Primary Care Committee Tuesday 6 February am 11.30am Sherwood Board Room 1 A G E N D A

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1 Primary Care Committee Tuesday 6 February am 11.30am Sherwood Board Room 1 A G E N D A Item Lead Enc. Time 1. Welcome & Apologies Chair 9.30am 2. Declaration of Interests Chair 3. Minutes of Previous Meeting held on Wednesday 10 January 2018 Chair PCC18/ am 4. Matters Arising Chair Operational Primary Care Budget 5. PMS Edna Muraya PCC18/ am Enhanced Services 6. E - Consultations Alex Friend PCC18/ am Any Other Business am 8. Date of next meeting Wednesday 7 March, 2pm 4pm Sherwood Board Room 1

2 PCC18/01 Present Richard Alsop Dr Nessan Carson Hilary Jones Edna Murayaa Kayley O Sullivan Will Perks Dr Nicola Smith Alexia Stenning Janine Welham Apologies: Dr Hopeson Alifoe David Foord Andrew Morton Mike Rowlands Nadia Shaw Matthew Webb In Attendance Hazel Webb RA NC HJ EM KO S WP NS AS JW HA DF AM MR NS MW HW PRIMARY CARE COMMITTEE Wednesday 10 January 2018 Sherwood Board Room 1 Minutes Director of Programme Delivery, MK M CCG Board Member, MK CCG Head of Quality, Deputy Director of Nursing, MK CCG Senior Finance Manager, MK CCGG Primary Caree Support Officer, MK CCG (Minutes) Lay Board Member, MK CCG (Chair) GP Chair, MK CCG Deputy Director of Programme Deliver and Head of Primary Care, MK CCG Primary Caree Development Manager, MK CCGG Board Member, MK CCG Director of Nursing and Quality, MK M CCG Chief Finance Officer, MK CCG Lay Board Member, MK CCG Healthwatch h Representative Chief Officer, MK CCG Delivery Manager Planned & Primary Caree 1. Welcome and Apologies As above 2. Declaration of Interest Dr Nessan Carson GP in MK Dr Nicola Smith GP in MK 3. Minutes of the previous meeting held on 15 November 2017 The minutes were accepted as an accurate record of the meeting. 4. Matters Arising Theree were no actions from the previous meeting and the action log is complete. 5. CEPN/Workforce Hazel Webb introduced herself to the committee. There is ring-fenced money to form a Community Education Provider Network developmentt and we aree working alongside our STP colleagues. An Expression of Interest hass gone out too see if primary care colleagues would like to join the committee. The first STP meeting is on 31 st January which Janine Welham,, Hazel Webb and Dr Nessan N Carson will be attending. In addition we have been successful in obtaining additional a funds from Health Education England and there iss a plan being developed to particularly look at training for Cardiovascular, Respiratory and possibly leg ulcer dressings for Primary Care Committee Minutes 10 January 2018 FINAL V1.0 NHS Classifed Action Page 1 of 4

3 PCC18/01 practice nurses and HCAs. The amount from Health Education is 18,000 and CEPN is 30,000. Both budgets will need to be spent by the end of the financial year. With the specialist training for nurses we are looking to obtain at least one nurse within each neighbourhood to attend. The CME Programme will finish at the end of March due to the programme not being funded. Dr Nessan Carson highlighted that practice nurses updates and training will need to continue locally within Milton Keynes. Threee practices in Milton Keynes have expressed an interest in the Overseas GP Recruitment Programme and a STP application will be submitted at the end of January. 6. Practice Boundaries This paper was circulated to committeee members for a virtual decision. Milton Keynes Village Practice have requested to decrease their practice boundary by removing Oakgrove whilst there practice extension is being completed. c Newport Pagnell Medical Centre has agreed to extend their practice boundary to include Oakgrove. The committee agreed to this decision and the practices havee been informed. 7. Primary Care Budget Currently overspent on indemnity insurance, maternity and sickness payments and QOF which is based on lastt year s achievement. Underspent t areas are global sum, seniority and MPIG which is being phased out along with rent and enhanced services/extended hours. Edna Muraya needs to verify extendedd hours as NHSE do not peruse practices that do not claim. Janine Welham has asked practices and some have not claimed for a couple of years but claims can go backk 6 or 7 years. The preceding years prior to delegated authority sit with NHSE and we have an agreement with them. Rent reviews are currently outstanding from informationn received from NHSE.. This year the practices that premises are managed by NHS property p services have received letters with increased costs for service charges. Majority of our r properties are leasehold but they have to wait for the Districtt Valuer to agree a the revised rents. NHSE are starting Bedfordshire CCG rent reviews prior to Milton Keyness but we need to make sure that ours are conducted first. EM to speakk to NHSE regarding this. In 18/ /19 EM informed the committee that hopefully the urgent care contract and 111 services will be moved out from the primary care budget lines. 8. E Consultations This paper was virtually sent to the committee to be able to get g the plan for delivery to NHSE to ensure that the funding was secured through the GP Forward View. Theree were a few amendments which were grammar and thee paper wass then submitted to NHSE. Alex Friend is working through the STP to t deliver this E- Consultation programme. There are currently one or two practices in each neighbourhood that have put in an expression of interest to take part in the pilot. Due to the procurement framework there is not a preferred bidder. AF too update the committee with NHSE framework for e-consultation. The GP s have requested that they are involved with the choice of provider prior to contract award. Primary Care Committee Minutes 10 January 2018 FINAL V1.0 NHS Classifed AF Page 2 of 4

4 PCC18/01 Committee agreed and update at next meeting. 9. Clinical Admin Training This is ring fenced money through the GPFV. It is for care navigation training, signposting training and READ code training this is already being rolled out in practices. Three companies came in too present to the Practice Managers and provider B was the preferred bidder. They are the least expensive but our Directory of Services will need to be up to date and there will need to be b work completed on this to be able to roll out in Primary Care. The money needs to t be spent this financial year and if there is money leftt over there are practices that still would like further READ code training due to stafff turnover and money may m be needed to be develop the Directory of Services. AF The committee agreed with provider B.. With the READ code training, Insight Solutions send JWe thee feedback forms once the training has been completed for thee staff to fill in. A suggestion was made that feedback is gathered by practices PPGs but it needs to be imbedded into the practice first. It would be measured better by outcomes, Walnut Tree have implemented signposting already and they have noticed that they have gained Clinical hours. Advise Healthwatch thatt this training is commencing. 10. Any Other Business EM/JWe are meeting with Milton Keynes Council regarding Section S 106 money as they retain the money rather than giving it to the CCG. There is money from Newton Leys where they will not be building a practice so would like to start discussions as to whether itt can be used it for workforce, training, development etc. Theree has been an indication from the Council that they are keen k for it too be used to ensure sustainability within primary care. EM to feed back at the next meeting. AF EM Future meetings - Committee agreed too monthly meetings onn a Wednesday afternoon but to ensure it does not clash with other external meetings m too allow a good attendance. Primary Care Committee Minutes 10 January 2018 FINAL V1.0 NHS Classifed Page 3 of 4

5 PCC18/01 Action Log 1. KO S to ensure resources for delegation is added as a standing agenda item 2. JW will chase the other 8 practices for the signed copies of their constitution 3. GPFV schemes that are complete need to be archived on the GPFV plan 4. Further work to be carried out for PMS reinvestment and Commissioning Intentions for 18/19 5. EM to incorporate PMS plus and enhanced services within the budgets 6. JW to provide a GPFV Highlight Report update at the next meeting 7. It was discussedd that an additional report could be produced for the PCC whichh includes further areas that are being worked on e.g. Commissioning Intentions. 8. Dr Nicola Smith will promote the Consultant Connect service at the next PLT but to also acknowledge the teething issues that are being addressed 9. HJ to provide the PCC visibility on this piece of work and advised of the use of these funds 10. HJ to catch up with Dr Nessan Carson and Edna Muraya as there will be a chance to bid next financial year for the workforce bid 11. Alexia Stenning to draft a letter to escalate the PCSE issues to NHSE 12. E-Consultationss - Janine to inform Alex that GPs need to be involved in the choice of provider 13. AF to update the committee with NHSE framework for e-consultation 14. E-Consultationss Update at the next meeting 15. Clinical Admin Training - Advise Healthwatch that this training is commencing 16. Section 106 meeting with the Council - Edna to feed back at the next meeting Date Outcome KO S 28/6/17 Completed JW 28/6/17 Completed KO S 28/6/17 Completed AS/JWe 28/6/17 Completed EM 28/6/17 Completed JWe 19/9/17 Completed AS/JWe 19/9/17 Completed NS 19/9/17 Completed HJ 19/9/17 Completed HJ 19/9/17 Completed AS 19/9/17 Completed JWe 10/01/18 AF 10/01/18 AF 10/01/18 AF 10/01/18 EM 10/01/18 Primary Care Committee Minutes 10 January 2018 FINAL V1.0 NHS Classifed Page P 4 of 4

6 PCC18/02 MKCCG Delegated Commissioning Finance Report December 2017 By Edna Muraya Senior Finance Manager

7 PCC18/02 DELEGATED COMMISSIONING FINANCE REPORT- DEC 2017 KEY MESSAGES ON THE BUDGET The budget for 17/18 for delegated commissioning is M. At Month 9 the budget was underspent by 524K and forecast to be underspend by 572K. This underspend partly relates to an uncommitted contingency reserve of 379K. This is phased equally in the budget with no actual spend currently forecast. In its 17/18 financial and operating plan the CCG held back 1.0% of its allocation to meet future Transformational costs. This totalled to 327K The areas that are underspending are: Global sum is underspent more year to date than the forecast due to the phasing of the plan as there are patient population growth is reflected in the last two quarters of the year. Minor surgery, rent and extended hours are lower than planned. We have received the updated claims from NHSE and adjusted the actual spend and forecast based on this latest data. MPIG underspend is growing as anticipated as it is being phased out and so are the seniority payments which are projected to be going down year on year.

8 PCC18/02 DELEGATED COMMISSIONING FINANCE REPORT-NOV 2017 (cont d) Business Rates expenditure was planned at 16/17 levels however post national rates rebate exercise are now being reflected in hence an underspend of 64K YTD and forecast at 86K. The areas that are overspending are as follows: Indemnity Insurance will overspend as its based on population size at 51.6p per patient. We are still awaiting direction from NHSE but this will be paid at the end of the financial year. The maternity and sickness payments are currently overspent based on the information we have and are awaiting NHSE to send the claims that have been put forward by practices. QOF achievement for 16/17 indicated an increase from the achievement level in 15/16 on which the 16/17 budget was based. Therefore a 140K YTD overspend exists and is forecast to overspend by 266K for the year

9 PCC18/02 Sum of YTD Budget Sum of YTD Actual Sum of YTD Variance Sum of Forecast Service Budget Variance APMS Contract APMS Contract 1,657,056 1,221,894 1,243,686 21,792 1,673,530 16,474 Sub total 1,657,056 1,221,894 1,243,686 21,792 1,673,530 16,474 Corp Other Indem Insurance 135, , ,507 10, ,676 13,472 Other Corp 95,872 71,904 47,110 24,794 15,642 80,230 Caretaking Fees 28,500 28,500 28, ,500 0 Sterile Services 32,060 24, ,045 47,172 15,112 Sub total 291, , ,117 38, ,990 51,646 EHS Extended Hrs 449, , ,773 54, ,030 72,693 Learning Dis 33,192 24,894 21,576 3,318 28,768 4,424 Minor Surg 357, , ,530 50, ,392 68,316 Violent Patients 54,000 40,500 40, ,000 0 Sub total 894, , , , , ,434 GMS Contract Global Sum 20,337,336 15,266,775 15,056, ,673 20,154, ,961 MPIG 254, , ,173 41, ,278 52,698 Sub total 20,592,312 15,458,007 15,206, ,731 20,356, ,659 PCO Mat Leave 152, , ,745 1, ,630 7,506 PCO Other 20,004 15, , ,004 Seniority 378, , ,369 20, ,159 27,369 sickness 50,064 37,548 63,149 25,601 70,084 20,020 Susp Drs Sub total 600, , ,263 8, ,872 19,847 PMS Contract FDR 944, , , ,091 3 PMS Reviews CCG 472, , , ,045 1 Sub total 1,416,132 1,062,099 1,062, ,416,136 4 Premises Actual rent 2,812,812 2,109,609 2,064,187 45,422 2,754,482 58,330 Clin Waste 188, , , ,397 3 Water 23,676 17,757 17, ,673 3 CQC Fees 0 104, , , ,650 PIG Rates 462, , ,530 64, ,707 85,640 Sub total 3,487,236 2,615,427 2,610,477 4,950 3,479,909 7,326 Presc/Disp Disp Presc 223, , , ,582 29,398 Sub total 223, , , ,582 29,398 QOF 0 ach 798, ,495 85,847 Asp 1,863,516 1,397,637 1,537, ,076 2,043, ,301 Sub total 2,662,164 1,397,637 1,537, ,076 2,928, ,148 Other Voluntary levy deductions Trade waste ,210 11,210 13,664 13,664 Sub total ,210 11,210 13,664 13,664 Total 31,825,859 23,270,408 23,031, ,400 31,632, ,020 Contingency , , ,152 Grand Total 32,205,011 23,554,772 23,031, ,564 31,632, ,172

10 PCC18/02 Other primary care budgets. Year to Date Month 09 Forecast Outturn Annual Plan Budget Actual Variance RAG Forecast Variance RAG % Rating % Rating GP Delegated Commissioning 32,205 23,555 23, % G 31, % G 1% Transformation Fund NHSE (GP Alloc) % G % G Local Enhanced Services 1,587 1, % G 1, % G PMS Plus Contract % G % G Support to GP Practices ( 3/head) % G % G GP Forward View 1, , % R 1, % R Commissioning Schemes for over 75s % G % G 111 Service % R % R Other Commissioning Schemes % G % G Urgent Care Contract 3,305 2,431 2, % G 3, % G TOTAL PRIMARY CARE 40,484 29,387 28,129 1, % G 38,511 1, % G Recommendations Primary Care Committee is asked to note the content of this finance report.

11 PCC 18/03 Subject: Meeting: Date of Meeting: Report of: GP Forward View (GPFV) Online Consultationss Primary Care Committee 6 February 2018 Alex Friend 1. SUMMARY The GPFV has identified funding for online consultations. This is ring fenced and is made available via the Department of Health. The fund is to be used towards the costss of providing patients with the facility to conduct a clinical consultation with their GP practice online. The fund will w cover a purchase cost associated with an annual licence for a hosted service on a per-patientp t basis. Funding will support the total project costs,, including towards the cost of services s orr software for online systems and to support the introduction of the new way of working, for example through backfill of staff time, engagement with patients or provision of o project management support. This fund will provide a significant contribution to the move towards providing new consultation types. Benefits will include improving access forr patients and making best use of clinicians time. The intention is to utilise a provider/it solution across the Bedford, Luton and Milton Keynes Sustainable Transformation Programme. 2. UPDATE The formal Funding Template was submitted to NHS England onn 8 December On Thursday 25 January Alex Friend received a call from the NHS England procurement team. They explained o The Dynamic Purchasing Solution (DPS) now has h 6 approved suppliers with in its framework. Of which one will be our STPss preferredd provider o To decide on a preferred provider the STP will be fully supported (with documentation and process advice) by NHS England o NHS England will support the STP as of this week with ann initial conference call scheduled for Tuesdayy 30 January Funding has now been released to individual CCGs Although the funding for the Project has been issued to t individual CCGs, it will be used to purchase the same Provider solution across the STP Pagee 1 of 2

12 PCC 18/03 There has been a very encouraging response for Phase 1 expressions of interest. o Milton Keynes CCG 8 practices o Bedford CCG 12 practices o Luton CCG 4 practices Stakeholder meetings have been ongoing. In particula there will now be a focus on the specification requirements. Work began on this in summer 2017 and this will be refined by working with the abovee practices (and Healthwatch) inn the coming weeks. Contract award to the preferred provider will be issuedd by 31 st March RECOMMENDATION The committee is kindly requested to read and comment on the t document as appropriate. Pagee 2 of 2