Oxfordshire Clinical Commissioning Group Oxfordshire Primary Care Commissioning Committee Date of Meeting: 2 May 2017 Paper No: 15 Title of Paper: Memorandum of Understanding (MOU) for Primary Medical Services Support to delegated CCGs Paper is for: (please delete tick as appropriate) Discussion Decision Information Purpose and Executive Summary: The MOU offer of support sets out the working arrangements and responsibilities for the delivery of primary care medical co-commissioning in South Central under delegated commissioning (level 3) from 1 April 2017 to 31 March 2018 Copies of the appendices are available on request. Financial Implications of Paper: The delegation of responsibility for primary care medical co-commissioning has come with no resource to the CCG for delivery of the agenda. Action Required: The Committee is asked to note the MOU. OCCG Priorities Supported (please delete tick as appropriate) Operational Delivery Transforming Health and Care Devolution and Integration Empowering Patients Engaging Communities System Leadership Equality Analysis Outcome: Not applicable 1
Link to Risk: 769- Primary Care Capacity. Author: Ginny Hope, Head of Primary Care, NHS England South (South Central): ginnyhope@nhs.net Clinical / Executive Lead: Catherine Mountford, Director of Governance catherine.mountford@oxfordshireccg.nhs.uk Date of Paper: 24 April 2017 2
(Updated version 2017/18) 1
NHS England South Central Primary Medical Services Support 1. Introduction This offer of support sets out the working arrangements and responsibilities for the delivery of primary care medical co-commissioning in South Central under delegated commissioning (level 3) from 1 April 2017 to 31 March 2018, between: NHS England South Central and the following clinical commissioning groups: Aylesbury Vale Clinical Commissioning Group Bath and North East Somerset Clinical Commissioning Group (Level Bracknell & Ascot Clinical Commissioning Group Chiltern Clinical Commissioning Group Newbury & District Clinical Commissioning Group North & West Reading Clinical Commissioning Group Oxfordshire Clinical Commissioning Group South Reading Clinical Commissioning Group Slough Clinical Commissioning Group Swindon Clinical Commissioning Group Wiltshire Clinical Commissioning Group Windsor, Ascot and Maidenhead Clinical Commissioning Group Wokingham Clinical Commissioning Group 2. Purpose This offer of support is a joint agreement between NHS England and each CCG that has moved to delegated status for the commissioning of general medical services. The offer sets out: the common purpose of the parties in delivering primary medical care functions at delegated commissioning levels the initial period of the relationship and review period the governance arrangements how each party will contribute to the delivery of the primary care functions 2
3. Key Principles Delegated commissioning enables CCGs to have greater influence on decisions relating to primary care medical services and enables an integrated approach to improving health care locally, providing opportunities for a more collaborative approach to designing local solutions to support delivery of the CCG Primary Care Strategy and the wider strategic aims of CCGs. In doing so NHS England and Clinical Commissioning Groups need to ensure they are able to share expertise and knowledge to enhance strategy, policy development and decision making working in an integrated way. This ensures contracts and commissioning functions are delivered in line with the Primary Medical Care Single Operating Model (Policy book) https://www.england.nhs.uk/commissioning/wpcontent/uploads/sites/12/2016/01/policy-book-pms.pdf As outlined in Next steps towards primary care co-commissioning Next Steps towards primary care co-commissioning states that there are no additional administrative resources available for primary care commissioning services at this time, but individual CCGs may choose to deploy additional resources; Pragmatic and flexible solutions should be agreed by CCGs and NHS England local offices to put in place arrangements that will work locally for 2017/18; Delegated commissioning (level 3) allows CCGs to assume full responsibility for commissioning general medical services, while NHS England retains responsibility for reserved functions including Section 7A Public Health services, professional performance, complaints and controlled drugs. It has been agreed with South Central CCGs and NHS England: There is an ongoing need for the roles currently performed by staff employed by NHS England to continue being delivered in 2017/18 as part of the transition to delegated commissioning; The safe delivery of core functions is essential this includes payment processes for practices; The expertise to deliver these functions currently resides within the core NHS England team; The existing core NHS England team will agree practical and effective working relationships with South Central CCGs during the transition to delegated commissioning for those authorised in 2017, enabling the transfer of expertise to CCG colleagues in a managed way; NHS England South Central will set out an offer for the collective tasks involved in the commissioning of general practice; The core NHS England team is not relocated and remains within NHS England structures for 2017/18; The core NHS England team will respond flexibly to provide escalation support and expertise, working alongside the identified CCG team managing primary medical care commissioning. 3
4. Objectives The objectives of this document are to outline the agreed working arrangements for the delivery of primary care medical commissioning in respect of: CCGs taking on full delegation having access to a fair share of the primary care medical commissioning team staffing resource during transition, to enable delivery of their commissioning responsibilities. NHS England South Central retaining a fair share of existing resource to deliver all their ongoing primary care commissioning responsibilities, in relation to the other areas of primary care commissioning (dental, pharmacy and optometry) which are not currently included in co-commissioning. 5. Primary Care Medical Commissioning Team The current primary care medical commissioning resource will be co-located as a standalone multidisciplinary team delivering a single service offer across the mixed economy of CCG commissioning levels. This includes input from the following teams: Primary Care Commissioning Finance Quality and Nursing Communications Premises The provisions contained within the Memorandum of Understanding are not intended to be legally binding. Service and staffing levels may vary as a result of unforeseen circumstances or other service requirements. 6. Governance The governance arrangement for Delegated Commissioning is articulated in the CCG Constitution and in the Terms of Reference for the Primary Medical Services Committee. Monthly operational groups will continue between NHS England and each CCG along with, at least, quarterly meetings in public. 6.1. Strategic and Operational Leads NHS England (South Central) has nominated strategic and operational leads who will act as key points of contact. Head of Primary Care will be first point of contact for the MOU and associated support from the NHS England team and will provide the strategic lead. Senior manager operational leads will liaise on all operational matters and advise Strategic Leads Senior manager Finance leads will be present at both operational and Primary Care Commissioning Committees 4
6.2. Transition NHS England will arrange to meet with each CCG to provide a summary of all transitional issues currently being dealt with by NHS England that will need to be managed via delegated commissioning arrangements. The GP Contracts Team will also provide a brief document summarising all transitional issues currently being dealt with by NHS England that will need to be managed via these new arrangements. For level 3 delegated commissioning this document will be forwarded to the relevant CCG prior to 30 March 2017. 7. Service Offer Delivered by an integrated core team (commissioning, finance and nursing & quality) the Primary Care Medical Commissioning Team will continue to enable the contracting and commissioning of general practice to be managed in an efficient and consistent way. Working with CCGs to deliver local commissioning strategies and improve outcomes for patients, through flexible and innovative use of existing contracts and resources. The Primary Medical Care Commissioning Team and CCG Team will agree a high level transition plan from 1 st April 2017 onwards. The plan will list the key systems and processes to be handed-over to CCG colleagues. Linked to this will be agreement about which team is the first point of contact for contractual issues. Unless the CCG wants to take this role immediately for all issues, it is expected that this will be phased, in-line with the transition plan. Communication to contractors will be agreed throughout the transition process, ensuring contractors have clear information about who their contact is for different contractual issues. Given CCG established co-commissioning roles to-date, it is recognised the CCG may become aware of issues via local intelligence. During transition, Operational Managers will meet monthly informally, to ensure information is exchanged and teams are informed of issues. It should be noted that issues will fall in to two categories; those which the Primary Care Medical Commissioning Team can deal with as part of everyday business in accordance with NHS England Single Operating policy and procedures and those which require CCGs to make a decision. 7.1 Core Services The Primary Medical Care Commissioning Team will deliver the following, in-line with the transition plan: Support the transition of functions detailed in the transition plan; Ensure functions are delivered in accordance with NHS England policies or, linking to CCG colleagues in line with CCG policy where appropriate; Produce reports and recommendations to the Primary Care Commissioning Committee, attending where appropriate; 5
A named strategic lead (and deputy) and also a named operational lead to enable the core team to develop a productive working relationship and better understanding of individual CCGs commissioning agendas; A standardised / consistent approach to recommendations on types of decision across South Central in line with NHS England Single Operating Policy Recommendations in-line with current national regulations and guidance, including associated risks; Contracting advice to support delivery of new models of care / bigger primary care / new provider models; Advice on Enhanced Services; Continue to deliver in accordance with NHS England Single Operating Policy and relevant Regulations; Advice on proposed changes to GP contracts and QOF. 7.2 Safeguarding Safeguarding and promoting the welfare of children and adults is the responsibility of everyone who comes into contact with them and their families/carers. All NHS providers including general practice have statutory obligations under Section 11 of the Children Act 2004, Working Together to Safeguard Children 2013 and the Care Bill 2013 to ensure their organisation has arrangements in place to safeguard and promote the welfare of children and adults. CCGs already have systems in place to monitor compliance with the contractual standards set out in the NHS Provider Safeguarding Audit Toolkit (2015) and Local Safeguarding Policies. It is not anticipated that these arrangements will change post 1 April 2017. 7.3 Primary Care Finance NHS England will liaise with CCG Finance teams to agree financial reporting responsibilities. The attached document (Appendix A) sets out the detailed working arrangements between the NHS England South (South Central) Primary Care Finance Team and CCGs for the provision of Financial Management, Reporting and Support for GP Services from 1 st April 2017. It is proposed that the Primary Care Finance Team will support delegated CCGs in a consistent manner. 7.4 Nursing & Quality NHS England South (South Central) Nursing and Quality Team will liaise with CCGs for the transition of activity in relation to the delegation of primary care commissioning. The attached document (Appendix B) sets out the functions that will be transitioned; it is recognised that each CCG is at a different stage in their progress towards delegation and therefore the pace of transition in some areas will be negotiated with each CCG. 6
7.5 Communications and Engagement The NHS England South (South Central) Communications and Engagement Team will liaise with CCG Communications and Engagement teams to support the transition of activity in relation to the delegation of primary care commissioning. The attached document Appendix C sets out the phased approach to the transition arrangements, while Appendix D sets out the functions this relates to. It is recognised that each CCG is at a different stage in their progress towards delegation and discussions will be held with each CCG to refine plans. 7.6 Premises i. Rent and Rates Delivery of the three yearly rent review process and payment of rent/rates will be transitioned in-line with local arrangements. This includes liaison with practices and the District Valuer team. NHS England and CCGs will adhere to the Premises Cost Directions. ii. Premises Development Through their Local Estates Strategies CCGs will continue to lead on the development of commissioning plans, designed to provide health care services for the future with clear priorities for investment in premises, including support for ETTF schemes. NHS England will oversee the Estate Technology and Transformation Fund (ETTF) process, linking to South and National processes, provide advice and guidance to CCG premises leads as appropriate. This will allow each CCG to maximize the investment available through the ETTF scheme. 7.7 Information Governance As per section E of the Delegation Agreement 7.8 Safety Culture and Incident Reporting NHS England has been actively encouraging General Practice to report patient safety incidents. Nationally via the NRLS GP e-form, offering local support to Practices to learn from incidents and drive improvements. Learning from analysing trends and themes has been shared across South Central as a result. NHS England South (South Central) Nursing and Quality Team will liaise with CCGs for the transition of incident management, including both serious and nonserious incidents. Whilst it is recognised that CCG s are at different stages in readiness for this, the expectation is that all delegated CCG s will have taken responsibility by March 2018. 7
The Nursing and Quality Team will liaise with CCG s on opportunities to maximise shared learning across the STP footprints, whilst helping to develop stronger, positive and more mature safety cultures within Primary Care Medical Services with greater emphasis on patient involvement. 7.9 Team Management Team management will be provided from existing staffing resource and will oversee all Primary Medical Care Commissioning Team staff management and development. Staff accountability will be via the senior management of NHS England South Central. CCG staff delivering primary medical care will be managed and accountable to the senior management of the CCG. 7.10 NHS England Support Services It is recognised that NHS England regional and national teams currently provide a range of support services to NHS England employees. Prior to transition to CCGs, NHS England employees will continue to access the following functions appropriate to delivery of their role: Procurement support and advice Legal advice Communications and engagement support and advice Data analytical support GIS mapping GMS contract support and advice from NHS England Central Team CCG employees will access support services in-line with CCG arrangements. 7.11 Primary Care Support Service Primary Care Support England (PCSE Capita) are commissioned through a national contract to provide support services to all primary care contractors, include general practice. These arrangements will continue in-line with the contract. NHS England Primary Medical Care Commissioning Team and CCG Teams will continued to support contractors with appropriate escalation of PCSE issues. 7.12 Additional Services In order to support wider primary care commissioning some CCGs may wish to undertake additional or developmental activities related to the commissioning of general practice. This would require appropriate resource from individual CCGs or a pooled resource to provide a common service to all CCGs. Where this incorporates national programs, such as Enhanced Services or QoF, this must be done in consultation with NHS England, to ensure compliance with regulation and 8
guidance. Formal authorisation to proceed with changes to national programs will be required from NHS England. Such activities may include: Developing alternatives to QOF; A higher level of input into supporting delivery of new models of care / at scale primary care / new provider models; LIS/LES development; DES reviews; Development of new contractual models encompassing elements of GMS services; Input into CCG estates strategies; Strategic planning; Support applications for capital funding; 7.13 Escalation Following transition of primary medical commissioning and contracting to CCGs, the NHS England Primary Medical Care Commissioning Team will be available to provide escalation support, subject to capacity across the team. This may assist CCGs dealing with an increased number of contractual issues. 7.14 Reserved Functions Under the arrangements for delegated commissioning, a number of functions are retained by NHS England, as detailed below: i. Complaints: As per the delegation agreement, complaints are a reserved NHS England function. A quarterly report will be provided by the NHS England South Central complaints team, to inform the Primary Care Commissioning Committees oversight of contractor quality issues. There may be patient enquiries which PALS teams will be involved in managing on behalf of the CCG and NHS England will provide advice as required ii. Professional Performance, GP Appraisal and Revalidation iii. Controlled Drugs iv. Section 7A Public Health Services 8. Key Interactions In order to ensure the Primary Medical Care Commissioning function can continue to delivered, there are a number of teams / organisations with which strong working links will need to be maintained and strengthened. These include: Medical Director, NHS England South Central for all issues regarding individual practitioner performance NHS Property Services Primary Care Support England NHS England Assurance Team Local Professional Networks Local Medical Committees 9
9. Service Sustainability NHS England ability to deliver this offer of support is subject to: CCGs agreeing to a standardised approach across all 14 CCGs in South Central area and that any deviation away from this will result in a decreased level of service delivery and support to transition; CCGs agreeing not to fragment the existing staffing resource as this will limit the team s ability to deliver transition of core functions; CCGs agree risk share where appropriate, for example: Violent Patients Service, Discretionary Payments, Clinical Waste contract. 10. Terms of the Agreement As this is an evolving document quarterly reviews will be undertaken, linked to CCG transitional plans, and any amendments signed off by the CCGs and NHS England at an operational level. These arrangements will be reviewed during the period with a view to either agreeing a continuation of the model into future years or its cessation and movement to a new arrangement. The scope of this review would also incorporate a feasibility study into establishing a model for any phase 2 of Primary Care co- commissioning to incorporate Dental, Pharmacy and Optometry services. 11. Signatories Signed For NHS England South Central Signed; 10
Appendices A Financial Management B Nursing & Quality Team C - Communications D Communications Protocol E NHS England & key contact list (local team) F PCSE scope of services G CSU services (local agreements) 11