Meeting of the Primary Care Commissioning Committee Part I. 4th Floor Unex Tower, 5 Station Street, London E15 1DA. 25 th January pm 4.

Transcription

1 Meeting of the Primary Care Commissioning Committee Part I 4th Floor Unex Tower, 5 Station Street, London E15 1DA 25 th January pm 4.30pm 1

2 ACRONYM AC ACC A&E APMS AQP BDG Bart's / BHT BAF BMA BCP C&MCC CCC CQC CAG CCG CQRM CQUINs CSU CHN CHS CPD CCU DTOC DoH DRSS DES DASL ELFT EMIS web EPR EPCS EPCT FOI GMC GMS GP HoT HWT ICC IMT IMCA IG ITU MEANING Audit Committee Acute Commissioning Committee Accident & Emergency Alternative Provider Medical Services (a type of Primary care contract) Any qualified provider Board Development Group Barts Health NHS Trust Board Assurance Framework British Medical Association Business Continuity Plan Children & Maternity Commissioning Committee Community Commissioning Committee Care Quality Commission Clinical Academic group Clinical Commissioning Group Clinical Quality Review Meeting Commissioning for Quality and Innovation (Payment Framework) Commissioning Support Unit Community Health Newham Directorate Community Health Systems Continuing Professional Development Critical Care Unit Delayed Transfers of Care Department of Health Diabetes Retinopathy Screening Service Direct Enhanced Service Drug and Alcohol Service in London East London Foundation Trust Egton Medical Information Systems (System that records patient consults) Electronic Patient Record Extended Primary Care Service Extended Primary Care Team Freedom of Information General Medical Council General Medical Services (a type of Primary care contract) General Practitioner Heads of Terms (Contract Summary) Healthwatch Integrated Care Committee Information Management and Technology Independent Mental Capacity Advocate Information Governance Intensive Therapy Unit 2

3 ITT KPI LD LD SAF LAP LAs LCFS LES LMC LAS LBN MM MHCC MPIG NICE NUH NHSE NELCSU NCCG OOH PC PC PCCC PALS PPE PPG PREM PROM PMS PCT PHE QC QOF QIPP RAID RAG RC RTT R&D RLH SPR SPA TOR TIC TDA TSCL TST UCWG UCC UCC WELC Invitation to Tender Key Performance Indicator Learning Disability Learning Disability Self-Assessment Framework Local Area Partnership Local Authorities Local Counter Fraud Specialist Local enhanced service Local Medical Committee London Ambulance Service London Borough of Newham Medicines Management Mental Health Commissioning Committee Minimum Practice Income Guarantee National Institute of Health and Care Excellence Newham University Hospital NHS England North East London Commissioning Support Unit Newham Clinical Commissioning Group Out of hours Procurement Committee Practice Council Primary Care Commissioning Committee Patient Advice and Liaison Service Patient and Public Engagement Patient and Public Group Patient Reported Experience Measure Patient Reported Outcome Measures Personal Medical Services (a type of Primary care contract) Primary Care Trusts Public Health England Quality Committee Quality Outcome Framework (Assessor Validation Reports) Quality, Innovation, Productivity and Prevention Rapid Assessment Interface Discharge Red, Amber, Green Remuneration Committee Referral to Treatment Research & Development Royal London Hospital Service Program Review Single Point of Access Terms of reference Transformation and Innovation Committee Trust Development Authority Transforming Services Changing Lives Transforming Services Together Urgent Care Working Group Urgent Care Centre Urgent Care Centre Waltham Forest, East London and City (Integrated Care Programme) 3

4 Whipps X / WX Whipps Cross Hospital WTE Whole Time Equivalent 4

5 Primary Care Commissioning Committee - Part I 25 th January :00-16:30pm AGENDA No Time Item Action Page Presenter Required 1 Welcome, Introductions, Apologies and Declarations of Interest Note Verbal Chair 2 Minutes of the Part I meeting November 2016 Decision Chair 3 Part I Action Log Decision Chair 4 CEPN - mainstreaming proposals Decision N Hamer 5 External Committee Feedbacks impacts on Decision N Hamer Primary Care 18 6 EPCS Principles Discussion N Hamer 7 Conflict Management Protocol Decision Provisional M Sims 8 NCCG Finance Report Monitor C Whitton 9 Risk Register Monitor J Lee 10 Forward Plan Information Chair

6 Statement of advice on declaring interests at NCCG meetings Guidance All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent be that before or at the meeting. If during the course of a meeting an interest not previously declared is identified, this must be declared at that time. The record of a declared interest is the interest declared verbally at the meeting. An attendee cannot refer to interests already declared on the register of interests or an interest already declared at a previous meeting. There is no such thing as an ongoing interest. The minutes of the meeting will detail all declarations made and any relevant responses and/or action taken. Direct Financial Interest If you have a direct financial interest in any matter on the agenda you must not participate in any discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter. Indirect Financial Interest You are required to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct. Other Interest You are required to declare an interest where a decision in relation to the business of the meeting might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. If in doubt you should assume that a potential conflict of interest exists. Action upon declaration of an interest at a meeting For direct financial interests you must leave the meeting for that item For indirect financial interests and for other interests the action required will vary dependent upon the interpretation of the extent and influence of the interest and may involve; o leaving the meeting, o remaining at the meeting and not voting or speaking, o remaining at the meeting and both speaking and voting Chairs ruling For the avoidance of doubt the Chairs decision on a declaration of interest and its management is final 6

7 Primary Care Commisioning Committee (PCCC) Part I - Wednesday 30 th November pm 4.30pm The Stratford Room (FO24), 4th Floor, Unex Tower, 5 Station Street, London E15 1DA Voting members present: Wayne Farah - Chair Andrea Lippett Steve Gilvin Chad Whitton Fiona Smith Lay Member Patient & Public Engagement NCCG Lay Member Remuneration NCCG Chief Officer NCCG Chief Finance Officer NCCG Registered Nurse NCCG Non-voting members present: Meradin Peachey Alison Goodlad Public Health Member LBN NHSE Member In Attendance: Mike Sims Neil Hamer Jason Kelder Board Secretary NCCG Associate Director Primary Care NCCG Assistant Finance Director- Property NCCG 1. Welcome, Introduction, Apologies for Absence & Declarations of Interest Welcome The Chair welcomed the members to the meeting. Apologies were received from the following members: 1.3 Greg Cairns LMC Member Dr Ashwin Shah GP Member Clive Furness Local Authority Member LBN Dr Ambady Gopinathan GP Board Member Declarations of interest. There were no declarations of interest 2. Minutes of the Part I meeting 26 October Minutes Approved as accurate record of the meeting 2.2 Action Log 65 - Commence a dialogue with LMC on where any scope to develop any items of local agreement on GMS/ PMS - NHSE / LMC have confirmed by letter that they are no 7

8 longer seeking to negotiate an agreement on GMS / PMS von a London wide basis. The CCG is therefore now seeking to implement a locally negotiated agreement by 30/6/17 - completed 67 - Provide report on COI rationale at PCCC meetings for October meeting on agenda for November meeting - completed 68, 69 - items confirmed as on forward plan - completed 3 Strategic Items 3.1 Primary Care Access Offer NHC proposal Comments Clarified cost of pilot is 436,000. Clarified a premium paid for Saturday and Sunday appointments. Consensus that demand management data would be essential for approval of any scheme extension. Actions The following demand data to be provided in next report: a) 8 to 8 weekend activity both interims of level of demand not just take up; in particular, Sundays. Assessment on impacts another work flows e.g. UCC. Times of day analysis of the appointments. b) Return pilot update report with the analysis for March meeting. Decisions Agreed the proposed period and format for the 8-8 access scheme pilot and the funding to be allocated to the scheme. Agreed without required data for March report no further approval for pilot extension will be granted. 3.2 Referral Management Scheme Development and outline of proposed programme Comments Noted there will be a focus on referrals from new GPs and Locums. Actions Return update reports on progress on targets to February 17 meeting. Decisions Agreed PCC would retain responsibility for monitoring the referral management scheme. 3.3 Management of Conflicts at PCCC Comments A consensus that since the formation of the Committee the nature of the business being conducted, in particular under Part II of the meeting, has changed and that GPs were increasingly at risk of being conflicted at that session. Noted that both Tower Hamlets and Waltham Forest had independent GPs in attendance at Part II meetings. Noted that anymore away from including local GPs on the committee would need both Board and Practice Council authorisation. Actions Develop a protocol for review for dealing with both Part II and III agenda items which could involve independent GP members. Decisions 2 8

9 Agreed to develop a protocol for further review. 3.4 Quality Dashboard Comments CQC inspection data had not been fully updated and therefore a fully updated dashboard could not be provided. Summary to date was: rated as good 2. 5 required improvement 3. 3 rated as inadequate Confirmed that well led indicators already existed within the report. Actions: None. Decisions Agreed to adopt the new trigger indicator process from the Quality Dashboard. 3.4 Practice Quality & Improvement Group Comments Consensus the approach was in the right direction. Agreed the Chair of PCCC would chair the PQIG. Actions Consider and repot back how clinical input would be achieved by PQIG. Decisions Agreed the establishment and membership of the PQIG with the chair of PCC to chair PQIG. Agreed the step by step pathway for supporting practices identified by the quality dashboard. 3.4 NCCG Finance Report Comments Month 7 reports continues to forecast a breakeven position for primary care. Actions None. Decisions The report was noted. 3.4 Risk Register Comments Use of word Update should read Change. Actions Reduce the risk of achieving equalisation process for GP contract given local LMC negation can now recommence. Decisions The report was noted. 4. Information items 3 9

10 4.1 ETTF Update Comments Secured 5.3m for primary care premises over two years. Spend has to be committed this financial year. Actions None. Decision 4.2 Forward Plan Comments None The report was noted. Actions Chair delegated to review Decisions The Report was noted 4 10

11 ITEM 3 - highlighed items represent a recommendation to remove from register Primary Care Commissioning Committee - Action Log Part January 2017 Action Meeting Action reference date Owner Deadline Update PCCC70 Pimary Care Access Offer - provide March 30/11/2016 decision report M Sims January Added to forward plan - completed PCCC71 Referral management Scheme - review progress 30/11/2016 M Sims at february meeting January Added to forward plan - completed Protocol may be available for January meeting if can PCCC72 30/11/2016 Produce a conflicts management protocol M Sims January be worked through in advance with Chair - to be advised at meeting Clinical input can be obtained via out of area 2 GP s who were approached for independent support to the PMS negotiations. PCCC73 Recommend how clinical input will be achieved 30/11/2016 by newly established PQIG N Hamer January PCCC74 30/11/2016 Reduce risk of achievijng contract equalisation given local LMC negotiation can re-commence J Lee January Risk remains LMC lead unexpectedly unavailable 11 1

12 Primary Care Commisioning Committee (PCCC) 25 th January 2017 Title: Workforce Capacity and Development Report Agenda item 4 Author: Presented by: Contact for further information: This Paper is for: Action required: Executive summary: Liz Delauney Organisation, Project Lead for the Newham Together the Community Education Provider Network (CEPN) Dr Stuart Sutton, Chair of Newham Together The CEPN Liz Delauney Organisation, Project Lead for the Newham Together The Community Education Provider Network (CEPN); liz.delauney@newhamccg.nhs.uk; Discussion The CCG Primary Care Commissioning Committee is asked to: Discuss the content of the report. The report asks the Committee to: 1. Note the contents of the report and the issues for consideration. 2. Provide feedback on any other information which may be helpful in supporting future discussions. Supporting papers: How does this fit with Newham CCG Strategy: Values: Commitment to continuous Learning and Development Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Where has the paper been already presented? Risk: Equality Impact: Stakeholder engagement: No previous presentation to any meeting. The following risks are relevant: Failure to effectively integrate health & social care Failure to deliver the stated TST benefits including quality and financial efficiency The training and development programmes delivered through the CEPN will increase the capability and capacity of staff within health and social care organisations, improve the delivery of integrated care approaches, and will ultimately improve the quality of services to deliver safe care. An evaluation of the CEPN was undertaken with views collated from a wide range of staff and organisations. Newham Together facilitated a collaborative workshop with partner organisations including TST, Skills for Care and 12

13 Financial Implications neighbouring CEPNs for sustainability discussions. The CCG has committed to the support and development of the CEPN programme for the financial year 2016/17. Funding for 2017/18 is to be decided. Other funding opportunities are currently provided by HEE NCEL with the CEPN s delivery of the STP and 5YFV priorities. Further financial questions can be discussed with the CCG Finance Team. The CEPN is currently seeking to identify funding from other sources for its sustainability. Page 2 of 6 13

14 1. Introduction This report provides the Newham CCG Primary Care Commissioning Committee with an update on Newham Together s (CEPN) activities in the third quarter of the financial year, and outlines the progress made in regards to CEPN sustainability discussions. It must be noted that the CEPN s routine work of developing and delivering training programs especially to general practice staff, as well as the management of other key projects such as the development of the Learning Management System continues CEPN Developments and Activity November 2016 to January 2017 Locality Funded Projects Robust monitoring of the thirteen projects that are currently being funded though the 170k HEE NCEL Locality Funds continues. All project leads are being supported with the implementation of the projects, as well as in ensuring that their evaluations are being built in at each stage of delivery. Progress is as follows: 8 projects are RAG rated Green and are likely to be completed within the 2016/17 financial year; 2 Projects are RAG rated Amber, however all plans are in place to support delivery by the end March 31 st 2017; 3 projects are RAG rated Red and negotiations have commenced with HEE NCEL to allow delivery of the projects to be completed in 2017/18 financial year. The delays are due to either lack of capacity, or the projects involve both organisational, governance and cultural changes which cannot be achieved in a 6 month timescales, which is the reality for delivery from when funds are received. The Apprenticeship Project The Apprenticeship programme also continues to deliver with a further 11 apprenticeship starts in GP Practices since November 2016 bringing the total starts to 51 new apprentices since December Work is in progress with Newham CCG in regards to implementing a widening participation programme and the recruitment of apprentices. 2.3 Transformational Fund Projects At the end of November 2016, HEE NCEL announced the availability of a potential 250K worth of funding to CEPNs to support STP and 5YFV workforce priorities. The CEPN approved 17 bids against the following HEE NCEL criteria: 5 bids on Retention of the Workforce - 80k 3 bids on Clinical skills - 40k 3 bids on Apprenticeships and Widening Participation - 30k Primary and Secondary care interactions - 40k 2 bids on Empowering Carers and Communities - 30k 1 bid on New Ways of Working - 30k Five of the bids will be implemented across the TST or WEL geography demonstrating the CEPN s ability to be a vehicle in delivering STP priorities. The projects will be implemented and monitored on the receipt of HEE NCEL s final approval. 2.4 Page 3 of 6 Collaborative Ventures to support sustainability 1. Piloting and Implementing Medical Assistants in GP Practices The CEPN has been successful in a collaborative bid with the City & Hackney CEPN for 152K from HEE NCEL for one of two pilots designed to meet 5YFV workforce initiative to establish the Medical Assistant role in GP practices. 14

15 The collaboration will be between City & Hackney CEPN, CCG and GP Confederation and Newham CEPN, CCG, and Newham Health Collaborative. The partnership builds on a strong track record of innovative primary care workforce development in City & Hackney and Newham. This role of Medical Assistants will be further defined within the pilot. However, the concept for this role is as a means of up skilling clerical roles to include elements of work, such as coding, letter reading and patient liaison, which can alleviate some of the administrative pressures on GPs and clinical staff. The delivery of the Pilot Project will be overseen by a Steering Group with representatives from all partner organisations. 2. Support Nursing In Care Homes The outcome is awaited on another collaborative bid to the Royal College of Nursing on a project which aims to develop a creative and sustainable partnership between the NHS, care home sector, local authorities, London Ambulance Service, service users, carers and universities to address improvements in the quality of care in Care Homes. If the bid is successful, this project will be hosted within Newham CCG. 2.5 Developments in Practice Nursing The CEPN has recruited 7 new General Practice Nurse trainees (GPN) to help address the workforce crisis within Primary Care triggered by difficulties in recruiting and retaining both GPs and practice nurses in the face of rising demand for health services. This will bring the total of GPNs to 17 over 2 years, with the current cohort commencing in January Three practice nurses were sponsored to undertake the Advanced Nurse Practitioners programme with financial support for salaries and mentorship; however only 2 will proceed. This will support the increase in capacity and capability in primary care to directly address the shortage of GPs, as well as providing the skills to provide more complex care with the shift of care from acute to primary care. Page 4 of 6 15

16 Sustainability of the CEPN The previous Workforce Capacity and Development report outlined the steps that the CEPN was taking to develop a sustainable proposition for its future in regards to where it is hosted, its administrative resourcing and the extent to which it can be integrated across the health and social care landscape to support real transformation change. A final decision has not yet been reached however current actions includes: Investigating the options for alignment with one of the stakeholder partners. Working with the GP Federation on developing a sustainable self-funding model for training and this work is in progress. Negotiating with CEPN stakeholder organisations to gain their commitment and agreement on financial and resource contributions. This work is also in progress. The establishment of a Task and Finish Group to scope all funding opportunities. Members of the Group are currently researching the viable funding options. The ongoing development of Board members. 3.2 Developing an Integrated Workforce Commissioning Support Function Option One option which is currently being scoped is that of the potential service offer that could be delivered through an integrated workforce commissioning support function across LB Newham Adults Social Care and Newham Clinical Commissioning Group. The proposal notes the significant opportunity to bring together the workforce commissioning activity currently undertaken by the LBN Adults Services and Newham Clinical CCG/Newham Together to ensure a coherent and cost effective approach to health and social care workforce development activity and delivery of the STP and Integrated Care Programme priorities at a local level. There are potential advantages to an integrated function namely (but not limited to): 1. The opportunity to provide strategic oversight and responsibility to respond to sector wide workforce and capacity issues, and in addressing the requirements of the JSNA/Health and Wellbeing Board. 2. Supporting workforce integration. 3. Supporting organisational development of Newham CCG and LBN in a co-ordinated way. 4. Supporting Workforce Governance Functions with the oversight of workforce aspects of LBN and Newham CCG service specifications and contracts to ensure that national standards are met. There are however some key issues which will need to be addressed including: 1. That the strategic oversight which the CEPN gets within the CCG may be compromised; 2. That Health Education England are unable to divest funds to non-nhs bodies, and therefore the hosting arrangements will need to remain with the CCG or be transferred to another NHS organisation, thus creating some complexities of responsibilities. 3. That the CEPN may be drawn into being a transitional support for LB Newham provider-arm pending externalisation. 4. That local political consideration may adversely impact on the delivery of the CEPN. A decision is critical in light of the pending financial year end and the activities which have to be delivered in 2017 /18. HEE NCEL also has to be notified and agree with any governance change. Reputation wise, the right decision is important for the CEPN s continued effectiveness. The CCG PCCC will be informed as soon as a decision is reached. Page 5 of 6 16

17 4. Financial considerations The income expected to be provided to the CEPN in 2016/17 is detailed in the table below. Project Amount Notified Status of funds Locality Funding 170,000 Received General Practice Nurse Trainees (7) 266,000 Contract awaited Admin Support 25,0000 Contract signed and funds awaited Advanced Nurse Practitioner trainees 76,000 Contract awaited Transformation Fund 250,000 Contract signed and funds awaited Medical Assistant Pilot 76,000 Confirmed. Funds awaited Total 863, Recommendations The CCG PCCC are asked to: 1. Note the contents of the report and the issues for consideration. 2. Note the progress made in regards to the sustainability of the CEPN. 3. Provide feedback on any other information which may be helpful in supporting future discussions. Page 6 of 6 17

18 Primary Care Commisioning Committee (PCCC) 25 th January 2017 Title: External Committee feedback Agenda item 5 Author: Neil Hamer NCCG Assoc. Dir. of Primary Care Presented by: Neil Hamer NCCG Assoc. Dir. of Primary Care Contact for further information: Neil Hamer NCCG Assoc. Dir. of Primary Care, neil.hamer@newhamccg.nhs.uk This Paper is for: Information Action required: The Committee are asked to Note the contents for Information. No action is required by the Committee other than noting the Report and discussing where the committee feel further exploration is required or feedback needs providing Discuss the content of the feedback report. No decision is required Executive summary: The report asks Committee to note the actions of other NCCG committee s which may impact on primary Care and note any dependencies which may exist. Supporting papers: None How does this fit with Newham CCG Strategy: Values: Effective & collaborative communication Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Where paper has already been presented? The Feedback is collected from the IT, Integrated Care, Mental Health and Commissioning Committee and BHC Risk: Reference should be made to risks that link to the NCCG Board Assurance Framework (BAF) done via individual project teams Equality Impact: As per individual programmes Stakeholder engagement: Advise where consultation has taken place. via independent programmes 18

19 1. BHC Committee BHC Development of Hubs to host a range of community services is being included in the BHC documentation as a requirement for providers to be able to integrate and co-locate. As a pre-requisite these Community Hubs should have Primary Care at their Heart and if not on site then in close proximity. Risk identified to BHC team that funding is extremely limited for any new hubs and development times for premises are 2-3 years. The BHC team have agreed to advise the public in their engagement documents that 6 Hubs are provisionally planned at the following indicative locations: Manor Park HC SLG Sir Ludwig Guttman Vicarage Lane Tollgate Shrewsbury Road Surgery New Canning Town - New River Place Hubs are expected to serve a population of approximately k and have a range of core services the draft proposal for these is as below Core Services in all Community Hubs Optional/ Advanced Services Extended primary care services (EPCS) x-ray/ultrasound/magnetic Resonance Imaging (MRI) MDT care planning Care Coordinator Social care worker Virtual consultations with Acute LTC care (Diabetes, COPD, Obesity, CVD) Outpatient provision Urgent care services (Rapid response) Services to support discharge Physiotherapy/Occupational Therapy Sexual Health services. Step up/step down beds Health and well-being services Community pharmacies and clinical pharmacist support in practices Mental health services New models of care will allow for the development of collaborative networks of provision, based upon the following principles: Multi-disciplinary Primary Health Care Teams with clear service specifications that secure the shift from treatment to promotion, prevention, early detection and intervention in the community- Integrated working across these teams through the establishment of service networks rather than co-location and designated links alone. Commissioning of primary and community based service with support from Acute Specialists will emphasise the sharing of skills and locally based services to specific populations designed around their needs Integration of the Primary Health Care Teams with local authority provision, acute and mental health services in community settings, with clear access routes to Page 2 of 4 19

20 secondary care and specialist services Rather than allow providers of health and social services to continue functioning in isolated silos, the HUB requires them to work collaboratively, reaching out to those at greatest risk and connecting them to evidence-based interventions, with a focus on prevention and early treatment. The diagram below illustrates the proposed generic pathway for the BHC programme and how the Community care hub will deliver the key elements of the pathway: Service Specifications are being prepared by the LTC and Primary Care Teams for the overall specification 2 IM&T There is a new WEL wide IG committee for approval of all IG and data sharing agreements Newham CCG IG lead is a member of the committee Local Digital Roadmap now in place these are being linked across the STP Review underway on I-plato and EMIS SMS messaging systems (relevant for access) Programme supported by Primary Care to increase the adoption of POL to at least 10% - Access to Patient record Appointments Booking EPS Page 3 of 4 20

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22 Primary Care Commisioning Committee (PCCC) 25 th Jan 2017 Title: EPCS/LIS : 2017/18 Principles going forward Agenda item 6 Author: Anne-Marie Maher-Vyas Associate Director, Long Term Conditions Mohsin Patel Programme Lead, Primary Care Presented by: Mohsin Patel Programme Lead, Primary Care Contact for further information: Anne-Marie Maher-Vyas Associate Director, Long Term Conditions This Paper is for: Discussion Action required: This report provides an update on the principles of EPCS/LIS review presented to the November PCCC. The review has been undertaken against the backdrop of changes in relation to the GMS contract, the updates under national QOF schemes, the local CCG priorities (STP) and PMS review etc. The PCCC members are asked to discuss and approve the principles and the CCG s Primary Care team will then undertake the review of specifications for Executive summary: The report sets out the outline principles which will inform the development of the technical papers with specification changes and finances. The Committee These will presented to the CCG SMT for final sign off before taking to the LMC/practices/federation for agreement and implementation. Supporting papers: Current EPCS/LIS documents and national QOF, PMS KPIs have been presented to the PCCC or available in the public domain. How does this fit with Newham CCG Strategy: Values: Transparency with our decision-making and leadership Aims: Reducing quality variation 22

23 Where has the paper been already presented? N.A. Risk: Risk of not reviewing EPCS/LIS would mean that health planning and service delivery is reflective of current clinical priorities and may impact on health outcomes of the Newham population. Equality Impact: Effective delivery of these schemes will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham by ensuring improved consistency and appropriateness of service delivery. Stakeholder engagement: Various clinical forums, cluster leads, long term conditions team etc. Financial Implications Failure to review EPCS/LIS may impact on practice direct incomes and CCG discretionary spends on primary care. Page 2 of 7 23

24 1. Introduction and Background Extended Primary Care Services (EPCS) and Local Incentive Schemes (LIS): From 1 April 2013, local enhanced services (LESs) became the responsibility of the CCGs. All services delivered under the old LES structures moved onto the NHS Standard Contract from 1st April The terminology for LESs changed and locally Newham CCG established them as Extended Primary Care Services (EPCSs). Newham CCG EPCSs were developed as part of the CCG's 2014 Primary Care Strategy and were offered to all Newham general practices as part of a three year contract from 2014/15 to 2016/17. These services are in line with population clinical priorities as identified by, London Borough of Newham's Joint Strategic Needs Assessment (JSNA), NHS England Commissioning for Value data packs, Newham CCG's operating plan and locally held primary care data National benchmarking data indicated that the population of Newham experience worse health outcomes compared to national and similar CCGs for Cardiovascular Disease groups, respiratory, cancer and overall mortality for both men and women. Hence, the EPCS were developed in these gap areas and the related incentive scheme based on outcomes was developed as a LIS. Additionally, IT elements, GP engagement as commissioners and prescribing Quality Improvement (QI) schemes were also included as part of this initiative. EPCS/LIS 2014/15 to 2016/17 - journey 2014/15 was the first year of the EPCS/LIS which were commissioned by the CCG through primary care GP practices. Although the financial envelope has been stable throughout the three years, there were a number of clinical and financial changes made each year based on outcomes and agreement with clinical leads and the LMC. Generally, the uptake was around 75% for EPCSs and 90-95% for LIS payments with both elements being well received within primary care. Overall, practices managed to gain 7-8 per patient registered list over and above their GMS and DES funding. The CCG produced reports setting out the key outcomes, which have been presented to various committees, demonstrating that the CCG has reduced inequalities by promoting more case finding and reviews for diabetes, CVD (hypertension, heart failure, atrial fibrillation), COPD which have shown measurable outcomes. In addition to this, there is some evidence that there has been an impact on acute activity, although this is more clinical and GP opinions as it is very difficult to measure due to the complexities of patient pathways and other variables that impact on acute activity. Cases found directly through NHS Health Checks and EPCS/LIS schemes have been provided, and schemes such as LTBI case finding and reviews, and ECG have shown overwhelming uptake, response and outcomes. NHS England s national TB Strategy to focus on Latent TB screening was significantly influenced by Newham CCG s EPCS scheme. There have also been outcomes in primary care IT based schemes with a good uptake of initiatives including Electronic Prescribing Service and GP behaviour changes to innovate such as EMIS web group, and all practices migrating to nhs.net generic addresses., T-Quest for pathology and diagnostics, patient access to medical records and online patient appointments were introduced in and are expected to show some outcomes by the end of 16/17. The Medicines Management schemes have always generated promising results for all three years. Page 3 of 7 24

25 2. Key Considerations 2.1 EPCS/LIS 2017/18 onwards: As the initial contract was agreed for three years from 14/15 to 17/18, the CCG is now required to review the contract envelope and service lines based on the outcomes of the schemes for the past three years, in line with seeking continuous improvement and keeping it in line with evidenced base in order to justify public spending in these primary care areas. A table top exercise was undertaken with Primary Care, Long Term Conditions and GP clinical leads to provide an initial review of the current EPCS service specifications and CEG dashboards (previous 3 years) in line with QOF & PMS indicators, national & local priorities. Current service specifications were reviewed with the following principles. The initial review can be found in appendix A of this document Principles: 1. In line with the CCG s primary care strategy assess if the service can be offered a cluster level (one practice offers on behalf of others at hub or super practice level) or by Newham Health Collaborative at a Borough level. This will mean that sub-contracting clauses are reviewed and in line with the CCGs priorities and BHC (Building Healthier Communities re-procurement) programme. Different contracting options are available either single Borough-level provider sub-contracted to all practices or the reverse contract individually with all practices but with a sub-clause provision to contract to any other provider (GP practice, federation or any other) Decommission service lines that have had low outcomes and impact on health and social care (both low and high volume even if they had a good uptake). Clinical opinions have been sought on a few such service lines and there is general agreement to re-invest or make better use through alternate schemes or innovation. (e.g. diabetes care plans being superseded by generic primary care plans). 4. Amalgamate service lines and make it simpler in line with the CEG EMIS templates used by practices. This would mean all case finding service lines would be incorporated into one spec, all LTC reviews would be another, and there would be few that would have their own specification. 5. Map out in a tabular format all QOF schemes, any PMS KPI clinical schemes, and continuing EPCS schemes so that it is easier for practices to understand and absorb, and not differentiate income lines. They would simply be asked to fill the templates when they see the patients, and they would get paid for activity through one scheme or the other. This would also reduce unnecessary patient appointments if they are called once for QOF, and next for EPCS or flu etc. 6. All schemes reviewed and continued will have measurable activity and outcomes so that they can be revisited and reviewed as per clinical needs and CCG priorities. 7. To maintain the QOF scheme unchanged in year 1 (2017/18) with a provision to review as part of CCG delegated functions. 8. To review all PMS clinical KPIs (except cancer screening ones) as part of the PMS Review process to eliminate duplication with indicators that are already available under QOF or EPCS/LIS, and to align schemes and check how they Page 4 of 7 25

26 support the BHC programme, or TST, or as per national Right Care initiative. 9. Review the financial envelope as part of CCG budget-setting process for if savings are required, then to review service lines that can be delivered and achievable under these. 10. To begin work to review if QOF and all non-core clinical schemes can be brought under a single scheme of monitoring to gain efficiencies at scale. Many practices have welcomed this approach as there is less bureaucratic monitoring and chiefly because many practices lose income (not 100% uptake) due to complexities of reporting under individual schemes. This is with a view to full implementation in Recommendations and conclusion: The Committee is asked to discuss the principles and the next steps, so that the CCG leads are able to review each and every service line to produce the new specification in time for the start of The new financial envelope needs to be agreed as part of the CCG s budget setting process so that service line activity and targets can be set accordingly. Offer of services through different contract options (single provider contract delivered by group or practices or all practices) or existing model (contract with all GP practices individually with a clause to sub-contract to others or federation if they so wish) needs to be reviewed and agreed in light of new models of care and emergence of federation and joint working between practices and clusters. Page 5 of 7 26

27 Appendix A desktop review of current EPCS Service line to remain as currently commissioned Service line to be updated / amalgamate with other services Service line to be decommissioned / removed Delivered at practice/ cluster level Primary prevention:- All elements Atrial Fibrillation:- Opportunistic pulse check for patients without CVD Risk Stratification & commencement of anti-coag therapy Atrial Fibrillation Opportunistic pulse review of patients with CVD double payment in cardiac review Practice Practice Practice / cluster Post Cardiac Event Review:- Add to Cardiac review service Practice Cardiac Review CVD review Cardiac Review Heart failure review added to Cardiac review Cardiac Review Provision of care plan Practice Heart failure:- Heart failure review added to Cardiac review Heart failure:- Case finding element as was a catch-up programme Practice AUA:- review all elements Practice Self-management - All elements Practice 27

28 T2 diabetes:- CKD SMI:- LTBI Discharge from secondary care Monitoring appointment Insulin initiation Review patients with egfr decline CKD register development Acute assessment referral and patient consent Optimisation of patient care post consultant renal assessment On depot Mandatory training new patients screening IGRA positive consultant and management of IGRA positive patients (CATAPULT trial practices ECG:- All elements Type 2 diabetes:- COPD SMI :- LTBI:- MDTs case finding review 6 monthly review review against QOF Type 2 diabetes:- care plan Practice Practice Cluster Practice Practice Practice Practice Practice Cluster (for non ECG service provision practices) physical health checks Practice Cancer existing patients screening r/v look back period Cancer care review Cancer Remove RCGP audit Significant Event Reviews Practices practices practice Potential new services based on right care packs, local identified need Asthma, frailty, referral management, dementia Page 7 of 7 28

29 Primary Care Commisioning Committee (PCCC) 25 th January 2017 Title: Primary Care Medical Finance Report Month 9 Update on 2016/17 Budget Agenda item Author: Chad Whitton, Chief Finance Officer Newham CCG Presented by: Chad Whitton, Chief Finance Officer Newham CCG Contact for further information: Chad Whitton, Chief Finance Officer Newham CCG Chad.Whitton@newhamccg.nhs.uk Lei Wei, Deputy Chief Finance Officer Newham CCG Lei.Wei@newhamccg.nhs.uk This Paper is for: Monitor Action required: The Primary Care Commissioning Committee are asked to Note the summary Primary Care allocation and projected spend (Appendix 1) Note the risk and innovation reserve (Annex A) Executive summary: The CCG identified the 5 year allocations in the May report. It has received indicative allocations at a practice level and these are in the ledger. A Primary Care risk and innovation reserve of 2.028m was established by the CCG. All additional primary care funding in 2016/17 must be contained within this cash envelope. The reserve is reported monthly and a formal quarterly risk assessment is presented to the PCCC to ensure risk is appropriately monitored. The 2016/17 delegated budget is currently forecasting a breakeven position. Supporting papers: Appendix 1 Primary Care Delegated Budgets Updated Position Annex A Primary Care Risk and Innovation Reserve 29

30 How does this fit with Newham CCG Strategy: Accountability and Responsibility - Requirement to meet target surplus. Where has the paper been already presented? N/a Risk: The Primary Care delegated budget financial plan as identified in the CCG Finance and Activity Plan is an essential component in identifying and managing financial risk and ensuring the CCG delivers its financial requirements. Equality Impact: Effective delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham. Stakeholder engagement: Integrated Care Impact This report has been subject to no specific prior consultation but reflects any comments from NHSE assurance processes and any comments, queries or suggestions raised by CCG members in relation to earlier reports. Effective financial planning, monitoring and control delivering value for money enables effective targeting of resources to support delivery and continuous improvement of high quality services for patients. Financial Implications The report provides a high level view of the CCG s Primary Care Medical financial performance at Month /17 Page 2 of 2 30

31 Appendix 1 Primary Care Delegated Budgets Updated Position 16 th January 2017 Expenditure The month 9 year to date position for delegated co-commissioning was 178,000 adverse. The current forecast remains breakeven position. The expenditure year to date has been adjusted to reflect the changes of lease and rent agreements received by NHSE within October. Table 1 Practice Type Annual Budget YTD Budget YTD Actual YTD Variance Over/(Under) APMS 7,105,216 5,328,587 5,268,197 (60,390) GMS 10,052,957 7,538,875 7,446,831 (92,044) PMS 33,159,572 24,868,449 24,647,416 (221,033) 50,317,745 37,735,911 37,362,444 (373,467) Net Savings Requirement (62,745) (176,439) 18, ,734 50,255,000 37,559,472 37,380,739 (178,733) Included in the month 9 position is a non-recurrent benefit relating to the premises revaluation provision; held locally. Risk and Reserves At this point the CCG is holding a Risk and Innovation reserve of 2m for primary care. Details of the identified risk and proposed innovation commitments are attached as Annex A. 31

32 Appendix 1 From the initial 2m reserve identified in April, 1.32m was committed to Innovation Schemes, of which 0.35m relates to schemes that remain unconfirmed. In addition 0.68m of the initial risk reserve has been committed to schemes to reduce clinical risk. It is understood that financial support maybe required by practices going through transitional periods (i.e. cessation of caretaking contracts / new contract holders commencing). Discussions relating to practices going through transition are ongoing and the Risk Reserve listing will be updated accordingly. Newham CCG has been made aware of a number of payments that have not been made in relation to a suspended practice. Although work is ongoing current estimates indicate that this will equate to a liability of 100k by the end of 2016/17. Newham CCG has been made aware that no payments have been made in relation to violent patient activity for a number of years. The practice concerned has been contacted and activity data has been requested to ascertain the total liability for both Newham CCG and NHSE. It is understood that the contract in relation to violent patients has not been reviewed since 2013/14; as such the CCG is conducting a review in order to quantify the liability attached to this activity. Conclusion This report updates PCCC members on the financial position based on Month 9 data. Currently spend is expected to break-even against the allocation. The report also lists the risk and innovation reserves in Appendix A. The CCG will need to continue to seek to put effective measures in place to control spend in primary care budgets and maximise the funding available for initiatives that reflect the CCG and TST priorities. 32

33 Annex A Primary Care Reserves Analysis The CCG has established a Primary Care Risk and Innovation Reserve from which all Primary Care risks and innovation not met within the delegated budget, EPCS contracts or other contracts rolled over from 2015/16 must be met. Reserves will be utilised over the year with monthly transfers to budget lines. 33

34 Annex A Standing Notes: Where reserves for specific items are deemed to be no longer required initially they will be transferred to contingency within the overall Primary Care Reserve. The CCG financial position requires all unapplied reserves to be held pending development of measures currently in place to guarantee financial balance. However, until the end of Quarter 3 any unallocated reserves will remain held in the Primary Care Reserve schedule and may be used as a first call on any unavoidable costs that may yet emerge in Primary Care. A decision on any transfer out of Primary Care will be made in the new calendar year as part of a report to the Board following consultation with the Primary Care Committee. However, it should be noted that all available contingency has already been applied to emerging primary care commitments. Additional funding of 542,000 is due to be received from the successful bid for Access funding will initially held in reserves pending roll-out of the initiative. The reserve will be updated on a monthly basis with a formal quarterly review that will be shared with the Chair of the PCCC and the CCG Executive Committee. 34

35 Primary Care Commisioning Committee (PCCC) 25 January 2017 Title: Primary Care Risk Register Agenda item 9 Author: Joseph Lee, Newham CCG, Primary Care Commissioning Manager Presented by: Neil Hamer, Assistant Director of Primary Care This Paper is for: Monitor Action required: The Committee are asked to: Noted for Information Executive summary: Newham CCG is a level 3 delegated commissioner and as part of the governance and oversight within the Primary Care Commissioning Committee, the Primary Care Team have produced a risk register to identify key risks and mitigating actions associated with the CCG s delegated functions of commissioning primary care services. Supporting papers: Appendix A Primary Care Risk Register Appendix B Primary Care Risk Register Summary Appendix C Primary Care Risk Register Trend Summary How does this fit with Newham CCG Strategy: Explain which single value and single aim the report best fits delete others as appropriate. Values: Effective & collaborative communication Transparency with our decision-making and leadership Accountability and responsibility Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of Health and Wellbeing outcomes Where has the paper been already presented? Previous version of the risk register has been submitted to Primary Care Commissioning Committees 35

36 Risk: Failure to comply with the recommendations of the report risks Equality Impact: There are no identified equality issues associated with this paper and therefor no equality impact conducted. Stakeholder engagement: There has been no engagement regarding the current risks within primary care, however other CCG colleagues, such as finance, provide information which contributes to the assessment if the current risks. Financial Implications There are no financial implications associated with this report other than those identified within the specific risks and actions. Page 2 of 7 36