Primary Care Commissioning Committee Held in Public Meeting Thursday 6 July 2017 2pm-4pm Boardroom, Kempthorne House, St Martins Hopsital, Bath, BA2 5RP Minutes Members of the Committee Suzannah Power (SP) (Chair) Corinne Edwards () John Holden (JSH) Katie Hall (KH) Val Janson (VJ) Helen Harris (HH) John Fogg (JF) In Attendance Cllr Vic Pritchard (VP) Nikki Holmes (NH) Tamsin May (TM) Rebecca Reynolds (RR) Apologies Debra Elliot (DE) Dr Ruth Grabham (RG) Dean Walton (DW) John Trevains (JT) Sarah James (SJ) Alex Francis (AF) Dr Gareth Bryant (GB) James Childs-Evans (J) Lay Member, PPI, BaNES CCG Director of Acute & Primary Care Commissioning, BaNES CCG Lay Member, Audit, BaNES CCG Lay Member, Quality, BaNES CCG Assistant Director of Nursing and Quality, BaNES CCG Practice Manager, BaNES CCG Senior Finance Manager Cabinet Member for Adult Social Care & Health, B&NES Council Head of Primary Care, South Central, NHSE Head of Communications, BaNES CCG Consultant in Public Health, B&NES Council Director of Commissioning, South Central, NHSE Medical Director, BaNES CCG Head of Primary Care Finance, NHSE Assistant Director of Nursing, Patient Experience & Safeguarding, South Central, NHSE Chief Financial Officer, BaNES CCG Project Co-ordinator, Healthwatch Deputy Chief Executive, LMC Senior Commissioning Manager for Primary Care, BaNES CCG PCCC Meeting Thursday 6 July 17 Page 1 of 7
Item Topic Action 1. Opening Business 1.1 Chair Welcome and Apologies The Chair welcomed everyone to the Primary Care Commissioning Committee. Apologies were received as outlined above. 1.2 Declarations of interest There were no declarations of interests received on any issues arising at the meeting which might conflict with the business of BaNES CCG in addition to those already declared on the Interest of Declarations meetings register. The meeting was declared quorate. 1.3 Minutes of 23 March 2017 The minutes of 23 March 2017 were approved as an accurate record of the meeting. 1.4 Action List and Matters Arising The action list was noted with the following comments: - 19/10/16 3.1: AF not in attendance to update meeting. AF updated prior to the meeting and a draft report circulated to all attendees with the meeting papers. Closed. All present confirmed they had received the email from Nigel Watson of the LMC regarding the Daily Telegraph article on NHS IT systems in general practice and the sharing of data. 1.5 Final PCC Terms of Reference asked for her new job title to be updated. Change to Director of Acute & Primary Care Commissioning. TM requested on paragraph 2 the and was changed to & in Bath and North East Somerset Council. PCCC noted the final approved Terms of Reference. 2. Primary Care Update 2.1 Operational Report presented the Operational Report. The following was highlighted:- Heart of Bath merger has now been re-scheduled to 1 January 2018. Delegated commissioning had gone smoothly in the first 3 months. Page 2 of 7
Meeting with NHSE is scheduled for 3 August 2017 to discuss the next transition phase and handover. The risk for delegated commissioning on the Primary Care Risk Register has now been downgraded due to a successful first 3 month transition. However, this will be kept under review. Clinical Pharmacist in General Practice the CCG is still waiting to hear the outcome of the national panel held on 21 June panel. noted an error on the Ophthalmology section of the report the dates should read 17/18 and not 16/17. Regarding GPFV Funding for 2017/18 KH asked for clarification on the 70-80 discreet initiatives within the GPFV. NH confirmed although this is a large number of initiatives they were broken down into national and regional initiatives. The NHSE team would be concentrating on local initiatives which have specific funding and access requirements e.g. improving access and care navigators. JSH raised concerns on the reporting of potential slippage in the ETTF funding for 2016/17. explained nationally there had been some slippage due to the lead in time for schemes. The CCG have asked NHSE about whether there will be any opportunity to access this slippage for schemes not in the prioritised list or to fund any improvement grants following the outcome of the six facet survey. The CCG is still waiting to hear back from NHSE, but will check if J has had a response. KH asked for clarification on what the 6 facet survey entailed. NH explained the 6 facet survey assesses practices infrastructure against six quality domains. It provides information to practices on their estates regarding use, condition and compliance. SP asked when the CCG is likely to have the final reports from the practices who received the local transformation funding during 2016/17. anticipated that the CCG should receive these during July, but would check J and Melissa Kendall. SP thanked J and Melissa Kendall for all their work on producing a thorough operational report for the committee. PCCC noted the report. 3. Commissioning & Strategy 3.1 GPFV Plan presented the GPFV Plan. explained the plan will be a living Page 3 of 7
document, updated on a regular based given developments expected at a National, STP and local level. HH asked if the CCG s primary care strategy will be written from the GPFV plan. confirmed this was intention building on the Statement of Intent (May 2016) and the roadmap for the development of community health and care services delivered by Virgin Care. A meeting has been arranged between the CCG and Virgin Care to discuss this in more detail, particularly the development of the care co-ordination centre and locality hubs and how these will interact with primary care, including the timescales for implementation.. KH acknowledged the plan was a 5 year plan but raised concerns there were a number of tbc s under the KPI s/plan Trajectories. confirmed the NHSE team (Elsa Brown and Sue Rest) were working with the CCG to support the development of the plan going forward but confirmed there was a need to firm up some timings going forward. VJ raised concerns over STP workforce streams and the need for more pace in resolving the issues such as the increase in GP and practice nurse retirements and inevitable workforce gap. VJ reiterated resilience funding was essential going forward to help in addressing skill shortages. suggested an update on CPEN to future PCOG meetings would be beneficial. TM reiterated from a comms perspective a more accessible GPFV plan document was needed to go out to the public. The Committee agreed and the comms team will work with the primary care team to develop this. RR commented the GPFV Plan was a very helpful document and highlighted some synergies between public health and primary care. RR suggested inviting J and Melissa Kendal to the public health team meetings to look at some joint primary care/public health initiatives. RR to send an invitation to J and MK. RR JSH commented the Primary Care Strategy needed to clearly set out what the CCG is doing for the community outside of hospitals. JSH supported the GPFV plan but recommended that the strategy was a more concise document with the plan supporting it. confirmed after the meeting with Virgin Care and the Board Seminar in August, the primary care team would draft a Primary Care Strategy in readiness for the next PCCC in October. 3.2 Patient and Public Engagement GP Engagement Survey TM explained that all practices had been surveyed about how the CCG engages with them. Currently there is a bimonthly GP Forum, bimonthly cluster session and a fortnightly GP bulletin. TM reported the survey closed yesterday; Wednesday 5 July. TM presented some top line results from the survey. Emerging themes were as follows:- Page 4 of 7
Issues with password protected access on the intranet for GP s Good feedback on the GP newsletter, opportunity build on this resource Careful consideration needed on the content and relevance of topics Request to reimburse/locum/salaried GPs for forum attendance Allow more time for discussion at meetings. No more meetings than already planned One or two topics at meetings, keep them focused TM reported there is also another survey currently out to the public on access to GP appointments. The results of this survey will be reported to PCOG. Your Health Your Voice Feedback SP gave an update on the Your Health Your Voice meeting held on 29 June. The agenda focused on:- Update on the development of the BaNES, Swindon and Wiltshire Sustainability & Transformation Partnerships (STP) Access to appointments survey What do you want from Primary Care? SP highlighted the main feedback from the meeting was as follows:- Patients happy to see a range of clinicians and were not concerned about having to see the same GP every time as long as they see the correct clinician for their problem/issue. No real demand for Sunday appointments with some demand for Saturday appointments, although it was noted the audience were of a more mature age. A younger audience may feedback differently. Happy to have appointments via telephone although not keen on Skype and digital technology. Again a younger audience may feedback differently. TM reported a communications plan will be developed to support the plans for improving access with an expectation that engagement activity begins in September 2017. SP noted a thank you to Alex Francis from Healthwatch for the draft report on St James Surgery. SP referred to a quote within the St James Survey report from an 87 year old lady who is now using the RUH instead of St James Surgery. to contact Ian Orpen (GP at St James) to ensure that this lady s needs are being met by the practice. Page 5 of 7
NHSE 17/18 Assessment Framework SP updated the meeting on the NHSE 2017/18 Assessment Framework for CCGs which now has two additional indicators specifically for Patient and Public Engagement outlining 10 key actions on how to embed PPE into the CCG s work. SP reported following delegation PPE is now the responsibility of the CCG and there is further information available on the new requirements in the Assessment Framework for 2017/18. reported after attending the NHSE Q1 Assurance Meeting earlier this week there are changes due later in the year to move towards a system wide quarterly assurance process. 4. Quality & Governance 4.1 Quality Report VJ presented the Quality Report. The main points raised were as follows:- Friends and Family Test (FFT) returns are currently low. HH commented she has sent out a reminder to all practices to reiterate their contractual obligation to return these responses. A reminder has also been sent out to practices via CQRS. There was one incident of MRSA in BaNES, this has now been resolved. NH commented there had been a significant event in the region and she would be sharing learning from this event with the Quality Leads across the STP. JSH commented on the small list size for some practices across BaNES. SP reported this is where mergers and federations were beginning to be considered. HH commented a small list size does not always reflect how complex the patients can be and the number of appointments a practice deals with needs to be considered. SP asked NH to chase John Trevains on providing some outstanding data for complaints and GP appraisals following on from the last meeting. NH PCCC noted the report. 5. Finance & Performance 5.1 Finance Report JF presented the Finance report giving an update on the financial position for Primary Care services as at 31 May 2017. JF confirmed following transfer of the Primary Care budgets from NHSE England to the CCG on 1 April, these budget and costs are now all held by Page 6 of 7
the CCG. JF commented a small number of system issues are still being worked through between the CCG and NHS England, but these have not affected the payments to practices. JSH commented on the rise in budget of 450K from 2016/17 to 2017/18. JF explained this was due to the PMS Review, Winter Pressures and a GP Engagement underspend. JSH requested the items excluded on the budget be shown in future so an overall budget associated with primary care can be viewed. JF to add to the budget. JF SP questioned why the INR locally commissioned service was so expensive. HH confirmed this is due to the service being contracted out to the RUH for some practices as they are unable to deliver this service themselves inhouse. PCCC noted the report. 5.2 Primary Care Risk Register presented BaNES CCG primary care risk register and confirmed two risks had been downgraded:- Delegation: Due to a positive Q1 transition. Primary Care Strategy: Implementation of GPFV Plan JSH raised the workforce risk and the potential impact on the sustainability of primary care. The Committee felt this was risk they would expect to see on the risk register. to update the risk register accordingly. PCCC noted the register. 6. Closing Business 6.1 Any Other Business TM reported the GP Patient Survey results for BaNES had just been released with a positive result of 93% of patients rating GP practices in BaNES good/very good with the national average being 85%. No other items of business were discussed. The next meeting of the Primary Care Commissioning Committee to be held in public Thursday 12 October 2017 at 2pm Centurion Hotel, Charlton Lane, Midsomer Norton, Radstock, BA3 4BD Page 7 of 7