Meeting Primary Care Commissioning Date Tuesday 9 July...

Meeting Title

Primary Care Commissioning Committee – meeting in public Date Tuesday 9 July 2019

Meeting No. 48. Time 9:30am – 10:35am

Chair Mr Clive Wood Deputy Chair of the CCG and Independent Lay Member

Venue / Location

Please note, change of room: Room G52, Leicestershire County Council, County Hall, Glenfield, Leicester, LE3 8TB.

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING

PC/19/44 Welcome and Introductions Clive Wood Verbal 9:30am

PC/19/45 To receive questions from the Public in relation to items on the agenda

To receive Clive Wood Verbal 9:30am

PC/19/46

Apologies for Absences: • Dr Nick Glover • Dr Girish Purohit • Ms Donna Enoux


PC/19/47 Notification of Any Other Business To receive Clive Wood Verbal 9:35am

PC/19/48 Declarations of Interest on Agenda items


PC/19/49

To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 4 June 2019

To approve Clive Wood A 9:40am

PC/19/50 To Receive Actions and Matters Arising following the meeting held on 4 June 2019

To receive Clive Wood B 9:40am

GOVERNANCE ARRANGEMENTS

PC/19/51 Primary Care Delivery Group (PCDG): Terms of Reference

To receive Jamie Barrett C 9:45am

PRIMARY CARE FINANCE REPORT

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING

PC/19/52 Primary Care Finance Report 2019/20 (Month 2, May)

To receive Donna Enoux D 9:50am

OPERATIONAL ISSUES

PC/19/53 Exploring Health Inequalities in Oadby and Wigston: A Qualitative Approach

To receive

Dr Emily Maile, Public Health E 10:00am

PC/19/54

South Leicestershire Medical Group - Update on Merger between Kibworth Medical Centre and The Two Shires Surgery

To receive Seema Gaj F 10:15am

PC/19/55

Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T) Work Programme update

To receive Tim Sacks G 10:25am

ANY OTHER BUSINESS

PC/19/56 To receive Clive Wood Verbal 10:30am

DATE OF NEXT MEETING

PC/19/57

Tuesday 6 August 2019 at 9:30am – 12:30pm, Gartree Committee Room, ELR CCG, Leicestershire County Council, County Hall, Glenfield, Leicester, LE3 8TB.

Clive Wood Verbal 10:35am

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Paper A ELR CCG Primary Care Commissioning Committee

9 July 2019

Minutes of the Primary Care Commissioning Committee held on Tuesday 4 June 2019 at 9:30am in the Framland Committee Room, ELR CCG, County Hall, Glenfield,

Leicester, LE3 8TB

Present: Mr Clive Wood Deputy Chair of the CCG and Independent Lay Member (Chair) Mr Alan Smith Independent Lay Member Dr Nick Glover GP Locality Lead, South Blaby and Lutterworth Dr Girish Purohit GP Locality Lead, Syston, Long Clawson and Melton Dr Vivek Varakantam GP Locality Lead, Oadby and Wigston (from item PC/18/142

onwards) Mr Tim Sacks Chief Operating Officer Mr Colin Groom Head of Finance (on behalf of Chief Finance Officer) Mrs Tracy Burton Chief Nursing and Quality Officer Dr Katherine Packham Public Health Consultant In attendance: Mrs Daljit Bains Head of Corporate Governance and Legal Affairs Mr Jamie Barrett Head of Primary Care Mrs Amardip Lealh Corporate Governance Manager (Minutes) Public Gallery: Ms Zainab Younous GP Registrar, Public Health

ITEM LEAD

RESPONSIBLE PC/19/25 Welcome and Introductions

Mr Wood welcomed all members to the Primary Care Commissioning Committee (PCCC) meeting, in particular Ms Younous. Dr Packham informed the Committee that Ms Younous has joined Public Health for a period of 4 months as part of her GP role within Leicester City. This was followed by a series of introductions.

PC/19/26 To receive questions from the Public in relation to items on the agenda There were no questions from members of the public present at the meeting and no questions had been received.

PC/19/27 Apologies for absence: • Ms Donna Enoux, Chief Finance Officer

PC/19/28 Notification of Any Other Business Mr Wood had not received notification of any other business.

PC/19/29 Declarations of Interest

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ITEM LEAD RESPONSIBLE

GPs present declared an interest in items relating to commissioning of primary care where a potential conflict may arise, which did not include any specific declarations on this occasion. It was RESOLVED to:

• NOTE the conflicts of interest declared.

PC/19/30 To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 5 March 2019 (Paper A) Mr Wood noted the minutes of the meeting held in March 2019 were reviewed at the previous meeting in May 2019, however, could not be approved as the meeting held in May 2019 was not quorate. Therefore, these minutes have been bought forward to this meeting. The minutes of the meeting held in March 2019 were accepted as an accurate record of the meeting, subject to the following amendments:

• PC/19/11 – Development of PCNs and in Leicester, Leicestershire and Rutland (LLR): page 6, last paragraph Dr Varakantam confirmed he had queried whether the PCNs were required to cover geographical areas as opposed to the number of patients. It was agreed for Dr Varakantam to liaise with Mrs Lealh and amend the paragraph accordingly.

It was RESOLVED to:

• APPROVE the minutes of the meeting, subject to the above amendment.

PC/19/31 To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 7 May 2019 (Paper B) The minutes of the meeting held in May 2019 were accepted as an accurate record of the meeting It was RESOLVED to:

• APPROVE the minutes of the meeting.

PC/19/32 To Receive Matters Arising following the meeting held on 7 May 2019 (Paper B)

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The matters arising following the meeting held in May 2019 were received. It was RESOLVED to:

• RECEIVE the matters arising.

PC/19/33 Primary Care Commissioning Committee (PCCC): Terms of Reference (Paper D) Mrs Bains presented this report, which provided the Terms of Reference for the Committee following its annual review to ensure they remain fit for purpose and in line with the authority delegated to the Committee by NHS England (appendix 1). Mrs Bains informed the Committee there were no changes made at this time and a copy of the Terms of Reference for the Committee (version 1, draft 5) was also appended to the CCG’s Constitution, which were approved by NHS England in January 2019. Dr Varakantam queried the inclusion of a GP Member within the quoracy section (i.e. section 25) if the membership of the Committee requires 3 GPs in attendance (i.e. section 18), which Dr Glover was also going to raise. Mrs Bains confirmed the guidance does not stipulate a GP Member forms part of the quoracy for this meeting, however the Committee felt it was valuable for GPs to form part of the discussions held; hence their inclusion as attendees of this Committee. Mr Wood valued the contributions made by GP Members, which supported the Committee to gain an understanding of the issues it is presented with. It was agreed for the Terms of Reference for the Committee to be presented to the Governing Body for approval in June 2019 as part of the PCCC summary report. It was RESOLVED to:

• RECEIVE the Terms of Reference for the Committee.

Clive Wood / Daljit Bains

PC/19/34 Primary Care Commissioning Committee (PCCC): Conflicts of Interest Register 2018 – Public (Paper E) Mrs Bains presented this report, which provided an overview of the declarations made by members of the Committee at the meetings held in public during 2018 and action taken where there has been a potential and actual conflict. It was reported that a register of declarations is maintained for

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members of the Governing Body, however, a separate register of conflicts has been established for this Committee to ensure transparency in the management of conflicts declared, which is also reviewed by the Audit Committee. In response to Mr Wood’s query as to the Chair of the Audit Committee and whether they have reviewed the register of interests for this committee, Mrs Bains confirmed the Audit Committee is chaired by Mr Warwick Kendrick, Independent Lay Member, who is also the Conflicts of Interest Guardian for the CCG. In addition, the Audit Committee received the register of conflicts for the PCCC at its meeting in March 2019, of which Mr Smith is also a member. Dr Purohit queried whether this is the first time this has been presented to the Committee as the conflicts have been managed and documented in a robust manner. Mrs Bains confirmed the register of conflicts for this Committee is presented on an annual basis. Dr Purohit also queried whether it would be useful to implement a register of conflicts for the Governing Body too. Mr Wood agreed to discuss its implementation with Dr Ursula Montgomery, Chair of the CCG and Ms Donna Enoux, Deputy Managing Director for the Governing Body. Dr Glover suggested Mr Wood also discuss whether it was possible to identify any themes or outputs of the conflicts raised that may also require escalation to Dr Montgomery and Ms Enoux. Mr Sacks confirmed a conflict of interest declared at the PCCC meeting in December 2018 has been listed as “a resident in Uppingham” when he is a resident of Ketton. It was agreed for this to be amended. It was RESOLVED to:

• RECEIVE the update.

PC/19/35 Primary Care Finance Report 2018-19 (Month 12, March 2019) (Paper F) In the absence of Ms Enoux, Mr Groom presented this report, which was taken as ‘read,’ and summarised as follows:

• The financial accounts for 2018-19 have now closed and the final position reported to the Committee at its meeting in May 2019;

• The CCG achieved all key financial areas; • The reported position included a number of expenditure

estimates (accruals) for which actual charges have now been received. The table within the report showed the

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difference between accrued amounts and actual charges for the main primary care budget areas and calculates a total over accrual (2019/20 benefit) to the CCG of £26k.

• Appendix 1 of the report, includes the prescribing outturn per Practice;

• Appendix 2 of the report provided a breakdown of the budget for 2019-20, which equated to £98.5m that included a £5.3m QIPP delivery target.

It was reported that there was no financial impact to Primary Care at this stage, however, a number of risks that could impact the financial position for 2019-20 included the following:

• Prescribing • Co-commissioning • PCN Funding

Dr Glover noted the pressure around Prescribing and queried whether a brief report could be compiled in order to review the level of savings made by primary care prescribing as part of the QIPP savings as the continuation of this will inevitably impact the service from a quality perspective. Mr Groom noted the comment made and confirmed QIPP prescribing has been fed back to NHS England and including within the financial reporting and agreed to compile the information requested over a number of years, which can be shared with the Committee. Members of the Committee queried when the CCG is likely to receive feedback from the CCG’s Internal Auditors (360 Assurance) on a Practice based audit. Mr Sacks confirmed this is currently under review with Mrs Bains as the audit undertaken was not in line with the audit scope agreed. Dr Glover confirmed his Practice; the Northfield Medical Centre was part of the audit. In addition, Mrs Bains confirmed the audit is currently in progress as the Auditors continue to meet with Practices; however a draft report has been issued. Mr Smith stated that the Audit Committee were advised through the Auditors report of the complications for contracting with dispensing Practices, which was raised with NHS England at the meeting. Mrs Bains queried whether the scheme for dispensing Practices is set out in Schedule 8 of the General Medical Services (GMS) contract. Mr Sacks confirmed the contract for dispensing Practices is held by NHS England and the CCG holds the GMS contract. It was noted there was no correlation between the two contracts. Dr Glover referred to the £1m QIPP delivery target on page 3 of the report for Urgent Care Centres (UCCs) and queried whether the CCGs across Leicester, Leicestershire and Rutland continue to

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cross charge for this service. Mr Groom confirmed this was correct. Mr Sacks believed the information detailed within the QIPP section of the report was incorrect and required recalculating. For example, the £1m QIPP for UCC as referred to by Dr Glover forms part of the Acute Access funds, which is calculated within a different budget line and accounted for in line with the CCG’s Co-commissioning budget. In addition, Mr Sacks noted other elements were included within the GP Support Framework and the £0.4m QIPP for Extended Access has not been accounted for correctly. Mr Wood thanked members of the Committee and noted the figures are open to interpretation and it was not appropriate for the Committee to review and resolve these at this moment in time. It was suggested Mr Groom and Mr Sacks review the figures in terms of accuracy and feedback to the Committee. Mr Glover suggested the provision of Acute Access is also included within the expenditure and a breakdown, as this will impact PCNs. Mr Sacks confirmed the detailed information was presented to the CCG’s Governing Body at its confidential meeting in March 2019, which included all elements stated above. Mr Wood noted the comments made and reminded the Committee that the information presented to the Governing body was during their confidential meeting and the discussion currently being held was within a PCCC meeting in public. Mr Smith agreed with comments made by Mr Wood. In light of the comments made, Mr Sacks agreed to circulate the report to the Governing Body in March 2019 to members of the PCCC for information purposes and agreed to review the way in which the QIPP information has been accounted for with Mr Groom, as this is misleading. It was agreed for Mr Groom to liaise with Mr Sacks to review the prescribing spend in July 2019 in order to ensure the QIPP figures are accurately reflected from both a primary care and financial perspective for 2019-20. Mr Smith queried why the Terms of Reference and/or the scope of the audit changed. It was noted further clarification was required in relation to this. Mrs Bains agreed to liaise with Mr Smith in order to review the concerns raised. In light of the conversation held, Mr Sacks requested this report is removed from the public domain. Mrs Bains confirmed it would not now be possible to remove this report from the public domain as it has been published on the CCG’s website with the remainder of

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the PCCC public papers the previous week. It was RESOLVED to:


PC/19/36 Primary Care Networks (PCNs): Update (Verbal) Mr Sacks informed the Committee that a total of 7 PCN applications received that include all Member Practices within the CCG, which have been submitted to NHS England for ratification and the outcome to be issued to the CCG week commencing 3 June 2019. Ms Sacks thanked all Practices, GP Members within the CCG and the Primary Care Team during the PCN process to date; and confirmed a formal report will be presented to the Committee in due course. It was RESOLVED to:


PC/19/37 Policy Guidance Manual (PGM): Update (Paper G) Mr Barrett presented this report, which provided an update following publication of the reviewed Primary Medical Care Policy and Guidance Manual (PGM) in April 2019 by NHS England. It was noted the PGM has been updated to reflect the changing landscape within primary care co-commissioning and includes a suite of new and revised policies that are to be followed by all Commissioners of NHS primary medical care. In addition, the guidance ensures all commissioners, providers and patients are treated equitably and that both NHS England and the CCGs meet their statutory duties. The detailed guidance is available from NHS England (https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/) and a summary of changes were listed within section 10 of the report. In response to Dr Glover’s query as to a ‘Discretionary Payment (under section 96), which was listed as the 10 amendment within the guidance, Mr Barrett confirmed this is applied to Practices that are struggling and require the use of a Locum GP, for example - the CCG will offer up to £50k to the Practice in services and repayment. It was RESOLVED to:

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https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/


9 July 2019


• RECEIVE the report;

• APPROVE the use of the revised Primary Medical Care Policy and Guidance Manual (PGM) as part of the CCGs suite of primary care policies and procedures.

PC/19/38 Uppingham Surgery – Final update on Ketton branch surgery

closure (Paper H) Mr Barrett presented this report, which provided an update following the closure of Ketton branch surgery in November 2018. The Committee were reminded that in May 2018, the Uppingham Surgery applied to the CCG requesting to close their branch surgery in Ketton. Since then, the Committee were presented with updates that were summarised as follows:

• July 2017 – initial proposal presented setting out the case for change; recommendation from the Committee was for the Practice to submit a detailed options appraisal, including plans for Practice sustainability.

• November 2017 – detailed options appraisal presented with 6 options; preferred option to close the Ketton branch surgery and commence a 90 day consultation with patients.

• August 2018 – outcome of consultation presented; approval

given by the Committee to close Ketton branch surgery.

• December 2018 – progress update on exit plan and status of mitigating actions identified during consultation provided, which was noted by the Committee and a further update in June 2019 recommended.

Appendix 1 of the report listed the concerns raised during the consultation and the actions taken by the Practice; and Appendix 2 of the report provides additional assurance. It was noted all actions have been completed and the Practice has responded to the best of their ability. As a result of the above, a total of 28 patients de-registered from the Practice, which was a fairly minimal impact. Mr Wood thanked Mr Barrett for the updated report and the significant amount of work undertaken by the Primary Care Team, which was also acknowledged. It was RESOLVED to:


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PC/19/39 General Practice Quality and Outcomes Framework (QOF)

2019 – 2020 (Paper I) Mrs Burton presented this report, which provided an update on the changes to the GP QOF for 2019 – 20 and the CCG’s proposal to facilitate support for Practices. It was reported the QOF is a voluntary system for the performance management and payment of NHS GPs in England, Wales, Scotland and Northern Ireland, which rewards contractors for the provision of quality care and helps standardise improvements in the delivery of primary medical services. Changes to the QOF are agreed as part of wider changes to the General Medical Services (GMS) contract, which are negotiated annually by NHS Employers (on behalf of NHS England) and the British Medical Association’s (BMA) General Practitioners Committee (GPC). In January 2019, NHS England agreed a new five-year framework for GP contract reform to implement The NHS Long Term Plan, which included a number of improvements to QOF in line with the recommendations of the QOF Review (published in July 2018). A number of changes have therefore been made to the QOF allocation for 2019 – 20, which are detailed in section 5 of the report. It was also reported that the first 2 modules introduced in the new QOF Quality Improvement (QI) domain (i.e. Prescribing and End of Life) intend to lead to improvements in safety and aspects of care. It was noted the Quality Lead within the CCG has met with Locality Leads to discuss the QOF changes and proposed a timeline of events (section 11 of the report), which is supported by the Practice Manager Representatives and discussed at the Primary Care Delivery Group in May 2019. Dr Glover drew the Committee’s attention to section 6b of the report which listed the better monitoring of potentially toxic medications and the creation of safe systems to support drug monitoring thorough a focus of lithium prescribing, which was an opportune moment of focus, especially as this has become a hot topic. Members of the Committee noted work being undertaken with the Shared Care Group in relation to the numerous changes, and an increase in ‘left shift’ activity. In addition, with the formations of Primary Care Networks (PCNs), the QOF will undoubtedly change of the next few years or so.

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The Quality Lead for the CCG will update the next Practice Manager’s Forum in June 2019; and the Head of Prescribing and the Locality Leads will introduce the audits and requirements, including available resources, tools and templates too. It was RESOLVED to:


PC/19/40 Sustainability and Transformational Plan (STP): GP Programmes Update (Paper J) Mr Sacks presented this report, which provided an update on the work programme for the STP Primary Care Board, which included the following appendices:

• Appendix A – PCB Terms of Reference The PCB is responsible for designing a 5 year strategy of sustainable transformational change in General Practice that meets local needs and delivers the GP 5 Year Forward View (5YFV) and the primary care aspects of the NHS Long Term Plan and PCN agenda. The PCB will provide leadership in the design, development, planning, commissioning and delivery of new models of general practice, in partnership, and in accordance with, respective partner across the system.

• Appendix B – Structure Chart This laid out the structure of the PCB supported by the Primary Care Commissioning Group and the Primary Care Contracting Group and feeds into the Senior Leadership Team (SLT). The PCB are also supported by the following Enabling Groups: - Workforce Group - IM&T Group - Estates Group - Quality Group

It was also reported that despite the complexities of the above Groups, a host of positive work and actions had been undertaken to date, which were more system based and thus, reduced the complex issues. In response to Mr Sacks request for comments from members of

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the Committee in relation to the appendices provided, the following were raised:

- Mr Smith’ queried whether the role of the PCCC would be impacted once these documents have been approved. It was noted the PCB was an advisory group only.

- Mrs Burton felt the role of the Quality Group needs to be reviewed further across the LLR CCGs as resource within the Quality teams is quite limited.

- Dr Glover agreed with comments made, and stated a single

Quality Dashboard is in the process of evolving in light of the structure outlined.

- Mr Wood was disappointed to see the inclusion of a Lay

Member from a single CCG across LLR, which can be difficult as other similar Boards have a Lay Member from each CCG. In addition, the Quality Group will require input from the Lay Member.

- Dr Varakantam queried how the PCNs and Accountable

Clinical Directors from these networks will feed into this process to ensure all areas of activities have been captured. Mr Sacks confirmed it would not be possible to have a meeting with the 26 ACDs across LLR as suggested by Dr Varakantam, as this could be overwhelming especially with regards to conflicts of interest; however, primary care activity commissioned by the LLR CCGs sits within the remit of the PCB.

It was RESOLVED to:


PC/19/41 Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T): Work Programme update (Paper K) Mr Sacks presented the bi-monthly report for information purposes, which provided an update on the IM&T work programme across LLR that supported the delivery of the Local Digital Roadmap and implementation of the GP 5YFV requirements. It was RESOLVED to:


PC/19/42 Any other business

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Mr Wood noted Mr Smith had decided to step down from the role of an Independent Lay Member with the CCG. Mr Wood thanked Mr Smith for his time and valuable contribution. Members of the Committee also thanked Mr Smith professionally and wished him all the best for his future It was RESOLVED to:


PC/19/43 Date of next meeting The date of the next Primary Care Commissioning Committee meeting will be held on Tuesday 9 July 2019 at 9:30am – 12:30pm, Sparkenhoe Committee Room, County Hall, Glenfield, Leicester, LE3 8TB. Members of the Committee were informed this meeting has swapped with the meeting of the Governing Body in July 2019.

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Paper B ELR CCG Primary Care Commissioning Committee Meeting

9 July 2019

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTE MEETING

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at 9 July 2019

Status

PC/19/33 June 2019 Primary Care Commissioning Committee (PCCC): Terms of Reference

Clive Wood / Daljit Bains

To present the Terms of Reference for the Committee to next Governing Body meeting for approval.

June 2019 PCCC Terms of Reference approved by the Governing Body in June 2019. Action complete.

GREEN

PC/19/35 June 2019 Primary Care Finance Report 2018-19 (Month 12, March 2019

Colin Groom / Tim Sacks

To review the prescribing spend in July 2019 in order to ensure the QIPP figures are accurately reflected from both a primary care and financial perspective for 2019-20.

June 2019 Verbal update to be provided. Action ongoing.

AMBER

No progress made On-Track Completed

Key

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Paper C Primary Care Commissioning Committee Meeting

9 July 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Front Sheet

REPORT TITLE: Primary Care Delivery Group – Terms of Reference Updated

MEETING DATE: 9 July 2019

REPORT BY: Seema Gaj, Senior Primary Care Contract Manager

SPONSORED BY: Jamie Barrett, Head of Primary Care

PRESENTER: Jamie Barrett, Head of Primary Care

PURPOSE OF THE REPORT The Primary Care Delivery Group (PCDG) is a sub-group of the Integrated Governance Committee and its purpose is to design, plan, develop and deliver processes and systems for primary care services across ELR CCG. The Group is expected to progress ELR CCGs response to the LLR Primary Care Board priorities and in particular Commissioning of Primary Care Services and Contracts Monitoring and Performance and further local implementation of the GP 5 Year Forward View. As part of the annual review of the Term of Reference for this Group, amendments have been made to include additional duties to incorporate the implementation of the Long Term Plan which includes development of the Primary Care Networks (PCN). The role of the PCDG will be to design, support and facilitate the delivery of the PCN level working towards an integrated way across health, social and third sector teams. The purpose of this report is to inform the Primary Care Commissioning Committee of the amendments to the PCDG’s Terms of Reference in recognition of the publication of the Long Term Plan.

RECOMMENDATIONS: East Leicestershire and Rutland CCG Primary Care Commissioning Committee are asked to:

• NOTE and COMMENT on the amendments outlined within the Terms of Reference for the Primary Care Delivery Group for further review in June 2020.

• NOTE revised Terms of Reference shared with Integrated Governance Committee (IGC) for approval.


9 July 2019

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions

Improve integration of local services between health and social care; and between acute and primary/community care.

Improve the quality of care – clinical effectiveness, safety and patient experience

Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare

Living within our means using public money effectively

Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is not deemed appropriate for this report.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The report highlights the following risks:

• BAF 3 - Quality Primary Care - The quality of care provided by primary care

providers does not match commissioner’s expectation with respect to quality and safety.

• BAF 6 (a) Primary Care Commissioning – ability to perform delegated duties whilst maintaining member relations and Clinical Engagement

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9 July 2019 EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Primary Care Delivery Group – Terms of Reference Updated 9 July 2019

Introduction

1. The Primary Care Delivery Group is a sub-group of the Integrated Governance

Committee. The purpose of this group is to design, plan, develop and deliver processes and systems of primary care services as delegated by the Integrated Governance Committee.

2. The group is not a formal decision-making Group, but makes recommendations to the Primary Care Commissioning Committee for matters relating to Primary Care and to the Integrated Governance Committee for any commissioning or quality issues.

3. The Group is expected to progress ELR CCGs response to the LLR Primary Care Board priorities and in particular Commissioning of Primary Care Services and Contracts Monitoring and Performance and further local implementation of the GP Forward View.

4. ELR Primary Care Delivery Group (PCDG) will feed into the Primary Care Board

position on Primary Care Contracts and Primary Care Commissioning structures/ processes; however PCDG will still maintain its accountability to both the Integrated Governance Committee and Primary Care Commissioning Committee.

5. The Terms of Reference for this group are reviewed annually and detailed in

Appendix 1.

6. With the publication of NHS England’s Long Term Plan (January 2019), the role and duties of the Primary Care Delivery Group have incorporated key facets from the plan to ensure these are incorporated as part of monitoring and delivery of primary care services.

7. The amended duties implemented address the key Primary Care Contracting

and Commissioning responsibility in ensuring there is consistency in information sharing overall primary care processes that can be presented to both the Primary Care Board and Primary Care Commissioning Committees for consideration and decision.

8. The Primary Care Commissioning Committee are therefore asked to consider the revised Terms of Reference for the Primary Care Delivery Group outlined in Appendix 1.

9. And to acknowledge the role of this Group in ensuring that the NHS England

Long Term Plan requirements are incorporated into the Groups strategy for planning, implementation and monitoring process.

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9 July 2019 Recommendations

10. The Primary Care Commissioning Committee are requested to:

• NOTE and COMMENT on the amendments outlined within the Terms of Reference for the Primary Care Delivery Group for further review in June 2020.

• NOTE revised Terms of Reference shared with Integrated Governance Committee (IGC) for approval.

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Paper C – Appendix 1 Primary Care Commissioning Committee Meeting

9 July 2019

NHS EAST LEICESTERSHIRE AND RUTLAND CCG

Primary Care Quality Delivery Group

Terms of Reference (v3.1, draft 1 – May 2017June 2019)

1. Purpose

The Primary Care Quality Delivery Group (the ‘Group’ hereafter) is a sub-group of the Integrated Governance Committee. Its purpose is to design, plan, develop, and deliver the business cases, processes and systems of primary care services as delegated by the Integrated Governance Committee. The Group is not a formal decision-making Group; it will make recommendations to the Primary Care Commissioning Committee for primary care commissioning matters and Integrated Governance Committee for any quality / patient safety issues or concerns. The Group is also expected to progress ELR CCG response to the LLR STP and implementation of the GP 5 Year Forward View. any commissioning or quality issues. The Group is expected to progress ELR CCGs response to the LLR Primary Care Board priorities and in particular Commissioning of Primary Care Services and Contracts Monitoring and Performance and further local implementation of the GP 5 Year Forward View.

2. Membership

The membership of the Group will consist of: • Head of Primary Care /Deputy Chief Operating Officer – chair of the Group • GP Governing Body member -–( Primary Care Lead) – deputy chair • All GP Governing Body members who do not attend Primary Care

Commissioning Commitee – member of the Integrated Governance Committee Practice Manager representatives x 2

• Senior Primary Care Contracts Manager • Primary Care Implementation and Delivery Manager/Locality Managers • Head of Prescribing or representative Medicines Management • Deputy Chief Nurse • Finance representative

Should members of the Group not be able to attend, nominated deputies may take their place. A recommendation put to a vote at a meeting shall be determined by a majority of the votes of members present. In the case of an equal vote, the Chair of the Group shall have a second and casting vote.

3. Attendance The Group may request attendance by other personnel when focussing on particular issues, for example representative from the public health team. Other individuals shall be in attendance as required.

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4. Quorum

Although the Group is not a decision making group, to ensure appropriate level of engagement and agreement on recommendations to be escalated, the quorum for the Group will be the following: The quorum for the Group will be the following:

• Chair of the Group or Deputy Chair • A GP member of the Governing Body Governing Body member • Deputy Chief Nurse or deputy in a nursing capacity • Senior Primary Care Contracts Manager or a representative from the CCG

Primary Care Operations Team • A Practice Manager

5. Administration

The administration and minute taking of the Group will be carried out by the Locality Administrator.

6. Frequency of meetings The Group will meet on a monthly basis and conduct its meeting ensuring adherence to the CCG’s Constitution, policies and the Nolan Principles.

7. Duties

The Primary Care Quality Delivery Group will:

a) Plan the delivery and design process and monitoring and performance of primary care services delegated by the Integrated Governance Committee and Primary Care Commissioning Committee.

b) Develop business cases on behalf of the Primary Care Commissioning

Committee in line with the Primary Care Strategy and following approval of the financial allocations. Make recommendations to the Primary Care Commissioning Committee for approval of business cases and options appraisals (where appropriate).

c) Implementation of the GP 5 Year Forward View across ELR CCG. d) Act as an advisory group on primary care related matters from service

design, operational queries, concerns and local intelligence and information sharing. Escalate areas of commissioning and quality concern to Integrated Governance Committee

e) Develop and recommend service priorities for East Leicestershire and

Rutland CCG based on available resources to be communicated to the Primary Care Commissioning Committee.

f) Develop, support and improve primary care services in East Leicestershire

and Rutland CCG.

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9 July 2019

g) Oversee the process for implementing the CCG Quality Framework for

primary care services and getting sign off from the appropriate forum. h) Maintain effective internal and external communication flows that will support

development of consistent approaches to service delivery across the whole health economy

i) To act within the groups remit and scope detailed above

a) Support the formation and implementation of Primary Care Networks (PCNs) across ELR

b) Contribute to the design and delivery of the Long Term Plan elements for Primary Care across ELR

c) Support the development of a commissioning structure to enable service delivery at a PCN/Neighbourhood level

d) Facilitation of service design and delivery at an ELR PCN level, working towards an integrated way of working between Neighbourhood health, so-cial and third sectors teams

e) Delivery of contracts and performance of the GMS, APMs and General Practice Forward View across general practice in ELR.

f) Oversight, management, reporting, payments and verification for ELR of;

• Quality Outcomes Framework (QOF) • Direct Enhanced Services (DES) • New Primary Care Network (PCN DES) • Community Based Services (CBS) • Locally commissioned primary care services

g) Act as an advisory group on ELR primary care contract related matters

from service delivery, operational queries, concerns and local intelligence and information sharing. Escalate areas of commissioning and quality concern to the Primary Care Board and Primary Care Commissioning Committee

h) Oversee the process for implementing an ELR Quality Framework for pri-mary care services and getting sign off from the appropriate forum.

i) To act within the groups remit and scope detailed above

8. Reporting responsibilities

The Group will provide a written summary report of the outcomes of the meeting; propose recommendations to both the Primary Care Commissioning Committee; and and detail risks and issues to be escalated to both the Primary Care Commissioning Committee and the Integrated Governance Committee. The Integrated Governance Committee update will include escalation of any quality /

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9 July 2019

patient safety commissioning concerns. The ; and the Primary Care Commissioning Committee update will capture primary care related themes including primary care commissioning matters. The Group is formally a sub-group of the Integrated Governance Committee.

9. Review of Terms of Reference These Terms of Reference will be reviewed annually or sooner if required and recommendations made to the Integrated Governance Committee for approval, with comments sought from the Primary Care Commissioning Committee. Date of approval: April 2017 – Primary Care Commissioning Committee

supported the minor amendments to the terms of reference and for the Group to report to the Integrated Governance Committee. May 2017 – Integrated Governance Committee approved the terms of reference for the Group with some amendments and also changed the name of the Group to “Primary Care Quality Delivery Group”. June 2019

Review Date: Initial review in 6 months i.e. November 2017 June 2020

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Paper D ELR CCG Primary Care Commissioning Committee Meeting

9 July 2019


Front Sheet

REPORT TITLE: Primary Care Finance Report 2019/20 (Month 2, May)


REPORT BY: Richard George, Senior Primary Care and Non-Acute Commissioning Accountant

SPONSORED BY: Donna Enoux, Chief Finance Officer

PRESENTER: Colin Groom, Deputy Chief Finance Officer

PURPOSE OF THE REPORT: The purpose of this report is to provide an update on the 2019/20 budget and financial position for Primary Care services.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG PCCC is requested to:

• RECEIVE the 2019/20 opening budget information, the Month 2 reported variance position and note the key risks against the Primary Care budgets based on the reporting information available.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions




Reduce inequalities in access to healthcare Living within our means using public money effectively


EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not required at this point.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK:

• Report covers finances for (but not the operational delivery of) Primary Care Budgets that support the delivery of Primary Care Strategy (BAF 6);

• Report supports the appropriate management of Primary Care Budgets and the achievement of financial targets (BAF 10).

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9 July 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING Primary Care Finance Report 2019/20 (Month 2, May 2019) 9 July 2019 1. 2019/20 Opening Budget

The 2019/20 annual budget for Primary Care as per the financial plan approved by the Governing body and submitted to NHS England totals £98.5m. As a result of further budget refinement since the plan submission, it will be updated in Month 3 to:

• Realign funding between budget headings to more accurately reflect the areas of expenditure and QIPP delivery

• Recognise the impact of exceeding the QIPP stretch target by £273k which has been mitigated through the full year effect of the 2018/19 programme

In addition to this, the CCG is anticipating a £1.84m funding allocation transfer from NHS England for GPFV Extended Access, this has been built into the Month 3 budget assumptions. Following these adjustments, the anticipated budget to be reported at Month 3 will be £100m. A number of appendices are attached to this report:

• Appendix 1 – Opening budget analysis • Appendix 2 – Analysis of increase in 2019/20 net budget • Appendix 3 – Analysis of movements across budget headings

2. Month 2 Year to Date and Forecast Outturn Position

At this early stage in the year a break even forecast outturn has been reported. However, in recognition of a cost pressure against the co-commissioning budget, a year to date overspend of £50k has been highlighted.

3. Cost pressures and Risks to the Primary Care Budget While a balanced forecast outturn position is currently being reported, there are a number of pressures and risks that will require close monitoring throughout the year:

• Co-commissioning - Despite removing Oadby Urgent Care Centre costs of £1m out of the co-commissioning budget, an annual cost pressure of c£400k still remains in this area. There are a number of assumptions made when reaching this estimate including:

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9 July 2019

o Premises costs (in particular rent and rates charges) exceeding the 0.09% inflationary increase included in the 2019/20 allocation uplift c£75k

o Practice claims for locum staff covering maternity, paternity and sickness are forecast to reach £253k

o Increasing the number of PCNs from 6 to 7 at a cost of £72k Close scrutiny of all expenditure under this area is being undertaken, however it should be noted that scope to limit / reduce the potential overspend is difficult as much of the expenditure falling under in this area is directly linked to GMS contracted payments.

• GP Prescribing – As in previous years, NCSO drugs and Category M price increases continue to be a pressure to the CCG. While £1.6m has been built into the 2019/20 financial plan, this volatile and unpredictable area presents a real risk in delivering a balanced budget in 2019/20.

• GP Prescribing QIPP. The prescribing QIPP programme being pursued in

2019/20 totals £2.7m including the already delivered £0.5m stretch. While a plan has been developed to deliver in full, it still remains a very ambitious and challenging target to meet that is dependent on working with provider partners to ensure its success.

4. Recommendation:

The ELR CCG Primary Care Commissioning Committee is requested to:

• RECEIVE the 2019/20 opening budget information, the Month 2 reported

variance position and note the key risks against the Primary Care budgets based on the reporting information available.

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9 July 2019

Appendix 1

East Leicestershire & Rutland CCG - Primary Care Commissioning Report

2019/20 Opening Budget

2019/20 Opening Budget

AdjustmentsAnticipated

Budget Month 3

£000's £000's £000's

CCG PrescribingGP Prescribing (Including Dressings) 45,831 (1,303) 44,528Prescribing Investments 0 39 39Prescribing Other & UCC 376 1,160 1,536Prescribing Income (Local Authorities and Other) (180) (180)Prescribing Income (NHSE Flu Vaccines) (603) (603)Prescribing Rebate Scheme 39 (169) (130)OptimiseRx 104 104High Cost Drugs 970 970Central Prescribing 1,346 1,346Home Oxygen 456 456Prescribing Incentive 690 (355) 335

Total CCG Prescribing 49,029 (628) 48,401

Enhanced ServicesCommunity Based Services 797 1,300 2,097

Total Enhanced Services 797 1,300 2,097

Co Commissioning (including £1.6m for PCNs) 43,405 74 43,479Total Co-Commissioning 43,405 74 43,479

GP Support Framework 2,178 (668) 1,510Total GP Support Framework 2,178 (668) 1,510

OtherPCN Network Support 501 501Acute Access 0 431 431Unallocated Primary Care Budgets / anticipated allocations -905 936 31GPFV - GP Receptionist Training 18 18GPFV - GP Online Consultation 92 92Licences 111 (42) 69Primary Care Corporate -18 163 145Section 106 37 37GP IT 1,070 1,070Urgent Care Centres (net cost to ELR for all LLR UCC services) 2,175 2,175

Total Other 3,082 1,488 4,570

GRAND TOTAL - Primary Care 98,491 1,567 100,058

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9 July 2019

Appendix 2

Appendix 3

Summary - Allocation movement from plan to Month 3 £'000Budget As per Submitted Plan to NHSE 98,491

Additional Agreed QIPP Stretch - Prescribing FYE 2018/19 -273GPFV - Extended Access - Assumed Allocation 1,840Movement 1,567

Revised Primary Care Budget 2019/20 100,058

Primary Care Budget Movements 2019/20 M2 to M3£'000

Adjustments AnalysisGP Prescribing (Including Dressings) (1,160)

130-273

(1,303)

Prescribing Investments 39

Prescribing Other & UCC 1,160

Prescribing Rebate Scheme -39

-130(169)

Prescribing Incentive (355)

Community Based Services 1,300

Co-Commissioning 74

GP Support Framework (668)

Acute Access 431

Unallocated Primary Care Budgets / anticipated allocations 936

Licences (42)

Primary Care Corporate 18323083

163

Movement between Approved Plan and M3 Anticipated Budget 1,567

To clear unallocated budget lines

QIPP - INR STAR

Budget realignmentDiabetes Specialist NursesNHSE allocation - Practice PharmacistsReinstated 2018/19 underspend - HEEM

Prescribing QIPP (rebates)

Prescribing Incentive QIPP - reduce to £1 per patient

Realignment of Primary care QIPP Target

PMS Reinvestment underspend 2018/19

Primary Care QIPP

Proportion of Acute Access funded out of GPFV monies

Non GP Prescribed dressings re-categorised to 'Prescribing other & UCC'Prescribing QIPP (rebates) removed from GP Prescribing

Medicines Optimisation in Care Homes

Additional stretch QIPP - full year effect of 2018/19 schemes

Non GP Prescribed dressings - disaggregated from GP prescribing budgets

Medicines Optimisation in Care Homes - re-categorised to prescribing investments

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Paper E ELR CCG Primary Care Commissioning Committee Meeting

9 July 2019


Front Sheet

REPORT TITLE: Exploring Health Inequalities in Oadby and Wigston: A Qualitative Approach


REPORT BY: Dr Emily Maile, HEEM Leadership and Management Fellow Dr Vivienne Robbins, Consultant in Public Health

SPONSORED BY: Tim Sacks, Chief Operating Officer

PRESENTER: Dr Emily Maile, HEEM Leadership and Management Fellow

EXECUTIVE SUMMARY: Background and Context The most recent available data (2015-2017), published as part of the Public Health Outcomes Framework, demonstrates that Oadby and Wigston has an inequality in life expectancy at birth of 12 years for males and 10 years for females. In February 2019, a health summit was held to discuss the health inequalities in Oadby and Wigston and following this a number of semi-structured interviews and focus groups were facilitated with key local individuals, healthcare professionals and local residents in order to develop a more detailed understanding of the wider issues and potential solutions. Methods Individuals from a range of organisations attended the health summit and were invited to discuss four key questions before giving verbal feedback to the wider group. Following the summit, the snowball method of sampling (Sadler et al. 2010) was used to identify participants and further qualitative research was planned. The qualitative data from all sources was then analysed using thematic analysis (Braun and Clarke, 2006) in order to identify themes within the discussions. Results and Analysis The thematic analysis identified nine main themes which are discussed in this report; three communities, services, collaborative working, education and employment, engagement, individual beliefs and behaviours, local environment, population demographics and mental health. Recommendations This report makes eight recommendations for consideration for future action at the Oadby and Wigston Health and Wellbeing Board and ELR CCG Primary Care Commissioning Committee.

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9 July 2019

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Primary Care Commissioning Committee is requested to:

• COMMENT ON the report findings, recommendations and define next steps for the CCG to support a reduction in health inequalities across Oadby and Wigston.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: Transform services and enhance quality of life for people with long-term conditions




Reduce inequalities in access to healthcare Living within our means using public money effectively


EQUALITY ANALYSIS The report details the current health inequalities across Oadby and Wigston. A full Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the report has only summarised findings from the summit and qualitative analysis. Further equality analysis will be completed on the agreed action plan once developed.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies action(s) to be taken / are being taken to mitigate the following corporate risk(s) as identified in the Board Assurance Framework:

If no further work is completed there is a risk that the health inequality within the borough may continue or increase.

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9 July 2019


Exploring Health Inequalities in Oadby and Wigston: A Qualitative Approach

9 July 2019

BACKGROUND AND CONTEXT

1 In October 2018, a report produced by Leicestershire County Council, “Inequalities

in Life Expectancy between Oadby and Wigston” reported that in 2014-2016,

Oadby and Wigston in Leicestershire had the fourth largest inequality in male life

expectancy at birth in England, at 13.5 years. In females, the inequality was 9.5

years, representing the 22nd largest inequality in England (Leicestershire County

Council, 2018). For both males and females, the inequality in life expectancy at

birth had been increasing in each time period from 2010, with life expectancy for

those in the least deprived decile increasing and in the most deprived decile

decreasing, resulting in the widening gap in life expectancy.

2 The most recent available data for 2015-2017, published as part of the Public

Health Outcomes Framework, has subsequently shown the male life expectancy at

birth inequality to be slightly lower at 12 years, now the 15th largest inequality in

England. In females however, the overall inequality is now 10 years and represents

the 20th largest inequality in the country.

3 The populations of Oadby and Wigston have many significant differences; Wigston

has an overall older population (22.7% of its residents aged over 65 years

compared to 19.1% in Oadby) whilst in Oadby 47.5% of the population are from a

Black and Minority (BME) ethnic group compared to 11.6% in Wigston. There is

also a significant difference in affluence with 64.5% of the Oadby population living

in the most affluent 20% of areas nationally compared to 23.3% of the Wigston

population and almost a quarter (24.6%) of the population in Wigston live in the

30% most deprived areas nationally compared to just 5.9% of the population in

Oadby.

4 Following the report highlighting these inequalities, Oadby and Wigston Borough

Council, East Leicestershire and Rutland Clinical Commissioning Group (ELR

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9 July 2019

CCG) and Leicestershire County Council Public Health invited representatives

from a range of healthcare, social care, third sector organisations and patient

representatives to an Oadby and Wigston Health Inequalities Summit on 28th

February 2019 where the latest data was shared and subsequently discussed. The

aim of the session was to raise awareness of the health inequalities amongst those

attending, and through group discussion to understand potential contributing

factors, possible solutions and to start to develop a plan to address the issue.

Following the health summit a number of semi-structured interviews and focus

groups were held with key local individuals, healthcare professionals and local

residents in order to develop a more detailed understanding of the wider issues and potential solutions.

5 This report summarises the key results from the summit and subsequent research

and provides recommendations for future action at the Oadby and Wigston Health and Wellbeing Board and ELR CCG Primary Care Commissioning Committee.

METHODS

Health Summit

6 Fifty-four individuals from a range of organisations attended the health summit, and

were assigned to small groups to discuss four key questions before giving verbal

feedback to the group as a whole:

• What do you think may be contributing to the difference in life expectancy

across Oadby and Wigston?

• What changes have you seen in your role or community in the last few years

that may explain the challenges?

• What do you think needs to happen to address this health inequality?

• What can you or your organisation do differently that will help tackle this issue?

7 Bullet point notes were recorded of the feedback session which were then

analysed alongside notes made at the subsequent semi-structured interviews and focus groups, to identify common themes.

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9 July 2019

Further Qualitative Data Collection

8 Using the snowball method of sampling (Sadler et al. 2010) to identify participants

from those who attended the summit, a number of semi-structured interviews were

planned with key local individuals, and a focus group for health professionals was

arranged. A focus group with local residents was also organised with participants

to be identified by the key individuals who attended the semi-structured interviews,

again using the snowball sampling method. Table one summarises the planned

methods of data collection.

Method Participant

Semi-structured interview Local area coordinator (LAC) - Wigston

Semi-structured interview LAC - South Wigston

Semi-structured interview Representative from Helping Hands

(voluntary sector organisation, South

Wigston)

Semi-structured interview Councillor for Wigston Fields

Focus group Local residents, to be identified through

semi-structured interview participants

Focus group NHS healthcare professionals including

GPs, invited through the ELR CCG

Oadby and Wigston locality meeting

Table 1: Planned methods of data collection

Data Analysis

9 The qualitative data from all sources was then analysed using thematic analysis

(Braun and Clarke, 2006) in order to identify themes within the discussions. Braun

& Clarke's six point framework was used to analyse the data in the following six

stages; become familiar with the data, generate initial codes, search for themes,

review themes, define themes and write up report. During this process, open

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9 July 2019

coding was utilised with codes developed and modified throughout the process,

rather than using a set of pre-defined codes (Maguire & Delahunt, 2017).

RESULTS AND ANALYSIS

10 Table two (below) presents the different semi -structured interviews and focus

groups which were conducted.

Table 2: Final sources of qualitative data

11 Following the health summit, semi-structured interviews were carried out with LACs

for Wigston and South Wigston and the councillor for Wigston Fields. Due to the

short time frame available, it was not possible to arrange an interview with a

representative from Helping Hands and so the decision was made to instead

conduct an interview with a representative for the Salvation Army, another large

Method Participant(s)

Health summit group discussions 54 individuals from a range of local

organisations

Joint semi-structured interview LACs - Wigston and South Wigston

Semi-structured interview Councillor for Wigston Fields

Semi-structured interview Representative from Salvation Army -

South Wigston

Focus group Four residents visiting the Salvation

Army café - South Wigston

Written notes Nordic walking group leader - Oadby and

Wigston

Joint semi-structured interview Representatives from community

therapies team and district nursing team

Semi-structured interview Specialist health visitor - Oadby,

Wigston and South Wigston

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9 July 2019

voluntary organisation in South Wigston, identified through the LAC for South

Wigston.

12 There was no response to an appeal for a residents focus group, however we

instead were able to conduct a focus group with four local residents who were

visiting the Salvation Army café and agreed to take part. One local resident who

runs the Nordic walking group was unable to attend the focus group but instead

submitted written notes for inclusion.

13 Health professionals including GPs, community occupational therapists,

community physiotherapists and health visitors were invited to attend a focus

group through the ELR CCG Oadby and Wigston locality meeting, although due to

service demands on the day of the interviews GPs were unable to attend. Semi-

structured interviews were subsequently conducted with representatives from the

community therapies team and district nursing team, and with a specialist health

visitor.

14 The thematic analysis subsequently identified nine main themes, many of which

were further divided into subthemes; three communities, services, collaborative

working, education and employment, engagement, individual beliefs and

behaviours, local environment, population demographics and mental health.

Results from each theme are discussed below:

1. Three Communities

15 There was significant discussion that Oadby and Wigston is viewed by residents

and health professionals as being three individual communities; Oadby, Wigston

and South Wigston. Participants felt it would be helpful if the health inequalities

data for Wigston was divided into Wigston and South Wigston, or based upon

postcode, in order to understand the three communities individually.

16 Several references were made to there being a 'hierarchy' in the area with Oadby

at the top, Wigston in the middle and South Wigston at the bottom, particularly

regarding affluence. One individual commented that South Wigston has always

been viewed as "the poor relation" and Wigston as "the more affluent cousin". It

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9 July 2019

was also suggested that within South Wigston and Wigston there are many smaller

sub-communities, each with their own characteristics, which it would be useful to

understand in more detail. Participants described Wigston as having distinct areas

including Wigston Magna, Wigston Meadows, Wigston Harcourt and Little Hill and

commented that whilst the Fairfield area is part of South Wigston, it is on the same

side of the railway bridge as Wigston and feels more like Wigston than South

Wigston. The Oadby and Wigston Borough Council Residents' Forum for South

Wigston is held at various locations in South Wigston including the Fairfield area,

in part to encourage and enable attendance by residents from all parts of South

Wigston who participants felt may be less likely to attend if the meetings were

regularly held in either the centre of South Wigston or in the Fairfield area. South

Wigston was also described as having a very strong community spirit where

individuals will help each other in a crisis, but this can mean that it is challenging for those viewed as outsiders to engage with the community.

2. Services

17 NHS, social and community services were discussed widely, with much discussion

around the different access to services, funding of services and service closures across Oadby and Wigston.

Access to Services

18 Access to NHS services was felt to be a significant issue, with individuals

commenting that there are significant differences in use of, and access to,

healthcare services including General Practitioners (GPs), in Oadby and Wigston.

Individuals felt it would be useful to identify any gaps in service provision between

Oadby, Wigston and South Wigston; two differences initially noted were the lack of

a Local Area Coordinator (LAC) for Oadby, and the primary care walk-in centre

being located in Oadby.

19 In terms of access to GP services, individuals felt there is increasing demand for

GP services locally and therefore an increasing need to improve access to GPs. It

was also suggested that there is inequality of GP funding between Oadby and

Wigston with Oadby also having the only walk-in centre in the area. Some

individuals commented that it can be difficult to access GP appointments when

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9 July 2019

required, although it was noted at the Health Summit that South Wigston Health

Centre were planning to introduce a new appointment system which should

improve access - the new system was subsequently introduced in May 2019.

20 The issue of attendance at the Emergency Department (ED) was also discussed,

with individuals commenting that there is a higher ED attendance rate for

Wigston/South Wigston than Oadby, and a need to understand why this is. Uptake

of NHS health checks in the area were also noted to be very low, and suggestions

made that health checks could be taken into the communities rather than held in

GP practices. N.B. There has subsequently been a Health Check Campaign in

South Wigston in March and an evaluation is being completed.

21 Participants also suggested that use of services in Oadby and Wigston may be

impacted by how empowered individuals feel and how much knowledge they have

of the healthcare system. It was suggested that individuals in affluent areas such

as Oadby may feel more empowered to access services and may have the

resources to use private healthcare, lowering NHS GP waiting times. In South

Wigston, health professionals noted that individuals tend to feel as though they 'don't want to bother the doctor' and may therefore delay accessing healthcare.

Changes to Services

22 Participants commented that the organisation and structure of healthcare services

often changes, such as the Primary Care Coordinator (PCC) role at University

Hospitals of Leicester being recently decommissioned and future changes planned

to how physiotherapy, occupational therapy and nursing care are delivered to

patients upon discharge from hospital. Individuals felt that such changes to

services can lead to uncertainty for staff and can affect morale. Changes to

services can also be confusing for patients and for healthcare staff who may not

always be up-to-date with the latest service configurations and referral processes.

Some individuals also commented that previous community multidisciplinary team

meetings (MDTs) which included GPs, staff from UHL and the ambulance service

worked well for complex patients e.g. in planning to avoid unnecessary hospital

admissions, and they would find something similar useful going forwards as part of

the Integrated Locality Team.

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9 July 2019

Service Closures and Funding Cuts

23 Service funding was discussed as an important issue, with individuals expressing a

feeling that there is a need for greater investment in services particularly in South

Wigston. Funding cuts to social care, children's centres, community groups and in

the voluntary sector, and the closure of services such as the Bassett Street centre,

a "community hub" in South Wigston, were felt to have had a large impact upon the

community. Participants also commented that there are no longer any community

spaces available for use in South Wigston, and a lack of funding available to hire

private function rooms as an alternative option for community groups and activities.

3. Collaborative Working

Communication and Collaboration

24 Communication and collaboration across the different health, social and voluntary

organisations in Oadby and Wigston was felt to be vital, and an area which could

be improved. Participants commented that whilst GPs are important, addressing

health inequalities goes "beyond doctors in GP surgeries" and there is a clear need

for closer working, better collaboration and increased communication between all

organisations including, but not limited to, the East Leicestershire and Rutland

Clinical Commissioning Group (ELR-CCG), GP Practices, Oadby and Wigston

Borough Council and local voluntary organisations. It was also suggested that

reviewing best practice and models of working in other areas of the country may be

beneficial, whilst many individuals felt that the creation of one central directory

(such as a website) of all local services would be very helpful for healthcare staff to

share and may help to improve active signposting and referral to other services

which was felt to be important.

25 Communication between the above organisations and local residents was also felt

to be an area which could be improved, with participants commenting on the need

for consistent and shared messages rather than mixed messages from different

organisations which can cause confusion.

Social Prescribing and LACs

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9 July 2019

26 Participants felt that LACs, social prescribing and signposting are all important

tools for tackling health inequalities, although some individuals commented that the

difference between social prescribing and active signposting is not always

understood and it would be useful if there was greater clarity regarding referral to

First Contact Plus and LACs. The possibility of social prescribers within Primary

Care Networks (PCNs) was also raised, and it was felt that if further social

prescribing roles are created it will be important to understand and clarify their role

within the current social prescribing model. There was also recognition that whilst

Wigston and South Wigston have allocated LACs, Oadby does not, and that

greater awareness of the LAC role and referral process amongst health

professionals may be helpful.

Non - NHS Organisations

27 A number of specific local organisations were identified in the discussions as being

important to collaborate and communicate with;

• GPs

• LACs

• Oadby and Wigston Borough Council (OWBC) and Councillors

• East Leicestershire and Rutland CCG (ELR CCG) and ELR CCG Oadby &

Wigston locality

• The Police

• Fire Service

• Colleagues working in debt and housing

• The University of Leicester Business School

• Local supermarkets

• Local churches

• Community health champions

• Third sector organisations including:

• Salvation Army, South Wigston

• Helping Hands, South Wigston

• Oadby and Wigston Lions Club

Proactive and Preventative Approach

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9 July 2019

28 Participants commented that there is a need for a long term proactive approach

with a focus on health promotion and disease prevention, such as advice on

smoking cessation to prevent future disease and identifying frail patients to carry

out a holistic assessment with the aim of preventing falls.

4. Education and Employment

Health and Wellbeing Education

29 Education was felt to be crucial in addressing health inequalities, with suggestions

made that education around healthy lifestyles, food choices and health services to

improve health literacy, would be beneficial.

Schooling

30 School education was discussed widely and was felt to be both one of the causes

of health inequality and also potentially one of the solutions. Individuals reported a

perception that schools are better in Oadby compared to Wigston, and that in

South Wigston, young people have lower aspirations and expectations. There were

also comments that schooling and funding has recently changed in the area and

this may have impacted the schools' ability to support pupils who have special

educational needs. A further suggestion was to consider teaching health, mental

health and wellbeing in schools which may be beneficial in terms of addressing

health inequalities from an earlier age.

Employment

31 Employment was felt to be an important factor in the health inequalities, with

individuals commenting that South Wigston used to be a very industrial area and

this may have impacted upon residents' health. Participants also suggested that

unemployment may be higher in South Wigston than Wigston and Oadby, and that

it may be difficult for people to manage their careers if they have poor health. In

recent years, most of the factories in South Wigston have closed and there have

been changes to remaining industry and health and safety practices, which may

improve health of future generations.

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5. Engagement

Importance and Challenges

32 Participants reported that engaging the local communities, particularly hard to

reach groups, is crucial in order to make a difference to the health inequalities. The

groups interviewed recognised that community engagement can be challenging,

particularly in South Wigston more so than Wigston or Oadby.

Methods and Suggestions

33 In order to better engage South Wigston, individuals suggested the need to be

approachable and to regularly and actively reach out to the community in places

such as the local supermarkets, food banks, pubs and schools. The idea of local

representatives was mooted for South Wigston, as it was believed the community

may be more responsive to known individuals rather than ‘outsiders’. Different

methods should be used such as leaflets in public places, social media and

ensuring that any surveys are representative and include the younger generations.

34 Local events were also discussed as one particular method of engagement, with

many suggestions made for family days out, road shows and "pop-up" health

checks and events with a focus on health, wellbeing and community.

Further Understanding Required

35 Participants at the Health Summit felt that further research, both qualitative and

quantitative, is required to understand the populations of Oadby, Wigston and

South Wigston in more detail, and highlighted the need to ensure that surveys and

data are truly representative of the individual populations.

Community Groups

36 Many participants discussed the need for more community groups and clubs in the

area, such as mental health forum, dementia forum, gentle exercise classes and

craft groups. Individuals expressed a preference for groups to be held locally so

that residents who do not drive or have easy access to transport can attend and

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would prefer groups in the daytime to avoid driving or travelling at night and

returning home in the dark.

6. Individual Beliefs and Behaviours

Health Beliefs and Attitudes

37 Individuals commented that there is a perceived 'fundamental' difference in health

beliefs between residents of Oadby and Wigston/South Wigston and that some

individuals do not take personal responsibility for their health, lack motivation, and

there is a need to 'instil a can-do attitude’. It was also recognised however, that

individuals in South Wigston may have ‘more on their plate’ to deal with, such as

low income, and that their health may therefore not be their first priority.

38 Empowerment was also felt to be very important for health. There was a

perception that the South Wigston population ‘doesn't have a voice’ whereas the

Oadby population does have a voice and is more confident. Groups felt that that

those who feel more confident and empowered may be more likely to challenge or

access services compared to those who feel less empowered.

Exercise and Nutrition

39 Physical activity was recognised as being crucial for health and wellbeing, and that

a lack of physical activity may be contributing to the health inequalities.

Participants suggested that it is easier for those who are more affluent to afford to

exercise, and one individual asked why the gym referral scheme needs a referral

from a GP, suggesting that this may be perceived as a barrier to access. It was

also suggested that seated exercise classes are needed in Wigston/South Wigston

and that clear physical activity guidelines, a green (outdoor) gym and a ‘Parkrun' in

Wigston may be helpful in encouraging physical activity (there is not currently a

'Parkrun' in Oadby, Wigston or South Wigston). There is a walking group based at

the Methodist Church in South Wigston, and a Nordic Walking group with activities

across the three communities.

40 Group participants commented that eating habits may differ between Oadby,

Wigston and South Wigston, which may be linked to a higher number of fast food

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outlets, takeaways and lower income in South Wigston. It was also noted that

South Wigston has a large food bank run from the Congregational Church and

another food bank and community market at the Salvation Army which are used

regularly by a number of local residents, predominantly from South Wigston.

Lifestyle

41 Participants commented that levels of smoking may impact upon lung disease and

lung cancer, and it was suggested that alcohol consumption may be related to

religious beliefs and ethnicity (there is a known significant difference in BME

demographics in Oadby and Wigston). Individuals also suggested that cannabis

may impact upon mental health and shared the perception that drug use may be a

greater issue in South Wigston.

7. Local Environment

Physical Environment

42 South Wigston was described as having a number of physical boundaries including

the railway line, bridges and canals which act as a "barrier" to residents travelling

to other areas such as Wigston and Oadby. It was also noted that there is a lack of

green space in South Wigston compared to Oadby and a suggested need to

review the infrastructure and facilities of the area.

High street and Shops

43 There was an overall feeling that the high streets in Wigston and South Wigston

are declining, which may be linked with antisocial behaviour, whilst the high street

in Oadby is improving. Comments were made regarding the difference in

availability of different types of food, as Oadby has a farmers market and Wigston

and South Wigston have more hairdressers, vape shops and takeaways, and that

fast food outlets could potentially be limited by the planning department.

Air Pollution, Traffic and Transport

44 Interviewees were concerned that air pollution could also be a contributing factor to

poorer health across Oadby and Wigston, although some felt that this may be a

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greater issue in Wigston due to heavy traffic and South Wigston due to higher

levels of industry, compared to Oadby.

45 Participants also suggested that there is heavy, stationary traffic in Wigston and

South Wigston with one individual commenting that it left them feeling 'trapped' in

their home in South Wigston at certain times of day. 'Poor' public transport links

and the lack of any public transport link between South Wigston and Oadby was

also discussed and participants suggested that the lack of public transport to

Oadby may impact upon the ability of individuals from South Wigston to access

services and facilities such as the walk-in primary care centre, exercise classes at

Parklands leisure centre and Brocks Hill country park.

Housing

46 Housing was felt to impact upon health inequalities and individuals commented

that there has been "massive" expansion of housing in the local area with 'no

thought' for health services, and newly built flats with no parking spaces. However,

it was also commented that when planning social housing there are resources

available for the community to tackle associated issues which may arise. The cost

of housing, particularly in Oadby, was also noted as an issue, whilst participants

commented that in South Wigston there is more social housing, and that many of

the privately rented housing stock is in poor condition, including homes with damp

and no central heating.

Community Assets

47 Participants reported that there are less community assets and facilities in South

Wigston and Wigston compared to Oadby, but also commented that facilities could

be better utilised, such as using school facilities out of school hours. It was also

noted that since the closure of the Basset Street Centre and library in South

Wigston, there are very few community rooms available for clubs to use, and that

funding limits the ability to hire private function rooms such as those at the

Salvation Army or Elliott Hall.

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8. Population Demographics

48 Participants felt that there were fundamental differences in the population

demographics of Oadby, Wigston and South Wigston, commenting that the

communities are made up of a different mix of ethnic and religious backgrounds

and that there is less migration in and out of South Wigston compared to Oadby. It

was also suggested that in Wigston, the LACs primarily work with older adults,

many of whom feel isolated, whereas in South Wigston, LACs work with many

young families who are often dealing with unemployment, low income, schooling

and education issues.

Affluence and Deprivation

49 Wealth was discussed widely as a contributing factor to health inequalities, with

many individuals commenting that Oadby is perceived as being affluent, Wigston

as financially stable and South Wigston as generally more deprived.

50 Participants felt that how affluent individuals are may impact upon their ability to

make healthy lifestyle choices, and that in South Wigston many individuals have

lower incomes and struggle to manage financially. It was also noted that Universal

Credit is now being rolled out in the area, although it was estimated that only

around a third of people on benefits in South Wigston have currently been changed

to this new system. Some individuals reported that they have already seen an

increase in families struggling and accessing services such as food banks since

the change to Universal Credit and reported concern that this may increase further

as the roll out continues.

Different Generations

51 Participants felt that it was important to recognise the different generations living

within the communities and the different needs that they may have, such as more

issues around parenting and child protection in South Wigston and isolation in

older adults in Wigston. Individuals also discussed the importance of hearing the

youth voice in the area and recognising that to do so may require different

approaches to engagement.

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Isolation and Social Interaction

52 Isolation and loneliness were discussed as issues within the community and as a

possible barrier to engagement. It was suggested that funding cuts may have led

to less social opportunities and an increase in isolation, and that groups such as

the Nordic walking group help individuals to feel more socially included and less

isolated, as well as providing exercise. It was also suggested that projects which

link the different generations may be beneficial in addressing loneliness and

isolation.

9. Mental Health

53 Mental health was felt to be a significant issue, with participants commenting that

mental health problems such as depression and anxiety seem to be increasing and

that for individuals with mental health problems their physical health may not be

their first priority.

54 It was suggested that local mental health and dementia forums in the area would

be of benefit, whilst it was noted that there are mental health facilitators in Wigston

and South Wigston. Participants also commented that the police are often the first

to pick up mental health issues and so collaborating more closely with the police

service would be useful, whilst increased mental health support in schools would

also be beneficial.

RECOMMENDATIONS

55 This report makes eight recommendations for consideration for future action by the

Oadby and Wigston Health and Wellbeing Board and ELR CCG Primary Care

Commissioning Committee.

Recommendation 1: Developing further understanding

56 Further explore whether it is possible to evaluate the population data in different

ways e.g. by GP practice in order to develop a better understanding of Oadby,

Wigston and South Wigston as separate communities.

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Recommendation 2: Oadby & Wigston BC Health and Wellbeing Board

57 Consider reviewing the Oadby & Wigston Borough Council Health and Wellbeing

Board Terms of Reference, including attendance list, action plan governance, the

use of task and finish groups and wider partner communication (including minutes

dissemination and possible bulletin to wider partners).

Recommendation 3: Connecting the Three Communities

58 Explore the possibility of improved transport link between South Wigston, Wigston

and Oadby. I.e. public transport and volunteer transport for specific

events/activities (e.g. activities at Parklands Leisure Centre).

59 Consider creating a leaflet containing information for health professionals and

residents regarding all transport options, including public transport and voluntary

transport

Recommendation 4: Community Engagement

60 Consider developing a programme of engagement events in the local communities

such as health and wellbeing fairs and community health checks in accessible

places such as supermarkets and community spaces. Link to Health and Wellbeing

Board action plan, to increase communication, collaboration and co-ordination

across organisations.

Recommendation 5: Education

61 Raise awareness of the health inequalities in the local education settings across

the district by sharing the attached review and ensuring a representative on the

Health and Wellbeing Board.

62 Review local schools and nurseries progress on the "Leicestershire Healthy

Schools" and "Leicestershire Healthy Tots" programmes. Potential ambition could

be for all schools to have enhanced Healthy Schools status and nurseries to have

Healthy Tots accreditation.

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Recommendation 6: Social Prescribing

63 Ensure Primary Care Network (PCNs) potential social prescribing funding is fully

maximised by considering how it links to the current Leicestershire social

prescribing system, including First Contact Plus, Local Area Coordinators and care

coordinators.

64 Embed Making Every Contact Count (MECC) Plus across partner agencies to

support social prescribing and for staff to embed prevention conversations and

appropriate referrals to prevention services as a core part of their role.

Recommendation 6: Improving Communication: Across organisations and with local residents

65 Explore the possibility of creating one single resource, such as an online directory,

which contains detailed information on all local public, community and voluntary

services in the Oadby and Wigston area. This may be used by professionals and

residents. Consideration is needed to maintain the resource in a timely way.

Examples include The Bury Directory (www.theburydirectory.co.uk).

Recommendation 7: South Wigston Health Centre

66 ELR CCG to review and prioritise opportunities to re-develop the South Wigston

Health Centre building. This may include potential space for a community

asset/room to deliver social prescribing within the heart of the community.

Recommendation 8: Community Spaces

67 Review the social value element of a range of public sector contracts to identify

any community assets/ spaces within the area that could support social prescribing

and community development. Consider small non-recurrent funding streams to

support hiring private venues if no local free assets are available.

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http://www.theburydirectory.co.uk/


9 July 2019

Recommendation

68 The East Leicestershire and Rutland CCG Primary Care Commissioning

Committee is requested to:

• COMMENT ON the report findings, recommendations and define next steps for the CCG to support a reduction in health inequalities across Oadby and Wigston.

REFERENCES

Braun, V. and Clarke, V., 2006. Using thematic analysis in psychology. Qualitative

research in psychology, 3(2), pp.77-101.

Leicestershire County Council (2018). Inequalities in Life Expectancy between

Oadby and Wigston.

Maguire, M. and Delahunt, B., 2017. Doing a thematic analysis: A practical, step-

by-step guide for learning and teaching scholars. AISHE-J: The All Ireland Journal

of Teaching and Learning in Higher Education, 9(3).

Sadler, G.R., Lee, H.C., Lim, R.S.H. and Fullerton, J., 2010. Recruitment of

hard‐to‐reach population subgroups via adaptations of the snowball sampling

strategy. Nursing & health sciences, 12(3), pp.369-374.

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Paper F ELR CCG Primary Care Commissioning Committee Meeting

9 July 2019


Front Sheet

REPORT TITLE: South Leicestershire Medical Group - Update on Merger

between Kibworth Medical Centre and The Two Shires Surgery


REPORT BY: Khatija Hajat, Primary Care Contracts Manager

SPONSORED BY: Jamie Barrett, Head of Primary Care

PRESENTER: Seema Gaj, Senior Primary Care Contracts Manager

EXECUTIVE SUMMARY: In May 2018 Kibworth Medical Centre (KMC) and The Two Shires Surgery (TTSS) submitted an Expression of Interest to East Leicestershire and Rutland CCG to merge their General Medical Services contract and rename them as South Leicestershire Medical Group. The following reports were presented to PCCC for consideration;:

• June 2018 – the initial Expression of Interest was presented outlining the key proposal, including the reasons for the merger, the proposed benefits to patients, premises and other considerations. Approval was given by the PCCC to develop the Service Plan and commence a 90 day consultation with patients and stakeholders;

• November 2018 – A report on the Service Plan was presented which included the outcome of consultation with patients. Approval was given by the PCCC for practices to formally merge with effect from 1 April 2019.

The purpose of this report is to provide the PCCC with an update and assurance post implementation of the merger.


• NOTE and RECEIVE the update on the merger between Kibworth Medical Centre and The Two Shires Surgery to form South Leicestershire Medical Group. A further update will be provided to PCCC in six months for full assurance.

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EQUALITY ANALYSIS An equality analysis and due regard to the positive general duties of the Equality Act 2010 was undertaken by both the practice and the CCG as part of the consultation undertaken with patients and stakeholders. These were attached to the November PCCC paper.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The report highlights the following risks:

• BAF 3 - Quality Primary Care - The quality of care provided by primary care providers

does not match commissioner’s expectation with respect to quality and safety.

• BAF 6 (a) Primary Care Commissioning – ability to perform delegated duties whilst maintaining member relations and Clinical Engagement

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9 July 2019


South Leicestershire Medical Group - Update on Merger between Kibworth

Medical Centre and The Two Shires Surgery

9 July 2019 Background and Context 1. In May 2018 Kibworth Medical Centre (KMC) and The Two Shires Surgery

(TTSS) submitted an Expression of Interest to East Leicestershire and Rutland CCG to merge their General Medical Services contract. The following reports were presented to PCCC for consideration:

• June 2018 – the initial Expression of Interest was presented outlining the key proposal, including the reasons for the merger, the proposed benefits to patients, premises and other considerations. Approval was given by the PCCC to develop the Service Plan and commence a 90 day consultation with patients and stakeholders

• November 2018 – A report on the Service Plan was presented which included the outcome of consultation with patients. Approval was given by the PCCC for practices to formally merge with effect from 1st April 2019.

2. Kibworth Medical Centre and The Two Shires Surgery formally merged on 1 April 2019 and renamed their practice as South Leicestershire Medical Group.

3. The purpose of this report is to provide the PCCC with an update and assurance post implementation of the merger.

Mobilisation of Practice Merger – Status as at June 2019

4. Following approval by the PCCC in November 2018, the CCG has held regular

monthly meetings with the Practice Managers of both practices to monitor execution of the mobilisation plan. Key elements included:

• Communication with patients and stakeholders • Management of patient records • Premises management • IT installation/configuration • Installation of new telephone system • Contract management • Finance & Insurance • Business continuity plan • Liaison with CCG/NHSE Finance/PCSE/NHSBSA and ensuring

completion of all necessary forms • Partnership agreement

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5. On 8 April 2019, the SystmOne migration was successfully completed and both practices now run on one IT system.

6. The practice has also purchased a new telephone system which will be formally rolled out in the summer.

7. As part of the monthly review meetings, it was noted that key actions have been completed, however the following area are still in progress and will be monitored by the CCG till completed for overall assurance, these include;

Table 1: Outstanding Actions for Practice Merger Key Action Current status CQC registration CQC are to provide the practice with GP log-in details to

update their registration. The practice plan to update the Registered Managers details when the status amends.

Business Plan for merged practices

To be progressed following appointment of the Business Manager – CCG to follow up with the practice

Amalgamated Policies and Procedures

In progress and projected to be completed by December 2019. The CCG will follow up with the practice to ensure this is progressed in time for the CQC Annual Regulatory Review.

Review of Job Descriptions

The practices have noted variance in contracts across both practices therefore HR advice has been sought.

Premises No current changes, however activity and usage across sites is being monitored to ensure demand is addressed appropriately.

Finance and Bank Accounts

In progress – CCG and NHSE Finance will be provided with updated details.

Concerns highlighted during Consultation

8. Key concerns identified during the consultation have been addressed by the

practice which is detailed in Appendix A and summarised as follows: • The impact of growth due to house addressed by increasing access across 8

sites and recruitment of Nurse Practitioner

• Lack of public transport or mobility restrictions have not been raised as an issue as patients can access services across more sites that may not require public transport or are fit for purpose facilities.

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• New telephone system to be installed to ensure access is improved

• Continuation of outreach clinics

• Practices have maintained continuity of care and offer choice of appointments through extended opening hours and alternative Saturday clinics

9. The practice has also committed to carry out a patient survey in the next 6 to 12

months to assess whether or not all concerns raised during the consultation have been addressed.

Recommendation: The East Leicestershire and Rutland CCG Primary Care Commissioning Committee is requested to:

• NOTE and RECEIVE the update on the merger between Kibworth Medical Centre and The Two Shires Surgery to form South Leicestershire Medical Group. A further update will be provided to PCCC in six months for full assurance.

Page 5 of 10

Paper F - APPENDIX A

CURRENT STATUS OF ADDRESSING PATIENT CONCERNS RAISED DURING CONSULTATION – 13 JUNE 2019

Concern How addressed Supporting Data/Evidence

RAG

1 Housing Development – The growth in housing development is a concern. It was felt that the Practices struggle to cope under the current demand and any increase could lead to access problems for patients.

The CCG responds to notification from HDC of housing developments to secure s106 funding to mitigate impact on practices’ Both Practices monitor list size ratios with clinicians and number of appointments to ensure there is enough capacity. This would be continued if the proposal was accepted. The Practices would also look to develop and evolve, particularly in relation to appointments and access.

The two surgeries have maintained the services. Clinical capacity has been increased by recruiting an Advanced Nurse Practitioner for an additional 6 sessions per week who will work across all sites and this will be for on the day access.

3 Transport was a concern particularly for elderly patients, patients with mobility problems and young people who might not have support from their family and friends to take them to appointments. Many villages have no public transport and there is no bus service that stops outside Kibworth Medical Centre.

The practice acknowledged lack of public transport to access Kibworth Medical Centre. Due to change in Practice Management practice has not been able to have an open dialogue with Leicestershire County Council around transport issues.

The practice has confirmed that elderly patients with transport issues are now accessing Old School Surgery as this is within walking distance for them. Elderly patients in Great Glen previously needed to drive but are now able to access Great Glen surgery which is within walking distance for them. The Hallaton and Medbourne outreach clinics have also seen an increase in patient access. The practice will be updating the business plan to reflect the changes in patient movement/demand across all sites and consider increasing clinic times and offer more appointments if required.

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RAG

4 Parking at Two Shires Medical Practice in Kibworth was a concern particularly for elderly patients and patients with mobility problems.

This was a common theme amongst patients and we advised that there is plenty of parking at Kibworth Medical Centre which patients from Two Shires Medical Practice would be able to access if the proposal is approved.

Improvements to parking at TSS are restricted as the premise is landlocked. However, the practice has been monitoring the situation and have identified trend whereby younger families able to drive are now accessing KHC and elderly patients are accessing Old School Surgery. Through the patient survey it will be established if this is an issue.

5. Access to Surgeries – Elderly patients and those with mobility problems and families with young children using pushchairs expressed concerns in accessing surgeries. Patients stated that doorways can be a barrier as well as inadequate parking.

Kibworth Medical Centre has automatic doors, parking for disabled patients and parent and child parking. The surgery is single story with several disabled bathrooms and a separate baby changing facility. Under approval of the proposal, access would therefore be improved for patients currently registered at Two Shires Medical Practice.

This has been addressed to some extent in point 4. Above. However, practice acknowledge improvements could be made to doorways etc and will explore options on how this can be improved using s106 funding.

6 Telephone Access – Difficulty accessing the Practices by telephone, in particular at Two Shires Medical Practice.

At every consultation people discussed the difficulties experienced in being able to get through on the telephone at Two Shires Medical Practice. There were reports of wait times for longer than 30 minutes, with people being cut off after holding for a long time and people just never able to get through to speak to a member of staff.

A review of telephone system has been completed resulting in a new telephone system being installed across all sites. All calls are routed centrally. When a patient rings for an appointment they will be offered an appointment at any one of the 8 sites.

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RAG

A review of the telecoms system is already underway. If the proposal is to go ahead then a new system will be in place by the proposed merge date on 1st April 2019. There are plans to implement a system that covers all surgeries with different options for patients if they want to select a specific surgery to contact. The proposal will have an impact on this but it will be to improve the system and access for patients.

Patient survey to obtain patient views on the telephone access

7 Threat to outreach clinics – The perceived threat to outreach clinics run at Hallaton and Medbourne. Patients felt they should not be made to travel excessive distances to access a clinician if the services were discontinued.

Many attendees at Hallaton and Medbourne consultation drop in sessions expressed concerns that the proposal may mean the outreach clinics run on Mondays would cease. There was concern that this would mean access to healthcare would be difficult for many villagers, not helped with the fact that there are no public transport services going to each village. It was clear patients value these clinics and we assured patients that there is no intention to reduce the clinics as the Practices are aware of the benefits to patients and therefore the proposal will have no impact on these clinics.

Services at Hallaton and Medbourne are continuing with increased access. There are no plans for these to removed or reduced.

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RAG

8 Continuity of Care was also a theme that arose at every single consultation drop in session with the focus being on the increasing elderly population and patients with chronic long term conditions. Patients felt that by combining practices it would be difficult for patients to continue to see the GP of their choice. Patients also felt that Doctors who are perceived to be the best will become more popular with new patients, making it harder to access appointments with them.

The Practices maintained that continuity was equally important to them and assured patients with planning, evolution and development we will endeavour to ensure this is not affected by the proposal and will remain at least no different to present but will likely improve. The Practices plan to educate patients on clinicians areas of expertise. Therefore patient would be able to book the appropriate clinician for a particular problem, getting to the most suitable clinician, the first time. It will also be important to ensure that staff actively signpost patients, especially to those requesting to be seen urgently on the day as Acute Illness Clinics are available and are appropriate for most patients.

There have been no changes to the GP rotas with regard to location of where they work and hence maintained continuity of care for patients through patient choice.

Availability and choice of appointments was a concern expressed by many with almost 50% of survey respondents stating that this was the most important factor to them. There was a request for longer opening hours, especially for those patients who work or have children.

If the proposal is approved and can commence from 1st April 2019, we improve the appointment system for patients and communicate developments and system changes clearly to patients. This can be done in a variety of ways which will include us writing to all patients to inform them of the outcome of the proposal and will include in it any planned changes to appointments. The Practices can also communicate via websites,

Letters have been sent to patients informing them of the outcome of the consultation. Changes have been communicated to patients via practice websites, posters and newsletters. Practice has increased opening hours at KHC now opening from 8 – 6.30pm, previous open hours were from 8 – 5.30 In addition KHC patients also have

Page 9 of 10



RAG

posters and newsletters. With a larger clinical team and may more areas of specialty being available to patients, it will be important to educate patients on the areas of expertise for all clinicians so that we can ensure patients see the most suitable clinician for their problem, the first time. This will ensure there are efficiencies in the appointment system.

access to early morning appointments between 7.30 and 8.00am and alternate Saturdays 8.00 till 12.00pm.

Equality Impact Assessment (EIA)

The EIA carried out by the practice as part of patient/stakeholder consultation identified positive or neutral impact on the following 8 protected characteristics:

• Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion or belief • Sex • Sexual orientation

The EIA identified potential negative impact on the Age characteristic, mainly elderly patients needing to travel further to see the clinical of their choice.

Actions practice has taken include: • Patients in care homes will be

visited by Nurse Practitioner to offer continuity of care for patients.

• Housebound patients – plans are in

place for Nurse Practitioner to undertake reviews of housebound patients.

• Practice has identified increased

demand at Hallaton and Medbourne and as part of their business plan considering increasing clinic times to meet increased demand. This will be promoted via practice website/posters and text messaging.

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Paper G ELR CCG Primary Care Commissioning Committee

9 July 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Front Sheet

REPORT TITLE: Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T) Work Programme update


REPORT BY: Kirsty Tite, IM&T Work Stream Manager for LLR

SPONSORED BY: Tim Sacks, Chief Operating Officer

PRESENTER: Tim Sacks, Chief Operating Officer

EXECUTIVE SUMMARY: This paper provides an update on the IM&T Work Programme across LLR which supports the delivery of the Local Digital Roadmap and implementation of GP 5YFV requirements. • IM&T June Newsletter (appendix a)


• RECEIVE the report.








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9 July 2019


Leicester, Leicestershire and Rutland (LLR) GP Information Management and

Technology (IM&T) Work Programme update

9 July 2019

Introduction

1. The aim of the GP IM&T work programme is to deliver the IM&T initiatives which support the GP Five Year Forward View (GP5FV) and the Leicester, Leicestershire and Rutland Local Digital Road Map, overseen by the GP IM&T Steering Group. The Steering Group are also the forum to discuss any emerging initiative or development that will impact on GP IT.

IM&T Work Programme

2. Within the programme there are 7 key initiatives which are being delivered in response to national NHS E GP IT framework mandates, GP5FV or those locally defined strategic objectives of the LDR (Record sharing, Supporting pathways, Digital self-care and BI& research).

a. Online Consultations b. GP Clinical System Migration c. Electronic Record Sharing d. Flagging and notifications e. Clinical System Optimisation f. Patient WIFI g. Self-care and mobile apps

3. Progress updates and current position are given for each project on the IM&T

tracker and key points for information covered in the items for escalation to PCCC section of this paper.

Items for escalation from the LLR GP IM&T Steering Group 13 June 2019

Work Stream Update

4. eConsultations. Local due diligence and contract negotiations have been

completed and the final contract was approved for signing by JMT on Monday 17th June. We are in the process of obtaining signature from the CFO and MD of each CCG. Software approval has been granted and implementation will begin in the second quarter.

5. System Migration. The position remains the same as reported last month as

are still awaiting the outcome of capital funding bids for 19/20 funding. Practices who have expressed interest will be kept informed and we will progress with migrations as and when we are able based on funding.

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9 July 2019

6. Electronic Record Sharing. Leicestershire County Council has completed the RA process for staff involved in the LLR Proof of Concept for Summary Care Record into Adult Social Care. Refresher training is currently underway and we are anticipating go live mid-late July.

RECOMMENDATIONS

The East Leicestershire and Rutland CCG Primary Care Commissioning Committee are requested to:

• RECEIVE the report for information

Page 3 of 3

1

IM&T Update Leicester, Leicestershire and Rutland

June 19 Volume 1, Issue 6

LHIS Update—LLR Post-Natal Template

2

Cyber— LLR Security Guidance

3

Care Hone SystmOne 4

Enhanced SCR Promotional Patient Video

4

End of Life and Frailty Report Searches

4

Special Education Needs & Disabilities (SEND) – New PRISM pathway to support statutory obligations &

5

SNOMED Update 5

PRISM Summer Newsletter

6-10

A Partnership of Clinical Commissioning Groups:

East Leicestershire and Rutland CCG Leicester City CCG

West Leicestershire CCG

LLR PCN IT Discussion Afternoon 2019/20 GMS requirement for online appointment bookings

From July 2019 practices will be expected to make 25% of their appointments available for booking online. GMS Regulations will be amended to make this a contractual requirement.

This requirement relates to the complete range of appointments practices offer, including, but not limited to:

• GP appointments;

• a variety of nurse and other health care professional led clinic appointments, for example,

cervical smear tests, vaccinations and immunisations, asthma reviews, blood tests and similar.

• appointments that have been made available for direct booking by NHS111 (see below) and in the future, subject to the introduction of the appropriate technology, appointments booked on patients’ behalf by 111.

Further information is available in the Setting up patient online services section at https://www.rcgp.org.uk/patientonline.

Inside this issue:

NHS App promotional materials

A range of materials have been produced to help CCGs and GP practices prepare their staff and systems for the NHS App.

Leicester, Leicestershire and Rutland practices have been connected to the NHS App allowing patients to register.

Materials include a new film featuring GP practice staff in Liverpool talking about their experience of working with the app.

Materials are also available to help practices promote the app to patients once they are connected. Practice and CCG staff can join NHS England webinars to learn more and have any questions answered.

https://www.rcgp.org.uk/patientonline

https://www.rcgp.org.uk/patientonline

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-j/

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-t/

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-i/

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-d/

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-d/

https://ccgbulletin.cmail20.com/t/d-l-pikdrlk-cjttjuhth-h/

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LHIS Update—LLR Post-Natal Template

To support practices offering post-natal examinations and to improve the quality of care for patients in line with NICE guidelines a LLR Post-Natal Template has been developed with support from GPs and Midwives.

SystmOne

For SystmOne users this template is available to you from your template launchers:

EMIS Web

Please import the EMIS Web template into your template manager as per instructions and remember to deactivate / archive any older versions.

Loros Unit

Please note the following change in the LOROS unit for your information

Example of the change in a test patient record as below:

The events under this admission will now be available automatically without having to right click and

This will ensure other services can find information recorded under the admission.

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Cyber Security Update

Leicester, Leicestershire and Rutland (LLR) - Security Guidance, June 2019

Issued by Leicestershire Health Informatics Service (LHIS)

1: Unauthorised Software

LHIS has responsibilities for ensuring the IT systems and services we use, operate securely and that the systems and networks adequately protect the confidentiality of healthcare and patient information. To ensure new software and services do not introduce threats and risks to this information, we have to conduct security and compatibility checks prior to their installation. These checks also ensure the service / product complies with NHS security standards. This ‘Software/Service Approval’ process is managed by LHIS and, if you wish a new IT product or service to be installed on our computers and networks, the associated forms must be completed. A link to the form is as follows https://nww.leics-his.nhs.uk/_ITRequestForms.aspx and can also be found on the LHIS self-service portal.

2: Network Shares

A recent security review has highlighted that some users are sharing confidential information by making their local or ‘H’ drive available to other users. This presents a significant security risk to the confidentiality of healthcare information. If you are sharing information in this manner, could you please disable these shares and seek guidance from the LHIS Service Desk ([email protected]) on how to do this in a secure manner. At the end of July 2019, another review will be conducted and, if these shares are still present, they will be disabled.

3: Forwarding Emails

Please be aware that forwarding personally identifiable, confidential or patient information to your personal email accounts is strictly prohibited. This practice presents significant security and governance risks, which could result in a major data protection breach, with associated fines and penalties.

A couple of examples where the Information Commissioner’s Office (ICO) has taken action are contained in the following links.

https://ico.org.uk/action-weve-taken/enforcement/jeannette-baines/

https://ico.org.uk/about-the-ico/news-and-events/news-and-blogs/2019/04/former-nhs-manager-fined-for-sending-personal-data-to-her-email-account/

This practice also breaches NHS confidentiality regulations. Users forwarding such information to their personal email accounts could also be subject to disciplinary sanction, which could include dismissal.

Should you require further advice and / or support, please contact LHIS as follows:

[email protected] or (0116) 295 3500 – Option 5 for the LHIS Service Desk

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Care Home SystmOne Pilots are progressing well. There is two SystmOne Care Homes live and a further 6 in the pipeline.

There are meetings being scheduled with GP prac-tices that are associated with the pilot care homes.

If any practices require any further information please contact Jaz Dhinsa.

The following feedback has been received from one of the care Homes currently live

“Since started with SystmOne, we Everdale already experiencing a big change and improvement on spending time chasing prescriptions,

referrals even communication between us and our local Surgery’s with the “system task”, communica-tion improved has reduce significantly

time spending on waiting list on phone calls, also fax that are send and lost, are now more effective using the Task on SystmOne”

NHS D have provided us with a video to promote enhanced summary care records to patients and asking them to consent.

This will be shared with secondary care and social care. Please feel free to add this to your practice websites and any screens within the practices. https://www.youtube.com/watch?v=tTEVnxzijAs

Enhanced SCR Promotional Patient Video

Care Home SystmOne Pilots

End of Life and Frailty Report Searches

You will know that sharing the enhanced Summary Care Record 2.1 is crucial to good and safe patient care when they present to other providers, and is also how we share our Integrated Care Plans. All pa-tients can benefit from this consent and we know practices are working towards this.

To help you identify the patients who will benefit most from and enhanced SCR we have created some SystmOne searches. These show End of Life and Frail patients who do not have their enhanced Summary Care Record set to share.

LLR is top of the national table for shared enhanced Summary Care Records and we thank you for your continued hard work in this area.

SystmOne

The searches can be found in SystmOne, Clinical Reporting, EOL and Frailty Reports.

EMIS WEB

The searches for EMIS WEB have been sent to practices separately.

https://www.youtube.com/watch?v=tTEVnxzijAs

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Feedback or Questions?

If you have any feedback or questions relating to anything you have read in this newsletter or any other IM&T issue please contact Kirsty Tite, IM&T Workstream Manager

[email protected]

For any technical queries please call LHIS on 0116 295 3500

As part of the STP IM&T SEND work a new PRISM based process for Primary Care contributions to Statutory Education, Health and Care Assessments will be launched on July 1st 2019. The new process will facilitate consistent contributions and remove the need to print paper summaries. Requests for GP contributions will continue to be sent from the LPT SEND team on behalf of the Local Authorities.

The new PRISM pathway titled Education Health Check GP Contribution can be found in SystmOne under S for Special and E for Education and in PRISMWeb it can be found under Admin and Paediatrics. Practices will be notified of new requests via workflow / tasks.

If you require any support with the new process please contact the LHIS Application Support team on 0116 295 3500

Special Education Needs & Disabilities (SEND) – New PRISM pathway to support statutory obligations & patient care

EMIS WEB

EMIS WEB have reported that the pilot is progress-ing well and deployment is scheduled for early July with completion in August. Staff at the pilot prac-tices have reported positively.

NHS D strongly recommend that users review the EMIS guide and undertake the recommended house-keeping tasks to prepare for migration to SNOMED CT as soon as possible.

All reports and templates produced by LHIS for the purpose of claims and patient safety are most up to date as they are all written in both clinical systems with SNOMED mapping. The reports undergo a thorough quality check process involving clinical leads and clinical safety officer sign off.

TPP Deployment across the estate is complete. Guides have been circulated with previous newsletter issues.

SNOMED Update

https://supportcentre.emishealth.com/help/care-record/snomed-ct/what-do-you-need-to-know-now/

PRISM NEWSLETTERN H S L E I C E S T E R S H I R E H E A L T H I N F O R M A T I C S S E R V I C E

SUMMER IS HERE! INSIDE THIS ISSUE:

Making Referrals Count

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SPOTLIGHT ON: THE NEW PRISM PORTFOLIOSince PRISM was conceived in 2012 the team have worked tirelessly to develop

PRISM's core functionality. Whilst working with our key partners (primarily LLR

CCGs and Planned Care STP), we recognised the importance of extending our

offer to optimise benefits for all stakeholders; most importantly the patient.

The PRISM portfolio which you can find more information on here: https://www.leics-

his.nhs.uk/products/prism/ now recognises and builds on the success of PRISM referrals in a

number of ways -

From PRISM core, which includes, clinical pathways and support, directory of services (currently

ambulatory care services within UHL but soon to be expanded), resource library, and portal, we

are now are able to offer an extended range of services including:

Referrer to Referrer - Community or acute services may want to refer between themselves

and share resources. Whilst UHL does not have an electronic patient record we have the

facility to initiate this in other ways.

Application Programming Interface (API) Suite - Essentially a set of functions and procedures

allowing the creation of applications that access the features or data of an operating system,

application, or other service. This provides the link to:

Mobile Applications, website and Intranets that can be directly updated by PRISM in real

time providing a direct link to patients providing information and resources such as self

management tool and advice around self referrals. This is an exciting development for us and

one that you will be hearing more about in the near future.

The PRISM team welcome your comments regarding any PRISM pathway or if youwant a pathway to be built then please contact us by using the “Contact us” button onSystmOne (front page of the dashboard) or PRISM Web. Alternatively you can [email protected]

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https://www.leics-his.nhs.uk/products/prism/

http://leicestershire.nhs.uk/

https://www.leics-his.nhs.uk/products/prism/

SystmOneReferrals from SystmOne GP practices to other Services on SystmOne should be sent via SystmOne

Electronic Referrals. This functionality is not the same as the NHS Electronic Referrals (previously

called Choose and Book).

The following pathways should be sent using this method.

· Adult Speech and Language Therapy

· Community Continence Service

· Community Paediatrician Service

· Diana Children’s Community Service

· Dietetics (for Adult, Paediatrics and Domiciliary Visits)

· Integrated Care Mental Health (only for GP practices that are commissioned within the City)

· Podiatry (both Podiatry Assessment and Fast Access)

· Specialist Palliative Care

· Tissue Viability

Please ensure that you send the Electronic Referral to the correct unit, which will be printed in the

Recipient Details eg., Community Paediatrician referral should be sent to the Leicester,

Leicestershire & Rutland CHS Unit. There is no need to attach anything to the electronic referral as

the letter remains in Communication and Letters.

As more services move to SystmOne this list will continue to grow. The PRISM letter will always tell

you where to send the referral. There is a handout which can be found on the PRISM Intranet.

WHAT’S CHANGED AND

WHAT DID YOU NEED

HELP WITH?Each issue we review what

we have received support

calls for to share best

practice with you .

WHATS NEW?One of the questions we regularly get

asked is ‘what’s new in PRISM?’ The

easiest way to find out is to go to

PRISM Web (either from your desktop

or via the SystmOne Dashboard) and

click on the New Pathways Link.

New pathways are tagged for 4 weeks

as new, pathways are regularly added

to PRISM .

Integrated Care Mental Health A reminder that Referrals into this service from specificGP practices within Leicester City should be sent directlyto the service (for our SystmOne Practices - via SysmOneElectronic Referrals, for our EMIS practice via nhs.net)and not via SPA. Please also ensure that a PRISM letteris created and not just the questionnaire completed.

You will then be presented with a list

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TOPTIPS

NEW PODIATRY REFERRAL FORM

0116 295 3500

[email protected]

CONTACT US @ l e i c s h i sF O L L O W U S

www.leics-his.nhs.uk

EMAILING PRISM GENERATED REFERRALS

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