Primary Care Commissioning Committee In Public Meeting held on 17 th May 2018 2:00pm, Conference Room A Present: Smith, Pam (PS) Ritchieson, Chris (CR) McAlavey, Andy (AMcA) Marsh, Laura (LM) Wedd, Paula (PW) Murray, Sarah (SM) Pomfret, Steve (SP) Perkins, Jeremy (JP) Jones, Annabel (AJ) Powell, Simon (SPow) Lee, Alison (AL) Sutton, Carla (CS) In Attendance: Jefcoate-Malam, Tanya () Hardy, Cheryl Lay Member, NHS West Cheshire Clinical Chair, NHS West Cheshire Clinical Medical Director, NHS West Cheshire Clinical Commissioning Group Director of Commissioning, NHS West Cheshire Clinical Director of Quality and Safeguarding, NHS West Cheshire Clinical Head of Primary Care, NHS West Cheshire Clinical GP Network Chair, Rural GP Network Chair, Ellesmere Port and Neston GP Network Chair, City Local Medical Committee Representative Chief Executive Officer, NHS West Cheshire Clinical Senior Contract Manger, NHS England North (Cheshire & Merseyside Deputy Head of Primary Care, NHS West Cheshire Clinical Business Administrator, NHS West Cheshire Clinical Agenda Agenda Item No 2018-31 Welcome Introduction and Apologies Action Pam Smith welcomed everyone to the meeting. It was noted that this is a meeting held in public, although no members of the public were present. Apologies were received from Gareth James and Louise Barry. 2018-32 Declarations of Interest No standard declarations of interest were made. 2018-33 Minutes of last meeting 15 th March 2018 The minutes of the meeting held on 15 th March 2018 were agreed as an accurate record. Notes of Primary Care Commissioning Committee 1 NHS West Cheshire Clinical
Matters Arising There were no matters arising to be discussed. Actions 2017-45 Minor Ailments Scheme This action has now been completed. 2018-34 Primary Care Quality and Performance Report confirmed she has repeated the audit on practices with high numbers of outstanding patient records to see if there had been an improvement in the transfer of patient notes. She noted due to other pressures in primary care some practices have not supplied the information however these practices have been chased. Although there has been a small improvement in the number of outstanding notes we would still want to see further improvement. advised she has escalated this to NHS England and advised the group that PCSE have responded today to say work is being undertaken to improve the situation however this has been delayed due to an issue in the South of the country. NHS England have provided assurance that improvements have been made in the North West however advised that she did not feel assured by this and has agreed to resend data to PCSE. In addition, CS suggested that may wish to contact Practices to find out if they have received communication from PCSE to transfer outstanding and historic notes. would find this out and feedback to the next meeting. Following a discussion at the Primary Care Commissioning Committee in March 2018, the Primary Care Operational Group agreed the best forum in order to enable sufficient scrutiny of Primary Care Quality and the progression of the GP Quality Agenda. It was decided to re-create the GP Quality Group and the first meeting of this reinvigorated forum took place in May 2018. The group discussed a number of GP quality issues and agreed actions to lead to improvement (these are highlighted in the report). One of the key areas within the meeting was increasing awareness and education around sepsis, both a local and national priority. CR asked in terms of the GP Quality Group is there an expectation we would receive datix reports to recognise more common themes. It was noted the GP Quality Group did previously receive updates and it was agreed this would be reinstated. The Commissioning Committee also wanted assurance that patient experience data would be reviewed by the GP Quality Group, including results of the Friends and Family test. This was noted, it was suggested that although the primary care monitoring report does include data this cannot be relied on for all Practices as there is an inaccuracy in the way this data is reported by some Practices. However this issue is being rectified and should be correct within the next report. Notes of Primary Care Commissioning Committee 2 NHS West Cheshire Clinical
The group agreed it is useful to look at how other partners approach quality and how the CCG engage with the wider Primary Care administrative teams to support quality improvement. SM informed the group that the legacy programme should support this work going forward and the group noted that the various workstreams that support quality improvement need to be brought together and reported holistically. PS suggested the terms of reference for the GP Quality Group need to be revisited. advised that the Primary Care Operational Group the terms of reference have been amended to encompass GP Quality. Primary Care Operational Group Part one and Part two. The committee also agreed that a workplan now needs to be put into place for the GP Quality group and suggested that this should be done outside of the meeting and brought back here to be reviewed. PW suggested more qualitative information should be included in the workplan. The group agreed a workplan would help show where any gaps are and they agreed Lead names need to be included against each item. PW also suggested it would be good to include nurse clinical leadership on the workplan. The Primary Care Committee noted the contents of the report, including: the further steps taken to escalate Primary Care Services England issues the continued work carried out to monitor the performance of Primary Care across West Cheshire the reinstatement of the GP Quality Group, along with actions agreed to improve GP quality for screening, immunisation and sepsis prevention. 2018-35 Primary Care Commissioning Report SM informed the group that a workshop was held with key stakeholders from across Cheshire on the 1 May 2018 regarding the potential for collaborative working across Cheshire following West Cheshire becoming fully delegated commissioners of primary care. A report on the outcomes of the workshop and recommendations will be produced for the Joint Executive Team at their meeting on 21 May 2018, to agree next steps. A Primary Care Commissioning Manager has been appointed to support the primary care commissioning agenda and will take up the post in June. SM confirmed interviewing has been successful for the Clinical Pharmacist role and advised that they are hoping to have someone in post for the Senior Clinical Practice Pharmacist shortly. Notes of Primary Care Commissioning Committee 3 NHS West Cheshire Clinical
NHS England Sustainable Improvement Team has agreed for the Clinical to run the realising time to for care programme for a fourth Cohort of practices. This will start in September 2018 and there will be learning and sharing event held at the Membership Council in November 2018 which NHS England will attend. Following conversations at the GP networks they have supported the reduction of the number of Care Communities from 9 7 across West Cheshire. AL noted she was pleased with the wellbeing service mobilisation and was keen to see the success factors when this starts in July. AL was also keen to note that these successes need to be consistently monitoring and reported. SM informed the group that Emma Leigh and Ian Ashworth are meeting with herself and Colin McGuffie to discuss this in relation to other similar services commissioned separately. SM advised weekly meetings are taking place with Primary Care Cheshire to discuss the mobilisation plan and LM clarified that updates are coming through the operational group. JP suggested it would be useful for this to be discussed at GP Networks. The group noted there was a 0 missing from point 14 and this should read populations of between 30,000 and 50,000. AL queried how the realising time for care programme has provided a return on investment and asked if this is freeing up time to see more patients or improving the quality of life in Primary Care. SPow felt this has taken pressure out of the system giving back additional time to clinical staff, although the burden on administrative staff is increasing. Clinicians feel this has been a worthwhile piece of work and would encourage those who have not done it to do so. LM suggested a survey could be compiled for those who have completed this programme. The group agreed it would be good to have a learning repository. AL queried what the main objective is for the e-consult project, SM clarified this is a tool that is used to free up face to face consultations with GPs and offers patients a different way of interacting with doctors and obtaining information. SPow however felt that some tasks e- consult does could be delivered in other ways and therefore this does not save as much clinical time as estimated. In addition, he felt part of this could be wrapped up in the digital front door project of the Integrated Care Partnership. AJ advised the Committee that admin teams are more positive around this service than GPs as it allows an alternative for patients to request sick notes and repeat prescriptions. Notes of Primary Care Commissioning Committee 4 NHS West Cheshire Clinical
noted the report provides evidence from practices on the Personal Medical Service contract Key Performance Indicators (KPI) progress to demonstrate whether these have been achieved. She clarified that the funding for this premium has already been paid to Practices. asked the committee to decide whether funding should be ongoing. There has however been some concerns over whether this committee has the appropriate authority to approve these payments. It was decided this could be achieved through the delegated responsibility of the directors present. PS raised concerns around continuing the payments to the two Practices where issues had been identified within the report. advised that the Primary Care Operational Group have requested that payment continue for Western Avenue as this was used for front line services and they have demonstrated patients have been better served by their change in focus. The group agreed to allow them to keep the entirety of their PMS funding and monitor what they are doing to ensure they are delivering value for money. agreed to advise the practice that they should consult with the Clinical Commissioning Group prior to making any service changes. Bunbury were asked to offer 15 appointments per month to patients within the cluster who meet the well man criteria however only one other practice agreed to send patients to them. advised they have done everything they can to engage with practices around this however other practices chose not to refer patients due to this not being a long term service that they felt would benefit their patients. As the practice did fill the 15 appointments with their own patients CR felt they had done what is within their gift. The group agreed if this service is not perceived to be of value we could ask them to change this KPI later in the year. NHS England has notified the Clinical that four Practices have received additional funding, over and above their contract, for historically agreed services. These are going through a similar review as PMS funding to ensure that all practices are receiving equitable funding. NHS England has written to the four Practices to ask for further information on what this funding has been used for. An update on this will be provided at the next Part 2 meeting. noted that the primary care CQUIN has been reviewed at this meeting, and the 2018/19 scheme has now been launched. A number of practices have raised concerns that the block funding agreed at the beginning of the year might not meet activity demands due to reasons outside of their control for example changes in population size, practices who have had their lists closed who are now reopening or broken machinery may mean activity is higher. The report suggests an appeals process where practices can appeal to the Primary Care Operational Group first and then to the Primary Care Commissioning Committee, giving evidence to demonstrate that their activity has increased. A number of factors will then be assessed before a decision is made if this process is approved. Notes of Primary Care Commissioning Committee 5 NHS West Cheshire Clinical
LM agreed there needs to be a process in place asking practices to let us know if any significant changes happen either way we need to ensure value for the CQUIN. The Primary Care Commissioning Committee: noted the work carried out to date by Personal Medical Service Practices at quarter four. noted the payment of the premium to those Practices by NHS England on the basis of work completed, although note that one Practices has been contacted to request further evidence. noted the work carried out to date to engender sign-up and engagement for the Primary Care CQUIN. approved the appeals process for material changes. noted the work carried out by NHS England to review core hours across West Cheshire. 2018-36 Minutes of Sub-Committees The committee accepted the minutes of the primary care operational group and IT Infrastructure Board. 2018-37 Any Other Business PS agreed to set up a separate meeting with LM, SM, and GJ to look at the scheme of reservation and delegation. PS Date and Time of Next Meeting The next meeting will be on Thursday 19 th July 2018 at 2:00pm in Conference Room B. Notes of Primary Care Commissioning Committee 6 NHS West Cheshire Clinical