Co-Commissioning Joint Committee Meeting Wednesday 7 th December 2pm - 4pm Sherwood Board room 1 A G E N D A

Co-Commissioning Joint Committee Meeting Wednesday 7 th December 2pm - 4pm Sherwood Board room 1 A G E N D A Item Lead Enc. Time 1. Apologies & Welcome Chair 2pm 2. Declaration of Interests Chair 3. Minutes of Previous Meeting held on 5 th October 2016 Chair CC16/01 4. Matters Arising Chair Operational 5. Primary Care Contract & Procurement Update Broughton Gate/Brooklands Development Western expansion Area Neath Hill Janine Welham CC16/02 2.10pm 6. NHSE Update Lesley Harrison CC16/03 2.15pm 7. Feedback from Risk Sharing Meeting Alexia Stenning Verbal 2.25pm Strategy 8. Delegation 9. GP Access Fund Any Other Business Alexia Stenning Rebecca Green CC16/04 CC16/05 2.35pm 2.45pm 10. All 11. TBC Date of next meeting

Agenda Item 3 - CC16/01 [ MINUTES Present: Will Perks WP MKCCG Lay Board Member Chair Dominic Cox DC Locality Director, NHS England, Midlands and East (Central Midlands) Dr Nicola Smith NS GP Chair, MK CCG Lesley Harrison LH Quality, NHSE Mike Rowlands MR MKCCG Lay Board Member Richard Alsop RA Interim Director of Transformation & Delivery, MK CCG Jill Wilkinson JWi Director of Nursing & Quality, MK CCG In attendance: Alexia Stenning AS Assistant Director Primary & Community Services, MKCCG Janine Welham JWe Primary Care Development Manager, MK CCG Alex Friend AF Primary Care Development, MKCCG Rebecca Green RG Head of Strategic Planning & Partnerships, MKCCG Kimberley Kingsley KK Quality, NHSE Edna Muraya EM Senior Finance Manager, MK CCG Alan Hancock AH Healthwatch Representative Paul Roblin PR LMC Representative Sara Godward SG Public Health Registrar Lisa Giles Kayley O Sullivan NHS England and MK CCG Co-Commissioning Joint Committee Meeting 5 October 2016 Sherwood Drive, Board Room 1 LG KOS Assistant Contract Manager, NHSE Primary Care Administrator, MK CCG (Minutes) Apologies received: Nessan Carson NC MK CCG Board Member Muriel Scott MS Public Health, Milton Keynes Council Matt Webb MW Chief Officer, MK CCG 1. Apologies Apologies were received as noted above. 2. Declaration of Interests Nicola Smith GP within Milton Keynes 3. Minutes of the Meeting 3 rd August Agreed as accurate 4. Matters Arising Matters arising from 3 August meeting 5. Primary Care Contract & Procurement Update - Rebecca Green/Janine Welham Rebecca Green circulated the Building plans for the Brookland development to the group, building is due for completion in June 2018 and is currently on track. 1 V0.3 05102016 NHS Classified Action

Agenda Item 3 - CC16/01 Registered population size for the practice is 22,500. Ground floor will be for pharmacy, café and the 1 st and 2 nd floors will be GP rooms. White House Western expansion due to complete in June 2019. Similar concept to Brooklands, population size and project plan. Janine Welham updated the committee on the Broughton Gate and Neath Hill procurements, patient engagement letters have now been sent out. It will be 30 day patient engagement period which ends on the 6 th November. Drop in sessions have been planned at both surgeries. The feedback from the engagement will then inform the service specification for both contracts. 6. NHSE General Update Lesley Harrison NHS England update September 2016.pdf Lesley Harrison presented the NHSE update. Supporting Vulnerable Practices and GP Practice Resilience Programme Five practices where offered assistance on the Supporting Vulnerable Practices Scheme. However due to the time delay on the diagnostic support some practices may now be transferred on to the GP Resilience Programme. Practices where requested to complete an expression of interest form. The CCG and NHSE had a panel where all applications where discussed and the form of support most suitable for those practices. These will now be put forward to the regional team. Lesley Harrison to update at the next meeting. Targeted Investment 7 practices applied across central Midlands, 5 went to the regional panel, 3 went to the National panel. The MK practice bid was unsuccessful as it did not meet one of the core criteria s. Lesley Harrison to feed back which core criteria the practice did not meet at the next meeting. LH GP Forward View 3 more dates have been added to the GP Forward View Conference. There has been an announcement for project management money to NHSE to bring in extra resource by January 2017 at the least. There will be a centralised team, GP Resilience Scheme will be a main focus. If MKCCG goes delegated this will not be affected as it is an NHSE scheme. The GP Access data web tool is open from Monday for GP practice until the end of October. Janine Welham asked if the CCG could access this information, Lesley Harrison to check. 7. Primary Care Access results LH Janine Welham presented the attached paper. The initial actions where agreed in 14/15 following visits carried out by NHSE. Updates have been obtained from practices along with any improvements made since January 2016 which may not be reflected within the current patient survey results. V0.3 05102016 NHS Classified 2

Agenda Item 3 - CC16/01 Agenda Item 7 - CC16.02.pdf The 5 original practices have all increased in patient satisfaction results from between 1% and 12%. Overall in Milton Keynes 11 telephone systems have improved/updated within practices. All 27 practices offer urgent and online appointment. There is a high DNA rate in MK which needs to be addressed. Janine requested the committee to note the report and also the ongoing work that is required to improve GP patient survey. 8. Enhanced Services update Alexia Stenning The enhanced services review is currently ongoing, recommendations have been presented to the CCG Managers but this still requires clinical, practice manager and LMC Input. Alexia advised ongoing discussions are still being had with the emerging federation, which will be the direction of travel and to fit with the primary care strategy and MCP model. 9. Feedback from the PMS Workshop Reinvestment for year 2 Alexia Stenning Excellent attendance from the practices and LMC were also present. Practices for year one with agreement from the LMC did a data exercise. Practices were very engaged. Suggestions for year 2 from the lists of activities over and above contract were Phlebotomy - GP generated and dressing (wound services) over 10 minutes. A locality based service would be advantageous and for the federation to run. Work to be completed to quantify the data and talk about the provisions before April. Practices are also still sending data to provide a clearer picture. Update to be given at the next meeting 10. Feedback from Risk Sharing Meeting Alexia Stenning Discussed issues about specific users. CQC were at the meeting and gave feedback on their visits and reports. Performance and complaints where also looked at. Whaddon Practice received an outstanding CQC report, this was within all four domains which is rare. MKCCG have written to congratulate them and NHSE will also be sending a letter. AS It was suggested that a press release be done for the local newspaper and to be included in the Health watch e-alert. The practice may also be attending a national event to present. 11. Primary Care Strategy Alexia presented the group a PowerPoint presentation. Primary Care Strategy for Milton Key The strategy at the moment is very draft. Patient involvement is necessary, hub V0.3 05102016 NHS Classified 3

development and federation needs to align with the Health & Wellbeing strategy and commissioner vision. Luton is a pilot of Primary Care at home through the STP work stream. Articulate a strategy that primary care can feed to the younger generation that can deliver services within tight finances. Rebecca Green will lead on this piece of work and once it has been written will start to socialise it to gain opinions from stakeholders through different meetings such as PLT, QPT, Neighbourhood etc. Alexia Stenning has already discussed the strategy at the Stroke Association Conference. Agenda Item 3 - CC16/01 Logical next step is to develop and plan a timeline for committee members. AS/RG 12. Delegation Alexia Stenning Alexia advised the committee that Commissioning Delivery Group and MKCCG Board have approved this report and recommendation to proceed with member practice engagement and voting to move to delegated commissioning from April 2017. Application needs to be made by 1 st December 2016 to NHSE. Alexia to speak to Chiltern CCG to gain information from their experiences from areas of engagement and to keep links with Graham Jackson and Lou Pattten. AS It was noted that if two out of the three CCGs become delegated this could be tricky as part of the STP footprint. There are 7 CCGs in Central Midlands that are now fully delegated Kimberley Kinglsey to share their details with Alexia. 13. Estates, Technology & Transformation Fund Update Janine Welham to email an update due to time limitations of discussions within todays meeting. 14. GPAF Janine Welham JWe A letter from NHSE has been received to advise that the CCG will be liable for commissioning the service as from 1 st April 2017. It was agreed that an extra ordinary meeting would be held in November. To discuss different options for procurement and commissioning of the service. JWe/KO S 15. AOB Extraordinary Meeting needs to be arranged for November to discuss the Primary Care Strategy and Delegation 16. Dates of next meeting All meetings to be held at Sherwood Place 7 th December 2pm 4pm, Boardroom 1 Action Log 1. Targeted Investment LH to feedback why the practice didn t meet one of the core LH criteria s 2. The GP Access data web tool is open LH to check CCG s access LH 3. Feedback from the PMS Workshop Reinvestment for year 2 Update to be given AS at next meeting 4. Primary Care Strategy - Logical next step is to develop and plan a timeline for committee members. AS/RG V0.3 05102016 NHS Classified 4

Agenda Item 3 - CC16/01 5. Delegation AS to speak to Chiltern CCG AS 6. Estates, Technology & Transformation Fund Update - JWe to email an update due JWe to time limitations of discussions 7. Extraordinary Meeting needs to be arranged for November to discuss the GP Access Fund. JWe/KO S V0.3 05102016 NHS Classified 5

Agenda Item 5 - CC16/02 Subject: Meeting: Broughton Gate / Neath Hill Procurement Updates Co-Commissioning Joint Committee Date of Meeting: 7 December 2016 Report of: Janine Welham, Primary Care Development Manager 1. Summary The purpose of this paper is to inform the Co-Commissioning Joint Committee of the timeline and progression of both the Broughton Gate Practice and Neath Hill Health Centre Alternative Provider Medical Services (APMS) procurements. 2. Current Situation The current provider of Broughton Gate Practice is The Practice PLC the contract commenced on 13 November 2009 for a five-year period; this has since been extended until 31 March 2017. The walk in element of the contract following a public consultation will cease as from 31 January 2017 and just the registered GP element will be re-procured. Neath Hill Health Centre is currently under a caretaker arrangement with Stony Medical Centre under a one year APMS contract which is due to expire on the 31 March 2017. It was agreed that both procurements will be done at the same time and bidders can bid for either lots or just the one. 3. Patient Engagement A 30 day patient engagement has been carried out for both surgeries, along with drop in sessions, a patient survey sent to all registered households on areas that are important for patients and any new services they would like to see introduced at the surgery. The service specifications will reflect the outcome from the patient survey. 4. Evaluation Panel The evaluation panel will consist of staff from both NHS England and Milton Keynes Clinical Commissioning Group along with patient representatives from both surgeries.

Agenda Item 5 - CC16/02 5. Timelines Task Start Date End Date Patient Engagement period (30 days) 05/10/2016 10/11/2016 completed PIN-OJEU and Contracts Finder 17/10/2016 Procurement Contract Notice/Opportunity Listing OJEU & 07/11/2016 14/12/2016 Contracts Finder ITT period (30 Calendar Days) 14/11/2016 14/12/2016 ITT Bidder Clarification Question period 14/11/2016 07/12/2016 Clarification deadline (from Bidders) (10am) 02/12/2016 ITT Closes (12noon) 14/12/2016 ITT evaluations 14/12/2016 16/12/2016 Clarification period bidders to respond to 14/12/2016 19/12/2016 clarification questions Evaluators re-score clarification responses - 14/12/2016 19/12/2016 update AWARD Pre Moderation 16/12/2016 16/12/2016 Moderation (Face to Face or Via WebEx) 19/12/2016 19/12/2016 Bidder Clarification Interviews (If required) 20/12/2016 20/12/2016 Tender award report identifying Preferred Bidder 21/12/2016 21/12/2016 NHS England sign off and approval of Preferred 04/01/2017 Bidder at NHS England PCCP Governance Board Award Approval Commercial Executive Group (as per SFI s 13.3.3) Paper s to NHSE Board (1 st Thursday of month) 05/01/2017 Meeting Scheduled (2 nd Thursday of month) 13/01/2017 Publish Outcome letters 20/01/2017 Standstill period (10 Cal) midnight 23/01/2017 01/02/2017 Contract Finalisation 06/02/2017 10/02/2017 Mobilisation Mobilisation Period 13/02/2017 31/03/2017 Service Commencement 01/04/2017 6. Recommendation To note contents of the report, timelines and progress of the procurement to date. An update will be brought back to the next Co-Commissioning Joint Committee to inform the members of the successful bidders for both procurements.

Agenda Item 6 - CC16/03 Primary Care Co-Commissioning Joint Committee 7 th December 2016 Title: NHS England update Author: Lisa Giles, Primary Care Assistant Contract Manager Number: PCCJC-15-XX Executive Director: Dominic Cox, Locality Director Central Primary Care Co-Commissioning Joint Committee - Action Required For Approval / Decision For Review For Assurance To Receive Update Executive Summary General Updates Practice List Closure Red House Surgery had informally closed their list but has now notified that with effect from 1 st December 2016 the list would reopen. Targeted Investment in Recruiting Returning Doctors Update: 1 practice had been successful Supporting Vulnerable Practices (SVP) Update: Currently there is 1 practice in Milton Keynes CCG on the SVP scheme who are currently awaiting a diagnostic visit. Practices in other regions who have undertaken a diagnostic visit or who have expressed an interest in the programme have been working jointly with other practices facilitated by their LMC. General Practice Resilience Programme All practices were invited to complete a self-referral questionnaire by the 7 th October 2016. All selfreferrals along with referrals from the CCG /LMC were assessed by a panel on 30th September and prioritised for either support, reserve or not included in this first cohort. 6 self-referrals were received from Milton Keynes, 2 of which were supported and one was placed on a reserved list. 95 applications were received in total across Central Midlands, this included Milton Keynes.

Agenda Item 6 - CC16/03 Support to practices will be conditional on matched commitment from practices, evidenced through an agreed action plan which will need to include clear milestones for exiting support. Practices will not be required to match fund the support. By the end of December NHSE Central Midlands is required to confirm how the investment is to support general practice through the GPRP. General Practice Forward View Project Management resource for the oversight, management and implementation of the NHSE initiatives within the GPFV has been identified nationally. A project team to provide support for Central Midlands is being established with all posts in place by the end of January 2017 latest. CCGs are to submit a GPFV plan by the 23 rd December 2016. Discussions are ongoing to ensure that the CCG GPFV plan and the GPFV submission in the NHS Central Midlands Direct Commissioning plan align. Updates from Regional Bulletins October Improvement and Assessment Framework: Conflicts of interest indicator (Publications Gateway Ref No: 05787) As part of the CCG Improvement and Assessment Framework, CCGs are required to submit quarterly and annual self-certification returns to demonstrate compliance with the requirements of the revised statutory guidance on managing conflicts of interest for CCGs. Update on Progress Against General Practice Forward View Commitments (Publications Gateway Reference No. 05943) NHS England has published an update setting out the latest measures it is implementing to help general practice cope with increasing demand - boosting GP numbers and tackling burnout as part of the General Practice Forward View. A nationwide, 19.5m NHS GP Health service will be introduced in January 2017, aimed at improving access to mental health support for general practitioners and trainee GPs while the Induction and Refresher scheme will be revamped to speed up the time it takes for GPs to return to practice in England. Contact for further information: For I&R please contact: england.primarycareworkforce@nhs.net and for GP Health Service please contact: england.primarycareops@nhs.net November Integrated IAPT Early Implementers Improving Access to Psychological Therapies (Publications Gateway Reference No. 05948) On 19th October 2016, NHS England announced the locations of wave one of the new Integrated IAPT Early Implementers across England. These sites will be supported by additional funding to develop psychological therapies services within long term condition care pathways including

Agenda Item 6 - CC16/03 services for people with diabetes, respiratory, cardiac and medically unexplained conditions. Evidence shows that providing mental health support in tandem with physical health care improves both the outcomes and experiences of patients and carries long term cost savings for the NHS. Updated statutory guidance for CCGs (Publications Gateway Reference No. 06052) NHS England has updated published statutory guidance on constitution change, merger or dissolution. This document supersedes guidance published in October 2015 and outlines the process whereby a CCG can apply to NHS England to make changes to its constitution, and to dissolve or merge two or more CCGs. This guidance has been revised to provide CCGs with a set of clear criteria when considering mergers. NHS Standard Contract for 2017/18-2018/19 publication of documents (Publications Gateway Reference Numbers below) (Publications Gateway Reference No. 06036-06043) The NHS Standard Contract 2017/18/-2018/19 (full length and shorter-form versions) have now been published in final form on the NHS Standard Contract 2017/18 web page. Quality Premium 17-19 Guidance (Publications Gateway Ref No: 05988) The Planning Guidance Annex B Information on the Quality Premium - has been updated to replace the summary level indicator detail with a full technical specification for the national indicators. This revised document now becomes the Final Quality Premium Guidance document for 2017-19, and this is available via the Quality Premium webpage. The Quality Premium scheme is a similar structure to previous years, made up of 5 national indicators, 1 locally selected indicator and gateway tests focussing on Constitutional Standards, Quality and Finance. The scheme requires Regional Teams and CCGS to agree a locally selected indicator from the RightCare Commissioning for Value Packs, and also to select a Mental Health indicator from a menu. These choices will be collected early in 2017 via Unify, and guidance for this will be issued via Unify ahead of the collection. Contact Name and email address for any queries: ENGLAND.qualitypremium@nhs.net Recommendations The Committee is asked to note the update

Agenda Item 8 - CC16/04 Subject: Meeting: Delegation Co-Commissioning Joint Committee Date of Meeting: 7 December 2016 Report of: Alexia Stenning, Assistant Director of Primary Care and Community Services 1. SUMMARY The purpose of this paper is to inform the Co-Commissioning Joint Committee of the outcome of the vote for delegated commissioning by our member practices across Milton Keynes. 2. RECOMMENDATION The Co Commissioning Joint Committee is asked to note and agree the following: The strong support from member practices for commissioning in primary care to be delivered by NHS Milton Keynes CCG. Confirmation of the commitment to Milton Keynes CCG taking on delegated commissioning. Support the application process to meet the NHSE deadline. Recognise and support the need to appropriately resource the function of delegation, request executives to agree and confirm arrangements and report back to the Co Commissioning Joint Committee in February 2016.

Agenda Item 8 - CC16/04 Subject: Meeting: Delegated Commissioning Update Co Commissioning Joint Committee Date of Meeting: 7 December 2016 Report of: Alexia Stenning Assistant Director Primary and Community Services 1. Summary The purpose of this paper is to inform the Co-Commissioning Joint Committee of the outcome of the vote for delegated commissioning by our member practices across Milton Keynes. 2. Current Situation Milton Keynes Clinical Commissioning Group (MKCCG) considered the option to move to delegated arrangements from April 2017; this was endorsed by our CCG Board in September. The Primary Care Team undertook engagement with our member practices, as the move to delegated commissioning is subject to member practices agreement. A vote was taken by our practices during November. Each practice had 1 vote per practice and the results are as follows: 25 practices voted for commissioning in primary care to be delivered by NHS Milton Keynes CCG 1 practice voted for NHS England to continue to commission primary care 1 practice abstained from voting. Therefore our member practices have voted overwhelmingly for delegated commissioning, and have shown their strong support. 3. Next Steps As set out in national guidance, those CCGs where member practices have voted in favour of moving to delegated commissioning, will be required to work with NHS England (Central Midlands) to complete and jointly submit the formal application checklist and finance template for delegated budgets. This will require sign off by the CCG Accountable Officers and Elliot Howard-Jones, Central Midlands, Director of Commissioning Operations. The timescale for submission of applications is 5 December 2016 Following submission of CCG applications they will be centrally reviewed by NHS England as part of their short approvals process. CCGs will be informed of the outcome by early January 2017.

Agenda Item 8 - CC16/04 If approved the CCGs and NHS England (Central Midlands) would enter into a joint delegation agreement which has been developed nationally to ensure consistency. The delegation agreement provides the operational details on how the parties to the delegation will operate. Below details the high level priorities for MKCCG, to ensure successful delivery of Primary Care Commissioning across Milton Keynes and meets the requirements associated with full delegation in 2017: Working through the specific requirements for a move to full delegation from 2017. Submission and application process to NHS England. Review of staffing arrangements and recommendations on resourcing these. Development of the 'Primary Care Committee' as part of the requirements for delegated commissioning. Financial Development - managing the risk within the framework of moving to delegated commissioning. Development of the governance arrangements to support fully delegated commissioning. Reviewing capacity and resources to ensure that there is sufficient capacity, resources and skills to take on delegated commissioning including contract management, payment authorisation etc. Development of a comprehensive Communication and Engagement Plan. To provide a forum for specific discussion/decisions that are required i.e. practice closures, GP retirements. Developing the future quality performance indicators for Primary Care. 4. Timelines MKCCG s action plan and timescales on the process of moving to delegated arrangements from April 2017: Aim Objective Timescales for commencement Enter into early discussions with NHS England (Central Midlands) To understand the resources potentially available to MKCCG including staffing, procurement, complaints, legal and financial costs. September 2016 ongoing To progress with named individuals for due diligence processes for moving to delegated arrangements. To explore staffing arrangements to appropriately resource the function of delegation. November 2016 to March 2017 November 2016 to March 2017

Agenda Item 8 - CC16/04 Establish a stakeholder task and finish group of clinical and non-clinical staff including LMC representation Clinical engagement with MKCCG member practices Co-Commissioning Joint Committee Decision making process Co-Commissioning Joint Committee To determine and promote the benefits and opportunities of delegated commissioning To ensure delivery of the high level priorities to ensure successful delivery of Primary Care Commissioning in Milton Keynes and meet the requirements associated with full delegation Help member practices understand what joint and delegated commissioning (pros and cons) will mean for them. Understanding both as members of MKCCG as well as providers of primary care medical services Progress report to the committee including MKCCG due diligence checks for delegated commissioning Give member practices an opportunity to vote on whether to move to delegated or remain in joint arrangements. Inform member practices of the outcome, next steps and keep updated over forthcoming months Inform the Chair and members of the Committee of member practices vote Update the Co Commissioning Joint Committee on progress to delegation May need to agree an extraordinary meeting to ensure September 2016 Ongoing September 2016 - Ongoing September 2016 November 2016 COMPLETE October 2016 Ongoing November 2016 COMPLETE December 2016 November 2016 December 2016 Ongoing

Agenda Item 8 - CC16/04 MKCCG complies with NHSE requirements to review governance arrangements including joint constitutional arrangements 5. Recommendations The Co Commissioning Joint Committee is asked to note and agree the following: The strong support from member practices for commissioning in primary care to be delivered by NHS Milton Keynes CCG. Confirmation of the commitment to Milton Keynes CCG taking on delegated commissioning. Support the application process to meet the NHSE deadline. Recognise and support the need to appropriately resource the function of delegation, request executives to agree and confirm arrangements and report back to the Co Commissioning Joint Committee in February 2016.

Agenda Item 9 - CC16/05 Subject: Meeting: GP Access Fund Milton Keynes Co-Commissioning Joint Committee Date of Meeting: 7 December 2016 Report of: Rebecca Green, Joint Head of Strategic Planning 1. SUMMARY This paper highlights the steps that Milton Keynes Clinical Commissioning Group (MKCCG) will need to take to secure the future of the GP Access Fund Milton Keynes from when it transfers into the responsibility of the CCG as from 1 st April 2017. A full procurement process will need to be undertaken and the Co-Commissioning Joint Committee members are asked to note the short timescale available and the resultant risks that arise. 2. RECOMMENDATION The Co-Commissioning Joint Committee members are asked to note report. For members to discuss the content and note the short timescale available. For members to support the outlined procurement process and the highlighted risks. Page 1 of 1

Agenda Item 9 - CC16/05 The Prime Minister s GP Access Fund 2017/18 1. Introduction This paper highlights the steps the CCG will need to take to secure the future of the GP Access Fund from when it transfers into the responsibility of the CCG from 1 st April 2017. As a full procurement process will need to be taken the Co-Commissioning Joint Committee members are asked to note the short timescale available and the resultant risks that arise. 2. Background & Context Formerly known as the Prime Minister s Challenge Fund, the GP Access Fund Milton Keynes (GPAF MK) is an NHS England funded programme to pilot new ways of working to increase capacity in and improve access to primary care services. The scheme commenced in April 2015 when Milton Keynes was awarded funding from wave two of the Prime Minister s Challenge Fund (now known as the GP Access Fund GPAF) to deliver a pilot based on 4 key areas; 1. Improved access to general practice 2. Extra support to improve pathways for children and young people 3. Strengthened support to complex patients 4. Fostering development of the GP collaboration Funding for the GP Access Fund (GPAF) has to date been provided through NHS England at an annual budget of 6.00 per head for the programme members registered population; for GPAF (MK) this gives an annual budget for 2016/17 of 1,428,000. The NHS Operational & Planning Contractual Guidance 2017/18 confirms funding for next 2 years stating that CCGs should plan to receive 6 per weighted patient for each of these sites in 2017/18 and 6 per weighted patient in 2018/19. 2.1 The successes of the GPAF pilot scheme so far Improved access to general practice and fostering development of the GP collaboration 235,577 (Source: List size data at October 2015) of the patient population in MK have access to the extended access primary care service. 10,182 additional GP and phlebotomy appointments have been provided in extended hours between 21st September 2015 and 12th June 2016. Since January 2016 (when the service went live for all 22 collaboration practices) the programme as a whole has maintained activity at 73% of the bid target of 34,000 appointments per annum (this includes children and rapid response appointments). Patient satisfaction with extended access is high - 84.8% of users would be likely or extremely likely to recommend the service to their friends or family. 83% of staff surveyed from participating hubs and practices felt that the service has helped improve access to their practices and 56% that it had reduced waiting times. The rollout of SystmOne and the two way information sharing agreements have bought a step change in patient record sharing across general practice in Milton Keynes, allowing practices to book appointments between themselves and share healthcare records. They book patients into a Central SystmOne GP Unit and patient records are shared to that unit with patient consent. GP leadership has been strengthened - the collaboration board has developed leadership to the pilot programme and is now leading a local General Practice 1

Agenda Item 9 - CC16/05 partnership. It is seeking to form a partnership with an existing MK primary care confederation. Extra support to improve pathways for children and young people An expert team of highly skilled nurses have been recruited. The service is currently offering 146 face to face contacts per week (week beginning 13 June) and has already helped more than 900 families. 95.4% of parents would recommend this service to friends and family with 96.7% saying they would use this service again. Referrals from GPs have increased and are now up to 50-60 per week. Feedback from the first Health Promotion session delivered the team was positive from parents who felt supported by the team during the session. Dr Chana, Paediatric Consultant in the hospital has called the work of the team highly inspiring and highly commendable. Strengthened support to complex patients (Rapid response) A pharmacy Technician has provided a medicines optimisation service to a number of frail, vulnerable patients who are at risk of admission to hospital as a result of medication issues. During the 18-week pilot 60 referrals were made, these resulted in 41 home visits. There has been positive service user feedback which indicates this type of service is highly valued. Six possible or likely hospital admissions have been avoided (based on Croydon Admission Avoidance Tool). However, at this stage the service has not shown any cost benefit and a new revised model now needs to be considered. 3. Potential Developments to Scheme Delivery In the future, it is critical that the services delivered by the GPAF provide services of added value over and above those that might be reasonably expected from core general practice and which demonstrate value to the health system from general practice working at scale. This is the key to future, sustained investment in GPAF by the CCG. The children s service described above is a good example of the added value services we will want to procure in the future. Others could include, for example; In- hours home visiting service Care Home visiting service Extended length assessment consultations for a range of more time intensive conditions including mental health MSK telephone based advice service staffed by Physiotherapists providing verbal and written advice or arrange an appointment to see a physiotherapist face to face where necessary Telephone and/or face to face based support and assessment for patients who access health services on a higher than average basis Any development and redefinition of the service will need to ensure the 2017/18 national core requirements are still met. These requirements include the requirement to commission a minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population. 2

Agenda Item 9 - CC16/05 4. Procurement When NHS England signalled the devolvement of the GPAF to the CCG from April 2017, the CCG looked initially for agreement to roll forward the contract further, working with the current provider to deliver efficiency and quality improvement. However following determination from NHS England is has been confirmed that due to the pilot nature of the current contract this will not be possible and therefore an open market tender process commencing in Autumn/Winter 2016/17 will need to be undertaken. Whilst an open market tender would satisfy concerns about competition and procurement best practice, in reality it will necessitate the procurement of essentially as is services for 2017/18, given the restrictive timescale. As a result, the CCG will want to offer a contract for services with as much flexibility built in to enable the new providers to further develop the services to deliver greater value to the health system in the longer term. 5. Conclusions It is frustrating that the CCG needs to procure the GPAF contract before the end of the pilot phase and before full evaluation has been carried out and the long term configuration of the scheme has been established. Procurement processes are time and cost intensive for all parties and carry an increased risk of destabilising the current service provision. By extending the current contract for a period of 12 months there would have been be the opportunity to develop a comprehensive service specification for a scheme that fully meets the local requirements. The risks of destabilising services and partnership working across Milton Keynes in pursuance of a new contract from April 2017 are significant. In addition the staffing capacity required to undertake a procurement process within such a short period of notice should not be underestimated. 3