NHS DORSET CLINICAL COMMISSIONING GROUP (CCG) PRIMARY CARE REFERENCE GROUP (PCRG) 26 SEPTEMBER 2018 NOTES A meeting of the Primary Care Reference Group of NHS Dorset Clinical Commissioning Group was held at 09:00hrs on Wednesday 26 September 2018 at Vespasian House. Present: In Attendance: Apologies: Claire Lehman, CCG Clinical Lead, Primary Care Quality PCRG Chair (CL) Anu Dhir, CCG Clinical Lead, Primary Care Development (AD) Craig Wakeham, Clinical Chief Information Officer (CW) Tom Knight, GP Representative East Cluster North Bournemouth (TK) Ben Sharland, GP Representative East Cluster Central Bournemouth (BS) Jenny Bubb, GP Representative West Cluster Mid Dorset () David Haines, GP Representative Mid Cluster Purbeck (DH) Judith Young, PM Representative East Cluster North Bournemouth (JY) Sue Richards, PM Representative Mid Cluster East Dorset (SR) Jane Goodson, PM Representative West Cluster Mid Dorset (JG) Emma Wilson, CCG Senior Primary Care Lead () Jane Thomas, CCG Primary Care Programme Officer (JT) Jo Knight, CCG Senior Management Accountant (JK) Chloe Longman, CCG Admin Support, Primary Care Team (CLo) Note Taker Sam Crowe, Public Health Acting Director (SC) Ruth Doe, CCG Programme Lead (RD) David McDonald, DCC Senior Procurement Officer (DM) Karen Kirkham, GP Representative West Cluster Weymouth & Portland (KK) Andy Purbrick, LMC Medical Director (AP) Sarah Walker, CCG Primary Care Programme Lead (SW) Sally Sandcraft, CCG Director of Primary & Community Services (SS) Rob Payne, CCG Head of Primary Care (RP) Luna Hill, CCG Primary Care Principal Lead (LH) 1. Welcome and Apologies CL welcomed everyone to the meeting and introductions were made. Apologies received. Action 2. Declaration of Interest Forms DOI forms (Enclosure A) were made available prior to the meeting for any additional declarations. There were no new declarations made. 3. Notes, Actions and Matters Arising from previous meeting The notes from the previous meeting (Enclosure B) were reviewed and agreed. Action tracker was updated accordingly. 4. Health Checks Update Public Health SC provided an update. Three meetings have taken place to date in relation to health checks, as a result of these meetings principles were formed. Current contracts end at the end of the financial year. Public Health are seeking views of the proposal and are keen to run tender in a more collaborative way. 1
It has been agreed uptake will be greatest if the invitation comes from GPs. Public Health would like to run procurement directly awarding the contract to any practice and pharmacy who would like to deliver Health checks, without competition. DH suggested targeting invitations to those who do not regularly use the service. Invitation will need to be clear of options available, DH suggested there should be a steer for patients to be seen at own practice. Feedback from task and finish groups showed patients were keen to be offered choice of practices to be seen at, or any other provider in Dorset. SC suggested local ownership is beneficial. Nationally, South West of England is an area of concern. Public Health are taking much closer interest in finance element. Expected to deliver 23k checks but delivered closer to 7k. Contractually, the end user has choice of where they receive their Health Check. DH suggested this will not help resilience of Primary Care, however there was an understanding that localities should work in a collaborative way to ensure the patient has choice and an equitable quality service wherever they choose to go. Public Health will continue to work on the tender, next steps include working on specification. General feeling of support, recognising some areas of concern. Liaising with localities to optimise engagement, to hopefully go live in April 2019. 5. Ophthalmology Update New community Ophthalmology service in place, Evolutio. Still being bedded in. Increase in number of referrals from what they had expected. Important for practices to have opportunity to ask questions, share feedback etc. CW suggested using learning from other programmes and engaging with localities for feedback which is a powerful way to identify solutions. RD confirmed the team are keen to join locality meetings for this purpose. Initial relationship issues between providers which delayed collaborative working. DH suggested the service is still not working for rural areas nothing in Purbeck for his patients and Evolutio are not delivering the service they should be. RD to link with LOD to provide feedback, looking at making further links. Dorset-wide clinical meeting taking place on 12 October, to review further. RD 6. GP Contract Plus Update presented the principles for PMS premium allocation. Increased list size will be taken into consideration for 2019/20 contracts and will reflect October 201818 list size. Seeking recommendation of using the PMS allocation for Phlebotomy or to explore further pressures in Primary Care that were identified within the paper and by discussing with a wider Primary Care audience (Membership Event). Phlebotomy was debated regarding whether the PMS allocation should be used for this area. It was confirmed there appears to be no new monies to fund Phlebotomy. 2
DH suggested bidding for Phlebotomy via OFRG, to which JK confirmed there is no further funding available for this. SR queried if there will be Frailty uplifts as this is an area of concern to practices. to explore this. It was asked if PMS Premium money should be used for Phlebotomy and there was no unanimous consensus. There was also no further discussion on what the allocation should be used for. It was agreed CCG Senior Leadership Team need to fully acknowledge the commitment to make a bid. to discuss with Simone as representative. 7. Near Patient Testing Update Good progress has been made, engagement made should be acknowledged. Current greatest challenge is in gaining engagement from acute providers. Rheumatology seems to be main concern and Primary Care team currently working on this. It was agreed it is important not to review model in West if it will not also work in East. Systems in Primary Care to support acutes to deliver the service. Opportunity to work with practices who have highlighted an issue. Workshop taken place with practice and acute representatives involved. Communication seems to be a real challenge. Shared care arrangements and guidelines need to be put in place to allow consistency across. Also an element of contract management process needs to be put in place. Group to be kept informed. Vast workload that has fallen on Primary Care with no funding to support. Funding has been provided in East but not in West. 8. Influenza Outbreak Funding Update and Draft Specification Last PCRG reviewed responses to Influenza in care homes. It was confirmed this funding does not need to come from IAGPS. Identified 10k which can be used, this is currently non-recurrent. Proposal to seek Expressions of Interests for localities to deal with outbreaks of flu. Care homes will be mapped by locality to then deploy a nominated response team to treat as necessary, within 36-48 hours. Also mapped will be pharmacy teams. Locality teams should consist of GP (including Prescribing), Advanced Nurse Practitioner and Admin to be paid 100 per hour, adopting MDT approach for three hours. currently working with South West Immunisations team to identify which practices have been unable to obtain enough vaccinations, to highlight in advance which areas are likely to see outbreaks. Group supportive of this proposal. to circulate Expression of Interest form to localities. 9. Any Other Business raised the issue of SystmOne temporary patient registrations. Unable to make any amendments to medication. Only way to do this involves sending request to patient s permanent practice. Tried to raise with SystmOne and Medicines Management who have acknowledged risk but not been able to identify a solution. This is a significant risk to practices and patients. to email concerns to CL and CW. Also to be added to GP Bulletin to alert practices to this issue. However, agreed that, as a workaround, patients should be registered as permanent patients to allow changes in medication and for patient safety. To be discussed at next meeting. 3
CW highlighted concerns around data extraction for practices, moving to SNOMED. Request for Practice Managers to provide feedback to CW as requires approval. JT provided an AliveCor update. Over 70 practices have received a device. Registration issues have now been resolved, comms have been sent to all practices. Generally positive feedback received from practices. JY suggested the process can be quite time consuming and is not always efficient with large numbers of patients being seen at clinics. Number of results showing as indeterminant. CW reported Cardiologists are happy to receive AliveCor traces. 10. Date of Next Meeting Wednesday 28 November 2019, 9.00am 11.00am JY/JG/ SR Action Tracker Meeting Action Date 8/8/18 Create an action tracker to monitor outstanding actions. PC team to review GP Contract Plus to identify any areas which may require PMS investment for 2019/20. Report back at next meeting Group to disseminate information to localities/clusters and inform Nichola Arathoon of contact for resources at flu clinics. Email: Nichola.Arathoon@dorsetccg.nhs.uk to invite Christian Verrinder to next meeting to present Principles behind using the Caudal Epidural Allocation from 2019/20 Group to disseminate information in relation to the task and finish group to localities/clusters and send any expressions of interest to Sarah Walker. Email: Sarah.Walker@dorsetccg.nhs.uk 26/9/18 Ophthalmology RD to link with LOD to provide feedback, looking at making further links GP Contract Plus it was queried if there will be Frailty uplifts as this is an area of concern to practices. to query this. PMS Premium CCG SLT should fully acknowledge the commitment to make a bid. to discuss with Simone to raise. Influenza Expression of Interest forms to be issued to form locality response teams. Action Owner Status Notes CLo Complete To be circulated prior to next meeting. ALL to liaise with Nichola Arathoon to form a communication to practices in relation to mymhealth Work in progress ALL RD First meeting taking place today update to be provided at next meeting. 4
SystmOne temporary registration concerns to email concerns to CL and CW to be raised further. Data extraction Practice Managers to provide feedback to CW. JY/JG/ SR 5