PRIMARY CARE COMMISSIONING COMMITTEE AGENDA

PRIMARY CARE COMMISSIONING COMMITTEE HELD IN PUBLIC SESSION ON FRIDAY 29 SEPTEMBER 2017 1:00pm 3:00pm THE BOARD ROOM, 3 RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which: one must be either the Chair or Vice-Chair of the Committee one must be the Chief Finance Officer/Deputy Chief Finance Officer or Chief Nursing Officer AGENDA Time Item Attachment Presented by 1.00 pm 1 Apologies Mr S Wellings Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. 1.00 pm 2 2.2 This meeting is being held in public and is being recorded purely to Mr S Wellings assist in the accurate production of minutes, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded. 1.00 pm 3 Questions from the Public Mr S Wellings 1.05 pm 4 Minutes of last meeting held on Friday 11 August 2017 Enclosed Mr S Wellings 1.05 pm 5 Matters Arising/Action Log Enclosed Mr S Wellings Contractual 1.10 pm 6 Enclosed 6.1 Patient Participation Group Update Ms H Codd 6.2 Report from the Primary Care Operational Group Enclosed Mrs J Robinson 6.3 Primary Medical Services Report Enclosed Mrs J Taylor 1:40 pm 7 Risk Register Enclosed Mrs C Brunt Quality 1:50 pm 8 8.1 Report from the Quality and Safety Team Enclosed Mrs C Brunt 2.00 pm 9 Finance 9.1 Finance Report Enclosed Mr P Cowley 2.10 pm 10 High Oak Premises Development Enclosed Mr P Cowley 11 Date and Time of Next Meeting Friday 20 October 2017 1pm 3pm The Board Room, Third Floor, Brierley Hill Health and Social Care Centre 1 P age

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Title First Name Surname Job Title Declarations of Interest Mrs Caroline Brunt Chief Nurse None Mr Philip Cowley Mrs Jayne Emery Senior Finance Manager Primary Care Chief Officer of Dudley Healthwatch Partner works for Central Midlands CSU None Dr Christopher Handy Lay Member for Quality & Safety Chief Executive, Accord Group Visiting Professor at Birmingham City University Board Member of: - Black Country LEP Board - Matrix - Redditch Co-operative Homes - Black Country Consortium - Birmingham Chamber of Commerce - Walsall Housing Regeneration Agency - Direct Health Mr Matthew Hartland Dr Tim Horsburgh Mrs Julie Jasper Ms Teresa Jeavons Mr Daniel King Dr Vippin Mittal Chief Operating & Finance Officer Clinical Executive for Primary Care & LMC Representative Lay Member Patient & Public Involvement Primary Care Contracts Support Officer Director of Membership Development & Primary Care GP Representative at Primary Care Commissioning Committee Director of Dudley Infracare Lift LTD Director of Whitbrook Management Company Member of Chartered Institute of Public Finance and Accountancy Interim Strategic Chief Finance Officer, Walsall CCG Interim Strategic Chief Finance Officer, Wolverhampton CCG Sessional GP - Netherton Health Centre. Member of the Local Medical Committee Clinical Lead for Partners in Paediatrics Lay Member - Sandwell and West Birmingham CCG Managing Director of Westland s Associates Ltd Member of CIPFA None None GP at Crestfield Surgery Membership MDU Membership GMC Mrs Anna Nicholls Senior Contract Manager - NHS England None

Dr David Pitches Mrs Julie Robinson Mr David Stenson Public Health Representative - Primary Care Commissioning Committee Primary Care Contracts Manager Patient Opportunity Panel Representative Primary Care Commissioning Committee Member at Dudley CCG Consultant in Public Health Medicine, Dudley MBC Wife is a Consultant Obstetrician at Heart of England Foundation Trust Occasional Church organist fees received for giving recitals or playing for services None Non-Executive Director _ Black Country Partnership NHS Foundation Trust Volunteer, Healthwatch Dudley Mr Thomas Thomik Dudley Local Pharmaceutical Committee Representative Mr Steve Wellings Lay Member - Governance Dudley LPC Member Royal Pharmaceutical Society Member Wife employed by Dudley MBC Housing Department One Niece employed by DGFT as a nurse Member of CIPFA

PRIMARY CARE COMMISSIONING COMMITTEE MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 11 AUGUST 2017 THE BOARD ROOM, 3 RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Mrs C Brunt Dr C Handy Mrs J Jasper Ms S Johnson Dr D Pitches In Attendance Mr P Cowley Dr T Horsburgh Mrs A Nicholls Mrs J Robinson Mr D Stenson Mrs J Taylor Mr T Thomik Minute Taker: Ms D Gilbert Non-Executive Director for Governance, Dudley CCG (Chair) Chief Nurse, Dudley CCG Non-Executive Director, Quality and Safety, Dudley CCG (Vice Chair) Non-Executive Member for Patient and Public Involvement, Dudley CCG Deputy Chief Finance Officer, Dudley CCG Consultant in Public Health, Dudley MBC Senior Finance Manager, Dudley CCG Clinical Executive for Primary Care, Dudley CCG/LMC Representative Interim Deputy Head of Commissioning (Primary Care) NHS England (West Midlands) Primary Care Contracts Manager, Dudley CCG Patient Opportunity Panel Representative Commissioning Manager for Primary Care, Dudley CCG Dudley LPC Representative Personal Assistant, Dudley CCG 1. APOLOGIES FOR ABSENCE Apologies were received from: Mrs L Broster, Director of Communications and Public Insight, Dudley CCG Mrs J Emery, Chief Executive, Healthwatch Dudley Dr V K Mittal, GP Representative 2. DECLARATIONS OF INTEREST To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. Mrs Jasper declared her standing interest as NED for Sandwell and West Birmingham CCG. Mr Stenson declared his standing interest as Non-Executive Director for Black Country Partnership NHS Foundation Trust. Mr Thomik declared his standing interest as representative for Dudley LPC, although he does not have a voting position on the Committee. 1 P age

It was to be formally recorded that Dr Horsburgh as well as being in attendance as Clinical Executive for Primary Care; Dudley CCG was also in attendance as Secretary of the LMC. Declarations of Interest were distributed at the meeting and will be appended to the Primary Care Commissioning Committee (PCCC) agenda and papers in future. 3. QUESTIONS FROM THE PUBLIC Mr Wellings had received no questions from the public and no public were in attendance. 4. MINUTES FROM THE PREVIOUS MEETING HELD ON 21 JULY 2017 The minutes of the Committee held on Friday 21 July 2017 were accepted as a true and accurate record with the following exceptions: Item 4 the last two sentences related to the meeting held on 21 July 2017 and it was agreed these would be included in the minutes under the relevant agenda item. It was noted that agenda Item 6.1 had been deferred until after agenda Item 9.0 and it was agreed that this would be reflected in the minutes. Item 5. Matters Arising, PCCC/APR/2017/14.0. The action should be Mrs Gretton s rather than Mrs Jasper s. Item 5. Matters Arising. PCCC/JUNE/2017/10.0. For clarification add Primary Care Commissioning before annual report to distinguish it from the CCG s Annual Report. Item 6.1. Report from PCOG was deferred until after Item 9. Clinical Peer Review. Item 6.1 Report from the PCOG. The third paragraph, last sentence should read the practice has since recruited a salaried GP, rather than been approved as a salaried GP. Item 6.1. Report from the PCOG. The final paragraph, second sentence should read NHS England have also agreed as an option that the procurement could be incorporated into the MCP procurement rather than NHS England have also agreed that the procurement should be incorporated into the MCP procurement. Item 10.2 Report for IRIS Business Case, add a final sentence: The Committee asked that if CCG staff are preparing a business case, they follow the guidance and seek support from relevant support staff. Item 11.1 Finance Report. Mr Cowley presented the finance report for the period to June 2017 not the baseline budgets. Item 13.0 Risk Register. There was an unnecessary d and it should read with an updated Board Assurance Framework and Risk Register. 5. MATTERS ARISING/ACTION LOG MATTERS ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2017/9.1(a), (b) Performance Report The Committee would like a report addressing the points raised regarding the PCAT tool at previous Committee meetings to go to a future private meeting of this Committee. 2 P age

ACTION: MR FRANKLIN PCCC/JAN/2017/9.1(c) Performance Report Mrs Brunt also to raise formally with Clinical Quality Review Meeting (CQRM.) ACTION: MRS BRUNT PCCC/MAR/2017/7.1(b) PCCC/MAR/2017/11.0 PCCC/APR/2017/8.2 PCCC/APR/2017/12.0 PCCC/APR/2017/13.0 PCCC/APR/2017/14.0(a) PCC/APR/2017/14.0(b) PCCC/MAY/2017/9.1 PCCC/JUNE/2017/8.1 PCCC/JULY/2017/6.1 PCCC/JULY/2017/7.0 Quality and Safety Report This item will be discussed in the Quality and Safety section and a detailed report will follow. To be deferred to November 2017. DPMA Training Budget Business Plan The Committee was informed that an evaluation had been requested though was still outstanding and it was agreed that this item be deferred until September 2017. Health Infrastructure Strategy Implications for Primary Care The CCG are now looking to refresh the strategy to include providers following a request from Dudley Group. As this is a lengthy process it was agreed that this be removed from the action log and brought forward as part of the revision. It was suggested that in the meantime the CCG write to practices outlining that a decision has been made, the potential implication for other practices and advising that as soon as anyone has any potential premises changes that they wish to make that they contact the CCG. Primary Care Organisational Structure This item was a duplicate and it was agreed it should be removed. Supporting Professional Decisions This item was omitted from the agenda; a report was presented at the meeting. It was recorded that regular meetings are to be held to look into protocol/procedures/coding. An update would be provided at the December meeting unless anything arises that the Committee should be made aware of prior to this. Patient Participation Group Update This item was deferred until September 2017 Patient Participation Group Update This item was covered under PCOG update Performance Report This item was a duplicate of item PCC/JAN/2017/9.1 and it was agreed it should be removed. Reporting to the Primary Care Commissioning Committee This item had been superseded by new Primary Care organisation structure and it was agreed it should be closed. High Oak Medical Practice The High Oak Medical Practice APMS contract is due to expire in March 2019. This item was on the Agenda, Item 6.2. This item to be closed. Extended Access Scheme This was on the Agenda as Item 7.0 ACTION: MRS TAYLOR 3 P age

PCCC/JULY/2017/9.0 Clinical Peer Review On Page 5 the minutes refer to Clinical Peer Review and an update was provided. Dr Horsburgh, Dr Gee and Mr Curran had met to discuss how to take the project forward. This matter will be raised at the Clinical Executive meeting on Monday 14 August for discussion. There is funding to support this as a possible incentive scheme for GPs. Following discussions this will be brought back to the Committee. A response was still awaited from NHS England. ACTION: DR HORSBUGH PCCC/AUGUST.2017/6.1 PCC/JUNE/2017/10.0 PCCC/JULY/2017/8.0 PCCC/JULY/2017/13.0 PPGs As all Dudley practices have a PPG, a report is to be prepared in due course stating how PPGs are working and their positive outcomes. Annual Report This item was complete and could be closed. Terms of Reference for the Primary Care Development Group The Terms of Reference had been agreed the previous month and therefore this item could be closed. Risk Register This was a standing agenda item and therefore could be removed. 6. CONTRACTUAL 6.1 REPORT FROM THE PRIMARY CARE OPERATIONAL GROUP Mrs Robinson spoke to this item to update the Committee following the Primary Care Operational Group (PCOG) meeting held on 2 August 2017. The group considered one contract variation and recommended for approval the addition of a new partner at Wychbury Medical Group. The group received a report from NHS England in respect of Primary Care Support Services. This is a service provided by Capita under the name of Primary Care Support England (PCSE) on behalf of NHS England. The purpose of the report was to reflect the changes that have been made to improve the service and at the same time acknowledge that there is still some action to be taken. The report outlined the next steps to be taken to ensure that the recovery of PCSE services is nearing completion. The PCOG meeting focussed on reviewing the Primary Care Analysis Tool (PCAT). The group recommend to Committee that the PCAT scoring matrix will be reviewed at each PCOG meeting and will also include a monthly area of focus. The determined actions will be monitored through the PCOG action log and on-going assurance regarding the performance of primary care contractors will be provided to Committee through the Quality and Safety report. Any issues that require contractual action will be reported to Committee through the PCOG report. The Quality and Safety report will present to Committee at Septembers meeting under the private section. Mrs Brunt invited Committee members to attend any PCOG meeting to discuss the PCAT tool to provide a more detailed insight into its operational issues. Within PCAT, one indicator relates to emergency admissions. There has been an agreement that the coding to date overstates the CCG position. This will be addressed by Dudley Group over the coming weeks. 4 P age

Following the appointment of a new Practice Manager at the only practice without a PPG, a PPG had now been established. Committee requested an update report to cover the current situation and future plans regarding PPGs to include how they are working and the positive outcomes. Resolved: 1) The Committee noted the report for assurance 2) The Committee noted and approved the recommendations in relation to the contract variation request 3) Results of the PCAT tool be reported to the Committee 4) Any member of the Committee invited to attend a PCOG meeting to discuss the PCAT tool 5) A report to be prepared in due course regarding how PPGs are working and positive outcomes 6.2 HIGH OAK APMS CONTRACT RE-PROCUREMENT Mrs Brunt spoke to this item in respect of arrangements for the re-procurement of a provider of primary medical services for patients registered with High Oak Surgery. This was an extension of the discussion that was held at the previous Committee when a paper was presented regarding the potential option of the High Oak APMS contract being re-procured under the MCP as a fully integrated practice. NHS Property Services have communicated with the CCG regarding options for extending the timeframe that the building would be available up until March 2022. The email included a seven month programme for the premises to be open in a refurbished form by April 2018. They are requesting approval by 1 September 2017. Quotes have been received for this and the CCG will be looking to proceed with the intention to create room for an extension. The Committee was asked to give approval in principle to allow discussions to continue committing the CCG to any abortive costs should the CCG decide not to proceed. A report to be brought back to the September Committee. Resolved: 1) The Committee noted the report for assurance 2) The Committee approved the proposal in principle 3) A detailed report to be presented to the September Committee 7. 0 PRIMARY CARE EXTENDED ACCESS SCHEME 2017/18 ACTION: MR COWLEY Mrs Taylor spoke to this item to present to Committee the proposals for the Primary Care extended access scheme in 2017/18. Proposals had been received from all localities. Lead practices have been contacted regarding the outcome of the panel s discussion asking them for further clarity. Practices have been asked to provide a detailed submission of the daily schedule of provision for each practice, where the location of services is going to be for that provision and details of staffing. The CCG have been working with the Communications team regarding the public message that needs to be distributed. It is hoped that the launch would take place the following week. IT and refresher training has been organised. Standard NHS contracts will be drawn up over the following week for the next seven months. The Committee thanked Mrs Taylor and everyone involved in this process for obtaining full coverage across the population. The extended access scheme starts on 1 September 2017. Resolved: 1) The Committee noted the report for assurance 2) The Committee approved the process following clarification on some of the recommendations INANCE REPORT 8.0 QUALITY 8.1 FINANCE REPORT 5 P age

8.1 REPORT FROM THE QUALITY AND SAFETY TEAM Mrs Brunt spoke to this item to provide on-going assurance to Committee regarding primary care quality and safety in accordance with the CCG s statutory duties. Work is on-going in relation to supporting practices with negative CQC ratings. Following the support provided which includes an offer of a mock inspection a positive outcome is reported upon re-inspection with an improvement in the measures of quality. Resolved: 1) The Committee noted the report for assurance 8.1 FINANCE REPORT 9.0 FINANCE 9.1 FINANCE REPORT Mr Cowley spoke to this item to provide an overview of financial performance against budgets delegated to Committee. Due to the timing of the Committee Finance had not yet prepared the monthly reports. It was noted that the CCG had received one allocation since the last report which was the Quarter 1 allocation for extended access. Resolved: 1) The Committee noted the report for assurance 10.0 RISK REGISTER Mrs Brunt spoke to this item to provide the Committee with an updated Board Assurance Framework and Risk Register for those risks assigned to Primary Care Commissioning Committee. It was noted that eight risks were proposed for closure, one for transfer to the Finance and Performance Committee and five new risks encompassed all the risks around Primary Care Commissioning. The risks proposed for closure would be taken to the Audit and Governance Committee and Board, where appropriate, for approval. It was agreed that the Risk Register item would follow the Contractual section on future Committee agendas. Resolved: 1) The Committee received the report for assurance 11.0 DATE AND TIME OF NEXT MEETING Friday 29 September 2017 1pm 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Signed Title Date 6 P age

PRIMARY CARE COMMISSIONING COMMITTEE OUTSTANDING ACTION LIST 11 AUGUST 2017 MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE DATE COMPLETED PCCC/JAN/2017/9.1(a), (b) Performance report The Committee would like a report addressing the points raised regarding the PCAT tool at previous Committee meetings to the next private meeting of this Committee in September. Mr Franklin In Progress September 2017 PCCC/JAN/2017/1(c) PCCC/MAR/2017/7.1(b) PCCC/MAR/2017/11 PCCC/APR/2017/13.0 Mrs Brunt will follow this up and give an update to the Committee in September. Mrs Brunt also to raise formally with CQRM. Quality & Safety Report The Committee requested a detailed report from Public Health for further details on the immunisation landscape DPMA Training Budget Business Plan The Committee requested evaluation of the proposal to see the success of training and also that columns included to see alignment to the MCP Supporting Professional Decisions The Committee requested further detail around the membership of the panel and how that would work Mrs Brunt In Progress September 2017 Mrs Brunt In Progress November 2017 Mrs Taylor In Progress September 2017 Dr Horsburgh In Progress December 2017 1 P age

MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE DATE COMPLETED PCCC/JUNE/2017/9.0 PCCC/JULY/2017/9.0 PCCC/AUGUST/2017/6.1 PCCC/AUGUST/2017/6.2 Dementia Local Improvement Scheme Review of Dementia Diagnosis Evaluation to take place in six months time to evaluation whether numbers are continuing to increase and the target has been met. Clinical Peer Review Following discussions this will be brought back to the Committee. PPGs As all Dudley practices have a PPG, a report to be prepared in due course stating how PPGs are working and their positive outcomes. High Oak Premises proposal to be brought back to a future Committee meeting. Mr Hindle In Progress December 2017 Mr Horsburgh In Progress To be agreed Mrs Codd In Progress September Mr Cowley In Progress September 2 P age

PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 29 th September 2017 Patient Participation Group Update Report: Agenda Item: 6.1 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: Patient Participation Group Update To update on current situation and future plans regarding PPGs Helen Codd Engagement Manager Laura Broster Director of Communications & Public Insight Dr David Hegarty A PPG share, learn and network event was held in August PPGs are unique and made up of volunteers who give their time freely The People in the Lead work stream will be looking at innovative approaches towards practice champions. This reports directly to Partnership Board as a system approach and is also intertwined with the Empowering People and Communities work That practices are required to contact the primary care team if they do not have a PPG The Communications & Public Insight team continue to support PPGs and practices That we develop a new approach towards practices and their PPGs/volunteers We work with willing practices and patients/groups as opposed to a challenging approach towards practices of concern FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: None On-going support to all PPGs & practices that request it Bi-monthly Patient Opportunity Panel (POP) meetings PPG and practice event held August 2017 ACTION REQUIRED: To agree the recommendations 1 P age

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE 29 th September 2017 Patient Participation Group Update 1. Purpose of report 1.1 The report will detail activities and information relating to PPGs across Dudley. 2. Background 2,1 All practices are required to have a PPG as part of their GMS contract. The Communications and Public Insight team work with any PPG or practice that requests their help. 2.2 We do not have access to all PPGs as they are volunteers and their relationship is primarily with their practice. 2.3 There is no capacity to collect routine data from practices regarding their PPGs in terms of membership, activities, how often they meet, copies of minutes etc. 2.4 We encourage a dialogue and relationship with PPGs and practices and we strongly believe that we need to build trust and rapport to encourage innovative approaches to volunteers within practices that is supportive and nurturing. 3. PPG Share, learn and network event 3.1 August saw the second PPG event hosted by the CCG and partners. The first event held in March 2017 was successful and participants had asked for a follow up event. 3.2 63 participants attended from 19 practices 3.3 Prior to the event we asked PPG members what they might like to achieve from attending the event 3.4 The event had a number of opportunities: - Opening presentation by Dr Gillian Love, Chair of GP Steering Group and Stephanie Cartwright, Director of Human Resources and Organisational Development. This helped to set the scene and context and reality to the changes within primary care and impending arrival of the MCP. There was also time for questions and answers - Other PPGs sharing their success stories and how they overcame barriers including Moss Grove, Feldon Lane and 3 Villages - Opportunity to find out more and sign up directly to Patient Online 2 P age

- Request help and support with funding and applications - Request help and support with the PPG Navigation Guide and self-assessment - Opportunity to find out more about Making Every Contact Count (MECC) with the office of public health - Healthwatch sharing information and opportunities on Activate and Community Information Champion training 3.5 Above all there was a great buzz and lots of energy in the room. Participants made lots of connections and swapped ideas and agreed to buddy up and share information. Participants also made comment on the frankness of Dr Love and appreciated honest conversation. 4. Conclusion and next steps 4.1 Members of PPGs really appreciate the opportunity to come together and meet like-minded people. We know that some PPGs see their roles within practice as quite functional, e.g. undertaking surveys, discussing improvements and monitoring complaints. We believe there is a need and an appetite for PPGs to evolve into a new era with the MCP. As part of the People in the Lead work-stream, which reports to Partnership Board and links in with Empowering People and Communities, we want to explore working together to create healthier people and communities by harnessing enthusiasm for practice health champions and developing practices which are more community focused. We would aim to co-design an approach with partners, which would include patients and practice staff, that would help explore and pilot this approach perhaps tackling some key issues such as loneliness and isolation or frequent attendees. For more information, please see: http://www.altogetherbetter.org.uk/data/sites/1/--altogether-betterevaluation-report---working-together-to-create-healthier-people-and-communities-2015.pdf 3 P age

PRIMARY CARE COMMISSIONING COMMITTEE Date of Committee: 29 September 2017 Report: Update from the Primary Care Operational Group Agenda Item: 6.2 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: Update from the Primary Care Operational Group To update the Committee following the Primary Care Operational Group meeting held on 15 September 2017 Mrs J Robinson, Primary Care Contracts Manager Mrs C Brunt, Chief Nurse Dr T Horsburgh, Clinical Executive for Primary Care The group provides assurance that there are no contractual breaches to be issued for any Dudley practice The group considered the quality and safety issues that are set out in the quality and safety report Committee is asked to: RECOMMENDATION: Note the actions of the primary care operational group for assurance FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: Not applicable Not applicable Decision Approval Assurance 1 P age

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP 1.0 INTRODUCTION 1.1 This report provides an update from the Primary Care Operational Group (PCOG) following its meeting held on 15 September 2017. Due to the number of apologies members were also asked to contribute to the meeting by email. 2.0 CONTRACTING ISSUES 2.1 PRIMARY CARE CONTRACTUAL CHANGES 2.2 The group received details of an initial proposal for the merger of two Dudley GP practices. 2.3 CCG representatives will be meeting with the practices to discuss the implications and consultation process prior to any formal application. 2.4 The group gave their support to the initial proposal. 2.5 PCOG received details of a practice where serious IT issues forced the closure of a branch surgery. A full summary of the event was received along with details of the action taken by the practice. 2.6 The GMS contract was breached however due to the circumstances and actions taken, PCOG make a recommendation to Committee that a breach notice should not be issued. 2.7 PCOG requested that the CCG IT manager formally addresses the escalation process with the CCG IT supplier to ensure that any future outage that may result in significant loss in service will be reported to the CCG in a timely manner. 3.0 PRIMARY CARE QUALITY & SAFETY 3.1 The group considered the quality and safety issues that are set out in detail in the Quality and Safety report to the Primary Care Commissioning Committee. 3.2 The group monitored the agreed actions following review of the Primary Care Assurance Tool (PCAT). The actions are set out in the Quality and Safety report to provide on-going assurance to Committee. It was agreed that next month s indicator of focus will be NHS Choices ratings. 3.3 There are no issues in the quality and safety report that require contractual actions to be taken against any practice. 4.0 RECOMMENDATION Committee is asked to: Note the actions of the primary care operational group for assurance. 2 P age

PRIMARY CARE COMMISSIONING COMMITTEE Date of Report: 29 th September 2017 Report: Primary Medical Services Report Agenda item: 6.3 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: Primary Medical Services New Contractual Framework To present to the Committee an update on the Dudley Quality Outcomes for Health (DQOFH) framework 2017/18 Mrs. J Taylor, Primary Care Commissioning Manager Mr. C. Brunt, Chief Nurse Dr. T Horsburgh, Clinical Executive for Primary Care The phase three pilot is continuing to be undertaken in 42 of our 45 membership practices The CCG continues to receive feedback on the template and indicators from Membership practices The phase three evaluation is currently in progress and will be presented to Committee once complete The CCG has invested in resources to support practices in infrastructure transition The interim indicator findings are presented to Committee for assurance RECOMMENDATION: The Committee is asked to note for assurance The DQOFH framework update FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: The cost of this proposal will be contained within the existing financial envelope for the commissioning of primary medical services Initial engagement has taken place with patients and the public Members Meetings Locality meetings Dudley Local Medical Committee (LMC) CCG Clinical Executive Team Practice Managers Steering group CCG Clinical Leads Decision Approval Assurance 1 P a g e

DUDLEY CLINCAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE 29 th September 2017 PRIMARY MEDICAL SERVICES REPORT NEW CONTRACTUAL FRAMEWORK 1.0 PURPOSE OF REPORT 1.1 To present to the Committee an update on the Dudley Quality Outcomes for Health framework 2017/18. 2.0 BACKGROUND 2.1 The phase three pilot has been in operation in 42 or our 45 membership practices; 2.2 At the Committee meeting in April 2017 the final draft business rules for the DQOFH framework contract for 2017/18 contract were approved. 3.0 UPDATE 3.1 The CCG continues to receive feedback on the template and indicators from Membership practices which is regularly discussed and debated at the steering group; 3.2 The phase three evaluation framework has commenced implementation. The three practices which have been identified as the case study practices to undertake the in depth evaluation have been contacted and confirmed. The timescales to undertake this detailed evaluation will occur in September 2017 with the expectation that the final evaluation report will be ready to present to committee in October 2017; 3.3 The CCG has invested in resources to support practices in infrastructure transition particularly in setting up call and re-call systems and coding around the new framework. This will be targeted towards practices that appear to be struggling but available to all practices over the next 12 months. 4.0 INTERIM INDICATOR FINDINGS 4.1 The CCG continues to extract the data from the DQOFH framework. Although many of the indicators are new some of the findings in the last 12 months are: 45,489 patients have received a holistic comprehensive assessment including a medication review which is 50% of our LTC population 42,827 patients have received a person centered care plan with individualised goals which is 50% of the LTC population Of the total LTC population 54% have had a physical activity assessment, 57% have had a screen for depression and 83% have had their BP recorded in the last 12 months 89% of patients with atrial fibrillation with a CHADSVASC score of 2 or more have been prescribed anticoagulation medication 51% of patients diagnosed with COPD in the last 12 months COPD have had a post bronchodilator assessment 1 P age

63% of patients with Diabetes have their BP treated to evidence based target of 140/80mmHg ( 130/80mmHg with retinopathy, CKD or CVD complications) 81% of patients with Diabetes have a HbA1c of 75mmol/mmol or less 66% of patients with Hypertension have their BP treated to evidence based target of 140/90mmHg 76% of patients with a vascular condition have their BP treated to evidence based target of 140/80mmHg 86% of patients with a vascular condition have been appropriately treated with anticoagulant/antiplatelet therapy 65% of patients with a learning disability have had an annual health check 4.2 The CCG Business Intelligence (BI) team has developed the Primary Care Analysis Tool (PCAT) which includes all of the indicators within the framework which will be reported to committee on a regular basis in the future. 5.0 NEXT STEPS 5.1 Development of a contractual monitoring framework for the 2017/18 contract which will be presented to Committee in October 2017; 5.2 Further review of the current indicator set and associated business rules by the long term conditions steering group in preparation for the 2018/19 contract; 5.3 Phase three evaluation to be completed which will inform any financial modelling which will need to be undertaken prior to the 2018/19 contractual offer being ratified by Committee and presented to Membership practices. 6.0 RECOMMENDATION 6.1 The Committee is asked to note DQOFH framework update for assurance.

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2017/18 15-Sep-17 Updates from August Committees ID Original Date Last Review (Committee Date) Last Update (Risk Amended) Risk DescriptionAccountable LINK TO CORPORATE OBJECTIVE (SEE KEY ABOVE) 135 21/07/2017 21/07/2017 21/07/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to either quality or individual performer issues Committee Accountability Sponsor & Owner Management Lead PCC Steve Wellings Caroline Brunt 3 4 12 P I Initial Risk Key Controls Score (PxI) Score before any controls are in What controls/systems are in place to assist in securing delivery of our objective. Such as strategies, policies and procedures Working Work regular with CQC & NHS England (Via PPIGG) to ensure that any concerns are addressed early. Primary Care Team visits with practice to obtain soft intelligence Gaps in Control Where are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of Receiving timely information from NHSE, There is no robust mechanism in place for the CCG to be informed of issues early on eg. Complaints, GMC investigations etc. Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting. Internal Assurances Board Reports, Minutes of meetings Report to PCCC regarding formal performance issues Feedback from individual practices is reported through PCOG External Assurances Internal and External Audit Reports, CQC Reports (R) P (R) I Appraisal process for individual GPs carried out by NHS England (Moved from Key controls) Residual Risk Score (PxI) Score following controls put in place Risk Trend 3 4 12 = Actions To improve control, ensure delivery of principal objectives, gain assurance 1) Contribute to the review of the PPIGG structure and function 2) Discuss with NHSE regarding better ways of receiving timely complaints information Timescales Date action will be completed 1) August 2017 2) June 2017 COMMENTS 1) Fed back initial comments to PPIGG. 2) Pilot process agreed with NHSE for timely complaints information to be provided Annual Workforce Audit for clinical and non-clinical staff carried out Recruitment Fayres/ Joint working and raising profiles in Primary Care 136 21/07/2017 21/07/2017 21/07/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce PCC Steve Wellings Caroline Brunt 4 4 16 Training needs and skills set assessment Gaps in reporting to Committee needs to be clarified as some of Primary Care Team visits with practice Workforce plan to be developed the soft intelligence is not to obtain soft intelligence suitable for a public meeting. No current model of care Engagement with NHS England, Health available to address the Education England and Local workforce gaps CCG do not currently receive Workforce Advisory Board committed to notification from NHSE in respect training and professional development. of outstanding appraisals Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development Enabling practices to improve and change (EPIC Programme) Report to PCCC regarding training needs and workforce analysis Feedback from individual practices is reported through PCOG Report to PCC regarding EPIC Programme progress 2 3 6 = 1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing 1) April 2019 in the clinical and non clinical workforce 2) 2017/18 TBC 2) Develop a joint action plan with external partners (eg. HEE) to establish future workforce needs moving into an MCP provider. 137 21/07/2017 21/07/2017 21/07/2017 4B 138 21/07/2017 21/07/2017 21/07/2017 4B 139 21/07/2017 21/07/2017 21/07/2017 4B There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to unplanned loss of Estates or infrastructure There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to Financial issue There is a risk that there is insufficient workforce within the primary care team to deliver the delegated Primary Care Commissioning functions and projects such as the GP Forward View Plan PCC Steve Wellings Caroline Brunt 2 4 8 PCC Steve Wellings Caroline Brunt 2 4 8 PCC Steve Wellings Caroline Brunt 5 3 15 CCG Estates Strategy in place Rent Reviews in place Review of Leases Regular contact with practices to highlight premises issues GPFV related increases in investment in Primary Care General Practice Resilience Programme Reinvestment of PMS Premium PCCC will monitor the capacity of the PC team following restructure due to MCP development. Work allocation, work plans and capacity is discussed at 1:1 and primary care team meetings Alternative suitable space is not readily available in the event of an unplanned loss. The CCG has no power to compel the relocation of practices from unsuitable premises. No additional resources have been identified to support the PC team on delivery of the GP Forward View There is no requirement upon practices to report issues with premises to the CCG. GMS Contract responsibilities in respect of premises are not robust. No assurance regarding that Business Continuity Plans do include alternative locations As independent businesses, the CCG have no oversight of financial issues Monitoring has not been reported back to PCCC Feedback on individual practice issues is provided to PCOG. Issues are discussed at the monthly Estates Operational Group Primary Care Strategy Group Report To PCCC re investment in DQOFH None 2 3 6 = GPFV Transformation Board 2 4 8 = None None 3 3 9 = 1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing infrastructure 1) April 2019 and estate to deliver the model 2) September 2017 2) Develop and maintain a log of the alternative service locations included in Business Continuity Plans Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of Apr-19 the new model, developing and investing in the back-office efficiency of practices Review capacity and inform PCCC and agree a way forward. Establish a robust process for monitoring capacity issues on an on-going basis

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE Date of Meeting: 29 September 2017 Report: Quality & Safety Report Agenda Item No: 8.0 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR(s) OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: Quality and Safety Report To provide on-going assurance to the Primary Care Commissioning Committee (PCCC) regarding quality and safety in accordance with the CCG s statutory duties Mr J Young, Quality and Patient Safety Manager Mrs C Brunt, Chief Nurse Dr Ruth Edwards, Clinical Lead, Quality & Safety There have been three CQC reports published since the last meeting, including one inadequate rating There has been a productive flu / other imms planning meeting held The Primary Care Commissioning Committee is asked to: Note this report for assurance FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: None to report N/A Assurance Page 1 of 1

Primary Care Analysis Report Primary Care Analysis Report PCCC, 29/09/2017 Produced : 20 th September 2017 Robert Franklin BI Developer & Analyst (Dudley CCG) Jim Young Head of Quality Assurance (Dudley CCG)

Primary Care Analysis Report Summary Care Quality Commission (CQC) There have been three reports published: Bath Street Medical Centre have been rated as inadequate overall and for the safe and well-led domains. CCG follow-up visits have been carried out on 24/08/17 & 20/09 to support the practice. Dialogue continues with CQC to help identify the best course of action regarding their findings. The Greens Health Centre have been rated on re-inspection as good overall and for all domains following a previous requires improvement rating for the safe domain Dudley Partnerships for Health (now Dudley Wood) have been rated as good overall on re-inspection following a previous requires improvement overall rating One practice Coseley Medical Centre have been re-inspected but not yet reported A mock inspection (CCG) has been carried out at Stourside to support their preparation for re-inspection Infection Prevention & Control (IPC) Two audits have been completed since the last meeting The latest immunisations & flu planning meeting on 11/09/17 confirmed the flu plan for this winter with GP practices taking responsibility for the whole of a residential home and community nurses doing the same for individual patient homes. This whole building approach is designed to be more robust than last year and has been the product of good cooperation across the health economy Work now switches focus to other immunisations and identifying ways to further improve uptake Progress continues on the sepsis prevention and identification work with a primary care newsletter planned for circulation in September Serious Incidents (SIs) Currently, there is one SI open. Support is continuing to be provided by the Q&S team to ensure a robust RCA is carried out and documented. Service Developments Datix Three practices are now using the live system as well as the UCC. Further meetings / demos are being arranged with other practices. Performance Indicators actions taken The actions described previously following review of the Primary Care Assurance Tool (PCAT) dataset at the August PCOG meeting remain ongoing; these identified seven practices that required some further discussion of the data In addition, the September data identified two further practices as potentially requiring further review and/or support based on the results of the July 2017 GP Patient Survey

Primary Care Analysis Report

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE Date of Report: 29 September 2017 Report: Finance Report Agenda item No: 9.0 TITLE OF REPORT: Primary Care Commissioning Finance Report PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: FINANCIAL IMPLICATIONS: WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: The report provides an overview of financial performance against budgets delegated to Committee. Mr P Cowley, Senior Finance Manager Mr M Hartland, Chief Operating and Finance Officer Dr T Horsburgh, Clinical Executive for Primary Care There has been one allocation change in June, with an allocation of 1,442,000 being received in respect of Extended Access for Quarters 2-4. A break-even position is forecast against co-commissioning and GP Forward View Allocations, and a small underspend is forecast against core CCG budgets. The report highlights the level of reserves available to be committed non-recurrently this financial year, with a more detailed report on proposed uses of the reserves to be presented in month 6. Committee is requested to note the reported financial position for assurance. As above. None Decision Approval Assurance 1 P age

Finance Report (August 2017) This report submitted to Dudley CCG Primary Care Commissioning Committee provides a provisional breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of August. Contents Financial Overview Financial Detail p2 p3

Financial Overview Budget Allocations Budgets reported to the committee have an annual value at August 2017 of 43,583,000, including both the delegated cocommissioning allocation and core CCG budgets. There has been one allocation change in August; an allocation of 1,442,000 in respect of Extended Access. This allocation is in addition to the allocation of 481,000 received in July, and represents the full year allocation for the service Allocation Breakdown GP Forward View 1,977k Primary Care Co- Commissioning 41,058k CCG Core Commissioning 548k 2

Delegated Co-Commissioning Summary Position The forecast expenditure level against delegated budgets continues to reflect a break-even position. There are small variances in respect of the following areas: GP Contract the underspend of 8,000 represents the value of PMS transitional payments to Bilston Street which are no longer payable following the practice closure. QOF and Enhanced Services an underspend of 45,000 is reported against the Minor Surgery LIS scheme. A number of significant variances are recorded at a practice level, and further investigation is ongoing to ascertain whether this is a genuine reduction or due to under-reporting/emis coding issues in practices Annual Budget ( '000) Forecast Variance ( '000) Budget Area (WTE) GP Contract 27,333 (8) QOF and Enhanced Services 6,441 (45) Premises Costs 4,731 - Dispensing/Prescribing Drs 273 (19) Other GP Services 1,004 (0) Development and Training Funds 0.80 263 - Non-Core GPIT 143 - Reserves 870 72 Total - 41,058 (0) Dispensing/Prescribing Drs a small underspend of 19,000 is forecast in respect of fees payable to practices in respect of personally administered drugs, based upon June data. It should however be noted that the majority of these payments are due over autumn/winter in respect of Flu vaccinations, and that the forecast is therefore still volatile at this stage of the year. Reserves this forecast overspend reflects the assumption that additional funds will be committed from reserves to offset underspends against budget areas and ensure a break-even position is achieved. Reserves As a more detailed picture of expenditure against committed budgets becomes clear, the CCG will be in a position to release its 1% non recurrent reserve and other uncommitted reserves, although the 0.5% contingency reserve must be retained uncommitted until January. These reserves total 870,000, including the 203,000 contingency reserve, as shown in the table above In order to ensure that the required break-even position is achieved at the end of the financial year, it will be necessary to draw up plans to commit these remaining reserves, and any underspends that may arise in committed budgets. A more detailed report will be presented at month 6 highlighting the full extent of these available resources, and a range of options for their effective utilisation. 3

CCG Core Commissioning and GP Forward View Core Commissioning Small underspends are forecast against both the GP with Special Interest and Practice Engagement LIS budgets. GP Forward View As reported above, the CCG have this month received an allocation of 1,442,000 in respect of Extended Access, taking the annual allocation to 1,923,000. A break-even position was reported at month 5 against all allocations, although more up to date information is now available in respect of GPFV Extended Access. Annual Budget ( '000) Forecast Variance ( '000) Budget Area (WTE) GP with Special Interest 0.50 64 (8) Practice Engagement LIS 484 (8) Total 0.50 548 (16) Annual Budget ( '000) Forecast Variance ( '000) Budget Area (WTE) Reception and Clerical Staff Training 54 - Online Consultation Software - - GPFV Extended Access 1,923 - Total 1,977 - GPFV Extended Access Costs in respect of the Winter Extended Access scheme which continued running until August are not yet finalised, but based upon claims received to date it is now estimated that this scheme could see an underspend of 250,000 against this budget for that period. As the scheme from September onwards is at a fixed cost, this underspend will not be used up by the current scheme and alternative options will be developed for its use in line with GPFV requirements. Such schemes should fill gaps in current fulfilment of NHSE requirements and may include: Bank Holiday opening (Christmas/Easter) IT integration to support delivery of extended access Increased promotional activities Training in support of the scheme Commissioners will be requested to work up initial proposals for the use of these funds, to be brought back to committee for approval. Recommendation: Committee is asked to note the reported financial position for assurance. 4

PRIMARY CARE COMMISSIONING COMMITTEE Date of Report: 29 September 2017 Report: High Oak Premises Development Agenda item No: 10.0 TITLE OF REPORT: PURPOSE OF REPORT: AUTHOR OF REPORT: MANAGEMENT LEAD: CLINICAL LEAD: KEY POINTS: RECOMMENDATION: High Oak Premises Development To seek approval for costs involved in an extension to the premises of High Oak Surgery Mr P Cowley, Senior Finance Manager Mr M Hartland, Chief Finance and Operating Officer Dr T Horsburgh, Clinical Executive for Primary Care High Oak Surgery provides Primary Medical Services under an APMS contract to approximately 3,900 patients in an area of high deprivation and health need. The Surgery currently operates from significantly undersized modular premises, for which planning consent expires in March 2019. As agreed at Committee in August, the CCG have instructed NHS Property Services Ltd to devise a plan to extend the current premises, providing 2 additional consulting rooms and additional administration space. Included as appendices to this report are a finalised plan for the extended premises and high level costings for the provision of the required space. This comprises an additional modular unit to be added to the existing building. The report outlines an initial development cost of 115,000 for groundworks to support an additional modular unit, and a recurrent revenue cost of 5,000 per month ( 60,000 per annum for the hire of the unit. Committee is requested to: Approve the proposed solution to meet the practice s requirements. Approve the required capital expenditure and increased revenue cost of the proposed solution. FINANCIAL IMPLICATIONS: Estimated Non-recurrent development cost - 115,000 Estimated Annual rental increase 60,000 1 P age

WHAT ENGAGEMENT HAS TAKEN PLACE: ACTION REQUIRED: There has been significant engagement with the practice, as well as with Dudley MBC and NHS Property Services Ltd Decision Approval Assurance 2 P age

PRIMARY CARE COMMISSIONING COMMITTEE 29 SEPTEMBER 2017 HIGH OAK PREMISES DEVELOPMENT 1.0 INTRODUCTION This report presents to Committee a proposal for a development of the premises at High Oak surgeryextension to the current modular premises of High Oak Surgery, and seeks approval for additional revenue rental costs and development costs associated with the proposal. 1.1 As part of a discussion of options for the reprocurment of services at the expiry of the current contract in March 2019, Committee discussed the current situation in respect of premises, and requested a costed plan to provide the additional space required by the practice and extend the life of the premises to March 2022. 1.2 The rationale for this was to provide for the immediate needs of the patients of the practice, while also providing the Multispecialty Community Provider who would be commissioned to provide services the time to determine its clinical and estates strategies and procure permanent facilities for the service. 2.0 BACKGROUND High Oak Surgery was set up as an APMS practice in 2004 to offer Primary Medical Services to the population of Pensnett, and was provided with modular premises in which to operate. Since its establishment in 2004, the practice has grown from a standing start to hold a list size of nearly 3,900 patients, in one of the most deprived areas of Dudley. 2.1 The modular premises solution provided to the practice was always designed to be temporary, and there has been a previous unsuccessful attempt to provide a permanent base for the practice through a development in partnership with Dudley Infracare LIFT, the Local Improvement Finance Trust (LIFT) for the area. This scheme failed in the wake of the NHS reorganisation of 2010-2012. 2.2 The current premises consist of two modular units leased from a 3 rd party (Wernick Hire Ltd) on a former local authority car park which has been leased to NHS Property Services Ltd (NHS PS). This lease, and planning permission for the temporary facility, are currently due to expire on 31 st March 2019. 2.3 The facility itself contains 3 consulting rooms and a nurse treatment room, a records room and a reception/administrative office. There is no separate interview room, or practice manager office, should private conversations need to be held with staff or patients, and no kitchen or other dedicated staff area. The surgery waiting room also holds a library kiosk, which it is proposed to retain in extended premises. 2.4 Due to the pressure of its growing list size, the practice put forward an application for an extension to its premises in 2016 under the Estates and Technology Transformation Fund (ETTF), although its application was not able to be considered through this route as it did not fit the requirements of this scheme. Its application for additional space was however supported in principle, as the current premises are clearly not adequate for a practice of its size, and NHS PS were instructed to engage with the practice to draw up proposals for additional space. 3.0 PRACTICE ENGAGEMENT Following the CCG s instruction, NHS PS engaged with the practice to determine its requirements, and a schedule of accommodation (SoA) was drawn up detailing the needs of the practice. This SoA showed that the practice required an additional 2 consulting rooms, and most urgently required administrative space for its staff. This consisted of a separate practice managers office, records stores and additional administrative space. 3 P age

3.1 Based upon these requirements, the architects engaged by NHS PS constructed initial drawings and these have since been shared with the practice. These were agreed with one amendment: as records have been moved off-site in the period since the SoA was produced, the records room has been replaced by a staff room/kitchen. 4.0 LOCAL AUTHORITY ENGAGEMENT The proposed development and extension of the premises life to 2022 requires two separate permissions from Dudley MBC; the CCG will need to seek both planning permission and an extension to the current lease for the car park on which the facility is sited. The CCG have therefore entered into discussions with the local authority on these issues, and these discussions indicate that the local authority would be prepared to extend the lease on the building from its current 2019 expiry to 2022. 4.1 The approval of planning would of course be subject to a formal application and public consultation, but investigations have indicated that the proposal would not contravene planning policy and the most likely concern of the local authority is the loss of parking spaces at the site. The proposed plan has therefore maximised the possible car parking, resulting in the loss of only 2 spaces, and the architect has expressed a high level of confidence that the proposed design should be capable of approval without, or with only minor, amendment. 5.0 THE PROPOSED SOLUTION The design solution proposed by the architects, and supported by the CCG Estates function, is for an additional modular unit to be added to the exsting facility. Alternative capital build options were considered for the premises, but due to the modular nature of the existing facility and short period of use this was not considered to be a viable option. 5.1 Current and proposed site and floor plans for the premises are included in appendices 1-4 to this paper, and committee will note that the proposed design increases the number of clinical rooms by 50%, from 4 to 6, as well as providing an adequate space for the administrative functions supporting this clinical work. 5.2 The programme of works, from approval at Committee to the handover of the facility, is estimated at 6 months, with work starting on site in early February 2018 and the extended facility being handed over to the practice in early April. The design and programme for the development will be constructed in order to enable the practice to continue operating from the facility with the minimum of disruption. 5.3 A draft project plan for the development has been produced, and is included in Appendix 5. 6.0 FINANCIAL IMPLICATIONS The proposed solution has two distinct costs associated with it. These are: the non-recurrent cost of groundworks to allow new a module to be installed, plus associated changes to the current grounds and modules, both to be undertaken by NHS Property Services Ltd; and the ongoing revenue cost of leasing an additional module from the current hire company. The estimated cost of each of these elements, subject to tender and any changes resulting from the planning process, are outlined below. 6.1 Non-recurrent costs: NHS Property Services have provided an estimate of the non-recurrent construction costs of the development, which includes the preparation of the site for the new unit and also any internal modifications that are required to be made to the existing modules to prepare them. These costs are 4 P age

based upon the work of a Quantity Surveyor, and will be tested through a tender exercise for which the CCG will be given full visibility. Item Construction Costs 90,000 Contingency at 10% 10,000 Fees at 15% 15,000 Total 115,000 6.2 Under the NHS PS Customer Capital policy for commissioner-requested premises development, as an alternative to funding these upfront costs the CCG could make an application for NHS PS to fund the initial cost of this work and recharge it to the CCG over the life of the lease of the premises. However, given the relatively short life of the premises (4 years) over which this funding would be repaid, the current availability of non-recurrent funding within the Primary Care budget, and the delay that such an application would entail, this is not an attractive option option for the CCG. 6.3 The funding source for these costs would be the 1% non-recurrent reserve for Primary Care, which totals 406,000 and of which 320,000 remains uncommitted 6.4 Recurrent Costs: For a temporary building such as High Oak Surgery, the modules installed will not be reusable at the end of their life so the lease cost of a module is determined by the capital cost of the premises and the length of the initial lease term. A short initial lease of the premises, up until 2022, means that the lease cost of the additional modular unit is significantly in excess of the current units, with a monthly rental estimated to be 5,000 per month (compared to 5,200 per month for the current two units). 6.5 Added to the existing premises, the combined rental cost of the premises will be approximately 120,000 per year, or 30 per weighted patient. This is significantly higher than the CCG average of 12 per patient, and this would make the per-patient premises cost of High Oak Surgery the 5 th highest in the CCG area, but in the circumstances of this contract is believed to represent the market rate for this type of premises. 6.6 This recurrent increase in costs will be funded from growth in the delegated co-commissioning allocation in 2018/19, and will be factored into the long term financial model for estates as part of the CCG financial planning process. 6.7 Summary: The estimated cost of ground works to support an additional module is 115,000. The estimated recurrent lease cost of the additional module is 4,700 per month ( 56,400 per annum. Final costs will be subject to tender, with the CCG to be provided full visibility of the tender process. 7.0 RECOMMENDATION Committee is requested to: Approve the proposed solution to meet the practice s requirements, and the associated recurrent and non-recurrent costs as currently estaimted. 5 P age

P Cowley Senior Finance Manager September 2017 Appendices: Appendix 1 current floor plan Appendix 2 proposed floor plan Appendix 3 current site plan Appendix 4 proposed site plan Appendix 5 draft project plan 6 P age

Store 3.79 sq m Consultation & Treatment 12.93 sq m Store 1.86 sq m Consultation & Treatment 12.08 sq m Practice Manager, Records & Bev. Accessible WC 3.44 sq m Reception & Admin 30.11 sq m Waiting 20.55 sq m Notes: This drawing is to be read in conjunction with all other consultants engineers and specialist sub contractors drawings, All items are to be cross referenced throughout design, tender, construction. Any discrepancies whatsoever discovered must be reported to the Main Contractor or Contract Administrator (CA) as soon as they become apparent. The main contractor is responsible for checking all dimensions prior to commencement of work. All specified manufacturers are o.s.a. (or similar approved) o.e.a. (or equal approved) whether stated or not, Any equivalent product or manufacturer must be approved in writing by the CA before use. Grid Lines are generally inside face of blockwork. All movement joints are 10mm wide and contained within vertical brickwork perpends. For movement joints within structural frame refer to structural engineers drawings. Consultation & Treatment 13.59 sq m Lobby 6.56 sq m All steelwork shown on these drawings is based on structural philosophy it is to be fully designed, detailed, dimensioned by others. Refer to structural engineers plans for up to date structural design. Refer to setting out plans for grid lines and brickwork setting out. All drawings are to be read in conjunction with site specific NBS (national building specification) Rev No Date Revision Details Author P1.1 10/8/17 Initial Issue HH Status P Purpose For Issue For Information Consultation & Treatment 15.12 sq m Staff WC 2.16 sq m Client Job Ref a r c h i t e c t s The Design Büro (Coventry) Ltd 5. Euston Place, Leamington Spa, CV32 4LN. Telephone: 01788 555 350 www.thedesignburo.co.uk NHS Property Services High Oak Surgery Dwg Title Existing GA Plan Drawn Date Checked Date HH May 17 TP May 17 D Buro Job No DBC1282 1:200 @ A3 Drawing Number 1282-DB-XX-ZZ-DR-A-003 Revision P1.1 The copyright of this drawing is vested in the Architect/ Designer and must not be copied or reproduced without his written consent. Figured dimensions only to be taken from this drawing. All contractors and / or specialists must visit the site and be responsible for taking and checking all dimensions relative to this work. 24th April 2013

Notes: This drawing is to be read in conjunction with all other consultants engineers and specialist sub contractors drawings, All items are to be cross referenced throughout design, tender, construction. Any discrepancies whatsoever discovered must be reported to the Main Contractor or Contract Administrator (CA) as soon as they become apparent. The main contractor is responsible for checking all dimensions prior to commencement of work. All specified manufacturers are o.s.a. (or similar approved) o.e.a. (or equal approved) whether stated or not, Any equivalent product or manufacturer must be approved in writing by the CA before use. Grid Lines are generally inside face of blockwork. All movement joints are 10mm wide and contained within vertical brickwork perpends. For movement joints within structural frame refer to structural engineers drawings. All steelwork shown on these drawings is based on structural philosophy it is to be fully designed, detailed, dimensioned by others. Refer to structural engineers plans for up to date structural design. Refer to setting out plans for grid lines and brickwork setting out. All drawings are to be read in conjunction with site specific NBS (national building specification) Consultation & Treatment 12.93 sq m Consultation & Treatment 12.08 sq m (4 Person) (2 Person) Admin 22.83 sq m Reception 11.35 sq m Store Store 3.79 sq m 1.86 sq m Waiting 31.05 sq m Consultation & Treatment 13.59 sq m Consultation & Treatment 16 sq m Consultation & Treatment 16 sq m Practice Manager 12 sq m Interview/ Staff Room 11.49 sq m Bev. 2.97 sq m WC HOL006 3.68 sq m KIT010 Accessible WC 6.71 sq m SPA015 Lobby 6.05 sq m Rev No Date Revision Details Author P1.1 10/8/17 Initial Issue HH P1.2 20/9/17 Status P Purpose For Issue Updated following end user meeting, Records store changed to Staff room/interview. Admin and reception split in two, with access door between. Fit For Infomation JJ Consultation & Treatment 15.12 sq m Staff WC 2.16 sq m Client Job Ref a r c h i t e c t s The Design Büro (Coventry) Ltd 5. Euston Place, Leamington Spa, CV32 4LN. Telephone: 01788 555 350 www.thedesignburo.co.uk NHS Property Services High Oak Surgery Dwg Title Proposed GA Plan Drawn Date Checked Date HH May 17 TP May 17 D Buro Job No DBC1282 1:200 @ A3 Drawing Number 1282-DB-XX-ZZ-DR-A-004 Revision P1.2 The copyright of this drawing is vested in the Architect/ Designer and must not be copied or reproduced without his written consent. Figured dimensions only to be taken from this drawing. All contractors and / or specialists must visit the site and be responsible for taking and checking all dimensions relative to this work. 24th April 2013

Brick wall 2.00m Concrete Steps PR Fence 1.20m Sleepers 0.50m Concrete PR Fence 1.20m Steps Brick wall 0.40m PR Fence 1.20m Dense vegetation Grass Bare Soil Dense vegetation Brick wall 1.20m 10 11 12 13 14 Staff WC 2.16 sq m Consultation & Treatment 15.12 sq m Consultation & Treatment 13.59 sq m Store 3.79 sq m Consultation Store & Treatment 1.86 sq m 12.93 sq m Brick Wall 2.00m 9 8 7 6 5 4 Tarmac Tarmac 15 16 17 18 Tarmac PO PO PO 20 21 Disabled parking 22 Disabled parking PO PO PO PO Consultation & Treatment 12.08 sq m Practice Manager, Records & Bev. Accessible WC 3.44 sq m Reception & Admin 30.11 sq m Palisade fence 1.80m Dense vegetation Notes: This drawing is to be read in conjunction with all other consultants engineers and specialist sub contractors drawings, All items are to be cross referenced throughout design, tender, construction. Any discrepancies whatsoever discovered must be reported to the Main Contractor or Contract Administrator (CA) as soon as they become apparent. The main contractor is responsible for checking all dimensions prior to commencement of work. All specified manufacturers are o.s.a. (or similar approved) o.e.a. (or equal approved) whether stated or not, Any equivalent product or manufacturer must be approved in writing by the CA before use. Grid Lines are generally inside face of blockwork. All movement joints are 10mm wide and contained within vertical brickwork perpends. For movement joints within structural frame refer to structural engineers drawings. All steelwork shown on these drawings is based on structural philosophy it is to be fully designed, detailed, dimensioned by others. Refer to structural engineers plans for up to date structural design. Refer to setting out plans for grid lines and brickwork setting out. All drawings are to be read in conjunction with site specific NBS (national building specification) Rev No Date Revision Details Author P1.1 10/8/17 Initial Issue HH 3 2 19 Tarmac Lobby 6.56 sq m Waiting 20.55 sq m PO 1 Palisade Fence 1.80m Flag stones Status P Purpose For Issue For Information Dense vegetation Brick Wall 2.00m Tarmac Bare Soil Brick Wall 4.00m 30 Tarmac 29 28 27 26 25 24 Panel Fence 1.80m 23 Bin Store Dense vegetation Client Job Ref a r c h i t e c t s The Design Büro (Coventry) Ltd 5. Euston Place, Leamington Spa, CV32 4LN. Telephone: 01788 555 350 www.thedesignburo.co.uk NHS Property Services High Oak Surgery PO Panel Fence 1.20m Bare Soil Garage Existing Total Number of Spaces: 30 Dwg Title Existing Site Plan Drawn Date Checked Date HH May 17 TP May 17 D Buro Job No DBC1282 1:200 @ A3 Drawing Number 1282-DB-XX-ZZ-DR-A-002 Revision P1.1 The copyright of this drawing is vested in the Architect/ Designer and must not be copied or reproduced without his written consent. Figured dimensions only to be taken from this drawing. All contractors and / or specialists must visit the site and be responsible for taking and checking all dimensions relative to this work. 24th April 2013

SPA015 HOL006 Brick wall 2.00m Notes: This drawing is to be read in conjunction with all other consultants engineers and specialist sub contractors drawings, All items are to be cross referenced throughout design, tender, construction. Concrete PR Fence 1.20m Bare Soil Remove Steps Proposed Concrete Proposed Planting PR Fence 1.20m Dense vegetation Sleepers 0.50m Grass Concrete PR Fence 1.20m Proposed Tarmac Path (w/ shallow gradient) Remove Steps Brick wall 0.40m Any discrepancies whatsoever discovered must be reported to the Main Contractor or Contract Administrator (CA) as soon as they become apparent. The main contractor is responsible for checking all dimensions prior to commencement of work. All specified manufacturers are o.s.a. (or similar approved) o.e.a. (or equal approved) whether stated or not, Any equivalent product or manufacturer must be approved in writing by the CA before use. Grid Lines are generally inside face of blockwork. All movement joints are 10mm wide and contained within vertical brickwork perpends. For movement joints within structural frame refer to structural engineers drawings. All steelwork shown on these drawings is based on structural philosophy it is to be fully designed, detailed, dimensioned by others. Refer to structural engineers plans for up to date structural design. Refer to setting out plans for grid lines and brickwork setting out. All drawings are to be read in conjunction with site specific NBS (national building specification) Dense vegetation Brick wall 1.20m STAFF STAFF STAFF STAFF 9 10 11 Existing Pathway Staff WC 2.16 sq m Consultation & Treatment 15.12 sq m Consultation & Treatment 13.59 sq m Store 3.79 sq m Store 1.86 sq m Consultation & Treatment 12.93 sq m STAFF 8 Tarmac 12 PO Proposed Ramp Consultation & Treatment PO PO 16 sq m Disabled parking Consultation & Treatment 12.08 sq m Brick Wall 2.00m 7 13 Consultation & Treatment 16 sq m PO PO Admin 22.92 sq m 6 14 Disabled parking Practice Manager 12 sq m PO PO 5 4 3 Tarmac 15 16 17 Proposed Paving Interview/ Staff Room 11.49 sq m Accessible WC 6.71 sq m Bev. KIT0102.97 sq m WC 3.68 sq m Waiting 31.05 sq m Reception 11.26 sq m Palisade fence 1.80m Dense vegetation Rev No Date Revision Details Author P1.1 10/8/17 Initial Issue HH P1.2 20/9/17 Updated following end user meetings: Removal of front entrance landscaping, and rearrangement of spaces. Records store replaced with Interview/Staff room. Reception JJ and admin split into two rooms. Path to main street changed to exclude steps had have a shallow slope instead. 2 1 Lobby 6.05 sq m Proposed Paving Palisade Fence 1.80m PO Dense vegetation Status P Purpose For Issue Fit For Infomation Brick Wall 2.00m PO Tarmac Panel Fence 1.20m Bare Soil Brick Wall 4.00m Bare Soil 22 Tarmac 21 Garage 20 19 18 Panel Fence 1.80m STAFF Bin Store Flag stones Dense vegetation Existing Total Number of Spaces: 30 Proposed Total Number of Spaces: 28 Note: All new windows to be fitted with security bars and cages. Client Job Ref Dwg Title The Design Büro (Coventry) Ltd 5. Euston Place, Leamington Spa, CV32 4LN. Telephone: 01788 555 350 www.thedesignburo.co.uk Drawn Date Checked Date HH May 17 TP May 17 D Buro Job No DBC1282 Drawing Number a r c h i t e c t s NHS Property Services High Oak Surgery Proposed Site Plan 1282-DB-XX-ZZ-DR-A-005 1:200 @ A3 Revision P1.2 The copyright of this drawing is vested in the Architect/ Designer and must not be copied or reproduced without his written consent. Figured dimensions only to be taken from this drawing. All contractors and / or specialists must visit the site and be responsible for taking and checking all dimensions relative to this work. 24th April 2013