Primary Care Commissioning Committee Part 1 Agenda

Transcription

1 Primary Care Commissioning Committee Part 1 Agenda Thursday 1 st December pm 4.40pm Bevan Room, Aylesbury Vale CCG, 2 nd Floor The Gateway, Gatehouse Road, Aylesbury, Bucks HP19 8FF Agenda Item 1 Welcome and Introductions: Apologies: Desired Outcome(s) Contributor Graham Smith CHAIR 2 Declarations of Interest Graham Smith CHAIR 3 Questions from members of the public 4 Minutes of the September 2016 meeting and action log 5 Primary Care Commissioning Governance - Delegated decision making - PCCC Terms of Reference - PCOG Terms of Reference 6 Managing Primary Medical Services Disputes Approve Primary Care Commissioning Approve Graham Smith CHAIR Graham Smith CHAIR Helen Delaitre AVCCG Approve Helen Delaitre AVCCG 7 Quality in Primary Care Discussion Dr Karen West AVCCG 8 GP Forward View Operational Plan and Improved Access Trajectory 9 Any Other Business - Additional PCCC to discuss Direct Awards, QOF, QIS and Committee in Common ToR Primary Care Transformation Approve Any Other Business Approve Louise Smith/Helen Delaitre Helen AVCCG Graham Smith CHAIR Papers/Times pm Paper A pm Paper B pm Paper C pm Paper D pm Paper E pm Page 1 of 2 Pack Page 1

2 For Information Only Paper F Finance Report Report from the Primary Care Operational Groups held in October and November 2016 Verney Close Value for Money Audit Primary Care Support Services provided by Capita: Briefing for Primary Care Commissioning Committees Paper for information only Paper for information only Paper for information only Paper for information only Page 2 of 2 Pack Page 2

3 Paper A Primary Care Commissioning Committee (PCCC) Thursday 8 September 2016, 3.30pm 5.00pm Bevan Room, AVCCG, The Gateway, Gatehouse Road, Aylesbury, Bucks Present: Graham Smith (GS) Lay Member for AVCCG Governing Body, Chair Louise Patten (LP), Chief Officer AVCCG & CCCG Dr. Raj Bajwa (RB), Clinical Chair CCCG Nicky Wadely (NW), Programme Manager for Co-commissioning, NHS England Robert Majilton (RM), Director of Sustainability & Transformation, AVCCG & CCCG Dr. Graham Jackson (GJ), Clinical Chair AVCGG Helen Delaitre (HD), Head of Primary Care, AVCCG & CCCG Dr. Karen West (KW), Clinical Director for Integrated Care, AVCCG & CCCG Colin Hobbs (CH), Assistant Head of Finance, NHS England South Central Dr. Jane O Grady (JOG), Director of Public Health, Bucks CC, representing for the Health & Wellbeing Board Thalia Jervis (TJ), Chief Executive, Healthwatch Bucks Jessica Newman (JN), Assistant Contracts Manager Medical, NHS England South Central John Trevains (JT), Assistant Director of Nursing & Safeguarding, NHS England, Presenting Wendy Newton (WN), Primary Care Manager, AVCCG & CCCG, Notes Tania Atcheson (TA), Safeguarding Lead & Designated Nurse for Child Protection, AVGGC & CCCG Item Agenda Item No. 1 Welcome & Apologies Actions Members of the Primary Care Commissioning Committee were welcomed to the meeting and introductions given. 2 Declarations of Interest. No further declarations of interest made in addition to those declared at previous PCCC meetings. It was noted that some items on the agenda could potentially create conflicts for GPs as primary care providers. 3 Questions from Members of the Public No questions from the public were received. 4 Minutes and Actions of Committee Meeting 2 nd June 2016 Minutes of 2 June 2016 agreed without amends. Action log was reviewed and updated accordingly. Pack Page 3

4 5 Primary Care Commissioning Committee Terms of Reference (ToR) q The ToR for the Primary Care Commissioning Committee had been reviewed and amended to include Chiltern CCG (CCCG) representation. CCCG does not currently hold delegated or co-commissioning responsibilities however the Committee aims to include CCG for the purpose of shared learning in the confidence that CCCG will move towards delegated status in the forthcoming months. CCCG representatives will not hold voting rights. The decision regarding CCCG s future commissioning status should be known early in the New Year 2017 at which time the Committee s ToR will be reviewed again. Actions: Following comments from Committee members, further amendments to the draft ToR to be made by HD to include: Clear indication of which members hold voting rights Statement on quoracy. LP & HD to consider the role and purpose of inviting a Community Nurse to join the Committee as a permanent member. PCCC agreed to adopt revised ToR as a working document with further amends to be made. 6 Mandeville Practice Procurement and the Practice Group APMS Contract The Primary Care Operational Group (PCOG) requested an extension to the temporary contract for the Mandeville Practice which is currently held by The Practice U Surgeries. The Group concurred that more time was required for robust patient engagement and to fully consider new models of care and vanguards and to ensure that the new service specification is fit for purpose and fully meets the needs of the local population. The current contract runs until April 2017 and includes the opportunity for a six month extension. The PCOG has requested a 12 month temporary contract extension which will require a single tender waiver application to be submitted. The provider is agreeable to a 12 month contract extension providing the terms and conditions of the contract remain unchanged. Actions: HD to draft a single tender waiver application for approval by the CCG s Chief Finance Officer prior to submission to the CCG Audit Committee on 28 th September CH/NW to review the Standing Financial Instructions (SFIs) for NHS England and clarify whether the single tender waiver application also needs approval from NHS England. HD CH/NW 7 Vulnerable Practice Scheme (VPS) / General Practice Resilience Programme (GPRP) VPS launched in December AVCCG and CCCG have subsequently received 35,000 each to be used to support individual practices that have been identified by the CCG as vulnerable. An operational policy for approving spend against VPS budget has been drafted by the PCOG and shared with Clinical Locality Leads. Support for practices would need to be mutually agreed by the CCG and the practice. The practice would be Pack Page 4

5 expected to act as co-investors in their future and agree to match CCG funding with either funding, or commitment by the practice in other forms (e.g. backfill to release staff for training, cost of venue hire). Due to the nature of general practice a rigid criteria to identify and support practice is not always practical with local intelligence and personalised action plans being required. VPS will be a standard agenda item for the PCOG who will act on behalf of the PCCC to review and approve applications and spending for AVCCG. As CCCG do not hold delegated commissioning responsibility a decision will be required as to whether the PCOG can agree proposals for spending money from the VPS for CCCG. Money has been received by both AVCCG and CCCG as part of the GPRP. AVCCG has received 44,000 and CCCG 70,000. This is the first allocation of money expected over the three year programme. Early suggestions for use of the GPRP is for some of the money to be held as a reserve facility for practices to access a small fund immediately which could be approved outside of PCCC meetings. NW advised that where a substantial amount of money is given to a practice then a memorandum of understanding will also need to be signed to formalise the practice s commitment to work through identified actions. There is potential for the majority of the funding to be used to develop a bank of locum staff, both clinical and non-clinical. It was noted that initial thoughts on use of this funding need to be submitted to NHS England by 16 th September The meeting acknowledged the potential inequity of this funding, particularly between practices identified early on in the process as being vulnerable and therefore benefitting from some of the limited funding. The group also agreed that the schemes should demonstrate maximum value for money by using the pre-approved NHS England framework of suppliers where possible. CCGs to report to NHS England on a monthly basis on activity and how the money has been spent. HD confirmed that there was no expectation that the County or District Councils would need to offer specific support to practices under these schemes. PCCC approved the process for AVCCG. Governing Body to agree process for CCCG. Actions: HD to provide an algorithm for accessing funding. Once completed, NW to provide a list of pre-approved suppliers to ensure maximum value for money. NW to provide contact details for shared learning opportunities with other areas that have developed a locum bank of staff. HD NW NW 8 Verney Close Practice, Buckingham Update NW updated that processes are underway for the closure of the contract for Verney Close Surgery on 30 th September The bulk transfer of patients to The Swan Practice will happen between 7 th and 10 th October Services to patients at both practices will continue uninterrupted during the transfer period. Patient information about the list dispersal, bulk transfer of patients to The Swan Practice and alternatives for patients not wishing to register with them has been made available on Pack Page 5

6 both surgery sites. There has been positive feedback from patients. NHS England South Central Prescribing Services Regulation Committee (PSRC) met on 24 th August to consider the rights of the doctors at Verney Close Surgery to continue dispensing to eligible patients. The PSRC concluded that for the purpose of maintaining services for dispensing patients at Verney Close Surgery, the situation should be considered as an amalgamation of dispensing lists. The PSRC concluded that as a number of dispensing GPs will continue to perform primary medical services at Verney Close surgery providing care for the same cohort of patients, a pragmatic approach should be taken to ensure dispensing services are maintained. This means that eligible patients will continue to be able to have their prescriptions dispensed from the Verney Close dispensary. There will need to be a change of practice boundary for The Swan Practice to facilitate this which will be submitted to the Primary Care Operational Group in October. A contract variation will be issued to The Swan Practice to reflect the additional site (Verney Close Surgery) and new boundary. 9 Report on Safeguarding in Primary Care JT shared and presented the key highlights from the Quality Report for Primary Care Safeguarding: All key Buckinghamshire health safeguarding posts are in place and well established Recent primary care safeguarding audit received a response rate of 34 out of 53 practices, a 64% return with good assurance achieved CQC inspections of primary care have a focus on safeguarding practice The Ofsted inspection 2014 identified Buckinghamshire Children s Services and the Safeguarding Children Board as Inadequate There is a strong health Network in place for safeguarding professionals in the Buckinghamshire health community There are a range of health focussed safeguarding developments/training events being delivered in 2016/17 The Ofsted inadequate judgement is of note though there is good assurance that remedial action is being taken Good evidence to demonstrate that safeguarding is a key consideration within general practice however the challenge for NHS England is to work with other primary care services e.g. optometry, to achieve a similar high profile. It was noted that the NHS England Quality Team are aiming to provide the PCCC with themed quality updates. 10 AOB Quality Report - KW reported she had not received the quarterly quality report and it was agreed that JT would follow up and feedback to KW re the report s circulation. Conflict of Interest Update - JT / KW Pack Page 6

7 Members of the Committee were asked to note new guidance published by NHS England in June 2016 which strengthens requirements for recording and reporting conflicts of interest in primary care. There is now a requirement for all members of the CCG (i.e. all member practices) to declare conflicts of interest including all GP Partners. A declaration form and Question and Answer document will be circulating to all member practices on 8 September, with a request for all declarations to be returned to Locality Business Managers by 23 September. Going forward all declarations will be reviewed and updated every six months. Meanwhile declarations of conflicts of interest will remain a standing item on all committee agendas. Members of the Committee are reminded of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of the CCGs. Declarations declared by CCG members of the Primary Care Commissioning Committee are listed in the CCG s Register of Interests (covering committees and staff). The Register is available from the Corporate Governance Lead. CCGs are now required to publish all declarations on the registers on public websites, where they must remain for a minimum of 6 months. In addition, the CCG must retain a private record of historic interests for a minimum of 6 years after the date on which it expired. In circumstances where a potential perceived or actual conflict is known to exist, best practice indicates that the member or individual should remove themselves from all discussion and subsequent vote on the associated item. This should include leaving the room, even though this is not formally required as part of statutory guidance. This should especially apply where information to be discussed is of a confidential or commercially sensitive nature. Date of the Next Meeting: Primary Care Operational Group: 6 October 2016, 3.30pm 3 November 2016, 3.30pm Primary Care Commissioning Committee: 1 December 2016, 3.30pm Pack Page 7

8 Open Action Log Primary Care Commissioning Committee Agenda Action Owner Open/ Item No. Closed Date 02/06/ Berryfields Portakabin LP requested the PCCC delegate a sub group to make this decision and then report back to the September 2016 PCCC meeting. Updated 08/09/2016 July PCOG had received further information provided by the practice. PCOG agreed to postpone making a formal decision until the outcome of the ETTF bid is known. Additional Portakabin is anticipated to provide sufficient capacity for 24 months whilst permanent premises are secured. Full report to be reviewed by PCOG on 06/10/2016 and outcome reported to PCCC in December PCOG to use the newly developed checklist for funding or discretionary awards developed for CCCG & AVCCG. 02/06/ Verney Close Contract LP asked NHSE to provide an indication of the income stream in order to undertake a value for money audit on preferred reprovision option. Updated 08/09/2016 Value for money audit to be undertaken at end of the process to ensure full costs are included. NW to confirm whether NHS England will continue paying MPIG in year 2. Discussions to be held outside of meeting and reported at the next PCCC meeting. 08/09/ PCCC Terms of Reference Following comments from Committee members further amendments to the draft ToR to be made to include: Clear indication of which members hold voting rights HD HD NW HD PCOG has approved funding to provide additional capacity at Berryfields. A log of discussions held is contained within the PCOG minutes. Individual member decisions has been logged. Action will now be closed. Chiltern CCG undertaking a VFM audit attached to Committee papers for information. Action will now be closed. NW confirmed MPIG included in Year 2. Action will now be closed. Agenda item. Pack Page 8

9 Statement on quoracy. LP & HD to consider the role and purpose of including a Community Nurse as a permanent committee member. 08/09/ Mandeville Practice Procurement HD to draft a single tender waiver for approval by Chief Finance Officer prior to submitted to CCG Audit Committee on 28 th September CH/NW to review the SFIs and clarify whether the single tender waiver would require approval from NHS England. 08/09/ VPS / GPRP HD to provide an algorithm for the VPS Policy. NW to provide a list of pre-approved suppliers to ensure maximum value for money. NW to provide contact details for shared learning opportunities for other areas where they have developed a locum bank of staff. 08/09/ Quarterly Quality Report John Trevains to liaise with KW regarding circulation of the Quality Team Quarterly Report. LP / HD HD CH/NW HD NW NW JT / KW Audit Committee approved Single Tender Waiver. Action will now be closed. Algorithm drafted and signed off at PCOG in October. NW has provided details of other areas. Actions will now be closed Information is generated by NHSE Quality Team and will be sent through to CCG Quality Team. Action will now be closed. Pack Page 9

10 Closed Action Log Primary Care Commissioning Committee Date Agenda Item No. Action Owner Open/ Closed Invite LMC, Health-Watch Bucks and the Health Louise Smith OPEN and Wellbeing Board to all future meetings CLOSED LS/GH to discuss the membership of the Operational Group Louise Smith Ginny Hope OPEN CLOSED LS to amend the TOR to reflect meeting can be held virtually The committee need to develop a progression and exit strategy GH to sign off the comms message to our members Louise Smith OPEN CLOSED Louise Smith OPEN CLOSED Ginny Hope OPEN CLOSED GH to feedback the discussions to Jess Newman Ginny Hope OPEN CLOSED LS to produce a 12 month work plan Louise Smith OPEN CLOSED LS to produce a FAQ sheet Louise Smith OPEN CLOSED LS to add this amendment to the TOR to state GS will appoint a replacement Chair (namely Healthwatch Bucks representative) if he is unable to attend future meetings LS and CH to hold further discussions on the payment mechanisms needed to implement the C&SP changes MET and had op meetings It was agreed a delegated group will be established consisting of 2 NHSE reps, GS as Louise Smith OPEN 15/06/2015 CLOSED 24/09/2015 Louise Smith Colin Hobbs OPEN 15/06/2015 CLOSED 24/09/2015 OPEN 15/06/2015 CLOSED 24/09/2015 Pack Page 10

11 chair and LP to sign off AUS DES + once the areas of concern are clarified by NHSE NW to speak to JF to establish practice nurse revalidations NW has flagged to JF who has reported back to LP. 24/09/15 4 LS to amend the Care & Support Planning Business Case by adding the presentation shown in the meeting as an appendix and provide clarity needed on the business plan for 2016/17 including a value for money assessment and a process for the evaluation framework. 24/09/15 11 LS to invite the AHSN onto the Healthy Town Partnership group Updated : LS has made contact but no reply to date. Action remains open Nicky Wadley OPEN 15/06/2015 CLOSED 24/09/2015 Louise Smith OPEN: CLOSED: Louise Smith OPEN: Updated /12/15 14/12/15 Updated : Unfortunately we were not successful with the bid. 7 PR asked NHSE if practices have to sign the results of CQRS and if they want to dispute the extraction figures contradicted within first part of the specification, should they sign or hold of signing? NW agreed to raise this question nationally as national guidance is needed to resolve this issue. 8 LP raised a concern with the lack of safeguarding information in the report. We need this information in the next report. The paper does not reflect the amount of training and support AVCCG gives to practices on safeguarding issues. NW to raise this with the NHSE Quality Team. Updated :Report has been amended accordingly CLOSED: Nicky Wadely OPEN: CLOSED: Nicky Wadely OPEN: CLOSED: Pack Page 11

12 14/12/15 10 It was agreed a meeting with AVCCG, NHSE and the new provider at Mandeville Surgery will be set in the new year. Updated : CLOSED 14/12/15 9 LP advised the CCG has had to fund an administrator in the multi-agency safeguarding hub. GH requested further details to assess if NHSE are able to cover this funding. Updated : No update available. Action Point remains open. Gary Passaway Gary Heneage Nicky Wadely OPEN: CLOSED: OPEN: Updated Updated Updated :NW will chase this up with GH Updated : NHSE are unable to cover funding. The position is filled by the current workforce 02/06/16 7 Avoidable Unplanned Admissions DES+ and QOF The PCCC delegated responsibility for sign off of the data for practice payment to the Primary Care Operational Group and a final report to come to the next formal Committee. CLOSED LS OPEN: CLOSED Updated 08/09/2016 Practices have been paid awards. Close action. Pack Page 12

13 MEETING: Primary Care Commissioning Committee DATE: Thursday 1 December 2016 TITLE: AUTHOR: LEAD DIRECTOR: Primary Care Commissioning Governance Helen Delaitre Debbie Richards PAPER B Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information X Summary of Purpose and Scope of Report: The purpose of this paper is to inform the Primary Care Commissioning Committee of proposed amendments to the Primary Care Commissioning governance arrangements. Amendments include: - Amendments to the scheme of delegation; - Delegation of decision-making to the PCOG; - Inclusion of list of voting members in both PCCC and PCOG terms of reference; - Agreement on voting structure. Scheme of Delegation The Governing Body Scheme of Delegation has recently been amended and is scheduled to be ratified at Audit Committee on 30 th November The proposed amendments, highlighted in red on the attached scheme of delegation list, focus on inclusions to the areas of responsibility delegated to the Primary Care Commissioning Committee: 1. (P4) Approve and ratify Direct Awards. 2. (P5) Approve and ratify practice incentive schemes having regard to guidance by the Secretary of State. Monitor and review any such schemes. 3. Authority to approve spend on premises improvement grants and capital developments, the award of PMS or GMS contracts, procurement of new practice provision, decisions in relation to the management of poorly performing GP practices and premises costs directions functions is limited to 50k. In order to support the Primary Care Commissioning Committee in maintaining a strategic focus, consideration should now be given to the functions where decision-making responsibility can be delegated to the Primary Care Operational Group. The proposed areas of responsibility for the PCOG are also highlighted in red on the attached scheme of delegation list and include the upper financial limit associated with these decisions which is in line with the CCG s Standing Financial Pack Page 13

14 Instructions. Primary Care Commissioning Committee Terms of Reference In line with comments made at September s PCCC, a list of voting members has been included as a Schedule in the Terms of Reference. Quoracy is achieved when five members of the Committee (or their deputies) are present including: - at least two lay members or one lay member and the Director of Quality; and - either the Chief Officer (CO) or the Chief Finance Officer (CFO). The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote if necessary. Primary Care Operational Group Terms of Reference In anticipation that the PCCC agrees that some decision-making responsibilities will be delegated to the PCOG, then a corresponding list of voting members has been drafted and attached as Schedule 1 to the Terms of Reference of the PCOG. Quoracy is achieved when at least four members of the total membership are present. This must include one from Aylesbury Vale or Chiltern CCG, one representative from NHS England, one lay representative and one clinical representative. The Operational Group shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote if necessary. Conflicts of Interest: None in respect of approvals requested. Members should note that Terms of Reference have been designed to ensure that the Committee will be quorate for decision making without any member GP/GP partners present. This is as a result of member GPs/GP partners who may otherwise be conflicted in respect of Direct Awards or primary care incentives being invited to attend rather than as formal members, and who would therefore be asked to leave the room when these decisions are discussed and reached. Strategic aims supported by this paper (please tick) Better Health in Bucks to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks to promote equity as an employer and as clinical commissioners X X X X Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary Patient & Public N/A Involvement Equality N/A Quality N/A Financial N/A Risks N/A Statutory/Legal N/A Pack Page 14

15 Prior consideration Committees /Forums/Groups Membership Involvement Y N/A Scheme of Delegation has been approved by the CCG s Audit Committee Pack Page 15

16 No Policy Area Decision PCCC PCOG P1 PRIMARY CARE COMMISSIONING Approve arrangements for the review, planning, and procurement of primary care services under delegated authority from NHS England. Y N P2 PRIMARY CARE COMMISSIONING Approval of the arrangements for discharging the CCG s responsibilities and duties associated with its primary care commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation, obtain advice from persons who taken together have a broad range of professional expertise and acting effectively, efficiently and economically. Y Y up to the value of 50,000. P3 P4 P5 PRIMARY CARE COMMISSIONING PRIMARY CARE COMMISSIONING STRATEGY AND PLANNING Day to day decisions on provider performance management and risk management associated with Primary Care to provide robust assurance to the Governing Body and NHS England. Y Y Approve and ratify Direct Awards. Y N Approve and ratify practice incentive schemes, having regard to guidance by the Secretary of State. Monitor and review any such schemes. Y N P6 PRIMARY CARE COMMISSIONING Approve the following primary care services: a. Primary medical care strategy; b. Planning primary medical care services (including needs assessment); c. Primary Care Estates Strategy; d. Premises improvement grants and capital developments (up to 50k only); e. Practice mergers Y N unless specifically delegated to do so for premises development up to the value of 50,000. Pack Page 16

17 P7 PRIMARY CARE COMMISSIONING Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements: a. The award of GMS, PMS and APMS contracts for primary care services to some or all of the CCG population where they are within CCG budgets (excluding GP contracts for which core contract approval/monitoring and appraisal sits with NHS England Area Team; This includes: the design of PMS and APMS contracts; and monitoring of contracts; taking contractual action such as issuing branch/remedial notices, and removing a contract) (up to 50k only); b. Procurement of new practice provision (up to 50k only); c. Discretionary payment (e.g. returner/retainer schemes); d. Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list) (up to 50k only); e. Premises Costs Directions functions (up to 50k only). Y Y up to the value of 50,000. P8 PRIMARY CARE COMMISSIONING Advise on or approve matters relating to primary care contracting within agreed levels, specifically in relation to commissioning Locally Commissioned Services, QOF, Out of Hour services, Walk-in Centres (including home visits as required and for out of area registered patients); Y Y up to the value of 50,000. P9 PRIMARY CARE COMMISSIONING Approval proposals for primary care support and development and any associated plans in connection with commissioning and performance monitoring and development within the remit of the CCG. Y Y Pack Page 17

18 Terms of reference for delegated commissioning arrangements including Scheme of Delegation and Primary Care Commissioning Committee Document Version Date Version Number Description of Changes Watermark added Change to paragraph 13 regarding number of votes Reference to Thames Valley area team removed and replaced with NHS England. Full Acronyms explained Change to secretariat from NHSE to AVCCG Change to membership section to read Chief Officer or Chief Finance Officer NOTE Sent to Graham Jackson for Chairs action and full Governing Body for approval of sign off. Sent to NHS England (South) as final version Documented updated to delegated commissioning arrangements including scheme of delegation and Primary Care Commissioning Committee Document updated to take account of joint working arrangements between Aylesbury Vale and Chiltern CCGs Document amended to include draft scheme of delegation at Schedule 4 and Document amended to include list of voting members, their deputies and deputising rights. Edited by Louise Smith Louise Smith Elaine Baldwin Elaine Baldwin Helen Delaitre Helen Delaitre Helen Delaitre 6 Pack Page 18

19 Introduction Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England was inviting Clinical Commissioning Groups (CCGs) to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG. 1. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2. The delegation is set out in Schedule 1 of these Terms of Reference. 2. The CCG has established the Aylesbury Vale CCG Primary Care Commissioning Committee ( Committee ). The Committee will function as a corporate decisionmaking body for the management of the delegated functions and the exercise of the delegated powers. 3. It is a committee comprising representatives of the following organisations: Aylesbury Vale CCG Chiltern CCG NHS England Health watch LMC Lay Chair Lay member Health and Well Being representative Statutory Framework 4. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. 5. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG. Pack Page 19 7

20 6. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2). 7. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below: Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P). 8. The Committee is established as a committee of the Governing Body of NHS Aylesbury Vale CCG in accordance with Schedule 1A of the NHS Act. 9. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State. Role of the Committee 10. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, Pack Page 20 8

21 planning and procurement of primary care services in Aylesbury Vale under delegated authority from NHS England. 11. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Aylesbury Vale CCG, which will sit alongside the delegation and terms of reference. 12. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. 13. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. 14. This includes the following: GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); Newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services ); Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF); Decision making on whether to establish new GP practices in an area; Approving practice mergers; and Making decisions on discretionary payments (e.g., returner/retainer schemes). 15. The CCG will also carry out the following activities: a) To plan, including needs assessment, primary care services in Aylesbury Vale. b) To undertake reviews of primary care services in Aylesbury Vale. c) To co-ordinate a common approach to the commissioning of primary care services generally. Pack Page 21 9

22 d) To manage the budget for commissioning of primary care services in the Aylesbury Vale area. e) To assist and support NHS England in discharging its duty under section13e of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) so far as relating to securing continuous improvement in the quality of primary medical services. f) To undertake and deliver an estates strategy across the Aylesbury Vale area. Geographical coverage 16. The Committee will comprise Aylesbury Vale CCG. It will undertake the function of AVCCG commissioning primary medical services for the Aylesbury Vale area, as defined within the Constitution. Membership The Chair of the PCCC should not also chair the Audit Committee. The Chair of the Committee shall be a Lay member of the AVCCG Governing Body The Vice Chair of the Committee shall be a lay member of the AVCCG governing body and agreed by the Governing Body. 17. The Primary Care Commissioning Committee shall consist of: Lay member (Chair) Lay member (Vice Chair) Chief Officer Chief Finance Officer Director of Operations & Performance Director of Quality or Public health representative Quality Lead CCG Chair If GP members need to withdraw from decision making for conflicts of interest reasons, the Committee would still be quorate with a lay and executive majority. Other non-voting attendees Invitation to a Health Watch representative Invitation to a Health and Wellbeing Board representative Pack Page 22 10

23 Local Medical Committee representative NHS England Aylesbury Vale/Chiltern CCG Head of Primary Care Non-conflicted GPs from other CCGs Additional Lay members Subject Matter experts (e.g. premises, workforce) Provision could be made for the Committee to have the ability to call on additional lay members or CCG members when required, for example where the Committee would not be quorate because of a conflict of interest. It could also include GP representatives from other CCG areas and non-gp clinical representatives (such as the CCGs secondary care specialist). Meetings and Voting 18. The Committee will operate in accordance with the CCG s Constitution, Standing Orders and Prime Financial Policies. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. 19. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible 20. The Primary Care Commissioning Committee has delegated authority to take decisions in accordance with standing orders and schemes of delegation (Schedule 4). Quorum 21. Five members of the Committee must be present for the quorum to be established including: At least two lay members or one lay member and the Director of Quality; and Either the Chief Officer (CO) or the Chief Finance Officer (CFO). Frequency of meetings 22. Meetings will take place in public on a monthly basis for the first four meetings followed by quarterly meetings thereafter. Pack Page 23 11

24 23. Meetings of the Committee shall: a) be held in public, subject to the application of 25(b); b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time. 24. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. 25. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 27. Members of the Committee shall respect confidentiality requirements as set out in the CCG s Constitution and relevant policies. 28. The Committee will present its minutes to NHS England and to the Governing Body of Aylesbury Vale CCG each quarter for information. 29. The CCG will also comply with any reporting requirements set out in its constitution. 30. The terms of reference will be reviewed at least annually with final approval being sought from Aylesbury Vale CCG. Amendments will be made, where appropriate, to reflect any updated national model terms of reference and local need. Pack Page 24 12

25 Accountability of the Committee 31. The Committee to have delegated authority from Aylesbury Vale CCG governing body: To carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. To assist and support NHS England in discharging its duty under section 13E of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) so far as relating to securing continuous improvement in the quality of primary medical services. To work with NHS England to agree rules for areas such as the collection of data for national data sets, equivalent of what is collected under QOF, and IT intra-operability. To comply with public procurement regulations and with statutory guidance on conflicts of interest. To consult with Local Medical Committee and demonstrate improved outcomes, reduced inequalities and value for money when developing a local QOF scheme or DES. To approve the arrangements for discharging the group s statutory duties associated with its GP practice commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation. Procurement of Agreed Services The below is taken from the Next Steps in Primary Care Co-commissioning document for further guidance on this please see link below The Committee must comply with public procurement regulations and with statutory guidance on conflicts of interest. The committee may vary or renew existing contracts for primary care provision or award new ones, depending on local circumstances. If the committee fails to secure an adequate supply of high quality primary medical care, NHS England may direct the CCG to act. 33. If the Committee is found to have breached public procurement regulations and/or statutory guidance on conflicts of interest, Monitor may direct the CCG or NHS England to act. NHS England may, ultimately, revoke the CCG s delegation. Any proposed new incentive schemes should be subject to consultation with the Local Medical Committee and be able to demonstrate improved outcomes, reduced inequalities and value for money. Pack Page 25 13

26 Consistent with the NHS Five Year Forward View and working with CCGs, NHS England reserves the right to establish new national approaches and rules on expanding primary care provision for example to tackle health inequalities. Review of Terms of Reference 34. These terms of reference will be formally reviewed by NHS England and Aylesbury Vale CCG in April of each year, following the year in which the committee is created, and may be amended by mutual agreement between NHS England and Aylesbury Vale CCG at any time to reflect changes in circumstances which may arise. 35. The Committee will make decisions within the bounds of its remit. 36. The decisions of the Committee shall be binding on NHS England and Aylesbury Vale CCG within the scope of these TOR and the CCG s Standing Orders. 37. The Committee will produce the minutes which will provide the update and agenda items provide any decisions for the Governing Body. This information will then be shared with NHS England and the governing body of Aylesbury Vale of the CCG. Schedule 1 Memorandum of Understanding (without appendices) Schedule 2 List of Committee Members Schedule 3 Primary Care Commissioning Committee Guidance Schedule 4 Extract from Scheme of Delegation relating to Primary Care Pack Page 26 14

27 Schedule 1 MOU without Appendices 1. Introduction NHS England South Central Primary Medical Services Support This offer of support sets out the working arrangements and responsibilities for the delivery of primary care medical co-commissioning in South Central under delegated commissioning (level 3) from 1 April 2016 to 31 March 2017, between: NHS England South Central and the following clinical commissioning groups: Aylesbury Vale Clinical Commissioning Group (level 3) Gloucestershire Clinical Commissioning Group (level3) Newbury & District Clinical Commissioning Group (level 3) North & West Reading Clinical Commissioning Group (level 3) Oxfordshire Clinical Commissioning Group (level 3) South Reading Clinical Commissioning Group (level 3) Wokingham Clinical Commissioning Group (level 3) 2. Purpose This offer of support is a joint agreement between NHS England and each CCG that has moved to delegated status for the commissioning of general medical services. The offer sets out: the common purpose of the parties in delivering primary medical care functions at both joint and delegated commissioning levels the initial period of the relationship and review period the governance arrangements how each party will contribute to the delivery of the primary care functions 3. Key Principles Co-commissioning enables CCGs to have greater influence on decisions relating to primary care medical services and enables an integrated approach to improving health care locally, providing opportunities for a more collaborative approach to designing local solutions to support delivery of the CCG Primary Care Strategy and the wider strategic aims of CCGs. Pack Page 27 15

28 In doing so NHS England and Clinical Commissioning Groups need to ensure they are able to share expertise and knowledge to enhance strategy, policy development and decision making working in an integrated way. As outlined in Next steps towards primary care cocommissioning : Next Steps towards primary care co-commissioning states that there are no additional administrative resources available for primary care commissioning services at this time, but individual CCGs may choose to deploy additional resources; Pragmatic and flexible solutions should be agreed by CCGs and NHS England local offices to put in place arrangements that will work locally for 2016/17; In joint commissioning arrangements (level 2) individual CCGs and NHS England remain accountable for meeting their own statutory duties; Delegated commissioning (level 3) allows CCGs to assume full responsibility for commissioning general practice services while NHS England retains residual responsibility for reserved functions including Section 7A Public Health services, professional performance. It has been agreed with all CCG in South Central and NHS England There is an ongoing need for the roles currently performed by staff employed by NHS England to continue being delivered in 2016/17 as part of the transition to delegated commissioning The safe delivery of core functions is essential this includes payment processes for practices The expertise to deliver these functions resides within the core NHS England team The existing core team will agree practical and effective working relationships with South Central CCGs at whatever level of co-commissioning they are authorised in 2016/17 NHS England South Central will set out an offer for the collective tasks involved in the commissioning of general practice. The core team is not relocated and remains within NHS England structures for 2016/ Objectives The objectives of this document are to outline the agreed working arrangements for the delivery of primary care medical commissioning in respect of: CCGs taking on full delegation having access to a fair share of the primary care medical commissioning team staffing resource to enable delivery of their commissioning responsibilities. NHS England South Central retaining a fair share of existing resource to Pack Page 28 16

29 deliver all their ongoing primary care commissioning responsibilities, for those CCGs operating at levels 1 to deliver on-going primary care responsibilities in relation to the other areas of primary care commissioning (dental, pharmacy and optometry) which are not currently included in cocommissioning. 5. Primary Care Medical Commissioning Team The current primary care medical commissioning resource will be co-located as a standalone multidisciplinary team delivering a single service offer across the mixed economy of CCG commissioning levels. This includes input from the following teams: Primary Care Commissioning Finance Quality and Nursing Communications Premises The provisions contained within the Memorandum of Understanding are not intended to be legally binding. Service and staffing levels may vary as a result of unforeseen circumstances or other service requirements. 6. Governance The governance arrangement for both Joint and Delegated Commissioning is articulated in the CCG Constitution and in the Terms of Reference for the Primary Medical Services Committee. Monthly operational groups will continue between NHS England and each CCG along with quarterly meetings in public Strategic and Operational Leads NHS England (South Central) has nominated strategic and operational leads who will act as key points of contact. Director level strategic leads will represent NHS England on Joint cocommissioning committees (level 2). Senior manager operational leads will liaise on all operational matters and advise Strategic Leads. Senior manager Finance leads will be present at both operational and Joint co-commissioning committees 6.5. Transition NHS England will arrange to meet with each CCG to provide a summary of all transitional issues currently being dealt with by NHS England that will need to be Pack Page 29 17

30 managed via delegated commissioning arrangements. The GP Contracts Team will also provide a brief document summarising all transitional issues currently being dealt with by NHS England that will need to be managed via these new arrangements. For level 3 delegated commissioning this document will be forwarded to the relevant CCG prior to 31 April Service Offer Delivered by an integrated core team (commissioning, finance and nursing & quality) the Primary Care Medical Commissioning Team will continue to enable the contracting and commissioning of general practice to be managed in an efficient and consistent way. Working with CCGs to deliver local commissioning strategies and improve outcomes for patients, through flexible and innovative use of existing contracts and resources. To maintain consistency and avoid confusion for practices it is proposed that the Primary Care Medical Commissioning Team continues to be the first point of contact for all contractual issues, although it is recognized that the CCG may become aware of issues via local intelligence. On receipt of any issue the team will follow the process as outlined below. It should be noted that issues will fall in to two categories; those which the Primary Care Medical Commissioning Team can deal with as part of everyday business in accordance with NHS England Single Operating policy and procedures and those which require CCGs to make a decision. 7.1 Core Services The Primary Medical Care Commissioning Team will deliver the following: The functions outlined as core support functions Service delivery in accordance with NHS England policies or CCG policy where appropriate Reports and recommendations to appropriate governance committees and attendance where appropriate A named strategic lead (and deputy) and also a named operational lead to enable the core team to develop a productive working relationship and better understanding of individual CCGs commissioning agendas. A standardised / consistent approach to recommendations on types of decision across South Central Recommendations in line with current national regulations and guidance, including associated risks. Contracting advice to support delivery of new models of care / bigger primary care / new provider models. Advice on Enhanced Services Continue to deliver in accordance with NHS England Single Operating Policy and relevant Regulations Pack Page 30 18

31 Advice on proposed changes to GP contracts and QOF 7.2 Safeguarding Safeguarding and promoting the welfare of children and adults is the responsibility of everyone who comes into contact with them and their families/carers. All NHS providers including general practice have statutory obligations under Section 11 of the Children Act 2004, Working Together to Safeguard Children 2013 and the Care Bill 2013 to ensure their organisation has arrangements in place to safeguard and promote the welfare of children and adults. CCGs already have systems in place to monitor compliance with the contractual standards set out in the NHS Provider Safeguarding Audit Toolkit (2015) and Local Safeguarding Policies. It is not anticipated that these arrangements will change post 1 April Complaints As per the delegation agreement complaints are a reserved NHS England function. A quarterly report will be provided by the NHS England South Central complaints team. There may be patient enquiries which PALS teams will be involved in managing on behalf of the CCG and NHS England will provide advice as required. 7.4 Primary Care Finance NHS England will liaise with CCG Finance teams to agree financial reporting responsibilities. The attached document (Appendix A) sets out the detailed working arrangements between the NHS England South (South Central) Primary Care Finance Team and CCGs for the provision of Financial Management, Reporting and Support for GP Services from 1 st April It is proposed that the Primary Care Finance Team will support the following delegated CCGs in a consistent manner. 7.5 Nursing & Quality NHS England South (South Central) Nursing and Quality Team will liaise with CCGs for the transition of activity in relation to the delegation of primary care commissioning. The attached document (Appendix B) sets out the functions that will be transitioned it is recognised that each CCG is at a different stage in their progress towards delegation and therefore the pace of transition in some areas will be negotiated with each CCG. 7.6 Communications and Engagement The NHS England South (South Central) Communications and Engagement Team will liaise with CCG Communications and Engagement teams to support Pack Page 31 19

32 the transition of activity in relation to the delegation of primary care commissioning. The attached document Appendix C sets out the phased approach to the transition arrangements, while Appendix D sets out the functions this relates to. It is recognised that each CCG is at a different stage in their progress towards delegation and discussions will be held with each CCG to refine plans. 7.7 Premises NHS Property Services are commissioned to manage the three year rent review process and manage liaison with the practices and the District Valuer team. NHS England and CCG will adhere to the Premises Directions. Through the primary care transformation fund CCGs will lead on the development of commissioning plans designed to provide health care services for the future, including producing Local Estates Strategies that will make clear their specific priorities for investment in premises. The support for the development of primary care premises will continue to be a regionally managed local process for CCGs to submit new scheme developments as and when ready and necessary. This will allow each region to maximise the investment available. 7.8 Information Governance As per section E of the Delegation Agreement 7.9 Reporting Reports will be developed for regular submission to CCGs. content to be agreed with the CCG. Frequency and 7.10 Incident Reporting Current arrangements for incident reporting will continue and STEIS reporting shall continue to be managed by the Nursing & Quality Team of NHS England South Central Team Management Team management will be provided from existing staffing resource and will oversee all Primary Medical Care Commissioning Team staff management and development. Staff accountability will be via the senior management of NHS England South Central NHS England Support Services It is recognised that NHS England regional and national teams currently provide a range of support services, which we understand will continue to be available to NHS England staff transacting business on behalf of CCGs. However it Pack Page 32 20

33 should be noted that this is a finite resource and additional capacity may be required: Procurement support and advice Legal advice advice provided may differ across the levels of delegation Communications and engagement support and advice Data analytical support GIS mapping GMS contract support and advice from NHS England Central Team Primary Care Support Service (Capita) * For clarity CCGs will not have direct access to NHS England support services, with the exception of Communications and Engagement Services Additional Services In order to support wider primary care commissioning some CCGs may wish to undertake additional or developmental activities related to the commissioning of general practice, which the Primary Medical Care Commissioning Team would be well placed to support. This would require additional resource from individual CCGs or a pooled resource to provide a common service to all CCGs. Where appropriate, CCG staffing resources could be co-located with the Primary Medical Care Commissioning Team or additional staff employed via the Primary Medical Care Commissioning Team. Such activities may include: Developing alternatives to QOF A higher level of input into supporting delivery of new models of care / bigger primary care / new provider models LIS/LES development DES reviews Development of new contractual models encompassing elements of GMS services Input into CCG estates strategies Strategic planning Support applications for capital funding 8. Key Interactions To ensure the Primary Medical Care Commissioning Team can continue to deliver all the core functions there are a number of teams / organisations with which strong working links will need to be maintained and strengthened. These include: Medical Director, NHS England South Central for all issues regarding individual practitioner performance CCGs NHS Property Services Pack Page 33 21

34 Primary Care Support Services NHS England Assurance Team Local Professional Networks Local Professional Committees 9. Service Sustainability NHS England ability to deliver this offer of support is subject to: CCGs agreeing to a standardised approach across all 14 CCGs in South Central area and that any deviation away from this will result in a decreased level of service delivery. CCGs agreeing not to fragment the existing staffing resource as this will limit the team s ability to deliver core functions CCGs agree risk share where appropriate for example: Violent Patients Service, Discretionary Payments, Clinical Waste contract 10. Terms of the Agreement As this is an evolving document quarterly reviews will be undertaken and any amendments signed off by the CCGs and NHS England at an operational level. These arrangements will be reviewed during the period with a view to either agreeing a continuation of the model into future years or its cessation and movement to a new arrangement. The scope of this review would also incorporate a feasibility study into establishing a model for any phase 2 of Primary Care co- commissioning to incorporate Dental, Pharmacy and Optometry services. 11. Signatories Signed For NHS England South Central Signed; Pack Page 34 22

35 Schedule 2 List of Committee Members ROLE Lay CCG NHS England Lou Patten X Chief Officer (deputy Robert Majilton) Debbie Richards X Director of Commissioning and Delivery (deputy Louise Smith) Graham Smith X Lay Member (Chair) (deputy Colin Seaton) Lisa McLean X Director of Quality (deputy Lisa Beaumont) Philip Murray X Chief Finance Officer (deputy Alan Cadman) Paul Roblin Local Medical Committee Dr Graham Jackson X Clinical Chair Dr Karen West X Quality Lead Helen Delaitre X Head of Primary Care Dr Jane O Grady Health & Well Being Board Thalia Jervis Health Watch Bucks Nicky Wadely X NHS England Colin Hobbs X NHS England Non-conflicted GP s from other CCG s Additional Lay members Subject Matter experts (e.g. premises, workforce) Additional input ad hoc (e.g. data analyst, contracting etc.) VOTING RIGHTS YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO Pack Page 35 23

36 Schedule 3 Primary Care Commissioning Committee Guidance It is for CCGs to agree the full membership of their primary care commissioning committee. CCGs will be required to ensure that it is chaired by a lay member and have a lay and executive majority. Furthermore, in the interest of transparency and the mitigation of conflicts of interest, a local Health Watch representative and a local authority representative from the local Health and Wellbeing Board will have the right to join the delegated committee as non-voting attendees. Health Watch and Health and Wellbeing Boards are under no obligation to nominate a representative, but there would be significant mutual benefits from their involvement. For example, it would support alignment in decision making across the local health and social care system. CCGs will want to ensure that membership (including any non-voting attendees) enables appropriate contribution from the range of stakeholders with whom they are required to work. Furthermore, it will be important to retain clinical involvement in a delegated committee arrangement to ensure the unique benefits of clinical commissioning are retained. Pack Page 36 24

37 Schedule 4 Extract from Scheme of Delegation No Policy Area Decision PCCC P1 PRIMARY CARE COMMISSIONING Approve arrangements for the review, planning, and procurement of primary care services under delegated authority from NHS England. Y P2 P3 P4 P5 PRIMARY CARE COMMISSIONING PRIMARY CARE COMMISSIONING PRIMARY CARE COMMISSIONING PRIMARY CARE COMMISSIONING Approval of the arrangements for discharging the CCG s responsibilities and duties associated with its primary care commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation, obtain advice from persons who taken together have a broad range of professional expertise and acting effectively, efficiently and economically. Day to day decisions on provider performance management and risk management associated with Primary Care to provide robust assurance to the Governing Body and NHS England. Approve and ratify Direct Awards. Approve and ratify practice incentive schemes, having regard to guidance by the Secretary of State. Monitor and review any such schemes. Y Y Y Y P5 P6 PRIMARY CARE COMMISSIONING PRIMARY CARE COMMISSIONING Approve the following primary care services: a. Primary medical care strategy; b. Planning primary medical care services (including needs assessment); c. Primary Care Estates Strategy; d. Premises improvement grants and capital developments (up to 50k); e. Practice mergers. Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements: a. The award of GMS, PMS and APMS contracts for primary care services to some or all of the CCG population where they are within CCG budgets (excluding GP contracts for which core contract approval/monitoring and appraisal sits with NHS England Area Team; This includes: the design of PMS and APMS contracts; and monitoring of contracts; taking contractual action such as issuing branch/remedial notices, and removing a contract) (up to 50k); b. Procurement of new practice provision (up to 50k); c. Discretionary payment (e.g. returner/retainer schemes); d. Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list) (up to 50k); e. Premises Costs Directions functions (up to 50k). Y Y Pack Page 37 25

38 P7 PRIMARY CARE COMMISSIONING Advise on or approve matters relating to primary care contracting within agreed levels, specifically in relation to commissioning Locally Commissioned Services, QOF, Out of Hour services, Walk-in Centres (including home visits as required and for out of area registered patients); Y P8 PRIMARY CARE COMMISSIONING Approval proposals for primary care support and development and any associated plans in connection with commissioning and performance monitoring and development within the remit of the CCG. Y Pack Page 38 26

39 Primary Care Commissioning Operational Group Terms of Reference Document Version Date Version Number Description of Changes Model ToR content changed to reflect AVCCG local adaptation Amendments to membership following first primary care quality assurance and performance delivery group Amendments to include group renamed as Primary Care Commissioning Operational Group and to take account of Chiltern CCG quality assurance and performance issues relating to primary care Amends made as directed by the Primary Care Commissioning Operational Group Amends made to ToR to include deputy chair arrangements Amends made to clarify voting members and voting arrangements Edited by Louise Smith Louise Smith Helen Delaitre Helen Delaitre Helen Delaitre Helen Delaitre Role of the Primary Care Commissioning Operational Group 1. To provide assurance to the Aylesbury Vale Clinical Commissioning Group (AVCCG) Primary Care Commissioning Committee, the Federated CCGs Executive Committee and NHS England (NHSE) that there are robust systems and processes in place for monitoring, managing and assuring the quality and safety of primary medical services and for driving continuous service improvement. 2. To make decisions on behalf of the AVCCG Primary Care Commissioning Committee where delegated decision making responsibilities have been devolved to the Primary Care Operational Group, which are in line with the CCG s Scheme of Delegation. Decision-making process to take into consideration: local health need local and national policy patient and public voice and experience access to a full range of high quality primary care services, appropriate to the populations health needs. 3. To make commissioning recommendations to the AVCCG Primary Care Commissioning Committee which have taken into consideration: Pack Page 39 27

40 local health need local and national policy patient and public voice and experience access to a full range of high quality primary care services, appropriate to the populations health needs. 4. The operational group will act as the working group of the AVCCG Primary Care Commissioning Committee, producing routine and ad hoc reports to include as a minimum: Membership General practice quality and performance Finance Primary Care infrastructure development 5. The group shall consist of the following: Lay Member (Chair), AVCCG or CCCG Primary care clinical lead, AVCCG/CCCG Primary care management lead, AVCCG/CCCG Primary care quality lead AVCCG /CCCG Primary care manager, AVCCG/CCCG Deputy Chief Finance Officer, AVCCG/CCCG Co-commissioning Programme Manager, NHS England Head of Primary Care Finance, NHS England Assistant Contracts Manager, NHS England Quality Improvement Manager, NHS England 6. The Chair of the Primary Care Commissioning Operational Group shall be a lay member of Aylesbury Vale CCG or Chiltern CCG. The Group will elect a Deputy Chair who shall be a lay member of Aylesbury Vale CCG or Chiltern CCG. 7. The CCG Primary Care management lead will agree the agenda in discussion with the lay member chair. 8. There will be a standing invitation to: Clinical Chairs, AVCCG/CCCG Chief Officer, AVCCG /CCCG Directors, NHSE Quorum 9. The meeting will be quorate when at least four members of the total membership are present. This must include one from AVCCG or CCCG, one Pack Page 40 28

41 Voting representative from NHS England, one lay representative and one clinical representative. 10. Each voting member of the Group will have one vote. The Group shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Group will be to achieve consensus decision-making wherever possible. Frequency of Meetings 11. The group will meet monthly with the exception of those months in which a Primary Care Commissioning Committee meeting is scheduled to take place. Accountability and Reporting 12. The Operational Group will be accountable to the AVCCG Primary Care Commissioning Committee for matters concerning Aylesbury Vale CCG and to the Federated CCGs Executive Committee and NHS England for matters concerning Chiltern CCG. Members of the Operational Group will also be held accountable to their individual organisations which will have sight of the minutes of meetings and reports on request. Key Responsibilities 13. The Operational Group will undertake responsibility: Operational management of primary medical services To receive regular reports regarding: o Local Professional Networks (LPN) o Primary Care Premises o Performance management o List closure/merger applications o Appraisal and revalidation o Complaints and concerns o Safety including incident reporting o Serious Incidents o CQC o FFT, PPG and Patient Experience o Workforce development o Service improvement initiatives. To consider all matters relating to the management of primary medical care contracts (GMS, PMS and APMS) including: o the design of PMS and APMS contracts o monitoring and management of contracts, potential breaches and local disputes Pack Page 41 29

42 o taking contractual action such as issuing breach/remedial notices and removing a contract. To make determinations in respect of establishing new GP practices in an area and approving practice mergers. To make determinations in respect of matters relating to the maintenance of GP patient lists including practice areas, patient allocations, list closures, and zero tolerance. To make decisions on discretionary payments such as the returner/retainer schemes. To manage the commissioning quality assurance and contract monitoring functions of primary medical service contractors including receiving information in relation to quality, performance and variation and agreeing how to address issues identified. Assurance and Guidance to the Primary Care Commissioning Committee To provide specialist knowledge and advice in relation to all aspects of primary medical services commissioning, contracting, performance management and quality assurance. To affect the delivery of services provided by independent primary medical care contractors and, in the light of any changes to national or local circumstances make recommendations for change. Making recommendations to the AVCCG Primary Care Commissioning Committee relating to the performance and management of independent primary medical care contractor services in accordance with statutory regulations. Supporting the Strategic Direction of Primary Care To oversee the development, maintenance and delivery of a commissioning and quality strategy for primary care services across AVCCG/CCCG areas and identify how associated local and national commissioning strategies can be taken forward. To receive and, where appropriate, ratify recommendations from the national primary care team in relation to changes in government policy that will impact on the future delivery of primary care services. To consider newly designed Local and Directed Enhanced Services. To design local schemes for primary care providers which demonstrate added value to the system as alternatives to those already in place such as the Quality and Outcomes Framework (QOF); To ensure the relevant stakeholders/ organisations are consulted and their views considered by the group when assessing changes to services such as practice relocation. Conflicts of Interest 14. There must be transparency and clear accountability. The Chair will ask at the beginning of each meeting, as a standing item, whether any member has conflict of interest to declare about any items being discussed at the meeting in accordance with the CCGs conflict of interest policy. If a member has a Pack Page 42 30

43 direct or indirect connection with an issue on the agenda which may impact on their ability to be objective they must declare an interest to the Chair. A decision will then be taken by the Chair as to whether it is appropriate or not for this member to remain involved. All declarations of interest and decisions on participation shall be reported in the minutes. Review Arrangements 15. The group will review its Terms of Reference and work programme on a routine quarterly basis and as necessary in the light of emerging national guidance. Schedule 1 List of Primary Care Operational Group members Schedule 2 - Scheme of delegation relating to primary care Pack Page 43 31

44 Schedule 1: List of Primary Care Operational Group Members ROLE Lay CCG NHS England Graham Smith X Lay Member (Chair) or Deputy Louise Smith X Associate Director, Commissioning and Locality Delivery (deputy Helen Delaitre) Alan Cadman / Kate Holmes X Deputy Chief Finance Officer Nicky Wadely X Programme Manager, Cocommissioning, NHS England (deputy Jessica Newman) Colin Hobbs X Assistant Head of Finance, NHS England (deputy Alan Overton) Lay Member X AV and Chiltern CCGs Dr Raj Bajwa X (Interim) Primary Care Clinical Lead Dr Karen West X Quality Lead (deputy Tania Atcheson) Helen Delaitre X Head of Primary Care AV and Chiltern CCGs Jessica Newman Assistant Contracts Manager NHS England Wendy Newton X Primary Care Manager AV and Chiltern CCGs Rebecca Tyrrell X Quality Team NHS England VOTING RIGHTS YES YES YES YES YES NO NO NO NO NO NO NO Pack Page 44 32

45 MEETING: Primary Care Commissioning Committee DATE: Thursday 1 December 2016 TITLE: AUTHOR: LEAD DIRECTOR: Managing Primary Medical Services Disputes Helen Delaitre Debbie Richards PAPER C Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information X Summary of Purpose and Scope of Report: In April 2016, Aylesbury Vale CCG assumed responsibility for delegated commissioning of primary care services. Although formal disputes are relatively rare as every effort is made to resolve issues between contractors and commissioners on an informal basis, there are occasions where a formal dispute resolution process needs to be followed. This paper sets out the policy that has been drafted for use by Aylesbury Vale and Chiltern CCGs when a contractor has requested to follow the NHS Dispute Resolution Process or where the CCG elects to follow the NHS Dispute Resolution Procedure. The policy has been written using the NHS England Policy Book for Primary Medical Services v1.0 published 12 January 2016 as its reference. The draft policy was reviewed at the Primary Care Operational Group in November 2016, and recommended to go forward to the Primary Care Commissioning Committee for approval in December. The Primary Care Commissioning Committee is requested to review the draft policy, approve and ratify the adoption of the policy where a formal dispute resolution process needs to be followed. Conflicts of Interest: None in respect of approvals requested. Members should note that Terms of Reference have been designed to ensure that the Committee will be quorate for decision making without any member GP/GP partners present. Pack Page 45

46 Strategic aims supported by this paper (please tick) Better Health in Bucks to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks to promote equity as an employer and as clinical commissioners X X X Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary Patient & Public N/A Involvement Equality N/A Quality N/A Financial N/A Risks N/A Statutory/Legal N/A Prior consideration Committees /Forums/Groups Membership Involvement N/A Submitted to PCOG in November 2016, recommended approval by PCCC. N/A Supporting Papers: Draft policy Managing Disputes for Primary Medical Services Pack Page 46

47 Managing Disputes for Primary Medical Services 1. Introduction 1.1 This policy describes the process to determine the action required when a contractor has requested to follow the NHS dispute resolution process or where the Commissioner elects to follow the NHS dispute resolution procedure. 1.2 The policy focuses on primary medical care contracts in their various forms and will also cover disputes arising from the Quality and Outcomes Framework (QOF). Where primary care services are commissioned using the NHS Standard Contract, the dispute resolution process designed to support the NHS Standard Contract will apply. 1.3 This policy has been written using the NHS England Policy Book for Primary Medical Services v1.0 published 12 January 2016 as the reference. 2. Background 2.1 The Commissioner must identify whether the contract is an NHS contract or a non- NHS contract. In GMS contracts, the Commissioner can do this by reviewing clause 14 of the standard GMS contract. A similar clause will also be set out within PMS and APMS contracts. 2.2 An NHS contract (as set out at section 9 of the NHS Act) is an arrangement under which one health service body arranges for the provision of goods or services to another health service body. It must not be regarded as giving rise to contractual rights or liabilities. 2.3 A non-nhs contract is where the contract is legally binding. 2.4 Contractors have the right to be regarded as a health service body under regulation 10 of the GMS Regulations or regulation 9 of the PMS Regulations or where the APMS contractor is a health service body by virtue of section 9 of the NHS Act. 2.5 Where a contractor is regarded as being a health service body, its contract will be an NHS contract. Where a contractor is not regarded as a health service body, its contract will not be an NHS contract. Health service body status affects the eligibility and application process for NHS dispute resolution. 2.6 GMS and PMS contracts require the parties to make every reasonable effort to communicate and co-operate with each other with a view to resolving the dispute before referring the dispute for determination in accordance with the NHS dispute resolution procedure or, where applicable, before commencing Court proceedings. 2.7 There are two different routes that can be taken for resolving contractual disputes, depending on the contractor s health service body status: where the contractor is a health service body and the contract is an NHS contract the steps laid out in this policy will be used to resolve all matters of dispute. The parties should not make a claim at Court in relation to the contracts; Pack Page 47

48 or where the contractor is not a health service body and the contract is a non- NHS contract, the dispute can either be resolved using the process described within this policy or using the Court system. 2.8 The dispute resolution process for APMS contracts is specific to the parties' agreement as set out in the APMS contract. The APMS contract must be reviewed in the event of a dispute and that process followed. The APMS Directions do not require the NHS dispute resolution to be included in the APMS contract and more commercial terms are usually set out. 2.9 The use of the Court system can be expensive. In normal circumstances, non-health service bodies will elect to follow NHS dispute resolution The NHS England Policy Book for Primary Medical Services v1.0 states that where the parties have followed this policy and NHS dispute resolution to the end determination, the result is binding. A second referral to the Court system for a further ruling on the same issue cannot be made other than to enforce the decision as having the status of a County Court Judgement or to seek Judicial Review of the process. 3. Managing Disputes Informal Process 3.1 The parties must make every reasonable effort to communicate their issues in relation to decision-making and rationale and must co-operate with each other to resolve any disputes that emerge informally before considering referring the matter for determination through formal dispute resolution procedures. 3.2 The formal process should not be initiated until the informal process has been exhausted and it should be noted that both parties may wish to involve the relevant professional representative (e.g. LMC). 3.3 The use of an informal resolution process helps develop and sustain a partnership approach between contractor and Commissioner. 3.4 The informal process may include (but is limited to): regular telephone communications; face-to-face meetings at a mutually convenient location; and/or written communications. 3.5 It is essential that the Commissioner maintains accurate and complete written records of all discussions and correspondence on the contract file in relation to the dispute at all levels of dispute resolution. The Commissioner should ensure that it responds to contractor concerns and communications in a timely and reasonable manner. 4. Managing Disputes Stage 1 (Local Dispute Resolution) 4.1 The timescales set out in this stage 1 are indicative only. The Commissioner should ensure any timescales used are appropriate to the circumstances. Regardless of timescales, the parties must ensure that every reasonable effort to communicate and co-operate with each other is made prior to invoking stage 2 of the dispute resolution procedure. Pack Page 48

49 4.2 Where a dispute arises, the Commissioner should refer to the relevant policy that covers the issue that caused the dispute to determine whether due process has been followed. 4.3 The contractor should notify the Commissioner of its intention to dispute one or more decisions made in relation to its contract. This notification should usually be received no later than 28 days after the Commissioner advises the contractor of its decision except in exceptional circumstances. 4.4 The Commissioner will immediately cease all action in relation to the disputed notice or decision until: there has been a determination of the dispute and that determination permits the Commissioner to impose the planned action; or the contractor ceases to pursue the NHS dispute resolution procedure; Whichever is sooner. 4.5 Where the Commissioner is satisfied that it is necessary to terminate the contract or impose a Contract Sanction before the NHS dispute resolution procedure is concluded in order to: protect the safety of the contractor s patients; or protect the CCG or NHS England from material financial loss; then the Commissioner shall be entitled to terminate the contract or impose the contract sanction at the end of the period of notice it served. This should only be followed with close reference to the GMS Regulations and PMS Regulations, pending the outcome of that procedure. 4.6 The paragraphs below set out a process that may be adopted for stage 1 (Local Dispute Resolution). 4.7 The Commissioner may acknowledge the notification of dispute within seven days of receipt and request the submission of supporting evidence from the contractor within a further 28 days from the date they receive the letter. An example acknowledgement letter is provided in Annex Upon receipt of the evidence the Commissioner should review the evidence within 28 days and invite the contractor to attend a meeting, which should be as soon as possible, but at the very latest within a further 28 days. The contractor(s) has the opportunity to invite representative bodies to support it at the meeting, for example, the LMC. An example invite letter is provided in Annex Once the meeting has been held, the Commissioner should notify the contractor in writing of the outcome of the meeting, whether this is that the dispute will now need to be moved to stage 2 of the NHS dispute resolution procedure (refer to the example stage 1 outcome letter in Annex 3) or that the dispute has been successfully resolved (refer to the example stage 1 outcome letter in Annex 4). Pack Page 49

50 4.10 Where the matter is resolved, the issue can be deemed closed and the Commissioner should document the outcome accordingly on the contract file Where the matter remains unresolved, the process may be escalated to the next stage of the dispute resolution procedure At this point the Commissioner should commence preparation of the contract file to ensure that if and when the FHSAU (Family Health Services Appeal Unit) or Court requests submission of evidence in respect of the dispute the documentation is in order. 5. Managing Disputes Stage 2 (NHS Dispute Resolution Procedure) 5.1 The informal process and stage 1 (Local Dispute Resolution) should be exhausted before proceeding to this stage of the process. The Commissioner or a contractor wishing to follow this route must submit a written request for dispute resolution to the FHSAU, which carries out the NHS dispute resolution functions of the Secretary of State in the GMS Regulations and the PMS Regulations, which should include: the names and addresses of the parties to the dispute; a copy of the contract; and a brief statement describing the nature and circumstances of the dispute. 5.2 The written request for dispute resolution must be sent within a period of three years from the date on which the matter gives rise to the dispute occurred or should have reasonably come to the attention of the party wishing to refer the dispute. Please see FHSAU determination reference for further details on the date that the dispute should have reasonably come to the attention of the relevant party. 5.3 The Commissioner will be required to prepare documentation, evidence and potentially an oral presentation in response to evidence presented in support of the dispute. Each party will be asked to prepare representations on the dispute, which will be circulated to the other party and an opportunity to provide observations on the other party's representations will be given. Again, the observations of each party will be circulated to the other party. 5.4 The Commissioner should not underestimate the preparation that will be required in the event that evidence is required by the FHSAU, as all records pertaining to the contractor in question may be required, including (but not limited to) all contract documentation and contract variations, all written correspondence (both to and from the Commissioner and the contractor) and any electronic correspondence that may have passed between the parties, in relation to the dispute. This process will benefit from a clearly recorded contract file. 5.5 The Commissioner must ensure that records of communications and contract files are maintained to a high standard and all documentary evidence is collated correctly prior to submission to the FHSAU. Pack Page 50

51 5.6 Once the FHSAU has reached a conclusion (the determination) the Commissioner will receive a copy and will be required to act upon it. A copy of the Guidance Note for parties involved in Dispute Resolution at the NHSLA (FHSAU) is attached in Annex 5 and should be followed by the parties to the dispute. Other Dispute Resolution Procedures 6.1 The GMS and PMS Regulations allow the NHS dispute resolution procedure to be used by the contractor as a means of resolving every dispute except where an assessment panel makes a determination that the Commissioner may assign new patients to contractors which have closed their practice list of patients. The procedure to follow in such circumstances is set out in paragraph 7 below. 6.2 Disputes may also arise prior to a contract being entered into. Such disputes will relate to the eligibility of the person seeking to enter into the contract or contract terms. 6.3 Where the Commissioner is of the view that a person seeking to enter into a contract does not meet the eligibility conditions the Commissioner must notify the person in writing. 6.4 This notice must state the Commissioner view of the person's eligibility, the reasons for that view and guidance on the person's right of appeal. Co-commissioning - delegated commissioning arrangements A CCG that has delegated commissioning arrangements will have entered into a Delegation Agreement with NHS England setting out the scope of those arrangements. The Delegation Agreement includes a section on Claims and Litigation which is likely to include a dispute with a GMS, PMS or APMS contractor that has been referred to Stage 2 of the NHS dispute resolution procedure. In such cases, the CCG is required to act in accordance with the Delegation Agreement which includes but is not limited to: notifying NHS England of any documents concerning the dispute and providing copies of these documents; co-operating fully with NHS England in relation to such dispute and the conduct of such dispute; providing, at its own cost, to NHS England all documentation and other correspondence that NHS England requires for the purposes of considering and/or resisting such dispute; and/or at the request of NHS England, taking such action or step or providing such assistance as may in NHS England s discretion be necessary or desirable having regard to the nature of the dispute and the existence of any time limit in relation to avoiding, disputing, defending, resisting, appealing, seeking a review or compromising such dispute or to comply with the requirements of the FHSAU in relation to such dispute. Pack Page 51

52 6.5 Where the Commissioner has issued such a notice, the recipient of the notice has a right of appeal to the First-Tier Tribunal. 6.6 Where the dispute relates to the parties being unable to agree on a particular proposed term of a GMS or PMS contract, either party may refer the dispute to the Secretary of State to consider and determine the matter in accordance with: for GMS contracts, paragraphs 101(3) to (14) and 102(1) of Schedule 6 and regulation 9(3) of the GMS Regulations; or for PMS agreements, paragraphs 95(3) to (14) and 96(1) of Schedule 5 and regulation 8(3) of the PMS Regulations, except where both parties to the prospective agreement are health service bodies (in which case section 9 of the NHS Act applies). 7.Assignment of Patients to Lists: Procedure Relating to Determinations of the Assessment Panel 7.1 Where an assessment panel makes a determination that the Commissioner may assign new patients to contractors which have closed their practice list of patients, any contractor specified in that determination may refer the matter to the Secretary of State to review the determination of the assessment panel. 7.2 If a referral is made to the Secretary of State, it shall be reviewed in accordance with the following procedure: where more than one contractor specified in the determination of the assessment panel wishes to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly, and in that case the Secretary of State shall review the matter in relation to those contractors together within the period of seven days beginning with the date of the determination by the assessment panel, the contractor(s) shall send to the Secretary of State a written request for dispute resolution which shall include or be accompanied by: the names and addresses of the parties to the dispute; a copy of the contract (or contracts); and a brief statement describing the nature and circumstances of the dispute. 7.3 Each party will be asked to make representations and observations on the representations of the other party both of which will be allocated between the parties. 7.4 Within the period of 21 days beginning with the date on which the matter was referred to him, the Secretary of State shall determine whether the Commissioner may assign patients to contractors which have closed their lists of patients. If the Secretary of State determines that the Commissioner may make such assignments, the Secretary of State shall also determine those contractors to which patients may be assigned. 7.5 The Secretary of State may not determine that patients may be assigned to a contractor which was not specified in the determination of the assessment panel. Pack Page 52

53 7.6 In the case of a matter referred jointly by contractors, the Secretary of State may determine that patients may be assigned to one, some or all of the contractors that referred the matter. 7.7 The period of 21 days for determination may be extended (even after it has expired) by a further specified number of days if an agreement to that effect is reached by: the Secretary of State; the Commissioner; and the contractor(s) that referred the matter to dispute resolution. 7.8 The Secretary of State shall record the determination and the reasons for it in writing and shall give notice of the determination (including the record of the reasons) to the parties. Dated: November 2016 Pack Page 53

54 Annex 1 Example Acknowledgement Letter [date] [CCG address] [contractor address] Dear [contractor name] Ref: [contract details] Further to your recent notification, dated [notification date], I can confirm we have received your intention to dispute our decision dated [insert date] in relation to: [matter 1 details] [matter 2 details] [matter 3 details] To proceed with the dispute resolution process, please submit to the above address your supporting evidence in relation to the matters under dispute within 28 days from the date of this letter. Yours sincerely, [name] [title] Pack Page 54

55 Annex 2 Example Invitation Letter [date] [CCG address] [contractor address] Dear [contractor name] Ref: [contract details] Following the receipt of evidence regarding your dispute relating to: [matter 1 details] [matter 2 details] [matter 3 details] We would like to invite you to discuss the matter at a meeting on: [proposed date], [proposed time], [insert proposed location] Our representatives [insert names of CCG representatives], will attend at the meeting. You may have a representative from your Local Medical Committee (LMC) or a friend (or other appropriate professional body colleague to attend with you). Please be aware that any representative(s) present as a supportive colleague(s) will not normally be permitted to speak at the meeting. Where a solicitor accompanies you, the Chair of the meeting will make it clear that the meeting is not required by legislation. Professional advisors, such as solicitors or accountants, will not normally be in attendance in a representative role unless especially requested in advance of the meeting. I would be grateful if you would confirm in writing your acceptance to attend this meeting and provide details of any representatives you may wish to accompany you. Yours sincerely, [name] [title] Pack Page 55

56 Annex 3 Example Stage 1 Outcome Letter (FHSAU Referral) [date] [CCG address] [contractor address] Dear [contractor name] Ref: [contract details] Further to our recent meeting on [date/time/location of meeting] to discuss your dispute, I am writing to confirm the following outcome(s): [outcome 1 details] [outcome 2 details] [outcome 3 details] As we were unable to resolve this dispute by local dispute resolution, you may now wish to refer the matter(s) to the Secretary of State for dispute resolution in accordance with the National Health Service [General Medical Services Contracts or Personal Medical Services Agreements] Regulations If you do wish to refer the matter(s) to the Secretary of State, then please send all supporting documentation to the NHSLA (FHSAU) which undertakes the delegated function of the Secretary of State. We have enclosed a copy of the NHSLA (FHSAU) Guidance Note for parties involved in Dispute Resolution. Yours sincerely, Yours sincerely [name] [title] Pack Page 56

57 Annex 4 Example Stage 1 Outcome Letter (Matter(s) Resolved) [date] [CCG address] [contractor address] Dear [contractor name] Ref: [contract details] Further to our recent meeting on [date/time/location of meeting] to discuss your dispute, I am writing to confirm the following outcome(s): [outcome 1 details] [outcome 2 details] [outcome 3 details] We are pleased to confirm the outstanding matters are now resolved and your contract file has been updated to reflect this mutual resolution. Yours sincerely, [name] [title] Pack Page 57

58 MEETING: Primary Care Commissioning Committee Paper D DATE: 1 December 2016 TITLE: AUTHORS: LEAD DIRECTOR: Quality in Primary Care comprising Paper 1:Quality in Primary Care Delivery Plan (Internal Document) Paper 2: Practice Update on Quality in Primary Care Paper 1: Lisa Beaumont Paper 2: Dr Karen West Lisa Maclean Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information Summary of Purpose and Scope of Report: Paper 1 Quality In Primary Care Delivery Plan This paper sets out the quality assurance framework to deliver the statutory and delegated responsibilities for quality, which includes the development of a Quality and Performance dashboard. Paper 2 Practice Update on Quality Care This paper is derived from Paper 1 and builds on the previous paper - AVCCG Framework for Quality in Primary Care (Jan 2016), to provide an update to practices on how the CCGs will discharge their statutory function with regard to quality, in supporting GP Practices going forward, in light of CCCG moving to delegated status from April Conflicts of Interest: No known conflicts of interest identified. Strategic aims supported by this paper (please tick) Better Health in Bucks to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks to promote equity as an employer and as clinical commissioners Pack Page 58

59 Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary Patient & Public Involvement Equality Quality Patient safety, clinical effectiveness/patient experience. Financial Risks N Statutory/Legal N Prior consideration Committees /Forums/Groups Paper 1 internal document - reviewed and signed off at the Primary Care Operational Group (Oct 16) and Quality and Performance Committee (Nov 16). Paper 2 signed off at Quality and Performance Membership Involvement Committee (Nov 16). Paper 2 - Practice Update to be shared with members via Localities. Supporting Papers: None Pack Page 59

60 Quality in Primary Care Delivery Plan (Internal Document) Introduction CCGs have a statutory duty to assist and support NHS England (NHS E) in securing continuous improvement in the quality of primary medical services. Aylesbury Vale CCG (AVCCG) has taken on full delegated commissioning since April Chiltern CCG (CCCG) is due to take on full delegated commissioning from April Delegated commissioning allows the AVCCG full responsibility for commissioning general practice services, whilst legally, NHSE retain the residual liability for the performance of primary medical care commissioning, and as such NHSE require that its statutory functions are being discharged effectively by the CCG. The statutory responsibilities of the CCG include quality, financial resources and public participation. Delegated responsibilities include contractual GP performance and budget management. AVCCG recognises that, under delegated commissioning arrangements, it will remain accountable for its pre-existing statutory functions, including in relation to quality assurance, but that these will need to be extended across the primary care contracts for which it will take on responsibility. AVCCG has incorporated within the Terms of Reference of the Primary Care Commissioning Committee the requirement for that Committee to provide assurance to the Governing Body (meeting in common) regarding the quality, safety and contracting process of primary medical care services. Primary Care Governance The diagram below sets out the governance arrangements for delegated commissioning for the Buckinghamshire CCGs. AVCCG with full delegated responsibility, delivers its statutory and delegated responsibilities via the AVCCG Primary Care Commissioning Committee. AVCCG & CCCG Governing Body (in common) AVCCG Primary Care Commissioning Committee Information AVCCG & CCCG Joint Executive Committee AVCCG CCCG AVCCG & CCCG Primary Care Operational Group Pack Page 60

61 Quality Assurance Framework in Primary Care Whilst the practice as the provider is accountable for the quality of services, NHS England and CCGs as commissioners have a shared responsibility for quality assurance. The quality assurance framework describes our proposed approach to monitor quality within Primary Care commissioned services for both CCGs. A single definition of quality for the NHS was first set out in High Quality Care for All in 2008, following the NHS Next Stage Review led by Lord Darzi, and has since been embraced by staff throughout the NHS and by successive governments, this definition set out the three domains to quality that must be present to provide a high quality service. The three domains of quality: patient safety, clinical effectiveness and patient experience will be monitored through routine internal contractual processes and clinical governance structures and external sources such as CQC, peer reviews, national surveys etc. GP practices as providers of NHS funded care are required to have their own quality monitoring processes in place. Quality assurance is the systematic and transparent process of checking whether a product of service being developed is meeting specified requirement. The contractual relationship with commissioners requires primary care providers to provide information and assurance to commissioners and engage in system wide approaches to improving quality. The following describes the process and escalation in relation to Quality Assurance: Stage 1 Routine Quality Monitoring for Primary Care: Routine monitoring is undertaken by NHSE and CCGs utilizing a series of dashboards and methodologies: NHSE/CCG: Routine Quality Metric Monitoring quality dashboard NHSE/CCG: Patient safety indicators including monitoring of HCAI, safeguarding vulnerable children and adults, reporting of patient safety incidents, workforce numbers, skills and training, uptake of vaccinations and immunisations. NHSE/CCG: Patient Experience Indicators including complaints, Friends and Family Test (FFT), access to appointments/services CCG: Effectiveness indicators including emergency admissions data, referral rates, and prescribing data. Duty of Candour Test. The dashboard will consist of a range of metrics across the three domains of quality incorporating information from the following sources: GP Web Tool High Level Indicators (HLIs) GP Web Tool Outcome Standards (GPOS) Care Quality Commission (CQC)- inspection outcomes Patient Experience- including Friends and Family Test (FFT) results, Patient Satisfaction Surveys and complaints data. Patient Safety including Serious Incident (SI) data. The dashboard will include KPIs for patient experience, CQC compliance and for the CCGs clinical priorities such as prescribing, end of life care planning, anticoagulation and learning disabilities health checks etc. KPIs will clustered by locality and benchmarked nationally if possible. Information within the dashboard will be used to determine a Red/ Amber/ Green (RAG) Pack Page 61

62 rating for the different components of quality. The methodology used to rate the practices will be as follows: GP Web Tool GPOS- practices will be risk stratified based on the number of adverse outlying indicators. Practices classed as an outlier: 6 level 2 triggers or more turn Red, Any Level 2 and/or 6 or more Level 1 triggers turn Amber, No level 2 triggers and less than 6 level 1 triggers turn Green. GP Web Tool HLIs- practices will be risk stratified based on the number of adverse outlying indicators. Practices classed as an outlier: 6 outliers or more turn Red, Any outliers turn Amber, No outliers turn Green. CQC- practices will be risk stratified based on their latest CQC inspection outcome. Practices classed as Inadequate turn Red, Requires Improvement turn Amber, Good turn Green, Outstanding turn Blue, No visit turn grey. Patient Experience- practices will be risk stratified based on the number of adverse outlying indicators. Practices classed as an outlier (3 adverse indicators or more from Friends and Family Test/ Healthwatch/ Patient Participation Groups) turn Red, any adverse outlying indicators turn amber, No adverse outliers turn green. Complaint information will be recorded on the dashboard and trends/ themes will be identified but this will not attract a rating. Patient Safety- Serious Incident information will be recorded on the dashboard and trends/ themes will be identified but this will not attract a rating. Stage 1 Routine Quality Surveillance Assurance Support Visits / Arrangements for Primary Care Routine Monitoring undertaken by the Primary Care Operational Group includes the following: Routine Quality Metric Monitoring using the Primary Care Dashboard (GP Web Tool, CQC, Patient Experience, CCG Indicators and Safety Indicators) Other Patient Safety Indicators including: monitoring of Health Care Associated Infections (HCAI), safeguarding vulnerable children and adults, reporting of patient safety incidents, workforce numbers, skills and training, uptake of vaccinations and Immunisations Other Patient Experience Indicators including: the complaints managed by NHSE and Healthwatch feedback Scheduled practice support visits. Practice support visits are intended to be an informal way for practices to have an open discussion about areas of their practice. This is intended to be a supportive process and part of the on-going dialogue with practices and the CCG. Potential concerns / risks identified through the regular reviews at Stage 1 will be assessed for importance and urgency to inform the short and medium term response. It is important to note that an outlying score does not necessarily mean there is a concern but it does indicate that performance in the area identified needs further examination. The Primary Care Operational Group will use the dashboard and risk matrix and any other relevant intelligence to identify those practices that require escalation to Stage 2 and report to the Primary Care Commissioning Committee. Stage 2 Quality Surveillance (Enhanced) If an increasing risk is identified the practice will be supported through enhanced surveillance. A quality support visit will be undertaken to gain assurance of the quality and safety of the provision of services for patients. Enhanced surveillance will be initiated through a joint NHS England / CCG decision making process. There should be consideration at this point of the contractual process and recommendation to Thames Valley Quality Surveillance Group (TVQSG) of the change in monitoring status. A report detailing the findings and recommendations of the Pack Page 62

63 support visit, which should also include areas of good practice, should be produced by the CCG and agreed with the practice, who will both then mutually agree an action plan. This action plan will be monitored through the agreed governance arrangements. This is the reactive element of the quality assurance framework. The provider is escalated to this level where there are a number of potential concerns / risks, or a concern / risk is considered significant. Actions should focus on supportive measures to bring about improvements to practice quality performance. In significant, exceptional circumstances, the breach may be so severe that the Primary Care Commissioning Committee may escalate the practice to Stage 3. Stage 3 Risk Summit Should the identified risk remain or increase, a Risk Summit will be considered. This would involve NHS England, the relevant CCG quality and contracting teams and the practice. In most cases this will include formal investigation including an initial conversation with the practice to share the intelligence, understand the situation, substantiate the concerns / issues and where necessary to formally agree improvement actions and any support required. Should the identified risk remain or increase a Risk Summit will be considered. This would involve the Primary Care Team; Quality Team; Contracting colleagues, NHS England and the provider. Action will be monitored via the Primary Care Operational Group and escalated to the Primary Care Commissioning Committee. Stage 4 Formal Action Following formal investigation, the NHSE/CCG may need to consider whether a breach has occurred and whether any further action needs to be taken. In this respect, there are several options: - Take no action - Agree an action with the practice - Issue a remedial notice - Issue a breach notice - Apply a contract sanction; or - Terminate the contract. For practices where actions have been placed upon them, and where risks/issues are considered significant, individual case reports will be provided by the Primary Care Operational Group to the Primary Care Commissioning Committee. Monitoring Quality Quality Assurance Framework Stage 4 Formal Action Formal contractual actions considered Stage 3 - Risk Summit Risk increases or remains and there is reduced quality assurance Stage 2 - Enhanced Quality Surveillance Increasing risk identified with practice NHS England, CCG and provider risk summit Enhanced quality surveillance support visit undertaken Stage 1 - Routine Quality Monitoring / Assurance Local Assurance External Assurance Pack Page 63

64 Patient safety: Incident reporting Safeguarding incidents SCR/IMR HCAI Vaccinations & Immunisations uptake Medicines Management CAS alert compliance Workforce Section 11 audit Patient Experience: Complaints FFT PPG Patient Surveys (national and local) including access to services Clinical Effectiveness: Emergency admissions A&E attendances Clinical Concerns Referral Rates NHS health check Partnership working QOF Visits: Visits will be offered to support arrangements in the following areas: medicines management, safeguarding, IPC, incident investigation support, contract monitoring and maintaining high professional standards. External Bodies: CQC - registration /inspection / compliance Public Health England Professional Bodies - (GMC revalidation / appraisal / investigations) Healthwatch LMC Deanery - training Thames Valley Quality Surveillance Group (TVQSG) External Data: Health and Social Care Information Centre NHS England Quality Dashboard (up to April 2017) National Reporting and Learning System (NRLS) - Safety Incidents Central Alert System (CAS) Primary Care Web Tool NHS Choices Assessment Tools Targeting the use of resources around the greatest needs will ensure sustainable change and improvement in the quality and safety of services within primary care. To enable the CCG to focus resources and provide support to those practices where an improvement opportunity exists, we will use enablers such as: Vulnerable Practice Scheme - to identify those practices that are at risk and would therefore benefit from targeted help and support. GP Resilience Programme designed to enable support before a practice becomes vulnerable. The CCG will utilise this funding to build resilience at scale. Governance The governance structure provides the framework to operationalise and deliver the statutory and delegated responsibilities including quality. In relation to quality, the monthly Primary Care Operational group is responsible for: Providing assurance to the AVCCG Primary Care Commissioning Committee, the joint CCG Executive Committee and NHS England (NHSE) that there are robust systems and processes in place for monitoring, managing and assuring the quality and safety of primary medical services. Driving and enabling continuous service improvement. Producing a General Practice Quality and Performance Report Receiving and reviewing reports in relation to the following: o Complaints / concerns o Safety - including incident reporting, infection control o Safeguarding o Serious Incidents o CQC inspections o Patient experience Pack Page 64

65 o o Service improvements Contract assurance for PMS / GMS contracts in relation to quality and clinical variation The AVCCG Primary Care Commissioning Committee receives reports summarising key quality issues. Any significant concerns are reported to the Governing Body (meeting in common). Developing and Harnessing Expertise We recognise that there is a huge amount of expertise within Primary Care, in relation to quality and safety, and we are currently exploring opportunities in which we can harness, nurture and develop expertise to further support and enhance the delivery of high quality patient services. We will be working with NHSE to support our primary care staff in accessing any targeted training packages for primary care staff e.g. CQC pre and post inspection training. Complimenting this will be support from the CCG Quality team to help support primary care staff in developing skills such as the development of robust post CQC action plans using the SMART approach. We are looking to harness and develop expertise through the following: Clinical groups and professional networks e.g. Practice Managers Forums, clinical networks Develop expertise within specific roles such as Practice Managers, Practice Nurses and Locality Nurses. (The development of Practice Nurse and Locality Nurse roles to help support the quality agenda within primary care is being considered within the CCG s Nursing Strategy). Utilise Practice Learning Time (PLT) previous sessions have included safeguarding and we are looking to extend this to include the wider quality and safety agenda in future sessions. The Practice Managers network who meet regularly to share best practice. Delivering Quality Safeguarding There is a practice lead for safeguarding within every practice, who has the opportunity to attend twice yearly training provided by the Safeguarding Team, to cover training, education, SCRs, and disseminate learning. Throughout the year, practices receive regular updates from the safeguarding team and they provide pre and post CQC inspection support around safeguarding arrangements. Medicines Management Each practice has a nominated lead for medicines management, who attends meetings held by the CCG medicines management Team. There is a quality improvement scheme currently underway, for primary care prescribing which a number of practices are involved in. This scheme is looking at improving practice prescribing levels, best practice and reducing clinical variation. Infection control Each practice has a nominated Infection Control Lead. The CCG has an Infection Control Lead Nurse who works closely with practices to undertake training, audits and offer advice and guidance. Localities Practice locality representatives attend locality meetings on behalf of their practice. Quality concerns and clinical variation will be included in the discussions at these meetings. The GPs can also feedback any commissioning concerns. We are also exploring options of how locality nurses can help support the quality agenda. Practice buddying We are considering the use of practice buddying, whereby a practice with an area of development is brought together with another practice that has appropriate expertise in that area. Communications There is a monthly CCG Bulletin which we have the opportunity to use to share Quality news, updates ad learning. We also have the CCG website which provides another information source. Pack Page 65

66 CCG Quality Team We are looking to create capacity and develop expertise within the CCG Quality Team (resources allowing) to look at how we can support the quality agenda within primary care, in the following ways: Supporting learning from significant event analysis, to improve practice Populating the quality dashboard Providing targeted support e.g. post CQC inspection or for vulnerable practices Buddying set up Quarterly quality report CQC post inspection action plan support Building relationships with practices through the localities Patient experience work with PPGs and other patient organisations. Challenges for the CCG There are challenges for the CCG in delivering quality in primary care. Resources: When the CCG assumed responsibility for primary care, no resource was transferred from the Area Team to the CCG. The CCG is currently in discussion with NHSE regarding transition arrangements and timescales for when full responsibility for primary care will transfer to the CCG, and when all support from NHSE will be withdrawn. Capacity is limited within the CCG to deliver quality in primary care. We are therefore looking at current roles, vacancies and expertise within the quality team to see how we can maximise our ability to support quality in primary care and ensure it is embedded as part of business as usual within practices. Data access: Accessing and collating primary care data presents a major challenge, and we are looking at how we can directly access as much primary care data as possible, so as not to add to the reporting burden for practices. This paper should be read in conjunction with the following strategies / reports: Primary Care in Buckinghamshire Strategy June Dr Malcolm Jones and Dr Chris North Aylesbury Vale and Chiltern CCG Quality Strategy Framework For Quality in Primary Care January 2016 (updated November 2016) - Dr Karen West Pack Page 66

67 Practice Update on Quality in Primary Care Introduction This paper builds on the previous Aylesbury Vale CCG (AVCCG) Framework for Quality in Primary Care from January This has been updated and attached for information. The CCG s proposed approach is summarised below, and outlines how they will support member practices to provide high quality services, for the benefit of our local population. It is important to note that CCGs have a statutory duty to assist and support NHS England (NHSE) in securing continuous improvement in the quality of Primary Care Medical Services. AVCCG has also taken on full delegated commissioning since April Following a 94% vote by member practices in favour of full delegation, Chiltern CCG (CCCG) is currently submitting an application to NHSE to take on full delegated commissioning from April Delegated commissioning allows the CCGs full responsibility for commissioning Primary Care Medical Services, whilst legally, NHSE retain the residual liability for the performance of Primary Care. As such, NHSE require that its statutory functions are being discharged effectively by the CCGs. The statutory responsibilities of the CCGs include quality, financial resources and public participation. As previously outlined in the Framework for Quality in Primary Care, the CCG recognises that, under delegated commissioning arrangements, it will remain accountable for its pre-existing statutory functions, including quality assurance, but that these will need to be extended across the Primary Care contracts for which it will take on responsibility. The CCG Primary Care Commissioning Committee will be responsible for providing assurance to the Governing Body (meeting in common) regarding the quality, safety and contracting process of Primary Care Medical Services. The diagram below sets out the governance arrangements for delegated commissioning for the Buckinghamshire CCGs. AVCCG with full delegated responsibility, delivers its statutory and delegated responsibilities via the AVCCG Primary Care Commissioning Committee (PCCC). AVCCG & CCCG Governing Body (in common) AVCCG Primary Care Commissioning Committee Information AVCCG & CCCG Joint Executive Committee AVCCG AVCCG & CCCG Primary Care Operational Group CCCG Once Chiltern CCG becomes fully delegated there will be a Bucks CCGs Primary Care Commissioning Committee (meeting in common). This means that each CCG would have its own committee but they would meet together at the same time and in the same place. Having the committee meetings in common will promote cross CCG working and help manage conflicts of Pack Page 67

68 interest through more transparency. However, each CCG will retain responsibility for its own primary care budget. Quality Assurance Framework in Primary Care The CCGs have now developed their Quality Assurance Framework, as outlined in the Framework for Quality in Primary Care. Whilst the practice as the provider is accountable for the quality of services, NHS England and CCGs as commissioners have a shared responsibility for quality assurance. The Quality Assurance Framework describes our proposed approach to monitoring quality within Primary Care Medical Services for both CCGs. The three domains of quality: patient safety, clinical effectiveness and patient experience will be reviewed, utilising external sources such as CQC, peer reviews, primary care web tool, national surveys etc. The CCGs Primary Care Commissioning Committee will receive reports summarising key quality issues. Any significant concerns will be reported to the Governing Body (meeting in common). The following is an example of the proposed Quality Dashboard: Pack Page 68

69 Developing and Harnessing Expertise We recognise that there is a huge amount of expertise within Primary Care, in relation to quality and safety, and we are currently exploring opportunities in which we can harness, nurture and develop this expertise to further support and enhance our Primary Care Medical Services. We are looking to achieve this through the following: Clinical groups and professional networks e.g. locality meetings, medicine management meetings, nursing forums etc. Utilising CCG Practice Learning Time (PLT) previous sessions have included safeguarding and we are looking to include the wider quality and safety agenda in future sessions. Developing expertise within specific roles such as Practice Managers, Practice Nurses and Locality Nurses. The Practice Managers network who meet regularly to share best practice. Practice buddying - we are considering the use of practice buddying, whereby a practice with an area of development is brought together with another practice with appropriate expertise in that area. We will also be working with NHSE to support our Primary Care staff in accessing any targeted training packages e.g. CQC pre and post inspection training. Complimenting this will be input from the CCG Quality team to help support practices in developing skills such as the development of robust post CQC action plans. There is a monthly CCG Bulletin which we will use to share Quality news, updates ad learning. The CCG websites will provide another information source. NHSE Practice Support Options Targeting the use of NHSE resources around the areas of greatest need will ensure sustainable change and improvement in the quality and safety of Primary Care Medical Services. We recognise this is a challenging environment, both in terms of finances and the demand on services. Below are the two NHSE practice support options currently available to us: Vulnerable Practices Scheme - This programme aims to provide support to practices via externally facilitated provider support. This support is in addition to, not instead of, the existing flexibilities available to commissioners under Section 96 of the 2006 NHS Act. The aim of this additional external support is to assess and treat the causes of vulnerability, securing practice improvement and building longer term resilience rather than deliver short term quick fixes. GP Resilience Programme This programme is designed to enable support before practices become vulnerable. Support will be considered, both in terms of individual practices and the resilience of the wider locality. Additional Information Bucks Framework for Quality in Primary Care Pack Page 69

70 MEETING: Primary Care Commissioning Committee DATE: Thursday 1 December 2016 TITLE: AUTHOR: LEAD DIRECTOR: GP Forward View Plan Helen Delaitre Debbie Richards Paper E Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information X Summary of Purpose and Scope of Report: The Primary Care Commissioning Committee are presented with an extract of the most appropriate sections of the CCGs operating plan to provide an overview of the ambition and key deliverables in terms of primary care transformation over the next two years. This is summarised below but generally focuses on plans to achieve sustainable primary care including better access to services for the whole population. The CCG has now drafted its two year Operational Plan. This year s plan is the first completely joint Clinical Commissioning Operational Plan for Buckinghamshire and sets out what the two CCGs, working as one team, will deliver as part of the wider local Buckinghamshire system plan and Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation footprint. Whilst this plan demonstrates the progress the CCG will make in a number of areas, including the national Must Dos and constitutional pledges, a set of key local deliverables have also been developed. Primary care transformation and new models of care, including the delivery of integrated community based services are seen as the cornerstone of sustainable primary care and key to the survival of general practice. GP Forward View General Practice is experiencing unprecedented workload and workforce challenges; this means that whole system transformation of both community and primary care services is required in order to turn the CCG s primary care strategy and longer term sustainability plans into reality. NHS England has acknowledged that action is needed to accelerate the support offered to general practice and a set of funded actions have been announced to help make a tangible difference to both practices and their patients. The plan sets out the next steps in delivering the Buckinghamshire Primary Care Strategy and national Must Dos as outlined in the NHS Operational Planning and Contracting Guidance for 2017/18. Pack Page 70

71 Improved Access CCGs, such as Aylesbury Vale, that were unsuccessful in being awarded Prime Minister s Challenge Funding will be required to start improving access to primary care in 2018/19. The current plan for set outs the CCG s trajectory for achieving improved access coverage for the whole population of Buckinghamshire by 2019/20. This additional capacity can be provided on a hub basis with practices working at scale, based on criteria set by NHS England as follows: Weekday provision of access to pre-bookable and same day appointments between 6.30pm and 8pm Weekend provision of access to pre-bookable and same day appointments on both Saturday and Sunday to meet local population needs The CCG has now set its trajectory for achieving improved access over the next two years, and this is set out at the end of this paper. Conflicts of Interest: None in respect of approvals requested. Members should note that Terms of Reference have been designed to ensure that the Committee will be quorate for decision making without any member GP/GP partners present. Strategic aims supported by this paper (please tick) Better Health in Bucks to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks to promote equity as an employer and as clinical commissioners X X X X X Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary Patient & Public X Involvement CCG has hosted community events during November to discuss STP and primary/community hubs. Equality X The plan will ensure that there is equal access for all patients in Bucks to access primary care services. Quality X The CCG will ensure that high quality primary care services are maintained. Pack Page 71

72 Financial X The CCG intends to invest in improving primary care access and the financial implications of this are outlined in the paper. Risks A risk log will be established aligned to delivery of the GP Forward View Plan. Statutory/Legal X None identified. Prior consideration X Committees /Forums/Groups Membership Involvement Supporting Papers: X Discussed internally with Senior Management Team. Some membership involvement relating to elements of the GP Forward View Plan. Further involvement and engagement will be necessary once plans to improve access and associated timescales are worked up. Excerpt from CCG Operating Plan and Improved Access Trajectory. Pack Page 72

73 The Current Picture IN DRAFT Primary Care [National Must Do #3] General Practice is experiencing unprecedented workload and workforce challenges; this means that whole system transformation of both community and primary care services is required in order to turn our primary care strategy and our longer term sustainability plans into reality. NHS England has acknowledged that action is needed to accelerate the support offered to general practice 7 and a set of funded actions have been announced to help make a tangible difference to both practices and their patients. This plan 8 sets out the next steps in delivering the Buckinghamshire Primary Care Strategy, Primary Care in Buckinghamshire: our strategy for proactive, co-ordinated, out of hospital care. FINAL_ pdf The vision for primary care which underpins the strategy and was shaped by the public and the CCG s member practices is that: Everyone working together to provide high quality, personalised care to help keep Buckinghamshire people happy and healthy, optimising value from our collective efforts 7 NHS England, General Practice Forward View, The plan addressed both the GP Forward View, the national Must Dos and the 10 point action plan from NHSE/HEE and the RCGP and BMA Pack Page 73

74 The strategy identified six goals to achieve the vision with 4 tiers of care broadly identified to cover the whole population with Tier 3 Plus being the transformational element of the model of care with some GP practices (or other providers) able to offer a wider range of out of hospital services and with GPs at the heart of seamless integrated health care. Pack Page 74

75 What are we going to do? Priority Key Action Priority Key Action Priority 1: Workforce Establish a Community Priority 2: Workload Use training funds for Improving recruitment into general practice Education Provider Network GP Workload additional places and Retaining doctors within general practice (CEPN) 9 and agree delivery Locality Integrated Teams upskilling Supporting those who wish to return to general practice plan the four workstreams Practices working together Roll out integrated Training and Education Primary Care Resilience teams in all localities (See Section 10) Support development of FedBucks 10 and models of practices working together Explore establishing a Bucks GP Locum chamber Priority 3: Estates and Technology Complete countywide assessment of all infrastructure as part of One Public Estate and STP Estates priorities Establish a methodology for CIL/S Priority 4; New Ways of Working (See Section 10) Care and Support planning Care Home Integrated Service Locality Integrated Teams Live Well Stay Well Prevention Matters Specialised paramedics in primary care Establish Community Hubs Starting with Aylesbury Central, Buckingham and Wycombe Localities (c 50% of total population) before rolling out to the other 4 localities Include the requirements for extended GP appointments into weekend / evening Pilot in 2017/18 increasing to 100% by 2019/20 Priority 5: Primary Care Resilience Training & Development 10 High Impact Productivity actions Capacity and Primary Care model Accessing Urgent Services Recruit GP lead for Primary care to champion primary care resilience Implement a GP Development Programme Roll out releasing time to care programme Priority 5: Primary Care Resilience Training & Development 10 High Impact Productivity actions Capacity and Primary Care model Recruit GP lead for Primary care to champion primary care resilience Implement a GP Development Programme Roll out releasing time to care programme 9 CEPNs are a new way of developing the primary care workforce and is an opportunity for general practices and other primary care providers to get involved in developing and delivering education and training as part of a supported network ( Pack Page 75

76 More detail on the actions to support our priorities is given in Appendix E of the CCG Operating Plan. Delegated Responsibility for Primary Care Aylesbury Vale CCG is categorised as Level 3 in respect of delegated commissioning arrangements and assumed responsibility for commissioning primary care in April Following a unanimous vote by 94% of practices in support of delegated commissioning in October 2016, Chiltern CCG is applying for delegated status to assume responsibility from April A Primary Care Commissioning Committee has already been established, which has GP representation and is chaired by a lay member of the Governing Body. From 2017/18, the two CCGs will hold a Primary Care Commissioning Committee in common. This means that each CCG will have its own committee but they will meet together at the same time and in the same place. Having the committee meetings in common will promote cross CCG working and help manage conflicts of interest through greater transparency. What are the outcomes and benefits? Resilient primary care workforce, skilled in providing a wider range of services in the community; General practice working together to provide 24/7 services to patients within their locality; GPs will lead a wider network of professionals, all working to the same improved patient outcomes; Improved access to primary care throughout the week and in extended hours; Development of key enablers such as estates and technology to support the delivery of community hubs in line with integration model; More people will be supported to self-care and will be seen and managed nearer to home by the right professional at the right time. How will we achieve the plan? The Primary Care Commissioning Committee will be responsible for monitoring the CCGs progress against the GPFV Delivery Plan 13 which includes all actions and targets associated with delivering sustainable primary care over the next two years. We also aim to work collaboratively with other CCGs in the BOB footprint and the NHS England transformation teams. We will support our practices who are successful in obtaining Estates and Technology Transformation funding (ETTF) to maximise their potential for delivering patient focused, integrated services that meet the primary care strategy. This will include improved access based on local needs which are line with GP Forward View trajectory. 10 FedBucks is a GP federation covering 45 out of 52 practices in Buckinghamshire 11 These are contributions from developers 12 DLS Pilot is Digitial Life Sciences, a pilot GP access call centre hub in Central Aylesbury Locality Pack Page 76 7

77 Timescales In 2017/18, 3 per head will be allocated to prepare primary care to deliver improved access across 7 days of the week and also encourage practices to explore working together, new models of care and the skillsets required to work in integrated teams. 2018/19 will see the first year of commissioning improved access to primary care services for at least 50% of the Bucks population. We envisage that this will be done through practices working together and through a new contract framework, such as PACS or MCP. In 2019/20, 100% of the Bucks population will have the ability to access urgent or on the day booked appointments 7 days a week. We also anticipate that all our new community hubs will either be up and running or in the mobilisation phase prior to go-live. Summary Delivering the GP Forward View will ultimately deliver: Better patient care including equity of access to services More benefits for primary care staff working in Bucks Greater efficiencies made possible through new contracting frameworks (e.g MCP) Robust resilience within primary care Pack Page 77

78 Integrated Care [National Must Dos #7, #8] Transforming Primary and Community Services through Integration The Current Picture: As GP-led commissioning organisations, we recognise that the majority of our patients care takes place outside hospital and that the first contact and gateway to services is through the GP practice. However, supporting services such as specialist advice, community nursing, mental health, local diagnostics and comprehensive information access for long term conditions remains poorly co-ordinated across weekdays, evenings, overnight and weekends and consequently take a lot of time to set up around our patients. Added to this, General Practice is experiencing unprecedented workload and workforce challenges; this means that whole system transformation of both community and primary care services is required in order to turn our primary care strategy and our longer term sustainability plans into reality. Localities When CCGs were first created a key aim was that they would enable services to be tailored and adapted to local needs. Our primary mechanism for this is through each of the localities assessing the needs of their local population and developing plans to meet them. Many themes are shared across the Localities but implementation may vary in each and there are several projects specific to the needs of individual areas. The Localities are also the route to understand local people s views about current services. What are we going to do? Priority Key Action Priority Key Action Priority 1: Develop the provider model Implement new incentives for Priority 2: Creation of Establish Community Hubs provider to work collaboratively Community Hubs Starting with Aylesbury through networked Central, Buckingham and arrangements Finalise an MCP model for the North Aylesbury Locality (Buckingham) incorporating Wycombe Localities (c 50% of total population) before rolling out to the other 4 localities. ENT Consider models for other localities, led by the development of primary care provider collaborations Pack Page 78

79 Priority 3: Develop further our locality based programmes of work Continued review of referral management Locality Integrated nursing and social care for the over 75 s / Integrated Primary Care Services Supporting care homes (see section 14.3) Increased use of e-referral system Increased co-ordinated access to primary care Programmes around Better Health and Better Care e.g. Community dementia support Groups of GP practices, working together through common geographies and population demographics will be supported by rapid access to diagnostics and a wrap-around wider team of practice and community nurses, mental health workers, pharmacists, social and voluntary supporting services, co-ordinated through a local community hub that ensures timely access to the right care response. Traditional out of hours services will be transformed through the commissioning of extended GP practice hours within each locality, with overnight and further weekend support being provided by secondary care, working collaboratively with all other community, social and voluntary services, supported by our ambulance service and NHS 111. The NAPC work on Primary Care Home 14 and the Multi - Specialty Community Provider (MCP) model 15 from the five year forward view supports the concept of groups of GPs working at scale. National and local evidence suggests these at-scale groups are most effective around a population base of 30 to 50 thousand registered list patients 16 ; this means a maximum multi-disciplinary team of around 150 personnel which is suggested to be optimal for communication and integrated working practices. We recognise the importance of timely access to other high quality supporting services, such as diagnostics (ECG, X-ray, bloods) and to specialist professionals (such as tissue viability nurses, cardiologist advice). Our community hubs will be the centres in each locality where these services can be co-ordinated and locally provided; this may mean a physical building where tests can be carried out and where video conferencing can bring specialist consultant opinion and support to the patient, equally it may be a virtual centre of co-ordination National Association of Primary Care: The Primary Care Home, 2015 Pack Page 79

80 What are the outcomes and benefits? Improved access to primary care throughout the week and in extended hours; Greater compliance with agreed care pathways and more efficient patient pathway Increased patient self-management and illness prevention Patients will have access to a wider range of services which are co-ordinated and tailored to their needs; Patients and their carers will have consistent information about services to enable them to stay well; All primary and community care will be using the same EMIS Web patient notes recording system, ensuring there is effective shared information; GPs will lead a wider network of professionals, all working to the same improved patient outcomes; More people will be seen and managed nearer to home by the right professional at the right time. Increase outcomes for patients and efficient and effective resource utilisation How will we achieve our plans? We know that some of our GP practices are already working at scale, for example the MCP in the North Aylesbury locality and the pan- Buckinghamshire organisation, FedBucks that currently covers over 80% of our practices. There are many more examples of GP collaboration, such as the Wycombe practices sharing access to appointments and we know from experience that such initiatives are most successful when local clinicians themselves have developed their ideas, working to a set of outcomes, rather than working to a commissioner-led specification. Pack Page 80

81 We have some long established projects where services have been integrated to develop solutions for our frail and/or elderly patients; these have provided significant reductions in emergency admissions and lengths of stay. Some projects in other localities are building on this experience and tailoring their integrated working to fit their specific patient group needs, aiming for similar outcomes. At locality level, there is a greater understanding of the current health needs of the population, the views of the community on healthcare and the assets available to them in that community. As such, the locality clinical leads can act as the driving force behind localisation and implementation of services appropriate to their population needs making this model a very effective way to deliver change. Timescales Over the next two years we will be taking advantage of the current enthusiasm for integrated services and will begin to support a wider roll out of these working practices. April 2017/18 will be our year of transition, where commissioner efforts will be focussed on developing willing groups of GP practices to work collaboratively with their wider multi -disciplinary community teams, aligning their work efforts to reduce admissions and lengths of stay for their population. The reductions in non- elective care episodes will help us to fund our community services development. Whilst some practices are already stating intentions to work together, other groups of practices will require more support to achieve this. We anticipate a slightly varied response and will ensure that our leading light groups of practices will be actively encouraged to develop at pace, whilst we actively communicate the benefits and support our follower practices to achieve a similar working model. It is anticipated that three of our seven localities will be including social care into this integrated provider model within this transitional year. For April 2018/19 we aim to be commissioning a single outcomes based contract with our GPs, secondary care and mental health providers. We will have a Buckinghamshire system of health and care, made up of seven localities with groups of GP- led multispecialty providers (including social care) working collaboratively, regardless of their employing organisation and supported by community hubs. Summary The next two years will see the development of multi-disciplinary teams wrapped around geographical groups of GP practices, offering new opportunities for different working arrangements for GPs, other clinicians and managers. It is expected that over time this will help manage demand for general practice, by building community networks, connecting with the voluntary sector, and supporting patient activation and self-care. Pack Page 81

82 The CCG s Trajectory for improving access to primary care over the next two years Aylesbury Vale CCG Pack Page 82

83 Chiltern CCG Pack Page 83

84 MEETING: Primary Care Commissioning Committee DATE: Thursday 1 December 2016 TITLE: Papers for Information Paper F Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information X X Summary of Purpose and Scope of Report: The Primary Care Commissioning Committee needs to be assured that business as usual operational matters concerning primary care are managed effectively by the Primary Care Team. These papers will update the Committee on: - Primary Care Finance - Primary Care Operational Group - Verney Close Value for Money Audit - Capita Primary Care Support Services AV CCG Finance Report To update the Committee on the financial position for month 7 of 2016/17 for the delegated Primary Care Services joint commissioning budget of Aylesbury Vale CCG. The overall position at month 7 is a favourable variance of 18k against plan. Primary Care Operational Group To provide the Primary Care Commissioning Committee with an update from the Primary Care Commissioning Operational Group (PCOG) meetings held on 6 October and 3 November Verney Close Value for Money Audit To inform Committee of the financial impact of the agreed action taken following the closure of Verney Close Surgery and the subsequent dispersal of patients across to The Swan practice. Capita Primary Care Support Services To explain how NHS England is responding to the significant issues experienced by primary care contractors and other stakeholders since Capita were commissioned to provide primary care support services. In summary, NHS England s Intensive Expert Management Team is working with Capita to affect improvements to address the underlying problems causing the issues. NHS England is confident that recent short- Pack Page 84

85 term difficulties caused by the changes will be more than offset over the medium term by the efficiencies and improvements which will be delivered through this new contract. Conflicts of Interest: None. Strategic aims supported by this paper (please tick) Better Health in Bucks to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks to promote equity as an employer and as clinical commissioners X X X X X Supporting Papers: Aylesbury Vale CCG Finance Report Primary Care Operational Group Update Verney Close Value for Money Audit Capita Primary Care Support Services Pack Page 85

86 Joint Commissioning Primary Medical Services Committee Pack Page 86

87 Report to the Joint Primary Care Co-Commissioning Committee Operational Group Aylesbury Vale CCG Prepared by: Alan Overton, NHS England South (South Central), Finance Analyst Classification: OFFICIAL The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes. Pack Page 87

88 1. Introduction 1.1. This paper sets out the financial position for month 7 of 2016/17 for the delegated primary care services joint commissioning budget of Aylesbury Vale CCG. Month 7 Year to Full Aylesbury Vale CCG Date Year GP Services 16/17 Plan Actual Variance Plan Actual Variance Plan FOT Variance Prior yr k k k k k k k k k k GP Contract payment 1,346 1,359 (13) 9,419 9,595 (176) 16,147 16, QOF payments (328) 1,358 1, ,328 2, GP Seniority and Locums (30) GP Drug payments ,025 1, ,758 1, GP Premises 229 (82) 312 1,605 1, ,752 2, GP Enhanced Services 106 (188) ,275 1, GP Other Items 3 3 (0) CCG Prescribing (214) Collaborative Fees 5 5 (0) GP Premises other GP General Reserves Total 2,094 2, ,659 14, ,893 25, Pack Page 88

89 2.0 Month Position The position for month 7 is a favourable variance of 49k. 2.1 Year to Date Position Overall the YTD position is a favourable variance of 18k against plan. GP Contracts 176k adverse due to unbudgeted MPIG and a Sec 96 payment. Funding to be reviewed by NHS England. GP Premises 72k favourable due to timing of payments. GP Enhanced Services 80k favourable due to Extended Hours as all practices had a budget but not all have signed up and income received ( 26k) to be moved in M Forecast Outturn The actual FOT is on plan. 3.0 Assumptions on reporting The figures have been prepared in accordance with the following national guidance: Prior year balances/costs will remain with NHS England. Accruals will be as per accounting standards and will be to the expected year end outturn position. 4.0 Contracting and procurement activity Mandeville Surgery, Aylesbury - New provider commenced 1 st April 2016 Verney Close, Buckingham Managed dispersal of patient list to the Swan practice on 1 October Pack Page 89

90 Report from the Primary Care Operational Group Purpose of Paper To provide the Primary Care Commissioning Committee with an update from the Primary Care Commissioning Operational Group (PCOG) meetings held on 6 October and 3 November Deputy Chair A lay member or representative from Healthwatch will be invited to sit on the PCOG as Deputy Chair. The ToR will be amended to reflect the details of the new Deputy Chair. Verney Close Surgery / Swan Practice Merger The Swan Practice list has now been successfully dispersed to Verney Close Surgery. No concerns or problems with the list dispersal or changes to the infrastructure have been reported. A new GMS contract has been signed by the CCG and is awaiting signature from the practice, the new contract reflects the changes to the Verney Close Surgery boundary which allow Verney Close Surgery to offer the same dispensing rights for the majority of patients who were registered at The Swan Practice. Berryfields Medical Centre Additional Portakabin Accommodation On 2 June 2016 the PCCC were asked to make a decision on the funding of additional portakabin accommodation for Berryfields Medical Centre. The PCCC requested further information on the expected list growth trajectory and further information on the practice s plans for a permanent premises solution. The PCCC delegated responsibility for the decision to the PCOG once the additional information had been collated. Due to local housing developments the practice list for Berryfields Medical Centre is currently growing at a rate of approximately 1,000 new patients a year. Whilst options for a permanent premises solution continue to be explored an additional portakabin will allow the practice to meet the demand of their growing patient list for 2 years based on the current growth rate. On 6 October 2016 the PCOG agreed to fund the provision of an additional portakabin for Berryfields Medical Centre at a one-off cost of 11, with associated rent reimbursement for 104 weeks of 10, Following the PCOG meeting, the practice was informed of the decision made. At this point in became apparent that the practice had also originally applied for additional funding of 9,256 to complete internal refurbishment. This money would allow the Practice Manager s office to move into the new portakabin accommodation and to reconfigure the space to allow for additional clinical capacity. This additional funding request was not included in the paper that went to the PCCC in June or the PCOG in October. It is believed this omission was caused by a change of staff dealing with the application at the practice. The additional costs were debated at the PCOG meeting on 3 November 2016 where the group agreed to pay for 66% of the internal reconfiguration costs if the practice funded the remaining 34% themselves. Following the PCOG meeting, Helen Delaitre (HD) reviewed the Premises Costs Directions (2013) and the Standing Financial Entitlements (2013). These regulations allow the CCG to fully fund one-off discretionary payments and to fully fund temporary accommodation. 7 Pack Page 90

91 It further became apparent that NHS England had previously fully funded applications from Berryfields Medical Centre and that in July 2015 and January 2016 additional accommodation was agreed with no contribution required from the practice. Given the additional information, HD felt that it would be difficult at this stage for the CCG to insist that the practice makes a financial contribution to the work required. In order to prevent an extended delay to the work, voting members of the PCOG were asked to consider the supplementary information and to vote virtually on this matter. Members of the PCOG were asked to approve the funding of the full additional costs and eight members out of 10 voted in favour. PCCC should note that as a result of this matter the template used to review applications for premises funding has now been amended to include a section asking the author to refer to the relevant clause within either the Premises Costs Directions or the Standing Financial Entitlements that provides the rationale for the funding application. Aylesbury Vale Direct Payment Awards On 6 October 2016 the PCOG were informed that a reporting error had been identified with regards to the Direct Payments for Aylesbury Vale CCG. This led to 6 practices underclaiming for the Care Home Enhanced Service amounting to a total underpayment of approximately 14,000. One practice initially alerted the CCG to the issue and requested a full reimbursement of unclaimed earnings. After debate the PCOG on 6 October 2016 agreed to reimburse all of the practices affected by the reporting error for the current financial year. One practice appealed the decision of the PCOG as they felt it was unfair to limit the reimbursement to the current financial year. PCOG met again on 3 November 2016 and agreed to reimburse all practices who had under claimed for earnings not received in 2015/16 and for the first two quarters of 2016/17. PCCC should note that lessons have been learnt and the CCG will amend wording of the Direct Award documentation so that responsibility for accuracy of data provided rests with the practice. Mandeville Contract Extension The CCG is looking to extend the temporary APMS contract with TPG for a further year to enable a robust re-procurement process, patient engagement and further consideration of the optimum model of service to take place. TPC has highlighted to the CCG concerns regarding the viability of the contract as their pay and non-pay costs are currently significantly higher than expected. It was reported that the CCG will meet with TPC to review income and expenditure. Community Education Provider Networks (CEPN) A bid submitted to Health Education England Thames Valley (HEETV) by Aylesbury Vale CCG, Chiltern CCG and FedBucks has been successful. HEETV have agreed 68, of funding for the establishment of the CEPN which will be known as Bucks Training Network. A Project Manager will be recruited on a 1 year fixed term contract to oversee the establishment of the training organisation and a CEPN Board. Estates and Technology Transformation Fund (ETTF) It was noted that none of the four Aylesbury Vale estates bids put forward in June 2016 had been successful in going forward to the Due Diligence stage. One project has however been given the go ahead to do pre-project planning. The CCG s senior management team have been informed and will now make representations to NHS England to reconsider this decision. 8 Pack Page 91

92 The CCG was successful with one GP Technology bid for 370k for New Ways of Working in Primary Care. 9 Pack Page 92

93 Finance Impact of The Swan Practice / Verney Close Surgery Merger Author Kate Holmes, Deputy Chief Finance Officer Introduction: Following the decision of the Verney Close Practice to give notice on its GMS contract at the end of 2015/16 Aylesbury Vale CCG, under delegated authority from NHS England, were required to recommission primary healthcare services on behalf of the 8,759 patients registered to Verney Close Surgery. Various options were considered by the Primary Care Commissioning Committee, however, it was felt that the most effective option for continued primary healthcare services for the registered patients of the Verney Close Surgery was for the patients to bulk transfer across to the nearby Swan Practice. A contract variation was issued to The Swan Practice with effect from 1 st October 2016 reflecting the additional site (Verney Close Surgery) and a new practice boundary was set. For the purpose of maintaining services for dispensing patients at Verney Close Surgery, the situation was considered as an amalgamation of dispensing lists and as such dispensing rights remain for eligible patients across the whole of the revised boundary as currently. At the Primary Care Commissioning Committee held in June 2016, there was a request for a brief value for money briefing to be produced to assure the Committee that the preferred reprovision option had not been detrimental. Summary of GMS Contract Payments 2016/17 A complete summary of the GMS payments due to The Swan Practice is deemed to be confidential but this information has been reviewed in preparing this report. The main point for the Committee to note is that overall there is minimal difference in cost to Aylesbury Vale CCG/NHS England visible due to this change in contract through this re-provision option. Core Services: GMS contract Sum The main GMS contract sum is based on the national GMS contract terms being per head weighted practice population adjusted for temporary resident addition and a reduction for Out of Hours opt out at 5.15%. Payments in this area are made on the weighted list size, updated on a quarterly basis, and as such there is no increase in costs in this area under the new re-provision of services compared to previous service provision. Minimum Practice Income Guarantee (MPIG) Each of the existing practices were receiving MPIG and as such under the re-provision the sum due to the merged practice is simply the combined sum. The phased reduction of MPIG will continue with the merged practice as previously. Pack Page 93 10

94 Total Core Services for the pre and post contract re-provision are shown in the table below and it can be seen that there is a negligible increase in cost under the re-provision of services. The Swan Practice Verney Close Surgery Merged Practice Weighted List Size 17,612 8,112 25,724 (1/7/2016) Annual Sum Total Core Services 1,374, ,825 2,051,538 ( Adj GSUM + MPIG) Annual Sum Core Service/weighted popn Directed Enhanced Services: Costs payable in this area are made based on either actual activity via submitted claims or by practice list size. On this basis, and assuming that service provision remains consistent to practice populations as previously seen, there is no increased cost due to the re-provision of services. Quality & Outcomes Framework (QOF): Costs payable in this area are made based on actual calculated points achieved. On this basis, and assuming that service and quality provision remains consistent to practice populations as previously seen, there is no material increased cost due to the re-provision of services. Premises: On the basis that the remaining sites will continue, albeit under the merged contract, rent reimbursement and costs associated with non-domestic rates and clinical waste will not differ from those claimed under two separate contracts. Other Payments and Deductions: These are costs broadly related to vaccination programmes; dispensing payments, seniority/ retainer/ locum/ superannuation. Assuming that service and quality provision remains consistent to practice populations as previously seen there should be no difference in cost visible relating to vaccination programmes due to re-provision arrangements. As detailed above it has been agreed that current dispensing arrangements will continue under the contract variation and new practice boundary. There should therefore be no increased costs in this area due to the method of service re-provision agreed. Under the merged contract, there may be some changes to staffing as efficiencies of the merged practice evolve. It is not anticipated that claims relating to seniority/retainers/locum/superannuation will differ significantly from those claimed under two separate contracts. Conclusion: From the costs and assumptions outlined above it can be seen that the agreed method of reprovision of primary healthcare services under the new merged contract will not differ significantly from the current cost of service provision under two contracts. Income streams for the merged practice continues under the national GMS contract and are consistent with other practices in the local area, across the CCG and therefore benchmark with other practices countywide and nationally. KH: Pack Page 94 11

95 Primary Care Support Services provided by Capita 12 Pack Page 95