Primary Care Commissioning Committee

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1 Primary Care Commissioning Committee Part I pm Wednesday 25 April 2018 Committee rooms, 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA

2 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 2

3 Primary Care Commissioning Committee Part I pm Wednesday 25 April 2018 Committee rooms, 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA Agenda No Time Item Action Required Page Presenter 1. Administration and updates 1.1 Welcome, introductions and apologies 1.2 Declarations of interests Monitor pm Minutes of the previous meeting Approve Action log Monitor Chair s action Londonwide operating model Note 8 2. Strategic items pm Workforce, Capacity and Development report from CEPN pm Applications to Vary a GMS Contract or PMS Agreement - conditions for intervention and points of principle Chair Note 13 L Delauney Approve 20 L Hutchinson/J Mazarelo pm Improvement academy proposal update Approve 27 Ashwin Shah pm GP access: expectations in respect of core and Note extended hours updated NHS England 38 J Mazarelo guidance 3. Any other business pm AOB Chair Next meetings: Wednesday 30 May 2018 business meeting Wednesday 27 June discussion meeting pm Committee rooms 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA 3

4 Primary Care Commissioning Committee Part I meeting: pm Wednesday 28 March 2018 Committee rooms, 4 th Floor, Unex Tower, 5 Station Street, E15 1DA Minutes Voting members present: Selina Douglas Wayne Farah Ambady Gopinathan Ashwin Shah Fiona Smith Non-voting members present: Clive Furness Alison Goodlad Lorna Hutchinson Andrea Lippett Jenny Mazarelo Meradin Peachey Anil Shah In Attendance: Kate McFadden-Lewis (minutes) Leonardo Greco Dr C M Patel Apologies: Greg Cairns Selina Rodrigues Acting Managing Director, Newham CCG Lay Member Patient & Public Engagement, NCCG GP Board Member, Newham CCG GP Board Member, Newham CCG Registered Nurse, Newham CCG London Borough of Newham NHS England NHS England Lay Member Remuneration, NCCG Associate Director Primary Care, Newham CCG Public Health Member, LBN GP Member, Newham CCG Board Secretary, Newham CCG Healthwatch Newham GP, LMC LMC Healthwatch Newham No Item Welcome, introduction, apologies for absence and declarations of interest W Farah welcomed attendees to the meeting and introductions were made. Apologies were noted from Selina Rodrigues, Healthwatch Newham and Greg Cairns, LMC. There were no declarations of interest. 1.3 Minutes of the previous meeting and matters arising The minutes of the business meeting held 31 January 2017 and the discussion meeting held 28 February 2018 were accepted as an accurate record. 4

5 1.4 Action log The action log was reviewed and the Committee agreed to close actions PCCC99 and PCCC Chair s action - e-consult provider for Newham The Committee noted the Chair s Action regarding the e-consult provider for Newham. 1.6 Londonwide Operating Model for Co-Commissioning of Primary Care Services A Goodlad updated the group on the revised Londonwide Operating Model for Co-Commissioning of Primary Care Services, reporting that there are no significant changes that affect the Committee s programme of work, or result in a change in the ToR. The Committee asked to see the key changes outlined and circulated to the Committee. The model will then be signed off by Chair s Action. (ACTION: AG) 1.7 GMS / PMS Update A Goodlad updated the Committee on the recently announced changes to the GMS contract, reporting that there are no significant changes, however there will be further changes next year. Work is on-going across London to ensure all practices are working within the new PMS contract which is still to be agreed by the LMC. 2. Strategic items 2.1 GP access: expectations in respect of core and extended hours J Mazarelo presented the recent Londonwide policy guidance from NHS England on its expectations for GP access, and the proposal that CCGs review both current core hours and sub-contracting arrangements to assess adequacy. Key points included: i. that a survey will be circulated to assess core and extended hours arrangements for all Newham s GP practice. Practices will be offered support to meet the deadline of 11 April 2018 ii. practices will also be asked if they would be interested in receiving support in their demand and capacity planning. The Committee approved the proposal. It was agreed that the outcome of the survey and the next steps will be discussed and agreed at PCCC meetings in April and May (ACTION: JM) 2.2 Estates update J Kelder joined the meeting to update the Committee on the delivered schemes in , the planned schemes for as well as investment over in the next five years. Members were assured that the CCG continues to match developments with the health needs of Newham residents, while ensuring value for money. The Committee noted. 2.3 Improvement academy proposal update: this item was deferred to the next meeting. 3. Patient and Public Engagement 3.1 Questions from the public: None 4. Performance 4.1 Risk Register J Mazarelo presented the risk register, highlighting that the detail behind the risks from NHS England s risk register, in respect of delegated commissioning, is now included (risks 15 and 16). In discussion, the Committee noted that, although risks 15 and 16 are managed by NHS England, more detail is needed around how the CCG mitigates for Newham residents. This will be included in the risk register report in May. (ACTION: JM) 4.2 NCCG Finance & QIPP Report S Douglas presented the year to date financial position to the Committee, reporting that Newham CCG remains on track to meet its financial targets for the year. The Committee noted. 5

6 5. AOB 5.1 Dr Ashwin Shah announced his upcoming retirement, which will be discussed in more detail at the next meeting. Next meetings: Wednesday 25 April 2018 Wednesday 30 May pm Committee rooms 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA 6

7 Highlighted items represent a recommendation to remove from register item April 2018 Primary Care Commissioning Committee - Action Log Part I Action reference Meeting date Action Owner Deadline Update PCC93 29/11/2017 Referral Pathway Scheme - a full update to be provided to March meeting J Mazarelo Mar-18 This has been deferred to May on the planner PCCC94 29/11/2017 Review of Roma Community access to Primary Care The proposal for roll out of this training across Newham GP practices to be discussed by the Committee early S Sanghera May-18 On the meeting planner for May PCCC95 29/11/2017 Improvement Academy - further assurance to be provided on the alignment with the CCG's primary care strategy A Shah Mar-18 On the agenda for April 2018 PCCC102 28/03/2018 Londonwide operating model - Chair's Action A Goodlad Apr-18 Complete PCCC103 28/03/2018 GP access: expectations in respect of core and extended hours Survey results and next steps to be reported to the Committee. J Mazarelo May-18 Survey circulated for return by 16/04/18. Further guidance issued by NHS England on 11/04/18. Additional guidance on the agenda, with findings and next steps to be discussed in May and June PCCC104 28/03/2018 Risk Register More detail around how the CCG mitigates the NHS England risks for Newham residents to be included in the next risk register report in May. J Mazarelo Apr-18 On the agenda for May

8 Chair s Action Primary Care Commissioning Committee a) NHS Newham CCG s Constitution gives the Chair of a meeting of its governing structure the authority to take a decision normally reserved for that body by virtue of the following paragraphs within its Constitution: The provisions of these standing orders shall apply where relevant to the operation of the Practice Member Council, Board, the board s committees and sub-committees and all committees and sub-committees unless stated otherwise in the committee or subcommittee s terms of reference 4.6. Chair's ruling The decision of the Chair of the Board on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final 4.9. Emergency powers and urgent decisions The powers which the Board has reserved to itself within these Standing Orders may in emergency or for an urgent decision to be exercised by the Chief Officer and the Chair after having consulted at least two non-executive members. The exercise of such powers by the Chief Officer and Chair shall be reported to the next formal meeting of the Board in public session for formal ratification And that as a matter of interpretation it is deemed that the phrase where relevant to the operation of committees and sub-committees is appropriate in relation to paragraphs 4.6 and 4.9 b) These paragraphs relate to; The Executive Committee The Audit Committee The Remuneration Committee The Quality Committee The Primary Care Commissioning Committee c) The terms of reference of the following committees (approved by the Executive Committee), which are not part of the Constitution, gives the Chair of these meetings the authority to take a decision normally reserved for that meeting with guidance on the requirement to report back on the action taken to the next meeting; The Integrated Care Committee The Acute Commissioning Committee The Community Commissioning Committee The Mental Health Commissioning Committee The Children and Maternity Commissioning Committee The Urgent Care Working Group The Information Management and Technology Committee The Finance Committee The Medicines Management Committee 8

9 1. Decision taken normally within the terms of reference of the Committee The revised Londonwide Operating Model was taken to the meeting of the Primary Care Committee on 28 March for ratification, following approval by the Londonwide Primary Care Commissioning Board. It was agreed that a summary of the key changes since the 2015 version would be produced and given final approved by Chair s Action, to ensure that were no changes that would affect the Committee s Terms of Reference. 2. Reason decision cannot await consideration at next meeting Paper has already been discussed and provisionally approved at the 28 March Meeting. Final approval to be given, once further detail has been made available. 3. Date of next meeting where decision will be reported to the Committee 25 April 2018 Signed Date Chair of the committee 9

10 Title Operating Model Londonwide Co-Commissioning of Primary Care Services Agenda item Further Information provided for Chair s Action following PCC on 28 March. Author Alison Goodlad, Head of Primary Care (NEL) NHS E Presented by Alison Goodlad, Head of Primary Care (NEL) NHS E Contact for further information Alison Goodlad, Head of Primary Care (North East London), NHS England, alison.goodlad@nhs.net This paper is for Decision Action required The Committee is asked to accept the Operating Model for Primary Care Services, as approved by the Londonwide Primary Care Management Board, which has representation from the all primary care leads in each STP. Executive summary The Committee is asked to accept the Londonwide Operating Model for Primary Care Services. As discussed at the Primary Care Commissioning Committee, a summary of key changes to the document since it was first agreed in 2015 have been included. Supporting papers N/A. Next Steps/ Onward Reporting N/A Where has the paper been already presented? Londonwide Primary Care Management Board How does this fit with NHS Newham CCG strategy? Value: Effective and collaborative communication Patient/public voice throughout our decision making Transparency with our decision-making and leadership Commitment to continuous learning and development Accountability and responsibility Working with our partners to improve health outcomes Aim: 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. 10

11 Londonwide Operating Model Background The Operating Model was developed in April 2015 and sets out how NHS England (London) Region s STP primary care contracting teams will consistently support CCGs with joint or delegated co-commissioning arrangements (as of April 2017). The Operating Model provides the standard offer of NHS England in terms of supporting Primary Care Commissioning activities, this document will has been endorsed by NHS England Primary Care Management Board, which includes STP Primary Care Leads, prior to consideration by Primary Care Commissioning Committees. Primary Care Commissioning Committees (PCCCs) and Primary Care Joint Committees (PCJC s) were asked to adopt the first version of the Operating Model in autumn of The Operating Model has been revised to include up to date National and London policies, procedures and/ or guidance. It also summarises reporting required to support decision making and associated responsibilities, together with committee, governance, processes and capabilities. The revised Operating Model also reflects the geographical alignment of NHS England teams with London s 5 STP footprints. PCCCs across London are being asked to consider the revised documentation for endorsement for adoption between February and April 2018 with the aim of complete coverage by the end of April PCCC members will be aware that there are a significant number of National and London polices/guidelines/protocols that sit behind the Operating Model, which will used by STP Primary Care teams following of the approval of this Operating Model. It is expected that there will be a regular need to review the Operating Model on an annual basis, as a minimum. However it is not intended that non material changes should result in PCCCs needing to sign off of such amendments, as these could be delegated by PCCCs to Chief Officers/Managing Directors. Key changes made to the document since the 2015 version are summarised below 1.1 An additional statement to explain that updates of working policies and guidance referred to in the document would need to be considered and approved by London Region s Primary Care Management Board Urgent and unplanned decisions Removal of text that states that in the event of an urgent decision being required, if an appropriate CCG contact cannot be reached, NHS England will make the decision. 11

12 2.3 Reporting Requirements This section has been updated to reflect a range of additional reports, on areas such as complaints data etc that will be made available to CCGs via a web based information resource 2.4 Reference to NHS England teams being accommodated at lead CCGs has been added. Safeguarding Additional text added to state that CCGs will be responsible for ensuring that the GP services commissioned have effective safeguarding arrangements in place to improve the well-being of children and adults. Annex 1 Detailed processes The section on PMS Reviews has been updated to reflect the fact that PMS Reviews have been led by CCGs. Some further detail has been added on counter fraud processes and controlled drugs reporting and safeguarding adults. The following annexs have been removed: NHS England Primary Care Commissioning Organisational Chart PCIF Process 15/16 Standard Report Formats 15/16 PCC Meeting Planner The following annex has been added Annex 5 - Pan London Responsibilities of NHS England STP Based Teams 12

13 Primary Care Commissioning Committee Part I Wednesday 25 April th Floor Unex Tower Title: Workforce Capacity and Development Report Agenda item 2.1 Author: Presented by: Contact for further information: This Paper is for: Action required: Executive summary: Supporting papers: How does this fit with Newham CCG Strategy: Where has the paper been already presented? Risk: Equality Impact: Stakeholder engagement: Financial Implications Liz Delauney Organisation, Interim Senior Transformation Manager - (CEPN) Jenny Mazarelo Liz Delauney Organisation, Interim senior Transformation Manager (CEPN); l.delauney@nhs.net; 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. Newham Together Operating Plan Value: Commitment to continuous Learning and Development Aim: Improving health outcomes through developing models of integrated care and focusing on prevention No previous presentation to any meeting. The following risks are relevant: Failure to effectively integrate health & social care Failure to deliver the stated ELHCP, TST and commissioning benefits including the delivery of safe and high quality clinical and care services as well as financial efficiency. The training and development workforce 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 seeks ultimately to improve the quality of services to deliver safe care. An evaluation of the CEPN has been undertaken as part of developing its annual report utilising the views collated from a wider range stakeholder organisations. Newham Together has facilitated discussions and collaborative workshops with a range of partner organisations LBN Public Health team, TST, Skills for Care and neighbouring CEPNs / CCGs for sustainability discussions. Failure to adequately deliver the educational, training and development programmes expected of the CEPN may result in an adverse impact on its financial sustainability. 13

14 1. Introduction This report provides the Newham CCG Primary Care Commissioning Committee with an update on Newham Together s (The CEPN) activities over the financial year 2017/18. The report outlines the key activities of the CEPN, its alignment to national and local policy, and its key achievements which will form an overview of the content of the 2017/18 Annual Report, and confirms the priorities for 2018/19, including sustainability plans. 1.1 Context The CEPN has just completed its fourth year as a multi-organisational Network, and has maintained its focus in shaping the delivery of education and training to the wider health and social care staff, as well as being a partner and sometimes the lead in a number of workforce planning initiatives. The activities of the CEPN are inextricably linked to delivering against the priorities of the East London Health and Social Care Partnership (ELHCP), Five Year Forward View (5YFV) and Health Education (HEE) mandates and it has maintained a strong partnership and membership with the TST programme, as well as other CEPN partners. The CEPN has extended its membership to include other partners such as UCL Partners, thus strengthening its ability for collaborative working. 2. Achievements The achievements of the CEPN will be captured in its developing Annual Report, however key areas for highlight includes: Coordinating 25 uni-disciplinary and multi-disciplinary projects (including 15 Transformation Fund projects) all of which have either been delivered within the 2017/18 year, or have extended their scope of delivery with plans for completion into 2018/19. Appendix 1 outlines the extent of CEPN programmes Generating 304k to primary care in supporting major transformational change with the recruitment of 4 General Practice Nurses (GPNs) and the training of 2 Advanced Nurse Practitioners (ANP). At the start of 2018, the CEPN also attracted another 440k with the recruitment of 6 GPNs and training another 2 ANPs Attracted 148,800 with successful bids to UCLP, ELHCP, DoH and HEE for a range of projects, most of which will be delivered in 2018/19 Attracted 78k from HEE for the development of an Operational Plan Attracted 20k for implementing R&D elements within its activities to undertake deep dive exercises and other aspects of research as a means of accessing the impact and viability of projects delivered. Systems have been implemented for research to be undertaken on two Transformation Fund projects and the publication of at least two articles Increasing the number of professional learning events by 23% on the previous year from 73 to 121, with a wider reach of attendees across the health and social care workforce Further increased the number of apprenticeships with 30 starters during the year. In addition 42 primary care candidates have applied for the suite of Management and Leadership Apprentice level 3 7 programmes, the delivery of which will take place on 2018 Developed increased partnerships with Providers such as QMUL, which has resulted in a 3% increase of medical student placements from 235 in 2016/17 to 241 in 2017/18. The collaboration has also resulted in a successful bid for an increased number of medical students with an extra 32 medical students commencing in 2019 Establishing systems for the delivery of the GPN 10 Point Plan with a110% increase in practice nurse mentors in primary care from 10 21; and increasing the number of GP training practices for pre-registration nurses from 1 4 Becoming a key partner in the development of the CCG and LBD Suicide Prevention Plan through its programme of mental health training programmes to 321 health and social care, including voluntary services staff including: 14

15 o o o o 3 Newham staff trained as Trainers to deliver suicide awareness training, and being part of a wider team with Tower Hamlets to deliver training across the STP footprint. To date 113 Newham staff have been trained on safetalk with further programmes planned for staff trained in Mental Health First Aid Across the Lifespan perinatal, young people, adult mental health and dementia 75 staff trained in Mental Health First Aid and First aid Lite Focussed training on the use of Apps that could assist the management of young people is in delivery. Success in introducing new roles with 67 Medical Assistants trained to support the efficiencies in primary care by releasing clinical time for general practitioners. In total 107 general practice staff attended the training including general practitioners and practice managers. The CEPN was a successful bidder for one of the first national MA pilots in the UK 117 Receptionists in general practice were trained on a range of topics signposting, medical terminology, customer care and improving patient experience. This was the first focussed training for that group of staff. Another 30 staff are currently in training as Trainers to increase the internal capacity for transforming primary care. 2.1 Resources developed In 2017/18, the CEPN developed the following tangible resources: A variety of resources placed on the Learning Management System, including videos of training sessions for use by general practice staff. An e-learning module about the management of latent tuberculosis Syllabi and resources for training programmes which will be rolled out and disseminated in future years User friendly leaflets accompanying carers training including the development of the Carer s Guide to GP Services in Newham 2.2 Added Value Impacts In 2017/18 the network added value to what might otherwise not have been achieved locally by: Drawing together partners to plan jointly and share resources. Key examples include: a. the Careers project led by the LBN representative working with the TST with the delivery of a range of Career videos highlighting the East End as a place of choice for employment b. and joint commissioning and delivery with CEPN colleagues on the Receptionist and Mental Health training. Extending access to education amongst groups such as unpaid carers, apprentices and care homes Improving the quality of training offered, by monitoring deliverables, developing and evaluation framework to allow consistency of evaluating impacts and making refinements Improving recruitment, including placements for apprentices, student nurses and others Developing strategic plans to ensure consistency and raise the profile of, and demand for apprenticeships in primary care and community pharmacy. The CEPN s work on apprenticeships was highlighted as an excellent example in the collaborative project with Skills for Care, the STP, TST and other CEPNs to develop a wider Apprenticeship Plan for the ELHCP area Accessing a wider range of funding than was previously available Co-production with of products with Carers, with 4 Carers trained to deliver training on Behaviour Management techniques to families. 15

16 Sharing learning In 2017/18, Newham Together shared learning in the following ways: Via resources placed on the Learning Management System Presentations at forums, conferences and meetings, including the Lancet, Royal College of General Practitioners and Health Education England Stakeholder events to reflect on learning and priorities The publication of articles in newsletters and academic journals e.g. in the Lancet and Health & Social Care in the Community 2018 Posters and reports from training programmes Sustainability and Transformation Partnership and TST workgroups. Planning for the future The CEPN is keen to ensure that it remains proactive, forward thinking and involved in local strategic plans, and to that end, the CEPN Board has an agreed plan for delivery in 2018/19, notwithstanding the potential for new funding received, with the need for a new range of projects for delivery. Key plans currently include: The embedding of all 15 STP Transformation Fund Projects as outlined within the CEPN Operating Plan. This includes work, which focuses on care closer to home, mental health, End of Life care, new roles, Quality Improvement, integrated working and CEPN collaboration. A copy of the Operating Plan is available on request The CEPN has identified End of Life Care and Self-Care Management as its areas of priority. Work has commenced with LBN Public Health on developing the appropriate schemes for delivery Delivery of two ELHCP Workforce Enablers projects Multi-professional QI which will focus on medicines management in Care Homes and the impact on reducing hospital admission and attendance; and First Five Retention scheme Delivery on an HEE Care Homes project focussed on multi-disciplinary learning Developing a Care Homes and Domiciliary Carers electronic training programme an App Implementing a support programme for medical trainees and their trainers Supporting the STP programme on the GPN 10 Point plan Implementing research and development to ensure that evidence based principles are applied to the roll out of projects Continuing to work with the TST on the GP recruitment programme Delivery of UCLP projects on Grand Rounds and mental Health Apps. 16

17 Sustainability Board members of Newham Together believe that working as a network achieves more than any one organisation working alone. There is a desire to continue the network and its remit is growing with the delegation of responsibilities from HEE, and the increasing reliance on the CEPN from ELHCP on assisting with workforce and training projects. For the CEPN, sustainability means more than merely surviving and being dependant and current sources of funding. For the CEPN, it means that there is a need to continue to develop further and stronger to maintain a central position to the changing agendas across health and social care, and to become mainstreamed in the delivery of workforce development initiatives within Newham and across ELHCP. As a result, sustainability remains a key subject on the CEPN s agenda, and key activities include: 1. Newham Together is actively seeking resources from member organisations and other funding sources to sustain the network. At present, the network is financially reliant on Health Education England, the CCG and London Borough of Newham (LBN), but proactively applies for other funding from a range of other sources. A broader range of members has joined the network s Board, with useful links to funding sources. Joint bidding for funds with other CEPNs will also continue and build on the success of work with the City and Hackney CEPN on Medical Assistants. 2. Previous reports outlined the potential governance configurations for the CEPN including an alignment with another stakeholder partner. This work has progressed recently with a proposed collaboration between the CEPN, UCLP and LBN in the development of an Improvement Academy. The proposed approach is through a prototype Academy specification, during which the team will informally test collaborative working, whilst co-designing the Academy business case, specification and proposal for beyond March The prototype specification incorporates fourteen selected existing initiatives for delivery during 2018/19. It is anticipated that the joint approach will reduce duplication across the partnership, and increase efficiency. The proposed specification should achieve four prioritised outcome themes previously agreed by Newham CCG, Primary Care Home, Integrated Care System (ICS), and ELHCP namely: a) Patient satisfaction, b) staff satisfaction, c) efficiency and d) clinical outcomes. Further information will be shared as the business case is developed. 3. In its efforts to be main streamed, the CEPN has engaged proactively with the CCG s Lead on ICS to determine how it may best support the developing agenda. To take this forward the CEPN will be hold a workshop facilitated by the Kings Fund for Board members and other interested parties including the CCG ISC leads on the 26 April The CEPN on a regular basis will show case its activities and achievements at a range of events, and will be holding its annual Stakeholder Event on the 19 April. This will allow for raising awareness to new and potential partnerships, but it will also ensure that current partners engage with decision making on the future activity of the network. 5. The CEPN is of the view that sustainability also includes the longevity of all of its programmes so that each programme leaves a legacy. Currently all legacy impacts of programme over the years are being collated, and will be made available through the Newham Together website and learning management system (LMS), or any other appropriate system. Discussions are ongoing between the CEPN and LBN to share IT capacity to move the development of the LMS forward. 3.2 Considerations related to sustainability Issue of note include: 1. Funding reduction: HEE funding of the CEPN reduced by over 60% and continues to be reduced year on year. This impact on the ability of the CEPN to maintain the level, scope and reach of training. The continuing uncertainty of funding also leaves the CEPN with challenges in regards to planning over the medium to longer term, thus increasing the risk of inefficiencies. This risk may be mitigated with the development of the Improvement Academy, and the potential for an increased team resource that will allow for business development. 2. Capacity: the internal capacity of the CEPN has reduced with the transfer of the previous Commissioning Manager's post to members of the primary care team, whilst the work of the CEPN increases. In addition, the funding allocated for the GP Education Leads, and GPN 17

18 administrative support has also been reduced by 50%. The CEPN has managed to source some temporary funding for an Apprentice Lead for a 3 month period, however, consideration needs to be given to such a role in the longer term ideally within the GP Federation. The CEPN Transformation Manager provides on a 3 day a week interim contract cover. The current situation is therefore not sustainable. 3. Nursing Leadership: this is a developing and significant area of work with the requirement for the CCG to deliver on NHS England s GPN 10 Point plan. The CEPN Transformation Lead is managing the practice nursing agenda on a limited basis, but also this is not sustainable. Nursing leadership is critical to ensure that the requirements of the GPN10 Point Plan can be achieved, that appropriate funding is applied for, and that practice nurses are provided with professional leadership. 4. Finance The CEPN s 2017/18 income is all committed, however, the chart below outlines the funding received for projects that are to be delivered in 2018/19. Project Amount Notified Status of funds CEPN Operation Plan delivery 78,000 Received General Practice Nurse and Advanced Nurse Practitioner Trainees PSU Funding for support to medical and trainees and trainers UCLP bids for Grand rounds and Mental Health Apps ELHCP Workforce Enablers bids for Multi-professional QI and First Five Year Retention 440,000 Funding received on a quarterly basis 4,0000 Received 35,000 Received 44,600 Received Research funds from DoH 20,000 Received Staff development 1,200 Received The CEPN awaits confirmation of further HEE funding for the delivery of further Transformation Fund projects, and developments in general practice nursing. In addition, there is the potential to bid for funding from NHSE for the delivery of the GPN 10 Point Plan. Confirmation of funding is awaited. 5. Recommendations The CCG PCCC is 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. 18

19 Workstream & Structure Chart Newham CCG Board HEE NCEL Key Yellow: key projects Blue: Reporting Boards and Committee Red: In Planning/early development Primary Care Commissioning Committee Newham Community Education Provider Network Board Inner East London Nursing Super Hub General Practice Education and Training Steering Group Workforce Planning & Development Transformation New and developing and Locality Projects Funding Projects (HEE NCEL) Preceptorship, mentorship for GPNs; Care Certificate STP / TST and CCG PC Projects ASC Development Workforce Enablers projects Multicompartmental (ELCHP) Project 2015/18 Multi-professional QI and Fi t 5 R t ti R&D and Publication of CEPN projects Pre-reg nursing placements in care homes GPN / ANP R&R (HEE NCEL) Mental Health Training safetalk & ASIST Learning Medical Assistant Education & STP GPN Managemen pilot (HEE NCEL) Training in Development t System (HEE NCEL) Primary Care 10 Point Plan Nurse Receptionist Training (NHSE) PA Elearning Health & Care Training 2016/18 Care Homes and Dom Carers Project Booklet, End of Life Care Self-Management UCLP Bids x 2 Grand Rounds Mental Health Apps Care Homes Ward Round Project (HEE NCEL) Apprenticeship & Leadership Training (external to TF) PSU bid (HEE) The embedding of 2017/18 Transformation Fund projects will be delivered in 2018/19 Retention of the Workforce x 4 projects Primary/Secondary Care Interface x 3 project New Ways of Working x 1 project Recruiting GP s via the Building Bridges Empowering Carers Apprenticeships Clinical x Skills 3 x 2 projects projects projects 19

20 Primary Care Commissioning Committee Part I pm Wednesday 25 April 2018 Committee rooms, 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA Title Applications to Vary a GMS Contract or PMS Agreement - conditions for intervention and points of principle Agenda item 2.2 Author Lorna Hutchinson, Assistant Head, North East London Primary Care Commissioning, NHS England Jenny Mazarelo, Associate Director Primary Care, Newham CCG Presented by Lorna Hutchinson, Assistant Head, North East London Primary Care Commissioning, NHS England Contact for further information Lorna.Hutchinson@nhs.net Jenny.Mazarelo@nhs.net This paper is for Decision Monitor Discussion For Information Action required The report asks the Committee to : 1. Note the contractual requirements and processes for considering applications to vary a contract. 2. Note where the Primary Care Committee has the discretion to consider an application to vary a general medical services contract or Agreement 3. Seeks approval of the principles for managing the risk for proposed contract changes in respect to individuals and partnerships. Executive summary Since assuming fully delegated responsibility for commissioning of primary care services, commissioners have dealt with a number of instances where the robustness of applications to vary a GMS contract or PMS agreement has resulted in a risk to patient care from inadequate arrangements being implemented and/or failing at a later stage. As well as the risk to patient care, there is significant financial risk to Commissioners of time spent managing failing arrangements and legal costs in remedying the situation. This report sets out the requirements and processes for considering applications to vary a contract and seeks approval of the principles by which future proposed changes will be managed. Supporting papers Appendix A: Contract variation requirements Appendix B: Contract variation process 20

21 Appendix C PMS Business Case Template (to be tabled) Next Steps/ Onward Reporting To enact when applications to vary are received. Where has the paper been already presented? No previous presentation to any previous meetings/forums. How does this fit with NHS Newham CCG strategy? Value: Transparency with our decision-making and leadership Accountability and responsibility. Aim: Reducing quality variation Ensuring equity of health and wellbeing outcomes. Risk Sustainability of contract arrangements to ensure continuity of care and service delivery. Equality impact Stakeholder engagement No previous presentation to any previous meetings/forums. Financial Implications 21

22 1. Contractual requirements The Commissioner is required to consider requests for variations to existing GMS contracts and PMS Agreements. Variation requests include: 1. changing to more than one individual contract holder 2. changing from more than one contract holder to an individual 3. partnership changes 4. retirement (including 24-hour retirement) 5. novation, mergers and splits 6. death of a contractor 7. company changes 8. Joining a Multi-Professional Community Provider (MCP). In the majority of cases, requests for variations to an existing GMS contract or PMS agreement usually fall within the first four categories listed above. The GMS, PMS Regulations and the APMS Directions set out the provisions for varying contracts which are underpinned by the NHS England Primary Medical Policy and Guidance manual Whereas the PMS Agreement allows for Commissioner s discretion in agreeing all contract changes via the Primary Care Commissioning Committee, there is less flexibility in agreeing changes to a GMS contract, although Commissioners will need to seek assurance that proposed changes will meet the needs of the practice s patient population. Further information of the requirements are reflected in Appendix A. The processes for receiving and processing requests is mapped out in Appendix B. 2. Principles applied to strengthen the requirements To manage the risks of proposed insufficient or unsustainable arrangements, there is scope for strengthening the requirements as appropriate for each contract type. All contractors are required to provide a minimum of 28 days notification in advance of the proposed date of change however, this does not allow sufficient time for the Commissioner to discuss the implications with the contractor and for alternative arrangements to be pursued and agreed, if these are deemed inadequate. Therefore, prior knowledge of practices succession plans will aid Commissioners in proactively engaging with individuals/partnerships to discuss their intentions and/or alternative proposals in advance of the 28 day notification timescale. The Business case template (Appendix C) sets out the information the PMS contractor is requested to supply to satisfy Commissioners of their ability and capacity to fulfil the obligations of the contract and their proposals for the future of the services following the proposed variation. The existing Regulations do not mandate individuals to enter into a formal partnership agreement, however, to minimize the risk of inadequate arrangements and/or potential disputes, Commissioners will seek assurance that prior to entering into proposed arrangements, individuals have undertaken due diligence relating to the practice business, have obtained independent professional advice or consulted with the LMC and/or BMA on a formal partnership agreement, have secured the practice premises and fully understand their contractual liabilities. The Commissioner has the discretion to approve a request for a PMS variation on assurance the business case sets out satisfactory arrangements for service delivery when the variation is enacted. The information requirements can be strengthened to ensure additional information is provided to assess that risks such as business continuity, are properly managed. Although not a contractual requirement, local procedures have been implemented which mandate contractors to provide evidence of their application to the CQC for a change of registration details in respect of partnership changes pending processing of an application. In considering an application to vary a GMS Contract or PMS Agreement, Commissioners will take into account any existing commitments, e.g. contractual responsibility for the delivery of other GP 22

23 contracts with which proposed new signatories may be involved. 2.8 The Committee is requested to: Note the contractual requirements and processes for considering applications to vary a contract. Note where the Primary Care Committee has the discretion to consider an application to vary a general medical services contract or Agreement Approve the principles for managing the risk for proposed contract changes in respect to individuals and partnerships. 23

24 Item 2.2 Appendix A Contract variations Partnership arrangements GMS Individual to Partnership If an individual GP contractor wishes to enter into partnership with one or more individuals the contractor is required to provide written notification to the Commissioner of the proposed change and supply the following information:. the name of the person or persons with whom the contractor proposes to practice in partnership confirmation that the person or persons is either a medical practitioner or a person who satisfies the conditions specified in section 86(2)(b) of the NHS Act confirmation that the person or persons satisfies the conditions imposed by regulations 4 and 5 of the GMS Regulations whether or not the partnership is to be a limited partnership and if so, who is a limited and who is a general partner the date on which the contractor wishes to change its status (which shall not be less than 28 days from the date on which the notice was served on the Commissioner). Partnership to an individual The parties to the contract should provide the Commissioner at least 28 day notice in advance of the date on which the contractor proposes to change its status from that of a partnership to that of an individual medical practitioner The Commissioner should be satisfied that the arrangements for continuity of service are robust. Where the Commissioner is not satisfied that the nominated partner is eligible to hold the contract as the remaining individual, the Commissioner should have discussions with the Partners to explore potential solutions. PMS Contract Variations The PMS Regulations do not allow PMS agreements to be treated as made with a partnership. Where individuals are practising in partnership, the PMS agreement is entered into with each individual (which may or may not be in partnership). The individual signatories to a PMS agreement collectively form the contractor. 24

25 Item 2.2 Appendix A Contract variations PMS variation - Individual to more than one individual If an individual medical practitioner holding a PMS agreement wishes to have one or more individual join them under that agreement, they must seek the Commissioner's consent in writing for any such variation to the contract. The contractor is required to provide relevant information as requested in Annex A at least 28 days in advance of the date on which the contractor proposes to change its status from that of a partnership to that of an individual medical practitioner. The Commissioner must ensure the proposed individual(s) meet the eligibility criteria for holding a PMS agreement as set out (Annex A). PMS variation - More than one individual to an individual If two or more individuals wish to change to an individual contractor, they must seek the Commissioner's consent in writing for a variation to the contract. The Commissioner should ensure: the proposed individual(s) meets the eligibility criteria for holding a PMS agreement and that it is satisfied that the contractor will remain eligible to hold the agreement after the variation. For the variation to have effect, it must be in writing and signed by all existing (and new) individuals to the contract. the post-variation contractor's ability and capacity to fulfil the obligations of the contract and their proposals for the future of the service. 25

26 26 Item 2.2 Appendix B

27 Primary Care Commissioning Committee Part I pm Wednesday 25 April 2018 Committee rooms, 4 th Floor, Unex Tower, 5 Station Street, London E15 1DA Title Accelerating Primary Care Improvement Capability in Newham Agenda item 2.3 Author Steve Gilvin, Special Projects Director, North East London CCGs Presented by Ashwin Shah, Newham CCG, co-opted Board member Contact for further information Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG jenny.mazarelo@nhs.net, This paper is for Decision Action required The Committee is asked to: Approve: The proposed vision, ambition and Academy activities The mandate to scope and develop the proposed future Academy The recommended governance structure. Executive summary A Quality Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme The programme addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. From April 2018 the Improvement Academy will focus on sustainability. The report asks the Committee to approve: The proposed vision, ambition and Improvement Academy activities 2017/19 The mandate to scope and develop the proposed future Improvement Academy The recommended governance structure. Supporting papers Appendix A Full proposal Accelerating Primary Care Improvement capability in Newham How does this fit with NHS Newham CCG strategy? Values Commitment to continuous learning and development Enhancing local experience and talents Aims Reducing inequalities and improving accessibility 27

28 Where has the paper been already presented? Health and Well-being board 1 November 2017 Approved Newham Partnership Steering Group 9 November 2017 Approved Newham CCG Primary Care Committee 29 November Approved in principle Risk The proposal addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Failing to adopt the proposal will: Impact the future sustainability of improvement activities and initiatives already being invested in Primary care over the last years Impact the sustainability of existing training and education across Newham due to diminishing resources. Equality impact This report conserves the duty of Newham CCG in respect of equality and this has been considered when developing the proposal for consideration and any mitigating actions. Stakeholder engagement This proposal has been developed with input from Primary care, LBN, CCG, public health and TST staff and is based on conversations with providers including The Newham Health Collaborative (the GP Federation), Newham Together Community Education Providers Network (CEPN) and UCLPartners. Financial Implications The Improvement Academy proposal for 2017/ /19 will be delivered within the existing financial envelop of 502,

29 1. Introduction and background 1.1 A Quality Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme The programme addresses the challenge to deliver increasing demand for highquality services with limited and diminishing resources. In 2017/18 the key focus of Quality Improvement Programme has been: 5 Newham Improvement projects resulting in a range of practical interventions related to Low weight birth babies feeding, Diabetes and pre-diabetes, Cardiovascular patients, Dynamic population and churn, GP Development and Emotional resilience in young people 4 Quality Improvement Collaboratives for approx. 300 primary care staff 6 Improvement learning primary care network events Embedding an evidence based approach and evaluation to improvement work supported by Academic Researchers (University East London, UCL, Queen Mary s University of London) RCGP accredited Primary care leadership Programme for 17 selected emerging leaders. 1.2 Proposal Improvement Academy 2018/19 - vision, ambition and activities and governance Our vision is to grow and develop a workforce who prioritise high quality patient care and wellbeing, understand the science of improvement, feel empowered to lead change in their own workplace and know where and how to seek further support By April 2019, Newham CCG ambition is that all primary care training and education in Newham will be aligned, and hosted within the umbrella of an Improvement Academy to provide and support an evidence based quality improvement approach to all initiatives Activities during 2018 include: The Academy to transition from delivering some workforce training and courses, to a structure that brings together and facilitates all existing training and development options. Bringing together evidenced based improvement, training and education provided by providers to ensure better use of resources supporting long-term sustainability, acceleration and spread of learning in Newham Delivering the ambition will require a different governance structure: A single Strategic Advisory Group will comprise of representatives from the Newham Health Collaborative, Newham CCG, Newham Council, East London Health & Care Partnership, the Local Workforce Action Group and Public Health. Providers of services would report into this group and the group would be responsible for the strategic direction of all Academy programmes, oversee progress and ensure that training and other staff development initiatives were aligned To deliver the Improvement Academy 2018/19, we need to initiate a process to: 1. Agree our shared vision for developing our workforce 2. Determine the scope and extent of primary care staff development activities across Newham 3. Design an effective governance structure 4. Quantify the resources and support mechanisms we need to deliver our vision 29

30 Document Accelerating Primary Care Improvement Capability in Newham Proposed activities, next steps and roadmap for Newham Improvement Academy to April 2019 Version Final October 2017 Reviewed 24 th Jan 2018 Strategic Advisory group Author(s) Newham CCG in partnership with UCLPartners Presenter(s) Meeting Steve Gilvin (Newham CCG) Ashwin Shah (Newham CCG) Health and Well-being board 1 Nov Partnership Steering Group 9 Nov CCG Primary Care Committee 29 Nov CCG Board 13 Dec CCG Primary Care Committee 28 Mar Purpose of paper Proposal to address the long-term sustainability of workforce training and education in Newham. Background An Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme It addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Between April and September 2017, the Academy s focus has been Quality Improvement and Leadership training and QI Learning network events facilitation. Recommendations The Newham Oversight Group seeks the approval for: 1) The proposed vision, ambition and Academy activities ) The mandate to scope and develop the proposed future Academy 3) The recommended governance structure and the outline plan for the Academy development in

31 Accelerating Primary Care Improvement Capability in Newham Proposed activities, next steps and roadmap for Newham Improvement Academy to April Introduction and background 1.1. Introduction In Newham there are 53 GP surgeries to serve a growing population of over 365,000 patients. The borough is facing a huge challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Many health care staff in the area are nearing retirement age, meaning that the borough will need to attract staff. To face this challenge, we are committed to equip our primary care staff with the skills they need to work in new ways, maximising capacity and freeing up time for care. To achieve this, we now need to initiate a process to: 1. Agree our shared vision for developing our workforce; 2. Determine the scope and extent of primary care staff development activities across Newham; 3. Design an effective governance structure; 4. Quantify the resources and support mechanisms we need to deliver our vision. Our aspiration is for the Newham Improvement Academy to support patient care, needs and well-being, to be at the heart of tackling our workforce challenges and to attract new staff to Newham. The Academy s founding principle is to support population well-being, addressing: health literacy, community engagement, and prevention. It will bring together all existing and future primary care improvement and development activities in one place and as part of our overall workforce offer. Our vision is to grow and develop a workforce who prioritise high quality patient care and wellbeing, understand the science of improvement, feel empowered to lead change in their own workplace and know where and how to seek further support. In the long-term the Academy will: Improve the ability and capacity to achieve rapid, safe and sustainable improvements to any aspect of care Improve awareness of primary care quality improvement science and achievements Increase the sustainability of improvement initiatives Attract and retain more staff The road-map to April 2019 in section 4, sets out a process for further engagement on this vision and the establishment of the Academy. 31

32 1.2. Background The Academy was established in April 2017 as a result of the Newham-UCLPartners partnership programme 1. The programme accelerates our understanding of how to improve the health of people in Newham. It puts ideas into practice to make a real, longterm difference. Examples of the successes to date include: A diabetes self-management programme which has improved the health of young people An integrated electronic referral form that has improved information sharing for patients with cardiovascular disease, creating better patient and staff experiences Over 300 staff have been trained to release more time to care for patients, increasing staff satisfaction using quality improvement methodology The Academy April 2017/18 will consist of the following elements (see figure 1 and appendix 1): Access to online platforms including the Institute for Health Improvement's e-learning modules, Life QI, and the CEPN Newham Together website Business management support to embed the learning from the Improvement Themes carried out through 15/16 and 16/17 into business as usual and commissioning intentions The development of improvement implementation projects as result of the QI collaboratives Embedding an evidence based approach and evaluation to all work programmes supported by a Researcher in Residence The outcomes of the Academy are aligned with Newham s prioritised Care Quality Commissioning outcomes framework themes, East London STP themes and Patient Satisfaction outcomes measures. 2 Figure 1. Academy Summary of Activities 2017/18 Four Quality Improvement collaboratives The Emerging Leadership Programme Co-developed local improvement learning network to share improvement and quarterly UCLPartners primary care development events 1 The Programme partnered with NHSE, Xytal, Dartmouth, Staff College, Care City, QMUL, UEL, Barts Health to deliver improvement training and evidence based intervention 2 CQC themes: Safe, effective, caring responsive and well led. STP level themes are Patient experience, Staff satisfaction, Efficiency (time to care) 32

33 The total investment from Newham CCG for the Academy over 2017/19, is 502k. The breakdown of these funds is detailed in Figure 2. Figure 2. Academy s 502k offer launched in April 2017 To ensure the continued success of the Academy there are several objectives which must be achieved. This will be addressed as follows: In the short-term (6 months) Ensure clarity across Newham regarding the purpose and role of the Academy; Agree a shared commitment and mandate to achieve our aims, to which all parties, will sign-up and support; Develop a governance structure that enables stakeholders to contribute meaningfully to the Academy, and holds organisations to account where necessary; Create the right capacity in our business as usual structures to implement change and assure long-term sustainability. In the longer-term (12 months) Develop an open system that encourages and enables existing improvement skills and capability to join and work with the Academy, to help achieve our vision; Align with the wider East London wide vision to primary care development. Always Ensure that the staff s voice is at the core of the Academy and that all relevant stakeholders are appropriately involved in responding to it; Commit to and support learning across the wider system; Structure our governance and actions around, and in conjunction with, our staff to ensure positive impact; Support the development of a patient focused culture; Support primary care to develop and implement local initiatives; Promote service innovation and learning from best practice nationally and internationally. 33

34 2. Developing improvement capability 2018/19 By April 2019, our ambition is that all primary care training and education in Newham will be aligned, and hosted within the umbrella of the Academy to provide and support an evidence based quality improvement approach to all initiatives. This may include improvement training and education provided by: Community Education Providers Network (CEPN) The National Resilience programme providers UCLPartners Programme General Practice Vocational Training Scheme Patient and public prevention education International workforce induction programme Network learning events, providing a platform to promote improvement Access to online platforms Improvement implementation projects Evidence and academic research Figure 3. Proposed future Academy offer During 2018 the Academy will transition from delivering some workforce training and courses, to a structure that brings together and facilitates all existing training and development options. Bringing together training and education provided by the organisations listed above and others will ensure better use of resources supporting long-term sustainability, acceleration and spread of learning in Newham. The future offer includes the following activities: Quality Improvement training Leadership programme Primary care and care workforce education, training, awareness of technology and digital solutions 34

35 3. Ensuring progress and accountability 3.1. Capacity required We need to move towards an Academy that spreads learning faster, increasing the impact for our local population. This will require different resources and governance structures. In future, capacity must be drawn from within our local staffing: The Newham Health Collaborative (the GP Federation) The Newham Together Community Education Providers Network (CEPN) The GP practice support team Existing Quality Improvement Leads across Newham Resilience support team Public Health A single Strategic Advisory Group will replace the existing reporting lines into the various boards for providers. The advisory group, would comprise of representatives from the Newham Health Collaborative, Newham CCG, Newham Council, East London Health & Care Partnership, the Local Workforce Action Group and Public Health. Providers of services would report into this group and the group would be responsible for the strategic direction of all Academy programmes, oversee progress and ensure that training and other staff development initiatives were aligned Governance and accountability Our governance must: Support leadership across Newham, including within our local GP Federation as they become the focal point for delivering high quality integrated services to local people; Provide a set of enabling functions that support workforce development delivery across the Newham care system; Provide a platform to track progress and outcomes 35

36 4. Plan to implement the Academy Figure 4. Suggested blueprint future Academy Road map January 2018 to April 2019 Our aim is to deliver a fully developed Academy by April 2019, therefore requiring us to have affirmed our vision and have collectively agreed the proposed Academy infrastructure and governance structure required to deliver it (see figure 4 below). This will involve engagement across Newham Primary Care staff. To progress the work a small design and development group should complete the mapping of existing training/courses, scoping of resources and develop a business plan High level timeline (between now and March 2019) 3 Milestone Key steps Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Sign-off Academy MoU 2017/19 by Commissioner Establish a small local Academy design and development group Initial scoping funding, requirements, resources and training/courses Approval Prototype Business model and Academy specification Approval Delivery plan 2018/19 Transition to new Academy structure Sign-off specification and Service Level Agreement 2019 onwards Complete transition and fully functioning Academy 3 The plan shows the key steps required between now and March

37 APPENDIX 1. Improvement Academy Delivery plan

38 Primary Care Commissioning Committee Part I Wednesday 25 April 2018 Committee Rooms, 4 th Floor Unex Tower Title GP access: expectations in respect of core and extended hours Agenda item 2.4 Author Jenny Mazarelo, Associate Director Primary Care, Newham CCG Presented by Jenny Mazarelo, Associate Director Primary Care, Newham CCG Contact for further information Jenny Mazarelo, Associate Director Primary Care, Newham CCG E: jenny.mazarelo@nhs.net; T: This paper is for Noting Action required The Committee is asked to note the update published by NHS England on 11 April Executive summary Both national and Londonwide guidance has been drafted to help commissioners to work with their providers of general practice, in respect of the services that they offer to patients during core hours, as well as the conditions that should govern the commissioning of extended hours. At its last meeting, the Committee noted that NHS England had published a Londonwide policy guidance of its expectations for GP access. This policy is intended to create a standard approach to: Identifying GP Practices who are closed for a regular period during core hours Establish sub-contracting arrangements and confirm the relevant notice/approval has been provided to the commissioner In the absence of formal approval, provide an opportunity for practices to seek formal approval in accordance with contractual requirements from the Primary Care Commissioning Committee Where GP Practices continue to close without approval, provide evidence to the Primary Care Commissioning Committee to determine whether the GP Practice is satisfying the reasonable needs of patients. This policy guidance proposes that both current core hours and sub-contracting arrangements are reviewed to assess adequacy. The Committee agreed the contents of a letter and revised survey to be circulated to practices. The survey was circulated to practices for return by 16 April the findings and proposal for further management will be presented at the next Committee. 38

NHS Newham CCG Board Part I. 14 June :30pm 3:30pm. Committee Rooms, Unex Tower, 5 Station Street, Stratford, London, E15 1DA

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