Meeting of the Primary Care Joint Committee

Meeting of the Primary Care Joint Committee to be held on Tuesday 29 November 2016, 4.30 pm 6 pm in the Armstrong Stephenson Room, Newcastle Civic Centre, NE1 8QH Agenda Papers Presenter 1. Welcome and Apologies for Absence - Chair 2. Confirmation of Quoracy - Chair 3. Declarations of Interest - Chair 4. Minutes of the Previous Meeting held on 18 October 2016 and Matters Arising Enc Chair 5. Action Log Enc Chair 6. Application for Delegated Commissioning Enc KMcH 7. Primary Care Commissioning Committee Draft Terms of Reference Enc NM/PF 8. Role of Committee Members Future Training Verbal PF 9. Basket of Care Project Group Annual Review of Terms of Reference Enc KMcH 10. Falcon Road Medical Centre / Thornfield Medical Group Merger Update Verbal NHSE 11. NHS Property Services - Service Charges / Market Rents Enc NHSE 12. Dinnington Practice Void Cost Implications Verbal JM 13. Any Other Business - All Date of next meeting: Tuesday 13 December 2016

D R A F T Minutes of the Primary Care Joint Committee meeting held on Tuesday 18 October 2016 at the CCG, Riverside House Present: Mr Jeff Hurst CCG Lay Member (Chairman) JH Ms Mandy Taylor CCG Lay Member MT Mr Paul Gertig CCG Lay Member PG Dr Neil Morris CCG Medical Director NM Ms Tracy Johnstone NHS England TJ In attendance: Mr Douglas Ball Healthwatch Gateshead DB Mr John Costello Gateshead Health and Wellbeing Board JC Ms Katharine McHugh CCG Primary Care Portfolio Manager KMc Prof Eugene Milne Newcastle Wellbeing for Life Board EM Ms Jill McGrath CCG Head of Finance JMc Ms Lyndsay Yarde Healthwatch Newcastle LY Minutes: Ms Sue Tulloch PA Support ST 10/16 01 Welcome and Apologies for Absence The Chairman welcomed everyone to the meeting. Apologies for absence were received from Ms Christine Keen (NHS England), Ms Steph Edusei (Healthwatch Newcastle) and Jane Mulholland (NG CCG). 10/16 02 Confirmation of Quoracy The Committee was confirmed as quorate. 10/16 03 Declarations of Interest Neil Morris declared a potential conflict regarding his work with Gateshead Community Based Care as a sessional doctor. There were no other declarations of interest relating to items on the agenda. 10/16 04 Minutes of the Previous Meeting held on 27 September 2016 The minutes of the previous meeting were agreed as an accurate record with amendments made to the attendance list on page 1: Tracy Johnstone to be added as present for NHS England rather than in attendance Apologies from Christine Keen and Steph Edusei to be added 1

10/16 05 Action Log 07/16 07 Integrated Long Term Conditions Management in Primary Care. Ongoing (May 2017) 07/16 08 Vulnerable Syrian Families. Katharine McHugh agreed to progress this to ensure contact is made between Bev Lockett and Mandy Taylor regarding community projects. Ongoing (November 2016) 09/16 06 Co-commissioning Process Assurance. Tracy Johnstone reported that a new governance assurance checklist had been issued which gives information on membership. It does not make specific reference to LMC representation and she agreed to pursue this. It was agreed that LMC representation would be beneficial. Pauline Fox is currently working through the checklist document as part of her work on drafting the terms of reference. Complete 09/16 07 General Practice Strategy Implementation: Communication and Engagement Action Plan. Neil Morris reported that the document had been amended to include the Health and Wellbeing Board. Complete The action log was accepted. 10/16 06 Primary Care Commissioning Finance Update Jill McGrath, Head of Finance, presented the summary position on Primary Care budgets provided by NHS England for the period ended 30 September 2016. It showed the annual budget of 65m broken down across the main areas of spend with a 350k reserve for one-off, unexpected expenditure. The forecast outturn to date is reported as break-even with pressures recognised in some areas. The Committee discussed the background to the potential pressures in GMS/PMS and enhanced services. With regard to reimbursement of premises costs, work is underway to manage this and a letter to practices from NHS England has been circulated to outline the situation. It was noted that there may be central funding for this but until confirmed it was necessary to note this as a potential pressure. The Committee requested quarterly update reports on the Primary Care budgets. 10/16 07 Primary Care Commissioning Outcome of Practice Vote Neil Morris reported on the outcome of the General Practices vote on the preferred way forward for the CCG in relation to Primary Care Commissioning. There had been a high turnout and an overwhelming vote to move to Level 3 Delegated Commissioning. Work is underway to prepare the application to NHS England for commencement on 1 April 2017. Douglas Ball asked about the benefits that residents could expect as a result of the change to delegated commissioning. Neil Morris said that information that had been collated for practices could be adapted and made available to 2

help inform residents. The CCG would work towards communicating ongoing key messages throughout the progression through the process. Lyndsay Yarde asked about the status of the Primary Care Joint Committee with regard to the new commissioning arrangements and it was confirmed that the Committee would continue with revised terms of reference and membership. The draft terms of reference would be considered at the next meeting. 10/16 08 General Practice Forward View GP Resilience Programme Katharine McHugh outlined the GP Resilience Programme which is part of the General Practice Forward View (GPFV) aimed at supporting struggling practices. 904k is available across North East and Cumbria. The CCG considered around 20 bids and 17 were submitted to an NHS England panel. Tracy Johnstone confirmed that there had been a good response across the region. The bids had been considered by the panel and CCGs would be informed later in the week on the outcome. 10/16 09 NHS England and NHS Improvement Operational and Contracting Planning Guidance 2017-2019 Neil Morris presented this item for information. He reported that General Practice is prominent in the guidance linking with the Sustainability and Transformation Plan (STP) and GPFV. It was noted that: The timetable requires contracts to be signed by 23 December 2016. CCGs are required to submit a GPFV plan to NHS England by 23 December 2016. The guidance gives more detail on how the extra funding in the GPFV will be used. It was noted that estates and technology bids would be included in the 4.2 billion extra investment. The Operational Plan will need to address 9 priorities which must be delivered. Must-do 3 regarding Primary Care was highlighted with improvement in access to General Practice and workforce issues being prominent. Mandy Taylor raised the reference to expansion of Improving Access to Psychological Therapies (IAPT) and asked whether this related to both adults and young people. Neil Morris said that further detail was yet to become available. It was noted that Committee members need to be prepared and informed on matters, particular relating to the GPFV, which may in future require deliberation at Committee meetings. It was noted that as well as the must dos in the guidance there would be some decisions that will require consultation. 3

10/16 10 Any Other Business There was no further business. Next meeting: Tuesday 29 November 2016 4

Agenda item 5 Primary Care Joint Committee November 2016 Action Log Meeting Minute Action Lead Status date reference 19/07/16 07/16 07 Integrated Long Term Conditions Management in Primary care i. establish measures of success ii. JM to speak to Sam Hood re JH joining approval sub-group iii. Bring back to May 2017 meeting to review performance JH/JM/NM JM ST May 2017 19/07/16 07/16 08 Vulnerable Syrian Families Bev Lockett to contact Mandy Taylor regarding community projects. KMcH to prompt Bev to contact Mandy KMcH Nov 2017 27/09/16 09/16 06 Co-commissioning Process Assurance Tracy Johnstone to clarify whether LMC can attend PCJC private and public meetings 27/09/16 09/16 07 General Practice Strategy Implementation - communication and engagement action plan Neil Morris to add Gateshead Health and Wellbeing Board into the strategy TJ NM Complete Complete

Cover Sheet Meeting Title Primary Care Joint Committee Date 29 November 2016 Agenda Item 6 Report Title Synopsis Application for Delegated Commissioning This paper is to inform Primary Care Joint Committee that Governing Body has approved the application to NHS England for delegated commissioning (level 3). NHS England has invited the remainder of CCGs operating under joint or greater involvement co-commissioning models to apply for full delegation between now and 5 December 2016. In preparation for this, in September NGCCG member practices voted in support of the move to level 3 delegated commissioning. Under delegated commissioning the CCG will take on the delegated functions which include; decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to: o Enhanced Services o Local Incentive Schemes including the design of such schemes o establishment of new GP practices and closure of GP practices performance management of GP practices, including liaison with the CQC management of the Delegated Funds NHS England retains the residual liability for the performance of primary medical care commissioning as well as exercising the Reserved Functions including; management of the performers list revalidation and appraisal process complaints management capital expenditure functions The specific delegation roles and responsibilities of NHS England and level 3 CCGs are currently being established and will be agreed by the Executive Committee.

The NGCCG application for delegated commissioning is attached for information as Appendix 1, along with the Objectives and Benefits, Appendix 2. Implications and Risks Recommendation Direct financial implications of taking on the delegated functions The ability of the Primary Care Commissioning Committee to make effective decisions associated with the delegated functions CCG commissioning, holding and managing GP contracts including performance management could damage or worsen relationships or lead to conflicts of interest. Increased risk of conflicts of interest as the CCG will be procuring services from member practices. The risks will be mitigated through; Implementation of quality and contract assurance processes within the CCG The development of a clear agreement of responsibilities with NHSE based on the delegation agreement Skills development within the CCG Effective resource planning Revised corporate documentation e.g. Conflicts of Interest and clear terms of reference To note; The application to NHS England for delegated commissioning (level 3) The Objectives and Benefits Report history Executive Committee recommended the application for approval to Governing Body on 15 th November 2016 Governing Body approved the application on 29 th November 2016 Lead Director & Report Author Classification Director: Dr Neil Morris Title : Medical Director Official Author: Katharine McHugh Title: Portfolio Manager Primary Care Purpose (click one box only) Decision Information 2

Benefits to patients & the public Links to Strategic objectives Identified risks & risk management actions Resource implications Outlined in Appendix 2 Links to all of the strategic objectives See above implications and risks Direct financial implications relate to the need to absorb any potential unforeseen spend. Capacity resource implications will be identified as the next stage once the application has been successful and the delegation responsibilities between the CCG and NHS England identified. Legal implications & equality and diversity assessment Sustainability implications NHS Constitution N/A Principles; 1 The NHS provides a comprehensive service available to all 3 The NHS aspires to the highest standards of excellence and professionalism 6 The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources Next steps Paper to Primary Care Joint Commissioning Committee for information Submission of application to NHS England before 5 th December Planning for assuming the delegated functions Appendices Appendix 1 Application Appendix 2 Objectives and benefits 3

Appendix 1 Delegated commissioning application process and checklist for 2017/18 Introduction NHS England s Board has committed to support the majority of CCGs to assume delegated responsibilities for the commissioning of primary medical services from 1 April 2017. Giving CCGs more control over general practice is part of a wider strategy to support the development of place-based commissioning and a key enabler of the development of new care models. The delegated commissioning model is delivering a number of benefits for CCGs and local populations. It is critical to local sustainability and transformation planning (STP), supporting the development of more coherent commissioning plans for healthcare systems and giving CCGs greater ability to transform primary care services. CCGs have also reported that delegated commissioning is giving them greater insight into practice performance issues, greater opportunities to develop a more sustainable primary care workforce and is helping to strengthen relationships between CCGs and practices. In 2016/17, 114 CCGs have delegated commissioning responsibilities. NHS England has invited the remainder of CCGs operating under joint or the great involvement cocommissioning models to apply for full delegation between now and 5 December 2016. CCGs are encouraged to have an early conversation about their delegated commissioning application with their NHS England local team and finance leads to ensure that all the necessary documentation is updated and approved in advance. We request that CCGs and the NHS England Director of Commissioning Operations (DCO) jointly complete the delegated commissioning checklist and finance template for delegated budgets for submission nationally. The completed templates should be signed by the CCG and the relevant NHS England DCO and emailed to england.cocommissioning@nhs.net, with a copy to regional leads for co-commissioning, details are as follows Region Regional lead for Contact email address co-commissioning North Richard Armstrong richard.armstrong1@nhs.net Midlands and East Vikki Taylor vikkitaylor@nhs.net London Liz Wise liz.wise1@nhs.net South Sarah Khan sarah.khan12@nhs.net 4

Following submission of the checklist, your application will be reviewed by NHS England as part of a short approvals process. We will inform CCGs of the outcomes of this process by early January 2017. Please note we will consider applications from CCGs with directions or in special measures on a case-by-case basis. If you require any further information, please contact your regional co-commissioning lead in the first instance, followed by england.co-commissioning@nhs.net. Delegated Commissioning Application Checklist This checklist and finance template should be completed jointly by the CCG and the relevant NHS England DCO. All supporting documentation should be submitted to the NHS England DCO and not the national co-commissioning team. Delegated Commissioning Application Checklist Newcastle Gateshead CCG has set out clearly defined objectives and benefits of the delegated arrangement. The CCG s constitution or proposed constitutional amendment has been updated in line with the guidance 1 (and this has also been approved by the NHS England regional office with confirmation sent to england.cocommissioning@nhs.net - constitutional amends can be confirmed by 1 April 2017). The CCG has updated its governance documentation in line with the NHS England guidance (on constitutional amendments). The CCG has reviewed its conflicts of interest policy in line with NHS England s revised statutory guidance on managing conflicts of interest for CCGs https://www.england.nhs.uk/commissioning/pc-co-comms/coi/. The CCG confirms that they will be fully compliant with the conflicts of interest guidance by 1 April 2017. The CCG s IG Toolkit meets level 2 criteria as a minimum. Y Y Y Y Y The CCG s Year End Assurance rating is Outstanding 1 Constitutional changes will be required if the CCG takes on delegated commissioning because the CCG will need to establish a new committee to manage the delegated functions and to exercise the delegated powers. In the CCG Model Constitution, the references to this committee will need to be added to sections referenced in 6.4.1.a. and 6.6.3.c. unless there is already a clause permitting new committees without additional direct references. These will also need to refer to the Terms of Reference for this committee. 5

Delegated Commissioning Application Checklist The DCO confirms that there are no performance, finance, leadership or governance issues that prevent the CCG taking on the function. Finance template for delegated budgets completed in full (include completed table below): Y / N Y Notes for completing the finance template: 1. Double click into the table to complete the excel template. 2. Please enter the notified numbers for your CCG and how the primary care allocation is split between GP Services and other primary care services for 2016/17 (below) 3. This will be reconciled back to the area team allocation for primary care and subsequent in year adjustments. Where possible M6 2016/17 figures should be used. PART II Finance Template for delegated budgets Notified delegated Budget (1) Movement out of GP Services (2) Movement Into GP Services (3) Total '000 '000 '000 '000 GP Services + - + +/- General Practice - GMS 32042 32042 General Practice - PMS 9992 9992 Other list based services (APMS) 2898 2898 Premises cost reimbursements 6808 6808 Other premises costs 8 8 Enhanced services 3266 3266 QOF 6771 6771 Other GP services 4097 4097 Primary care NHS property services - GP 0 Sub Total GP services 65882 0 0 65882 N/A + - +/- Acute services 0 Mental health services 0 Community health services 0 Primary care services 0 Continuing care services 0 Other care services 0 Sub total CCG programme costs 0 0 0 Total 65882 0 0 65882 Please provide a description in the change in spend detailed above The DCO confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements. The DCO confirms the CCG is capable of taking on delegated functions Y / N Y / N 6

Delegated Commissioning Application Checklist Three scanned / electronic signatures provided at the foot of this email. Typed names unfortunately cannot be used. Y / N I hereby confirm that <CCG Name> membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2017/18. NHS England is requested to progress the application to the regional panels for consideration. Signed by <CCG Name> Accountable Officer Signature (scan/electronic version required): Print Name: Position: Date: Signed on behalf of <CCG Name> Audit Committee Chair Signature (scan/electronic version required): Print Name: Position: Date: Signed by NHS England Director of Commissioning Operations Signature (scan/electronic version required): Print Name: Position: Date: 7

Appendix 2 Delegated Commissioning Objectives and Benefits Vision Our vision for general practice in Newcastle Gateshead CCG is to see; Groups of practices working together at scale delivering new models of care. that are integrated with community, secondary care, social care and the voluntary sector. A flexible workforce with enhanced skills across the system to deliver higher quality care and improved access. Patients see the right person at the right time and in the right place. Clinical systems and a shared clinical record support the new care models. We see delegated commissioning as enabling the CCG to work more closely with practices to bring about the transformational change needed. This will be supported by the ability to shift services and investment out of hospital and into general practice to ensure a sustainable model of care for the future. Newcastle Gateshead CCG recognises the importance of General Practice and its positioning as the cornerstone of NHS care. Equally, the CCG is aware that the demands being placed on practices and their teams have never been greater. Our emphasis is upon ensuring the sustainability of General Practice which is able to adapt and be central to the emerging new models of care. Our goal is to ensure that in the future General Practice can expand its purpose and become the hub from which we lead, co-ordinate, plan and manage care. The General Practice Forward View (GPFV) aims to facilitate a stepped change in the investment and support into general practice. The CCG is driving this change, implementing initiatives in consultation with our member practices. The GPFV covers 5 key areas; investment, workforce, workload, infrastructure and care design. Our General Practice Strategy broadly mirrors the GPFV structure. Our General Practice Strategy also aims to strengthen and increase the resilience of practices. Our ambition is to facilitate and support transformational change to ensure that General Practice is well placed to play an integral part in delivering the outcome ambitions we have for people living in Newcastle and Gateshead (CCG Five Year Plan 2015-2020). Our collective aim is to support development of a new model for General Practice where people will benefit from; Innovative service offer through bringing together General Practices and utilising strong partnerships to deliver an increased range of services which enable more pro-active out of hospital care whilst still maintaining core strengths of localism, continuity, familiarity and accessibility. Communities who are fully engaged in shaping services, sharing ownership of the health challenges they face.

Increased ability to adapt to the conditions they live with confident and connected. Knowing that individual and community assets are valued and fostered. A voluntary and community service sector fully engaged in the planning and where appropriate provision of services for patients and public. Integrated working across primary, secondary, tertiary, community, voluntary and social care providers. High quality secondary care services for those who need to access them. World renowned specialist services locally accessible to our patients. Health and social care without walls, organisations without barriers. Benefits of delegated commissioning The CCG has already started to enable transformational change in general practice through; The Care Homes Vanguard and Proof of Concept, in particular through the intermediate care redesign. Clinical work streams such as; o long term conditions Year of Care programme focussing on holistic care planning o planned care consultant advice and guidance to ensure people see the person they need to Urgent care alliance hub working to improve access. A project is in place to reinvesting PMS monies back into practices. Investment of health care navigators and the development of a social prescribing strategy. At scale initiatives such as GP in A&E and centralised home visiting. Workforce initiatives such as and Integrated Career Start GP posts, Career Start Nurse scheme and Practice Manager Development Programme. The CCG sees delegated commissioning as a lever which will support the delivery of the GPFV/General Practice Strategy. We see the benefits of delegated commissioning to be as follows; The CCG will be able to ensure that practices have a strong voice in the development of new models of care and the MCP model in particular. CCG will be able to drive forward the development of the GP provider models, GPFV and 5YFV agendas. It will enable the CCG to make decisions to shift investment from acute to primary and community services to support sustainability and the movement towards an out of hospital model. It will enhance the opportunity for GPs to influence the development and investment in general practice. It will enable and support new collaborative ways of working with practices. Budget slippage will be retained for the CCG to invest in primary care locally whereas at level 2 budget slippage is retained by NHSE to spend across the area or return as underspend. Local knowledge and relationships will increase the potential to; o support collaborative solutions to problems o enable more timely resolution of queries 9

CCG roles and structures provide easier contact points and ongoing support for practices. The CCG will have the ability to align GP national schemes (eg DESs) to ensure best fit with local services. 10

Cover Sheet Meeting Title Primary Care Joint Committee Date 29 November 2016 Agenda Item 7 Report Title Synopsis Primary Care Commissioning Committee - Terms of Reference It has been decided that the CCG should apply for level 3, fully delegated primary care commissioning; hence a CCG Primary Care Commissioning Committee will be required, with appropriate terms of reference (ToR), from April 2017. Draft terms of reference for the NHS Newcastle Gateshead CCG Primary Care Commissioning Committee have been prepared, using the Model terms of reference that are provided by NHS England and drawing on the experience of CCGs that are already at level 3. The draft ToR are attached to this paper. This draft has been considered by the Primary Care Group, Executive Committee and Audit Committee. Governing Body members are being asked to approve the Terms of Reference for the Primary Care Commissioning Committee. Members of the Primary Care Joint Committee are asked to note them. Recommendation Members are asked to: Note the Primary Care Commissioning Committee Terms of Reference, as set out in the appendix Lead Director & Report Author Classification Director: Neil Morris, Title: Medical Director Official Author: Pauline Fox Title: Head of Corporate Affairs Purpose (click one box only) Decision Information

Benefits to patients & the public Links to Strategic objectives Identified risks & risk management actions Resource implications Legal implications & equality and diversity assessment Sustainability implications NHS Constitution Next steps Appendices Clear committee terms of reference support transparent and effective decision making This recommendation supports the corporate objective 5: Ensure that strong corporate governance and information governance processes are in place to provide assurance to the CCG Clear committee terms of reference support the committee remaining focused and mitigate the risk of the committee acting outside its remit N/A N/A N/A N/A The committee will take effect from April 2017, replacing the current Joint Commissioning Committee. Draft terms of reference for the Newcastle Gateshead CCG Primary Care Commissioning Committee 2

Primary Care Commissioning Committee Terms of Reference 1. Introduction 1.1 The Governing Body has established the Newcastle Gateshead CCG Primary Care Commissioning Committee (the Committee). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers in line with Newcastle Gateshead CCG s Constitution. 2. Statutory Framework 2.1 NHS England has delegated to the CCG authority to exercise the primary care commissioning functions as set out in Schedule 2 in accordance with section 13Z of the NHS Act. 2.2 Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England and the CCG. 2.3 Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O) b) Duty to promote the NHS Constitution (section 14P) 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) Page 3 of 8

2.4 The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those in accordance with the relevant provisions of section 13 of the NHS Act: a) Duty to have regard to impact on services in certain areas (section 13O) b) Duty as respects variation in provision of health services (section 13P) 2.5 The Committee is established as a committee of the Governing Body in accordance with Schedule 1A of the NHS Act. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State. 3 The role of the Primary Care Commissioning Committee 3.1 The Committee has been established in accordance with the above statutory provisions to enable the members of the committee to make collective decisions on the review, planning and procurement of primary care services in Newcastle and Gateshead, under delegated authority from NHS England. 3.2 The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, as set out in section 4, below. 3.3 In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Newcastle Gateshead CCG, which will sit alongside the delegation and terms of reference. 3.4 The functions of the Committee are undertaken in the context of a desire to promote increased quality, efficiency, productivity and value for money and to remove administrative barriers. 4 Responsibilities of the Primary Care Commissioning Committee The responsibilities of the Committee include the following: a. Decisions in relation to General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Providers of Medical Services (APMS) contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract) b. To manage the budget for commissioning of primary medical care services c. Decisions in relation to newly designed enhanced services (Local Enhanced Services and Directed Enhanced Services) d. Decisions in relation to local incentive schemes, including the design and implementation of such schemes Primary Care Commissioning Committee Terms of Reference draft v3 November 2016 Page 4 of 8

e. To plan primary medical care services, including Primary Care needs assessments f. To undertake reviews of primary medical care services g. Decision making on whether to establish new GP practices in an area h. Approving practice mergers and de-mergers i. Decisions on practice closures j. Planning new primary care estate k. Making decisions on discretionary payment (e.g. returner/retainer schemes) l. Responsibility for GP practice contract management and performance m. Discussions in relation to the management of poorly performing GP practices (excluding any decision in relation to the performers list). 5 Geographical Coverage The Committee will comprise the area covered by Newcastle Gateshead CCG 6 Membership of the Committee 6.1 The committee shall have a lay/executive majority. Membership of the committee will consist of: i). A Lay Member of the CCG (Chair of the committee 1 ) ii). A Lay Member of the CCG (Vice Chair of the committee 2 ) iii). iv). v). vi). vii). viii). The CCG Medical Director The CCG Chief Finance Officer (or designated deputy) The CCG Director of Operations and Delivery The CCG secondary care specialist doctor A CCG GP Clinical Director (non-voting) A representative from NHS England (non-voting) 1 This cannot be the CCG Audit Committee Chair 2 This should not be the CCG Audit Committee Chair Primary Care Commissioning Committee Terms of Reference draft v3 November 2016 Page 5 of 8

In attendance: i). The CCG Designated Lead for Primary Care 6.2 To ensure effective management of actual or potential conflicts of interest, the circulation of meeting agenda and papers will be circulated to ensure committee members do not receive papers on items that they are conflicted on and GPs will withdraw from the meeting as requested to do so by the Chair of the committee 6.3 A standing invitation will be made to specified partners in a non-voting capacity, namely: i). ii). iii). iv). v). vi). A representative from HealthWatch (Gateshead) A representative from HealthWatch (Newcastle) A representative from the Health and Wellbeing Board (Gateshead) A representative from the Wellbeing for Life Board (Newcastle) A representative from the Newcastle and North Tyneside Local Medical Committee A representative from the Gateshead and South Tyneside Local Medical Committee 6.4 Other CCG Governing Body members, officers, employees, practice representatives and Commissioning Support Unit staff may be invited to attend all or part of meetings of the committee to provide advice or support particular discussion from time to time. 6.5 Those invited to attend will not be entitled to vote, but will be an integral part of all discussions. 6.6 Those invited to attend in a non-voting capacity will not be entitled to attend the meeting in private session, unless specifically invited to do so by the Chair for a particular item. 6.7 The membership will meet the requirements of the CCG s Constitution. 6.8 The Medical Director will be the lead officer for the committee, or will nominate a Director to undertake this role. 7 Meetings and Voting 7.1 The Committee shall adopt the Standing Orders of NHS Newcastle Gateshead CCG insofar as they relate to the: a. Notice of meetings; Primary Care Commissioning Committee Terms of Reference draft v3 November 2016 Page 6 of 8

b. Handling of meetings; c. Agendas; d. Circulation of papers; and e. Conflicts of interest 7.2 Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible. 8 Quoracy The quoracy for the committee is 50% of voting members. A lay member must be present for the committee to be quorate. 9 Frequency and operation of meetings 9.1 The committee will meet at regular intervals and not less than 4 times per year. 9.2 In exceptional circumstances, an extraordinary meeting of the committee may be required and can be called by the Chair by providing members with a minimum of five working days notice. The quoracy for this meeting is the same as that set out above. 9.3 Meetings of the Committee shall: a) be held in public, subject to the application of 9.3(b) (below); b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) 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 for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time. 9.4 Declarations of interest will be a standing agenda item. All potential conflicts of interest will be declared and dealt with in accordance with the CCG s Constitution and CCG policies and procedures for Standards of Business Conduct. 9.5 Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. 9.6 The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties relevant governance arrangements, are recorded in a Primary Care Commissioning Committee Terms of Reference draft v3 November 2016 Page 7 of 8

scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.. 9.7 The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 9.8 Members of the Committee shall respect confidentiality requirements as set out in the CCG s Standing Orders and Standards of Business Conduct policy. 9.9 The Committee will make decisions within the bounds of its remit. The decisions of the Committee shall be binding on NHS England and the CCG. 9.10 The Committee will present its minutes to the CCG Governing Body and to NHS England (Cumbria and the North East sub region), for information and will also comply with any reporting requirements set out in the CCG Constitution. 9.11 The Committee will produce an executive summary report which will be presented to NHS England and the governing body for information no less than annually. 10 Review of Terms of Reference These Terms of Reference will be formally reviewed on an annual basis, or as required reflecting experience of the Committee in fulfilling its functions or changes in guidance or legislation. Approved by Governing Body: [date to be added] Due for Review: [date to be added] Schedule 1 Delegation [to be added] Primary Care Commissioning Committee Terms of Reference draft v3 November 2016 Page 8 of 8

Cover Sheet Meeting Title Primary Care Joint Committee Date 29 November 2016 Agenda Item 9 Report Title Synopsis Basket of Care Project Group Terms of Reference The annual review of the Basket of Care Project Group terms of reference has been undertaken and the amended version attached for approval. The Basket of Care Project Group was established as a task and finish group to meet 3 objectives; Ensuring equitable provision across Newcastle and Gateshead Remunerating practices for identified work coming from secondary care Investing PMS monies into primary care from April 2016 Commissioning decisions will be made by Executive Committee in line with commissioning intentions and taking into account wider service implications. The Primary Care Joint Committee will approve and assure the design of services and specifications to be commissioned from primary care as detailed in the Committee terms of reference. Implications and Risks Recommendation Service provision across Newcastle Gateshead is complex therefore it is anticipated that achieving like for like may not be feasible Funding is limited with the PMS monies already committed to (1) above for 2016/17 and 2017/18. A significant shortfall exists for 2016/17 Expectations relating to service provision via the basket are high, financial limitations are being made transparent The Committee are asked to approve the revised terms of reference Report history Basket of Care Project Group 10 November 2016 Lead Director & Report Author Director: Neil Morris Title : Medical Director Author: Katharine McHugh Title: Portfolio Manager Primary Care Classification Official Purpose (click one box only) Decision Information

Benefits to patients & the public Links to Strategic objectives Identified risks & risk management actions Resource implications Legal implications & equality and diversity assessment Sustainability implications NHS Constitution Care closer to home Service efficiencies through savings in secondary care Links to all of the strategic objectives Expectations have been high - the terms of reference along with effective communication will ensure reasonable expectations Current differences in provision across the patch could present barriers - general practice consultation is key PMS monies are already committed for 16/17, 17/18 Funding implications of the GP 5 year forward view are awaited Precedence has been set that schemes must be financially viable ie are; Within a financial envelope Funded by PMS monies or Self-funding through savings elsewhere Align financially with the STP and the GP 5 year forward view and link to the commissioning intentions process This will be undertaken for each element of work Sustainability of the project outcomes will be assessed as part of a business case Principles; 1 The NHS provides a comprehensive service available to all 3 The NHS aspires to the highest standards of excellence and professionalism 6 The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. Next steps Appendices Appendix 1 Terms of reference 2

Basket of Care Project Group Terms of Reference 1. Introduction The basket of care project group has been established as a task and finish group to meet 3 objectives; Ensuring equitable provision across Newcastle and Gateshead Remunerating practices for identified work coming from secondary care Investing PMS monies into primary care from April 2016 The Group reports to the CCG Primary Care Joint Committee. 2. Position - April 2016 and beyond It was agreed by the group to take a two phase move towards equity: i). ii). Enhanced service for 2016/17; by April 2016 an urgent need related to the commitment of PMS monies for 2016-17 for work already carried out in general practice but currently unfunded, while ensuring a move towards equitable provision. To deliver this a Supporting Transfer of Care Service was established across the CCG along with the roll out of PSA testing and denosumab monitoring for Newcastle. Establish a basket of care and the achievement of equitable service provision across NHS Newcastle Gateshead CCG potentially covering any areas of care planned, urgent and mental health etc. This is seen as a long term project for which a project plan is required. This work would be taken forward by this project group. 3. Role of the Basket of Care Project Group Progress the move towards equity of service provision across Newcastle and Gateshead Recommend and oversee investment of PMS monies into primary care from April 2016 Remunerate practices for some of the work coming from secondary care Identify services for potential inclusion in the basket of care for development by the appropriate commissioning leads Assess priorities and the viability of proposed schemes Ensure effective communication and involvement with general practice Ensure schemes are financially viable; o Establish and work within a financial envelope o Ensure that schemes are either funded by PMS monies or o Self-funding through savings elsewhere o Align financially with the STP and the GP 5 year forward view and link to the commissioning intentions process

Review existing service differences Promote simple contract and payment mechanisms through the basket mechanism 4. Membership The membership of the group will consist of: i). Director of Primary Care Chair ii). Clinical Directors (2) iii). Practice Manager(s) - Newcastle or Gateshead iv). Practice nurse v). Medicines optimisation lead vi). CCG contracts/finance lead vii). Delivery team lead portfolio manager viii). NECS contracting lead ix). Portfolio Manager Primary Care project lead x). Service Planning and Reform Manager project lead xi). LMC representation Other CCG officers, employees and practice representatives may be invited to attend all or part of meetings to provide advice or support particular discussion from time to time. 5. Quoaracy and Decision making The decision to recommend will be made by the Group when a minimum of the following are present; i). the Chair or one of the clinical directors ii). CCG finance/contracts representative and iii). a practice manager Recommendations will be made to Executive Committee on commissioning decisions. The design and specification of enhanced services/local incentive schemes for primary care will be developed by commissioning leads and approved by the Primary Care Joint Committee. 6. Review of Terms of Reference These terms of reference will be formally reviewed by NHS Newcastle Gateshead CCG annually. Review Date: reviewed November 2016. Approval Date: [approved by Primary Care Joint Committee November 2016] 4

Cover Sheet Meeting Title Primary Care Joint Committee Date 29 November 2016 Agenda Item 11 Report Title Synopsis Implications and Risks NHS Property Services - Service Charges / Market Rents To discuss the implications for the CCG and General Practice in the area of the changes to NHS Property Services (NHS PS) charging processes. NHS PS have amended their charging policies in respect of Service Charges and Facilities Management charges and have moved to a full cost recovery basis for charging practices. This change was with effect from April 2015 and as such practices will have received charges from NHS PS that may be in a different format and also significantly different value from previous years. NHS PS have also moved to charging rent on a Market Rent basis from April 2016. As rent is reimbursable to GP practices under the NHS Premises Directions this does not represent a risk to General Practice. However it does represent a financial risk to the reimbursing body currently NHS England. Recommendation Report history The Committee is asked to note the risk to General Practice of the change in NHS PS charging policies. The Committee is also asked to note the work currently being undertaken by NHS England to understand what support can be offered to practices to mitigate this risk. N/A Lead Director & Report Author Classification Director: Neil Morris Title : Medical Director Official Author: Keith Davison Title: Senior Finance Manager- NHS England Purpose (click one box only) Decision Information

Benefits to patients & the public Links to Strategic objectives Identified risks & risk management actions Resource implications Legal implications & equality and diversity assessment Sustainability implications NHS Constitution Next steps Appendices Decision made will ensure that the funding available to primary care in Newcastle and Gateshead is used to provide best possible benefits to patients and public. To embrace the principles of cost effectiveness and improving value for money in co-commissioning. Risk to the stability of General Practice in the CCG area. NHS England have proposed a way of mitigating this risk by looking at historic subsidy arrangements. This will impact on Practice Management workload as well as that of the Finance team at NHS England. N/A N/A Principle 6: The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. NHS England currently working with GP practices to establish historic subsidy arrangements. N/A 2

Primary Care Joint Committee NHS Property Services - Service Charges / Market Rents 1.0 Service Charges 1.1 Background NHS PS charge tenants (including GP practices) for premises costs in three separate elements :- 1. Rent 2. Service Charges (e.g. rates, utilities, waste management, insurance, management charges) 3. Facilities Management (e.g. building and lift maintenance, cleaning and pest control) Under the NHS (General Medical Services Premises Costs) Directions 2013 a GP practice may claim reimbursement of Rental charges and also certain elements of the Service Charges i.e. Rates, Water and Sewerage and Clinical Waste. With effect from April 2015 NHS PS amended their charging policies with regard to Service Charges and Facilities Management charges and moved to a full cost recovery basis for charging tenants. As such those GP practices who are tenants of NHS PS will have received charges in a different format and possibly also for a significantly different value. Where those charges have increased from 14/15 the reasons may include:- 1. Services Charges and Facilities Management costs to the landlord may have increased over time without those increases being passed on to the tenants 2. There may be an element of the charges that have been subject to a subsidy as agreed by previous commissioners (e.g. NHS England and PCTs previously). Historically these were charged directly to NHS England but may now be being directly charged to practices. 1.2 NHS England Proposal NHS England (Cumbria and the North East) currently hold the budget for historic local subsidies. They are aware of the issue of increase in charges to practices and have given the following undertaking in relation to practice premises subsidies:- NHS England will work with each practice on a case by case basis to understand if evidenced historic subsidies should still be applied to practice bills. If so funding will be made available to the practice as an additional reimbursement. 3

Where a practice has an explicit subsidy agreement from a previous NHS organisation (e.g. a written agreement from a PCT) then this will be funded by the relevant budget holder currently NHS England. Where a practice has a long standing subsidy arrangement and can provide reasonable evidence of such (e.g. having had a subsidy for a significant number of years) it is also expected that these arrangements will also be funded by the relevant budget holder currently NHS England. Where costs have simply increased over time then practices as tenants should negotiate and agree an appropriate level of Service Charge and Facilities Management charge with NHS PS as landlords, and practices will be expected to pay these costs. 1.3 Actions taken to date NHS England has written to all practices in the Newcastle Gateshead CCG area setting out this proposal. Practices have been advised to contact their relevant Locality Finance Manager at NHS England if they feel that their service charges have historically been subsidised. 2.0 Market Rents 2.1 Background NHS PS have moved to charging rent on a Market Rent basis from April 2016. As rent is reimbursable to GP practices under the NHS Premises Directions this does not represent a risk to General Practice. However it does represent a financial risk to the reimbursing body currently NHS England. It is NHS England s intention to fund in 2016/17 those CCGs who will have additional cost impacts, as well as to defund any CCG who would be gainers. NHS PS has employed an independent valuer Montagu Evans to carry out valuations of all their premises and NHS England is using these figures to calculate the funding adjustment for each CCG. 2.2 Risk The market rent valuations have been carried out by an Independent Valuer so there should be no debate over the 16/17 charges. However because of the uncertainty over the 15/16 charging regime and the fact that rents are still being negotiated and re-negotiated for this period there is uncertainty about the CCGs historic position upon which the funding adjustment will be calculated. November 2016 4