AGENDA NHS Leeds CCG Primary Care Commissioning …… · 2019. 10. 2. · Venue: Hinsley Hall, 62...

AGENDA NHS Leeds CCG

Primary Care Commissioning Committee – Held in public

Date: Wednesday 2 October 2019

Time: 14:00 – 17:00

Venue: Hinsley Hall, 62 Headingley Lane, Leeds, LS6 2BX

Item Description Lead Paper Time

PCCC 19/54

Welcome and Apologies

Purpose: To record apologies for absence and confirm the meeting is quorate.

Chair N 14:00

PCCC 19/55

Declarations of Interest

Purpose: To record any Declarations of Interest relating to items on the agenda:

a) Financial InterestWhere an individual may get direct financial benefit fromthe consequences of a decision they are involved inmaking;

b) Non-financial professional interestWhere an individual may obtain a non-financialprofessional benefit from the consequences of adecision they are involved in making;

c) Non-financial personal interestWhere an individual may benefit personally in ways thatare not directly linked to their professional career and donot give rise to a direct financial benefit, because of thedecisions they are involved in making; and

d) Indirect InterestsWhere an individual has a close association with anotherindividual who has a financial interest, a non-financialprofessional interest or a non-financial personal interestwho would stand to benefit from a decision they areinvolved in making.

Chair Y

PCCC 19/56

Questions from Members of the Public

Purpose: To receive questions from members of the public

Chair N 14:05

PCCC 19/57

Minutes of the Primary Care Commissioning Committee meeting held on 7 August 2019

Purpose: To approve the minutes

Chair Y 14:15


PCCC 19/58

Matters Arising

Purpose: To consider any outstanding matter arising from the minutes that is not covered elsewhere on the agenda

Chair N

PCCC 19/59

Action Log

Purpose: To note the items on the outstanding action log

Chair Y

PCCC 19/60

Chief Executive’s Update

Purpose: To receive the Chief Executive’s update for information

Tim Ryley N 14:20

PCCC 19/61

GP Confederation Update - Primary Care Networks

Purpose: To receive an update for discussion

Gaynor Connor/ Kirsty Turner

Y 14:30

PCCC 19/62

Chair’s Summaries from the Primary Care Operational Group in August and September 2019

Purpose: To receive the summaries for information

Kirsty Turner Y 14:40

PCCC 19/63

Chair’s Summary from the Quality and Performance Committee meeting held on 11 September 2019

Purpose: To receive the summary for information

Dr Phil Ayres Y 14:50

PCCC 19/64

Primary Care Integrated Quality & Performance Report (IQPR)

Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee


BREAK FOR 5 MINUTES

PCCC 19/65

Primary Care Risk Report

Purpose: To receive an updated risk report


PCCC 19/66

Primary Care Finance Update

Purpose: To receive an update

Visseh Pejhan-Sykes

Y 15:20

PCCC 19/67

Forward Work Programme 2019/20

Purpose: To receive, accept and input to the programme

Chair Y 15:30

PCCC 19/68


Purpose: To receive questions from members of the public

Chair N 15:35


PCCC 19/69

Any Other Business Chair N 15:45

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" PCCC 19/70

Confidential Minutes of the Primary Care Commissioning Committee meeting held on 7 August 2019

Purpose: To approve the minutes

Chair Y 15:50

PCCC 19/71

APMS Contract Extension – Future Long Term Options

Purpose: To provide a verbal update and discuss the scope of future intentions

Deborah McCartney

Y 15:55

PCCC 19/72

Urgent Action Decisions

a) Recommended Bidder Report

Purpose: To ratify the urgent action meeting held on 29 August 2019

b) Recommended Bidder Report

Purpose: To ratify the urgent action meeting held on 10 September 2019


PCCC 19/73

Practice Update - Merger

Purpose: To approve the engagement process


PCCC 19/74

Primary Care Procurements

Purpose: To approve the primary care procurements

Michelle van Toop Y 16:35

PCCC 19/75

Review of Dispensing Services

Purpose: To receive an update

Anna Ladd N 16:50

Dates and venues of future meetings:

4 December 2019 – The Old Fire Station, Gipton Approach, Leeds LS9 6NL

5 February 2020 - Hinsley Hall, 62 Headingley Lane, Leeds LS6 2BX

1 April 2020 - The Old Fire Station, Gipton Approach, Leeds LS9 6NL

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PCCC members and attendees - September 2019

Title Name Job Title

(where applicable)

Role Practice B

Code (Practice

Only)

Declared Interest- (Name of the

organisation and nature of business)

Type of Interest Is the interest

direct or

indirect?

Interest From Interest

Until

Action Taken to Mitigate Risk

Angela Collins Lay Member for Patient

and Public Participation

Governing Body

Member

N/A Nil Declaration

Anna Ladd Senior Primary Care

Manager NHS England

Other Committee

Member

N/A Spouse is Senior Contract Manager for

Yorkshire Ambulance Service

Financial Interests Indirect 01/01/2015 OngoingDeclare any conflict or perceived conflict within

context of any relevant meeting or project work

Deborah McCartney Head of Primary Care

Commissioning and GP

Forward View

Band 8d and above or

Employee Decision

Maker

N/A Nil Declaration

Gaynor Connor Associate Director of

Primary Care


Employee Decision

Maker

N/A Role embedded within Leeds GP

Confederation

Non-Financial

Professional

Interests

Direct 01/10/2018 Ongoing Declare any potential or perceived conflict of

interest at relevant meetings/workshops. Stand

down from the meeting and sit in public gallery

during items where there is a specific conflict

Dr Ian Cameron Director of Public Health,

Leeds City Council

Governing Body

Member

N/A Director of Public Health, Leeds City

Council

Financial Interests Direct 01/04/2016 Ongoing Any decisions affecting joint working with Leeds

City Council including policy and resource

decisions Joanne Harding Executive Director of

Quality and

Safety/Governing Body

Nurse

Governing Body

Member

N/A Joint Chair of the NHSCC National

Nurses Forum

Non-Financial

Professional

Interests

Direct 01/07/2019 Ongoing Declare any conflict of interest at relevant

meetings/workshops.

Dr Julianne Lyons GP Member

Representative

Governing Body

Member

B86110 GP Partner at Leeds Student Medical

Practice

Financial Interests Direct 01/01/2016 Ongoing Declare any potential conflict of interest at

Governing Body/Board, sub committees and

relevant meetings Dr Julianne Lyons GP Member

Representative

Governing Body

Member

B86110 Leeds Local Medical Committee

Member




Representative

Governing Body

Member

B86110 Spouse is a Director of Leeds

Haematology Ltd

Indirect Interests Indirect 01/05/2013 Ongoing Declare any potential conflict of interest at



Representative

Governing Body

Member

B86110 Spouse is a trustee of UK Myeloma

Forum




Representative

Governing Body

Member

B86110 Spouse is an employee of the

University of Leeds




Representative

Governing Body

Member

B86110 GP lead for Leeds Primary Care

Workforce and Training Hub




Representative

Governing Body

Member

B86110 Spouse has an honorary contract with

Leeds Teaching Hospitals NHS Trust




Representative

Governing Body

Member

B86110 Shareholder of Leeds West Primary

Care Limited




Representative

Governing Body

Member

B86110 I am a member of LSMP and The Light

PCN

Financial Interests Direct 01/07/2019 Ongoing Declare any potential or perceived conflict of

interest at relevant meetings/workshops

Katherine Sheerin Director of System

Integration (Interim)

Governing Body Member N/A Director, Ambition Health Ltd (Health

consultancy)

Financial Interests Direct 30/09/2017 Ongoing Ambition Health Ltd. Not to bid for or undertake

work in the West Yorkshire and Harrogate area.

Katherine Sheerin Director of System

Integration (Interim)

Governing Body Member N/A Part of the role of Director of System

Integration is to work for the NHS

Providers in Leeds to support integration

of services. The role is part funded by

these providers as follows - Leeds

Community Healthcare NHS Trust; Leeds

Teaching Hospitals NHS Trust; Leeds and

York Partnerhsip NHS Foundation Trust;

Leeds GP Confederation.

Non-Financial

Professional

Interests

Direct 01/04/2019 31/03/2020 Declare any interest/potential interest at relevant

meetings/workshops. If relevant decisions to be

taken, meeting Chair to check with Conflicts of

Interest Guardian/ Head of Corporate Governance

whether further actions are required. KS not to be

involved in any procurement decisions/processes.

Attendance at Governing Body and other

committees will be in a non-voting capacity.

Kirsty Turner Associate Director of

Primary Care


Employee Decision Maker

N/A Husband is the Deputy Chief Finance

Officer

Financial Interests Indirect 01/04/2018 Ongoing Discussion with line manager. Declare as part of

ongoing discussions,

Laura Parsons Head of Corporate

Governance and Risk



N/A Close friend works for Leeds Teaching

Hospitals NHS Trust as Resourcing Co-

ordinator

Indirect Interests Indirect 03/09/2018 Ongoing Declare any potential or perceived conflict of

interest at relevant meetings/workshops

Dr Oliver Corrado Healthwatch Representative Other Committee

Member

N/A Lead Physician for the National Audit of

Dementia

Non-Financial

Professional

Interests

Direct 08-Dec-17 Ongoing Declare any potential conflict of interest at


relevant meetings

Phil Ayres Governing Body Member Governing Body Member N/A I have personal friendships with two

members of the Rawdon Surgery

Financial Interests Indirect 01/01/2017 Ongoing Declare interest at meetings as relevant

Phil Ayres Secondary Care Consultant Governing Body Member N/A I am a management consultant and may

work with providers in the city on clinical

leadership development

Financial Interests Direct 01/06/2018 Ongoing Maintain awareness of potential influence over

decisions I may take as independent practitioner.

Abide by GMC code of conduct. Declare this interest

at relevant meetings.

Cllr Rebecca Charlwood Chair HW Board Other Committee

Member

N/A Nil Declaration

Sabrina Armstrong Director of Organisational

Effectiveness

Governing Body Member N/A Close friend works as Director of System

Capability and Operations at NHS

England.

Indirect Interests Indirect 01/01/2014 Ongoing Declare any potential or perceived conflict of

interest at relevant meetings/workshops.

Sabrina Armstrong Director of Organisational

Effectiveness

Governing Body Member N/A Pool member with NHS Interim

Management and Support (NHS IMAS).

Non-Financial

Professional

Interests

Direct 01/01/2014 Ongoing Declare any potential or perceived conflict of

interest at relevant meetings/workshops.

Sam Senior Lay Member for Primary

Care Co-Commissioning

Governing Body Member N/A Lay Member for Primary Care Bassetlaw

CCG

Financial Interests Direct 01/09/2013 Ongoing Declare conflict or perceived conflict within context

of any relevant meeting or project work



Governing Body Member N/A Lay Representative National School of

Healthcare Science





Governing Body Member N/A Lay Advisor Health Education England

(West Midlands)





Governing Body Member N/A Patient and Public Panel Member -

National Institute Health Research





Governing Body Member N/A Chairperson - Brampton United Junior

Football Club (S63 6BB)

Non-Financial

Personal Interests

Direct 01/05/2013 Ongoing Declare conflict or perceived conflict within context




Governing Body Member N/A Independent Lay Member to Rotherham

Federation Connect Healthcare

Non-Financial

Professional

Interests

Direct 29/05/2019 Ongoing Declare at relevant meetings as required

Dr Sarah Forbes Associate Medical Director Band 8d and above or


B86022 GP Partner at Oakwood Lane medical

Practice

Financial Interests Direct 01/01/2014 Ongoing Declare any potential conflict of interest at relevant

meetings



B86022 Husband Director, Craggs Shoe Repairs -

has some contracts with fire and

ambulance services

Financial Interests Indirect 01/01/2003 Ongoing Declare any potential conflict of interest at relevant

meetings



B86022 Aunt has financial interest in SPARC -

(Adult diagnosis of autism Birmingham).

Autism West Midlands trustee. Autism

Education Trust - Board member

Indirect Interests Indirect 01/01/2013 Ongoing Declare any potential conflict of interest at relevant

meetings



B86022 Director, Craggs Wetherby Ltd - this is a

shoe repair shop in Wetherbu

Financial Interests Direct 01/11/2018 Ongoing Declare any potential conflict of interest at relevant

meetings

Sue Robins Director of Operational

Delivery

Governing Body Member N/A Nil Declaration

Susan Brear Lay Member for Audit and

Conflict of Interest

Governing Body Member N/A Nil Declaration

Tim Ryley Chief Executive Governing Body Member N/A Nil Declaration

Visseh Pejhan-Sykes Chief Finance Officer Governing Body Member N/A Niece works for CCG as Digital

Communications Officer

Indirect Interests Indirect 11/12/2017 Ongoing Not to participate in any decisions which may affect

this post, eg cut budget.

1

Minutes NHS Leeds CCG – Primary Care Commissioning Committee

Wednesday 7 August 2019 2.00pm – 5.00pm

The Old Fire Station, Gipton, Leeds LS9 6NL

Members Initials Role Present Apologies

Sam Senior SSe Lay Member – PCCC (Chair)

Dr Phil Ayres PA Secondary Care Specialist Doctor

Angela Collins AC Lay Member – Patient & Public Involvement

Tim Ryley TR Chief Executive

Jo Harding JH Director of Quality and Safety

Sue Brear SB Lay Member – Audit & Conflict of Interest

Visseh Pejhan-Sykes VPS Chief Finance Officer

Carl Smith

(deputising for Visseh Pejhan-Sykes)

CS Head of Commissioning Finance

Susan Robins SR Director of Operational Delivery

Helen Lewis

(deputising for Sue Robins)

HL Head of Unplanned Care & Long Term Conditions

Dr Simon Stockill SSt Medical Director

Additional Attendees

Councillor Rebecca Charlwood

RC Health & Wellbeing Board Representative

Dr Ian Cameron IC Director of Public Health Medicine

Dr Julianne Lyons JL Member Representative

Katherine Sheerin KS Director of System Integration

Dr Oliver Corrado OC Healthwatch Leeds Representative

Sabrina Armstrong SA Director of Organisational Effectiveness

Kirsty Turner KT Associate Director of Primary Care

Gaynor Connor GC Director of Transformation, Leeds GP

Confederation

Deborah McCartney DM Head of Primary Care Commissioning &

GP Forward View (GPFV)

Anna Ladd AL Primary Care Manager, NHS England

2

Members Initials Role Present Apologies

Laura Parsons LP Head of Corporate Governance & Risk

Sam Ramsey (Minutes) SRa Corporate Governance Manager

Members of the Public Observing the Meeting – 1

No. Action

PCCC

19/31

Welcome and Apologies The Chair welcomed everyone to the meeting. Apologies had been received from Angela Collins, Phil Ayres, Katherine Sheerin, Councillor Charlwood and Anna Ladd. Apologies had also been received from Visseh Pejhan-Sykes and Sue Robins, however Carl Smith and Helen Lewis were deputising. The Committee noted that Julia Walker, Quality Manager, NHS Leeds CCG, would be observing the meeting from the public gallery.

PCCC

19/32

Declarations of Interest The Chair noted members’ Conflicts of Interests (CoI) and asked members to declare any updates or changes to the COIs which were relevant to the meeting. An additional conflict of interest had been declared by Julianne Lyons and would be added to the register for all future meetings as JL was now a member of The Light Primary Care Network (PCN). There were no conflicted agenda items for the meeting; therefore JL would remain at the meeting for the duration. SA highlighted that her interest recorded on the register had now expired and two additional interests would be recorded from 1 August 2019. These were not relevant to the meeting. SSe highlighted that due to an administration error, her role as the Independent Lay Member to Rotherham Federation Connect Healthcare had not been included on the register circulated.

PCCC

19/33

Questions from Members of the Public A member of the public asked for further details on timescales in relation to the Urgent Care Treatment Centre in East Leeds. TR highlighted that an evaluation had taken place on the first Urgent Treatment Centre and this would guide timescales for future centres. Confirmation of timescales could not be provided at the meeting, therefore a response would be sent directly to the member of the public following the Committee meeting.

SRa

3

No. Action

PCCC 19/34

Minutes of the Primary Care Commissioning meeting held on 5 June 2019 The minutes of the meeting held on 5 June 2019 were approved as a correct record. SSt clarified that from 1st July, the interest he had declared as role of Clinical Director for Whitby Coast and Moors Primary Care Network had become a financial interest. The Primary Care Commissioning Committee:

a) approved the minutes of the PCCC meeting held on 5 June 2019.

PCCC 19/35

Matters Arising There were no matters arising.

PCCC 19/36

Action Log The Primary Care Commissioning Committee (PCCC) reviewed the action log and noted the following updates: 19/19 – the Committee acknowledged that an update would be brought to the October Committee meeting and agreed to close the action. The Chair confirmed that all other actions had been completed. The Primary Care Commissioning Committee:

a) received the action log.

PCCC 19/37

Chief Executive’s Update TR informed members that the CCG had received an outstanding rating from NHS England from the annual assessment for 2018/19 against the Improvement and Assessment Framework. It was acknowledged that this was in partnership with primary care and their colleagues. In addition to this, TR highlighted that from July 2019, all GP practices across Leeds were rated Good or Outstanding and thanks were given to members and the Primary Care teams within the CCG. Members were informed that a Quarter 1 assurance meeting had taken place with NHS England (NHSE) in relation to Primary Care Networks (PCNs) and NHSE had provided positive feedback. Recognition had been made that all Clinical Directors were in post and PCNs were developing well.

4

No. Action

The challenges related to Improving Access to Psychological Therapies (IAPT) across the city were highlighted and members were informed that the procurement had now been agreed and the preferred provider had begun mobilisation. The contract would go live on 1 November. The Committee was made aware of a review of CCG director portfolios and the transfer of accountability for Primary Care Development and Medicines Optimisation to the interim Director of System Integration. This would support primary and community based services working more closely together. The Primary Care Commissioning Committee: a) received the Chief Executive’s update.

PCCC 19/38

GP Confederation Update - New GP Contract Overview KT provided an update on the development and implementation of Primary Care Networks (PCNs) and highlighted that following the ratification of 18 PCNs at the last PCCC, there had been a revision through an urgent action meeting to establish a 19th PCN. Middleton PCN had initially been established with a population of nearly 62,000 patients. Discussions with the PCN reflected that the population needs would be better served by splitting the Middleton network into two so that there was a concentration on a smaller geographical footprint. An urgent action meeting was held on 27 June 2019 and approved the development of the 19th PCN. The Committee acknowledged that all PCNs had confirmed their arrangements for the extended hours arrangements and work would continue to ensure that patients were aware of the local provision. The increase in access to service should provide greater access for patients across Leeds. It was reiterated that one of the key priorities of the new GP Contract was to address the workforce challenges in general practice and establish a workforce baseline, supported by the additional roles reimbursement scheme. Clinical Directors had taken responsibility to sign up to the baseline and work was underway with PCNs to mobilise the roles and encourage appointments. The Primary Care Commissioning Committee: a) ratified the establishment of 19 Primary Care Networks; b) noted the workforce baseline submission submitted by the CCG and on behalf of Clinical Directors; and c) noted the work undertaken to date to formalise the establishment of 19 Primary Care Networks.

5

No. Action

PCCC 19/39

Health Inequalities Audit An update was provided on the health inequalities audit action plan and members recognised that work had been undertaken, including work with public health colleagues to review patient experience along with a review of the barriers to enable local populations to have the best possible access to primary care services in Leeds. The Committee acknowledged that the action plan had been refreshed and developed into a working document and updated with current progress for quarter 1, 2019/20. Members were informed that the GP Patient Survey 2019 had recently been published and would be reviewed to understand the barriers to access reported more recently. A number of new objectives had been introduced as part of the MindMate project and work would continue with GPs across Leeds to understand the referral process. The Committee noted that work would continue with the GP Confederation on addressing inequalities of access through the Extended Access contract. An early priority for the GP Confederation would be developing cervical cytology clinics as one element. There would also be a focus through the Quality Improvement Scheme on Learning Disability Health Checks and Severe Mental Illness physical health checks to drive improvements for those vulnerable populations. This would feature as part of a ‘hot topic’ in the next practice dashboard. In addition to this, the CCG had signed up to the Rainbow Badge scheme to support primary care to demonstrate and raise awareness and inclusion. TR highlighted a paper from West Yorkshire in relation to hip surgeries and differences in access relating to deprivation. TR agreed to share the paper with the Committee for information. The Committee requested a further update on the action plan in six months. A query was raised in relation to the priorities and progress made against the action plan and what the top areas for progress would be. KT suggested that the action plan should be considered further to reflect on the original driver of inequity to access. This would be considered in the next update to the Committee. The Primary Care Commissioning Committee: a) noted the briefing paper and action plan.

TR

KT

PCCC 19/40

Chair’s Summaries from the Primary Care Operational Group in June 2019 and July 2019

6

No. Action

The success of the Primary Care Conference was highlighted and a paper reflecting the event and evaluating the feedback and impact on the wider system would be presented to a future Primary Care Operational Group. A query was raised in relation to the British Sign Language contract and the issue that the provider could not deliver all elements of the contract. The Committee was assured that the issue was resolved and a recommendation would be made for a wider procurement to be undertaken with partners to drive the quality of the interpretation service. The Committee was informed that Kirsty Turner, Associate Director of Primary Care would Chair the Primary Care Operational Group going forward. The Primary Care Commissioning Committee: a) received the summaries for information.

PCCC 19/41

Quality Improvement Scheme DM provided an overview and summary to the Committee of the key achievements of the Quality Improvement Scheme (QIS) for year 1. The scheme provided additional resources to practices totalling £10 per (weighted) population, with 80% paid in advance and 20% paid on achievement. The Committee was informed that all practices would achieve the End of Life element of the QIS based on the citywide improvements. In relation to Atrial Fibrillation (AF) prevalence, a tolerance of 1% was applied. The Committee was provided with an infographic to summarise the key headlines and recognised that work would continue to review the achievements from year 1. The infographic highlighted how the figures related directly to the number of people that it had affected. 993 more people with severe mental illness had a health check. It also highlighted that 50,000 more patients had had a long term condition annual review. The achievement payments that been made totalled just over £1million. The Chair highlighted this as a positive investment into Primary Care. The Committee commended the infographic and thanked the wider teams for their support in devising the scheme. SSt iterated to the Committee that the scheme demonstrated a successful payment and reward scheme and would provide evidence to assure internal auditors of this process.

7

No. Action

The Primary Care Commissioning Committee: a) noted the improvements identified from the Quality Improvement Scheme; and b) noted the achievement payments totalling just over £1m.

PCCC 19/42

Chair’s Summary from Quality & Performance Committee meeting held on 10 July 2019 The Committee noted the Chairs Summary from the Quality & Performance Committee. The Primary Care Commissioning Committee: a) received the summary for information.

PCCC 19/43

Primary Care Integrated Quality & Performance Report (IQPR) The Committee was informed that the Primary Care team continued to monitor performance against indicators and in particular the variation between practices. Particular areas noted included a declining number of incident reporting compared to the previous year. The Committee was informed that training and support was being offered, alongside best practice examples and consistent feedback. A zero tolerance campaign would be launched later in the year. Members acknowledged that 100% of practices had now been rated as good or outstanding by CQC. One practice had moved from an inadequate rating to a good rating in six months and the practice was commended for the effort and energy put in to rectify the issues. Primary Care would continue to work with CQC and individual practices. Members were made aware that the national Patient Survey had recently been published and demonstrated that Leeds was above the national average in respect of satisfaction in some areas. The Primary Care team would be encouraging practices to review the results with their Patient Participation Groups. A query was raised in relation to measurements on successes, for example weight management and whether this information was available. The Committee was informed that work was ongoing with specialist and primary care commissioning and that there were contract measures within services which would include successes. These would be a system outcome measure rather than specific to the CCG. The Committee discussed that measures and outcomes would evolve over time, particularly through the Quality Improvement Scheme and maturity of PCNs.

8

No. Action

The Primary Care Commissioning Committee:

a) received the Integrated Quality and Performance Report.

PCCC 19/44

Primary Care Risk Report The Committee was presented with the Primary Care risk report which detailed the ten risks aligned to the PCCC. There were no high amber risks and one corporate red risk to report, risk 651, General Practice Workforce. The Committee recognised that the new GP contract was supported by an additional investment in 5 mandated workforce roles, however there would still remain a risk in relation to recruiting to the roles. Members noted a reduction in score to two existing risks with regards to risk 670 and risk 675. Risk 670 now had zero practices with closed lists and therefore the score had been reduced and risk 675 in relation to the development of Primary Care Networks had also been reduced following the establishment of 19 PCNs; however this would continue to monitored by Primary Care. In relation to risk 672, delivery of online consultations, members noted that there were ongoing discussions with the provider due to a timing issue. The Committee was assured that there was a contingency plan in place, but would need to ensure support was in place for practices. A query was raised in relation to the risk report and the absence of detail relating to cost. KT informed members that there would not always be an associated cost. KT and SB agreed to meet to discuss the risk report in full. A further query was raised in relation to risk 651 and ensuring that the narrative reflected that there were factors that were outside the CCG control. KT agreed to consider the wording to reflect the comment. The future housing growth of the city was raised as a concern with the need to ensure it was factored in to plans and priorities. KT assured the Committee that this was considered within risk 653, but recognised that further work could be undertaken. SSt agreed to explore this area further, summarise and return to next PCCC. The Primary Care Commissioning Committee:

a) reviewed the high scoring amber risks as presented to the Committee; and

b) considered the recommended level of assurance.

PCCC 19/45

Primary Care Finance Update

9

No. Action

The Committee was presented with the Primary Care and Prescribing Budgets at month 3. The transfer of £1.8million budget from CCG core allocation to co-commissioning allocation in line with the equitable funding changes had taken place. The update included the new payments made for the new Primary Care Networks (PCNs), of which 18 out of 19 had been paid. One had formed late and therefore missed the payment deadline.

The work to breakdown the £122million prescribing budget to practice level had been completed and the data had been submitted within the national level. The freed up resources were currently being considered to practice level.

The Committee was made aware of a national risk, after receiving national guidance with effect from August 2019. The Category M medicines margin would be increased by £15m per month to the financial year end, an increase of £120m in total nationally. In relation to Leeds it had been assumed that the CCG would receive increases of 1% of the national value, £1.2m (£150k per month over 8 months) and this had been added to the financial risk register.

With regards to Estates, the Committee noted that there were six ETTF schemes. An issue was raised in relation to Community Health Partnerships (CHP) non-reimbursable costs and the support the CCG could give to practices.

A query was raised in relation to balancing prescribing costs and reinvesting in general practice. The Committee was assured that there was a criteria followed in relation to reinvestment, however it was acknowledged that further work would need to be undertaken to move towards outcome based commissioning.


a) noted the Primary Care financial position for June and the PrimaryCare Network payments made in July; andb) noted the update from the Primary Care Estates Group.

PCCC 19/46

Windmill Health Centre – Development of New Premises

The Committee was informed that an urgent action meeting had been held on 15 July 2019 to approve the development of Windmill Health Centre with recurrent revenue of £126,000 per annum. Members acknowledged that PCCC had previously supported this development, however there had been a lack of clarity in relation to decision making between the CCG and NHE England. Following discussions, NHSE confirmed support for the development. The practice and developers would be considering plans and purchasing the site.


10

No. Action

a) ratified the development of Windmill Health Centre; b) ratified the recurrent revenue costs of £126,000 (plus VAT); and c) ratified that the CCG would write to the practice to outline the above.

PCCC 19/47

Forward Work Programme 2019/20 The Committee agreed that an update on the Health Inequalities audit would be provided in six months. The Primary Care Commissioning Committee:

a) received the Forward Work Programme for 2019/20.

PCCC 19/48

Questions from Members of the Public A member of the public highlighted the positive news in relation to the development of new premises for Windmill Health Centre. A query was raised in relation to charges from practices for medical reports. SSt confirmed that although practices cannot charge for copies of notes, it is at the discretion of the practice to charge for medical reports as this is not stipulated in the GP contracts.

PCCC 19/49

Any Other Business There was no other business.

The Primary Care Commissioning Committee resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Approved and signed by: Sam Senior, Lay Member – Primary Care Co-Commissioning / Deputy Chair Date:

MINUTES ACTION LOG – PRIMARY CARE COMMISSIONING COMMITTEE

UPDATED 25 September 2019

ITEM NO:

ACTION NO:

ACTION: ACTION BY:

COMPLETED/UPDATE

PRIMARY CARE COMMISSIONING COMMITTEE MEETING

OUTSTANDING ACTION LIST

28 March 2019 PCCC

18/134

1. APMS Contract Extension Paper regarding long-term options for the practice to be brought to the PCCC meeting in August 2019.

KT/ SSt In progress. Agenda item 19/71 - APMS Contract Extension: Future Long Term Options.

5 June 2019 PCCC 19/19

1. Updated Primary Medical Care Policy and Guidance Manual (PGM) Primary Care Estates Group to review new chapter in PGM re: premises running costs and service charges.

VPS Complete. Update included in agenda item 19/66 – Primary Care Finance Update.

7 August 2019

PCCC 19/33

1 Questions from Members of the Public Query from Cllr Jenkins regarding Urgent Treatment Centres and timescales for the UTC in East Leeds. The Committee agreed a response would be sent to Cllr Jenkins by Debra Taylor-Tate.

DTT Complete. Letter sent on 12.08.2019.

PCCC 19/39

1 Health Inequalities Audit TR highlighted paper from West Yorkshire in relation to hip surgeries. Agreed to circulate to PCCC members for information.

TR Complete. Circulated to members on 8 August 2019.

PCCC 19/39

2 Health Inequalities Audit A query was raised in relation to the top priorities in relation to Health Inequalities and the Committee agreed to receive an update in 6 months’ time and focus on the top priorities and progress made.

KT In progress. Added to forward plan for February 2020.

PCCC 19/44

1 Primary Care Risk Report Future housing growth raised as a concern with the need to ensure it is factored in to plans and priorities. Committee agreed to explore further, summarise and return to next PCCC.

KT/KS In progress. Verbal update to be given at PCCC in October 2019 (PC Estates group)

PCCC 1 AOB KT Complete.

MINUTES ACTION LOG – PRIMARY CARE COMMISSIONING COMMITTEE

UPDATED 25 September 2019

ITEM NO:

ACTION NO:

ACTION: ACTION BY:

COMPLETED/UPDATE

19/49 Committee agreed to send a letter of acknowledgement to the practice that had recently moved rating from inadequate to good

Letter sent 20.08.2019.

1

Leeds Health & Wellbeing Strategy Outcomes – that this report relates to:

1. People will live longer and have healthier lives

2. People will live full, active and independent lives

3. People’s quality of life will be improved by access to quality services

4. People will be actively involved in their health and their care

5. People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to:

1. Deliver better outcomes for people’s health and wellbeing

2. Reduce health inequalities across our city

We will work with our partners and the people of Leeds to:

3. Support a greater focus on the wider determinants of health

4. Increase their confidence to manage their own health and wellbeing

5. Achieve better integrated care for the population of Leeds

6. Create the conditions for health and care needs to be addressed around localneighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge

2. Failure to assure the delivery of high quality services, leading to commissioned services notreflecting best practice and improving care

3. Failure to achieve financial stability and sustainability

4. Lack of provider and clinical support for change will impact on the development andimplementation of the CCG strategy

5. Resources are not targeted effectively to areas of most need, leading to failure to improvehealth in the poorest areas

6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions

7. Failure to enable partners to work together to deliver the CCG commitments

8. Failure of system to be adaptable and resilient in the event of a significant event

Agenda Item: PCCC 19/61 FOI Exempt: N

NHS Leeds CCG Primary Care Commissioning Committee Meeting

Date of meeting: 2 October 2019

Title: GP Confederation Update - Primary Care Networks

Lead Governing Body Member: Katherine Sheerin, Director of System Integration

Category of Paper Tick as

appropriate

()

Report Author: Kirsty Turner, Associate Director of Primary Care & Gaynor Connor, Director of Transformation (Leeds GP Confederation)

Decision

Reviewed by EMT/Date: N/A Discussion

Reviewed by Committee/Date: N/A Information

Checked by Finance (Y/N/N/A - Date): N/A

Approved by Lead Governing Body member (Y/N):

2

EXECUTIVE SUMMARY:

Primary Care Networks (PCNs) have been formally established since 1st July 2019. This paper is intended to provide an update on the activities of networks since the PCCC meeting on 7 August 2019 and will cover:

• PCN assessment against NHS England (NHSE) maturity matrix• Workforce in line with the ‘additional roles reimbursement scheme’ of PCN Directed

Enhanced Service (DES).

NEXT STEPS:

The Leeds GP Confederation and Leeds CCG will continue to work with PCNs to facilitate and support the developing maturity of networks and ensure the appropriate utilisation of the financial allocation to PCNs.

RECOMMENDATION:

The Primary Care Commissioning Committee is asked to:

a) Note the progress in relation to Primary Care Networks in Leeds;b) Consider any actions to further support the development of effective Primary Care

Networks.

3

Primary Care Networks – Update

1. BACKGROUND 1.1 A primary care network (PCN) consists of groups of general practices working together with

a range of local providers, including across primary care, community services, social care and the voluntary sector, to offer more personalised, coordinated health and social care to their local populations.

1.2 19 PCNs were established in Leeds on 1st July 2019. Since the last update was provided to Primary Care Commissioning Committee (PCCC) , networks have been focused on the required tasks following their set up including agreeing legal network agreements setting how they will work together including managing their finances and new workforce; and ensuring delivery of the enhanced hours DES to 100% of their population.

1.3 In order to support PCNs, NHSE have developed a PCN Development Support Prospectus and Maturity Matrix which was sent directly to each Clinical Director across the West Yorkshire and Harrogate Health and Care Partnership (Integrated Care System (ICS)) in August 2019. Assessment against the maturity matrix is the first step in describing a development plan for each PCN capturing early and subsequent priorities and actions.

1.4 The maturity matrix is ultimately a diagnostic tool intended to help identify what is expected of PCNs and what developmental support PCNs might be needed in order to ensure progression of networks. The national ambition is that by March 2020, all PCNs will: • Have a development plan in place • Be functioning increasingly well as a single team • Be part of a ‘network of PCNs’ that helps shape the ICS plan to implement the Long

Term Plan • Formed clear and agreed multi-disciplinary teams with community provider partners • Building on existing relationships, form links with local people and communities to

understand how to work most effectively for their benefit • Have made 100% use of their funding entitlement for additional roles in line with

national guidance • Have started work on at least one service improvement project of some kind, linked to

Long Term Plan goals • Have started thinking about their future estate needs, jointly with community partners • Be ready to deliver new national service specifications from April 2020

1.5 Additional funding has been allocated to ICS for in-year delivery of PCN development support. The funding is over and above that set out in the GP contract agreement and is for Clinical Director and PCN development support only. The completion and collation of network development plans will inform how this funding will be utilised across the ICS. A meeting with PCN development leads and NHSE will be held late September to identify the amounts available to each ‘place’ and the process for accessing the resource.

1.6 The timescale for completing the tool has been incredibly ambitious, with the diagnostic tool being sent out during August with a requirement for completion and submission to NHSE by 20 September 2019.

4

1.7 The Leeds GP Confederation have been providing significant support to PCNs to complete

the initial maturity assessment. The majority of PCNs have had several hours of facilitated discussion / support. The assessment requires consideration of the position against 5 domains:

Leadership planning and partnerships

Use of data and population health management

Integrating care

Managing resources

Working with people and communities.

1.8 The nationally available support is focused on developing maturity across these 5 domains. PCNs are being asked to identify their current and future needs for development for:

PCN set up

Organisational development and change

Leadership development support

Supporting collaborative working

Population health management

Social prescribing and asset based community management.

1.9 Ensuring the future and continued development of PCNs is described in a series of system roles and responsibilities, summarised as follows:

5

1.9 The CCG has through embedding of some functions within the Leeds GP Confederation devolved some responsibility for PCN development; however the PCCC will need to assure the continued progress of PCNs.

1.10 It is worth reiterating that the ambitions for PCNs over the next 5 years include: • Stabilised general practice, including the GP partnership model • Helped solve the capacity gap and improved skill-mix by growing the wider workforce by

over 20,000 wholly additional staff as well as serving to help increase GP and nurse numbers

• Become a proven platform for further local NHS investment • Dissolved the divide between primary and community care, with PCNs looking out to

community partners not just in to fellow practices • Systematically delivered new services to implement the Long Term Plan, including the

seven new service specifications, and achieved clear, positive and quantified impacts for people, patients and the wider NHS.

2.0 WORKFORCE

2.1 As reported at the last update, PCNs have had to agree with the commissioner the

workforce baseline which will be used to test the additionality for the five reimbursable roles:

Clinical pharmacists (from 2019)

Social prescribing link workers (from 2019)

Physician associates (from 2020/21)

First contact physiotherapists from (2020/21)

First contact community paramedics (from 2021/22)

2.2 During 2019/20, each PCN in Leeds will have a maximum reimbursable amount of £53,942.25 to cover the period July 2019 to March 2020 and the guidance suggests that at least 1 social prescribing link worker and 1 clinical pharmacist per PCN should be employed.

2.3 Revised guidance has been issued that specifically states PCNs should plan in advance for how they anticipate using their allocation including recruiting flexibly the number of pharmacists / social prescribing link workers to meet their population needs. PCNs are advised to use year 1 ‘underspend’ to bring forward the employment of the workforce they would have been recruiting in year 2.

2.4 The guidance also advises that CCGs should consider local arrangements to ensure that any unused financial entitlement be used across PCNs in order to ensure that the funding is used in full.

2.5 As the CCG has already invested in social prescribing within Leeds there is currently a risk

as some PCNs may not wish to appoint further PCN link workers and therefore under-utilising the financial allocation. We are continuing to work with PCNs on establishing their workforce plans so that we can fully assess the risk of any underspend and understand the best way of supporting PCNs within the ‘flexibility rules’.

6

2.6 The CCG working with the Leeds GP Confederation have established a process to enable CCGs to request additional workforce over and above the year 1 allocation. To date, 2 PCNs have requested to employ 2 pharmacists (instead of a social prescribing link worker) which have been supported by Primary Care Operational Group.

2.7 We are aware that a further 2 PCNs will also be requesting 2 pharmacists whilst 2 other

PCNs wish to employ 2 social prescribing workers. 2.8 As a system, our recommendation is that we do not currently feel we can support some

PCNs employing more than 2 pharmacists whilst there are gaps within the remaining PCNs.

2.9 The guidance is clear that the roles that can only be reimbursed within this financial year

are the identified pharmacist and social prescribing link worker. We do however have some PCNs that would wish to develop first contact practitioners earlier than April 2020.

3. NEXT STEPS 3.1 The Leeds GP Confederation and Leeds CCG will continue to work with PCNs to further

support the developing maturity of networks and ensure the appropriate utilisation of the financial allocation.

4. FINANCIAL IMPLICATIONS AND RISK 4.1 The CCG Primary Care and Finance teams will continue to monitor the financial allocation

in the context of PCN workforce plans to understand any associated underspend. 4. RECOMMENDATION

The Primary Care Commissioning Committee is asked to:

a) Note the progress in relation to Primary Care Networks in Leeds; b) Consider any actions to further support the development of effective Primary Care

Networks.

Leeds CCG - Primary Care Operational Group Chair’s Summary – August 2019

Workforce

The group were informed about the September plan for TARGET which is themed around health inequalities. Feedback will also be given on comments from last year’s Conference using a “you said, we did” format.

Commissioning

PCNs are working towards required milestones and development needs to be identified using a self-assessment tool for completion by September. These assessments will feed into the ICS.

The group were updated that the GP Connect programme allows 111 to directly book a number of GP appointments as required by the new GP Contract.

The group discussed funding claims by GP practices for the mandated roles. Claiming the whole funding if posts are not filled for the whole year will not be allowed. A full time post for six months instead of a part time for the whole year will be reimbursed. Guidance for this is expected to be released week commencing 12 August.

It was agreed by the group that if requests for role reimbursements were clear then approval could be given between meetings and any exceptional requests would come to PCOG for a decision.

The group discussed the long term plan for commissioning intentions. A key area to start planning for is the ageing well section through the Enhanced Care Homes specification and integration with other services.

An update was given on the complex and challenging process to redistribute “PMS Premium” funding across the city, as following the equitable funding review there is less money to distribute.

The options appraisal for the British Sign Language contract was discussed and 6 options were presented. LTHT have been approached to jointly commission a service with Leeds and Wakefield CCGs and will make a decision after a joint engagement event for BSL on 2 October. Digital inclusion will be covered in the engagement event. PCOG recommended that the preferred option to be pursued would be to commission a joint translation and interpretation service collaboratively with Wakefield CCG.

The group were updated on community care beds. An acute-type GP service is currently provided by 4/5 practices for 272 step down/step up beds procured by LCH/LTHT and LCC. Discussions have taken place with neighbourhood commissioning team on moving to a more enhanced specification and service provision by PCNs for 20/21. The group supported the proposal to take this through a PCN award and align it to the Care Homes Enhanced specification from April 2020.

Quality, Risk and Performance

The group were informed that NHSE have advised there may be delays in flu vaccines from some suppliers. Practices have been surveyed and none have declared a shortfall. This is to be picked up outside of this meeting with a seasonal immunisations update at TARGET.

The group were updated that all Leeds practices are now CQC rated good or outstanding.

The future of Freed Up Resources (FUR) was discussed and is to be debated along with other financial incentives given the level of funding into primary care.

Concern was expressed in the meeting for smaller PCNs in that they may not be able to afford the same level of staff next year. Clinical Pharmacists are training roles and carry a commitment to 18 months training to be funded so must be permanent contracts. It was noted that using the LCH employment model would resolve many issues.

The group were updated on Online Consultations. The current provider has been advised the contract will not be progressed and a second procurement will start using the DPS framework.

Leeds CCG - Primary Care Operational Group Chairs Summary – Sept 2019

Workforce

The group received feedback regarding Septembers TARGET sessions on Health Inequalities that we are currently in the midst of. It was noted that there is a need for more nurses/Confed in the steering group and more help on the TARGET event days. The group discussed the need for more feedback on the in house TARGET which should be rebranded PCN TARGET.

The Primary Care workforce work plan is currently being worked up and needs to be brought back to this group at a future meeting.

The group were up dated on a programme called ‘GP Generation X’ starting in October in response to interest from mid-career GPs.

Commissioning

The group were updated on the PCN Maturity Matrix. A development plan has now been produced. NHSE send this directly to clinical directors. The Primary Care development and pharmacy teams are working with CD/PCNs to complete it.

A finance update was given to the group which informed that the CCG has now concluded negotiations with a specific practice and all is now resolved.

The Group discussed the future procurement relating to an APMS practice and agreed that due to the challenges faced with engagement of the local population due to the estates plans the CCG should consider a contract extension in the meantime.

Quality, Risk and Performance

Issues were identified around offering PCN costs. This was raised at LMC as an issue and it was agreed this needs to be looked at collectively on all costs.

The group were updated following the evaluation of the General Practice Annual eDeclaration. Following evaluation of responses the Primary Care Commissioning team are assured that all practice are 100% compliant against the GP contract.


NHS Leeds CCG – Primary Care Commissioning Committee


Title: Chair’s Summary of Quality & Performance Committee Meeting held on 11 September 2019

Lead Board Member: Phil Ayres, Chair – Quality & Performance Committee & Secondary Care Specialist Doctor


appropriate

()

Report Author: Sam Ramsey, Corporate Governance Manager

Decision

Discussion

Information

Approved by Lead Governing Body member (Y/N): Y

EXECUTIVE SUMMARY: This report provides the Primary Care Commissioning Committee with a summary of the primary care items considered at the Quality & Performance Committee meeting held on 11 September 2019.

RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) RECEIVE the report.

Description of key items of business discussed

1. Please note that this is a brief summary of the primary care items considered at the meeting of the Quality & Performance Committee on 11 September 2019. Further information can be obtained by reference to the minutes of that meeting.

Integrated Quality & Performance Report 2. The Committee received an update on elective waiting list performance and action being

taken to address areas of underperformance. The issue of unintended consequences of out of area care and how it impacts back into primary care for follow up appointments was raised. The Committee was assured that the surgical package would be assessed to include a discharge package.

Providers Under Enhanced Surveillance 3. The Committee recognised the positive status in primary care that 100% of practices had

been rated good or outstanding by the CQC.

Research Assurance Annual Report 4. The Committee received the annual research report for 2018/19. Members commended the

amount of research activity and agreed that they had full assurance that the CCG had met its statutory obligations with regards to research. It was highlighted that every member practice across the CCG has contributed to the CROP (Campaign to Reduce Opioid Prescribing) interrupted time series analysis by providing anonymised aggregated data. This directly supported the NHS constitution by supporting research and improving care.

1














6. Create the conditions for health and care needs to be addressed around local neighbourhoods


2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care


4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy

5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas







Title: Integrated Quality and Performance Report – Primary Care

Lead Governing Body Member: Katherine Sheerin, Director for System Integration


appropriate

()

Report Author: Kirsty Turner, Associate Director for Primary Care / Jane Isherwood, Senior Information Analyst

Decision


Reviewed by Committee/Date: N/A

Information



2

EXECUTIVE SUMMARY: The Primary Care team continues to monitor performance against the indicators and in particular looking at the variation between practices. Champions for specific high priority indicators have been identified within the primary care team to link with partners across the organisation / system to support improvements in quality. Due to the timings of Committee meetings, the indicators within the Integrated Quality and Performance Report (IQPR) have not significantly changed since they were presented at the last Primary Care Commissioning Committee (PCCC). All areas continue to be addressed through quality improvement schemes in place and through engagement in specific areas. The Quality Surveillance/Support Group (QSG) continues to monitor quality at practice level with 100% of practices now rated Good or Outstanding with Care Quality Commission (CQC). CQC Overview

CQC Rating Number of Practices

Outstanding 4 (5%)

Good 92 (95%)

Requires improvement 0 (0%)

Inadequate 0 (0%)

The QSG is now actively monitoring the change in rating as practices move onto their 2nd or 3rd inspection (the figures below indicate where a practice may have had a rating in one domain but that has now changed).

• 12 practices (citywide) inspected since January 2019 to date: - 5 practices received an improved rating - 1 practice received a decreased rating - 6 practices’ ratings remained the same as their previous inspection rating.

NEXT STEPS: The IQPR is being updated to reflect changes in the new GP contract. Hot topics for the next release of the practice level dashboard will be on Learning Disability and Serious Mental Illness physical health checks and is due out in September 2019. Nationally, a Primary Care Networks (PCN) dashboard is also being developed and therefore the team will review any changes to the Practice Quality Improvement Dashboard once this has been shared.


a) Receive the Integrated Quality and Performance Report.

CurrentLowest

Value

Highest

ValueTrend

Hot Topic

58.4% 35.4% 74.7%

9.5% 2.5% 28.9%

5.8% 1.1% 30.1%

22.6% 1.3% 63.8%

78.6% 51.2% 93.4%

75.0% 74.8% 25.0% 87.4%

55.0% 47.9% 21.4% 66.6%

55.0% 49.0% 15.7% 71.4%

40‐65% 46.3% 13.8% 77.9%

Mar‐19 69.5% 74.1% 42.1% 95.3%

Contractual Requirements

10.0% 29.0% 0.0% 57.2%

3.5% 4.9% 0.0% 18.5%

2.0% 3.4% 0.0% 16.1%

56.0% 76.8% 0.0% 109.0%

10.0% 16.3% 0.0% 52.0%

PreventionPrenatal Pertussis vaccine uptake (2017‐18) Mar‐19 76.2% 83.0% 0.0% 100.0%

Shingles Vaccine Uptake (coverage for the Routine Cohort since 2013 ‐ 2018/19)2018/19

Q348.3% 46.7% 14.1% 100.0%

HPV (Two doses) CCG level only 2017‐18 83.8% 88.0% n/a n/a

Prevalence 16+ 18.44 7.3 59.4

% patients with smoking status recorded 95.22% 84.5% 99.1%

% of smokers offered smoking cessation advice in the last 24 months 87.0% 85.9% 44.1% 100.0%

Referrals to Smoking Service 5,412 0 653

Referrals of eligible patients 1,925 0 230

% of GP registered population with an Audit C score 59.0% 23.0% 96.7%

Audit C Score >8 11.5% 1.0% 23.5%

Cervical ‐ 3.5/5.5 yr coverage % ‐ Target age range (25‐64) Jan‐19 80.0% 72.5% 17.2% 71.1%

Breast ‐ 3 coverage % ‐ Standard age range (50‐70) Oct‐18 80.0% 71.0% 14.3% 83.2%

Bowel ‐ Uptake % ‐ Extended age range (60‐74) Oct‐18 60.0% 59.2% 23.0% 87.0%

Patient Experience34.1% 31.4% 6.0% 55.7%

68.6% 68.9% 31.7% 100.0%

67.3% 70.8% 34.9% 100.0%

85.0% 84.9% 55.0% 97.7%

2019 YTD 90.7% 90.7% 0.0% 100.0%

Number of ratings 2,085 0 422

Number of stars (out of ) 3.4 1 5

AccessAccident & Emergency Mar‐19 283 172 1,956

GP Streaming Mar‐19 17.3 1.1 104.5

Minor Injury Unit Mar‐19 53.3 1.4 185.7

Shakespeare Walk‐in Centre Mar‐19 42.2 2.7 391.8

111 244.3 117.6 425.3

Out of hours 86.2 30.8 167.2

Extended Access ‐ Hub Mar‐19 90.8 0.3 594.3

Online Consultations Mar‐19 5.8 n/a n/a

Health Inequalities95.9% 51.0% 100.0%

86.1% 30.6% 99.0%

Safe

3,503 0 190

1,842 0 110

1,661 0 82

1,487 0 129

E. coli Mar‐19 520 0 16

Flu vaccinations

(only to be included in

Q3/Q4)

Pneumococcal Polysaccharide Vaccine (PPV) Uptake 2017‐18 Only

Primary Care

National

Target or

Average

Period

Information &

Technology

Leeds

Performance Measures (1 of 2)

Mar‐19

Apr‐19

MMR Vaccinations

May‐19

Group Name

Incident Reporting

Mar‐19

Jan‐19

2018/19

Q4

Apr‐19

Number of patients accounts registered for online services as % list

Electronic Repeat prescription requests as % accounts

Electronic Appointments booked online as % accounts

Electronic Prescription Service Utilisation (EPS)

(80% of repeat prescriptions)

EPS Repeat Dispensing Utilisation

GP Survey response rate

Jan‐Apr

18

2018/19

Q4

Smoking

Weight Management

Alcohol

Cancer ‐ Uptake for screening programmes

www.nhs.uk ratings

Attendances/Calls 2018‐19 YTD

(Rate per 1,000 Patients ‐ Weighted List Size)

Mar‐19

Vaccinations

Number of patients not vaccination ‐ Aged 25+

Flu vaccinations over 65

Flu vaccinations at risk clinical group

Flu vaccinations pregnant women

Flu vaccinations all children (Aged 2‐8)

Number of patients not vaccination at any age %

Number of patients not vaccination ‐ Aged 1 to 5

Measure



Total Incidents reported on Datix (2018‐19)

Non‐medication Incidents reported on Datix (2018‐19)

Medication related incident reported on Datix (2018‐19)

Number of Significant Event Audits (SEA) completed (2018‐19)

Overall experience of making an appointment (Good)

Ethnicity ‐ % recorded

First Language ‐ % recorded

Ease of getting through to someone at GP surgery on the phone (Easy)

Overall experience of GP surgery (Good)

Respondents are likely to recommend the GP Practice

Collection and reporting of a core primary care data set for all E coli BSI ‐ 2018‐19 YTD

Appendix A

CurrentLowest

Value

Highest

ValueTrend

Effective

1.91 1.66 0.01 3.67

1.91 2.01 0.00 5.09

13.94 12.54 0.20 21.32

AF – Management plans in place (Treatment gap) (WY Ave) Apr‐19 21.0% 23.9% 0.0% 100.0%

Exception reporting rate 2017‐18 5.69 8.17 0.00 33.33

>20% risk ‐ % recieved CCSP review or annual review in the last 12mQ4 17/18‐

Q4 18/1931.8% 0.0% 96.7%

NHS Health Checks % of patients with a CVD Risk Score (Qrisk) of > 20%2018/19

Q43.1% 0.0% 15.4%

Hypertension ‐ Management plans in place (Treatment gap) (WY Ave) 14.3% 13.9% 4.3% 57.5%

Hypertension ‐ On repeat Amlodipine/Felodipine, not on the register (WY Ave) 19.6 1,254 0 91

Hypertension ‐ Register changes (increases) 4,257 ‐27 1192

% high risk of developing 7.2% 0.1% 11.5%

Referrals to NDP programme (CCG quarter target) 975 1,654 0 217

% achieving target for 1 treatment across 3 treatment areas 75% 94.3% 85.0% 98.6%



Exception reporting rate 2017‐18 12.24 12.43 2.85 27.13

Mental Health:SMI % patients who have had all six physical health checks in the last 12 months2018/19

Q450% 39.6% 9.5% 70.2%

COPD Emergency admissions in the last 12 months (Rate per 1,000 patients) Feb‐19 1.90 0.00 5.78

% of deceased patients with LTC registered on EPaCCs 40% 44.1% 0.0% 83.3%

% of deceased patients where actual place of death recorded 90% 80.5% 0.0% 100.0%

Severely Frail (65 years old+) (From practice systems) 7,024 0 335

Moderately Frail (65 years old+) (From practice systems) 17,264 0 659

Summary Care Record ‐ Additional information consent (SCR‐Al)

(65 years old+ Moderate/Severe Fraility)7,517 0 426

48.1% 2.6% 105.0%

14.6% 0.0% 175.0%

2018/19

Q319.0% 28.80% 0.0% 90.0%

Caring99 of 99

practices

25.11 0.00 91.82

Well Led42 of 99

practices

0.36 0.00 8.00

Primary Care

NHS Health Education

Workforce Tool

Performance Measures (2 of 2)

Group Name Period National

Target or

Ave

Leeds

2018/19

Q3

2018/19

Q4

2018/19

Q4

Year of Care

Collaborative Care and

Support Planning

(CCSP)

AF ‐ % Prevalence

COPD ‐ % Prevalance

Hypertension ‐ % Prevalance

Targeted Prevention of

Long Term Conditions

Q4

2018/19

Completed the workforce tool for current quarter

GP vacancies within practice

Quality Improvement

Scheme

All eligible adults 40‐74 against target (100% by year end) cumulative position

All eligible adults 40‐74 against target within latest quarter

NHS Health Checks

Apr‐19

Measure

Practices implementing CCSP

Reviews undertaken in latest quarter per 1,000 population

2018/19

Q4

AF

Cardiovascular Disease

Hypertension

Mar‐19Frailty

End of Life Care Planning & use of EPaCCs

Diabetes

Better Management of

Long Term Conditions

Learning disabilities ‐ % completed

2018/19

Q4

Period TargetMonth/

QuarterTrend

Proportion of the population with access to online consultations 2019/20 Q1 30% 37.6%

Extended Access Appointment Utilisation Jun‐19 75% 92.2%Data not

currently

available25% n/a

2019/20 Q1 300 768

Number

4

92

0

0

Action

Continued review and challenge of Leeds Cancer Screening

performance at Leeds Cancer Prevention, Awareness and

Increasing Screening Uptake and Leeds Integrated Cancer

Services Board.

We plan a good news story with practices in September to

celebrate recent increases in bowel screening performance.

Roll‐out of cervical screening to the Cancer Screening

Champion model in Leeds (across 50 GP practices) – training

sessions took place with the 50 practices in May. Cervical

focused workshops planned in September.

Some planning required, due to capacity issues raised at LICS

by LTHT – in relation to cytology lab turnaround times –

liaising closely screening colleagues to share clear

communications regarding waiting times.

Mobilisation of locality screening and awareness model

project.

Virtual clinics commenced in Leeds from the 1st May. Ongoing

monitoring of project is underway.

Performance and Quality Summary

Serious Mental Illness

The national target for completion of physical health checks is 60% and the current CCG position is 37.4%. Delivery of the health checks

has been part of the Practice Quality Improvement Scheme throughout 18/19 which has raised the completion rate from 27.2%. The target

for practices under the scheme was 30% which has been exceeded. SMI Health checks remain part of the 19/20 scheme with a target this

year of 60% which should enable us to meet the national target.

It is worth noting that the Quality Improvement Scheme now requires practices to complete 12 checks in line with the NHS Planning

Guidance however, it is not currently possible to measure all 12 checks and therefore the next iteration of this report will include

measurement of 9 of the 12 checks.

Cancer Screening

The CCG is not currently achieving compliance against the national screening targets for Breast and Cervical Screening.

Performance is monitored closely via our Leeds Cancer Prevention, Awareness and Increasing Screening Uptake meeting which includes

representation from CCG cancer commissioner, Public Health, Primary Care and NHS England Screening leads (commissioners).

Collectively we have worked to increase Bowel Screening uptake via the provision of a bowel screening champion model within Primary

Care, which aims to increase bowel screening uptake. Working with these practices, the locality development team are ensuring the

scheme continues to be embedded with the practical elements being worked through i.e. SystmnOne and EMIS templates have been

developed and all practices are now able to record/evidence increased uptake following multiple contacts with patients who haven’t

accepted screening. The scheme has been extended in 19/20 to include a focus on cervical screening processes as well. 50 GP practices

(with IMD Score of 1‐4) have been invited to participate in the scheme and have signed up, with contracts in place. Workshops are

scheduled for September to focus on cervical screening processes.

Following the development of a bid with Leeds City Council for the development of a locality based screening and awareness programme in

Leeds (covering Breast, Cervical and Bowel), we have learnt that funding has been secured (a 3 year programme). Mobilisation is now

underway. The funded programme will allow significant investment into increasing screening uptake across Leeds. A project manager for

the project is currently being recruited and work is underway to select four localities who will have in place a locality screening coordinator

to prioritise targeted work on cancer screening.

AF Treatment Gap

The CCG continues to work collaboratively with the Y&H AHSN (applied Health Science Network) to target and support practices with the

greatest number of identified patients in treatment gap in order to risk assess and treat appropriately.

In 2019/2020 Leeds CCG received funding from NHSE to participate in the AF Medicines Optimisation Demonstrator project. Project

mobilisation is complete with pharmacy roles recruited to – the project provides the provision of virtual clinics with Primary Care to

support the above QIS targets. Virtual clinics commenced in Leeds from the 1st May. 285 virtual reviews were completed in Qtr 1. In

addition, the Quality Improvement Scheme has delivered an increase in the number of patients with AF at high risk of a stroke on

treatment from 5617 to 7610.

Quality Indicators

Performance and Quality

Constitution/Planning Measure

Proportion of population that the urgent care system (NHS 111) can directly book appointments for in

contracted extended access

Number of personal health budgets that have been in place, at any point during the financial year

Primary and Proactive Care

Outstanding

Good

Requires Improvement

Inadequate

CQC GP Inspection

Rating

1


























Title: Primary Care Risk Report

Lead Governing Body Member: Katherine Sheerin, Director of System Integration


appropriate

()

Report Author: Anne Ellis Playfair, Risk Manager/ Kirsty Turner, Associate Director of Primary Care

Decision




Approved by Lead Governing Body member (Y/N):

2

EXECUTIVE SUMMARY: The Risk Management Strategy has been reviewed to ensure it reflects best practice in risk management and was approved by the Governing Body at its meeting in May 2019. The CCG is implementing the changes to the risk management arrangements in line with the new strategy. The following changes are included in this report for the first time:

Target risk score for each risk, based on the CCG risk appetite;

Actions to manage the risk to the target level;

Target date by which the risk is to be reduced to the target level. Risk Register The risks are included on the CCG operational risk register and reviewed within individual directorates on a regular basis. In line with the Risk Management Strategy, Executive Management Team (EMT) and relevant CCG Committees receive and review the risks rated as high amber (12) and above. The CCG Governing Body receives the corporate risk register (all red risks scored at 15 and above) for review at each meeting, supported by the CCG committee chair updates. Active and Accepted Risks The risk register now contains 58 risks in total, (previously 57), 10 of which are aligned to the CCG Primary Care Commissioning Committee (PCCC) . 5 of these 10 risks are categorised as ‘Accepted’ risks. This means that the current level of risk is deemed acceptable. Accepted risks are risks that are at, or below, the target risk score (approved by the responsible Director) or are green on the risk matrix below. These risks are reviewed by management at least on an annual basis or when the CCG becomes aware of a change to the risk. High amber (12) or red risks are unlikely to be accepted and will continue to be reported to the relevant Committee and Governing Body.

Impact score

Likelihood 1 2 3 4 5

Insignificant Minor Moderate Major Catastrophic

5 Almost Certain

5 10 15 20 25

4 Likely 4 8 12 16 20

3 Possible 3 6 9 12 15

2 Unlikely 2 4 6 8 10

1 Rare 1 2 3 4 5

There are 5 Active risks aligned to the Committee, 1 of which is reported to the Committee as its current score is over 12. This relates to the following risk:

Risk: 651: General Practice Workforce

A summary of the above risk is provided below but further detail, including controls and assurances, can be seen in Appendix 1.

3

Ris

k I

D

Ris

k T

itle

Current Position Risk Rating

Cu

rren

t

Previous

Ta

rge

t S

co

re

Ta

rge

t D

ate

Ch

an

ges t

o

Ta

rge

t D

ate

Au

gu

st

19

Ju

ne 1

9

651

Ge

ne

ral P

ractice

Wo

rkfo

rce

A baseline against the 5 mandated

workforce roles has been established and

submitted to NHSE.

2 further actions added to develop a

workforce plan, completion date March

2020. It is not expected to reduce to target

by this date - further actions will be added

on completion of the workforce plan.

15 15 15 6

31/3

/21

0

Summaries are provided of the remaining active risks aligned to the PCCC at Appendix 2 and the accepted risks at Appendix 3, for information.

NEXT STEPS:

All risks will be reviewed as per the bi monthly cycle in accordance with the CCG risk management strategy.

The corporate risk register will be presented to the Leeds CCG Governing Body meeting.


a) Review the high scoring (12+) risk; b) Consider whether the controls and actions are effective and whether assurances

are sufficiently robust; and c) Agree any further actions required to manage the risk to the target set.

Appendix 1

Risk IDD

ate

ris

k ad

de

d

Ris

k Ti

tle

Risk Description

Dat

e la

st

revi

ew

ed

Lead

Dir

ect

or

Ris

k O

wn

er

Co

mm

itte

e

Re

spo

nsi

ble

Init

ial

C 1-5

Init

ial

L

1-5

Init

ial S

core

1-2

5

Positive Controls & Existing Assurance in Place

Cu

rre

nt

C 1-5

Cu

rre

nt

L 1-5

Cu

rre

nt

Sco

re

1-2

5

Gaps in Control and Assurance Actions required

Targ

et

C

1-5

Targ

et

L 1-5

Targ

et

Sco

re

1-2

5

Targ

et

dat

e

Ch

ange

s to

tar

get

dat

e

Re

aso

n f

or

chan

ge t

o t

arge

t

dat

e

651

01

/09

/20

17

Gen

eral

Pra

ctic

e W

ork

forc

e

There is a risk that the quality of and

access to general practice services in

Leeds is compromised due to local

and national workforce shortages

resulting in the inability to attract,

develop and retain people to work in

general practice roles.0

9/0

9/2

01

9

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Gay

no

r C

on

no

r, D

irec

tor

of

Tran

sfo

rmat

ion

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

4 5 20

The Quality Improvement Scheme (QIS) places an

ask for localities to engage in a locality workforce

plan.

Leeds participating in the international

recruitment programme.

A city wide primary care workforce group has

been re-established with wide stakeholder

involvement to oversee the workforce plan for

Leeds and links to wider West Yorkshire

approach.

Work with planned care team on development of

new approaches to workforce such as first

contact practitioner model.

Performance against trajectories is reported via

GPFV and WY&HICS via Primary and Community

Care Workforce Steering Group.

Primary Care Workforce Steering Group meets bi-

monthly chaired by CEO of GP Confederation

with membership from all stakeholders.

3 5 15

As GPs are independent contractors, the

CCG has limited control over their

workforce practices.

Gaps exist relating to workforce data and

therefore no accurate picture of

workforce.

Agree workforce plan template with

PCN Clinical Directors.

Workforce plan for each PCN to be

completed by March 2020.

2 3 6

31

/03

/20

21

0 N/A

C = Consequence (Impact)

L = Likelihood

Current ScoreInitial Score Target Score

Appendix 2

Risk IDD

ate

ris

k ad

de

d

Ris

k Ti

tle

Risk Description

Dat

e la

st

revi

ew

ed

Lead

Dir

ect

or

Ris

k O

wn

er

Co

mm

itte

e

Re

spo

nsi

ble

Init

ial

C 1-5

Init

ial

L

1-5

Init

ial S

core

1-2

5


Cu

rre

nt

C 1-5

Cu

rre

nt

L 1-5

Cu

rre

nt

Sco

re

1-2

5

Gaps in Control and Assurance Actions required

Targ

et

C

1-5

Targ

et

L 1-5

Targ

et

Sco

re

1-2

5

Targ

et

dat

e

Ch

ange

s to

tar

get

dat

e

Re

aso

n f

or

chan

ge t

o t

arge

t

dat

e

653

01

/09

/20

17

Pri

mar

y C

are

Infr

astr

uct

ure

There is a risk that the Leeds CCGs

are unable to support the wider

transformation of primary care and

support out of hospital care due to

the limitations of the current

primary care estate and technology.

09

/09

/20

17

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er, A

sso

ciat

e D

irec

tor

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

4 3 12

The CCG is currently supporting a number of

existing ETTF submissions and supporting

practices through the process

Primary care estates needs are linked to the

strategic estates group and 3 priority

geographical areas have been identified - the

strategic estates group has membership from

the wider health and social care economy.

Localities will be supported to identify individual

locality development plans with a focus on

estates.

An independent primary care premises stocktake

was commissioned to assess the current

condition of all premises and priorities have been

agreed.

CCG has made appropriate links with LCC site

allocation planning team to ensure that future

housing growth is factored into our plans and

priorities for future estate needs

Primary care estate group has been established

to oversee all primary care estate matters to

ensure consistency

PCCC has regular update on primary care estate

Additional investment secured to support

improvements

3 3 9

Practices may not engage with the CCG in

discussions relating to premises i.e. sale

and leaseback

Whilst some ETTF sites are identified as

priorities this is part of a national process

and some practices are in urgent need of

development. ETTF process is nationally

led and dependent on timescale and

process set out by NHSE

Limited resource to dedicate to

infrastructure

Capital availability for IT and estate is

limited.

Recurrent impact of costs related to

estates and impact of PCNs on GPIT

budget

CCG to submit Project Initiation

Documents to NHSE with a view to

securing capital investment in

relation to 2 or 3 schemes

CCG to discuss internally the

recurrent impact of PCNs on GPIT

and other budgets

CCG with support for GP

Confederation to consider future

estate needs (in the context of the

maturity matrix)

2 3 6

31

/01

/20

20

0 N/A

655

01

/09

/20

17

Mem

ber

En

gage

men

t

There is a risk that engagement with

member practices may deteriorate

following strategic changes within

the CCG 09

/09

/20

17

Kir

sty

Turn

er, A

sso

ciat

e D

irec

tor

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 4 12

Primary care engagement scheme funding

provides support through investment

Senior leadership team representation at

member events to ensure transparency and

visibility

In accordance with the CCG constitution and

scheme of delegation, members will continue to

be involved in decision making and consultation

processes

Locality leads in place and have developed strong

working relationships to enable good

engagement and support

Development of confederation strategic and

exec board

Feedback from members events, and delivery

against the Primary Care Engagement Scheme

presented to primary care operational group and

reported to Primary care commissioning

committee

Feedback as part of the annual 360 process

3 3 9

Development of locality leadership teams

and alignment of locality managers

underway.

CCG to review all mechanisms for

member engagement in the context

of capacity to support the

development of PCNs including:

clinical commissioning forum

member meetings

TARGET meetings

Council of members

3 2 6

01

/04

/20

20

0 N/A

Initial Score Current Score Target Score

660

10

/11

/20

17

Del

iver

y o

f H

igh

Qu

alit

y P

rim

ary

Car

e Se

rvic

es

There is a risk that patients are

unable to access high quality

services; including those services

that are rated as requires

improvement or inadequate by CQC. 09

/09

/20

17

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er, A

sso

ciat

e D

irec

tor

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 4 12

Quality session delivered to member practices to

raise awareness of support available and

promote 'self-referral' for support

Use of various of sources of intelligence for

improvement to help identify themes and trends

and areas for quality improvement i.e. primary

care web took, PQI

Quality surveillance processes to monitor

themes and trends

Clinical lead for Quality identified

Proactive schedule of quality visits planned

QRP processes in place where quality issues are

identified

Quality Surveillance Group to monitor progress

against action plan

Multi team approach to review approach

(Medicines Optimisation, Quality, Primary Care,

Clinician)

Regular meeting planned with LMC to share

approach to quality surveillance

Report to PCCC and Quality and Performance

Committee

Systematic sharing of information through PQI

now established across the City.

Current position of CQC ratings compared to

national position.

3 3 9

Practices may not pro-actively engage

with the CCG in raising any concerns

around quality.

4 mergers have recently taken place

which may have an impact on quality due

to change and engagement of staff.

Failure to appoint a provider through

procurement may have a detrimental

impact on the service due to uncertainty.

Pro-active visits to practices

scheduled, based on feedback from

CQC reports (must and shoulds)

October 2019 member meeting

opportunity to reiterate offer of

support - quality and resilience

3 2 6

01

/04

/20

20

0 N/A

672

17

/07

/20

18

Del

iver

y o

f O

nlin

e C

on

sult

atio

ns

There is a risk that not all practice

will implement online consultations

by March 2020.

09

/09

/20

17

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Julie

tte

Mar

tin

,

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 4 12

Development of regional programme team to

support the delivery

Support for roll out of 10 high impact actions

Overseen by GP Workload group

Sharing of learning from existing users

Procurement supported through NHSE Dynamic

Purchasing System

Monthly GPFV return to NHS England

Regional team implemented

Workload group to oversee roll out and clinical

input

3 3 9

Funding allocated via ICS and may not

support all costs.

Inability to fully understand appetite for

implementation.

Due diligence is still in progress and has

not progressed due to delays in receiving

information.

Survey to be circulated to all

practices outlining next steps and

benefits of online consultation

Procurement process to commence

2 3 6

30

/11

/20

19

0 N/A


L = Likelihood

Appendix 3 Accepted Risks

Risk IDD

ate

risk

ad

ded

Ris

k Ti

tle

Risk Description

Dat

e la

st

revi

ewed

Lead

Dir

ecto

r

Ris

k O

wn

er

Co

mm

itte

e

Res

po

nsi

ble

Init

ial

C 1-5

Init

ial

L

1-5

Init

ial S

core

1-2

5


Cu

rren

t

C 1-5

Cu

rren

t

L 1-5

Cu

rren

t Sc

ore

1-2

5

Gaps in Control and Assurance

Targ

et

C

1-5

Targ

et

L 1-5

Targ

et S

core

1-2

5

609

25

/05

/20

16

Pri

mar

y C

are

Pay

men

ts There is a risk that there is

insufficient 'cash' available errors

made by PCSE when processing GP

payments that flow from the CCG

Bank Account or result in the

practice not being paid by the

contractual date.

09

/09

/20

19

Kat

her

ine

Sh

eer

in, D

ire

cto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er,

Ass

oci

ate

Dir

ect

or

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

2 3 6

Increase communication with NHSE to ensure the CCG is aware

of all payments that will be made from.

CCG finance team to approve payments and have the ability to

stop any payments.

2 2 4CCG is not able to directly input the

payment details2 2 4

652

01

/09

/20

17

Del

iver

y o

f G

P E

xten

de

d A

cces

s Se

rvic

e

There is a risk that patients will not

be able to access routine and

extended access to primary care

services across 7 days. 09

/09

/20

19

Kat

her

ine

Sh

eer

in, D

ire

cto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er,

Ass

oci

ate

Dir

ect

or

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

4 2 8

Regular contract meetings now in place

Revised trajectory agreed for the City providing assurance as to

the delivery

Monthly performance return to track progress

Current performance at 100% and increasing utilisation.

Primary care operational group monitor delivery against

trajectories

The CCGs report against trajectories and submit to NHSE.

2 2 4

The new GP contract places an additional

requirement for Primary Care Networks

to have a greater say in access delivery.

We will need to work with networks to

understand the potential implications in

terms of contract award / procurement

and delivery.

Some sessions may be cancelled at short

notice preventing delivery of the

contract.

2 2 4

668

12

/07

/20

18

Failu

re t

o A

pp

oin

t a

Pre

ferr

ed

Pro

vid

er

The CCG has a number of current

and proposed procurements to

support the delivery of primary

medical services either directly or

indirectly. There is a risk that the

CCG fails to appoint a suitable

provider.

09

/09

/20

19

Kat

her

ine

Sh

eer

in, D

ire

cto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er,

Ass

oci

ate

Dir

ect

or

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 3 9

The CCG has developed a procurement policy to support

decision making around procurement

PCCC has supported the practice support policy which outlines

the commissioning strategy in relation to local procurements

A primary care procurement steering group has been established

to operationally manage procurements

Learning from previous procurements helps support the future

processes

Procurements known and added to the procurement log

External procurement advice is commissioned to support

individual procurements

Ongoing market development through bidder events

Regular updates through primary care operational group and

PCCC

As the procurement for The Light was stopped with a view to

this being re-started. PCCC have approved a contract extension

to ensure continuity of care for patients. It needs to be

recognised that this provided some uncertainty for staff at the

service which can have an effect on quality of care which the

CCG will continue to monitor through QSG.

3 2 6

Ability for general practice to respond to

local opportunities due to market

immaturity. 3 2 6

Initial Score Current Score Target Score

670

12

/07

/20

18

Ch

ange

s to

Gen

eral

Pra

ctic

e

There is a risk that patients are

unable to register with GP practices

due to the capacity of current

practices 09

/09

/20

19

Kat

her

ine

Sh

eer

in, D

ire

cto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er,

Ass

oci

ate

Dir

ect

or

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

4 3 12

Practices need to formally apply to close the practice list in line

with the NHS Policy

Primary Care Operational Group will monitor list closures and

will continue to monitor the risk, supported through the quality

surveillance process

Encourage practices to discuss early any issues affecting

capacity.

Primary care operational group monitor delivery against

trajectories

The CCGs report against trajectories and submit to NHSE

2 2 4

The new GP contract places an additional

requirement for Primary Care Networks

to have a greater say in access delivery.

We will need to work with networks to

understand the potential implications in

terms of contract award / procurement

and delivery.

Some sessions may be cancelled at short

notice preventing delivery of the

contract.

2 2 4

675

08

/08

/20

18

Dev

elo

pm

ent

of

Pri

mar

y C

are

Ne

two

rks

There is a risk that not all practices

will be part of a Primary Care

Network by 30 May 2019.

09

/09

/20

19

Kat

her

ine

Sh

eer

in, D

ire

cto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er,

Ass

oci

ate

Dir

ect

or

Pri

mar

y C

are

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 2 6

Continued engagement with member practices

Alignment of Primary Care Development Team in progress

through the business case

100% coverage of the GP confederation

18 identified localities, moving to 19 Primary Care Networks and

13 local care partnerships which encompasses all 100% of

practices (including Safe Haven which was previously excluded)

Development plan in place for evolving LCPs including OD

approach

LCP strategy and operational group

3 1 3

Capacity and capability of team to drive

change

Impact of relationships and morale as

move through significant change

Capacity of leadership teams (at PCN

level)

Communication difficulties in reaching all

staff groups.

Changes in a locality resulting in

unsustainable locality.

Operational commitment from across the

system

3 1 3


L = Likelihood

1







NHS Leeds CCG Strategic Commitments

We will focus resources to:








Assurance Framework – which risks on the GBAF does this report relate to:

1. Inadequate patient and public engagement results in ineffective decisions and challenge











Title: Primary Care Finance and Estate Update

Lead Governing Body Member: Visseh Pejhan-Sykes, Chief Finance Officer


appropriate ()

Report Author: Carl Smith, Head of Commissioning Finance & Kirsty Turner, Associate Director Primary Care

Decision





2

EXECUTIVE SUMMARY: The purpose of this paper is to update the Primary Care Commissioning Committee on the Primary Care and Prescribing Budgets that are in place in 2019/20. The paper will also update the committee around the Primary Care Estates position.

NEXT STEPS: The CCG Finance and Primary Care teams along with NHS England will work closely together to understand and mitigate any known risks in the system throughout the year.


a) Consider and comment on the Primary Care financial position for August and the new guidance around underspends against the role reimbursement budget; and

b) Consider and comment on the update from the Primary Care Estates Group.

3

1. SUMMARY

The paper describes the financial position for Primary Care, Prescribing and Proactive care at Month 5. The paper also provides an Estates update from the Primary Care Estates Group.

2. FINANCE UPDATE

2.1 NHS Leeds CCG 2019/20 Co-Commissioning Budget Of the £139.9 Million budget held for Primary Care, £118.2 is allocated to the Co-Commissioning budget held with NHS England (NHSE). The remaining £21.7M are locally commissioned budgets including Proactive Care.

The Co-Commissioning budget forecast remains in line with budget at Month 5. Of the 19 Primary Care Networks (PCNs) set up across the city payments are now flowing to 18 of them. We are awaiting bank account details for Burmantofts, Harehills and Richmond Hill PCN before payments can be made. Funding transferred to PCNs on a monthly basis so far include the following- • Core PCN Funding £1.50 per Registered Patient • Clinical Director Contribution £0.514 per Registered Patient • Extended Hours Access £1.099 per Registered Patient. No payments have yet been made for staffing reimbursements. These payments are expected to begin in October, the budget was set from July meaning there will be an under spend against this funding. However the latest guidance strongly encourages CCGs to put in place local schemes to share that unused financial entitlement across the other PCNs in the area to enable them to carry out further recruitment on the terms set out in the Network Contract Direct Enhanced Service (DES).

The distribution of the £1million ‘PMS premium’ budget focussed on health inequalities and discussed at a previous Primary Care Commissioning Committee (PCCC) meeting, has

NHS Leeds CCG 2019-20 YTD Budget YTD Actual

YTD

Variance

2019-20

Budget

Forecast

Outturn

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

GMS 11,548 11,470 -78 27,714 27,714 0

PMS 21,560 21,245 -315 51,744 51,744 0

APMS 1,044 1,091 47 2,504 2,504 0

Premises cost reimbursements 7,689 7,755 65 15,658 15,658 0

Other premises costs 21 11 -10 51 51 0

Enhanced Services 1,704 1,700 -4 4,305 4,305 0

QOF 4,070 4,214 144 9,768 9,768 0

Other GP Services(inc PCO) 2,791 2,941 150 6,486 6,486 0

Total Primary Care Co-Commissioning 50,427 50,427 0 118,230 118,230 0

4

been finalised at practice level. The payment will remain at these agreed levels for two years. The distribution is weighted towards deprivation and ethnicity. 2.2 NHS Leeds CCG 2019/20 Locally Commissioned Primary Care Budget The total of the CCG’s locally commissioned budgets is £18,659K, this includes the allocation increase to move former Leeds South and East and Leeds North CCGs to £6 per head for GP Access. The Service Development Improvement Plan is currently being reviewed by the CCG to identify how the increased funding of £1.35M will be spent. At Month 5 all Local Primary Care budgets are expected to spend in line with the budgets set.

2.3 NHS Leeds CCG 2019/20 Proactive Care Budget Proactive Care now sits within Primary Care at the CCG. We are forecasting a small underspend of £57K against the budget of £2.98M. This is due to expected slippage against the Supporting Wellbeing Independence for Frailty and Home Independence contracts. The remaining contracts are forecast to spend at budgeted levels.


YTD

Variance

(Under)/

Overspend

2019-20

Budget

Forecast

Outturn

Forecast

Variance

(Under)/

Overspend

£'000 £'000 £'000 £'000 £'000 £'000

Quality Incentive Scheme 3,619 3,619 0 8,685 8,685 0

Care Homes/Nursing Homes 324 324 0 778 778 0

Core £1.50 PCN Funding 553 553 0 1,327 1,327 0

Estates Reserves 208 208 0 500 500 0

Amber Drugs 378 378 0 907 907 0

GPFV Improved GP Access 2,219 2,219 0 5,325 5,325 0

Other Primary Care Budgets 474 474 (0) 1,136 1,136 0

Total Core Primary Care Services 7,775 7,775 0 18,659 18,659 0


YTD

Variance

(Under)/

Overspend

2019-20

Budget

Forecast

Outturn

Forecast

Variance

(Under)/

Overspend

£'000 £'000 £'000 £'000 £'000 £'000Social Prescribing 667 714 47 1,600 1,600 0

Vulnerable Populations 67 68 0 161 162 1

Welfare Advice 39 39 0 93 93 0

Alcohol Services 120 120 0 289 289 0

Home Independence & Warm Service 63 33 (29) 150 115 (35)

Supporting Wellbeing Independence for Frailty 50 25 (25) 120 60 (60)

Neighbourhood Networks 125 125 0 300 300 0

Other Projects 110 93 (17) 263 300 37

Total Proactive Care Services 1,240 1,216 -24 2,976 2,919 -57

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2.4 NHS Leeds CCG 2019/20 Prescribing Budget June 19 data has now been received. With only 3 months of data available, the forecast remains at budgeted levels. The forecast includes managing the anticipated increase in costs as a result of amendments to Category M Prices which is forecast to be £1.2M for the remainder of the year. The process for Practices’ Freed up Resources for 2018/19 has commenced, with all Practices receiving formal notification of amounts due to them. A panel has been set up to review proposed spend around this funding.

3. Estates Update The CCG continues to review progress against Estates schemes through the primary care estate group and a pipeline of developments or proposals are currently being considered.

At the September 2019 meeting, the group reviewed progress on the six Estates and Technology Transformation Fund schemes (ETTF); 1 of which is nearing completion and 2 of which are currently on site with expected completion dates between now and December 2019. Two of the schemes are still in progress. The group considered one scheme which requires additional documentation and the delay in the practice providing the documentation may result in this scheme being pulled from the pipeline which the group supported due to the need to draw a final timeline. Four new proposals continue to be developed with ongoing work needed following feedback from the regional capital group and Leeds City Council (LCC). Two of these relate to LS8/9 and are progressing applications to NHSE for ETTF. Another proposal relates to a scheme in LS15 and is being developed in collaboration with the Council and a further development in LS11. The group continued to support all applications with a caveat on the proposal in LS11 to be subject to further ratification and on the basis the practice use less space within the proposed new site and carryout comprehensive patient and stakeholder engagement including opportunities of retaining a presence in the existing areas. The overall recurrent impact of these developments will be in the region of £345K The group continued to discuss a current national problem relating to increased Community Health Partnership (CHP) non-reimbursable costs and what support the CCG can give to practices on this and further discussions are due to take place to progress this. Following engagement with the affected practices the group were in favour of working against a local process with a non-recurrent offer to those particular practices. For service costs in


YTD

Variance

(Under)/

Overspend

2019-20

Budget

Forecast

Outturn

Forecast

Variance

(Under)/

Overspend

£'000 £'000 £'000 £'000 £'000 £'000Prescribing 50,848 50,848 0 122,034 122,034 0

Ex centrally funded drugs 1,423 1,423 0 3,414 3,414 0

Oxygen contract 518 518 0 1,243 1,243 0

Total Prescribing Services 52,788 52,788 0 126,691 126,691 0

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particular this would involve using the justification template in NHSE policy book to help when justifying the rational when supporting practices.

Windmill Health Centre still remains the highest priority for the organisation; the District Valuer (DV) report has now been received for the building and confirms a small increase in the previously approved rental but supported by the primary care estate group.

4. RECOMMENDATION The Primary Care Commissioning Committee is asked to: a) Consider and comment on the Primary Care financial position for August and the new

guidance around underspends against the role reimbursement budget; and b) Consider and comment on the update from the Primary Care Estates Group.

Primary Care Commissioning Committee– Work Programme 2019/20

June Aug Oct Dec Feb April Notes

STANDING ITEMS

Welcome & apologies X X X X X X

Declarations of interest X X X X X X


X X X X X X

Minutes of previous meeting

X X X X X X

Matters arising X X X X X X

Action log X X X X X X

Forward Work Programme

X X X X X X

Chief Executive’s Report X X X X X X

GOVERNANCE ITEMS

Terms of Reference X

Assessment of Committee Effectiveness

X

PCCC Annual Report X

COMMISSIONING AND STRATEGY

New GP Contract Overview

X X X X X X

GP Confederation Update

X X X X X X

PPGs/Primary Care Engagement

Local Primary Care Schemes

Includes delivery and prescribing schemes

Quality Improvement Scheme

X X X X X X

Approve newly designed enhanced services (LDS/DES)

As required

Chair’s Summary from Primary Care Operational Group

X X X X X X

Health Inequalities Audit X X

Recommended Bidder Report

X

NHSE National Policies As required

QUALITY, PERFORMANCE AND RISK AND SUMMARY REPORTS

Integrated Quality and Performance Report

X X X X X X

Summary from Quality and Performance

X X X X X X

Committee

Corporate Risk Report X X X X X X

FINANCE

Finance update X X X X X X

Approve ‘discretionary’ payments

As required

OTHER

Approve contractual action e.g. branch/remedial notices, contract variation GMS, PMS and APMS contracts

As required

Approve new GP practices and practice mergers

As required

AGENDA NHS Leeds CCG Primary Care Commissioning …… · 2019. 10. 2. · Venue: Hinsley Hall, 62...

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Transcript of AGENDA NHS Leeds CCG Primary Care Commissioning …… · 2019. 10. 2. · Venue: Hinsley Hall, 62...