Primary Care Commissioning Committee Public Meeting To …

Primary Care Commissioning Committee

Public Meeting To be held on Thursday 8 February 2018

Commencing at 12.30pm – 2.30pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Lead

Enc Action

1 Apologies for Absence

Chair Verbal Information

2 Declarations of Interest

Chair Verbal Review

3 Minutes of the meeting held 11 January 2018

Chair Enc A Approval

4 Matters Arising not on the Agenda, including progressing the action tracker

Chair Enc B Review

5 Primary Care Risk Register

Chair Enc C Review

6 Finance:

6.1 Full Quarterly Report

Mrs Tingle Enc D Information

6.2 Primary Care Leases & Debtor Issues with CHP and Action Plan

Mrs Tingle To Follow Information

7 Quality:

7.1 Full Quarterly Report

Mrs Cookson Enc F Information

7.2 Primary Care Heatmap Update

Mr Empson Enc G Discussion

8 Committee Business:

8.1 Delivery Plan Exception Report

Mrs Wastnage Enc H Discussion

8.2 ACS Primary Care Steering Board Minutes of 18 December 2017 Top 3 priorities for Primary Care

Mrs Ogle Mrs Ogle

Enc I

Enc J1+J2

InformationInformation

8.3 Primary Care Commissioning Committee Annual Report

Chair Enc K1+K2 Information

8.4 DRAFT Primary Care Delivery Group Minutes

Mrs Ogle Enc L Information

8.5 Primary Care Provider Engagement Group Notes

Dr Alsindi Enc M Information

9 Commissioning:

9.1 Primary Care Strategy 2018/2019

Dr Alsindi

Enc N

Approval

9.2 GPFV Update

Mrs Ogle Enc O Information

9.3 The Phoenix Medical Practice and The Flying Scotsman Update

Mrs Ogle Verbal Information

9.4 Dunsville Medical Centre List Closure –Extension

Mrs Ogle Enc P Approval

9.5 Barnburgh Surgery Update Mrs Ogle Enc Q Information

9.6 Thorne Moor List Closure Mrs Ogle

Enc R Approval

9.7 Estates Strategy Mrs Ogle Enc S Information

10 Potential Risks

Chair Verbal Discussion

11 Any Other Urgent Business

Chair Verbal Discussion

12 Date and Time of Next Meeting Thursday 8 March 2018, Boardroom, Sovereign House at 12.30pm

Information

1

Minutes of the Primary Care Commissioning Committee Held on Thursday 11 January 2018 commencing at 12.30pm

In the Boardroom, Sovereign House Voting Members Present:

Mrs Linda Tully – Lay Member (Chair) Mrs Sarah Whittle – Lay Member Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mr Anthony Fitzgerald – Director of Strategy & Delivery

Non-Voting Members Present:

Dr Niki Seddon – Locality Lead, North West Locality Dr Khaimraj Singh – Locality Lead, South East Locality Mrs Carolyn Ogle – NHS England Representative

Formal attendees present (non-voting):

Mrs Zara Head – Lead Nurse, Primary Care Quality Mr Andrew Russell - (Attending on behalf of Mrs Suzannah Cookson) Mr Ian Carpenter – Head of Communications Dr Dean Eggitt – Medical Secretary, Doncaster Local Medical Committee (LMC) Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term Conditions Mr Andrew Goodall - (Attending on behalf of Mrs Hilditch

In attendance:

Mrs Jayne Satterthwaite – PA to Chair & Chief Officer - (Taking Minutes) Mrs Claire Burns – Head of Procurement (Observing)

ACTION

1. Apologies for Absence Apologies were received from: Mrs Kayleigh Wastnage - Primary Care Support Manager

Dr Nicholas Leigh-Hunt – Public Health Representative

Mrs Suzannah Cookson – Deputy Chief Nurse

Mrs Debbie Hilditch - Health watch Doncaster Representative

2. Declarations of Interest The Chair reminded Committee members of their obligations to declare any interest they may have on any issues arising at Committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group. Declarations declared by members of the Committee are listed in the

2

CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub-Committee/working groups: None declared. Declarations of interest from today’s meeting: None declared.

3. Minutes of the Previous Meeting held on 14 December 2017 The minutes of the meeting held on 14 December 2017 were agreed as an accurate record.

4. Matters Arising not on the Agenda, including progressing the action tracker Urgent & Emergency Treatment Centre Update Mrs Tingle confirmed that the current cost of NHS 111 is £427k. Dunsville Medical Practice Mrs Ogle stated that the practice has requested to extend the closure of their patient list and a paper will be presented for discussion at the next Primary Care Commissioning Committee meeting. Risk Register Mrs Tully requested that the Risk Register be added as a standing agenda item.

Mrs Ogle/ Mrs Smith

Mrs Smith

5. Finance 5.1 Interim Exception Report Mrs Tingle stated that there is nothing to report. 5.2 Annual Budget Setting DRAFT Mrs Tingle presented the draft 2018/2019 Financial Plans for Primary Care to the Committee for noting and explained that, as the planning guidance is still awaited, the Financial Plans are in draft form. It is expected that the total will be £49.856.000.

http://www.doncasterccg.nhs.uk/

3

Mrs Pederson queried when the changes in the GP contract are expected. Mrs Tingle advised this would be later in the year. The Primary Care Commissioning Committee noted the draft 2018/2019 Financial Plans for Primary Care.

6. Quality: 6.1 Interim Exception Report Mrs Head reported that there are currently 16 practices receiving resilience support. The Care Quality Commission (CQC) inspections have commenced however due to winter pressures, those practices which have received an ‘Outstanding’ CQC rating may apply to delay their inspection until later. Those practices which have received a ‘Requires Improvement’ rating may not apply. The Primary Care Commissioning Committee noted the report.

7. Committee Business: 7.1 360 Assurance Primary Care Strategy Internal Audit Report The 360 Assurance Primary Care Strategy Internal Audit Report was presented to the Audit Committee on 11 January 2018. A review of the governance arrangements in place at NHS Doncaster CCG to oversee the implementation of the Primary Care Strategy was undertaken and highlighted the following points:

There is some confusion in the Terms of Reference of the Primary Care Commissioning Committee and the Quality & Patient Safety Committee which will be examined further.

We must state what is required on agendas and identify deliverables.

It was noted that there was no work plan for the Primary Care Delivery Group. Action Logs have now been developed for all Primary Care meetings.

Overall, the Primary Care Strategy received significant assurance from Internal Audit.

Mrs Tully stated that we are addressing Key Performance Indicators (KPIs) through a robust work plan and when the Annual Review of Committee Effectiveness is completed we will look at how we integrate sub groups. Mr Fitzgerald acknowledged that overall this was a positive report and it is pleasing that we link well with Primary Care on the ground. Dr Alsindi is currently in the process of updating the work plan for

4

2018/2019. Mr Fitzgerald proposed that facilitated workshops be held with the Local Medical Committee (LMC) and the Federation to discuss and work on any key issues; workforce for example. Dr Eggitt stated that we need to look at how General Practice can support us. Mrs Whittle commented that she was unsure that the Engagement & Experience Committee (EEC) linked with Primary Care and there could be an opportunity to collaborate with Healthwatch going forward. The Primary Care Commissioning Committee noted the 360 Assurance Report and supported the proposal to hold a workshop. 7.2 Delivery Plan Exception Report Dr Alsindi presented the Delivery Plan Exception report to the Committee for noting and highlighted the following:

Amber – Tier 2 Enhanced Service – More work is to be undertaken regarding finance.

Amber – Workforce – This is due to the work with the Federation, the Accountable Care System (ACS) and Health Education England.

Red – Estates – There has been little progress made towards the Primary Care Estates Strategy.

Mr Fitzgerald stated that the Primary Care Delivery Plan will be refreshed and made more tangible for the forthcoming year. The Primary Care Commissioning Committee noted the Delivery Plan Exception Report. 7.3 ACS Update

Mrs Ogle gave the following update:

A meeting was held on 18 December 2017 where a presentation was delivered by the NHS England Personalised Care Team. There is an appetite to support Doncaster for social prescribing.

Discussions were held on the map building taking place through the Shape Atlas.

The caretaker contract was discussed and we need to liaise with the North East Commissioning Support Unit as this is also being done nationally. Mrs Pederson requested that if timescales are too long nationally that we implement our own framework which is ready to be launched.

Local Care Networks A bid was submitted in December 2017 for Project Management support and Organisational Development to support the development

Mrs Ogle

5

of Local Care Networks. The funding is a single payment and does not have to be spent this year. Mrs Pederson advised the Committee that she had met with Mrs Sherburn and they discussed the development of a plan to look at how we may work together going forward. 7.4 Primary Care Delivery Group Minutes

The Primary Care Commissioning Committee received and noted the Primary Care Delivery Group minutes dated 8 December 2017. 7.5 Primary Care Commissioning Committee Forward Planner

The Primary Care Commissioning Committee noted the Forward Planner and agreed that the Risk Register should be added to the Planner.

Mrs Smith

8. Commissioning: 8.1 Proactive Care Specification Quarterly Report Dr Alsindi presented the Proactive Care Specification Quarter 4 Report to the Primary Care Commissioning Committee for noting and highlighted the following points:

All 42 practices who have signed up to the service have submitted their report covering the July to September period. For the majority of practices this was the 4th quarter of the service in its current form. Practices have become much more efficient in submitting their reports.

A total of 6717 patients are now on a Proactive Co-ordinated Primary Care register, there are 3014 who have new or reviewed care plans in place, 1865 patients now have a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) in place and 2891 patient have now consented to the Enriched Summary Care Record.

1459 patients were asked, via a Patient Survey, how confident they felt in managing their own health. The response rate was good with 80% of patients declaring they felt confident enough.

38 practices have been delivering their Proactive Co-ordinated Primary Care Service since October/November 2016. The service specification was issued in July 2016 for an initial period of October 2016 to March 2018, as part of a 3 year scheme. The AUA Enhanced Service was discontinued by NHS England on 1 April 2017 with the funding being rolled over into the Global Sum. Practices were given some advice at the time about how they might take this into account with their register.

The new General Medical Services (GMS) required practices to routinely identify moderate and severe frailty in patients aged 65 years and over from July 2017. For those patients identified as

6

living with severe frailty, practices are to: o Deliver a clinical review, including providing an annual

medication review and where clinically appropriate discuss whether the patient has fallen in the last 12 months.

o Provide any other clinically relevant interventions. o Explain the benefits of the Enriched Summary Care Record

(SCR), seeking informed patient consent to activate it. o Code clinical interventions for this group appropriately.

The Key Service Outcomes of the Proactive Co-ordinated Primary Care Service include: o Case finding and review. o Named professional. o Care planning. o Patients supported to manage their health and wellbeing. o Multidisciplinary working.

Mrs Whittle queried if the care plans and the multi-disciplinary working could be brought together for case management. Dr Alsindi advised that the logistics of this could be quite challenging. Dr Eggitt asked if the correct data is being collected. Dr Alsindi acknowledged that this may not be the case as people interpret things differently. Mrs Whittle also highlighted that it was difficult to see where value for money was captured and asked if there was a risk stratification tool which could be built in. Dr Alsindi stated that value for money was included within the system as a whole and that it would be difficult to do this across all practices. Mrs Tully stated that a lot of work has been invested however queried what is being done about possible variations and if we could eradicate any ambiguity. Dr Alsindi advised that we could obtain clarification and a description on what has been done. Mrs Tully also commented that there are high numbers of frail patients whose health needs are increasing. Mrs Pederson added that some patients are unable to access services . Concern was expressed that we may not be capturing the correct information and the Rapid Response model will have an impact. The Primary Care Commissioning Committee noted the report and requested that any further comments be forwarded to Dr Alsindi for discussion at the next Primary Care Commissioning Committee meeting on 8 February 2018. 8.2 TARGET Mrs Ogle informed the Committee that the Clinical Tutor for TARGET has now left the organisation and that the Federation is providing cover on an interim basis. NHS Doncaster CCG is currently out to tender for a permanent provider who can deliver educational aspects with the inclusion of more multi-professional elements.

All/ Dr Alsindi

7

8.3 Church View Mobilisation Update Mrs Ogle updated the Committee that a new contract is to be awarded from 1 February 2018. Patients will be informed and the TUPE of staff to the new provider has commenced. There are challenging issues regarding premises and a meeting has been arranged to discuss this further. Mr Russell stated that there have been lessons learned throughout the process particularly in the length of time for mobilisation. The Primary Care Commissioning Committee noted the update and agreed to review again in March/April 2018. 8.4 GPFV Monitoring Survey

Mrs Ogle advised that the GPFV Monitoring Survey has been submitted to NHS England. The Primary Care Commissioning Committee noted the update.

Mrs Ogle/ Mrs Smith

9. Potential Risks Mrs Tingle informed the Primary Care Commissioning Committee that the Audit Committee discussed the overarching risks on 11 January 2018. Mrs Tingle agreed to feedback comments from the Audit Committee to Mrs Tully.

Mrs Tingle

10. Any Other Urgent Business Dr Seddon reported that some laptops are not working correctly and that security problems have been encountered. Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) IT department is currently working on solutions and Mrs Tingle agreed to discuss this further with Mrs Stones and agree a communications plan for General Practice.

Mrs Tingle

11. Date and Time of Next Meeting Thursday 8 February 2018, Boardroom, Sovereign House at 12.30pm

No. Date of Meeting Agenda Item Action Action by Action due Update Status

15 13 July 2017Application to Close List - Thorne

Moor Medical PracticeCCG to facilitate exploration of available space within the building for the practice to expand into.

Hayley Tingle August

CommitteeCCG liaising with CHP. CHP picking up with Practice.

Outstanding

18

13 July 2017Application to Close List - Dunsville

Medical Centre UpdatePC Team to continue to support the Practice and update the committee on a monthly basis.

PC Team

Update required at

each Committee

Extension to list closure being considered at the February committee.

On-going Action

31

12 October 2017 Primary Care Quality DashboardDebbie Hilditch and Chris Empson to meet and discuss use of qualiative data within the PC Matrix and dashboard

Chris Empson / Debbie Hilditch

In due course

Still to be arranged.On-going

Action

3512 October 2017

Extended Primary Care - Revised Tier 2 LES

The Committee GP's will discuss the ring pessary fit requirements outside of the Committee and feedback at the next meeting

All Committee GP's

In due course

Nabeel to include in the new Service Specification.

On-going Action

39 09 November 2017 Finance Quarterly Report Query whether LIFT management costs are capped. Hayley TingleIn due Course

On-going Action

43 09 November 2017 Quality Quarterly ReportMeeting to be arranged between CCG and LMC regarding Incident Reporting and use of NRLS.

Anthony Fitzgerald

In due Course

On-going Action

46 14 December 2017 Finance - CHPHayley Tingle to confirm whether Practices are able to put CHP on notice.

Hayley TingleIn due Course

On-going Action

4714 December 2017 Finance - CHP

Hayley Tingle and Dean Eggitt to discuss lease options with CHP.

Hayley Tingle and Dean

Eggitt

In due Course

On-going Action

48 14 December 2017 Finance - CHP Hayley Tingle to present a CHP Action Plan Hayley TingleFebruary

CommitteeOn-going

Action

50

14 December 2017Urgent & Emergency Treatment

Centre UpdateAilsa Leighton to contact Health Watch as part of the engagement proces.

Ailsa Leighton and Debbie

Hilditch

In due Course

On-going Action

5214 December 2017 Primary Care Heatmap

Anthony Fitzgerald to meet with the LMC and Primary Care Doncaster to discuss working closer together to avoid duplicating data collection from Practices.

Anthony Fitzgerald

In due Course

On-going Action

56 11 January 2018 Committee Business - ACS UpdateCarolyn Ogle to speak to North East Commissioning Unit to discuss caretaker timescales.

Carolyn OgleApril

CommitteeOn-going

Action

57 11 January 2018Commissioning - Proactive Care Specification Quarterly Report

Comments around the report to be sent to Nabeel Alsindi. All February

CommitteeOn-going

Action

59 11 January 2018 Potential RisksHayley Tingle to feedback Audit Committee comments to Linda Tully.

Hayley TingleFebruary

CommitteeOn-going

Action

6011 January 2018 Any Other Business

Hayley Tingle to discuss laptop issues with with Gail Stones and agree a communications plan for General Practice.

Hayley TingleFebruary

CommitteeOn-going

Action

The Risk Register is used for recording operational directorate-level risks (risks which underpin strategic Assurance Framework risks).

Risk

Dir

ecto

rate

Ref

En

try d

ate

Co

mm

itte

e

Str

ate

gic

Ob

jecti

ve L

ink

Assu

ran

ce F

ram

ew

ork

Lin

k

Ris

k T

yp

e

Ris

k O

wn

er

Description

Co

nseq

uen

ce

Lik

eli

ho

od

Rati

ng

Ris

k d

escri

pto

r

Co

nseq

uen

ce

Lik

eli

ho

od

Targ

et

Lik

eli

ho

od

Rati

ng

Ris

k d

escri

pto

r

Key Controls Internal Assurance External Assurance Positive Assurance Gaps in Control Gaps in Assurance

Ris

k T

reatm

en

t

Next

revie

w d

ate

Risk Reviews Action Plan Progress

Du

e d

ate

Do

ne d

ate

Prim

ary

Care

PC

P-0

10

24th

Marc

h 2

017

Prim

ary

Care

Com

mitte

e

SO

1 /

SO

3

2.3

Com

mis

sio

nin

g

Caro

lyn O

gle

Potential lack of viability and

sustainability in General

Practice due to practices

closing at short notice.

4 4 16

VE

RY

HIG

H

4 3 2 12H

IGH

• Quality Team and

dedicated Primary Care

Quality Nurse in post

• Strategic Primary Care

Leadership

• Primary Care

Commissioning

Committee

• Quality & Patient

Safety Committee

• Primary Care Delivery

Group

• Primary Care Quality

Dashboard


Safety Committee

Minutes

• Framework for

dynamic purchasing (list

of providers available at

short notice) - in

development

• LMC Intelligence


Dashboard

• Primary Care

Commissioning

Committee Minutes

• Contingency Plan for

failing practices

• NHS England

• CQC Reports

• NHS Englands Central

Primary Care National

Programme

• Same Day Health Centre

• NHS England Caretaker

Providers for General

Practice

• Procurement and

transition costs cannot

be controlled in the

short term

• None

TR

EA

T

31 M

arc

h 2

018

24.03.17 - Risk added.

20.06.17 - Dynamic Purchasing System in place. Practices have

been offered financial analysis support on income and

expenditure. Federation will support from July 2017.

27.09.17 Risk reviewed. Action plan updated. Ownership of risk

changed. Review in 3 months.

21.12.17 Risk Reviewed. Progress updated. Review in 3 months.

Implement dynamic purchasing

system. Proactively work with

practices to ensure financial

viability

27.09.17 Purchasing system has not been implemented nationally due to

capacity. A fully established GP Federation has now been implemented

which may support practices although there is no robust plan in place if

federation did not have capacity to support at short notice. Action to be

reviewed in 3 months.

21.12.17 Accountable Care System documentation ready to release re:

the South Yorkshire and Bassetlaw Footprint System. This has been

agreed at Primary Care Board on 18th December 2017. Currently working

with the Primary Care Board on agreement to use a national system.

31 M

arc

h 2

018.

Prim

ary

Care

PC

P-0

11

20th

June 2

017

Prim

ary

Care

Com

mitte

e

SO

1/S

O3

2.3

Com

mis

sio

nin

g

Caro

lyn O

gle

Preperation and readiness for

future Primary Care policy

requirements -

Primary Care Delivery Plan

impementation is not

effectively delivered for

national 'must do's' such as

extended GP Practice hours

with lack of continuity from the

CCG and Provider perspective

with regards to the national

delivery plan

3 5 15

VE

RY

HIG

H

3 3 2 9

HIG

H

• Quality Team and

dedicated Primary Care

Quality Nurse in post

• Strategic Primary Care

Leadership

• Primary Care

Commissioning

Committee


Safety Committee


Group


Dashboard


Safety Committee

Minutes

• Framework for

dynamic purchasing

• LMC Intelligence


Dashboard

• Primary Care

Commissioning

Committee Minutes

• Contingency Plan for

failing practices

• Governing Body

• NHS England

• CQC Reports

• NHS Englands Central

Primary Care National

Programme

• Same Day Health Centre

• Federation Delivery

• NHS England Caretaker

Providers for General

Practice

• Procurement and

transition costs cannot

be controlled in the

short term

• None

TR

EA

T

31 M

arc

h 2

018

20.06.17 Risk added. Opportunities to further align CCG

functions to the federation. Emerging risk. Review in 3 months.

27.09.17 Risk Reviewed.

21.12.17 Risk Reviewed. Action progress updated. Review in 3

months.

Delivery plan for Primary Care

to be the focus for Governing

Body in November 2017.

Delivery plan now being monitorred more closely with progress being

reported to Primary Care Commissioning Committee to ensure better

control. No concerns anticipated on delivery plan.

21.12.17 Delivery Plan well received at Governing Body in November

2017. Focus of discussion on areas when not on track and spoke of areas

of good practice. Workforce and Estates Strategy discussed. Market

Engagement to take place in 2018 for extended General Practice hours.

National timescales brought forward to December 2018. 30th

Novem

ber

2017

Prim

ary

Care

PC

P-0

12

09th

August

2017

Prim

ary

Care

Com

mitte

e

SO

1/S

O3

2.3

Fin

ancia

l

Caro

lyn O

gle

Significant financial pressures

in Primary Care with regards to

IT infrastructure and locum

payments. There is a risk that

there is not enough funding to

cover increased requests for

locums due to GP sickness and

maternity leave and to cover

the increased requests for

mergers and the impact this

has on the IT infrastructure.

3 4 12

HIG

H

2 3 2 6

ME

DIU

M

• Primary Care

Commissioning

Committee


Group

• Locality Meetings

(South East)

• Business Case for

merger

• Primary Care

Commissioning

Committee Minutes


Group Minutes

• NHS England - accountable

for the use of delegated

budgets and mergers

• None• Lack of control in GP

locum payments • None

TO

LE

RA

TE

31 M

arc

h 2

018 09.08.17 Risk added. Emerging risk. Review in 3 months.

27.09.17 Action plan updated.

21.12.17 Risk reviewed and regraded to medium risk as there is

an underspend in Primary Care to offset any associated costs. IT

Infrastructure plans have been structured and funded. Review in

6 months.

09.08.17 A local policy needed.

Further engagement required

with LMC. Ensure better use of

GP IT budget by effective

planning on mergers and

working with Federation on

horizon scanning.

27.09.17 Training on 'Business as Usual Capital' to take place on

28.09.17 to ensure capital funding to support.

30th

Novem

ber

2017

Prim

ary

Care

PC

P-0

13

09th

August

2017

Prim

ary

Care

Com

mitte

e

SO

1.S

O3

2.3

Govern

ance

Caro

lyn O

gle

Lack of Primary Care Estates

Strategy in Doncaster. A

number of large buildings with

empty space have been

identified that the CCG has to

pay for in void costs.

4 4 16

VE

RY

HIG

H

4 3 2 12

HIG

H

• Primary Care

Commissioning

Committee

• Doncaster Strategic

Estates Group


Group

• Chief Finance Officer

link to LIFT

• Primary Care

Commissioning

Committee Minutes

• Doncaster Strategic

Estates Group Minutes


Group Minutes

• Primary Care Strategy

Audit

• NHS England

• Doncaster Metropolitan

Borough Council Head of

Planning chairs DSEG

• Estates Technology and

Transformation Fund

feasability studies money

• Lack of strategy

around estates• None

TR

EA

T

31 M

arc

h 2

018

09.08.17 Risk added. Review in 3 months.

27.09.17 Action plan updated.

21.12.17 Risk reviewed. Action progress updated. Additional

internal assurance added. Review in 3 months.

09.08.17 CCG to sit on task

and finish group for Bentley

GP's to discuss feasability of

new build reviews. 6 facets

survey and data to be reviewed

by the CCG. Identify priority

areas with Community Health

Partnerships to do a study on

all findings from the feasability

study to ensure it happens.

CCG to ensure better use of

core capital within the CCG.

27.09.17 Internal estates meeting to take place on 02nd October 2017

held by the Chief Finance Officer.

21.12.17 Discussed and agreed meeting with CHP at PCCC to progress

the Estates Strategy. Currently an increased costs to Practices due to

void space. Management costs have also increased for General Practices

owned by NHS PS and LIFT buildings therefore making practices less

sustainable as unable to maintain costs. Internal meeting took place on

02nd October 2017 with a further meeting planned for 2018. to take

forward feedback on Estates Strategy.

30th

Novem

ber

2017

(1) (2) (3) (4) (5)

Rare Unlikely Possible Likely Almost certain

(1) Negligible 1 2 3 4 5

(2) Minor 2 4 6 8 10

(3) Moderate 3 6 9 12 15

(4) Major 4 8 12 16 20

(5) Extreme 5 10 15 20 25

1-5 Low The risk appetite under which risks can be tolerated is a score of 11 or below.

Risk Review

NHS Doncaster CCG Risk Register

Mapping Uncontrolled risk Controlled risk Controls & Assurances

The Risk Register is coordinated by the Corporate Governance Manager, to whom risks should be reported. The Risk Register will be regularly reviewed and updated (at least quarterly) by the

Corporate Governance Manager in liaison with Leads identified on the Register and updates reported quarterly via the Corporate Assurance Report to the Governing Body. The Register will also be

reported to and reviewed by the Audit Committee on an annual basis.

Strategic Objectives (SOs)

SO1 Commission Innovative healthcare and pathways to improve patient experience, outcomes and cost effectiveness.

SO2 Contract and performance manage for continuous quality improvement.

SO3 Achieve economic efficiency and effectiveness within the allocated resource limit.

SO4 Develop transparent and accountable relationships with stakeholders.

SO5 Ensure all our Corporate Governance systems and processes are robust and transparent.

SO6 Foster effective organisational development and leadership.

Risk Matrix

Likelihood

Co

ns

eq

ue

nc

e

RiskD

irecto

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Ref

En

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ate

Co

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Str

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gic

Ob

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ink

Assu

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ram

ew

ork

Lin

k

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yp

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Ris

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Description

Co

nseq

uen

ce

Lik

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Rati

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Ris

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pto

r

Co

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uen

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Lik

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Targ

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Lik

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Rati

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Ris

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Key Controls Internal Assurance External Assurance Positive Assurance Gaps in Control Gaps in Assurance

Ris

k T

reatm

en

t

Next

revie

w d

ate

Risk Reviews Action Plan Progress

Du

e d

ate

Do

ne d

ate

Risk ReviewMapping Uncontrolled risk Controlled risk Controls & Assurances

6-11 Medium Risks scored at or in excess of a score of 16 must be escalated to the Governing Body

12-15 High

16-20 Very High

25 Extreme

Score Category Review frequency

1 - 5 Low Annually

6-11 Medium 6-monthly

12 - 15 High Quarterly

16-20 Very High Monthly

25 Extreme Monthly

Meeting name Primary Care Committee

Meeting date 8th February 2018

Title of paper

Primary Care Q3 Finance Report 2017/18 and Update on Primary Care Funding Streams

Executive / Clinical Lead(s)

Hayley Tingle Chief Finance Officer

Author(s) Genna Miller, Senior Finance Manager and Tracy Wyatt, Deputy Chief Finance Officer

Purpose of Paper - Executive Summary

This report outlines the 2017/18 financial position as at 31st December 2017 for all Primary Care Budgets. It also includes an update on Primary Care Funding Streams.

Recommendation(s)

Members are asked to receive the report and note the position and highlighted financial risks.

Impact analysis

Quality impact

None identified

Equality impact

None identified

Sustainability impact

Nil

Financial implications

As highlighted within the report

Legal implications

None identified

Management of Conflicts of Interest

None Identified

Consultation /

Engagement (internal

departments, clinical,

stakeholder &

public/patient)

N/A

Report previously

presented at None

Risk analysis

Assurance Framework

1.2, 1.4, 2.4, 3.1, 3.2, 6.2

NHS DONCASTER CCG Primary Care Q3 Finance Report 2017/18 and Update on Primary Care Funding Streams 1. Introduction

NHS Doncaster CCG assumed responsibility for managing the Primary Medical Care Budget from NHS England with effect from 1st April 2016, adding to the current CCG responsibility for Enhanced Services, Out of Hours Contract, Oxygen and GP IT.

2. Quarter 3 2017/18 Financial Position (as at 31st December 2017) Delegated

Co-Commissioning

The total 2017/18 Primary Care Delegated Co-Commissioning GP Contract annual budget is £42,036,558, with no change from Q2 2017/18. As at Quarter 3 2017/18 we are forecasting an underspend of £396k with a number of highlighted risk, as detailed below, where we are awaiting further information to order to calculate the associated financial risk.

YTD Budget

£000

YTD Actual

£000

YTD Variance

£000

Annual Budget

£000

Forecast Outturn

£000

Variance

£000

General Practice – GMS 16,462 16,517 55 21,951 22,041 90

General Practice – PMS 4,528 4,115 -414 6,038 5,468 -570

General Practice – APMS 590 1,193 603 787 1,436 649

Premises 4,380 4,250 -130 5,844 5,589 -255

Enhanced Services 887 889 2 1,193 1,209 16

QOF 2,347 2,142 -205 4,471 4,311 -160

Other – GP Services 1,315 1,011 -303 1,753 1,587 -166

Total Delegated Budgets 30,509 30,117 -392 42,037 41,641 -396

Areas of concern relate to;

Premises - NHS England are working with CHP regarding the on-going national issue relating to management allowance reimbursement (for information – management allowance was a non reimbursable cost in 2016/17 i.e. practice cost. CHP have discovered that a number of leases do not include the management allowance in the documentation, therefore they cannot recharge the practices. CHP have now stated that this is a reimbursable cost i.e. NHS cost. This is not covered in the premises directions, therefore NHS England are working with CHP to agree a national stance). The impact is an additional cost of £82k, which is not included in the Q3 position.

Enhanced Services – Component 2&3 of the Avoiding Unplanned Admissions DES for 2016/17 is yet to be approved in CQRS and paid to practices. This should be covered by the 2016/17 accrual but until final figures are known, this could cause a financial cost pressure. Awaiting confirmation from NHS England that all claims have been approved in CQRS.

QOF – The current QOF achievement forecast outturn is based on 30% of the CQRS aspiration calculation (based on 2016/17 actual point achievement at 2017/18 price per point). This has been offset against the 2016/17 final year end accrual position. Potential for overperformance linked to the 2016/17 position due to increased points performance and changes to practice prevalence (2017/18 external practice training event to help practices understand how to maximize their prevalence levels against national) which will impact on the overall spend.

Other – changes to the locum sickness cover became mandatory from 1st April 2017, therefore any sickness claims are a cost pressure to the CCG as there was no expenditure in 2016/17 therefore no allocated budget. Costs will be unknown until a claim is submitted. Current sickness claims - year to date £48k, forecast £67k. Indemnity levy has been included within the Other category forecast position (£171k, no change from Qtr 2 2017/18). We are still awaiting confirmation from NHS England whether this is a CCG cost or NHS England cost (NHS England funded in 2016/17). No allocation has been received to cover this cost.

3. Local Primary Care Funding

The local primary care funding is £5.8m and includes the national GP Forward View funding for Care Navigators £54k and National Funding for GP Wi-Fi Services £86k. A summary is shown below; there are no material risks related to these budgets that require noting.

YTD Budget

£000

YTD Actual

£000

YTD Variance

£000

Annual Budget

£000

Forecast Outturn

£000 Variance

£000

Oxygen Services 460 494 34 614 670 56

Enhanced Services 2,032 1,922 -111 3,027 3,024 -3

Mental Health Assessments 120 148 28 160 202 42

DBH - GP Consumables 74 75 1 99 101 2

8-8 services 667 628 -40 890 841 -49

GPIT 666 716 50 888 888 0

GP Forward View 41 41 0 54 54 0

Total Local Funding 4,060 4,024 -38 5,732 5,780 48

4. National Funding

As part of the GP Five Year Forward View a number of national initiatives have been agreed with funding phased over a number of years. Funding for Doncaster CCG is as outlined in the table below and is all non-recurrent:

16.17 17.18 18.19

£'000 £'000 £'000

Online Consultations 0 81 108

Care Navigator Funding 27 54 54

Access Funding 0 0 1,087

Primary Care Network Funding 0 315 0

GP Wi-Fi Services 86

Totals 27 536 1,249

4. Conclusion and Recommendations Members are asked to: Receive and note the Quarter 3 2017/18 financial position and the associated risks and note the update to the national Primary Care Funding Streams.

Meeting name Primary Care Commissioning Committee


Title of paper

Primary Care Quality Report

Executive / Clinical Lead

Suzannah Cookson

Author Zara Head, Lead Nurse Primary Care Quality


The purpose of the Primary Care Quality Report is to provide the Primary Care Commissioning Committee with an update of the recent activity and progress made by the NHS Doncaster CCG Quality Team in relation to Primary Care.

Recommendation(s)

The group are asked to receive and note the progress made during this time period.

Impact analysis

Quality impact As detailed in the report

Equality impact

None


Positive, supporting sustainability of general practice.


None

Legal implications

None

Management of Conflicts of

Interest None

Consultation / Engagement

(internal departments,

clinical, stakeholder & public/patient)

Engagement with member practices is on-going.

Report previously

presented at None

Risk analysis

There are no risks to report at this time.

Assurance Framework

1.2, 1.3, 2.1, 2.2, 4.3, 5.1

Primary Care Quality Report 1. Introduction 1.1 The purpose of this paper is to provide an overview of the quality and patient

safety issues in relation to Primary Care, this is a developmental process. This paper refers to the information submitted since the last meeting.

2. Delegated Authority 2.1 The Primary Care Committee is meeting regularly and there is a regular agenda

item for quality. 3. Primary Care Quality Support 3.1 Currently there are on-going quality and assurance conversations with 16

practices, including assurance visits, resilience support, development of action plans and support of quality improvement as a whole.

3.2 This also includes discussions with practices where variations in data have

been identified on the Primary Care Matrix. 3.3 The Lead Nurse for Primary Care Quality has also spent a full day in three

further practices supporting quality improvement alongside further development of areas that the practices feel they are excelling in.

3.4 These visits have included looking at policies and procedures, significant event

reporting and sharing of learning, patient access and any other areas where quality and patient experience could be improved.

4. National Reporting and Learning System 4.1 Use of NRLS appears to be growing; eleven practices are using this system

regularly now and several more have started submitting their significant events this way and sharing these events with the CCG for learning and quality improvement.

4.2 No themes or trends have been identified. 4.3 Conversations have been held following reporting of incidents, processes have

been reviewed and new policies developed to further improve quality and patient safety.

5. Primary Care Matrix Evaluation Group (PCMEG) 5.1 Following the approval to expand the remit to incorporate the CCG’s priority

areas, the January meeting of PCMEG looked at referrals into secondary care services including use of eRS (Electronic Referral Service).

5.2 The Primary Care Matrix Evaluation Report has been updated with the relevant data sets support these discussions.

5.3 The Primary Care Matrix has also undergone a 6 month refresh of the data sets

contained within. 5.4 New recommendations for practice ‘conversations’ were discussed at January’s

Primary Care Delivery Group. 5.5 The PCMEG is kept aware of other GP quality schemes that are on-going and

lead by the Primary Care and Quality Team such as the GP Resilience Fund and CQC outcomes.

5.6 Conversations triggered by the Primary Care Matrix have been positive and well

received by practices. An example of this is where a practice was identified as having lower uptake in cytology screening than a neighbouring practice. Conversations were held in May 2017 around what the practice staff perceived to be the reasons behind the lower uptake and they put plans in place to address this. The practice undertook an audit from January 2017 to January 2018. This audit showed an increase in uptake from May 2017 onwards and for the quarter, September to December 2017 their cytology screening numbers had increased by 30% compared to the previous year.

6. Care Navigation

6.1 The Care Navigation Programme went live on the 13th October 2017 with the four services as planned.

6.2 The CCG is developing a performance and activity dashboard which will be

reviewed by the Primary Care Delivery Group and the Practice Managers Forum. The Primary Care Team will be discussing wave 2 services with the Primary Care Provider Engagement Group in January 2018.

6.3 October’s draft Care Navigation Dashboard detailed that 206 patients have had

their care needs navigated. 6.4 The total number of accepted navigations by service is set out below:

Service Number Navigated

October 2017

Minor Ailments Service 98

Service Not Specified 53

IAPT 42

Dental Services 7

Social Prescribing 6

Total 206

6.5 Further work to cleanse the data and develop the dashboard further is on-going

and being led by the Graduate Trainee within the Performance and Information Team.

7. Workforce 7.1 The CCG is working with local stakeholders to develop a primary care

workforce strategy. Primary Care Doncaster has undertaken a soft stock take of the workforce in general practice, however only 25 of 43 practices completed the return and Primary Care Doncaster can only share the data with the CCG at an aggregated level.

7.2 The specification for GP and Nurse TARGET is finalised and the service has

gone out to tender. Due to the CCG GP TARGET Tutor leaving, Primary Care Doncaster have been asked to care take the programme with support from the CCG Jan – March 2018.

7.3 The CCG continues to engage with Health Education England and the ACS

Workforce Work-stream.

8. Case Conference Reporting / Attendance

8.1 Reports requested for initial child protection conferences

Month

Initial child protection conference [total] GP Reports Received

Percentage in relation to number invited too %

May 2017 18 4 25%

June 2017 26 9 45%

July 2017 22 7 32%

August 2017 26 9 38%

September 2017 25 10 40%

October 2017 29 13 45%

November 2017 26 12 46%

December 2017 32 16 50%

8.1.1 The number of reports submitted by GPs for initial child protection conferences is still fluctuating.

8.1.2 Despite a large increase in GP reports being sent to initial conference in March

2017 which was attributed to the targeted training provided, this reduced significantly in May and July 2017. However there has been a slow, month on month continued increase since then up to December 2017.

8.1.3 It is anticipated that with the use of the new SPOC number, GP’s will be given

more time to write and submit a report resulting in further increases in the future.

8.1.4 In addition there is a new GP report template, which has been designed to

make it easier for the report writer to include all relevant information required this too should see a further increase in returns.

8.2 Reports required for review child protection conferences

Month

Review child protection conference GP Reports Received

Percentage in relation to number invited too %

April 2017 43 13 30%

May 2017 52 25 49%

June 2017 53 24 46%

July 2017 49 19 40%

August 2017 30 10 32%

September 2017 58 30 52%

October 2017 47 21 45%

November 2017 48 17 35%

December 2017 42 13 31%

8.2.1 In January 2017 Doncaster Children’s Trust business support team began

sending invites 6 weeks in advance to all review conferences which has seen the reports submitted increasing. GP’s now have 6 weeks’ notice to submit the report to RCPC which they seemed more able to achieve as opposed to tighter timescales for ICPC’s. However, the numbers of reports returned is dropping again. These numbers will continue to be monitored and discussions are on-going with practices failing to return reports so that any barriers can be overcome.

9. Care Quality Commission 9.1 The next phase of inspections by the Care Quality Commission (CQC) has

begun and practices are being inspected again. 9.2 The new approach to inspections will begin in April, it is not yet known exactly

what this will entail, however the document Shaping The Future, the CQC strategy for 2016 to 2021 which was published in May 2016, sets out an ambitious vision for a more targeted, responsive and collaborative approach to regulation.

9.3 The Lead Nurse Primary Care Quality has offered support to all practices with

any questions relating to inspection. 9.4 Carys Murray-Cook, who is the Care Quality Commission’s lead inspector for

Doncaster, will be attending a practice manager meeting following the publication of the new methodology. She will be giving a short presentation around the new way of regulating and inspecting and will then be open for questions.



Title of paper

Doncaster Primary Care – Heat Map.


Anthony Fitzgerald / Nabeel Alsindi

Author(s) Chris Empson – Informatics Programme Manager


The request for the development of a ‘heat map’ originated from the Primary Care Commissioning Committee and this paper is a follow up to those discussions.

This heat map will be used to proactively identify potential ‘hot spots’ in Doncaster and therefore allow NHS Doncaster to support its member organisations effectively. It is a working concept (draft) and is currently in development.

This paper has been created to seek further guidance on this methodology and to ensure the development is in line with original expectations.

Recommendation(s)

It is recommended that we utilise the information from the Primary Care Matrix to build a heat map to identify potential areas of concern (also referred to as ‘hot spots’).

It is also recommended that we look to create the analysis in the format and structure demonstrated in the document.

Impact analysis

Quality impact

Identifying good practice and areas of concern in Primary Care can

help reduce negative outcomes for patients and enable GP Practices to learn from each other and implement areas of best

practice.

Equality impact

Neutral


Failure to proactively analyse Primary Care can result in sudden or

increasing sustainability concerns.


Failure to proactively analyse Primary Care can result in sudden or

increasing financial implications.

Legal implications

Nil


Interest

The document outlines analysis on identifying areas of concern

within GP Practices. Conflicts of interest may occur from staff or partners associated with a GP Practice.




The development of the analysis includes engagement from Performance & Intelligence, Primary Care and Patient Quality & Safety.

Report previously

presented at

The Primary Care Matrix has been discussed at previous Primary

Care Commissioning Committees.

Risk analysis

Nil

Assurance Framework

1.3

1

Monday 18 December 2017, 10.00 – 12.00pm, Redmires/Howden Room, Don Valley House, Saville Street East, Sheffield, S4 7UQ

Meeting of the South Yorkshire and Bassetlaw ACS

Primary Care Work Stream Steering Board

Minutes

Name Role Initials Dr Tim Moorhead Karen Curran

Chair, Sheffield CCG (Meeting Chair) ACS Primary Care Programme Lead , NHS England

TM KCu

Katrina Cleary Carolyn Ogle Victoria McGregor-Riley Jacqui Tuffnell Alastair Bradley Victoria Lindon Catherine Wormstone

Programme Director Primary Care, Sheffield CCG Chief of Partnerships and Primary Care & Senior Primary Care Manager, NHS England Executive Lead for Primary Care, Bassetlaw CCG Head of Co-commissioning, Rotherham CCG SY&B (Sheffield) LMC Senior Primary Care Manager, NHS England Senior Primary Care Commissioning Manager, Barnsley CCG

KC CO VMR JT AB VL CW

Apologies: Name R Role Initials Dr Ben Jackson Jackie Holdich Dr Alastair Dickson Mandy Philbin

Health Education England Head of Delivery (Integrated Primary and Out of Hospital Care) GP Clinical advisor on Transformation, SY&B, NHS England.

D Deputy Chief Nurse, Sheffield CCG

BJ JH AD MP

Dr Avanti Gunasekera Strategic Executive Lead GP for Primary Care, Rotherham CCG AGu Dr Nabeel Alsindi Dr Anthony Gore Dr Mehrban Ghani Dr Eric Kelly Maddy Ruff Louise Nunn Roxanna Naylor Dean Eggitt In Attendance Name Tim Straughan Bev Taylor

Clinical Lead for Primary Care and Long Term Conditions, Clinical Lead for Out of Hospital Care, Sheffield CCG Medical Director, Barnsley CCG Clinical Chair, Bassetlaw CCG ACS Primary Care SRO, Accountable Officer, Sheffield CCG Chair, Sheffield CCG (Meeting Chair) ACS Senior Finance Manager, NHS England Acting Chief Finance Officer SY&B (Doncaster) LMC Role Head of Choice Volunteer Development Manager

NA AG MG EK MR LN RN DE Initials TM BT

Item Title Action 1. WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting; there was a round of introductions. Apologies received from Dr Ben Jackson, Maddy Ruff, Jackie Holdich, Dr Alastair Dickson, Louise Nunn, Mandy Philbin, Dr Gunasekera, Dr Alsindi, Dr Gore, Dr Ghani, Dr Kelly, Dr Eggitt and Roxanna Naylor.

2

2. 1.36 1/09 1.41 11/09 1.43

Review of Minutes and Actions from 11 October 2017 Review of minutes of the last meeting, Catherine Wormstone to be added to the attendance list. International Recruitment KCu suggested that a sub-group of the CCG PC and GP Leads meet to discuss learning from an existing scheme and feasibility of a joint SY&B application. A proposal for International Recruitment is to be brought to the January or February board. Finance Update Finance Update item 5 on the agenda. LCN Workshop Item 7 on the agenda.

Action KCu

3. Choice – Role of link workers/care navigators Tim Straughan (Head of Choice) and Bev Taylor (Volunteer Development Manager) from NHS England presented a proposal to test the role of link workers in patient choice and personal health budgets. The proposal includes:-

Funding for £150,000 for 2017/18, with further funding in 2018/19 (amount TBC). The funding has been given to the ACS for use in Primary Care, Elective Care, Urgent and Emergency Care, EoL and Mental Health.

Working with 1 or 2 CCGs to develop and evaluate the role of link workers/care navigators not only to support an enhanced social prescribing model in a number of different settings, but also to support patient choice and shared decision making.

Opportunity to include digital component, asset mapping of social prescribing providers by creating a directory of service (DOS) on the SHAPE tool.

Support and subject matter expertise from the personalised care team. TM commented that the CCGs in SY&B are at different stages of majority with development of social prescribing, and posed a question whether the project should focus on one or two areas or spread evenly across each CCG. TM pointed out one of the challenges is investment in the voluntary sector to cope with the increase in demand for services. JT stressed that for the Rotherham team, risk stratification would be key to include in the project. VMR agreed that risk stratification and risk escalation should be looked at, and welcomed the development of a DOS. VMR suggested to the group that it would be important to agree the scope of the project, definition of care navigators in some areas they may be community workers in others GP receptionists, common understanding of what is intended outcome, and benefits realisation. VMR suggested a workshop in the New Year to discuss and agree some of the above.

3

TS agreed that a workshop would be helpful; with regard to investment in community service informed the group that social fund approach is working well in both Lincolnshire and London. KCu agreed to request funding via Will Cleary Gray, for PC to test the use of link workers/care navigators, to include the costs for a project manager post, development of a DOS and workshop to define the project.

Action KCu

4. Strategic Health Asset Planning and Evaluation (SHAPE) Atlas KCu summarised Barbara Coyle (SHAPE Programme Manager) proposal to develop the SHAPE tool to asset map SY&B PC services. KCu explained this would include pharmacy and eye care extended services, community voluntary sector providers and workforce data, at a cost of £15,000. KCu informed the group that the ACS has £100,000 for developing data lakes, and has discussed with Michael Rodgers the link of this work with SHAPE. VMR suggested that it would be helpful to include local housing developments and population growths on the SHAPE tool; currently county councils do not have access to SHAPE to include housing plans. CO agreed it would be good to have hotspots and QOF outcomes mapped on SHAPE. JT asked that training on how to use SHAPE is included and to consider how the information is kept up to date. KCu agreed to request funding from the ACS to do this work.

Action KCu

5.

Finance Update KCu explained the spreadsheet prepared by LN detailing showed cumulatively ongoing investment in primary care, by scheme, funding source and destination. KCu explained that RN is working with CFOs to agree the inclusion of CCG investment in primary care. TM commented that this was a good piece of work and informative, that it would be useful to see the funding information by investment in front line staff and funding for pump priming/project support. KCu informed the group that there has been some misunderstanding recently relating to regional funding when it comes into the ACS, to clarify funding is held in a holding account by Sheffield CCG, this does not mean that Sheffield CCG received funding before other CCGs. Where monies are for per head of population, all CCGs are required to submit a plan for how they are planning to spend the monies, as with online consultation funding. JT commented that Rotherham have not received any project support from the Transformation Team to support on-line consultation or development of 8 to 8 services. KCu explained that the team is carrying two vacancies, which only leaves one member of the team in post. Two vacant TT posts and a part time vacant band 7 post is being replaced with two band 7 and a band 5, the posts will be blended PC and Transformation posts. JT asked why the decision on how to replace the posts did not come to board and asked for clarification on the process for making these decisions. TM explained as that it is still not clear what decisions are made collectively and what decisions are made individually and how funding and resources decision are made, for example, funding for social prescribing does PC bid for a portion of the

4

money, we need to know how to access monies where PC has a legitimate claim? TM agreed to raise issue about transparency of processes at the Executive Steering Group. It was agreed a finance update would be a standing item on the agenda.

Action TM

6.

Local Care Network (LCN) Workshop Feedback and Next Steps KCu asked for feedback from the group about their thoughts on the LCN Workshop held on 29th November. JT reported to group that the Rotherham contingent found the workshop helpful, particular the table top discussions. TM agreed the workshop and the table top discussions were helpful, which Sheffield used to start to formulate a contract for LCN working. KC stated that some of the front line staff had feedback that it they would have liked to hear more from the national team on what they could practically do to develop LCN. The next steps include submitting a plan on how the CCGs plan to invest the £1 per head including how each LCN map against the development matrix, KC explained that Sheffield had planned to ask each LCN to complete this has a self-assessment, however would not realistic to complete this by the deadline. KCu asked the high level CCG plan is prioritised for completion, detailing how each CCGs plan is utilise the £1 per head, this is required for the ACS to release the funding. TM asked the group for thoughts on the topic for the next workshop, due to be held in March. KCu commented that feedback from evaluation forms included Workforce and IT & Digital. KC stated that the CCG have a workforce workshop planned for January so another one so soon would not be helpful for Sheffield. CCGs PC Leads to discuss further and propose a topic.

Action CCG PC Leads Action CCG PC Leads

7. Interim Provider Framework CO summarised the benefits of using a provider framework, single framework, wider choice of providers. CO acknowledged some providers may not want to provide a service to the whole of the SY&B, which could be managed by allowing providers to state the areas they would like to cover. The group felt that where possible using a single provider framework would be sensible to do so.

8. AOB No any other business.

9. DATE AND TIME OF NEXT MEETING ACS Steering Board: Monday 29th January 2018, 9.30 – 11.30, Birch/Elm meeting room, Oak House, Rotherham, S66 1YY.

1

ACS Work-stream Top 3 Priorities: Primary Care

SOUTH YORKSHIRE AND BASSETLAW ACCOUNTABLE CARE PARNTERSHIP COLLABORATIVE BOARD

January 2018

Author(s) Karen Curran – Primary Care Workstream Lead

Sponsor Maddy Ruff and Tim Moorehead – Primary Care Workstream SROs

Is your report for Approval / Consideration / Noting

Consideration/noting

Links to the STP (please tick)

Reduce

inequalitiesJoin up health

and care

Invest and grow

primary and

community care

Treat the whole

person, mental

and physical

Standardise

acute hospital

care

Simplify urgent

and emergency

care

Develop our

workforce

Use the best

technology

Create financial

sustainability

Work with

patients and the

public to do this

Are there any resource implications (including Financial, Staffing etc.)?

Funding to support implementation of the GPFV is available and being tracked through the ACS Primary Care Programme workstream. Additional resources have been received (£1 per head/population) to support establishment of Local Care Networks at ‘place’ , this is in addition to the expectation that CCGs commit from within baseline funding to support GPFV programmes £3 per head over 2 years (17/18 – 18/19) to support transformation. This resource has already been committed by the SY&B CCGs. Resource implications have been identified for projects referenced within this paper, most have been addressed with the exception of proposals to support growing the workforce which will require further consideration.

Summary of key issues

The purpose of this brief is to present to the Collaborative Partnership Board the South Yorkshire and Bassetlaw Accountable Care System (SYB ACS) Primary Care workstream’s top three priorities.

Recommendations

The Collaborative Partnership Board is asked to approve the proposed top three priorities for the Primary Care workstream.

2

1. Purpose This paper presents for approval the top three priorities which have been identified by the Primary Care Work stream. 2. Key issues The Primary Care programme of work incorporates an element of oversight of the delivery of the GP Forward View at ACS level but also includes the national agenda for integration of wider workforce and service delivery models. Whilst CCGs are accountable for the delivery of GPFV, the ACS must have a clear understanding of the aggregate position across its footprint and as such will from time to time need to address emerging priorities in support of its CCGs . The majority of the aspirations set out in the GPFV are delivered at ‘place’ but elements can be identified as having potential to benefit from working collaboratively at ACS level, doing something once or sharing learning and expertise that enables us to move further faster. In consideration of this and how we prioritise the work of the Primary Care Work stream we aim to ensure that

our work compliments and enhances the work of ‘place’ to deliver added value as an ACS,

that this is in addition to or complimentary to NHS England DCO responsibilities and

supports delivery of wider primary care objectives that may not be CCG/Place direct responsibilities currently or are commissioned/funded in a limited and/or variable way and

we identify where benefit can be derived from targeted support from the SY&B Primary Care &Transformation Team or the offer being made through the national system transformation group.

The CPB is also asked to note that for Primary Care there are significant interdependencies with other work streams, some see the primary care work stream as a partner in delivery, others where we are only recently identifying expectations that the primary care work stream will lead, have oversight of or contribute to projects that support delivery or alignment of wider activities and funding streams across the ACS. For example the Primary Care work stream is ideally placed to identify the business requirements of primary care and will work collaboratively with the Digital workstream to ensure these are met by digital initiatives and projects such as e-consultation and WiFi in GP practices. The following 3 priority areas are proposed as they are key to the successful transformation of primary care within the wider health system.

Priority Increased Investment in Primary care in order to deliver service transformation

Impact Multiple funding streams targeted at primary care (GPFV, Pharmacy Integration Fund, Resilience Fund, Training and workforce initiatives etc) are co-ordinated to deliver maximum impact.

Opportunities are identified to do things once, recognising the primacy of ‘Place’ but where appropriate to consolidate funding streams to maximise effectiveness of schemes or initiatives across the ACS.

Target National commitment to increase investment into primary care by at least £2.4bn by 20/21.

Rationale To deliver the national aim of increasing investment in primary and community care additional funding is required to create sustainable providers able to transform and work differently.

Planning guidance asks that CCGs commit £3 per head of population to support transformation in primary care across 2017/18/19. Multiple funding streams are, in addition, targeted across multiple national initiatives each bringing with it a plethora of ‘guidance’ which is difficult to navigate and per capita allocations disaggregate into such small sums that impact at ‘place’ for some is difficult to achieve. The work stream is mapping funding streams (eg GPFV, Pharmacy Integration Fund) and uptake, by

3

Place, of resources offered as part of specific national, regional and local programmes (including associated guidance and outcomes targets) and will propose and facilitate collective agreement for ACS wide areas for investment which reflect ACS and Place priorities. Recent examples of this include securing national investment for project support to CCGs in SYB developing social prescribing, an element of this funding will also support a recent proposal to utilise and build on the PHE SHAPE Place platform to provide an enhanced interactive mapping component for wider primary care (including workforce data) across SY&B.

Priority Wider Workforce

Impact Alignment of workforce activities and investments across the ACS and Place reducing duplication and unwarranted variation.

Increase in community pharmacy and eye care providers working collaboratively with General Practice to deliver primary care services in the community.

Alignment of development programmes working with LWAB and Pharmacy/eye care professional bodies and providers

SYB programme of master class and learning sets across ACS, widening learning environment and promoting consistency as identified at ACS wide learning event focused on Local Care Networks.

Facilitated organisational development across scaled footprints.

Target National targets to increase retain and return clinical workforce and introduce new workforce models.

Rationale The Primary and community care workforce of the future will be responsible for delivering population based outcomes and the sustainability and development of a workforce with the capability and capacity to deliver this is a key priority for the SY&B LWAB strategy.

Much of this work will be done at ‘place’ to reflect the needs of specific population groups – i.e. clinical pharmacists working in general practice. However to enable local care networks to form and focus on wider delivery models than current general practice requires a step change in capacity and capability at practice level and some economies of scale in order to maximise on the funding streams available, the latter being facilitated through collaboration between the ACS Primary Care and Workforce work streams.

Each CCG is at different stages in workforce baselining and strategy development, this information needs to be brought together to give an ACS view and for the SYB workforce plan to then build on and to maximise on the resources we have in people and funding to support workforce initiatives.

Priority Local Care Networks

Impact Mapping against a development matrix the current provision of ‘at scale’ models of primary care and the strategy for future models at Place. Wider primary care community is incorporated into ‘at scale’ strategies eg. Community Pharmacy and voluntary sector organisations are factored in to place strategies. Consistency in approach to MOUs for neighbourhood working.

Target National: Local Care Networks to be established covering populations of c.30, 000 – 50,000.

Rationale New models will bring together staff across different disciplines into manageable sized teams based on natural geographies, however within CCGs there is variation in degrees of engagement and pace of implementation which should ideally be aligned in order to create a system wide environment that supports the proposed ‘left shift’ and the SYB LWAB strategy. Pump priming investment to develop LCNs during 2018 has been made available to the SYB ACS and a recent review of progress mapped against a development matrix will enable a programme of support and investment to be developed and agreed with our CCGs that will enable each local system to progress toward fully operational

4

networks during 2018/19. A LCN workshop identified a number of initiatives which would significantly enhance progress with development of LCNs, these centred on system level OD resource and understanding and addressing the skills gap in clinical leadership, the Primary Care work stream is working with the national new care models team around an offer of support to developing networks.

3. Recommendations The Collaborative Partnership Board is recommended to approve the above areas as the Primary Care Work stream’s top three priorities..

Primary Care Work Stream

1

1. Increase/Maximise

on Investment in

Primary Care

2. Workforce

Governance and joint

working

3. Local Care

Networks

• Co ordination of learning and best practice across wider Y&H /North

Region

• Map programme development across SYB against new care models

development matrix

• Work with national team on bespoke support package

• Alignment of activities and investment (national/regional/local) to

support SYB workforce (LWAB) proposals

• Promote and grow opportunities for the wider workforce across SYB

working with LPNs and professional bodies

• Facilitate OD across scaled footprints.

•

• Co ordination or consolidation of funding streams for maximum

effectiveness/impact across SYB

• Facilitate collective agreements/proposals for use of new resources

• Mapping of resources utilisation and programme uptake across ACS

footprint

• Primary Care Steering Board membership with link roles to other ACS

work streams

• NHS England Transformation Team support to priority areas

1

Meeting name Governing Body

Meeting date 15 February 2018

Title of paper

Primary Care Commissioning Committee Annual Report


Anthony Fitzgerald, Director of Strategy & Delivery

Author(s) Linda Tully, Lay Member, Chair of Primary Care Commissioning Committee


On 1 April 2016, NHS Doncaster CCG was given delegated responsibility from NHS England for the commissioning of Primary Care medical services. The Primary Care Commissioning Committee makes decisions within the delegated functions in the Terms of Reference that are binding on the CCG and NHS England. Minutes of the Committee are presented to the CCG Governing Body and are available to the Public through the CCG Website; http://www.doncasterccg.nhs.uk/about-us/public-meetings/ This paper summarises progress on the Committee business and work plan and details the management of potential and real conflicts of interest covering the period 31 January 2017 to 1st February 2018.

Recommendation(s) This paper is presented for information and Governing Body are asked to endorse the report prior to submission to NHS England.

Impact analysis

Quality impact The aim of the committee is to improve quality

Equality impact

positive


nil


Nil

Legal implications

nil


Interest

The PCCC approach to managing conflict of interest and a detailed summary over the last 12 months is set out in section 2.2 of the report


Nil

Report previously

presented at N/A

Risk analysis

Assurance Framework

http://www.doncasterccg.nhs.uk/about-us/public-meetings/

2

NHS DONCASTER CCG, PRIMARY CARE COMMISSIONING COMMITTEE

2017/18 Annual Report to Governing Body and NHS England

1. INTRODUCTION On 1 April 2016, NHS Doncaster CCG was given delegated responsibility from NHS England for the commissioning of Primary Care medical services as set out in Schedule 2 and in accordance with section 13Z of the NHS Act. This was enacted through a Delegation Agreement (as a national model) directly between NHS England and the Primary Care Commissioning Committee (the Committee) rather than the Governing Body. The Committee thus makes decisions within the delegated functions set out in the Terms of Reference that are binding on the CCG and NHS England. Minutes of the Committee are presented to the CCG Governing Body and are available on the Public CCG Website. This report is presented for information and summarises the Committee’s work programme from 1st February 2017 to 31st January 2018.

2. GOVERNANCE

2.1 Membership. The Primary Care Commissioning Committee function as the corporate decision-making body responsible for collective decisions on the review, planning and procurement of primary care services in Doncaster, under delegated authority from NHS England. The Committee is appropriately constituted, its terms of reference are regularly at least annually. In 2017 the membership comprised of: Voting Members: Lay Member with responsibility for Primary Care Commissioning (Chair) Lay Member (Vice Chair) Chief Officer Chief Finance Officer Chief of Primary Care (until July 2017) Director of Strategy and Delivery (from Aug 2017) Non-Voting Members: Clinical Leaders x 3 NHS England Representative Healthwatch Representative Doncaster Health and Wellbeing Board Representative Doncaster LMC Representative Formal Attendees: Quality and Patient Safety Committee representative Primary Care Manager Head of Communications

3

2.2 Managing Conflicts of Interest: The role of the committee is to support the CCG to effectively exercise its statutory duties in terms of commissioning Primary Care services. It aims to ensure quality primary care services and reduce inequalities across our localities, whilst considering variation in provision and impact on local services. Underpinning this is a robust management of real or potential conflicts of interest. A conflict of interest can be:

Financial: Where there may be direct financial benefits from the consequences of a commissioning decision.

Non-financial professional: There may be non-financial professional benefit from the consequences of a commissioning decision, (e.g. increasing their professional reputation or status or promoting their professional career)

Non-financial personal: There may be personal benefit not directly linked to a professional career and does not give rise to a direct financial benefit.

Indirect: Close association with an individual who an interest in a commissioning decision as described in any of the categories above.

All declarations of interests made by members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk The Committee takes a robust but proportionate approach to the management of potential or real Conflicts of Interest. It is important to ensure full compliance with statutory guidance whilst avoiding restricting local innovation. In the event of any issue with a conflict of interest, the Committee would call upon the CCG Audit Committee Chair who acts as the conflicts of interest guardian. During the meetings referred to in the report, there has been no exclusions affecting the quorum of the meetings. Full details of actions taken are set out in Appendix 1. 2.3 Committee Effectiveness The Committee is accountable to the Governing Body of the CCG, and operates with the support of two sub groups: The Primary Care Provider Engagement Group, and The Primary Care Management Group. The Committee is the escalation point for both the Priamary Care

Matrix Evaluation Group and the Primary Care Management Group.

The Committee also benefits from a range of internal and external skills within the membership including representation from the CCG’s Quality and Patient Safety Committee, and Engagement and Experience Committee, HealthWatch, Local Medical Committee (LMC) and the Health and Wellbeing Board. The Committee undertook a self-assessment exercise. The scores were largely positive. The lowest scoring areas relate to the clarity of the work between the Committee and other Committees, and the Governing Body. There is also a lower score relating to attention to issues raised by external groups.

A review of the Governance arrangements in place to effectively support delivery of the Primary Care Strategy was undertaken by 360 Assurance Internal Audit and received “significant assurance”. Lessons from both the self-assessment and internal audit review will be the focus of a dedicated development session for Committee members to be held the Spring of 2018.

3. 2017/18 WORK PROGRAMME


4

The list below provides some insight into the Committee work undertaken in 2017/18: 3.1 Finance:

Received and approved the 2017/2018 financial plan and associated budget for Primary Care, including delegated Medical Contracts. Updates have been provided at every meeting.

Considered the strategic approach to the primary care Estate within Doncaster, and agreed outcome for each Estates and Technology Transformation Fund (ETTF) bid, previously known as the National Primary Care Transformation Fund bids

Received and considered reports on the GP Five Year Forward View implementation plan (approved in December 2016).

Considered quarterly reports on the Proactive Co-ordinated Primary Care Service. This was the first pillar on the Primary Care Strategy to be commissioned and started in Practices on 1 October 2016. Forty-two practices have signed up to the service.

Endorsed the Keeping Well Pillar of the Primary Care Strategic Model and approved the payment schedule

Considered reports on the Extended 3-Tiered Primary Care Pillar framework, (operational from April 2017).

Considered and approved the Prescribing Gain Share Enhanced Service.

4.2 Contracting: The Committee Considered the following business cases:

Request Practice Outcome

Practice Mergers

Oakwood Surgery and the Mayflower Medical Practice

Approved

Auckley Surgery and The Village Practice

Approved

Carcroft Doctors group and Princess Medical Centre

Approved

Phoenix Medical Practice and The Flying Scotsman Health Centre

Approved

Temporary List Closures

Thorne Moor practice

Work in progress

Dunsville practice

Approved

Branch Surgery Closure

Ransome Practice closure of their Scawthorpe branch surgery

Recommended formal consultation with NHS England

Procurement Process

Church View Surgery

Approved

Barnburgh Surgery Approved

4.3 Strategy and Commissioning:

Noted the development of Primary Care Doncaster, the single GP provider federation for Doncaster.

Received briefings on the implications of the GMS Contract changes 2017/18

Received and considered Primary Care Quality reports

Noted and guided the development of the Primary Care Matrix Evaluation Report

Considered and notes the Primary Care Delivery Plan Highlight and Exception Report

5

Advised on development and received updates on the progress of the Primary Care Delivery Plan

Considered the planning of regular Doncaster-wide Member Practice engagement events.

Introduced the concept of a GP Resilience Programme and commissioned a heat map to identify potential area across member organisations who might welcome proactively support. Fourteen Practices have received support from the Programme over the last two years.

Received reports on the Sheffield city Region Health Led Employment Trial.

Received and considered the Doncaster GP Patient Survey results

Receive and considered the 360 Assurance Internal Audit review of Governance arrangements in place to effectively support delivery of the Primary Care Strategy.

Received updates for the Urgent and Emergency Treatment Centre.

Received minutes from o Primary Care Provider Engagement Group o Primary Care Management Group o sub groups ACS Primary Care Steering Board minutes

Terms of reference reviewed in February 2017 and July 2017

Discussed and escalated issues brought to the Committee by members e.g. local and national issues with Community Health Partnerships (CHP) and NHS Property Services

Approved the CCG’s approach to implementing the GP Forward view schemes and funding streams including Online Consultations, Extended Access and Care Navigation

Assisted development and approved a local emergency contractor call off framework

Reviewed all Primary Care data and information submissions to NHS England

Assisted the development of business cases that have an impact on Primary Care services e.g. complex wound care services.

4. RECOMMENDATION

Governing Body are asked to endorse the report prior to submission to NHS England. Linda Tully, CCG Lay Member Chair Primary Care Commissioning Committee January 2018

date Chair Person Person

Declaring

Interest

Agenda Item

09.02.17. Linda Tully Dr Seddon Item 6 - National Primary Care Transformation

Fund (Capital

Infrastructure & IT)

09.02.17. Linda Tully Dr Seddon Item 9 – Extended Primary Care Pillar – Tiered

Framework

09.02.17. Linda Tully Dr Eggitt Item 10 – Practice Merger Business Case

proposal .

09.03.17. Linda Tully Dr Seddon Item 7 - National Primary Care Transformation

Fund (Capital Infrastructure & IT)

09.03.17. Linda Tully Dr Seddon Item 10 – Extended Primary Care Pillar – Tiered

Framework

13.04.17. Linda Tully

11.05.17.

08.06.17. Linda Tully Mrs Laura

Sherburn

All Committee Business

08.06.17. Linda Tully All Non-Voting

GP Members

Item 8, Extended Primary Care Pillar

Developments – Complex Wound Care

Enhanced Service

13.07.17. Sarah Wittle




09.11.17. Linda Tully Dr Seddon item 6. Quality,

14.12.17. Linda Tully Dr Seddon 9.1 Carcroft Doctors Group & Princess Medical

Centre Merger


NHS Doncaster CCG Primary Care Commissioning Committee

Interests Declared 2017

Appendix A

Detail of Interest Declared Action

Potential financial interest as a

bidder

Update only. No advantage or direct benefit to be gained. Dr

Seddon remained in the meeting.

Potential financial Interest as

service provider

Update only, No advantage or direct benefit to be gained. Dr


Financial Interest. Named in the

business case as a partner of the

Oakwood Surgery

Agreed that Dr Eggitt leave the room.

Potential financial interest as a

bidder

Update only. Dr Seddon remained in the meeting.

Potential financial Interest as

service provider

Update only, No advantage or direct benefit to be gained. Dr


None declared.

No meeting

Non-financial personal: Mrs

Sherburn is shortly to be seconded

from the CCG to work for Primary

Care Doncaster, a new GP

Federation in Doncaster.

Until she is seconded, Mrs Sherburn will not take part in any

decisions regarding primary care where there could be an

actual or perceived conflict with her future role. the Chair

noted that no decisions of this nature were scheduled on

today’s agenda, and therefore Mrs Sherburn could remain in

the room and participate in the discussions.

Financial Interest as potential

service providers.

No advantage or direct benefit to be gained above any GP

member of Doncaster CCG. Therefore no one was excluded

from the discussion.

None declared.

None declared.

None declared.

None declared.

Financial interest as a serrvcie

provider.

The Committee agreed Dr Seddon could remain present for

the discussion as there no decision to be made.

Indirect interest as Partner of

Carcroft Doctors Group.

The Committee agreed Dr Seddon could remain present for

the discussion as the Committee would merely be looking to

ratify the previous decision.

None declared.

NHS Doncaster CCG Primary Care Commissioning Committee

Interests Declared 2017

1

Primary Care Delivery Group

19 January 2018, 9:30am Board Room, Sovereign House

Present: Carolyn Ogle Primary Care, DCCG (Chair) Kelly Smith Primary Care, DCCG Kayleigh Wastnage Primary Care, DCCG Zara Head Quality, DCCG Adele Spence Finance & Contracting, DCCG Jo Forrestall Strategy & Delivery, DCCG Lee Eddell Primary Care, NHS England Dr Nabeel Alsindi Primary Care, DCCG Claire Burns Procurement, DCCG Genna Miller Finance & Contracting, DCCG Gemma Munce Performance & Intelligence, DCCG Gail Stones Data Quality, DCCG Ben Williams Performance & Intelligence, DCCG Karen Leivers Strategy & Delivery, DCCG Anthony Fitzgerald Strategy & Delivery, DCCG

Action

1. Welcome, Apologies and Conflicts of Interest Carolyn Ogle welcomed all to the Meeting. Apologies were noted from:

Emma Ross, Primary Care, DCCG

Chris Empson, Performance & Information, DCCG

The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: Dr Nabeel Alsindi declared a conflict of interest as a GP in Doncaster, and revisited this under Item 5. Complex Wound Care.

2. Minutes of the last meeting held on 8 December 2017 The minutes were noted as an accurate record. Any actions within were


2

noted as complete or in progress.

3. Matters Arising not on the Agenda Care Navigation Genna agreed to discuss the possibility of carrying the Care Navigation funding forward with Tracy Wyatt but indicated that this was unlikely. SNOMED Update Gail advised the group that the rollout will now be phased from April 2018 across 20 pilot sites; Doncaster is not one of those sites. Quarterly LES Activity Report Nabeel met with Jonathan Briggs and Chris Empson to discuss secondary care data. The CCG are looking into the possibility of using Guru. Care Navigation Dashboard Following a discussion with Ben Williams and the Data Quality Team, Kayleigh advised the group that a mandatory field cannot be added to the electronic template. The Primary Care team will look to raise awareness with Practices. The Care Navigation Dashboard was discussed at the Practice Manager’s Meeting; the group gave positive feedback and requested that the Dashboard is presented at the Meeting regularly. The Dashboard was also discussed at the Primary Care Provider Engagement Group (PEG) where some Practices queried the consent to share data. Gail advised the group upon sign up, Practices gave their consent for the CCG to use their data, but did not give consent to share the data. Outline Business Case for Mexborough New Build Lee shared comments with Carolyn as previously agreed. The Business Case was taken to the Strategic Estates Group; however as Mexborough was not a priority area it was not taken further. The comments were shared with the developer. Information Sharing According to reports from FCMS, using the new template for end of life patients has improved information sharing. Communication & Engagement FCMS have been included on the distribution list and invited to the 1 February 2018 Primary Care Event. MECS Kayleigh advised the group that the meeting took place; a further meeting is scheduled in the coming weeks. Pharmaceutical Needs Assessment As agreed, Carolyn shared the link with members of the group, following last

GM

3

month’s meeting.

4. Primary Care Strategy Strategy Refresh Update The Primary Care Strategy 18/19 presentation was shared with the group ahead of the meeting; Nabeel advised the slides had been presented at Strategy and Delivery Group. Proactive Coordinated Primary Care Was discussed at this month’s Primary Care Commissioning Committee and was shared with the group ahead of the meeting. The Report showed a good amount of interventions this quarter with some Practices undertaking high quality work on a large number of patients, while some other are undertaking much less. Since October 2017, it was agreed that Practices would receive the full £5 per head plus the final £0.45 at 31 March 2017, providing they fully engaged with the reporting process and provide sufficient evidence of their activity. This final payment over the full year was increased to £0.90 per patient from 1 April 2017 to 31 March 2018. Nabeel asked how this might be refreshed given the inequity of service across Doncaster. At the last PEG it was suggested that as the current service works well, the service should not change and that Practices would struggle to increase the work. The group felt that their Practices should be paid in accordance with how much work has been undertaken and that the CCG should take a stronger stance with those Practices that are less engaged. Nabeel asked the group for any thoughts. Anthony explained that all elements of the Primary Care Strategy need to show links into the overall aims for Doncaster. Jo questioned whether Practices could better evidence their coordinated care, with their neighbours, as part of the reporting process. Gail suggested requesting additional data in the reports, such as End of Life Care, Summary Care Records and Patient Online. The group agreed that the reporting and entitlement to full payment needs to be amended. For those Practices that are not engaged and not having an impact, the group agreed that the £0.90 should not be paid and could be used for other work within Primary Care. Nabeel advised the group that a number of Practices are struggling with Workforce and would therefore look to include this. Keeping People Well Nabeel advised the group that since the service began, the activity has been minimal. The budget for this service was £140,000, currently the spend is

4

less than £1,000 to date. The feedback from PEG was that there is a lack of services to refer the patients on to, once they come in. Nabeel advised the group that following discussions with Public Health, it was recommended to focus on self-management. Gail suggested looking into the IT around self-management early on, such as patient apps and Patient Online. A recommendation will be given to the Primary Care Commissioning Committee on 8 February 2018, to suspend in the meantime. Carolyn suggested the service could link into the minor ailments element of Care Navigation. Nabeel asked that any further suggestions or comments on either of the above are given to the Primary Care Team. Extended Primary Care Nabeel shared a list of all the GP Local Enhanced Services (LESs) and highlighted the Glucose Tolerance Test, Hpylori Breath Test and Prostate Cancer Monitoring. Nabeel explained that all 3 of the services are being looked at in depth. Jo suggested looking into the Minor Surgery for Non Registered Patients Service as the cost for this, is potentially higher than it would be in secondary care. Nabeel has requested the costings from Finance as part of the LES review. Pharmacy Local Enhanced Services Nabeel has arranged to meet with the LPC to discuss the Minor Ailments issues. Proactive Coordinated Primary Care Q4 Report The Report was shared as a paper, the group noted the report. 360 Assurance Internal Audit Report The Report was shared as a paper. Carolyn encouraged the group to read the report and highlighted governance, stakeholder engagement and the Primary Care Matrix. Carolyn has arranged to meet with Mike Taylor to discuss Terms of Reference and agreed to add the Primary Care Delivery Group Terms of Reference to the forward planner. Post Meeting Note; Terms of Reference is on the forward planner for April 2018. Risk Stratification (post April 2018) Ben advised the group that the CCG purchased the Sussex Risk Stratification tool, back in 2012. The contract for this expired in November 2017. The team have discussed this with Practice Managers who felt that a tool isn’t necessary as most practices use the frailty index.

NA

CO/KS

5

Ben has arranged to present the feedback to the Executive Committee, along with alternatives, one being that the Performance and Information Team may be able to create a tool, in-house.

5. Contracts / Commissioning / Decisions impacting Primary Care Annual LES Review Nabeel previously highlighted the LES Review earlier in the agenda, under Extended Primary Care. Nabeel asked for any further services for suggestion, Gail advised the group that a neighboring CCG pays their member practices, via a LES, to participate in audits via Survey Monkey. Nabeel advised the group that LES Reviews are undertaken with the appropriate Commissioning Manager. Pharmacy Contracts for 2018/19 Adele advised the group that 2 year contracts were brought in, by NHS England, last year. Adele advised the group that Pharmacy Contracts are up for renewal this year, using the new paperwork. The Standard Contract Quality and Report Requirements were shared as a paper, ahead of the Meeting for information, Adele highlighted national requirements reported locally that can be requested within the template and asked whether the group felt this should be included. Lee agreed to share the Community Pharmacy Assurance Framework (CPAF) information with Adele. Complex Wound Care Update Nabeel Alsindi declared a conflict of interest as a GP in Doncaster; the group agreed that Nabeel could remain present for the discussion. Jo shared the draft business case which had been tabled for the meeting. Zara began discussions by recapping previous issues with the service, which led to the business case. Zara reminded the group that District Nurses are commissioning only for housebound patients and do not have the capacity to take on all wound care cases. The current Treatment Room LES specifies that practices undertake un-complex wound care dressings; however some Practices are picking up complex patients and are not funded to do so. The first step in the process was to standardise the definition of complex and non-complex, for this a baseline was used of what a Community Health Care Assistant would treat. A gap analysis was then undertaken of what District Nurses and Practices could do. From this, a list of complex and non-complex was agreed with system partners including RDaSH, Practice Managers, Practice Nurses and DBTHFT. Jo and Zara talked through the proposal to commission a Tier 2 wound care service with a community setting. The service will cover wounds that have been assessed as being more complex and failed to respond to treatment within Tier 1. The less complex wounds of Tier 1 will be done as part of the

LE

6

existing Treatment Room LES. Any wounds that are more complex than Tier 2 will be referred into Tier 3, Specialist Tissue Viability Nurses. The group talked through the costings within the business case. Nabeel queried the potential activity and asked whether this might be low, due to the numbers of issues and questions raised about the previous service. Jo advised the group that following discussions, with Practice Nurses, the activity feels correct. Claire advised the group that a Prior Indication Notice (PIN) will be published prior to procurement. The business case will be discussed at the Executive Committee. Gail highlighted the importance of looking into the referral process early on, as allowing the service to go live before a referral process is put in place, results in interim arrangements being put in place which causes difficulties. Jo agreed and explained that electronic referrals are being looked at. Anthony suggested flow charts of the proposed model accompany the business case for the Executive Committee.

6. GPFV Implementation Workforce Update Nabeel and Carolyn recently met with NHS England, Health Education England and Primary Care Doncaster to discuss the ongoing work around workforce. Primary Care Doncaster are undertaking data collection around workforce and reported that they have currently received 25 of the 43 collections back. Nabeel advised the group that the data from the collection belongs to Primary Care Doncaster and is not for sharing with the CCG. Nabeel advised the group that Workforce will be discussed at the 1 February 2018 Primary Care Event. Primary Care Doncaster has been piloting a workforce tool and would encourage Practices to use APEX. GP Extended Access Emma Ross and Healthwatch have released an Extended Access Survey, the survey results were shared as a paper, ahead of the meeting, Nabeel will discuss this at the February Primary Care Delivery Group.

NA

7. Infrastructure (Estates / Technology / Finance) Online Consultation Guidance Carolyn advised the group of letter which was sent to CCG in December 2017, as a result of this, the CCG are required to declare what cohort Doncaster would be. Carolyn advised the group that both Doncaster and Rotherham will be in cohort 3.

7

Estates Following a meeting with LIFT in Hull, a brief was pulled together for Doncaster’s Estates Strategy. Hayley Tingle has sanctioned the strategy and agreed funding and support.

8. Prescribing & Medicines Management Carolyn advised the group that the post of Head of Medicines Management has not yet been appointed to.

9. Quality Primary Care Matrix Evaluation Group (PCMEG) Update Zara shared the outcomes for one of the listed Practices that were initially identified via PCMEG as has having variance on Cytology, to their neighbouring Practice. Following facilitated discussions between the Practices, the Practice has reported increasing their cytology by approximately 30%. Gemma advised the group that PCMEGs end of year evaluation would be presented to the group and the Primary Care Commissioning Committee in April/May 2018. PCMEG are currently focussed on referrals, e-Referral Service (e-RS) and Consultant Connect and have identified a number of Practices. Zara is in the process of arranging to visits those Practices to begin discussions. As part of the PCMEG action plan, the group are looking at variations between Practices that are in the process of merging, Kayleigh will be discussing this with the Practices. Concerns had been raised informally, with the Primary Care team around a Practice, PCMEG have looked at the data for that Practice which is not concerning. Zara is visiting the practice for a supportive and preventative discussion. The group noted the action plan, which had been shared ahead of the meeting. Primary Care Heatmap Gemma shared drafts of the Primary Care Heatmap, which had been tabled. The drafts presented the data in different format; the group agreed the data sorted by post code was the most appropriate. The group suggested that the areas are shaded in red, amber and green for internal CCG use. Anthony asked whether the data has been cross checked and whether it meets the brief, Gemma confirmed that it has and it does work. Gemma advised the group that the Performance and Intelligence team are working with DMBC to access the mapping software to plot the data on a map of Doncaster.

8

The group were unsure if the draft fully meets the brief and noted that some data points are missing, including housing. The group also questioned whether change in status can be easily tracked. Gemma agreed to feed the comments back to Chris Empson. Palliative Care QOF Registers As part of the assurance framework for 2018/2019, new indicators have been added. Chris is looking to like this with PCMEG as a further quality measure.

GM

10. Communication & Engagement February 2018 Doncaster Wide Primary Care Event Agenda Paper shared ahead of the meeting, for information. Locality Consultation Update Paper shared ahead of the meeting, for information. Practice Visit Engagement Programme Evaluation Paper shared ahead of the meeting, for information.

11. Wider Primary Care It was noted that an eye care workshop had been held the previous week and had been very useful in identifying the priorities to be taken forward.

12. Primary Care Delivery Plan Karen advised the group that the second wave of Clinical Thresholds go live on 1 February 2018.

13. ACS Update Due to time constraints there was nothing urgent to discuss.

14. Primary Care Commissioning Committee Due to time constraints this item was not discussed but members of the Group could access the agenda and minutes via the internet. 11 January 2018 Feedback Nothing urgent to discuss. 8 February 2018 Agenda Nothing urgent to discuss. Items for escalation Nothing urgent to discuss.

15. Any Other Business No further business.

9

16. Date and Time of Next Meeting

9.30am – 11.30am Friday 16 February 2018 Board Room, Sovereign House

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Primary Care Provider Engagement Group Wednesday 10th January 2018 Board Room, Sovereign House

1pm – 3pm

Present: Dr Nabeel Alsindi DCCG Sue Bushell Carcroft Doctors Group Amy Calder Carcroft Doctors Group Stuart Hollingworth The Lakeside Practice Amanda Perry The Mayflower Medical Practice Julie Dodd Tickhill & Colliery Surgery Angela Dean The Edlington Practice Dr Davinder Singh The Scott Practice Rose Fells The Scott Practice Alison Maw Kingthorne Group Practice Chris Jones West End Clinic Nick Hunter LPC

Action 1. Welcome, Introductions and Apologies

Nabeel welcomed all to the meeting and introductions were made and apologies noted.

2. Notes and Actions from Last Meeting The notes were agreed as a true and accurate record of the meeting.

3. Care Navigation There was a general feeling that care navigation to the four live services was working well. There are still issues for some practices with navigating into the community pharmacy/the Minor Ailments Scheme with some patients being bounced back to the practice particularly when the usual pharmacist is away and the locum is unaware of what the pharmacy is signed up to. Nick Hunter has helped when he’s been made aware of these issues so encouraged practices to let him or the Primary Care Team know the specifics. There was a wider discussion about the Minor Ailments Scheme and the restrictions in it; it has previously been reviewed by the CCG and the decision made not to expand it. Nabeel agreed to meet with the LPC to look again at the Minor Ailments Scheme as well as ways of improving care navigation between practices and pharmacies. The care navigation dashboard was reviewed. There was a discussion about the source and reliability of the data with some feeling that it didn’t reflect what was taking place. Practices had different ways of recording care navigation, with it working well when the template popped up when a receptionist opened the patient record. It was also acknowledged that this was the first iteration of the dashboard and if there are the same issues when it has been refreshed then it will be worth bringing back for a further

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discussion. The Group also reviewed the longlist of potential Phase 2 services that had been generated at the initial workshops. It was felt to be premature to be moving onto Phase 2 when there remained two Phase 1 services (Physiotherapy and Minor Eye Condition Service) that were still being developed. Alongside this many of the services on the longlist seemed inappropriate or already self-referral (with practices being variable in whether they were aware of this), it would be better for a separate piece of work to be done to clearly communicate which of these services are self-referral, and bring a list of potential Phase 2 services which could be opened up and appropriate for care navigation.

4. Primary Care Strategy & Access Update Nabeel went through the slides on the Primary Care Strategy for 2018/19 with a discussion around the options. Key points of the discussion were:

Very challenging for the practices who are delivering a high quality Proactive Coordinated service to do more within the £5 per patient. Increased value for money for the CCG from the investment should be through strengthened Key Performance Indicators and addressing those practices who don’t appear to be delivering what they should

Uncertainty is a big problem for those practices who are employing additional staff to deliver services and need to have greater notice in the future if there is a risk of the service or funding changing

To commission something different for Keeping Well rather than make changes to the current service. This could address a gap in services available to be referred into, particularly weight management

Nabeel will feed in the views of the Group into the decision paper going to Primary Care Commissioning Committee on 8th Feb and make sure the decisions are communicated to practices as soon as made. February’s Provider Engagement Group will look at how to implement any changes.

NA

5. 360 Assurance – Primary Care Strategy The Group briefly discussed the report focussing on engagement. There was a feeling that this could be done more efficiently as there is often duplication between the different forums and each meeting is time out of practice for clinicians and non-clinicians. This is exacerbated by those with the ability to make decisions often not being at the meetings, resulting in the same topics coming up without being addressed. Nabeel accepted that these were very reasonable points and would be taken into account when responding to the recommendations in the report.

6. 2018 Meeting Dates It was noted that the next Provider Engagement Group was scheduled at 9am and many people would not be able to make this Post-meeting note: This has been changed to 12-2pm as below

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7. Date & time of next meeting: Thursday 22nd February 12-2pm, Boardroom, Sovereign House This meeting will definitely go ahead as per item 4



Title of paper

Primary Care Strategy 2018/19


Anthony Fitzgerald, Director of Strategy and Delivery Dr Nabeel Alsindi, Clinical Lead for Primary Care & LTC

Author(s) Dr Nabeel Alsindi, Clinical Lead for Primary Care & LTC


Doncaster’s Primary Care Strategic Model began to be formally implemented with the commencement of the Proactive Co-ordinated Primary Care service in October 2016. During 2017/18 there has been a first attempt at commissioning a service through the Keeping (People) Well pillar and the channelling of non-recurrent transformation funding and various GP Forward View funds to support Responsive Primary Care in a number of ways. The paper outlines the progress and made in 2017/18 and outlines the reasons for the recommended approach to be taken with each pillar in 2018/19. These are based on engagement and discussions in a number of internal and external forums including the Primary Care Delivery Group, the Primary Care Provider Engagement Group and previous Committee meetings.

Recommendation(s)

Primary Care Commissioning Committee members are asked to: - Note and feedback on the contents - Discuss and approve the recommendations to the Proactive Co-ordinated Primary Care service from 1st April 2018 - Approve the non-renewal of the Keeping Well service after 31st March 2018 and agree the next steps - Discuss the recommended options in Responsive Primary Care

Impact analysis

Quality impact

Positive – recommended changes to the Proactive Co-ordinated Primary Care Service will help evidence the quality provided

Equality impact

Positive – acting on inequalities is one of the core requirements of improved access to General Practice


Positive – through workforce development and maintaining additional investment into Primary Care


Neutral – maintenance of existing investment and deployment of additional resources via the GP Forward View with limited evidence

of impact on savings elsewhere in the system

Legal implications

Procurement of additional capacity to meet access requirements


Conflicts of interest with GP and LMC members of the Committee. Each member has completed a conflicts of interest form.

Consultation /



stakeholder &

public/patient)

Primary Care Delivery Group Strategy & Organisational Development Forum

Primary Care Provider Engagement Group Primary Care Commissioning Committee

Patient survey supported by Healthwatch around improved access to General Practice

Report previously

presented at n/a

Risk analysis

As per the financial implications with, as detailed in the paper, limited evidence at this stage on how effective this investment is

Assurance Framework

2.3, 3.3, 4.2

Primary Care Strategy for 2018/19 The CCG’s Primary Care Strategic Model was developed in June 2016 on the back of the previous Primary Care Strategic Framework and the publication of the GP Forward View. Although aspects were already in place, e.g. Local Enhanced Services and Transforming Primary Care (the precursor to the Proactive Co-ordinated Primary Care pillar), implementation started with the commencement of the Proactive Co-ordinated Primary Care service in October 2016 and approval of the new Extended Primary Care Framework. During 2017/18 there has been a first attempt at commissioning a service through the Keeping (People) Well pillar, channelling of non-recurrent transformation funding and various GP Forward View funds to support Responsive Primary Care in a number of ways, and attempts to improve what is offered through Extended Primary Care. The Proactive Co-ordinated Primary Care and Keeping Well services are due to be renewed ahead of 1st April 2018, whilst changes to the various LES’s are usually made ahead at the same time with any required notice. .

Figure 1: The 4 pillars of the Primary Care Strategic Model

Proactive Co-ordinated Primary Care Service

Investment Approximately £1.8 million annually, representing a potential £5.90 per patient registered to a Doncaster practice, excluding those at one practice

Progress in 2017/18 42 out of 43 practices have signed up to and continued to deliver this service to at least 2% of their frail/complicated patients. Practices have been given the freedom to identify their patients and deliver the service in the way that they feel best meets their population’s needs. They are required to complete a quarterly report to evidence service delivery and receive an additional end of year payment for appropriately engaging with the process, alongside the £5 per patient payment through the year. In the first 6 months of the year (the deadline for receiving reports for the October to December period has only just passed), the number of patients on a register for this service has increased to 6717 and these patients have had 5740 new care plans or care plan reviews. 28% of these patients now have a DNACPR in place and 43% have consented to share their enriched Summary Care Record. There are a number of factors that make it challenging to assess the impact of the interventions delivered through this service at this stage based on the returns from the practices:

o The frailty of patients on the register naturally means that there are a number of deaths, and therefore changes to the makeup of the register at each practice, each quarter. This can positively or negatively impact outcomes such as A&E attendances or unplanned admissions independently of the interventions in place

o There aren’t baseline figures for this patient population prior to the start of this service in October 2016. The reports covering the period October to December 2017 will provide the first opportunity to compare outcomes with the same period in a previous year rather than through the year where there is considerable natural variation

o Practices have taken different approaches to patient identification and the way they are delivering interventions, apart from the group of 7 practices in the South West Locality, which means that conclusions are either drawn on a small number of interventions at a practice level or a large number with much inter-practice variation

o Inconsistencies in the reporting between practices with some questions potentially being open to interpretation

The service specification highlighted the tracking of a number of system wide indicators at a CCG level as another way of gauging the impact of the service. Figure 2 demonstrates how these indicators have changed since October 2016 and permit comparison with the previous period of between 6 and 18 months. It has to be acknowledged that this data can’t be broken down into a population group that aligns to how practices have generated their registers; whilst there will be overlap, only a proportion of the patients included will have had interventions through this service whilst a number of patients covered by the service may not be included. The patients covered by this service will also have been affected by other newly commissioned or improved services outside of General Practice, for example the commencement and ongoing expansion of the Rapid Response Service and wider Intermediate Care work around reducing unnecessary hospital attendances and admissions.

Figure 2a shows a fairly consistent level of all A&E attendances for over 65s since this iteration of the service went live in October 2016. Data from December onwards is awaited and will clarify whether October 2017 was an anomaly or the start of an improvement. Figure 2b demonstrates a very encouraging reduction in the number of emergency admissions in over 65s with Ambulatory Care Sensitive Conditions, something that both this service and a number of other services commissioned by the CCG would be expected to positively impact. A similar pattern is seen in Figure 2c with regards to re-admissions within 90 days of discharge, with post-discharge reviews being part of the interventions carried out by practices. Delayed transfers of care, Figure 2d, is harder to interpret given the significant change around July 2016, and has a less direct relationship with this service; however this has improved in the last 12 months compared to the preceding year.

Figure 2a: A&E attendances in patients over the age of 65

Figure 2b: Emergency admissions in patients over the age of 65 with Ambulatory Care Sensitive Conditions

Figure 2c: Re-admissions within 30 days of discharge in patients over the age of 65

Figure 2d: Delayed transfers of care for patients of any age

Discussion and recommendations for 2018/19 This service is the largest additional investment from the CCG into General Practice and, unlike in some other CCGs, has remained ring-fenced for General Practice since the initial investment into Transforming Primary Care began in 2014. The £5 payment for each patient on the total practice list per year has remained unchanged in this time, although the service requirements have been more defined since this iteration began in October 2016. An additional payment of £0.90 per patient is available at the end of the year for fully engaging with the reporting process. As highlighted in the previous service updates to the Committee, there is considerable variation in the activity reported by practices on a quarterly basis as well as the detail in the responses to the qualitative questions. There is also no formal process for assurance on the quality of the interventions, for example the quality of the care plans and what constitutes a care plan review. The feedback from the Provider Engagement Group was clear that for those practices who feel they are

providing a high quality service, which includes employing external staff or putting on additional sessions from their existing staff, it is already challenging enough to meet the demands of the current service specification with the existing resource. They felt that the focus for 2018/19 should be on strengthening and more rigorously enforcing the Key Performance Indicators to reduce the variation in the level of the service being provided between practices. This approach , and how to effectively implement it, was discussed at the latest Primary Care Delivery Group, along with other ways of making sure this investment is appropriately supporting other CCG requirements or priority areas. At January’s Committee, alongside the need to evidence the quality of the services being provided, it was queried whether we can evidence value for money for this considerable investment. At this stage there isn’t sufficient information available at an individual practice level or across the whole system to support or refute this. Alongside this, changes in the commissioner and provider landscape over the coming year may also provide an opportunity to commission a related service in a more integrated way for 2019/20. The recommendation for 2018/19 is to fundamentally continue the service commissioned for 2018/19 but with the following changes to give the best chance of being able to evidence the quality and value of the investment, as well freeing up some financial resource to support other CCG priorities with General Practice or Primary Care:

1. No change to the £5 per patient payment to meet the revised service specification for at least 2% of the practice’s (or group of practices) frail, complex or vulnerable patients. However the separate payment for engaging with the reporting process will be stopped and instead this will be an essential requirement of continuing to receive the main £5 per patient payment

2. Revise the Key Performance Indicators and Quarterly Report forms to reflect learning since the service went live in October 2016 and input received across a number of forums. This will include more on end of life care as well as requiring practices to also focus on a portion of their patients who have been on their register for over 12 months and reviewing their progress over that time

3. Add in a requirement for practices to engage with a visit from either a member of the Primary Care or Quality team (or another appropriate member of the CCG) to meet with those involved in delivering the service, attend an MDT meeting or care home ward round, look at a number of care plans etc

4. Agree an option with practices who are struggling to fully meet the service requirements for at least 2% of their patients, where they can receive a smaller pro-rata payment to focus on a smaller population

5. The revised service to have a commitment until 31st March 2019 with an initial decision about the plans beyond this date to be made in October 2018, this will give practices sufficient notice to deal with any staffing implications in the event of a significant change to the commissioning approach

Keeping (People) Well Service This new service began in May 2017 and focuses on practices delivering lifestyle interventions on patients under the age of 40 without long term conditions who had

multiple risk factors for developing various long term conditions or ill health. For a number of reasons the service specification has not generated meaningful activity, with only 24 claims so far for the initial consultation and 1 claim for the 6 month follow up so far, spread across 7 practices. Addressing the concerns correctly raised by practices around the searches/reports issued by the CCG - by allowing practices to identify the patients meeting the criteria through their own searches since November - has not had a noticeable effect on the rate of claims suggesting there are more fundamental issues with the way the service has been commissioned. Other reasons for why the Keeping Well service has failed to build momentum have been discussed extensively with the Provider Engagement Group and at the Primary Care Delivery Group. This is a difficult patient group to engage with as they are of working age and don’t have frequent contact with the healthcare system, an exception being women attending for contraception reviews. Effective engagement, where this may be possible, may require considerable time and effort from practices for what amounts to a small cohort of patients on an individual practice basis, with no upfront funding or payment if the patient doesn’t end up attending. As information about risk factors is not collected routinely, this information may not be recorded or out of date for those with the biggest need. Practices have also commented on reductions in some of the services commissioned that patients can be referred or signposted into to support the lifestyle interventions.

Recommendation for 2018/19 Whilst changes to the criteria and funding could stimulate more activity for this service, the recommendation following discussions in the above groups and with Public Health colleagues is to not commission a revised version of the existing service. It is felt that the resource would be better utilised:

o Supporting self-management and measuring/analysing patient activation o Commissioning an additional preventative service

It is proposed to work with Public Health on potential options over the next couple of months with there likely being an interval between the current service finishing at the end of March and a new agreed approach being put in place. Responsive Primary Care

Progress in 2017/18 There isn’t a formal service specification for Responsive Primary Care. The £3 per head non-recurrent funding received as part of the GP Forward View for practice transformational support was fully devolved to establish and be deployed by a new GP federation which has all 43 practices as member shareholders. Primary Care Doncaster is now a legal entity, limited by shares, with an elected board made up of GPs and practice managers along with a Chief Executive and Business Manager. During its first new months, the federation has launched the local version of the NHS England Releasing Time For Care Programme, with 25 practices signing up for the resulting Practice Collaborating Workshops which will focus on the High Impact Areas identified by practices as local priorities. There will be 6 workshops taking

place between March and September 2018. There is also a 2 day Improving Leadership – Fundamentals Course being held in Doncaster over January and February with 43 individuals having signed up for this following the launch. Workforce and workload are key enablers for this aspect of the Primary Care Strategy, with responsibilities and ability to impact these sitting across a number of organisations. A number of practices piloted a workforce tool with NHS England now looking to roll out an improved version across the patch. Primary Care Doncaster have started undertaking their own workforce analysis and are currently in discussions with the CCG about how this could be supported and lead to a local workforce strategy and subsequent workplan; this should link in with the workforce plans across the Accountable Care System. One of the early outcomes of this workforce analysis is a bid to the NHS England Clinical Pharmacist in General Practice scheme, which is awaiting a response. The federation is also supporting practices interested in recruiting Physicians Associates. Workload support from the CCG has focussed on the investment of the GP Forward View funds for care navigation into the upskilling of reception staff into care navigators. 4 of the 6 “phase 1” care navigation services have gone live, with more work needed on the remaining two, physiotherapy and minor eye care services, before they are also available. There has also been training provided for managing medical correspondence and practice manager training. 8 practices have also completed the Productive General Practice programme through NHS England, taking an in-depth look across pathways at an individual practice, leading to improvements in working with pharmacies, reducing avoidable appointments, managing medical correspondence, team planning and role development.

Plans for 2018/19 The CCG will continue to work with individual practices, Primary Care Doncaster, the Accountable Care System and other relevant partners to make sure that the continuing (e.g. care navigation) and new (e.g. online consultations) resources deployed through the GP Forward View are made the most of. Workforce, which has an intrinsic link to workload, is an area of focus for the coming year as many local and regional plans are predicated on doing more for patients out of hospital and the capacity for this is a limiting factor. A baseline workforce analysis, preferably one that is detailed enough to make predictions on the likely position a number of years down the line, is essential to inform the workforce strategy, whether the strategy is developed and led by the CCG, Primary Care Doncaster and/or the regional workforce group. The CCG is also required to commission improved access to General Practice, with 100% coverage by a revised deadline of October 2018. This is to be achieved through a payment of £3.34 per patient to the CCG in 2018/19 and then the full funding of £6 per patient from 2019/20. This is to provide additional same day and routine consultation capacity, meeting the core requirements in Figure 3. A period of market engagement has just begun in order to gauge the interest amongst providers and inform the procurement process with provider meetings timetabled for mid-March. A patient survey, supported by Healthwatch, was completed in late 2017 and

will feed into the service specification – we are awaiting clarification on whether there will be a national framework for this specification.

Figure 3: The core requirements for improving access to General Practice

To support the principles of the Responsive Primary Care pillar it is recommended that, alongside the GP Forward View and improved access requirements and opportunities, the CCG drives practice engagement with the development of the workforce strategy, starting with completion of the Primary Care Doncaster workforce analysis and the rollout and use of the revised workforce tool from NHS England. This could be done by:

o Paying practices to take part in these and other related pieces of work around workforce using some of the £0.90 per patient released from the Proactive Co-ordinated Primary Care Service

o Paying practices to take part in a programme of work around workforce and other agreed priority areas for the CCG where further progress is needed (e.g. Patient Online, electronic repeat dispensing, e-Referral Service, specific clinical audits or areas to focus on) using the £0.90 per patient released from the Proactive Co-ordinated Primary Care Service

o Building in a requirement for this into either receiving the funding for the Proactive Co-ordinated Primary Care service or being able to deliver Local Enhanced Services

Extended Primary Care The classification of the existing General Practice Local Enhanced Services into Tiers 1, 2 and 3 has taken place. All practices have signed up to the Tier 1 Group LES which means there is now a minimum level of additional services that a patient

can expect to have provided in their practice, or in a small number of exceptions at another practice. The new Tier 2 LES’s for non-registered patients, approved in principle at a previous Committee, have not been rolled out due to concerns over the potential financial impact if the expected increased activity in Primary Care can’t be resourced by taking activity out of the contract with the acute trust. There is work going on with the Performance & Intelligence and Finance teams to progress this. The individual existing LES’s, including those also commissioned from Pharmacies and Optometrists, are being checked with input from the appropriate commissioning and clinical leads to make sure they reflect current practice or changes in the wider system since they were reviewed last year. It is not intended to routinely bring these changes to Committee but an update will be provided on the progress made with the Tier 2 LES’s in March if it is unlikely to be in place for 1st April.



Title of paper

GP Forward View Update


Anthony Fitzgerald, Chief of Strategy and Delivery

Author(s) Carolyn Ogle, Associate Director Primary Care


To provide the quarterly update to the Primary Care Commissioning Committee on the implementation of the GP Forward View further to the report presented in November 2017

Recommendation(s)

Primary Care Commissioning Committee members are asked to: - Note the contents of the enclosed paper - Advise on any further action to be taken by the Primary Care Team

Impact analysis

Quality impact

Quality will be monitored through the Primary Care Quality Strategy and Quality Dashboard. The aim of the GPFV plan is to increase quality of general practice across the board.

Equality impact

EIAs will be done as part of the service specifications and other work-up


The aim is to invest in primary care to sustain services into the future


As per the paper

Legal implications

Procurement regulations will be complied with as services are commissioned


Will be preserved through the PCCC’s Constitution

Consultation, Engagement

(internal depts,

clinical, stakeholder

public/patient

An ongoing process for each of the workstreams

Report previously

presented at

Previous update presented to November Primary Care Commissioning Committee

Risk analysis

As per paper

Assurance Framework

1.2, 2.3

GP Forward View Update

Introduction The General Practice Forward View published in April 2016 commits to an extra £2.4billion per year to support general practice services by 2020/21. This paper serves to provide an update of progress made/activities having taken place since the last update in November 2017. 1. Workforce – expand and support GPs and wider primary care staffing

1.1 International Recruitment There is a further opportunity to put forward proposals for an international recruitment scheme as an ACS footprint. The deadline for bids is 28 February 2018. The recruitment, development and support for international recruits is now all funded centrally and therefore the ACS bid will focus on retention and integration into the local community. As a first step all five CCGs are seeking clarification from their practices with vacancies to see whether or not they would be committed to recruiting an overseas doctor. In Doncaster we have contacted those practices advertising for GP vacancies through the LMC newsletter, although notification has gone to all practices. At the time of writing one practice had responded positively to this commitment. An update will be provided at the meeting as the deadline for responses is 2nd February 2018. 1.2 Workforce Hub The South Yorkshire and Bassetlaw Primary Care Workforce Group is putting forward a proposal for the primary care element of the anticipated ACS Workforce Hub which builds on the advanced training practice scheme, providing an expanded team who will be place based and support CCG place plans with identified experts in the various new emerging roles. The team would provide support for Federations, CCGs and the ACS. The Hub would be developed in partnership with Health Education England and be co-located with the South Yorkshire Excellence Centre and the Faculty of Advanced Practice.

The recruitment of an expanded team will ensure there is a clinical expert for each place to work with Federations, CCGs and practice networks around workforce need. A co-ordinator for each place to skill up practice teams and work closely with practice managers including signposting practices to available resources. Due to the vastly different sizes of places there will be a rationalisation of the resource to ensure appropriateness and that the larger places receive enough support. A three year costed proposal is going to the ACS Primary Care Steering Board for consideration and support. It is understood that funding has been found for

the first year of the proposal but that additional funding will need to be found from each place for subsequent years.

1.3 Workforce Survey

Primary Care Doncaster is continuing its efforts to undertake a workforce survey to gather data from all practices to establish a baseline position. To date 25 practices have submitted a return and further staffing resource is being sought to facilitate this work which will inform the development of a workforce strategy. 1.4 Practice Manager Development The General Practice Development Programme team have allocated monies to support the development of practice managers at a local level through initiatives for hard to reach areas, to support training practice manager appraisers and to support mentoring and coaching. The funding has been received by NHS England at a Yorkshire & Humber level and is broken down for South Yorkshire and Bassetlaw as follows:

Support in hard to reach areas

£40,881 27.35% of total list size

Support coaching and mentoring

£14,254 27.35% of total list size

Local allocation to LMCs £32,316 Each LMC receives £6,463.27 regardless of size

To pro rata this allocation further would mean each CCG would receive a small allocation. It was planned to discuss the use of this funding across the ACS footprint for economies of scale, however this has proved difficult to organise and therefore discussions are ongoing about the best use of this funding for each place. 1.5 Care Navigation Care navigation is now established and discussions have been held at Provider Engagement Group about the next steps. It was felt that it was important to conclude wave 1 which would mean that physio services and minor eye care services were introduced prior to a second wave of services being launched. However in the meantime a list of services will be compiled jointly with Primary Care Doncaster which will identify those services which will fit the care navigation model. Issues have been raised about the minor ailments service not working effectively and therefore it has been suggested that further training and development work with local pharmacies should take place. 1.6 Clinical Pharmacist Programme 2 bids have been put forward for the Clinical Pharmacist Programme, one from Kingthorne, Frances Street and St Vincents as a joint bid and one from Primary Care Doncaster. The outcome of the panel decision is awaited.

2. Workload

2.1 Managing demand 25 Practices have signed up for the Learning in Action - Practice Collaborative Workshops. (the fundamentals courses). The high impact areas that will be focused on are Active Signposting, Develop the Team, Productive Workflow and Self-Care. Primary Care Doncaster continues to support practices to engage with these programmes. 2.2 Building practice resilience

All practices put forward for funding are engaging except one which is being followed up in early February 2018. A further £20,000 has been identified from slippage funding for use in Doncaster and this is being directed by the CCG to those areas of high need for sustainability support including practice mergers, preventing list closures and supporting contractor changes.

2.3 Workload Tool The two companies currently commissioned to provide workforce/workload tools have agreed to collaborate. NHS England has offered to fully fund licenses and additional support to ensure maximum value from the system for 2018/19. The ACS Primary Care Board strongly encourages the involvement of all practices in order that a case can be put together for funding 2019/2020, as this will provide economies of scale and value for money.

3 Practice Infrastructure

3.1 GP Wifi The five CCGs across South Yorkshire & Bassetlaw have agreed to take a collective approach to the implementation of GP Wifi. A full procurement process supported by the Crown Commercial Service was undertaken prior to Christmas with the conclusion that a preferred bidder was not identified. Further conversations have been taking place with commercial suppliers with the expectation that a preferred supplier will be identified imminently.

3.2 Online consultation system

CCGs are being encouraged to work through the ACS to agree a high level approach to online consultation to support effective alignment with plans for 111 online. The ultimate ambition is that an integrated digital experience is supported that supports patients to access appropriate services based on their needs. Allocations are identified by CCG, however as the guidance came out quite late in the financial year those CCGs that are already well advanced in their planning are going first. The online consultation systems are being rolled out in cohorts as follows with Doncaster aiming for cohort three:

Cohort 1 Invested CCGs Already spent and can demonstrate that they meet the specification

Cohort 1 Early adopters Ready to spend in 17/18

Cohort 2 Adopters Expected to procure before Sept 18

Cohort 3 Follower CCGs Expected to procure before March 19 (deadline for applications is 7 September 18)

Cohort 4 Remainder CCGs Expected to procure early 20

3.3 Estates Work is commencing on the development of a primary care estates strategy.

Those ETTF schemes which were put on hold due to the lack of a strategy but which meet the criteria for business as usual capital funding have been put forward for consideration.

The GPFV committed to providing financial support for every GP practice that is

a tenant in an NHS Property Services or Community Health Partnerships building to enter into a new lease. This scheme now runs to the end of March 2018 and includes:

Reimbursement of stamp duty land tax for the initial term (up to 15 years)

Contributing up to a £1,000 plus VAT of legal fees related to the lease transaction

Reimbursement of management fees for 2016/17 and 2017/18

4 Care Redesign

4.1 Extended access The deadline for the roll out of extended access to 100% of the population is now expected to be 1 October 2018. The key deliverables which will be outlined in the planning guidance will be timings, capacity and advertising with potentially a longer time frame to deliver the remaining core requirements. A Prior Information Notice (PIN) was published on Friday 26 January 2018 to gauge market interest in the procurement of extended access in Doncaster. Meetings will be held with interested parties during March 2018 to help inform the final model which will be commissioned via an APMS contract. The contract will run from October 2018 to September 2020 after which it will be reviewed.

1



Title of paper

Dunsville Medical Centre List Closure Application Extension


Anthony Fitzgerald, Director of Strategy and Delivery, DCCG

Author(s) Kayleigh Wastnage, Primary Care Manager, DCCG


Background: In April 2017 the Primary Care Commissioning Committee (the Committee) approved Dunsville Medical Centre’s (the Practice) Application to Close Practice List of Patients for a 12 month period. This 12 month period is due to end. The Practice has submitted an Application to Extend a Closure Period which is appended to this paper for consideration by the Committee (Appendix A). NHS England’s List Closure Extension Policy: NHS England’s List Closure Policy requires the Practice to submit an application no less than eight weeks before the closure period is due to end and the application must include:

Details of the options the Practice has considered, rejected or implemented in an attempt to relieve the difficulties encountered during the closure period or which may be encountered when the closure period expires

The period of time when the contractor wishes its list of patients to remain closed (not more than an additional 12 months)

Details of any reasonable support that the Practice considers would enable its list of patients to re-open or would enable the proposed extension of the closure period to be minimised

Details of any plans the contractor may have to alleviate the difficulties mentioned in the application to extend the closure period so the list of patients can reopen at the end of the proposed extension of the closure period without such difficulties

Any other information the contractor considers ought to be drawn to the attention of the commissioner.

The commissioner must acknowledge receipt of the application within seven days, then if necessary, discuss potential support that could be offered to the Practice, discuss with an affected LMC and consult other affected parties, before reaching a decision on the application to extend within 14 days from receipt of the application.

2

If the decision is to accept the application the commissioner must issue an extended closure notice as soon as possible after the decision is reached. If the decision is to reject the application then the commissioner must provide the Practice with a notification including the reasons for rejection and at the same time send a copy of the notification to the LMC and to any other person consulted in the decision making process. The Practice may re-open its list before the closure period expires if the commissioner and the Practice agree. Dunsville Medical Centre Dunsville Medical Centre is a PMS practice situated in the North East locality of Doncaster. The Practice reduced from 3 GP partners to 2 GP partners in 2016, 1 of these partners is on long term sickness and has been since October 2016. The Practice has been unable to recruit another GP in the last 12 months. Over the past 12 months the practice has seen a decrease in their patient list by 115 patients, as detailed below:

April 2017 5,311

July 2017 5,250

October 2017 5,156

The practice has an annual turnover of patients of 2.07% (CCG mean is 6.9%). Other Points for Consideration

The Practices deprivation score is IMD 22 (CCG mean is 30.21). (high number = more deprived)

The Practice received a ‘Good’ CQC rating in August 2016

The Practice has 19.30% of its registered list signed up to patient online services which is an increase from April 2017.

GP Patient Survey shows 89.24% of patients have a good experience when using the practice.

GP Matrix Evaluation Report indicates the Practice is ranked: The Practice has improved its ranking in the Use of Same Day Health Centre and Use of Out of Hours and has dropped ranking in the A&E Attendances and GP Referrals (DBHFT) domains.

Rank Domain Comments

25/43 Use of SDHC Low number shows lowest use

20/43 Use of OOH Low number shows lowest use

18/43 List Size Movement over 5 years

Low number is lowest % movement

3

33/43 List Size Movement over 1 year

Low number is lowest % movement

19/43 High Risk Patients - Very High

Low number is lowest amount of patient movement

20/43 High Risk Patients - High Risk

Low number is lowest amount of patient movement

19/43 A&E Attendances Low number is low A&E Attendances

36/43 GP Referrals (DBHFT) Low number is low amount of referrals

36/43 Outpatient Usage Low number is lowest discharge at first attendances

The Practice is in an area that is undergoing local development. Approximately 3,500 dwellings are to be erected over the next 20 years on land that spans from Dunsville to Hatfield. This is the Unity site.

The Practice submitted a bid to the ETTF in June 2016 for renovation to their building and conversion of the loft space to office and training space. This would allow for the existing 1st floor to be reconfigured providing space for a lift, reconfiguration of consulting rooms and dedicated space for training and education with student trainees and staff. The Practice withdrew this application in February 2017 as the practice did not have the capacity or resource to complete the paperwork and extensive work up of the project plan that was required.

As part of the List Closure Application Process a set of standard questions are used by NHS England to help inform the decision. These questions, including the practice response and comments by NHS England are detailed below for consideration.

Question Response NHSE Comment

Is the Practice open Thursday afternoons

Yes – opening hours are 8am – 6pm Monday - Friday

In line with expectation

Is the Practice open 8am – 6:30pm Monday to Friday

No, Practice is open until 6pm

In line with the rest of Doncaster

Has the Practice reviewed the list outside their outer boundary

Yes, numbers are not significant

Practice indicated this at meeting on 13 March 2017 with NHSE and CCG

Has the Practice considered boundary changes

The Practice does not feel that this is appropriate or would aid the situation

Are clinical sessions maximised i.e. are GP’s working 9 sessions

GP sessions are: Partner Dr Mohan 10 Salaried Dr Nawaz 2 Locum Dr Chowdray 1-2 Locum Dr Jones 3 Locum Dr Paul 2

Dr Mohan = 1wte Locum cover = 1wte Salaried GP = 2.75wte

Are there nursing No.

4

capacity issues, if so what contingencies have been put in place

Are there GP capacity issues if so what contingencies have been put in place

Yes, the Practice has gone from 3 partners to 2 with 1 on long term sick. The Practice has been unable to recruit

Locums are in place as detailed above

Has the practice reviewed the provision of nursing/skill mix

Yes and considered other skills within the Practice

Is the PPG supportive, what is the evidence of support, has the practice considered wider consultation of patients

The PPG members in attendance are supportive of the application.

Is the locality supportive, is there any evidence of support

Dr Mohan informed those in attendance at locality meeting that the Practice will be formally applying to extended the list closure. No comments were made by attendees.

A letter to the LMC and locality/neighbouring practices has been sent by NHS England to give opportunity for comments. – comments from those who replied are below.

Has there been a recent spike in list size

No, the list has been closed and the practice has seen a decrease in patient list size as detailed above.

Does the Practice undertake telephone triage

Yes.

Is the Practice delivering extended hours DES

No

Has the Practice signed up to the CCG basket of enhanced services

Yes. Practice is signed up to all Tier 1 services. Practice is not signed up to deliver any Tier 2 services except ring pessary fit for registered patients.

Practice has indicated that it will still register new care home patients – this will allow the continued performance of the Proactive Coordinated Care specification

Within the Practice area there are 8 other GP practices, 4 of which are within a 2 mile radiance of Dunsville Medical Centre:

Hatfield Health Centre, Hatfield (1.2m)

Kingthorne Group Practice branch site, Kirk Sandall (1.8m)

St Vincent Medical Practice, Hollybush branch site, Edenthorpe (1.9m)

5

Field Road Surgery, Barnby Dun branch site (2.0m)

The Village Practice, Armthorpe (2.9m)

White House Farm Medical Practice, Armthorpe (2.9m)

Thorne Moor Medical Practice, Thorne (5.4m)

Northfield Surgery, Thorne (5.4m) All 8 practices and the LMC have been offered the chance to express comments or views. Responses have been received from Dr Andrew Oakford, GP, Field Road Surgery and the LMC and are below for consideration: Dr Andrew Oakford, GP, Field Road Surgery: ‘Having considered the circumstances relevant to Dunsville at present, I would be in favour of allowing the extension of list closure’ Doncaster LMC: ‘…we support the extension of the list closure for Dunsville on the ground that there has been little change to their circumstances to alleviate the pressure that they are under. We continue to have serious concerns about the knock on consequences to other practices in this locality and advocate engagement with them as soon as possible to develop a bespoke strategy.’ Formal Application Form The completed Application to Close Practice List of Patients attached at Appendix A for consideration together with the above information. The application form provides more detail on:

The reasons for why the Practice wishes to close its list

The options that the Practice has already considered

The detailed outcome of neighbouring practice and patient consultation

Suggested support the Practice feels would enable the list of patients to remain open or the period of proposed closure to be minimised

Practice plans to alleviate their current situational difficulties

Recommendation(s)

6

The Primary Care Commissioning Committee members are asked to:

Consider the detail in the Executive Summary together with the Application to Extended a Closure Period.

Make a decision whether to approve or reject the application

Make a decision whether to approve or reject the request to continue to register Care Home/Nursing Home patients during the Closed List Period if approved.

Impact analysis

Quality impact If the decision is made to reject the list closure there is potential for a negative impact on the quality of services provided as detailed in the

application form.

Equality impact

There will be no impact as the practice will not be discriminative when refusing registration.


If the decision is made to reject the list closure there is potential for a negative impact on the sustainability of the practice as detailed in the

application form.


There financial implication to the CCG is neutral. The financial implication to the Practice is neutral.

Legal implications

By closing the practices list it may leave the practice open to legal challenge from patients refused registration.


Interest

The partners at the practice have completed declarations of interest forms.

Dr Mohan is the practice lead for the CCG North East Locality meeting. This is noted on his declaration of interest form.




NHS England and DCCG have been consulted and met with the practice on the 13th March 2017.

The attendees at March’s North East Locality Meeting have been informed of the application.

Report previously

presented at Original List Closure Application came to PCCC in April 2017

Risk analysis

All risks to the Practice and CCG have been set out in the Executive Summary and the appended application form. Risk of setting a precedent

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across the SYB footprint if approved.

Assurance Framework

1.2, 1.3, 1.4, 2.1, 2.3, 2.4, 6.2

Appendix A - Application to Extend a Closure Period

Activity By Whom

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

18th 25th 1st 8th 15th 22nd 29th 5th 12th 19th 26th 5th 12th 19th 26th 2nd 9th 16th 23rd 30th 7th 14th 21st 28th

Planning & Process

Weekly Task and Finish Group Meetings Kayleigh

Update Primary Care Commissioning Committee Anthony/Carolyn

Develop Project Plan Kayleigh

Develop Communication & Engagement Plan Kayleigh

Instruct HealthWatch Doncaster Carolyn 23rd

Develop comms materials as detailed in Plan Ian, Carolyn, Kayleigh

Meet with Practice and advise of Project & Comms Plan Anthony/Carolyn

Support to practice staff & contractor on close down HealthWatch, Carolyn

Inform BSA of close down Carolyn, Kayleigh

Inform IT of close down Carolyn, Kayleigh

Arrange collection of IT equipment Kayleigh, Wendy Lawrence

Inform utilitiy companies of close down Dr Wagstaff

Reconcile final payments from CCG & NHSECarolyn, Genna Miller,

Hayley Tingle

Procurement process

Advert Published Claire Burns 12th

ITT Published Claire Burns 12th

ITT Clarification Question Deadline Claire Burns 2nd

ITT Closing date Claire Burns 9th

ITT Opening and Initial Review Claire Burns

Individual Evaluation Claire Burns 16th

Clarification questions to providers Claire Burns

Clarification Interviews Claire Burns

Consolidation and Moderation Meeting Claire Burns 20th

Recommended and Reserve Bidder identified Claire Burns 21st

Approval of Recommendation Claire Burns 21st

Standstill Period Claire Burns 21st

Debrief Unsuccessful Bidders Claire Burns 5th

Award Claire Burns 5th

CONTRACT

Contract Clarification discussions Claire Burns / Caroyln Ogle tbc

Contract Signature Claire Burns / Carolyn Ogle tbc

Contract Award Notice (OJEU & Supply2health)(48 Days) Claire Burns / Carolyn Ogle

MOBILISATION AND IMPLEMENTATION - 3 MONTHS

Mobilisation Claire Burns / Carolyn Ogle tbc

Contract Commencement Claire Burns / Carolyn Ogle 10th

Stakeholders

Meeting with Dr Wagstaff Carolyn / Anthony / Ian 25th

Inform MP's Jackie Letter Meet

Inform Councillors Jackie Letter Meet

Inform Public Health Carolyn, Anthony Letter

Inform DMBC Carolyn, Anthony Letter

Inform Parish Council Jackie, David, Anthony, Ian, Letter 26th 14th

Share comms plan with DMBC Carolyn, Anthony

CCG engage with Barnsley & Rotherham CCG Carolyn, Anthony

CCG engage with all neighbouring Practices Carolyn, Anthony letter

CCG engage with all neighbouring Local Authorities Carolyn, Anthony

Inform all 3rd Party stakeholders e.g. LMC, DBTH, LPC, RDASH Carolyn, Anthony

CCG ascertain what capacity neighbouring Practices have and what

service offer by Practice isCarolyn, Kayleigh

Evaluation of Stakeholder responsesCarolyn, Kayleigh,

HealthWatch, Ian

Overview and Scrutiny Committee Consideration Jackie, HealthWatch, Carolyn

Patients & Public

Week

Procurement and list dispersal in parallelDecember January February March April May

Practice Staff Engagement by Contractor Dr Wagstaff

Meet with PPG Ian, HealthWatch, Dr

Develop patient and public questionnaire Rachel Mather

Arrange Public and Patient meeting Ian, HealthWatch, Dr TBC

Questionnaire sent to registered patients HealthWatch, Ian, Carolyn

Alternative arrangements for feedback for patients & stakeholders unable

to complete questionnaireHealthWatch, Ian, Carolyn

Develop Press release / statement Ian, Dr Wagstaff

Press release issued Ian

Evaluation of Public and Patient feedback Ian, HealthWatch, Carolyn

Overview and Scrutiny Committee Consideration Jackie, HealthWatch, Carolyn

Implement recommendations / actions from OVS Committee Ian, HealthWatch, Carolyn

PCSE Deadline for Patient Letter as need 6 week lead in time Carolyn, Kayleigh, PCSE 26th

Patient letter to all registered patients with details of other GP Practices Carolyn, PCSE

Ensure all patients have re-registered or declared intention not to register

elsehwereCarolyn, PCSE

Key To action

complete

important

Chair: Dr David Crichton Chief Officer: Mrs Jackie Pederson

Sovereign House Heavens Walk

Doncaster DN4 5HZ

Tel: 01302 566300

Fax: 01302 566321 Website: www.doncasterccg.nhs.uk

31 January 2018 Dear Mrs Fleur Firth List Closure Application Further to our previous correspondence regarding the application to close patient list received from Thorne Moor Medical Practice I can confirm that the members of the Primary Care Commissioning Committee (the Committee) have considered your application. The Committee have considered all the issues set out in the application and feel that they were unable to make a decision due further information being required. Therefore the Committee decision is not to close your patient list at this point in time. The Committee understands that the main issues the practice face are with workforce, space utilisation within the existing premises and an increase in patient demand both in physical volume due to the economic and housing growth in the area and the complexity of care required. The NHS England list closure policy encourages the Clinical Commissioning Group (CCG) to support and enable the Practice to keep its list of patients open. As you will be aware we are working with our system partners to find solutions for the issues you have raised and are proposing that we work with you over the coming months with allocated dedicated CCG managerial resource to resolve these where possible. The Committee will then reconsider your application at the Committee meeting in March 2018. This will allow for further work to be agreed and for any patient engagement to be undertaken if change to premises are required. I am sorry that this is not the response you had hoped for but please be assured that the CCG is committed to understanding your issues in detail and supporting your practice to reach a practical solution and we look forward to engaging with you over the coming weeks. A member of the Primary Care Team will contact you shortly to discuss the action plan for the Practice and the CCG. Kind regards Linda Tully Lay Member and Chair of Primary Care Commissioning Committee


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Meeting date 8 February 2018

Title of paper

Doncaster Primary Care Estates Strategy


Hayley Tingle, Chief Finance Officer

Author(s) Carolyn Ogle, Associate Director for Primary Care


At the December meeting of the Primary Care Commissioning Committee in confidential session it was agreed that an estates strategy for primary care was needed in order that Doncaster did not miss out on potential funding opportunities through the ACS Premises workstream and other funding sources. A meeting was held with Dan Simmons of Citycare Developments Ltd who is working with CHP strategy team and a draft brief of a primary care estates strategy agreed with Barnsley and Rotherham CCGs was shared. For economies of scale the work will apply to each of the CCG areas but the output will be a report split into the CCG specific areas. The brief is detailed below:

1 Analysis of Six Facet Surveys Review the survey information by CCG and cross reference with existing data to see if significant changes to any of the six facets influence priorities or actions and to understand potential for expansion to support population change

2a Understanding/linking Commissioning Strategies

Working with CHP/NHS England / CCG a review meeting with each CCG to consider the impact of any service review and commissioning plans and their impact on current Asset base.

2b Review STP/SEP priorities to ensure best fit with the SEP priorities to use existing core estate and improvement proposals

3a Mapping CCG localities Create Asset maps for CCG/Locality areas that will give a visual picture to be supported by action plans

3b Create draft CCG/Locality action plans

4a CCG Action Planning Identify key issues from mapping

4b Draft action plans for discussion/consideration by CCGs and partners.

4c Consider draft plans and seek comment/sign off.

5a Primary Care Estate Strategy Document

Produce an area wide Primary Care Estate strategy document that provides a visual plan at the three at levels (area, CCG, and Locality) which is underpinned with recommendations and actions across a 5 year period.

Under item 3 the mapping of neighbourhoods is to be included in order that the scope for Local Care Networks to develop their own thinking around estates issues is highlighted. The need for housing development and growth to feed into the

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strategy and its recommendations has also been requested. The estimated costs for this work have yet to be finalised however Dan Simmons has been invited to the March meeting of the Primary Care Commissioning Committee to give an update.

.

Recommendation(s)

The Committee is asked to note the development of a primary care estates strategy brief.

Impact analysis

Quality impact

The six facet surveys look at the impact on the quality of the primary care estate and the impact on patient care

Equality impact

Not applicable


Increasing sustainability is one of the key priorities for the estates strategy


The cost of the development of the strategy is not yet known but there will be economies of scale due to working with two other

CCGs.

Legal implications

None known


Conflicts of interest with GP and LMC members of the Committee. Each member has completed a conflicts of interest form.

Consultation /



stakeholder &

public/patient)

Stakeholder engagement will form part of the strategy

Report previously

presented at Not applicable

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Risk analysis

None identified

Assurance Framework

1.1,1.2,1.3,1.4, 4.1,4.2,4.3, 6.2

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