Primary Care Commissioning Committee

Tuesday 27 October 2020, 3.15 pm – 4 pm Microsoft Teams video-conference

Agenda

No Timing Item Papers Presenter

1 Welcome and Apologies for Absence - Chair

2 Confirmation of Quoracy - Chair

3 Declarations of Interest Enc Chair

4 Draft Minutes of Previous Meeting – 29 September 2020 Enc Chair

5 Action Log – no outstanding actions Chair

6 3.20 2020/21 Primary Care Co-Commissioning Budget Enc Jill McGrath

7 3.35 Primary Care Assurance Framework Update Enc Dominic Slowie

8 3.45 Any Other Business - All

Date and time of next meeting: Tuesday 24 November 2020

Declaration of Interest Register 2020/21

EMPLOYEES: Declaration completed by employees

Fina

ncia

l Int

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Non

-Fin

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Prof

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onal

Inte

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Non

-Fin

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Nor

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G Jo

int

Com

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Staf

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Clin

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Lea

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Dri

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Hos

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Dec

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Cairns JackieDirector for Newcastle

SystemSelf Nothing to declare Y Y Y Y Y 08.07.19 No change for 2019/20

Corrigan Joe Chief Finance Officer SelfSibling is GP whose

practice is a member of CCG

NoWill declare in meetings

where relevantY Y Y Y Y Y 05.07.19 No change for 2019/20

self Gateshead Council Yes Direct Senior Officer ongoingWill declare if needed at

meetingsY

spouse NHS England Yes Indirect employee ongoingWill declare if needed at

meetingsY

SelfCare Quality

CommissionerNo

Member of CQC Inspection Team

01.04.17 Ongoing Y Y Y Y Y Y 19.06.2020Updated to reflect

medical examiner role

Self Medical Examiner YesMedical Examiner,

Northumbria FT01.06.2020 Ongoing Y Y Y Y Y Y 19.06.2020

Updated to refelct medical examiner role

Dodds PhilippaPortfolio Manager -

Primary Care DeliverySelf Nothing to declare Y Y 23.09.20

Updated to add PCCC attendance

Gertig PaulLay governing body

memberdaughter Indirect

My Eldest daughter is on the GP core

training programme in our area. Her 1st 6 months is with a GP

practice in Gateshead

Aug-19 Aug-22

I will declare at meetings as required and comply

with the standards of buisness conduct and

declarations of interest policy.

Y Y Y Y Y 24/09/19 Updated

Goode Rosalind CCG Employee PartnerNorth of England Commissioning Support Unit (NECSU)

NoNon Financial Professional

Interests

Non Financial Personal Interests

IndirectBusiness Process Automation Lead 01.06.20 No conflict Y Y 14.09.20 Added

SelfNorthumberland CCG - providing governnace support and advice

N Y N Direct

Northumberland CCG - providing governnace support and advice

01.07.2020 OngoingI will declare at meetings

as required. Y Y Y Y Y Y Y Y 01.07.20

Updated to reflect N'land CCG role and wife's role at NCC.

SpouseNorthumberland County Council

N N N Indirect

Northumberland County Council - Assistant Director for Policy

01.07.2020 OngoingI will declare at meetings

as required. Y Y Y Y Y Y Y Y 01.07.20

Updated to reflect N'land CCG role and wife's role at NCC.

Newcastle YMCA. The YMCA hold public

health funding for anti-obesity programme.

Yes Directchief Executive

Officeron-going

will declare at meetings if necessary

Y Y Y Y

BillSecondary Care

Clinician

Hawkins NeilHead of Corporate

Affairs

Cunliffe

Com

men

ts

No change for 2019/20

Committees

08.07.19

Declared interest- (name of organisation and nature of business)

Is the interest direct or indirect?

Type of Interest

John

Gateshead HWB representative on

Primary Care Commissioning

Committee

Hurst

Surname

DECISION MAKERS: Declarations completed by Governing Body; members of Governing Body committees; staff grade 8d and above; joint committee members; members of advisory groups which contribute to direct or delegated decision making on the commissioning or provision of tax payer services

Dat

e Co

mpl

eted

14/02/19

Nature of Interest Action Taken

Date of Interest

ForenameCurrent Position(s) in

CCGDOI/Status

Costello

JeffLay Member and

Deputy ChairRemoved Rem ComSelf

Personal friend with Dr D Howarth and family,

Senior Partner, Denton Turret Medical Group. Friendship started 10

years ago.

No No Yes IndirectClose Personal

friendship dating back 10 years.

On-goingwill declare at meetings if

necessaryY Y Y Y

McGrath Jillian Head of Finance spouseWorks for North East Ambulance Service

No Yes Yes Indirectemployed in

organsiation which the CCG contracts

Pre-dates CCG present no conflict Y Y Y Y 05.07.19Updated - Details of

director CBC

Self

Association of Directors of Public Health - Board Member and Honorary

Treasurer

Yes Yes No Sessional payments 2006 PresentUnlikely to be a conflict - will declare as necessary

Y Y

SelfAdvisory Committee on

Resource AllocatiotnNo Yes No

Advisory Committee Board Member

2017 Present No conflct Y Y

Self Newcastle University No Yes No

Academic honorary status (and Vice-Chair

of FUSE strategy board)

1999 PresentUnlikely to be a conflict - will declare as necessary

Y Y

Wife

Queen Elizabeth Hospital Gateshead /

City Hospitals Sunderland

IndirectConsultant

Histopathologist1997 Present

Will declare at meetings as required Y Y

Self

Operating Theatre. Takes commissions for

plays on health themes for a number of

professional, student and general audiences

No Yes Yes Direct Trustee OngoingI will declare at meetings

as requiredY Y Y Y Y Y

Self

WeCan Enable. A Hexham based charity,

that receives some funding from

Northumberland County Council and

raises funds

No Yes Yes DirectTrustee/Board

MemberOngoing

I will declare at meetings as required

Y Y Y Y Y Y

SelfSessional GP at Bridges

Medical PracticeYes No No Direct

Sessional GP, no permanent or

business influencing role in the practice

OngoingI will declare at meetings

as requiredY Y Y Y Y Y

SelfBritish Academy of

Childhood DisabilityNo Yes Yes Direct GP representative Ongoing

I will declare at meetings as required

Y Y Y Y Y Y

self

GP partner Park Medical Group -

member f NGPS (GP federation)

Yes No No DirectGP profit sharing partner fulltime

whole period Y Y Y Y

selfmember of NGPS (GP

federation)Yes No No Direct

Park Medcial group shares in the output of the federation but

has no board membership

whole period Y Y Y Y

Wilkins RachelPrimary Care

Commissioning Committee attendee

Self

Healthwatch Newcastle and Gateshead (Tell us

North CIC), engagement and

Yes Yes No IndirectProject Manager

(employee)11/07/2019 to date

Will be declared at meetings as necessary

Y 11.07.19 Added

Wilson LynnDirector for Gateshead

Systemself

Foster Carer Durham Council

indirect Nov-13 current No conflict Y Y Y Y Y 08.08.19 No change for 2019/20

Be Wellbeing (providing training and

wellbeing services, subsidiary of Tyneside and Northumberland

Mind)

Yes Direct Director 2019 OngoingWill declare at meetings

as appropriateY Y Y Y Y

Northumbria University Yes Direct Employee 2019 OngoingWill declare at meetings

as appropriateY Y Y Y Y

Summers Steve

urgent care cincial lead- attends Exec CMT and a

range of local and regional urgent care

meetings - co-chairing regional operational

board

Wood

No change for 2019/2027.08.19

Oliver Lay Member Self 23.09.20Updated to add PCCC

responsibility

Slowie Dominic Medical Director

16.10.2019

Hurst 14/02/19

Milne Eugene

Newcastle Wellbeing for Life Board

representative on Joint Commissioning

JeffLay Member and

Deputy Chair

Removed lines - no longer has an

involvement with NICE or the Journal of Public

Health

17.12.19

Removed Rem ComSelf

Think Ahead (Charity training mental health

social workers)Yes Direct Employee 2019 Ongoing

Will declare at meetings as appropriate

Y Y Y Y Y

Northen Youth Theatre Project

Yes Direct Trustee/Director 2019 OngoingWill declare at meetings

as appropriateY Y Y Y Y

Date decision maker register last published -

16/10/2019

Wood Oliver Lay Member Self 23.09.20Updated to add PCCC

responsibility

Page 1 of 4

D R A F T

Minutes of a meeting of the Primary Care Commissioning Committee

Tuesday 29 September 2020

Due to Covid-19, the PCCC met via a video conference Present:

Members: Mr Jeff Hurst Lay Member (Chair) Ms Jackie Cairns Director of Newcastle System (items 1 – 9) Dr Bill Cunliffe Secondary Care Clinician Ms Jill McGrath Head of Finance Dr Dominic Slowie Medical Director Dr Steve Summers GP Clinical Director Dr Lynn Wilson Director of Gateshead System (items 1 – 7) Mr Oliver Wood Lay Member In attendance:

Mr John Costello Gateshead Health and Wellbeing Board Ms Philippa Dodds Portfolio Manager – Primary Care Delivery Ms Ros Goode Primary Care Project Lead Ms Caroline Kavanagh PMO Manager (item 6 only) Ms Jennifer Long NHS England Ms Michelle Stamp Newcastle Wellbeing for Life Board Ms Rachel Wilkins Healthwatch Newcastle Gateshead Ms Sue Tulloch PA Support

09/20 01 Welcome and Apologies for Absence

There were no apologies from members. Apologies received (in attendance) from Prof Eugene Milne (Newcastle

Wellbeing for Life Board).

09/20 02 Confirmation of Quoracy

The Committee was confirmed as quorate.

09/20 03 Declarations of Interest

Declarations of interest documentation had been circulated with the agenda. There were no further declarations of interest relating to items on the agenda.

Page 2 of 4

09/20 04 Draft Minutes of the Previous Meeting held on 28 July 2020

The minutes of the previous meeting were agreed as an accurate record.

09/20 05 Action Log There were no outstanding actions. 09/20 06 Care Home DES+ Specification

The PCN Direct Enhanced Service (DES) has a requirement for PCNs to implement the Enhanced Health in Care Homes Framework. Caroline Kavanagh presented the Enhanced Health in Care Homes DES+ Specification which had been approved by the CCG Executive Committee on 15 September 2020. The specification, which replaces the CCG Care Home Local Enhanced Service (LES), has been developed with a wide-ranging collaborative design approach. Highlighted in the specification are the national DES requirements and the local additions warranting extra funding.

Jackie Cairns expressed her thanks to Caroline and Michelle Crawford for

coordinating this complex piece of work. There had been some concern at the outset about the additionality and how this would fit within the overall system response to care homes. They had successfully gained wide engagement giving all those involved an opportunity to have a voice and the outcome is some excellent ways of working that fit with the wider system.

The Committtee received the report for information noting the considerable work involved in developing the specification.

09/20 07 PCCC Terms of Reference Annual Review Neil Hawkins presented the review of the terms of reference for approval with

no changes proposed. Highlighted was the imminent retirement of Dr Steve Summers leaving a vacancy on the Committee for a GP Clinical Director and the challenge there may be for a replacement with limited Clinical Director availability.

The Committee’s comments included:

• To have clinically-led Primary Care services, the Committee needs experienced primary care clinicians to provide advice and guidance and bring their knowledge, skills and experience to discussions.

• Steve Summers involvement in discussions has been valuable in

providing input for more robust decision-making with insightful and grounded points on the reality of situations.

Page 3 of 4

• Without a GP Clinical Director, should the Medical Director be absent from Committee, there would be no primary care clinical representation.

• Consideration of shadow appointments as well as substantive

appointments to retain continuity. • On occasions of conflict of interest for one clinical director, the need for

another clinician to provide primary care guidance in decision-making. • Steve Summers indicated he is willing to be available for Committee

meetings in the short term for continuity and handover. The Committee unanimously agreed to approve the terms of reference and therefore retain the current membership and pursue a replacement for the vacant GP Clinical Director post.

09/20 08 Risk Register Report

Neil Hawkins presented the summary of the primary care risk profile as at 9

September 2020. Four main risks were highlighted relating to: the sustainability of primary

care; optimal utilisation of estates; implementation of Primary Care Networks (PCNs); and robust management and assurance of primary care commissioning arrangements by the PCCC.

It was reported that one ‘Extreme’ risk (implementation of PCNs) had been

reduced to ‘High’ following management of short term impacts earlier in the year relating to Covid-19.

There were no further comments regarding the register and the report was

received and noted for information. 09/20 09 PCN Extended Hours Q1 2020/21 Assurance

Philippa Dodds presented the report providing Quarter 1 assurance regarding Extended Hours at PCN level.

A report to the July 2020 Private PCCC meeting, summarising the review of PCN Extended Hours, highlighted a query with one PCN showing a much lower provision than others in quarter 4 (around the time of suspension due to Covid-19). This has now been clarified with sight of the paperwork showing the PCN at a similar level to others.

The CCG extended the suspension of provision of Extended Hours into Q1 2020-21 but asked PCNs to report on what they had achieved and this is outlined in the report. PCNs have been asked to begin Extended Hours provision again for Q2 2020-2021.

Page 4 of 4

Jenny Long stated that the NHS England position was that the Extended Hours DES was not stood down during the Covid-19 period and it was the CCG’s decision regarding payment during this time.

The Committee noted the report for information.

09/20 10 Any Other Business With virtual meetings in place, the public are invited via social media to put

forward questions to the Committee relating to items on the agenda. It was noted that no questions had been received on this occasion.

There was no further business.

1

Purpose (click one box only) Decision ☐ Information ☒

Classification

(delete as appropriate) Official

Meeting Primary Care Commissioning Committee

Date 27 October 2020 Agenda Item 6

Report Title 2020/21 Primary Care Co-Commissioning Budget

Lead Director & Report Author

Director: Joe Corrigan Title : Chief Finance and Operating Officer

Author: Jill McGrath & Gillian Wood Title: Head of Finance & Locality Finance Manager

Synopsis This report outlines the financial position for the Primary Care Co-Commissioning Budget for the year to date Month 6 2020/21.

Implications and Risks As disclosed in report

Recommendation

The CCG Primary Care Commissioning Committee is asked to: • note the year to date costs against budget for the six months to

September 2020, • note the changes to the financial framework and allocations for Months

7-12 2020/21, and • note the potential risks and mitigations outlined in the report.

Benefits to patients & the public / link to strategic objectives

Outlines the performance against budget year to date to support sustainable commissioning plans for primary care. Achievement of financial balance and commissioning of services within the primary care funding allocation.

Resource implications (finance; HR)

Total application of CCG primary care commissioning budgets

Legal / equality & diversity / sustainability implications

N/A

Report history N/A

2

Next steps Financial performance will be monitored against budget in year and reported to the Primary Care Committee on a quarterly basis.

Appendices N/A

Submission checklist – to be completed by author ahead of inclusion on meeting agenda

Has the paper been cleared by the lead Director? Yes ☒ No ☐

Does the covering paper clearly state what the Committee are asked to do – i.e. clear recommendations?

Yes ☒ No ☐

Have the CCG finance team been consulted about any resource implications? Yes ☒ No ☐ N/A ☐

Person(s) consulted: Jill McGrath & Gillian Wood

Are there any wider implications that require consideration – HR, contracting, procurement, etc? If so, have CCG leads been consulted?

Yes ☐ No ☐ N/A ☒

Person(s) consulted:

Does the proposal realise any savings that could be captured through QIPP – if so have the PMO been consulted?

Yes ☐ No ☐ N/A ☒

Person(s) consulted:

3

Primary Care Budgets 2020/21

1. Background This report updates on the financial position of the CCG in relation to Primary Care Co-Commissioning budgets. For Months 1-6 in 2020/21 temporary financial arrangements were put in place by NHS England/Improvement which were intended to reduce transactions across the service, monitor actual spend and ensure all CCGs end up in a breakeven position overall. NHS England calculated expected monthly expenditure for all CCGs for the first four months of the year based on prior year spend with some national growth assumptions applied to provide the CCG with an initial allocation. Actual costs were then monitored, with a further retrospective allocation adjustment made each month to ensure funding allocations match actual costs where these were agreed by NHS England to be reasonable. This arrangement was then extended to Months 5 & 6 to cover the full period April to September 2020. From Month 7 to Month 12 an updated financial framework has been put in place for all NHS organisations, with allocations made at CCG/provider level together with additional funds to be managed across the Integrated Care Partnership (ICP). 2. Financial Position Year to Date Month 6

SUMMARY:

Appendix 1 sets out the financial position for month 6 – April to September 2020. The expected allocation for 2020-21 was £73,754k with additional allocations of £820k expected to give a total of £74,574k. However, due to the Covid-19 situation, temporary financial arrangements were implemented by NHS England, which led to a reduction in funding.

The Primary Care allocation for the 6 months to September 2020 is £36,486k, but this is expected to be topped up for any overspend once the month 6 reporting is reviewed. Had the CCG received its full allocation for 6 months ie 50% of £73,754k the figure would be £36,877k. The actual allocation received is £36,486k, with a further top-up of £181k expected for month 6, which is a shortfall of £210k to month 6.

4

MAIN VARIANCES:

Points to note:

• The GMS, PMS and APMS lines currently show an overspend of £163k. This is mainly due to:

o a drop in list size in July 2020 (£47k) o the budget set for demographic growth not utilised (£63k) o Out of Hours adjustment for an AMPS contract (£ 5k) o overspend on APMS as additional transitional support

in excess of budget £285k

• The Premises line shows a forecast underspend of £58k which is made up as follows:

o Developments not yet started (£228k) o 6 months practice allocation accrued £170k

• Other GP Services shows a forecast underspend of £113k, the majority of

which relates to: o Personally Administered drugs (£168k) o Increase in locum costs £80k o Seniority (£13k)

• There is currently a pressure relating to negative reserve of £156k.

RISKS TO FINANCIAL POSITION (Month 6):

Financial Risks to this reported forecast position include: • QOF Achievement payments in respect of 2019-20 have been paid.

Where achievement was less than 2018-19 due to Covid-19, it was agreed to protect practice income. As a result, some practices received top-up payments to match 2018-19 achievement. However, a number of practices in other areas have queried the methodology used by the national team which may result in additional adjustments being made. Further guidance is being sought by NHS England Commissioning Team.

• There are a number of other Prior Year accruals carried forward from

2019-20 including Enhanced Services, Seniority and Premises costs. These accruals may result in a non-recurrent gain/pressure depending upon the level of actual payments made. Dispensing and Prescribing accruals have been released into the 2020-21 position as these payments are now known.

3. Funding Allocation for Month 7-12

For the period 1 October 2020 – 31 March 2021 the CCG has notified of an initial allocation of £36,877k which represents 50% of the full year funding which was initially anticipated for the 2020/21 financial year. This is £200k higher than the actual costs reported for the year to date to Month 6 and further work is ongoing to review any additional pressure or potential benefits in the second part of the year.

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Appendix 1 Primary Care Financial Report for the 6 months to September 2020

Summary Apr-Sep 20 Budget Apr-Sep 20

Actual Apr-Sep 20

Variance

General Practice - GMS 18,989,456 18,874,187 -115,269 General Practice - PMS 6,329,263 6,241,657 -87,605 General Practice - APMS 767,289 1,132,789 365,500 Sub-total GMS, PMS,APMS 26,086,007 26,248,633 162,626 QOF 3,452,415 3,452,415 -0 Enhanced Services 474,032 476,543 2,511 Premises Cost Reimbursement 3,327,067 3,268,665 -58,402 Other GP Services 783,948 670,539 -113,409 PC Networks 2,519,021 2,550,582 31,561 Reserves -156,490 0 156,490 Grand Total 36,486,000 36,667,376 181,376

NOTE: Under the financial framework for Month 1-6 a retrospective adjustment to increase the Primary Care allocation by £181,376 is anticipated which will bring this position into balance.

Cover Sheet

Purpose (click one box only) Decision ☐ Information ☒

Classification

(delete as appropriate) Official

Meeting Primary Care Commissioning Committee

Date 27 October 2020 Agenda Item 7

Report Title General Practice Assurance Framework Update Q1 2020/21

Lead Director & Report Author

Director: Dominic Slowie Title : Medical Director

Author: Neil Macknight Title: Head of Quality and Patient Safety

Synopsis This report highlights the current position of assurance data for the NGCCG General Practice Assurance Framework.

Implications and Risks

Recommendation The Primary Care Commissioning Committee is asked to note the report.

Benefits to patients & the public / link to strategic objectives

Measuring and improving quality in primary care is a central duty and is reflected in Our Mission which is to build a better health service for our population by ensuring services are safe, accessible and of the highest quality.

Resource implications (finance; HR)

Legal / equality & diversity / sustainability implications

Report history Quarterly reports provided to the PCCC

Next steps

Appendices Quarterly reports provided to the PCCC

2

Submission checklist – to be completed by author ahead of inclusion on meeting agenda

Has the paper been cleared by the lead Director? Yes ☒ No ☐

Does the covering paper clearly state what the Committee are asked to do – i.e. clear recommendations?

Yes ☒ No ☐

Have the CCG finance team been consulted about any resource implications? Yes ☐ No ☐ N/A ☒

Person(s) consulted:

Are there any wider implications that require consideration – HR, contracting, procurement, etc? If so, have CCG leads been consulted?

Yes ☐ No ☐ N/A ☒

Person(s) consulted:

Does the proposal realise any savings that could be captured through QIPP – if so have the PMO been consulted?

Yes ☐ No ☐ N/A ☒

Person(s) consulted:

3

General Practice Assurance Framework Update – Q1 2020/21 Introduction This paper sets out the current position regarding the data utilised in the assurance framework for general practices in Newcastle and Gateshead. Background The CCG’s GP assurance framework was suspended in March 2020 with the onset of the COVID-19 pandemic. With the reduction in community infection rates in July and August, the CCG took the decision to re-establish the general practice assurance framework as a “business as usual” process for commissioned services. An outline timescale was published in the last PCC update that set out the steps required for assurance data to be processed by NECS business intelligence and assessed at the Primary Care Quality Group on 10th September. Current position The data was received from NECS business intelligence on Friday 4th September, with the stage 1 meeting held virtually on Monday 7th. Analysis of the data showed a number of inconsistencies with the NHS England data that could not be explained by those present. One example was a practice that was known to be rated as ‘requires improvement’ by CQC, but this was not reflected in the supplied data. A recommendation was taken to the Primary Care Quality Group that assurance should not be sought on individual practice performance, based upon the NHS England data supplied for Quarter 1 of 2020/21. This recommendation was accepted. Conclusions from Primary Care Quality Group The data supplied by NHS England for the basis of the CCG’s assurance framework has long been acknowledged to be based upon and out-of-date data. The suitability to accurately assure current practice performance is frequently questioned by practice managers and lead GPs that are subject to assurance correspondence or practice visits. NHS England commenced a project in the autumn of 2019 to develop a new assurance framework dataset, however this work has not progressed due to the COVID-19 crisis. The Primary Care Quality Group concluded that NECS business intelligence unit should be tasked to produce a data dashboard utilising data drawn from the RAIDR system. Next steps Discussions with NECS have highlighted that two local CCGs have begun to RAIDR data in order to assure GP practice performance, rather than placing reliance upon NHS England data. An example dashboard utilising one of the existing formats of other CCGs will be brought to the Primary Care Quality Group on 12th November for consideration as the preferred tool for assuring Newcastle Gateshead CCG GP practices. An update report will be brought to PCC in January.