PRIMARY CARE CO-COMMISSIONING COMMITTEE - PUBLIC MEETING A G E N D A

PRIMARY CARE CO-COMMISSIONING COMMITTEE - PUBLIC MEETING Meeting of the Public Primary Care Co-Commissioning Committee to be held on Thursday, 11 January 2018 at 11.30 am 12.30 pm in Room F14, Venture House, Boston, Lincs A G E N D A Standing Items Enc. Lead 1. Welcome and Introductions Verbal Mrs Owen 2. To note Apologies for Absence Verbal Mrs Owen 3. To note any Pecuniary or Non-Pecuniary Interests: Members are reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of Lincolnshire East CCG. Declarations declared by members of the PCCC Committee are listed in the CCG s Register of Interests. The Register is available either via the Corporate/Board Secretary or on the CCG s website at the following link: http://www.lincolnshireeastccg.nhs.uk/ 4. To consider the Minutes & Action Log from the Public Primary Care Co-Commissioning Committee held on 7 December 2017 Verbal Enclosure Mrs Owen Mrs Owen 5. To consider Matters Arising from the previous minutes Verbal Mrs Owen 6. To receive a Finance Update Enclosure Mrs Williamson 7. To receive an update on the Risk Register To Follow Mrs Williamson General/Current Issues 8. To discuss the proposed merger of Stuart House & Westside Verbal Mrs Williamson/ Mrs Starbuck 9. To receive an Update on Extended Hours Analysis Q1/Q2 Enclosure Mark Hall 10. To receive a report on the Primary Medical Care Policy Manual Enclosure Mark Hall 11. To receive an Update on the Wainfleet Branch Surgery Verbal Mrs Starbuck 12. To approve the Terms of Reference for the PCCC Committee Enclosure Mrs Owen Any Other Business 13. To consider items of Any Other Business Verbal All Date and Time of Next Meeting 14. Thursday, 1 March 2018 2.30 3.30 pm, Room F14, Venture House, Boston, Lincs

The items on this agenda are submitted to the Primary Care Co-Commissioning Committee for discussion, amendment and approval as appropriate. They should not be regarded, or published, as organisation policy until formally agreed. Papers are available to view on Lincolnshire East CCG website www.lincolnshireeastccg.nhs.uk. In case of difficulty accessing the papers, please contact Claire Wilson, Corporate/Board Secretary on 01522 515308 or via email claire.wilson@lincolnshireeastccg.nhs.uk The Primary Care Co-Commissioning Committee will be asked to consider the following resolution:- 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 of which would be prejudicial to the public interest. Section 1(2) Public Bodies (Admission to Meetings) Act 1960) Items in the private part of the meeting are either commercial in confidence or relate to individual staff and patients Claire Wilson, Corporate/Board Secretary

Pecuniary or Non-Pecuniary Interests Definitions Type of Interest Financial Interests Non-Financial Professional Interests Non-Financial Personal Interests Indirect Interests Description This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being: A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; A shareholder (or similar owner interests), a partner or owner of a private or not-forprofit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; A management consultant for a provider; In secondary employment; In receipt of secondary income from a provider; In receipt of a grant from a provider; In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider; In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is: An advocate for a particular group of patients; A GP with special interests e.g. in dermatology, acupuncture etc; A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE); A medical researcher. This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:- A voluntary sector champion for a provider; A volunteer for a provider; A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; Suffering from a particular condition requiring individually funded treatment; A member of a lobby or pressure groups with an interest in health. This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include: Spouse / partner Close relative e.g. parent, grandparent, child, grandchild or sibling; Close friend; Business partner.

PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC MEETING Minutes of the Primary Care Co-Commissioning Committee Public Meeting held on Thursday, 7 December 2017 at 2.30 3.30 pm in Room F14, Venture House, Boston, Lincs Present: In Attendance: Dr D Boldy, Secondary Care Doctor (Chair) Dr Brynnen Massey, Lay Member Primary Care Ms S Milbank, Interim Accountable Officer Mrs S Williamson, Chief Finance Officer (up to Item 114/17 only) Mrs S Starbuck, Senior Performance & Commissioning Manager Miss H King, Senior Locality Manager Mrs J Evans, Healthwatch Mr T McGinty, Interim Director of Public Health, LCC Mrs C Wilson, Corporate/Board Secretary Mrs C Stubbs, Lead Nurse - Quality Mrs B Glet, Senior Performance Manager Mr J Singleton, Performance Officer Mrs R Billingham, Primary Care Support Contract Manager, NHSE Mr T Bailey, Contracts Manager, NHS England Dr S Baird, Clinical Leader, LECCG (as member of the public) 105/17 Welcome and Introductions Action Dr Boldy welcomed all those present to the meeting and round the table introductions were made. 106/17 Apologies for Absence Apologies for absence were received from Ms Tracy Pilcher, Mr Gary James, Mrs Brenda Owen, Mrs Kasia Pisarska, Mr Mark Hall and Cllr Mrs Sue Woolley. 107/17 Declarations of Pecuniary and Non-Pecuniary Interests Dr Boldy reminded committee members of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of Lincolnshire East CCG. Declarations declared by members of the Primary Care Co- Commissioning Committee are listed in the CCG s Register of Interests. The Register is available either via the Corporate/Board Secretary or on the CCG s website at the following link: http://www.lincolnshireeastccg.nhs.uk/ The following declarations were made:- Mrs Sandra Williamson registered patient at Stuart House and family registered at Stuart House/Westside

Mr James Singleton - registered patient at Stuart House Surgery Action Mrs Wilson to note on the Register of Interests for this meeting. Mrs Wilson It was noted that Mrs Williamson was only able to stay for the first part of the meeting, and therefore it would only be quorate until that point. It was agreed that the agenda would be taken out of order for this reason. A digital recorder would be used for minute taking purposes. 108/17 Minutes of the Meeting held on 21 September 2017 The minutes of the meeting held on 21 September 2017 were received and approved as a correct record of proceedings. 109/17 Matters Arising from the minutes 109/17.1 90/17 Finance Update: Mrs Starbuck confirmed that she would bring a report on the management and reviewing of enhanced services to the February meeting of this Committee. 109/17.2 92/17 Update on Primary Care Performance: Mrs Stubbs confirmed that the suggested listening clinic questions had been circulated. Future listening clinics would be targeted out of practice, and the CCG were also linking up with Kasia Pisarska for public health advice on this. Dr Boldy advised that he would action the letter to Practices on those that had achieved above 76% in the patient survey. Dr Boldy 110/17 Minutes of the Meeting held on 23 November 2017 The minutes of the meeting held on 23 November 2017 were received and approved as a correct record of proceedings. 111/17 Matters Arising from the minutes There were no matters arising. 112/17 To approve the Proposed Merger of Westside Surgery and Stuart House Rachel Billingham presented the paper on the proposed merger of Westside Surgery and Stuart House Surgery into a single practice. She advised that since the last discussion on this some GP resilience programme funding had been secured. The Practice would need to undertake some work around governance, financial management and capacity/demand modelling and the development of a stronger merger service plan. Page 2 of 7

It was therefore felt that in order for this work to be undertaken a revised merger date of 1 July 2018 would be more appropriate. Action Following discussion, the Primary Care Co-Commissioning Committee agreed:- To approve the merger subject to the completion of the necessary work, to be partly funded through the GP Resilience Programme and be subject to a s.96 agreement and memorandum of understanding with the practices. To approve a revised merger date of 1 July 2018. 113/17 To receive a Finance Update Mrs Williamson presented the report summarising the Month 7 position of the co-commissioning budget for 2017/18. She advised that the CCG were currently over performing against the allocation and was forecasting an overspend of 368k against the 37.7m budget. The main areas of overspend are payments for the Quality Outcomes Framework (QOF) and the main GMS payments to GPs. Mrs Williamson further advised that a plan for 18/19 would be brought to a future meeting, together with a view about how to allocate GP Forward View funding. She stated that any of the 1.50 per head not utilised this year would be moved to next year, and wanted to provide assurance to the Committee of that commitment. The Primary Care Co-Commissioning Committee agreed:- To note the report and the update provided. At this point of the meeting (3.00 pm), Mrs Williamson left the meeting. It was noted that the meeting would not be quorate for the remainder of the meeting. 114/17 To receive an update on the Risk Register Mrs Starbuck presented the report providing an update on the primary care co-commissioning risk register as at the end of November 2017. She advised that further work was being undertaken on the risk register with a more detailed update being available for the next meeting. Dr Boldy asked for an update on the Capita risk, and it was noted that Adrian Audis, NHSE, had been collating the feedback from Practices. This information will be incorporated into the update for the next meeting. Page 3 of 7

The Primary Care Co-Commissioning Committee agreed:- To note the update report and approve the risk register as at the end of November 2017. To note that a more detailed update would be provided at the next meeting. Action 115/17 To receive an Update on Primary Care Performance Mrs Glet presented the performance report relating to the contractual performance of GP practices. The report focussed on the Quality and Outcomes (QOF) data for 2016/17 which was published on 26 October 2017, together with details of the latest CQC inspections. In terms of QOF, the CCG s average score increased from 2015/16 by 1.96 points to 531.76 out of a possible 559 (95.48%). With regard to CQC, four practices were inspected during October and November. Following the re-inspection of Stickney in October, the practice has now been rated as good. Formal reports of the remaining inspections will be published within the next few months. Discussion took place on the Practice profiles cancer data with the England benchmark on the last page of the report and a query was raised with regard to what range was used for the data. A further assessment of the data would be undertaken, and Mr McGinty advised that if the CCG required more analytical help with that data then that could be arranged. Contact should be made with Kasia Pisarska in the first instance. Mrs Glet Dr Massey then referred to the additional data that had been sent out with the report on the drug costs for Diabetes. The data had been compared to other CCGs with a similar prevalence. In terms of the data, he advised that the prescribing costs looked exactly where they should be and that the diabetes drug spend was not overly high compared to similar CCGs. The Primary Care Co-Commissioning Committee agreed:- To note the performance report and the update provided. 116/17 To receive an update on the NHS England Policy Book Mr Tom Bailey provided an update on the NHS England Policy book, and advised that a paper was currently being drafted that would most likely be presented to the February meeting. He advised that the key issue to note is the tightening up of discretionary payments, with a lot more scrutiny on this nationally. Page 4 of 7

The Primary Care Co-Commissioning Committee agreed:- To note the verbal update and that a paper would be brought to the February meeting. Action Agenda 117/17 To receive an update on the GP Forward View Online Consultations Mrs Starbuck provided an update on the GP Forward View Online Consultation fund launched by NHS England. 45m nationally has been released for this, and the CCG will have to submit a proposal for funding. For 17/18 an application will be submitted at a Lincolnshire STP level to source some project management support to move forward on this, and then it will be reviewed for the 18/19 funding. Some engagement with Practices will take place over the coming months, and the CCG will ensure that our local needs are reflected within any application process. A further update will be provided in due course. The Primary Care Co-Commissioning Committee agreed:- To note the verbal update. 118/17 To receive an update on the GP Forward View Extended Access Pilots: Mrs Starbuck advised that this was in progress with the hope to get at least one pilot up and running within Quarter 4. Work was currently taking place on the delivery plan, and the CCG were also working with the communications team to ensure that it is advertised and engagement is undertaken. A full update will be provided at the next meeting. The Primary Care Co-Commissioning Committee agreed:- To note the verbal update. 119/17 To review the Terms of Reference Dr Boldy presented the Terms of Reference which were due their yearly review. The following amendments were noted:- Membership change Head of Commissioning to Senior Performance and Commissioning Manager Remove Head of Planning & Delivery Include Senior Performance Manager on attendance list Change reference to Area Team to DCO team An updated version of the Terms of Reference to be brought to the next meeting for approval with any amendments highlighted in yellow. Mrs Wilson Page 5 of 7

120/17 Dates and times of meetings for 2018 Action The dates and times for 2018 future meetings were received. The Committee confirmed that they will still happy with the frequency of the meetings. It was agreed that performance reports would be presented quarterly instead of monthly in the future. The Committee also agreed to switch the public and private meetings around for future meetings. Mrs Wilson to update the appointments. Mrs Wilson 121/17 Any Other Business No items of any other business were identified. 122/17 Date and Time of Next Meeting The next meeting will take place on Thursday, 11 January 2018 at 11.30 am in Room F14, Venture House, Boston, Lincs. Page 6 of 7

ACTION LOG FOR THE PRIMARY CARE COMMISSIONING COMMITTEE PUBLIC MEETING HELD ON 7 DECEMBER 2017 REF ACTION LEAD DATE FOR PROGRESS COMPLETION 107/17 Declarations of Pecuniary and Non- Pecuniary Interests: Mrs Wilson to update the Register of Interests Mrs Wilson 22.12.17 Actioned 22.12.17 109/17.2 92/17 Update on Primary Care Performance: Dr Boldy to draft letter to Practices on those that had achieved above 76% in the patient survey. 115/17 Update on Primary Care Performance: To undertake a further assessment of the Practice profiles cancer data. Dr Boldy 11.01.18 Actioned 04.01.18 Mrs Glet 11.01.18 116/17 Update on the NHS England Policy Book: A paper to be brought to the February meeting. NHSE/ Mrs Wilson 01.02.18 February meeting 119/17 Review the Terms of Reference: An updated version of the ToR to be brought back to the next meeting for approval. 120/17 Dates and times of meetings for 2018: Mrs Wilson to update the appointments to reflect the switching of the public and private meetings. Mrs Wilson 11.01.18 Agenda 11.01,18 Mrs Wilson 31.12.17 Actioned 14.12.17 Page 7 of 7

NHS LINCOLNSHIRE EAST CCG Primary Care Co-Commissioning Committee Report to: NHS Lincolnshire East CCG Agenda item: 6 Date of Meeting: 11th January 2018 Title of Report: Status of report: (decision and approval, position statement, information, confidential discussion) Lead Director: Author: Appendices: Primary Care Co-Commissioning Financial Position - Month 8 Information Sandra Williamson, Chief Finance Officer Helen Stead, Financial Accountant N/A 1. Purpose of the Report (including link to objectives) This report summarises the Month 8 position of the Co-Commissioning budget for 2017/18. 2. Recommendations The Committee is asked to consider the information that is provided and to request any further information and assurances that may be required. 3. Background Primary Care Co-Commissioning is the named budget given to GPs to run their practices. Primary Care Co-Commissioning previously sat with NHSE England. In 2015/16, it moved to CCG budgets to be run alongside NHS England. From 2016/17 onwards, the CCG became fully responsible for Co-Commissioning. The initial allocation received in 2017/18 was 37,723k for Co-Commissioning. The NHS financial planning business rules expect a 0.5% contingency to be created from the allocation which amounts to 185k. Updated information during the year has led to small adjustments to the budget which now stands at 37,680k. The allocation sets the limit expected on expenditure for primary care. The CCG has had to accommodate national cost pressures and obligations as best it can within the allocation provided. 4. Summary of Key Issues for Discussion The CCG is forecasting an overspend of 341k against the 37.7m budget. The main areas of overspend are payments for the Quality Outcomes Framework (QOF) and the main GMS payments to GPs. The main variances are shown in Table 1. 1

Table 1: Year to date at Month 8 and Forecast position for Co Commissioning YTD Budget '000 YTD Actual '000 YTD Variance '000 Annual budget '000 Annual Variance '000 Forecast '000 Enhanced Services 465 448 17 698 680 18 GMS 15,569 15,707-138 23,368 23,633-265 Other 617 330 286 1,032 793 239 PMS 266 242 24 398 362 36 Premises 2,481 2,496-14 3,722 3,864-142 Prescribing/Dispensing Drs 3,168 3,182-14 4,753 4,773-20 QOF 2,472 2,611-139 3,708 3,916-208 Grand Total 25,038 25,015 23 37,680 38,021-341 Table 2: Pie chart of YTD Expenditure The YTD figures have the same % breakdown as the Year End Forecast for 2017/18. 2

Table 3: Explanatory Comments for YTD Position and Full Year Forecast at Month 8 Enhanced Services GMS Other PMS Premises Prescribing/Dispensing Drs QOF At Month 8, Enhanced Services are being forecast at a slight underspend of 17k for the YTD and a forecast underspend of 18k. This is based on the amounts Practices have claimed to date for Q1 & Q2. This has been checked against Practice sign up forms for 2017/18, so that only practices who have signed up are claiming. This is the cost of the Global Sum & MPIG. The Q1 list size adjustment was much higher than was expected, at approx. 85k. The Q2 &Q3 List Size Adjustments have been reviewed and are a lower figure more in line with previous list size adjustments. The Seniority underspend is 58k at M8. The underspend for the full year is 80k based on the expected decreases during the year. The Yearend fallout is an underspend of 51k. The Sickness /Maternity /Paternity /Adoption pay forecast has decreased to 85k based on there being no expenditure to date at M8 for Maternity/Paternity/Adoption payments, although there is one sickness claim paid in during October & November for 7k. There are amounts in the forecast only for the Indemnity Scheme (this will be paid in Feb/Mar 2018) of 150k. The budget for this has been moved to Q4 to match to when the payments will be made. There is also 20k for the GP Retention Scheme. Forecast expenditure is not known for this at present. This is only one PMS practice remaining at present. Its current expenditure is 24k underspent at Month 8 and the overall forecast is within budget by 36k. The underspend is due to Ad-hoc Baseline Adjustments The rent reviews currently have a forecast in of 135k to cover any backdated payments due. The expenditure is based on the 2016/17 Outturn with an uplift of 1.1% for 2017/18. The QOF Achievement was reviewed during September 2017, as the Finance team became aware that not all Practices were being paid 70% of last years total Achievement. The estimated QOF Achievement for 2017/18 has been worked through and recalculated; therefore the total QOF forecast has decreased by 143k since M6, reducing the forecast overspend to 208k. Risks for 2017/18 At this stage in the year, there still remains some scope for changes to forecasts. QOF achievement could fall, reducing costs. Use of locum GPs to cover sickness / maternity / paternity would increase costs. The costs of this YTD at Month 8 are 7k. Enhanced Services outturn will vary calculations, although the number of practices that have signed up for each service is now known. Conclusions In the 8 months of the year to date, there is a small underspend compared to budget. This comes mainly from the fallout from 2016/17 expenditure that was paid in 2017/18 including QOF and Professional fees (Dispensing/Prescribing Doctors). The underlying spend each month is higher than budget plans, so it is expected that the underspend will be eroded, and that there will be a 341k overspend at the year end. 3

Any overspend in Co Commissioning will need to be recovered from efficiencies and new ways of working in other CCG budgets. 5. Care Quality Commission Implications: Not applicable. 6. Legal/NHS Constitution Considerations Not applicable. 7. Analysis of Risk including the link to the Board Assurance Framework and Risk Register Not applicable. 8. Resource Implications (Financial and Staffing) Not applicable. 9. Patient, Public and Stakeholder Involvement Not applicable. 10. Equality and Diversity Impact Not applicable 11. Health Inequalities Impact Not applicable. 12. References to previous reports Not applicable. 13. Freedom of Information Not applicable. 14. For further information or for any enquiries relating to this report, please contact Sandra Williamson, Chief Finance Officer Helen Stead, Financial Accountant Lincolnshire East CCG Lincolnshire East CCG Sandra.Williamson@LincolnshireEastCCG.nhs.uk Helen.Stead@LincolnshireEastCCG.nhs.uk 01522 513355 01522 513355 Ex 5501 4

NHS LINCOLNSHIRE EAST CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC MEETING Report to: Primary Care Co-Commissioning Committee Date of Meeting: 11 th January 2018 Agenda item: 9 Title of Report: Extended Hours Analysis Quarter 1 & 2 Status of report: (decision and approval, position statement, information, confidential discussion) Lead Director: Author: Appendices: Information Mrs S Williamson, Chief Finance Officer Rachel Billingham, Primary Care Support Contract Officer, NHS England Appendix 1 - Analysis 1. Purpose of the Report (including link to objectives) This report contains analysis of Quarter 1 and 2 data of the Extended Access, Enhanced Service for Lincolnshire East CCG. 2. Recommendations The Primary Care Commissioning Committee is asked to: Note the report extended hours data. 3. Background The Extended Hours Access Scheme is a Directed Enhanced Service that enables practices to provide appointments at times outside of core contracted hours. It allows patients to receive medical advice or consultation. Core hours are defined as Monday to Friday 08:00-18:30. The Enhanced Service requires practices to provide routine appointments at weekends and/or evenings, to reflect patient need. Practices sign up to the Enhanced Service for a period of one year. Both the Practice and NHS England may terminate the service by giving not less than one months notice in writing to the other party. 4. Summary of Key Issues for Discussion Data is now available for the last 2 quarters in relation to practices Extended Access appointments. This report focuses on two aspects; percentage appointment uptake and sessions not run by the practice. 1

Percentage appointment uptake Practice Quarter 1 Quarter 2 Liquorpond Surgery 67.33% 60.66% Merton Lodge 68.81% 70.23% Liquorpond identified low appointment uptake, flagging as amber for both quarter 1 and quarter 2. Liquorpond offer appointments Monday and Wednesday evenings 18:30-20:00 offering 28 appointments in total a week. Merton Lodge had low uptake in quarter 1, which slightly improved in quarter 2. Merton Lodge offers extended access appointments Monday Friday 18:30-19:00 with 24 appointments per week in total. Discussions have taken place with both practice managers in relation to the poor uptake. Both have stated that extended access appointments are offered daily but they continue to experience poor uptake. Due to the poor utilisation of appointments, consideration might need to be given as to whether the sessions are being offered at times/days that reflect patient need. Following discussions with the LMC, NHSE will be working with the Practice to improve the uptake of the appointments. Should the uptake of appointments continue at a low uptake level the Enhanced Service specification states: Where there is evidence that appointments are consistently underutilised, NHS England may decide to decommission the service with that practice / group of practices. Where this decision has been taken, NHS England will communicate this, in writing to the practice(s), giving the agreed notice period. Sessions not run Practice Quarter 1 Quarter 2 The Kidgate Surgery 23.08% 1.92% As per section 4.18 of the Extended Hours Enhanced Service specification, if a practice cancels/does not run a clinic, they are required to reschedule the session within 1 week unless the clinic falls on a bank holiday. Analysis of the Extended Hours data returned by practices to NHS England for Quarter 1 and Quarter 2 of the financial year 2017-18 has identified a number of practices that have failed to run or re-provide their contracted number of Extended Hours sessions. Most noticeably, The Kidgate Surgery did not run or re-provide 6 of their contracted 26 sessions for the Quarter 1, which equates to 23.08% of their planned sessions for the quarter. Even though the percentage of the sessions not run/re-provided by The Kidgate Surgery in Quarter 2 decreased, it was still the practice that ranked highest in Lincolnshire East CCG for sessions not run/re-provided. With Annual Leave being cited by the practice for not providing the sessions for both of these quarters. Where it is found that a practice has not provided the Extended Hours service they have been contracted and paid for, NHS England will take steps to reclaim the difference between the funds paid and the service delivered. 2

5. Care Quality Commission Implications: N/A 6. Legal/NHS Constitution Considerations N/A 7. Analysis of Risk including the link to the Board Assurance Framework and Risk Register In terms of uptake of appointments, there is a risk that if the extended access appointments are not being utilised effectively, patients could be relying on alternative services, such as walk in centres or A&E. This is also relevant to practices that are failing to re-provide sessions that have not been held. 8. Resource Implications (Financial and Staffing) There are financial implications in that, unless money is clawed back, NHSE are paying for sessions which are not being re-provided. There is also a risk that with so many sessions being underutilised, fundamentally the service at the practice may not be financially viable. 9. Patient, Public and Stakeholder Involvement N/A 10. Equality and Diversity Impact DUE REGARD TO THE PROACTIVE DUTIES OF THE EQUALITY ACT 2010 HAS BEEN TAKEN IN DEVELOPMENT OF THIS PAPER AND: Due Regard is applicable and the following work has been undertaken: NOTE: Policies/decisions may need to be adjusted in line with any Equality Analysis or Due Regard that is brought back at a future date. Any decision that is finalised without being influenced by appropriate Due Regard could be deemed unlawful. 11. Health Inequalities Impact N/A 12. References to previous reports N/A 13. Freedom of Information Public Report 14. For further information or for any enquiries relating to this report, please contact Rachel Billingham, NHS England Primary Care Support Contract Manager rachel.billingham@nhs.net 3

Appointment uptake- Quarter 1 Appointment uptake- Quarter 2 Sessions not run- Quarter 1 Sessions not run versus Sessions planned- Quarter 1

Sessions not run- Quarter 2 Sessions not run versus Sessions planned- Quarter 2

NHS LINCOLNSHIRE EAST CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC MEETING Report to: Primary Care Co-Commissioning Committee Date of Meeting: 11 January 2018 Agenda item: 10 Title of Report: Status of report: (decision and approval, position statement, information, confidential discussion) Lead Director: Author: Appendices: Primary Medical Care Policy Manual Information Dianne Wells, Primary Care Support Contract Manager 1. Purpose of the Report (including link to objectives) The purpose of the paper is to inform the Committee of the policy and guidance manual updates which reflect the changing landscape in primary care co-commissioning. 2. Recommendations The PCCC is asked to note the content of this report and adopt the Primary Medical Care Policy and Guidance Manual changes. 3. Background In 2016, the Policy Book for Primary Medical Services was published which provided commissioners of GP services with the context, information and tools to commission and manage GP contracts. As part of the co-commissioning strategy, as at 1 April 2017, 176 Clinical Commissioning Groups (CCGs) have responsibility for commissioning and contract monitoring GP services in their locality, with NHS England maintaining overall accountability. Local Offices of NHS England retain responsibility for commissioning and monitoring the performance of GP services for the remaining CCGs. Recognising the need to strengthen guidance for CCG commissioners, NHS England reviewed its Policy Book and the feedback received since its first publication and has made the following additions and amendments and published herewith in this Primary Medical Care Policy and Guidance Manual (PGM). 1

4. Summary of Key Issues for Discussion The PGM has been divided into 4 parts (A-D). The language throughout has been amended to cover all commissioners, recognising 85% of CCGs are now operating under fully delegated authority or joint arrangements. Reflecting feedback, templates have been embedded as extractable documents for easier onward use. Part A Excellent Commissioning and Partnership Working 1 Introduction An existing chapter with minor amendments 2 Abbreviations and Acronyms An existing chapter with minor amendments 3 Commissioning Described An existing chapter with minor amendments 4 General Duties of NHS England (including addressing health inequalities) An existing chapter which has been redrafted jointly by the Legal and Equalities and Health Inequalities Teams 5 Working Together Commissioning and Regulating A new chapter drafted collaboratively with the Care Quality Commission (CQC) Part B General Contract Management 1 Contracts Described An existing chapter with minor amendments 2 Assurance Framework Contract Review A new chapter 3 Managing Patient Lists An existing chapter that has been strengthened and refined. It also describes the Primary Care Support (PCS) Services delivered nationally through Primary Care Support England (PCSE) 4 GP Patient Registration Standard Operating Principles for Primary Medical Care A new chapter in the PGM, but which updates existing registration guidance published by NHS England in November 2015 5 Temporary suspension to patient registration A new chapter in the PGM 6 Special Allocation Scheme (SAS) A new chapter drafted jointly with NHS England s PCS Services, Legal and Information Governance Teams and the National Security Management Coordinator. 7 Contract Variations (templates available) - An existing chapter that has been strengthened and refined by the Legal team and provides increased guidance in relation to Practice Mergers 8 Managing a PMS Contractor s Right to a GMS Contract An existing chapter with minor amendments 9 Practice Closedown (Planned / Scheduled) An existing chapter with minor amendments 10 Discretionary Payments (made under Section 96) A new chapter drafted jointly with NHS England s Legal and Finance Teams Part C When things go wrong 1 Contract Breaches, Sanctions and Terminations An existing chapter with minor amendments 2

2 Unplanned / Unscheduled and Unavoidable Practice Closedown A new chapter drafted jointly with PCS Services, Information Governance and GPIT teams, to address issues such as Orphan Records 3 Death of a Contractor (excluding single handers see adverse events) An existing chapter with minor amendments 4 Managing Disputes An existing chapter with minor amendments 5 Adverse Events (e.g. flood fire) An existing chapter with minor amendments Part D General 1 GP IT Operating Model: Data and Cyber Security Arrangements A new chapter drafted by the GPIT team 2 Protocol in respect of locum cover or GP performer payments for parental and sickness leave A new chapter in the PGM but previously published in April 2017 with Gateway Ref 06791 3 Guidance Note: GP Practices serving Atypical Populations A new chapter in the PGM but previously published in December 2016. NHS England recognises the scale and pace of change in Primary Medical Care commissioning, service delivery and redesign. As such it is committed to reviewing this policy and guidance regularly, to ensure it supports the commitments set out in the General Practice Forward View, the Five Year Forward View and with changes in legislation and regulation. 5. Care Quality Commission Implications: None 6. Legal/NHS Constitution Considerations None 7. Analysis of Risk including the link to the Board Assurance Framework and Risk Register None 8. Resource Implications (Financial and Staffing) None 9. Patient, Public and Stakeholder Involvement None 10. Equality and Diversity Impact DUE REGARD TO THE PROACTIVE DUTIES OF THE EQUALITY ACT 2010 HAS BEEN TAKEN IN DEVELOPMENT OF THIS PAPER AND: Either: Due Regard is not applicable because this is an update of the progress on the Equality Objectives. (The 3

Equality Objectives inherently include Due Regard) Or: Due Regard is applicable and the following work has been undertaken: NOTE: Policies/decisions may need to be adjusted in line with any Equality Analysis or Due Regard that is brought back at a future date. Any decision that is finalised without being influenced by appropriate Due Regard could be deemed unlawful. 11. Health Inequalities Impact None 12. References to previous reports None 13. Freedom of Information Public report 14. For further information or for any enquiries relating to this report, please contact Dianne Wells Primary Care Support Contract Manager Dianne.Wells1@nhs.net 4

Introduction Lincolnshire East Clinical Commissioning Group Primary Care Co-Commissioning Committee Terms of Reference 1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit Expressions of Interest setting out the CCG s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG. 2. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to Lincolnshire East CCG. The delegation is set out in Schedule 1. 3. As such the Clinical Commissioning Group has established the Primary Care Co-Commissioning Committee ( Committee ). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers. 4. It is a Committee comprising representatives of the following organisations: Lincolnshire East CCG Central Midlands DCO TeamArea Team NHS England Healthwatch Statutory Framework 5. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. 6. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG. 7. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); Page 1 of 7

i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2). 8. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below: Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P). 9. The Committee is established as a Committee of the Governing Body of Lincolnshire East CCG in accordance with Schedule 1A of the NHS Act. 10. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State. Role of the Committee 11. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in East Lincolnshire, under delegated authority from NHS England. 12. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Lincolnshire East CCG, which will sit alongside the delegation and terms of reference. 13. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. 14. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. 15. This includes the following: GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); 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). 16. The CCG will also carry out the following activities: To plan, including needs assessment, primary medical care services. To undertake reviews of primary medical care services; To co-ordinate a common approach to the commissioning of primary care services; To manage the budget for commissioning of primary medical care services; To develop and implement integrated commissioning across acute, community and social care services; Page 2 of 7

To develop and continuously improve the quality of commissioned primary medical services; To develop local incentives schemes (as an alternative to QoF) to adapt the primary medical care service offer to the needs of local patients; To develop and support vulnerable GP practices to ensure the continuity of services to the local population; To develop and implement primary care commissioning intentions which address inequalities within the registered and non-registered population; To plan and develop the primary care workforce; To develop and implement primary care commissioning intentions to prepare primary care to deliver the NHS Five Year Forward View through the Better Care Together/Lincolnshire Health and Care programme; To develop and implement primary care commissioning intentions to deliver the operational plans of the CCG and strategic plans of the relevant Unit of Planning for Lincolnshire; To develop federated/network/collaborative arrangements as required to support the health needs of the population and the continuity of primary medical services; To develop and implement primary care commissioning intentions to strengthen population-wide prevention, promote self-care and improve access to healthy lifestyle services; To develop and commission a wider range of community based multi-specialty services which provide episodic care to the local population; To work collaboratively with the Central Midland DCO TeamArea Team of NHS England to maintain the stability of the AT Direct Commissioning function during 2015-16. Geographical Coverage 17. The Committee will comprise the area of Lincolnshire East CCG, as defined within the CCG s Constitution. Membership 18. The Committee shall consist of: CCG Two Lay Members (voting) CCG Secondary Care Doctor (voting) CCG Accountable Officer (voting) CCG Chief Finance Officer (voting) CCG Chief Nurse (voting) In attendance: Senior Performance and Commissioning Manager Head of Commissioning (non-voting) Head of Planning & Delivery (non-voting) Senior Performance Manager (non-voting) Locality Manager (non-voting) Public Health Representative LCC (non-voting) Adult Care Representative LCC (non-voting) Health & Wellbeing Board Representative (non-voting) Healthwatch Representative (non-voting) Page 3 of 7

NHS England Representative (non-voting) Clinical Leader from each Locality (non-voting) Public Session only 19. The Chair of the Committee shall be a Lay Member of the Governing Body or the Secondary Care Doctor of the Governing Body (but not the Lay Member for Governance). 20. The Vice Chair of the Committee shall be a Lay Member from the CCG Governing Body or the Secondary Care Doctor of the Governing Body. Meetings and Voting 21. The Committee will operate in accordance with the CCG s Standing Orders. The CCG Corporate/Board Secretary will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than five days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. 22. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible. Quorum 23. The Quorum shall be four members, and must always have one Lay Member/Secondary Care Doctor (the Chair and/or Vice Chair of the Committee) and CCG Officer present. Frequency of meetings 24. The Committee shall meet on a monthly basis in the first instance, but this will be reviewed after a period of six months. 25. If necessary, additional Extra-Ordinary meetings shall be called as required. 26. Meetings of the Committee shall: a) be held in public, subject to the application of 26(b); b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time. 27. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to Page 4 of 7

the best of their knowledge and ability, and endeavour to reach a collective view. 28. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest. 29. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 30. Members of the Committee shall respect confidentiality requirements as set out in the CCG s Constitution and Standing Orders. 31. The Committee will present its minutes to Central Midlands DCO TeamArea Team NHS England and the Governing Body of Lincolnshire East CCG each month for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 25 above. 32. The CCG will also comply with any reporting requirements set out in its Constitution. Accountability of the Committee 33. The Primary Care Commissioning Committee is a Committee of the Governing Body and is accountable for making decisions on review, planning and procurement of primary care services in Lincolnshire East, under delegated authority to the CCG from NHS England. 34. For the avoidance of doubt, in the event of any conflict between the terms of this Scheme of Delegation (Terms of Reference) and the CCG s Standing Orders or Standing Financial Instructions, the latter will prevail. Procurement of Agreed Services 35. The CCG will make procurement decisions as relevant to the exercise of its delegated authority and in accordance with the detailed arrangements regarding procurement set out in the Delegation Agreement. Decisions 36. The Committee will make decisions within the bounds of its remit. 37. The decisions of the Committee shall be binding on NHS England and Lincolnshire East CCG. 38. The Committee will produce an executive summary report, which will be presented to Central Midlands DCO TeamArea Team of NHS England and the Governing Body of Lincolnshire East CCG for information. Date Approved: January 2018November 2016 Approved by:. Page 5 of 7

Date for next review: December 2018November 2017 Page 6 of 7

Schedule 1: Scheme of Delegation As set out in the CCG s Constitution - Appendix D Scheme of Reservation and Delegation of Powers Schedule 2: Delegated Commissioning Functions GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking 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). Delegated commissioning arrangements exclude GP performance management (medical performers list for GPs, appraisal and revalidation). NHS England retains responsibility for the administration of payments and list management. Page 7 of 7