Primary Care Commissioning Committee (PCCC)

Transcription

1 Primary Care Commissioning Committee (PCCC) Meeting to be held at 11:00 on Thursday 29 th September 2016 in the Board Room, Sanger House, Brockworth, Gloucester GL3 4FE No. Item Lead Recommendation 1 Apologies for Absence Chair 2 Declarations of Interest Chair 3 Minutes of the Meeting held on 28 th July Chair Matters Arising Chair Approval 5 General Practice Forward View update HG For information 6 Delegated Primary Care Commissioning CL For Information Financial Report 7 Smaller Improvement Grant Proposals AH Approval 8 Primary Care Quality Report MAE For information 9 Any Other Business (AOB) Chair Date and time of next meeting: Thursday 24 th November 2016 at 11:00am in the Board Room at Sanger House A recording will be made of this meeting to assist with the preparation of the minutes. This recording will be made on an encrypted device owned by the CCG and will be held securely for a maximum of one week before being deleted

2 Primary Care Commissioning Committee Minutes of the Meeting held on Thursday 29 th July 2016 in the Board Room, Sanger House, Gloucester GL3 4FE Present: Alan Elkin AE Chair Marion Andrews-Evans MAE Executive Nurse and Quality Lead Colin Greaves CG Lay Member - Governance Cath Leech CL Chief Finance Officer Dr Andy Seymour AS Clinical Chair Mark Walkingshaw (part MW Deputy Accountable Officer meeting) In attendance: Helen Goodey HG Director of Primary Care and Locality Development Becky Parish BP Associate Director, Engagement and Experience Cllr Dorcas Binns DB Chair of the Health and Wellbeing Board Andrew Hughes AH Locality Implementation Manager Jeanette Giles JG Head of Primary Care Contracting Stephen Rudd SR Head of Locality and Primary Care Development Claire Feehily CF Chair of Healthwatch Gloucestershire Penny Fowler (part meeting) PF Health and Social Care Commissioning Manager Miriam Street (part meeting) MS Senior Commissioning Manager Alan Potter AP Associate Director of Corporate Governance Fazila Tagari FT Corporate Governance Support Officer There were 4 members of the public present. 1 Apologies for Absence 1.1 Apologies were received from Mary Hutton and Julie Clatworthy. 2 Declarations of Interest PCC Committee Minutes 26/05/16

3 AS declared the following f interests: general interest as a GP member; agenda item 7 as a GP provider for Learning/Physical Disability Communityy Enhanced Service; and agenda item 10 - General Practice Forward View Investment Plan. CF, as a Healthwatch representative declared a general interest in relation to any Patient Participation Group discussions. Minutes of the Meeting held on Thursday y 26 th May 2016 The minutes weree approved subject to the amendmea ents below: BPi to be amended to read CF in thee list of attendees.. Section to be amendedd to read BP provided an update on the engagement process and members noted that an engagement exercise on the draft Primary Care Strategy would commence following the feedback received at the meeting today. Section to be amendedd to read HG alsoo confirmed that the CCG had been engaging with ST3s (Speciality Trainee, 3 rd Year) in collaboration with the Deanery Matters Arising AI 5.8 Springbank Procurement Update HG confirmed that the nurse led paediatric model fromm Swindon had been received from NHS England. Item Closed Item Application to close branch surgeries in Hawkesbury Upton and Wickwar from Culverhay Surgery JG provided an update and advised that no complaints or negative comments had been received and that thee closures had provided an opportunity to release more appointments at the main surgery. It was also noted that t concerns had not been raisedd by patients in relation to patientt transport. Item Closed Item Stow Surgery new premisesp s development AH advised that the Valuee for Money reportt had not been completed as it had been recommended that the scheme was assessed by the PCC Committee Minutes 28/07/16 Page 2 of 12

4 Building Research Establishment Environmental Assessment Methodology (BREEAM) which was a national standard for assessing the sustainability of new construction developments. As a result of the national standard, the construction costs had increased by approximately 60K. AH advised that the District Valuer had indicatedd that the schemee represented significant Value for Money and that the final report should be available shortly Item Draft Primary Caree Strategy CF advised that feedback had been discussed with BP. Item Closed. Primary Care Strategy HG presented the draft Primary Care Strategy which was taken as read and provided the background context to developing the strategy. The earlier draftt Strategy had been previously presented at the May 2016 PCCC meeting. HG advised thatt this had been the first Primaryy Care Strategy developed for Glouceste ershire which was comprehensive and highlighted that a shortened version would be produced for the wider audience. SR provided an update on the changes that hadd been made to further develop the Strategy following the May meeting. These included: an improved patient focused section; the patient section entitled Listening to andd learning from patients experiences was featured earlier in the document; the most recently published national GP Patient Survey results (July 2016) ) and the Healthwatch Gloucestershire survey results; the vision and the components were more focused on how the Strategy would improve patient experience and / orr health outcomes; and a wider engagementt process. 5.4 SR advised that as part of the engagement process, three specific questions were asked. These were: PCC Committee Minutes 28/07/16 Page 3 of 12

5 Have we got the right vision? Have we got the right plan to deliver the vision? Have we got the expected outcomes right? 5.5 SR informed members of the feedback received to date and advised that the vision had been widely accepted by the stakeholders, i.e. providers, patient groups, parish councils etc. 5.6 SR advised that he had met with CF and had also included her feedback in the latest draft document. This included addressing health inequalities from the 30,000 place based model. SR also advised that CF had agreed to provide support with the development of the patient version document. 5.7 DBi suggested that statistics and graphs were included within Annex 3 (locality level demographics) and felt that a comparison should be undertaken on a like for like basis in order to distinguish between localities. HG 5.8 CG stated that he was interested in the format of the short guide and was advised that the process would link with the process that was currently underway to produce a short guide for the STP RESOLUTION: The Committee: recommended that the Governing Body approve the Strategy subject to the comments above; and agreed the proposed approach for a public-friendly short guide of the Strategy. 6 Delegated Primary Care Commissioning Financial Report 6.1 CL presented the report which outlined the financial position on delegated primary care co-commissioning budgets as at the end of June CL advised that the CCG had reported an underspend against delegated budgets as at the end of June and anticipated that the CCG would be forecasting a breakeven position for 2016/ RESOLUTION: The Committee noted the report. PCC Committee Minutes 28/07/16 Page 4 of 12

6 PF and MS joined the meeting at Learning/Physical Disability Community Enhanced Service 7.1 HG presented the report and provided a background context to the service. HG advised that the CCG had developed an enhanced service over two years ago for the care of older people in nursing and residential homes. The report was taken as read. 7.2 HG explained that the enhanced service had been developed comprehensively and that a QIPP requirement of reducing emergency admissions was included as part of the original specification. 7.3 HG advised that the original service specification did not include the service users with Learning Disabilities (LD) or Physical Disabilities (PD) and that the new service would improve the quality of care for LD/PD service users and provide equity for patients. 7.4 CG understood that the Cheltenham Locality had delivered a successful savings programme. PF advised that the CCG had been reviewing the data for emergency admissions which highlighted that there had been significant decreases in emergency admissions although there were variations by locality primarily accounted for by the number of care homes and the number of practices who had signed up to the service. 7.5 CF enquired of the scope of the intentions and if they covered ophthalmology, podiatry, dental, etc. requirements as these were often health associated issues. AS advised that this should be covered as part of core business. 7.6 CF felt that there was a risk that an opportunity might be missed for social integration for patients who may use the primary care services delivered at the GP practice as a social gain. AS advised that there should be a balance between the two and that patients could visit the practice if there were any health concerns as well as the GP visiting the care homes for assurance. 7.7 DB highlighted the criteria which stated that each resident should PCC Committee Minutes 28/07/16 Page 5 of 12

7 be assessed within two weeks of admission and queried if this was satisfactory and was advised that a fully comprehensive assessment would be undertaken. AS advised that any other requests would be addressed as appropriate. 7.8 MAE requested that the service supported screening services as it was well recognised that people with learning disabilities had significantly lower take-up of health checks, such as cancer screening services. 7.9 BP advised that her team visited the care homes to interview staff and service users as part of the evaluation process and noted that this would be extended to the LD/PD service as part of the overall evaluation process RESOLUTION: The Committee (MW joined the meeting for the vote, AS abstained from voting): considered the recommendation from the Primary Care Operational Group meeting of 19 th July 2016; and approved the Care Home Enhanced Service for Nursing Homes, Residential Homes and Supported Living for People with Learning Disabilities or Physical Disabilities. PF and MS left the meeting at Sevenposts: Bishops Cleeve premises development 8.1 AH presented the report and provided a background context to the development which was on a greenfield site north west of Bishop Cleeve. The report was taken as read. 8.2 AH advised that on completion of the new surgery, the two current surgeries would close (Sevenposts surgery and Greyholmes surgery) and all services would be provided from the new facility. 8.3 Members were informed that NHS England had approved the previous business case in August 2014 with a requirement that the patient transport issues were resolved and following confirmation by the District Valuer of a positive Value for Money judgement. 8.4 AH advised that the practice and their advisors had been liaising PCC Committee Minutes 28/07/16 Page 6 of 12

8 with the District Valuer and the CCG regarding financial elements, particularly around the impact of reduced land costs resulting from the Section 106 arrangements. It was reported that the District Valuer had now reviewed all elements of the financial appraisal and had confirmed Value for Money. 8.5 AH advised that the scheme would be assessed by the BREEAM approach as it exceeded 2m in value. It was noted that an excellent rating was being sought. However, this may not be achievable due to factors outside of the CCG s control i.e. transportation, land use and ecology reasons. AH assured members, that all, reasonable endeavours would be made to achieve the excellent rating and if this proved not be possible, that there would be robust evidence to reflect this. 8.6 DB enquired of the planning application process as she acknowledged that a planning application was being submitted in August DB queried if an outline planning application had been approved and if the scheme would be approved. AH advised that it would be difficult to speculate the outcome of this application and recognised that this was a potential risk associated with the development. AH also highlighted that there was a time limit associated with the Section 106 which stipulated that agreements should be in place by November 2016 and anticipated that the development should receive approval. 8.7 DB asked if there was a contingency plan in place if the scheme was not approved by the Planning Committee and was advised that this scheme was being submitted on behalf of the practices. Their views had not been sought on the way forward if the scheme did not proceed and if that were the case, that further discussions on the business strategy would be required. 8.8 AE queried if the Premises Strategy would be reviewed in particular ensuring that planning approval was in place for developments and was advised that site identification and securing premises was a key risk as part of the Primary Care Infrastructure Plan in terms of securing value for money. AH also advised that he was working closely with the local authorities to ensure that there was a collaborative approach. 8.9 CG highlighted that the scheme had generated a great deal of PCC Committee Minutes 28/07/16 Page 7 of 12

9 public concern and media interest and recommended that Anthony Dallimore was involved in the communication process BP advised that there had been concerns raised by the Prestbury residents and that the CCG had undertaken regular communication with the stakeholders which included providing regular briefings and travel information. It was also noted that CCG managers have agreed to attend Parish Council meetings AE enquired of the concerns that had been raised by residents and was advised that the distance from home was the primary concern for the Prestbury residents. BP informed members that Georgina Smith had undertaken a transport evaluation which highlighted that there were adequate public transport infrastructures in place although it was recognised that this may not be the preferred option for older and frail patients. BP advised that there was a further development in Cheltenham which could provide an alternative option for patients rather than travel to the new premises. The Committee agreed that trying to ensure continuity of care for patients was an important issue HG proposed that a training session was arranged for the Committee to provide further information on premises development and to support effective decision making. The Committee agreed that this would be useful AH suggested that a regular progress report was presented to the Committee on a quarterly basis to update members on premises. HG / AH AH 8.14 RESOLUTION: The Committee approved the scheme in principle and agreed the financial implications outlined with the report subject to the District Valuer s Value for Money conclusion. 9 Primary Care Quality Report 9.1 MAE presented the Primary Care Quality Report which provided assurance to the Committee that quality and patient safety issues were given the appropriate priority and that there were clear actions to address them. The report was taken as read. PCC Committee Minutes 28/07/16 Page 8 of 12

10 9.2 MAE advised that the Primary Care Clinical Quality Review Group had been cancelled and that there had been issues with insufficient GP representations at this meeting. 9.3 Members noted that the responsibility for complaints and concerns in relation to primary care still remained with NHS England. It was noted that the NHS England national complaints team were developing an approach which would allow some information to be shared with CCGs. 9.4 MAE advised that the Named GP for Safeguarding Adults and Children had now commenced her role and was already busy in her area of work. 9.5 MAE updated members on the Friends and Family Test (FFT) results for primary care and noted that the response rates were low, which was in line with other areas nationally. MAE advised that work was ongoing to improve response rates. 9.6 It was noted that the CCG had established the Gloucestershire Patient Participation Group (PPG) Network. It was also noted that over 90% of practices had established a PPG. 9.7 MAE updated members on the Care Quality Commission (CQC) inspections of Gloucestershire practices and noted that the dashboard of published CQC inspections reports was summarised in Appendix 1 of the report. MAE understood that there had been two practices that required improvement and assured members that there were no patient safety issues raised. 9.8 Members were informed that the CCG achieved all three improved antibiotic prescribing Quality Premium targets for 2015/16 although it was recognised that there was further work to undertake on antibiotic prescribing. In order to support this work, a Medicines Optimisation Programme Group had been established and the appointment of an Independent GP Prescribing support. 9.9 CF stated that the mechanisms in place to capture feedback from the public in relation to primary care services should be strengthened. MAE concurred and advised that there were other methods of collecting information and noted that the report was PCC Committee Minutes 28/07/16 Page 9 of 12

11 being developed further to include this information CG expressed concerns regarding the relaxation of the CQC inspection regime and felt that standards could fall which would place a greater emphasis on the CCG to review its monitoring arrangements in order to seek assurance. MAE concurred and reminded members that as commissioners, the CCG had a legal obligation to seek assurance on quality arrangements HG advised that a data review exercise would be undertaken by the CCG in order to triangulate all the information held for practices and correlating this with information held by the CQC DB suggested if the practices could identify best practice which could be shared with other practices who were awaiting inspections. AS suggested that a guidance document was established which could be shared with practices HG advised that a buddying approach had proven to be successful for practices and that Bronwyn Barnes was developing this into a model RESOLUTION: The Committee noted the report. 10 General Practice Forward View Investment Plan 10.1 HG presented the report which provided an update on the response to the General Practice Forward View and supported the 30,000 place-based model HG advised that the General Practice Forward View sets out a range of investments in primary care and makes a commitment that CCGs would provide 171 million of practice transformational support. MW joined the meeting at HG stated that the General Practice Forward View reflected the ambitions of the Sustainability and Transformation Plan (STP) and the Five Year Forward View in terms of developing a practice resilience program. HG articulated that this did not suggest practice PCC Committee Minutes 28/07/16 Page 10 of 12

12 mergers and primarily related to supporting a collaborative and integrated work approach i.e. sharing workforce and administrative functions HG advised that all practices were invited to collaborate into groups, or clusters, with a total registered list size of 30,000 patients or more to develop an expression of interest for innovative, transformative ideas that improved patient outcomes along with the sustainability of primary care and the wider Gloucestershire health economy HG explained that 15 clusters had been established by the 81 practices converging and bringing their localities to form the clusters which was outlined in Page 2 of the report. HG highlighted that these were not contractual clusters but practices working together at scale which had geographical or demographical alignment HG advised that that 14 bids had been received which could be categorised into the following themes. These were: clinical pharmacists in primary care; urgent care; and frailty provision HG advised that mental health also feature as part of the proposed scheme for Gloucester and that the focus was to keep patients at home, improve quality and safety and as a result reduce spend across the healthcare system CG highlighted that one cluster had yet to submit a bid and queried if the funding value took account of this. HG confirmed that this was covered within the funding allocation RESOLUTION: The Committee noted the report 11 Any Other Business 11.1 AS informed members on the Gloucestershire CCG Annual Assurance 2015/16 and reported that Gloucestershire CCG was rated as good overall and that the delegated commissioning PCC Committee Minutes 28/07/16 Page 11 of 12

13 component was rated as outstanding. Members noted that Gloucestershire CCG was the only CCG in the country to receive outstanding for delegated commissioning. The Committee congratulated the CCG and the Primary Care Team for this achievement. 12 The meeting closed at 12: Date and Time of next meeting: Thursday 29 th September 2016 in the Board Room at Sanger House. Minutes Approved by Gloucestershire Clinical Commissioning Group Primary Care Commissioning Committee: Signed (Chair): Date: PCC Committee Minutes 28/07/16 Page 12 of 12

14 Matters arising from previous Primary Care Commissioning Committee Meetings July 2016 Item 28/01/2016 Item /05/2016 Item /07/2016 Item /07/2016 Item 8.12 Description Any Other Business Minutes of the Meeting held on Thursday 31st March 2016 Primary Care Strategy Sevenposts: Bishops Cleeve premisess development Response CG suggested that a self-assessms ent was undertaken to reflect on the role as a Committee in order to improve on processes and identify areas for development where further training was required CG highlighted section relating to the Stow Surgery new premises development and enquired if the Value for Money Report from the District Valuer had been received. HG agreed that she would confirm this with Andrew Hughes. 28/07/2016 Item to remain open as the Value for Money report had not been received as the scheme was being assessed by the BREEAM approach. DBi suggested that statistics and graphs were included within Annex 3 (locality level demographics) and felt that a comparison should be undertaken on a like for like basis in order to distinguish between localities. HG proposed that a training session was arranged for the Committee to provide further information on premises development and to support s effective decision making. The Committee agreed that this would be useful. Action with AE HG HG HG/Andrew Hughes Page 1 of 2

15 28/07/2016 Item 8.13 Sevenposts: Bishops Cleeve premisess development AH suggested that a regular progress report was presented to the Committee on a quarterly basiss to update members on premises Andrew Hughes Page 2 of 2

16 Working together at scale: General Practice Forward View

17 History of GPFV

18 History of GPFV Oct 14: Five Year Forward View (FYFV) set out a new roadmap for the NHS, with primary care placed front and centre: The foundation of NHS care will remain list based primary care The FYFV points out that England is too diverse for one care model; instead models such as Multispeciality Community Providers (MCP) and Primary and Acute Care Systems (PACS) should be pursued. Dec 15: Delivering the Forward View: NHS planning guidance 2016/ /21. In addition to the mention of a new GP voluntary contract for 2017: Five year Sustainability and Transformation Plan by June 2016; New Care Models to cover 50% of population by 2020 Improved access weekends and evenings: 20% by 16/17; 100% by 2020 Urgent care integration and redesign of 111, MIU, UCCs and OOHs Emphasis on place based planning and integrated care Deliver triple aim to close gaps in: health & wellbeing; finance & efficiency; care & quality; Much greater use of technology 3

19 History of GPFV Apr 16: General Practice Forward View. Set out a range of measures: Investing an additional 2.4 billion a year by 2020/21; A further 0.5 billion of non recurrent STP investment; A practice resilience programme; Increased use of technology; Supporting new models of care; A range of workforce measures, including: Double growth rate of workforce Support for doctors suffering burnout Practice nurse development and return to work Practice manager development New roles: clinical pharmacists, physician assistants, mental health workers Announces a risk based approach to Care Quality Commission (CQC) inspections Describes new legal requirements for hospitals that reduce workload on practices

20 At a glance: NHSE announcements 28/7 1. Practice Resilience Programme: 40m fund to support struggling practices; first 16m in 2016/17 2. General Practice Development Programme: First phase of 96m announced, with aim to give every practice training and development opportunities 3. MCP care model framework: Proposals for how new multi year voluntary contract will work with whole population budgets

21 1. General Practice Resilience Programme

22 General Practice Resilience Programme Menu of support available (in addition to Vulnerable Practice Prog): Diagnostic assessment to quickly identify areas for improvement Specialist advice and guidance which could be operational, HR, IT, finance etc, for example to take forward merger / federation etc Coaching / Supervision / Mentorship as appropriate to need Practice management capacity support e.g. covering LT absence Practices at risk of closure Delivering rapid support, e.g. additional clinical capacity needs due to sudden critical vacancies or poor CQC Workforce issues e.g. creating pool of portfolio GPs; supporting with additional clinical capacity; workforce planning etc Change management Providing dedicated project management support to develop and implement proposals, e.g. for working at scale

23 General Practice Resilience Programme Key milestones By 19 August: NHSE local teams to share proposals with partners of how they will deliver. By 23 September: NHSE local teams to confirm centrally how they are delivering. By 30 September: NHSE local teams to confirm centrally which practices selected to receive support in 16/17. MoUs to follow. By 14 October: Practices in urgent need not receiving support via VPP will need to have begun to receive support (this could include Section 96 funding ahead of other delivery arrangements). By 30 December: NHSE to submit centrally evidence of spend or that they ve fully committed expenditure

24 2. General Practice Development Programme

25 General Practice Development Programme Three components of 96m funding: 45m to support training of reception and clerical staff for navigation of patients and handling clinical paperwork to free up GP time 45m to support uptake of online consultation systems 6m practice manager development Aim: Free up time Time for Care Lay foundations for new models of integrated care

26 General Practice Development Programme Menu of support: Releasing time for care national resources and expertise to help groups of practices plan their own programme Building capability for improvement free training and coaching in improvement science and leading change Training for reception and clerical staff funding via CCGs for active signposting and managing more correspondence Practice manager development Networking and peer topeer support Online consultation systems funding via CCGs to fund practice costs of installing online consultation systems

27 3. MCP Care Model Framework

28 MCP Care Model Framework Multi speciality community provider (MCP): a population based new care model for the physical, mental and social, health and wellbeing of a local population centred around the general practice registered list of circa 100k+. Aim: to provide joined up, place based care for patients. MCP Framework published 28 July for feedback, set out proposals for how the voluntary contract will work (see next slide) the MCP dissolves the divides

29 MCP Care Model Framework MCP end state once fully mature: Responsibility for improving health of the MCP whole population and tackling health inequalities, through a single, whole population based budget for all the services it provides, including primary medical services However, it is recognised there are incremental stages in reaching this point that may take several years A big reason to develop an MCP is to provide practical help to sustain general practice right now NHS England.

30 MCP Stages of Development GPs working at scale Alliance arrangement Partially integrated Fully integrated c. 30,000+ Virtual MCP Partial MCP Full MCP Allows coordination of some services either loose or formal (merger / federation) arrangement. Basis of starting to work differently, such as improved access, shared clinical pharmacists etc Establish a shared vision between providers without contractual changes. Requires clear governance and risksharing, along with details of how services will be delivered. MCP contract procured by commissioner. Contract holder responsible for all non primary care services but must integrate with general practice. Could be a new organisation or an existing one takes lead role across system. Single provider taking on whole population budget under a single MCP contract procured by commissioner, inclusive of primary care services.

31 MCP Contract NHSE developing outline contract of partial and full models; both voluntary. Streamlined version of NHS standard contract; for 10 or 15 years. Will consist of (i) local requirements, (ii) national expectations, (iii) mandated elements. Commissioners to scope services and finalise a service specification. Payment will consist of: i. Whole population budget for range of services covered ii. iii. Performance element replacing QOF and CQUINs Gain/risk share for acute activity Could be a CIC, a limited company, a partnership, or a statutory NHS provider. Must be integrated primary and community based care. Must be procured in transparent and fair way

32 MCPs Support from NHSE New national care models funding stream invitations linked to STPs in autumn. Looking for narrow and deep rather than wide and shallow, i.e. specific communities (of say 30,000 50,000 patients) instead of whole CCG or STP footprints. NHSE will then prioritise based on a RoI that is consistent with STP financial assumptions; delivering demand moderation and provider efficiency.

33 MCPs What is success? Transformation of care: prevention, enabling active communities, accessible and responsive urgent care, reducing demand; Use of technology: harnessing digital in back office and directly in patient care Workforce:empowers staff to work in different ways, create new MDTs, redesigning jobs to be rewarding and sustainable, implementing new professional roles.

34 MCPs Commissioner role Consult Decide on scope including risk/gain share arrangements Develop the service specification and budget Advertise through a prior information notice (PIN) in the OJEU; encourage prospective bidders to engage with GPs Develop selection process using agreed selection criteria and an open process Publish contract award NOTE: GPs do not have preferred provider status. However, they do not lose their right to provide against their will.

35 NHSE MCP Contract Timescales 2 September 2016: Engagement on draft framework closed By end September 2016: Draft MCP Contract available January 2017: Final MCP Contract available 2017/18: Contract ready for use

36 Our Response to the General Practice Forward View Focus on Primary Care at Scale

37 Primary Care Strategy GCCG developed Primary Care Strategy Initially a stated intention of delegated commissioning responsibilities Our strategic intent for implementation of the General Practice Forward View

38 GP Locality Provider Leads GP Provider Leads for all seven localities Developmental Networking and sharing New Models of Care Board representatives of their localities Locality Cheltenham Forest of Dean Gloucester City GP Lead Dr Jim Pascoe Watson Dr Sophia Sandford Dr Joan Nash North Cotswolds Dr Hywel Furn Davies South Cotswolds Dr Stephen Jenkins Stroud and Dr Andrew Sampson Berkeley Vale Tewkesbury, Dr Jeremy Welch Newent and Staunton

39 Sustainability and Transformation Collaborative bids sought in c.30,000 units; Seeking innovative bids to support sustained change; Focus on delivery of General Practice Forward View; 15 clusters formed across the county; Only 2/81 practices not yet within a collaborative, resulting in 98% of our registered patients being within identified clusters

40 Practice collaborations Locality Cheltenham (three clusters, circa 50,000 patients each) Forest of Dean (60,000) Gloucester City (four clusters, 30,000 52,000) North Cotswolds (29,000) South Cotswolds (58,000) Stroud and Berkeley Vale (four clusters, 18,000 39,000) Tewkesbury, Newent and Staunton (43,000) Collaborations St Pauls Corinthian, Portland, Royal Well, St.Catherine s, St.George s Central Berkeley Place, Crescent Bakery, Overton Park, Royal Crescent, Springbank, Underwood, Yorkleigh Peripheral Leckhampton, Sixways, Seven Posts, Stoke Rd, Winchcombe All eleven practices in one cluster Rosebank and Hadwen Bartongate, Gloucester City Health Centre, Partners in Health, Kingsholm Brockworth, Cheltenham Road, Churchdown, College Yard, Hucclecote, Longlevens Barnwood, London, Heathville, Saintbridge All five practices in one cluster All eight practices in one cluster Cluster 1: Acorn, Cam & Uley, Chipping, Culverhay, Marybrook, Walnut Tree Cluster 2: Beeches Green, Locking Hill, Rowcroft, Stroud Valleys Cluster 3: Frampton, High Street, Regent Street, Stonehouse Cluster 4: Frithwood, Michinhampton, Painswick, Prices Mill All four practices in one cluster

41 Primary Care Bids Locality Cheltenham Expressions of interest themes Central (c.53,000) and Peripheral (c.51,000) Clusters Pharmacists: Utilising clinical pharmacists to support primary care St Pauls (c.50,000) Urgent home visiting service proposal, shared across practices, utilising new primary care role such as an ENP. Forest of Dean (60,000) Gloucester City Pharmacists: Utilising clinical pharmacists to support primary care Rosebank and Hadwen (c.41,000) Clinical navigation: Mental health nurse and clinical pharmacist Bartongate, Gloucester City Health, Partners in Health, Kingsholm (c.36,000) Pharmacists: Utilising clinical pharmacists to support primary care B worth, Chelt Rd, Churchdown, College Yd, Hucclecote, L levens (c.52,000) Frailty: Creating a service to help manage frail patients at home Barnwood, London, Heathville, Saintbridge (c. 30,000) Pharmacists: Utilising clinical pharmacists to support primary care

42 Primary Care Bids Locality North Cotswolds (29,000) South Cotswolds (58,000) Stroud and Berkeley Vale Expressions of interest themes Urgent Care: Utilise funding to support integrated urgent care hub with GCS in MIIU, separating urgent and routine, with a paramedic visiting service Frailty+: Additional support to the Frailty project, for example a Clinical Pharmacist to address polypharmacy Cluster 1 (c.39,000): Pharmacy hub: Handling all medication requests as a shared back office function across the cluster Cluster 2 (c.35,000): No bid as yet Cluster 3 (c.18,000): Pharmacists: Utilising clinical pharmacists to support primary care Cluster 4 (c.28,000): Pharmacists: Utilising clinical pharmacists to support primary care Tewkesbury, Newent and Staunton (43,000) Urgent Care: Create an integrated urgent care hub with GCS, separating urgent and routine, with a visiting service and specialised reception team

43 General Practice Resilience Working with LMC Contacted all practices 30 August Responses back by 12 September Work with LMC and NHSE to prioritise those who need most urgent support to ensure they receive it in October support can range from urgent actions following CQC to support for merger / federation.

44 Work Programme Governance All elements of programme are being developed into a Programme Plan Will be delivered through the Primary Care Operational Group Primary Care at Scale will report to NMOCB Overall programme will report to the Primary Care Commissioning Committee and be accountable to the GCCG Governing Body

45 Any Questions?

46 Agenda Item 6 Primary Care Commissioning Committee Meeting Date Thursday 29 th September 2016 Title Delegated Primary Care Commissioning financial report as at 31 st August 2016 Executive Summary At the end of August 2016, the CCG s delegated primary care co-commissioning budgets reported an underspend of 75k and a breakeven forecast. Risk Issues: None Original Risk Residual Risk Financial Impact The current position and forecast has been wholly assumed within the CCG s overall financial position. Legal Issues (including None NHS Constitution) Impact on Health None Inequalities Impact on Equality and None Diversity Impact on Sustainable None Development Patient and Public None Involvement Recommendation The PCCC are asked to: note the contents of the paper. Author Andrew Beard Designation Deputy Chief Financial Officer Sponsoring Director (if not author) Cath Leech Chief Financial Officer Page 1 of 3

47 Primary Care Commissioning Committee 29 th September 2016 Delegated Primary Care Commissioning financial report as at 31 st August Introduction 1.1 This paper outlines the financial position on delegated primary care co-commissioning budgets at the end of August Financial Position The CCG reported an underspend of 75k against delegated budgets at the end of August (see table below). This represents an improvement to the position reported in July; representing an increased underspend of 25k. At this stage, the CCG is forecasting a breakeven position for 2016/17 as there are future risks to this position, these include the impact of changes to rents by NHSPS. The reasons for the year to date variance are: Underspends on Other General Supplies & Services; Underspends on the Doctors Retainer Scheme and Locum Maternity where a budget was estimated for a larger number of GPs than has been paid for to date; an underspend against the 2015/16 QoF estimate has been reported previously but it is assumed that this may be utilised fully in the current year. 3 Recommendation(s) 3.1 The PCCC are asked to: Note the contents of the paper Page 2 of 3

48 Gloucestershire CCG 2016/17 Delegated Primary Care Co Commissioning budget 2016/17 Total Budget August 2016 Year to Date Budget Year to Date Actual Year to Date Variance In Month In Month In Month Area Budget Actual Variance SPEND Contract payments GMS 46,747,154 3,895,535 3,895,535 19,477,745 19,477,745 Contract payments PMS 3,356, , ,674 1,398,377 1,398,377 Contract payments APMS 1,379, , , , ,792 Enhanced Services 4,216, , ,206 1,756,198 1,756,198 Other GP Services 2,174, , ,830 (25,000) 914, ,779 (75,000) Premises 8,147, , ,794 3,394,142 3,394,142 Dispensing/Prescribing 3,125, , ,991 1,140,648 1,140,648 QOF 8,198, , ,159 3,415,880 3,415,880 Forecast Variance TOTAL 77,345,155 6,417,147 6,392,147 (25,000) 32,072,561 31,997,561 (75,000) 0 FUNDING Allocation (revised) 78,523,000 Less : nationally mandated adjustements 1% headroom (785,230) 0.5% contingency (392,615) 77,345,155 SURPLUS/DEFICIT 0 Global Sum (GMS contract payments) has now been published and represents a 5.33% increase on 2015/16 Global sum per weighted patient moves from to in April 2016 Other GP Services includes: Legal & professional fees Seniority Doctors retainer scheme Locum/adoption/maternity/paternity payments Other general supplies & services Page 3 of 3

49 Primary Care Commissioning Committee Agenda Item 7 Meeting Date Thursday 29 th September 2016 Title 2016/17 Smaller Improvement Grant (IG) Proposals Executive Summary The CCG recognises that there is an ongoing need for minor capital grants to make improvements to primary care premises. Previously, the vehicle for this was Improvement Grants (IGs) as defined in the 2013 Premises Cost Directions. IGs are for minor capital works and are designed to meet capital schemes with a value of between 5,000 and 500,000, including any non-recoverable VAT. Commissioning organisations can provide between 33% to 66% contribution Through NHS England, the CCG is in the process of finalising a small devolved fund of 242k to help practices make improvements to their existing buildings. All practices were given the opportunity to apply for a smaller IG in March 2016 and the invitation letter is attached at appendix 1. A number of applications were received. Risk Issues Financial Impact It is proposed that the CCG would support as many small schemes as possible. In order to do this, the level of funding contribution would be no higher than 33% of total costs including Appendix 2 provides a summary of the proposals received to date including total estimated project costs and the proposed CCG contribution. The key risk regarding this proposal is that some practices will defer/cancel necessary premises improvements that could impact on patient care and CQC/regulatory compliance. In 2016, NHSE asked CCGs to apply for additional Page 1 of 5

50 Legal premises related funding and Gloucestershire requested 242k. The CCGs awaiting confirmation of the 242k from NHS England. If agreed there is no additional cost pressure to the CCG. Without this funding, the proposals will not be able to be funded. The CCG will need to apply NHS Premises Costs Directions to rights and responsibilities of the practices and the CCG. Impact on Health Inequalities Impact on Equality and Diversity Impact on Sustainable Development Patient and Public Involvement Recommendation In terms of the NHS Constitution the author considers You have the right to expect your NHS to assess the health requirements of your community and to commission and put in place the services to meet those needs as considered necessary and You have the right to be cared for in a clean, safe, secure and suitable environment as the most pertinent NHS Constitution rights applicable to this scheme. No health inequalities assessment has been completed for this report. No assessment has been completed for this report As these are small scale IG projects then Building Research Establishment Environmental Assessment Method (BREEAM) is not a factor. However, all works will need to be carried out by suitably accredited/qualified contractors and on completion all CCG approved works will be inspected by the District Valuer on behalf of the CCG. It is assumed that practices will inform and engage with their Patient Participation Group. The PCCC is asked to consider the contents of this report and: agree the approach described in this paper; approve the individual proposals and the proposed level of funding for each proposal; and note that approval is subject to the CCG obtaining funding from NHSE. Authors Andrew Hughes and Declan McLaughlin Designation Locality Implementation Manager/Primary Care Project Support Manager Sponsoring Director Helen Goodey Director of Locality Development and Primary Care Page 2 of 5

51 1 Introduction, Background and Context Following previous discussion and delegated sign off to the Chair of the Committee and the Accountable Officer, the PCCC approved a number of premises and IT bids to the 2016/17 Estates and Technology Transformation Fund (ETTF), which were successfully submitted by the national deadline of 30 th June The ETTF is primarily a potential funding vehicle for larger premises/it projects as the emphasis is on truly transformational type projects that support NHS England s (NHSE) GP Forward View. The CCG also recognises that there is an ongoing need for minor capital grants to make improvements to primary care premises. Previously, the vehicle for this was Improvement Grants (IGs) as defined in the 2013 Premises Cost Directions. The key objective for using these capital funds is to make improvements to primary care premises which deliver a direct benefit to patients, e.g. increasing capacity, improving access to services or enabling practices to comply with national standards, e.g. Care Quality Commission. IGs are for minor capital works and are designed to meet capital schemes with a value of between 5,000 and 500,000, including any non-recoverable VAT and commissioning organisations can provide between 33% to 66% contribution. Apart from the ETTF there is currently no national funding available for improvements to existing primary care premises. Through NHS England, the CCG is in the process of finalising a small fund of 242k to help practices make improvements to their existing buildings. Although, the proposal is to provide CCG funding for smaller IG type projects, it would make sense to adhere as far as possible to NHSE improvement grant processes. Page 3 of 5

52 It should also be noted that all practices were given the opportunity to apply for a smaller IG, please refer to Appendix 1 which is a letter sent by the CCG in March 2016 inviting bids from practices where the practice is not currently engaging in or recently completed a capital improvement project. Smaller improvement grant proposal Appendix 2 sets out proposals received to date including a brief summary and total estimated project costs/ccg contribution. The proposal is that the CCG would seek to support as many small schemes as possible. Subject to the approach being agreed, funding would be no more than 1/3 rd of total project, including non-recoverable VAT. It should be noted that the CCG had discussions with some practices about how this might operate, including obtaining initial funding applications Financial issues In 2016, NHSE asked CCGs to apply for additional premises related funding and Gloucestershire requested 242k. The CCG s Finance Team are awaiting confirmation of the 242k from NHS England. The proposal is predicated on this funding being confirmed. It is also recognised that for some projects it may not be possible to complete the project within this financial year. In such situations it may be necessary to roll over agreed funding over the following financial year. CCG Finance will need to confirm accounting rules. There is not expected to be any significant impact on Revenue Costs, e.g. rent reimbursement, as a result of these works. On completion, all CCG approved works will be inspected by the District Valuer on behalf of the CCG. If applicable the Abatements rules will be applied as set out in the current NHS Premises Costs Directions. Page 4 of 5

53 3.4 It should also be noted that the estimated contribution from the CCG is at present significantly less than the budget available, circa 60k. 4 Recommendation 4.1 The PCCC is asked to consider the contents of this report and: - agree the approach described in this paper; approve the individual proposals and the proposed level of funding for each proposal; and note that approval is subject to the CCG obtaining funding from NHSE. 5. Appendices Appendix 1 Invitiation letter Appendix 2 - NHS Gloucestershire 2016/ 2017 Smaller Improvement grant proposals Page 5 of 5

54 Sent by to all Practice Managers in Gloucestershire 2 nd March 2016 Sanger House 5220 Valiant Court Gloucester Business Park Brockworth Gloucester GL3 4FE Tel: andrew.hughes8@nhs.net Dear colleague Re: Invitation for Smaller Applications to the 2016/17 Primary Care Transformation Fund (Formerly Primary Care Infrastructure Fund) You may know that before Christmas 2015, I attended Locality meetings across Gloucestershire explaining the CCG s emerging Primary Care Infrastructure Plan (PCIP) that was referenced in the 10 th December 2015 edition of What s new this week. I have enclosed the latest version of the PCIP that I aim to have finally signed by the CCG Primary Care Committee and Governing Body at the end of March Part of the CCG s PCIP was to identify key priorities across Gloucestershire that entail major capital projects. The CCG has already begun the process of working with the identified practices to develop plans. However, the CCG is also aware that there may be a number of smaller scale developments that, if approved, could increase capacity and quality of care to patients. As many of you are aware, there is a national fund of around 750m managed by NHS England to support premises as well as technology developments called the Primary care Transformation Fund (previously the Primary care Infrastructure Fund). This will be the main source of funding for such proposals. It should be noted that the CCG coordinates and recommends applications to NHS England for appraisal Therefore, we are now inviting all practices that are not specifically identified in the CCG s emerging PCIP to consider its own premises and assess any particular small scale needs where the practice is not currently engaging in or has recently completed a capital improvement project. This will include but is not limited to any practice that submitted a 2015/16 application to the Primary Care Infrastructure Fund, some of which may be carried over to 2016/17. It is also expected that any grant award would be no lower than 33% of total costs and no higher than a maximum of 67% of total costs. Although NHS England has not released the application process and documentation, the deadline for submission of applications is at present set for the end of April 2016, which is fast approaching. It is for that reason that the CCG is asking you to use the structure of the attached Improvement Grant Expressions of Interest Form to help formulate your thoughts and set out your key requirements.

55 In completing the documentation you should note that NHSE has provided the following key criteria to be used in assessing applications. There will probably be 4 main criteria and all applications irrespective of size must support at least one, the main criteria at present are: Enabling 7 day access to effective care; Increased capacity of clinical services out of hospital; Increased training capacity; Enabling access to wider services as set out in commissioning intentions to reduce unplanned admissions to hospital l would also like to draw your attention to following additional key national criteria that is also likely to form part of the assessment of applications: - There is a clear, identified need and the proposal is consistent with the CCG Local Estates Plan; The proposal needs to be flexible to changing healthcare delivery patterns; The proposal has had appropriate patient involvement and engagement; The proposal is deliverable within financial years 2016 to 2019; Hopefully this letter provides the information you need and the application form is self - explanatory. However, should you require further help, or clarification on any matter, please do not hesitate to contact me via the address, or telephone number included in this letter. In the meantime I look forward to receiving expressions of interest in due course and ask they are submitted by the close of play on Friday 8 th April Yours sincerely Andrew Hughes Locality Implementation Manager Cc: Helen Goodey Director Locality Development and Primary Care Andrew Beard, Deputy Chief Financial Officer Cherri Webb - Primary Care Development & Engagement Manager Declan McLaughlin - Primary Care Project Support Manager Enclosed: Draft Primary Care Infrastructure Plan 2016/ 2021 version 4 IG Blank 1 form