Joint Co-Commissioning Committee Agenda

Joint Co-Commissioning Committee Agenda Thursday 20 October 2016, 10:00am-12pm Focolare Centre for Unity, 69 Parkway, Welwyn Garden City, Room 2 Part I Public Meeting Chair Yvette Twumasi-Ankrah Item Subject Report Action Indicativ e Timings 1. WELCOME AND APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTERESTS To receive any new declarations of interest or declarations relating to matters on the Agenda. Chair - Verbal 2 Chair - Verbal 3 3. MATTERS ARISING ACTION LOG To approve latest part 1 action log Chair Agree action log Enclosed 10 QUALITY/SAFETY 4. QUALITY & RISK SHARING GROUP REPORT Quality Lead, ENHCCG Information and Discussion Enclosed 15 5. 2016/17 FLU SEASON LOCALITY PLANS OPERATIONAL Associate Director, Commissioning Primary Care Information Enclosed 10 6. PREMISES, ESTATES AND TECHNOLOGY TRANSFORMATION FUND & SEP UPDATE Assistant Director Premises, ENHCCG Information and Discussion Enclosed 10 7. GP RESILIENCE PROGRAMME UPDATE GP and Pharmacy Contract Manager, NHS England Information and Discussion Enclosed ` 10

8. JOINT CO-COMMISSIONING COMMITTEE TERMS OF REFERENCE; UPDATED AD for Commissioning and Primary Care Review and Discussion Enclosed 10 9. DRAFT JOINT CO- COMMISSIONING WORKING GROUP; TERMS OF REFERENCE AD for Commissioning and Primary Care Review and Discussion Enclosed 15 STRATEGY/POLICY 10. NHSE PRIMARY CARE BUDGET 2016-17 UPDATE Locality Director NHSE Central Midlands Information and Discussion Enclosed 15 11. STP UPDATE - PRIMARY AND COMMUNITY CARE WORK STREAM David Law, Chief Executive, HCT and Karen Taylor, HPFT 15 Verbal 15 INFORMATIONAL 12. ANY OTHER BUSINESS To consider any other matters which, in the opinion of the Chair, should be considered as a matter of urgency ALL 4 13. DATE, LOCATION & TIME OF NEXT MEETING TBC 26 January 2016, 10am 1:30pm, Beales Hotel, Hatfield ALL 1 Resolution to exclude members of the press and public The Joint Co-Commissioning Committee resolves that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest, in accordance with the Public Bodies (Admissions to Meetings) Act 1960.

Meeting Date Subject Précis from Minutes - Decision/Action 21.4.2016 / 8.9.2016 NHSE Primary Care Budget 2016-17 Joint Co-Commissioning Committee in Public - ACTION TRACKER SM, AP, JG, HB and DC to work together outside meeting on this and NHSE to bring update to next meeting (28 July 2016). Premises budget and budget methodology are to be clarified by NHSE. Responsible Person/s DC/AP Deadline Date Date Action Completed (by deadline unless stated) 20.10.2016 Paper sent with July 2016 JCC papers 8.9.2016 Terms of Reference Update paper due at 20 October meeting ToR to be reviewed and updated - Chair to discuss further with commissioning team and whole group following facilitated session held on 8.9.2016 Chair / whole group ASAP Chair to discuss further with commissioning team and whole group following facilitated session held on 8.9.2016 8.9.2016 Sustainability GP improvement fund NI to look into sustainability GP improvement fund Rachel Hind is person involved in this NI to touch base with Rachel. Contract Manager, NHSE ASAP Joint Committee Action Tracker 1 14/10/2016

Agenda Item No: 4 Date of Meeting: 20 th October 2016 Joint Co-Commissioning Committee in Public Paper Title: Quality and Information & Risk Sharing Group Report Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Julie Ballard, Quality Lead, ENHCCG Sheilagh Reavey, Director of Nursing and Quality, ENHCCG Lisa March Assistant Director of Quality, NHSE Central Midlands Purpose of the paper: To inform and discuss the latest quality information available and agree appropriate actions. Conflicts of Interest involved: To be addressed at the committee Recommendations to the Joint Committee For NHSE and ENHCCG to continue working jointly to agree quality priorities. 1

This report reviews the latest information available for a number of quality indicators relating to GP Practices in ENHCCG. 1. Care Quality Commission (CQC) Inspections To date a total of 37 Practices have been inspected under the new CQC regime. Of the practices inspected to date whose reports have been published, the following outcomes have been achieved. Locality Outstanding Good Requires Improvement The current situation across the CCG are is as follows: 29 practices rated as Good 7 practices rated as Require Improvement Abbey Road Surgery (Waltham Cross) Park Lane Surgery (Broxbourne) South Street Surgery (Bishops Stortford) Church Street Partnership (Bishops Stortford) Cromwell Medical Centre (Cheshunt) Portmill Surgery (Hitchin) St Nicholas Surgery (Stevenage) The CQC have been undertaking follow-up visits of practices that require improvement, to date follow-ups have been undertaken on 4 or the above practices and the outcomes are awaited. The Limes Surgery (Hoddesdon) previously rated as Requires Improvement received a follow-up visit on 23 rd August 2016 and were subsequently rated good for all areas. 1 practice rated as Inadequate Sollershott Surgery (Letchworth) 22 practices still require inspection or are awaiting publication of their inspection report. The CQC are part of the Information and Risk Sharing Group so information can be shared regarding any concerns or issues. Action being taken by the CCG: Inadequate Inspected awaiting outcome North Herts 0 5 1 1 5 Stevenage 0 2 1 0 6 WelHat 0 7 0 0 2 ULV 0 11 1 0 4 LLV 0 3 2 0 3 SVV 0 1 2 0 2 CCG Area 0 29 7 1 22 Correct as at 12 th October 2016 2

The CCG continues to provide support to practices in respect of their CQC action plans, this has been offered to all practices requiring improvement or above. In response to Sollershott Surgery, a team of CCG staff including a GP, Practice Nurse, Quality Lead have been visiting /liaising with the practice regularly to support them with implementing the CQC actions. 2. Friends and Family Test GP Data The results of the FFT results for the 4-month period, May August 2016, show the following: The 6 practices with the highest responses (over 100) for the 4-month period are: PRACTICE Number of responses Recommend Scores South Street Surgery 747 74 90% Burvill House 255 86 93% Knebworth and Marymead 180 83 88% Canterbury Way 178 94 98% Stockwell Lodge 143 61 89% Spring House Medical Centre 134 100% 36 practices have obtained 10 or less responses per month; with 10 practices reporting no responses during the period. These include: Ashwell Surgery Baldock Surgery Whitwell Surgery Dolphin House Haileybury College Standon and Puckeridge Health Centre Buntingford Medical Centre Sawbridgeworth Medical Services Central Surgery Lister House Surgery There is a large disparity between practices in terms of response rates during the 4-month period with practices ranging from 0 747 responses. It is clear that there is opportunity to provide support to those practices that do not currently undertake the FFT or have low response rates and to learn from those practice who achieve large numbers of responses. Action being taken by the CCG: The CCG will offer support to the 10 outlying practices with no responses to help improve their friends and family participation and their response rates. 3. Joint NHSE and CCG Quality Visits Update Further to the last JCC meeting follow up visits to Abbey Road Surgery and Stockwell Lodge Surgery were planned for early September however these were both postponed until January at the request of the Locality Lead GP, as locality work is being undertaken around capacity and demand management which will influence the work of the practice. A quality visit to Stockwell Lodge is currently being arranged utilising the new Quality Visit template which has been designed to ensure quality visits are undertaken in line with other providers and the CQC key lines of enquiry. 3

4. Primary Care Workforce Planning and Education The CCG Primary Care Workforce Planning and Education Network (ENH-CEPN), continues to develop initiatives which focus on recruitment, education and retention of the primary care workforce. The following provides an update on the work of the network: Mentorship The Primary Care Nurse Co-ordinator/Nurse Tutor is actively promoting mentorship courses and opportunities to ensure that General Practice becomes an equally attractive opportunity for student placements. There are now 12 mentors in place ready to take student nurses with a further 8 who have attended the mentorship update but require completion of paperwork to be approved and 12 who are booked onto the next update course. Since April, 4 students have completed placements, a further 3 are currently placed in practices, and 4 are due to commence in November this will bring the 16/17 total to 11. Practice Nurse Development A small number of new GPN's have commenced on the Nurse Preceptorship course for a year, funded through the Beds and Herts Nurse Preceptorship Scheme led by HVCCG. This course has now changed to a Foundation Course, which is a 6-month accredited course to allow new practice nurses to gain fundamental practice nurse skills and encourage new nurses into practice nursing. CCG funding has been made available for this course and it is being promoted across the CCG by the Nurse Tutors, in particular in practices that are struggling to recruit experienced practice nurses. Workforce data collection The CCG continues to build up detailed workforce and education statistics, to date we have returns from over 500 GPs/GPNs and Practice managers. The completion of workforce returns is now a required metric as part of the Commissioning Funding Framework. Data is currently being collated and will be available by locality and CCG on Monday 17 th October, this will then be utilised alongside Locality Plans to determine and secure the necessary workforce development and training required to implement them. GP Fellowship Scheme A total of 6 new high calibre GP fellows were initially appointed to the GP fellowship scheme and despite there being some attrition there has also been further interest - currently we have 4 who have taken up post September/October with a further 2 expected to come on board within the next few months. A further round of advertising is expected to take place to align with Semester B university courses. Primary Care Workforce Programme Manager the CCG/HEE has recently appointed to this post, this role will be to support the work of the CEPN and co-ordinate the apprenticeship programme across primary care in Beds and Herts, the post is funded by HEE. The development of apprenticeships across practices in the CCG area will provide opportunities for both new and existing staff in terms of education and development. Community Pharmacy The first in a series of multidisciplinary education sessions with GPs/PNs and Community Pharmacies is planned in WelHat to focus on COPD encouraging and exploring ways that GP practices and pharmacies can work together for the benefit of patients. End of Life Care Active involvement in the End of Life Steering Group with the planned development of an education sub-group to ensure multi-disciplinary training is developed for those staff involved as this will be fundamental to the implementation and delivery of the strategy. 4

Practice Managers A small reference group of practice managers has met to look at their training needs both on appointment and an ongoing basis and how these might best be delivered. A proforma will shortly be going out to all Practice Managers to ascertain their views on this and how their need might be addressed. 5

Agenda Item No: 5 Date of Meeting: 20 October 2016 Joint Co-Commissioning Committee in Public Paper Title: Flu Season 2016/17: locality plans Decision Discussion Information Follow up from last meeting Report author: Report signed off by: James Gleed Associate Director Commissioning Primary Care East and North Hertfordshire CCG Emily Perry Project Officer Primary Care East and North Hertfordshire CCG Beverley Flowers Chief Executive East and North Hertfordshire CCG Purpose of the paper: To inform the Joint Co-Commissioning Committee of the locality 2016/17 seasonal flu plans. This follows the CCG Governing Body s recent decision to make an additional financial investment at locality level to support new local initiatives intended to improve vaccination coverage. Conflicts of Interest involved: None in the preparation of this paper Recommendations to the Joint Committee To note the locality plans

1. Purpose of Paper To inform the Joint Co-Commissioning Committee of the CCG locality plans to support the 2016/17 flu programme and improve vaccination coverage. 2. 2016/17 Seasonal Flu Programme 2.1 CCG investment for improving coverage In summer 2015, a number of options believed to have had the potential to increase vaccine uptake were presented to the CCG s Governing Body. The option that was recommended and agreed for the 15/16 flu season was more extensive promotion of the flu vaccine by the CCG to practices and the local population via direct communications and locality meetings, but no additional direct funding at practice or locality level. Unfortunately vaccine uptake in the three key eligible groups in 15/16 fell from 14/15 figures. Therefore in July 2016 the CCG s Governing Body was asked to re-review other options that may help increase uptake of flu vaccine. The Governing Body agreed to invest an additional 30,000 to be split across the six localities on a pro rata basis. In order to draw down this financial support localities were asked to submit for approval, their plans for how it would be used. Each locality was also asked to identify a flu lead. All six localities submitted plans and have subsequently received the additional funding. A summary of the local plans per locality is provided below: 2.2 North Herts Funding will be dispersed pro rata to practices across the locality for them to target high risk groups and liaise with their local pharmacies this will include the following: o o o o Each practice will have a flu lead Each practice will target at-risk groups Each practice will aim to maintain their position above CCG mean or improve on last year s figures Practices will use the money to go toward funding of letters to at-risk groups. 2.3 Upper Lea Valley The locality will work in hubs (Hertford, Ware/Watton-at-Stone, Hoddesdon/Broxbourne and Buntingford). Their plans include: Holding discussions with local pharmacists to ensure all providers are targeting eligible patients and cross-referring where appropriate Producing posters to be displayed in local businesses advertising flu clinic open days and pharmacy details Opening flu clinics on the same day across certain surgeries Advertising in local journals re flu clinic eligibility and dates Utilising websites and social media to advertise flu clinics whenever possible Practice Nurses will attend warden controlled accommodation and hold flu clinics in the communal areas Working with Health Visitors and local nurseries to promote the service 1

Dispensary will flag patients for vaccination Working with colleagues from teams such as Herts Help, Pulmonary rehab team and Herts Health Walks, asking them to attend practice flu clinics 2.4 Lower Lea Valley Local communications plans including banners, flyers, posters and posters in bus shelters Working closely with the locality s participating pharmacies Targeted chasing telephone calls to patients across the localities 8 practices. 2.5 Welwyn Hatfield Running a local press campaign through both hard copy and online advertising including running four 1 page adverts listing the surgeries and clinic times in the local paper this will be in combination to the practices writing to and contacting all eligible patients Producing new locality flu banners for each practice in the locality Technology support for practices the locality will introduce Mjog for practices for a 3 month period. This will support multiple contacts with patients through SMS texting and landline voicemails All Welwyn Hatfield practices will liaise with pharmacy colleagues to ensure timely upload of data. 2.6 Stort Valley and Villages Funding a flu task and finish group that will concentrate on the collaboration between practices and pharmacists Coordinating individual practice and pharmacist campaigns and agreeing actions required to ensure the best uptake for target groups Advertising in the local newspaper, SMS messaging, patient flyers Opportunistic vaccination in all surgeries and participating pharmacies Using the new shared IT platform with HCT colleagues which will allow the locality to monitor housebound patient uptake and ensure their needs are met Developing activities to target specific groups, e.g. the locality are running a diabetic patient engagement event in Bishops Stortford where they will provide a flu vaccination station as part of the health promotion activities. 2.7 Stevenage Meeting with all pharmacies offering the flu vaccination programme during 2016/17 in Stevenage. The practices and pharmacies will discuss the positive and negative points from the 2015/16 flu campaign and resolve any current and potential problems. The initial meeting will be followed by a monthly meeting from October 2016 - January 2017. Practices will order and display flu communications materials. 2

3. Next steps The CCG has asked all localities to submit a short report in March 2017 with feedback on delivery of their locality plans and outcomes. This will help the CCG to establish which initiatives were most successful in improving vaccination coverage and to share this learning across localities and the wider system. 3

Agenda Item No: 6 Date of Meeting: 20 October 2016 Joint Co-Commissioning Committee in Public Paper Title: Premises, Estates and Technology Transformation Fund & Local Estate Strategy update Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Sue Fogden - Assistant Director, Premises ENHCCG Alan Pond Director of Finance ENHCCG Dominic Cox Locality Director, NHSE, Central Midlands Purpose of the paper: To provide an update on the Estate Technology Transformation Fund and the Local Estates Strategy Conflicts of Interest involved: To be addressed at the Committee Recommendations to the Joint Committee That ENHCCG and NHSE continue working together under the joint co-commissioning arrangements to ensure that we optimise the use of available funds

1. ESTATE TECHNOLOGY TRANSFORMATION FUND (ETTF) The Committee were last updated on ETTF via the paper dated 28 July that was circulated remotely. That paper provided background to the scheme, outlined the principles that NHS England (NHSE) had set out and explained the process that East and North Hertfordshire CCG (ENHCCG) had followed in determining which schemes met the core criteria and the order of prioritisation. Eleven schemes were uploaded onto the NHSE portal by the 30 June 2016 with a confirmation of receipt by NHSE. In the guidance published by NHSE, the timeline stated that NHSE would confirm to all CCGs the outcome of the review panels by 31 August 2016, the Central Midlands review panel met on 21 July 2016 but the outcome was not communicated until 20 September 2016, and then only verbally. NHSE, Central Midlands advised ENHCCG that the national sum available was now 404m. The value of the bids submitted, nationally, was far in excess of the fund allocation and very few bids were rejected. NHSE therefore decided that the funding should be allocated to each Sustainability and Transformation Plan footprint (STP) under a weighted capitation percentage methodology with the STP tasked to prioritise their schemes within the funding available. STPs were also required to identify schemes into the cohorts set out below. Funding would be earmarked for schemes in cohorts 1 and 2 and those in cohort 3 would effectively be reserve schemes should those in the earlier cohorts fail due diligence tests or prove not to be deliverable for other reasons. 1. Cohort 1 schemes that can complete by 31 March 2017 2. Cohort 2 schemes that can complete in the period 1 April 2017 and 31 March 2019 3. Cohort 3 schemes that can complete in the period 1 April 2019 and 31 March 2021 The Hertfordshire and West Essex STP allocation is 10,332,000. Given the limited time available and in the interest of fairness, all three CCGs (ENHCCG, Herts Valleys CCG and West Essex CCG), with the agreement of Tom Cahill as STP lead, agreed that the same weighted capitation percentage methodology would be applied to identify funds available at CCG level. For ENHCCG the total available is 3,904,000. On 27 September 2016, each CCG under the umbrella of the STP was required to confirm the bids they would still support and the relevant cohort for these schemes. NHSE would not allow any expenditure on development plans or feasibility studies if an end asset could not be guaranteed within the timeframes above and therefore we agreed to withdraw the three feasibility bids. Due to the reduced fund and hence allocation the cost of the remaining schemes exceeded the funds available. We considered that the current Letchworth scheme, with its significant lease redemption costs, would struggle to demonstrate value for money and was at risk of failing the due diligence tests. We therefore asked that this be held as a reserve project rather than withdrawn entirely.

All other schemes were reviewed for costs and timelines for delivery and put forward to NHSE. One small Improvement Grant scheme was placed into cohort 1, with the remaining six schemes included in cohort 2. The timelines for delivery recognise the urgency on NHSE to respond and grant consent to start the projects but regretfully, NHSE Central Midlands could not confirm next steps and dates. NHSE Central Midlands team said that NHSE would be closely monitoring the progress of each scheme and if it appeared that a scheme was not progressing then they would withdraw it. The CCG has asked NHSE to apply consideration to the complexities of delivering health technology and infrastructure projects and requested certainty of funds and on-going support to give confidence in proceeding with projects. Our practices with schemes have been informed of the position.

Agenda Item No: 7 Date of Meeting: 20 th October 2016 Joint Co-Commissioning Committee in Public Paper Title: The Supporting Vulnerable Practices (SVP) and the General Practice Resilience Programme (GPRP) update Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Andrew Tarry, Assistant Contract Manager Dominic Cox, Locality Director Purpose of the paper: Update the on the Supporting Vulnerable Practices (SVP) and the General Practice Resilience Programme (GPRP) Conflicts of Interest involved: None Recommendations to the Joint Committee For information only

Executive Summary Background In June 2015 the Secretary of State for Health announced that NHS England would work to develop a 10m programme of support for practices identified as experiencing difficulties. In December 2015, NHS England published the Support for Vulnerable GP Practices (SVP) Pilot Programme, where NHS England local teams were asked to identify practices that had the greatest need for support using criteria developed with NHS Clinical Commissioners. It was initially assumed that this would be a recurrent programme and therefore NHS England would need to put in place a procurement framework to support the on-going support programme. However, it has been confirmed that the SVP is a non-recurrent commitment which will be completed in 2016/17. When announced, practices entering onto the scheme were expected to contribute matched funding as a measure of their commitment to improvement. The GP Practice Resilience Programme (GPRP) was announced in the GP Forward View and offers a fouryear 40m funding commitment in addition to existing national programmes of support. GPRP was launched in early June 2016 and this means that the additional funding can be used to support even more practices. Under this programme there is a menu of support that offers a wider range of assistance for practices that can be delivered in a more flexible and responsive way. This will include provision of immediate help to practices facing urgent operational pressures as well as transformation support for practices to enable them to move to more resilient care models. The scheme provides a range of support for individual practices or groups of practices, including, where appropriate, an initial diagnostic service to identify areas for improvement. Support under the scheme will be conditional on matched commitment from practices, evidenced through an agreed action plan which will need to include clear milestones for exiting support. An MOU has been developed for this purpose. Funding under this scheme should not be used where there is no identifiable exit strategy and where there is no engagement with the local primary care strategy. The RCGP Peer Support Programme is also available alongside the SVP and GPRP, specifically targeted at those practices that have been placed in Special Measures by the CQC. Support through this scheme has been extended until March 2017. This scheme also initially required matched funding by the practice.

Current Position Previously many practices were reluctant to accept support due to the matched funding commitment. This element has now been removed from all programmes and the team and CCGs continue to encourage practices to participate in the relevant scheme. NHS England Central Midlands funding for these schemes for the current financial year are as follows: SVP 776,000 GPRP 1.3m The GPRP funding for 2017/18, 18/9 and 19/20 is set at 668k per annum. A diagnostic framework has been developed locally and teams trained to carry out diagnostic visits across Central Midlands. A number of these visits have taken place across Central Midlands as part of the SVP Pilot Programme, with follow up visits arranged. Help is also available to formulate action plans where necessary. Initially the deadline set for local teams to identify a list of practices selected for support under the GPRP was 30 th September 2016. This deadline was then extended to 18 th October. Practices have been offered the opportunity to self-refer into the scheme by 7 th October. For East & North Herts, an assessment panel, including NHS England, CCG and LMC has assessed and prioritised the proposals received against national criteria and using local intelligence. The final, overall combined Central Midlands list of selected practices will be submitted nationally by Tuesday 18 th October. Following selection and prioritisation of practices, local teams must confirm the investment support committed to named practices by 30 th December 2016.

Agenda Item No: 8 Date of Meeting: 20 October 2016 Joint Co-Commissioning Committee in Public Paper Title: Revised Joint Co-Commissioning Committee Terms of Reference (Draft) Decision Discussion Information Follow up from last meeting Report author: Report signed off by: James Gleed Associate Director Commissioning Primary Care East and North Hertfordshire CCG Alan Pond Chief Finance Officer East and North Hertfordshire CCG Purpose of the paper: To present the draft revised Joint Co-Commissioning Committee Terms of Reference Conflicts of Interest involved: None in the preparation of this paper Recommendations to the Joint Committee For discussion and approval

Appendix 1: Terms of Reference for Joint Committee Introduction 1. The NHS England and NHS East and North Hertfordshire Clinical Commissioning Group Joint Commissioning Committee is a ( Joint Committee ) with the primary purpose of jointly commissioning primary medical services for the people of East and North Hertfordshire. Statutory Framework 2. The National Health Service Act 2006 (as amended) ( NHS Act ) provides, at section 13Z, that NHS England s functions may be exercised jointly with a CCG, and that functions exercised jointly in accordance with that section may be exercised by a joint committee of NHS England and the CCG. Section 13Z of the NHS Act further provides that arrangements made under that section may be on such terms and conditions as may be agreed between NHS England and the CCG. Role of the Joint Committee 3. The role of the Joint Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act except those relating to individual GP performance management, which have been reserved to NHS England 4. This includes the following activities: General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts (including the design of PMS and APMS contracts, monitoring of contracts, approving list closure applications, reviewing proposed contractual action such as issuing breach / remedial notices, and removing a contract); Newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services ); Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF); Decision making on whether to establish new GP practices in an area; Approving practice mergers; and making decisions on discretionary payment (e.g. returner / retainer schemes). 1

5. In performing its role the Joint Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS East and North Hertfordshire Clinical Commissioning Group, which will sit alongside the Scheme of Reservation and Delegation and Terms of Reference. This is the proposed agreement to deal with activities such as information sharing, resource sharing, contractual mechanisms for service delivery (and ownership) and interplay between contractual and performance list management. Geographical coverage 6. The Joint Committee will comprise of NHS England (Central Midlands) and NHS East and North Hertfordshire Clinical Commissioning Group ( the Group ). It will undertake the function of jointly commissioning primary medical services for East and North Hertfordshire. Membership 7. The Joint Committee shall consist of: The Group s Lay Member for Governance The Group s Lay Member for Co-Commissioning The Group s Lay Member for Patient and Public Engagement Four Executive members of the Group: o Chief Finance Officer o Director of Commissioning o Director of Operations o Director of Nursing and Quality Three GP members of the Group s Governing Body Three NHS England Central Midlands Executives: o Locality Director o Medical Director o Director of Nursing. The membership will meet the requirements of the Group s Constitution. 8. Joint Committee Members may nominate an appropriate deputy to attend in their place 9. The Chair of the Joint Committee shall be the Group s Lay Member for Co-Commissioning 10. The Vice Chair of the Joint Committee shall be the Group s Lay Member for Governance 11. The following representatives will usually be in attendance: Secretariat; Associate Director of Primary Care Commissioning of the Group GP Contract Manager NHS England Central Midlands Health Watch representative; Health and Wellbeing Board representative; Local Medical Committee representative; Associate Director of Quality for East and North Hertfordshire CCG. 2

Meetings and Voting 12. The Joint Committee shall adopt the Standing Orders of the Group insofar as they relate to the: Notice of meetings; Handling of meetings; Agendas; Circulation of papers; and Conflicts of interest. 13. The Joint Committee shall reach decisions by a simple majority vote of members present. However, because the Group has ten members on the Joint Committee and NHS England (Central Midlands) has three members, the Group members shall have one vote each and NHS England (Central Midlands) members shall have three and one third votes each. In the event of a tied vote, the Group shall have a casting vote on any CCG statutory functions included within the scope of the joint committee s responsibilities and NHS England (Central Midlands) shall have a casting vote on any NHS England statutory functions included within the scope of the joint committee s responsibilities. 14. To be quorate each of the following criteria must be met: Six members of the Joint Committee are present, including at least one member of The Group and at least one member of NHS England (Central Midlands) There is a non-gp majority within the members present No formal business shall be transacted where a quorum is not reached. 15. A minimum of 4 scheduled meetings shall take place per year. Where required additional meetings will be arranged. 16. Meetings of the Joint Committee: a) Shall, subject to the application of 17(b), be held in public; b) The Joint 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. 17. Members of the Joint Committee have a collective responsibility for the operation of the 3

Joint Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavor to reach a collective view. 18. The Joint Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 19. Members of the Joint Committee shall respect confidentiality requirements as set out in the Standing Orders referred to above unless separate confidentiality requirements are set out for the Joint Committee in which event these shall be observed 20. Secretariat to the Joint Committee will be provided by The Group 21. The Secretariat to the Joint Committee will circulate the minutes and action log within 5 working days of the meeting to all members. 22. These Terms of Reference will be reviewed annually, reflecting experience of the Joint Committee in fulfilling its functions and the wider experience of NHS England and CCGs in primary medical services co-commissioning. Decisions 23. The Joint Committee will make decisions within the bounds of its remit. 24. The decisions of the Joint Committee shall be binding on NHS England and the Group. 25. Decisions will be published by both NHS England and The Group 26. The Secretariat will produce an Executive Summary Report on a quarterly basis, which will presented to the NHS England Central Midlands and the Governing Body of the Group for information. Key Responsibilities 27. This will include but not be limited to areas such as planning, including carrying out needs assessments, primary medical care services for the geographical area in question; undertaking reviews as appropriate; co-ordinating a common approach to primary care commissioning as appropriate; managing relevant budgets. Review of Terms of Reference 28. These Terms of Reference will be formally reviewed by the NHS England Central Midlands and the Group in April of each year, following the year in which the Joint Committee is created, and may be amended by mutual agreement between the NHS England Central Midlands and the Group at any time to reflect changes in circumstances, which may arise. 4

[Signature provisions] Schedule 1 List of Members populate once membership agreed Linda Farrant, The Group s Lay Member for Governance Yvette Twumasi-Ankrah, The Group s Lay Member for Co-Commissioning Diane Desmulie, The Group s Lay Member for Patient and Public Engagement Four Executive members of the Group: o Alan Pond, Chief Finance Officer, ENHCCG o Harper Brown, Director of Commissioning, ENHCCG o Sharn Elton, Director of Operations, ENHCCG o Sheilagh Reavey, Director of Nursing and Quality, ENHCCG Three GP members of the Group s Governing Body o Dr Deborah Kearns o Dr Nicky Williams o Dr Alison Jackson Three NHS England Central Midlands Executives: o Dominic Cox, Locality Director, NHSE o Aly Rashid, Medical Director, NHSE o Manjit Darby, Director of Nursing, NHSE 5

Agenda Item No: 9 Date of Meeting: 20 October 2016 Joint Co-Commissioning Committee in Public Paper Title: Joint Commissioning Operational Group (JCOG) Committee DRAFT Terms of Reference Decision Discussion Information Follow up from last meeting Report author: Report signed off by: James Gleed Associate Director Commissioning Primary Care East and North Hertfordshire CCG Harper Brown Director of Commissioning East and North Hertfordshire CCG Purpose of the paper: To present the draft Joint Commissioning Operational Group (JCOG) Draft Terms of Reference Conflicts of Interest involved: None in the preparation of this paper Recommendations to the Joint Committee For discussion and approval

1 Joint Commissioning Operational Group (JCOG) Terms of Reference Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

2 1. Introduction 1.1 The National Health Service Act 2006 (as amended) ( NHS Act ) provides, at section 13Z, that NHS England s functions may be exercised jointly with a CCG, and that functions exercised jointly in accordance with that section may be exercised by a joint committee of NHS England and the CCG. Section 13Z of the NHS Act further provides that arrangements made under that section may be on such terms and conditions as may be agreed between NHS England and the CCG. 1.2 The Joint Commissioning Operational Group (JCOG) is established in accordance with section 6 of NHS East and North Hertfordshire Clinical Commissioning Group s Constitution, as a sub-committee of the Co-Commissioning Joint Committee which is a joint Board of NHS England and the CCG Governing Body. 1.3 Since its inception East and North Hertfordshire Clinical Commissioning Group (CCG) has commissioned services from primary care and played a pivotal role in the quality and development of primary care services. Additionally the CCG commissions a wide range of other out-of-hospital services. NHS England (NHSE) and East and North Hertfordshire CCG entered into a co-commissioning arrangement April 2015 and established a Joint Co-Commissioning Committee (JCC) with the primary purpose of jointly commissioning primary medical services for the people of East and North Hertfordshire. The joint committee meets four times a year and it is recognized that this is not frequent enough to make joint decisions on key primary medical services contracting processes. 1.4 The establishment of a Joint Commissioning Operational Group (JCOG), which would meet more regularly than the Joint Commissioning Committee, was approved by the Co-Commissioning Joint Committee on 6 th October 2016. 1.5 The JCOG was established to undertake the day-to-day business of the JCC making decisions within its current terms of authorisation and reporting back up to the JCC. 1.6 It is recognized that the CCG is currently in joint co-commissioning arrangements with NHS England. In this model the CCG is required to collaborate with NHS England on the majority of primary care contract decisionmaking processes, however the responsibility for these functions remains with NHS England. In the event that the CCG moves to full delegated commissioning, it will need to develop both the capacity and capability to be able to fulfil this role unilaterally. It is envisaged that the JCOG will be pivotal to all of the above. 1.7 The main remit of the JCOG will essentially be that of GMS and APMS contract management. Decisions on CCG commissioned primary care and community services e.g. The Consolidated Funding Framework will not routinely fall within the jurisdiction of the JCOG. The JCOG will however be mindful and take into account wider out-of-hospital services commissioning in the planning and decision making that falls within its remit. 1.8 The JCOG will meet sufficiently regularly to debate, resolve, recommend or decide outcomes within the set national, regional and local timeframes in line with the terms of reference which will be signed off by the Co-Commissioning Joint Committee. Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

3 1.9 Geographical Coverage The JCOG shall make decisions relating to the provision of primary medical services for the population of East and North Hertfordshire. 2. Membership 2.1 The membership of the committee shall include: CCG Director of Commissioning (Chair) CCG Associate Director Commissioning Primary Care (Vice Chair) CCG Finance Manager Localities / Primary Care Contracts CCG Associate Director Nursing and Quality NHS England Primary Care Contracts Manager NHS England Assistant Contracts Manager The following will routinely be in attendance in a non-voting capacity: CCG Primary Care Projects Officer (Secretariat) 2.2 In the event of the Chair of the committee being unable to attend all or part of the meeting, they will nominate a replacement from within the Membership to deputise for that meeting. 2.3 Representatives in attendance The following representatives will have a standing invitation to attend: CCG Chair CCG Lay Members CCG Locality GP Leads NHS England Central Midlands Clinical Quality Lead 2.4 Other (non-core) staff or leads may be invited to attend in a non-voting capacity, as appropriate to the agenda. These may include, but are not limited to: Public Health England Consultant lead for screening and immunisation CCG Assistant Director of Premises CCG Associate Directors of Localities ENH practice managers Local Medical Committee (LMC) representative Patient representative from Patient Participation Group membership or Healthwatch 2.6 JCOG members may nominate an appropriate deputy to attend in their place 2.7 The JCOG may call additional experts to attend meetings on an ad-hoc basis to inform discussions. Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

4 3. Quorum 3.1 A minimum of 3 core members of the group must be present including the Panel Chair or Vice Chair if financial or contractual decisions are being made. 3.2 No formal business shall be transacted where a quorum is not reached. 4. Frequency of meetings and attendance 4.1 A minimum of 12 scheduled meetings shall be held per year. Additional meetings will be arranged if required. 4.2 Members of the panel should make every effort to attend all meetings of the panel. The Secretary to the committee will monitor attendance and will report on this annually. Attendance figures will be published annually in the cocommissioning reports to the CCG Governing Body. Members of the JCOG have a collective responsibility for the operation of the Group. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability and will endeavour to reach a collective view. 4.3 Meetings of the JCOG shall be held in private. 5. Delegation of Authority 5.1 The scope of activities associated will be limited to General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider of Medical Services (APMS) Contractors in the context of the ENHERTS Primary Care Strategy, GP Forward View and STP. The JCOG must make decisions relating to primary medical services commissioning in accordance with the delegated authority received from the JCC. Other decisions must be taken in accordance with any delegated authority, by exception, received from the Governing Body such as CCG CFF and other enhanced services. The committee is authorised by the Co-Commissioning Joint Committee to: Review and approve newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services ); Review the Quality Outcomes Framework (QOF) and if appropriate to oversee the design of an alternative local incentive scheme. To make recommendations on the design of any new alternative scheme; Review and approve business cases to establish new GP practices in an area; Review and approve business cases for practice mergers; Review and make decisions on matters associated with GP Practice procurements and list dispersals; Review of contractor performance and quality and making decisions on the appropriate contractual intervention including both support and sanctions; Review and make decisions on discretionary payments (e.g. returner / retainer Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

5 schemes); Consider and make decisions on requests for GP practice list closures; Co-ordinate the investment plans for support funding available through GP Forward View such as GP Resilience Programme and help deliver the primary care strategy for ENH; In connection with the above, work with CCG workforce and education leads in evaluating and approving /recommending Primary Care workforce schemes including those relating to training and education, skill mix development, recruitment and retention; Ensuring close working and co-ordination with the Primary Medical Care Information and Risk Sharing Group which meets bi-monthly -feed into and receive information out of this group; Consider and propose development of joint working with Herts Valley CCG and West Essex CCG Primary Care Structures to avoid duplication of effort and combine where there are opportunities for joint investment or joint functions. 5.2 The JCOG shall reach decisions by a simple majority vote of core members present subject to the rules governing conflict of interest and the meeting being quorate. 6. Emergency powers 6.1 Where an urgent decision needs to be made between scheduled meetings, members of the committee can convene an extraordinary meeting to discuss a particular issue. Quorum rules in paragraph 3 still apply. 6.2 If it is not practicable to meet in person, matters can be dealt with through telephone or the exchange of emails. The exercise of such powers shall be reported and minuted at the next committee meeting. 7. Duties 7.1 In performing its role, the JCOG will on behalf of the JCC exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS East and North Hertfordshire CCG, which will sit alongside the Scheme of Reservation and Delegation and Revised CCG Constitution. This is the proposed agreement to deal with activities such as information sharing, resource sharing, contractual mechanisms for service delivery (and ownership) and interplay between contractual and performance list management. 8. Reporting arrangements to the Governing Body 8.1 The group will report to the JCC on a quarterly basis and the following documents will be presented: Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

6 Minutes of the committee s meetings; Quarterly Report. 9. Reporting arrangements & relationships with other committees and groups 9.1 The following committees and groups will report into the committee and provide minutes of their meetings: None Meeting Name N/A Frequency 9.2 The JCOG will ensure a robust flow of pertinent information between itself and the following committees and groups: Meeting Name ENH Local Estates Forum CCG IMT Steering Group NHS England (Central Midlands) Primary Care Contracts Panel (PCCP) NHS England CCG Risk and Information Sharing Group Frequency As appropriate As appropriate As appropriate As appropriate 10. Annual review of the Group 10.1 The group, if it continues beyond March 2017, will undertake an annual selfassessment to: Review compliance with these terms of reference with and whether they remain fit for purpose; Determine whether the planned activities and responsibilities for the previous year have been sufficiently discharged; Recommend any changes and / or actions it considers necessary, in respect of the above; Provide the JCC with an annual report, which details the outcome of the annual review. 10.2 These Terms of Reference will be reviewed annually, reflecting experience of the JCOG in fulfilling its functions and the wider experience of NHS England and CCGs in primary medical services co-commissioning. Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

7 11. Committee servicing 11.1 The committee shall be supported administratively by the CCG Primary Care Projects Officer (or other nominated representative), who s duties in this respect will include: Agreement of the Agenda with the Chair and collation of papers in-line with the committee s Annual Cycle of Business; Providing written notice of meetings to committee members, and the papers, not less than 5 working days before the meeting; Taking the minutes and keeping a record of matters arising and issues to be carried forward; Producing a single document to track the committee s agreed actions and report progress to the committee; Producing draft minutes for approval within 5 working days of the meeting. Terms of Reference reviewed by: Approval Date: Next Review Date: JCC To be confirmed One year after approval date Joint Commissioning Operational Group (JCOG) Terms of Reference V1.0 17.10.16

Agenda Item No: 10 Date of Meeting: 20 th October 2016 Joint Co-Commissioning Committee in Public Paper Title: Financial Report for Primary Medical Services: Quarter 2 2016/17 Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Stephen Makin Chris Ford, Director of Finance Purpose of the paper: This paper sets out the financial position at Quarter 2 (Q2) for Primary Medical Services (GP Services) in East & North Hertfordshire CCG. Conflicts of Interest involved: None Recommendations to the Joint Committee For information

Choose an item. Central Midlands Financial Report for Primary Medical Services: Quarter 2 2016/17 FOOTPRINT: EAST & NORTH HERTFORDSHIRE CCG September 2016 1