of a paper regarding QOF to be agreed virtually. 9 Mar 17 Terms of Reference Mrs Tully to make the necessary amendments Colposcopy service - Dr Alsindi to meet and discuss with Claire Burns, the next steps needed to move forward. Application for Ransome Practice Branch Closure - Mrs Wastnage to feedback to the practics that the practice is to work with the CCG and NHSE and follow due process, the first step of which is to have an urgent meeting with representatives from NHS Property Services, the CCG and NHSE to discuss the implications of their proposal. Mrs Sherburn asap Mrs Tully asap Dr Alsindi asap Mrs Wastnage asap

24 GMS Contract changes Mrs Tingle to present a paper at the meeting on 13 Apr 17 Mrs Tingle asap Mrs Satterthwaite to include standing agenda item re potential risks identified Mrs Satterthwaite asap Potential Risks identified has been added to the April agenda 30 Mar 17

25 Meeting name Primary Care Commissioning Committee Meeting date 13 April 2017 Title of paper GP Forward View Implementation Plan: Progress Update Executive / Clinical Lead(s) Author(s) Laura Sherburn, Chief of Partnerships Commissioning and Primary Care As above Purpose of Paper - Executive Summary The purpose of this paper is to brief the Primary Care Commissioning Committee on the progress of the GP Forward View Implementation Plan, that was submitted to NHS England in December Recommendation(s) Primary Care Commissioning Committee members are asked to: - Note the contents of the enclosed paper - Advise on any further action to be taken by the Primary Care Team Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient) Report previously presented at Risk analysis Assurance Framework Quality will be monitored through the Primary Care Quality Strategy and Quality Dashboard. The aim of the GPFV plan is to increase quality of general practice across the board EIAs will be done as part of the service specifications work-up The aim is to invest in primary care to sustain services into the future. As per the paper Procurement regulations will be complied with when commissioning the Tiers of enhanced services. Will be preserved through the PCCC s constitution Primary Care Stakeholder Engagement plan pending N/A As per paper 1.2, 2.3

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27 INTRODUCTION IMPLEMENTING THE GP FORWARD VIEW IN DONCASTER PROGRESS UPDATE TO PRIMARY CARE COMMISSIONING COMMITTEE 13 TH APRIL 2017 The purpose of this paper is to provide Primary Care Commissioning Committee with a progress update against each of the areas of the Doncaster GP Forward View Delivery Plan, which was submitted in December 2016 to NHS England. This paper should be read in conjunction with the Delivery Plan, as it does not seek to repeat the content. INVESTMENT Proactive Co-Ordinated Pillar ( 1.8m) The specification for Proactive Co-Ordinated Primary Care was implemented across the majority of practices from October 2016, and the remaining practices (with the exception of one) from January The aim of the specification is to target the most vulnerable and/or frail 2% of the practice list, and provide proactive advanced care planning for those patients. The first quarterly report has been received by the Primary Care Commissioning Committee. Encouraging progress is being made, with most practices on a journey to full multi-disciplinary delivery. Extended Primary Care Pillar ( 1m) The local enhanced services commissioned currently from general practice have been organised into 3 tiers, to make clear: which should be delivered by all practices; which should be delivered by a smaller number of practices on behalf of the whole; and which should be delivered by 1 pan- Doncaster provider. All practices have signed up to deliver all Tier 1 services, thereby removing the previous inequity for patients. Work is underway to review Tier 2 services in and achieve full coverage by general practice so as to be able to decommission secondary care for any of this delivery. New Tier 2 services are also being developed, including a carpal tunnel pathway, a dermatology pathway, and a DVT pathway. Keeping Well Pillar ( 155K) This specification was offered to practices on 31 March 2017, asking for practices to consider and sign up for delivery from 1 st May The requirement is for practices to compile a clustered risk factor register, of patients aged 18-40, that are already on the smoking and obesity registers but not on a specific disease register. These patients will be offered a lifestyle consultation, with the aim of changing their life choices in order to reduce the risk of developing long term conditions. Practices will be paid a fee of 30 for the consultation, and 18 for follow-up at 6 months. Responsive Care Pillar ( 1.275m) 135K Care Navigation & Upskilling Non-Clinical Staff ( ) This funding stream is allocated to the CCG by NHS England, as per the commitment in the GPFV, for the CCG to implement Care Navigation (streaming patients away from general practice at reception,

28 to more appropriate services) and upskilling non-clinical staff (to release GP time from administrative tasks that could be done alternatively, ie managing medical correspondence). The CCG has purchased an implementation and training package for Care Navigation from West Wakefield GP federation. The first stakeholder event is on 7 April, with a wide range of confirmed attendees. Thereafter a task & finish group will be set up to create the protocols and clinical templates to support care navigation, and to roll out the online learning. In the medium term, we will be working on an STP footprint to align approaches and deploy funds most effectively going forward over the next 2 years. Thornfields Training Specialists have been engaged to deliver Level 1 and Level 2 training for practice staff in Managing Medical Correspondence. Level 1 sessions take place over April and May, with a TARGET slot planned for GPs in June. Level 2 will be organised thereafter. 189K online consultations ( ) There is draft GPFV guidance around online consultation in the final stages of sign off within NHS England. It is expected that within this guidance, there will be detail regarding the expectations of and support for CCGs/GPs in the procurement of online consultation systems. 951K Transformation Funds ( 3 per head ) This investment, as stipulated by the GP Forward View, is designed to be used to stimulate development of at scale providers for improved access, stimulate implementation of the 10 high impact actions to free up GP time, and secure sustainability of general practice. Looking at each requirement, it is increasingly clear that the way to achieve most impact is for the money to be spent at scale, with practices working together. Few practices, if any, will be able to demonstrate transformational impact by working on these areas alone. The CCG wishes to work with the emerging federation/s and the LMC to deploy the funds so as to have maximum benefit and impact for general practice in Doncaster. Five indicative areas are outlined for deployment of the funds, as follows: 1) Establishing a pan-doncaster Federation 2) Undertaking change projects aligned to the High Impact Areas outlined in the GPFV 3) Engaging with the Productive General Practice Quick-Start Programme 4) Understanding workforce & workload 5) Preparing for delivery of extended access from April 2018 Each of these areas are described in more detail in the relevant section below. GP Resilience Programme (106K) Slippage from this fund in was made available to Doncaster CCG in December 2016 for local deployment in-year. The intention was for it to be used in increasing sustainability and general practice in Doncaster. The Primary Care Commissioning Committee considered the potential options and agreed that it should be devolved to the emerging federating groups to consider amalgamation of functions and reduction of duplication. Since then, the groups have come together and agreed the

29 need for an overarching federation in Doncaster. They are finalising a work plan for the establishment of this federation, against which the 106K will be deployed. SUPPORTING & GROWING THE PRIMARY CARE WORKFORCE The CCG continues to engage with the South Yorkshire and Bassetlaw Primary Care Workforce Group, which is part of the STP workstream structure. This group has organised a workforce planning event on 11 th May, where DCCG will be represented and to which all general practice have been invited, with the offer of backfill. In addition, the CCG has set up and funded TARGET sessions in April to concentrate on workforce solutions, with input from Health Education England and the local education providers. We continue to explore models that are being put in place elsewhere that we could replicate in Doncaster. Part of the 951K transformational fund has been badged against understanding workforce and workload. The first step towards this will be to trial a workforce insight tool, subsidised by NHS England, in volunteer practices. This provides practices with the ability to analyse patient activity levels in considerable detail and explore staffing needs at a practice, neighbourhood and system level. The tools and the approaches have been piloted in other parts of the North. Practices that participate in this pilot will benefit from gaining the ability to: review practice activity levels over a 24 month period and analyse how that activity fluctuates/changes over time; consider the impact increases in activity or implementing changes to the way activities are undertaken could have on staffing needs; and explore and make decisions on the appropriate staffing model for the practice and neighbourhood. This will provide the opportunity for the federation to develop an informed workforce plan leading the conversation around its specific needs and the potential options for addressing those needs. The aim is to engage interested practices over April through the TARGET sessions, then discuss the allocation of funds with the LMC in May (as a proxy for the federation), to enable the process to commence in June. IMPROVING ACCESS IN & OUT-OF-HOURS From , there will be national requirements for general practice to offer extended access in order to qualify for additional income of 3.34 per head. The CCG wishes to work with practices in to pilot various ways of achieving these requirements in readiness for April 2018, using transformational funds within the 951K to pump-prime projects and new ways of working. These could include: hub and spoke models; pooling back office functions; centralised triage/home visit services; optimised remote/online consultations; workforce innovations, such as clinical pharmacists in general practice; and optimising whole system capacity by working in a more integrated way with partners, such as Healthy Living Pharmacies. As a minimum, the work done relating to access generally, incorporating all of the elements in this plan to Release Time For Care, will need to enable all practices to offer a minimum number of appointments (GP & nurse) per week by 2018; the

30 national average is often said to be around the 70 appointments per 1000 population mark. We will work to define this, using the available evidence-base. TECHNOLOGY & INFRASTRUCTURE The mainstays of this agenda continue to develop in Doncaster, namely, the Digital Roadmap and the local Estates Strategy. There are two specific updates in relation to these for the purposes of this paper. Firstly, the CCG s bid for funding from the Primary Care Estates & Technology Transformation Fund (ETTF) to facilitate remote access consultations in general practice has been successful. Throughout March and April, the equipment is being installed in practices. The development of an evaluation framework, to inform future decision-making for the PCCC, is underway, with the Primary Care team working with the Data Quality team to establish this. The Primary Care Provider Engagement Group have had some initial discussions about this so far, and agreed that we will need to understand any barriers to using this technology such as patients having the correct equipment/wifi connection and knowing how to benefit from this, patient responsibility for ensuring they are in a suitable location to receive the call if the clinician needed to establish if other people (such as carers) were in the room for the call additional time spent by reception staff when making the offer to patients. In addition, an evaluation framework will need to capture: - which cohorts of patients particularly benefited from the video consultations - where the level of assurance through using video rather than phone has been such that it has not been necessary to see the patient face-to-face, and therefore released appointment capacity - what else the equipment was useful for; ie, care home interaction, participation in MDTs, as well as patient consultations It was suggested that it might be useful to work with a small number of practices on their approach to utilisation, and also evaluation, to understand the finer detail of the issues. Further reports will come to the PCCC in due course. In relation to estates, there are a number of interdependent factors that need to be properly understood going forward. Doncaster has a high number of bids against the ETTF, and the majority of these are in Cohort 2, ie, assessed as being able to spend the money before March However the ETTF is significantly oversubscribed and not all of these bids will receive funding. The CCG has met with Cohort 2 practices and discussed the need for rationalisation of bids, reduction of duplication, and working together. Additionally, the CCG is working with CHP on utilisation of LIFT buildings; plus liaising with the local authority on planning developments. A workshop is planned on 12 th April to agree a set of strategic aims that provides the longer-term framework for estates development and utilisation. The outputs will be presented to Primary Care Committee on 13 th April.

31 MANAGING WORKLOAD AND REDESIGNING CARE PROVISION Federation: Key to this section of the delivery plan is the successful establishment of a Doncasterwide GP Federation. Three workshops have now been held with representatives of general practice, and consensus has been reached to set up a company limited by shares, named Primary Care Doncaster, to a) increase sustainability and resilience of core general practice, and b)provide the collective voice of general practice in ongoing system development and transformation, acting as a vehicle to attract investment into general practice either via delivery of services, or via other funding streams including the GP Forward View. The intention is for the Federation to be in existence during the summer of This is a huge step forward for general practice in Doncaster and will be a fundamental platform upon which to build sustainable, high quality services. Productive General Practice: One of the areas for deployment of the 951K transformational fund is the Productive General Practice Quickstart Programme. This broadly consists of 6 consultancy sessions per practice to deep dive into particular areas of function and process, aligned to a menu of modules on offer. There are significant benefits to the practice in doing this, as it is proven to release GP time and improve effectiveness and efficiency of the practice. 14 practices have expressed an interest in taking up this offer. The CCG and the PGP Delivery Partner, Shaping Health Solutions, are working together throughout April to engage further with these practices before submitting a delivery plan on 5 th May to NHS England, after which funding will be formally confirmed or otherwise. The local transformational funds will then be deployed to create the capacity for these practices to properly engage with the delivery partner, through funding backfill or similar. Change projects: Another area for the transformational monies is the undertaking of change projects aligned to the GPFV High Impact Change Areas. This is a key dimension of the GPFV Releasing Time For Care programme. The CCG is working closely with its allocated national development advisors to design this process for Doncaster. A Releasing Time for Care launch event is scheduled for 15 th June 2017, where the federation representatives/board members will meet with the national advisors & the CCG and design a process to take forward collaborative change projects in Doncaster. Consultant Connect: In recognition of the increasing number of referrals from primary to secondary care, and the amount of resource this consumes in the system, the CCG has approved the procurement of Consultant Connect. This is a UK based telephone solution that allows GPs to contact hospital specialty consultants directly and immediately for advice and guidance. The GP dials a local number and the call is answered by a local specialty consultant, typically in under a minute, pick up rate is 80-90% and calls last between 3-5 minutes. Timely advice can be sought during a patient appointment in the GP consulting room. The aim is for this to reduce unnecessary referrals, improve patient experience, and reduce workload not only in general practice but across the wider system.

32 RISKS AND MITIGATION Risk Mitigation Update April 2017 Catalysing development of collaboration through funding PCC to work with practices Embryonic state of federation in Doncaster compromises deployment of funds/specifications Delay to guidance around monitoring requirements/specific deployment of various GPFV funds may delay implementation for fear of misdirecting them Progress with engagement with practices to achieve deployment against local needs, in continuous liaison with NHSE team Federation anticipated to be established by summer In the meantime LMC and Federation Task & Finish Group acting as proxy to a federation, in the event that mobilisation of funds is needed sooner. Traction is being gained on various elements of GPFV; practice interest in PGP programme is encouraging. Workforce is a key risk, and CCG has limited powers in this regard to train/employ/develop staff, or fund placements Lack of availability of education providers to deliver key programmes ie care navigation Lack of clarity about access to funds controlled centrally, ie GP Resilience Programme, and risk of over-subscription to these funds Oversubscribed ETTF means that funds are not released to Cohorts of practices; fundamentally jeopardising ability of general practice to transform as so much estate is not fit for purpose Close working with HEE and NHSE through the SYB Primary Care Workforce Group Look at pooling funds across SYB and the STP to increase leverage with suppliers and maximise impact, work with NHSE GPFV transformation team Work with NHSE team and keep close to GP needs locally in order to be ready to apply for funds when process is clear; concerted effort needed to draw down funds from STF for primary care Explore alternative funding routes within core capital/lift/nhsps Continue with original mitigation, workforce planning events and tools being discussed CCG has sourced providers of Care Navigation and Managing Medical Correspondence training and development Continue original mitigation, no update Bringing together all strands of estates planning via workshop on 12 th April 2017 SUMMARY The above provides an update against the key areas of the GPFV Delivery Plan, which are not reported elsewhere (for instance, Primary Care Quality is a regular item on the Primary Care Commissioning Committee agenda, so is not repeated here). Work to implement the GPFV continues

33 apace and in a number of different formats, as described above. Outcomes of these initiatives will be monitored as closely as possible and reported back to the Primary Care Commissioning Committee on a regular basis. RECOMMENDATIONS Primary Care Commissioning Committee is asked to - note the contents of this paper - advise on any further actions to be taken by the Primary Care Team

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35 Meeting name Primary Care Commissioning Committee Meeting date 13 April 2017 Title of paper Dunsville Medical Centre List Closure Application Executive / Clinical Lead(s) Author(s) Laura Sherburn, Chief of Partnership Commissioning and Primary Care Carolyn Ogle, Senior Primary Care Contract Manager, NHSE Kayleigh Wastnage, Primary Care Support Manager, DCCG Joan Wright, Practice Manager, Dunsville Medical Centre Purpose of Paper - Executive Summary Background: In January 2017 Doncaster CCG became aware that Dunsville Medical Centre had informally closed their list to new patient registrations on advice of Doncaster s Local Medical Committee (LMC). The Practice has been asked to keep a record of each patient that is refused registration, what their reason for wanting to register with the Practice was, and inform the CCG of each time this occurs. The Practice also has a contractual obligation to write to each patient denied registration detailing the reasons why. The Practices situation was reviewed again at the beginning of March. As the situation was no different the Practice completed a formal application to close their patient list. The application is attached at Appendix A and the practice is requesting to close its list for a period of 12 months. NHS England s List Closure Policy: NHS England s List Closure Policy requires the Practice and the CCG to meet and discuss any possible support or changes that would help keep the patient list open. It should be noted that there are currently no closed lists in South Yorkshire & Bassetlaw. The CCG is obliged to make a decision within 21 days of receipt of an application, unless a longer time period is agreed with the Practice. Decision Considerations: Application Granted If approval is granted then a closure notice is issued as soon as possible following the decision with a copy to the LMC and to any persons who have been consulted as part of the process. The notice will set out that the practice can only register immediate family members of registered patients while closed and set out the time frames for the process as outlined in the policy. The Practice must close on the date specified in the notice and remain closed for the time specified, unless it is agreed to reopen earlier. 1

36 Application Rejected If the decision is made to reject the application the CCG must make the Practice aware as soon as possible which should include why the proposal was rejected. Details of the dispute and appeal process and timeframes for making a further application should also be provided at this time with a copy sent to the LMC. If the application is rejected no further applications can be made for three months. If the decision is appealed, then this three month period starts after the final appeal decision. However a further application can be made if there is a change in circumstances which affects the Practices ability to deliver services. Extension of Closure Period If the Practice wants to extend the closure period it has to apply at least 8 weeks before the notice is due to expire. The CCG must acknowledge the extension notice within 7 days, discuss with the LMC and affected parties and reach a decision within 14 days of receipt. Following a decision the same process is applied as for the initial application. If the extension is rejected, the practice list remains closed for the original time period. Assignment of Patients If a practice list is closed patients can only be assigned to the Practice in the following circumstances: If most or all providers of essential services in the area have closed lists If NHS England s assessment panel says that a patient must be assigned to the practice and this decision hasn t been overturned by NHSLA The CCG/NHS England has discussed with the practice taking on a particular patient and agreed additional support. Dunsville Medical Centre Dunsville Medical Centre is a PMS practice situated in the North East locality of Doncaster. The Practice has recently reduced from 3 GP partners to 2 GP partners, 1 of these partners is on long term sickness and has been since October 2016, there is no anticipated return date for the partner. The Practice has also seen a steady increase in its list size over the last year with a total of 74 new patients, as detailed below: April ,291 July ,302 October ,326 January ,365 The practice has an annual turnover of patients of 2.07% (CCG mean is 6.9%). 2

37 Other Points for Consideration The Practices deprivation score is IMD (CCG mean is 30.21). The Practice received a Good CQC rating in August 2016 The Practice has above CCG average Patient Survey results with the exception of the ability to see preferred GP domain. The Practice has 18.99% of its registered list signed up to patient online services. GP Quality Dashboard indicates the practice is: o a deprivation tier 1 practice o 40/43 for Same Day Health Centre usage o 22/43 for OOH usage o 14/43 for A&E attendances o 33/43 for referrals to secondary care If the Committee approve the request this will be the first approval across South Yorkshire and Bassetlaw and will set precedent. The Practice is in an area that is undergoing local development. Approximately 3,500 dwellings are to be erected over the next 20 years on land that spans from Dunsville to Hatfield. This is the Unity site. The Practice submitted a bid to the ETTF in June 2016 for renovation to their building and conversion of the loft space to office and training space. This would allow for the existing 1 st floor to be reconfigured providing space for a lift, reconfiguration of consulting rooms and dedicated space for training and education with student trainees and staff. The Practice withdrew this application in February 2017 as the practice did not have the capacity or resource to complete the paperwork and extensive work up of the project plan that was required. During the informal list closure period the practice has had 10 patients request to register with the practice that has been declined. The patient reasons for wanting to register are: 6 moved into the area 2 were unsatisfied with their current practice in the local area 2 no reason Each patient is written to explaining the reason the application has been declined (the shortage of GP resource). The template letter the practice uses is at Appendix B. As part of the List Closure Application Process a set of standard questions are used by NHS England to help inform the decision. These questions, including the practice response and comments by NHS England are detailed below for consideration. 3

38 Question Response NHSE Comment Is the Practice open Thursday afternoons Yes opening hours are 8am 6pm Monday - Friday In line with expectation Is the Practice open 8am 6:30pm Monday to Friday Has the Practice reviewed the list outside their outer boundary Has the Practice considered boundary changes Are clinical sessions maximised i.e. are GP s working 9 sessions No, Practice is open until 6pm Yes, numbers are not significant The Practice does not feel that this is appropriate or would aid the situation GP sessions are: Partner Dr Mohan 10 Salaried Dr Nawaz 2 Locum Dr Chowdray 1-2 Locum Dr Jones 3 Locum Dr Paul 2 In line with the rest of Doncaster Practice indicated this at meeting on 13 March 2017 with NHSE and CCG Practice indicated this at meeting on 13 March 2017 with NHS and CCG Dr Mohan = 1wte Locum cover = 1wte ANP = 0.75wte Salaried GP = 2.75wte A list size of 5,365 would expect 2,000 patients per 1wte GP. The Practice, in theory, has GP cover for 5,500 patients. Are there nursing capacity issues, if so what contingencies have been put in place Are there GP capacity issues if so what contingencies have been put in place Has the practice reviewed the provision of nursing/skill mix Is the PPG supportive, what is the evidence of support, has the practice considered wider consultation of patients No, the Practice has recruited 1wte ANP and a 0.8wte ANP will start in April Yes, the Practice has gone from 3 partners to 2 with 1 on long term sick. The Practice has been unable to recruit Yes and considered other skills within the Practice List closure was discussed at the PPG meeting on the 28 th March The PPG members in attendance were supportive of the application. The Practice has employed a further ANP who starts April Locums are in place as detailed above 4

39 Is the locality supportive, is there any evidence of support Has the practice list size increased in line with Doncaster s population Has there been a recent spike in list size Does the Practice undertake telephone triage Does the Practice actively encourage patients to access online booking for appointments and ordering of repeat prescriptions Is the Practice delivering extended hours Has the Practice signed up to the CCG basket of enhanced services Does the practice have a high turnover of patients Dr Mohan informed those in attendance at March s locality meeting that the Practice will be formally applying to close the patient list for 12 months. No comments were made by attendees. Dunsville increased April 2016 January 2017 by 1.4%. Doncaster increased by 0.76% No, a steady increase from 5,291 in April 2016 to 5,365 in January 2017 has been observed. This is an increase of 74 patients. Yes but the Practice could strengthen this. 19.2% of the practice list size has signed up to online booking. CCG average is circa 8.2% 18.91% of the practice list size has signed up for electronic repeat prescriptions No Yes. Practice is signed up to all Tier 1 services. Practice is not signed up to deliver any Tier 2 services except ring pessary fit for registered patients. No. The turnover for the Practice is 2.07%. The CCG average is 6.9%. A letter to the LMC and locality/neighbouring practices has been sent by NHS England to give opportunity for comments. comments from those who replied are below. Practice has a population increase greater than the Doncaster average. Practice has indicated that it will still register new care home patients this will allow the continued performance of the Proactive Coordinated Care specification 5

40 Within the Practice area there are 8 other GP practices, 4 of which are within a 2 mile radiance of Dunsville Medical Centre: Hatfield Health Centre, Hatfield (1.2m) Kingthorne Group Practice branch site, Kirk Sandall (1.8m) St Vincent Medical Practice, Hollybush branch site, Edenthorpe (1.9m) Field Road Surgery, Barnby Dun branch site (2.0m) The Village Practice, Armthorpe (2.9m) White House Farm Medical Practice, Armthorpe (2.9m) Thorne Moor Medical Practice, Thorne (5.4m) Northfield Surgery, Thorne (5.4m) All 8 practices and the LMC have been offered the chance to express comments or views. The LMC replied in support of the list closure. The Village Practice offered support to Dunsville Medical Centre stating that they have capacity to support the practice and would be happy with the practice offering the option of registration at The Village Practice for their patients that reside within the DN3 area. Formal Application Form The completed Application to Close Practice List of Patients attached at Appendix A for consideration together with the above information. The application form provides more detail on: The reasons for why the Practice wishes to close its list The options that the Practice has already considered The detailed outcome of neighbouring practice and patient consultation Suggested support the Practice feels would enable the list of patients to remain open or the period of proposed closure to be minimised Practice plans to alleviate their current situational difficulties Recommendation(s) The Primary Care Commissioning Committee members are asked to: Consider the detail in the Executive Summary together with the Application to Close Practice List of Patients. Make a decision whether to approve or reject Dunsville Medical Centre s Application to Close Practice List of Patients for a period of 12 months Make a decision whether to approve or reject the request to continue to register Care Home/Nursing Home patients during the Closed List Period if approved. 6

41 Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient) Report previously presented at Risk analysis Assurance Framework If the decision is made to reject the list closure there is potential for a negative impact on the quality of services provided as detailed in the application form. There will be no impact as the practice will not be discriminative when refusing registration. If the decision is made to reject the list closure there is potential for a negative impact on the sustainability of the practice as detailed in the application form. There financial implication to the CCG is neutral. The financial implication to the Practice is neutral. By closing the practices list it may leave the practice open to legal challenge from patients refused registration. The partners at the practice have completed declarations of interest forms. Dr Mohan is the practice lead for the CCG North East Locality meeting. This is noted on his declaration of interest form. NHS England and DCCG have been consulted and met with the practice on the 13 th March The attendees at March s North East Locality Meeting have been informed of the application. None All risks to the Practice and CCG have been set out in the Executive Summary and the appended application form. Risk of setting a precedent across the SYB footprint if approved. 1.2, 1.3, 1.4, 2.1, 2.3, 2.4, 6.2 7

42 Appendix A - Application to Close Practice List of Patients 8

43 9

44 10

45 Appendix B Template Patient Letter Dr C Mohan Dr D A Gibson 126/128 High Street Dunsville Doncaster DN7 4BY Dunsville Medical Centre Telephone Fax Our Ref/JW/CM Date: To: You recently requested to be registered at Dunsville Medical Centre. Unfortunately we have had to deny your request. The practice currently has a shortage of GP s due to a GP partner being on long term absence and our salaried GP leaving. It is proving extremely difficult to replace the salaried GP, which has been caused by a national shortage of GP s. We are employing locum GP s to undertake the sessions of our absent GP Partner which is not an ideal situation but we are trying to provide the best possible care to our current patient list with the resources we currently have. We hope the situation will resolve in the near future but we are unsure when this will be. Your name and details have been added to a waiting list and once the situation is resolved we will contact you to make arrangements to come along and register if you still wish to do so. Kind regards Joan Wright Practice Manager 11

46 12

47 Meeting name Primary Care Committee Meeting date 13 April 2017 Title of paper Burns Practice Rent Reimbursement Executive / Clinical Lead(s) Author(s) Laura Sherburn, Chief of Partnership Commissioning and Primary Care Lee Eddell, NHS England Purpose of Paper - Executive Summary The Committee are asked to consider the implications of the increased rental reimbursement from 33,000 per annum to 60,554 per annum payable to The Burns Practice following an extension to their Cantley branch site. The extension has been funded via the Primary Care Infrastructure Fund. Premises Directions It is the responsibility of each GP Practice to provide suitable accommodation for the provision of the primary care services they are contracted to provide. In return for providing such accommodation the GP Practice is entitled to be paid or reimbursed rent by the Commissioning Board. The key legislation setting out the terms and conditions on which such rent is reimbursed is the Primary Medical Services (Premises Development Grants, Improvement Grants and Premises Costs) Directions The Burns Practice Cantley site is owned by the GP partners and as such is owner occupied. In the case of owner-occupied premises the rent that is reimbursed is known as a notional rent payment. The Commissioning Board or CCG if fully delegated pays the current market rental value of the practice premises. The Premises Directions set out how the current market rental is to be assessed; the District Valuer assesses the level of notional rent. As no actual lease exists the Premises Directions makes certain assumptions as to the terms of the notional lease for which rent is to be assessed. This is because different levels of rent will be payable depending on the terms of the lease; for instance a tenant will pay more rent for a lease where the landlord is liable for maintenance and repair than would be the case for a lease where the tenant is liable. Rent abatements apply to owner/occupiers, notional rent may be abated (i.e. the notional rent amount may be reduced) if NHS money is introduced to improve the premises, the calculation of the abatement is detailed in the directions. Additionally, if the practice receives reimbursement for the total building area and rental income from other organisations using the premises, the rent received should be abated from the reimbursement, i.e. no double payment. If the other provider s services are not NHS services, the practice must charge a rent to the provider. If other NHS services are being provided from the premises, there is no requirement 1

48 to charge a rent for this and the practice may receive full rent. Change to Notional Rent The Burns Practice was awarded 520,350 from the Primary Care Infrastructure Fund towards the cost of an extension at the Cantley site; this represented 66% of the total cost of 788,408. As required by the NHS Premises Directions 2013 the District Valuer was requested to complete a Before and an After valuation in order that the necessary abatement can be applied. Prior to the extension being built the current market rent of the property was 34,000pa, after the extension was completed the current market rent is 103,000pa. In terms of abatement, the previous market rent is subtracted from the current market rent to give the current market rent value of the premises improvement - 71,000. The Burns Practice contributed 34% towards the cost of the improvement; therefore they are entitled to 34% of the current market rent for the improvement which is 24, % towards landlord costs totalling 26,554. The rental reimbursement per annum will therefore be 60,554. The period of abatement will be for 15 years as the contribution by the NHS was in excess of 250,000+VAT. Within the practice there are three rooms used for NHS services not provided by the practice, the value of those rooms for rental purposes is 3,425pa. The Burns Practice do not charge rent to those services that use these rooms. Recommendation(s) Primary Care Committee are asked to: Note the increased rental reimbursement from 33, to 60, Consider the budgetary implications Make a decision whether to approve or decline to pay the increased notional rent 2

49 Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient) Report previously presented at Risk analysis Assurance Framework Nil Nil Not supporting the increase in notional rent to the Practice could destabilise the Practice as they would have to fund the total cost of the premises. The increase in notional rent will have an impact on both the CCG and the Practice. Funding the increase is an additional cost pressure to the CCG yet not supporting the increase will impact the cash flow to the practice and could destabilise the Practice. The CCG could be open to legal challenge by the Practice if it chooses not to support the increase in notional rent as agreement and support has been implied. All conflicts of interest have been documented in the CCG s Conflict of Interest Records. NHS England and the Practice have been consulted with. None Risks have been identified above. 1.2, 1.4, 3.1, 3.2, 4.2, 4.3, 5.1, 5.2 3

50 4

51 Meeting name Primary Care Committee Meeting date 6 April 2017 Title of paper 2017/18 GP Contract Changes Executive / Clinical Lead(s) Author(s) Hayley Tingle Chief Finance Officer Genna Miller Finance Manager Purpose of Paper - Executive Summary This report outlines the key changes to 2017/18 GP contracts and the financial impact for Delegated Primary Care Medical Contract. Recommendation(s) Members are asked to receive the report and note the position.

52 Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient ) Report previously presented at Risk analysis Assurance Framework None identified None identified Nil As highlighted within the report None identified None Identified N/A None 1.2, 1.4, 2.4, 3.1, 3.2, 6.2

53 NHS DONCASTER CCG 2017/18 KEY CHANGES TO 2017/18 GP CONTRACTS AND THE FINANCIAL IMPACT ON DELEGATED PRIMARY CARE MEDICAL CONTRACT BUDGET 1. Introduction NHS Doncaster CCG assumed responsibility for managing the Primary Medical Care Budget from NHS England with effect from 1 st April Key Changes to the 2017/18 GP Contract a) Core Contract The following will be included in the core contract requirement for all GP contracts from 1 st April Identification & Management of Patients with Frailty National Diabetes Audit NHS Digital Workforce Census Data Collection Registration of Prisoners Access to Healthcare Below is a breakdown of the 1 st April 2017 uplift to be applied to GP Contract /weighted patient GMS PMS APMS 1. MPIG Seniority Reinvestment Elements of the deal Enhanced Services reinvestment 5. Inflation Uplift TOTAL MPIG reinvestment is the redistribution of the phased deduction of MPIG from GMS contracts 2. Seniority reinvestment is the redistribution of the phased deduction of seniority from GMS/PMS contracts 3. Elements of the deal relate to additional pension administration levy costs, workforce survey administration, overseas visitors cost recovery, nonrecurrent additional patient records workload, and other increased business expenses 4. Enhanced Services reinvestment is the reinvestment of the Avoiding Unplanned Admissions DES, which ceased on 31 st March 2017 and is now part of the core contract for all practices in relation to frail patients Inflation uplift of 1% on pay, along with an appropriate uplift to expenses (not specified)

54 The estimated impact of applying the above uplift to NHS Doncasters CCG GP contracts is 600k. b) Carr Hill Formula The Carr Hill Formula is the weighting index used to assess practices registered populations in terms of age, sex, deprivation. Negotiations on changes to the Carr Hill Formula are commencing, and the earliest start date for changes will be 1 st April c) QOF The price per QOF point will be increasing from 1 st April 2017 from to , an increase of 3.6%. The estimated impact of this change is 162k. d) DES s The Learning Disability DES price change from 1 st April 2017 of 20.69% is estimated to have an impact of 10k. The Extended Hours DES is to remain unchanged until 1 st October The Avoiding Unplanned Admission DES ceased on 31 st March Funding has transferred into core contract to fund the new contractual requirement relating to Identification and Management of Patients with Frailty. The estimated impact of transferring the DES into core contract is 21k, which is included within the 600k cost pressure highlighted above for core contract changes. e) Other Changes Other changes cover: GP retention scheme updated GP sickness leave updated and classed as mandatory CCG s to reimburse practices directly for CQC fees. Awaiting confirmation of guidance and process. Estimated cost pressure of 225k Amendments to NHS England Public Health for Vaccinations and Immunisations NHS England agreed to make payments to practices for indemnity inflation in 2016/17 and 2017/18. NHS England funding 2016/17 directly and 2017/18 a cost pressure for CCG s. Awaiting further guidance relating to 2017/18 price per patient and process

55 3. Conclusion and Recommendations Members are asked to: Receive and note the 2017/18 GP Contract changes for Primary Care Delegated Medical Contracts, and the estimated financial impact of 997k.

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57 Meeting name Primary Care Committee Meeting date 6 April 2017 Title of paper Delegated Primary Care 2017/18 Financial Plans Executive / Clinical Lead(s) Author(s) Hayley Tingle Chief Finance Officer Genna Miller Finance Manager Purpose of Paper - Executive Summary This report outlines the 2017/18 financial plans for Primary Care, including delegated Medical Contracts. Recommendation(s) Members are asked to receive the report and note the position.

58 Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient ) Report previously presented at Risk analysis Assurance Framework None identified None identified Nil As highlighted within the report None identified None Identified N/A None 1.2, 1.4, 2.4, 3.1, 3.2, 6.2

59 NHS DONCASTER CCG 2017/18 PRIMARY CARE PLANS 1. Introduction NHS Doncaster CCG assumed responsibility for managing the Primary Medical Care Budget from NHS England with effect from 1 st April 2016, adding to the current CCG responsibility for Enhanced Services, Out of Hours Contract, Oxygen and GP IT /18 Financial Plans The total 2017/18 Primary Care Financial plans total 47,584,000, including 41,992,000 relating to Delegated Medical Contract and 5,592,000 relating to Other Primary Care budgets which cover oxygen, enhanced services, out of hours and GP IT. 000 General Practice GMS 20,675 General Practice PMS 5,833 General Practice APMS 748 Premises 6,197 Enhanced Services 2,210 QOF 4,462 Other GP Services 1,867 TOTAL DELEGATED MEDICAL CONTRACTS 41,992 TOTAL OTHER PRIMARY CARE 5,592 TOTAL PRIMARY CARE 47,584 Areas of concern relate to Delegated Medical Contracts premises and the impact of the 2017/18 GP contract negotiations. 3. Conclusion and Recommendations Members are asked to: Receive and note the 2017/18 Financial Plans for Primary Care.

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61 Primary Care Commissioning Committee Forward Programme Agenda Item Requested by Why requested Who will present How long May 2017 Strategy Business Proposal to commission Carpal Tunnel LES Taking Forward Primary Care Strategic Model Q report Proactive Coordinated Primary Care Service Any application to close sites/lists, applications for mergers etc Approve process to procure Church View Surgery LES Contract Variations Quality Quality update June Strategy Business Proposal to commission Complex Wound care LES Taking Forward Primary Care Strategic Model ETTF update Any application to close sites/lists, applications

62 for mergers etc Quality Quality update July Strategy Taking Forward Primary Care Strategic Model ETTF update Business Any application to close sites/lists, applications for mergers etc Quality Quality update August Strategy Business Taking Forward Primary Care Strategic Model ETTF update Q Proactive Coordinated Care Report Any application to close sites/lists, applications for mergers etc Ratification of Church View Surgery Procurement Outcome Quality Quality update September

63 Strategy Taking Forward Primary Care Strategic Model ETTF update GPFV Delivery Plan progress update Business Any application to close sites/lists, applications for mergers etc Quality Quality update October Strategy Taking Forward Primary Care Strategic Model Review of CCG Remote Consultation kit, decision re continuation & revenue costs in & Q Proactive Coordinated Care Report Business Finance report Laura Sherburn/Hayley Tingle Decision Wendy Lawrence/Gail stones 15 minutes

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65 Meeting name Primary Care Commissioning Committee Meeting date April 2017 Title of paper Primary Care Quality Report Executive / Clinical Lead(s) Author(s) Suzannah Cookson Deputy Chief Nurse Z. Head, Primary Care Quality Nurse & S Cookson Purpose of Paper - Executive Summary The purpose of the Primary Care Quality Report is to provide the Primary Care Committee with an update of the recent activity and progress made by the NHS Doncaster CCG Quality Team in relation to Primary Care. Recommendation(s) The group are asked to receive and note the progress made. Impact analysis Quality impact Equality impact Sustainability impact Financial implications Legal implications Management of Conflicts of Interest Consultation / Engagement (internal departments, clinical, stakeholder & public/patient) Report previously presented at Risk analysis Assurance Framework As detailed in the report None Positive, supporting sustainability of general practice. None None None Engagement with member practices is on-going. Quality and Patient Safety Committee. There are no risks to report at this time. 1.2, 1.3, 2.1, 2.2, 4.3, 5.1 1

66 Primary Care Quality Report 1. Sharing of complaints Complaints received by NHSE cannot yet be shared with the CCG. The Primary Care Quality Nurse has been in discussion with NHSE and was told that this has been the case since a new system (CRM) was implemented in Reporting is done by the national complaints team who are looking to put together a dashboard per CCG and the first draft of these has been released to the regional complaints leads. However, there were some issues identified and they are working on a further draft but it is not clear when this is expected to be released. 2. Practice Visits The Primary Care Quality Nurse has visited 38 practice and by May 2017 all NHS Doncaster CCG practices will have received an initial introductory visit. There is on-going quality and assurance dialogue with 5 practices, including assurance visits and support. (However it is predicted that two of these practices will no longer require the higher level of support within the next few weeks). 3. FGM Reporting Following notification from NHS England there still appears to be a number of Doncaster Practices which were yet to register in accordance with the national requirements. The Deputy Designated Nurse and Named GP for Safeguarding are currently investigating barriers to submitting registrations and the Primary Care Quality Nurse is supporting specific practices if they have problems submitting an application. There appears to be a number of practices who believed they had registered however they are not appearing on the system. A colleague from NHS Digital has offered to support these practices to ensure they are registered correctly. The willingness to register is certainly there, it seems that the process is more complex than first thought. 4. GP reporting to Child Protection Conference Data shows a reduction in reports received from practices in February. However one report was requested with two days notice and one report was not requested at all due to the amount of time that the social worker took to confirm details of the GP. If these were taken into consideration, this would show an actual increase in reporting to 39%. However this is still a low percentage. The new style of report: GP reporting to Child Protection Conference shows the time scales between ringing and ing the practice and the date of the conference when the report is required. The report states that there is still significant delay being seen between the date the Social Worker sends the initial booking request form and the date that the GP details are obtained. The report states that this is due to the Social Worker not getting this information prior to submitting. On average, Doncaster Children s Trust requested the report from the GP eight days before the conference. In one instance the report was requested two days before the conference and in other instances the report was requested up to 14 days before the conference date. 2

67 5. Reports requested for initial child protection conferences Month Initial Child Protection Conference GP Reports Received Percentage % August % September % October % November % December % January % February % In September 2016 a proposal was agreed by the named GP, Deputy Designated Nurse, and the Safeguarding and Standards Child Protection service to support GPs contributing to child protection conferences. This would be via telephone contact with GP practices in advance of meetings informing them of the meeting date and requirement of a report. However the increased submission of reports has not been maintained. Conversations are on-going between the Primary Care Quality Nurse and Doncaster children s Trust and The Deputy Designated Nurse, The Named GP for Safeguarding and The Primary Care Quality Nurse will continue to work with practices to identify barriers to reporting. All practices have reported compliance against this standard and conversations with practices not supplying reports when requested are also on-going. 6. Primary Care Matrix The first major phase of the Primary Care Matrix (PCM) is now complete. The online version of the PCM is now live and available to GP Practice and key stakeholders within NHS Doncaster CCG. The report which is created from the same information available online will be used internally to identify specific variations in behaviour of GP Practices. An evaluation group (PCMEG Primary Care Matrix Evaluation Group) has been created who will report directly to the Primary Care Delivery Group, who will in turn grant permission allowing the PCMEG to contact practices to understand the contributing factors to the variations and work with the organisations in driving improvements. The next steps for the Primary Care Matrix are to begin adding the remaining domains ( Improvement and Innovation and Safe and Appropriate Clinical Care ) and increasing awareness of the online tool with GP Practice. Alongside this, the PCMEG group will be identifying practices as described above. Other steps will be to continue to add functionality to the online tool in line with suggestions from its users. It would be worthwhile in the future to present the current version of the online tool to the Primary Care Committee and further explain the work streams that ensure the information created is being used to understand and action the real variations in GP Practice. 7. Workforce Development Work is on-going to look at how Practice Nurse training is supported and how this platform can be used to build a general practice nurse support network, or forum. 3

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69 Primary Care Delivery Meeting 10 March 2017, 9am Meeting Room 3, Sovereign House Present: Laura Sherburn Partnerships & Primary Care, DCCG Chris Empson Performance and Intelligence, DCCG Zara Head Quality, DCCG Kayleigh Wastnage Primary Care, DCCG Gemma Sessions Performance and Intelligence, DCCG Lee Edell NHS England Nabeel Alsindi Clinical Lead for Long Term Conditions & Primary Care, DCCG Kelly Smith Primary Care, DCCG Claire Hudson Finance & Contracting, DCCG Gail Stones Data Quality, DCCG Jo Forrestall Head of Strategy & Delivery 1. Welcome and Apologies Laura Sherburn welcomed all to the Meeting. Apologies were noted from: Claire Burns Procurement, DCCG Carolyn Ogle - Primary Care, NHS England Susannah Cookson Deputy Chief Nurse, DCCG Genna Miller Finance & Contracting, DCCG Mark Randerson, Medicines Management, DCCG Andrea Butcher, Commissioning, DCCG Action 2. Minutes of the last meeting held on 10 February 2017 & Matters Arising The minutes of the last meeting were agreed as a true and accurate record and all actions were noted as complete. 3. Conflicts of Interest Laura Sherburn reminded meeting members of their obligation to declare any interest they may have on any issues arising at meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by are listed in the CCG s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: The meeting was noted as quorate. 1

70 4. Primary Care Work Plan The group discussed and updated the current work plan which will be circulated after the meeting with the updated information. 5. Primary Care Registration Guidance Kelly advised the group that a condensed version of the NHSE Guidance has been produced to be circulated to GP Practices. NHSE have approved the condensed version which includes information in relation to declining registration requests and over boundary care Kelly agreed to send information on the pilot being carried out in Newcastle relating to over-seas patients being eligible for secondary care. It was also agreed to include the guidance re carrying out home visits for patients registered outside practice boundaries in the summary, as this was the subject of some debate/query recently. Kelly Smith 6. Palliative Care Pilot Evaluation The aim of this service was to increase the availability of palliative care drugs in pharmacies that are geographically placed around Doncaster. This service aimed to improve access for patients, carers and healthcare professionals to specialist medicines when they were required, ensuring no delay in a patient s end of life treatment whilst also providing access and choice, and not directing or influencing them to a particular contractor. The Pilot has been refreshed and opened up to other areas, this has increased awareness as it has become more incentivised and better communicated. Feedback is awaited from the End of Life group - Jo Forrestall and Lucy McGibbon to look at the pilot and gain feedback. The group acknowledged the work done around this and that the costing s and cost implications are to be confirmed. Then there will be an SMT discussion. Jo Forrestall / Lucy McGibbon It was agreed to roll the pilot over for a further 3 months to allow more work to be carried out. 7. Church View Procurement Project Plan The group noted the report and were advised that an advert will be published in May and there will be a period of assessment. GP views and objectives will be required. 8. Primary Care Dashboard Chris Empson is taking feedback on the content from practices; they are keen to use the Primary Care Matrix for benchmarking purposes. 2

71 Dashboard will be more of an internal tool to access variation and identify any further dialogue needed. A small working group has been set up to take this forward and will report into Primary Care Delivery Group. Once agreed by the group, Zara will liaise with the relevant practices and provide an update to the next Primary Care Delivery Group. A TOR document will be produced for the working group and a rationale will be developed and presented at the next Primary Care Delivery Group. Chris Empson 9. GP Find The system has been set up to enable GP s to find pathways and service information for patients during their consultations. The system will also include referral forms. The GP element of the system will enable access to the more in depth data on websites and will include the 2 week wait referral forms. Content is being designed and built via joint working with lead commissioners. The planned go live date for the system is 1 st April The referral forms can be sent to Chris Empson for uploading and there will also be annual checks carried out to ensure the most up to date forms are available on the system and a notification will be sent when updates are available. Conversations with TPP and EMIS will be held at a later date to look at system integration. Work can also be done to look at how the service is used for the areas within the Primary Care Tiers and also with locality specific areas. Chris Empson will be providing an update around this at the next DCCG Managers meeting. Chris Empson 10. Primary Care Matrix This will combine the variations across all domains into one area. The NHSE specific contact detailed will be uploaded alongside variation reports to enable comparisons between practices to be highlighted and locality averages to be accessible if required. Data from the previously used systems will be transferred over and information requests will be able to be submitted if required. This is planned to go live on 1 st April Chris Empson will be providing an update around this at the next DCCG Managers meeting. Chris Empson 11. Any other Business There were no items raised 12. Date and Time of Next Meeting Friday 7 th April 2017 at 9:30am Meeting Room 3 THIS MEETING IS CANCELLED DUE TO CARE NAVIGATION STAKEHOLDER EVENT. 3

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73 Primary Care Provider Engagement Group Wednesday 22 nd February 2017 Board Room, Sovereign House 10.00am 12.00pm Present: Laura Sherburn DCCG Dr Nabeel Alsindi DCCG Kelly Smith DCCG Kayleigh Wastnage DCCG Emma Ross DCCG Claire Burns DCCG Chris Empson DCCG Joan Wright Dunsville Medical Centre Paula Farmer Dunsville Medical Centre David Mehdizadel Mayflower Medical Practice Dr Jill Saddler Mayflower Medical Practice Jo Franklin NHS England Alison Maw Kingthorne Group Practice Stuart Hollingworth Lakeside Practice Georgina Martin Nelson Practice Rose Fells The Scott Practice Angela Dean The Edlington Practice Sue Bushell Carcroft Doctors Group Amy Calder Carcroft Doctors Group Ruth Price Petersgate Medical Centre Angie Smart Phoenix Medical Practice Nick Hunter LPC Chris Simmonds TMC Frances Street Dr Cheng Looi Community Geriatrician Dr Joe Firth Thorne Moor Medical Practice 1. Welcome, Introductions and Apologies Action Laura Sherburn welcomed all to the meeting and introductions were made. 2. Notes and Actions from Last Meeting The notes were agreed as a true and accurate record of the meeting. All actions were discussed. Laura indicated that the LES price for non-registered patients would be with practices next week along with the 17/18 Treatment Room LES funding detail which has been restructured to be on a weighted capitation basis. Nabeel also confirmed that the CCG is looking into whether can use e- Page 1 of 6

74 referrals for inter-practice referrals for the Tier 2 LES s; there are potentially issues in e-referrals between EMIS and TPP users that have started to be explored 3. Keeping Well Specification Laura provided the background to the development of the Keeping Well specification including the discussions held at previous PEG meetings. In the interim the CCG has trialled the proposed patient searches as detailed in the specification via the Data Quality Team. Initial searches produced a nil return for patients aged in Doncaster who are on all four of the suggested risk factor registers (smoking, obesity, physical inactivity and alcohol intake) and have no existing long term conditions. This is probably due to data not being collected or coded equally for all four risk factors, particularly physical inactivity. The revised suggestion of using just the patients on both the smoking and obesity registers initially and then potentially including the other risk factors at later stages was discussed along with ways that could increase the numbers of patients identified by the search. The Group were asked to discuss in tables the practicalities of delivering the specification with the clinical staff in the room being asked to specifically consider the clinical interventions to be undertaken during the appointment with the patient detailed in the specification. Feedback from tables and group discussion included: Concerns around the capacity planning needed from practices to deliver the specification when level of activity/overall payment is uncertain; this may be more easily done in groups of practices Need to be clear in the specification about what qualifies for the 30 payment; if the healthy lifestyle conversation is best done when blood results are available, then this will require 2 appointments; only when both are achieved will the 30 be payable Need to be clear on what is expected to qualify for the 18 follow-up fee; what needs to be measured, what level of reporting is required Agreed that telephone consultation or e-consultation could be used for aspects of the service, and may be preferable for some of this patient group Agreed that extended hours could be used to deliver, given this cohort of patients will generally be working age The training requirements for staff delivering the specification. The Group discussed the intention for the service to be delivered by Nurses and HCA s and the possibility for other services such as Public Health and RDaSH to provide healthy lifestyle training to support the delivery of the service. Laura agreed this was something that could be looked into Agreement that if a patient had undertaken the specified blood investigations within the last 12 months then they would not need to be retaken LS Page 2 of 6

75 Rather than limiting the specification to just patients on smoking & obesity registers, it could be changed to those on two or more of the original four risk registers; this would allow practices to make use of alcohol and physical inactivity registers where these exist To make more easily available the directory of services and to highlight those services likely to be utilised most. Concerns on uptake of the service due to the cohort of patients identified being of working age. Discussed different ways of practices engaging patients including the option of group sessions The gap in weight management services and whether the specification could have been used to fund practices to directly deliver this service. The specification is broader than this but there is the option for practices to pool their resources to provide and/or fund interventions Laura thanked everyone for their input and agreed to contact clinicians outside of the meeting to look at the clinical thresholds. Laura will make the consequent updates to the specification and recirculate ASAP. The implementation date had originally been planned to be 1 st April but Laura acknowledged further work was needed to get the specification finalised and it was more important to make sure the specification is right than rush it for that deadline. It was agreed practices would receive at least 1 month s notice prior to a go live for this specification. LS 4. Releasing Time for Care Laura shared information the CCG had received from the national team in the last week around the Releasing Time for Care funding available for practices, information embedded within the presentation below. PEG discussion 21 st Feb 2017 The Group discussed the preferred method to approach general practice regarding the Releasing Time for Care offer of support. The general consensus was to invite the allocated Development Advisors from the NHS England programme to the next pan-doncaster event in June 2017 rather than have a separate meeting. CCG 5. Responsive Primary Care The Group have previously discussed potential options for the responsive care pillar. The pillar is being funded through the 3 per head GPFV money. The potential requirements for the money are: Deliver change projects against at least 2 High Impact Areas of the Releasing Time for Care Programme and demonstrate how these Page 3 of 6

76 release capacity Demonstrate how that change project has released capacity in readiness to deliver extended access in 2018 Engage with the Releasing Time for Care Programme A potential measure of the effectiveness of the above work might be for each practice to be able to offer, as a minimum, the widely accepted figure of 72 (or 70 to 80) GP or ANP appointments per 1000 population each week. This requirement is increasingly common in APMS contract procurement. It was accepted that this figure has a limited evidence base with some practices who offer significantly more still feeling like they don t have enough appointments to cope with demand. The Group discussed how best to commission the Responsive Primary Care pillar e.g. from individual practices, groups of practices or from a federation(s). This discussion will be taken forward by the CCG, with the LMC and the federation leads throughout March. Practices are asked to contact the primary care team with comments and suggestions prior to the next meeting. 6. Primary Care Website Chris Empson presented the new GP Find, Analyst Service and GP Matrix tools to the Group. GP Find this is an electronic directory of services for commissioned pathways and the corresponding referral routes and contact details. It won t require a login but will need an N3 connection to access it. GP Matrix the GP Matrix is a compilation of data sets (some already publicly available) pooled in an online database for practices to be able to compare their performance with other individual practices or averages across localities or levels of deprivation. The tool works in a similar manner to other comparison websites such as Go Compare or Compare the Market. Analyst Service practices will be able to request additional support in analysing the data from the GP Matrix, or other sources from the Performance and Intelligence Team. Chris informed the Group that he and Gemma Sessions will be visiting practices, along with using other meetings and forums, before the April 1 st launch date to spread awareness of the above. Nabeel presented a mock-up of layout of the Primary Care Website that will also go live on 1 st April and outlined the intended purpose and content. It will be accessible on any internet connection and not require a login. It will form an important part of communicating and engaging with primary care, and will reduce the reliance on individual s. Page 4 of 6

77 7. Proactive Co-Ordinated Primary Care Nabeel provided an update on the reports from the first quarter of the Proactive Co-Ordinated Primary Care service. Nearly all practices/groups have submitted their reports, with capacity issues due to sickness or recruitment problems the most common theme although many practices were confident that these had been addressed. Some practices expressed uncertainty about the Enriched Summary Care Record and have had/scheduled a discussion with NHS Digital; the CCG will follow this up as it s not clear whether the practices who haven t consented any patients yet but didn t make any comments have similar issues. Laura brought up the recent confirmation that the Avoiding Unplanned Admissions ES would be rolled into the global sum from 1st April It was anticipated that this might be the case and the specification for PCPC was designed with this development in mind. For practices that went through their patients covered by the AUA ES and identified the ones who would be appropriate for this service as well, there ought to be little impact. Where practices decided to keep the lists largely separate then thought will have to be given by them as to whether their current PCPC register consists of the patients who most benefit from the additional interventions offered or whether changes to the register should be made. The quarterly reporting template has a specific question on changes to the register from the previous quarter which will allow practices to outline any changes made as a result. This will be made clear in a communication to practices in March, along with an offer to discuss it further for practices unsure how to approach the ending of the AUA ES. 8. Any Other Business There was no other business discussed. 9. Date & time of next meeting: 9.00 am am, Thursday 16 th March 2017, Boardroom, Sovereign House Please note that dates, times and venues may be subject to change. Page 5 of 6

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79 Primary Care Provider Engagement Group Thursday 16 March 2017 Board Room, Sovereign House 10.00am 12.00pm Present: Laura Sherburn DCCG Dr Nabeel Alsindi DCCG Kayleigh Wastnage DCCG Emma Ross DCCG Simon Francis Sheffield City Region Joan Wright Dunsville Medical Centre Paula Farmer Dunsville Medical Centre David Mehdizadel Mayflower Medical Practice Georgina Martin Nelson Practice Rose Fells The Scott Practice Sue Bushell Carcroft Doctors Group Amy Calder Carcroft Doctors Group Ruth Price Petersgate Medical Centre Paula White The Medical Centre Richard Wells LPC Chris Simmonds The Medical Centre Dr Karen Wagstaff Barnburgh Surgery Amanda Perry Mayflower Medical Centre Chris Jones West End Clinic Julie Dodd Tickhill and Colliery Medical Practice 1. Welcome, Introductions and Apologies Action Laura Sherburn welcomed all to the meeting and introductions were made. 2. Notes and Actions from Last Meeting The notes were agreed as a true and accurate record of the meeting. All actions were discussed. Laura acknowledged funding details for the Treatment Room LES had not been distributed and that the Primary Care Team were chasing this information. Laura confirmed an invite had been extended to the Development Advisors from the Releasing Time for Care NHSE programme, unfortunately they were unable to attend the next planned pan Doncaster Page 1 of 5

80 event, however Laura advised that they are looking at other dates and will link in the first instance with the emerging federation regarding how to engage general practices. 3. Employment, an alternative therapy? DH-DWP WORK AND HEALTH UNIT HEALTH-LED EMPLOYMENT TRIAL 20/03/ SIMON FRANCIS March 2017 Simon Francis was introduced to the group and gave the above presentation. Simon discussed the 2 year trial, which basically looks to integrate employment and careers services with health services, so that patients off work with either long-term MSK or mental health problems can be better supported to return to work. Additional funding is available to implement this trial. The group discussed referrals into the integrated service. There are discussions about how RDaSH will be able to provide the model by reconfiguring their existing services (physical & mental health). Social prescribing and IAPT will be key gateways into the service, however this is not exclusive of direct referrals from health professionals such as GPs and community nurses. The group voiced concerns around ensuring that local employers were engaged in the trial to ensure the offer is end-to-end. Simon confirmed this is within the scope of discussions at this point. Simon suggested inviting a practice manager and pharmacist to the task and finish group for further input. Laura confirmed that the service model for the trial is still in development and information on how to refer would be distributed when available. It was estimated this service would be live towards the end of 2017/early Page 2 of 5

81 4. Responsive Care Specification - 3 per head Deploying 3 per head - DRAFT.docx Laura distributed the attached with apologies that it had not been distributed with the meeting papers. Laura confirmed the document detailed ideas/discussions which had been born through this meeting and asked members to read and feedback. Federation Following discussion with the current representatives for the provider networks/neighbourhoods around Doncaster, a plan to explore establishing a single Doncaster wide federation has been agreed. The current federation/practice group reps will be attending a 3 rd workshop to discuss the company type and explore how neighbourhoods fitted into this, on 30 th March, led by Jayne Brown. Change Projects Productive General Practice Laura confirmed an expression of interested had been completed on behalf of Doncaster. This information would be distributed to current federation representatives to discuss with member practices as this was an opportunity for approximately 12 practices to receive support in the way of consultancy sessions. Understanding workforce & workload NHSE would like to test a workforce tool with practices. Both Rose Fells & Paula White agreed they would like to find more information around this and Laura agreed to arrange an invitation to the exploratory meeting with the supplier for both practice managers. LS Preparing for Extended Access Further information is required around this as the current guidance is not clear. The CCG would like practices to think about ways to pilot extended access in neighbourhoods. Additional investigation on 70 appointments per 1000 patients was needed and the CCG would feed this back to the group. Laura informed the Group that the LMC has been engaged with the development of the Responsive Care Pillar Proposal and is happy with its content so far. 5. Extended Primary Care Update Page 3 of 5