Executive summary: The Committee is asked to note the outstanding legacy issues and Primary Care risks noted within the CCG register.

Transcription

1 Paper Summary Sheet Presented to: Primary Care Commissioning Committee Date of Meeting: 25 September 2018 For: Discussion Agenda Reference: itle: PCCC/18/09/09 Update on Delegated ransition Plan Executive summary: he Committee is asked to note the outstanding legacy issues and Primary Care risks noted within the CCG register. It is asked to note the number of legacy issues on the register and the fact the formal offer of support from NHSE ceases 31 October Recommendations: Previously considered by: Author(s): Sponsoring Director / Clinical Lead/ Lay Member: he Committee is asked to support the request from the Primary Care team to extend the NHSE formal offer of support until such a time the legacy issues are complete or additional staffing support from NHSE to complete these ahead of the NHSE self-imposed deadline. Primary Care Operational Group Victoria Stanley, Primary Care Commissioning Manager Jo Cullen, Director of Primary and Urgent Care Risk and Assurance: Financial / Resource Implications: Legal, Policy and Regulatory Requirements: Communications and Engagement: Equality & Diversity Assessment: Noted within the Risk Register Noted within the legacy and risk register Noted within the legacy and risk register None N/A 1

2 Reference: P - 13/027 Entry Date: 21/10/2013 Review Date: 15/08/2018 -otal Risk Status: Accepted Jo Cullen, Director of Primary & Urgent Care Garreth Saunders Head of Urgent care & Resilence Lead & Joint Commissioners' Group Contract Performance W - 13/ M SWAS monthly and YD performance continues to be below contracted levels. he increase in response times has the potential to adversely affect clinical outcomes for Wiltshire patients. As part of arrangements for 2016/17 A&E Improvement Plan, nationally the desired focus for this coming winter would be on achieving 95% on the four hour A&E target mandating 5 improvement initiatives for LDBs including Ambulance Dispatch on disposition and code review pilots. he Ambulance Response Programme (ARP)aims to increase operational efficiency whilst maintaining a clear focus on the clinical need of patients. he programme aims to deliver improved outcomes for all 999 patients, with a generally reduced clinical risk through: - he use of a new pre-triage set of questions to identify those in need of the fastest response at the earliest opportunity (Nature of Call); - Dispatch of the most clinically appropriate vehicle to each patient within a timeframe that meets their clinical need (Dispatch on Disposition); and - A new evidence-based set of clinical codes that better describe the patient s problem and response/resource requirement Bi monthly contract management and reporting, including delivery by SWAS of consolidated action plan; Review of SWAS Winter Plans and ARP Performance - through LDB Continuing liaison with SWAS and monitoring of contract via lead and joint commissioners group. Autumn 2017 on-going ARP trial outcomes now mandated (as one of 7 UEC priorities) into business as usual, with SWASF already implemented as early adopter. New rota patterns being implemented to improve utilisation Realignment of fleet to meet new response requirements under ARP being implemented Development of specialist paramedic (Band 6) being implemented as per national requirements, that will support increase in non conveyance Review of Winter Capacity Plans and Resource Escalation Allocation Plan (REAP) as part of SP wide Winter Plan APR has since been adopted as a national bench mark. SWAS are struggling to achieve performance under the ARP matrix. SWAS have confirmed that they require significant additional funding to be in a postion to meet current demand. SWAS have undergone, rota review and implementation, management restructuring, fleet procurement and recruitment - these work streams remain ongoing Position on previous Governing Body report: Not on report 2

3 Reference: P - 14/037 Entry Date: 28/04/2014 Review Date: 15/08/2018 Risk Status: Closed -otal Jo Cullen, Director of Primary & Urgent Care Patrick Mulcahy, Associate Director of Urgent Care IQPMB/LDB Quality and Performance Reports W-14/ M L C NHS 111 performance is consistently below acceptable KPI thresholds within a number of parameters, specifically but not limited to Ambulance Disposition Rate (ADR), ED Referral Rate (EDRR) and Warm ransfer Rate (WR). 9 Ongoing contract performance arrangements; Financial penalties linked to KPI applied RAP being refreshed by SCWCSU on behalf of commissioners Ongoing review through Winter Planning process and assurance sought via LDB Ongoing transiton / exit plan being managed as transition into IUC service from May 2018 with new 111 sub contractor Risk closed as NHS111 now incorporated into new Integrated Urgent Care Service commenced 1st May 2018 RAP being refreshed by SCWCSU on behalf of commissoners Relationship management in place via SCWCSU to support contract exit plan Q4 2017/18 Contract performance meetings continue. Commissioner supported ED Validation line in place with Care UK that has seen improvements in ED disposition rates much closer to KPI of 5% Rota fill and recruitment continue to impact on local service delivery, with increased calls being triaged across Care UK network. Position on previous Governing Body report: Not on report 3

4 Reference: P - 16/044 Entry Date: Jul-16 Review Date: 15/08/2018 -otal Risk Status: Accepted M Jo Cullen, Director of Primary & Urgent Care Garreth Saunders, Head of Urgent Care and Resilience Local Delivery Board Urgent care system pressures threaten delivery of constitutional targets for 4hr ED performance, impacting on timely treatment for patients and poorer outcomes. Corresponding impact on Primary Care. Additional staffing issues in GWH ED indicate patient experience and safety cannot be assured. SP Winter Resilience Plan (including Flu Plan) submitted and ongoing assurance process NHSE/NHSI Monthly Local A&E Delivery Boards (previously System Resilience Groups) (Wiltshire for SF, Bath and North East Somerset for RUH and Swindon for GWH) examining strategic level actions and assurance - responsible for ED performance over winter South system facing - weekly Senior Decision Makers meeting at SF: developing map of capacity and additional coming on line: developing daily capture tool for capacity ORCP funding targeted to manage patient flow through the hospital to assist A&E target delivery; Monthly contract performance review meetings and routine performance management arrangements. Daily and weekly reports and dashboards on acute performance. Group Urgent Care Networks. Quality and Safeguarding Reporting. Strategic conference calls as required. System wide escalation process in place - now reflecting new national guidance. Agreed escalation process in place with CCG support x 3 acutes as required. Senior Decision makers call re introduced weekly. Key stakeholders invited to call. First hursday of each month will be a face to face meeting. October 2018 Winter Resilience Plan v9 submitted and receioved NHSE/NHSI ongoing assurance responses Weekly Winter Planning leads call (all commissioners and providers across SP) South System focus on weekly Senior Decision Makers meeting; cacpaity mapping: daily capture tool for WHC, Medvivo, Wiltshire Council, Care Homes Discharge / Break the System event planned 14th November at SF OPEL response and escalation reporting to NHSE on variation of status at OPEL 3 and 4 in place Monitoring of rust and system OPEL status in place and escalation processes enacted as necessary Monitoring of DoC position in place with supportive action planning in place to assist patient flow. he WICC created during 2018 winter pressures has assisted in managing patient flow. Home first' faciliated by WHC now contribrutes towards limiting LoS thus reducing pressure in system Position on previous Governing Body report: 1 4

5 Reference: P - 16/045 Entry Date: 21/02/2017 Review Date: 15/08/2018 Risk Status: Action Required - otal Jo Cullen, Director of Primary & Urgent Care racey Strachan, Deputy Director of Primary Care PCCC Operational Risk M L C aking on delegated responsibility for primary care commissioning from April 2018 has impacted on capacity of existing staff and requires additional staffing with no transfer of resource from NHS England. Potential impacts include reduced support to practices and localities at a time of vulnerability; delayed practice payments, reporting, contract reviews or variations. Hosting services for other CCGs would increase the risk that current or new staff are overwhelmed with issues in other areas and core support is impacted. 6 Ongoing meetings and requests for information from NHS England. Alignment of NHS England staff until October 2018 Detailed processes transitioning with handover from NHSE in a planned and agreed timescale - flexible to impact of urgent transitions arising - e.g. new mergers Agreement to recruit to two vacancies in Primary Care eam Staffing impact under ongoing review. Recruitment underway to 2 vacant posts. Extension to fixed term support post agreed. Continuous assessment of transition plan. Regular financial review and urgent payments raised as necessary - NHSE to provide backup information. 25/09/18 Ongoing NHS England meetings for primary care contracting and finance transition. One additional support staff member appointed on fixed term contract to March Paper on risks presented to Governing Body September Internal Audit report received on risks re delegation Successful recruitment to posts; one further post (Band 3) out to recruitment Ongoing discussion across SP to develop shared SOP, document risks and issues Legacy risks to be presented at next PCCC Position on previous Governing Body report: 20 5

6 Reference: P - 17/046 Entry Date: 29/08/2017 Review Date: 15/08/2018 Risk Status: Accepted - otal Jo Cullen, Director of Primary & Urgent Care racey Strachan, Deputy Director of Primary Care Clinical Executive/PCCC Operational Risk M L C Risk Description (including the effect of the risk): Vulnerability of practices - increasing numbers of practices under pressure from vacancies and sickness and unable to recruit. Risk to quality of service to patients and patient safety. Risk of increased activity in secondary care in both planned and urgent care services as knock on effect of use of locums and patient access difficulties. Continued recruitment issues or withdrawal of CCG support could cause practices to give notice on their contracts. CCG responsibility to ensure services available to patients and may need to tender new contracts and potentially contract for interim cover. 6 CCG working with LMC and individual practices to support. Locality plans being developed and proposal for increased project management in localities being drawn up. Regular review of impact of resilience work in practices. Monthly GPFV/GP Resilience board. Resilience Oversight Panel being developed. Support for practice mergers where agreed. Joint working with Medvivo to provide Clinical Assessment Service cover to vulnerable practices. Extension and expansion of POD agreed. Continuous assessment of practice risk. Continued support as per agreed principles. Development of exit strategy for support - including alternative provision. Development of county wide provider organisation and potential risk sharing. Continued and enhanced support to locality working. Next Resilience Ongoing GPFV/resilience meetings. Oversight Panel Practice provider organisation being developed. Nov 18 Agreed principles and criteria for GP resilience support/funding for 18/19 at Clinical Executive in January Review of all schemes and proposals at GP Resilience Oversight Panel 31/07/18 Position on previous Governing Body report: 3 6

7 MovementSymbols Reference: P - 18/047 Entry Date: 02/08/2018 New Review Date: 02/08/ otal Risk Status: Action Required Jo Cullen Victoria Stanley Primary Care Commissioning Committee By the CCG from the transition of Primary Medical Services from NHS As part of the delegation of Primary Medical Services, the Special Allocation Service (aka Violent Patient Service) was identified for transition. Currently this remains with NHS England (NHSE) due to a number of actions requiring completion in order to transfer the service safely. he allocated timescales for the transition of primary medical services has now overrun and the NHSE strategic focus has changed. his service is currently delivered by 1 GP provider in Wiltshire and historically difficult to source providers across our geography for this patient group. here is a risk that Wiltshire CCG may not be able to continue to provide this service M L C Service remains with NHSE and will not be transferred until target score has been achieved and minimal rick to the CCG here are a number of actions required to 'resolve' the risk and ensure a safe transition to the CCG is complete. hese include: Full provider engagement with Commissioner Confirmation of clinical oversight of the service Detailed analysis of service cost and activity Confirmation of the future delivery location Pathway decription, including process for a GDPR compliant referral system. 25/09/18 his is an item on Primary Care Commissioning Committee 25/09/18 for NHSE to bring update paper Position on previous Governing Body report: Not on previous report 7

8 Reference: P - 18/048 Entry Date: 02/08/2018 New Review Date: 02/08/ otal Risk Status: Accepted Jo Cullen Victoria Stanley Primary Care Commissioning Committee By the CCG from the transition of Primary Medical Services from NHSE As part of the delegation of Primary Medical Services, the CCG should hold all General Medical Services (GMS) and Personal Medical (PMS) contracts, whether that be paper or electronically. Following a CCG-led audit of all paper contracts it has been identified there is no copy held for the Millstream Medical Practice. herefore, there is currently no legal basis for the reimbursement of the contract. 2 8 M L C Action remains with NHSE and will not be transferred until target score has been achieved and minimal rick to the CCG he action is with NHSE to produce a copy of the contract, noting the changes from the creation of the GP Practice and supposed contract in Position on previous Governing Body report: Not on previous report 8

9 Reference: P - 18/049 Entry Date: 06/08/2018 New Review Date: 06/08/ otal Risk Status: Accepted Jo Cullen Victoria Stanley Primary Care Commissioning Committee By the CCG from the transition of Primary Medical Services from NHSE One practice is unable to access the 'Language Line' service due to no longer being on the list of practices. It is presumed this is an administration error. It is unknown if other practices are affected. he contract is currently held with NHSE, there has not been any response from NHSE to the concerns raised by the CCG and practice affected. he Language Line contract details shared by NHSE are also incorrect. o date, there has been one patient consultation where no interpreter was present due to the issue raised. his has compromised patient safety and the reputation of the NHS Contractor in providing equality of service to all patients. he risk therefore is error caused during a patient consultation due to no interpreter being present and the delegated commissioner being aware of the problem, but not having the authorisation or controls to change or manage the risk appropriately M L C None gained to date As contract holders, NHSE needs to either add the practice back onto the contract, or provide the CCG with the ability to alter details on the contract Position on previous Governing Body report: Not on previous report 9

10 What is the issue? Special Allocation Service (SAS) he service remains with NHSE and has not been transitioned to the CCG Millstream contract here is now a duplicate out of date copy of the contract. hree Chequers contract he GP Practice is yet to return a signed copy of the contract What practice(s) does this relate to (if applicable) Who is responsible for the issue What actions are required to resolve this? What are the timescales for resolution? Cross Plain Health Partnership Sharon Greaves, NHSE he CCG requires details of: Current service specification Current service spec prices Up to date activity Up to date cost/invoices Location of service provision and cost What are the consequential risks of this not being complete he provider may serve notice on the service. he CCG may find difficulty sourcing an alternative provider Millstream Medical Centre Melissa Kendall Milnes, NHSE he contract needs to be brought up to date NHSE yet to agree No legal basis for provision of services hree Chequers Melissa Kendall Milnes, NHSE A signed copy of the contract Friday 20th signed copy due back to NHSE MKM confirmed verbally this is now signed and will be forwarded to the CCG Friday 20th July 2018 No legal basis for provision of services Cost Rent review Following a cost rent review by NHSE, a number of practices are yet to submit a copy of their latest mortgage statement to evidece the cost rent they are curently reviving as per the SFE's Green Gables Purton Surgery Winterslow Branch Surgery Rowden Melissa Kendall Milnes, NHSE Awaiting a full update from NHSE letter to be sent from Dean Walton to remaining practices requesting information. BOA & Melksham Lovemead Purton have requested more information as only received 2017 New Court awaiting on accountant Ops Call NHSE verbally agreed cost rent review has been agreed and amount to be repaid by practice. NHSE will invoice for total and forward amount owing to CCG. Rowden am chasing PM Patford Ops Call NHSE practice have confirmed they do not have a mortgage. NHSE to investigate. Financial and relationship with member practices. he CCG may be required to recover additional cost rent paid to practices over a number of years. his may be of detrimental effect in the relationships with its member practices especially those experiencing resilience issues. No return from hree Chequers (Endless Street) Ops call with NHSE Practice do not have mortgage stats. will supply bank stats. NHSE meeting on the 20th update on the review Digital file transfer he CCG has received paper copies of the GP Contract and communication, it has not received the digital copy of the contracts and communication. herefore the CCG may be missing vital information, not saved in the paper file. All practices Sharon Greaves, NHSE NHSE have been required to submit a business case for I support to progress this. he CCG requires the total file size and whether CCG I Support will be required. If so a similar business case is required to support the process no update Key information/decisions regarding the contracts may be missing. he CCG may make contract decisions in opposition to previous decisions made by NHSE with the contractor. NHSE have also informed the CCG all QOF data is only stored electronically, therefore a solution is required before the CCG receives responsibility for this area Rent Reviews in Dispute Millstream Medical Centre he majority of the 3 yearly rent reviews New Court have been transitioned to the CCG. However there are a number of rent reviews that remain in dispute. hese remain the responsibility of NHSE and will not transition until resolved. Melissa Kendall Milnes, NHSE Millstream on going negotiation with NHSE New Court NHSE are still in conversations with practice Ops Call with NHSE no confirmation rec'd about agreement in GMS space still not agreed Financial. he CCG may be required to reimburse additional cost rent over a number of years that has not been accured for Leasehold Practices Unknown as yet as only recently Schedule of reviews. A schedule of review discovered should be provided for all leasehold premises. None has been provided. Sharon Greaves, NHSE A schedule of review for each leasehold premises Unknown as yet Malmesbury Clarification on whether VA is payable No due diligence carried out when the lease was originally agreed, hence unfavourable terms have been agreed to the NHS. Malmesbury Melissa Kendall Milnes & Dean Walton, NHSE Clarification on whether VA is payable None Financial. he CCG is currently reimbursing 100% of the occupation of the property as per the tersm of the lease. his will require renegotiation. he CCG is also currently reimbursing rent on a compounded RPI calculation. Market rent from 2018 is to be triggered by a landlord review only. Paying rent reimbursement all premises inkers Lane Rent reimbursement for PMS Practices Confirmation that no rent reimbursement is included in the PMS baseline of any surgery All PMS practices (15) Sharon Greaves, NHSE Confirmation from NHSE this is not the case of any PMS Practice Confirmed rent reimbursement not included in any PMS baseline Resolved. Financial and relationship with member practices. Rent reimbursement may need to be recovered from practices over a number of years. his may be of detrimental effect in the relationships with its member practices especially those experiencing resilience issues. Standard General Medical Services Contract Variation Notice 2017 he document was published in January 2018 and NHSE agreed to distribute to contractors. At this point in time the contract variations process had not transitioned. his has not been actioned. All GMS Practices (33) Sharon Greaves, NHSE NHSE to send and receive the Variation Notice to all GMS Contractors and ensure the contract is transitioned up to date not as yet started, but will let me know o be agreed he GMS contracts have transitioned out of date. Contract Variations for Abatements Contract variations should have been produced for all abatements Unknown as yet as only recently discovered Sharon Greaves, NHSE Review all GP premises files and create contract variations for all abatements currently in place o be agreed Finanical. Abatements may be lost and overpayments made to practices. VA Registration status of GP Contractors A list of the VA registration status should be provided for all practices, along with a relevant VA number before reimbursing rent. Leasehold premises only Sharon Greaves, NHSE Undertake a review of the VA registration status for all leasehold premises DW to National eam to confirm if required. Languageline & Action for Hearing Loss Contract ends and CCG will be required to procure a new contract for interpretation and translation services. However the contracts have not been formally novated across from NHSE. All practices Sharon Greaves, NHSE As contract holders, NHSE needs to either add the practice back onto the contract, or provide the CCG with the abaility to alter details on the contract MKM will contact details. SG Contracts Manager re ability for CCG to speak to Languageline. o be agreed Financial. PCD are quite clear VA may only be paid to a contractor when this is non recoverable, therefore the CCG may be in breach of regulations and overpaying practices. Patient safety. here has already been one patient consultion with no interpreter present. Clinical Waste It appears NHSE and the CCG are reimbursing for all clinical waste facilities at the Malmesbury Primary Care Centre Malmesbury John Reason, NHSE Unknown as yet Financial. he ccg is reimbursing more than it is contractually and legally required to do. Retainers Not as yet been transitioned All practices Sharon Greaves, NHSE All practices Sharon Greaves, NHSE raining sessions need to be scheduled QOF Not as yet transitioned from NHSE to CCG EPRR All practices Not as yet transitioned from NHSE to CCG Unknown Practice plans to be shared and/or assurance from NHSE provided to CCG that plans are in place Patient safety. If there is no plan and an event occurs in which the practice emergency resilience plan need to be used patient safety may be at risk 10