Primary Care Joint Committees (PCJC) Meetings The following Joint Committees meetings, listed below, will be held in common at:

Transcription

1 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings The following Joint Committees meetings, listed below, will be held in common at: Charlton Athletic Football Club The Valley, Floyd Road, London, SE7 8BL 6.00pm to 8.00pm on 06 August 2015 NHS Bexley CCG and NHS England PCJC NHS Bromley CCG and NHS England PCJC NHS Greenwich CCG and NHS England PCJC NHS Lambeth CCG and NHS England PCJC NHS Lewisham CCG and NHS England PCJC NHS Southwark CCG and NHS England PCJC Primary Care Joint Committees meeting held in common AGENDA (Part One) Item Time Papers Lead 1 Introductions and Apologies Greg Ussher 2 Declaration of Interests 6.05 A Greg Ussher 2 Minutes of the last Meeting 6.10 B Greg Ussher 3 Action log 6.20 C Gilbert George Governance 4 Governance and Operating Model NHS England Operating Model Standard Operating Procedures 6.25 D Di Dii Andrew Bland David Sturgeon David Sturgeon 1

2 Reporting and decision making 5 Contractual action - Month 1 to / Jill Webb Decisions for reporting (Bromley and Lewisham Committees) Decisions for reporting (All Committees) Item for decision (Southwark Committee) E F G 6 Quality an Performance Update report 6.55 H Jill Webb 7 Finance Update report 7.15 I David Sturgeon For discussion 8 Personal Medical Services (PMS) Review 7.25 J David Sturgeon For Information 9 Committee Terms of Reference K Gilbert George 10 Glossary of Terms L Gilbert George Other Business 11 Any other business Public Open Space 8.00 Close 2

3 Enc A Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Date: 30 July 2015 Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list NHS Bexley CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 3

4 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Blow, Sarah Chief Officer Nil No change Currie, Mary Governing Body Nurse Member Director Quality for Health Ltd - company offering consultancy service in healthcare sector - Materiality 50% Co-habiting partner is a Director of Physiological Measurements Ltd who deliver NHS clinical services No change 4

5 Deshmukh, Sid GP Locality Lead Senior Partner Sidcup Medical Centre PMS Contract - Personal Interest - Materiality 50% Shareholder Bexley Health Limited Shareholder Frognal Limited - Personal Interest Shareholder Blossoms Care Home Ltd - Personal Interest 15% Clinical Lead - Referral Management and Booking Service (RMBS) - Personal Interest Elected member Bexley Local Medical Committee (LMC) - Personal Interest Interest in Dr. Karkare's practice (practice partner) in gynaecology work Chairman fee 200 for meeting gynaecology and dermatology on 25/11/14) Chairman fee 200 for meeting on Alcohol Harm Reduction on 28/01/15 and 11/03/2015 Wife (Dr Sonia Khanna-Deshmukh) is member of NHS Bexley CCG Board Potential conflict as personal interest in Inspire Community Trust re: a. Wheelchair Service b. Joint Equipment Store c. Personal Health budget d. Information and service support for people with physical and sensory impairment - No financial interest Attend various locality/clinical meetings which could be sponsored by drug companies where refreshments are provided (from 5.00 to 30.00) Stoate, Howard Chair, NHS Bexley Partner Albion Surgery Materiality - 9% Personal Interest CCG Practice has a share in Bexley Health Ltd Materiality - less than 5% Medical Referee and Advisor Next Steps Fostering Agency Materiality Nil Clocktower Company - Materiality Nil Attend various locality/clinical meetings which could be sponsored by drug companies where refreshments are provided (from 5.00 to 30.00) No change Chairman s fee 200 Cardiovasc ular update at TUC 2 June

6 Wakeford, Sandra Lay Member - Patient Public Involvement Board Member of Bexley Healthwatch - Materiality One Vote Chair of the Patient Council Nephew-in-Law is Deputy CEO of Bexley Accessible Transport (BATS) Nephew-in-Law is Consultant to Pathways 21 No change Wood, Keith Lay Member, Governance Nil No change Nominated Observers (Non Voting) Murray, Anne Hinds Observer - Healthwatch Lotta Hackett Observer - Healthwatch Healthwatch Bexley Manager Employed by MIND in Bexley (Standing in for Murray, Anne Hinds) Dr Money, Richard P Observer - LMC Partner at Station Road Surgery Sidcup Director Bexley Health Ltd Director Bexley Neighborhood Care Ltd Nil No change O Neill, Teresa Robinson, Sue (Standing in for O Neill, Teresa) Observer - Health and Wellbeing Board Observer - Health and Wellbeing Board Nil Member of Bexleyheath & Crayford Conservative Association Director of the CIV No change 6

7 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list Date: 30 July 2015 NHS Bromley CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 7

8 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Dr Bhan, Angela Chief/Accountable Officer Secondment to Health Education England (Public Health education role) No change Guntrip, Harvey Lay Member, Governance (Vice Chair) Nil No change Lee, Martin Lay Member - Patient Public Involvement Nil No change Nelson, Sara Dr Paranjape, Ruchira Registered Nurse Quality Improvement Lead London Strategic Clinical Member Network (NHS England) salaried post (0.8 WTE) Member of Editorial Board of British Journal of Cardiac Nursing Patient of local GP practice Member of National Atrial Fibrillation Clinical Policy Group of UK Clinical Pharmacy Association Husband is GP in Lewisham and Clinical Director of Health Improvement Network (Academic Health Science Network, South London) Principal Clinical Lead GP Partner at Knoll Medical Practice (PMS) (33.3% share) Visiting Medical Officer (VMO) contract with Care UK for Foxbridge Nursing Home No change No change 8

9 Dr Parson, Andrew Clinical Chair Chislehurst Medical Practice (PMS) Partner (13% share) (Chislehurst Medical Practice is a member of Bromley GP Alliance) Bromley Y Wife is an employee Bromley Public Health GP Primary Care Lead for Diabetes (0.5 sessions per week) No change Nominated Observers (Non Voting) Gabriel, Linda Observer - Healthwatch Chair of Bromley and Lewisham MIND Chair of Healthwatch Bromley No change Dr Sahi, Mukesh Observer - LMC GP Partner at Trident Medical Centre Chair Bromely Local Medical Committee No change Cllr Jefferys,, David Observer - Health and Wellbeing Board Employment a Pharmaceutical physician Senior Vice President, Global Regulatory.Government Relations Public Affairs and Product Safety. Eisai Europe Ltd. Full time employee. Member of the ABPI Innovation Board and Chairman of the Regulatory Network. No change Dr Essop, Mark (Standing in for Dr Paranjape, Ruchira) Principal Clinical Lead GP Partner Southborough Lane Surgery No change 9

10 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list Date: 30 July 2015 NHS Greenwich CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 10

11 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Buckell, Maggie Burn, Annabel Registered Nurse on the NHS Greenwich CCG Governing Body Chief Officer, NHS Greenwich Clinical Commissioning Group Registered Nurse on the NHS Tower Hamlets CCG Governing Body Director/Owner Tester Consulting Ltd (Management consultancy Director Deborah Management Ltd (Residential Property Trustee of the NHS Greenwich Charitable Funds, Charity Commission ref No change No change Dr Rosen, Rebecca GP Member of the NHS Greenwich CCG Governing Body GP Partner Valentine Plus PMS Shareholder Circle Health Partnership Husband is Medical Director of Circle Health Partnership Co-author of London General Practice Framework specifications 2014 (Care Co-ordination Lead Our Healthier South East London Partnership Group, Clinical Executive Group, Clinical Strategy Committee and Clinical Commissioning Board Member Senior Fellow, The Nuffield Trust Member of Riverside Limited Liability Partnership (LLP) between 7 local practices which aims to provide extended services to our registered populations and may bid for contracts to provide other services in future No change 11

12 Dr Ussher, Greg Lay Member on the NHS Greenwich CCG Governing Body Chief Executive Officer, METRO Charity Chair, Trustee of the NHS Greenwich Charitable Funds, Charity Commission ref Director, Translate Consultancy Honorary Fellow University of Greenwich Member of the Labour Party Chair, Outhouse Chair, National LGBT Consortium East (supporting delivery of LGBT in Essex) Executive Director, Healthwatch Medway Board Member, East Kent Voluntary Action Support (EKVAS Chief Executive Officer of the charity which holds the contract with RB Greenwich for the delivery of Healthwatch Greenwich No change Dr Vanniasegaram, Iyngaran Secondary Care doctor on the NHS Greenwich CCG Governing Body Director Russets Healthcare Ltd with 25% share holding NELFT (North East London NHS Foundation Trust) Consultant in Audio-Vestibular Medicine Local Lead for multi-centre research project (Genetics) No change Wintour, Jim Lay Member on the NHS Greenwich CCG Governing Body Director, Mountfield Gardens Residents Association Trustee of the NHS Greenwich Charitable Funds, charity Commission ref No change Dr Wright, Ellen Chair and GP member of the NHS Greenwich CCG Governing Body GP Partner Vanbrugh PMS Clinical Academic Fellow at Kings College London GPCC Shareholder Grabadoc Member Trustee of Kairos Rehabilitation Trust (registered charity helping those who are suffering chronic pain or the aftereffects of trauma) Member of an over diagnosis' group (an online working group of the RCGP - a group of healthcare professionals committed to tackling over diagnosis and over medicalisation of patients) No change 12

13 Nominated Observers (Non Voting) Ms Gordon- Mackenzie, Leceia Observer - Healthwatch Chair Healthwatch Greenwich Metro are Healthwatch Greenwich s contract holder No change Dr Kenny, Dermot Observer - LMC GP partner Member and Chair Eltham Health LLP, provider of LTC contract with Greenwich CCG No change Cllr Gardner, David Observer - Health and Wellbeing Board Local Authority Member on the NHS Greenwich CCG Governing Body Elected Councillor and Cabinet Member for Health and Social Care, Royal Borough of Greenwich (RBG) RBG appointee on the Oxleas NHS Foundation Trust Council of Governors Member of the RBG Health and Wellbeing Board Employed as Director of Public Policy, KPMG. From time to time KPMG bid or contract for non-clinical NHS Services. No personal involvement in providing or bidding for services to NHS Clients RBG will receive a variety of research and funding grants for projects Co-convenor, Charlton Rail User Group Member of Charlton Society (for the conservation and improvement of Carlton) RBG will receive a variety of research and funding grants for projects. Co-convenor, Charlton Rail User Group Member of the Labour Party Member of the Co-operative Party Member of the Co-operative Group Member Amnesty International Member National Trust Governor, John Roan School No change 13

14 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Date: 30 July 2015 Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list NHS Lambeth CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 14

15 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Abbasi, Hasnain NHS Lambeth CCG Governing Body Clinical Member and South West Locality Representative Director at AT Medics, a GP led organization which provides core GMS services as well as a diverse portfolio of enhanced services in Lambeth and other boroughs. In Lambeth this includes APMS at Streatham High Practice, Edith Cavell Surgery and the Walk-in Centre at Gracefield Gardens Stratham High is a shareholder of the SW Federation GP Provider Prof. David, Ami MBE Board member Nurse Director AD Community Nursing Consultancy a subsidiary of Prasand International Limited specialising in risk management and offering consultancy/project management to health care organisations (Private and NHS) & Royal Colleges Partner / close personal friends / business partner Co-Director Prasand International Limited Co-Director / Owner Prasand International Limited - Occasional Consultancy offered on Community Nursing Visiting Professor of Nursing Leadership and Expert Practice London South Bank University Fellow Queens Nursing Institute Nurse Member Lewisham, Lambeth and Southwark CCG Governing Body Nurse Member No change 15

16 Eyres, Andrew NHS Lambeth CCG Chief Officer and NHS Lambeth CCG Governing Body Member Married to Jill Lockett, Director of Performance and Delivery Kings Health Partners from 29/10/12 Director of Lambeth Southwark and Lewisham LIFTco. representing the class B shares on behalf of Community Health Partnerships Ltd with the aim of inputting local knowledge to the LSL LIFTco, for the following LIFT companies: No change Building Better Health Lambeth Southwark Lewisham Limited Building Better Health Lambeth Southwark Lewisham (Holdco 2) Limited Building Better Health Lambeth Southwark Lewisham (Holdco 3) Limited Building Better Health Lambeth Southwark Lewisham (Fundco 2) Limited Building Better Health Lambeth Southwark Lewisham (Fundco 3) Limited Building Better Health LSL (Fundco Tranche 1) Limited Building Better Health LSL (Fundco Holdco Tranche 1) Limited Building Better Health LSL Bid Cost Holdco Limited Building Better Health LSL Bid Cost Limited Building Better Health - LSL (Holdco 4) Limited Building Better Health - LSL (Fundco4) Limited Sue, Gallagher NHS Lambeth CCG Governing Body Lay Member Self Employed Executive Coach, Facilitator and Development Consultant Working on a freelance basis with various organisations in the NHS, parts of the DH and other sectors Married to a Consultant Oncologist, Dr Chris Gallagher, employed at the Royal London Hospitals NHS Trust Voluntary work with Teach First Trustee for Guy s and St Thomas Charity Stakeholder Governor of GSTFT and KCHFT. No change 16

17 Laylee, Graham NHS Lambeth CCG Governing Body Lay Member and NHS Lambeth CCG Governing Body Vice Chair and NHS Lambeth CCG Governing Body Audit Chair Nil No change McLachlan, Adrian NHS Lambeth CCG Governing Body Chair and NHS Lambeth CCG Governing Body Clinical Member GP Partner at Hetherington Group Practice which includes membership of SELDOC GP Facilitator at Three Boroughs Primary Healthcare Team Chair Primary Care Substance Misuse Advisory Group Member of Lambeth Living Well Collaborative Member of the GSTT Charity Major Funding Committee Member NIHR NHS/Biopharmaceutical Industry R&D Leadership Forum. Shareholder in GP Federation Nominated Observers (Non Voting) Pearson, Catherine Observer - Healthwatch Representative for Healthwatch Lambeth No change 17

18 Law, Jenny Observer - LMC GP Performer in Lambeth Director of Londonwide LMCs Chair of Lambeth LMC Married to Dr John Balazs, Lambeth CCG Board rep GP Federation Dixon, Jim Observer - Health and Wellbeing Board Director of Four Communication Four Communications has previously undertaken PR work with NHS Trusts Council of Governors KCH Chair Lambeth Health and Well Being Board Cabinet Member Health and Well Being Board No change 18

19 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Date: 30 July 2015 Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list NHS Lewisham CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 19

20 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Prof. David, Ami MBE Board member Nurse Director AD Community Nursing Consultancy a subsidiary of Prasand International Limited specialising in risk management and offering consultancy/project management to health care organisations (Private and NHS) & Royal Colleges Partner / close personal friends / business partner Co-Director Prasand International Limited Co-Director / Owner Prasand International Limited - Occasional Consultancy offered on Community Nursing Visiting Professor of Nursing Leadership and Expert Practice London South Bank University Fellow Queens Nursing Institute Nurse Member Lewisham, Lambeth and Southwark CCG Governing Body Nurse Member No Change Dr McLeod, Jacky Clinical Director Salaried GP, The Vale Medical Centre Clinical Triage, Bexley Health Ltd Mrs Robbins, Diana Lay Member Volunteer Member of Data Analysis Group, Lewisham Healthwatch Periodically review research applications made to the NIHR for a small fee No Change 20

21 Dr Rowland, Marc Chair Partner, Jenner GP Practice Share in South East London Doctors Co-operative (SELDOC) Small sum for GP research received by the Practice. Approx 6000to Practice Professional Advisor to the Institute of Medical Education at the London Southbank University Mr Warburton, Lay Vice Chair Director of Ray Warburton's Perspectives Limited Ray OBE Registered with a GP practice in Lewisham Assistant Director for Social Services with Leeds City Council from 1990 to 1993 Made an appearance on Yorkshire TV when the City Council s Inspection Unit took action against a care home Made an appearance on a community radio station to promote the City Council s community care plans. Made an appearance on a national Roma radio station in 2010 to talk about DH work on improving the health status of Gypsies and Travellers Wilkinson, Martin Chief Officer Nil No Change No change Ramsay, Rosemarie Observer - Healthwatch Nominated Observers (Non Voting) Chair of Lewisham Healthwatch No change Dr Parton, Simon Observer - LMC GP Partner and member of Seldoc (South East London Doctors Cooperative) Director, MMP Oncology Ltd, Ltd company set up to support partners private oncology work in SW London Dr Marina Parton (Partner) Co-Director of MMP Oncology Ltd Chair, Lewisham Local Medical Committee Interviewed for pulse and daily telegraph in capacity as chair of Lewisham LMC No change 21

22 Sarah Wainer Observer - Health and Wellbeing Board Head of Strategy, Improvement and Partnerships, Community Services Directorate Lewisham Council Role includes responsibility for Lewisham S Adult Integrated Care Programme and Better Care Fund No change Carmel Langstaff Observer - Health and Wellbeing Board Manager, Interagency Service Development, Langstaff Resources and Regeneration, Lewisham ncil No change Role includes providing support for Lewisham s Adult Integrated Care Programme and Health and Wellbeing Board. 22

23 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Consolidated Primary Care Joint Committees (PCJC) Declaration of Interests Update and signature list Date: 30 July 2015 NHS Southwark CCG and NHS England PCJC All committee members and observers to update declarations and sign at each meeting. 23

24 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Members Bland, Andrew Chief Officer Employed by Southwark CCG Partner employed at NHS England as a Primary Care Contracts Manager for North West London. Stakeholder Governor at South London and Maudsley NHS Foundation Trust. No change Prof. David, Ami MBE Registered Nurse Member of Governing Body Director AD Community Nursing Consultancy a subsidiary of Prasand International Limited specialising in risk management and offering consultancy/project management to health care organisations (Private and NHS) & Royal Colleges Partner / close personal friends / business partner Co-Director Prasand International Limited Co-Director / Owner Prasand International Limited - Occasional Consultancy offered on Community Nursing Visiting Professor of Nursing Leadership and Expert Practice London South Bank University Fellow Queens Nursing Institute Nurse Member Lewisham, Lambeth and Southwark CCG Governing Body Nurse MemberRegistered Nurse Member Lewisham and Lambeth CCG Governing Bodies No change 24

25 French, Diane Lay member Governing Body Executive Director of Richmond Fellowship (not-for-profit provider of mental health services) Board member of 2Care (subsidiary organisation) Board member of new subsidiary Croftlands a mental health provider in Cumbria. Board member (NED) of County of Northampton Council on Addiction (CAN), which provides drug, alcohol and homelessness services is now a subsidiary of Richmond Fellowship SLaM psychiatrist has recently joined Richmond Fellowship Board. From 1 st April 2015, Richmond Fellowship will add a further subsidiary, Aquarius based in Birmingham No change Gibbs, Richard Lay member and Deputy Chair - Governing Body & CCG Conflicts of Interest Guardian Associate Consultant with Public Health Action Support Team (Public health consultancy), no involvement with PHAST work in SE London. Freelance management consultant in field of healthcare information and analysis No change Dr. Heaversedge, Jonty Dr. Howell, Sian CCG Chair and GP Clinical Lead Clinical lead, Governing Body Locum GP at Walworth Partnership GP at Crowndale Medical Centre in Lambeth Director Vitality Ltd. - specialists in Health Communications Work in the media both broadcast and print - related to work as a medical practitioner and not a health care commissioner or SCCG representative. Contribute to campaigns and conferences on an ad hoc basis which may be sponsored by pharmaceutical companies Salaried GP at Bermondsey & Lansdowne Medical Mission Practice is part of Quay Health Solutions CIC a GP federation for north Southwark general practices Husband is lay, unpaid chair of social enterprise providing IAPT in East London. No change No change Park, Robert Lay member Governing Body Nil No change 25

26 Nominated Observers (Non Voting) Gandesha, Arti Observer - Healthwatch Nil No change Lloyd, Claire Observer - LMC Chair of Southwark LMC Partner at Princess Street Group Practice and member practice of QHS who provide services to patients in North Southwark Partner at Evolution Health (company is being wound up and we no longer provide any health services and will not be doing so in the future) SELDOC GP member No change Dr. McAdam- Freud Kathy Observer - LMC LMC Joint Chair for Southwark Practice is part of Quay Health Solutions CIC a GP federation for north Southwark general practices GPwSI Diabetes, GP lead in Diabetes for the Southwark Diabetes Community team (1.5 sessions/ wk) Support to practices as GP lead for diabetes Southwark Community Team No change Flagg, Rachel Observer - Health and Wellbeing Board Nil No change George, Gilbert SEL Governance Consultant Nil No change 26

27 Name (Last / First) Position Held Declaration of Interest State change or No Change June 2015 Signed or in receipt of electronic confirmation of entries Voting Member (one vote only) Fryer, Jane Medical Director NHS England S London Salaried GP one session a week at The Gardens Surgery, Southwark No change Trainer, Matthew Director of Commissioning Operations Nil No change Sturgeon, David Director of Primary Care Nil No change 27

28 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) 11 June 2015 Meeting held at: Coin Street Community Builders Coin Street 108 Stamford Street South Bank London SE1 9NH Minutes Meeting Chair Executive Support Diane French Gilbert George Bexley Primary Care Joint Committee Attendees: Sandra Wakeford (SW) Member Committee Chair (Lay Patient Public Involvement) Keith Wood (KW) Member Committee Vice-Chair (Lay Governance) Mary Currie (MCV) Member CCG Governing Body Nurse Sarah Blow (SB) Member CCG Chief Officer Dr Howard Stoate (HW) Member CCG Chair Dr Sid Deshmukh (SD) Member CCG Governing Body GP David Sturgeon (DS) Member NHS England - Director of Primary Care Lotta Hackett (LH) Observer Healthwatch (Deputising for Anne Hinds Murray) Dr Richard P Money (RM) Observer Local Medical Committee Sue Robinson (SR) Observer Health and Wellbeing Board (Deputising for - Teresa O Neill) Apologies: Anne Hinds Murray Teresa O Neill Dr Jane Fryer Matthew Trainer Healthwatch Health and Wellbeing NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Bromley Primary Care Joint Committee Attendees: Martin Lee (ML) Member Committee Chair (Lay Patient Public Involvement) Harvey Guntrip (HG) Member Committee Vice-Chair (Lay Governance) Sara Nelson (SN) Member CCG Governing Body Nurse Dr Angela Bhan (Dr AB) Member CCG Chief Officer Dr Andrew Parson (AP) Member CCG Chair Dr Mark Essop (ME) Member CCG Governing Body GP (Deputising for - Dr Ruchira Paranjape) David Sturgeon (DS) Member NHS England - Director of Primary Care 28

29 Linda Gabriel (LG) Observer Healthwatch Dr Mukesh Sahi (MS) Observer Local Medical Committee Cllr David Jefferys (DJ) Observer Health and Wellbeing Board Apologies: Dr Ruchira Paranjape Dr Jane Fryer Matthew Trainer CCG Governing Body GP NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Greenwich Primary Care Joint Committee Attendees: Dr Greg Ussher (GU) Member Committee Chair (Lay Patient Public Involvement) Jim Wintour (JW) Member Committee Vice-Chair (Lay Governance) Dr Iyngaran Vanniasegaram (IV) Member CCG Governing Body - Secondary care clinician Annabel Burn (ABu) Member CCG Chief Officer Dr Ellen Wright (EW) Member CCG Chair Dr Rebecca Rosen (RR) Member CCG Governing Body GP David Sturgeon (DS) Member NHS England - Director of Primary Care Leceia Gordon-Mackenzie (LG) Observer Healthwatch Dr Dermot Kenny (DK) Observer Local Medical Committee Cllr David Gardner (DG) Observer Health and Wellbeing Board Apologies: Dr Jane Fryer Matthew Trainer NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Lambeth Primary Care Joint Committee Attendees: Graham Laylee (GLK) Member Committee Vice-Chair (Lay Governance) Professor Ami David (AD) Member CCG Governing Body GB Nurse Andrew Eyres (AE) Member CCG Chief Officer Dr Adrian McLachlan (AM) Member CCG Chair Dr Hasnain Abbasi (HA) Member Local Medical Committee Apologies: Sue Gallagher Cllr Jim Dixon Dr Jane Fryer Matthew Trainer Committee Chair (Lay Patient Public Involvement) Health and Wellbeing Board NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Lewisham Primary Care Joint Committee Attendees: Ray Warburton OBE (RW) Member Committee Vice-Chair (Lay Governance) Ami David (AD) Member CCG Governing Body Nurse Martin Wilkinson (MW) Member CCG Chief Officer 29

30 Dr Jacky McLeod (JM) Member CCG Governing Body GP David Sturgeon (DS) Member NHS England - Director of Primary Care Rosemarie Ramsay (RR) Observer Healthwatch Dr Simon Parton (SP) Observer Local Medical Committee Carmel Langstaff (CL) Observer Health and Wellbeing Board Apologies: Diana Robbins Dr Marc Rowland Dr Jane Fryer Matthew Trainer Committee Chair (Lay Patient Public Involvement) CCG Chair NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Southwark Primary Care Joint Committee Attendees: Diane French (DF) Member Committee Chair (Lay Patient Public Involvement) Ami David (AD) Member CCG Governing Body Nurse Andrew Bland (AB) Member CCG Chief Officer Dr Jonty Heaversedge (JH) Member CCG Chair Dr Sian Howell (SH) Member CCG Governing Body GP David Sturgeon (DS) Member NHS England - Director of Primary Care David Cooper (DC) Observe Healthwatch Dr Kathy McAdam Freud (KMF) Observer Local Medical Committee Rachel Flagg (RF) Observer Health and Wellbeing Board Apologies: Arti Gandesha Dr Claire Lloyd Dr Jane Fryer Matthew Trainer Healthwatch Local Medical Committee NHS England (Medical Director for South London) NHS England (Director of Commissioning Operations) Seminar All six Joint Committees Item 1 Meet and Greet Action AB welcomed members, observers and members of the public to the inaugural meeting of the Primary Care Joint Committees (PCJCs) consisting of: NHS Bexley CCG and NHS England NHS Bromley CCG and NHS England NHS Greenwich CCG and NHS England NHS Lambeth CCG and NHS England NHS Lewisham CCG and NHS England NHS Southwark CCG and NHS England AB explained that all six PCJCs had agreed to work collaboratively and in doing so they would meet at the same time and in the same place. He went on to explain that 30

31 all of the committees had some degree of shared membership and that NHS England members were members of all six committees. AB explained that in advance of the main agenda item the committee would receive a seminar style session outlining some background to the committees formation, under Primary Care co-commissioning arrangements now agreed for each borough as of 1 April 2015, collective working and the strategic context that was common to the six boroughs in south east London 2 Introductory Seminar AB introduced the seminar session of the Primary Care Joint Committees and invited SB to present the background to Primary Care Co-commissioning. SB reminded Joint Committees that all six CCG Governing Bodies, acting with a mandate from their members had applied for and received approval as Level 2 cocommissioners of primary care or Joint commissioning with NHS England. SB outlined how NHS England and the six CCGs will work together for primary care co-commissioning, giving focus to the NHS Five Year Forward View (FYFV) and specifically New Models of care. This would involve joining up the commissioning systems through co-commissioning to help unlock barriers to integrated care and the models described in the FYFV such as Multispecialty Community Providers (MCPs). SB continued with a focus on how joint commissioning arrangements would allow for local flexibility alongside national requirements and the designing of locally focussed schemes. SB spoke about Our Healthier South East London and transformation of Community Based Care (CBC), which would be supported by Local Care Networks (LCNs) with federations or At Scale delivery of general practice with collective responsibility for the population; developing the workforce; patient centred coordinated care and continuity of care. AB then directed Joint Committees to the Our Healthy South East London Strategy Programme including its Whole system model. Emphasis was placed on the importance of LCNs, being the foundation of the whole system model providing person centred care to both individuals and to local populations. AB drew Joint Committees attention to the slide Whole System Model the model consisted of six models of care focused on by the programme: Community Based Care Maternity Children and Young People Cancer Planned care Unscheduled and emergency care RW (Lewisham CCG) informed Joint Committees that he welcomed the whole system model slide, but impressed on Joint Committees the importance of engaging with those who are marginalised and disenfranchised in our communities. There should be clear pathways on how we are going to reduce inequalities in our communities. He also emphasised that we must find ways to reach out to those in our communities who are harder to reach so that we can make a difference to all sections of our 31

32 communities. ABu made Joint Committees aware that the whole system model was developed with local authorities and she was confident that working together will deliver the outcomes desired by all. She also informed Members and Observers that south east London CCGs had good working relationship with the voluntary sector and that these were being strengthened. JH commented that he understood the Primary Care Joint Committees governance structures, the commissioning intent but wanted to be informed on how having Primary Care Joint Committees specifically with NHS England could best strengthen our approach. DS responded by outlining the advantage of NHS England working jointly with the six CCGs in making joint commissioning decisions that allowed the entire locally available NHS budget to be considered would underpin the implementation of the strategy. Meeting in Common of the Primary Care Joint Committees in South East London 3 Welcome and Introductions AB informed Joint Committees that to facilitate an effective meeting DF was asked to be the interim Chair of the meeting (as opposed to any one committee and this was acceptable to the members of all six committees. DF asked members and observers to introduce themselves by name, position and organisation representing. 4 Election of Chair for the meetings AB requested nominations from amongst Chairs of the six Primary Care Joint Committees for the Chair and Vice-Chair for the Primary Care Joint Committees meetings. GU was nominated to be Chair of the meetings of the Primary Care Joint Committees; there were no objections and GU was duly elected by chairs of all Committees to be the Chair of the Primary Care Joint Committee meetings. ML was nominated as the Vice-Chair; there were no objections and ML was duly elected by all chairs to be Vice Chair of the Primary Care Joint Committees meetings. Joint Committees agreed that the elected roles (Chair and Vice-Chair) would be for duration of 12 months with a review after six months. 5 Terms of Reference The Joint Committees noted the Terms of Reference for their respective committees which had previously been approved by the six CCGs Governing Bodies and Membership and with NHS England at the point of application for joint commissioning and subsequent approval. Members of the Lewisham committee noted that the version of the Terms of Reference included in the Committee papers was an incorrect version and would need GG 32

33 to be replaced with a correct version. DS informed the Joint Committees that any fundamental changes to the approved Terms of Reference will require a further approval by NHS England. A member requested clarification on how the Joint Committees would be able to manage budgets as outlined in the section remit of Joint Committees in the Terms of Reference. DS informed the Joint Committees that NHS England will be providing reports on budget and performance of the CCGs on a routine basis for discussion at the Joint Committees meetings and that under Level Two co-commissioning they remained responsible for doing so. An observer noted that Terms of Reference gives no voting rights to those designated as observers of the Primary Care Joint Committees and that this should be reviewed. DS confirmed that the terms of reference provided and approved compiled with national guidance. AB confirmed that the Terms of Reference and the wider application for co-commissioning had been the subject of a significant engagement process in each borough with the stakeholders including those groups from which observers were drawn. Members and Observers requested that the Bexley Terms of Reference be corrected for an error on page 6, 2nd paragraph. GG 6 Register of Interests Members and observers of: NHS Bexley CCG and NHS England NHS Bromley CCG and NHS England NHS Greenwich CCG and NHS England NHS Lambeth CCG and NHS England NHS Lewisham CCG and NHS England NHS Southwark CCG and NHS England Made their declarations of interests with reference to the register of interests that had been compiled in advance of the meeting (and was available at the meeting) and updated declarations where required. The register of interest was agreed to be circulated to all members following the meeting and that it would be made available at the next meeting and all subsequent meetings. GG 7 Operating Model of Joint commissioning in south east London s boroughs AB introduced this section of the meeting and informed Joint Committees that it would consists of three elements: Primary Care Co-commissioning Memorandum of Understanding (MoU): Core principles (NHS England) Overview of NHS England (London Region) Draft Operating Model: Cocommissioning of Primary Care Version 5 33

34 Operating Models and arrangements in support of Primary Care Joint Committees in South East London Memorandum of Understanding (MoU) DS informed Joint Committees that whilst the MoU had been approved by NHS England for use it was subject to change pending comments from CCGs and if changes were required then they would be brought to the Joint Committees before being enacted. DS outlined the purpose and contents of the MoU. He also informed the committees that the resourcing in his team was subject to change and that individuals would have split roles between commissioning and performance / contracting. Draft Operating Model DS drew the attention of the Joint committees to the Draft Operating Model, he reminded Joint Committees that all six south east London CCGs had opted for Level Two, which meant that NHS England and CCGs would be involved in decision making and as a result any decisions required by NHS England will be brought to the Joint Committees; unless they were being made under a clear National policy or an existing Standing Operating Procedure (SOP). All NHS England national policies or SOPs will be brought to the Joint Committees next meeting. DS DS commented on the planned Service Level Agreement (SLA) for co-commissioning, he stated this was for those CCGs who had opted for level 3 or full delegation. RW enquired how quickly financial reports would be published and made available in view of the remit of the Joint Committees to make decisions based on financial reports and recommendations from CCGs. DS replied that reports will be made available as per the normal cycle of reporting currently being used by CCGs (Monthly). Joint Committees requested the following change and inclusion to the operating model: Guiding principles Themes and examples to add clarity An appeals process to be drafted into model Managing complaints explicit statement Review process of the operating model Definition and examples of urgent decisions which cannot wait until the next committee Examples of other decisions the Joint Committees may make AB (Southwark CCG) concluded that although the operating model was still work in progress, it was a document that the Joint Committees could work with until it was completed and ready for approval of the Committees. All parties agreed to operate in the spirit of the framework until that point. Operating Models and arrangements in support of Primary Care Joint Committees AB introduced this paper emphasising the need to set up sub groups of the Joint 34

35 Committees and to establish how these committees would report to and support the Committees. He also acknowledged an interdependency between this arrangement and the previous items in this agenda item as they need to reflect one another. A LMC observer queried on who will be invited to join the sub groups referred to in the documentation. AB responded that this would be for local determination and may differ in each borough. It would be driven by the actions required of that group. It was noted that the reference to the role of Local Medical Committee Page 5 of 13, bullet point would be replaced as follows: The PCJC will include a representative from the relevant Local Medical Committee who [Delete - and will] represents the interests of GP providers who may be impacted by decisions taken at the PCJC. [Delete - The LMC representative will promote a greater understanding of commissioning and associated commissioner responsibilities amongst the primary care workforce they represent]. 8 Recommendations for amendment to the terms of reference for the Joint Committees The committees considered whether their review of the items outlined in the previous agenda items would require amendment to the committee Terms of Reference, beyond the changes required under item 5 of the meeting. The committee members sought assurance that the Terms of Reference allowed for the establishment of working groups in support of the committee and determined that this was allowed for; noting that the outcome of the NHS England Operating Model work may require a future amendment. The committee members also sought assurance that the Terms of Reference allowed for any appropriate matters to be considered in a Part Two on private part of the committee business and again this was confirmed to be possible. 9 Questions from members of the public A member of the public concurred with the desired outcomes outlined in the whole system model and focus on health inequalities. He asked if funding would be made available for patients with mental health issues and why more innovative ways to treat patients with mental health issues had not been introduced by clinicians. In addition, he asked about support for people with emotional distress and using models that have worked well in other countries to support people diagnosed with psychosis. He added that this approach has proven successful and would reduce dependence on the welfare state. A member of the public stated that mental health staff should all be trained in the open dialogue approach. He went on to ask what percentage of South London and Maudsley NHS Foundation Trust (SLAM) funding is from CCGs and why SLAM recovery rates are low? DF thanked members of the pubic for raising these issues and clarified that the Primary Care Joint Committees meeting was not the forum for decisions on care pathways for mental health patients specifically but that these issues had been heard and requested that CCG commissioners take account of them when assessing their 35

36 commissioning intentions for mental health services. A member of the public asked for a glossary to be provided with the Primary Care Joint Committees papers. DF responded by saying this was normal for other public committees of the CCGs. She added that circulation of papers for the next Joint Committees meeting will contain a glossary and apologised for not having one circulated at this meeting. GG A member of the public asked whether there is Patient Participation Group (PPG) presence/ influence on this committee. A number of committee members noted that their engagement with PPGs was undertaken through their governance structures that supported their Governing Body in its work and that as co-commissioners of care they welcomed the opportunity to receive and act upon that representation within those processes. A member of the public brought the committees attention to his experience and that of people he had spoken with that waiting times for a GP appointment were ten days. DS invited further and specific details to be brought to his attention with regards this particular example. 10 Meeting close 36

37 Primary Care Joint Committees 11 June 2015 Signed Attendance Sheet (Public and other observers) Gary Beard Angela Buckingham Rebecca Burns Diana Braithwaite Lesley Chandler Helen Chourn Sharon Fernandez Malcolm Hines Liam Link Dolly Mace Susanna Masters Andrew Parker Barry Silverman Jill Webb NHS England Melbourne Parkside Kings College Hospital NHS FT NHS Lewisham CCG Public DMC Patient Participation Group NHS England NHS Southwark CCG Public Public NHS Lewisham CCG NHS Lambeth CCG OHSEL Patient Public Advisory Group NHS England 37

38 38

39 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Enc C Primary Care Joint Committees Meeting Action Log Ref Meeting Committee Action required Due Owner Action Taken Status Date Date All All committee terms of reference to be reviewed and revised as necessary in line with committee recommendations CCG Chief Officers All joint committee terms of reference have been revised and updated to reflect agreements at the committee and are provided to the August 2015 committee meeting for information Closed All Register of interests to be updated following completion and declarations made by members at the meeting and re-circulated to members and to be made available at the next meeting Gilbert George Updated register of interests circulated to committee members and register to be made available at the August meeting Closed All Feedback of the committee members upon the Draft NHS England Operating Framework to be considered and addressed in future versions of the document David Sturgeon Latest version of the NHS England Operating Model is included for consideration as an item on the August 2015 meeting of the committees Open All Existing and any new NHS England Standard Operating David Sturgeon SOP documentation is included as an item on the Open 39

40 Procedures (SOPs) or relevant policies that will be used by commissioning organisations on behalf of the committee to be made available to committee members to note agenda for the August 2015 meeting All Local operating models and arrangements established in support of the Primary Care Joint Committees to be reviewed in light of current and future requirements of the committees business as outlined by the Terms of Reference and the NHS England Operating Model CCG Chief Officers A review is being conducted in each borough in parallel to the drafting and agreement of the NHS England Operating model. The progress of that review will be reported to the August 2015 meeting noting that work to establish final local arrangements will not be completed until the end of September 2015 Open All A glossary of terms of terms to be provided as a live document to be regularly updated and circulated with committee papers Gilbert George Draft Glossary of Terms completed and circulated with papers for the committees Closed 40

41 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 AUTHOR: ENCLOSURE D Update on Governance & Operating Models Jill Webb, Head of Primary Care, NHS England (London Region) Andrew Bland, Chief Officer, NHS Southwark CCG SUMMARY: The most up to date version of the Primary Care Co-Commissioning Operating Model is provided for Joint Committee oversight and assurance. This is nearing its final version and will be brought to the Joint Committee in September 2015 for final review and sign off. A brief overview of the NHS England s Primary Care Commissioning Standard Operating Procedures (SOPs), Interim Policies, the GMS Contract changes and Directed Enhanced Services (DES) commissioned in are also provided to provide more insight into the governance in place at both England and London Region levels which the Joint Committee will rely upon as part of its decision making processes. At its June 2015 meeting the committees received proposals for the local operating models and arrangements in support of the Primary Care Joint Committees. In light of the emerging NHS England Operating model and with reference to the Standard Operating Procedures in place at a national and regional level each CCG, working with NHS England, will review and adapt their current arrangements and groups that support the decision making of the committee. These arrangements will be presented to the September meeting of the committee for approval. Whilst local variation will be required to ensure the alignment of local governance arrangements, the six boroughs have proposed the establishment of local (Borough) Primary Care Boards that will review the quality, performance and development of primary care services. Those Boards will provide a single forum in each borough for the consideration of all matters relating to primary care and specifically they will make recommendations to the Joint Committee on these matters or work to inform and support any Chair s action or other urgent decision on the exceptional occasions where it cannot wait for the next committee 41

42 meeting. KEY ISSUES: The NHS England Operating Model provides a blueprint for the way that NHS England (London) primary care commissioning and contracting teams will support CCGs that have moved to joint or delegated co-commissioning arrangements (as of April 2015). The document provides the standard offer of NHS England in terms of supporting Primary Care Co-Commissioning activities. There are further changes that need to be completed to this document before it is signed off by NHS England (through its Primary Care Management Board) and then joint committees. In particular a review of urgent decision making outside of level 2 and level 3 committees needs to be concluded in order to establish a set of consistent operating principles for meetings which act on behalf of standing committees when urgent planned or unplanned decisions are required. A further inclusion in the document will be how contract and individual performer issues (the latter being a reserved responsibility of NHS England) will be addressed by committees and what information will be provided. Standard Operating Procedures (SOPs) are nationally agreed or, where these do not exist are developed and agreed at London Region level. SOPs must be adhered to. In the absence of NHS England wide SOPs, London Region has developed a number of interim policies and procedures such as Discretionary Funding which provides discretionary financial support to GPs who apply to take leave (e.g. sickness; maternity). This policy will be superseded by the NHS England national policy when it is published. Proposed London policies are shared with LMCs in order to take into account their views and follow appropriate legal advice to ensure compliance with current legislations. The attached document also provide an overview of 2015/16 national contract changes which apply to all contractors and the range of Directed Enhanced Services specifications which are prescribed nationally and which contractors have the option to provide. The GMS Contract Changes and DES nationally negotiated. Negotiating partners NHS Employers on behalf of NHS England, General Practitioners Committee (GPC) and the British Medical Association (BMA). 42

43 RECOMMENDATIONS: To note progress on the Primary Care Co-Commissioning NHS England Operating Model and that it will be presented to the next joint Committee for review and formal adoption. To note the SOPs and polices in place which the Joint Committee will rely upon as part of its decision making processes. To note that the local arrangements established to support the decision making of the committee are being reviewed in each borough to reflect the Operating Model and the SOPs and will be presented to the Joint Committees for approval in September NHS England / CCG CONTACT: Name: Andrew Bland andrewbland@nhs.net Name: Jill Webb jill.webb3@nhs.net AUTHOR CONTACT: Name: Andrew Bland andrewbland@nhs.net Name: Jill Webb jill.webb3@nhs.net 43

44 Operating Model Co-Commissioning of Primary Care Services DRAFT 44

45 Document filename: Operating Model Directorate / programme Document reference Primary Care Commissioning Project Project manager David Sturgeon Status Draft Owner Primary Care Management Board/ Primary Care Committees Version 8.0 Author Patrick Newton Version issue date 39T Primary Care Commissioning 45

46 Operating model: Co commissioning of primary care Document management Revision history Version Date Summary of changes First draft Revision following Christina Windle review Revision following Heads of Primary Care review Draft for review by David Sturgeon Review by Primary Care Commissioning and Primary Care Management Board Draft updated following comments Updated to reference initial comments from CCGs (to be approved in PCMB) Draft updated to reflect agreed comments Reviewers This document must be reviewed by the following people before being shared externally: Reviewer name Title/responsibility Date Version David Sturgeon Jill Webb Julie Sands William Cunningham-Davis Director of Primary Care Commissioning Head of Primary Care Head of Primary Care Head of Primary Care Approved by This document must be approved by the following groups: NHS England: Name Signature Title Expected Date Version Simon Weldon (in recognition of approval at the Primary Care Management Board) Regional Director for Operations and Delivery (London) 27/07/

47 Following sign off by NHS England (London), this document must be accepted by each of the cocommissioning committees. These groups are therefore shown below: Co-Commissioning Committees: Area Signature Title Expected Date Version North Central London City and Hackney* South West London Joint Committee CCG Joint Committee South East London Joint Committee 06/08/15 North West London Joint Committee 17/09/15 Tower Hamlets Waltham Forest Newham Barking & Dagenham, Havering & Redbridge Delegated Committee Delegated Committee Delegated Committee Delegated Committee 05/09/15 * This CCG does not have a co-commissioning committee and therefore the forum for this signature is un-confirmed. Related documents Title Owner Location NCL Terms of Reference for Joint Committee v0.2 Primary Care Committee North Central London SWL Terms of Reference Primary Care Committee South West London Annex F Delegated TOR Tower Hamlets v0.1 Annex F Delegated TOR Waltham Forest v1.0 Annex F Delegated TOR Newham vfinal Primary Care Committee Primary Care Committee Primary Care Committee Tower Hamlets Waltham Forest Newham BD Updated Annex F (ToR) Primary Care Committee Barking and Dagenham Havering Updated Annex F (ToR) Primary Care Committee Havering Document control The controlled copy of this document is maintained by NHS England. Any copies of this document held outside of that area, in whatever format (e.g. paper, attachment), are considered to have passed out of control and should be checked for currency and validity. 47

48 Co-commissioning of primary care services: Target Operating Model Contents Document management... 3 Revision history... 3 Reviewers... 3 Approved by... 3 Related documents... 4 Document control Introduction Purpose of this document Governance of this document and Processes Operating model processes for individual committees Defining co-commissioning Terminology: Differences between Joint and Delegated Committees Responsibilities remaining with NHS England Decision Making Decision making principles Decision making process Reporting Requirements Conflicts of interest Other decision-making processes finance and strategy Other potential Committee responsibilities Governance and people Committee constitution Committee resourcing Processes & Capabilities Meeting process: Agenda contents Meeting in private: Annexes Annex 1: London CCGs set out by level of co-commissioning Annex 2: on statutory framework and duties Annex 3: Detailed processes Annex

49 Primary Care Infrastructure Fund (PCIF) bids a model approval and prioritisation process Annex 5: Standard report formats Annex 6: Year Plan: Meeting frequency

50 1. Introduction 1.1 Purpose of this document This document aims to provide a blueprint for the way that NHS England (London) primary care commissioning and contracting teams will support CCGs which have moved to joint or delegated co-commissioning arrangements (as of April 2015). CCGs which will be participating at the greater involvement level of co-commissioning should discuss with their local team how they would like to be involved. As this document provides the standard offer of NHS England in terms of supporting Primary Care Co-Commissioning activities, this document will need to be signed off by NHS England (through the Primary Care Management Board) and then co-commissioning committees, before it is considered final. It is important to note that some specific details (i.e. the contact points for different committees/ areas) will differ per committee. Where these areas have been identified this is highlighted in red 1.2 Governance of this document and Processes Once this document has been signed off by both parties, any variance from the processes described here will need to be agreed between the Committee and NHS England as: Having no impact on support (for example changes to the contact to be involved in urgent decision making) and can therefore be adopted for a specific Committee Is an adjustment or improvement to the process which would be beneficial for all Committees and therefore should be made as a change to standard processes (for example reporting format or processes which makes the reporting cycle more efficient or information more easily understood) Is a required change for a specific Committee(s) and therefore a change request will need to be logged (i.e. additional reporting). In all instances, agreement of these changes will require sign off at the Primary Care Management Board and then with Primary Care Co-Commissioning Committees before it can be considered confirmed. This may require resource and/ or cost implication assessments, and the ownership for any impact of these would need to be discussed as part of the agreement discussions. 1.3 Operating model processes for individual committees As mentioned above, this document aims to provide a standardised version of the operating model. However the below details will need to be discussed in each individual committee, and therefore decisions relating to the below are seen as acceptable levels of customisation within this standard model: Standard policies to assist decision making should be reviewed and agreed by the committee; the committee may wish to add others 50

51 The sub-committee structure is likely to be different per committee. This should follow the principles defined here and be discussed and agreed with NHS England if involved. The CCG representative(s) to be contacted in the event of urgent decisions being required. These elements should be discussed and agreed as part of committee discussions, and should be included as appendices or linked documents. 1.4 Defining co-commissioning Co-commissioning for primary care refers to the increased role of CCGs in the commissioning, procurement, management and monitoring of primary medical services contracts, alongside a continued role for NHS England. In 2015/16, the scope for primary care is general practice services only. CCGs have the opportunity to discuss dental, eye health and community pharmacy commissioning with their area team and local professional networks, but have no decision making role. There are three co-commissioning models, and as of April 2015 there are London CCGs at all three of these levels: Level 1: where CCGs have involvement in primary care decision making, Level 2: which is where the CCG (or CCGs) participate in decision making with NHS England in a Joint Committee Level 3: delegates decision making regarding certain functions (see below) entirely to the CCG (or CCGs) A high level overview of responsibilities is shown below: Figure 1: High level breakdown of co-commissioning responsibilities Level 1*: Greater involvement in primary care decision-making CCGs participate in discussions about primary care, but there is no committee, or other new governance arrangements, required to take on added responsibilities. NHSE retains its statutory decision making responsibilities. Increasing CCG control Level 2*: Joint commissioning arrangements NHSE and the CCG(s) form a joint committee (or joint committee in common ) to support commissioning of primary care. Together they vary/ renew existing contracts for primary care, and commission some specialised services. Can also design local incentive scheme as an alternative to the Quality and Outcomes Framework (QOF) or Directed Enhanced Services (DES). Level 3*: Delegated commissioning arrangements Figure 1: Co-Commissioning Levels The CCG assumes full responsibility for commissioning GP services, forming a committee on their own. Responsibilities are as above, but include contractual GP performance management, budget management and complaints management. NHSE retain legal liability for performance of primary medical commissioning, and therefore retain oversight of the committee. * Annex 1 sets out which CCGs are currently at each level of co-commissioning. 51

52 1.5 Terminology: At levels 2 and 3, co-commissioning decision making is conducted through a, or several, committee(s), which is joint with NHS England, or delegated. The committee could either consist of: Committees of single CCGs (with or without NHS England) Committees of more than one CCG (with or without NHS England) The Committees may either be: A joint committee is a single committee to which multiple bodies (e.g. NHS England and one or more CCGs) delegate decision-making on particular matters. The joint committee then considers the issues in question and makes a single decision 1. In contrast, under a committees-in-common or joint committees-in-common approach, each committee (with our without NHS England dependant on level) must still make its own decision on the issues in question For simplicity, throughout this document, the body which conducts decision making for co-commissioning is referred to simply as the committee, and it may refer to any of the parameters above. Where different processes are required for joint or delegated committees, these are called out. 1.6 Differences between Joint and Delegated Committees The move to co-commissioning, means that certain decisions (see Figure 2) which were previously conducted directly by NHS England, will now be made by the body constituted to support the level of co-commissioning each CCG has applied for i.e. committees with NHS England (for joint commissioning) or without NHS England (for delegated commissioning). Regardless of whether the CCGs are conducting Joint or Delegated commissioning, the functions enacted will be for the most part the same (except for financial and management accounting, contractual GP performance management, budget management and complaints management); the main difference is whether NHS England is part of the decision making process or not. 1.7 Responsibilities remaining with NHS England At all levels of co-commissioning, NHS England will retain a role in supporting delivery of commissioning and contracting functions. Also the following responsibilities will remain with NHS England and will not be included in joint or delegated committees: Continuing to set nationally standing rules to ensure consistency and delivery goals outlined in the Mandate set by government. The terms of GMS contracts and any nationally determined elements of PMS and APMS contracts will continue to be set out in the respective regulations/ directions. 1 Please note this is only an option for Joint Commissioning arrangements 52

53 Functions relating to individual GP performance management (medical performers lists for GPs, appraisal and revalidation). Administration of payments to GPs. Patient list management will remain with NHS England. Capital expenditure functions. 2. Decision Making 2.1 Decision making principles One of the exceptions to this as a standard document across all committees, is that there may be some variation as to what and how decisions are made in the committees. In addition to principles of good practice which are set out in the Next Steps in Co- Commissioning document, conflicts of interest policy, terms of reference etc, the following principles should be considered: In order to maintain the authority of the committee, all Primary Care Commissioning decisions should be made within the committee, excepting: o Sub-committees/ working groups may be required to conduct pre-work and make recommendations to the committee. (These groups should not be decision making) o Some decisions can be made based on agreed policy o Some decisions are urgent and therefore must be made outside of the committee Any urgent decisions made outside of the committee should be based on what is necessary to maintain patient care; wherever possible decisions will be taken within the committee. In the event that an urgent decision is required and action must be taken to maintain patient care outside of a committee, NHS England will reach out to the elected contact (via phone and ) to aim to involve them in the decision. o Elected CCG contacts are asked to make themselves available to respond to these urgent discussions o For Level 3 committees this is particularly important, and a deputy contact should always be identified if the main contact is not available 2.2 Decision making process Co-commissioning of Primary Care will enable committees to take responsibility for many decisions which currently sit with NHS England. Any CCG functions which are to be delegated into this committee are not included here. Decisions have been classified into three types in order to help capacity in the committee. These types are: 1. Decision making through policies which therefore require minimal/ do not require discussion because there is a clear approved policy which provides clarity on the action required 53

54 2. Urgent decisions which cannot wait until the committee. These decisions require emergency processes (see below) 3. Decisions to be discussed in the committee. Other General Practice commissioning decisions should be made within the committee. It is expected in many cases recommendations will be made into the committee from pre-work or subcommittees as appropriate. These decision types and the related processes can be seen in the below processes: Decision Making through policies 54

55 The below diagram shows how decisions where policies which are already defined might be used to support the co-commissioning committee. Please note, this process would be the same for both Joint and Delegated commissioning decisions: Figure 2: Decisions made through policies This policy shows that although the policies referred to here would be Nationally or Regionally agreed policies, and therefore with limited scope for change, it is proposed that these are discussed and agreed at one of the early committee meetings in order to confirm that the members are comfortable with the scope and approach. The process also includes provision for addendums to the policy. If for example there are concerns regarding the way a decision has been reached then the committee should talk about the way that this can be improved in the future. It is important to note that the content of an agreed policy may not be able to be changed, and the impact of any material change would need to be signed off at the Primary Care Management Board as well as the committee, but this is to illustrate the opportunity for continual improvement. 55

56 The purpose of this process is to relieve agenda pressure in the committee. If there are any decisions or elements of the report which the committee would like to discuss, this can be done and should be offered by the chair at the start of the meeting Decisions with defined policies The decisions which can be made through defined policies will be discussed and agreed by each co-commissioning committee, however the expected decisions where policies are expected to be used to make decisions: List closure Boundary changes Discretionary payments Contractual changes There are several other areas where standard operating processes or policies exist, but it is expected that decisions will still need to be made within the committee and therefore are not included here. The full list of potential decisions with policies can be found in Figure Urgent decision making: Urgent is defined in this document as a decision which cannot be made within a committee because of timing. The main co-commissioning committee is accountable for all decisions, and as referenced above it is important to note: Urgent unplanned decisions o Wherever possible, only decisions necessary to maintain patient care should be taken outside of the committee o The committee must ensure that an appropriate CCG contact is identified to be contacted in the event of an urgent decision being required o NHS England will reach out to this contact (by phone/ ) in order to involve them in the decision making process (see joint and delegated processes below) o In the event that the CCG is made aware of the need to make an urgent decision, they are: Required to reach out to NHS England to make the decision together if operating in joint commissioning Able to reach out to NHS England if they require support/ advice to make the decision in delegated commissioning The below diagram shows how urgent planned decisions might be made. Please note, these process would be the same for both Joint and Delegated commissioning decisions: 56

57 Figure 3: Urgent unplanned decisions Urgent planned decisions There may be some decisions which are expected, but: Cannot be made at an earlier committee as, for example there is insufficient information Must be made before the next committee This means that decisions do need to be made through an urgent process, but that some planning can be undertaken ahead of the decision. This is shown below: 57

58 Figure 4: Urgent planned decisions 58

59 2.2.3 Main decision types required Business as usual decisions The table below sets out of the main formerly NHS England functions which will now be decided in the committee. This includes a recommendation as to the type of decision the committee will be asked to make (this is not confirmed until this document has been approved by each committee), as well as estimates of the frequency of each activity. Please note: these are high level estimates based on the last 12 months and are for all of London rather than the volume any one committee will likely need to decide on. Process 1 Process 2 Process 3 Name Function Estimated volume of activity across London (12 months) Determinat ion of key decisions or requests Financial Processes Strategy & Policy Committee decisions needed (section 2.5) Decision possible with approved policy (s 2.6) Need for urgent decisions (s 2.7) List Closure 20 Yes Practice mergers/ moves 100 Yes Does a national/london SOP/policy/report exist? (If yes, attached in annex) Boundary Changes 20 SOP practice to apply and general DMG paper derived from this Securing services through 40 Yes options appraisal doc APMS contracts PMS (reviews etc) Ongoing In process Discretionary Payments 600 Process as per SOP. Appeal/ complaint Remedial and breach notices Contract termination-e.g Death/ Bankruptcy/ CQC Contractual changes (contentious/ important) Contractual changes (transactional) Ensuring budget sustainability Management Accounting Securing quality improvement Developing and agreeing outcome framework e.g. LIS Securing consistent population based provision of advanced and enhanced services Premises plans, including discretionary funding requests (Actual) (Actual) 100 paper below. Yes (Contractual issues of concern) Yes, for bankruptcy, and options paper 650 Yes (Contract signatory changes) Ongoing Ongoing Ongoing Request to issue breach over quality attached 70 Yes (for LIS schemes) 50 As above 200 Yes, example PID attached Figure 5: Table showing former NHS England functions which will now be decided in the committee Strategic Discussion and decision making The committee should also be used to support discussion on Primary Care strategies, such as delivery of the Strategic Commissioning Framework and other strategic aims. 59

60 2.3 Reporting Requirements The current standard reporting offer is shown below. Potential developments indicate where advancement of the reports may be possible but discussion would be required on impact and requirement: Report Source Freq. Usage now Available immediately Potential development Patient satisfaction with access NHS England Business Analytics (BA) Team Every 6 months Not currently used as part of decision making Data can be shared directly from BA team. This will not be fully analysed Interpretation/ summary or recommendations based on data as input into the committee Performance reporting (incl. breaches) NHS England case management team* Quarterly Used to identify under performers (i.e. bottom 5%) for discussion Reports (not anonymised) will be provided direct to CCGs. They can then decide if/ how to discuss in committees** Development of systematic approach to usage and response CCGs may want to add information to report (such as complaints) Primary Care Web Tool Online Quarterly CCG members with nhs.net and nhs.uk s will have access as required Finance & QIPP NHS England Finance team Monthly High level exceptions analysis Data is available by: Area team level (i.e. South, NCEL, NWL) Contractor type (GMS, PMS Development of information at a CCG level. Information to provide to joint 60

61 ns made related to the above, there will also be general reports which the committee will need to review and potential etc) Provided to committees: A summary file would be available to Level 3 committees No data would be available to Level 2 committees as cannot be broken down to sub area team level committees In additio n to making decisio ns and reviewi ng other decisio 61

62 Report Source Freq. Usage now Available immediately Potential development PMS Contract NHS England Contracts Management Team Not systematically available or reviewed Only available for areas which have developed KPIs Post PMS review, further information expected APMS a) KPI Monitoring NHS England Contracts Management Team Annually Not systematic Annual summary of achievement against targets b) NHS England Commissioned APMS contracts NHS England Contracts Management Team Annually Systematic review of achievement against targets Annual summary of achievement against targets List maintenance Primary Care Services Annual For analysing QIPP To be determined based on new provider To be determined based on new provider Direct Enhanced Services Sign Up report Primary Care Commissioning team Annual Payment analysis & budget setting List of practices/ practioners signed up to DES schemes Assurance of compliance and strategic achievement E-declarations sign off report Primary Care Web tool Annual For due diligence: - Non compliance List by practice by level of compliance Could be added to performance report 62

63 is investigated - Compliance declarations considered as part of performance management Further analysis of reports in consideration with other reports/ information * Subject to continued programme budget ** Need to define who this is sent to suggest safe haven approach Figure 6: NHS England reporting Conflicts of interest All committees must adhere to the conflicts of interest guidance 2 and this should also be considered for any sub groups set up to support the committee Other decision-making processes finance and strategy Finance Joint Co-Commissioning Committees For Joint Committees, NHS England will continue to do all financial and management accounting. However, it will produce monthly financial reports (for instance, covering spending against forecast and narrative on variance) which will be provided to each CCG. The CCG may then chose to add information to these reports before they are submitted to the committee(s). Delegated Co-Commissioning Committees 2 i.e. Managing conflicts of interest, Conflicts of Interest guidance and Code of Conduct guides 63

64 For Delegated Committees, a monthly journal will transfer costs of delegated functions to the CCG s ledger from NHSE, and the CCG will be responsible for their own reporting, and their own management accounting of their primary care costs. The CCG may also make further queries of NHSE, to support this process. Management accounting activities will likely include, but not be restricted to: Month end procedures Accruals, prepayments, and any payments additional to those in the financial plan The production of monthly & quarterly CCG management reports at GP practice or locality level to ensure robust financial forecasts and analyse variances to ensure they are explained Practice list size analysis by CCG locality for GM/system report downloads Quarterly forecasting on CQRS Additional year end tasks including working papers and support to AOB process Liaise with internal and external audit as required. 64

65 Figure 7: Process map showing financial processes Strategy and policy 65

66 66

67 2.4 Other potential Committee responsibilities In addition to the above standard processes, there are other Primary Care elements which the Committee is expected to be involved in. Some of these areas are listed below. Item Appeals and disputes Committee Requirement Responsible for agreeing a policy and procedure for managing appeals and disputes submitted by GPs in relation to their GP contract. Counter Fraud Ensuring that proper processes are in place to prevent fraud within the NHS Interpreting services Ensure that patients can interpret services when using GP practices Occupational Health The committee shall ensure that GPs have access to occupational health services in accordance with national guidance Controlled drugs The Committee is responsible for ensuring that practices are reporting complying with legal requirements for use of controlled drugs and that CCGs and NHSE have proper controls in place to maintain patient safety. The RT will carry out reporting, analysis and compliance that aids this. Safeguarding To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements, national guidance and Pan London Policy/ Procedures. The CCG will proactively support Primary Care to improve well-being of children and adults, providing assurance to NHSE, whose role it is to ensure compliance with safeguarding standards. Incident For both serious and non-serious incident management, the management Committee is responsible for ensuring that there are proper processes in place for the reporting and review of incidents, so that they can be identified and managed. The CCG and NHS E will support and contribute to investigations, as required. Domestic Homicide The Committee will ensure that GPs contribute to domestic Reviews homicide reviews, where necessary. The CCG and NHS E will support this where their resources are appropriate. Figure 8: Other potential Committee responsibilities 67

68 3. Governance and people 3.1 Committee constitution While much of the decision-making processes will be determined by Committees/ Joint Committees, the constitution of the Committees themes have been set by NHSE, as a condition of co-commissioning. The following are the criteria for a Committee (for Level Three co-commissioning), and for a Joint Committee (for Level Two co-commissioning). Level Two: Joint Committee Level Three: Delegated Committee Committee includes representation of both CCG and NHS England members and both bodies have equal voting representation* The Chair and Vice Chair of the committee are CCG Lay Members. There is a secretary, responsible for minutes, actions, the agenda, and reporting back Committee decisions to NHS England and CCGs; and these will also be publicly available on CCG websites Committee is made up entirely of CCG members (NHS England will not be members of the board). The Chair and Vice Chair of the committee are CCG Lay Members. There is a secretary, responsible for minutes, actions, the agenda, and reporting back Committee decisions to the CCGs. NHS England will also have access to the minutes etc from the board for assurance purposes, and all of these documents will also be publically available on CCG websites. Figure 9: Committee and Joint Committee constitution Other Committee attendees In the interests of transparency and the mitigation of conflicts of interest, a local HealthWatch representative and a local authority representative from the local Health and Wellbeing Board will have the right to join the joint committee as non-voting attendees. This will help to support alignment in decision making across the local health and social care system. 3.2 Committee resourcing There will not be a nationally-determined model of resourcing for co-commissioning, and there is a recognition of the additional workload these new ways of working will result in. We expect, therefore, local dialogue between CCGs and their area teams to determine how the Committees can access the existing primary care team support, recognising that 68

69 CCGs are taking on significant responsibilities from NHSE, and therefore will require access to a fair share of the area team s primary care commissioning staff resources Area teams need to retain a degree of this resource, in order to safely and effectively continue with their remaining responsibilities. Currently, there is no possibility of additional administrative resources from NHS England at this time, but this will be kept under review. 4. Processes & Capabilities 4.1 Meeting process: It is proposed that the method of operating the committee should follow processes already established in CCG s. The below illustrates a standard process for meeting setup: Length of meeting cycle, and regularity of meetings, to be defined by Committee/ Joint Committee Figure 10: Meeting process map Agenda contents It will be important for engagement between NHS England and CCGs ahead of meetings, particularly in cases where a particularly significant matter is on the agenda to be discussed. This may involve the need for additional meetings, or for information from NHS England to inform thinking. This will be particularly important for delegated commissioning, where NHS England will not be participating in the committee discussion. Each Committee should set out how this engagement will take place, as well as when, in the standard meeting process set out above (Figure 10), submissions will be accepted for discussion at each meeting. In general, clear and active engagement with NHS England, as well as the Committee sub groups, will help inform the content of the agenda we expect that agendas are likely to have the following components: Standard agenda items, which might involve items that can be expected at each meeting, such as an overview of finance and performance reports. Work-plan items, such as a review of the annual budget or developing a Primary Care Strategy, which is determined by the known upcoming work Any other items, which could include submissions from NHSE, sub groups, and the CCG. 69

70 There will also need to be a determination for whether part of the meeting needs to be in private. The process for determining the privacy of meetings is set out in 4.2, below. The schedule of Committee meetings in 2015/16 can be found in Annex Meeting in private: As standard, the Committee meetings will be held in public. However, the Committee may require to close part of the meeting on account of the matters to be discussed. It may be appropriate for the committee to seek the views of the audit chairs once a definition of this policy has been created for each committee. Below is some guidance which Committees may wish to consider: Whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings; or If the discussion is commercially sensitive; or Where the matter being discussed is part of an ongoing investigation; or For any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time. Otherwise, Members of the Committee shall respect confidentiality requirements as set out in the CCG Constitution and Standing Orders. 5. Annexes 5.1 Annex 1: London CCGs set out by level of co-commissioning Level 1: North central London (pending approval to move to level 2 on 1 st October 2015) Level 2: South West London (working as an SPG); South East London (working as an SPG); North West London (working as an SPG); Level 3: ; Tower Hamlets; Waltham Forest; Newham; Outer North East London/ BHR (working as an SPG) 5.2 Annex 2: on statutory framework and duties Arrangements made under section 13Z do not affect NHS England liability for exercising any of it functions, and in turn, CCG must comply with its statutory duties, and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); 70

71 c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2). Still subject to any directions and decisions made by NHSE or by the Secretary of State. 71

72 5.3 Annex 3: Detailed processes Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E 1. Determination of key decisions/ requests Determination to secure services through an APMS contract either a consequence of a practice vacancy, a finding that there are inadequate services in the area or following a contract expiration Procurement of new Services under APMS agreements To decide whether it is appropriate to undertake a procurement to appoint an APMS provider where there is a vacancy or a contract has expired. In making this decision the Committee must ensure that it is a viable and vfm service that will meet the needs of the current and future population, addresses inequalities, improves quality choice and access. The Committee is responsible for ensuring that appropriate engagement processes are in place to support decision making The Committee is responsible for approving a preferred provider following procurement process following the evaluation process To secure & provide, to the AT, local intelligence and feedback to support decision making. The CCG shall also provide relevant local strategic context to support decision making. The CCG may, if appropriate, agree additional resourcing for the service. To work jointly with the RT and local representative to identify new or alternative solutions to address the practice vacancy and additional local KPI requirements. The CCG is responsible for providing local standards and specifications to address local issues of access, quality and choice To secure & provide necessary information to support decision : - performance and service data; - equality impact assessment; - needs assessment; - available funding, including transitional funding; -service viability; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. To work jointly with the RT and local representative to identify new or alternative solutions to address the practice vacancy The RT shall develop and implement procurement policies & programmes aimed RT securing new APMS providers. Tasks: 1. Determine whether procurement is the best option in the interests of patients and the public and that no other options are viable to secure adequate services 2. Assure that correct processes have been followed, particularly in relation to patient and stakeholder engagement; 3. Confirm that the contract is affordable; 4. Confirm that the service is viable 5. Set tolerances for the cost and timeframe for implementation. 6. Ensure that an equality impact assessment has been undertaken 7. Ensure that the proposed procurement processes are undertaken in accordance with SFI's and regulations. Standard: Maintain a record of the decision, particularly in relation to potential conflicts of interest; Notify RT of decision with details of agreed funding and tolerances for implementation; Tasks: 1. Provide local intelligence to the RT to support their report: 2. Provide relevant information about local strategies to be included in the RT report: 3. Where necessary present paper to The Committee, with AT 4. Where appropriate, secure additional CCG funding to support a new service prior to the Committee's determination 5. Provide relevant specifications and data to support local KPI's. Standard: To provide relevant information to the RT within 15 WD's of the request. To ensure that the Committee has information to support their decision making, including confirmation of any funding the CCG intends to make available for the service. Tasks: Develop local standards and KPI's to be incorporated into APMS contracts. Support providers to ensure optimum delivery. Communicate with local stakeholders as required. Tasks: 1. Undertake required needs assessment, feasibility analysis, financial modelling and impact assessments to support the decision making process. 2. Implement an appropriate engagement plan. 3. Work jointly with the CCG to identify any local KPI's or other commissioning opportunities. 4. Identify and secure any additional resources required to support options. 5. Establish a procurement project team to implement the Committee's decision, if required. 6. To maintain and update a database of fixed term contracts. 7. To procure the service in accordance with directions, regulations and guidance. Standard: To process in accordance with regulatory requirements, Relevant SFI's and agreed procurement processes. Tasks: Develop London standards and KPI's to be incorporated in APMS Contracts. Standard: Use standard frameworks to secure services and ensure good value for money - Support providers to ensure optimum delivery. Standard: Procure APMS in line with the agreed commissioning strategy - Initiate formal procurement activity for each APMS scheme, within terms of any national procurement support. - Sign off/ finalise contracts with preferred bidder. - Agree/ implement the local mobilisation plan. - Undertake appropriate checks prior to service commencement (for example, premises inspection). - Make provision for emergency primary medical care services in the event of an unforeseen circumstance. Determination of a requests; - to close a branch practice; -for practice mergers; -PMS partnerships; -List Closures; -Rent Reviews To consider and determine requests in a timely manner following appropriate consultation and in accordance with statutory requirements and agreed policy; ensuring that any decision will secure continuity of services and provide benefits for patients and the public. The Committee will pay due considerations to Strategic imperatives and Statutory requirements to secure primary care services to meet the current and future needs of the population. To secure & provide, to the AT, local intelligence and feedback to support decision making. The CCG shall also provide relevant local strategic context to support decision making. To secure & provide necessary information to support decision: - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. Tasks: 1. Determine request; 2. Assure that correct processed have been followed, particularly in relation to patient and stakeholder engagement; 3. Provide minutes and decision rationale 4. Ensure continuity services as a consequence of their decision: 5. Maintain records of all decisions; 6. Respond to questions and queries relevant to the decision, including FOI requests.. Standard: Provide decision and rationale within 5 WD of the meeting: - Ensure that service continuity is not compromised as a consequence of their decision: - Ensure patient and public benefits are secured: - Acknowledge all queries within 5 WD offering full response within 20 WD: - Comply with FOI timescales Tasks: 1. Provide local intelligence to the RT to support their report: 2. Provide relevant information about local strategies to be included in the RT report: 3. Work jointly with RT to ensure patient benefit and service continuity; 4. Where necessary present paper to The Committee, with AT. Standard: All requested information to be provided within 10 WD: To make available relevant staff for meetings and case conferences pertinent to the decision Tasks: 1. Processing the application; 2. Engagement/consulation with stakeholders and patients; 3. Notifying the CCG and The Comittee secretariate ; 4. Preparing & presenting the report to the Comittee, using agreed format; 5. Issue decision letters/ notices; 6. Suport any practice closure using agreed protocol; 7. Updating databases and notifying 111 via CSU. Standard: To process in accordance with: - National & London SOP; - Regulations- Contract and Patient Public engagement 72

73 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E GP Practices list maintenance The Committee is responsible for decisions on any ad hoc list maintenance requests and for the setting of cleansing periods NHS England is responsible for coomissioning a process of practice list maintenance in accordance with national guidance as stated in Schedule 2 Part 1 Section of the Delegation Agreement and will liaise with NHS Shared Business services and any other external partner as part of that. Issue of Contract Breach Notice Contract Termination To determine whether a provider has breached the terms of their contract and to make a proportionate decision as to whether: -a remedial or breach notice is warranted; -the practice should be asked to submit a improvement plan; -no action is required under the circumstances. To review outcome of remediation /improvement plans. Determine the appropriateness of contract termination To identify & manage any resultation risk to services they commission as a consequence of an adverse finding. To provide support or facilitation for any relevant improvement plan/actions To identify & manage any resultation risk to services they commission as a consequence of an adverse finding. To provide support or facilitation for any relevant improvement plan/actions To investigate concerns and provide evidence where a contract has been breached together with any mitigation offered by the provider using an agreed London template: To implement decisions To investigate concerns and provide evidence where a contract has been breached together with any mitigation offered by the provider using an agreed London template: To implement decisions Tasks: 1. Review evidence and confirm that a contract has been breached; 2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation. Standard: Provide decision and rationale within 5 WD of the meeting: Ensure that service continuity is not compromised as a consequence of their decision: Ensure that there is a formal review of the outcome of all remediation and improvement plans. Tasks: 1. Review evidence and confirm that a contract has been breached; 2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation. Standard: Provide decision and rationale within 5 WD of the meeting: Ensure that service continuity is not compromised as a consequence of their decision: Ensure that there is a formal review of the outcome of all remediation and improvement plans. Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider.. Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider.. Standard: Tasks: 1. Identify concerns: 2. Investigate concerns: 3. Notify the provider of concerns and any evidence to support they have breached the contract: 4. Present evidence of the breach to the The Comittee along with any mitigation provided by the provider: 5. Issue notices to the provider: 6. follow up remedial actions /action plans 7. liaise with the CQC and carry out actions to support registration 8. Produce format for local notices and breaches. Standard: Contract Regulations; National SOP Local protocols Tasks: Develop contract termination documentation, systems and processes. - Prepare Reports and Evidence for the Committee, securing necessary legal advice. - Issue termination notices. - Develop action plans to manage termination of contracts and implement in consultation with and supported by stakeholders. Update the contractor database with sanction information. 73

74 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Contractual Payments The Committee is responsible for assuring that systems and processes are in place to ensure accurate and prompt payments to GP Practices in accordance with Contracts, Agreements, The SFE and SFI's The CCG is responsible for notifying the Committee of any systematiic failure to promptly pay GP Providers in accordance with the Contract / Agreements and SFE, setting out how this is to be addressed NHS E is responsible for notifying the Committee of any systematiic failure to promptly pay GP Providers in accordance with the Contract / Agreements and SFE, setting out how this is to be addressed Tasks: 1. Review evidence and confirm that a contract has been breached;2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation. Standard: Provide decision and rationale within 5 WD of the meeting:ensure that service continuity is not compromised as a consequence of their decision:ensure that there is a formal review of the outcome of all remediation and improvement plans. Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider. Tasks: - Agree appropriate contract variations (for example, list size changes) including their input to payment systems. - Calculate any agreed local quality and outcomes framework arrangement. - Calculate the impact of key performance indicators on contractual payments (alternative provider medical services contracts). - Determine entitlements to personal allowances (for example, seniority/ locum reimbursement). - Calculate and pay enhanced services that are specified nationally.- Calculate payments for GP registrars in respect of salary, mileage and travel grants. - Calculate prescribing and dispensing drug payments. - Calculate entitlements under the GP retainer/ GP returner and flexible career schemes.- Calculate payments in respect of the dispensary service quality scheme. Administer superannuation regulations, including all deductions, in relation to joiners, leavers, retirements, increased benefits, adjustments and pay these to the pensions division. - Administer and validate GP annual certificates. - Administer GP locum and GP- Solo contributions. - Provide the NHS pension assurance statement.- For suspended contractors, ascertain the individual s entitlements, advise the contractor, validate all documentation, and adjust payment accordingly. Disputes and Appeals The Committee is responsible for agreeing a policy and procedure for managing appeals and disputes submitted by GP's in relation to their GP Contract. This includes ensuring there is a local res.olution process and that a Panel is established to consider disputes and appeals where local resolution is not sucessful. Tasks: The Committee shall establish a Panel who will consider any appeal or dispute.. Standard: The Committee shall ensure that all decisions are made in accordance with the Contract Regulations,SFE, SOP and previous determinations. Tasks: The RT shall : 1. Ensure that contractors receive a clear and concise notice setting out any determination under the contract; 2. Implement local resolution where a contractor disputes a determination; 3. Where Local Resolution is not successful notify the Committee of the need to establish a Panel; 4. Provide a report to the Panel setting out their rationale and evidence in support of their decision; 5. Present evidence & representations to the Panel 6. Notify the contractor of the outcome; 7. Provide information as required by the Litigation authority in relation to any appeal 2. Financial processes Determine total budget requirements for all primary care services, including premises and information technology The Committee is responsible for ensuring that financial balance is secured and maintained. Under Delegated Arrangements the CCG CFO will approve the financial plan plus any in year revisions NHS E will carry out the day to day financial management tasks, including the production of monthly reports showing spending vs the agreed budget and variance analysis. NHSE will develop the annual fianncial plans within the region's allocaiton and overall PC plan, under the oversight of the CCG. Tasks: Ensure apprpriate financial controls are in place to securely manage the budgets.. Standard: Operates in accordance with NHSE or CCG SFIs. Tasks: Where CCGs have full delegation: a) Maintain control total for revenue and capital limits and agreement of RFTs b) Financial Planning & Reporting including monthly board report, external reports, financial plan submissions and in year review of plans, budget setting & team co-ordination, month end overview. non ISFE reports to region, QIPP reporting. Standard: Tasks: a) Maintain control total for revenue and capital limits and agreement of RFTs b) Financial Planning & Reporting including input to monthly board report, external reports, financial plan submissions and in year review of plans, budget setting & team co-ordination, month end overview. non ISFE reports to region, QIPP reporting. 74

75 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Management Accounts Financial systems and BI The Committee will: - review the financial reports; - Make decisions to address financial deficits; - Approve any payments additional to those in the financial plan The Committee shall assure that appropriate systems and SOPS are in place to manage and maintain financial control in line with the relevant financial instructions The CCG will scrutinise the financial reports prepared by the RT and will ensure that the appropriate decisions are brought to the attention of the Committee The CCG will ensure correct calculations and payments are carried out in line with the contracts by ensuring that the RT team provides has appropriate internal and external audit arrangements in place audit NHS E will provide appropriate monthly financial reports to enable budget holders to monitor and take decisions on the budgets, NHS England is responsible for the correct calculation of payments to all contractors in line with their contracts Tasks:. Standard: Tasks: Where CCGs have full delegation: The production of monthly & quarterly CCG management reports at GP practice or locality level to ensure robust financial forecasts and analyse varainces to ensure any variances are explained: Month end procedures a) complete regular task file b) variance analysis & narrative c) accruals & prepayments d) monthly year end forecasts at practice level or locality level and input to system e) meet with budget holders f) Practice list size analysis by CCG locality for GM/system report downloads g) Quarterly forecasting on CQRS(inform forecasting h) additional year end tasks including working papers and support to AOB process i) liaise with internal and external audit as required.. Standard: Tasks: Where CCGs have full delegation: Ensuring compliance with central requests and timelines and utilising their system and BI reports to best effect: a) Financial System Management including setting up new ISFE reports, locality reporting, controls, exception reporting liaison with with RT finance department.. Standard: Tasks: The production of monthly & quarterly management reports at GP practice or locality level to ensure robust financial forecasts and analyse varainces to ensure any variances are explained: Month end procedures a) complete regular task file b) variance analysis & narrative c) accruals & prepayments d) monthly year end forecasts RT practice level or locality level and input to system e) meet with budget holders f) Practice list size analysis by CCG locality for GM/system report downloads g) Quarterly forecasting on CQRS(inform forecasting h) additional year end tasks including working papers and support to AOB process i) liaise with internal and external audit. Standard: Tasks: Ensuring compliance with central requests and timelines and utilising the system and BI reports to best effect: a) Set up new suppliers or amend existing suppliers on ISFE e.g changes to bank account details, and to reflect practice mergers b) Financial System Management including setting up new reports, locality reporting to CCGs, controls, exception reporting d)liaison with SBS and central NHS England. Standard: 3. Strategy and policy Develop and agree a Primary Care Strategy (SPG) The Committee to: - approve strategy and, - provide oversight to development and implementation To contribute information & resources to: -support strategy development, -implement plans and strategies, - contribute resources to facilitate joint working To ensure primary care strategies are aligned to CCG strategies and plans To develop and implement engagement plans in line with primary care strategy. To contribute information & resources to: -support strategy development, -implement plans and strategies, - contribute resources to facilitate joint working To develop and implement engagement plans in line with primary care strategy. Standard: Engage and consult with key stakeholders, including patients, carers and the public in relation to priority areas for improvement,ensure that the London Specifications / Framework is integrated into Local CCG and SPG Strategies, Ensure that primary care is integrated into local joint strategic needs assessment planning processes, Integrate and align primary care strategies with health and well being strategies, Integrate and align primary care strategies with CCG and SPG strategies, particularly in relation to urgent care and collaborative care Primary Premises Plan /Strategy Workforce Audit and planning The Committee is responsible for reviewing and determining business cases for new premises developments in accordance with local CCG premises development plans, national guidance and primary care directions The Committee shall ensure that appropriate workforce audit and planning is place to support service delivery The CCG is responsible for developing local Strategies and Development Plans in conjunction with NHS E and NHS property holding organisations (Trusts, NHS PS and CHP) The CCG to undertake local audits as required The RT is responsible for providing information to CCG's and other organisations to support the development of strategic premises plans The RT shall implement the national workforce audit and is responsible for ensuring that all practices submit their return 75

76 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E GP Provider Development - Organisation Structures The Committee is responsible for determining responses to requests to close or merge practices To support the below : - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. The CCG will consult with local stakeholders to arrive at a final decision. To secure & provide necessary information to support decision : - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. Standard: The Committee shall ensure that all decisions in relation to mergers, closures and procurement support the London and Local aims for provider development Develop and agree outcome frameworks for GP Services The Committee shall agree an outcome framework for GPs services that enables continuous quality improvement and that it is aligned to national and local strategies. The framework shall be based on the national primary care GPOS and High performance indicators plus any local outcome and indicators set by the CCG The CCG shall make available performance against locally agred outcome and indicators required under the framework as required NHSE shall make available practice and CCG performance against national GPOS and High Level indicators via the Primary Care Web-Tool Tasks: The CCG developf a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data againt locally agreed outcomes and standards - Providing locally agreed performance reports Undertake Service reviews : LIS (or LES) Specifications. Standard: Tasks: The RT will support the development of a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data againt nationally agreed outcomes and standards - Providing nationally agreed performance reports on an annual or quaterly basis via the Primary Care Web Tool Undertake service reviews :GP Contracts, Advanced Services & DES. Standard: Planning PMS Review The Committee shall oversee the implementation of the national PMS review to ensure that all contracts are reviewed within the national timescales and that agreements are varied to reflect new prices and premium payments Delegated CCGs shall lead on the development and implementation of Local PMS Premium specifications and payments. NHS England shall be responsible for the PMS Programme for Greater Involvement (Level 1) and Joint Commissioning (Level 2) CCGs. They may also be asked to support the PMS review for delegated CCGs Tasks: The CCG developf a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data againt locally agreed outcomes and standards - Providing locally agreed performance reports Undertake Service reviews : LIS (or LES) Specifications. Tasks: Financial Review, contract review, engagement (public and stakeholder), implementation of agreement changes Securing Quality Improvement The Committee is responsible for review and approval of all Local Improvement Schemes (LES's). The Committee is responsible for review and approval of the use of APMS to secure quality improvement under collaborative arrangements The CCG will develop and lead the implementation of local schemes /Local Enhanced Services aimed at improving the quality in primary care. This will include development of clinical leadership and of peer support for practices. The RT shall make available information to support quality improvement, and will support the CCG in the implementation of local schemes. Tasks: Develop and implement local improvement schemes /Local Enhanced Services aimed at improving quality in primary care. -- Procurement and implementation of collaborative services aimed RT quality improvement under APMS arrangements. - Support and develop peer support for practices and practice staff. - Support and develop clinical leadership Standard: LCSF Tasks: The RT will incorporate any Local Incentive Schemes into the provider contracts as stated in Schedule 2 Part 1 Sections 2.11 The RT will negotiate, in partnership with clinical commissioning groups, quality improvement plan with each practice. Standard: Securing Directed Enhanced Provision The Committee shall review uptake and performance of all national DES and where necessary direct CCG's and AT's to take action to improve uptake or develop alternative local schemes To support implementation as directed within the specifications To support implementation as directed within the specifications. To provide information to the Committee on uptake and performance Tasks: The CCG shall support local implemenation and training as required under the national specification. Standard: Tasks: The RT will disseminate all national DES specifications to practices together with local implementation guidance and a sign up sheet in accordance with the national timetable/ MOU (KPI's). Standard: 76

77 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Securing Advanced Service Provision The Committee shall review uptake and performance of all additional service provision and where necessary direct CCG's and AT's to take action to improve uptake or develop alternative local schemes To provide information to the Committee about uptake and performance of non GP providers, making recommendations where additional services should be commissioned To provide information to the Committee about uptake and performance of GP (& Pharmacy) providers, making recommendations where additional services should be commissioned Tasks: Where necessary to direct the CCG or RT to take action to improve service provision. Standard: Tasks: Procure additional services from non GP providers where practices do not wish to undertake them. Standard: Tasks: Agree opt outs from the general medical services contract. Discuss locally the provision of additional services (where practices wish not to undertake them) with clinical commissioning groups. Standard: Development of Policies and Proceedures Contract Maintenance Quality Assurance GP Services The Committee shall approve all Local and endorse all London policies procedures in line with regulations The Committee shall ensure that the RT and CCG maintain all GP contracts in line with national and local variations and that systems are place to implement material changes The Committee will reiveiw reports to ensure GP's services are safe and meet all national and local standards. This will be monitored through an annual report on performance and the use of exception reports as required or as a result of a critical incident - Monitor activity on performers lists alongside practice performance data to generate a complete picture of quality The RT will be responsible for the carrying out of several responsibilities specifically highlighted in the Delegation Agreement, including: 1. Managing Contract Variations Schedule 2 Part 1 Section The RT shall report, by exception, any failure to properly maintain contract documentation and provide an action plan to address this oversight The RT will provide a regular quality report, based on the national framework to The Committee to support locality-wide quality assurance of primary care. This will include exception reports as required. Tasks: Support practices and performers in the achievement of their quality improvement plan. Standard: Tasks: Develop and maintain policies and procedures in line with regulations. Standard: Tasks: - Issue national standard contract variations in line with changes to regulations. - Produce and issue local contractor specific variations (including, partnership changes, relocations, and mergers). - Implement changes to relevant systems to contractor payments. - Raise contract variations which may have a significant impact on the delivery of patient services and finances with localities and commissioners. - Maintain the contractor data base, including hard copies of all signed contracts for primary care providers, pertinent to the geographical area covered by the local area team (including contract variations and breaches). Tasks: The RT shall, using the nationa GPOS, High Level indicators, practice E-Delarations & CQC reports: 1. Collate Compliance Reports 2. Assess practice performance from analysed data and identify priorities for further interrogation 3. Provide an Annual 4. Performance Report and any exception reports 4. Conduct contractual compliance and quality reviews, developing and agreeing action plans to address performance issues with contractors.. - Support each clinical commissioning group in the development of a primary medical care quality improvement strategy involving all practices. - The RT will support the CCG with information to establish any cause for concern and act accordingly, including a quality review where necessary and performance management arrangements for poorly performing practices, as set out in Schedule 2 Part 1 Section 6.2. In particular the RT will ensure that: 1. It maintains regular and effective colaboration withe the CQC and responds to CQC assessments as set out in Schedule 2 Part 1 Section / / Ensure and Monitor Practice remedial action plans as set out in Schedule 2 Part 1 Section Develop processes and systems to ensure fair, open and transparent decision making The CCG is responsible for implementing processes and systems as required by the Committee The RT is responsible for implementing processes and systems as required by the Committee 4. Other 77

78 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Counter fraud Collaborative Payments To ensure that proper processes are in place to prevent fraud within the NHS To ensure that processes are in place to make payments to GP practices To ensure that patients have access to interpreting services when using GP practices Implementation of the Deloitte Counter-Fraud service Tasks: Issue notification of stolen prescription forms or persons attempting to obtain drugs by deception, to GPs, pharmacists, counter fraud, drug squads and other interested parties. Tasks: Approve and process payments to practices. Interpreting Services FOI Dependant on source of information as to owner of FOI responsibility Tasks: To provide any information that the CCG holds about GP services as requested under the FOI act. Standard: Tasks: To provide any information that the RT holds about GP services as requested under the FOI act. Ocupational Health EPRR Implementation of Premises Directions Information sharing The Committee shall ensure that GP practices have access to occupational health services in accordance with national guidance The Committee shall ensure that the RT and CCG develop strategies and plans to respond to rising tides, major incidents and service failure. Approval of DV Rent Reviews, responding reimbursement appeals; Approval of discretionary payments for SDLT, Legal Fees and Development costs to practices; Procurement of Support for the Development of Strategic business cases; Aprroval of improvement grants; Approval of business cases for new premises / expansion; Approval of capital schemes; Approval of business cases for new premises /expansion The Committee is responsible for ensuring that information relevant to the assure the quality of primary care commissioning is shared in accordance with legislation and guidance. The CCG is responsible for making availabe any information required to assure the quality of primary care commissioning as provided within IG rules The RT shall bring to The Committee's attention as part of the regular reporting any matters requiring decision in relation to the Premises Cost Directions Functions (Schedule 2 Part 2 Section 7 and) including but not limited to: - new payments applications - existing payments revisions The RT is responsible for making availabe any reasonable and available information required to support primary care commissioning. Tasks: The CCG will respond to any requests from NHS England for relvant information to support the assurance of primary care commissioning.. Standard: Tasks: The CCG will respond to any requests from NHS England for relvant information to support the assurance of primary care commissioning.. Standard: Tasks: To secure contracts for OH; To make prompt payments under the contract. - Responding to local service disruption. - Responding to major service disruption. - Planning for major service disruption. - Flu Pandemic Planning. - Other Public Health Responses (e.g Ebola). - Issuing Communications to practices. Tasks: The RT will provide sufficient information to support The Committee's decision. Following decision from The Committee the RT is responsible for carrying out all subsequent payments (Delegation Agreement Section ). The RT must liaise where appropriate with NHS Property Services Ltd., Community Health Partnerships Ltd and NHS Shared Business Services. Standard: Tasks: The RT will respond to any requests from NHS England around information sharing as specified and will be responsible for auditing and ensuring that providers accurately record and report information as set out in Schedule 2 Part 1 Section Standard: Controlled drugs reporting The Committee is responsible for ensuring that practices are complying with legal requirements for use of controlled drugs and CCGs and NHSE have proper controls in place to maintain patient safety The RT will carry out any reporting, analysis, complance or investigations involving controlled drugs as specified in Schedule 3 Section 8.5 Tasks: The CCG shall 1. Analyse prescribing data available as set out in Schedule 3 section Complete the periodic self assessments / self declarations as set out in Schedule 3 Section Report all incidents and other concerns to NHS Englands CDAO as set out by Schedule 3 Section Tasks: The RT will support The Committee to comply with its obligations under Controlled Drugs regulations by: 1. Reporting all complaints as set out by Schedule 3 Section

79 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Safeguarding children To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements and national guidance and Pan London Policy and Procedures. Ensure appropriate response from primary care to safeguarding enquiries and serious case reviews (including approval of IMRs) Support and facilitate Primary Care to proactivley improve the safety and well being of children registered within the practice setting, providing assurance to NHSE that practices are compliant with safeguarding standards. To monitor and review compliance with safeguarding standards Tasks: The RT will ensure that: 1. GP Contracts include requirements for safeguarding; and 2. GP practices annually declare compliance; The RT shall provide representation at the LSCB. The RT shall approve GP IMRs. Standard: Safeguarding adult To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements, national guidance and Pan London Policy and Procedures Ensure appropriate response from primary care to safeguarding enquiries and serious case reviews (including approval of IMRs) Support and facilitate Primary Care to proactivley improve the safety and well being of those adults most vulnerable registered within the practice setting, providing assurance to NHSE that practices are compliant with safeguarding standards. To monitor and review compliance with safeguarding standards Tasks: The RT will ensure that: 1. GP Contracts include requirements for safeguarding; and 2. GP practices annually declare compliance; The RT shall approve GP IMRs. Assure primary care relating to safeguarding and MCA awareness, including oversight of training compliance.. Ensure primary care adheres to the pan london policy for safeguarding adults. Representation at LSAB to provide assurance to board around primary care services.. Assure primary care relating to safeguarding and MCA awareness, including oversight of training compliance.. Ensure primary care adheres to the pan london policy for safeguarding adults. Domestic homicide Ensure that GPs contribute to domestic homicide reviews where relevant and where necessary take action to remedy any oversight. To support practices in undertaking DHR where resources are held by the CCG To support practices in undertaking DHR where resources are not held by the CCG Tasks: Provide funding and advice where resources are not held by the CCG Provide representation at DHR Panels. Serious incidents Incident management The Committee shall processes are in place to report and review incidents so that serious incidents can be identified and managed. This includes reviewing the outcome of SI investigations and where necessary make recommendations to improve patient safety The Committee shall ensure that there are proper processes in place for GP practices to report incident (subject to a national review) and shall review reports on incidents at least once annually or where necessary by exception. The Committee shall make recommendations where necessary as a consequence on incident reports To support and contribute to investigations To support and contribute to investigations To support and contribute to investigations. To monitor compliance To support and contribute to investigations. To monitor compliance Tasks: The RT will ensure that: 1. GP Contracts include requirements for reporting incidents; and 2. GP practices annually declare compliance; - Provide Advice and guidance to primary care practitioners and practice staff who wish to report an incident; Co-ordinate SI case management, including evaluation of final report; Liaison with NHS England Performance and Revalidation team regarding performance concerns. Tasks: The RT will ensure that: 1. GP Contracts include requirements for incident management; and 2. GP practices annually declare compliance; Regularly log into the NRLS site to access any eforms (reported incidents); Ensure reported incidents are assessed to determine if SIs and manage accordingly; Provide expert guidance on NRLS form/function. 79

80 Responsibilities Tasks/ Standard Definition The Committee CCG NHS E The Committee CCG NHS E Central Alerting System (CAS) Alerts The Committee shall ensure that processes are in place to ensure that CAS alerts are dessimated in accordance with guidance. To monitor compliance Tasks: The RT will ensure that: 1. GP Contracts include requirements for incident management; and 2. GP practices annually declare compliance; Regularly log into the NRLS site to access any eforms (reported incidents); Ensure reported incidents are assessed to determine if SIs and manage accordingly; Provide expert guidance on NRLS form/function. Engagement and Consultation The Committee shall ensure that all parties comply with statutory requirements to consult and engage with stakeholders. This is includes reporting to Local OSC, Healthwatch and HWB For undertaking local engagement Engagement related to strategic planning Engagement linked to chnages in urgent care or LES Engagement and consultation associated with changes to GP services, including: -closures, - premises development, - mergers Tasks: Consultation with LMC Presentations to OSC. HWB and Healthwatch Notification letters to patients Consultation letters to patients and stakeholders. 80

81 5.4 Annex 4 Primary Care Infrastructure Fund (PCIF) bids a model approval and prioritisation process Summary Bids against the PCIF fund are due to be returned to NHS England by 16 th Feb There is a very tight programme for regional teams to sift and assess the bids and recommend support against the agreed assessment criteria in time for a ministerial announcement on the use of the initial 250m during March Each NHS England sub-regional team will ensure that they have a robust process in place that enables them to collate and review bids and provide a recommendation to their regional team. The regional director, supported by a member of the NHS England Project Appraisal Unit, will decide which bids will be supported and will allocate each bid to one of four categories: Supported as a priority investment in 2015/16 Supported subject to clarification of specific issues but deliverable in 2015/16 Supported in principle but subject to further work up and submission against the 2016/17 PCIF Not supported Regions will produce a brief summary of the bid and submit this report to the national panel by 4 March Funds will be allocated to each region so that decisions about bids can be made in regions under the terms of their delegated authority. Process The process described here outlines a methodology that is supported by the national project team as one that will provide the necessary assurance whilst aligning to existing governance regimes. Regions may flex this methodology to align with their own existing processes whilst ensuring that they continue to work within the confines of their delegated authority. There are nationally agreed approval criteria that are provided as part of the PCIF toolkit. There will be a concentration of work within a very short period of time to collate, analyse and recommend support for the PCIF bids received by the sub-regional teams from the national programme team whilst recognising that there will also be a cross over between the criteria for qualification for the PCIF, the Prime Minister s Challenge Fund (PMCF) and the general NHS England capital programme. To enable that, and the ongoing project management of the PCIF to work effectively, it is recommended that local teams consider the procurement of a programme management resource for receiving, collating, recording and managing the whole process, including providing relevant professional premises advice to validate reliability of cost and specification of bids. This resource will be critical to the success of the programme. The flow diagram attached (Figure 1) describes how the process from receipt of bid to scheme completion is managed. The flow diagram attached (Figure 2) describes the process as recommended in the draft primary care infrastructure Principles of Best Practice 81

82 document (PoBP) for local determination of business as usual (BAU) schemes submitted as PIDs, improvement grants or business cases. The PoBP (currently in draft awaiting publication) recommends a primary care screening panel, accountable to the sub-regional team s business case and capital investment pipeline group (or equivalent title), to be set up and take responsibility for assessing and assuring all schemes presented to the sub-regional/regional team, including those supported by improvement grant applications, PIDs, and business cases (see figure 2). The principle described in this draft including the membership and responsibility assigned to the screening panel can be used to form a local sub-regional/regional panel to review the PCIF bids and recommend support to the regional team based on the approval criteria issued by the national team. The membership of the PCIF screening panel can be flexed to suit local arrangements but the suggested membership will include a senior primary care manager, a senior finance officer, a professional premises adviser and relevant representatives from CCGs. The screening panel can call upon other colleagues as necessary to support its work. This may include an invitation to a representative officer of the Local Medical Committee (LMC). For the purposes of managing the PCIF timelines, it is recommended that LMCs are invited to a meeting in advance of the PCIF screening panel meeting in order to share the scope of the bids that have been submitted and to the process by which bids are being assessed. The intention behind this meeting will be to demonstrate that the process that the Regional or sub-regional offices have used are fair and transparent. It is expected that the regional team will perform the necessary assurance against the national criteria and confirm their support for the bids with assistance and support for this part of the process by a member of the NHS England Project Appraisal Unit. Bids, sorted into the four categories identified above and endorsed by the regional team, are to be forwarded to the national panel by 4 th March The national programme team will review and assess those returns and use the information to reconcile to the original allocation of funds to regions/sub-regions. At this point a local assurance process will be followed for those bids that require further development. A suggested regional BAU process is described in Figure 2. This may include reaffirming alignment with strategic estates and service plans and determining what further work is required to move the bid into an approvable form. Following the national programme team s assessment, improvement grant requests that comply with the NHS (GMS Premises Costs) Directions 2013 may be approved by the regional/sub-regional team on recommendation from the screening panel. The pipeline group will be responsible for further assurance and recommendation for approval and prioritisation by the regional team for significant grant or investment proposals via its established approval structures. It should be noted that proposals that are commissioner led, require capital other than that allowed under the Premises Costs Directions, (for example bullet payments into otherwise revenue funded schemes, or improvement grants in excess of 66% of total cost) or require CHP or NHSPS commitments will require approval from the NHS England central team. 82

83 Figure 2 Suggested BAU investment assurance and governance process for regional/sub-regional teams (Based on the process identified in draft Primary Care infrastructure Principles of Best Practice) Suggested Membership ToRs OBC/FBC GP PID Improvement Grants PID (NHSE) Scheme proposals/bids Strategic finance manager Management and updating of pipeline with all known bids, schemes etc ensuring clarity of owner/sponsor PM support Pipeline management All schemes Pipeline of schemes for info PM support Regional screening panel governance and assurance process Chaired by Head of primary care, finance manager, PCC, professional advisor, relevant CCG. Input from LMC as required Strategic fit of primary care element, assurance of schemes, recommendation for approval of IGs to regional team - PIDs and BCs to Pipeline Group PIDs and BCs Regional Pipeline Group Chaired by finance lead, PAU, CHP,NHSPS, relevant head of primary care, scheme owners. Assurance of process, recommendation for further specific work, recommend approval of PIDs, capital grants, BCs to regional team Improvement Grants PIDs and BCs Regional Team decision Chaired by DoF, May include PAU, Regional Team directors, senior primary care regional lead, owners Approval of IG, and PIDs, GPBCs within delegated authority. Recommendation for approval for schemes requiring national oversight Schemes allowing local approval Schemes requiring national approval Notification of decision Central team signoff NHS England Board, IC or DoF depending on value Approval for schemes requiring national oversight Scheme Owner Notification of decision 83

84 5.5 Annex 5: Standard report formats List closure REQUEST TO CLOSE PATIENT LIST Practice Name and address Contract (GMS/PMS) GMS Raw list size 4950 (April 14) CCG Area Ealing Date Application made: Report template completed by Initial application received June Commissioning Manager worked with practice to help find solutions. Update application was received in July and August B Johnson Area team Date completed North West London 26 August 2014 Assessment Criteria 1. Reasons for applying to close practice s register to new registration. 2. What options have the practice considered, rejected or implemented to relieve the difficulties they have encountered about their open list and, if any were implemented? Details of success in reducing or erasing such difficulties? 3. Has the practice had any discussions with their registered patients about their difficulties in maintaining an open list? If yes, practice to provide a summary of same, including whether registered patients thought the list of patients should or should not be closed. 4. Has the practice spoken with other contractors in the practice area concerning their difficulties maintaining an open list? If yes, practice to provide a summary of same of discussions, Guidance Notes/Evidence that needs to be attached Application to close practice list template completed by contractor. Presentation of Case 84

85 including whether other contractors thought the list of patients should or should not be closed? 5. How long does the practice wish their list of patients to be closed? (This period must be more than three months and less than 12 months). 6. What reasonable support does the practice consider the AT would be able to offer, which would enable the list of patients to remain open or the period of proposed closure to be minimised? What plans does the practice have to alleviate the difficulties they are experiencing in maintaining an open list, which you could be implemented when the list of patients is closed, so that list could reopen at the end of the proposed closure period? Does the practice have any other information to bring to the attention of the AT about this application? AT recommendation to the Panel Date of PCC Decision Making Group (DMG) Feedback from PCC DMG Panel Members: Mergers between practices Outcome: Approved / Approved with Conditions/ Rejected London Area Teams Criteria for considering a request for Practice Merger Practice Name & Address (1) Practice Name & Address(2) Contract GMS E87067 Contract GMS E87699 Raw list size 01/07/ Raw list size 01/07/ Borough CCG area - West London Borough CCG area West London Date Application made: 20/08/2014 Area team North West London Report template completed Rachel Ryan Date completed 22/09/

86 by The Principles of Cooperation and Competition 2010 were replaced by the NHS Procurement, Patient Choice and Competition Regulations Monitor acts as the Regulator since Principle 10 of the earlier document stated: Mergers including vertical integration between providers are permissible when there remains sufficient choice and competition or where they are otherwise in patients or taxpayers interests for example because they will deliver significant improvements in the quality of care. This is not written succinctly in the 2013 Regulations but an overarching guide suggests that the individual components are all still relevant within the full 76 page guide Assessment Criteria Background in respect of each of the practices Guidance Notes/Evidence that needs to be attached Include relevant background number of clinical providers and support staff, teaching practice, opening hours, distance between sites Presentation of Case Information about local demography What are the strategic benefits of agreeing a merger and do they meet the criteria set out above Performance of the individual Contractors within each practice Practice performance Include - Information about local practices - Geographical location and distance - Would a merger result in significant reduction in patient choice For example - Services provided from one fit for purpose site in either the short or long term - Longer opening hours - Access to a wider range of services - Within easy reach - Financial savings as a result of the merger - Improved IT access - Improved workforce capability Are any providers linked to the existing Contracts voluntarily not working, suspended by the GMC or NHS England, or unable to work by virtue of Bail conditions. Evidence should include information for the past three years in relation to - QOF - GPOS /GPHLI performance - Contractual sanctions And, where applicable, evidence that action plans are in place and Existing patients access to single service including consistent provision across: Home visits; booking appointments; additional & enhanced hours: opening hours; extended hours; single IT & phone system; premises facilities: (Amended for brevity) No 86

87 Will the merger result in services being provided from premises that are fit for purpose in accordance with minimum standards set out in 2013 GMS Premises Costs Directions, or that have a Business Plan to achieve within no more than 12 months Has specified a clear plan of service improvements that will arise as a result of the merger What is the CCG s view of the proposed merger? AT recommendation to the Panel (will be subject to patient engagement) being actioned Feedback from NHS choices Provide available information about the premises and any commitments made by the Contractor to address outstanding issues within the required timeframe. Outcome of infection control visit and outcome of CQC inspection if either or both have been undertaken. A business case should be supplied by the practice that sets out their future plans. At the minimum this should include a commitment that GP premises and phone lines will be open throughout core hours Include both the primary care lead and the IT lead (if applicable) in the discussion. Any other relevant information not included elsewhere e.g. proposed start date patient engagement proposals Date of PCC Decision Making Group (DMG) Feedback from PCC DMG: Please insert 29/09/2014 Outcome: Please delete as appropriate Approved / Approved with Conditions/ Rejected Panel Members: Please insert 87

88 Contract termination e.g. Death/ Bankruptcy/ CQC BRIEFING TITLE XX Medical Practice TO: DMG DATE: 6/3/2015 AUTHOR: Purpose To brief the DMG on the current position regarding the bankruptcy of XX and the actions taken. Background Comments: Current status Next Steps Recommendation 88

89 Changes to Contract Signatories London Area Teams Single Handed PMS Practices - Criteria for allowing an additional clinical Contract signatory Practice Name Single Handed PMS Provider s name Date Application made: Report template completed by Date of PCC Decision Making Group (DMG) Panel Members: Raw list size CCG Area team Date completed Outcome: Approved / Approved with Conditions/ Rejected All of the following criteria will need to be met for the application to be approved: Assessment Criteria There is a strategic need for the practice to be retained, from an AT & CCG perspective Performance of the single handed Contractor does not give cause for concern. Practice performance does not give cause for concern Has premises that are fit for purpose in accordance with minimum standards set out in 2013 GMS Premises Costs Directions, or has Business Plan to achieve within no more than 12 months Has specified a clear plan of service improvements that Guidance Notes/Evidence that needs to be attached Include relevant background number of wte providers, teaching practice, local demography, has this practice had multiple Contract signatories in the past. Evidence of feedback from the CCG Detail the links to the primary care strategic direction locally e.g. information about relationship with local practices, new developments, engagement with CCG priorities If any provider linked to the Contract is voluntarily not working, suspended by the GMC or NHS England, or unable to work by virtue of Bail conditions this would automatically give cause for concern. Evidence should include information for the past three years in relation to - QOF - GPOS /GPHLI performance - Contractual sanctions And, where applicable, evidence that action plans are in place and being actioned Feedback from NHS choices Provide available information about the premises and any commitments made by the Contractor to address outstanding issues within the required timeframe. Outcome of infection control visit and outcome of CQC inspection if either or both have been undertaken. A business case should be supplied by the practice that sets out their future plans. (It is not expected that an Presentation of Case 89

90 will arise as a result of changes in numbers of partners Has a list size that can demonstrably sustain proposed WTE extra partner increase, CV of proposed new provider does not give commissioners cause for concern AT recommendation to the Panel application which facilitates 24 hour retirement of the Contractor will meet the criteria) At the minimum this should include a commitment that GP premises and phone lines will be open throughout core hours The business case should demonstrate this. (This would typically be patients) The CV should be attached. If the proposed new provider is not yet known it is possible to approve the request subject to review of the CV prior to final approval. Any other relevant information not included elsewhere Application approved* Application approved subject to following conditions* Application rejected * PCC DMG TO INCLUDE CONDITIONS PCC DMG TO INCLUDE REASONS WHY 90

91 Contractual Issues of Concern London Area Teams Request for PCC DMG to consider a contractual issue of concern and to make recommendations Practice Name Weighted list size Contract Type Report template completed by Date of PCC Decision Making Group (DMG) Panel Members: Raw list size CCG Area team Date completed Outcome: Issue for consideration: Include current position, relevant background information and recommendations for consideration Relevant background information to support the decision making process Include relevant background number of wte providers, teaching practice, local demography, has this practice had multiple Contract signatories in the past. Evidence of feedback from the CCG Detail the links to the primary care strategic direction locally e.g. information about relationship with local practices, new developments, engagement with CCG priorities If any provider linked to the Contract is voluntarily not working, suspended by the GMC or NHS England, or unable to work by virtue of Bail conditions this would automatically give cause for concern. Evidence should include information for the past three years in relation to - QOF - GPOS /GPHLI performance 91

92 - Contractual sanctions And, where applicable, evidence that action plans are in place and being actioned Feedback from NHS choices Provide available information about the premises and any commitments made by the Contractor to address outstanding issues within the required timeframe. Outcome of infection control visit and outcome of CQC inspection if either or both have been undertaken. Any other relevant information not included elsewhere Recommendations made by the PCC DMG 92

93 Request to issue breach over quality Date: 1. Contractor type General Practice Community Dentist Community Pharmacist Community Optometrist General Practice 2. Area 3. Practice code 4. Practice Name 5. Name/position of lead officer 6. Permission being sought Issue of remedial breach notice 7. Local Resolution LMC involvement Yes 93

94 8. Summary of case for issuing notice 9. Name/position of determining officer 10. Permission to proceed Yes No 11. Determining officer s comments 12. Date of determination 13. Signed 94

95 Local Improvement Schemes Local Improvement Scheme: NHS England Assessment Template The template should be submitted with the full specification. Title of scheme CCG name CCG to complete for each LIS scheme NHS England to complete at the point of assessment Named Commissioner Status of CCG Approval of Scheme Either 1. Approved by CCG subject to NHS England approval 2. Draft yet to be considered by CCG Governance structure Has the CCG consulted with the LMC? NB. NHS England cannot approve schemes unless the LMC has reviewed and commented What was the outcome of LMC engagement? Does the Scheme fit strategic and/or commissioning priorities of CCG? CCGs need to specify the link to their primary care strategic priorities. CCGs should specify whether the scheme supports improvement in the quality of primary medical care services under the following categories? 1. Reducing variation in quality 2. Improving quality 3. Undertaking clinical audit 4. Peer review 5. Other Does the scheme have clear, measurable processes and/or clinical outcomes? NB. These need to be articulated 95

96 clearly and process outcomes should show how progress will be tracked against milestones throughout the year in order to demonstrate how the expected outcomes will be achieved. Is the scheme rewarding outcomes? NB. NHS England cannot approve schemes that do not reward outcomes. Is there any overlap with what is paid for under the Primary Medical Care Contract, DES, QOF? NB NHS England cannot approve duplicate payments but there will be situations where a LIS scheme is paying for work in excess of existing arrangements What are the proposed Contractual arrangements? e.g. SLA, Letters of Intent, National Contract (not mandated) What is the total financial value of the scheme? What is the payment structure? NB. Itt is expected that there will be a payment that is only realised on achievement of key deliverables. i.e. not all of the payment will be made up front What are the arrangements if outcomes are not achieved? e.g. Clawbacks or no achievement payment released Is participation in the scheme optional or mandatory for CCG member practices? If other scenarios apply, please specify FOR NHS ENGLAND USE ONLY Does remuneration and pricing model appear reasonable (when compared with specification requirements)? Assessor recommendation to the PCC Decision Making Group (PCC DMG) 96

97 Comments/Feedback following the PCC DMG Assessor recommendation to the PCC Decision Making Group Approved by NHS England: Yes/No: Date CCG Informed: Yes/No: Date Deputy Head of Primary Care for Relevant CCG Area is responsible for arranging feedback to lead CCG Commissioner 97

98 5.6 Annex 6: Year Plan: Meeting frequency Agreed meeting/ Apr 15 May Jun report frequency Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 North Central London Committee/ Joint Committee meeting schedule City and Hackney North West London South West London South East London Tower Hamlets (WEL) Waltham Forest (WEL) Newham (WEL) WEL BHR Monthly TBC Monthly Monthly Monthly Monthly Quarterly Monthly * Likely to be cancelled due to low attendance 21 st May 20 th Aug* 17 th Sep 2 nd June 6 th Aug 15 th Oct 28 th Apr 26 th May 23th Jun 28 th Jul 25 th Aug 22th Sep 27 th Oct 24 th Nov 22th Dec 5 th Jan 6 th May 3 rd Jun 8 th July 5 th Aug 2 nd Sep 7 th Oct 4 th Nov 2 nd Dec 6 th Jan 3 rd Feb 2 nd Mar 14 th May 1 st week 5 th Aug* 5 th Sep 98

99 Key Planned meeting Forecast meeting 99

100 Annex 7 Changing co-commissioning arrangement after 1 April 2015 This section sets out the process for changing a co-commissioning arrangement from 2015/16. This includes the approvals process and timeline. CCGs are at different stages of their developmental journey and are facing a variety of local challenges. Therefore it is likely that the appetite to take on further responsibilities for primary care co-commissioning will vary across the country. We want CCGs to be able to move at their own pace, whilst also indicating that we see co-commissioning as a needful development towards mitigating current health inequalities and securing better integrated, more easily accessed, high quality care for patients. We expect that many CCGs entering into joint commissioning arrangements for 2015/16 may decide to take on delegated responsibilities for 2016/17. The process for changing levels of co-commissioning is as follows (as of July 2015): CCGs who are currently at Level 1 (Greater Involvement) are able to apply to move to Level 2 (Joint Commissioning) quarterly. CCGs should reach out to discuss this with regional teams if they would like to enact this. The proposed dates for applications for joint commissioning are: o 1 July 2015 o 1 October 2015 o 1 January 2016 o 1 April 2016 CCGs who would like to apply for Level 3 (Delegated Commissioning) in 2016/17 will need to apply on the 2 October Their applications will be considered by Regional and National teams in the below order o Regions will work with CCGs prior to submission to provide the necessary documentation o Regional panels will take place to make recommendations to National teams o National moderation will be provided by the Primary Care Oversight Group (PCOG) the week commencing 19 October 2015 o Approvals will be made by the Executive Scrutiny Group week ending 6 th November 2015 CCGs currently at Levels 3 are able to terminate their agreement with effect from midnight on 31 March in any calendar year provided that o On or before 30 th September of the previous calendar year, the CCG sends written notice to NHS England of its requirement that NHS England revoke the Delegation and intention to terminate this Agreement; and o The CCG meets with NHS England within ten (10) Operational days of NHS England receiving the notice set out above to discuss arrangement for termination and transition of delegated functions to a successor commissioner 100

101 Primary Care Contracting Standard Operating Procedures Overview 6 th August

102 Contents 1 NHS England Standard Operating Procedures (SOPs) overview 2 SOPs Summary 3 SOPs Summary 4 NHS England London Region interim policies 5 Contract support and Changes 6 Key Contract changes in Directed Enhanced Services (DES)

103 NHS England Standard Operating Procedures (SOPs) NHS England commissioned Primary Care Commissioning (PCC) to develop a comprehensive suite of policies and procedures for the future management of all four primary care contractor groups. All policies have been developed in line with current regulations and legislation. Electronic copies of all policies and procedures can be found on the NHS England website. This briefing summarises the policies and procedures to support the primary medical contractor area, all of which come under gateway reference 00013(s). 103

104 National SOPs Summary Assurance Assurance framework - outlines the approach, based on securing excellence principles, to be taken by NHS England when managing primary medical care contracts to ensure compliance with quality standards. Guidance to support delivery of the primary medical care assurance framework it provides an outline for assessing general practice through the normal contractual framework, sets out an approach to working with GP contractors and provides a guide to managing these where there is a potential or actual breach of contract. Contractual Management Managing contract breaches, sanctions and terminations - provides area teams with the processes to be undertaken to ensure a consistent approach is taken when a contract is considered to have been breached and when either contractual party are seeking to move to terminate the contract. Managing regulatory and contract variations the policy describes the process to determine any contract variation, whether by mutual agreement or required by regulatory amendments, to ensure that any changes reflect and comply with national regulations so as to maintain robust contracts. 104

105 National SOPs Summary Contractual management (continued ) Managing the end of time limited contracts the policy outlines the consistent and proportionate approach to be taken by area teams when a time-limited medical services contract is coming to an end and includes a timescale for management of consultation, re-commissioning or procurements leading up to the natural end date of a contract. Managing a PMS contractors right to a GMS contract the policy outlines the approach to be taken when a personal medical services (PMS) agreement holder exercises their right to a general medical services (GMS) contract in accordance with the PMS regulations Operational Branch closure Closed lists Death of a contractor List inflation Patient assignment Dispute resolution Framework for responding to CQC inspections of GP practices Joint - joint policies are those which cover two of more of the primary care contract areas, namely medical, dental, eye care and pharmaceutical services

106 NHS England London Region Interim Policies These policies have been developed for the London Region in line with current legislation and guidelines. Premises SOP for developing Business Cases for primary care premises infrastructure which will assists discussions between contractors, NHS England, clinical commissioning groups, local authorities and other key stakeholders at project initiation document (PID) stage on what overall additional facilities space may be required in addition to the schedule space when planning the development of new or refurbishment of existing primary, community and social care premises. Discretionary Funding (National policy is currently being updated) to address payments for GP cover for parental leave. Patient Registration Pan-London Standard Operating Principles Agree a consistent approach across London to clarify, simplify and standardise the patient registration process for practices and patients Embed best practice approaches across all provider organisations Ensure fairness, equity and transparency in the way general practice services are delivered across London Congestion Charging - Process for claiming reimbursement of eligible Congestion Charging or GPs, Pharmacists, practice staff and agency contractors. These policies have previously been shared with GP Contractors and also available on request from the London Regional Team 106

107 Contract support National Reporting and Learning System (NRLS) A guide has been produced for staff working in general practice as an introduction to the National Reporting and Learning System (NRLS), the NHS national database of patient safety incidents. It also introduced a new e-form developed by the NHS England Patient Safety Domain specifically to make it quick and easy for general practice staff to report a patient safety incident. GMS Contract Changes In September 2014, NHS Employers (on behalf of NHS England) and the General Practitioners Committee (GPC) of the British Medical Association (BMA) announced the agreed changes to the General Medical Services (GMS) contract for 2015/16. The full guidance is available on the NHS Employers website 107

108 Key Contract Changes for GMS, PMS, AMS contracts in The following key contract changes are noted for your information: Named accountable GP for all Patients Publication of GP Net Earnings Seniority Assurance of Out of Hours Provision Changes to registration to reflect armed forces health requirements Payment for GP cover for parental leave Alcohol related risk reduction Patient participation Patient online access 108

109 Directed Enhanced Services (DES) Extended hours access Facilitating timely diagnosis and support for people with dementia Learning disabilities health check scheme Proactive Care Programme - Avoiding Unplanned Admissions: proactive case finding and patient review for vulnerable people Minor Surgery (London Region) These are all nationally commissioned services 109

110 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 ENCLOSURE E Decisions made by NHS England (London Region) Primary Care Commissioning Decision Making Group prior to establishment of Primary Care Joint Committees (April to July 2015) AUTHORS: Sharon Fernandez, Assistant Head of Primary Care, GP and Pharmacy Lambeth, Southwark and Lewisham - NHS England (London Region) Gary Beard, Assistant Head of Primary Care, GP and Pharmacy Bexley, Bromley and Greenwich - NHS England (London Region) SUMMARY: Between April and July 2015 NHS Bromley CCG and NHS Lewisham CCG submitted Local Improvement Schemes for review and agreement by NHS England having completed all governance and related requirements of their organisations. The requirements, monitoring arrangements, payments and expected outcomes for both schemes were reviewed and approved and are listed below: Bromley Medicines Management Local Incentive Scheme 2015/16 for 150,000 was approved on 11 May 2015 Lewisham Prescribing Quality Incentive Scheme 2015/16 for 60,000 was approved on 16 July 2015 KEY ISSUES: None 110

111 RECOMMENDATIONS: The committee is asked to note the decisions outlined that have been undertaken in discussion with local CCG Commissioners. NHS England / CCG CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) jill.webb3@nhs.net AUTHOR CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) jill.webb3@nhs.net 111

112 Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 ENCLOSURE F Locum Reimbursements under London s Discretionary Funding Standard Operating Procedure (SOP)between April and July 2015 AUTHOR: Sharon Fernandez, Assistant Head of Primary Care, GP and Pharmacy Lambeth, Southwark and Lewisham - NHS England (London Region) Gary Beard, Assistant Head of Primary Care, GP and Pharmacy Bexley, Bromley and Greenwich - NHS England (London Region) SUMMARY: This brief report is supported by the attached spread sheet detailing thedecisions that have been taken on applications for locum reimbursements and the consequent level of commitments since 1 April A notional allocation of 916k for South East London has been calculated based on the 2014/15 final out-turn of locum reimbursements for London, which has then been allocated at CCG level on a weighted population basis. Notional allocations for level 3 CCGs have also been calculated and delegated on this basis. The SOP includes payments formaternity, paternity, adoption & sickness leave, doctors suspended from the performers list & prolonged study leave. The claims received between April and July 2015 amount to 258k. Whilst this appears to be an underspend against the 916k notional budget at the month four stage, it should be noted that there are gaps in the spreadsheet where claims relating to July 2015 had not yet been received. 112

113 Budget/Spend to date information is as follows: Budget for Locum Fees - South East London Budget is based on the final outturn for south London then allocated to CCG by weighted population GMS PMS APMS Total Spend to Date Bexley 9,198 99,041 2, ,549 34,077 Greenwich 1, ,880 10, ,691 23,767 Bromley 57,871 97,555 5, ,664 15,461 Lambeth 8, ,069 22, ,558 15,082 Southwark 6, ,258 16, ,406 21,395 Lewisham 9, ,449 2, , ,698 SEL 93, ,252 59, , ,480 KEY ISSUES: Applications that are received over the course of one year will have no bearing on the following year, as approved reimbursement reflects primarily unplanned events. This is one of the reasons why the budget has been managed on a London wide basis in order to manage the predictable variations across London. These variations may therefore create risks or benefits to level 3 CCGs in managed their delegated budgets. Monitoring of commitments against SE London s notional budget will continue throughout the year and reconciliation will take place across the whole London (non-delegated) allocation as necessary at year end. The number of Maternity claims in Lewisham far exceeds the number in other CCG areas. RECOMMENDATIONS: To note the action and related expenditure for the six boroughs of south east London 113

114 NHS England CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) AUTHOR CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) 114

115 NHS England (London Area Teams) INTERIM GP LOCUM REIMBURSEMENT POLICY MATERNITY, PATERNITY, ADOPTION & SICKNESS LEAVE, DOCTORS SUSPENDED FROM THE PERFORMERS LIST & PROLONGED STUDY LEAVE CONTENT This policy sets out the process for the consideration of applications for reimbursement in accordance with the National Health Service, England General Medical Services Statement of Financial Entitlements Directions 2013 ( the SFE ) and the National Health Service, England Personal Medical Services Agreements (Payments for Specific Purposes) Directions 2013 ( the Directions ) i. This policy applies to those GP contractors covered by the NHS England London Area Team who hold either a General Medical Services ( GMS ) contract or a Personal Medical Services ( PMS ) contract ii. The reimbursements covered by this policy are: 1. Maternity, Paternity and Adoption Leave 2. Sickness Leave 3. Doctors suspended from the Performers List 4. Prolonged Study Leave 5. Health Education England schemes (set out at Annex 1) Health Education England schemes (which cover Retainer, Returner, Flexible Career schemes) are subject to Health Education England s determination. These are usually paid by NHS England if an individual is accepted onto one of these schemes. Further detail is set out in Annex 1. In the event that any of the terms of this policy contradict the terms of any relevant contractual provisions in the contractor s GMS or PMS contract, the Directions, the SFE or any other relevant legislation, the application of the contractual provision, the Directions, the SFE and relevant legislation will take precedence, as appropriate. 1. PROCESS FOR THE CONSIDERATION OF APPLICATIONS FOR REIMBURSEMENT NHS England (London Area Teams) will review individual applications in line with the SFE, the Directions, relevant contractual provisions and this policy. 115

116 All applications are subject to the prior approval of NHS England. Applications should be sent to the following addresses. South London Area Team: North West London Area Team: North Central & East London Area Team: Once received, an application will be passed to the relevant contract manager who will acknowledge receipt of the application, review the application and seek to ensure that all of the necessary paperwork and evidence is complete: Decisions on applications will be made by an Assistant Head of Primary Care (or their nominated Deputy) for the relevant Area Team. Any dispute arising out of or in connection with this policy between NHS England and a contractor is to be resolved as a dispute arising out of or in connection with the contractor s GMS or PMS contract, i.e. in accordance with the NHS dispute resolution procedures or by the courts. VAT 2. GENERAL PRINCIPLES VAT should only be claimed on the agency commission portion of the locum cost. Agencies should not charge VAT on the clinical cost and practices should therefore claim this back from the agency if it is charged. NHS England will only reimburse VAT on the commission part of the locum cost where the GP contractor is not registered for VAT and therefore cannot claim this back from HMRC. GP Contractors registered for VAT should claim this element back from HMRC. MULTIPLE CLAIMS GP contractors cannot claim multiple locum reimbursement costs for a single performer at any one time. APPROVAL GP contractors should not assume that reimbursement has been agreed and approved until they have received formal written notification of this from NHS England. 116

117 All claims covered by this policy will require approval before any reimbursement payment is made. This will require submission of the completed form at Appendix 1, together with the relevant evidence to their contract manager. 3. INTERIM ARRANGEMENTS FOR DEALING WITH OUTSTANDING APPLICATIONS AND PAYMENTS BEING MADE UNDER PREVIOUS PCT POLICIES If a GP contractor is aware of a locum providing cover for a performer who is on maternity, paternity, adoption or sickness leave, or is suspended from the Performers List, or is on prolonged study leave, and that contractor intends to make a claim for locum reimbursement but has not yet done so, they must submit a claim within 28 days of the date this policy comes into effect i.e.1 st September NHS England will honour all claims previously approved and which are currently being reimbursed, in line with current policies. With regard to all claims, NHS England will keep these under review. NHS England may require its contractors to submit evidence that the locum reimbursement currently being paid remains necessary.. 117

118 MATERNITY, PATERNITY AND ADOPTION LEAVE The procedure for the reimbursement of the cost of employing a locum to cover maternity or paternity or adoption leave is set out at Section 15 of the SFE, which states as follows: Section 15: PAYMENTS FOR LOCUMS COVERING MATERNITY, PATERNITY AND ADOPTION LEAVE General Employees of contractors will have rights to time off for ante-natal care, maternity leave, paternity leave, adoption leave and parental leave, if they satisfy the relevant entitlement conditions under employment legislation for those types of leave. The rights of partners in partnerships to these types of leave are a matter for their partnership agreement If an employee or partner who takes any such leave is a performer under a GMS contract, the contractor may need to employ a locum to maintain the level of services that it normally provides. Even if the Board is not directed in this SFE to pay for such cover, it may do so as a matter of discretion. However, if (a) the performer is a GP performer; and (b) the leave is ordinary or additional maternity, paternity leave or ordinary or additional adoption leave, the contractor may be entitled to payment of, or a contribution towards, the costs of locum cover under this SFE. Entitlement to payments for covering ordinary or additional maternity, maternity and ordinary or additional adoption leave In any case where a contractor actually and necessarily engages a locum (or more than one such person) to cover for the absence of a GP performer on ordinary or additional maternity leave, paternity leave or ordinary or additional adoption leave, and (a) the leave of absence is for more than one week ; (b) the performer on leave is entitled to that leave either under (i) statute; (ii) a partnership agreement or other agreement between the partners of a partnership; or 118

119 (iii) a contract of employment, provided that the performer on leave is entitled under their contract of employment to be paid their full salary by the contractor during their leave of absence; (b) the locum is not a partner or shareholder in the contractor, or already an employee of the contractor, unless the performer on leave is a job-sharer; and (c) the contractor is not also claiming another payment for locum cover in respect of the performer on leave pursuant to this Part, then subject to the following provisions of this Section, the Board must provide financial assistance to the contractor under its GMS contract in respect of the cost of engaging that locum (which may or may not be the maximum amount payable, as set out in paragraph 15.5) The Board must consider whether or not it is or was in fact necessary for the contractor to engage the locum, or to continue to engage the locum and have regard to the following principles (a) it should not normally be considered necessary for the contractor to employ a locum if the performer on leave had a right to return but that right has been extinguished; and (b) it should not normally be considered necessary for the contractor to employ a locum if the contractor has engaged a new employee or partner to perform the duties of the performer on leave and it is not carrying a vacancy in respect of another position which the performer on leave will fill on his return. Ceilings on the amounts payable The maximum amount payable under this Section by the Board in respect of locum cover for a GP performer is (a) in respect of the first two weeks for which the Board provides reimbursement in respect of locum cover, 1, per week; and (b) in respect of any week thereafter for which the Board provides reimbursement in respect of locum cover, 1, per week. Payment arrangements The contactor is to submit claims for costs actually incurred after they have been incurred, at a frequency to be agreed between the Board and the contractor, or if agreement cannot be reached, within 14 days of the end of the month during which the costs were incurred. Any amount payable falls due 14 days after the claim is submitted. 119

120 Conditions attached to the amounts payable Payments or any part of a payment under this Section are only payable if the contractor satisfies the following conditions (a) if the leave of absence is maternity leave, the contractor must supply the Board with a certificate of expected confinement as used for the purposes of obtaining statutory maternity pay, or a private certificate providing comparable information; (b) if the leave of absence is for paternity leave, the contractor must supply the Board with a letter written by the GP performer confirming prospective fatherhood and giving the date of expected confinement; (c) if the leave of absence is for adoption leave, the contractor must supply the Board with a letter written by the GP performer confirming the date of the adoption and the name of the main care provider, countersigned by the appropriate adoption agency; (d) the contractor must, on request, provide the Board with written records demonstrating the actual cost to it of the locum cover; and (e) once the locum arrangements are in place, the contractor must inform the Board (i) (ii) if there is to be any change to the locum arrangements; or if, for any other reason, there is to be a change to the contractor s arrangements for performing the duties of the performer on leave, at which point the Board is to determine whether it still considers the locum cover necessary If the contractor breaches any of these conditions, the Board may, in appropriate circumstances, withhold payment of any sum otherwise payable under this Section. 120

121 Practical Application In accordance with the SFE quoted above, the procedure for claiming payments for locums covering maternity, paternity and adoption leave is as follows: 1. Any claim must be submitted to the Primary Care Contract Manager in the Local Area Team based at Southside. 2. Any claim must be made after the actual costs have been incurred and within 14 days of the end of the month during which the costs were incurred, or at a time agreed between the Board and the contractor. (15.6) 3. Any claims must be made on the form set out in Appendix 1 and must include copies of the supporting documentation. (15.7) 4. Subject to the claim being agreed by the Board, any claim payable will be due 14 days after the claim is submitted. (15.6) 5. NHS England must be notified of any changes to the locum arrangements. This notification may be made by contacting the GP Contract Manager. (15.7(e)) 121

122 SICKNESS LEAVE The procedure for the reimbursement of the cost of a locum to cover sickness leave is set out at Section16 of the SFE, which states as follows: General Section 16: PAYMENTS FOR LOCUMS COVERING SICKNESS LEAVE Employees of contractors will, if they qualify for it, be entitled to statutory sick pay for 28 weeks of absence on account of sickness in ay three years. The rights of partners in partnership agreements to paid sickness leave is a matter for their partnership agreement If an employee or partner who takes any sickness leave is a performer under a GMS contract, the contractor may need to employ a locum to maintain the level of services that it normally provides. Even if the Board is not directed in this SFE to pay for such cover, it may do so as a matter of discretion and it may also provide support in order for the contractor to employ a locum for performers who are returning from sickness leave or for those who are at risk of needing to go on sickness leave. It should in particular consider exercising its discretion (a) where there is an unusually high rate of sickness in the area where the performer performs services; or (b) to support contractors in rural areas where the distances involved in making home visits make it impracticable for a GP performer returning from sickness leave to assume responsibility for the same number of patients for which that performer previously had responsibility. Entitlement to payments for covering sickness leave In any case where a contractor actually and necessarily engages a locum (or more than one such person) to cover for the absence of a GP performer on sickness leave, and (a) the leave of absence is for more than one week; (b) if the performer on leave is employed by the contractor, the contractor must (i) be required to pay statutory sick pay to that performer; or (ii) be required to pay the performer on leave his full salary during absences on sick leave under his contract of employment; (c) if the GP performer s absence is as a result of an accident, the contractor must be unable to claim any compensation from whoever caused the 122

123 accident towards meeting the cost of engaging a locum to cover for the GP performer during the performer s absence. But if such compensation is payable, the Board may loan the contractor the cost of the locum, on the condition that the loan is repaid when the compensation is paid unless (i) no part of the compensation paid is referable to the cost of the locum, in which case the loan is to be considered a reimbursement by the Board of the costs of the locum which is subject to the following provisions of this Section; or (ii) only part of the compensation paid is referable to the cost of the locum, in which case the liability to repay shall be proportionate to the extent to which the claim for full reimbursement of the costs of the locum was successful; (d) the locum is not a partner or shareholder in the contractor, or already an employee of the contractor, unless the performer on leave is a job-sharer; and (e)the contractor is not already claiming another payment for locum cover in respect of the performer on leave pursuant to Part 4, It is for the Board to determine whether or not it was in fact necessary for the contractor to engage the locum, or to continue to engage the locum, but it is to have regard to the following principles (a) it should not normally be considered necessary to employ a locum if the performer on leave had a right to return but that right has been extinguished; and (b) it should not normally be considered necessary to employ a locum if the contractor has engaged a new employee or partner to perform the duties of the performer on leave and it is not carrying a vacancy in respect of another position which the performer on leave will fill on return; (c) it should not normally be considered necessary for a contractor with two or more GP performers to engage a locum to replace the GP performer, unless the absence of the performer on leave leaves each of the other GP performers (not including members of the Doctor s Retainer Scheme) with average numbers of patients as follows Absences lasting or expected to last Not more than 2 weeks Not more than 6 weeks Longer than 6 weeks Full-time GP Three-quarters time GP Half-time GP patients patients patients patients patients patients patients patients patients 123

124 Ceilings on the amounts payable The maximum amount payable under this Section by the Board in respect of locum cover for a GP performer is 1, per week However, the maximum periods in respect of which payments under this Section are payable in relation to a particular GP performer are (a) 26 weeks for the full amount of the sum that the Board has determined is payable; and (b) a further 26 weeks for half the full amount of the sum the Board initially determined was payable In order to calculate these periods, a determination is to be made in respect of the first day of the GP performer s absence as to whether in the previous 52 weeks, any amounts have been payable in respect of that performer under this Section. If any amounts have been payable in those 52 weeks, the periods in respect of which they were payable are to be aggregated together. That aggregate period (whether or not it in fact relates to more than one period of absence) (a) if it is 26 weeks or less, is then to be deducted from the period referred to in paragraph 16.6(a); or (b) if it more than 26 weeks, then 26 weeks of it is to be deducted from the period referred to in paragraph 16.6(a) and the balance is to be deducted from the period referred to in paragraph 16.6(b) Accordingly, if payments have been made in respect of locum cover for the GP performer for 32 weeks out of the previous 52 weeks, the remaining entitlement in respect of that performer is for a maximum of 20 weeks, and at half the full amount that the Board initially determined was payable. Payment arrangements The contractor is to submit to the Board claims for costs actually incurred during a month at the end of that month, and any amount payable is to fall due on the same day of the following month that the contractor s Payable GSMP falls due. Condition attached to the amounts payable Payments or any part of a payment under this Section are only payable if the following conditions are satisfied (a) the contractor must obtain the prior agreement of the Board to the engagement of the locum (but its request to do so must be determined as quickly as possible by the Board), including agreement as to the amount that is to be paid for the locum cover; 124

125 (b) the contractor must, without delay, supply the Board with medical certificates in respect of each period of absence for which a request for assistance with payment for locum cover is being made; (c) the contractor must, on request, provide the Board with written records demonstrating the actual cost to it of the locum cover; (d) once the locum arrangements are in place, the contractor must inform the Board (i) if there is to be any change to the locum arrangements; or (ii) if, for any other reason, there is to be a change to the contractor s arrangements for performing the duties of the GP performer on leave, at which point the Board is to determine whether it still considers the locum cover necessary; (e) if the locum arrangements are in respect of a performer on leave who is or was entitled to statutory sick pay, the contractor must inform the Board immediately if it stops paying statutory sick pay to that employee; (f) the GP performer on leave must not engage in conduct that is prejudicial to that performer s recovery; and (g) the GP performer on leave must not be performing clinical services for any other person, unless under medical direction and with the approval of the Board If any of these conditions are breached, the Board may, in appropriate circumstances, withhold payment of any sum otherwise payable under this Section. 125

126 Practical Application 1. The contractor must obtain the prior approval of the Board to the engagement of the locum, including agreement as to the amount paid for the locum cover. (16.10(a)) 2. Whether prior approval is given will be considered on receipt by the Board of the form and supporting documentation in Appendix 1. A response will be provided by the Board as quickly as possible. (16.10(a)) 3. Once prior approval has been obtained, the contractor should submit to the Board claims for costs actually incurred during the relevant month at the end of that same month. (16.10(c)) 4. Any amount payable shall fall due on the same day of the following month that the contractor s Payable Global Sum Monthly Payment falls due.(16.9) 5. NHS England must be notified of any changes to the locum arrangements. This notification may be made by contacting the GP Contract Manager. (16.10(d)) 126

127 DOCTORS SUSPENDED FROM THE PERFORMERS LIST The procedure for the reimbursement of the cost of employing a locum to cover a suspended doctor is set out at Section 17 of the SFE, which states as follows: Section 17: PAYMENTS FOR LOCUMS TO COVER SUSPENDED DOCTORS General The Board has powers to suspend GP performers from the medical performers list A GP performer who is suspended from a medical performers list may be entitled to payments directly from the Board. This is covered by a separate determination under regulation 13(1) of the Performers Lists Regulations. Eligible cases In any case where a contractor (a) either (i) is a sole practitioner who is suspended from the Board s medical performers list and is not in receipt of any financial assistance from the Board section 96 of the 2006 Act as a contribution towards the cost of the arrangements to provide primary medical services under the contractor s GMS contract during the contractor s suspension, (ii) is paying a suspended GP performer (aa) who is a partner of the contractor, at least 90% of that performer s normal monthly drawings (or a pro rata amount in the case of part months) from the partnership account; or (bb) who is an employee of the contractor, at least 90% of that performer s normal salary (or a pro rata amount in the case of part months); or (iii) paid a suspended GP performer the amount mentioned in paragraph (ii)(aa) or (bb) for at least six months of that performer s suspension, and the suspended GP performer is still a partner or employee of the contractor; 127

128 (b) actually and necessarily engages a locum (or more than one such person) to cover for the absence of the suspended GP performer; (c) the locum is not a partner or shareholder in the contractor, or already an employee of the contractor, unless the absent performer is a job-sharer; and (d) the contractor is not also claiming any payment for locum cover in respect of the absent performer under Part 4, then subject to the provisions in this Section, the Board must provide financial assistance to the contractor under its GMS contract in respect of the cost of engaging that locum (which may or may not be the maximum amount payable, as set out in paragraph 17.5) It is for the Board to determine whether or not it is or was in fact necessary to engage the locum, or to continue to engage the locum, but it is to have regard to the following principles (a) it should not normally be considered necessary to employ a locum if the performer on leave had a right to return but that right has been extinguished; and (b) it should not normally be considered necessary to employ a locum if the contractor has engaged a new employee or partner to perform the duties of the performer on leave and it is not carrying a vacancy in respect of another position which the performer on leave will fill on that performer s return. Ceilings on the amounts payable The maximum amount payable under this Section by the Board in respect of locum cover for a GP performer is 1, per week. Payment arrangements The contractor is to submit claims for costs actually incurred after they have been incurred, at a frequency to be agreed between the Board and the contractor, or if agreement cannot be reached, within 14 days of the end of the month during which the costs were incurred. Any amount payable falls due 14 days after the date on which the claim is submitted. Conditions attached to the amounts payable Payments or any part of a payment under this Section are only payable if the contractor satisfies the following conditions 128

129 (a) the contractor must, on request, provide the Board with written records demonstrating (i) the actual cost to it of the locum cover; and (ii) that it is continuing to pay the suspended GP performer at least 90% of that performer s normal income before the suspension (i.e. the normal monthly drawings from the partnership account, that performer s normal salary or a pro rata amount in the case of part months); and (b) once the locum arrangements are in place, the contractor must inform the Board (i) if there is to be any change to the locum arrangements, or (ii) if, for any other reason, there is to be a change to the contractor s arrangements for performing the duties of the absent performer, at which point the Board is to determine whether it still considers the locum cover necessary If the contractor breaches any of these conditions, the Board may, in appropriate circumstances, withhold payment of any such sum otherwise payable under this Section. Practical Application Examples of the types of supporting documents required to be submitted together with the application form at Appendix 1 include, but are not limited to: evidence of the locum costs incurred together with evidence of the dates and times the locum attended the practice. a copy of the locum contract (if a performer is employed for a substantial period). This evidence must be submitted monthly to NHS England, within one month of the costs being incurred. All payments will be made monthly in the month following the receipt of the necessary evidence of expenditure, unless other arrangements are agreed due to exceptional circumstances NHS England must be notified of any changes to the locum arrangements. This notification may be made by contacting the GP Contract Manager. 129

130 PROLONGED STUDY LEAVE GP performers may be entitled to take Prolonged Study Leave. GMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by GMS contractors, are set out at Part 18 of the SFE, which states as follows: General Section 18: PAYMENTS IN RESPECT OF PROLONGED STUDY LEAVE GP performers may be entitled to take Prolonged Study Leave, and in these circumstances, the contractor for whom they have been providing services under its GMS contract may be entitled to two payments (a) an educational allowance, to be forwarded to the GP performer taking Prolonged Study Leave; and (b) the cost of, or a contribution towards the cost of, locum cover. Types of study in respect of which prolonged study leave may be taken Payments may only be made under this Section in respect of Prolonged Study Leave taken by a GP performer where (a) the study leave is for at least 10 weeks but not more than 12 months; (b) the educational aspects of the study leave have been approved by Health Education England or a committee or person recognised by Health Education England, having regard to any guidance on Prolonged Study Leave that has agreed nationally; and (c) the Board has determined that the payments to the contractor under this Section in respect of the Prolonged Study Leave are affordable, having regard to the budgetary targets it has set itself. Educational allowance payment Where the criteria set out in paragraph 18.2 are met, in respect of each week for which the GP performer is on Prolonged Study Leave, the Board must pay the contractor an Educational Allowance Payment of , subject to the condition that where the contractor is aware of any change in circumstances that may affect its 130

131 entitlement to the Educational Allowance Payment, it notifies the Board of that change in circumstances If the contractor breaches the condition set out in paragraph 18.3, the Board may, in appropriate circumstances, withhold payment of all or any part of an Educational Allowance Payment that is otherwise payable. Locum cover in respect of doctors on Prolonged Study Leave In any case where a contractor actually and necessarily engages a locum (or more than one such person) to cover for the absence of a GP performer on Prolonged Study Leave, then subject to the following provisions of this Section, the Board must provide financial assistance to the contractor under its GMS contract in respect of the cost of engaging that locum (which may or may not be the maximum amount payable, as set out in paragraph 18.7) It is for the Board to determine whether or not it was in fact necessary to engage the locum, or to continue to engage the locum, but it is to have regard to the following principles (a) it should not normally be considered necessary to employ a locum if the GP performer on leave had a right to return but that right has been extinguished; and (b) it should not normally be considered necessary to employ a locum if the contractor has engaged a new employee or partner to perform the duties of the performer on leave and it is not carrying a vacancy in respect of another position which the performer on leave will fill on that performer s return The maximum amount payable under this Section by the Board in respect of locum cover for a GP performer is 1, per week. Payment arrangements The contractor is to submit to the Board claims for costs actually incurred during a month at the end of that month, and any amount payable is to fall due on the same day of the following month that the contractor s Payable GSMP falls due. Conditions attached to the amounts payable Payments or any part of a payment in respect of locum cover under this Section are only payable if the following conditions are satisfied (a) the contractor must obtain the prior agreement of the Board to the engagement of the locum (but its request to do so must be determined as quickly as possible by the Board), including agreement as to the amount that is to be paid for the locum cover; (b) the locum must not be a partner or shareholder in the contractor, or already an employee of the contractor, unless the performer on leave is a job-sharer; 131

132 (c) the contractor must, on request, provide the Board with written records demonstrating the actual cost to it of the locum cover; and (d) once the locum arrangements are in place, the contractor must inform the Board (i) if there is to be any change to the locum arrangements; or (ii) if, for any other reason, there is to be a change to the contractor s arrangements for performing the duties of the performer on leave, at which point the Board is to determine whether it still considers the locum cover necessary If any of these conditions are breached, the Board may, in appropriate circumstances, withhold payment of any sum in respect of locum cover otherwise payable under this Section. PMS CONTRACTORS Details of the payments that may be made under the Scheme and the criteria that must be satisfied by PMS contractors are set out at Part 5 of the Directions, which states as follows: PART 5 Prolonged Study Leave 30. GP performers may be entitled to take prolonged study leave, and in these circumstances, the contractor for whom they have been performing services under its PMS agreement may be entitled to an educational allowance, to be forwarded to the GP performer taking prolonged study leave. Types of study in respect of which prolonged study leave may be taken 31. Payments may only be made under this Part in respect of prolonged study leave taken by a GP performer where (a) the study leave is for at least 10 weeks but not more than 12 months; and (b) the educational aspects of the study leave have been approved by Health Education England, having regard to any guidance on prolonged study leave that has been agreed nationally; and (c) the Board has determined that the payments to the contractor under this Part in respect of the prolonged study leave are affordable, having regard to the budgetary targets it has set for itself. 132

133 Educational allowance payments 32. Where the criteria set out in direction 31 are met, in respect of each week for which the GP performer is on prolonged study leave, the Board must pay the contractor an educational allowance payment of , subject to the following condition that where the contractor is aware of any change in circumstances that may affect its entitlement to the educational allowance payment, it must notify the Board of that change in circumstances. 133

134 Annex 1 DOCTORS RETAINER SCHEME This established scheme is designed to keep doctors who are not working in general practice in touch with general practice. GMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by GMS contractors, are set out at Section 20 of the SFE, which states as follows: General Section 20: DOCTORS RETAINER SCHEME This is an established Scheme designed to keep doctors who are not working in general practice in touch with general practice. Payments in respect of sessions undertaken by members of the Scheme Subject to paragraph 20.3, where (a) a contractor who is considered as a suitable employer of members of the Doctors Retainer Scheme by Health Education England employs or engages a member of the Doctors Retainer Scheme; and (b) the service sessions for which the member of the Doctors Retainer Scheme is employed or engaged by that contractor are arranged or approved by Health Education England. the Board must pay to that contractor under its GMS contract in respect of each full session that the member of the Doctors Retainer Scheme undertakes for the contractor in any week, up to a maximum of four sessions per week. Provisions in respect of leave arrangement The Board must pay to the contractor under its GMS contract any payment payable under paragraph 20.2 in respect of any session which the member of the Doctors Retainer Scheme is employed or engaged to undertake but which that member does not undertake because they are absent due to leave related to (a) annual holiday up to a maximum number of sessions annually equivalent to 6 weeks worth of arranged sessions for the member of the Doctors Retainer Scheme; 134

135 (b) maternity, paternity or adoption, in accordance with the circumstances and for the periods referred to in Section 15 (payments for locums covering maternity, paternity and adoption leave); (c) parental leave, in accordance with statutory entitlements (except that the normal statutory qualifying period of one year s service with the contractor does not apply); (d) sickness, for a reasonable period as agreed by the contractor and the Board; (e) an emergency involving a dependent, in accordance with employment law and any guidance issued by the Department for Business, Innovation and Skills; and (f) other pressing personal or family reasons where the contractor and the Board agree that the absence of the member of the Doctors Retainer Scheme is necessary and unavoidable. Payment conditions Payments under this section are to fall due at the end of the month in which the session to which the payment relates takes place. However, the payments, or any part thereof, are only payable if the contractor satisfies the following conditions (a) the contractor must inform the Board of any change to the member of the Doctors Retainer Scheme s working arrangements that may affect the contractor s entitlement to a payment under this section; (b) the contractor must inform the Board of any absence on leave of the member of the Doctors Retainer Scheme and the reason for such absence; (c) in the case of any absence on leave in respect of which there are any matters to be agreed between the contractor and the Board in accordance with paragraph 20.3 above, the contractor must make available to the Board any information which the Board does not have but needs, and which the contractor either has or could be reasonably expected to obtain, in order to form an opinion in respect of any of the matters which are to be agreed between the contractor and the Board; (d) the contractor must inform the Board if the doctor in respect of whom the payment is made ceases to be a member of the Doctors Retainer Scheme, or if it ceases to be considered a suitable employer of members of the Doctors Retainer Scheme by Health Education England If a contractor breaches any of these conditions, the Board may, in appropriate circumstances, withhold payment any payment otherwise payable under this Section. 135

136 PMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by PMS contractors, are set out at Part 4 of the Directions, which states as follows: PART 4 Doctors Retainer Scheme 25. This is an established Scheme designed to keep doctors who are not working in general practice in touch with general practice. Payments in respect of sessions undertaken by members of the Scheme 26. Subject to direction 27, where (a) a contractor who is considered as a suitable employer of a member of the Doctors Retainer Scheme by Health Education England employs or engages a member of the Doctors Retainer Scheme; and (b) the service sessions for which the member of the Doctors Retainer Scheme is employed or engaged by that contractor have been arranged by Health Education England, the Board must pay to that contractor under its PMS agreement in respect of each full session that the member of the Doctors Retainer Scheme undertakes for the contractor in any week, up to a maximum of four sessions per week. Provisions in respect of leave arrangements 27. The Board must pay to the contractor under its PMS agreement any payment payable under direction 26 in respect of any session which the member of the Doctors Retainer Scheme is employed or engaged to undertake but which that member does not undertake because they are absent due to leave related to (a) annual holiday up to a maximum number of sessions annually equivalent to 6 weeks worth of arranged sessions for the member of the Doctors Retainer Scheme; (b) maternity, paternity or adoption, in accordance with the circumstances and for the periods referred to in Section 15 of the Statement of Financial Entitlements (payments for locums covering maternity, paternity and adoption leave); (c) parental leave, in accordance with statutory entitlements (except that the normal statutory qualifying period of one year s service with the contractor does not apply); (d) sickness, for a reasonable period as agreed by the contractor and the Board; 136

137 (e) an emergency involving a dependant, in accordance with employment law and any guidance issued by the Department for Business, Innovation and Skills; and (f) other pressing personal or family reasons where the contractor and the Board agree that the absence of the member of the Doctors Retainer Scheme is necessary and unavoidable. Payment conditions 28. Payments under this Part are to fall due at the end of the month in which the session to which the payment relates takes place. However, the payments, or any part thereof, are only payable if the contractor satisfies the following conditions (a) the contractor must inform the Board of any change to the member of the Doctors Retainer Scheme s working arrangements that may affect the contractor s entitlement to a payment under this Part; (b) the contractor must inform the Board of any absence on leave of the member of the Doctors Retainer Scheme and the reason for such absence; (c) in the case of any absence on leave in respect of which there are any matters to be agreed between the contractor and the Board in accordance with direction 27 above, the contractor must make available to the Board any information which the Board does not have but needs, and which the contractor either has or could be reasonably expected to obtain, in order to form an opinion in respect of any of the matters which are to be agreed between the contractor and the Board; and (d) the contractor must inform the Board if the doctor in respect of whom the payment is made ceases to be a member of the Doctors Retainer Scheme, or if it ceases to be considered a suitable employer of members of the Doctors Retainer Scheme by Health Education England. 29. If a contractor breaches any of these conditions, the Board may, in appropriate circumstances, withhold payment of any payment otherwise payable under this Part. 137

138 Annex 1 RETURNERS SCHEME This is an established Scheme designed to facilitate the return of qualified GPs to the NHS. It is managed by Health Education England. GMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by GMS contractors, are set out at Section 21 of the SFE, which states as follows: General Section 21: RETURNERS SCHEME This is an established Scheme designed to facilitate the return of qualified GPs to the NHS. It is managed Health Education England. Returners Scheme Doctor Payments If a GP performer has been employed or engaged by a contractor, and that GP performer is a doctor who is a member of the Returners Scheme (RS), the Board must, in respect of that doctor, pay to the contractor, in respect of each year of membership of the Scheme (a) an annual RS Doctor Payment of 1,050; and (b) a payment to cover the amount of any employer s national insurance contributions which are payable by the contractor in respect of the RS Doctor Payment If (a) a RS doctor s membership of the RS ceases during a year of membership; or (b) a RS doctor moves to a new employer during a year of membership of the RS, or becomes a partner or shareholder in a different contractor, but remains a member, the amount of the RS Doctor Payment payable to the contractor is to be adjusted as follows. Multiply the amount of the payment otherwise payable by the following fraction: the number of days for which the RS doctor is contracted to work for the contractor during the membership year, divided by 365 (or 366 where the membership year 138

139 includes 29th February) and any payment of employer s national insurance contributions under paragraph 21.2(b) is to be adjusted accordingly Payments under this Section to the contractor are to fall due on the last day of the month during which (a) the date on which the GP performer joins the RS falls; or (b) the anniversary of the date on which the GP performer joined the RS falls. Conditions attached to Returners Scheme Doctor Payments and overpayments RS Doctor Payments, or any part thereof, are only payable if the following conditions are satisfied (a) a contractor who receives a RS Doctor Payment in respect of a GP performer must give that payment to that GP performer (i) within one calendar month of it receiving that payment; and (ii) as an element of the personal income of that doctor, subject to any lawful deduction of income tax, national insurance and superannuation contributions, once it has secured from the doctor an enforceable undertaking that he will repay to the contractor any amount repayable by the contractor to the Board under this Section in respect of that GP performer; (b) the contractor must inform the Board if the GP performer in respect of whom the payment is made ceases to be a member of the RS If a contractor breaches these conditions, the Board may require repayment of the payment paid, or may withhold payment of any other payment payable to the contractor under this SFE, to the value of the payment paid If as a result of a doctor leaving the RS, the Board has paid a larger amount to the contractor in respect of that doctor s RS Doctor Payment than the amount to which the contractor is entitled under this Section, the Board may require repayment of the excess paid, or may withhold payment of any other payment payable to the contractor under this SFE, to the value of the excess paid Where, pursuant to paragraph 21.6 or 21.7, a contractor is required to repay any or any part of a RS Doctor Payment, the arrangements by which the contractor may seek to enforce the undertaking referred to in paragraph 21.5(a) as a consequence of that repayment are a matter for the contractor. 139

140 PMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by PMS contractors, are set out at Part 3 of the Directions, which states as follows: PART 3 Returners Scheme 17. The Returners Scheme is an established Scheme designed to facilitate the return of qualified general practitioners to the National Health Service. It is managed by Health Education England. Returners Scheme Doctor Payments 18. If a GP performer has been employed or engaged by a contractor, and that GP performer is a doctor who is a member of the Returners Scheme (RS), the Board must, in respect of that doctor, pay to the contractor, in respect of each year of that doctor s membership of the Scheme (a) an annual RS Doctor Payment of 1,050; and (b) a payment to cover the amount of any employer s national insurance contributions which are payable by the contractor in respect of that RS Doctor Payment. 19. If (a) an RS doctor s membership of the RS ceases during a year of membership; or (b) an RS doctor moves to a new employer during a year of membership of the RS, or becomes a partner or shareholder in a different contract, but remains a member of the RS, the amount of the RS Doctor Payment payable to the contractor is to be adjusted as follows. Multiply the amount of the payment otherwise payable by the following fraction: the number of days for which the RS doctor is contracted to work for the contractor during the membership year, divided by 365 (or 366 where the membership year includes 29th February) and any payment of employer s national insurance contributions under direction 18(b) is to be adjusted accordingly. 20. Payments under this Part to the contractor are to fall due on the last day of the month during which 140

141 (a) the date on which the GP performer joins the scheme falls; or (b) the anniversary of the date on which the GP performer joined the scheme falls. Conditions attached to Returners Scheme Doctor Payments 21. RS Doctor Payments, or any part thereof, are only payable if the following conditions are satisfied (a) a contractor who received an RS Doctor Payment in respect of a GP performer must give that payment to that GP performer (i) within one calendar month of it receiving that payment, and (ii) as an element of the personal income of that doctor, subject to any lawful deduction of income tax, national insurance and superannuation contributions, once it has secured from the doctor an enforceable undertaking that that doctor will repay to the contractor any amount repayable by the contractor to the Board under this Part in respect of that GP performer; (b) the contractor must inform the Board if the GP performer in respect of whom the payment is made ceases to be a member of the RS. 22. If a contractor breaches any of the conditions in direction 21, the Board may require repayment of the payment paid, or may withhold payment of any other payment payable to the contractor under this Part, to the value of the payment paid. 23. If as a result of a doctor leaving the RS, the Board has paid a larger amount to the contractor in respect of that doctor s RS Doctor Payment than the amount to which the contractor is entitled under this Part, the Board may require repayment of the excess paid, or may withhold payment of any other payment payable to the contractor under this Part, to the value of the excess paid. 24. Where pursuant to direction 22 or 23, a contractor is required to repay any or any part of a RS Doctor payment, the arrangements by which the contractor may seek to enforce the undertaking referred to in direction 21(a) as a consequence of that repayment are a matter for the contractor. 141

142 Annex 1 FLEXIBLE CAREERS SCHEME This is an established Scheme for certain part-time doctors. It is managed by Health Education England and is for employed doctors only. Contractors are eligible for contractor payments under this Scheme, but will also receive payments to be forwarded to doctors. GMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied, are set out at Part 22 of the SFE, which states as follows: General Section 22: FLEXIBLE CAREERS SCHEME This is an established Scheme for certain part-time doctors. It is managed by Health Education England and is for employed doctors only. Contractors are eligible for contractor payments under this Scheme, but will also receive payments to be forwarded to doctors. Flexible Careers Scheme Contractor Payments The Board must pay to a contractor under its GMS contract a Flexible Career Scheme (FCS) Contractor Payment if (a) it employs a part-time doctor who is a member of the FCS; and (b) that FCS doctor performs primary medical services under its GMS contract, as a general practitioner, with a working commitment that generates a Time Commitment Fraction of at least one fifth but not more than five ninths, except that the doctor may also work (i) an additional 28 hours, during the membership year, of funded education time for personal and professional development; and (ii) a limited amount of additional time in the National Health Service, with the approval of Health Education England For the purposes of the calculation of time commitment in paragraph 22.2(b), the following periods of leave are discounted (a) annual leave up to a maximum of six weeks pro rata (compared to full-time); 142

143 (b) maternity, paternity, parental or adoption leave endorsed by the Board; (c) sickness leave endorsed by the Board; (d) special leave in an emergency, which is granted in accordance with employment law and guidance issued by the Department of Business, Innovation and Skills; and (e) other special leave for pressing personal or family reasons, endorsed by the Board. Amount of FCS Contractor Payments The Board will need to obtain from the contractor at the end of each quarter a return of the actual cost to the contractor, rounded to the nearest pound, of it employing the FCS doctor while he is a member of the scheme. This is (a) to include salary, national insurance contributions and NHS Pension Scheme employer s superannuation contributions (where these are paid by the contractor); and (b) not to include costs relating to any additional work the FCS doctor is permitted, with the approval of the Health Education England to undertake outside the FCS A percentage of that amount is then payable as the contractor s FCS Contractor Payment, as calculated (subject to the following provisions of this Section) in accordance with the following table TABLE In respect of FCS doctors Year 1 50% Year 2 25% Year 3 10% For these purposes (a) the qualifying date for the first payment, and so the start of the doctor s first year in the Scheme, is the date the doctor joins the Scheme; (b) if, in relation to any period of leave referred to in paragraph 22.3 Health Education England reasonably determines that, for exceptional reasons, the year of membership of the FCS in which the period of leave started should be extended, that year of membership shall not be taken to have elapsed until a full year has elapsed from the start of that year of membership, discounting the period of leave, and that doctor s qualifying date for payments must be adjusted accordingly; and 143

144 (c) if the quarterly return relates to costs incurred in respect of different years of membership of the FCS, the contractor must specify which costs relate to which year of membership of the scheme. Amount of FCS Doctor Payments Subject to the following provisions in this Section, if a contractor is eligible for a FCS contractor payment, the Board must also pay to the contractor under its GMS contract, in respect of the doctor who is a member of the FCS (a) an annual FCS Doctor Payment of 1,050; and (b) a payment to cover the amount of any employer s national insurance contributions which are payable by the contractor in respect of that FCS Doctor Payment. Payments in respect of part years If (a) an FCS doctor s membership of the FCS ceases during a year of membership; or (b) an FCS doctor moves to a new employer during a year of membership of the FCS scheme but remains a member of the scheme, the amount of the FCS Doctor Payment payable to the contractor is to be adjusted by multiplying the amount of the payment otherwise payable by the following fraction: the number of days for which the FCS doctor is contracted to work for the contract during the membership year, divided by 365 (or 366 where the membership year includes 29th February) and any payment of employer s national insurance contributions under paragraph 22.7(b) is to be adjusted accordingly. Payments in respect of educational sessions In respect of each of up to eight educational sessions attended in a year of membership of the FCS by an FCS doctor, and on the basis of a return from the contractor at the end of each quarter, the Board must reimburse the contractor who employs the FCS doctor under its GMS contract for (a) the actual cost of employing the FCS doctor during those sessions; and (b) any expenses claimed by and paid to the FCS doctor by the contractor to cover the cost of his actual travel and subsistence in attending those sessions, if these costs are reasonable in the opinion of the Board. 144

145 Payment arrangements FCS Doctor Payments to the contractor are to fall due on the last day of the month during which that contractor qualifying date falls, taking account of any adjustment of the qualifying date in accordance with paragraph The other payments under this Section are to fall due on the last day of the month following the quarter in respect of the quarterly return is made. Conditions attached to Flexible Career Scheme payments and overpayments FCS Contractor Payments and payments or any part of a payment under paragraph 22.9(a) is only payable if the contractor satisfies the following conditions (a) the contractor must make available to the Board any information which the Board does not have but needs, and the contractor either has or could reasonably be expected to obtain, in order to calculate the payment. In particular, the contractor must, on request, provide the Board with written records demonstrating the actual costs it is seeking to recover; and (b) all information supplied pursuant to or in accordance with this paragraph must be accurate FCS Doctor Payments, or any part thereof, are only payable if the following conditions are satisfied (a) a contractor that receives an FCS Doctor Payment in respect of a doctor must give that payment to that doctor (i) within one calendar month of it receiving that payment; and (ii) as an element of the personal income of that doctor, subject to any lawful deduction of income tax, national insurance and superannuation contributions, once it has secured from the doctor an enforceable undertaking that that doctor will repay to the contractor any amount repayable by the contractor to the Board under this Section in respect of that doctor; (b) the contractor must inform the Board if the doctor in respect of whom the payment is made ceases to be a member of the FCS Payments in respect of expenses under paragraph 22.9(b) are only payable if the following conditions are satisfied (a) the contractor must make available to the Board any information which the Board does not have but needs (including receipts), and the contractor either has or could reasonably be expected to obtain in order to calculate the payment; and 145

146 (b) all information provided pursuant to or in accordance with sub-paragraph (a) must be accurate If a contractor breaches the conditions set out in paragraph or 22.14, the Board may in appropriate circumstances withhold payment of any or any part of a payment to which the conditions relate that is otherwise payable If a contractor breaches the conditions in paragraph the Board may require repayment of any payment paid to which the condition relates, or may withhold payment of any other sum payable to the contractor under this SFE, to the value of the payment paid If as a result of the doctor leaving the FCS, the Board has paid a larger amount to the contractor in respect of a FCS Doctor Payment than the amount to which the contractor is entitled, the Board may require repayment of the excess paid, or may withhold payment of any other sum payable to the contractor under this SFE, to the value of the excess paid Where, pursuant to paragraph or 22.17, a contractor is required to repay any or any part of a FCS Doctor Payment, the arrangements by which the contractor may seek to enforce the undertaking referred to in paragraph 22.13(a) as a consequence of that repayment are a matter for the contractor. PMS CONTRACTORS Details of the payments that may be made under the Scheme, and the criteria that must be satisfied by PMS contractors, are set out at Part 2 of the Directions, which states as follows: PART 2 Flexible Career Scheme 3. The Flexible Careers Scheme is an established Scheme for certain part-time doctors. It is managed by Health Education England. Contractors are eligible for contractor payments under this Scheme, but will also receive payments to be forwarded to doctors. Flexible Careers Scheme contractor payments 4. The Board must pay to a contractor under its PMS agreement a Flexible Career Scheme ( FCS ) contractor payment if (a) it employs a part-time doctor who is a member of the FCS; and (b) that FCS doctor performs primary medical services under the PMS agreement, as a general practitioner, with a working commitment that generates a time commitment 146

147 fraction of at least one fifth but not more than five ninths, except that the doctor may also work (i) an additional 28 hours, during the membership year, of funded education time for personal and professional development, and (ii) a limited amount of additional time in the National Health Service, with the approval of Health Education England. 5. For the purposes of the calculation of a time commitment in direction 4(b), the following periods of leave are discounted (a) annual leave up to a maximum of six weeks pro rata (compared to full-time); (b) maternity, paternity, parental or adoption leave endorsed by the Board; (c) sickness leave endorsed by the Board; (d) special leave in an emergency, which is granted in accordance with employment law guidance issued by the Department for Business, Innovation and Skills; and (e) other special leave for pressing personal or family reasons, endorsed by the Board. Amount of FCS contractor payments 6. The Board will need to obtain from the contractor at the end of each quarter a return of the actual cost to the contractor, rounded to the nearest pound, of it employing the FCS doctor while that doctor is a member of the FCS. This is (a) to include salary, national insurance contributions and NHS Pension Scheme employer s superannuation contributions (where these are paid by the contractor); (b) not to include costs relating to any additional work the FCS doctor is permitted, with the approval of Health Education England, to undertake outside the FCS. 7. A percentage of that amount is then payable as the contractor s FCS contractor payment, as calculated (subject to the following provisions of this Part) in accordance with the following table Table In respect of FCS doctors Year 1 50% Year 2 25% Year 3 10% 8. For these purposes 147

148 (a) the qualifying date for the first payment, and so the start of the doctor s first year in the Scheme, is the date the doctor joins the Scheme; (b) if, in relation to any period of leave referred to in direction 5, Health Education England reasonably determines that, for exceptional reasons, the year of membership of the FCS in which the period of leave started should be extended, that year of membership shall not be taken to have elapsed until a full year has elapsed from the start of that year of membership, discounting the period of leave, and that doctor s qualifying date for payments must be adjusted accordingly; and (c) if the quarterly return relates to costs incurred in respect of different years of membership of the FCS, the contractor must specify which costs relate to which year of membership of the Scheme. Amount of FCS doctor payments 9. Subject to the following provisions of this Part, if a contractor is eligible for a FCS contractor payment, the Board must also pay to the contractor under its PMS agreement, in respect of the doctor who is a member of the FCS (a) an annual FCS Doctor Payment of 1,050; and (b) a payment to cover the amount of any employer s national insurance contributions which are payable by the contractor in respect of that FCS doctor payment. Payments in respect of part years 10. If (a) an FCS doctor s membership of the FCS ceases during a year of membership; or (b) an FCS doctor moves to a new employer during a year of membership of the FCS but remains a member of the FCS, the amount of the FCS Doctor Payment payable to the contractor is to be adjusted by multiplying the amount of the payment otherwise payable by the following fraction: the number of days for which the FCS doctor is contracted to work for the contractor during the membership year, divided by 365 (or 366 where the membership year includes 29th February) and any payment of employer s national insurance contributions under direction 9(b) is to be adjusted accordingly. Payments in respect of educational sessions 11. In respect of each of up to eight educational sessions attended in a year of membership of the FCS by an FCS doctor, and on the basis of a return from the contractor at the end of each quarter, the Board must reimburse the contractor who employs the FCS doctor under its PMS agreement for 148

149 (a) the actual costs of employing the FCS doctor during those sessions; and (b) any expenses claimed by and paid to the FCS doctor by the contractor to cover the cost of his actual travel and subsistence in attending those sessions, if these costs are reasonable in the opinion of the Board. Payment arrangements 12. FCS Doctor Payments to the contractor are to fall due on the last day of the month during which that contractor s qualifying date falls, taking account of any adjustment of the qualifying date in accordance with direction The other payments under this Part are to fall due on the last day of the month following the quarter in respect of which the quarterly return is made. Conditions attached to Flexible Career Scheme payments 14. FCS contractor payments and payments under direction 11(a), or any part thereof, are only payable if the contractor satisfies the following conditions (a) the contractor must make available to the Board any information which the Board does not have but needs, and the contractor either has or could reasonably be expected to obtain, in order to calculate the payment. In particular, the contractor must, on request, provide the Board with written records demonstrating the actual costs it is seeking to recover; and (b) all information supplied pursuant to or in accordance with this direction must be accurate. 15. FCS doctor payments, or any part thereof, are only payable if the following conditions are satisfied (a) a contractor that received an FCS Doctor Payment in respect of a doctor must give that payment to that doctor (i) within one calendar month of it receiving that payment, and (ii) as an element of the personal income of that doctor, subject to any lawful deduction of income tax, national insurance and superannuation contributions, once it has secured from the doctor an enforceable undertaking to repay to the contractor any amount repayable by the contractor to the Board under this Part in respect of that doctor; and (b) the contractor must inform the Board if the doctor in respect of whom the payment is made ceases to be a member of the FCS. 149

150 16. Payments in respect of expenses under direction 11(b) are only payable if the following conditions are satisfied (a) the contractor must make available to the Board any information which the Board does not have but needs (including receipts), and the contractor either has or could reasonably be expected to obtain in order to calculate the payment; and (b) all information supplied pursuant to or in accordance with paragraph (a) must be accurate. i Where the SFE and the Directions refer to the Board, this is reference to the NHS Commissioning Board, also known as NHS England. ii Arrangements for APMS contracts will be subject to the terms of the individual APMS contract. 150

151 SE London Locum Reimbursement April - July 2015 Borough Type of Cover Start Date of Claim End Date of Claim Authorised Payment Comment BEXLEY Maternity 20/03/ /09/ , Approved on 27/4/2015 Practice has no insurance policy in place. BROMLEY Sick Leave 22/04/2015 N/A Claim rejected as sufficient remaining WTE to cover the sickness. This is in line with the Statement of Financial Entitlement. BROMLEY Maternity 01/03/ /09/ , Approved on 13/7/2015 The practice has no insurance policy in place and is claiming for 8 sessions a week. BROMLEY Maternity 19/01/ /07/2015 9, The practice has an insurance policy in place, but was unable to claim at the time because the GP was already pregnant when the practice took out the policy. BROMLEY Maternity 01/04/ /08/2015 1, The practice is claiming the maximum of 8 sessions a week. The practice does not have an insurance policy in place. BEXLEY Sick Leave 26/08/ /05/ , This claim may not be closed, as the practice has sent the invoices too late for payment in July. GREENWICH Maternity 10/11/ /11/2015 7, Payments are being made to the practice for 52 weeks in accordance with the GP's contract of employment and is based on 8 sessions a week. GREENWICH Maternity 11/05/ /10/2015 1, Payments are being made to the practice for 22 weeks in accordance with the GP's contract of employment and is based on 8 sessions a week. GREENWICH Maternity 01/09/ /06/2015 6, Payments are being for 41 weeks in accordance with the GP's contract of employment and is based on 6 sessions a week. Payments are being made for 22 weeks in accordance with the GP's contract of employment LAMBETH Maternity 15/10/ /03/2015 based on 6 sessions a week. WHILST PERIOD OF CLAIM OVER, FINAL CLAIM DETAILS OUTSTANDING. LAMBETH Maternity 11/05/ /10/ , Payments are being made for 22 weeks e in accordance with the GP's contract of employment and is based on 6 sessions a week. LAMBETH Maternity 15/05/ /02/2016 3, Payments are being made for 22 weeks and are being made in accordance with the GP contract of employment and is based on 6 sessions a week. LAMBETH Maternity 21/11/ /04/2015 Payments are being made for 22 weeks in accordance with the GP's contract of employment and is based on 4 sessions a week. CLAIM DETAILS BEING SOURCED. LAMBETH Maternity 13/10/ /04/2015 Payments are being made for 26 weeks in accordance with the GP's contract of employment and is based on 6 sessions a week. CLAIM DETAILS BEING SOURCED. LAMBETH Maternity 01/12/ /05/2015 Payment are being made in accordance with the GP's contract of employment for 26 weeks and is based on 6 sessions. CLAIM DETAILS BEING SOURCED LEWISHAM Paternity Leave The paternity claim will start in August 2015 and will be paid in line with the GP's contract of employment. 151

152 LEWISHAM Maternity Leave 03/11/ /04/ , This claim has now concluded and the last claim was sent to finance on 27/5/15. Payments are being made in accordance with the GP's contract of employment for 26 LEWISHAM Maternity Leave 16/03/ /09/ , weeks. LEWISHAM Maternity Leave 01/09/ /01/ , This claim has now concluded and the last claim was sent to finance on 27/5/15. LEWISHAM Maternity Leave This claim has now concluded and the last claim was sent to finance on 16/5/15. FINAL CLAIM DETAILS BEING SOURCED Payment are being made in accordance with the GP's contract of employment for to 22 LEWISHAM Maternity Leave 26/01/ /06/2015 8, weeks. LEWISHAM Maternity Leave 08/12/ /05/ , This claim has now concluded last claim sent to finance on 22/6/15. LEWISHAM GP Retainer Scheme 11/06/ /01/2016 4, The claim is submitted quarterly. LEWISHAM Maternity Leave Awaiting claim to be submitted. LEWISHAM Special Leave 17/12/ /06/ , This claim has now concluded last claim sent to finance on 17/6/15. LEWISHAM GP Retainer Scheme 25/02/ /02/2016 3, This claim is submitted quarterly. LEWISHAM Maternity Leave 03/12/ /05/ , This claim has now concluded last claim was sent to finance on 5/6/15. Payment are being made in accordance with the GP's contract of employment for to 22 LEWISHAM Maternity Leave 09/03/ /08/ , weeks. SOUTHWARK Sick Leave 27/04/ This claim relates to short term sickness. SOUTHWARK Maternity Leave 03/11/ /04/2015 2, This claim has now concluded last claim was sent to finance. SOUTHWARK Maternity Leave This claim has not yet submitted. SOUTHWARK Sick Leave 13/04/ /05/2015 5, This claim has now concluded last claim sent to finance on 19/6/15. SOUTHWARK Suspension 01/06/2015 3, This claim is on going. SOUTHWARK Maternity Leave This claim has not yet been submitted. SOUTHWARK Maternity Leave This claim has not yet been submitted. SOUTHWARK Maternity Leave 06/05/ /09/2015 9, Payment is being made in accordance with the GP's contract of employment. 257,

153 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 AUTHOR: ENCLOSURE G Request for Temporary Closure of Practice List (Southwark Committee) Sharon Fernandez, Assistant Head of Primary Care, GP and Pharmacy Lambeth, Southwark and Lewisham - NHS England (London Region) SUMMARY: Nunhead Surgery (SE15 3LY) is a PMS practice and has a registered list of 8,715 (April 2015). Under the terms of their PMS Contract the Surgery applied to NHS England to temporarily close their list for a period of six months. NHS England has considered the request in consultation with NHS Southwark CCG. This paper outlines the request made by Nunhead Surgery and the assessment criteria used to determine if request should be approved. It provides a recommendation to the Southwark PCJC committee for decision. KEY ISSUES: Nunhead Surgery s initial request was received by NHS England on 1 April Further information was sought from the surgery and the formal application was received 11 May In summary the reasons provided by the surgery for the list closure request were: Their belief that the surgery is struggling to manage with the number / volume of new patient registrations. That there has been an increase in new patient registrations due to a local practice closing. A list closure would allow the surgery to review these patients and for the summarising of their medical records. The practice is concerned that the increase in patient registrations will affect access to appointments for their patients. 153

154 There are new housing developments in the local area and a list closure will allow for organisational change to manage the extra demand. The key lines of enquiry used to determine if the request should be approved are outlined below, and are requirements that need to be considered, as set out in the GP contract. The information provided by the practice against these areas is available to the Committee should they require it and the document attached to this enclosure gives details of the London Region Team s considerations against these lines of enquiry to make a recommendation. Key Lines of Enquiry 1 The reasons for applying to close the practice s register to new registrations. 2 The options that the practice has considered, rejected or implemented to relieve the difficulties they have encountered due to their open list and, if any changes were implemented what success in reducing or erasing such difficulties have these made. 3 If the practice has had discussions with their registered patients about their difficulties in maintaining an open list. 4 If the practice has had spoken with other contractors in the practice area concerning their difficulties maintaining an open list. If formal consultation has taken place with all the practices in the area. 5 If the practice has had any formal discussions with the LMC, CCG or any other organisation. 6 The number of appointments made available per month (per year) with a general medical practitioner or a nurse practitioner. 7 The number of clinical sessions available each month. 8 The number of whole time equivalent (WTE) GP s/ Nurse s the practice employs. The number of sessions each practitioner provides per month. The length of each session (hours). 9 Whether the Partners engage in out of practice roles, for example with CCG, Local Authority, NHS England or any other organisation. And if so the number of sessions this equates to per month and if locums are employed to backfill these sessions. 10 The appointment allocation per month for the Extended Primary Care Scheme (EPCS) (the Prime Minister Challenge Fund) and the practice s utilisation of the 154

155 appointment allocation. 11 The length of time the practice has requested to close its list. 12 If the practice has requested support from NHS England which would enable the list of patients to remain open or the period of proposed closure to be minimised. 13 The plans in place at the practice to alleviate the difficulties being experienced in maintaining an open list which will be implemented when the list is closed to enable the list to reopen at the end of the proposed closure period. 14 Other information the practice has supplied to support the application. The practice s responses to these areas have been assessed/commented on with the resultant recommendation outlined below. RECOMMENDATIONS: It is recommended to the Committee that the request is not approved for the following reasons: There is limited evidence of business continuity planning, the increase of patients has been gradual over the past year and a robust business continuity plan will have allowed the surgery to proactively take actions with triggers to recruit extra staff as required. The request for list closure is a reactive measure. The surgery stated that one of the main reasons for the increase in list size was due to a local practice closing. Analysis (including mapping analysis) shows that it is reasonable to accept that some of these patients will have registered with Nunhead Surgery, a sizable majority will have also registered elsewhere. Furthermore, this practice has now been closed for almost one year and therefore there will be no more additional patients associated with the closure. The regional team s own analysis of list size changes in the vicinity of Nunhead Surgery highlights a significant decrease in patient list size for a practice approximately 0.9 miles away from Nunhead Surgery; the Area Team has taken action and agreed an Action Plan with this practice to increase appointment numbers and access and also take any remedial actions with regards to complaints. 155

156 The Nunhead Surgery has had no formal discussions with other practices in the area with regards to its position and possible support. The surgery has not had formal discussions with the CCG. The CCG does not support the list size closure at this time. The surgery has not had formal discussions with the LMC. The LMC does not support the list closure. Analysis of appointments provided by Nunhead Surgery concludes that the surgery provides approximately the correct number of required appointments as per its contract. The practice could further improve capacity by increasing the length of clinical sessions to three hours as recommended by the BMA. It is evident from the application and the PPG minutes that the pressure being experienced by the practice is around administrative functions (clinical capacity is correct and at an efficient level). To improve utilisation of administrative capacity the surgery can recruit extra staff and if not required long term then on a short term basis. It is accepted that partners do engage in out of practice roles and this was commended, however, all sessions need to be backfilled, and furthermore the backfill needs to be remunerated by the organisations for which the GP s are providing services. The surgery should seek confirmation of its allocated number of appointments available for patients at the extended primary care service and both clinical and clerical staff should proactively encourage utilisation of these appointment with patients and through its PPG. NHS England / CCG CONTACT: Name: Jean Young, Head of Primary, Community and Children s Commissioning jean.young4@nhs.net AUTHOR CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) jill.webb3@nhs.net 156

157 157

158 REQUEST TO CLOSE PATIENT LIST Practice Name and address G85685 Nunhead Surgery 58 Nunhead Grove SE15 3LY Contract (GMS/PMS) PMS Raw list size 8715 April 15 CCG Area Southwark Date Application made: Initial request received 1st April Area team South London Senior Commissioning Manager requested additional supportive information. Formal application was received 11 th May 2015 Report template completed by Sharon Fernandez Sarb S Bansal Date completed 31 st May 2015 Assessment Criteria 1. Reasons for applying to close practice s register to new registration. Guidance Notes/Evidence attached Appendix A - Application to close practice list template completed by contractor. Appendix B - Practice List size Information provided by Practice Over the last 10 months list size has increased significantly, registering in excess of new patients each month. The majority of the deductions are due to the FP69s and list cleansing, so many of these patients would not have been accessing the services regularly so their demand was minimal. Many of the new patients registered have come from Dr Sharma s practice (which was based at East Dulwich Primary Care, East Dulwich Grove SE22 8PT) are very complex and require a lot of clinical input. There was no GP2GP records transfer the additional South London Area Teams consideration NHS England does not have an exact number of transfers from the now closed Dr Sarma s Practice. Once a practice is closed, PCSS cannot calculate patients received from the closed practice as it no longer exists. In May 2014 NHS England completed a capacity audit for registration of patients for Dr Sarma s practice closure, although Nunhead indicated that it would be able to register only a small number of patients over June/July 2014, there was no indication that any increase in list size may consequently 158

159 workload of fully summarising and reviewing these patients was significant. Practice is also registering quite a high number of patients that are already registered with practices locally. The practice is in an area of high deprivation and many patients have complex psychosocial and medical needs. lead to a request for list closure. Appendix F is a scatter graph of the patient distribution of the closed Dr Sarma s Practice and Appendix G provides Dot Maps of patient registrations from 01/04/2014 to 01/04/2015 for Nunhead Surgery Dr Sarma s practice closed on 31 st July 2014, and although there can be no doubt that some patients from the closed practice will have registered with Nunhead Surgery, Appendix F and G show that: o The majority of Dr Sarma s patients were not located in the vicinity of Nunhead and not in its catchment area o The majority (if not all) of patients that have registered with Nunhead are within its own catchment area and have exercised there right of choice and registered with Nunhead Surgery From the above, notwithstanding the closure of Dr Sarma s practice it may be appropriate to conclude that these patients will have registered with Nunhead Surgery in any case, irrespective of the closure. The Surgery will be aware that GP2GP records transfer is not accepted as a complete transfer of records, unfortunately when using GP2GP large documents over a particular size cannot be transferred using this system, therefore when patients transfer from one practice to another a complete set of records are printed and transferred with the patient. 159

160 2. What options have the practice considered, rejected or implemented to relieve the difficulties they have encountered about their open list and, if any were implemented what was the success in reducing or erasing such difficulties? For example has the practice considered x3 sessions a day or longer sessions? 3. Has the practice had any discussions with their registered patients about their difficulties in maintaining an open list? If yes, practice to provide a Appendix C - GP/Nurse appointments Jan-March 2015 Appendix D PPG minutes Appendix E Patient support letter Practice has increased clinical sessions by 2 additional GP sessions per week and has employed an HCA for 2 days per week Adjusted clinic times for duty doctor and allowing more telephone triage throughout the day to try and utilise where possible, the Extended Primary Care Service. The vast majority of patients want to be seen inhouse, which we will not deny. Our on-call doctor can have over 35 telephone calls throughout the day. The urgent calls are made up of patients needing same day advice, or patients requesting to be seen on the day when we have no appointments left to offer them. In addition to this, clinicians have booked morning and afternoon surgeries, see walk-in patients on the day and have a share of the increasing amount of hospital letters, pathology results and prescriptions. We also implemented an extras clinic in the morning at 11:30, where we allocate additional emergency appointments based on the number of GPs working, on top of the booked morning and afternoon clinics. We continue to offer late night extended hours on a weekly basis. Meeting with our PPG 29th April 2015 Minutes attached, letter of support from PPG member attached In summary: - Nunhead surgery is one of the lower users of the PMCF EPCS - as patients prefer to be seen by their own GP. - The Practice is applying to close the list to new. The minutes of the meeting are provided. The reason for the increase in Nunhead patient list has been attributed to Dr Sarma s practice closure, but this may or may not be the case. NHS England s view is that the circumstances leading to the closure of Dr Sarma s list, together with the planning, processes and mitigating actions employed to assist patients to find another GP were 160

161 summary of same, including whether registered patients thought the list of patients should or should not be closed. registrations for 6 months to clear the backlog of administrative tasks currently building up. - Patient comment had not felt the impact of extra patients, as she normally books with PN s but felt that perhaps there is need for another practice nurse. - Members voiced that it was not a good situation to be in, but the general consensus was that the Practice would have to work very hard in the next 6 months In order to reach the short term goals already outlined. not accurately explained to the PPG, with which commissioners could have assisted. The objective of the Extended Primary Care Service (EPCS) is to increase access by making available additional appointments, thus consequently easing the pressure on individual practices. The PPG meeting was an opportunity to explain and promote the EPCS and encourage take up through the group. 4. Has the practice spoken with other contractors in the practice area concerning their difficulties maintaining an open list? If yes, practice to provide a summary of same of discussions, including whether other contractors thought the list of patients should or should not be closed? Has formal consultation Spoken to a few neighbouring practices, some of which have highlighted issues they are having and have shared some of our concerns, but they have not been registering at the rate we have, so feel we are in a very different position, which is why we feel it necessary to request to close our list for a short period in order for us to catch up with back log, recruit a GP to actively manage this significant increase in workload and think of efficient ways of increasing space in which to deliver services. No formal discussions with any other party, We are aware of local services recommending our practice to patients who have experienced problems at their existing practice, There are many discussions on local forums regarding the issues at some local practices, Appendix H provides an analysis of list size changes for surgery s in the vicinity of Nunhead, and although it can be seen that the list size for Nunhead has increased a considerable amount it is not the largest percentage increase and the three closest practices also show an increase in list size The practice that is showing the largest decrease in patient population has now an Action Plan in place following consultation with NHS England; this has resulted in an increased number of appointments available at that practice. At the time of Dr Sarma s closure, practices highlighted in yellow declared that they could take on extra capacity of 1,000 to 2,000 patients. Nunhead Surgery may wish to proactively approach these practices with a view to discussing its current situation and possible support 161

162 taken place with all the practices in the area and what was their response? 5. Has the practice had any formal discussions with the LMC, CCG or any other organisation? What was their response? No formal discussions yet LMC s view: o List closure cannot be supported, o Consider reducing the practice s catchment area as an alternative to help cope with excessive demand. o Practice may benefit from visit from LMC to have a high level discussion and analysis of its finances, skill mix etc. to see if there is room for efficiency savings or income generation NHS England cannot support reducing the practices catchment area due to the impact on neighbouring practices; NHS England welcomes the support offered by LMC. Southwark CCG s position statement: - Our endeavour is to increase access to primary care and increases in list volume should be supported with actions that exhaust all opportunities such as space utilisation and increase in clinical capacity which is not clearly evident at this time - It is noted that for Nunhead, 2 partners are actively engaged in out of practice leadership roles with a GP Federation and clinical commissioning; this is welcomed and supported but leaves an unanswered question regarding sufficient practice 162

163 6. How many appointments do you make available per month (per year) with a general medical practitioner or a nurse practitioner? Please provide record of appointments data for at least the previous 3 months. Appendix C - GP/Nurse appointments Jan-March 2015 Appendix C -GP/Nurse appointments Jan-March 2015 coverage with backfill proportionate for the list size; we suggest a watching brief on the practice list growth Data provided by the practice shows that on average 554 GP and 195 Nurse appointments are completed each week (Total average appointments per week is 749) The Practice s core contract requires it to make available 3.5 appointments per weighted patient per year. Patient list at 01/04/2014 was 9013 and at 01/04/2015 was 10,013 Therefore the total number of appointments the practice is required to make available is: o 35,045 per annum o 674 per week The above 674 appointments per week is for the core contract, in addition appointment will available through Extended hours DES and the EPCS. It may be concluded from above that the practice is providing on average of 75 extra appointments per week over its core contract. However, the practice participates in the Extended hours DES and also has an allocation of appointments with the EPCS, therefore it may be concluded that the practice is operating at the correct capacity for its registered population. 7. How many clinical sessions Appendix C - GP/Nurse Appendix C -GP/Nurse appointments Jan-March 2015 How the practice organises its sessions is a matter for it to consider with regard to 163

164 do you make available each month? Please provide record of session s data for at least the previous 3 months 8. How many WTE GP s/nurse s does the practice employ? How many sessions does each practitioner provide per month? What is the length of each session (hours)? Please provide details 9. Do any of the partners; engage in out of practice roles, for example with CCG, Local Authority, NHS England or any appointments Jan-March full-time nurses, both working 37 hours per week. They both work sessions each per week, session times vary AM sessions normally 2 hours and PM session s 2 hours, with the exception of Tuesdays when they have an additional 1 hour extended hour s session. In addition to their appointments, both nurses have 6 daily slots for telephone advice/triage. 5 WTE GP s, with a total for 40 sessions available per week. GP sessions vary, but a normal morning clinic would be 2.5 hours and an afternoon clinic 2 hours, with the exception of Tuesdays when they offer a 3 hour clinic to cover the extended hours. In additional to this there is an extra clinic each morning which is used to offer appointment for patients needing to be seen on the same day. This clinic length is based on how many GP s working that day, but equates to 4 extra patients per GP. Yes, partners engage in out of practice roles: Dr Lu is Clinical Director for IHL, this equates to 4 sessions per week. Dr Roe is a clinical lead for CCG, this equates to 3 sessions per week. Where possible, all sessions are backfilled by locums, or covered in-house fulfilling the requirements of its patient needs and its contract The practice may wish to consult with other practices, CCG, LMC and patients with regards to the model which would best provide the best efficiency for patients and the practice. BMA guidance is 3 hours length for clinical sessions and I hour 10 minutes for administrative work related to the session. For both nurse sessions and GP sessions the practice reports the length of sessions as 2.0hrs to 2.5hrs except for Tuesdays when an additional extra hour is completed for the Extended hours DES. The practice will need to consider whether the length of its clinical sessions is appropriate for the current demand. The practice is required to fulfil its contractual requirements, all sessions need to be backfilled or the practice should consider employing a salaried GP, and furthermore the backfill needs to be remunerated by the organisations for which the GP s are providing services. 164

165 other organisation? If so what is the number of sessions this equates to per month? Are locums employed to backfill the above sessions? Please provide detail/evidence. 10. Extended Primary Care Scheme (EPCS) (the Prime Minister Challenge Fund) What is the practices appointment allocation per month? Is the practice using the complete appointment allocation? Please provide record. 11. How long does the practice Allocation is not known, but usage is low. Nunhead Surgery continues to review this and discuss ways of increasing uptake. All clinicians know about the service and encourage patients as first offer to be reviewed at the EPCS.. 6 months Allowing time to recruit and clear our backlog. Nunhead Surgery is not able to ascertain its allocation of appointments; it can only deduce that it is a low user of the service. Part of any action plan to alleviate the current pressures requires: o Confirmation of allocated appointments at EPCS o Proactively promote through its PPG the benefits to both patents and the practice of using this service The objective of the EPCS is to increase access, by taking up its full allocation of appointments the surgery will increase access and thus ease the pressure on patients and the practice 165

166 wish their list of patients to be closed? (This period must be more than three months and less than 12 months). 12. What reasonable support does the practice consider the AT would be able to offer, which would enable the list of patients to remain open or the period of proposed closure to be minimised? 13. What plans does the practice have to alleviate the difficulties they are experiencing in maintaining an open list, which you could be implemented Re-organise our whole filing system and purchase more storage units. Recruit and offer additional clinical sessions and have additional administration support in place. Bid for infrastructure funding for 2016/17 to enable us to expand the site and make better use of the premises. Additional administration support to help re-organise filing system during our closure Funding towards the cost of additional storage,. 166

167 when the list of patients is closed, so that list could reopen at the end of the proposed closure period? 14. Does the practice have any other information to bring to the attention of the AT about this application? We work in an area of high deprivation and many patients have complex psychosocial and medical needs. We aim to offer a holistic approach to their care as we feel this is time well spent in the long run as hopefully it improves patient understanding and involvement in their care It is believed that by putting systems in place now will allow the Practice to expand and prepare for the future in a timely manner. There are already a number of developments in the local area which will inevitably bring in a number of new patients. Closing the list now will allow for organisational changes to take place thus enabling the Practice to manage the extra capacity We do not want to lose experienced GP as a result of the current workload they are faced with, nor be in a situation where a serious incident occurs that could have been avoided, because we did not acknowledge or act upon the Partners or the employees concerns. AT recommendatio n to the Panel Whilst within its contract a practice may request a closure to its practice list, this should be a last resort, when all else has failed and patient services for registered patients are compromised. With regards to the number of new patients registered at Nunhead and Dr Sarma s retirement, although it is reasonable to accept that some of them will be from the previous Dr Sarma s Practice, as provided above in our analysis the majority of Dr Sarma s patients were not from the area of Nunhead. Furthermore, most (if not all) of the new patients are from the catchment area of Nunhead Surgery and therefore may exercise their right to register with Nunhead Surgery in any case. 167

168 When Dr Sarma s list was dispersed (due to his retirement) all practices in the vicinity including Nunhead Surgery were requested to declare if they had capacity to take on additional patients, although Nunhead at that time stated that it could provide for a small number only, it should have included in its business continuity plan the possibility of a larger number of patients requesting to register. Furthermore, Dr Sarma s practice has now been closed for almost one year, therefore one can reasonably state that patients that had not registered with a new practice at the point of closure will have now registered where they wish and there should be no more patients registering from that particular location. The list size has been gradually increasing (irrespective of the absolute reason) over the past year, this trend should have been recognised and actions taken by the surgery, a robust business continuity plan will have already led to actions by the surgery and therefore no requirement to request for list closure. All business continuity plans should include actions to ensure the stability of services in cases where there is an unexpected rise or gradual rise in the patient registrations, including the triggers for recruitment of additional staff. As stated above list closure should only be approved in exceptional circumstances. There is also the potential for practice to lose income, as any closure would lead to no new patients and no new income, given the transient nature of patients in London, at the end of any period of closure the practice may have a much lower list which may take time to increase to previous levels due to potential patients still thinking the list is closed. The question should be also be raised that any practice that has an agreed closed list, by default, should not be in a position to take on any additional services offered by either NHS England, CCG or any other organisation, for the same reasons it requested to close its list, thus leading to further decrease in income. The regional team is recommending not to approve the practice request to close the patient list, based on the following reasons: There is limited evidence of business continuity planning, the increase has been gradual over the past year, a robust business continuity plan will have allowed the Surgery to proactively take actions with triggers to recruit extra staff as required, the request for list closure is now a reactive measure One of the main factors the surgery is citing as the reason for the increase in list size is the closure of Dr Sarma s practice, as the regional team s analysis provides, although it is reasonable to accept that some of Dr Sarma s patient will have registered with Nunhead Surgery, a sizable majority will have also registered elsewhere. Furthermore, Dr Sarma s practice has now been closed for almost one year therefore there will be no more additions from that closure. The regional team s own analysis of list size changes in the vicinity of Nunhead Surgery highlights a significant decrease in patient list size for a practice approximately 0.9 miles away from Nunhead Surgery; the Area Team has taken action and agreed an Action Plan with this practice to increase appointment numbers and access and also take any remedial actions with regards to complaints. The Nunhead Surgery has had no formal discussions with other practices in the area with regards to its position and possible support. The CCG does not support the list size closure for the reasons provided above. 168

169 The LMC does not support the list closure for the reasons provided above. The regional team has provided an analysis of the appointments being provided by Nunhead Surgery from the information provided by the surgery; it can be concluded that the surgery provides approximately the correct required number of appointment as per its contract. The practice could further improve capacity by increasing the length of clinical sessions to 3 hours as recommended by the BMA It is evident from the application and the PPG minutes that the pressure being experienced by the practice is around admin functions (clinical capacity is correct and at an efficient level). To improve effectivity of admin capacity the surgery can recruit extra staff, if not required long term on a short term basis. It is accepted that partners do engage in out of practice roles and this is to be commended, however, all sessions need to be backfilled, and furthermore the backfill needs to be remunerated by the organisations for which the GP s are providing services. With regards to EPCS, Nunhead Surgery needs to confirm its allocated number of appointments and staff both clinical and clerical proactively encourage usage patients and also through its PPG. Enclosures Appendix A - Application from Nunhead Surgery Appendix B - Nunhead Surgery List Size Growth Appendix C - Nunhead Surgery GP/Nurse Appointments Appendix D - Nunhead Surgery PPG Minutes Appendix E - Patient Support Letter For List Closure Appendix F - Map of Dr Sarma s Patient Distribution Appendix G - Nunhead Surgery Dot Maps of Patient Registrations Appendix H - List Size Analysis of Practices in the Vicinity of Nunhead Surgery Date of PCC Decision Making Group (DMG) Outcome: Approved / Approved with Conditions/ Rejected Feedback from PCC DMG Panel Members: 169

170 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 ENCLOSURE: H Primary Care Commissioning Quality & Performance Report AUTHOR: Sharon Fernandez, Assistant Head of Primary Care, GP and Pharmacy Lambeth, Southwark and Lewisham - NHS England (London Region) Gary Beard, Assistant Head of Primary Care, GP and Pharmacy Bexley, Bromley and Greenwich - NHS England (London Region) SUMMARY: Overview of the Primary Care Service Provision in South East London including the changes that have taken place since 01 st April Primary Care Service Provision in SEL slide 3 Tally of contracts by contract type Changes in Service Provision slide 4 Closures, mergers & relocations of SEL practices Primary Care Performance Data slide 5 QOF 12/13 and 13/14 All Domains, Clinical, Q+P, & Patient Experience; Overview of General Practice Outcome Standards (GPOS) data. NHS England GP Survey Borough Data slides 8/9 Performer Performance Concerns slide 10 Issues around GP Provider performance Contractual Breaches since1 April 2015 slide 11 The committee is asked to note that as co-commissioning arrangements in each borough develop the format and focus on quality and performance monitoring will be enhanced and will seek to blend and enrich a wider range of measures. Each borough will consider the current quality of general practice locally and will work across commissioners to develop actions and support to make improvements. 170

171 KEY ISSUES: Primary Care Performance Data QOF 12/13 & 13/14 Overall In 13/14 QOF points achieved were generally 2-4% due to a number of practices failing to submit. Clinical Domains Between 12/13 and 13/14 there has been a decrease between 1-5% in achievement. Quality & Productivity Between 12/13 and 13/14 there was a noticeable decrease in performance achievement for 2 CCG area between 6-13% due to non- submission to Area Team GP Outcome Standards The number of practices approaching an internal review across SE London is 110 out of a total of 224 NHS England is working with local stakeholders to improve local healthcare provision, with further analysis and appropriate responses planned to manage service outliers. QOF data source: CQRS GPOS data source: Primary Care Webtool Performance Cases: Medical Directorate Breaches: Primary Care Commissioning Team RECOMMENDATIONS: For review and discussion NHS England / CCG CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) jill.webb3@nhs.net AUTHOR CONTACT: Name: Jill Webb, Head of Primary Care, NHS England (London Region) jill.webb3@nhs.net 171

172 Primary Care Commissioning Quality and Performance South East London 27 July

173 Contents Primary Care Service Provision in SEL - 3 Changes in Service Provision - 4 Primary Care Performance Data - 5 NHS England GP Survey/Borough Data - 8/9 Performers Performance Concerns -10 Contractual Breaches since1 April

174 Primary Care Service Provision in SE London Primary Care Contractors per CCG area South East London APMS GMS PMS Grand Total NHS Lambeth CCG NHS Southwark CCG NHS Lewisham CCG NHS Bexley CCG NHS Bromley CCG NHS Greenwich CCG Grand Total

175 Changes in Service Provision since 1 April 2015 South East London Mergers Practice Closure Practice Relocation NHS Lambeth CCG N/A N/A N/A NHS Southwark CCG N/A N/A N/A NHS Lewisham CCG N/A 1 N/A NHS Bexley CCG N/A N/A N/A NHS Bromley CCG N/A N/A N/A NHS Greenwich CCG N/A N/A N/A 175

176 Primary Care Performance Data QOF 12/13 and 13/14 (1 of 2) The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice. The QOF contains five main components, known as domains. The five domains are: Clinical; Public Health; Public Health - Additional Services; Patient Experience; Quality and Productivity. Each domain consists of a set of achievement measures, known as indicators, against which practices score points according to their level of achievement. The 2013/14 QOF measured achievement against 121 indicators; practices scored points on the basis of achievement against each indicator, up to a maximum of 900 points. A typical clinical indicator would be the proportion of patients with coronary heart disease who had cholesterol measured in the financial year, or the number of patients with depression who have answered a standard questionnaire on severity. Organisational indicators include such things as the availability of practice leaflets and practice staff education. An important feature of the QOF is the establishment of disease registers. These are lists of patients registered with the contractor who have been diagnosed with the disease or risk factor described in the register indicator. While it is recognised that these may not be completely accurate, it is the responsibility of the contractor to demonstrate that it has systems in place to maintain a high quality register. An example of this is DM001: The contractor establishes and maintains a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed CCG Name List Size List Size All DOMAINS Achievement Achievement QOF points total / 1000 available (per cent) Points achieved as per cent of max QOF points available QOF points total / 900 available (per cent) Points achieved as per cent of max QOF points available Year on year change for all indicators (per cent) Year on year change where register exists (per cent) NHS BEXLEY CCG 226, , % 96.52% 93.98% 93.98% % % NHS BROMLEY CCG 331, , % 94.77% 92.42% 92.48% % % NHS GREENWICH CCG 268, , % 93.69% 89.51% 89.67% % % NHS LAMBETH CCG 378, , % 94.97% 94.83% 94.93% 0.25 % % NHS LEWISHAM CCG 298, , % 95.08% 92.06% 92.20% % % NHS SOUTHWARK CCG 325, , % 93.18%% 91.7% 91.76% % % Further data available at

177 Primary Care Performance Data QOF 12/13 and 13/14 (2 of 2) The QOF gives an indication of the overall achievement of a surgery through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of surgery workload, local demographics and the prevalence of chronic conditions in the practice's local area. Clinical: the domain consists of 93 indicators across 20 clinical areas (e.g. chronic kidney disease, heart failure, hypertension) worth up to a maximum of 610 points. Quality and productivity: the domain consists of nine indicators (worth up to 100 points) as a service area in its own right (previously part of the now retired organisational domain). Patient experience: the domain consists of one indicator (worth up to 33 points) that relates to length of consultations CCG Name CLINICAL DOMAIN Year on Achievement (per cent) Achievement (per cent) Year Change (per cent) QUALITY AND PRODUCTIVITY Year on Achievement (per cent) Achievement (per cent) Year Change (per cent) PATIENT EXPERIENCE Year on Achievement (per cent) Achievement (per cent) Year Change (per cent) NHS BEXLEY CCG 96.42% 92.24% -4.33% 97.25% 100% 2.82% 96.43% 100% 3.71% NHS BROMLEY CCG 93.80% 90.56% -3.43% 92.64% 97.65% 5.14% 97.83% 100% 2.22% NHS GREENWICH CCG 92.23% 88.41% -4.14% 100% 86.19% % 92.86% 100% 7.69% NHS LAMBETH CCG 94.12% 93.42% 0.75% 93.24% 99.90% 7.14% 97.96% 100% 2.08% NHS LEWISHAM CCG 92.45% 91.10% -1.46% 100% 93.68% -6.32% 100% 100% 0.00% NHS SOUTHWARK CCG 93.32% 90.77% -2.73% 89.68% 91.89% 2.47% 91.30% 100% 9.52% Further data available at

178 Primary Care Performance Data General Practice Outcome Standards CCG Total No. of Higher Achieving Achieving Practice Approaching Practice with Review Practices: Practice: Practice: Review: Identified: NHS LAMBETH CCG NHS SOUTHWARK CCG NHS LEWISHAM CCG NHS BEXLEY CCG NHS BROMLEY CCG NHS GREENWICHCCG The Primary Care Web Tool is a website of practice identifiable statistics on individual practices and CCGs (Clinical Commissioning Groups). It displays a wealth of data on demographics and performance indicators that range from QOF (Quality and Outcomes Framework) results, clinical outcomes and prescribing habits, to patient access and satisfaction ratings - and everything in between. This data on individual practices is compared to national and local averages. Outliers are graded using triggers described below: Level One Trigger The practice is currently achieving a level which is greater than 0.5 standard deviations below the mean average for England, but not more than 2 standard deviations below. Level Two Trigger The practice is currently achieving a level which is below the mean average for England and is greater than 2 standard deviations of the target. Higher Achieving England practice The practice has between 0-1 triggers in total and 0 level two triggers. Achieving Practice The practice has between 2 5 triggers in total or 1 level two trigger. Approaching review The practice has between 6 8 triggers in total or no more than 2 level two triggers Review identified The practice has 9 or more triggers in total or 3 or more Level two triggers. Further data available at

179 NHS England GP Patient Survey Access and Experience Assessment Tool Uses National GP Patient Survey Data for 8 access and experience indicators: Ease of getting through on the telephone Helpfulness of receptionist Overall experience of making an appointment Confidence & trust in GP Confidence & trust in nurse Satisfaction with opening hours Overall experience of GP surgery Would recommend GP surgery to someone who has just moved to local area Benchmarked against London & England Practices rated Green (3 points); Amber (2 points); Red (1 point) ; Black (0 points) based on quartile of patient satisfaction achievement level for each indicator. Maximum score = 24 points (8 x 3 points) Practices rated black are >2.0 SDs below the average (statistically significant) 179

180 Total Score Per Borough GP Patient Survey Access and Experience Assessment Tool CCG Area NO.OF PRACTICES RAG RATED GREEN RAG RATED AMBER RAG RATED RED RAG RATED BLACK LOWEST TO HIGHEST SCORE RANGE AVERAGE TOTAL SCORE PER BOROUGH OUT OF 24 AVERAGE % TOTAL SCORE PER BOROUGH NHS LAMBETH CCG % NHS SOUTHWARK CCG NHS LEWISHAM CCG NHS BEXLEY CCG % % % NHS BROMLEY CCG NHS GREENWICH CCG % % 180

181 Performer Performance Concerns South West London Number of live cases as at April 2015 (incl. new cases from April 2015) Number of new cases from April 2015 Key issues NHS Lambeth CCG 7 0 NHS Southwark CCG 14 5 NHS Lewisham CCG 15 6 NHS Bexley CCG 16 4 NHS Bromley CCG 10 4 Clinical Issues Manner and attitude Inappropriate claims/financial probity Coroners Investigations False Declaration and/or Failure To Declare Child/Adult safeguarding NHS Greenwich CCG 12 3 Grand Total

182 Contractual Breaches since 1 April 2015 Underachieving practices are issued with contractual breach notices; a formal statement notifying the practice of their poor performance and deviation from the requirements of their medical services contract. A series of contractual breaches may be grounds for the withdrawal of a medical services contract from the provider. South East London Contractual Breaches Reason NHS Lambeth CCG 0 N/A NHS Southwark CCG 0 N/A NHS Lewisham CCG 0 N/A NHS Bexley CCG 0 N/A NHS Bromley CCG 0 N/A NHS Greenwich CCG 0 N/A 182

183 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 AUTHOR: ENCLOSURE: I Finance Update Report Month Three Toyin Akinyemi, Head of Finance Primary Care Contracting, NHS England (London Region) SUMMARY: The overall financial position for South East London Primary Medical services is showing a slight overspend of 249k against issued budgets for year to 3 months ending 30 th June. This quarter 1 results comprise overspends on PMS 242k and GMS 10k with a slight underspend on APMS. The overspend is primarily due to non-delivery of QIPP to date. KEY ISSUES: The identification and delivery of sufficient QIPP schemes within Medical Services to balance the budget is challenging, particularly given the London-wide transactional savings made in 2013/14 and 2014/15. Regional commissioners welcome the opportunity to work with CCG colleagues to develop local transformational schemes. RECOMMENDATIONS: The committee is asked to note the report CCG / NHS ENGLAND CONTACT: Name: David Sturgeon, Director of Primary Care Contracting, NHS England (London Region) david.sturgeon@nhs.net 183

184 AUTHOR CONTACT: Name: Toyin Akinyemi, Head of Finance Primary Care Contracting, NHS England (London Region) 184

185 Enc I (i) NHS England - London Region Financial Reports 3 Months to 30 th June 2015 South East London Primary Medical Services 1. Overview: The overall financial position for South East London Primary Medical services is showing a slight overspend of 249k against issued budgets for year to 3 months ending 30 th June. This quarter 1 results comprise overspends on PMS 242k and GMS 10k with a slight underspend on APMS. Primary Medical Services Expenditure Summary The expenditure summary for South East London for 3 months to 30th June 2015 is set out in Table 1 below with a break down at CCG level in Appendix A. Table 1 South East London Total Service Annual Budget YTD Budget YTD Actual Expenditure YTD Variance YTD Variance 2014/15 Outturn 000's 000's 000's 000's % 000's PMS 188,191 47,046 47, % 188,533 GMS 20,600 5,148 5, % 20,469 APMS 18,026 4,506 4,503 (3) -0.1% 18,280 Other Medical Services % 381 Total Primary Care Medical Services 227,353 56,834 57, % 227,663 Bexley CCG PMS 23,555 5,890 5, % 23,636 GMS 2, % 1,965 APMS % 608 Other Medical Services % 20 Total Primary Care Medical Services 26,231 6,559 6, % 26,229 Greenwich CCG PMS 30,841 7,709 7, % 30,119 GMS (1) -1.0% 406 APMS 3, (12) -1.5% 3,783 Other Medical Services % 10 Total Primary Care Medical Services 34,357 8,589 8,577 (12) -0.1% 34,318 Bromley CCG PMS 22,824 5,706 5, % 22,764 GMS 12,315 3,076 3, % 12,290 APMS 1, ,625 Other Medical Services % 89 Total Primary Care Medical Services 36,968 9,239 9, % 36,

186 Lambeth CCG PMS 41,580 10,394 10, % 42,357 GMS 2, % 1,883 APMS 6,971 1,741 1, % 6,787 Other Medical Services % 99 Total Primary Care Medical Services 50,690 12,671 12, % 51,126 Southwark CCG PMS 33,843 8,460 8, % 34,015 GMS 1, ,828 APMS 4,676 1,169 1,162 (7) -0.6% 4,571 Other Medical Services % 95 Total Primary Care Medical Services 40,317 10,078 10, % 40,509 Lewisham CCG PMS 35,548 8,887 8, % 35,642 GMS 2, (5) -1.0% 2,097 APMS 1, % 906 Other Medical Services % 68 Total Primary Care Medical Services 38,790 9,698 9, % 38,713 Brackets denote underspend 1.1 Medical Services Key Financial Indicator : Medical: Over/(Under) spend against budget 249k Medical services are showing an overspend of 249k (0.4%) across South East London. This is partly due a higher than estimated performance in 2014/15 QOF and a delay in realising the planned savings on some QIPP projects in the first quarter of year. Annual budgets are reported net of 3.2m QIPP savings across South East London. Details of QIPP projects and their associated savings will be reported in future reports. There has been a year on year growth of 0.8% in South East London s weighted population from April 2014 to April At quarter 1, the April 2015 capitation report shows a reduction of 0.3% less than the previous quarter (January 2015). Demographic growth has been funded at 1.3% in 2015/16 financial plan therefore demographic growth is adequately covered. Overall, in absolute terms the South East London population has seen an increase of 14,219 year on year and a reduction of 6,032 when compared with the previous quarter in its normalised weighted population. It is important to note that growth is net of list reduction emanating from the list cleansing QIPP project which is difficult to quantify. 186

187 Key Risk Areas Mitigation Action Impact YTD QIPP in-year slippage. Alternative savings opportunities to be identified in order to make up for shortfall in savings. Year to date deficit 2. Appendix A details each CCG s financial performance for the 3 months to the end of June. 2.1 Bexley 3 months results to 30 th June is showing a slight overspend of 28k (0.4%) due to a non-recurrent cost pressure on QOF emanating from a shortfall in 2014/15 accrual. Bexley s weighted population has increased by 1.6% year on year from April 2014 to April There has been a growth of 0.3% in the first quarter of the year (April 2015) over the last quarter of 2014/15 (January 2015). 2.2 Bromley 3 months results to 30 th June is showing a slight overspend of 36k (0.4%) due to a non-recurrent cost pressure on QOF emanating from a shortfall in 2014/15 accrual. Bromley s weighted population has increased by 0.5% year on year from April 2014 to April There has been a reduction of 0.2% in the first quarter of the year (April 2015) when compared to the last quarter of 2014/15 (January 2015). 2.3 Greenwich 3 months results to 30 th June is showing a slight underspend of 12k (-0.1%) due to a slight under performance on APM QOF. Greenwich s weighted population has increased by 2% year on year from April 2014 to April There has been a growth of 0.4% in the first quarter of the year (April 2015) over the last quarter of 2014/15 (January 2015). 2.4 Lambeth 3 months results to 30 th June is showing a slight overspend of 93k (0.7%) due to a non-recurrent cost pressure on QOF emanating from a shortfall in 2014/15 accrual. Lambeth s weighted population has increased by 0.8% year on year from April 2014 to April There has been a reduction of 0.6% in the first quarter of the year (April 2015) when compared to the last quarter of 2014/15 (January 2015). 2.5 Lewisham 3 months results to 30 th June is showing a slight overspend of 64k (0.6%) due to a non-recurrent cost pressure on QOF emanating from a shortfall in 2014/15 accrual. Lewisham s weighted population has increased by 0.2% year on year from April 2014 to April There has been a reduction of 0.9% in the first quarter of the year (April 2015) when compared to the last quarter of 2014/15 (January 2015). 187

188 2.6 Southwark 3 months results to 30 th June is showing a slight overspend of 42k (0.4%) due to a non-recurrent cost pressure on QOF emanating from a shortfall in 2014/15 accrual. Southwark s weighted population saw a 0.1% reduction year on year from April 2014 to April There has also been a reduction of 0.7% in the first quarter of the year (April 2015) when compared to the last quarter of 2014/15 (January 2015). 3. Exclusions This report excludes: Surplus brought forward from 2014/15 across all services of the Primary care budgets. 1% headroom is also excluded from this report. 188

189 NHS England London Region Enc I (ii) APPENDIX A Primary Care Services South East London (Summary by Service) Medical Services Financial Summary 3 Months to 30th June 2015 Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 135,967 33,322 (669) 135, ,158 PMS QIPP Savings (2,674) (2,674) 0 0 Enhanced Services 8,757 2, , ,275 Quality and Outcomes Framework (QOF) 14,706 3, , ,650 Premises Payment 26,738 6, , ,722 Seniority 3, , ,096 Other Administered Funds (Maternity etc) Personally Administered Drugs Total PMS 188,191 47, , ,533 GMS Global Sum & MPIG 14,930 3,658 (73) 14, ,192 GMS QIPP Savings (293) 0 73 (293) 0 0 Enhanced Services 1, , ,298 Quality and Outcomes Framework (QOF) 1, , ,063 Premises Payment 2, , ,155 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Total GMS 20,600 5, , ,469 APMS Essential and Additional Services 14,049 3,447 (65) 14, ,998 APMS QIPP Savings (263) 0 65 (263) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) (2) Premises Payment 2, , ,503 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Total APMS 18,026 4,503 (2) 18, ,280 Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Non Contractual Costs Total Other Medical Services Total Primary Care Medical Services 227,353 57, , ,663 Additional and Essential Services 164,946 40,427 (807) 164, ,348 QIPP Savings (3,230) (3,230) 0 0 Enhanced Services 10,548 2, , ,293 Quality and Outcomes Framework (QOF) 17,531 4, , ,705 Premises Payment 31,548 7, , ,380 Seniority 3, , ,554 Other Administered Funds (Maternity etc) ,031 Personally Administered Drugs Other Medical Services Total 227,353 57, , ,

190 NHS England London Region Enc I (ii) Appendix AB Primary Care Services South London (Bexley) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 16,939 4,151 (84) 16, ,487 PMS QIPP Savings (335) 0 84 (335) 0 0 Enhanced Services 1, , ,672 Quality and Outcomes Framework (QOF) 2, , ,349 Premises Payment 2, , ,559 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 23,555 5, , ,636 GMS Global Sum & MPIG 1, (8) 1, ,418 GMS QIPP Savings (30) 0 8 (30) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS 2, , ,965 APMS Essential and Additional Services (2) APMS QIPP Savings (8) 0 2 (8) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 26,231 6, , ,229 GP registrar income Additional and Essential Services 18,810 4,609 (94) 18, ,345 QIPP Savings (373) 0 94 (373) 0 0 Enhanced Services 1, , ,849 Quality and Outcomes Framework (QOF) 2, , ,594 Premises Payment 2, , ,815 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 26,231 6, , ,

191 NHS England London Region Enc I (ii) Appendix AC Primary Care Services South London (Bromley) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 16,641 4,079 (81) 16, ,113 PMS QIPP Savings (326) 0 81 (326) 0 0 Enhanced Services 1, , ,469 Quality and Outcomes Framework (QOF) 2, , ,169 Premises Payment 2, , ,403 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 22,824 5, , ,764 GMS Global Sum & MPIG 8,921 2,186 (44) 8, ,503 GMS QIPP Savings (175) 0 44 (175) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) 1, , ,398 Premises Payment 1, , ,118 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS 12,315 3, , ,290 APMS Essential and Additional Services 1, (6) 1, ,091 APMS QIPP Savings (25) 0 6 (25) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS 1, , ,625 Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 36,968 9, , ,768 GP registrar income Additional and Essential Services 26,694 6,542 (131) 26, ,707 QIPP Savings (526) (526) 0 0 Enhanced Services 1, , ,332 Quality and Outcomes Framework (QOF) 3, , ,672 Premises Payment 3, , ,889 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 36,968 9, , ,

192 NHS England London Region Enc I (ii) Appendix AD Primary Care Services South London (Lambeth) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 28,719 7,032 (148) 28, ,317 PMS QIPP Savings (590) (590) 0 0 Enhanced Services 1, , ,171 Quality and Outcomes Framework (QOF) 2, , ,698 Premises Payment 7,976 1, , ,061 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 41,580 10, , ,357 GMS Global Sum & MPIG 1, (7) 1, ,311 GMS QIPP Savings (29) 0 7 (29) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS 2, , ,883 APMS Essential and Additional Services 5,246 1,286 (25) 5, ,950 APMS QIPP Savings (101) 0 25 (101) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment 1, , ,129 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS 6,971 1, , ,787 Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 50,690 12, , ,126 GP registrar income Additional and Essential Services 35,468 8,686 (180) 35, ,578 QIPP Savings (720) (720) 0 0 Enhanced Services 2, , ,565 Quality and Outcomes Framework (QOF) 3, , ,194 Premises Payment 9,380 2, , ,437 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 50,690 12, , ,

193 NHS England London Region Enc I (ii) Appendix E Primary Care Services South London (Greenwich) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 22,576 5,534 (110) 22, ,492 PMS QIPP Savings (438) (438) 0 0 Enhanced Services 1, , ,281 Quality and Outcomes Framework (QOF) 2, , ,536 Premises Payment 4,215 1, , ,046 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 30,841 7, , ,119 GMS Global Sum & MPIG (1) GMS QIPP Savings (6) 0 1 (6) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS APMS Essential and Additional Services 2, (11) 2, ,298 APMS QIPP Savings (44) 0 11 (44) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) (12) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS 3, (12) 3, ,783 Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 34,357 8,577 (10) 34, ,318 GP registrar income 0 0 Additional and Essential Services 25,594 6,276 (122) 25, ,071 QIPP Savings (488) (488) 0 0 Enhanced Services 1, , ,371 Quality and Outcomes Framework (QOF) 2, (10) 2, ,695 Premises Payment 4,506 1, , ,390 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 34,357 8,577 (10) 34, ,

194 NHS England London Region Enc I (ii) Appendix F Primary Care Services South London (Lewisham) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 25,266 6,190 (126) 25, ,582 PMS QIPP Savings (505) (505) 0 0 Enhanced Services 1, , ,832 Quality and Outcomes Framework (QOF) 2, , ,610 Premises Payment 5,671 1, , ,625 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 35,548 8, , ,642 GMS Global Sum & MPIG 1, (7) 1, ,434 GMS QIPP Savings (29) 0 7 (29) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) (4) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS 2, (4) 2, ,097 APMS Essential and Additional Services (4) APMS QIPP Savings (17) 0 4 (17) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS 1, , Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 38,790 9, , ,713 Additional and Essential Services 27,529 6,744 (137) 27, ,629 QIPP Savings (551) (551) 0 0 Enhanced Services 1, , ,003 Quality and Outcomes Framework (QOF) 2, , ,822 Premises Payment 6,219 1, , ,149 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 38,790 9, , ,

195 NHS England London Region Enc I (ii) Appendix G Primary Care Services South London (Southwark) Medical Services Financial Summary 3 Months to 30th June Description Annual Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 2014/15 Outturn 000's 000's 000's 000's 000's 000's PMS Essential and Additional Services 25,826 6,336 (120) 25, ,167 PMS QIPP Savings (480) (480) 0 0 Enhanced Services 1, , ,850 Quality and Outcomes Framework (QOF) 2, , ,288 Premises Payment 3, , ,028 Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total PMS 33,843 8, , ,015 GMS Global Sum & MPIG 1, (6) 1, ,245 GMS QIPP Savings (24) 0 6 (24) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total GMS 1, , ,828 APMS Essential and Additional Services 3, (17) 3, ,606 APMS QIPP Savings (68) 0 17 (68) 0 0 Enhanced Services Quality and Outcomes Framework (QOF) (6) Premises Payment Seniority Other Administered Funds (Maternity etc) Personnaly Administered Drugs Total APMS 4,676 1,162 (6) 4, ,571 Other Medical Services Occupational Health Scheme/CRB Checks Premises valuation and other associated costs Other Total Other Medical Services Total Primary Care Medical Services 40,317 10, , ,509 GP registrar income Additional and Essential Services 30,851 7,570 (143) 30, ,018 QIPP Savings (572) (572) 0 0 Enhanced Services 1, , ,173 Quality and Outcomes Framework (QOF) 2, , ,728 Premises Payment 4,514 1, , ,700 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Total 40,317 10, , ,

196 Enc: J Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 ENCLOSURE J Overview of London Region s PMS Contract Reviews AUTHOR: David Sturgeon, Director of Primary Care, NHS England (London Region) SUMMARY: Overview of London Region s Primary Medical Services (PMS) Contract Reviews which includes: What are we trying to achieve? Programme scope Opportunities & challenges Principles for the review Communications Mobilisation/timelines Programme set up London Region s offer This item of the Joint Committee agenda will provide a forum for discussion of this area in the context of the six boroughs that make up South East London. KEY ISSUES: In February 2014, NHS England s Area Teams received National guidance setting out a requirement to review all PMS contracts by March The purpose of the review is to secure best value from future investment of the premium element of PMS funding. As a result of these reviews, any additional investment in general practice services that go beyond core national requirements (whether this is deployed through PMS or through other routes) should: reflect joint NHS England /CCG strategic plans for primary care; secure services or outcomes that go beyond what is expected of core general practice or improve primary care premises; help reduce health inequalities; 196

197 give equality of opportunity to all GP practices, PMS,GMS and APMS (provided they are able to satisfy the locally determined requirements); support fairer distribution of funding at a locality level. In September 2014, further guidance was issued clarifying that CCGs must be involved in commissioning decisions related to PMS funding. RECOMMENDATIONS: The Joint Committee is asked to note and discuss the PMS review and to endorse the proposal that a PMS Working Group is established with CCG and NHS England representation. CCG / NHS England CONTACT: Name: David Sturgeon david.sturgeon@nhs.net AUTHOR CONTACT: Name: David Sturgeon david.sturgeon@nhs.net 2 197

198 Enc Ji Framework for Personal Medical Services (PMS) Contracts Review. 198

199 Document Title: Framework for Personal Medical Services (PMS) agreements review. Version number: v1 First published: Sept 2014 Prepared by: Dr David Geddes Area Team Reference

200 Background 1. In January 2014, area teams were asked to review local PMS agreements over a two-year period ending in March Area teams were asked to develop proposals (by the end of March 2016) to ensure over time that any additional investment in general practice services, whether it is deployed through PMS or through other contractual routes: reflects joint strategic plans for primary care that have been agreed with the relevant CCG(s); secures services or outcomes that go beyond what is expected of core general practice; helps reduce health inequalities; offers equality of opportunity for GP practices in each locality (i.e. if one or more practices in a given locality are offered the opportunity to earn extra funding for providing an extended range of services or meeting enhanced quality requirements, other practices in that locality capable of providing those services or meeting those requirements should have the same opportunity); supports fairer distribution of funding at a locality level. PMS review framework 3. NHS England fully supports the use of PMS contracts as a way of securing innovation and addressing specific needs of patients or bringing together groups of NHS or GP contractors into new organisational models for delivering care. 4. This guidance is intended to ensure a fully collaborative approach with CCGs; and to ensure that any changes arising from local reviews are managed at a pace that does not unduly destabilise any practices. It should be read in conjunction with the principles outlined in paragraph Key principles underpinning the PMS review process include the following: a. Area teams should ensure, wherever possible, that any decisions relating to future use of PMS funding are agreed jointly with CCGs as part of anticipated co-commissioning arrangements. b. Area teams should ensure that there is a case-by-case review of all affected practices to ensure that they are not serving special populations that merit continued additional funding and that they would not be unfairly disadvantaged by the changes. 200

201 c. Any proposals to reduce current levels of PMS funding for any practices should reflect decisions on how the money freed up will be redeployed, including proposals for reinvestment of resources from area team or CCGs to support local improvement and innovation in primary care. This is to ensure that changes to practice funding reflect the overall net impact of any change, and practices don t have to manage a reduction of funding, before subsequent reinvestment. d. Where changes to services are proposed which result in different services being available to patients, there is a need to engage with patients and/or patient representative groups, to ensure NHS England complies with its various duties to consider the impact of its decisions on patients. The degree to which area teams should engage depends on the proposal being considered and what is safe and practical within the time and resources available. e. Any resources freed up from PMS reviews should always be reinvested in general practice services (including, as appropriate, general practice premises developments). f. Except with the agreement of all the CCGs involved, PMS resources should not be redeployed outside the current CCG locality. (i.e. the CCG of which the PMS practice is a member). g. Area teams were previously asked to make local decisions on the pace of change for any redeployment of funding arising from PMS reviews. Without prejudice to agreements that have already been reached with practices, but in the interests of greater consistency for future decisions, area teams should unless there are compelling reasons otherwise redeploy any freed-up resources over a minimum four year period (year one being 2014/15). h. Where, as a result of PMS reviews, practices are likely to move towards levels of funding equivalent to GMS funding, area teams should consider the potential benefits of practices nonetheless having the option of remaining on PMS agreements as a way of preserving future flexibility. i. These principles will not apply retrospectively where agreements between area teams and practices have already been made. 201

202 PMS Contract Reviews London 202

203 What are we trying to achieve? In February 2014 Area Teams received National guidance setting out a requirement to review all PMS contracts by March The purpose of the review is to secure best value from future investment of the premium element of PMS funding. As a result of these reviews, any additional investment in general practice services that go beyond core national requirements (whether this is deployed through PMS or through other routes) should: reflect joint NHS England /CCG strategic plans for primary care; secure services or outcomes that go beyond what is expected of core general practice or improve primary care premises; help reduce health inequalities; give equality of opportunity to all GP practices, PMS,GMS and APMS (provided they are able to satisfy the locally determined requirements); support fairer distribution of funding at a locality level. In September 2014, further guidance was issued clarifying that CCGs must be involved in commissioning decisions related to PMS funding All savings gained from this exercise must be reinvested into General Practice 203

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206 Principles for the review In addition to the national criteria set out for PMS contract reviews nationally, London will use a set of principles to underpin our approach. These principles are set out below by topic: Contract/Commissioning 1. The single national NHS England PMS contract model to be used across London 2. Develop a PMS Premium specification of required services over and above GMS requirements, across an CCG or SPG footprint. 3. The specification will include the appropriate and measurable indicators in the London Framework Specification that have been prioritised to be commissioned through PMS contracts at a London level. CCGs/SPGs should select from those prioritised indicators to meet the local needs and that can be funded. 4. Consistent KPIs and monitoring regime included in the contract. Current APMS KPIs will inform this process. 5. All responsible commissioners NHSE/CCG are committed to the review process and commissioning aims to improve access and the improvement of primary care. 6. NHSE will ensure reviews are completed in partnership with Level 1 and 2 CCGs. Level 3 CCGs will be responsible for ensuring PMS contract reviews are completed within the timeframe which will be monitored by NHSE through the assurance process. Level 3 CCGs will have the opportunity to access the 1% headroom to support the work or can choose to commission NHSE primary care team to deliver it. 7. Where PMS contracts have KPIs in place, the performance data required by those contracts will be used by commissioners to review and assess future commissioning intentions. 8. Where PMS contract reviews have not already been completed and performance data is not available, commissioners will request evidence from PMS practices of current deliverables and assess future commissioning intentions. 9. Any released PMS funding will be reinvested in general practice. 10 CCGs/SPGs with NHSE may choose to commission locally specific services with released PMS funding or using additional funding at a CCG level. This could be contractualised through the PMS contract or separately through a Local Enhanced Service. 11 Practices whose contracts provide a specific service or population eg. services to homeless people, will be reviewed separately. 206

207 Principles for the review contd. Finance 1 The review will establish as a minimum an agreed cost per weighted patient for the delivery of the agreed specification across all PMS providers at a CCG level. 2 Transitional financial support up to 2 years considered for practices that have a reduction in contract value 10% or a specified financial amount. 3 Funding not invested in core PMS requirements to be reinvested in general practice for locally specific services by CCG or SPG through PMS contracts or other commissioning mechanisms. 4 Transitional funding requirements to be funded from 1% NR monies for a period of two years. Engagement 1 Engagement will be with individual practices, networks and representatives eg. LMC 2 Communication and engagement plan for patients and public to inform decisions made on commissioned services or changes to services before they happen

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212 London Region s Offer NHS England PMS contract template document Starter for 10: Specification & KPIs Financial modelling Analysis of ppwp of PMS contracts compared with Primary Care Web Tool Letter to practices where information not available on services delivered/performance against PMS premium Communications plan at London level High level assessment of CCG PMS contract alignment with national requirements Generic risk register 212

213 Co-commissioning of Primary Care South East London s CCGs and NHS England Primary Care Joint Committees Primary Care Joint Committees (PCJC) Meetings DATE OF MEETING: 06 August 2015 AUTHOR: ENCLOSURE: K Primary Care Joint Committees Terms of Reference Gilbert George, Executive support to the south east London Primary Care Joint Committees SUMMARY: The terms of Reference (ToR) for Primary Care Joint Committee (PCJC) in each borough were approved by NHS England as part of the south east London joint commissioning application as well as by respective CCG governing bodies and membership. The June 2015 meetings of the six borough Joint Committees review the TOR documents in light of changes to the arrangements for Joint Commissioning nationally since the time of that application and the first meeting of the committees in public. Comments and agreed amendments, largely related to administrative errors, made at that meeting have now been reflected in the documents appended for each committee here. The final version of the PCJCs ToRs are presented for noting by Members and Observers. KEY ISSUES: At the June Primary Care Joint Committee meetings the following specific actions were requested and have now been undertaken: The Bexley PCJC ToR to be corrected for a minor error on page 6, 2nd paragraph. The Lewisham PCJC ToR presented at the PCJC June 2015 meeting was an earlier iteration (not the version agreed by NHS Lewisham CCG s Delivery Committee) and the approved version is now provided. 213

214 RECOMMENDATIONS: The Committee members and observers are asked to note the terms of reference for each NHS England and CCG Primary Care Joint Committee. NHS England / CCG CONTACT: Name: Gilbert George Gilbert.George2@nhs.net AUTHOR CONTACT: Name: Gilbert George Gilbert.George2@nhs.net 214

215 NHS Bexley Clinical Commissioning Group The CCG Primary Care Joint Commissioning Committee Terms of Reference Introduction In May 2014 NHS England invited Clinical Commissioning Groups (CCGs) to expand their role in primary care commissioning and to submit expressions of interest setting out their preference for how they would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England and CCGs would co-commission primary medical services. One of the aims of co-commissioning is to help align the commissioning system and to develop better integrated out of hospital services based around the diverse needs of local populations. 215