Primary Care Committee Wednesday 28 June 2pm 3.30pm ... · Janine to discuss these points with...

Primary Care Committee Wednesday 28 June

2pm – 3.30pm Sherwood Board Room 1

A G E N D A

Item Lead Enc. Time

1. Welcome & Apologies Chair 2pm

2. Declaration of Interests Chair

3. Minutes of Previous Meeting held on 10 May 2017 Chair PCC17/01 2.05pm

4. Matters Arising Chair

Strategic

5. MKGP Federation update Diane McKerracher PCC17/02 2.10pm

6.

Delegation Staffing Resources Outstanding Issues/Clarifications Constitution

Alexia Stenning /Janine Welham

2.30pm

7. GPFV

Project Plan

Alexia Stenning PCC17/03 2.40pm

8. PMS Monies - Year 3 opportunities Janine Welham PCC17/04 2.50pm

Operational

9. Primary Care Contract & Procurement Update

Broughton Gate/Brooklands Development Neath Hill

Janine Welham PCC17/05 3pm

10. Delegated Finances Edna Muraya PCC17/06 3.05pm

Any Other Business

11. All 3.25pm

Date of next meeting

12. Wednesday 19 July, 2.30pm – 4.30pm, Sherwood Boardroom 1

Primary Care Committee Minutes 10th

May 2017 Page 1 of 5 V1.0 NHS Classifed

PRIMARY CARE COMMITTEE Wednesday 10 May 2017

Sherwood Place, Board Room 1

Minutes

Present Will Perks WP Lay Board Member, MK CCG (Chair) Richard Alsop RA Director of Programme Delivery, MK CCG Matthew Webb MW Chief Officer, MK CCG David Foord DF Director of Quality and Governance, MK CCG Alan Hancock AH Healthwatch Representative Dr Nicola Smith NS GP Chair, MK CCG Janine Welham JWe Primary Care Development Manager, MK CCG Alexia Stenning AS Assistant Director – Primary & Community Services, MK CCG Edna Muraya EM Senior Finance Manager, MK CCG Dr Paul Roblin PR Chief Executive Officer - Berkshire, Buckinghamshire and Oxfordshire

Local Medical Committee (BBOLMC) Andrew Morton AM Chief Finance Officer, MK CCG Kayley O’Sullivan KO’S Team Administrator - Primary Care Development Team, MK CCG

(Minutes) Apologies: Mike Rowlands MR Lay Board Member, MK CCG Nessan Carson NC Board Member, MK CCG Hopeson Alifoe HA Board Member, MK CCG Action

1. Welcome and Apologies

As above

2. Declaration of Interest

Nicola Smith – GP Paul Roblin – GP and LMC Rep

3. Minutes of the previous meeting held on 22 February 2017

Agreed as accurate

4. Matters Arising

Amend title to risk Terms of Reference wording regarding the virtual decision needs to be amended

5. Delegation

On the 1st April the CCG became fully delegated. A task and finish group was formed in January with fortnightly meetings to ensure that the CCG were fully prepared. A Memorandum of Understanding has been received from NHSE regarding the staffing structure and support, there will be four members of staff that will be assigned across the STP however Bedfordshire and Luton are not currently delegated and are still under joint commissioning arrangements. This week we were informed one member of staff will work at Milton Keynes one day a week. Alexia Stenning has sent an email raising concerns and that there needs to be consistency with the member of staff that will be allocated.

PCC17/01



Alexia to liaise with colleagues from Bedfordshire CCG and Luton CCG to discuss skills across the STP once everyone is fully delegated. Alexia to keep the committee updated. Janine Welham went to NHSE last Friday to discuss Calculating Quality Reporting Service (CQRS) and expectations on both sides of roles and responsibilities. There has been a high turnover of staff so there was query to whether the MOU covers vacancies/performance etc? The CCG has been informed that if there is a vacancy then it will be filled by NHSE like for like. Quality Transition Funding has been received from Primary Care Safeguarding. The Quality team have absorbed NHSE tasks. Primary Care are working closely with Quality. Outstanding Issues/Clarifications Finance are working through the rent reviews with Matt James (NHSE) as they will be back dated. The CCG is still awaiting an action plan for when the outstanding reviews will be completed from NHSE. Constitution The draft document has been circulated to practices. The final version has been to the Commissioning Delivery Group and needs to be circulated to practices to be signed. There is a lot of operational communication with practices and there are a number of things on the horizon since the CCG has taken on delegated commissioning. There will be a brief update at the next meeting which is being held in June.

AS AS/JWe

6. General Practice Forward View

Feedback was received from NHSE in a rag rating format. The CCG rating was green/amber overall. Access was amber/red, it was felt the plan was acknowledged but should be pushed further. The investment section was praised at the Q4 assurance meeting and has been recommended to other practices as a good example. The plan was worked on within the STP and a local one was also completed. There will be regular check points and reporting on this plan. A work plan has been developed from the General Practice Forward View to be delivered over the next year and then 2-3 years. There are 66 schemes some of which have been duplicated. Currently the Primary Care Team are performance managing this along with the committee. An exception report will be brought back to the committee for monitoring. The report needs to be scaled down and linked with other teams that can support with a view to blur the boundary between primary and secondary care. Alexia is working with comms to produce an easy read version for the GPs. Alison Joyner (Head of Strategy) is currently reviewing the document. The document is to be brought back to the committee prior to wider circulation.

JWe AS

7. Primary Care Contract and Procurement Update

Broughton Gate and Brooklands The Practice Group were successful bidders for the APMS contract and are now working with Milton Keynes Council on the new premises development. A construction team will be on site from the 24th July. The APMS contract is a five year contract and Key Performance indicators are currently being developed.

PCC17/01



Broughton Gate current site is a leased temporary building which the CCG will be responsible for removal off site once the new build is completed. Neath Hill Procurement The caretakers have been extended for three months up to the 30th June, whilst the second procurement is undertaken. The evaluation and moderation stage has been completed and a preferred bidder has been identified. There will be more details provided at the next meeting. Mobilisation is going to take place from the 1st June. The service specification and finance where readjusted for the 2nd procurement. NHSE informed the CCG that a branch surgery was not an option due to the type of contract. Timelines needs to be looked at for the White House procurement and this will allow a change in the service specification and new build development. There will be a forward plan discussion regarding the White House at a future primary care committee meeting.

8. Long-Acting Reversible Contraceptives (LARC)

Practices across Milton Keynes are currently delivering a locally commissioned service for contraceptive implants and intrauterine contraceptive devices (IUCDs) for reducing unintended pregnancies. Through the commissioned service practices are paid £90 per fitting of IUCDs. Milton Keynes Public Health have carried out an audit with our member practices from January – September and as a result identified that 106 IUCDs had been fitted for symptom control rather than for contraceptive reasons, this is an exclusion under the current service. If practices are not financially rewarded for this work then they could refer this activity into secondary care. As a result of this out of specification activity Public Health are looking to be reimbursed to the amount of £9,540 and have advised practices that they will not fund any future claims for symptom control. Practices currently deliver this service at a loss and if unfunded this activity could move into secondary care which would attract an outpatient attendance or through the gynaecology primary care outpatient clinic. It has been requested that the CCG funds and reimburses the activity for symptom control. The committee agreed the funding from 1st April 2017 for all symptom control activity. However the reimbursement on activity already carried out should come out of the budget already transferred to Public Health upon devolution of the PCT. Janine to discuss these points with Public Health.

JWe

9. PMS Monies

All 13 PMS practices agreed to move to GMS contracts with transitional funding in April 16. Following a workshop held with practices and the LMC it was agreed that funding for year 2 reinvestment would be used for phlebotomy service, wound dressings over 10 minutes and ulcer dressings. Currently Milton Keynes is one of the few CCG’s who do not pay practices for phlebotomy services. For year two the amount is £472,045 which equates to approximately £1.64 per patient based on January 2017 registered list size. Janine has capped the activity based on the data collection exercise which was undertaken in year one to ensure that the budget is not exceeded. Janine informed

PCC17/01



the committee that there will be quarterly returns and practices will be monitored closely in order that practices do not exceed the capping. There needs to be a consideration of equality of access for patients at all practices for phlebotomy, wound dressings and the majority of ulcer dressings. To be noted that there is a commissioning gap due to out of hours ulcer dressing at Urgent Care Service. Year three money could suggest funding around this gap and an opportunity for the federation. Janet Corbett has written a paper for a tissue viability nurse at a care home and there was a suggestion to whether nurses in primary care could be upskilled. The committee agreed and ratified. A list is to be complied with the opportunities in which could be available for the federation.

AS/JWe

10. Training and Development for Primary Care

The GPFV will provide £45 million extra funding nationally over five years so that every practice in the country can help their reception and clerical staff play a greater role in care navigation, signposting patients and handling clinical paperwork to free up GP time allowing the majority of clinical correspondence to be managed through trained staff. Four companies have presented their training packages for both clinical admin and signposting training at the CCG. Practice Managers attended all the presentations to ensure that the training offered would assist their practices. Following feedback from Practice Managers and the CCG Primary Care Team Insight Solutions will be commissioned to deliver the clinical admin training on a one to one basis with each practice to meet the needs of the individual practices. We are still currently scoping out training for signposting. Matt Webb or Andrew Morton to clarify the money and sign it off. The practice manager programme will commence on the 15th May with 34 practice managers and deputies already signed up to the development training. Emma Jacobs from Walnut Tree Health Centre is assisting in the production of the programme to ensure it is fit for purpose and at the right level. It will be led by a GP from Oxfordshire. Alex Friend is leading on the E-Consultation project across the STP. He currently scoping and an options paper will be going to the STP information sharing group. There is funding currently for three years which has been ring fenced. Alex is engaged with Health Watch. A practice in Bedfordshire is involved in a three month trial and will feedback to the group. Janine is currently waiting for NHSE to release the final service specification to ensure that we commission the correct services. E-consultation could be more advantageous for working patients; it could possibly be linked to the GP Access Fund. There will need to be a procurement undertaken and once procured it will be advertised to the public.

MW/AM

11. Any Other Business – Primary Care Budget

Following delegation the CCG have now received the full primary care budget. A paper has been presented at the Finance Committee, Joint Committee and Board for due diligence. Outstanding risks remain on rent reviews, premises and CQC costs. Finance update to be presented at the next meeting.

WR/EM

PCC17/01



12. Date of Next Meeting

Wednesday 28 June, 2pm – 4pm, Sherwood Board room 1

PCC17/01

Milton Keynes General Practice (Ltd) Federation Update to Primary Care Committee 28 June 2017 Background Milton Keynes General Practices came together in 2016 to form one General Practice voice for Milton Keynes General Practices involving the three historic General Practice organisations:

Milton Keynes General Practice Support Services Ltd (MKGPSS) founded in 1996 Roundabout Healthcare Ltd (Roundabout) founded in 2014 General Practice Access Fund (GPAF) Collaboration founded in 2015

Therefore, the New Milton Keynes General Practice Federation was formed in May 2017. This alliance led by Board members from each original board, developed a vision, strategy and organisational form for the new Federation which would facilitate the transformation into one single organisation. The current MKGP Federation Interim board still has members from the original alliance in order to continue building its foundation during this transformation period and until such time a permanent Federation Board is elected by its members. The vision of the Federation is to enable a sustainable, strong, effective General Practice in Milton Keynes delivering high quality, seamless services responsive to local needs. This in turn will solidify the heart of Primary care and the NHS. Progress on milestones

1. Election Process - The Federation election is underway for permanent business partner directors, the chair and lead practice manager. This process is due to report on 31st July.

2. Business plan – This is in the final stage of development having considered current and future income streams and development opportunities. This has generated an organisational structure which we believe will provide the right balance of both clinical and business support to the federation.

3. Corporate governance – the practices and processes by which the company is directed and controlled are currently being developed to ensure shareholder (and stakeholder) have confidence in the new business. We currently have an Interim Management team in place.

4. GPAF bid – the assurances required are in hand and we anticipate satisfying all identified points by bid submission on 30 June. This will mean the federation is in an acceptable position to receive the contract.

Business Continuity

1. Current service contracts - Taking ownership of and ongoing delivery of Roundabout service contracts,

2. Building membership – Current membership is 20 practices. We are approaching non-member practices to join and two new members are in the process of sign-up whilst a further 2 are considering the proposal which will take us to full complement (less caretaker practices).

3. Engagement - a federation information pack has been issued and ongoing newsletters and presentations are being delivered both centrally and at individual practices. We will engage all stakeholders to ensure our vision is delivered through joined up, seamless services with a significant emphasis on patient engagement and support to self-care.

Next Steps

1. Business Development - opportunities and funding streams being identified. Supporting local service redevelopment including BLMKSTP to ensure General Practice/Primary Care is represented.

2. GPFV & CCG identified opportunities – develop operational plans to secure these. 3. Engagement – building new and strengthening current relationships with member practices

to ensure work of the federation is maximised going forward. 4. Leadership development – the Federation will set up a leadership programme of clinical

and non-clinical networks which will develop leaders in every level of General Practice to support each network to innovate and work together (internally and externally) to achieve our vision.

PCC17/02

GP Forward View Delivery Workplan Date of last update: 21/06/2017

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GPFV – Improving access

Scheme 1

Michael Ramsden - Head of Programme Delivery: Planned Care &

Long Term Conditions

Hema Sutton - Planned Care Programme Lead

Review all current service specifications for community outpatient clinics to ensure

fit for purpose and value for money

End June 2017

u




Scope future opportunities for the commissioning of further community outpatient

clinics

End Q4

u

Michael Ramsden -Head of Programme Delivery: Planned Care &



Interrogate secondary care data to identify specialities with high numbers of

referrals

End Q4

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Work with primary and secondary care clinicians to model appropriate pathways for

patients

End Q4

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Take any potential business case through appropriate CCG governance processes for

agreement

End Q4

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Procure service End Q4

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Ensure regular contract review meetings with successful provider, ensuring

innovation and continual service improvement is carried out as appropriate.

End Q4 onwards

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Scheme 2

Primary Care Home -

Newport Pagnell Medical

Centre

The Ten High Impact Actions -

Partnership working

x The STP have agreed a standardised approach to care co-ordination (Primary Care Home). Luton Clinical

Commissioning Group (LCCG) is currently a rapid test site for this, and is supported by the National Association of

Primary Care (NAPC), who have helped develop the concept as a future core delivery mechanism for health and social

care services in the NHS. The key elements of Primary Care Home (PCH) are central to the design of the Multispecialty

Community Provider (MCP) model referenced in the Five Year Forward View.

• Creating integrated teams from primary and acute care, community services and social care, with a range of skills to

deliver services when and where the patients need them.

• A unified budget for the collective team, to avoid perverse incentives created by different funding flows.

• Focus on a population of 30,000 to 50,000 people, which experience has shown is large enough to create a

sustainable organisation while retaining local knowledge.

• A focus on prevention and maintaining wellbeing as well as caring for the ill.

Newport Pagnell Medical Centre:

Caroline Rollings - Business Partner

Dr Omotayo Kufeji - GP Partner

Alexia Stenning - Deputy Director of Programme Delivery & Head of

Primary Care, MKCCG

Maria Wogan - Director of Strategy and Planning, MKCCG

The provision of optimal out of hospital services and the delivery of more services

closer to home

This project is currently being scoped by the GP practice hence the details/actions

and milestones are not know at this time

This project is currently being scoped by

the GP practice hence the details/actions

and milestones are not know at this time

Currently working with NAPC

to deliver this model to the

registered population under

the wave 2 national pilot

scheme

Scheme 3

Place Based Care x

Scheme 3

Invitation to tender ITT published 21/12/2016

Deadline for submissions 23/01/2017

Evaluation period 24/01/17- 17/02/17

Preferred bidder announced 27/02/2017

Contract award 11/03/2017

Service commencement 01/04/2017 u

Monthly monitoring Ongoing through contract period

Ongoing innovation

Monthly board meetings

Scheme 4

Presentation booked with GP's and Practice Staff for feedback 14/02/2017

Scoping work

To appoint provider subject to presentation and clinical input 01/02/2017

Contract award 01/04/2017 u

Roll out across practices on a phased implementation basis 01/04/2017 u

Training for practices

Monitoring of usage and feedback Throughout 17/18

u

Scheme 5

Commencement of service 03/01/2017

continuous monitoring and promotion of the service until 31/03/2017

Scoping and decision to commission long term 01/03/2017

Scheme 6

1. Service Commenced - December 16 1. December 16

Constant monitoring for usage December - March 17

Reported fortnightly to NHSE December - March 17

Evaluation - March 17 Evaluation - March 17

Scheme 7

GPAF currently being

caretakered by MKUCS with

monthly performance

meetings. This arrangement is

in place until October 2017.

Working with MKGP Plus to

ensure governance and

processes are in place from

October 2017 for the delivery

of the GPAF as detailed within

the bid.

Scoping exercise completed

with 5 providers, working

through the information

sharing project team for the

STP. In the progress of

acquired up to date

procurement advice on an STP

wide e-consultation model of

provision. Awaiting national

service specification from

NHSE to inform of the required

criteria.

The service commenced from

December to end of March

through additional RTT

monies, sporadically used by

practices and decision taken

not to recommission currently.

This is dependant upon the

UECC model currently being

proposed

Schemes

Ten High Impact Actions

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Through funding in the Improving Access to General Practice we have commissioned a GP within A&E for patients who

attend A&E with a primary care need to be seen and educated in attending Primary Care

Alex Friend - Primary Care Co-Ordinator, Primary Care Support

MKCCG

Janine Welham - Primary Care Development Manager

Adoption and design of technology to increase access to a healthcare professional, looking at different models to

deliver e-consultation for our practice population.

Helps patients gain better access to instant medical care and advice while empowering GPs to run their practice.

E- consultation promotes the following:-

Determine the best course of action

Make consultation times quicker

Work more efficiently

Give patients better access

Capture critical illness quicker

Improving Access to General

Practice Plan -GP In A&E


Partnership working

x Steve Gutteridge - Urgent Care


Primary Care


MKCCG

Through funding in the Improving Access to General Practice we have commissioned additional wound care clinics

from MK Urgent Care Service Monday - Friday for practices to refer their patients into, frees up valuable nurse time, in

order for them to be able to see their minor illness patients and their long term conditions clinics capacity. Working at

scale across practices to provide extended access collectively.


Primary Care, MKCCG



Primary Care

Q2 Q3

Action / milestone Milestone delivery dateAction owner (organisation)Key deliverables

E-Consultation

Workload

Investment

Infrastructure

The Ten High Impact Actions-

New consultation Types,

Reduce DNA's, Support Self

Care, Develop QI Expertise

xxx

Q4

2017 2018

Q1

Primary Care Outpatient

Clinics and Community

Clinics


Partnership Working

x MK CCG's vision for planned care is to have a safer, more predictable and reliable planned health care system,

providing a consistent quality of service that will support the delivery of more services close to patient’s homes, and

ensure that they are getting the right treatment for their condition, by the most appropriate healthcare professional.

We have transferred appropriate activity out of the acute setting into Primary Care Outpatient Clinics (PCOCs).

We need to commission a greater proportion of activity in community and home settings to support the required

rebalancing of the health economy away from local acute services. This is necessary to support acute provider

sustainability and to ensure that services are delivered in the best location. However, this is not simply a strategy to

support a rebalancing of resources within the NHS – the CCG is also looking to understand where other care providers

can offer support to the population at least as effectively as statutory providers. MKCCG needs to find efficiency gains

from diverting 2ndary care activity to Primary care and by developing pathways that offer an alternative to

traditional hospital care.

GP Access Fund

Investment


Partnership Working, Reduce

DNA's, Productive work flows

The GPAF MK (formerly know as the Prime Ministers Challenge Fund) was part of the second wave of 37 schemes

announced in 2015. It delivers a GP led service for the registered population of MK, primarily delivered outside of core

primary care working hours. The service model had been developed in partnership with hub practices and

incorporates: Working at scale across practices to provide extended access collectively.

1. Primary Care Based: the service is embedded within routine GP services

2. Access at the point of contact: patients are offered and can book appointments through their own practice.

3. Choice: patients are offered choice of daytime, evening or weekend appointments.

x x x

x

xImproving Access to General

Practice Plan -Wound Care

clinics


Partnership working

PCC17/03

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Q4

2017 2018

Q1

First additional clinic date 24/12/2016

Second additional clinic date 31/12/2016

Evaluation of additional capacity

Evaluation of utilisation and need over Xmas/holiday period 01/01/2017

Scheme 8

1. Outline business case to be approved by MKC 1. January 2018 u

2. Meetings with architects 2. Autumn - January 2018 u u

3. Planning applications 3. Spring 2018 u

3. Land transfer 3. Spring 2018 u

4. Building work to commence 4. TBA

5. Building ready for occupation 5. Autumn 2019

6. Procurement for provider services 6. Process to start January 2019

7. New provider to commence services from April 17 and will move into the new

build upon completion

Scheme 9

1. Business case Submitted to ETTF 1. June 2016

2. Unsuccessful through ETTF due to lack of funding and oversubscribed scheme 2. November 2016

3. Working with Apollo and Gallagher Estates to find site 3. December 2016

4. Monthly meetings with Practice and Apollo to discuss progress of scheme 4. Throughout 2017/18u

5. Outline Business case to be approved by the CCG 5. Summer 2017 u u

6. District Valuer to be assess 6. Summer 2017 u u

7. Planning permission application 7. Autumn 2017 u u

8. Site to be completed subject to planning permission of local housing estate by

2019/20

8. 2019/20

Scheme 10

Business case discussed at Co-Commissioning Committee and support in principle

for utilisation of S106 monies for extension

Sep/Oct 16

Letter sent to Developer from NHSE confirming use of S106 monies and instructing

the District Valuer

submit planning application Oct-16

Planning approval expected end of April 2017; Apr-17 u

Works commence on site June 2017 Jun-17 u

Works completed and handed over December 2017. Dec-17 u

Construction completed and rooms ready for occupancy Autumn 17

Scheme 11

Section 106 investment -

within premises to create

capacity

With the ever increasing population growth in Milton Keynes there is a need to develop primary care estate - varied

locations across MK dependent on need and housing growth, utilisation of Section 106 monies for premises

remodelling / extensions


MKCCG

Utilisation of S106 monies to increase capacity within constrained practices to obtain

additional clinical space

Continuous joint working with Milton Keynes Council for appropriate use of s106

monies for primary care development

Throughout 2017/18

u

Scheme 12

Scoping work with all possible providers of this training, including practices

admin/practice manager to ensure the correct model procured. Quotes and

information received from Here, West Wakefield Org., FPM Group, Insight Solutions

Ltd, AT Medics

Jan - March

Appoint provider/contract award Apr-17 u

Obtain expressions of interest from practices April - May 17 u u

Implement roll out programme of training to practices June 17 throughout 18 u

Continuous promotion and monitoring of programme delivery

Scheme 13

1. ETTF bid approved in principle Nov-16

2. Due diligence checks carried out in conjunction with NHSE. Dec - Mar 16

3. Negotiations on-going with the DV;

4. Agreement to be finalised March 2017; Mar-17

5. Works to commence May 2017; May-17 u

6. additional clinical rooms ready for occupation Summer 17 u u

Scheme 14

1. Pre- Planning application submitted for consultation 1.January 2017 for consultation

2. Planning application process 2. 12/12/16 -22/06/17 u

3. Land transfer 3. 10/05/2017 u

4. Building work to commence 4. July 2017 u

5. Building ready for occupation 5. August 2018 u

6. Procurement for provider services 6. November - March 17

7. New provider to commence services from April 17 and will move into the new

build upon completion

7. April 17 and will move into the new

build upon completionu

Scheme 15

Working with MKC and The

Practice Group on ensuring

building is compliant to

practice needs. Building work

due to commence on 25 July.

This service was commissioned

whilst NHSE held the contract.

From the 1st April 2017 all

bank holidays will be part of

business as usual

commissioned by the CCG.

Working alongside third party

developer Apollo to scope

options. A business case will be

submitted to the Primary Care

Committee in due course.

Insight solutions will provide

the clinical admin training. This

is due to commence from

October.

x Through additional funding in the Improving Access to General Practice we have commissioned additional sessions

over the Christmas period for the peak times for attendances at A&E, 24th December and 31st December for GP

practices to book their patients into.


MKCCG

Development of primary care estate for a registered list size up to 22,000 for the housing growth within the Western

expansion of Milton Keynes, currently no primary care provision.

xxETTF Whitehouse

Development

Workforce

Infrastructure

Investment


Develop the team, Develop QI

expertise

xxImproving Access to General

Practice Plan - additional

capacity for GPAF


Partnership Working, Reduce

DNA's, Productive work flows


Primary Care, MKCCG

Janine Welham - Primary Care Development ManagerDevelopment of primary care estate for a registered list size up to 20,00 for the housing growth within Bletchley.

Current list size 14,000 with the practice having previously had a list closure. Looking a relocation to a new housing

estate subject to patient consultation which will incorporate training facilities so the practice are able to apply to

become a training practice.

xxRed House Surgery -Training

Practice

Investment



expertise


MKCCG

Development of primary care estate to increase space capacity by further developing additional 7 clinical rooms and

training capacity, additional clinical rooms will allow the practice to deliver to a 20,000 list size, current list size is

14,000

Additional capacity created with six more additional clinical rooms including a minor surgery room and additional

training room. Awaiting Planning permission

xxMilton Keynes Village -

premises extension

Infrastructure

Investment


Partnership working,

Productive work flows


Alex Friend - Primary Care Co-Ordinator, MKCCG

Reduction in practice burden and help release time for clinicians

Admin and clerical staff upskilled to actively signpost patients and clinically code appropriate correspondence freeing

up valuable clinical capacity

Support for the practice to develop its own internal systems including a safe and appropriate protocol to guide staff

Supporting the development of standard operating process & procedures

Regular audits of safety and effectiveness, including opportunities to learn from other practices

Quotes and information received from Here, West Wakefield Org., FPM Group, Insight Solutions Ltd, AT Medics

xxxxxxxCare Navigation and

Signposting Training

Workload

Investment


Develop the team, Productive

work flows, personal

productivity, support self

care, Active signposting,

reduce DNA's & social

prescribing

Janine Welham - Primary Care Development Manager, MKCCGRemodelling of CMK Medical

Practice through ETTF Fund

Workforce

Infrastructure

Investment



Productive work flows

Development of primary care estate due to population growth and will enable list size to increase. Currently 13

Clinical rooms to increase up to 19 clinical rooms with additional training facilities.

xx

Janine Welham - Primary Care Development Manager, MKCCGDevelopment of primary care estate for a registered list size up to 22,500 for the housing growth within the eastern

expansion of Milton Keynes

Milton Keynes Council will be the landlord and developer of the premises

xxBrooklands - New Build -

ETTF

Workforce

Infrastructure

Investment



expertise

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Q4

2017 2018

Q1

Investigate the use of Skype

for consultation


New consultation types &

reduce DNAs

x x Adoption and design of technology to increase access to a healthcare professional, telephone consultations with GPs

have been available for a number of years. To scope out the ability to be able to see the patient which could

potentially improve the diagnosis and advice given. This could alleviate pressure of GP consulting rooms and more

flexible way for the workforce to fit around other commitments. Skype consultations have also demonstrated saving

time and are on average 5 minutes compared to a face to face appointment of 10 minutes.


Alex Friend - Primary Care Co-Ordinator, MKCCG

Scoping work to start to include:

1. information governance

2. Locations that consultations could be carried out in

3. Obtaining patient consent

4. local procedures and protocol

5. IT Infrastructure

Scoping work to commence Q1 2017/18

u

This will form part of the e-

consultation scoping work.

Scheme 16

Telephone Consultation/

triage


New consultation types &

reduce DNAs

x x Adoption and design of technology to increase access to a healthcare professional Janine Welham - Primary Care Development Manager Summer 16 - baseline position of offer from practices for telephone

consultations/triage

Working with practices throughout

17/18 increasing awareness of this

availability through PPG

u

All practices within MK offer

either telephone triage or

telephone consultations.

Through the practice visit

programmes we are discussing

access improvements of which

telephone triage is part of

those discussions.

Scheme 17

Data collated from all practices April 16- March 17

Workshop held with all practices to review data submission Oct-16

Service specification with assistance from LMC devised November 16-January 17

Service specification approved through the CCG governance process Feb-17

Circulated to practices & LMC End of February 17

Contract issued to all practices Mar-17

Practices deliver care Apr-17 u

Quarterly returns and monitoring Quarterly monitoring through 17- 18

u u u u

GPFV – Workforce

Scheme 18

1. Application Successful 1. December

2. All paperwork completed and returned to NHSE 2. End of December

3. Interview done with Drs and practice manager 3. End January

4. Video of practice completed 4. January

5. Adverts and website being devised 5. Ongoing February

Scheme 19

Clinical Pharmacists in GP

Practices


Develop the team

x Changes to skill mix within general practice to make effective use of other clinicians within primary care

Clinical pharmacists work as part of the general practice team to resolve day-to-day medicine issues and consult with

and treat patients directly. This includes providing extra help to manage long-term conditions, advice for those on

multiple medications and better access to health checks. The role is pivotal to improving the quality of care and

ensuring patient safety.

Having a clinical pharmacist in GP practices means GPs can focus their skills where they are most needed, for example

on diagnosing and treating patients with complex conditions. This helps GPs manage the demands on their time.

Medicines Management Team and Primary Care Team - MKCCG Complete Complete

Ongoing monitoring of effectiveness and

workload

Wave 1 - MK Practices were

successful in their bid for

clinical pharmacists. These

have now been rolled out

across interested practices. MK

GP Plus has submitted an

application for wave 3 and are

awaiting the outcome.

Scheme 20

1. Evaluate the paramedic role in general practice 1. Q2 2017/18

u

2. Support further practices to employ paramedics as part of their multi disciplinary

team

2. Ongoing

3. Work with South Central Ambulance Service (SCAS) to scope rotational posts 3. Q1 2017/18 u

Scheme 21

SCAS retaining /recruiting

paramedics

Creating rotational posts


Develop the team

x Expand and support GPs and wider primary care staffing

Changes to skill mix within general practice to make effective use of other clinicians within primary care

Alexia Stenning - Assistant Director, Primary and Community Services

Mark Cox - Head of Urgent and Emergency Care

Commence scoping Q3 2017/18

u

Scheme 22

Mental Health Therapists

Investment


Develop the team,

Partnership working

x x Expand and support GPs and wider primary care staffing


Wayland Lousley - Mental Health Transformation Lead


Primary Care

Q1 2017/18 commencement of pilot in 4

practices

Development of service specification Q1

2017/18

Development of success criteria Q1

2017/18

u

Scheme 23

Social Prescribing

Workload


Social Prescribing

x Social prescribing can lead to a range of positive health and well-being outcomes. Studies have pointed to

improvements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of

depression and anxiety.

Social prescribing also lead to a reduction in the use of NHS services. Studies show that for more than 8 in 10 patients

referred to the scheme who were followed up three to four months later, there were reductions in NHS use in terms

of accident and emergency (A&E) attendance, outpatient appointments and inpatient admissions. The studies also

showed reductions in general practice attendance rates for most people who had received the social prescription.

These will need to be set once project is

scoped.

Scheme 24

The practice that was

approved through the scheme

underwent a recruitment drive

and this is now complete.

PMS contracts issued to all

practices. This will be

monitored on a quarterly basis

and discussions for year three

monies will commence in the

Autumn. LMC are fully

involved.



Primary Care

MKCCG with all practices input and LMC

Reinvesting primary care funding across the whole of MK registered population, through the first year reinvestment

practices collected data in areas above core GMS that are not funded by any other route. A workshop was held with

all practices in Autumn and Phlebotomy and Wound dressings over 10 minutes was agreed to be funded through year

2 PMS reinvestment, otherwise this work could potentially end up in the secondary care setting

The practice based service would meet the following strategic objectives:

• Improve access to care ensuring people receive the right care, at the right time and in the right place.

• Deliver care closer to home.

• Reduce pressures on hospital services by keeping people out of hospital when care can be delivered in other

settings.

• Ensure continuous improvements in clinical outcomes and people’s experience in accessing and receiving healthcare

interventions.

• Provide Better Care; Better Value and Better Health for our patient population

xPMS Reinvestment

Investment


Partnership working



Primary Care, MKCCG

Expand and support GPs and wider primary care staffing, pilot scheme to invest resources in practices which can

evidence that they have historically encountered difficulty in recruiting GP's ( Practices who have held vacancies for a

minimum of 12 Months) The pilot offers support to promote their practices and advertise their posts.

The intended audience includes

GPs who wish to return to practice either via the induction and Refresher scheme or otherwise

GPS who are currently on a retained doctors scheme who are interesting in applying for a non retained GP position in

targeted practice

GP practices who believe that they should be designated as a target practice

Targeted Investment in

Recruiting Returning Doctors

Scheme

Investment

xParamedics


Develop the team


Primary Care

Mark Cox - Head of Urgent and Emergency Care

Expand and support GPs and wider primary care staffing


PCC17/03

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Portfolio GPs Expand and support GPs and wider primary care staffing Q3 2017/18 scope portfolio options and

appetite within the health economy

Link in with Buckingham Medical School

Link with HEE u

GPFV – Workload

Scheme 25

1. Expression of Interest - circulated 1. September 16

2. Expression of interest received and evaluated 2. October 16

3. Acceptance on GPRP 3. November 16

4. Survey sent to practice 1 4. end November 16

5. Diagnostic team visited practice 1 5. December 16

6. Feedback given to practice 1 6. 31 January 17

7. Identified ongoing support required 7. February/Mar 17

8. waiting feedback from NHSE for support 8. February 17

9. Support meetings booked with the CCG 9. March 17 - throughout year

10. waiting finances for section 96 monies 10. January/February 17

Scheme 26

Practice Manager

Development Programme


Develop the team, Personal

Productivity

x x Expand and support GPs and wider primary care staffing Practice managers are a vital resource in the NHS, playing a

key role in maintaining a quality service and in redesigning care for the future. Yet they are also one of the most

neglected parts of the workforce, receiving relatively little formal training or ongoing development. Many practice

managers report feeling overburdened and isolated in their role, and it is often noted that the most efficient ways of

working are slow to spread between practices.

Primary Care Team Waiting more dates for the workshops from NHSE Successful in secured

additional funding from NHSE.

A training programme

modelled through NHSI and a

local practice manager. This

has been rolled out and

successfully delivered on a

three day programme to 28

practice managers.

GPFV – Infrastructure

Scheme 27

1. Bid submission across the STP 1. June 2016

2. Approval in principle 2. October 2016

3. STP IM&T Task and Finish Group meetings started- monthly meetings ongoing 3. December 2016

4. IM&T ETTF Workshop held with key stakeholders 4. February 2017

Scheme 28

Capital funding opportunity expression of interest submitted Jan-17

Waiting outcome Awaiting outcome

Scheme 29

Referral Management

Service (RMS)


Active signposting,

partnership working,

Productive workflows

x x x Managing demand more effectively

Support high quality referrals, enabling good outcomes and care within national set timeframes



Stephen Nall - Primary Care Project Manager

Develop the current operational model to ensure 100% of referrals are referred via

the RMS.

Referrers will refer via the RMS using e-RS

Providers are set-up on e-RS services upon commencement of contract

Develop generic SystmOne referral proforma(s)

Develop communication, mobilisation and training plans.

By End of Qtr 3 (2017/18)

u

GPFV – Investment

Scheme 30

1. Engagement with member practices 1. Q1 2017/18 u

2. Scoping of potential investment project(s) 2. Q2 2017/18 u

3. Agreement of project(s) to be implemented 3. Q2 2017/18 u

4. Business case to be taken through CCG governance route 4. Q2 2017/18 u

5. Implementation of successful project(s) 5. Q3 2017/18 u

Scheme 31

1. Federation currently forming 1. Q4 2016/17

2. Legal entity to be obtained Q1 2017/18 2. Q1 2017/18

u

Federation known as MK GP

plus now formed and is a legal

entity. Currently meeting with

federation management team

on a monthly basis to discuss

potential commissioning

One practice was successful on

the GPRP funding has been

received from Jan - June.

Currently working with

practice once funding has

ceased for future

sustainability.

Working through the

information sharing project

team to deliver this across

BLMK

Unsuccessful in securing any

funding

xFederation Development


Partnership Working


Primary Care

Wendy Rowlands - Deputy Finance Director

Investment to be ring fenced by CCGs for improvement in population health across the health economy

Non recurrent transformation support funded from CCG allocations to stimulate development of at scale providers,

implementation of 10 high impact actions and secure sustainability

Richard Alsop - Director of Programme Delivery


Primary Care

The enablement of differing models of networking and service provision across MK to develop and reflect the needs of

the local population.

xxx

Capital Funding Opportunity -

Provider Digitisation

Programme

£3 per Head Investment



productive workflows,

develop QI expertise,

Jonathan Elwood - Head of Corporate Services Adoption and design of technology to increase access to a healthcare professional

Provision of MPLS virtual COIN Network across MK GP Practice base which would deliver digital benefits much earlier

than current projections.

Begin implementation of mobile working infrastructure into care homes

Infrastructure to support proposed tele-medicine / e-consultation hub

Provision of SystmOne in local ED's

ETTF IM&T STP


Partnership working, Develop

QI expertise, Productive work

flows, New consultation

xxGP Practice Resilience

Programme


Develop the Team, Productive

work flows, Personal

Productivity

xxxx Nikki Barnes - Chair for IM&T STP steering group and project lead -

Bedfordshire CCG

Janine Welham - Primary Care Development Manager MKCCG

Adoption and design of technology to increase access to a healthcare professional

The programme forms the first phase of the BLMK approach to integration and digitisation, focusing on early tactical

developments that largely exploit existing technologies, and advance the information sharing agenda and

achievement of key Universal Capabilities. This programme represents the phase 1 tactical solutions of a longer term

work programme that can be progressed rapidly for clinical benefit.

Janine Welham - Primary Care Development Manager,

MKCCG

Expand and support GPs and wider primary care staffing

Diagnostic services to quickly identify areas for improvement support.

Specialist advice and guidance e.g. operational HR, IT, Management and Finance

Coaching/supervision/mentorship as appropriate to identified needs

Practice management capacity support

Rapid intervention and management support for practices at risk of closure

Co-ordinated support to help practices struggling with workforce issue.

Change management and improvement support to individual practices

x

PCC17/03

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PCC17/04

1

Subject: PMS Reinvestment Year 3 Meeting: Primary Care Committee Date of Meeting: 28 June 2017 Report of: Janine Welham, Primary Care Development Manager 1. Summary The purpose of this paper is to inform the Primary Care Committee of the opportunities for the PMS monies for year 3 and introduces an option to include schemes that could potentially be provided/delivered by the federation (MK GP Plus) over the next financial year (18/19). Current Situation All 13 PMS practices agreed to move to GMS contracts with transitional funding in April 16. This was following a PMS review programme established by NHSE (Central Midlands) in response to the national directives received in January 2014. The PMS monies received are to be reinvested within primary care in to general practice services that go beyond core national requirement and should:

Reflect CCG/NHSE strategic plans for primary care Secure services or outcomes that go beyond what is expected of core

general practice Help reduce health inequalities Give equality of opportunity to all GP practices Support fairer distribution of funding at a locality level Improve access to care ensuring people receive the right care, at the right

time and in the right place. Deliver care closer to home Reduce pressures on hospital services by keeping people out of hospital

when care can be delivered in other settings Ensure continuous improvement in clinical outcomes and people’s

experience in accessing and receiving healthcare interventions Provide Better Care; Better Value and Better Health for our practice

populations.

Year 2 reinvestment is £472,045 based on January 2017 registered list sizes, this equates to £1.64 per patient and it was agreed that this would fund practices to deliver phlebotomy, wound dressings over 10 minutes and ulcer dressings to

PCC17/04

2

their registered population. This was agreed with all member practices and the LMC.

. 2. Finances

Year 3 PMS reinvestment monies will be £708,068 based on April 17 registered list size this would equate to £2.44 per patient. Due to delegation MKCCG has an opportunity to add to this financial amount to invest into primary care ensuring and maximising quality of care, patient outcomes and value for money. Set out below are two options for consideration. For information, the following amounts will be available for reinvestment in the subsequent years:

Year 4 £944,091 Year 5 £1,180,113 Year 6 £1,416,136

3. Option 1

Utilise the year 3 PMS funding following consultation with practices for other services above core GMS to include the increased activity in phlebotomy, wound dressing and ulcer dressings for practices which is currently capped in year 2.

4. Option 2

Combine the year 3 PMS funding with the GP Access Fund innovation budget which, equates to approximately £400,000 and the £3 per head money as set out in the GP Forward View which equates to £430,000. This would enable the CCG to work with a potential budget of £1,538,068. If these amounts are combined it gives the opportunity for primary care/the federation to potentially deliver services that will: reduce secondary care activity reduce GP referrals into secondary care assist with primary care workload challenges assist with general practice resilience and sustainability encourage and support place based care and cluster working increase access to general practice improve patient satisfaction

PCC17/04

3

solve long standing challenges around commissioning of specific services/pathways.

Listed below are some areas that could be commissioned to address the challenges above:

Locally and Direct Enhanced services i.e. minor surgery, phlebotomy etc Leg ulcer dressings Care home and home visiting service Clinical peer review of referrals Flu vaccination for the hard to reach and other eligible cohorts to increase

uptake On the day, urgent access Cervical cancer screening Bowel cancer screening Homeless enhanced service LARC for symptom control

5. Recommendation

To note contents of the report and the available funding. To discuss and agree the preferred option as detailed above. To support the Primary Care Team in working up the preferred option.

Subject: Neath Hill Procurement Update Meeting: Primary Care Committee Date of Meeting: 28 June 2017 Report of: Janine Welham, Primary Care Development Manager 1. Summary The purpose of this paper is to update the Primary Care Committee of the timeline and progression of the Neath Hill Health Centre Alternative Provider Medical Services (APMS) procurement. 2. Current Situation Neath Hill Health Centre is currently under a caretaker arrangement with Stony Medical Centre under a one year APMS contract with a three-month extension which is due to expire on the 30 June 2017. A procurement process was commenced in Autumn 2016 but failed to award a contract. A second procurement was started in February 2017. 3. Patient Engagement A 30-day patient engagement had previously been carried out this included drop in sessions, a patient survey sent to all registered households this included areas that are important for patients and any new services they would like to see introduced at the surgery. The service specification reflects the outcome from the patient survey. 4. Contract Award Key Medical Services (KMS) a subsidiary of Celsus Limited was the preferred bidder and following the standstill period which ended on the 5th June have been awarded the contract for Neath Hill.

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5. Mobilisation Working with the NHSE assigned staff we are now commencing the process of mobilisation for the service to commence on the 1st July 2017. We will be meeting with KMS on a weekly basis initially to ensure that the transition from caretaker to KMS goes smoothly. Key Performance Indicators will be developed and monitored on a quarterly basis throughout the term of the contract. 6. Recommendation

To note contents of the report, timelines and progress of the procurement to date.

To note and support the mobilisation of the service and recognise the tight timeframe within this mobilisation.

PCC17/05

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MKCCG Delegated Commissioning Finance

Report

May 2017

By Edna Muraya Senior Finance Manager

PCC17/06

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The CCG was given delegated commissioning responsibility from April 2017. The transition was smooth and NHSE has assured the CCG that any legacy payments can be recharged to them.

KEY MESSAGES ON THE BUDGET

The allocation received for primary care was £32.532M of which £89k was transferred into Urgent Care Services centre following the closure of the walk in facility at Broughton Gate leaving a balance of £32.443M In its 17/18 financial and operating plan the CCG held back 1.0% of its allocation to meet future Transformational costs. This totalled to £327K The final 17/18 operational budget for delegated commissioning is therefore £32.205M. At Month 2 the budget was underspent by £97K and forecast to be underspent at 379K. This underspends relates to an uncommitted contingency reserve of £379K . This is phased equally in the budget with no actual spend currently forecast. APMS/GMS contracts are an underspend of 55K YTD and forecast £131K underspend.

DELEGATED COMMISSIONING FINANCE REPORT-MAY 2017

PCC17/06

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Business Rates expenditure was planned at 16/17 levels however post national rates rebate exercise are now being reflected in 17-18 hence an underspend of £15K YTD and forecast at £86K. Enhanced Services are currently underspent however due to delayed receipt of Claims it is expected to be on plan at the end of the year. The maternity and sickness payments are currently underspent but this is dependant on what claims are submitted during the year. The seniority payments will reduce as they are projected to be going down year on year. Premises are overspent by £154K as the CQC fees have been charged to this budget line and clinical waste expenses are greater than expected and this will be investigated. The forecast shows that the overspend will reduce to £51K at the end of the year. QOF achievement for 16/17 indicated an increase from the achievement level in 15/16 on which the 16/17 budget was based. Therefore a £28K YTD overspend exists and is forecast to overspend by £160K

DELEGATED COMMISSIONING FINANCE REPORT-MAY 2017 (cont’d)

PCC17/06

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Service Budget 2017-18

Sum of YTD

Budget

Sum of

YTD

Actual

Sum of YTD

Variance Sum of ForecastVariance

APMS Contract

APMS Contract 1,406,430 249,212 237,404 -11,808 1,424,425 17,995

Sub total 1,406,430 249,212 237,404 -11,808 1,424,425 17,995

Corp

Other-Indem Insurance 135,200 0 0 135,200 0

Other 95,872 0 0 95,872 0

Caretaking Fees 114,000 19,000 19,000 0 114,000 0

Sterile Services 32,063 5,344 0 -5,344 32,063 0

Sub total 377,135 24,344 19,000 -5,344 377,135 0

EHS

Extended Hrs 449,722 74,954 74,954 0 454,722 5,000

Learning Dis 33,192 7,192 7,192 28,768 -4,424

Minor Surg 357,702 59,617 41,449 -18,168 357,702 0

Violent Patients 54,000 9,000 9,000 0 54,000 0

Sub total 894,616 143,571 132,595 -10,976 895,192 576

GMS Contract

Global Sum 20,502,615 3,417,103 3,374,598 -42,505 20,353,585 -149,030

MPIG 254,973 42,495 42,496 0 254,973 0

Sub total 20,757,588 3,459,598 3,417,093 -42,505 20,608,558 -149,030

PCO

Mat Leave 152,128 25,355 32,070 6,715 131,654 -20,474

Other 20,000 3,333 0 -3,333 0 -20,000

Seniority 378,532 63,089 63,089 0 351,159 -27,373

sickness 50,060 8,343 8,343 -0 16,493 -33,567

Susp Drs 0 0

Sub total 600,720 100,120 103,502 3,382 499,305 -101,414

PMS Contract

FDR 944,091 157,348 157,348 -0 944,091 0

PMS Reviews CCG 472,045 241,186 86,481 -154,705 472,045 0

Sub total 1,416,136 398,534 243,829 -154,705 1,416,136 0

Premises

Actual rent 2,812,817 468,803 468,803 0 2,812,817 0

Clin Waste 188,397 31,399 114,377 82,978 188,397 0

Water 23,673 3,946 2,129 -1,816 23,673 0

CQC Fees 0 86,650 86,650 136,650 136,650

PIG 0 0

Rates 462,352 77,059 62,784 -14,274 376,707 -85,644

Sub total 3,487,239 581,206 734,743 153,537 3,538,244 51,006

Presc/Disp

Disp 0 0 0 0 0

Presc 223,976 37,329 37,330 0 223,976 0

Sub total 223,976 37,329 37,330 0 223,976 0

QOF 0

ach 798,647 0 0 0 884,495 85,848

Asp 1,863,514 310,586 339,408 28,822 1,937,656 74,141

Sub total 2,662,161 310,586 339,408 28,822 2,822,151 159,989

Other

Voluntary levy deductions 0 -1,254 -1,254 0

Trade waste 0 0 6,832 6,832 20,496 20,496

Sub total 0 0 5,578 5,578 20,496 20,496

Total 31,826,000 5,304,501 5,270,482 -68,038 31,825,618 -383

Contingency 379000 63,089 0 -63,089 0 -379,000

Grand Total 32,205,000 5,367,589 5,270,482 -97,107 31,825,618 -379,383

PCC17/06

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Recommendations

Primary Care Committee is asked to note the content of this finance report.

PCC17/06

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Primary Care Committee Wednesday 28 June 2pm 3.30pm ... · Janine to discuss these points with...

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Transcript of Primary Care Committee Wednesday 28 June 2pm 3.30pm ... · Janine to discuss these points with...