NHS England and MK CCG Co-Commissioning Joint Committee Meeting 3 August pm - 4pm Sherwood Drive, Board Room 1, Ground Floor PART 1 A G E N D A

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1 NHS England and MK CCG Co-Commissioning Joint Committee Meeting 3 August pm - 4pm Sherwood Drive, Board Room 1, Ground Floor PART 1 A G E N D A Item Lead Enc. Time 1. Apologies & Welcome Declaration of Interests Chair 3. Minutes of Previous Meeting held on 8 June 2016 Chair CC16/ Matters Arising Chair Primary Care Contract & Procurement Update Broughton Gate/Brooklands Development Neath Hill CCG/NHSE Vulnerable Practices update NHSE NHSE General update NHSE CC16/ GP Patient Survey Janine Welham 9. Anti-Coagulation Locally Commissioned Service Alexia Stenning 10. Prime Minister s Challenge Fund MKUCS/ a. Progress Report Programme Team 11. Any Other Business Chair To Follow 2.50 Verbal Update CC16/ Dates of next meetings 12. All meetings will be held at Sherwood Drive 5 October 2pm 4pm, Board Room 2 7 December 2pm 4pm, Board Room 1

2 Agenda item 3 - CC16/01 [ NHS England and MK CCG Co-Commissioning Joint Committee Meeting 8 June 2016 Sherwood Drive, Board Room 1 MINUTES Present: Dominic Cox DC Locality Director, NHS England, Midlands and East (Central Midlands) Matt Webb MW Chief Officer, MK CCG Dr Nicola Smith NS GP Chair, MK CCG Nicholas Ince NI Contract Manager, NHSE Mike Rowlands MR MKCCG Lay Board Member (Chair) Michael Ramsden MR Quality Standards Manager, MKCCG Attending on behalf of Jill Wilkinson Alan Hancock AH Healthwatch Representative In attendance: Alexia Stenning AS Assistant Director Primary & Community Services, MKCCG Janine Welham JWe Primary Care Development Manager, MK CCG (minutes) Alex Friend AF Primary Care Development, MKCCG Kimberley Kingsley KK Quality, NHSE Rebecca Green RG Head of Strategic Planning & Partnerships, MKCCG Thao Nguyen TN Clinical Lead GP Access Fund attended for agenda item 3 Graham Ball GB MKUCS, GP Access Fund attended for agenda item 3 Apologies received: Jill Wilkinson JWi Director of Nursing & Quality, MK CCG Nessan Carson NC MK CCG Board Member Muriel Scott MS Public Health, Milton Keynes Council Will Perks WP MKCCG Lay Board Member Chair Susan Hoath SH Programme Director, GP Access Fund Non Attendees Lisa Giles LG Assistant Contract Manager, NHSE 1. Apologies Apologies were received as noted above. 2. Declaration of Interests Nicola Smith GP within Milton Keynes 3. Minutes of the Meeting 6 th April Agreed as accurate 4. Matters Arising Matters arising from April 16 meeting Item 6 on the agenda Action V NHS Classified 1

3 Agenda item 3 - CC16/01 Item 6 Annely Robinson raised the queries with the landlord for the Milton Keynes Village Project, also confirmed the calculations with the developer on the Red House surgery. Item 6 Revenue implications completed with NHSE finance Item 7 Vulnerable practices update on the agenda Item 9 Dental issues still outstanding Nick Ince to request Dental Contracts Manager to contact Nicola Smith Item 11 Memorandum of Understanding on the agenda 4. GP Access Fund Thao Nguyen / Graham Ball Dr Thao Nguyen updated the committee with the following: NI Currently delivering additional appointments per week Looking to increase GP capacity through telephone consultations and are currently working through the governance and training issues. Introducing Nurse pathways and potential Physiotherapy Service Aiming to deliver additional healthcare appointments per week Additional capacity will be delivered by the Nurse and Physiotherapy service 95% Utilisation of appointments Patient satisfaction very high Dominic Cox stated that as MK CCG GP survey results should improve. Nicola Smith also advised that the absence of this service general practice could be under more pressure due to population growth. Children s service the utilisation is lower than expected but the feedback from GP s and patients has been very positive. The GP champion for the service is currently visiting practices that have high emergency admissions to reduce this activity. Rapid response is currently in a standstill period due to a new provider. Collaboration work stream: Working with practices on patient navigation Reductions of DNA s Currently the project is currently underspent and financial reports are produced and presented at the collaboration board. The project has officially been extended until the end of July. Due to the underspend it could be extended until September. MC/DC/GP Access Fund Matt Webb and Dominic Cox requested the full evaluation prior to any further commitment. A meeting will be held separately at the beginning of July to discuss the evaluation. Also to understand the issues to continue the service with the current programme team. Commitment from the programme team to submit an evaluation by the end of next week. Graham Ball and Thao Nguyen left the meeting. 5. Memorandum of Understanding Kimberley Kingsley Kimberley Kingsley presented the memorandum of understanding and Terms of Reference between NHSE and MK CCG. The alterations had been made from the previous meeting and also been reviewed by the Local Medical Committee. Kimberley wanted confirmation that Committee are now happy with the final format. Memorandum Of Understanding and Terms of Reference approved by the Co- V NHS Classified 2

4 Agenda item 3 - CC16/01 Commissioning Joint Committee. 6. Update from the Risk Sharing Group Kimberley Kingsley The first Risk Sharing Group was held on the 24 th May and was well attended by NHSE, MKCCG and CQC representatives. The first meeting mainly focused on the Memorandum of Understanding and Terms of Reference. As this forum evolves Clinical representation from both CCG/NHSE might be required. All agreed that the meeting was useful and generated a lot of conversation around CQC, Friends and Family Tests and highlights any practices that may require additional support. Meeting are to be held bi-monthly for the first year and fed back to the Co- Commissioning Joint Committee 7. Procurement updates Nicholas Ince/Janine Welham Janine Welham updated the committee on the premises timeline, still currently looking at June 2018 for completion of Brooklands, currently MKCCG, NHSE are working with MKC on the planning. The public consultation for the Walk in element of Broughton Gate had now been completed and a recommendation would be taken to the Board. Nicholas Ince apologised for not having an updated procurement timeline for the APMS procurement, but has been liaising with the procurement team and will ensure that it is circulated to the committee. Neath Hill procurement for a permanent provider will need to commence following an engagement exercise with patients. Once this has been completed the service specification for both Broughton Gate and Neath Hill can then be developed. Nicholas Ince to set up a weekly APMS Task and Finish group with Janine Welham and Alexia Stenning to work through the consultation/engagement elements. 8. Vulnerable Practices Scheme Nicholas Ince Nicholas Ince has spoken to local clinicians, Local Medical Committee, Practice Nurses and requested expressions of interest for diagnostic support team. Currently they have received a good response back for the entire area. They have selected a pilot site in Hertfordshire for the diagnostic team to visit on the week commencing 4th July. A second round of pilot sites will happen at the end of July for further roll out to the wider practices. NI Those practices who were initially selected will receive a letter and Janine and Nicholas have also had further discussion to identify further practices that may require support since the initial evaluation. Dominic Cox requested a formal update at the next meeting on the pilot and also the themes that are emerging. 9. Any Other Business None 10. Date of Next Meeting 3 August 2pm 4pm, Sherwood Board Room 1 5 October 2pm -4pm, Sherwood Board Room 2 7 December 2pm-4pm, Sherwood Board Room 1 NI V NHS Classified 3

5 Agenda item 3 - CC16/01 Action Log 1. Nick Ince to arrange for a member of the Dental Team to speak to Nicola Smith with NI regard the dental issues. 2. Evaluation of the GP Access fund to be submitted to the CCG/NHSE, meeting then to TN/MKUCS be held to discuss the report 3. Weekly APMS meetings to be set up with CCG/NHSE NI 4. Vulnerable Practices Scheme update to be presented at the next Co-Commissioning Joint Committee NI V NHS Classified 4

6 Agenda item 7 - CC16/02 Primary Care Co-Commissioning Joint Committee XXX Title: NHS England update Author: Lesley Harrison, Medical and Pharmacy lead Central Locality Number: PCCJC-15-XX Executive Director: Dominic Cox, Locality Director Central Primary Care Co-Commissioning Joint Committee - Action Required For Approval / Decision For Review For Assurance To Receive Update Executive Summary General Updates Supporting Vulnerable Practices (SVP) It was initially assumed that the Support for Vulnerable GP Practices programme would be a recurrent programme and therefore NHS England would need to put in place a procurement framework to support the on-going support programme. However, we have subsequently been advised that this programme is a non-recurrent commitment which will be completed in 2016/17. This will be superseded by the Practice Resilience Programme, announced in the GP Forward View April 2016, which is a four-year 40m funding commitment in addition to existing commitments The Practice Resilience Programme is due to be launched in early June 2016 and we have been advised that it has been prioritised as an early deliverable of the GP Forward View. Nationally it has been recognised that any support package to GP practices will have workload implications for already stretched local NHS England teams and CCGs and hence targeted support for practices may require the procurement of specialist suppliers to deliver this on behalf of the commissioner. Currently there is not a multi-supplier call-off framework in place to deliver national or local programmes. The national team has committed to develop a dedicated, multi-supplier call-off framework to simplify the procurement process for central and local NHS England teams. The aim is to launch the tender in mid-june 2016 and to award in early September Within the Central Midlands area about fifty practices were initially identified for support through the Support for Vulnerable Practices (SVP) programme and reported to the national team. However, it was recognised that other practices may be involved in the future (appreciating how quickly things can change) and in some cases, supported by CCGs, there may be a need for practices to participate in collaborative groups, working towards a shared vision of sustainable, high quality general practice. Current Position The focus of the SVP Project Team to date has been on the following elements of the project plan:

7 Agenda item 7 - CC16/02 Developing the diagnostic framework Establishing the diagnostic review teams Developing the digital diagnostic platform. These three areas have been prioritised in order that we are in a position to start diagnostic review visits in July 2016 to pilot the diagnostic framework and tool, with a full launch/roll out in September Diagnostic framework - The distinct quality of the SVP programme is its supportive rather than judgemental emphasis. As such, the diagnostic process needs to be holistic and inclusive - ensuring practices (and all staff involved) feel their voices are being fully heard, respected and positioned at the centre of the exercise. Otherwise any improvement planning that follows will seem to be driven externally, rather than from within the practices themselves. Diagnostic review teams Two invitations have been sent out for Expressions of Interest (EOIs) to be part of our visiting teams and undertake the initial diagnostic checks and develop recommendations for initial improvement plans. The visiting teams will be put together by NHS England Central Midlands to ensure breadth of interest and expertise while avoiding any conflict of interest. Training will be provided by NHS England Central Midlands for everyone recruited to undertake diagnostic visits in order to ensure a standardised approach and that colleagues are competent in the use of the diagnostic framework. Expressions of interest were invited from: GPs on the national Performers List Practice nurses Practice managers Health service managers with good working knowledge of general practice Registered nurses or allied health professionals with good working knowledge of general practice LMC Officers and liaison staff OR any of the above who have retired within the past 2 years, and who can demonstrate they remain up to date with changes in primary care and the NHS. 31 EOIs have been received and we are in the process of reviewing applications. Training is due to take place from mid-june to early July (3 to 4 days training) and includes a Train the Trainers half day session. Digital diagnostic platform - It is also essential we have a reliable mechanism for gathering and interpreting the data that is generated through the programme (i.e. the pre-survey of all practice staff, and interviews during the visit that follows). This is especially important given the wider potential of the programme. Over time an increasingly powerful database of regional strengths and vulnerabilities will emerge, broken down into patterns across all areas of general practice life. This can then inform and guide policy-making for local CCGs and NHS England Central Midlands and help us to become more proactive commissioners, robust in our planning and decision-making. The skills and expertise required to create such a comprehensive and coherent diagnostic framework and to develop a bespoke electronic performance assessment platforms are specialised. We have been working with specialists with proven expertise in creating comprehensive and coherent diagnostic frameworks for related purposes and developing bespoke electronic performance assessment platforms for use within similarly highprofile organisations, such as the NHS, where safety, security and reliability of data are paramount. NHS E approval for accessing this expertise and developing a bespoke digital framework and digital

8 Agenda item 7 - CC16/02 platform has been given for this work to progress. In addition to the work programme set out above it has been recognised that the urgency of circumstances in some practices need addressing sooner. NHS England has already commenced work with CCGs to identify individual practices or collectives of practices where this is the case and come to an agreement with the CCG to transfer the relevant SVP funds for the CCG to expedite the process. Such an arrangement is in place with Nene CCG for the East Northants locality. A letter was distributed and a meeting was held with CCGs and the LMC to explain the latest developments and the local flexibilities of the SVP programme. SVP Update letter May16 (practices that Targeted Investment in recruiting returning doctors pilot for 2016 A national pilot scheme to invest resources in practices which can evidence that they have historically encountered difficulty in recruiting GPs (held a vacancy for a minimum of 12 months and that this is causing a risk to the continuity of patient service. The support includes: Up to 2000 to enable cover when the new GP accesses education and development (within the first twelve months of employment) Access to up to three days(or equivalent) marketing support Up to 8000 relocation allowance for the practice to give to a newly employed GP. The scheme is open to: Any doctor who has completed the NHS England/ Health Education England Induction and Refresher Scheme and wishes to take up a post in a designated practice for at least 0.5 wte. Gps who are still on the performers list but who are not currently working and have been out of practice for less than 24 months and wish to take up a salaried post in a designated practice at least 0.5 wte. GPs who are currently on a retained doctor scheme who would like to increase their hours (taking a salaried position) and relocate to another practice in excess of 50 miles from their existing home/place of work. GP must work at least 0.5 wte and no longer eligible for the retained doctor s scheme. Practices on the SVP programme have been invited to apply and the LMC and CCGs have been asked to identify any additional practices who meet the criteria. Applications were submitted by the 7 th July and practices will be informed if they have been successful by mid-august. Seven applications were received in total for Central Midlands with one application received for Milton Keynes. It is expected that there will be funding available for fifteen pilots in Midlands and East following regional and national moderation.

9 Agenda item 7 - CC16/02 General Practice Forward View (GPFV) National slides to aid discussion and dialogue with stakeholders have now been received.. The funding flow also remains outstanding but it is hoped that there will clarity in the national slide set. Jo Franklin has been identified as the national lead and national policy leads for each work stream have also been identified. The 3 streams are support and sustaining general practice, enabling and supporting change and the care redesign package. At a local level, the document has been reviewed to identify what actions are required and the priorities in 2016/17. The document is to be shared with CCGs shortly. Locality meetings have taken place. The meeting focused on the key topics in the chapters, the need to understand the implications for the STPs. and collected questions to be escalated to the National team. There was agreement that there needed to be close/ collaborative working between NHSE and the CCGs. Following the recent publication of the General Practice Forward View, practices are now interested to know about the details of how the plans are being implemented and how they can engage with the new opportunities described in the Forward View. A series of national workshops have been arranged at which practices will hear from the regional and national primary care teams about the latest details for implementing the Forward View. There will be an opportunity to quiz the team and discuss how the new national development programme could best serve practices. Overview information can be found using the following link: Date Location Venue Link for booking 2 August Cambridge Holiday Inn Cambridge Holiday Inn, Lakeview, Bridge Road, Cambridge, CB24 9PH August London The Wesley, Euston House, Euston Street, London, NW1 2EZ (Cambridge, afternoon) (Cambridge, evening) (London 23 Aug, afternoon) (London 23 Aug, evening)

10 Agenda item 7 - CC16/02 31 August Leicester Holiday Inn, 129 St Nicholas Circle, Leicester, LE1 5LX 1 September 15 September London (For South Region) London 110 Rochester Row, Victoria, London, SW1P 1JP Friends House, Euston Road, London NW1 2BJ (Leicester, afternoon) (Leicester, evening) (South afternoon) (South evening) (London 15 September, afternoon) (London 15 September, evening) Recommendations The Committee is asked to note the update

11 Agenda item 10 - CC16/03 Milton Keynes Prime Minister s General Practice Access Fund (MKGPAF) Interim Evaluation Executive Summary for the Milton Keynes NHS Co-Commissioning Committee (June 2016) I. Introduction This report provides an analysis and evaluation of the MKGPAF between September 2015 May The service was established to improve access to General Practice by creating an estimated 34,000 (654 per week) additional pre-bookable primary care appointments per annum through a centralised booking system. The clinical data and financials were reviewed, in order to determine the impact and cost-benefits of this service. II. Delivery model The service was developed by various Task and Finish Groups, delivered by various providers and managed by the Programme Team. The pilot was developed as three distinct services with different delivery models. Each service model was developed in phases in order to capture any teething problems before final roll out. The three services are: Service description General Practice Access Service Children s Primary Care Service Rapid Response Medication Optimization Service Service provider MKUCS (supported by Programme Team) as Management HUB; subcontracting MKUCS MKUHT CNWL to 5 service delivery Hubs (CMK, The Grove, Parkside, Broughton Gate, Woverton) Service Location 5 GP Hubs MKUCS The Grove CNWL Patient s place of residence Appointment types GP face to Face Phlebotomy Childrens nurse Face to face Childrens nurse telephone follow up Pharmacy Technician medication optimization service Home visits Appointment times 7am-8am weekday 6pm-8pm weekday 8am-6pm Saturday 8am-4pm Sunday 10 am- 8pm Mon-Sun 9am-5pm Mon-Friday Service Objectives Access Pathway MK Practice Access Provide additional extended GP services. There is an exclusion criteria GP Reception GP 22 MK Practices Pre-bookable appointments released 15 days in advance To provide additional Children services for children 10days old - <18yrs old. For certain diseases GP Reception GP Practice Nurses MKUCS triage MKUCS clinicians 27 MK Practices Acute and follow up appointments released 48hrs in advance Clinical System MKHealth Extra SystmOne GP Unit Children s Service SystmOne Unit Paper Future development Acute Musculoskeletal appointments Nurse appointments Telephone appointments Pharmacist appointments Digital access Health visitor Direct Access PAU asthma review pathway High risk patients at risk of hospital admission due to recent illness with potential medication optimization problems Rapid response referral 27 MK Practices Acute within 48 hours III. Activity 10,182 additional appointments have been provided in extended hours between 21st September 2015 and 12th June 2016 Since January 2016 the services are achieving 61% of the bid weekly target of 34,000 appointments per annum. In most recent weeks the services are achieving 73% of the bid weekly target. The services are used by different practices at different levels of activity invariably the Hub practices using it the most. 60% of practices have used the service minimally. The service is 80% booked and has a 14.4 % DNA rate. 72 % of appointments are during the weekend and 64% of appointments are booked within 4 days. Collaborative working activity is progressively developing in the background with the vision for one General Practice Federation model. 1

12 Agenda item 10 - CC16/03 IV. Outcome For the General Practice Access service, 77% of patients who attended the service were of working age. A significant number of patients found the current service provision to be very convenient by Location (68.1%), by Day (68.8%) and by time (63.7%). 67.6% of patients found the booking process to be very good, a reflection on the patient s registered practice. 83.7% of users would be likely or extremely likely to recommend the service to their friends of family. Had patients not been able to access the service, 25.9% of respondents state that they would have gone to A&E, Urgent Care Services or the Walk in Centre (170 individuals). A further 53.9% would have delayed and waited to see their own GP. For the Children s service, 95.4% of parents were either likely or extremely likely to recommend this service to friends and family, with 96.7% saying they would use this service again if needed. 83.2% of patients who attended the service were referred by a GP, with 7.7% having previously attended hospital (either in-patient or day attendance). 89.3% of parents felt better able to care for their child since their appointment, with 96.0% saying that the nurses explained what signs/symptoms they should look out for. 96.7% of parents also felt that they and their children were listened to by the nurses. 94.0% of parents thought that the quality of care that their child received was good or excellent. 50.7% of parents (a decrease) said that they would have taken their child to either Urgent Care or A&E if the service was not offered, with a further 38.0% (an increase) saying that they would have gone to their GP. There is also a good mix of responses for patients who attended MKUCS (83.4%) and The Grove Surgery (16.6%). For the Rapid Response Medication Optimisation service there is no quantitative patient survey data. But anecdote report suggest that patient s valued the service. Overall the positive local patient surveys reflects the improved National Patient Survey where Milton Keynes has moved up 3 places compared to the previous 3 years where it has remained in the bottom 5 th. Individual practices who use the service the most have also seen an improvement on their national service ratings with one practice moving up by 16 places. The services have only been operational across Milton Keynes since January 2016, therefore it is in it s infancy in regards to outcome-based impact data. The service has developed safe best practice IT systems which has been recognised Locally and Nationally. The programme SRO and GEM lead were named National SystmOne Champions 2016 for their work by SystmOne providers. V. Summary, conclusions, recommendations The service is progressively reaching its intended target population and is valued by the patients with positive patient feedback. It has not reached its target activity as set out in the bid of 34,000 appointments per annum, but this should be achievable when all the other intended services/pathways are live. The pilot is currently underspent and there is still capacity in practices for increasing the use of the service. The service has not been running long enough or at its potential maximum capacity to show any significant impact on hospital or primary care activity. It is recommended that the service continues to development and providing appointments to enable it to reach its fullest potential. VI. The Future Following the formal announcement on 22 July 2016 that the pilot program will be extended until 31 March 2017 with some core requirements, the programme team will now set to review all the services and contracts to ensure they meet the core requirements. In addition, the services will be reprofiled in order to maximize on efficiency savings moving forward. The Programme will also work collaboratively with MKCCG to monitor outcome based impact data. Thao Nguyen, Clinical Director and SRO Susan Hoath, Programme Director 23 July

13 Agenda item 10 - CC16/03 Prime Minister s GP Access Fund (Milton Keynes) Hospital Campus, Standing Way Eaglestone, Milton Keynes, MK6 5NG FAO: Lesley Harrison, NHS England Cc: Dominic Cox, NHS England Janice Omar, NHS England Alexia Stenning, NHS MK CCG Janine Welham, NHS MK CCG Thank you for your of 20 July We were delighted to read that NHS England have successfully secured funding for our GP Access Fund schemes to continue both to deliver services and to pilot new ways of working in Primary Care. We have considered our ability to fulfil the core requirements and aims associated with this funding and our detailed response is below. In general terms, I would like to assure you that the PMGPAF programme in Milton Keynes is now well established to deliver many of these requirements within its existing specification. I am more than happy to discuss this further with you if required, and of course can offer any more detailed information you require. Best wishes, Susan Hoath Programme Director, PMGPAF (MK)

14 Agenda item 10 - CC16/03 Prime Minister s GP Access Fund (Milton Keynes) Response to the core requirements and aims for 2015/16 Core Requirements: For current GPAF schemes to be eligible for this additional funding, we are looking to provide a more standardised offer to be made to the public on extended access to General Practice going forward, whilst allowing local flexibility in how these requirements are met. This will help make it clearer to the public what they can expect, and help ensure we continue to drive value for money for the taxpayer. This means that we are now asking that GPAF schemes meet a minimum set of core requirements. Timing Weekday provision of access to prebookable and same day appointments to general practice services in evenings (after 6:30pm) to provide an additional 1.5 hours a day Weekend provision of access to prebookable and same day appointments for at least six hours on both Saturdays and Sundays. GPAF MK is already delivering appointments that can be booked either today or up to 15 days in advance (subject to patient choice and availability). Although they are often available, we do not currently protect same day appointments in our model but could look to this in future in response to changes in demand. We struggled to recruit to extended hours sessions of 6:30-8:00, with feedback from GPs that a 1.5 hours session is unattractive. In most cases, therefore, our evening sessions run for 2 hours; from 6:00-8:00. We consider all activity in these sessions to be additional hours over and above existing GP capacity in Milton Keynes and record it as such. Our existing service offers pre-bookable appointments on three different sites and across 12 hours on Saturday and on a single site for 8 hours on a Sunday. This exceeds the stated requirement.

15 Agenda item 10 - CC16/03 Robust evidence needs to be provided, based on utilisation rates, for the proposed disposition of services throughout the week. Our live evaluation process currently monitors demand and utilisation on a week by week basis, informing the release of future sessions. We have experienced steady demand for Sunday sessions, but a significantly higher DNA rate for these appointments. We have a programme of work in place to attempt to reduce DNAs. Capacity: Schemes should aim to deliver an additional 45 minutes per 1000 population outside core hours We assume that this level is per week and if so, this would equate for 180 hours per week for the population of the GPAF MK Collaboration. Our existing services provide c. 160 hours per week and are running at approximately 75% of maximum (based on clinical staff and room availability). We have steadily increased capacity (by releasing new, recurring, sessions) over time as demand (uptake) has increased. We plan to continue with the process of managed growth over time and, if current trends continue, should exceed 180 hours per week by the end of the year. As stated above, and for the avoidance of doubt, c. 40 of these hours are before 6:30pm (our session start time for most evenings being 6:00pm). We consider these to be of equal value in extending access and capacity for general practice and include them in our calculations. Schemes should aim to maintain the current offer to patients for extended access We expect to continue all existing extended access services and plan to use this funding assurance to design and deliver a number of further pilots of new ways of working to further improve access to primary care in Milton Keynes.

16 Agenda item 10 - CC16/03 Measurement: Usage of a nationally commissioned new tool to automatically measure appointment activity by participating practices, both in-hours and in extended hours Any other nationally agreed data requests eg highlight reports, patient polling. We gather that this refers to the Apollo data extraction and analysis tool and will of course cooperate with this and any other national data collection and evaluation process (insofar as it is within our ability to do so through existing membership, information sharing and contract documentation). Advertising: Evidence of communication to patients of these services, including implementation of a communications strategy promoting the extended access services which should include: o Notices in participating practices and notification on their websites, so that it is clear to patients how they can access these appointments and associated service. We are already using many of these techniques to promote the service, including: - Leaflets and posters in all member practices; - Information for participating practices to use in their own information resources; - Training and information for reception/booking staff in member practices, Walk In Centre and Urgent Care Centre; - Direct booking at point of contact (either face to face or over the telephone) - Promotion through local for a such as Healthwatch, Patient Participation Groups, etc. o Notices in local urgent care services (A&E), WIC, MIUs etc) advertising the service. o All practice receptionists able to direct

17 Agenda item 10 - CC16/03 patients to the service and offer appointments to extended hours service on the same basis as appointments to non-extended hours services. o Publicity through local channels, that reaches beyond the practice website and waiting room, such as community bulletins, social media etc. Access to extended access appointments Clear route for patients to access these appointments, for example through being offered slots by their own practice, through GP out of hours services or 111 or through new digital channels. Slots should be easily accessible. Our current model allows practices to book appointments directly from their own reception/appointment desk. Patients who request an appointment are therefore offered slots within the extended hours service alongside those within their host practice. Out of Hours service (MK Urgent Care Centre) can currently book appointments for patients who are under 18, as can Health Visitors and local Children s Services. We are in the process of widening referral routes for under 18s to include A&E. GP extended hours services are currently only bookable through the patient s practice; we are in the process of introducing alternative routes but have placed a high value on patient routes which actively enable and consent the sharing of medical records. We believe this offers better patient safety and supports better integration of our service with core general practice. We have not engaged with 111 a present, anticipating a whole-system procurement for

18 Agenda item 10 - CC16/03 urgent care which will include pathways of access to the GPAF services. Patients should have a choice of evening or weekend appointments on an equal footing to core hours appointments: patients should not have to specifically ask for a weekend appointment to be offered one. Patient information leaflets and receptionist training both include emphasis that the service is available seven days a week. Digital All schemes will need to confirm how they use digital approaches building on their work to date. Our existing scheme is based on a direct booking from point of contact, using a shared SystmOne module that works alongside that already in all our member practices. This approach, alongside explicit patient consent, allows extended hours session GPs access to full patient notes and allows them to record any interventions directly into the patient s notes. We use SMS systems for appointment reminders and to follow-up (if required). We use online tools to capture patient feedback. Our current model relies on booking from member practices to enable sharing of patient records (see paragraph above). We have not, this far, considered self-referral. Walk in services already exist in Milton Keynes to meet this need. Inequalities: Issues of inequalities in patients experience of accessing general practice identified by local evidence and actions Our Extended Hours service (MK Health Extra) has been running in full since January The children s service since May We already know that patients using the service are more likely to come from the more deprived wards and communities of Milton Keynes and from those areas where local practices have previously experienced

19 Agenda item 10 - CC16/03 implemented to resolve. access difficulties. This pattern means that patients living in communities with great inequalities are already accessing our services more than those from more affluent areas. However, it is also more likely that practices in these areas will be those with greater demand for GP services and therefore be the practices more likely to need to use our services to support their own.

20 Workstream Highlight Report MK Health Response This highlight report updates the Project Board about the progress to date, slippages, milestones & next steps. These will be developed to provide additional reporting Project Name: MK Health Response Project SRO: Thao Nguyen Programme Director: Susan Hoath Report Date: 07 July 2016 Current Project Stage: Mobilisation Next Project Stage: Evaluation Collaboration RAG Status Current: Amber RAG Status Rationale: Previous: Amber Concern regarding the remaining time until the end of the pilot vs. value of the data captured to-date. Progress since last Highlight Report Achievements: Supporting production of the interim evaluation report due 8 July Revised specification implemented and seeing patients via rapid response referral pathway Service performance data for May received and under review to gauge impact of change. GP referral pathway being finalised.

21 Likelihood Impact RAG Status Key milestones and deliverables summary Milestone Target Date Responsible Status Confirm service provider going forward Complete Complete review and update of service specification with provider Complete Publish draft end of term evaluation Complete Revised service commences Complete GP referral pathway live July Programme team / CNWL In progress Confirm final evaluation report date TBC Programme team Risks & Issues Summary - Top 3 Risk / Issue Description Risk Score Mitigating Actions A statement describing the cause, risk event and impact / issue Systems and processes that are in place and operating that mitigate this risk, including assurances Target resolution date It is an issue that the original service specification did not ensure the collation of relevant data to support an effective evaluation Concern regarding the remaining time until the end of the pilot vs. value of the data captured to-date. - 4 A Service specification has been updated and implemented. Service data for May received and under review Regular TAF established every two weeks to monitor. July-16

22 Workstream Highlight Report - Collaboration This highlight report updates the Project Board about the progress to date, slippages, milestones & next steps. These will be developed to provide additional reporting Project Name: Collaboration Project SRO: Thao Nguyen Programme Manager: Susan Hoath Report Date: 07/07/2016 Current Project Stage: Initiation Next Project Stage: Mobilisation RAG Status Current: Amber Rationale: (i.e. brief descriptions as to why the RAG status is green/amber/red. Previous: Amber Forward planning dependent on engagement of primary care and clarification of longer term expectations. Progress since last Highlight Report Achievements this period: Regular meetings held with existing MK Federation to facilitate fostering of collaborative working to realise a sustainable MK primary care CCG/NHSE Commissioner input increased Targets for next period: Gain clarity from NHSE on the expectations/assumptions behind ongoing funding announcements; Develop a primary care leadership development support package for the collaboration in order to facilitate primary care sustainability with strong Leadership across primary care Develop a collaborative fostering of shared learning and knowledge through initiatives like a young doctors forum To improve collaborative engagement through enabling further projects aimed at reducing primary care work load working collaboratively with MK federation To enable more collaborative working by continuing to directly support MK collaboration/federation Next steps: To work directly with MK collaboration/federation

23 Likelihood Impact RAG Status Key milestones and deliverables Milestone Target Date Responsible Status Clarification of the assumptions/conditions associated with ongoing funding and scope project plans accordingly. Project Manager In progress Meetings set up to progress collaborative working Work with MK federation to develop leadership programme Work with MK federation to develop fostering of shared learning Collaboration chair JZ, TN JZ, TN In progress In progress In progress Risks & Issues Summary Risk / Issue Description Risk Score Mitigating Actions A statement describing the cause, risk event and impact / issue Systems and processes that are in place and operating that mitigate this risk, including assurances Target resolution date Escalated to collaboration board Collaboration It is an issue that we are having difficulty establishing new services and workstreams due to a lack of engagement from collaboration practices. - 5 R Review ongoing commitment of collaboration practices Establish programme champions to improve engagement key groups, e.g. practice managers / partners. July-16 Continue to request and chase information from practices. Collaboration It is an Issue that a Collaboration / Federation cannot sustain itself without initial appropriate investment and support - 4 A Discussions with stakeholders Pilot small projects directly with mk federation TAF discussion with key stakeholders Review GPAF budget July-16

24 Workstream Highlight Report MK Health Extra This highlight report updates the Project Board about the progress to date, slippages, milestones & next steps. These will be developed to provide additional reporting Project Name: PMCF Access Project SRO: Thao Nguyen Programme Director: Susan Hoath Report Date: 07 July 2016 Current Project Stage: Mobilisation Next Project Stage: Evaluation Collaboration RAG Status Current: Previous: Amber Amber Rationale: Service capacity remains under continuous review to ensure that capacity meets demand, rather than over supplying. However some medical staff have now withdrawn from the service and this will now lead to a reduction in capacity in the service. Progress since last Highlight Report Project Delivery: Patient navigation toolkit under development with pilot practices, arranging gap training during July. Musculoskeletal service development is underway and first clinics due to start week commencing 25 July Second customer care training session scheduled 12 July. Phlebotomy service location options being scoped with a view to opening an additional site Development of an acute muscular skeletal service underway. Nursing: Developing a service specification for the provision of nursing services from a third-party using the clinical pathways defined by our nurse lead. Telephone consultation training scheduled for 30 July, being provided by RCGP. Pathway to be developed. Supporting production of interim evaluation report being prepared by Jenny Williams. Slow uptake of the Apollo tool which is impacting on the national evaluation of wave 2. Accommodation SLA for review in light of development of a sustainable service for the future. Service delivery: Some medical staff have now withdrawn from the service, and this is leading to a reduction in capacity in the service. Currently in discussion with hub practices to continue service until end of August. Following on from this will liaise with recruitment agencies to extend current GP locum contracts. Continued receipt of completed patient satisfaction surveys. Response rate is currently approximately 11% of attendees. Report included in pack.

25 Likelihood Impact RAG Status Key milestones and deliverables summary Milestone Target Date Responsible Status Interim evaluation published 8 July Programme Team In progress Acute muscular skeletal services commence 12 July Programme Team Planned Nursing services commence Aug 16 Programme Team Planned Telephone consultations Aug 16 Programme Team Planned Risks & Issues Summary Risk / Issue Description Risk Score Mitigating Actions A statement describing the cause, risk event and impact / issue Systems and processes that are in place and operating that mitigate this risk, including assurances Target resolution date Maintain regular calls and visits to practices Evaluation It is an issue that the Apollo tool is not yet installed at all collaboration practices. Delayed start of national evaluation. - 5 R Maintain updates at key meetings, hub manager, practice manager, Escalate to collaboration partners July-16 Escalate to collaboration board it is an issue that capacity has started to reduce due to withdrawal of clinicians - 4 A Reasons understood, require push on recruitment and induction, push on alternative appointments. Confirm long-term funding to secure commitments. July 16 It is an issue that around 15.27% of appointments are lost due to patient s failure to attend pre-booked appointments. Resulting in an increased overall cost per patient, inefficient utilisations of clinical staff, and reduced availability of appointments. - 4 A DNA reports sent to registered practices on a weekly basis, specifically highlighting any patterns, for action following their local procedures. DNA prevention training delivered during May and July PLTs. July 16

26 Workstream Highlight Report MK Health Children s This highlight report updates the Project Board about the progress to date, slippages, milestones & next steps. These will be developed to provide additional reporting Project Name: PMCF Children s Project SRO: Thao Nguyun Programme Director: Susan Hoath Report Date: 8 th July 16 Current Project Stage: Mobilisation Next Project Stage: Full Delivery RAG Status Current: Amber Rationale: Demand for the service is not currently utilising the available capacity. Establishing Previous: Amber new referral pathways and raising service awareness to close the gap. Progress since last Highlight Report Project delivery Assisting the service delivery team with the enablement of new referral pathways and raising awareness of the service to increase demand. Face to Face and Telephone appointments are steadily increasing with record numbers of appointments being booked. Bedford and Furzton St, receptionist training completed and referrals being received. GemArden are arranging training for the next wave of seven practices that have requested training. The children s service specification is being updated to ensure governance and monitoring of the service against targets. Hospital Pathway. The training for the Asthma and Wheeze, referral took place on 5 th July Service delivery All nurses in children s team have now completed paediatric minor illness course SystmOne Appointment Rota has been updated, increasing the available maximum clinical hours and improving the distribution of appointments. The number of face to face appointments in the rota has gone from 190 to 248 a week. Children s Service leaflet for health professionals and appointment cards have been printed and passed out to all referring services Dr Chana and Dr Shetty working with Dr Kirpalani are working on the training and mentoring programme for GPs. First session taking place on 12 th July 6 Health Promotion to Parents and Carers sessions have been held and were well received by parents

27 Likelihood Impact RAG Status Key milestones and deliverables Milestone Target Date Responsible Status GP champion attending Neighbourhood Meetings Dr Shana and Dr Shetty and first paediatrician training 11 th July Wolverton arranged Completed Completed Bedford and Furzton St receptionist training held with GemArden and referrals received Health visitor receptionist referral Parkside and Whaddon, Newport Pagnell Completed w/c 18thJuly Workstream Lead In Progress Hospital Asthma Referral pathway to start w/c 11 th July Workstream Lead In Progress Evaluation drafted for review July 2016 Programme Team In Progress Report to guide commissioning decision published 31/08/2016 Planned Risks & Issues Summary Risk / Issue Description Risk Score Mitigating Actions A statement describing the cause, risk event and impact / issue Systems and processes that are in place and operating that mitigate this risk, including assurances Target resolution date It is a risk that should MKUCS vacate the urgent care centre, the children s service may not have identified alternative accommodation for week day sessions, possibly leading to a reduction in service / reduced volume of data collated for evaluation. Risk transferred to MKUCS, agreement that the service supplier will ensure service continuity should this problem arise. Closed on project register New referral pathways being developed and piloted. It is an issue that Demand for the service is not currently utilising the available capacity. Delivery model not sustainable long-term. - 4 A Attending GP neighbourhood meetings to promote the service. Ongoing advice/support with the booking process being given by children's admin. Aug 16 Promotion leaflets, brochure produced and distributed to health professionals