HampshirePartnershipCCG … papers... · 2 Chairs initial -----1. Welcome and Apologies The Chair...

Hampshire Partnership CCGPrimary Care Commissioning Committee

Partnership Primary Care CommissioningBoard Room 6, The Middle Brook Centre, Middle Brook Street, Winchester

7 November 2019 10:00 - 7 November 2019 11:15

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INDEX

0. Agenda- 7th November- Public v3.doc.......................................................................................3

2. Declarations of Interests - Partnership Primary Care Commissioning - Oct'19.........................5

3. Draft Minutes- PCCC 5 Sept 2019- Public.docx.........................................................................7

4. PCCC Action Tracker Nov 2019.docx........................................................................................13

7.1 Cover sheet s.96 November 2019.DOCX................................................................................15

7.2 Policy for Section 96 Discretionary Payments FINAL.PDF......................................................17

7.3 S.96 Hard Copy of Template Application.docx.........................................................................21

8.1 Managing Practice Issues November 2019.docx.....................................................................27

8.2 Task and Finish Group Process - Inadequate and RI.DOCX...................................................29

9. 2019 7 Nov PCC Quality Report _All CCGs final.docx..............................................................31

10. Finance Update- Primary Care.docx........................................................................................37

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Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups

Page 1 of 1

Primary Care Commissioning Committees in CommonMeeting in Public

NHS FAREHAM AND GOSPORT CCGNHS ISLE OF WIGHT CCG

NHS NORTH HAMPSHIRE CCGNHS SOUTH EASTERN HAMPSHIRE CCG

Thursday, 7th November 2019 from 10.00- 11.15Board Room 6, The Middle Brook Centre, Middle Brook Street, Winchester

Item Title Lead Delivery Action Time1. Welcome and Introductions Chair Verbal

2. Declarations of Interest All Paper

10.00

Items for Decision3. Minutes of the meeting on 5th

September 2019Chair Paper Decision

4. Action Tracker from the meeting on 5th September and Matters Arising

Estates Prioritisation

All Paper Note

10.05

Items for Noting5. Isle of Wight Practice Closure Tracy Savage Paper Discussion 10.15

6. Primary Care Networks Update Primary Care Leads

Verbal Note 10.25

7. Section 96 Guidance Sophie Sitch Paper Discussion 10.30

8. Guidance for Managing Practice Issues

Sophie Sitch Paper Discussion 10.35

9. Quality Report Julia Barton Paper Note 10.45

10. Finance Report Paul Jones Paper Note 11.00

11. Any Other Business 11.10

12. Evaluation of Meeting and Meeting Close 11.15

0. Agenda- 7th November- Public v3.docOverall of 43

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First Name Surname Organisation Declared Interest - Name and Nature of Business

Jessamy Baird North Hampshire CCG Sanofi Pharmaceuticals - Shares Owned

Jessamy Baird North Hampshire CCG Sanofi Pharmaceuticals - Director of Market Access

Jessamy Baird North Hampshire CCG Benefactor of Treloars School through regular donations

Jessamy Baird North Hampshire CCG Sister works at Treloars School as Head of Music

Jessamy Baird North Hampshire CCGSister works as Deputy Director of Public Health at Bedford, Luton and Milton Keynes STP

Julia Barton All Partnership CCGsFriends with the family of contractor, Marcus Pullen, director of Blue Donut Studios

Julia Barton All Partnership CCGs Patient at the Bosmere Medical Practice

Julia Booth NHS England No interests declared

Normi Cadavieco North Hampshire CCG No interests to declare

David Chilvers Fareham & Gosport CCGUndertakes section 12(2) Mental Health Act assessments for Social Services

David Chilvers Fareham & Gosport CCG GP with Willow Group

Nicola Decker North Hampshire CCGPartner in GP Practice that is a shareholder in North Hampshire Alliance GP Commissioning Collaborative

Nicola Decker North Hampshire CCG Partner GP at Watership Health

Nicola Decker North Hampshire CCGHusband is an orthopaedic surgeon at Hampshire Hospitals NHS Foundation Trust

Nicola Decker North Hampshire CCGHusband is a member of the Board of Governors, Hampshire Hospitals NHS Foundation Trust

Lisa Harding Wessex LMC No interests to declare

Ros Hartley All Partnership CCGs Spouse is Marketing Manager for Gilead Sciences.

Paul Jones North Hampshire CCGMember of the Healthcare Financial Management Association (HFMA)

Paul Jones North Hampshire CCGMember of the Hampshire Hospitals NHS Foundation Trust

Alma Kilgarriff North Hampshire CCG No interests to declare

Kirsten Lawrence All Partnership CCGsDaughter works for NHS mental health provider in Essex

31st October 2019

2. Declarations of Interests - Partnership Primary Care Commissioning - Oct'19.pdfOverall of 43

Michele Legg Isle of Wight CCG Partner, Tower House Surgery

Michele Legg Isle of Wight CCGShares held in Company Island Clinical Academic Services

Michele Legg Isle of Wight CCGPartner undertakes work in the spinal triage clinic at St Marys Hospital and the EAS

Michele Legg Isle of Wight CCG President of IOW Osteoporosis Society

Michele Legg Isle of Wight CCG School Governor at Ryde School

Lisa MedwayFareham and Gosport and South Eastern Hampshire CCGs No interests to declare

Roshan Patel All Partnership CCGs No interests to declare

Barbara Rushton South Eastern Hampshire CCG Co-Chair of NHS Clinical Commissioners

Barbara Rushton South Eastern Hampshire CCG CCG Clinical Chair South East Hants CCG

Barbara Rushton South Eastern Hampshire CCG GP Locum

Tracey Savage Isle of Wight CCGVisiting Lecturer, Keele University School of Pharmacy (no payment)

Tracey Savage Isle of Wight CCG Husband is an employee of IOW NHS Trust

Margaret Scott All Partnership CCGsNorth East Hampshire CCG Primary Care Commissioning Committee

Margaret Scott All Partnership CCGs Patient at the Grange Surgery

Sophie Stitch South Eastern Hampshire CCG No interests to declare

Heather SmithFareham and Gosport and South Eastern Hampshire CCGs

Partner owns S Roberts upholsters. Carries out work for provider organisations (mainly Solent)

Heather SmithFareham and Gosport and South Eastern Hampshire CCGs Governor at Horndean Junior school

Sara TillerFareham and Gosport and South Eastern Hampshire CCGs

Working closely with South Hampshire GP Allicance, Southern Health NHS Foundation Trust and GP practices on the development of new care models

Carole Truman All Partnership CCGs Magistrate on the Isle of WightCarole Truman All Partnership CCGs Chair of the 1st Brighstone Sea Scouts Group ExecCarole Truman All Partnership CCGs Patient at South Wight Medical Practice.Nigel Watson Wessex LMC No interests declared

Andy Whitfield All Partnership CCGsGP Partner Voyager Family Health GMS Practice, Farnborough

Andy Whitfield All Partnership CCGs Shareholder in Salus GP Federation

Andy Whitfield All Partnership CCGsSon will be working with South Central Ambulance Service

2. Declarations of Interests - Partnership Primary Care Commissioning - Oct'19.pdfOverall of 43

1 Chairs initial ------

Minutes of the meeting of the Primary Care Commissioning Committees in Common- Meeting in Public held at 10.00 on Thursday, 5th September in Board Room 6, The

Middle Brook Centre, Middle Brook Street, Winchester, SO23 8DQ

PresentName RoleMargaret Scott Non-Executive Director (Chair)- HIOW PartnershipGeoff Barratt Head of Financial Transformation - North Hampshire CCG

(deputy for Roshan Patel)David Chilvers Clinical Chair- Fareham & Gosport CCGTom Crawford Quality Manager- North Hampshire CCG (deputy for Julia

Barton)Kirsten Lawrence Associate Director of Transformation- HIOW Partnership

(deputy for Ros Hartley)Michele Legg Clinical Chair- Isle of Wight CCGSara Tiller Managing Director and Executive Lead for Primary Care-

Fareham & Gosport and South Eastern Hampshire CCGsJudy Venables Non-Executive Director- HIOW Partnership (deputy for

Jessamy Baird)

In attendanceName RoleAdriane Becker NHS Management Trainee (shadowing Lisa Harding)Normi Cadavieco Senior Governance Manager- HIOW PartnershipLisa Harding Director of Primary Care, Wessex LMCJulie Hunt GP Fellow- Isle of Wight CCG (shadowing Michele Legg)Alma Kilgarriff Deputy Director of Primary Care Transformation &

Medicine Management – North Hampshire CCGTracy Savage Associate Director of Primary Care - Isle of Wight CCGSophie Sitch Senior Contracts Lead- Primary Care Transformation &

Contracting- Fareham & Gosport and South Eastern Hampshire CCGs

Simon Wilkinson Commissioning Manager – Primary Care & Prevention- North Hampshire CCG

Andy Whitfield Medical Director- HIOW Partnership

ApologiesName RoleJessamy Baird Non-Executive Adviser- HIOW PartnershipJulia Barton Director of Nursing and Quality- HIOW PartnershipNicola Decker Clinical Chair- North Hampshire CCGRos Hartley Executive Director of Strategy and Transformation- HIOW

PartnershipRoshan Patel Chief Finance Officer- HIOW PartnershipBarbara Rushton Clinical Chair, South Eastern Hampshire CCGCarole Truman Non-Executive Director- HIOW Partnership

3. Draft Minutes- PCCC 5 Sept 2019- Public.docxOverall of 43


1. Welcome and Apologies

The Chair welcomed members to the meeting. Apologies for absence were received as noted above.

2. Declarations of Interest

The register of interests was presented and members were asked to declare any changes or amendments. They were also advised to raise any interests relating to agenda items being considered at the meeting.

3. Minutes of the Previous Meeting

The minutes of the meeting held on 3rd July 2019 were presented to the Committee and were agreed as an accurate record.

4. Summary of Actions and Matters Arising

See attached Action Log.Action 19: Primary Care Workforce: Completed- action to be closed. Action 21: CQC Outcomes Summary: Completed- action to be closed.Action 22: CQC Outcomes Summary: Action to be carried over.

5. Bramblys Grange Medical Practice- Boundary Change

AK introduced the paper, noting that Bramblys Grange is requesting a boundary change as a result of their agreeing to take on the patient list for Rooksdown practice as of 10 September 2019. The boundary change will allow the practice to better serve its now expanded population and there is no anticipated impact for patients currently registered with either practice. The local Primary Care Operational Group has reviewed the proposal and supports the change.

The Committee sought assurance around patient and public engagement and recommended that AK work with the Comms team to develop an appropriate announcement related to the transition on 10th September 2019. (Action: AK)

The Committee approve Bramblys Grange Medical Practice’s proposal of amending their inner and outer practice boundaries.

6. Cedar Medical UpdateAK introduced the paper summarising the current position with Cedar Medical, highlighting the following:

Agreements are now in place for the managed transfer of patients from both Rooksdown and Beggarwood practices from 10th September 2019.

The long term sustainability of Beggarwood practice remains a concern due to weighting, which may make it difficult to find a long-term provider following the interim 2 year term with NHUC.



It remains unclear which PCN Beggarwood practice will join. However, all patients remain covered by Out of Hours access agreements.

Both sites are strategically important in the long term due to anticipated significant population growth in the local area by 2023.

The Committee requested further detail related to the long-term planning to accommodate the anticipated 50-60k new patients by 2023. AK noted that the CCG is developing an Estates plan with the partnership to understand possible Estates related options and additional planning including a six facet survey is underway.

The Committee thanked the North Hampshire team for their hard work in finding a safe solution for Beggarwood and Rooksdown patients.

The Committee noted the update.

7. Primary Care Networks UpdateThe Primary Care Leads provided an update on PCN development in their localities. AK noted that there are six PCNs in the North Hampshire geography, with the clinical directors now well connected and meeting fortnightly. The CCG continues to support practices in developing the PCNs an there are no current issues or risks to highlight to the Committee.

TS noted that there are three PCNs on the Isle of Wight and three Clinical Directors in place. The CCG locality directors are working to build relationships with the PCNs and working on PCN development plans. As of 9 September 2019, there will be a new PCN Network Development Support role in place to support PCN development and establishment.

KL noted that there are nine PCNs in the Fareham & Gosport and South Eastern Hampshire geography, with 13 Clinical Directors in place; two PCNs have two Clinical Directors, and one has three in a job sharing capacity. The CCG held an event on Tuesday, 3rd September support by the GP Federation and the LMC to introduce Clinical Directors to the various teams within the CCG, including workshops on how the teams can work with PCNs to support development.

LH added that the Wessex LMC will be running an event in October 2019 to bring people together and reflect on the first few months of PCNs being in place.

JV queried the approach to social prescribing being adopted by CCGs within the partnership, specifically with consideration for the clinical governance and supervision of the work to be varied out by social prescribers as well as areas for development and training needs specific to this group of staff. The primary care leads outlined the approach to social prescribing taken by each of the partnership CCGs, noting the following:

Social prescribers are currently in place, employed by the GP Federation, and will work together across the Isle of Wight in partnership with AgeUK and LivingWell.

In Fareham & Gosport and South Eastern Hampshire, only one PCN has recruited a social prescriber; the remainder are considering how to implement this role. #

Support is required for PCNs in North Hampshire to bring in social prescribers in an embedded way, similar to the six clinical pharmacists that are already working within PCNs across the patch.



KL added that the CCGs have strong links with the social prescribing network, which supports and review the work of social prescribers.

KL noted that funding has been made available for PCN and Clinical Director development by NHS England. The Hampshire and Isle of Wight STP has agreed that that funding will be distributed to PCNs on equitable basis.


8. Quality ReportTC provided the Quality Update as nominated deputy for Julia Barton, noting that that there are a total of nine practices rated as ‘Required Improvement’ across Fareham & Gosport, South Eastern Hampshire and North Hampshire CCG with one further practice in the North Hampshire CCG area rated as ‘Inadequate.’ All practices on the Isle of Wight are currently rated as ‘Good.’

ML highlighted a GP safeguarding risk on the Isle of Wight as a practice has been unable to recruit a Named GP for Safeguarding Children. An experienced safeguarding nurse is in place at the practice and the CCG is liaising closely with nurses where required. A model for working with a partner on the mainland is being considered to provide further resilience. There were no additional items for escalation to the Committee.

The Committee considered the timescale for practices rated inadequate or requires improvement to improve their ratings. This varies widely depending on the practice and the situation, but CQC normally visits practices that have been given these rating more frequently, and they can be asked to return sooner than one year if the practice is in a better position before then.


9. Finance ReportGB provided the Quarter 1 Finance Update, noting that the reports will be produced on a quarterly basis. The report has been modified slightly from the previously agreed template, with Year to Date totals added in an additional column. There are currently no issues to highlight to the Committee.

The Committee considered how prescribing budgets are allocated, as they are not included in all of the CCG reports. KL noted that this will be reported by exception and will vary based on the Medicines Management Team structures within each of the CCGs.

The Committee agreed that the format and information provided within the reports was sufficient.


10. Any Other Business

No other items of business were noted.



Next Scheduled MeetingDate: 2nd October 2019Time: 10.00-13.00Venue: Board Room 7, The Middle Brook Centre, Middle Brook Street, Winchester, SO23 8DQ

The meeting was closed at 11.15.

I confirm the minutes of the meeting were agreed as an accurate record

Signed by Chair: ………………………… Date:………………………


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of 1Rag Rating: Overdue In Progress Complete

Primary Care Commissioning Committees in Common Action Tracker 7 November 2019

Ref No

Date of Meeting/ Issue Originally Raised Title Summary of Action / Issue

Update Due Assigned To

Progress report / Update from previous meeting

RAG

22 3 July 2019

CQC Outcomes Summary

DC noted that there was no slide for Fareham & Gosport. WG agreed to look into this and update the Committee.

5/9/19 WG

245 Sept 2019

Bramblys Grange Medical Practice- Boundary Change

AK to work with the Comms team to develop an appropriate announcement related to the Rooksdown/Bramblys Grange transition on 10th September 2019.

7/11/19 AK

Previously completed actions have been archived.

4. PCCC Action Tracker Nov 2019.docxOverall of 43

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Primary Care Commissioning Committees in Common1

Coversheet

Title of Paper Section 96 guidanceAgenda Item 7 Date of meeting 7th November 2019Author FGSEH CCG (PCOG)

Exec Lead Sara Tiller, Managing Director- Fareham & Gosport and South Eastern Hampshire CCGs and Executive Lead for Primary Care

To ApproveTo RatifyTo Discuss x

Purpose

To Note

Executive Summary

This document outlines the policy agreed internally in Fareham and Gosport and South East Hampshire CCG, for reviewing and agreeing to Section 96 funding for member practices. This policy is for application in circumstances where a practice needs support, but the request does not fit into any other funding scheme.

Section 96 is a means by which the CCG can provide ad-hoc funding required by a GP practice. The Practice would submit an application (Appendix 1) which will then be reviewed against the criteria in this document.

The purpose of discussing this is to review the relevance and appropriateness of the content with a view to agreeing one document across the partnership for reviewing these applications.

Recommendations To agree a version of this document for use across the Partnership CCGs.

1 The Committees in Common comprise: North Hampshire CCG; Fareham & Gosport CCG; South Eastern Hampshire CCG and Isle of Wight CCG Primary Care Committees.

7.1 Cover sheet s.96 November 2019.DOCXOverall of 43

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Section 96 Payments 1. Introduction

1.1. Primary care is currently facing many challenges recognised in the General Practice Forward View, which offers a wide-ranging programme of change to create sustainability for the future

1.2. As part of the General Practice Forward View published by NHS England in April 2016 a programme to support practice resilience was announced. This incorporates the previously announced vulnerable practice scheme designed to support those practices that are most struggling, as well as the GP resilience programme

1.3. It may be that local intelligence suggests a GP practice is facing challenges, although they may not

necessarily qualify for support through a national programme if they do not meet the required criteria.,

1.4. This document outlines a statutory provision to make support available to a GP practice and

identifies some of the criteria against which it could be utilised. This document focusses on the use of this statutory provision at a time of crisis or impending crisis in a GP practice.

1.5. Commissioners recognise that there may be other occasions when this statutory provision could be

used to issue financial assistance to GP practices and the criteria below may not be relevant. In these circumstances, principles of transparency, fairness and equity should apply, to avoid setting precedent while considering the alternative likely consequences if financial assistance was not provided.

1.6. This statutory provision can only be utilised within the confines of commissioner’s budgets and

allocations.

2. Statutory provision 2.1. Section 96 of the National Health Service Act 2006 provides a route for awarding exceptional

financial assistance to providers of primary medical services. It states:

96 Assistance and support: primary medical services (1) A Primary Care Trust may provide assistance or support to any person providing or proposing to provide—

(a) primary medical services under a general medical services contract, or (b) primary medical services in accordance with section 92 arrangements.

(2) Assistance or support provided by a Primary Care Trust under subsection (1) is provided on such terms, including terms as to payment, as the Primary Care Trust considers appropriate. (3) “Assistance” includes financial assistance. Reference: http://www.legislation.gov.uk/ukpga/2006/41/section/96

3. Local application

3.1. When would this statutory provision be appropriate to use?

7.2 Policy for Section 96 Discretionary Payments FINAL.PDFOverall of 43

http://www.legislation.gov.uk/ukpga/2006/41/section/96

3.1.1. This statutory provision is designed to offer short term and immediate support to providers of

primary medical services. All other routes of support should be explored prior to considering use of section 96.

3.1.2. The provision is not designed to offer long term financial assistance to providers of primary

medical services.

3.2. What could the financial assistance be used for?

3.2.1. The NHS Act does not specifically define what this financial assistance could be used for.

3.2.2. Commissioners should not use this clause to circumvent other provisions within the NHS Act or the terms of a providers GMS/PMS contract. Funding should be awarded taking note of the General Medical Services Statement of Financial Entitlements.

3.2.3. Funding related to premises is subject to the provision of the Premises Cost Directions. 3.2.4. Funding must not contradict the intent of the NHS Forward View which requires equity of

global sum for the delivery of general medical services. 3.2.5. A general principle guiding the use of this statutory provision is that funding should only be

provided when all other routes of financial assistance have been explored. It should also be the opinion of the commissioner that, without this assistance, the immediate risk of a provider being unable to continue to deliver primary medical services is unacceptably high.

3.2.6. Individual decisions to agree assistance for providers of primary medical care services do

not set a precedent for the future.

3.3 Who will approve Section 96 funding?

3.3.1. Due to conflicts of interest and/or perceived conflicts of interest, approvals for section 96 funding will be reserved to the Primary Care Commissioning Committee.

4. Criteria for awarding funding

4.1. Prior to considering the issuing of financial assistance under section 96 GP practices should

demonstrate to commissioners that they have both looked out and looked in for alternative solutions to the challenges they are facing.

4.2. Looking out requires GP practices to explore opportunities for working together with others, for example in order to develop shared back-office services, and to find collective ways of delivering primary care at scale. It also requires providers to consider accessing alternative routes of support such as the vulnerable practice or resilient practice scheme available through NHS England.

4.3. Looking in requires GP practices to consider proposing closure of their list, changes to their

boundary or closure of a branch surgery. However, before getting to this stage, GP practices should demonstrate that they have reviewed the tools made available by NHS England (South West) in relation to sustainable general practice. GP practices should complete the Health Check Tool, which might provide indications of areas for change and/or improvements: https://www.england.nhs.uk/south/publications/sustainable-gp/.

4.4. If looking out or looking in fails to produce solutions to assist GP practices in addressing the

challenges they are facing, issuing of financial assistance under section 96 may be considered by commissioners.

4.5. In order to assess eligibility for this financial assistance the following framework sets out what will

be considered in deciding on whether or not to issue funding. Each scenario will be addressed on a case by case basis using this framework for guidance.


https://www.england.nhs.uk/south/publications/sustainable-gp/

No Criteria Rationale

1

There must be evidenced extenuating circumstances within the practice population related to:

1. Workload 2. Patient demographics 3. Significant change in service provision 4. Sudden or significant change to service requirements

This evidence may include an IMD score of 35 or higher for the practice population, a sudden increase in list size or evidence that local demographics dictate workload is not adequately reflected in the Carr Hill funding formula. This is proven by evidence of the downward weighting applied through the funding formula

Evidence of the consequential impact on a practice workload must be provided

2

No doctor in the practice should have declared pensionable earnings in excess of £99,969 p.a. (apportioned as relevant for part time GPs). This figure will be reviewed every year in line with nationally-available data.

Support not designed to increase pensionable income of GPs

3 The practice has been declined support through the vulnerable practice scheme and the GP resilience programme

Ensure only appropriate resilience or viability issues are funded through S.96

4 The impact of planned reductions in MPIG or PMS/APMS premium payments will have a proven negative financial impact on the practice

There must be a negative financial impact on the practice as a business (i.e. this indicator needs to be considered alongside point 2).

5 The funding must be non-recurrent, and the practice has a plan in place to recover the position.

As per the guidance

4.6. Requests for assistance should be considered taking into account the impact if support is not

provided and the provider is unable to continue to deliver the service.

5. Other requirements 5.1. The CCG Finance team may review the practice’s 12-month forward Profit & Loss and Cash flow

projections to test the practice’s future viability as well as provide assurance that the practice is maximising its current income streams.

5.2. Support should be provided for a set period agreed in confirmation of providing the funding 5.3. A clear audit trail will be kept by the CCG to demonstrate how the decision on the level of financial

assistance was reached. The CCG should be satisfied that financial assistance is the most appropriate assistance to provide.

6. Measurement and monitoring 6.1 All section 96 financial assistance must be formalised in a written Memorandum of Understanding

(MoU) to include:

Parties to the agreement

Intent and purpose of the award of financial assistance

Amount to be awarded

Duration of the funding

Description of the key deliverables to be achieved through the award of the financial assistance

Monitoring arrangements to ensure delivery of agreement

Dispute/recovery process

Providers should be regularly monitored against achievement of the agreed key deliverables. Failure to achieve these key deliverables could result in a request to return the funding provided.


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Hard Copy of Template Application

FORM REF: (NHSE use) Commissioner: Insert NHS England DCO / or Delegated CCG

GP Practice Application for Discretionary Funding Support (Section 96 NHS Act 2006)

1 Date of application:

2 Practice Name: ABC practice

3 Practice Identifier Code:

4 Contract type: GMS/PMS/APMS

5 Member of GP Federation (formal/informal?) Yes / No Name:

6 CCG Name:

7 Practice Address (of all contract sites) 1

2

3

8 Practice Raw List Size - Last Quarter

9 Practice Weighted List Size - Last Quarter

10 Reason for application (describe the issues to be resolved)

e.g. May be a GP recruitment issue - IMPACT is high cost of locum support - What are the circumstances that led to the situation? e.g. retirement, partnership split etc. How long has the vacancy existed? Describe recruitment attempts with dates and salary offered. CONSEQUENCES: describe effect on practice staff, patient services & access

11 Purpose of support requested and itemised value (non-recurrent) - above the practice budgeted level

7.3 S.96 Hard Copy of Template Application.docxOverall of 43

e.g. Support with cost of locums whilst further recruitment is attempted: e.g. Need X sessions per week covered with a premium of £X per week above budgeted cost of £Y per week. Difference of £Z for X weeks sought initially, TOTAL £X. (Practice has funded X weeks but cannot cover this cost much longer and may need to reduce service provision)

12 Period of support and profile of costs (taper-off) Period 1 insert dates insert £

Period 2 insert dates insert £





TOTAL REQUESTED £0

13 Supporting information - required for ALL applications at the outset

13.1Practice Recovery Plan (with actions and milestones to track success)

Yes No An MOU will detail agreed actions

13.2Current AND proposed staff establishment - budgeted with salary & WTE

Yes No State drawings for partners

13.3Evidence of recruitment attempts

Yes No e.g. advertisement invoices

13.4Annual income (all sources) & expenditure analysis OR Practice Accounts

Yes No to validate sustainability issue

13.5Cash flow forecast 12 months ahead

Yes No to understand predicted trend


Sustainability analysis Support Rationale Practice Response

14 Negative impact of Carr-Hill formula? (weighted list vs raw list) Atypical population: adverse

impact of Carr-Hill

Yes No

insert any comments

15 Does the practice have an 'atypical' population e.g. university, rural or new town which is not adequately reflected in the contract payment? Please explain:

'Atypical' criteria:Must evidence that local demographics dictate workload is not adequately reflected in Carr-Hill

Yes No Details required:

16 Are practice expenses greater than 65% of primary medical services (including Local Authority/CCG and NHS England) income?

South East average ratio of expenses: earnings is 65:35

Yes No Please state expenses: .................%

16b If yes, can this be sufficiently evidenced? Yes No insert any comments

1 insert £

2 insert £

3 insert £

4 insert £

5 insert £

6 insert £

7 insert £

8 insert £

17 Please state individually declared pensionable earnings per GP within the practice (pro-rata'd for part time) for the YEAR [INSERT YEAR](It is noted this may include non-GMS/PMS/APMS income & 'non-NHS' income.)

(£109.6k / £93.7k figures per NHS Digital GP Earnings and Expenses Estimates 2016/17 – average income before tax in England Contractor/combined contractor and salaried averages. Add 1%/yr – which for 2017/18 earnings would be £110.7k for contractors / £94.6k)

https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/2016-17

No doctor in the practice should have declared pensionable earnings in excess of Contractor = £110.7k.Or combined contractor & Salaried GP average not in excess of = £94.6kSupport not designed to increase pensionable income.

9 insert £

Local Context Information Practice to complete Practice to complete

18 Practice Total number of GP sessions worked/week? Understand GP access GP sessions X sessions/week


19 Number of patients per WTE GP Understand GP access Patients/GP XXXX patients/WTE GP

a) GP hrs/week

b) Nurse hrs/week

c) Other state e.g. Pharmacist hours/week

20 Total no. of clinical (GP & Qualified Nursing) hours offered per week (incl. concurrent hours)

Understand total clinical access

Total hrs/week

21 Has the practice received any contract breaches since 1 April 2013?

Potential marker of poorer quality practice

Yes NoDetails not required

22 Are any of the GP performers being investigated by NHS England Medical Directorate or GMC?



23 What was the Practices published CQC overall rating?Understanding of practice quality issues Please state

Outstanding / Good / Requires Improvement /

Inadequate?

24 Has the practice applied for a formal list closure at any point since 1 April 2013?

Marker of demand/practice issues


24b If yes, was this granted? Yes No

24c If application was approved how long was the list closed in total? Please state 3 months / 6 months / 9

months / 12 months

25 Number of practices within a 1-mile radius of practiceinsert number


To be completed by Commissioner - NHS England Local Context Information NHS England complete NHS England complete

26 Any previous S96 support received? Yes No Detail..

27 Any GP Resilience funding received? Yes No Detail..

28 Overview of deprivation - IMD Score? IMD is a marker of deprivation with consequential impact on workload

Practice Area:CCG Area:County Average:England Average:

29 A review of General Practice Indicators used by NHS England to assess quality and safety


Yes No

30 Annual contractual 'e-declaration' - non-compliance issues? Potential marker of poorer quality practice

Yes No

31 Patient satisfaction survey - outlier areas? Potential marker of poorer quality practice

Yes NoDetail issues:

Please return to: <insert local email> @nhs.net (ALL INFORMATION WILL BE HELD SECURELY)

Contractor name Practice signature (Contractor):

insert

CCG Support required in all cases:

CCG Lead Name insert CCG signature

or attach CCG email of support

NHS England Contract Officer reviewer - NHSE insert name insert


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CoversheetTitle of Paper Managing Practice IssuesAgenda Item 8 Date of meeting 7th November 2019

Author Sophie Sitch, Senior Contracts Lead- Primary Care Transformation and Contracting, Fareham & Gosport and South Eastern Hampshire CCGs

Exec Lead Sara Tiller, Managing Director- Fareham & Gosport and South Eastern Hampshire CCGs and Executive Lead for Primary Care

To ApproveTo RatifyTo Discuss

Purpose

To Note x

Executive SummaryFareham & Gosport and South Eastern Hampshire CCGs have seen an increase in ‘requires improvement’ and ‘inadequate’ CQC ratings which have triggered both a quality and contractual assurance process.

This process has been developed in line with the Policy Manual Guidance in order to ensure that these cases are managed equitably across the CCGs member practices. It has also reinforced the necessity to work more collaboratively across the directorates within the CCG, as well as the importance of engaging with NHS England & Improvement (NHSEI) and the local Wessex LMC early on to support practices further.

NHSE/I and the LMC have both fed into and signed this process off. The Primary Care Operational group for FGSEH CCGs have also noted it.

The purpose of bringing this item is to share the process with the partnership with a view to having a consistent approach.

Recommendations For other CCGs to consider the approach.


8.1 Managing Practice Issues November 2019.docxOverall of 43

Overall of 43

CQC draft 'Inadequate' or 'Requires

Improvement' report shared with practice and

CCG

Ensure Quality and Primary Care teams

are both sighted

Primary Care &/or Quality teams reach out to practice in line with the CCGs CQC support

offer

LMC and NHSEI colleagues notified

of concerns

Final 'Inadequate' or 'Requires Improvement report is published and

shared with practice and CCG

Ensure Quality and Primary Care teams

are both sighted

Primary Care, Quality & Clinical representatives offer informal visit to support and review

practices action plan

CCG communication and engagement

team support practice comms

Primary Care and Quality teams gather

information in line with Policy Guidance Manual

Section 2.6.8 'Gathering Information' of Policy

Guidance Manual (PGM)

PCOG to be informed that a Task and Finish

Group is required / has happened

Ensure this is minuted & captured on the decision log

Inform the practice that a Task and Finish Group is

required

Task and Finish Group is arranged as per the Terms of Reference

CCG share gathered information prior to

the meeting

PGM section 2.6.4 'Practice Visits -

Practical Support' taken to the

meeting

Task and Finish Group panel to agree action to

be taken

e.g. Do nothing, Formal Visit,

Convene Contract Review Panel (CRP)

Record on decision log to inform PCOG/PCCC

Task and Finish Group Process – CQC Inadequate/Requires Improvement

8.2 Task and Finish Group Process - Inadequate and RI.DOCXOverall of 43

Overall of 43

1


Coversheet

Title of Paper Primary Care Quality Exception Report(Covering North Hampshire, Fareham and Gosport, South Eastern Hampshire and Isle of Wight CCGs)

Agenda Item 9 Date of meeting 7th November 2019Exec Lead Julia Barton, Executive Director of Quality and NursingAuthors CCG Primary Care Quality Leads

For DecisionTo RatifyTo Discuss

Purpose

To Note X

Executive SummaryThis report details primary care quality risks, issues and exceptions from the following CCGs and their commissioned providers:

Fareham and Gosport CCG South Eastern Hampshire CCG Isle of Wight CCG North Hampshire CCG

New items for consideration are: Items for formal escalation to this committee:

Gosport Primary Care Services: Significant concerns about the quality and safety of services provided across Gosport. Specific themes draw on workforce and medicines management. CCG Quality team continue to work collaboratively with other CCG teams and offer support across primary care practices, community providers and PCNs to monitor current status and controls.

Beechgrove Surgery, Brading, IOW: The practice has notified the CCG that they will be ceasing to provide primary medical services from 31st March 2020. Substantial engagement with the public is ongoing through the communications team and an options appraisal will be communicated week beginning the 11th November.

Recommendations

Members are asked to:

1) Note the report and the risks, issues and challenges and improvements being made by respective CCGs.

2) Request any further information or assurance required on the content of the report.


9. 2019 7 Nov PCC Quality Report _All CCGs final.docxOverall of 43

2

CQC Regulatory Compliance - EXCEPTIONS

GP Practice Name

Inspection Date

Published date

CQC rating Comments

FGSEH CCGs practices (rated Requires Improvement or Inadequate)Staunton Surgery

Dec 18 Jan 19 Requires Improvement

Vine Medical Group

Nov 18 Jan 19 Requires Improvement

The Grange Surgery

Oct 18 Dec 18 Requires Improvement

Bury Road Surgery

Nov 18 Jan 19 Requires Improvement

CCG quality concerns escalated following each providers CQC inspections and publication of reports. CCGs provide support visits and remain vigilant, monitoring for quality assurance. CQC will re-inspect these providers within twelve months of report publication.

Brockhurst Medical Centre

Feb 19 June 19 Requires ImprovementWarning Notice Issued (Reg 12/17 of The Health &Social Care Act 2008)

Overall rating Requires Improvement (RI) with Inadequate in Safe and RI in Effective and Well-Led domains. Re-inspection of the warning notice by CQC on 13.05.2019. Compliance satisfactory and overall rating remains. CCG quality concerns remain regarding current workforce and update requested for medical recruitment and workforce status. CCG support continues following closure of the Breach Contract Notice (14.08.19) by the CCG contract review panel where satisfactory contractual and quality assurance was provided. CCG quality monitoring and support continues with a proposed quality visit in six months.

Bridgemary Medical Centre

24 June August 19 Inadequate Warning Notice Issued (Reg12/17 of The Health and Social Care Act 2008)

Overall rating inadequate with inadequate in effective and well-led domains. Re-inspection of the warning notice by CQC was upheld on 22.08.19 Report pending and overall rating will remain until full comprehensive inspection six months from publication (08.19) report. CCG support and visits provided and a CCG contract review task and finish meeting was held 17.09.19. No breach of contract considered applicable at this time.


3

GP Practice Name

Inspection Date

Published date

CQC rating Comments

Pinehill Surgery

Jan 19 April 2019 InadequateWarning Notice Issued (Reg12/17/19 of The Health and Social Care Act 2008)

Overall rating inadequate, with inadequate in safe, caring and well-led domains. RI in effective and responsive domains.

CQC comprehensive inspection on 17.09.2019 with evidence of significant improvement (publication of report pending). CCG support and assurance visits continue. Full comprehensive CCG contract panel review visit (01.10.19) provided final contractual and quality assurance and concluded at panel (15.10.19). The CCG continue to monitor ongoing quality concerns and remain vigilant as workforce concerns continue to escalate.

Remaining FGSEH CCGs practices (rated Good or Outstanding)30 GoodSouthern Hampshire Primary Care Alliance (SHPCA)

July 19 Sept 19 Good Overall rating of good across 3 sites inspected. Requires improvement (effective domain) across two sites and requires improvement (safe domain) for SHPCA HQ. CQC recommend improvements in the systems and processes to assess monitor and improve the quality and safety of the services provided. CCG continue to offer support and monitor quality through a new CQRM process.

Isle of Wight CCG practices (rated Requires Improvement or Inadequate)NoneRemaining Isle of Wight CCG practices (rated Good or Outstanding)100% (15) Remaining practices

Good

NHCCG practices (rated Requires Improvement or Inadequate)Watership Down Health

Jan 19 Apr 19 Requires Improvement

Overall rating RI with good in caring and responsive.Requirement notice under Regulation 17 (good governance); Regulation 18 (staffing) of the Health and Social Care Act.

These notices related to the governance in relation to medicine management and the oversight of staff training appropriate to their role.


4

GP Practice Name

Inspection Date

Published date

CQC rating Comments

Acorn Health Partnership

Mar 2019 May 2019

Requires Improvement

Overall rating RI with good in effective and caring.Requirement notices under Regulation 12 (safe care and treatment; Regulation 17 (good governance) of the Health and Social Care Act.These notices related to: not mitigating risks around fire safety, patient group directions and lack of systems and processes established and operated effectively to ensure compliance with requirements to demonstrate good governance.

Rooksdown and Beggarwood Sites

With the splitting of the Cedar Medical practice, the following CQC position is reported:

The Rooksdown Practice is now a branch site of Bramblys Grange Surgery and falls under their overall CQC rating (RI), until re-inspection occurs.

The Beggarwoord site is now provided by NHUC, and as yet has not been subject to CQC inspection, which is awaited.

Quality team support to both continues. Remaining NHCCG CCGs practices (rated Good or Outstanding)80% (12) Remaining practices

Good

Primary Care Quality Risks

Risk description Risk rating

Fareham and Gosport/ South Eastern Hampshire CCG IUC/111 Pathway Quality Risks 16Pinehill Surgery Quality concerns Southern Hants PC Alliance Quality Capacity and Governance arrangementsPHL staffing concernsGosport Primary Care Quality Concerns – Brockhurst, Bridgemary and Bury Road practices

High – (Concerns)Enhanced Monitoring

Isle of Wight CCGNo new primary care quality risks identified in this reporting period -North Hampshire CCG Risk ratingCapacity for the CCG to review the community acquired E.coli RCAs 9Care Homes - early recognition of deteriorating residents 9

Estates issues in primary care (where quality is affected)

Fareham and Gosport & South Eastern Hampshire CCGs, Isle of Wight CCG and North Hampshire CCGThere are no specific quality issues regards estates to report this month, however, IOW and NH CCGs have recently completed the 6 facets survey and the results are being analysed. The CCG


5

quality teams continue to support practices who have estates issues highlighted during CQC inspections.

Progress with Quasar Primary reporting Fareham and Gosport & South Eastern Hampshire CCGs

o Quasar HCP feedback (Sept) continues to be consistent across F&G and SEH - 94% from GPs. Top three concerns identified are: Reporting Follow up Medicines management with a focus on specific department’s in PHT.

o SHPCA live on Quasar and reporting regularly, providing surveillance data across GP extended access and IPCAS services. Quasar team supporting practices where less reporting is identified and all feedback shared with providers’ via quality portal monthly for awareness and learning.

Isle of Wight CCGo Three practices continue to utilise Quasar and the IOW quality team is working with FGSEH

CCGs to establish tools for roll out to all 15 practices on the Island. This includes upgrade of software originally installed and review of the contract.

North Hampshire CCGo Quasar CCG functionality demonstrated at Primary Care Operational Group and received

with interest. Quality team is exploring Quasar interest among PCN clinical champions. o The quality team will be establishing a new system to capture health care professional

feedback from primary care in relation to community services. The insight and experiences from primary care will enable a better understanding of the issues and challenges to be shared with community providers for improvement focussed learning. Feedback will be received via a generic email address monitored by the Quality team on a daily basis.

NHSE Primary Care Quality Data Portalo This is being hosted on the Quasar platform and is now live to CCG staff, bringing in a wide

range of data. Agreed HIOW data set is in place to standardise and benchmark. Plans now needed to design a route to share this information with practices, which was not included in original NHSE spec for the module.

--------------------------------------------------------------------------------------


Overall of 43


CoversheetTitle of Paper Primary Care Finance UpdateAgenda Item 10 Date of meeting 7th November 2019Author Heather Smith, Head of Financial Transformation, SEHFG CCG’sExec Lead Paul Jones, Deputy Chief Finance Officer NHCCG

To ApproveTo RatifyTo Discuss

Purpose

To Note x

Executive Summary

North Hampshire CCG, South Eastern Hampshire CCG, Fareham & Gosport CCG and Isle of Wight CCG each have delegated responsibility for the local primary care delegated budgets alongside the GP locally commissioned services in their respective geographies. In order for the Committee to monitor this delegated function, a Primary Care Finance Report is produced by each CCG on a quarterly basis.

The attached CCG Primary Care Finance Reports provide detail around primary care finance at Month 6 (September 2019) together with a RAG rating and exception reporting, incorporating the following:

1) The budget for the year;2) The year to date spend;3) Specific Committed Funds not in YTD Reported Spend Position;4) 2019/20 Reported Forecast Outturn.

RecommendationsThe Committee is asked to NOTE the current position of Primary Care budgets for North Hampshire CCG, South Eastern Hampshire CCG, Fareham & Gosport CCG and Isle of Wight CCG.


10. Finance Update- Primary Care.docxOverall of 43

North Hampshire CCGPrimary Care Summary - as at the end of September 2019/20 6

Service/Scheme2019/20

Annual Budget 2019/20

YTD Budget

Reported Year to Date (YTD)

Spend PositionYTD Variance

2019/20Reported Forecast

Outturn

RAG

Comments

Primary Care ServicesDiabetesTask 1 - 8 Basic Diabetes Care Processes 16,618 8,309 8,309 0 16,618Task 2 - Bi-Annual Review 12,477 6,239 6,239 0 12,477Task 3 - Diabetic Care Plan 16,618 8,309 8,309 0 16,618Task 4 - Multi-Disciplinary Team Meetings 86,620 43,310 44,444 1,134 88,888Task 5 - Pre-Diabetes Register and Patient Review 57,604 28,802 28,802 0 57,604Task 6 - Patient Initiated on Injectable Therapies 16,208 8,104 7,920 (184) 15,840

Diabetes Transformation - Diabetes HCA 23,495 11,748 0 (11,748) 23,494Budget to be transferred to

Southern HealthDiabetes Patient Event 0 0 372 372 372Sub Total Diabetes 229,640 114,820 104,395 (10,426) 231,911General Practice Development Scheme GPDS to be finalised (Previously Clinical Commissioning Incentive Scheme)

268,290 134,145 134,145 0 268,290

Target Meetings 21,736 10,868 0 (10,868) 21,736North Hampshire AllianceAnti Coagulation Monitoring 181,297 90,649 75,637 (15,012) 151,274Drug Monitoring 195,200 97,600 99,059 1,459 198,119Phlebotomy 127,257 63,629 61,175 (2,454) 122,350Other ServicesExtended Hours (Reception) 4,475 2,238 639 (1,599) 639Intra-Uterine Systems (IUS) Fitting (Menorrhagia) 7,341 3,671 835 (2,836) 7,341Minor Injuries 113,210 56,605 52,366 (4,239) 104,732The Wow Awards 11,737 5,869 0 (5,869) 11,737Tadley Proactive Care 39,000 19,500 39,000 19,500 39,000

GIS Practice Mapping Service 1,790 895 4,607 3,712 18,427FOT based on actual YTD costs

extrapolatedPlurex Drainage 0 0 1,530 1,530 1,530 Adhoc support for one patientPaedriatric Hubs 17,000 8,500 17,000 8,500 17,000EFFECTIVE PROFESSIONAL INTERACTIONS LTD 1,995 1,995Hickson and Hickson Different conversations forum 1,050 1,260Co-Create Consultancy 2,613 0

Contingency 13,918 44,453 0 (44,453) 10,754

Grand Total Primary Care Services 1,231,891 653,440 596,045 (63,052) 1,208,093 Budget phasing incorrect to be corrected in M7

Improved Access FundingGrand Total Improved Access 1,273,000 636,500 579,303 (57,197) 1,271,534

Primary Care DevelopmentGPFV Transformation Support (commitment b/f from 2018/19) 486,139 33,134 33,134 0 486,139Primary Care Networks 341,075 170,538 159,814 (10,724) 330,354Clinical Champions 89,000 44,500 31,089 (13,411) 72,672GP Forward View Retained Doctors Scheme 19,000 0 0 0 19,000GP Forward View Development & Reception Training 38,000 0 0 0 38,000Basket Of Services 561,325 280,663 283,096 2,433 566,192Grand Total Primary Care Development 1,534,539 528,834 507,132 (21,702) 1,512,35710. Finance Update- Primary Care.docx

Overall of 43

North Hampshire CCG CONTINUED

Primary Care Summary - as at the end of September 2019/20 6



YTD Budget

Reported Year to Date (YTD)

Spend PositionYTD Variance


Outturn

RAG

Comments

Commissioning SchemesMECS (PEARS) & GRR (PEARS+) 171,093 85,547 122,862 37,316 245,725 Activity Based ContractGynaecology clinic 55,073 27,537 23,547 (3,990) 47,094Urology 37,579 18,790 14,899 (3,890) 29,799Upper GI 110,204 55,102 50,763 (4,339) 101,527Flexi Sig 72,347 36,174 32,692 (3,482) 65,384

RAS ENT95,450 47,725 72,390 24,665 120,780

One off £24k payment - RAS ENT backlog clearance

The Firs 25,995 12,998 12,260 (738) 24,520Primary Care Commissioning CIC ( Training) 7,433 3,717 6,000 2,284 6,000Enhanced Care Home Pilot 300,212 150,106 132,813 (17,293) 265,627Better Local Care -Same Day Access Centre 100,000 37,663 20,091 (17,572) 100,000Contingency 14,869 0

Sub Total Primary Care Commissioning Schemes990,255 475,356 488,318 12,962 1,006,455 Budget phasing incorrect to be

corrected in M7

Enteral Feeding 387,338 193,669 254,657 60,988 484,501New Contract, dual running cost

Fresenius Kabi and Nutricia

Grand Total Commissioning Schemes 1,377,593 669,025 742,975 73,950 1,490,956

Primary Care DelegatedGMS/PMS/APMS Contract 19,764,887 9,734,403 9,734,403 0 19,764,887Directed Enhanced Services 1,537,899 635,897 635,897 0 1,537,899Primary Care Other 1,566,350 783,137 783,137 0 1,566,350Premises 3,665,133 1,832,458 1,832,458 0 3,665,133Quality Outcome Framework 2,705,731 1,352,800 1,352,800 0 2,705,731Grand Total Primary Care Delegated 29,240,000 14,338,695 14,338,695 0 29,240,000

Out of HoursNorth Hampshire Urgent Care Out of Hours 2,797,953 1,398,977 1,391,607 (7,369) 2,783,214Grand Total Primary Care Delegated 2,797,953 1,398,977 1,391,607 (7,369) 2,783,214

PrescribingGP Prescribing 29,791,499 14,895,744 15,050,141 154,397 30,662,932Central Drugs & ONPOS 1,364,616 682,308 656,252 (26,056) 1,312,360Grand Total Primary Care Delegated 31,156,115 15,578,052 15,706,393 128,341 31,975,292

GPITCSU Contract 435,027 217,514 215,825 (1,688) 433,339HSCN/N3 99,772 49,886 51,191 1,305 101,077Systems (Qmasters/EMIS/GPTeamNet/MJOG/Docman) 170,920 85,460 61,956 (23,504) 143,659

Other163,162 81,581 114,677 33,096 228,376

Additional spend on IT equipment and SMS Messaging

Grand Total Primary Care Delegated 868,881 434,441 443,649 9,209 906,451

Grand Total Primary Care 69,479,972 34,237,963 34,305,800 62,179 70,387,89810. Finance Update- Primary Care.docx

Overall of 43

Fareham & Gosport CCGPrimary Care Summary - as at the end of September (Month 6) 2019/20

Service/Scheme Annual Budget YTD Budget YTD Actual YTD Variance2019/20

Reported Forecast Outturn

Forecast Outturn Variance

RAG

Comments

£000 £000 £000 £000 £000 £000

Commissioning SchemesCommissioning LIS 853 427 391 (36) 782 (71)Block LCS 439 220 220 1 440 1Phlebotomy 307 154 154 1 308 1Low Vision 11 6 9 4 18 7Glaucoma 9 5 5 0 9 0SMI-Physical Health Checks 42 21 16 (6) 31 (11)Other 34 17 0 (17) 34 0Total Commissioning Schemes 1,695 848 794 (54) 1,622 (73)

Primary Care Network Support Network payment (£1.50 Per Head) 311 156 154 (2) 307 (4)Total Primary Care Network Support 311 156 154 (2) 307 (4)

GP Forward ViewGP Extended Access 1,011 438 449 11 1,024 14Home Visiting Service 575 268 142 (126) 449 (126)New Care Models - Clinical Leads and Transformation Team 197 186 59 (127) 133 (64)Total GP Forward View 1,783 891 650 (242) 1,606 (176)

Primary Care DelegatedGMS/PMS/APMS Contract 17,316 8,658 8,560 (98) 17,223 (93)Directed Enhanced Services 1,074 543 499 (45) 985 (89)PCN Additional Roles 318 106 35 (71) 320 2Premises 2,965 1,483 1,490 7 2,979 14Quality Outcome Framework 3,051 1,526 1,507 (18) 3,014 (37)Primary Care Other 1,096 595 650 55 1,219 123Total Primary Care Delegated 25,820 12,910 12,740 (170) 25,740 (80)

Out of HoursNorth Hampshire Urgent Care Out of Hours 1,652 826 722 (104) 1,464 (187)Grand Total Primary Care Delegated 1,652 826 722 (104) 1,464 (187)

PrescribingGP Prescribing 32,567 16,283 16,458 175 32,916 349Central Drugs & ONPOS 1,867 934 886 (48) 1,803 (64)Grand Total Primary Care Delegated 34,434 17,217 17,344 127 34,719 285

Primary Care GPITCharge from CSU 368 184 185 1 371 2HSCN 110 55 55 0 110 0Other 301 151 162 12 366 65Total Primary Care GPIT 780 390 403 13 847 67

Total Primary Care Budget 66,474 33,238 32,806 (432) 66,306 (169)


South Eastern Hampshire CCGPrimary Care Summary - as at the end of September (Month 6) 2019/20

Service/Scheme Annual Budget YTD Budget YTD Actual YTD Variance2019/20

Reported Forecast Outturn

Forecast Outturn Variance

RAG

Comments

£000 £000 £000 £000 £000 £000

Commissioning SchemesCommissioning LIS 909 455 418 (36) 837 (72)Block LCS 464 232 233 1 466 2Phlebotomy 324 162 164 2 327 3Low Vision 9 5 4 (0) 8 (1)Glaucoma 13 7 6 (1) 11 (2)SMI-Physical Health Checks 45 23 18 (5) 35 (10)Other 38 19 4 (15) 46 8Total Commissioning Schemes 1,802 901 847 (54) 1,731 (71)

Primary Care Network Support Network payment (£1.50 Per Head) 325 162 162 (0) 324 (0)Total Primary Care Network Support 325 162 162 (0) 324 0

GP Forward ViewGP Extended Access 1,073 471 461 (9) 1,087 14Home Visiting Service 496 171 173 2 498 2New Care Models - Clinical Leads and Transformation Team 194 240 59 (181) 130 (64)Total GP Forward View 1,763 882 693 (189) 1,714 (49)

Primary Care DelegatedGMS/PMS/APMS Contract 19,367 9,684 9,587 (96) 19,256 (111)Directed Enhanced Services 1,160 588 540 (48) 1,060 (100)PCN Additional Roles 318 106 42 (64) 327 9Premises 2,348 1,174 1,192 18 2,384 36Quality Outcome Framework 3,354 1,677 1,664 (13) 3,329 (25)Primary Care Other 1,570 830 535 (295) 1,433 (137)Total Primary Care Delegated 28,117 14,059 13,562 (497) 27,790 (327)

Out of HoursNorth Hampshire Urgent Care Out of Hours 1,610 805 755 (50) 1,556 (55)Grand Total Primary Care Delegated 1,610 805 755 (50) 1,556 (55)

PrescribingGP Prescribing 35,262 17,641 17,905 264 35,812 550Central Drugs & ONPOS 2,042 1,021 928 (92) 1,893 (149)Grand Total Primary Care Delegated 37,304 18,662 18,833 171 37,705 401

Primary Care GPITCharge from CSU 433 216 217 1 435 2HSCN 132 66 66 0 132 0Other 297 149 174 25 379 81Total Primary Care GPIT 862 431 457 26 946 84

Total Primary Care Budget 71,783 35,902 35,309 (592) 71,766 (17)10. Finance Update- Primary Care.docxOverall of 43

IOW CCG Primary Care Summary - as at the end of September (Month 6) 2019/20



YTD Budget2019/20

YTD Actual2019/20

YTD Variance


Outturn

RAG

Comments

£000's £000's £000's £000's £000's

Primary Care ServicesGP Federation - One Wight HealthOWH - Anticoagulation & DVT Service 610 305 317 (12) 610

GP ServicesAudit Clerks 78 39 39 0 78Health Care Assistants 373 186 186 0 373Advanced Care Planning 207 103 89 14 207Diabetes 234 117 117 0 234DMARDS 105 53 52 1 105Minor Injuries 169 85 85 0 169Phlebotomy 99 50 52 (2) 99Prostate Carcinoma 36 18 18 0 36Basket of Services - Leg Ulcer Service 217 109 122 (13) 217Other ServicesGlaucoma 0 0 0 0 0Rehabilitaion Beds 50 25 25 0 50ADHD - Shared Care 11 6 7 (1) 11Metal Health Pilot (Tower, Argyll & Esplanade Practices) 63 31 31 0 63Meetings (Room hire, Catering etc) 13 7 8 (1) 13GP Software Data lines 46 23 24 (1) 46Total Primary Care Services 2,311 1,157 1,172 (15) 2,311

Primary Care Network SystemDES - Primary Care Networks (£1.50 per patient) 217 109 109 0 217

Total Primary Care Network Support 217 109 109 0 217


IOW CCG Primary Care Summary - as at the end of September (Month 6) 2019/20



YTD Budget2019/20

YTD Actual2019/20

YTD Variance


Outturn

RAG

Comments

£000's £000's £000's £000's £000's

GP Forward ViewSandown Health Centre - GP Extended Access 45 23 21 2 45Shanklin Medical Centre - GP Extended Access 85 43 38 5 85Tower House Surgery - GP Extended Access 732 366 362 4 732Lighthouse Medical - GP Extended Access 45 23 19 4 45Total Improved Access (£899k baseline & £8k allocation in 2019/20) 907 454 440 14 907

Primary Care DevelopmentGP Federation - One Wight HealthGP Federation (One Wight Health) Infrastructure support 145 73 73 0 145Total Primary Care Development 145 73 73 0 145

Primary Care GPITPrimary Care GPIT 525 262 200 62 525Total Primary Care GPIT 525 262 200 62 525

Primary Care DelegatedGMS/PMS/APMS Contract 15,271 7,569 7,620 (51) 15,271Directed Enhanced Services 1,092 427 424 3 1,092Primary Care Other 399 200 185 15 399Premises 1,772 887 871 16 1,772Quality Outcome Framework 2,309 1,123 1,123 0 2,309Total Primary Care Delegated* 20,842 10,206 10,223 (17) 20,842

* Includes underspend against QIPP & Contingency Reserve


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