PRIMARY CARE COMMISSIONING COMMITTEE PUBLIC AGENDA

Transcription

1 PRIMARY CARE COMMISSIONING COMMITTEE HELD IN PUBLIC SESSION ON FRIDAY 15 DECEMBER :00pm 3:00pm THE BOARD ROOM, 3 RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which: one must be either the Chair or Vice-Chair of the Committee one must be the Chief Finance Officer/Deputy Chief Finance Officer or Chief Nursing Officer PUBLIC AGENDA Time Item Attachment Presented by 1.00 pm 1 Apologies Mr S Wellings Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item pm This meeting is being held in public and is being recorded purely to assist in the accurate production of minutes, decisions and Mr S Wellings actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded pm 3 Questions from the Public Mr S Wellings 1.05 pm 4 Minutes of last meeting held on Friday 17 November 2015 Enclosed Mr S Wellings 1.10 pm 5 Matters Arising/Action Log Enclosed Mr S Wellings 1.20 pm 6 Report from the Primary Care Operational Group Enclosed Mrs J Robinson 1:30 pm 7 Risk Register Enclosed Mrs C Brunt 1:50 pm 8 GP IT Systems - Best Practice Review Enclosed Mr R Corner 2:05pm 9 Value Proposition Funding Review Enclosed Mr G Griffiths- Dale 2:20pm 10 Report from the Quality and Safety Team 2:30pm 11 Update from The Primary Care Strategy Group GPFV work programme Enclosed Enclosed Mrs C Brunt Mrs J Taylor 2:40pm 12 Finance Report Enclosed Mr P Cowley 2:50pm 13 Primary Care Commissioning Committee Work Plan 17/18 Enclosed Mrs J Robinson Date and Time of Next Meeting Friday 26 January pm 3pm Venue to be confirmed 1 P age

2 Title First Name Surname Job Title Declarations of Interest Mrs Caroline Brunt Chief Nurse None Mr Philip Cowley Mrs Jayne Emery Senior Finance Manager Primary Care Chief Officer of Dudley Healthwatch Partner works for Central Midlands CSU None Dr Christopher Handy Lay Member for Quality & Safety Chief Executive, Accord Group Visiting Professor at Birmingham City University Board Member of: - Black Country LEP Board - Matrix - Redditch Co-operative Homes - Black Country Consortium - Birmingham Chamber of Commerce - Walsall Housing Regeneration Agency - Direct Health Mr Matthew Hartland Dr Tim Horsburgh Mrs Julie Jasper Ms Teresa Jeavons Mr Daniel King Dr Vippin Mittal Chief Operating & Finance Officer Clinical Executive for Primary Care & LMC Representative Lay Member Patient & Public Involvement Primary Care Contracts Support Officer Director of Membership Development & Primary Care GP Representative at Primary Care Commissioning Committee Director of Dudley Infracare Lift LTD Director of Whitbrook Management Company Member of Chartered Institute of Public Finance and Accountancy Interim Strategic Chief Finance Officer, Walsall CCG Interim Strategic Chief Finance Officer, Wolverhampton CCG Sessional GP - Netherton Health Centre. Member of the Local Medical Committee Clinical Lead for Partners in Paediatrics Lay Member - Sandwell and West Birmingham CCG Managing Director of Westland s Associates Ltd Member of CIPFA None None GP at Crestfield Surgery Membership MDU Membership GMC Mrs Anna Nicholls Senior Contract Manager - NHS England None

3 Dr David Pitches Mrs Julie Robinson Mr David Stenson Public Health Representative - Primary Care Commissioning Committee Primary Care Contracts Manager Patient Opportunity Panel Representative Primary Care Commissioning Committee Member at Dudley CCG Consultant in Public Health Medicine, Dudley MBC Wife is a Consultant Obstetrician at Heart of England Foundation Trust Occasional Church organist fees received for giving recitals or playing for services None Non-Executive Director _ Black Country Partnership NHS Foundation Trust Volunteer, Healthwatch Dudley Mr Thomas Thomik Dudley Local Pharmaceutical Committee Representative Mr Steve Wellings Lay Member - Governance Dudley LPC Member Royal Pharmaceutical Society Member Wife employed by Dudley MBC Housing Department One Niece employed by DGFT as a nurse Member of CIPFA

4 PRIMARY CARE COMMISSIONING COMMITTEE MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 17 NOVEMBER 2017 THE BOARD ROOM, 3 RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Mrs C Brunt Mrs J Jasper Ms S Johnson Dr D Pitches In Attendance Mr P Cowley Dr C Handy Dr T Horsburgh Mrs J Robinson Mrs J Taylor Mr T Thomik Minute Taker: Mrs G Lowe Non-Executive Director for Governance, Dudley CCG (Chair) Chief Nurse, Dudley CCG Non-Executive Member for Patient and Public Involvement, Dudley CCG Deputy Chief Finance Officer, Dudley CCG Consultant in Public Health, Dudley MBC Senior Finance Manager, Dudley CCG Non-Executive Director, Quality and Safety, Dudley CCG (Vice Chair) Clinical Executive for Primary Care, Dudley CCG/LMC Representative Primary Care Contracts Manager, Dudley CCG Primary Care Commissioning Manager, Dudley CCG Dudley LPC Representative Commissioning Support Secretary, Dudley CCG 1. APOLOGIES FOR ABSENCE Apologies were received from: Mrs J Emery Chief Executive, Healthwatch Dudley Dr V K Mittal GP Representative Ms A Nicholls Interim Deputy Head of Commissioning (Primary Care) NHS England (West Midlands) Mr D Stenson Patient Opportunity Panel Representative 2. DECLARATIONS OF INTEREST To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. Mrs Jasper declared her standing interest as NED for Sandwell and West Birmingham CCG. It was to be formally recorded that Dr Horsburgh as well as being in attendance as Clinical Executive for Primary Care; Dudley CCG was also in attendance as Secretary of the LMC. Mr Thomik declared his standing interest as representative for Dudley LPC, although he does not have a voting position on the Committee. 1 P age

5 Declarations of Interest were distributed at the meeting and will be appended to the Primary Care Commissioning Committee (PCCC) agenda and papers in future. 3. QUESTIONS FROM THE PUBLIC Mr Wellings had received no questions from the public. 4. MINUTES FROM THE PREVIOUS MEETING HELD ON 11 AUGUST 2017 The minutes of the Committee held on Friday 20 October 2017 were accepted as a true and accurate record with the exception of Mr Handy being in attendance when he was stated as being absent. 5. MATTERS ARISING/ACTION LOG MATTERS ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2017/9.1(c) PCCC/MAR/2017/7.1(b) PCCC/APR/2017/13.0 PCCC/SEPT/2017/7.0 PCCC/SEPT/2017/9.0 PCCC/OCT/2017/6.0 PCCC/OCT/2017/9.0 PCCC/NOV/2017/6.2 Performance Report Children s Attendance Audit results have been received and a report will be presented to Committee in February ACTION: MRS BRUNT Quality and Safety Immunisations Report This item will be discussed in the Quality and Safety section and a detailed report will follow. To be deferred to February Supporting Professional Decisions It was recorded that regular meetings are to be held to look into protocol/procedures/coding. An update would be provided at the February 2018 meeting. Alternative Service Locations A report on practice alternative service locations to be presented at the December 2017 Committee meeting. ACTION: MR COWLEY Finance Report A report relating to plans for expenditure against reserves to be presented at the December 2017 Committee meeting. ACTION: MR COWLEY Assurance Visit Outcome of NHSE assurance visit to be reported to Committee in December ACTION: MRS TAYLOR DPMA Training Budget Business Plan Subscription to the two websites to be addressed with the DPMA. An update to be provided to Committee in December ACTION: MRS TAYLOR Review of Premises Query to be raised as to who would carry out review of premises. ACTION: MR COWLEY 2 P age

6 6. CONTRACTUAL 6.1 REPORT FROM THE PRIMARY CARE OPERATIONAL GROUP (PCOG) Mrs Robinson spoke to this item to update the Committee following the PCOG meeting held on 1 November The group received information from the lessons learnt exercise from Bilston Street Surgery. The project went well and the overriding theme was that communication with the practice through a single point of contact, who has the authority to act, is essential. There are still approximately 300 patients who haven t yet registered. The Safeguarding team are working through the list. The merger of Norton Medical Practice and Lion Health should be in a position to be presented to Committee in January 2018 for a decision. PCOG was provided with an update in respect of the GP Resilience Programme for 2017/18 and 2017/18 and this will come to Committee through the Strategy Group. Resolved: 1) The Committee noted the report for assurance 6.2 CONTRACT MONITORING PROCESS FOR 2017/18 Mrs Robinson spoke to this item to present to Committee the proposed contractual obligations for framework which includes the new GMS contractual obligations for 2017/18. The 2016/17 contract monitoring template has been updated to include the new GMS contractual obligations for GMS contract 2017/18. The proposal is that the CCG monitor the key themes highlighted from Dudley 2016/17 visits, monitor new clauses for all practices, monitor recent issues including the publication of GP earnings and the CQC registered manager. After discussion with NHS England it was recommended to also include cold chain processes. Practices are required to complete an e-declaration against a wide range of GMS contract clauses. Mr Cowley said that, from an Estates point of view, there had been no review of premises since 2014/15 and queried whether this may be the time to do look into the condition of current buildings. ACTION: MR COWLEY Mrs Brunt stated that one of the issues links with chaperoning, which is a later agenda item. It was noted that there were inconsistencies. To be discussed outside of this meeting once guidance has been agreed. Mrs Brunt mentioned practice policies in relation to delegation of activities. The CCG need to be assured that there are consistent practices across Dudley in relation to that delegation, which sits under clinical governance and training support for staff. Excluded patients has risen from four to eighteen and a feature of exclusion, which is new, is where practices are seeking exclusion despite the exclusion not being consistent with the clinical issue, which is inappropriate. Resolved: 1) The Committee noted the report for assurance 2) The Committee approved the contract monitoring process for 2017/ RISK REGISTER Mrs Brunt spoke to this item to provide the Committee with an updated Board Assurance Framework and Risk Register. 3 P age

7 Regarding Risk 135 There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to either quality or individual performer issues. It had been decided that the wording was changed slightly by removing the words either quality or and to look at ownership for the quality issues within the Quality and Safety Committee. The themes that remain on the Risk Register include individual performers, workforce (there was no distinction between the staff groups), estates and finance. The Committee were to consider whether there were any other issues that may occur that do not fit into those four categories. A declaration of interest was made as an individual present was a patient at one of the practices being discussed when considering the risk scores. Resolved: 1) The Committee noted the report 2) The Committee noted the changes to the wording of Risk CHAPERONE REVIEW IN PRIMARY CARE Mrs Brunt spoke to this item to update the Committee on a review completed on chaperones within Primary Care. The CCG wished to create a more robust chaperoning policy that practices would support and find helpful. Patient Participation Group engagement will be encouraged to embed best practice. This issue to be raised at LMC where GPs within the group should be discussing how this should be taken forward. ACTION: DR HORSBURGH It was thought that coding may be an issue as a data quality exercise has recently been carried out with a coding of structured education for diabetes and many codes had been missed off. This indicates a wider issue that needs to be looked into regarding data quality within primary care and a template needs to be developed. There are companies that will provide data quality support and the Primary Care Development Group will be looking into this. Resolved: 1) The Committee noted the report for assurance 2) The Committee noted that a process should be agreed to move this forward 9.0 PRIMARY MEDICAL SERVICES REPORT DUDLEY QUALITY OUTCOMES FOR HEALTH (DQOFH) Mrs Taylor spoke to this item to present to the Committee the Dudley Quality Outcomes for Health (DQOFH) phase three pilot draft evaluation report for assurance. This is a draft report and a further report will be submitted which will include looking at the impact on the health service and improving the management of long term conditions. AW Surgeries have taken the opportunity to restructure. A query was raised regarding consideration by practices to share some of the staff that would give them an economy of scale around the redesign of the administrative element. This is going to be part of the GP Forward View transformation monies. It was pointed out that the figures on page 43 of the report were not a true reflection. Clarification, an evaluation and a detailed breakdown was needed from the Personal and Social Services Research Unit before the report went out to the wider audience. It was agreed that it would also be useful to check details regarding the assumption of bands. ACTION: MRS TAYLOR The Committee noted that this was a useful piece of work and stated that there were concerns about how the figures have been calculated, which needed checking. An executive summary to be prepared indicating the major issues in general. 4 P age

8 Resolved: 1) The Committee noted the report for assurance 2) We note the useful piece of work as a Committee 3) There are concerns about how the figures have been calculated which need checking 4) An executive summary to be prepared indicating major issues INANCE REPORT 10.0 QUALITY 8.1 FINANCE REPORT 10.1 REPORT FROM THE QUALITY AND SAFETY TEAM Mrs Brunt spoke to this item to provide on-going assurance to Committee regarding primary care quality and safety in accordance with the CCG s statutory duties. Information is required as to why an improvement had not been made at Coseley Medical Centre despite assistance in readiness for the CQC re-inspection. This will be picked up through PCOG. ACTION: MRS ROBINSON There is a continued theme with CQC when inspections are being carried out where practices are not accepting data despite the CCG providing information. There is an opportunity for us to follow up with Dr Steve Field that he could work with us if we do not get traction from practices. A query was raised as to whether there was an expectation by the CQC for practices to be assessing patients holistically as our framework says. This to be checked and clarified. ACTION: MRS TAYLOR The Board stated they did not want overall ratings and CQC domains but required additional information to include a narrative providing an explanation so that there was consistency across PCOG, PCCC and the Board. The PCCC to work with Mr Nicholls and Mr Franklin to prepare a document to be produced at the December 2017 Committee, prior to the next Board, to agree what it is felt was appropriate to be produced at Board. Resolved: 1) The Committee noted the report for assurance 8.1 FINANCE REPORT 11.0 FINANCE 11.1 FINANCE REPORT Mr Cowley spoke to this item to provide an overview of financial performance against budgets delegated to the Committee. There is a significant balance of reserves that remain uncommitted and due to significant workloads a report was not ready for today s Committee regarding plans for reserves. An additional 159,000 has been allocated for Primary Care over the last few days, which comes with conditions. Full details and clarification is still awaited from NHS England. There is a practice that has agreed to open during Christmas and New Year and a suggestion was made that some of the monies used to be fund this. Another suggestion made for use of the monies was extra support for the Primary Care Team and for a funding scheme to be set up to free up time for GPs and nurses to spend a number of sessions preparing for the MCP Development of the Primary Care Model. Resolved: 1) The Committee noted the report for assurance 12.0 DATE AND TIME OF NEXT MEETING 5 P age

9 Friday 15 December pm 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Signed Title Date 6 P age

10 PRIMARY CARE COMMISSIONING COMMITTEE OUTSTANDING ACTION LIST 17 NOVEMBER 2017 MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE PCCC/JAN/2017/1(c) PCCC/MAR/2017/7.1(b) PCCC/APR/2017/13.0 PCC/SEPT/2017/7.0 Performance Report Children s Attendance Report to be presented to Committee regarding findings of children s attendance. Quality & Safety Immunisations Report The Committee requested a detailed report from Public Health for further details on the immunisation landscape. Supporting Professional Decisions The Committee requested further detail around the membership of the panel and how that would work. Alternative Service Locations Report on practice Alternative Service Locations to be presented to Committee. Mrs Brunt In progress February 2018 Mrs Brunt In progress February 2018 Dr Horsburgh In progress February 2018 Mr Cowley In progress December 2017 PCC/SEPT/2017/9.0 Finance Report Plans for expenditure against reserves to be produced. Mr Cowley In progress December 2017 PCCC/OCT/2017/6.0 Assurance Visit Outcome of NHSE assurance visit to be reported to Committee next month. Mrs Taylor In progress December P age

11 MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE PCCC/OCT/2017/9.0 DPMA Training Budget Business Plan Subscription to the two websites to be addressed with the DPMA. Update to be provided to Committee. Mrs Taylor In progress December 2017 PCCC/NOV/2017/6.2 Review of Premises Query to be raised as to who would carry out review of premises. Mr Cowley In progress December 2017 PCCC/NOV/2017/8.0 PCCC/NOV/2017/9.0 PCCC/NOV/2017/10.0 PCCC/NOV/2010/10.0 Chaperoning Policy To be raised at LMC where GPs within the group should discuss how to take this forward. Dudley Quality Outcomes for Health Framework Phase Three Pilot Draft Evaluation Report Clarification, an evaluation and a detailed breakdown of figures needed and check the assumption of bands on page 43 Coseley Medical Centre This practice is still requiring improvement on response. Query raised as to why an improvement had not been made despite assistance in readiness for the CQC inspection. This will be picked up through PCOG. Holistic Assessment Query to be raised with CCG regarding expectation of holistic assessment. Dr Horsburgh In progress December 2017 Mrs Taylor In progress December 2017 Mrs Robinson In progress December 2017 Mrs Taylor In progress December P age

12 PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 15 December 2017 Report: Update from the Primary Care Operational Group Agenda Item: 6 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: Update from the Primary Care Operational Group To update the Committee following the Primary Care Operational Group meeting held on 6 December 2017 Mrs J Robinson, Primary Care Contracts Manager Mrs C Brunt, Chief Nurse Dr T Horsburgh, Clinical Executive for Primary Care The Primary Care Operational Group: Provides assurance that there are no contractual breaches to be issued for any Dudley practice Received initial proposals in respect of branch closure Received a report in relation to GP membership and education attendance and made a recommendation to the Clinical Executive Team Considered the quality and safety issues that are set out in the quality and safety report Committee is asked to: RECOMMENDATION: Note the actions of the primary care operational group for assurance FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: Not applicable Not applicable Decision Approval Assurance 1 P age

13 DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP 1.0 INTRODUCTION 1.1 This report provides an update from the Primary Care Operational Group (PCOG) following its meeting held on 6 December GMS CONTRACTING 2.1 Branch closure proposals 2.2 PCOG received initial proposals from a practice considering branch closure. 2.3 PCOG appreciated the rationale behind the decision. 2.4 CCG representatives have discussed the application and consultation process with the practice and a comprehensive communications and engagement plan has been received. 2.5 It is likely that an application will be presented to Committee at February s meeting. 3.0 DUDLEY GP EDUCATION AND MEMBERSHIP EVENT ATTENDANCE 3.1 PCOG received a report in relation to GP membership and education events following concerns raised by the Clinical Executive Team about poor attendance. 3.2 The report identified 12 practices with <50% average GP attendance at membership events and 9 practices with <50% attendance at GP education events. 6 practices were identified as having correlating <50% attendance at both events. 3.3 In addition to the report the Primary Care Team had undertaken a spot check which revealed that 6 practices had closed but there was no representation at the education event. 3.4 The CCG has an agreement with practices where they are allowed to close surgeries during core hours so that GP s can attend education events this is also included in the Dudley Quality Outcomes for Health Framework. The CCG provide alternative arrangements for the provision of medical services to cover the core hours period. 3.5 PCOG made a recommendation to the Clinical Executive Team that in the first instance the report should be shared at localities to generate peer pressure and that a strong message should be sent by Clinical Executives to members that if GP s are not attending the education event the practice must remain open during core hours as contracted. It should also be highlighted that this is free education something that if the CCG did not provide GP s would need to self-fund and source for appraisal. 3.6 It was agreed that the DQOFH framework specification and the GP Engagement scheme local enhanced services specification should be reviewed to ensure the obligations and consequences of failure to meet those obligations are clear. 4.0 PRIMARY CARE QUALITY & SAFETY 2 P age

14 4.1 The group considered the quality and safety issues and report from the GP Engagement lead that is set out in detail in the Quality and Safety report to Committee. 4.2 There are no issues in the quality and safety report that require contractual actions to be taken against any practice. 5.0 RECOMMENDATION The Committee is asked to: Note the actions of the primary Care Operational Group for assurance 3 P age

15 PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 15 December 2017 Report: Board Assurance Framework & Risk Register Agenda Item: 7.0 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: Board Assurance Framework (BAF) & Risk Register (RR) for Primary Care Commissioning Committee To provide the Committee with an updated BAF & RR Mrs J Robinson, Primary Care Contracts Manager Mrs C Brunt, Chief Nurse Dr T Horsburgh, Clinical Executive for Primary Care Enclosed is the BAF & RR as at 6 December 2017 RECOMMENDATION: Committee is asked to: o Review the current status of risks. FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: n/a n/a Decision Approval Assurance 1 P age

16 Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2017/18 05-Dec-17 MASTER Document with full Risk Review Information ID Original Date Last Review (Committee Date) Last Update (Risk Amended) Risk DescriptionAccountable LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE) /07/ /10/ /10/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to individual performer issues Committee Accountability Sponsor & Owner Management Lead PCC Steve Wellings Caroline Brunt P I Initial Risk Key Controls Score (PxI) What controls/systems are in Score place to assist in securing delivery before any of our controls objective. Such as strategies, are in policies and procedures place. Work regular with CQC & NHS England (Via PPIGG) to ensure that any concerns are addressed early. Primary Care Team visits with practice to obtain soft intelligence Annual Workforce Audit for clinical and non-clinical staff carried out Recruitment Fayres/ Joint working and raising profiles in Primary Care Gaps in Control Where are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance Receiving timely information from NHSE, There is no robust mechanism in place for the CCG to be informed of issues early on eg. Complaints, GMC investigations etc. Internal Assurances Board Reports, Minutes of meetings Report to PCCC regarding formal performance issues Feedback from individual practices is reported through PCOG External Assurances Internal and External Audit Reports, CQC Reports Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective Gaps in reporting to Committee Appraisal process for individual GPs needs to be clarified as some of the carried out by NHS England (Moved soft intelligence is not suitable for a from Key controls) public meeting. (R) P (R) I Residual Risk Score (PxI) Score following controls put in place Risk Trend = Actions Timescales To improve control, ensure delivery of Date action will be principal objectives, gain assurance completed 1) Contribute to the review of the PPIGG structure and function 2) Discuss with NHSE regarding better ways of receiving timely complaints information 1) August ) November 2017 COMMENTS 1) Fed back initial comments to PPIGG. 2) Pilot process agreed with NHSE for timely complaints information to be provided /07/ /10/ /09/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce PCC Steve Wellings Caroline Brunt Training needs and skills set assessment Primary Care Team visits with practice to obtain soft intelligence Engagement with NHS England, Health Education England and Local Workforce Advisory Board committed to training and professional development. Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development Workforce plan to be developed No current model of care available to address the workforce gaps Report to PCCC regarding training needs and workforce analysis Feedback from individual practices is reported through PCOG Report to PCC regarding EPIC Programme progress Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting. CCG do not currently receive notification from NHSE in respect of outstanding appraisals = 1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical workforce 2) Develop a joint action plan with external partners (eg. HEE) to establish future workforce needs moving into an MCP provider. 1) April ) 2017/18 TBC /07/ /10/ /09/2017 4B /07/ /10/ /09/2017 4B /07/ /10/ /09/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to unplanned loss of Estates or infrastructure There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to Financial issue There is a risk that there is insufficient workforce within the primary care team to deliver the delegated Primary Care Commissioning functions and projects such as the GP Forward View Plan PCC Steve Wellings Caroline Brunt PCC Steve Wellings Caroline Brunt PCC Steve Wellings Caroline Brunt Enabling practices to improve and change (EPIC Programme) CCG Estates Strategy in place Rent Reviews in place Review of Leases Regular contact with practices to highlight premises issues GPFV related increases in investment in Primary Care General Practice Resilience Programme Reinvestment of PMS Premium PCCC will monitor the capacity of the PC team following restructure due to MCP development. Work allocation, work plans and capacity is discussed at 1:1 and primary care team meetings Alternative suitable space is not readily available in the event of an unplanned loss. The CCG has no power to compel the relocation of practices from unsuitable premises. No additional resources have been identified to support the PC team on delivery of the GP Forward View Feedback on individual practice issues is provided to PCOG. Issues are discussed at the monthly Estates Operational Group Primary Care Strategy Group Report To PCCC re investment in DQOFH None None GPFV Transformation Board None There is no requirement upon practices to report issues with premises to the CCG. GMS Contract responsibilities in respect of premises are not robust. No assurance regarding Business Continuity Plans include alternative locations As independent businesses, the CCG have no oversight of financial issues Monitoring has not been reported back to PCCC = = = 1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing infrastructure and estate to deliver the model 2) Develop and maintain a log of the alternative service locations included in Business Continuity Plans 1) April 2019 Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of Apr-19 the new model, developing and investing in the back-office efficiency of practices Review capacity and inform PCCC and agree a way forward. Establish a robust process for monitoring capacity issues on an ongoing basis 2) November 2017

17 PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 15 December 2017 Report: Update from the CCG IT Strategy Group Agenda Item: 8.0 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: Update from the CCG IT Strategy Group GP Best Practice Review To update the Committee following the completion of the initial phases of the review to produce a new Best Practice guide for GP Practices when using their clinical and associated IT systems. Paul Fisher - Project Manager CCG IT Matthew Hartland CCG Chief Financial Officer Dr Jonathan Darby The report outlines the steps completed to:- Review the existing practices and procedures for clinical and associated IT systems used in GP Practice Produce a draft Best Practice document for GP Practice and Procedure Highlight the achievements, outcomes, next steps & benefits of the review process Committee is asked to: RECOMMENDATION: Accept / approve the achievements, outcomes, next steps and benefits highlighted in the paper / presentation FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: Not applicable Engagement with:- GP Practice staff from all 46 practices CCG staff Other external organisations that either provide or assist with the delivery of IT systems used in the GP Practice. (EMIS,PCTi,Mjog) Shared draft Best Practice with Dr Parry and Dr Lewis Presentations of full report to:- IT Strategy Group, DPMA, Primary Care Development Group Decision Approval Assurance 1 P age

18 GP IT Systems Best Practice Review

19 Contents Scope of audit Areas reviewed: o EMIS/WEB o Docman GP Document Management System o MJog Automated Patient Reminder & Comms System o Patient Self Check In (PSCI) &Digital signage o DNA o tquest o National Targets for:- EPS Electronic Prescription Service erd Electronic Repeat Dispensing ers Electronic Referral Service (formerly CAB) POL Patient On-line o Miscellaneous LAN Access, File Server Backup & Docmail Hardware audit completed for each practice Achievements / Outcomes Next Steps & Benefits Graphs of performance comparisons since initiation

20 Scope of audit Scope Review use of existing GP IT Systems Collation of Data, Information & processes from each GP Practice Acquisition of accurate IT Hardware Inventory for each GP Practice Confirm IT Hardware refresh requirements for each practice Outcome Effective and Optimal use of GP IT Systems. Immediate elimination of any serious flaws. Provide a Best Practice model for recommended use of GP IT Systems Up to date asset inventory MS License Reconciliation Indication of future S/W requirements Asset Management System developed Baseline requirements for:- Printer & Scanner refresh project Dual Monitor / Screen project Removal of faulty/un-wanted IT kit

21 EMIS WEB & DOCMAN Observations Actions Required Action Owner EMIS WEB A wide variation in the level of knowledge when administering the EMIS System. This was particularly noticeable for Starters & Leavers and staff absences. Action: 1. Produce High level guidelines re Starters & Leavers. 2. Provide guidance for other areas such as Out Of Office 3. Refresher and additional Training for GP Staff Benefit: No delay in the follow up of tasks or clinical activity Organised start and end for employees & locums Reduced clinical risk 1. CCG IT 2. CCG Primary Care 3. CCG Primary Care DOCMAN User maintenance very poor in some cases Excessive active Workflows Action: Ensure that user maintenance is kept synchronised with EMIS/WEB user configuration Benefit: Improved work flows. No suspended documents. Action: 1. Review workflows within the GP and clear down historic activity 2. Review document flows 3. Create optimised iworkflow to support practice Benefit: Improved work flows. No suspended documents Reduced clinical risk. GP Practices 1. GP Practices 2. GP Practices & CCG IT 3. GP Practices & CCG IT

22 MJog Observations Actions Required Action Owner CCG average of 68% for patients with a Mobile Number. (This number is to be confirmed) Action: Practices to continue to engage with patients to collect contact details to sustain and improve GP Practice & CCG IT 2 x Practices not using MJOG at all at time of audit Reminders used extensively beneficial for DNA Auto appointment CANCEL Logs not checked regularly Campaign (Flu, Diabetes, Health Checks) use varies from extensive to none. Action: At the time of audit visits two practices were not using MJOG. This has now been rectified. All 45 practices are active Action: All practices continue to use the Reminder function by default Benefit: Significant contribution to reduced DNA s since Mjog introduction Action: Practices to create Mjog accounts for reception staff and check the message log regularly at least twice daily Benefit: Reduced DNA rates. Even one case per practice per week achieves at least 2000 DNA s avoided. Action: Encourage GP Practices to use the Campaign function within Mjog. Benefit: Improved take up of services e.g. Flu, Health Checks Improved patient experience Reduced costs of running campaigns CCG IT, GP Practice & MJog None GP Practices GP Practices & CCG IT

23 PSCI, Digital Signage & tquest Observations Actions Required Action Owner PSCI & Digital Signage ENVISAGE digital signage use varies from zero to superb. User knowledge and expertise wide variation Action: Provide formal face to face training for practices where required. Include in any formal package created. Benefit: Improved patient experience Better communications from CCG & GP Practice CCG Primary Care, CCG IT, GP Practices tquest tquest Is well used across the estate for Pathology with Radiology just recently introduced. There have been issues with Locums using TQUEST but workarounds for this are being addressed. Action: Continue to monitor and advise. Benefit: Improved patient experience Less use of paper and less error prone. CCG Primary Care, CCG IT CCG IT, CCG Primary Care

24 DNA rates & Patient On-line (POL) Observations Actions Required Action Owner DNA Rates Relationship with Mobile Contact Data, MJOG & POL Action: Continue to monitor DNA rates compared with MJog reminders, Cancel by text and use of POL CCG IT, GP Practices & CCG Primary Care Patient On-line (POL) Patient On-line (POL) National Target March 2018 = 20% CCG Local Target March 2018 = 50% Level and extent of practice engagement depends on the demography of practice. GP site facilities to include Patient WiFi, equipment & resource Benefit: Improved patient experience by making it easier to cancel and thus more appointments available. Further reduction in DNA rates Action: Help GP Practices to continue to push develop their POL take up. (Posters, Introduction of Patient WiFi, App awareness, Mjog Campaign & T-Shirts) Benefit: Greater patient control over their care Less visits to the GP Practice Greatly improved interaction & communication Improved use of clinical resource. Meet target. CCG Primary Care, CCG IT, GP Practices

25 National (&Local) Targets Observations Actions Required Action Owner EPS National Target 2016/17 = 80% Ongoing looking to better the 80% Practices were reminded that to achieve, maintain and better the national targets is an on-going task and to remind patients to engage with their preferred pharmacist. Issues with Locums is being addressed erd National Target 2017/18 to convert 25% of EPS repeat prescriptions to erd There has been a very mixed approach to erd. The majority of practices have made very little effort to introduce erd. We have engaged the Community Pharmacists to help address the issues. Action: 1. Patients to be reminded of the existence and benefits of EPS 2. Engage with Community Pharmacy Teams to work with GP Practices and Pharmacies. Benefit: Improved take up of EPS. Enable more efficient processing of prescriptions Incorporate effect of POD & POL into process Achieve national targets Action: 1. Practices need to be reminded of ERD 2. Engage with Community Pharmacy Team to review approach and validity of national targets Benefit: Improved take up of erd, plus incorporate effect of POD and POL into equation. More realistic national target? CCG IT, GP Practices, Community Pharmacy Team CCG IT, GP Practices, Community Pharmacy Team ers (CAB) National Target 2017/18 = 90% CCG Local target of 100% by 30 th Nov 2017 ers was clearly the biggest cause for concern with all practices. They are concerned with the Appointment Slot Issues (ASI), Defer to Provider and their inability to book and secure appointments for patients and are frequently contacted by patients trying to find out what progress has been made. Action: Report back to the ers Commissioners the practice s concerns and ensure that NHS England is fully aware of the situation. Already done through local commissioners and NHS England. Benefit: ers System with sufficient capacity to enable bookings to be made successfully. Much reduced patient follow up due to timely appointments. CCG Primary Care, CCG IT, GP Practices & NHS England

26 Miscellaneous Observations Access to LAN The use of generic log-on s for LAN access needs to be addressed. Access to EMIS is controlled by Smart Cards but access to the LAN still opens access to other locally stored files. This is not only an IG risk but also constrains better use of personally configured applications such as OUTLOOK and the flexibility to work seamlessly on any PC connected to the LAN. Actions Required Action: Review with IT System Provider and Emis/Egton to scope requirements, feasibility and associated costs to implement Benefit: 1. Secure access to LAN and local resources, files 2. Folder re-direction, user desktop available on all practice PC s 3. Future proofed for more collaborative working. Action Owner CCG IT, TeraFirma, EMIS/EGTON, CCG Primary Care & GP Practices File Server Back Up All practices except Lion Health still have to take a daily back up of their on-site data. This was not happening in all practices. The backup tape cycles are not always optimal and minimal tape verification is taking place. Action: 1. Ensure that all practices are backing up 2. Review Tape Backup Cycles. Some sites only have 3 x tapes and are constrained with short backup cycle periods 3. Consider Tape Verification (CCG IT GP Agreement) 4. When Docman 10 is introduced review where local data is stored (Cloud?) and/or backed up. Benefit: 1. Backed up copy of data in the event of data loss / Cyber attack 2. Data backed up to provide longer retention periods and ability to go further back. 3. Proves that the tape is readable and that data can be restored if and when required. 1. CCG IT & GP Practice 2. CCG IT, EGTON & GP Practice 3. CCG IT & GP Practice

27 Hardware Audit A full Hardware Audit at each practice was carried out by GP Practice Staff. 1. This covered all PC s, Laptops, Printers,Scanners and Tablets, where details were provided. Asset tags were recorded, where present, as well as the relationships between items and primary users. 2. GP Practices were also asked where they needed:- Additional widescreen monitors alongside existing monitors Replacement printers for existing Brother Printers Replacement/additional Scanners Redundant equipment for disposal 3. The audit also enabled us to reconcile the expected Microsoft (and other) License counts against the details recorded and held on our behalf by TeraFirma. 4. The requests from practices for additional/replacement hardware were incorporated into the hardware deployment plans. 5. The output will be used to establish a BAU Asset / Inventory database.

28 Achievements / Outcomes 1. Best Practice document produced as a draft for a BAU living document 2. Identified critical areas in GP practices and procedures that need to be addressed. e.g. File Server backups, use of generic logons, timely user maintenance, remote connectivity, use of DELL tablets 3. Initiated immediate improvements to working practices as part of the initial visit. e.g. Timely user maintenance, Docman Workflow management, MJOG configuration, issues with Locums able to use systems effectively 4. GP IT Hardware refresh completed with the deployment of more than 250 x additional monitors, 220 x printers and 25 x scanners. 5. Provision of an accurate snapshot of all IT assets deployed in the GP workplace to enable the creation of a BAU GP Asset / Inventory database. 6. Follow up meetings were held with three GP Practices identified as needing attention in several areas 7. Recognition that there needs to be a Programme of Training for GP staff.

29 Next Steps 1. Establish the Best Practice document as a living document that is regularly reviewed and updated as processes and technology change. 2. Migrate GP IT asset data into a BAU asset / inventory database. 3. Re-visit all GP Practices to review areas that were identified as needing attention and to look for further improvements for the Best Practice model. 4. Set up Groups of Excellence from GP Practice & CCG Staff for key areas such as EMIS, Docman, MJOG, POL etc. in conjunction with DPMA and Primary Care to enable the collation, development and sharing of on-going Best Practice. These groups could also provide training sessions for other staff. 5. Work with GP Community and Primary Care to identify areas that could be improved and need more training e.g. Docman Workflow, EMIS User Maintenance 6. Assist with the introduction of patient WiFi in GP Practices to improve the take up of POL, MJOG and general patient interaction plus increased use of social media. 7. Continue to monitor and improve performance against local and national targets. (Such as, but not limited to, EPS, erd, ers, POL, tquest, DNA) 8. Improve local LAN security in GP Practices through the removal of generic logons. 9. Look to establish regular, automated KPI collation and publication to monitor performance & effectiveness of systems deployed

30 Benefits 1. Improved patient experience, communication and interaction increased MJog usage, MJog SMART App, POL, new POL App and enhanced use of Digital Signage. 2. Increased numbers of patients with Mobile contact details held by practices. 3. Enhanced patient control of their own care. 4. Improved staff productivity due to reduced wastage, optimised processes and un-necessary follow up and communications. 5. Reduced clinical risk through improved timely user maintenance and enhanced workflows 6. Improved progress to the achievement of individual national and local targets for EPS, erd, ers, POL, tquest etc. 7. Further reduction of DNA rates as patient communication improves 8. Establish Best Practice guide supported by new Groups of Excellence to include all points covered in this paper. 9. Automated collation and regular measurement of KPI s to track performance and trends 10. Identify the need for further in-depth studies to challenge practices & procedures 11. Support Paperless Support GP FYFV

31 Performance Comparisons % 80.00% 60.00% 40.00% 20.00% 0.00% 61.51% Feb-17 EPS EPS 71.24% Oct-17 EPS 80.00% Target Apr % 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 3.66% 4.76% Feb-17 erd erd Oct-17 erd 25% Target Apr % 80.0% 60.0% 40.0% 20.0% 0.0% ers 56.6% 56.8% 90.00% Jan 2017 Oct 2017 Target Apr % 74.5% 74.0% 73.5% 73.0% 72.5% tquest Pathology 73.5% Feb 2017 tquest Pathology 74.9% Oct 2017 tquest Pathology 60.0% 40.0% 20.0% 0.0% tquest Radiology 0.0% Feb 2017 tquest Radiology 52.1% Oct 2017 tquest Radiology Patient On-line Active Patients 60.00% 40.00% 20.00% 0.00% 18.40% 20.70% POL at Feb 2017 POL at Oct % Target Apr 2018

32 Performance Comparisons DNA comparisons after visit Practice A Practice B Blue box - Feb 2017 Red box - Nov Practice C Mjog - SMS Mjog - FFT messages Appointment sent Reminders Sent Feb 2017 Reminders Nov 2017 Reminders Mjog - Patient Appointments cancelled by patient text 2162 Feb 2017 Patient Cancels 2846 Nov 2017 Patient Cancels Feb 2017 FFT Mjog - Total SMS Messages Sent Feb 2017 Total SMS Nov 2017 FFT Nov 2017 Total SMS

33 Primary Care Commissioning Committee Date of Report: 15 December 2017 Report: Value Proposition Funding Review Agenda item No: 9 TITLE OF REPORT: Value Proposition Funding Review MDT Schemes PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: To provide Primary Care Commissioning Committee with the outcome of the external evaluation carried out into schemes funded by the Value Proposition funds relating to schemes integral to the development of Primary Care Multi-Disciplinary Teams (MDTs) Mr G Griffiths-Dale, Programme Manager Commissioning Mr N Bucktin Director of Commissioning Dr Jonathan Darby 2 services, Integration Plus and Care Co-ordinators, were developed as part of the Value Proposition investment to explore new models of integration around the emerging MDTs The 2 services have been externally evaluated in terms of qualitative impact and financial rate of return KEY POINTS: Integration Plus has demonstrated a considerable cultural success in changing pathways and supporting primary care. Care Co-ordinators have not been in place long enough to enable a determination to be made Neither service currently demonstrates a financial saving to match the investment, although the savings may be hidden in emergency care reductions. Wider savings will almost certainly be made in other parts of the public sector over time RECOMMENDATIONS: The Primary Care Commissioning Committee is asked to consider the evaluation of the 2 Value Proposition schemes, particularly from the perspective of primary care capacity and capability and the emerging MDT model. It is recommended that Integration Plus is mainstreamed with a range of partners engaged to minimise the recurrent impact of the cost, including some primary care contribution to reflect the productivity gain derived from the service 1 P age

34 It is recommended that Care Co-ordinators are supported in principle for mainstreaming, subject to a further review of their integration with the MDTs and exploring options for maximising input into risk stratification of the MDT caseload to improve care planning for individuals and demonstrating a reduction in expenditure from avoidable readmissions to offset the investment cost. FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: Mainstreaming both services will lead to a recurrent expenditure of 836,291 (at 2017/18 prices) from April 2018 unless alternative funding sources are identified Schemes have been individual engagement where appropriate, and the results of the evaluation were considered by the Partnership Board ACTION REQUIRED: Decision Approval Assurance

35 Evaluation of Value Proposition Schemes As part of the development of the Multispecialty Community provider (MCP) model under the New Models of Care programme, Dudley CCG received dedicated funding in order to accelerate innovative schemes that would promote cultural change and support the development of an innovative culture. It was acknowledged in designing the programme that some of the schemes would be experimental in nature and that some may be time-limited to promote change. Others were established to pump prime key building blocks of the future MCP model of care, recognising the need for double running costs as the new model was embedded. A key part of the Value Proposition (VP) process is an evaluation against the design objectives and the impact of the scheme in changing behaviours and pathways. It is recognised that schemes are at different stages of maturity and a number have adapted to challenges during the implementation phase making long term evaluation difficult due to a limited period of delivery. Schemes were established with a self-evaluation process in order to collect data and inform any future stop-go decision making process. The schemes have been independently evaluated by ICF Consulting Ltd and the Strategy Unit, with the outcome presented to the Partnership Board on 25 th October In addition to evaluating the individual schemes for delivery, the process also looked at the learning from the process for the emergent MCP There was also consideration of whether a pilot project had the potential for delivery at scale and would be affordable in the context of the competing pressures in the system and the likely payback of the project.

36 The schemes have then been evaluated against core criteria with evidenced gathered via interviews to reach a judgement score to support a decision. Two of the schemes developed using the Value Proposition money had particular relevance to the creation of the future MCP; Integrated Plus ( 587,291) and the Care Co-ordinator roles ( 249,000). Both of the schemes are relatively new and are components of a larger service and are therefore difficult to evaluate purely in terms of financial rate of return. The outcome benefits are more in terms of facilitating change and shifting the culture of the system to a more joined up pathway. Integrated Plus (IP) This scheme was set up to offer social prescribing support to patients in the top 2% of those at high risk of hospital admissions and frequent visits to GPs. Non-clinical needs may often explain frequent GP visits and risk of hospitalisation. Meeting non-clinical needs requires more coordinated, holistic care.

37 This is being addressed by the new care model through the MDTs, which bring professionals across the system together to look at the holistic needs of patients. Integrated Plus (IP) is integral to the MDTs; it was created to provide a link between health and social care, and wider community and voluntary services. By working closely with the MDTs, IP supports integrated working across all parts of the system. A key purpose of the scheme is therefore to bring about coordinated person-centred (preventative) care for high risk patients, within the context of reducing budgets and resources. Within Dudley, there were also low levels of referrals into the voluntary sector coming from GPs, indicating low knowledge in primary care of wider services. Without preventative intervention with this high-risk group, the CCG would face rising costs, outcomes for patients would worsen over time through repeated intervention at crisis points, and the new care model would be implemented using a clinical approach, without addressing social and economic needs. The IP service has five locality link officers (supported by ten support workers), who attend all 45 MDT meetings across Dudley. Link officers focus on the non-clinical needs of patients discussed at MDT meetings. Most referrals to IP come via this route, and some are also through NHS.net and by fax. The IP team also supports navigation of the health and social care system for professionals, clearing blockages for example through their direct link into the MDT meetings The specific aims of the scheme were to: Primary and secondary care services support patients with non-medical needs in order to reduce the demand on medical services. A particular focus is on reducing isolation and loneliness. This included ensuring that the holistic needs of patients are discussed and considered at MDT meetings. Improve quality of life by reducing isolation and helping to resolve other issues (e.g. housing, finances, and benefit entitlements) it was hoped that patients would have an improved quality of life. Voluntary and Community Sector (VCS) ensure that the VCS is represented in the new care model and to increase awareness of the VCS with GPs and other Health Care Professionals (HCPs) at the MDT meetings. Community engagement encourage people to be active and involved in their communities and in doing so increase patient awareness of community services. IP routinely collect data and their most recent evaluation report details the following outputs recorded from September July 2017: 2,619 referrals were received (broken down by locality and GP practices), 2,021 of these patients accepted the service, and 328 declined IP support. Data on the route of referrals show that there were 1,731 GP referrals to IP, 656 referrals from other MDT staff, and 232 referrals from other routes (e.g. Age UK social prescribing service).

38 5,766 outward referral destinations were recorded to 363 organisations, for services supporting basic needs; care and support; disability; faith; housing support; health and wellbeing; and mental health services. IP s evaluation report also shows a range of qualitative outcomes reported through 35 patient interviews carried out during , and a HCP survey carried out in 2015 (16 respondents). Patient interviews showed that as a result of receiving the IP service the following outcomes were reported: 94% of patients reported the service to be excellent/good, with the main reported benefits of the service being that: patients felt listened to; they valued someone spending time with them; appreciated the independent and flexible nature of the support; felt IP workers had no hidden agenda; and that IP helped them find solutions to their problems. 25% of patients were now accessing financial support and 22% were better able to manage their own finances. 28% felt safer in their community and comfortable in their peer groups. 47% felt more able to get out and about and 43% felt they had an improved healthy lifestyle. 69% reported reduced stress and anxiety, and 66% felt better able to cope with life. 38% reported having secure and safer accommodation and 28% felt that their accommodation now met their needs. 63% had increased friendships and 50% of patients reported a better quality of life. The HCP survey showed that the IP Link Officers added value to the MDT meetings, with 69% reported that IP workers added a great deal of added value and 31% reported that they added a lot of added value. Interviewees spoken to as part of this ICF evaluation reported that IP have plugged a gap and GPs describe them as the gold of the model. They also reported that IP workers have enabled MDT meetings to gain structure and grow. Relevance to the MCP implementation matrix The IP service relates very strongly to sub element 1.1 (component 1.1.i) and 1.2 (component 1.2.i) through its understanding of holistic health needs of the population (component 1.1ii). In doing so IP connects people to community activities/resources. IP also partly relates to sub element 1.3 (component 1.3.i) through addressing the social elements impacting on people s lives and encouraging people to take more responsibility for their own health care. The service also addresses the care element of on-going needs enhanced primary and community care. This specifically relates to sub element 3.2 where IP connects the voluntary sector to the clinical model through the MDT meetings.

39 Care element Sub element Sub element description Scheme addresses: In principle Scheme addresses: In practice Whole population - prevention and population health management Ongoing needs enhanced primary and community care Planning and tailoring services based on population health needs Better population health through community engagement Supporting self-care and patient activation Multi-disciplinary teams for those with long term conditions Very strongly Very strongly Partly Very Strongly Very strongly Strongly Partly Very Strongly A number of learning points have been derived from the service: An alternative workforce IP has provided an alternative a more cost effective and available workforce than clinical staff and one that supports patients. Culture change IP has contributed to the culture change hoped for by the new care model in supporting patients holistically, though this has not yet been fully achieved. Data collection Interviewees reported that data recording methods were overly burdensome. There were suggestions that the cost saving element of the data collection tool has changed the nature of the interaction with patients from a person centred approach to an assessment based approach. This led some interviewees to suggest that the tool could be streamlined to better fit the service: ultimately a robust and easy to use tool is needed, which adequately captures outcomes to show the benefits of the scheme. In terms of financial benefit, the following cost savings have been reported from the services annual report: Primary care: A reduction in demand was reported based on 438 (22%) patient referrals to IP (as extracted from EMIS). Cost savings are calculated using a scenario of estimated costs to the state if no interventions are provided compared to 12 month projected estimated cost to the state after IP support. Savings of around 18,000 were reported as resulting from: A 24% reduction in visits to the GP. A 15% reduction in GP home visits. A 15% increase in GP telephone consultations. Secondary care: A reduction in demand based on the number of A&E attendances (estimated at around 120 per patient) and emergency admissions (estimated at around 1,580 per patient) by patients 12 months before and after IP support, was reported as follows: A 4% reduction in A&E attendances, saving around 5,000 (522 patient referrals). A 7% reduction in emergency admissions, saving around 80,000 (441 patient referrals).

40 These identified savings of c. 100,000 are significantly less than the 587,291 invested, although the true scale of the savings are likely to be significantly higher for the NHS, with greater associated savings for other parts of the public sector. This is a service that functions best as a partnership activity and its long term funding model would ideally be across a number of different public sector commissioners. Care Co-ordinators (CCs) During 2015/2016, there were 17,560 emergency admissions for people aged 65 and over in Dudley CCG. This equated to an increase of over 1000 emergency admissions compared with the previous year, reflecting a rising trend of secondary care utilisation within the CCG. Additionally, the rate of delayed discharges attributable to social care in Dudley was higher than the national rate and forecasts indicate an estimated increase of 25,100 people in the over 65 population over the next twenty years. This implies a rise of those in the over 65 population requiring an additional layer of support - both prior to, and following, discharge from hospital as well as an absence in the availability of services to bridge the gap between hospital and community support. There was also a need for greater consistency across the MDTs. The MDT have been rolled out across Dudley CCG s 45 GP practices with each adapted as a model to best fit within the operations of each practice. As a result, the format, make-up and content of each MDT varies across the CCG, as does the extent to which each links with community and social care services. A solution was thus required for providing a consistent element in each, maintaining momentum between meetings and facilitating links among stakeholders within each MDT. Ten Care Coordinators (CCs) were recruited with two assigned to each of Dudley s five localities, based around the 45 GP practices. The CCs are employed by Dudley Group NHS Foundation Trust, providing them with direct access to patient information from the hospital, such as discharge and admission data. There are two main elements to the CC role: Providing connections at a practice level - attending the MDT meetings at each GP practice in their assigned locality, facilitating communication between members of the MDT, the hospital and community services. The CCs share information on A&E attendances, unplanned admissions and patients at risk of admission. Each CC also has responsibility for collating updates from those unable to attend to ensure the timely sharing of patient updates. Providing connections at a patient level - a key part of the CC role is to make contact with patients over 65 and registered with a Dudley GP who have been discharged from Russell s Hall hospital to provide a non-clinical welfare check by phone. This helps to identify if a patient needs support or signposting to other services following discharge - e.g. social care, district nurses and home aids - which the CCs can then arrange or refer patients onto. The CCs work alongside the hospital, with the aim of enabling patients to remain at home. The Care Coordinator service sets out to: Prevent and reduce readmissions to hospital. This is a primary objective for healthcare services in Dudley, and this scheme aimed to address this through providing a link between primary and secondary care and community services, assisting with emergency attendances, and supporting post-discharge care coordination.

41 Improve patient experience through developing a more seamless, joined up, coordinated pathway of care and support following discharge from hospital. Continue to improve the effectiveness and consistency of the MDTs across the 45 practices within Dudley through communication and regular attendance at meetings, as well as providing extra capacity to support the MDT workload. Improve communication and coordination between members of the MDT as well as between hospital and community services, facilitating both vertical and horizontal integration. The CCs were first introduced at the end of 2016 but initially went through an induction period to enable the team to build relationships and gain the local knowledge needed to best undertake the role, e.g. local services available and demographics of each locality. During this period, they shadowed different teams - including the IP team - and sat in on MDT meetings to understand their format. In early 2017, the CCs began to make contact with patients and joined the MDTs as official members. The CCs have been attending discharge meetings in the community where if they feel the patients were not fit for discharge, they can raise a concern and get a response in 48 hours. There is an aim to further extend the patient contact calls made by CCs to include those under 65 years identified on the top 2% hospital avoidance list. This will start to link into the work of Integrated Plus and strengthen the risk stratification process in primary care However, there is an ongoing lack of clarity of the role of the CCs and their relationship with GP practices. This has led to some staff turnover. Each of the 45 MDTs in Dudley are considerably different and as a result the ways in which the CCs are used by each has varied, promoting some inconsistency across the team. The CCs have received a mixed welcome from practices as a result and so their added value in each MDT has yet to be effectively determined in some. Contact data submitted by the scheme showed that: Between April and mid-august 2017, 4,492 patient contacts have been made by CCs with an average of 898 per month. Of the 4,492 patient contacts made: 439 patients were given advice, including discussing carer s allowances, providing a number for patient transport services and giving information about local food deliveries. 264 referrals were completed. This included 63 to services to provide equipment to support patients such as stair rails and wheelchairs, 44 to the local falls service and 27 to GPs. Every MDT meeting that has taken place within the CCG area has been attended by a CC. The short time period for the team, their induction and the lack of tracking of outcomes for the discharges that they have managed has made it difficult to evaluate the service. There is no financial modelling of the impact and to date it is difficult to demonstrate any direct savings to map against the 249,000 investment. The evaluation did offer some qualitative benefits of the service. Better communication between staff on MDTs as the CCs provide a consistent point of contact as well as facilitating the sharing of information on patients at risk of (re) admission and A&E

42 attendance. This has supported better identification of patients to be discussed during MDT meetings allowing resources to be more effectively focussed. Decreased use of primary care services some feedback from interviewees suggested that the service has had an impact on the pressure on primary care. Anecdotal feedback from CCs suggested that the number of telephone calls practices receive from patients following discharge from hospital has reduced as CCs now pick these up. Increased patient awareness of services interviewees described that patients are often not aware of the services that are available to them locally following discharge from the hospital. As a result, interviewees noted that patients often think that the first point of contact is A&E or an ambulance rather than other services and sources of support, which CCs can now signpost patients to or put into place. Improved patient experience a number of interviewees described that the service provides a port of call for the patient should it be needed as patients often would not have contacted services again unless readmitted to hospital. Feedback collected by the team provides examples of how the service has enhanced patient experience. For example, one referral to a GP resulted in the patient being referred on to a respiratory specialist for COPD. The patient was reported to be very happy with the outcome. Another contact uncovered that a patient was not coping well at home and the CC contacted the person s GP and the patient was eventually placed in a care home. In addition, sometimes CCs have found that patients can be discharged without adequate assessment or appropriate packages of care in place. CCs are able to make an urgent referral for a package of care, which provides access to this support sooner for patients potentially decreasing the risk of readmission. Relevance to the MCP implementation matrix The table below shows the care elements of the MCP implementation matrix that the service relates most closely to and the strength of these relationships. The scheme provides a point of access to wider services assisting patients to remain in the community and support themselves. The CC role strongly relates to the embedding of MDTs and in particular, proactively identifying patients at risk of (re)admission, better case management of patients in appropriate settings and supporting timely discharge. Linked to this, they help link patients in with appropriate support services in the community. The CCs also work with hospital discharge teams and provide a layer of support to patients upon discharge to understand their needs and ensure they are met, enabling patients to remain at home with appropriate services are in place. Care element Whole population - prevention and population health management Ongoing needs enhanced primary and community care Highest needs coordinated community based and inpatient care Sub element Sub element description Scheme addresses: In principle Partly Scheme addresses: In practice Partly 1.2 Better population health through community engagement 1.3 Supporting self-care and activation Partly Moderately 3.2 Multi-disciplinary teams for those Very strongly Very strongly with long term conditions 3.4 Services traditionally delivered in hospital are shifted to community Partly Partly settings 4.3 Coordinated discharge planning and integration into community care Very strongly Strongly

43 Partnership Board Partnership Board considered the evaluation of all of the Value Proposition schemes and supported both of these elements of the new MDTs. In terms of Integrated Plus, the scheme was widely supported: Key component of the model of care Potential to extend support to secondary care and mental health (subject to external funding) Concern expressed that significant proportion of the resource is consumed with quality assurance / data production rather than with value-adding activities Whereas the support for the Care Co-ordinators was more qualified: Some variation in the way care coordinators are used across different MDTs, leading to some frustrations with the role Consider potential for financial contributions from other system partners Taken together the 2 services represent an investment of nearly 850,000 which would be an additional cost pressure from 2018/19, with only marginal demonstrable financial returns dedicated to the programmes. However, the impact on the development of the MDT process has been far more significant, especially in the case of Integrated Plus. It can reasonably be expected that the impact will grow as the MDTs become more developed and a standard operating model is developed allowing partner organisations to more effectively engage and a more streamlined interaction developed. The feeling of all those who have evaluated the schemes is that these services are entirely consistent with the new model of care and exactly the gaps the Value Proposition schemes were seeking to fill. Integration Plus has been seen as a significant contributor to primary care capacity by making links with services previously invisible to primary care, and that care co-ordinators have potential though may require some re-engineering to have a demonstrable effect. Recommendations The Primary Care Committee is asked to consider the evaluation of the 2 Value Proposition schemes, particularly from the perspective of primary care capacity and capability and the emerging MDT model. It is recommended that Integration Plus is mainstreamed with a range of partners engaged to minimise the recurrent impact of the cost, including some primary care contribution to reflect the productivity gain derived from the service It is recommended that Care Co-ordinators are supported in principle for mainstreaming, subject to a further review of their integration with the MDTs and exploring options for maximising input into risk stratification of the MDT caseload to improve care planning for individuals and demonstrating a reduction in expenditure from avoidable readmissions to offset the investment cost.

44 DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE Date of Meeting: 15 th December 2017 Report: Quality & Safety Report Agenda Item No: 10 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR(s) OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: Quality and Safety Report To provide on-going assurance to the Primary Care Commissioning Committee (PCCC) regarding quality and safety in accordance with the CCG s statutory duties Mr J Young, Quality and Patient Safety Manager Mrs C Brunt, Chief Nurse Dr Ruth Edwards, Clinical Lead, Quality & Safety There have been three CQC inspections carried out since the last meeting The Primary Care Commissioning Committee is asked to: Note this report for assurance FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: None to report N/A Assurance Page 1 of 1

45 Primary Care Analysis Report PCCC, 15/12/17 Produced : 07/12/2017 Robert Franklin BI Developer & Analyst Jim Young Head of Quality Assurance

46 Primary Care Analysis Report Summary Care Quality Commission (CQC) The Waterfront Surgery have been re-inspected following a previous requires improvement rating Keelinge House Surgery have been re-inspected as part of CQC s review of 10% of good or outstanding practices Bath Street Medical Centre have been re-inspected following a previous inadequate rating overall Infection Prevention & Control (IPC) There have been no audits carried out since the last meeting. Serious Incidents (SIs) Currently, there is one SI open. The initial RCA has been reviewed and feedback provided to the practice Service Developments Datix - five practices & the UCC are now actively using Datix; meetings with further practices are being arranged PCAT - immunisation data has now been included in the PCAT analysis Performance indicators action taken A number of practice visits have been completed or are scheduled following review of the Primary Care Assurance Tool (PCAT) dataset at recent PCOG meetings The December PCOG analysis has identified one further practice as potentially requiring follow-up; there was no focussed analysis carried out this month.

47

48 PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 15 December 2017 Report: Update Report from the Primary Care Strategy Group GPFV work programme Agenda Item: 11.0 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: FINANCIAL IMPLICATIONS: Update Report from the Primary Care Strategy Group GPFV work programme To update the Committee following the Primary Care Strategy Group (PCSG) meetings held on 12 th October Mrs J Taylor, Primary Care Commissioning Manager Mrs C Brunt, Chief Nurse Dr T Horsburgh, Clinical Lead for Membership Development and Primary Care The PCSG has been established to oversee the implementation of the Dudley CCG GP Forward View (GPFV) Plan A high level project plan has been developed for the PCSG to monitor the delivery of all key work streams outlined within the GPFV plan The group received an update from the primary care development group (PCDG) to include the following work streams: o Black country STP leads o Workforce o Enabling Practices to Improve and Change (EPIC) o Clinical correspondence management training o Patient on-line o Telephone consultation training o IT utilisation audit of IT systems in primary care o Care navigation / Active signposting o GP resilience programme o Extended primary care access The group received an update from the IT strategy group The group received an update from the Estates strategy group The Committee is asked to: Note the update from the Primary Care Strategy Group for assurance Note that the Strategy Group will ensure that all transformation and improving access funds which have been directly allocated by NHSE to the CCG are used in accordance with the Statutory Financial Instructions (SFIs), and comply with all relevant guidance and legislation in relation to managing conflicts of interest and procurement All finances will be contained within the allocation for GPFV 1 P age

49 WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: Localities in development of Extended Access Scheme 2017/18 Update on GPFV work programme to localities in November 2017 Dudley LMC GP Collaborative practices Clinical Executive Dudley Practice Managers Alliance Decision Approval Assurance 2 P age

50 DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE UPDATE REPORT FROM THE PRIMARY CARE STRATEGY GROUP GPFV WORK PROGRAMME 1.0 INTRODUCTION This report provides an update from the Primary Care Strategy Group (PCSG) following meeting held on 12 th October. 2.0 BACKGROUND 2.1 The PCSG which has been formally established and approved as a sub-group reporting to the Committee in May 2017, will oversee and assure Committee that plans outlined within the GPFV plan are on track for successful delivery. 2.2 A number of key work streams outlined within the GPFV plan feed into the PCSG which include the recently formed Primary Care Development Group (PCDG), IT Strategy Group, Estates Strategy Group and Workforce Planning Development. 3.0 PROJECT PLAN FOR DELIVERY OF GPFV 3.1 A high level project plan has been developed for the PCSG to monitor the delivery of all key work streams outlined within the GPFV plan. In addition the PCDG has developed a detailed project plan around delivery of the GPFV relating to primary care developed. 3.2 Project plans will require further work and detail as the work streams develop and will be reviewed by both groups on a regular basis. Any significant risks to delivery timescales outlined within the GPFV plan will be escalated by the PCSG to Committee. 4.0 UPDATE FROM PRIMARY CARE DEVELOPMENT GROUP 4.1 Black Country STP Leads The primary care leads across the four CCG s within the STP footprint continue to meet on a monthly basis to share good practice and identify areas where a collaborative approach across the STP would be of value around delivery of the GPFV. This has included: Development and submission to NHSE of a joint STP workforce strategy which is awaiting ratification Collaborative approach to specification development and communications materials for extended access schemes Sharing approaches for implementation of on-line consultation Paul Maubach has been assigned the STP Accountable Officer for the GPFV work programme to oversee its successful delivery. 3 P age

51 4.2 Workforce A training needs assessment for Nurses (HCA to ANP) has been developed and will be distributed and facilitated by the CCG Nurse Mentors. This will further inform the Nurse Education and other training requirements for our nursing workforce for the future A Nurse competency framework is being devised which will run from HCA to ANP level to be implemented across primary care to create a standardised approach The group will be exploring the new care certificate for HCAs with a view to implementation in the future Work had commenced with our local Community Provider Education Network (Future Proof Health) around the Health Education England 10 point plan to increase the nursing workforce Twenty six nurses have been identified as having previously undertaken Nurse Mentor qualification that are not currently live on the Mentor register. The plan is too get these nurses live again as a strategy to increase the number of practices having pre-registration student nurses to potentially attract a younger workforce choosing primary care as a career path. There will need to be a clear plan of the time commitment required before practices will release their Nurses to undertake the training Six nurses have expressed an interest to undertake the non-medical prescribing qualification. The group has agreed to fund the required courses via the transformation monies in GPFV this includes the clinical skills course which is required prior to undertaking non-medical prescribing Following an unsuccessful supplementary submission on the back of Birmingham's bid for the GP International Recruitment Programme, Dudley with its STP partners had identified a different strategy. Sandwell has been working with its acute trust via a refugee scheme to identify trained GP's and Nurses in their home country that are currently working in alternative jobs i.e. taxi drivers on a programme of conversion to work in the work UK. This will form the basis of our STP GP workforce strategy. 4.3 EPIC programme The EPIC programme is ready to launch its offer to practices for 2017/18 and includes new modules for project planning, business case development, assertiveness and personal resilience The PCDG will be working with the Midlands and Lancashire Commissioning Support Unit strategy team to fully promote these modules to practices 4.4 Clinical Correspondence Management Training The PCDG have undertaken a procurement process for the delivery of the above training to all 45 practices over the next 12 to 18 months. This programme will involve the training of non-clinical staff under protocols to sign post correspondence to members of staff within the practice other than the GP. The tender closed on 21 st November with the 4 P age

52 moderation session undertaken on 30 th November. This is with a view to award a contract in December to commence in January Patient on-line The PCDG have invested in promotional t-shirts and lanyards for practices to promote the uptake and utilisation of patient on-line services. Further work will be taking place to relaunch on-line promotion including a new communications plan An issue was highlighted with the figures for patient online this month. There had been an error when EMIS had combined the live and active information which had resulted in a significant loss of patients who were previously registered. We are working with EMIS to get this resolved. 4.6 Telephone consultation training The PCDG has invested in telephone consultation training for both clinical and non-clinical in order to have a standardised approach and improve effective conversation with the public The preferred provider has been identified and a rolling programme will commence January IT utilisation audit of IT systems in Primary Care Following the recent audit around utilisation of IT systems a number of recommendations and potential developments have been identified The PCDG will be developing a package of training for new starters and also a refresher programme relevant to their roles which would cover a full range of primary care IT systems items A best practice guidance document is in development and super user groups will be developed around the various IT related systems The group are exploring a telephone system Babblevoice which interfaces and integrates directly with EMIS and Docmail as a strategy for reducing clinical correspondence costs. 4.8 Care navigation / Active signposting This programme involves the training of frontline reception staff to recognise when patients don t need a clinical appointment to signpost to alternative services for support. Work has taken place with Dudley Healthwatch to design a bespoke programme for Dudley practices in addition to the current programme consisting of two half day modules, to provide a more concise introduction The group will be commissioning more in depth training for reception staff who wish to gain a greater understanding and potentially develop into care navigation champions. 5 P age

53 4.9 GP Resilience Programme Five practices were part of the programme for 2016/17 and funding went directly to Primary Care Commissioning (who was directly commissioned by NHSE). Each of the practices has undertaken a diagnostic exercise and is following through with the recommendations As part of the 2017/18 three practices applied for resilience funding and were successful in their bids. The CCG was allocated 20k, which will be utilised to support the urgent resilience of practices Extended Primary Care Access The CCG has commissioned an Extended Primary Care Access scheme (on a collaborative locality model) in line with the specification requirements set out by NHSE which commenced 1 st September In addition the CCG has approached localities to increase provision from 30 to 45 mins per 1000 population per week during the winter period (December 2017 to March 2018) as a mechanism of further support to the urgent care system. 5.0 UPDATE FROM IT STRATEGY GROUP 5.1 The CCG IT team have been undertaking a scoping exercise around a variety of IT issues which have been recently reported from primary care and are looking at solutions to improve them. 5.2 As part of the migration to NHS mail2, migrations for GP Practices are still on track for completion on 13 th December. 5.3 Practice Wi-Fi is now fully implemented and the team have commenced scoping patient Wi-Fi roll out. 5.4 Docman share is being scoped as a potential solution to support the extended access scheme with access to clinical correspondence. 5.5 Docman10 is being implemented in two practices with a view to full roll out across all practices. 5.6 A Black Country STP IT Task and Finish Group has been developed how the STP might use technology to work more collaboratively. The main areas of focus and recommendation were, , file sharing and associated collaborative tools e.g. skype. 6.0 UPDATE FROM ESTATES STRATEGY GROUP 6.1 Part of the Estates strategy is improving current premises utilisation; with a draft prioritisation plan to achieve this recently being presented to the group. 6.2 The Estates strategy has been taken to the GP collaborative for further discussion. 6 P age

54 7.0 RECOMMENDATION The Committee is asked to: Note the update from the Primary Care Strategy Group for assurance Note that the Strategy Group will ensure that all transformation and improving access funds which have been directly allocated by NHSE to the CCG are used in accordance with the Statutory Financial Instructions (SFIs), and comply with all relevant guidance and legislation in relation to managing conflicts of interest and procurement 7 P age

55 DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE Date of Report: 15 December 2017 Report: Finance Report Agenda item No: 12.0 TITLE OF REPORT: Primary Care Commissioning Finance Report PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: The report provides an overview of financial performance against budgets delegated to Committee. Mr P Cowley, Senior Finance Manager Mr M Hartland, Chief Operating and Finance Officer Dr T Horsburgh, Clinical Lead There has been one allocation adjustment since the previous report to Committee, with an allocation of 159,000 being received to address winter pressures. This brings the total budget reported to Committee to M A break-even position is forecast against co-commissioning and GP Forward View Allocations, and a small underspend is forecast against core CCG budgets. The report highlights the current position in respect of the nonrecurrent reserves, with 272,000 available to be committed immediately and a further 203,000 contingency reserves which must remain uncommitted until January An initial proposal has been received to utilise a portion of the reserves on a scheme for the identification and education of patients at high risk of developing diabetes. Committee is requested to note the reported financial position for assurance. FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: As above None Decision Approval Assurance 1 P a g e

56 Finance Report (November 2017) This report submitted to Dudley CCG Primary Care Commissioning Committee provides a provisional breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of November. Contents Financial Overview Financial Detail p2 p3

57 Financial Overview Budget Allocations Budgets reported to the committee have an annual value at November 2017 of 43,774,000, including both the delegated cocommissioning allocation and core CCG budgets. There has been one allocation change in November, with an allocation of 159,000 being received as part of a wider allocation across the STP area in respect of Winter Pressures. Allocation Breakdown GP Forward View 2,009k Primary Care Co- Commissioning 41,217k CCG Core Commissioning 548k 2

58 Delegated Co-Commissioning Summary Position The forecast expenditure level against delegated budgets continues to reflect a break-even position, with small overspends against Enhanced services, Premises and Other GP services being offset by a reported underspend against uncommitted reserves. Two changes have taken place with regards to primary care reserves, and are detailed below: The CCG has received an allocation of 159,000 to fund its portion of an STP plan to provide additional capacity across urgent Primary Care services and NHS 111 through the winter period, following approval by NHS England. Responsibility for the funding of a Care Home Nurse practitioner supporting Extra Care facilities, which was previously funded from the Value Proposition, has been transferred to Primary Care, and the budget of 50,000 for this has been transferred to the section for Non-Recurrent Commitments. Reserves Position Budget (WTE) In addition to these changes, 63,000 of the reserves are being utilised to offset overspends in other areas, leaving a balance of uncommitted reserves totalling 475,000, of which 272,000 is available to be committed immediately. The remaining balance of 203,000 consists of contingency reserves which may be released from January dependent upon the wider CCG financial position. An initial proposal to utilise a portion of these reserves to fund a Local Improvement Scheme for an identification and education programme for patients at high risk of diabetes has been received, and is considered overleaf. Further potential uses of the reserves have also been identified as follows: The purchase of a selection of self-management resources for use by patients with Long Term Conditions Funding a refresh of IT equipment for practices Inviting practices to bid for Premises Improvement Grants for minor premises improvements Annual Budget ( '000) These and other options will be considered further and a final proposal brought to committee in January, in conjunction with further information in respect of the position regarding the availability of the contingency reserves. Forecast Variance ( '000) Area GP Contract 27,333 (8) QOF and Enhanced Services 6, Premises Costs 4, Dispensing/Prescribing Drs 273 (13) Other GP Services 1, Development and Training Funds Non-Core GPIT 143 (6) Non-recurrent Commitments Reserves 697 (63) Total - 41,217 (0) 3

59 Proposed LIS for the Identification and Education of Patients at Risk of Diabetes Background In Dudley we have approximately 18,000 patient currently diagnosed with Diabetes. This figure is increasing at an alarming rate with an additional 2500 patients being added to the disease registers on an annual basis. In addition we have one of the highest rates of childhood obesity (a key factor which increases the risk of developing diabetes) in the U.K. The CCG recognised some years ago the importance of recognition and intervention of people at risk of developing diabetes as a preventative strategy, which led to us previously investing in an annual review of our at risk population as part of the requirements of the Diabetes Local Improvement Scheme (LIS). The CCG participated as a phase 1 site for the National Diabetes Prevention Programme and for the last 2 years practices has been actively assessing and referring people to a targeted intervention programme of support. It is during this work programme the CCG have created searches centrally on the EMIS system to identify potential cohorts of people who meet the criteria for being at risk of developing diabetes. In accordance with our records we currently have 8,495 people on our at risk register however 4,843 of these now fall out of the criteria range (due to successful intervention) and therefore need to be removed. In addition we have 22,822 people who meet the criteria for being at risk but are not currently on register and therefore are not benefitting from any clinical review or targeted intervention. Proposal In order to address these issues, it is proposed to commission a local improvement scheme through which practices would undertake: a data quality exercise to ensure the at risk registers are robust and accurate in accordance with the criteria set out by NDPP an identification process with people who meet the criteria but are not currently on the at risk register an programme of educational intervention to advice and appropriately manage any risks identified, including referral to lifestyle services where appropriate An indicative assessment of the work involved for practices suggests that this LIS could have a value in the region of 150,000, but a detailed specification and pathway, with associated costings, will be developed and presented to PCCC virtually for ratification in the near future. 4

60 CCG Core Commissioning and GP Forward View Core Commissioning Small underspends are forecast against both the GP with Special Interest and Practice Engagement LIS budgets. GP Forward View A break-even position is currently reported against all GP forward View allocations. Updates in respect of the individual programmes show that: Reception and Clerical Staff Training following the completion of a procurement exercise, a contract for the provision of Document Management services has been awarded and the budget for this will be spent in full Area Budget (WTE) Annual Budget ( '000) Forecast Variance ( '000) GP with Special Interest (8) Practice Engagement LIS 484 (6) Total (14) Area Budget (WTE) Annual Budget ( '000) Forecast Variance ( '000) Reception and Clerical Staff Training 54 - GP Resilience Programme 32 - GPFV Extended Access 1,923 - Total 2,009 - A plan to spend the full allocation of funding received by the CCG under the GP Resilience Programme has been submitted to NHS England. All localities have signed up to provide increased extended hours coverage over the winter period, with the effect that the budget for GP Forward View Extended Access is now committed in full. Recommendation: Committee is asked to note the reported financial position for assurance. 5

61 PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 15 December 2017 Report: Primary Care Commissioning Committee Work Plan 17/18 Agenda Item: 13 TITLE OF REPORT: Primary Care Commissioning Committee Work Plan 17/18 PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: To present to the Committee the work plan for 17/18 for approval and assurance Mrs J Robinson, Primary Care Contracts Manager Mrs C Brunt, Chief Nurse Dr T Horsburgh, Clinical Executive for Primary Care KEY POINTS: Following a Committee Effectiveness review that was carried out by the Good Governance Institute, the Audit & Governance Committee requested that all Committees establish a Work Plan and Annual Report. The Annual Report was presented and approved by the Committee on the 16 June The Work Plan for 17/18 is presented today for approval and assurance. RECOMMENDATION: FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: Committee is asked to: 1) Approve the proposed work plan for 2017/2018 Not applicable Not applicable Decision Approval Assurance 1 P age

62 PRIMARY CARE COMMISSIONING COMMITTEE PLANNING CYCLE 2017/18 DATE COMMISSIONING CONTRACTING QUALITY APRIL 2017 MAY 2017 Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review and plan for sustainable primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports PRIMARY CARE DEVELOPMENT Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks RISK FINANCE ADMINISTRATION Review the current status of risks. Consider any new risks Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest Manage conflicts of Interest Receive the Primary Care Commissioning Committee Annual Report JUNE 2017 Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest Review and approve Primary Care Operational Group Terms of reference 1 P age

63 DATE COMMISSIONING CONTRACTING QUALITY assessment and procurement of primary care medical services ensuring as appropriate level of consultation engagement PRIMARY CARE DEVELOPMENT RISK FINANCE ADMINISTRATION JULY 2017 AUGUST 2017 Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks Review the current status of risks. Consider any new risks Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest Manage conflicts of Interest SEPTEMBER 2017 Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest 2 P age

64 DATE COMMISSIONING CONTRACTING QUALITY OCTOBER 2017 Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports PRIMARY CARE DEVELOPMENT Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks RISK FINANCE ADMINISTRATION Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest NOVEMBER 2017 DECEMBER 2017 JANUARY 2018 Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Consider any new risks Review the current status of risks. Consider any new risks Review the current status of risks. Consider any new risks Review the current status of risks. Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate Manage conflicts of Interest Manage conflicts of Interest Review Committee Terms of Reference Manage conflicts of Interest 3 P age

65 DATE COMMISSIONING CONTRACTING QUALITY FEBRUARY 2018 MARCH 2018 Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Approve Primary Care enhanced services Ensure delivery of Primary Care extended access requirements Review primary medical services. Receive reports in relation to DQOFH Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement Receive updates from Primary Care Operational Group Consider any breaches in contract and approve remedial/breach notices as appropriate Approve a wide range of contract variations and ensure that decision are made in public with appropriate level of patient and key stakeholder engagement reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports Receive Primary Care Quality reports Receive assurance of quality in Primary Care through the Primary Care Analysis Tool reports PRIMARY CARE DEVELOPMENT Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Receive regular reports on the improvement of Primary Care through various work programmes Ensure delivery against GP Five Year Forward View priorities Consider any new risks RISK FINANCE ADMINISTRATION Review the current status of risks. Consider any new risks Review the current status of risks. arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Receive reports providing an overview of financial performance against budgets delegated to Committee. Determine appropriate arrangements for the assessment and procurement of primary care medical services ensuring as appropriate level of consultation Manage conflicts of Interest Manage conflicts of Interest 4 P age

66 GLOSSARY ABBREVIATIONS Abbreviation Meaning #NOF Fractured Neck of Femur K 1,000 equivalent A&E Accident and Emergency ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for nominated staff members as well as assessment of services) ACRA Advisory Committee on Resource Allocation ACS Acute Coronary Syndrome AD Assistant Director AfC Agenda for Change AHSN Academic Health Science Networks ALE Auditors Local Evaluation ALOS Average Length of Stay (in hospital) AMI Acute Myocardial Infarction AMMC Area Medicines Management Committee Anti-D An antibody occurring in pregnancy Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn s disease ARIF Aggressive Research Intelligence Facility ASAP As soon as possible AVE Advertising Value equivalent BACs Bank Automated Credit BCC Black Country Cluster BCG Bacillus Calmette-Guerin BCPFT Black Country Partnership NHS Foundation Trust BCUCG Black Country Urgent Care Group BFT Behavioural Family Therapy BLCCB Black Country Local Collaborative Commissioning Board BME Black Minority Ethnic BMJ British Medical Journal BPAS British Pregnancy Advisory Board BSCCP British Society of Colposcopy and Cervical Pathology CAB Citizens Advise Bureau 1