Minutes for Primary Care Commissioning Committee Monday 20 February 2017, 9.30am Meeting Room 3, Beccles House, Beccles (Meeting held in public) Present Name: Position: Organisation: Cedric Burton (CB) Lay Member (Chair) NHS GYW CCG Melanie Craig (MC) Chief Officer (present for item 6.1) NHS GYW CCG Cath Byford (CBy) Deputy Chief Officer / Chief Nurse NHS GYW CCG Robert Temple (RT) Lay Member NHS GYW CCG Rebecca Driver (RD) Director of Commissioning & NHS GYW CCG Engagement (Executive, nominated by Cath Byford) Teresa Knowles (TK) Head of Quality & Safety NHS GYW CCG (deputising for Cath Byford) Wayne Rawlings (WR) Practice Manager Outside of GYW CCG Area East Harling & Kenninghall Medical Practice David Ellis (DE) Secondary Care Clinician Non-Executive Director, JPUH Mary Rudd (MR) Local Government Member Member from System Leadership Partnership Non-voting attendees Tracey Bullard (TB) Primary Care Development Manager NHS GYW CCG Stuart Quinton (SQ) Contract Manager NHS England Midlands & East Jean Goffin (JG) Vice-Chair, Patient Participation NHS GYW CCG Group (PPG) Forum Alex Stewart (AS) Healthwatch Representative Healthwatch Norfolk Dr Tim Morton (TM) Local Medical Committee Local Medical Committee Representative Martin Vallis (MV) Retained GP NHS GYW CCG In attendance Name: Position: Organisation: Karen Waters (KW) Contract Administrator (minutes) NHS GYW CCG Members of the public were in attendance 1. Apologies Action owner Better Health, Better Care, Better Value
1.1 Apologies were received from: Tessa Litherland (TL), Director of Contracting, NHS GYW CCG John Bailey (JB), Chief Financial Officer, NHS GYW CCG Andy Yacoub (AY), Healthwatch Representative, Healthwatch Suffolk Wendy Cooper (WC), Finance Manager, NHS England Midlands & East 2. Chairman s Introduction and report on any Chairman s actions 2.1 The Chairman welcomed everybody to the meeting. 3. Declarations of Interest 3.1 No interests were declared. The chair reminded those present that if any interests came to light during the meeting, they should be declared at that point. New guidance has been issued and documents will be updated accordingly. Any necessary training will be organised. 4. Approval of the minutes of the previous meeting held on 12 December 2016 4.1 The minutes of the previous meeting held on 12 December 2016 were approved as a true and accurate account of the discussions that took place. 5. Action Log 5.1 The action log was reviewed and updated as follows: Action 6: FFT response rate RD reported that patient representatives are questioning how genuine or helpful their involvement will be. JG advised that the PPG Forum feels that the patient survey is more useful. It was therefore agreed to close this action and revisit it if needed. Healthwatch Norfolk has access to live data and offered to send a quarterly report to the CCG. Action 6 to be closed, new action to be opened. Action: AS to arrange for quarterly reports to be forwarded to the CCG. AS Action 7: Involvement of NHS GYW CCG Prescribing Team in PCCC The Committee insisted that the Prescribing Team is involved in the next meeting. Action to remain open. Action 8: Inclusion of workforce data within the dashboard A report will be available for the next meeting. Page 2 of 6
The dashboard has been shared at the Clinical Leads Meetings which are attended by representatives from all practices. TM advised that the CQC s intelligence monitoring is very similar to the dashboard and it may be possible to use that to save duplication. TM will forward the CQC s dashboard to RD for internal discussion. It was noted that it is important for the dashboard to reflect trends and seasonal differences. Action to remain open. Action 9: Development of a template for wider circulation re potential triggers for list suspensions / closures This item will be received at the next meeting. Action to remain open. Action 10: Primary Care input on the Demand Management Board The LMC are of the view that they are content if there is Retained GP input and they receive the minutes of meetings. CBy confirmed that the meeting is attended by Dr Paul Berry, Retained GP and John Chapman, JPUH. There is an action log, not formal minutes. TM confirmed that this is acceptable. Action to be closed. 6. GP Forward View Feedback 6.1 MC and CBy were in attendance for this item. The Committee received a GP Forward View Feedback report which was a presentation from the first submission of the plan and an update on the process and progress of the development of the next submission. The first submission was rated as giving a good summary of the activities planned against all key elements and met the stage 1 requirement. There was a discussion regarding synergy between the strategy and the operational plan. The strategy was written with the Forward View in mind. NHS GYW CCG is looking at the plan and the second part final draft submission is due to be submitted next week. Quite a lot of detail has to be added to the next submission and this is seen as a good opportunity to ensure that things are joined up. RD confirmed that there are forthcoming meetings to ensure that Primary Care is involved as much as possible. NHS GYW CCG s Operational Plans have been shared with colleagues in Norfolk to ensure system-wide working. It was acknowledged that practices will need support in driving the plan forward. TM advised that he has requested a meeting with JB to discuss some concerns the LMC has regarding allocation of primary care finances. There was a discussion regarding primary care finance and the Sustainability and Transformation Plan (STP) and the integrated link. Compared to other areas of the country, the Norfolk and Waveney footprint is behind with STP work and there is lack of clarity regarding finances. The detail needs to be worked through. At CCG level however, Page 3 of 6
there is clarity and financial modelling behind the STP which takes into account NHS GYW CCG s financial recovery. 7. GP Patient Survey results for our local area 7.1 The Committee received a report on the latest results from the annual GP patient survey. TK went through the report highlighting areas of achievement. 89% of patients were satisfied overall with their experience of their GP surgery, compared to a national level of 85%. 78% of patients in Great Yarmouth and Waveney described getting through to a GP surgery on the telephone as easy; the national level is 70%. 90% of patients described receptionists at GP surgeries as helpful, compared to a national level of 87%. Some work is needed regarding online appointment booking. The national level is 31% and NHS GYW CCG achieved 27%. Performance for other CCGs was between 18% and 38%. TB confirmed that there is a dedicated team at NEL (Anglia) CSU who are working really hard with practices to drive improvement. The increase in demand means that practices now have to open up more online appointments. JG commented that discussion has been held at the PPG Forum and it is clear that some patients do not wish to use online services. The demographics also influence the take up of online services. TM raised a point regarding equality and equity and questioned whether the use of online services discriminates against some patients. He also questioned whether it reflects the workload and feels that access in primary care should be demand managed, as well as that of secondary care and that online bookings should be demand managed. It was noted however that there is a standard practices have to achieve as part of their contract. The Committee recognises that although there are areas where improvements need to be made; NHS GYW CCG is performing well in some areas. 8. Finance Report 8.1 In the absence of JB, MC was going to provide a finance update but she was urgently called away from the meeting. The Committee are aware of the continued critical nature of NHS GYW CCG s finances. 9. Primary Care Quality and Safety Report including performance 9.1 The Committee received the Primary Care Dashboard for February 2017 which was discussed as follows: There have not been any CQC inspections or published reports for Great Yarmouth and Waveney GP practices since the publication of the December 2016 dashboard. NHS GYW CCG continues to monitor CQC inspection reports and ratings of primary care services and is involved Page 4 of 6
with regular practice visits. Five QIRs against GP practices remain open and under investigation. It appears that some practices have not submitted their November returns and this is being investigated to establish whether it is correct. As Greyfriars Health Centre is now closed and there have been changes within Great Yarmouth, the data for that area is inaccurate. Greyfriars Health Centre will not be included within future reports. It was suggested that text be added to the report so that it can be viewed in context. Action: Text to be added to the report where necessary. CBy / TK NHS GYW CCG is in a good position in respect of prescribing and antimicrobial stewardship. The Medicines Optimisation Team at the CCG has spent a lot of time working with clinicians. Demand management visits with practices are taking place to discuss GP referrals to JPUH and NNUH. There was a discussion regarding A&E attendance per 1000 population and a comment was made that it would be interesting to know the times of day patients are attending and whether activity has increased during out of hours. This information could be passed to the Demand Management Board. Post minute note: The Unplanned Care Team have confirmed that they are looking at A&E data in quite a bit of detail, including time of day split between minors, majors, etc. This will be discussed at the A&E Delivery Board. The national target for dementia diagnosis rates per practice is 67%. NHS GYW CCG acknowledges that it has some work to do to increase the target locally. NHS GYW CCG has become aware that some patients with dementia in care homes have not been diagnosed and there are some real challenges. NHS GYW CCG s Retained GP, Dr Ardyn Ross, continues to work with practices. The Committee acknowledged that care should be taken with comparative data due to the demographic differences between practice areas. 10. Primary Care Strategy Update 10.1 The Committee received a Primary Care Strategy update. The draft Primary Care Strategy was received by the December Primary Care Commissioning Committee and the Governing Body considered 21 recommendations at their meeting in January. Those 21 recommendations have now been added to the strategy which will be draft until it has been presented to the Governing Body and the public. The Governing Body s recommendations will be transformed into a Page 5 of 6
detailed plan, integrating the Five Year Forward View and the STP. It was suggested that the Primary Care Strategy, Five Year Forward View and STP should drive the agenda for this Committee. Action: Consider re-formatting agenda. There was a discussion regarding the four localities and the differences within those areas and how the practices will work together. The practices do recognise that they are different demographically and there will be memorandums of understanding for them to work together, with the exception of one or two. Good progress is being made and it is acknowledged that each of the areas will progress at a different speed. The pace will have to be set at a certain level, with a degree of realism. MC / CB / TB / Andy Wall 11. Any Other Business 11.1 There was no other business. Date, time and venue of next meeting: Monday 24 April 2017, 1.30pm, Beccles House, Meeting Room 3 Page 6 of 6