NHS Ashford CCG and NHS Canterbury and Coastal CCG PCCC (Part 1)

Transcription

1 NHS Ashford CCG and NHS Canterbury and Coastal CCG PCCC (Part 1) Primary Care Commissioning Committee in Common Thanington Neighbourhood Resource Centre, Thanington Road, Canterbury CT1 3XE 21 July :00-21 July :15 Overall Page 1 of 64

2 AGENDA # Description Owner Time 0 Agenda PCCC Agenda Part 1v8.doc Welcome, Apologies and Introductions Chair 5 mins Declarations of Interest PCCC declaration of interests register - June 2016.doc 6 Chair 5 mins Minutes of the Previous Meeting Held on 16 June 2016 Chair 5 mins Minutes of PCCC in Common Mtg Actions Actions Log Part 1.doc 26 Chair 5 mins Review of Frequency of Meetings FC and Paper - Review of Frequency of meetings.docx 30 Bill Millar 10 mins Primary Care Commissioning Operating Group Minutes Bill Millar 10 mins FC PCCOG minutes.docx Primary Care Commissioning Operating Gro Primary Care Commissioning Work-plan progress FS - Primary Care Commissioning Work-plan.docx 38 Bill Millar 10 mins Primary Care Commissioning Work plan revis Verbal Contract Changes Wendy Malkinso n 10 mins Verbal Estates and Technology Transformation Fund (ETTF) Update Wendy Malkinso n 10 mins Overall Page 2 of 64

3 # Description Owner Time Primary Care Quality Update FS - Primary Care Quality Update.docx 46 Judith Marsh 10 mins Appendix 1 CQC Inspections July 2016.pdf 49 Appendix 2 Pt satisfaction Summary July 16.docx 52 Appendix 3 Workforce submission update July 16.docx Primary Care Commissioning Budget Update FS and report - Primary Care Commissioning Nick Dawe 10 mins Primary Care Commissioning Committee Risk Register Anthony May 10 mins FS and report - PCCC Risk Register July 2016.docx Appendix 1 - Primary Care Committee - Risk Any Other Business Chair Invitation for Questions from Members of the Public Date of Next Meeting Closure of Part 1 Chair 10 mins Chair Chair Overall Page 3 of 64

4 Ashford and Canterbury and Coastal CCGs Primary Care Commissioning Committee in Common Part 1 Thursday 21 July am to 12.15pm Venue: Thanington Neighbourhood Resource Centre, Thanington Road, Canterbury CT1 3XE Item No Paper Lead Timing Introduction 60/16 Welcome, Apologies and Introductions Chair 5 mins 61/16 Declarations of Interest Chair 5 mins 62/16 Minutes of the previous meeting held on Chair 5 mins 16 June /16 Actions Chair 5 mins For Decision/Approval 64/16 Review of Frequency of Meetings Bill Millar 10 mins For Information/Discussion 65/16 Primary Care Commissioning Operating Group Minutes Bill Millar 10 mins 66/16 Primary Care Commissioning Work-plan Bill Millar 20 mins progress 67/16 Contract Changes Verbal Wendy 10 mins Malkinson 68/16 Estates and Technology Transformation Verbal Wendy 10 mins Fund (ETTF) Update Malkinson 69/16 Primary Care Quality Update Judith Marsh 10 mins 70/16 Primary Care Commissioning Budget Nick Dawe 10 mins Update 71/16 Primary Care Commissioning Committee Anthony May 10 mins Risk Register 72/16 Any Other Business 73/16 Invitation for Questions from Members of the Public Chair 10 mins 74/16 Date of Next Meeting To be confirmed 75/16 Closure of Part 1 Resolution: That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (section 1(2) Public Bodies (Admission to Meetings) Act 1960). Conduct of meetings in relation to attendance by members of the public: Members of the public are asked to note that the Primary Care Commissioning Committee meetings are meetings of a Committee held in public. They are not public meetings where members of the public can speak at any point. Agendas PCCC Agenda Part 1v8.doc Page 1 of 2 Overall Page 4 of 64

5 identify when the Chair will receive questions and comments from the public. For all other agenda items speaking rights are reserved to Committee members and agreed representatives sitting at the table; members of the public should not speak or intervene in proceedings unless invited to do so. In all matters the Chair s decision is final. Written questions from the public: Any questions relating to Committee meeting papers which are received in writing three or more days in advance of the meeting will receive a verbal response at the meeting, and the response will be appended to the minutes of the meeting. Please send your question, along with a contact telephone number or address, to: NHS Ashford CCG and NHS Canterbury and Coastal CCG Primary Care Commissioning Committee Chair Inca House Trinity Road Eureka Science Business Park Ashford Kent TN25 4AB Or via ashford.ccg@nhs.net or c4.ccg@nhs.net PCCC Agenda Part 1v8.doc Page 2 of 2 Overall Page 5 of 64

6 Declarations of Interest (CCG) And Ashford Clinical Commissioning Group (CCG) Primary Care Commissioning Committee in Common Name Position Declaration of Interest Jonathan Sexton Chair of Primary Care Fellow of Faculty of Public Health Commissioning Committee in Common and Independent Honorary Lecturer in Public Health: Canterbury Christ Church University Member for Strategic Health Associate at the Centre for Research into Children and Families: Planning Canterbury and Canterbury Christ Church University Coastal CCG Trustee Home-Start Canterbury and Coastal Independent Chair Standards Committee, Thanet District Council Jackie Bell Joint Vice Chair/ Nil Lay Member, Governance Canterbury and Coastal CCG Steve Salt Joint Vice Chair/ Nil declaration Lay Member, Governance Ashford CCG Matthew Capper Director of Performance and Delivery Spouse is Speech and Language Therapist for East Kent Hospitals University Foundation Trust Ashford CCG and Canterbury Governor of a Primary School in Canterbury, Kent and Coastal CCG Alistair Challiner Secondary Care Clinician Canterbury and Coastal CCG Consultant in Intensive Care and Anaesthesia, Maidstone and Tunbridge Wells NHS Trust. Lead Anaesthetist for ECT, Priority House Maidstone, KMPT Practice rights at BMI Somerfield Hospital, Maidstone Practice rights at Nuffield Hospital, Tunbridge Wells Practice rights at Kent Institute of Medicine and Surgery (KIMS). Medical Advisor Tactical Medical Unit, Kent Police Fellow Royal College of Anaesthetists Fellow Faculty of Intensive Care Medicine Professional Adviser for Care Quality Commission (CQC) PCCC declaration of interests register - June 2016.doc June 2016 Page 1 of 4 Overall Page 6 of 64

7 Name Position Declaration of Interest Ray Davey Interim Chief Finance Officer Interim Chief Finance Officer Ashford CCG and Canterbury and Coastal CCG Dr Mark Davies Clinical Member, Ashford CCG GP partner Kingsnorth Medical Practice; Ashford Road, Ashford TN233ED (commissioned NHS services e.g. minor surgery, gynaecology, paediatric ENT) Provider of outreach gynaecology and ENT clinics. Member of Ashford Clinical Providers Ltd Lorraine Goodsell Martin Harvey Bethan Haskins Dr Navin Kumta Transformation Programme Director Lay member PPE Ashford CCG Chief Nurse Ashford CCG and Canterbury and Coastal CCG Clinical Chair, Ashford CCG/GP at Willesborough Working part time on the Vanguard MCP Project. Wife is a qualified counsellor. Nil GP partner, The Willesborough Health Centre, Bentley Road, Ashford, Kent; Independent session for South East Health Ltd. MSK in house clinic; Member of Ashford Clinical Providers Ltd Judith Marsh Anthony May Bill Millar Primary Care Quality Lead Ashford CCG and Canterbury and Coastal CCG Head of Corporate Services Ashford CCG and Canterbury and Coastal CCG Chief Operating Officer, Ashford CCG and Canterbury and Coastal CCG Member of the Hamstreet Surgery patient participation group Husband occasionally works for ic24 (previously South East Health) as a driver for the out of hours GPs. Nil Spouse works at Pilgrims Hospice PCCC declaration of interests register - June 2016.doc June 2016 Page 2 of 4 Overall Page 7 of 64

8 Name Position Declaration of Interest Ana Paula Nacif Lay Member PPE Executive Coach with the NHS London Leadership Academy Canterbury and Coastal CCG Consultant/trainer with Social Enterprise Kent and former Consultant/trainer with Red Zebra Independent Coach and facilitator with Living Well CIC, which Is a delivery partner for Turning Point Volunteer wellbeing coach with Porchlight Simon Perks Accountable Officer, Ashford Director and trustee of Cantercare Ltd, registered charity no: ; CCG and Canterbury and Trustee of Pilgrims Hospice. Coastal CCG Member of the Advisory Board of Transforming Systems Ltd. Dr Sarah Phillips Dr John Ribchester Clinical Chair, Canterbury and Coastal CCG/GP in Faversham Clinical Member, Canterbury and Coastal CCG (Whitstable) Member of Invicta Health CIC Member of Limited Liability Practice (LLP) that part owns the Pharmacy at Newton Place. Practice has signed up to the Vanguard Multispecialty Community Providers. GP partner Whitstable Medical practice and part owner Chestfield medical centre and Estuary View medical centre. Provider of GP enhanced services. Provider of a range of community outpatient, diagnostic, and day surgery services. Provider of a level 3 minor injury unit. Provider of community physical therapy services. Honorary Director and Shareholder, Thorndene Ltd, Swingfield, Dover, Kent. Appointed Member Downs Syndrome Association Shareholder of Invicta Health CIC, Canterbury. Member Kent postgraduate education centre, Canterbury, Kent. Member of the NHS Alliance Practice has signed up to the Vanguard Multispecialty Community Providers (MCP). Chair and Clinical Lead of Encompass Multi-speciality Community Provider (MCP) PCCC declaration of interests register - June 2016.doc June 2016 Page 3 of 4 Overall Page 8 of 64

9 Name Position Declaration of Interest Dr Dinesh Sinha Secondary Care Doctor Ashford CCG Secondary Care Lay Member on Governing Body Isle of Wight CCG and Brighton and Hove CCG; Secondary care specialist lay member on the Brighton & Hove CCG and was previously on Isle of Wight CCG. Employed part time as consultant psychiatrist with East London NHS Foundation Trust Self-employed medico legal work. Brother works at Guys and St Thomas Hospital. Associate Medical Director for Brighton and Hove CCG Trustee for Inner City Centre PCCC declaration of interests register - June 2016.doc June 2016 Page 4 of 4 Overall Page 9 of 64

10 Ashford and Canterbury and Coastal CCGs Primary Care Commissioning Committee in Common Part 1 Thursday 16 June am 12.00pm Venue: Thanington Neighbourhood Resource Centre, Thanington, Canterbury CT1 3XE Those Present: Jonathan Sexton (JS) - Chair/Independent Member for Strategic Planning, Canterbury and Coastal CCG Jackie Bell (JBe) - Joint Vice Chair/Conflict of Interest Champion/Lay Member, Canterbury and Coastal CCG Steve Salt (SS) - Joint Vice Chair/Lay Member, Ashford CCG Matthew Capper (MC) - Director of Performance and Delivery, Ashford CCG and Canterbury and Coastal CCG Lorraine Goodsell (LG) - Transformation Programme Director, Ashford CCG and Canterbury and Coastal CCG Bethan Haskins (BH) - Chief Nurse, Ashford CCG and Canterbury and Martin Harvey (MH) - PPE Lay Member, Ashford CCG Richard Ledgerwood (RL) - Deputy Chief Finance Officer, Ashford CCG and Canterbury and Coastal CCG (Delegate for Nick Dawe) Dr Simon Lundy (SL) - GP, Faversham/Clinical Lead (Delegate for Dr Sarah Phillips) Sarah Macdonald (SMac) - Director of Commissioning, Representing NHS England Wendy Malkinson (WM) - Practice Liaison Manager, Canterbury and Coastal CCG Anthony May (AM) - Head of Corporate Services, Ashford CCG and Canterbury and Coastal CCG Liz Mears (LM) - Representing Kent Local Medical Committee (KLMC) Bill Millar (BM) - Chief Operating Officer, Ashford CCG and Canterbury and Coastal CCG Ana Paula Nacif (APN) - PPE Lay Member, Canterbury and Coastal CCG Dinesh Sinha (DS) - Secondary Care Doctor, Ashford CCG Tracey Tipping (TT) - Operations and Delivery Manager NHS England Apologies: Dr Mark Davies (MD) - GP/Clinical Lead, Ashford CCG Nick Dawe (ND) - Chief Finance Officer, Ashford CCG and Canterbury and Coastal CCG Dr Navin Kumta (NK) - GP/Clinical Chair, Ashford CCG Simon Perks (SP) - Accountable Officer, Ashford CCG and Canterbury and Coastal CCG Dr Sarah Phillips (SPh) - GP/Clinical Chair, Canterbury and Coastal CCG Dr John Ribchester (JR) - GP/Clinical Lead, Canterbury and Coastal CCG Minutes of PCCC in Common Mtg Part 1v8.doc 1 Page 1 of 16 Overall Page 10 of 64

11 Minute-Taker: Maureen Thomas (MT) - PA to Director of Performance and Delivery and PA to Head of Corporate Services Ashford CCG and Canterbury and Coastal CCG 36/16 Welcome, Apologies and Introductions Apologies had been received as above. Dr Mark Davies had submitted his comments/queries ahead of the meeting. There were reduced numbers of attendees owing to a number of members attending the NHS Confederation Conference in Manchester, but owing to the important items on the agenda requiring a decision, the decision was made to still go ahead with the meeting. The Chair welcomed Elizabeth Jones (member of the public), Sarah Macdonald and Tracey Tipping from NHS England and Liz Mears representing Kent Local Medical Committee, Dr Simon Lundy, delegating for Dr Sarah Phillips and Richard Ledgerwood, Deputy Chief Finance Officer, delegating for Nick Dawe, new Chief Finance Officer. 37/16 Declarations of Interest Dr Simon Lundy, delegate for Dr Sarah Phillips, asked for the following declarations of interest to be taken in to account: GP Newton Place Surgery, Faversham Patient, Faversham Medical Centre Quality Lead Mental Health Lead 38/16 Minutes of the previous meeting held on 19 May 2016 The minutes of the previous meeting held on 19 May 2016 were agreed as a correct record, subject to the following amendments and were duly signed by the Chair:- 19/16 Primary Care Transformation Fund (PCTF) now known as Estates and Technology Transformation Fund (ETTF): Page 6, second paragraph, first sentence should read: WM stated that the existing premises funding still exists; this is an additional sum of money. 24/16 Finance Update: Minutes of PCCC in Common Mtg Part 1v8.doc 2 Page 2 of 16 Overall Page 11 of 64

12 Page 8, fifth paragraph, second sentence should read: The move to Capita has not gone so smoothly but issues are being addressed. 39/16 Actions from the meeting held on 19 May 2016 Action 1: Complete. Action 2: Terms of Reference to be reviewed in September Action 3: Complete. Action 4: Complete. Action 5: On agenda. Action 6: On agenda. Action 7: Carry forward. Actions from the meeting held on 21 April 2016 Action 2: Ongoing. WM meeting with NHS England and will bring a report to Primary Care Commissioning Committee meeting on 21 July Action 4: Ongoing. Action 5: Date of Dudley CCG members visit is to be re-scheduled from 5 July. LG will report back with new date once arranged. Action 7: Ongoing. Carry forward to Primary Care Commissioning Committee meeting on 21 July /16 Estates and Technology Transformation Fund (ETTF) Bid Evaluation The following people registered a conflict of interest, ahead of the discussion: JBe patient at Ivy Court Surgery APN patient at Faversham Medical Practice WM patient at Whitstable Medical Practice LG patient at Whitstable Medical Practice LM patient at Cossington House Surgery AMay patient at Kingsnorth Medical Practice SL GP at Newton Place and patient at Faversham Medical Practice JS gave an introduction around the purpose of the paper. It was noted that the committee needed to make a decision today following the extensive work that had been done to score the bids submitted by practices. The lowest scores represented the highest priority. The scores have to be compared alongside the current CCG Primary Care Strategy and Estates Strategy, taking in to account local knowledge and any other factors, such as significant Minutes of PCCC in Common Mtg Part 1v8.doc 3 Page 3 of 16 Overall Page 12 of 64

13 housing development. WM explained that the panel had consisted of six assessors who had looked at all the bids, looking at the weightings and all scores had been amalgamated. One practice had scored the highest out of all the assessments Ivy Court had scored the highest in Ashford, with the known factors being the development within the area of a significant number of houses being planned to be built. The Kingsnorth bid is more complicated because the main area of development is Finberry and there had already been a section 106 Agreement in place with the builder planning to build a medical practice within the development, expected to be around SMac wanted to make it clear to the committee the distinction between capital and revenue expenditure. Primarily around Capital investment, although the third party developers may invest capital, the revenue would still be paid for by the CCG. WM added that the premises directions anticipated to allow for 100% capital investment. Some of the larger schemes which allowed for 100% capital investment on a new build, there is the potential for no revenue costs to the CCG for at least 15 years. With regard to the high housing development within the Ashford area, a lot of work had already been done on community hub and services. With regard to the Kingsnorth bid, WM has asked the council for details of what the developers are proposing and if there is a Section 106 Agreement in place. Wye Surgery and Sydenham House have revenue consequences. They are expecting rent reimbursements, although this will not be for approximately 5 years. Willesborough practice have bid for a car park; this does not fully meet the criteria for the transformation fund. Canterbury Medical Practice bid is for a new site at Kent and Canterbury Hospital to relocate Cossington House Surgery and London Road Surgery and provide capacity for the housing developments in South Canterbury and out of hospital services. Faversham Medical Practice and Newton Place WM will discuss with both to explain that the bids can be combined as a CHOC, as they currently both provide similar services and are requesting Minutes of PCCC in Common Mtg Part 1v8.doc 4 Page 4 of 16 Overall Page 13 of 64

14 similar capacity expansion for the Town. Whitstable Medical Practice, Chestfield they have already bought the land will take patients from the Herne Bay Golf Club development. Northgate Medical Practice need confirmation of where the CHOCs will be, which is dependent on Canterbury City Council selling some of the car park to Northgate to double the size of the building/practice. This is a significant revenue scheme. Sandwich/Ash Market Place and The Butchery practice is in a building with an expired lease. There was a proposal by the local developer to allocate a piece of land. However the practices are now proposing to go in to partnership with each other, and are seeking to develop Eastry surgery to service both sites and become a CHOC, with a second site to support the space. LG stated that a meeting of the Canterbury Town Teams had been held to consider the location of the CHOCs. LG read out the that she had received from Ann Judges: Last night we discussed the Canterbury/Sandwich/Ash CHOC configuration the focus of that discussion was not based on which practices would host CHOC teams, it was focused on how the practices will group together and how Sandwich is best served. We discussed both the admin and clinical functions of the CHOCs and it was felt by the group that the admin referral functions should and could be located centrally the location of referral management was incidental as the IMT solutions exist to support remote operation. That moved us on to focus on clinical teams. Sandwich and Ash made a very strong and persuasive case that they should have a CHOC and the group agreed that was necessary given the geography etc. We then discussed whether there should then be a single super size Canterbury CHOC or 2 CHOCs broadly mapped to the way the PPs have been clustered. They group felt there should be 2 and the split should be: 1. Northgate and Sturry 2. CMP, NDR and University and Canterbury Health Centre (Health Centre may shift to Northgate one?) In terms of physical location, we discussed the fact that this year the CHOCs would be housed in Whit and Tank, FMP/Community Hospital, Market Place for Sandwich and K&C and possibly St Minutes of PCCC in Common Mtg Part 1v8.doc 5 Page 5 of 16 Overall Page 14 of 64

15 Martins for Canterbury. We did not discuss beyond this year, and there was no mention of estates bids etc. It was agreed that there was no need to locate CHOCs in primary care premises however and I think that may be important in terms of influencing thinking today. If anything it is more important to colocate the CHOCs in community bedded facilities where possible given the interface with managing urgent /step up/step down patients. SL asked if Section 106 funding could be used for extension of premises. WM s response was that Section 106 Agreement has to be agreed at the time the proposed development is given planning permission. Section 106 cannot be retrospectively applied. BM added that the CCG had received the opportunity to comment on the Section 106 and the council had always maintained that there would be a community centre. The comments from primary care were more about the number of doctors rather than the site. There will be a centre on the site as the development will become a very large village. Kingsnorth is not within the development area. WM explained that the direction is primary care at scale. Finberry is a development of circa 1100 houses within the area formally known as Cheeseman s Green. Chilmington Green is an additional development to the South West of Ashford (close to Kingsnorth) for 5,000 houses. The original plan was for 11,000 houses, but has been contained because of the current economy. NF and WM attended a meeting to overlay what the health requirements would be for the new development. DS asked about the consultation process and how it was determined what size of surgery is required. WM explained that the guidance given was that primary care should be at scale. LG added that a number of practices were working together which would equate to around 30,000 to 50,000 patients. It was generally accepted that because of the geographical location, Sandwich would be much smaller. JS summarised by saying that the committee would not be expected to make a perfect decision. The ETTF had been a nationally driven timetable, therefore the consultative dimension had not been done in the most desirable way. With regard to the bids for Faversham Medical Practice and Minutes of PCCC in Common Mtg Part 1v8.doc 6 Page 6 of 16 Overall Page 15 of 64

16 Newton Place Surgery, Faversham, as both practices had asked for very similar things, it would be advisable to produce one bid as one Town Team in support of the CHOC rather than the CCG to prioritise one more than the other. SL confirmed that discussions had already taken place between the two Faversham practices and he said that he would look in to producing an amalgamated bid for the two practices. WM suggested that it would be better for all practices, for all bids to complete the portal questions to ensure that nothing within a bid was mis-represented. Action 1: WM to discuss with Faversham Medical Practice and Newton Place Surgery an interdependent bid. AMay suggested that when the process would have been more effective if it had been more directive so that the practices were not in competition with each other. The bids should relate to the Estates Strategy and information around Section 106 should be contained within the strategy. WM explained that the CCGs cannot put every bid forward as a number one priority so a decision has to be made by the Primary Care Commissioning Committee about what is the CCG s priority order for the bids. NHS England will have to follow due diligence procedure and some schemes will be left off and some will be brought to the top of the list. The scoring is robust but it is important that the CCG can prove that it has done as much as possible to support the practices and the bids meet the criteria as set by NHS England. It was suggested that Willesborough could withdraw their bid for a car park, as it did not meet the criteria and would almost certainly get turned down. SMac stated that although there was an expectation that the process may dismiss some bids, it was not appropriate to ask a practice at this late stage to withdraw their bid. There were other funding routes that could be pursued for those bids not suitable for the ETTF. The Primary Care Commissioning Committee took a vote to support two separate submissions one for Ashford CCG and one for Canterbury and Coastal CCG. There was a query around the Minutes of PCCC in Common Mtg Part 1v8.doc 7 Page 7 of 16 Overall Page 16 of 64

17 clarification of Kingsnorth bid, which WM would be able to report back on. LM warned that the premises funding system was very difficult to navigate; there was an improvement grant route, although those funds were slowly diminishing. NHS England has some premises development money but it is available to Kent, Surrey and Sussex. Ashford CCG votes: unanimous (Those in favour: JS, MC, LG, MH, BH, BM, SS, DS) Canterbury and Coastal CCG votes: unanimous (Those in favour: JS, JBe, MC, AC, LG, BH, BM, APN). SL abstained due to conflict of interest. The sequencing of bids would be as follows:- Canterbury Medical Practice Combined Faversham Practices bid for CHOCs Extension at Northgate Extension at Whitstable Sandwich/Ash DS commented that the scoring had been used but he was not very comfortable in making decisions in this way. LM stated that she had been involved in other groups and wanted to congratulate the PCCC for Ashford and Canterbury for a very good thorough process. JS concluded that although it had been lengthy and complex, a lot had been learned from the process. 41/16 Personal Medical Services (PMS) Review Reinvestment Year 1 NHS England have undertaken a series of PMS reviews. The premium is being removed from the PMS practices and will go to the CCG to determine where it is best invested. The money for Ashford CCG will remain with Ashford and Canterbury and Coastal CCG money will stay with Canterbury it cannot be cross-invested. Practices were asked to submit their service ideas to the Health Reform Panel (HRP) to ensure that these are the services that the CCG would wish to commission. Some have already gone through the HRP and some are still in progress Minutes of PCCC in Common Mtg Part 1v8.doc 8 Page 8 of 16 Overall Page 17 of 64

18 The proposal is only about year 1. The investment is for a 5 year period, paying 20% per year. NHS England will seek assurance from the CCGs for year 1 money for the new contracts due on 1 July Investment will be on a per capita basis. The proposal is to pay all the practices on a per capita basis for work in preparation to assist the CCG to work up a really meaningful service. The CCG will work with practices on data collection etc. All the Canterbury practices have opted to revert back to GMS from PMS and have accepted their transitional funding arrangements. Ashford practices have followed, with the exception of one practice JBe expressed concern about how much funding individual practices might lose and whether they would be able to continue to provide appropriate services for patients. Ashford has the smaller funding amount. WM explained that the proposal was 20% of the premium. For those practices that could evidence that they would be unsustainable and financially unviable, they have been in discussion with NHS England who have agreed additional transitional support. WM gave an example of how much NHS England would pay back in years 1, 2, and 3. It was anticipated that by the end of years 1there would have been sufficient time for a full analysis of all the historic PMS services that have been in place. Any service that is developed should be made available, on an equitable offer basis, to all practices. This money will not be used for any other deficit and anything left over will go back to the practice for primary care services. LM stated that the PMS practices were not happy with the NHS England review of PMS practices. Two years ago a significant amount of funding was taken away. Since then those practices have managed to re-stabilise with the advice from the national GPC not to move forward until the commissioning intentions had been agreed. JBe queried that the money would be taken away from services and used for data collection. WM stated that services would be assessed through the Health Reform Panel and the money would be reinvested in those services but it was necessary in most cases to have the data in order to assess what services were required Minutes of PCCC in Common Mtg Part 1v8.doc 9 Page 9 of 16 Overall Page 18 of 64

19 AMay referred to Dr Mark Davies (MD) comments about the PMS review where he had quoted NHS England s guidance about funding changes being managed in a way that would not risk destabilising general practice and that all local commissioners having to ensure reinvestment proposals are confirmed locally to PMS practices before any actual reductions to funding are made to the PMS practices who are facing the reductions in funding. MD questioned how much preparation and work any practice would be prepared to put in for what appeared to be relatively small sums of money. He went on to add that before the PMS practice could proceed with any potential agreements with NHS England, they would need clear guidance on what services would be commissioned in the future. He also questioned what meaningful service could be commissioned with the small level of investment that would be available in year two. MD was also concerned about the increasing workload on the existing workforce. He mentioned the vote that took place at the LMNC conference to ask the GPC to negotiation an immediate cessation of any reduction in practice income by halting any further PMS redistribution to reduce the risk of destabilising practices. MD warned that taking large amounts of money away from one practice over a short period of time would destabilise the practice. It was important to be aware that engagement with the affected patients would need to take place before these services were withdrawn. If the process of decommissioning of services goes ahead, it would need to be added to the risk register as it would pose a risk to the CCG. He added that the quality aspects of the service being offered by the PMS practice was still under review via the Health Reform Panel. DS asked if a quality evaluation had been undertaken. SMac stated that a policy decision was made nationally by NHS England to negotiate GMS contracts locally to facilitate and align services with the contractual thinking around the Vanguard. Practices elected to go to PMS and negotiated PMS plus services or above standard GMS contracts. To ensure that those additional elements are being provided, the view nationally is that this is causing a disadvantage when paying premium GMS as we may have been paying a premium for services that may or may not have been provided, as it is not obvious where those additional services are being provided. DS suggested that this may have been down to poor contract management by NHS England Minutes of PCCC in Common Mtg Part 1v8.doc 10 Page 10 of 16 Overall Page 19 of 64

20 SL commented that good planning was an area that needed to be invested in to ensure that the right services were being provided for patients. SS stated that as there was no other option available, there appeared to be no other alternative but to endorse the proposal. The Primary Care Commissioning Committee voted unanimously (JS, MC, LG, MH, BH, BM, SS, DS, JBe, AC, APN) in favour of the proposal to support the recommendation as outlined in the paper. 42/16 Practice Mergers WM gave an update on the practice mergers. At the last Primary Care Commissioning Committee, the merger of Northgate Medical Practice/Chartham Surgery had been approved. WM had just received a form from Capita and now had a contact at Capita to liaise with. A provisional date of 30 September 2016 had been set to merge the two databases so that the practices could move forward with one G number. SMac reminded the Primary Care Commissioning Committee that they would not have the authority not to approve practice mergers. JS queried this statement and asked for clarification. Action 2: SMac/WM to provide clarification around the PCCC s authority to approve or not approve practice mergers. 43/16 Primary Care Annual Plan for Ratification BM thanked members for their part in the virtual process of approval of the Primary Care Annual Plan which had to be submitted to NHS England by the end of May The Primary Care Annual Plan was submitted to gain assurance from NHS England that the CCG plans for primary care were robust and credible. The key themes around engagement with the community in addition to a greater emphasis working with practices. Whilst the plan was submitted to NHS England following the committee s virtual approval, it has been brought here today for formal ratification. The Primary Care Commissioning Committee formally ratified Minutes of PCCC in Common Mtg Part 1v8.doc 11 Page 11 of 16 Overall Page 20 of 64

21 the Primary Care Annual Plan. 44/16 Primary Care Quality Update JM presented the report, explaining that all the documents presented here today were for discussion as a work in progress. The existing practice profiles for both Ashford and Canterbury were just a first draft to build on to provide a dashboard. There was some information missing from the Immunisation screens and selfprevention section, as well as patient engagement. It was planned to have just one dashboard, with the option to pull out specific items. Starting with month 12, with the CQC inspections and any mitigation. DS asked if Gantt Charts could be used to follow the data for the month and the year. When looking at the practice profile, it was not clear when comparing like for like that there could be some way in which we could waive population. MC explained that there is a wider piece of work being done around general practice and secondary care including quality issues. DS queried the referral hot spots such as Charing Medical Partnership. JM stated that this would be followed up through the Quality Committee. Working with the CSU to obtain more reliable data. APN stated that NHS England have just published the framework on patient engagement and they are developing a patient engagement measurement to be included on the CCG dashboard. LM referred to the high referring practice; a lot of practices provide additional services. LM asked if this information would be used in a supportive way or if practices would be penalised. MC confirmed that practices would be supported as part of a much larger piece of work. 45/16 Primary Care Commissioning Budget Update RL presented the Primary Care Commissioning Budget Update paper. Ashford CCG had received 225,000 increase from NHS England, bringing the budget up to 16M Minutes of PCCC in Common Mtg Part 1v8.doc 12 Page 12 of 16 Overall Page 21 of 64

22 Canterbury and Coastal CCG had received an increase of 37,000, from NHS England making a total of 26M. Additional allocations were confirmed through the Month 3 reporting process. All budgets are subject to risk. The backdated rent reviews is positive news. The monthly report to the Governing Body mentioned alignment of PMS/GMS payments and the pressure put on practices. A cash advance had been available to support those practices. There are risks, there had been a massive deviation in budgets. BM stated that at the last PCCC meeting it was reported that work was being done to do some validation. RL confirmed that all the information was available. 46/16 Primary Care Commissioning Committee Risk Register AMay presented the risk register, which had been updated following the discussion at the last Primary Care Commissioning Committee when further risks had been identified and added to the risk register. One of the highest risks is the transfer of resource from NHS England to the CCG. A meeting is being held next week to discuss this. The risk is now much reduced compared to last month. AMay asked the committee if there were any other risks to be identified. BH queried how a risk that was identified in part 2 would be recorded. MC stated that the risk should be on the risk register but would not include any details. The risk would then be discussed in more detail in part 2. BH suggested that the Terms of Reference should reflect the way part 2 risks are managed. WM asked for the risk around premises and the difficulty practices are finding now that the expertise is not available from NHS England. The risk would be the CCG s ability to manage that Minutes of PCCC in Common Mtg Part 1v8.doc 13 Page 13 of 16 Overall Page 22 of 64

23 Action 3: AMay to follow up with WM outside the meeting and add the risk around premises to the risk register. BM suggested that this risk should also appear on the Finance risk register as well as the Primary Care Commissioning risk register. LM stated that service changes were not reimbursable to practices so they could destabilise a practice. SL asked for the inability to recruit GPs to be added to the risk register. SMac added that the risk with NHS Property Services and the mitigations were known at a national level. These were the drivers behind the GP forward view. APN stated that the East Kent Strategy Board was developing a case for change. JM commented that the CEPN will be looking in to it once the risk has been assessed. 47/16 Support for General Practice BM had been asked to bring this item to the committee on behalf of Simon Perks. At a recent meeting of the Canterbury and Coastal CCG Consortium, a presentation highlighted pressures that GPs were under locally. The CCG needs to recognise the pressures and start to work with practices to mitigate the risks emerging particularly within workforce. Some practices are struggling. WM has circulated to Ashford and Canterbury and Coastal practices the targeted returning doctors pilot scheme which can provide funding to practices providing they meet the criteria. BH mentioned the CEPN is an East Kent wide board which is hosted by Ashford CCG on behalf of East Kent. The CEPN will be looking at health education, workforce and different ways of providing healthcare services from a variety of different healthcare professionals. It was felt that the CEPN should report in to the Primary Care Commissioning Committee in addition to the OLT. Action 4: BM to add this item as a standing item on the Primary Care Commissioning Committee agenda. APN asked if the workforce issue was strongly linked with the structure. WM explained that it was more of high level estates Minutes of PCCC in Common Mtg Part 1v8.doc 14 Page 14 of 16 Overall Page 23 of 64

24 LG stated that the CCG and the Vanguard would need to look at how primary care services are developed by looking at workforce through the CHOCs and other ways of releasing pressure on primary care, for example paramedic practitioners. LM mentioned the GP staff training team. The funding for the administration of this team ended in March. West Kent CCG have agreed to take the service over for six months in the interim. A decision will soon need to be made about the part funding of the service. BH stated that it was a risk because the service goes out of service in two months. SMac stated that she was planning on visiting all ten CCGs Primary Care Commissioning Committee meetings receiving a presentation on the GP Forward View. The BMA is very supportive of the 10 point plan (the role of digitisation, for example text messaging). BM confirmed that he had presented an executive summary of the GP Forward View at the last Primary Care Commissioning Committee on 19 May More work was required to make it a live document. 48/16 Any Other Business JBe asked when the final Conflict of Interest document would be available. Action 5: SMac to follow up with NHS England and feed back in time for the next Primary Care Commissioning Committee meeting on 21 July /16 Invitation for Questions from members of the public JS invited the member of the public to ask questions. Member of the public, Elizabeth Jones had the following comments and questions: Elizabeth Jones used to be involved in bidding processes and it would not be advisable to ask people to withdraw their bids once they had been submitted. When voting, it must be made clear who could vote and who could not vote for either CCG, otherwise the committee may be open to legal challenge later. AMay stated that the signing in sheet had an additional column Minutes of PCCC in Common Mtg Part 1v8.doc 15 Page 15 of 16 Overall Page 24 of 64

25 which gave the membership status of each person present. Some members could vote for both CCGs and some members could only vote for one of the CCGs. The signing in sheet reflected the detail within the terms of reference for the committee, which were separate for each CCG. As the Primary Care Commissioning Committee is a joint committee, Elizabeth asked if the delegation to each CCG had been done separately. SMac explained that the delegation is for each CCG but Ashford CCG and Canterbury and Coastal CCG work together, as do a number of other CCGs. NHS England are not concerned as long as the governance procedures are clear. NHS England have no concerns about how this Primary Care Commissioning Committee is run. 50/16 Date of Next Meeting The next meeting is on Thursday 21 July 2016 from 10.00am to 12.00pm at Thanington Neighbourhood Resource Centre, Thanington Road, Canterbury CT1 3XE 51/16 Closure of Part 1 JS announced the closure of Part 1. Resolution: That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (section 1(2) Public Bodies (Admission to Meetings) Act 1960). Minutes approved: Date. Name.. (Chair of today s meeting) Signature Minutes of PCCC in Common Mtg Part 1v8.doc 16 Page 16 of 16 Overall Page 25 of 64

26 Actions from the Primary Care Commissioning Committee in Common Meeting (Part 1) Held on 16 June 2016 Minute number Action Points By When By Who Status 40/16 Estates and Technology Transformation Fund (ETTF) Bid Evaluation 30 June 2016 Complete Action 1: WM to discuss with Faversham Medical Practice and Newton Place Surgery an interdependent bid. Wendy Malkinson 42/16 Practice Mergers Action 2: SMac/WM to provide clarification around the PCCC s authority to approve or not approve practice mergers. 46/16 Primary Care Commissioning Committee Risk Register 21 July July 2016 Sarah Macdonald/ Wendy Malkinson Complete: PCCC approval is required Complete Action 3: AMay to follow up with WM outside the meeting and add the risk around premises to the risk register. Anthony May/ Wendy Malkinson 47/16 Support for General Practice 21 July 2016 Complete: Action 4: BM to add this item as a standing item on the Primary Care Commissioning Committee agenda. Bill Millar Discussed at PCCOG and agreed to incorporate within work-plan Actions Log Part 1.doc 1 Page 1 of 4 Overall Page 26 of 64

27 48/16 Any Other Business Action 5: SMac to follow up with NHS England [when the new conflicts of interest guidance would be published] and feed back in time for the next Primary Care Commissioning Committee meeting on 21 July July 2016 Sarah Macdonald Complete: guidance has been published and Anthony May is developing implementation plan Minute number Action Points By When By Who Status Actions from the Primary Care Commissioning Committee in Common Meeting (Part 1) Held on 19 May /16 Primary Care Commissioning Operational Group (PCCOG)Terms of Reference Action 2: Terms of Reference to be reviewed after three meetings (September). September 2016 Anthony May Review to be undertaken at the September meeting. 22/16 Primary Care Working Group Summary Action 7: BM will take back to colleagues today and present it in a pictorial way. 21 July 2016 Bill Millar Complete: circulated to members and published on website Actions from the Primary Care Commissioning Committee in Common Meeting (Part 1) Held on 21 April Actions Log Part 1.doc 2 Page 2 of 4 Overall Page 27 of 64

28 03/16 Orientation Session: What is Primary Care Commissioning? Action 2: WM to specify precisely which services are being devolved to different parts of the NHS system by NHS England and which are to be retained. 21 July 2016 Wendy Malkinson Meetings with NHS England received and draft MOU received from NHS England. Awaiting Nursing and Quality appendix of MOU, report to Committee once received Actions Log Part 1.doc 3 Page 3 of 4 Overall Page 28 of 64

29 Minute number Action Points By When By Who Status 06/16 Delegation Agreement and Primary Care Commissioning Committee Terms of Reference Action 4: BM/AMay to develop a flow diagram for discussion around the protocols that describe the business process of primary care services. Ongoing Bill Millar Complete New Action 5: LG to circulate date and set an agenda for the Dudley CCG visit. 10/16 Invitation for Questions from Members of the Public 16 June 2016 Lorraine Goodsell New date to be arranged Action 7: Work currently being done on all of the CCGs committees, but once finalised, AMay to upload a diagram showing the relationships between all of the CCGs committees. Ongoing Anthony May Complete: circulated to members Actions Log Part 1.doc 4 Page 4 of 4 Overall Page 29 of 64

30 Primary Care Commissioning Committee Paper NHS Ashford and Canterbury & Coastal CCGs Agenda Item: 64 /16 Date of Meeting: 21 July 2016 Title of Report: Author: Lead Director: Action Required: Review of Frequency of meetings Anthony May Head of Corporate Services Bill Millar Chief Operating Officer Approval Decision X Discussion/ Assurance Information Conflict of Interest: None identified Purpose of paper: Since the committee was established in April 2016, it has been meeting on a monthly basis. Experience has shown that there are not sufficient decisions required to necessitate that the committee meets so frequently. The committee s terms of reference allow for decisions to be made virtually, or if required for urgent business, an extraordinary meeting could be arranged. Recommendations: It is recommended that consideration is given to running this committee on a bimonthly basis, allowing a schedule to be developed whereby the PCCOG and the committee meetings alternate on a monthly basis. Publication: Restriction (define) No Restriction X Supporting Paper/Appendices: None FC and Paper - Review of Frequency of meetings.docx Page 1 of 1 Overall Page 30 of 64

31 Primary Care Commissioning Committee Paper NHS Ashford and Canterbury & Coastal CCGs Agenda Item: 65 /16 Date of Meeting: 21 July 2016 Title of Report: Author: Primary Care Commissioning Operating Group (PCCOG) minutes Anthony May Head of Corporate Services Lead Director: Action Required: Bill Millar Chief Operating Officer Approval Decision Discussion/ Assurance X Information Conflict of Interest: None identified Purpose of paper: The Primary Care Operating Group (PCCOG) met on 12 July This paper provides a summary of that meeting. The recommendations made by the Group have been included as separate agenda items where appropriate. Recommendations: The Committee note this report Publication: Restriction (define) No Restriction X Supporting Paper/Appendices: Primary Care Commissioning Operating Group (PCCOG) minutes (draft) FC PCCOG minutes.docx Page 1 of 1 Overall Page 31 of 64

32 Ashford and Canterbury and Coastal CCGs Primary Care Commissioning Operating Group (PCCOG) Tuesday 12 July Venue: Board Room, Inca House, Ashford, Kent Those Present: Wendy Malkinson (WM) - Primary Care Commissioning Manager, Ashford CCG and Canterbury and Coastal CCG Anthony May (AM) - Head of Corporate Services, Ashford CCG and Canterbury and Coastal CCG Mike Parks (MP) - Representing Kent Local Medical Committee (KLMC) Bill Millar (BM) - Chief Operating Officer, Ashford CCG and Canterbury and Coastal CCG Judith Marsh (JM) - Primary Care Nursing & Quality Lead, Ashford CCG and Canterbury and Coastal CCG Kay Acott (KA) - Practice Manager, Charing Practice (Ashford CCG) Apologies: Dr Mark Davies (MD) - GP/Clinical Lead, Ashford CCG Dr John Ribchester (JR) - GP/Clinical Lead, Canterbury and Coastal CCG Christina Callister (CC) - Finance Business Manager Emma Ray (ER) - Practice Manager, Canterbury Medical Practice (Canterbury and Coastal CCG) Minute-Taker: Anthony May (AM) - Head of Corporate Services, Ashford CCG and Canterbury and Coastal CCG - Welcome, Apologies and Introductions Apologies had been received as above. Each member introduced themselves and BM described the purpose of the group stating that its terms of reference defined it as being responsible for making recommendations to the Primary Care Commissioning Committee (PCCC). BM explained that the PCCC would direct the group to undertake work. MP stated that he felt the group required some delegated responsibility to enable it to make decisions regarding smaller items that require a fast turnaround, citing contract variations and amendments to practice boundaries as particular examples. AM advised that the PCCC would review the terms of reference for this group in September, and confirmed this would be revisited then Primary Care Commissioning Operating Group (PCCOG) minutes.doc 1 Page 1 of 6 Overall Page 32 of 64

33 20/16 Primary Care Commissioning Work Plan BM introduced the work plan, explaining that it had been approved at the June 2016 PCCC meeting, and now required review to document progress. BM advised the group that following the publication of the General Practice Forward View (GPFV), it was likely that some of the actions detailed within the plan would need amendment and/or expansion. The group proceeded to review and update each action on the plan line by line JM gave a detailed review of the work that was progressing to deliver the Quality actions and advised the quality visits had commenced. It was agreed that BM would review the workplan and align it with the GPFV, incorporating actions to provide additional support to primary care. Action: BM to review the workplan as above, incorporating the GPFV and report to the next PCCC for approval. 21/16 Memorandum of Understanding (MOU) BM informed the group that following discussions with the local NHS England team, draft MOUs had been received regarding the resources that will be made available to CCGs with delegated commissioning responsibilities. The MOUs clarify what remains the responsibility of the NHS England and what has transferred to the CCG. NHS England will continue to deliver some of the delegated functions through the MOU. AM explained that although the MOU had not been formally agreed, in effect it was already being followed, since the transition of functions to the CCG was a gradual process, with several functions continue to be provided by NHS England. BM confirmed that the CCG was yet to receive Nursing and Quality element of the MOU, advising that it was expecting next week. KA stated that prior to receiving the papers for this meeting, she had been unaware of the significant transfer of responsibility from NHS England to the CCG, and advised that following a recent Practice Manager s meeting, this was typical of all practices across Ashford. The group agreed that there had been no detailed communication to member practices detailing the nature of the Primary Care Commissioning Operating Group (PCCOG) minutes.doc 2 Page 2 of 6 Overall Page 33 of 64

34 transfer, although the details of the delegation were published on the CCG website. BM described the processes that the CCG had been going through since receiving the delegation, advising that the CCG was currently going through a restructure to ensure sufficient resources were available to manage the functions effectively. It was agreed the communication would be developed and sent to all practices by the end of July, subject to successful completion of the restructure. The communication would detail key contacts and responsibilities. AM emphasised that the CCG should be the first point of contact for practices, rather than NHS England. Action: BM to work with WM to develop and distribute communication, detailing CCG delegation and key contacts, to practices by end of July 2016 Action: MOU to be reported to PCCC once full details received from NHS England. (BM) 22/16 Quality Update JM updated the group on the work being done by the Quality Team. A schedule of visits had been prepared and quality visits had commenced. JM explained that the CCG was taking a supportive, pro-active approach concentrating on enhancing relationships with practices to encourage shared learning and openness. JM advised that Practice Learning Time (PLT) was currently being reviewed as attendance varied by practice, and a different approach may be more appropriate. MP supported this and emphasised the importance of using these sessions appropriately, as well as linking in with the East Kent CEPN. JM explained that she had been working to clarify training expectations with regard to safeguarding and would ensure that these were distributed to practices prior to reporting on performance. KA and MP emphasised that clarity around training requirements would be appreciated by practices and supported the approach described. Action: JM to provide report to PCCC and continue work as described Primary Care Commissioning Operating Group (PCCOG) minutes.doc 3 Page 3 of 6 Overall Page 34 of 64

35 23/16 Estates and Technology Transformation Fund (ETTF) bids update BM and WM had attended the local NHS England area team to present the bids from GP practices from both CCGs on 8 July BM explained that additional information had been requested with just two days notice and thanked WM for her work in providing this information by the deadline. BM advised that the NHSE had said that the volume of bids was 149 across the 22 CCGs reviewed by the Area team. MP attended the presentations as an observer and fed back that he felt the CCGs had presented a strong case and should be praised for the level of detail and knowledge that accompanied each bid. MP also commented that he felt it was positive that the bids provided originated from the practices rather than the CCG. BM informed the group that they had been asked to state the highest priority proposal across the two CCG areas, but refused to provide this since they felt it was an inappropriate question. The group supported this stance. Communication to practices was discussed and it was agreed that an update detailing the generally positive feedback would be provided, together with a note that the CCG will expect to hear more information from NHS England during September. Action: WM to draft and distribute the communication to practices as above. MP cautioned that since the CCG had backed all of the bids with such enthusiasm, and given the limited funding available (and therefore likelihood that few bids would be funded), a fall-back plan should be developed. Action: BM and WM to seek clarification regarding estates funding relating to the GPFV and develop plan. 24/16 Confirmation of Actions Required for Primary Care Commissioning Committee (PCCC) The Group reviewed the draft agenda, and determined that the MOU with NHS England would need to be postponed as NHS Primary Care Commissioning Operating Group (PCCOG) minutes.doc 4 Page 4 of 6 Overall Page 35 of 64

36 England had not yet supplied all of the detail required. Support for General Practice would be combined within the actions to implement the GPFV which would be incorporated into the workplan for approval (see action 20/16). All other items on the draft agenda to remain. Action: AM to work with BM to amend workplan and distribute agenda. 25/16 Any other business WM raised a query regarding the cost of practices mergers, and whether this should be paid for by the CCG or the practice. MP advised that the drafting of legal documents and other associated administration was the responsibility of the practice, but IT system costs would be the responsibility of the CCG through the GP-IT contract. Action: WM to discuss with Matthew Capper, Director of Performance and Delivery WM raised the subject of CQRS payments, and the impact that practices not providing data could have on quality payments to the CCG. BM described how this funding worked and explained that the financial value of the payment was dependent on a range of factors in the CCG accessing Quality Premiums payments. The approximate value to Canterbury and Coastal CCG would be up to circa 800k per annum and up to 600k in Ashford CCG. Action: JM to emphasise the importance of uploading data during quality visits to practice MP raised the issue of an APMS contract that was due to expire later in the year and queried the progress that had been made. BM advised that the CCG had escalated concerns to NHS England and continues to work with them and communicate with the practice. BM advised that legal advice was being sought and that expert procurement advice was required in order to develop the actions. The group agreed that this was a significant risk due to the short amount of time left in the contract; the practice was already having problems retaining staff and the problems were likely to exasperate as the contract end date approached Primary Care Commissioning Operating Group (PCCOG) minutes.doc 5 Page 5 of 6 Overall Page 36 of 64

37 Action: BM to document on risk register and further develop actions. WM informed the group that she was aware that NHS England had approached Canterbury borough council regarding an application to open a pharmacy within chartham village. MP advised that he was aware of two applications. BM confirmed that the CCG does not have responsibility for commissioning pharmacies; this is a function of NHS England and does not form part of the delegation of primary care. MP recommended that the CCG responds in our capacity as a stakeholder. Action: MP to forward details of second applicant to WM, and WM to draft response to NHS England, in the CCG s capacity as a stakeholder. Minutes approved: Date. Name.. (Chair of today s meeting) Signature Primary Care Commissioning Operating Group (PCCOG) minutes.doc 6 Page 6 of 6 Overall Page 37 of 64

38 Primary Care Commissioning Committee Paper NHS Ashford and Canterbury & Coastal CCGs Agenda Item: 66/16 Date of Meeting: 21 July 2016 Title of Report: Author: Primary Care Commissioning Work-plan progress Bill Millar Chief Operating Officer Lead Director: Action Required: Bill Millar Chief Operating Officer Approval Decision Discussion/ Assurance X Information Conflict of Interest: None identified Purpose of paper: Recommendations: At the June meeting of the Primary Care Commissioning Committee (PCCC), the annual plan was agreed, which included the primary care commissioning work-plan for this year. This paper provides the committee with an update on progress that has been made, and also details that some actions will need to be amended in line with the General Practice Forward View. It is recommended that the Committee review the progress to date Publication: Restriction (define) No Restriction X Supporting Paper/Appendices: Appendix 1 Primary Care Commissioning Work-plan FS - Primary Care Commissioning Work-plan.docx Page 1 of 1 Overall Page 38 of 64

39 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 Actions completed On track but not yet delivered Original target date has not/will not be met G A R Objective Actions By when Update on progress RAG status Build the team capacity, knowledge 30 June 2016 Primary Care Manager appointed Amber Christina Callister providing financial support on an interim basis. Safe and efficient handover/transfer of skills from NHS England to CCGs Revised to November 2016 Deputy COO appointed, will start in November There are gaps with regard to Estates / surveyor knowledge. Review performance and progress at months 3 and 6 survey practices 30 Sept 2016 Revised to Dec 2016 Postpone and review in November and then again in March Amber Simplify practice administration DES/LES reporting/payments Identify priority areas for reducing practice effort in claims/assurance Set clearer expectations/standards and performance monitoring 30 July 2016 Revised to 31 Oct 2016 No formal handover from NHS England Need to re-visit after this as will need to reconcile payments made to practices Amber Clearer, focused Performance Management from CCG Perform practice quality visits, combining performance in Primary Care, contract delivery, 31 Oct 2016 Practice visits project in place and clear communications provided to practices. Visits will be supportive and encourage openness. Amber Primary Care Commissioning Work plan revised July 2016.docx Page 1 of 7 Overall Page Page 1 39 of 64

40 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 Objective Actions By when Update on progress RAG status prescribing, performance in enhanced services and commissioning role. Use delegated commissioning to help deliver new models of out-of-hospital care (reshaping primary care services and aligning to Ashford and Canterbury & Coastal CCGs) Improve coherence between different CCG initiatives in relation to Primary Care, focusing on improving service to patient and use of practice time in line with the GP forward view Improve links with practices Agree and implement plan to streamline contact and communication points re. GP contracts and all enquiries Understand practice view of CCG co-commissioning performance via 3 and 6 month survey Priority DES/LES/QOF areas to reshape primary care services and align to Ashford and Canterbury CCG objectives Project planning for priority areas: Avoiding Unplanned Admission DES, Over 75 s Proactive and Reactive Care Planning and Care home Enhanced Services, QIPP projects; Move towards outcome based payments for these schemes. 1 April 2016 revised to 31 July Oct 2016 revised to 31 March 2017 CCG restructure almost complete, Communication to practices by end of July detailing CCG responsibilities and key contacts. Also produce communication for practice managers and attend practice managers meeting Amend initial survey to November, then March, as above. 30 Sept 2016 Linking with other CCGs (Dudley) re: local QoF - Need to link with GPFV and National Contracts - Bolton GMS + additional money Amber Amber Primary Care Commissioning Work plan revised July 2016.docx Page 2 of 7 Overall Page Page 2 40 of 64

41 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 Objective Actions By when Update on progress RAG status Develop the Primary Care Workforce to deliver new models of care in line with Primary Care Workforce Strategy and Ashford and Canterbury New Models of Care 31 Mar 2017 Quality team reviewing Protected Learning Time (PLT), with input from practices and East Kent CEPN Amber Develop premises strategy and development plans aligned with new service models (Premises and IT Strategy). 31 Dec 2016 Premises strategy ready to be approved. This is an overarching reference strategy that will be refined and updated on a regular basis Amber Improve quality and consistency in Primary Care Develop Improving Quality Plan Build on the Quality Assurance tools available to identify small number of important quality markers and practices who are outliers and develop a primary care quality dashboard Understand actions and investments needed to improve the performance of outliers, share learning and improve clinical practice Incentivise improvement in line with commissioning intentions and our primary care strategy Provide clinical leadership and support for practice improvement plans Engaging Practices in Training and Education Continue to improve the content and quality of Membership Engagement and Protected Learning Training sessions 30 Nov 2016 Practice visits project in place and clear communications provided to practices. Visits will be supportive and encourage openness. Quality dashboards being developed. Quality reporting to Quality Committee and PCCC. 30 Sep 2016 Quality team undertaken review of PLT sessions, revising schedule. Practices have been approached as not all attend. Some practices send one GP, where as other practices send all GPs so expectations need to be clarified. Amber Amber Primary Care Commissioning Work plan revised July 2016.docx Page 3 of 7 Overall Page Page 3 41 of 64

42 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 Objective Actions By when Update on progress RAG status Use Workforce Tutor and Primary Care Commissioning plan to Linking with East Kent CEPN. increase number of practices involved in medical and practice Training sessions being developed. nurse training Develop programme of GP education sessions to underpin core GP work and linked to new models of care pathways and out-of-hospital care and commissioning intentions Primary Care Commissioning Work plan revised July 2016.docx Page 4 of 7 Overall Page Page 4 42 of 64

43 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 Work with NHS England on the development of local primary care strategies to reflect national priorities outlined in the GP forward view Safeguarding All GP practices to have a named lead for Safeguarding Adults and Children and share with Designated Nurses and are appropriately trained All staff to have access to safeguarding training (to include Domestic Violence, Prevent) and evidence of updating Ensure that practices have access to the pan Kent procedures and understand their responsibility and how to raise a safeguarding concern Ensure all updated procedures are available in all practices Work with NHS England to support the development of primary care strategies to support improved access and the provision of primary care at scale including new models of care. Work with NHS England to increase the number of GP referrals to be sent electronically to providers 30 Sept 2016 Ongoing Role based training matrix produced, to be shared with practices. Currently there are some problems monitoring as practices are not clear on the requirement. Supportive approach to be undertaken during practice quality visits. 30 Sept 2016 Plan to be developed to reflect aspirations within General Practice Forward View 30 Sept 2016 Plan to be developed to reflect aspirations within General Practice Forward View Amber Amber Development of the GP workforce planning with CCGs, Health Education KSS and the Community Education Provider Network (CEPN) Review evidence of a robust reporting system in place for reporting quality concerns (SIs), never events and for sharing learning from significant events To identify and support practices with severe difficulties to ensure continuity 30 Sept 2016 Ongoing via East Kent CEPN Amber 30 Sept 2016 Ongoing NHS England developing MOU regarding Nursing and Quality Amber 30 Sept 2016 Ongoing through Quality Team work Amber Primary Care Commissioning Work plan revised July 2016.docx Page 5 of 7 Overall Page Page 5 43 of 64

44 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 of patient care. Support practices with the further implementation of and spread of online service 30 Sept 2016 Plan to be developed to reflect aspirations within General Practice Forward View Amber Work towards 7 day working in general practice as part of primary care strategies. Ongoing Plan to be developed to reflect aspirations within General Practice Forward View Amber Working with CQC in relation to the inspection of independent contractors and support for failing practices. Ongoing Plan to be developed to reflect aspirations within General Practice Forward View Amber Ensure there is demonstrable evidence of improved patient satisfaction of primary care services, working closely with patient representative and voluntary organisations The CCG to roll out the outcome of national testing on ways to reduce outpatient demand. Ongoing Using surveys to gather information Amber Summer 2016 Plan to be developed to reflect aspirations within General Practice Forward View Amber The CCG to introduce a new standard contract measures for hospitals in 2017 to stop shifting work at the hospital/general practice interface. These will cover local access policies, onward referral, discharge summaries, outpatient clinic letters, results and treatments and medication on discharge. CCGs to ensure providers are held to account. April 2017 Plan to be developed to reflect aspirations within General Practice Forward View Amber Work with practices to ensure uptake of a national programme to help practices support people living with long term October 2016 Awaiting further guidance - expected from NHS England by September 2016 Amber Primary Care Commissioning Work plan revised July 2016.docx Page 6 of 7 Overall Page Page 6 44 of 64

45 Primary Care Co-Commissioning Work-plan 2016/17 Updated 12 July 2016 conditions to self-care. Support practices to offer patients more online self-care and self-management services. March 2017 Plan to be developed to reflect aspirations within General Practice Forward View Amber Work with practices to make it easier for practise to work collaboratively, including achievement of full interoperability across IT systems. March 2017 Plan to be developed to reflect aspirations within General Practice Forward View Amber Primary Care Commissioning Work plan revised July 2016.docx Page 7 of 7 Overall Page Page 7 45 of 64

46 Primary Care Commissioning Committee Paper NHS Ashford and Canterbury & Coastal CCGs Agenda Item: 69/16 Date of Meeting: 21 July 2016 Title of Report: Author: Primary Care Quality Update Judith Marsh - Primary Care Nursing & Quality Lead Lead Director: Action Required: Bethan Haskins, Chief Nurse Approval Decision Discussion/ Assurance X Information Conflict of Interest: None identified 1. Enhanced CCG quality assurance practice profile dashboard work is making good progress and can be presented within the next primary care quality report for both CCGs. This will provide data at practice, community network and CCG level to inform our quality assurance processes for our primary care providers. 2. Focus of the report this month is on: Purpose of paper: CQC inspection updates listed with mitigations (Appendix 1) ACCG: 14 practices: 6 inspected - 4 overall good (Inc. 2 practices inspected and rated Good with previous inspection criteria) CCCG: 21 practices: 6 have been inspected, -1 outstanding, 4 good & 1 report awaited. Patient Satisfaction (Appendix 2) Review of The GP patient Survey, which is an independent survey run by Ipsos MORI on behalf of NHS England. The latest results were published on 7th July 2016 Friends and Family Tests update: A review of recent data appears to show that the response rates remain low and some Ashford practices have not submitted any data FS - Primary Care Quality Update.docx Page 1 of 3 Overall Page 46 of 64

47 Workforce data (Appendix 3) This is a summary about the workforce data submission with information about the process currently in place and highlighting the risk of retirement in the primary care workforce. Risks: Need timely data to populate the enhanced quality assurance dashboards. Resource not available to collate and analyse data in a timely manner. Patient satisfaction data presented this month to link with lay members (patient representatives) around further areas to consider for assurance. To consider bi-monthly primary care quality reports to ensure data can be analysed in a more robust way Recommendations: Next steps: Primary Care Nursing & Quality Lead to incorporate enhanced quality assurance dashboards into the next Primary Care Quality Report To ensure there is a robust process in place for the Quality committee to assure the Governing Body of safe effective care delivered by their Primary care providers To ensure other Primary Care Team members in the new structure are fully aware of routes to feed into the Primary Care Quality Assurance processes. Workforce data further analysed and guidelines re: statutory and mandatory training expectations for practices to be formalised. Publication: Restriction (define) No Restriction X FS - Primary Care Quality Update.docx Page 2 of 3 Overall Page 47 of 64

48 Supporting Paper/Appendices: Appendix 1: CQC Inspections for both CCGs at July Appendix 2: Patient Satisfaction Review of practices with GP patient surveys and Friends & Family data Appendix 3: Workforce Data from Health Education England KSS Next steps: Enhanced quality dashboard to be completed at practice, community network and CCG level with focus on the variation between practices to inform quality of services being delivered. Further discussion around which other forums to share this data to inform patient services and commissioning plans Formal quality visit schedule to practices now in place To develop statutory and mandatory training guidelines for practices to ensure these requirements are met across all practices with clinical and non-clinical staff. Note the Ashford CCG Protected Learning Training (PLT) Evaluation for June: Dermatology & Managing Workload in Practice The PLT attendance will continue to be analysed with Practice Managers to ensure the percentage is accurate and meaningful in relation to expected attendance of clinicians. This will also assure the CCGs that the OOH cover is utilised effectively and learning outcomes are fed back into future planning FS - Primary Care Quality Update.docx Page 3 of 3 Overall Page 48 of 64

49 Appendix 1: CQC inspections Latest CQC Inspection Outcomes: ACCG & CCCCG Practice CQC Report Date Overall rating Is the service Safe Is the service Effective Is the service Caring Is the service Reponsive Is the service Wellled Older People People with long term conditions Families, Children and Young People Working age People People whose circumstances may make them vulnerable Faversham Medical Practice 11/02/2016 GOOD GOOD GOOD GOOD OUTSTANDING GOOD OUTSTANDING GOOD GOOD GOOD OUTSTANDING GOOD Newton Place Surgery Boughton Medical Centre The Coach House Surgery St Annes Group Practice The Park Surgery Not yet inspected Not yet inspected Not yet inspected Not yet inspected Not yet inspected People experiencing poor Mental Health William Street Surgery 16/02/2016 GOOD REQUIRES IMPROVEMENT GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD Whitstable Health Centre 21/01/2016 OUTSTANDING OUTSTANDING GOOD OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING OUTSTANDING Saddleton Road Surgery Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Cossington House Surgery Not yet inspected Summary Specific Services Northgate Medical Practice Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Awaiting report Chartham Surgery Market Place Surgery Sturry Surgery New Dover Road Surgery Not yet inspected Not yet inspected Not yet inspected Not yet inspected Ash Surgery 02/02/2016 GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD University Medical Centre The Butchery Surgery Canterbury Medical Practice The Old School Surgery Canterbury Health Centre Not yet inspected Not yet inspected Not yet inspected Not yet inspected Not yet inspected Charing Surgery Feb-16 GOOD OUTSTANDING GOOD GOOD OUTSTANDING GOOD OUTSTANDING GOOD GOOD GOOD GOOD GOOD Hamstreet Surgery Hollington Not yet inspected Not yet inspected Ivycourt 13/04/2016 GOOD GOOD GOOD GOOD OUTSTANDING GOOD GOOD GOOD GOOD GOOD GOOD OUTSTANDING Kingsnorth New Hayesbank Sellindge Singleton MC Sydenham House & Musgrove Willesborough Not yet inspected Not yet inspected Not yet inspected Not yet inspected Not yet inspected Not yet inspected Woodchurch Pending July 2016 S.A.Ms Aug-15 GOOD REQUIRES IMPROVEMENT GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD GOOD Appendix 1 CQC Inspections July 2016.pdf Page 1 of 3 Overall Page 49 of 64

50 Appendix 1: CQC inspections Overall Rating Caring for people safely Treating people with respect Providing individual care & treatment Staffing Quality of Management Wye 27/08/2014 (old CQC rules) GOOD GOOD GOOD GOOD GOOD GOOD Not rated Not rated Not rated Not rated Not rated Not rated Singleton Surgery 2014 (old CQC rules) GOOD GOOD GOOD GOOD GOOD GOOD Not rated Not rated Not rated Not rated Not rated Not rated See Sheet 2 for Mitigations if Requires Improvement Appendix 1 CQC Inspections July 2016.pdf Page 2 of 3 Overall Page 50 of 64

51 Mitigations following CQC Inspections William Street (CCCCG) Updated 20 April 2016 The practice is rated as requires improvement for providing safe services. Some staff understood their responsibilities to raise concerns, and to report incidents and near misses. However not all safety incidents were reported and not all staff understood what might constitute a significant event.. The practice had clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse. Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients and other people using the premises were kept safe, for example in addressing fire risks. Appropriate recruitment checks had been not always been undertaken prior to employment of all relevant staff. There had been no recent fire evacuation drills. Weekly tests of the fire alarm system, as required by the practice, were not taking place. Mitigation & Assurance for CCG: Responsibility Review Period Action & Update Primary Care Quality Lead: Revised To follow up on safety incidents, signficant events, JM End Sept 16 This practice will be visited during Aug /Sept and these areas will be discussed To follow up on recruitment checks and induction of new staff JM End Sept 16 This practice will be visited during Aug /Sept and these areas will be discussed To follow up re: Fire Evacuation / drills JM End Sept 16 This practice will be visited during Aug /Sept and these areas will be discussed Safeguarding Leads: To follow up on safeguarding processes, training and reporting CG / WB End Sept 16 These issues will be addressed in line with S/G training advice and support South Ashford Medics (ACCG) Updated 26 Nov 2015 The practice is rated as requires improvement for providing safe services There are areas where it should make improvements. Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, follow-up actions had not always been undertaken to implement and support improvements (for example, in relation to the storage of vaccines. Risks to patients were assessed and well managed, although training in relation to safeguarding had not been undertaken by all staff. The arrangements for checks of emergency equipment also required improvement. Mitigation & Assurance for CCG: Responsibility Review Period Action & Update Primary Care Quality Lead: Revised To follow up on reporting processes and storage of vaccines, JM End July 16 This practice will be visited during Aug /Sept and these areas will be discussed To follow up on checks of emergency equipment JM End July 16 This practice will be visited during Aug /Sept and these areas will be discussed Safeguarding Leads: To follow up on safeguarding processes, training and reporting CG / WB End of July 16 These issues will be addressed in line with S/G training advice and support Appendix 1 CQC Inspections July 2016.pdf Page 3 of 3 Overall Page 51 of 64

52 APPENDIX 2: PATIENT SATISFACTION Review of GP Patient Survey and Friends & Family Data for Ashford CCG and Canterbury & Coastal CCG. Summary of Review: The GP patient Survey is an independent survey run by Ipsos MORI on behalf of NHS England. The latest results were published on 7 th July 2016.The survey has been designed to give patients the opportunity to comment on their experience of their GP practice. It is used as a quality marker on a National level. These figures also give our CCGs an overview of public perception of the primary care services available across Ashford and Canterbury. For the purpose of this report, the results have been themed in 3 main areas: GP access, feedback for GPs and Nurses. The results have been reviewed at practice level but have been collated at CCG level for this report. Both Ashford and Canterbury & Coastal CCG practices fair positively in these surveys and the response rates for these surveys appear higher than the friends and family tests. The responses about the quality of care received from their nurses are all above the National average for both CCGs. The feedback for the quality of care received from their GPs in Canterbury & Coastal CCGs is above the national average. The lower than average feedback for the quality of care received from their GPs in Ashford practices relates mainly to 2 Ashford practices who score much lower in these questions, there also some lower scores in 2 of the larger practices. These results will help the CCGs to support these practices in line with other intelligence such as CQC inspections and other quality data to understand where improvements are needed. Appendix 2 Pt satisfaction Summary July 16.docx Page 1 of 5 Overall Page 52 of 64

53 Ashford CCG and Canterbury & Coastal CCG vs National Average. Lower than Average Higher than average ACCESS: % finds it easy to get through to this surgery by phone Ashford CCG 70% Canterbury CCG 80% National Ave 73% % of respondents describe their experience of making an appointment as good Ashford CCG 74% Canterbury CCG 82% National Ave 73% % of respondents usually waits 15 minutes or less after their appt time to be seen Ashford CCG 63% Canterbury CCG 68% National Ave 65% % finds the receptionists at this surgery helpful Ashford CCG 89% Canterbury Coastal CCG 90% National Ave 87% % were able to get an appointment to see or speak to someone the last time they tried Ashford CCG 87% Canterbury Coastal CCG 89% National Ave 85% % says the last appointment they got was convenient Ashford CCG 92% Canterbury CCG 94% National Ave 92% % describe their experience of making an appointment as good Ashford CCG 74% Canterbury CCG 82% National Ave 73% % feel they don't normally have to wait too long to be seen Ashford CCG 55% Canterbury CCG 60% National Ave 58% % are satisfied with the surgery's opening hours Ashford CCG 75% Canterbury CCG 79% National Ave 76% % describe their overall experience of this surgery as good Ashford CCG 85% Canterbury CCG 89% National Ave 85% % would recommend this surgery to someone new to the area Ashford CCG 79% Canterbury CCG 84% National Ave 78% FEEDBACK RE: GPs: % of respondents had confidence and trust in the last GP they saw or spoke to Ashford CCG 95% Canterbury CCG 97% National Ave 95% % of respondents with a preferred GP usually gets to see or speak to that GP Ashford CCG 58% Canterbury CCG 65% National Ave 59% % say the last GP they saw or spoke to was good at giving them enough time Ashford CCG 85% Canterbury CCG 90% National Ave 87% % say the last GP they saw or spoke to was good at listening to them Appendix 2 Pt satisfaction Summary July 16.docx Page 2 of 5 Overall Page 53 of 64

54 Ashford CCG 88% Canterbury CCG 91% National Ave 89% % say the last GP they saw or spoke to was good at explaining tests and treatments Ashford CCG 84% Canterbury CCG 89% National Ave 86% % say the last GP they saw or spoke to was good at involving them in decisions about their care Ashford CCG 81% Canterbury CCG 85% National Ave 82% % say the last GP they saw or spoke to was good at treating them with care and concern Ashford CCG 83% Canterbury CCG 87% National Ave 85% % had confidence and trust in the last GP they saw or spoke to Ashford CCG 95% Canterbury CCG 97% National Ave 95% FEEDBACK RE: NURSES. % of respondents say the last nurse they saw or spoke to was good at listening to them Ashford CCG 94% Canterbury CCG 92% National Ave 91% % say the last nurse they saw or spoke to was good at giving them enough time Ashford CCG 95% Canterbury CCG 95% National Ave 92% % say the last nurse they saw or spoke to was good at listening to them Ashford CCG 94% Canterbury CCG 93% National Ave 91% % say the last nurse they saw or spoke to was good at explaining tests and treatments Ashford CCG 93% Canterbury CCG 92% National Ave 90% % say the last nurse they saw or spoke to was good at involving them in decisions about their care Ashford CCG 87% Canterbury CCG 87% National Ave 85% % say the last nurse they saw or spoke to was good at treating them with care and concern Ashford CCG 92% Canterbury CCG 92% National Ave 91% % had confidence and trust in the last nurse they saw or spoke to Ashford CCG 98% Canterbury CCG 97% National Ave 97% Source: NHS England: Appendix 2 Pt satisfaction Summary July 16.docx Page 3 of 5 Overall Page 54 of 64

55 Friends and Family Tests for GP Practices (latest results May 2016). The Friends and Family Test continues to be a part of valuable patient experience feedback and Practices submit data directly to NHS England via CQRS and data is published monthly and it can also be found on NHS Choices. Up until April 1st 2016, there was a project manager in place to support practices to submit their data electronically. When reviewing recent data over the last 3 months, it appears that the response rates are low and some Ashford practices have not submitted any data, this will be checked with these practices as it would appear they are not collecting any friends and family tests. FRIENDS AND FAMILY (FFT) FOR CANTERBURY PRACTICES: MAY Canterbury and Coastal BOUGHTON MEDICAL CENTRE CANTERBURY BUTCHERY HEALTH CANTERBURY CENTREMEDICAL CHARTHAM PRACTICE SURGERY COACH HOUSE SURGERY COSSINGTON HOUSE FAVERSHAM SURGERYMEDICAL PRACTICE WHITSTABLE MEDICAL WILLIAM PRACTICE STREET SURGERY MARKET PLACE SURGERY NEWTON ROAD SURGERY NORTHGATE MEDICAL PRACTICE PARK SURGERY SADDLETON ROAD SURGERY ST ANNES GROUP PRACTICE Responses Not Recommended Recommended These monthly Friends and Family Test results show very low response rates, with the best response at 72 responses and one practice with no responses. The Quality team will be reviewing the methods of collecting the responses within the Canterbury & Coastal practices to share learning. On a positive note, the % of responses who would recommend their practice was >95% for 8 practices. The highest % for not recommending their practice is 8% suggesting that the majority of the patients are satisfied with their practice and this is also reflected in the GP patient surveys. Appendix 2 Pt satisfaction Summary July 16.docx Page 4 of 5 Overall Page 55 of 64

56 FRIENDS AND FAMILY (FFT) FOR ASHFORD PRACTICES: MAY Ashford CHARING SURGERY HAMSTREET SURGERY SYDENHAM HOUSE WILLESBOROUGH MEDICAL CENTRE HEALTH HOLLINGTON SURGERY IVY COURT SURGERY KINGSNORTH MEDICAL NEW HAYESBANK PRACTICE SURGERY SELLINDGE SURGERY SINGLETON MEDICAL SINGLETON CENTRE SURGERY SOUTH ASHFORD MEDICS WOODCHURCH CTR. SURGERY WYE SURGERY Responses Not Recommended Recommended This monthly data shows a very low response rate other than one practice who has reported 366 responses whereas 5 practices appear to have had no responses. These practices will be contacted regarding their lack of data and Wye Surgery will be asked about how they achieve this response rate as this will be useful learning for other practices. Of the 6 practices who uploaded data this month, 2 practices have >95% who would recommend the practice. The highest % for not recommending their practice is 17% and this will be reviewed in line with National responses. Appendix 2 Pt satisfaction Summary July 16.docx Page 5 of 5 Overall Page 56 of 64

57 APPENDIX 3: Workforce Data for Primary Care at July Practices were asked to submit workforce data as at 30 th March 2016 and any absences and vacancies between 1 October 2015 and 30 March The data is vital in addressing workforce pressures in primary care and securing a well-trained workforce for the future. This is submitted by practices every 6 months and will be reviewed and analysed in more detail in line with the training requirements our primary care providers. CCG Included in Spring 16 report No. practices to submit / update data during submission window Never included in PDP report Closures / Mergers NHS ASHFORD NHS CANTERBURY & COASTAL Total No. Practices The practices who did not submit in a timely way will be supported for the next submission, although we need to establish these first as HEKSS are unable to share which practices have or haven t submitted data, which is a challenge as they are depending on CCG support to encourage uptake. Note: The CCGs have requested this data from Health Education England Kent Surrey & Sussex (HEKSS) at practice level but they are unable to share practice level data as per their data sharing agreement. Some CCGs are working around this by asking practices themselves to send their practice report direct to the CCG as practices are able to download this report by practice, CCG and regional level through the site and is automatically generated by the system and this is available to practices direct through the site. (Not all practices were aware of this) CCGs are looking at enhancing the data sharing agreement in their area to allow HEKSS to share this data (however, this really requires all practices to sign up, so would not work in all areas). Reviewing the full picture for submissions, there were a few practices that made submissions direct to the HSCIC via their Tool. This is another challenge as this has resulted in 2 means to submit data in this region. HEKSS can only encourage practices to use their Tool; some will go direct to the HSCIC either through choice or confusion. Communications are sent to practices from us via the LMC and the HSCIC have started (half way through this last submission) including a link to our Tool Overall CC had 100% and Ashford only had one practice not submitting data in either Tool. The HSCIC data will be published in early October. Appendix 3 Workforce submission update July 16.docx Page 1 of 3 Overall Page 57 of 64

58 The tables below are included for information only in this report show the risk of retirement of the primary care workforce in the two CCGs from the data uploaded on 30 th March This is being analysed by HEKSS and the East Kent Community Education Provider Network (CEPN) who will be looking at how to address the potential workforce gaps across East Kent i.e.: development of new roles such as Associate GPs, Nurse Associates, supporting pharmacists and apprenticeships in practices. Appendix 3 Workforce submission update July 16.docx Page 2 of 3 Overall Page 58 of 64

59 Source: Workforce Minimum Data Set (wmds) - Submission window 1-27 April HSCIC. Appendix 3 Workforce submission update July 16.docx Page 3 of 3 Overall Page 59 of 64