1

Agenda and Papers

for the

West Kent Primary Care

Commissioning Committee

on

Tuesday 4th April 2017 at

3.00pm-5.00pm

at

Hadlow Manor Hotel, Hadlow,

Tonbridge, Kent, TN11 0JH

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Meeting of the Primary Care Commissioning Committee

To be held on 4th April 2017 @

Hadlow Manor Hotel, Hadlow, Tonbridge, Kent, TN11 0JH

A G E N D A Chair is Alistair Smith

Time Agenda no.

Agenda Item Lead Required Action?

3.00pm 1 Welcomes and Introductions Chair TO NOTE

3.05pm 2 Apologies for Absence Chair TO NOTE

3.10pm 3 Quorum and Declaration of Interests Chair TO NOTE

3.15pm 4 Minutes of the previous meeting held on 7th March 2017

Chair TO NOTE To go to Governing Body

on 25th April 2017 (Pgs 3-12)

3.20pm 5 Actions arising from the previous meeting held on 7th March 2017

Chair TO NOTE Pages 13-14

3.25pm 6 Primary Care Report (including Delegated Authority Actions and Primary Care Quality Report)

Priscilla Kankam / Debbie Dunn

TO NOTE Pages 15-29

3.45pm 7 Finance Report Reg Middleton FOR INFORMATION Pages 30-33

4.05pm 8 Risk Register Priscilla Kankam FOR DISCUSSION Pages 34-38

4.25pm 9 GP Premises Condition Survey Priscilla Kankam FOR DISCUSSION & TO NOTE Pages 39-44

4.40pm 10 PCCC Forward Planner Chair TO NOTE

4.50pm 11 Q&A from the public Chair TO NOTE

Date of the next meeting (as previously circulated):

6th June 2017 at 3.00-5.00pm (venue TBA)

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DRAFT MINUTES OF THE PRIMARY CARE COMMISSIONING COMMITTEE MEETING HELD IN PUBLIC ON TUESDAY 7th MARCH 2017 AT 15.00 HRS AT THE VILLAGE HOTEL, MAIDSTONE

Approved:

Those present:

Alistair Smith Chair of the Primary Care Commissioning Committee Gail Arnold Chief Operating Officer (Transformation), WK CCG Dr Sanjay Singh GP Member, WK CCG Dr Nick Cheales GP Member, WK CCG Sue Southon Lay Member for Patient & Public Engagement, WK CCG Andrew Hayes Healthwatch Kent Representative Richard Segall Jones Company Secretary, WK CCG Reg Middleton Chief Finance Officer, WK CCG Dr Mike Parks LMC Representative Ian Ayres Accountable Officer, WK CCG Caroline Becher Independent Nurse, WK CCG Cheryl Turner Contracts Officer, NHS England

Attending:

Lizzie Howe Corporate Services Manager, WK CCG Priscilla Kankam Head of Medicines Optimisation, WK CCG Yin Yau Deputy Chief Finance Officer, WK CCG

Apologies:

Nic Goodger Secondary Care Clinician, WK CCG David Selling NHS England Representative Richard Woolterton NHS England Representative Councillor Pat Bosley Health & Wellbeing Board Representative

1. Welcomes and Introductions

The Chair of the committee Alistair Smith welcomed everyone to the March 2017 meeting of the Primary Care Commissioning Committee for West Kent CCG.

2. Apologies for absence

Apologies for absence were noted.

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3. Quorum and Declaration of Interests

The Chair noted the meeting was quorate.

There were no new declarations of interest.

4. Minutes of the previous meeting held on Tuesday 3rd January 2017

The Minutes of the meeting held on Tuesday 3rd January 2017 were approved as an accurate record.

5. Actions arising from the previous meeting held on Tuesday 3rd January 2017

Actions were updated as per the attached Action Log.

6. Primary Care Report

The report had previously been circulated to the committee.

Mrs Arnold advised that the Report encompassed updates from the 26th January and 13th

February PCOG meetings. The main items were highlighted by Mrs Arnold within the Report.

It was noted that Boundary Change details within the Report covered the previous 12 months.

The two Federations plan to merge into one organisation from 1st April 2017. Details of the seven agreed Clusters were covered in the Report. Practice visit details were also given as well.

Ms Southon queried the MOU consultation information detailed in the Report and was advised by Mrs Arnold that Ruth Wells had attended the meeting and she would be able to provide further information.

The committee queried the purpose and remit of the Premises Strategy and Operational Group. Mrs Arnold advised that this was an NHSE led meeting, but would now become a CCG one with updates being fed back to the committee via the Primary Care Report. The group is strategic in focus, not operational. Ms Kankam updated that the Terms of Reference (ToR) for the group are awaited and once these are received it will enable a greater understanding of the group. Mrs Arnold advised that it currently encompasses Kent, Surrey and Sussex.

Dr Parks noted that with regards to GP allocations, there is a large volume of activity associated with this and this area had the potential to consume resources. His understanding was that NHSE employed four full time staff for allocations. Ms Turner advised that NHSE employed a band 3 for allocations and a band 6 for special allocations. These two roles also had other responsibilities within NHSE and were not employed purely to handle allocations.

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Mrs Arnold stated that this would be discussed with practices in the area and a well- constructed local agreement would emerge.

The Chair queried the matter of one practice giving notice in the West Kent CCG area. Mrs Arnold advised that there was a protocol under these circumstances which would be followed. There is a six month notice period and there are various options for the CCG; the population and Cluster arrangements would play a part in that.

The Chair queried the ETTF submission. Mrs Arnold advised that there was no deadline for submission. The practice is going into a hub and information is being pulled together. There is a MOU for 4 out of 5 practices. This will be an agreement between the CCG and the practice, with NHSE as an interested party. This can be awarded under a range of different options and Ms Turner explained the ratings to the committee.

Ms Becher was disappointed to read that a practice had declined a visit and asked if any particular reason had been given for this decision. Mrs Arnold advised that the CCG had accepted the decision of the practice, but the option was there for the practice to change their mind. This particular practice had stated there were time constraints with facilitating a visit by the CCG.

Mr Ayres wished to state that 59/60 practices being visited by the CCG was good work and the CCG should build on that. There are no serious performance issues within the practice that had declined a visit and he was fully supportive of Mrs Arnold’s position.

Mrs Arnold advised that practices receive a letter after their visit and this letter lists actions agreed on both sides. There is the option to categorise general themes if required.

Ms Becher was reassured by Mrs Arnold’s response but still felt from an engagement perspective it was disappointing to see a practice visit had been declined. Mrs Arnold hoped that once good news filters out from other practice visits, this practice may change their mind in the future.

The Chair asked about the Boundary Changes form. Mrs Arnold stated this was a well- rehearsed exercise and the form was an exact extract from the policy book. She did not see any reason to change it. The Chair queried whether a checklist for quality would be beneficial. Mrs Arnold said they had followed the process checklist given, but there could always be an amendment/supplement to the local policy if required. Mrs Arnold said there was not a requirement to change the policy but the Chair felt a separate addendum could be considered.

Ms Southon felt an example of an impact question could detail an adversely affected demography. Mrs Arnold spoke about the reasons practices often seek a boundary change and it is common sense. The committee also spoke about Tunbridge Wells boundaries as well.

The Chair thanked Mrs Arnold for the update.

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7. Primary Care Quality Report

A document had previously been circulated to the committee.

Mrs Arnold advised the committee that the information given had been taken from the Quality Report which had recently been to the WK CCG Governing Body meeting. It was noted that there was not a requirement for a separate quality report for this committee. It would not be appropriate to have a separate report. Mrs Arnold noted that further discussions would be taking place regarding dashboards and enhancements to the report for future meetings.

The Chair confirmed that the committee was not looking to replicate quality discussions elsewhere, but a quality overview was required. It was noted that extracts from future Quality Committee meetings would be fed through to the Primary Care Commissioning Committee and a dashboard would be incorporated within this.

Mr Ayres felt it would be beneficial for the Chair to attend and observe a Quality Committee meeting to gain a greater understanding of the committee’s role. The Primary Care Commissioning Committee needed a quality assurance and to see that nothing needed escalating. There is a process on how information is collected, including key issues being covered and sequencing.

The Chair queried SI’s and engagement with the RCA process within practices and whether quality visits were separate from Mrs Arnold’s practice visits. Mrs Arnold advised yes, the function is different.

Mr Ayres advised that quality visits focus on the practice GMS core services. Mrs Arnold’s visits focus on a broader range of issues. There is a distinct difference between developmental and performance visits.

Mrs Arnold stated that her visits were more holistic and there had to be a mutual recognition that things need to change. The main focus is often on discussing the practice packs issued by the CCG.

It was noted by the committee that a change in date of the bi-monthly meetings would enable more recent updates from the Quality Committee to be incorporated within the papers.

The Chair thanked Mrs Arnold for the update.

8. Capita GP Payment Problems

The Chair had requested this agenda item.

Dr Parks stated that this was a huge issue and any issues needed to be flagged up to NHS England and Capita. There was also the option of highlighting issues via the GP/BMA route as well.

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It was noted that there had been some improvements with the pensions element, but there are still issues with medical forms and invoicing / SBS (in particular what had been claimed and what had been paid).

Mr Ayres stated that the transfer of patient records had also been an issue and the problems are well known. This needs to be resolved faster and queried whether this matter should be added to the risk register. It was agreed that a letter would be drafted stating all the problems and concerns and this would be signed by the Chair and sent to NHS England.

Action: Gail Arnold / Alistair Smith

Dr Parks felt that Capita had not been adequately briefed with regards to the matters they were taking on and he felt NHS England needed to also take responsibility for the issues arising.

Mr Middleton emphasised that the CCG would help practices where ever possible and his deputy had also offered reassurance to practices. Mr Yau, Deputy Chief Finance Officer, stated that he had made sure practices were paid and support has also been made available for pensions, there are a lot of CCG resources being made available to resolve any queries.

Dr Cheales stated that Tunbridge Wells Cluster responses would be sent to Mr Ayres. The Chair stated a letter was definitely needed and the committee must not lose sight of this issue. Ms Southon said it was important to make sure all practices in the area were aware of the current issues.

9. Finance

Papers had previously been circulated to the committee. Mr Middleton presented the agenda item.

The document detailed the budget for 2016/17 and a forward look. The CCG is in a favourable position with a current primary care underspend position of £1.25m. For 2017/18, this is at a level identified by NHSE (an uplift of 4% beyond this year).

Mr Middleton mentioned contract settlement, premises, demography growth and business rate changes. More work is being undertaken at practice level and a budget framework will be going to the Governing Body for final approval. There is a contract uplift and the committee were asked to note the key assumptions detailed within the report.

The Chair queried the £3 per patient as part of the GP Five Year forward view and whether funds were on top of this. Mr Yau advised that this was on top of that money. Mr Middleton replied that there will be a granular review undertaken of finances and this will be looked at in relation to practices, clusters and premises. The £3 element is for sustainability. The discretionary sum detailed in the table on page 47 defined the activities the CCG may wish to invest in. There is a need to move away from responding to demands and the CCG has plans to move towards the next phase of development.

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Mr Ayres stated that for premises, some work has already been undertaken for this with regards to decision making modules.

There followed discussion on when further information could be fed back to the committee and it was noted that an overview would be available for the April meeting with a fuller update at the June meeting.

Dr Parks queried the underspend and funding commitments. He mentioned the CQC reimbursement and indemnity inflation for the next two years, the discount rate on claims could go up by 50% (or even 200%). He felt the CCG should also be mindful of the fact that sickness and maternity were cost pressures and would lead to higher expenditure. Mr Ayres said the GMS spend is a floor, not a ceiling. There is technical guidance and this would be an interesting challenge.

Mr Hayes asked about a recent news article concerning the postponement of surgery in the West Kent CCG area. Mr Ayres advised that this had been a badly written article which ended up syndicated across five or six newspapers. He wished to state that the CCG had not stopped referrals being made by GPs. Non-urgent surgery had been postponed until April 2017. It had not impacted on GP/patient consultations.

Mr Hayes queried funding and was advised by Mr Middleton that funding is part of the whole CCG allocation. Mr Ayres again reiterated that GPs had not been asked to slow down their work; progress would be as per normal. There had been a slowdown in hospital activity and the CCG had undertaken prudent housekeeping for this financial year in order to try to return non-urgent elective surgery to planned affordable levels.

The Chair felt these matters were more for the Governing Body and Dr Cheales stated that the message had gone out to practices from the planned care team.

The Chair thanked Mr Middleton for the update.

10. Section 106 Monies

This had been discussed at the January 2017 meeting under Any Other Business. Mr Ayres had been granted Delegated Authority. A paper had been circulated to the committee prior to the meeting. This written paper was being presented for approval by the committee.

Ms Southon queried whether monies could be lost if developers had specified a specific purpose for the funds. Mr Middleton advised that if a practice could not progress a scheme then funding would be lost. Dr Parks said this was not an improvement grant and a top up could be to 100% of the cost. Mr Middleton agreed, yes in the principles of fairness.

Mr Ayres updated that Mrs Arnold and her team had attended meetings district by district with regards to this stream of funding and there is the option to go back ten years for Section 106 monies. There will be a comprehensive list going forward, significant sums of money are there.

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Mrs Arnold said there was governance around the funding and district councils make their decisions based on the criteria given. She was pleased to advise that the first one for the CCG had been approved.

The committee approved the paper.

11. Business Rates Revaluation of GP Premises

Mr Yau, Deputy Chief Finance Officer, updated the committee on the latest position. Premises budgets had been uplifted by 3%. Inflation uplift will cover this. The CCG will reimburse and practices can appeal if they are unhappy with the decision given. Tolerances are being exercised now.

Mr Yau also spoke about the Business Improvement District Levy. This charge is business rates and above; district councils are looking at a 1% levy. Again, if applicable the CCG will reimburse this figure. This levy is applicable to Maidstone, Sevenoaks and Tonbridge and Malling councils, although Sevenoaks are the only council to have introduced it so far. Funding is available and practices have been reassured. This will erode discretionary investment though. The principles are known and further information is to follow. This will reduce funding for investment.

Dr Parks felt that GP premises would be under the businesses to be exempt and there had been discussions regarding this. Mr Middleton stated that Sue Crick from the Primary Care team is seeking clarification from NHSE on this matter. Further information would be available at future meetings.

An update would be provided at the April 2017 meeting. Action: Yin Yau

12. Risk Register

Papers had previously been circulated to the committee.

Ms Kankam gave an overview of the latest Risk Register.

Mr Middleton advised that four further risks would need to be included. Information from Andrew Brownless, Chief Information Officer, highlighted the following IT risks:

Business continuity

Cyber security

Financial

Data quality

Action: Reg Middleton

Mr Ayres requested that the Capita risk also be added to the risk register. Action: Priscilla Kankam

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The Chair noted the improved Risk Register, which contained more detail and that the document was still under development.

The committee noted that the first two risks were red.

Mrs Arnold advised that for risk PCCC02, she had recently appointed to three posts to support the existing primary care team and felt the risk could be down-graded now.

Ms Southon queried recruitment to general practice and Richard Segall Jones suggested the need for clarity over responsibility for workforce issues. The Education Network had this responsibility.

Mr Ayres felt that for PCCC01, the wording should state “workforce and skill mix”.

The Chair commented on PCCC09 (resilience) being down-graded and Mrs Arnold stated that a lot of support had been made available. There followed discussions on mitigating actions and making progress. Mr Ayres said that the CCG did know when to intervene and a score of four to three is right. It is about being in a stronger place to handle things, but it does not mitigate the consequence. Dr Singh also gave a GP viewpoint.

The Chair noted the benefit of Clusters. He also stated that where there is a plan, it does not itself reduce the risk.

13. MOS (Medicines Optimisation Scheme 2017/18)

Papers had previously been circulated to the committee.

Ms Kankam updated the committee that this was the fourth year the scheme was being offered by the CCG. It is a balance between safety and finances. The scheme had already been to the CSG for comments and feedback had been incorporated into the scheme now being presented to this committee.

Ms Kankam gave the committee an overview of the proposed scheme. The first step is for the practices to meet with a medicines pharmacy technician; this is a pre-requisite of the scheme. For the QIPP element, the practice has to agree with the project.

Eclipse Live (a safety risk stratification tool) is being offered again and this is being offered for the third year by the CCG. Practices will be asked to look at red and amber patients.

For the poly pharmacy, it was noted that feedback from last year included that this was too much work. The CCG is not asking for a template form for each patient this time, just a summary sheet for this element.

There are also two new elements within the scheme this year: secondary care drugs and review of EDN (electronic discharge notifications) review of medications post discharge. There are two clinical audits to choose from.

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The practice will receive 95p per patient for the elements and £300 for the EDN element.

Ms Becher said she was pleased to see the AKI (Kidney) element included in the scheme and secondary care prescribing. She supported the initiatives being offered.

For the poly pharmacy, she wondered if this element could be made less onerous. Ms Becher felt that patients taking 8+ medications and of the age group 60+ should be reviewed by their GP anyway.

Dr Singh stated that these patients provide a good starting point and would already be receiving several reviews a year; any good practitioner would be doing this for their patient anyway. Ms Becher mentioned current NICE recommendations and said the financial benefits would be spin offs. Mrs Arnold asked Ms Kankam for the MOG GP reasoning for the criteria. Ms Kankam said that some practices have good processes in house, for others it would be a useful aide memoire. It also ties in with CCG work to look at medicines management and reducing prescribing waste (often involving medicines on repeat prescription). Feedback has shown it has been a success. The four GPs who sit on the MOG felt the criteria was a good thing and workload concerns had been considered. The review this year will look at a separate 1% of patients and will exclude the 2.5% cohort from last year.

Mrs Arnold queried whether there was another option available for those who were already good at this element? Ms Kankam advised that she would feed that back to the MOG.

Dr Singh said that in secondary care often 3 x drugs can be started. He felt that education packs for GPs would be beneficial. It is seldom that any patient needs 8+ medications and this should be looked at from a quality and cost point of view.

The Chair enquired about the 2016/17 results in relation to practices seeing the full benefit. Ms Kankam advised that the 2016/17 scheme had not been completed yet. Once completed, the scheme will be validated at the MOG and any savings quantified. The results of the 2015/16 scheme have been fed back to the Audit Committee.

The committee requested that when providing a report to the committee in respect of the 2016/17 MOS an update should be provided on whether the benefits of the 2015/16 scheme had been sustained.

Action Priscilla Kankam

The Chair queried sustainability and Ms Kankam said these were on-going projects, especially for the QIPP, these would realise benefits over a longer period of time. For anti- biotics Ms Kankam advised that the NHSE average had been maintained.

Ms Southon said it was good to see the poly pharmacy included this year and asked about the calculated return on savings. Ms Southon also asked about the vitamin review and the prescribing of these medications.

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Ms Kankam said there was NICE guidance around prescribing vitamins in certain circumstances (for example, malnutrition) and some of them had been reviewed. Dr Singh also advised that in certain cases, for example alcoholism and liver disease, it was necessary to prescribe vitamin D.

For the predicted savings Ms Kankam said the CCG had looked at monies spent on those drugs and the 50% reduction as per the NHSE average.

Dr Parks stated that it was important to support and encourage high quality practice. It would be beneficial to have an LMC view of the schemes as this would give a wider clinical exposure. He did feel the 60 years + age element could be considered ageist.

Ms Kankam stated that the age criteria had been selected as the evidence supported it; research had also been undertaken at the 50/55 years age range as well.

It was deemed most appropriate to have the 60 years + age criteria as this showed the most benefit. Ms Kankam also stated that the MOG did have an LMC representative as they had seen the MOS and had input to it.

Dr Parks disagreed with Ms Kankam with regards to the LMC element of input to the scheme and said the CCG was missing an opportunity to have full LMC input.

The Chair stated that he accepted the point being made.

The Primary Care Commissioning Committee approved the Medicines Optimisation Scheme for 2017/18.

The Chair asked Mrs Arnold when the LIS (Local Improvement Scheme) would be ready. Mrs Arnold said she would provide an update at the April Primary Care Commissioning Committee meeting.

Action: Gail Arnold

14. Q&A from the public

No questions were raised. The Chair thanked everyone for their attendance and closed the meeting at 5.00pm.

Date of next meeting - the next meeting is scheduled for Tuesday 4th April 2017 at 3.00- 5.00pm at Hadlow Manor Hotel, Tonbridge, Kent, TN11 0JH.

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Action Points of West Kent CCG Primary Care Commissioning Committee (WK CCG PCCC)

Meeting held on Tuesday 7th March 2017, commencing at 3.00pm at The Village Hotel, Maidstone

Action No (in

accordance with agenda no)

Action Points Officer Status

8. Capita GP Payment Problems

It was agreed that a letter would be drafted stating all the problems and concerns and this would be signed by the Chair and sent to NHS England.

GA/Chair

11. Business Rates revaluation of GP premises

Dr Parks felt that GP premises would be under the businesses to be exempt and there had been discussions regarding this. Mr Middleton stated that Sue Crick from the Primary Care team is seeking clarification from NHSE on this matter. Further information would be available at future meetings.

An update would be provided at the April 2017 meeting.

Yin Yau

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Action No (in

accordance with agenda no)

Action Points Officer Status

12. Risk Register Mr Middleton advised that four further IT risks would need to be included

RM

12. Risk Register Mr Ayres requested that the Capita risk also be added to the risk register.

PK

13. MOS 2017/18 The committee requested that when providing a report to the committee in respect of the 2016/17 MOS an update should be provided on whether the benefits of the 2015/16 scheme had been sustained.

PK Update for future meeting.

13. MOS 2017/18 The Chair asked Mrs Arnold when the LIS (Local Improvement Scheme) would be ready. Mrs Arnold said she would provide an update at the April Primary Care Commissioning Committee meeting.

GA

Primary Care Commissioning Committee (PCCC)

This paper is for: To Note

Recommendation: The Primary Care Commissioning Committee is asked to note the

Primary Care Operational Group Report.

For further information or for any enquiries relating to this report please contact;

Priscilla Kankam, Lead Pharmacist Debbie Dunn, Primary Care Quality Assurance Lead

Date: 4th April 2017 Reporting Officer: Priscilla Kankam & D Dunn

ebbie Agenda Item: 6

Lead Director: Gail Arnold Version: Final

Report Summary: The paper gives an update on activities to the Primary Care Commissioning Committee.

FOI status: This paper is disclosable under the FOI Act;

Strategic objectives links: All

Board Assurance Framework

links: All

Identified risks & risk None management actions:

Resource implications: None

Legal implications N/A

Equality & Diversity Has an equality analysis been undertaken? Assessment ☐Yes

☒Not applicable

Report history: N/A

Appendices None

Next steps: N/A

April 2017

NHS West Kent CCG 15

Page 1 of 1

16

Primary Care Operational Group Report

April 2017

Patient focused, providing quality, improving outcomes

Page 2 of 11

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Primary Care Co-commissioning Operational Group (PCCOG) Update

The Primary Care Operational Group met on 16th March 2017. The main aspects discussed are summarised below.

Delegated Co-Commissioning

Kent & Medway Primary Care Network meetings

The attached letter appendix A set out the roles and responsibilities to be assumed by CCG with fulling delegated authority from the 1st of April 2017. The primary care team are putting in the necessary processes and arrangements to ensure a smooth transition from NHS England.

GENERAL PRACTICE RESILIENCE PROGRAMME

At the last committee meeting, CCG officers informed the committee that, in order to release the funds from NHSE, GP practices under the terms of the resilience fund must complete a Memorandum of Understanding (MoU) form supported by the CCG.

The MoU forms part of the General Practice Resilience Programme (GPRP) guidance which describes how NHS England sets out how to provide ‘upstream’ support to practices experiencing difficulties.

The MoU is to be used to provide clarity and understanding of the support services being provided to the Practice by NHS England and/or a third party supplier (Supplier) as set out in the Improvement Plan of the MoU and provide assurance on what can be expected as part of the GPRP.

In terms of governance and assurance on delivery under the MoU, NHS England retains the overall responsibility for the GPRP and has nominated strategic and operational leads who will act as key points of contact for the Practice and NHS England. The Strategic Lead shall be an NHSE officer and the Operational Lead shall be a CCG officer. The Strategic Lead will act for NHS England in providing strategic oversight and direction of the Improvement Plan as part of the wider oversight and governance of the GPRP in relation to the Practice. The Strategic Lead must be a member of NHS England. The Operational Lead will liaise on all operational matters relating to the agreed contributions to support delivery of the Improvement Plan and advise the Strategic Lead, providing assurance that the Key Objectives are being met and that the Improvement Plan is performing within the boundaries agreed with the Practice. The Operational Lead may be a member of NHS England or a representative nominated by NHS England.

To date, 3 out of 4 MOU’s have been completed and submitted to NHS England. CCG officers are working with the remaining practice with the finer details of the MOU.

Page 3 of 11

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CONTRACT VARIATIONS

It was reported that three new contract variations have been signed off by the CCG and forwarded to NHS England for processing since the last meeting. The group deliberated on an outstanding request for a partnership change. The request for variation in the contract was approved.

Date Cluster GCode Practice Reason for

Variation With effect from

07/02/17 Maidstone Wide

G82024 Greensands (Stockett Lane)

Change to partnership – Juliette Norton

01/04/17

28/02/17 Maidstone Wide

G82229 Sutton Valence Practice

Dr David Dawson Leaving the practice

01/04/17

08/03/17 Tunbridge Wells

G82016 Kingswood Surgery

Retirement of Dr Roome

31/08/17

20/01/17 Tunbridge Wells

G82025 Abbey Court

Dr Saad Joining the partnership

01/04/17

Delegated Authority Actions – Primary Care Operational Group (PCOG)

Delegated Action Date of initial

query /

contact

Date taken

to PCOG

Current Position Date of sign

off

Delegated

Officers

for sign

off

S13 - Request to

approve the

practice

application to

extend the GMS

space at the

Surgery and to

approve/support

the proposed

“draft lease”.

20th April 2016

– NHPS

instructed the

DV

16th March

2017

The final draft lease has

been sent to the DV for

comments. The practice

has been asked to

provide details relating to

the Cost rent

payments/loan – practice

have responded stating

that they cannot find any

details regarding this.

This will be further

discussed at the PCOG on

20th April 2017

MC98 - Business

case received to

7th November

2016 – NHSE

16th March The PCOG decision was

that the practice cannot

Awaiting sign

Page 4 of 11

19

include the extra

5 car parking

spaces for GMS.

Also the practice

has lodged an

appeal against

the Current

Market Review

of 3rd April 2016.

instructed the

DV

2017 appeal against the

Current Market Review

and the CCG upholds the

District Valuers

assessment.

off

March 2017 Update

We are pleased to announce that following discussions at the Tunbridge Wells cluster meeting a solution has been reached for St. James Medical Practice. The practice has started merger talks with Grosvenor Medical Practice.

PREMISES & RENT REVIEWS

- 30 practices are currently going through the rent review process; the reports have been given to 2 practices and have resulted in overpayments to both practices. Both practices have unofficially advised they may appeal the decisions;

- 3 practices currently are in local dispute and are currently with the district valuers; - 3 cases lease renewal requests received but pending for approval; a value for money report

has been received from the district valuers for one case which will be submitted to the PCOG in April 2017. A further case is waiting for further comments from the district valuers before the report can be submitted to PCOG. The final case is still on-going.

Comments

Practices Requested Boundary Change Application Form

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Tunbridge Wells Cluster (3) Malling Area Cluster (3) 1 new this month Weald Cluster (2) Maidstone Central (1) Maidstone Wide (1)

Practices Submitted Boundary Change Applications to CCG 3

1. Marden 2. St James 3. Kingswood

Boundary Change Agreed 1

Marden boundary reduction (Agreed Nov 16)

Boundary Change Deferred 2

St James (Deferred until Aug 17) Kingswood (Deferred until Aug 17)

Boundary Change Rejected 0

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- 1 issue with a practice with a crumbling wall; the CCG are waiting for the outcome of the 6 facet survey.

- 1 practice has a car parking query; they applied to NHS England for five extra car parking spaces in 2013 which was rejected and a second time in 2015. This case is still on-going.

- 1 practice has a VAT issue and has submitted a formal request which will be discussed at the April 2017 PCOG meeting.

- 1 practice is in non-agreement with their landlord who has instructed an independent expert to assess the current market rent. This case is still on-going.

PRACTICE VISITS

Practices visited 57

Pending bookings 2

Visits declined 1

Total practices in West Kent 60

There are 2 practice visits outstanding for 2016/17 which will be completed in April 2017. All visits are followed up with a post visit letter. A log of actions is collated by the primary care team and status of the actions updated regularly.

PRIMARY CARE FINANCIAL PERFORMANCE REPORT

The group received an update on the primary care budget. A comprehensive report will be provided for the primary care committee in April.

GP IT UPDATE

The group received an update from Andrew Brownless on the GP Information Technology work programme.

A revised publication on the Operation Model of securing Excellence in GP IT services which dictates how practices receive the GP IT Services. The model gives a redesign of roles and responsibilities and creates an assurance for measuring GP IT provision, supported by effective governance and accountability, by demonstrating improvements in digital maturity. It focuses on the alignment of primary care IT with the local digital roadmaps.

From April 2016 there should be in place strong local leadership and an assessment of were IT should be. Looking forward we should have by March 2018 a national single Digital Primary Care Operation Model supporting and aligned to primary care commissioning. In order to provide a framework which ensures digital technology fully supports and enables new models of care including new forms of primary care organisations and service integration.

GP IT Operating Model defines and lists core and mandated services which will included;

Expanded list of services

Universal support for all practices Including implementation of national digital systems such as SCR, Patient online and GP2GP

referral

Along with Enhanced services

Local targeted investment

Page 6 of 11

21

Optimising existing systems and infrastructure

May include 7 day working and extended hours

Transformational

Such as supports integrated of health and care

NHS England continues to provide national funding for GP IT as part of the CCG baseline.

Support arrangements for GP IT is provided by the Commissioning Support Unit (CSU) and following the merger will be supported by North East London CSU. The SLA is managed by the CCG on behalf of the practice. Each practice has signed a practice agreement detailing the service that the practice receives. SECSU carry out annual reviews with each practice, the findings from these are reported to the CCG. The CCG holds monthly service meetings to review KPIs, practice requests and any escalations.

Practices have the right to change their practice systems. If the system is on the national framework then the change can be funded, however the cost of the change falls to the CCG and/or the Practice, which could cost up to £20,000.

He updated the group on CPMS, KID and Vision 360 key functionalities. CMPS provides a shared care record that any provider can access. Vision 360 gives the ability for a practice to share appointment books across practices, along with practices having the ability to update another practices clinical record. Kent Integrated Dataset (KID) is a pseudo anonymised system which his primarily used for secondary purposes.

Care Plan Management System Waiting on response from 4 practices. 2 practices have actively declined to sign up to CPMS.

Vision 360 Waiting on response from 1 practice

Kent Integrated Dataset 6 practices are yet to respond. 2 practices have actively declined sign up.

Additional Primary Care Services (APCS) The current contract expires at the end of March 2017. All contract holders were sent a

notification from the primary care team on 28th March 2017 that the contract will be extended for a period of 1 year. Contract holders have to acknowledge receipt and agree to participate in the

extension of the contract by 7th April 2017. During the 1 year extension period the primary care team will review the services to inform prospective service redesign.

QUALITY UPDATE

Primary Care Variation In November 2015, WKCCG produced practice information packs to review variation in primary care. This was followed up with a series of practice based visits. We continue to work with practices to address issues raised and provide tailored support. The second iteration of these packs were circulated in September 2016.

Page 7 of 11

22

Primary Care Data Dashboards Improving quality alongside health and wellbeing, finance and efficiency is a key ambition for the 5 Year Forward View and underpins the development of STPs at a local level.

The Primary Care Team has now taken this work forward in collaboration with SECSU and the first

iteration of this new tool will be launched on 1st May 2017 and will be updated on a quarterly basis. This will allow for easy identification of quality outliers and for us to encourage a decrease in variation of quality of services and applying consistent quality criteria.

The dashboard will allow us to look at data over the CCG, individual practices and cluster level data, which will be both helpful to us as commissioners and an incentive to practices to not have data marking them as outliers in the newly forming clusters.

Co- Commissioning Primary Care Services

WKCCG Primary Care Commissioning Committee (PCCC) The first four meetings of PCCC have been held in September, October, January and March. The PCCC are seeking more quality information to be reported to them and a quality section will now be included as part of the Primary Care report to PCCC.

Serious Incidents (SIs) and Significant Events (SEs) The quality team is working on an updated SI policy which includes general practice and an information pack to direct practices where to report different types of SIs. This work is yet to be completed and circulated to practices. We are awaiting a handover workshop from NHSE. This was due to be held September 2016 as part of a Memorandum of Understanding between NHSE and WKCCG.

WKCCG Led Sis

October 2016 The first SUI from General Practice reported to WKCCG.

The return date for the Root Cause Analysis Investigation was January 2017.The template inherited from NHSE was deemed by the review group not to be suitable for general practice use and many questions were raised from the detail given. A new template has been agreed and support given to the practice in March 2017 to complete a second report. This will be reviewed at the next SUI review group.

Public Health Led SEs

January 2017 1 event with expired vaccines and cold chain issue found by CQC at inspection February 2017 1 event with extra dose of pre-school vaccine being given

These events are classified and reviewed by PHE (Public Health England) with input sought from the quality team and then closed by PHE.

Page 8 of 11

23

Workforce and Education

Primary Care Education Facilitators (PCEF) Interviews for the 0.5 WTE fixed term post were held on 17th March and the post has been recruited to.

GP Tutors Replacements are yet to be announced for the two GP Tutor posts that became vacant over the summer period.

Network PLT Event Plans for the External PLT event in June are underway which will include a Hot Topics session for nurses and Level 3 Safeguarding for GPs.

The February PLT event provided an introduction to Document Management, clinical updates and an update on nurse education. Evaluations are in process of being collated.

HEEKSS Commissions Because of the current national workforce shortage of registered nurses and the WKCCG workforce data showing 34% WK Practice Nurses are aged over 55 and 39% are in the 45-54 age group, part of our workforce planning is to expose more students to a career in general practice and to start to grow students with general practice as their base.

WKCCG Student Nurses We have 2 Open University student nurses based in our practices and 2 commissions for pre- registration nursing degrees commencing at the University of Greenwich this month. Both successful applicants have worked as HCA’s at local practices and are keen to develop their role in primary care. These are the last fully funded training commissions and we are particularly pleased to have been able to fill both places.

Practices Offering Placements to Pre-Registration Student Nurses The Nurse Mentor register has increased from 2 in June 2014 to 26 currently.West Kent now has

another “sign off” mentor in practice to support 3rd year nursing students. Discussions are underway with CCCU (Canterbury Christ Church University) to provide a training session locally to increase numbers further. We have received expressions of interest from another 9 practice nurses locally regarding completing their mentor training.

General Practice Staff Training Team The GP Staff Training Team have had their hosting arrangement with WKCCG extended until September 2017.

Practice Nurse Advisory Service Hosted by WKCCG and the arrangement extended to March 2017. We are currently in consultation with staff of this service.

West Kent Education Network The WKEN has had its first 3 board meetings. Our main thrust in this quarter has been to help develop practice clusters. This has involved collaborative work with the CCG and GP Federation and the introduction of three new PLT events (cluster PLT events).

Page 9 of 11

24

The first event was in January and was branded as a launch event. WKEN has set itself the task of ‘making West Kent a great place to work” and sees this happening under four main headings Recruit, Train, Refresh, Retain.

Cluster PLT is about training and refreshment of staff. We aim for future cluster PLT events to be self-determining but have given cluster leads a launch pack which describes what could be achieved through these sessions.

New Developments and Initiatives Planned / Initiated Other initiatives planned are reintroduction of a programme for new to practice GPs and practice nurses, pre-retirement workshops, speed dating initiative between GP trainees and practices looking to recruit and schools career sessions

The budget plan for 2017/2018 has been completed and a “host contract” between WKEN and HEKSS has been signed and returned to HEKSS. WKEN were successful in their bid to pilot physicians’ assistants and is one of 3 across Kent, Surrey and Sussex. Further funding requests are being submitted for specific work streams and projects aligning with the 5 Year Forward View.

Care Quality Commission (CQC) regulatory activity

No. of West Kent Practices 61

CQC Inspections completed 58 95%

CQC Reports Available 49 80%

Primary Care CQC Inspection programme

5 New inspections completed in January 2017:

- Lonsdale

- Speldhurst and Greggswood

- St Andrews Medical Centre

- The College Practice

- Westerham Practice

1 Desk based report completed

- St Johns Medical Practice

6 Reports published

- Brewer Street Surgery Good

- Grosvenor Medical Centre Good

- The Surgery, Wish Valley

Requires Improvement

- Thornhills Medical Practice Good

- Tonbridge Medical Group Good

- Woodlands, Paddock Wood Good

Page 10 of 11

25

0 New inspections completed in February 2017:

1 Follow Up Report Published

- St Johns Medical Practice Good

5 Reports published

- Bower Mount Good

- Lonsdale Good

- Northumberland Court Good

- St Andrews Good

- Greensands (Stockett Lane) Good

Practices requiring improvement by CQC are now routinely followed up by NHSE and WKCCG Quality team. NHSE to check for any contract breaches and the quality team to offer support to meet requirements. Some practices have taken advantage of the quality support offered.

Quality Visits

10 Quality visits have taken place in practices during February and March with quality team members advising and supporting practices. These visits are followed up with reports and recommendations.

Ongoing work from previous quality visits

Infection Prevention and control leadership in practice. Courses commissioned.

Nursing leadership and professionalism. Courses being commissioned

Practice Manager Business Development skills. Courses being commissioned Safeguarding, MCA and DoLs, especially putting training into every day clinical practice. This has

resulted in direction to online safeguarding training and some bespoke sessions.

Two member practices have had the opportunity to take part in the piloting of a Mental Capacity Act audit tool which has given bespoke training and support and will lead to us having a tool to both help practices and assure commissioners.

Kent and Medway Workforce sustainability Buurtzorg Project

KCHFT were successful in a pilot bid for this project and are working with partner organisations, KCC and WKCCG.

The aim of the project is to introduce a pilot Buurtzorg model wrapped around one of the GP Practices in West Kent.

Aim is to deliver:

Integrated working in line with the developing Sustainability and Transformation Plan (STP)

A new model of care for NHS England and Social Care which will be fully evaluated Improved staff engagement and retention for social domiciliary care and community healthcare

workers

Page 11 of 11

26

Increased productivity as integrated working reduces ‘hand-offs’ and increases clinical productivity and timely intervention to reduce the risk of patient requiring urgent medical care interventions or admissions to acute care.

The quality team identified College Practice, Maidstone to pilot this project and the practice agreed. There is a clinical microsystem starting to support this work.

Clinical Microsystem coaching

The Quality Improvement Tool of Clinical Microsystem work continues.

WKCCG has 4 coaches currently in training, bringing our total to 16

15 quality improvement projects have been completed or closed in general practice, with supporting data showing quality improvement in topics of the practice choice.

There are 4 clinical microsystems drawing to a close across MTW, 2 wards at each site, looking at discharge of patients.

There are 4 clinical microsystems working across KCHFT in community hospitals, looking at embedding Safer Bundle with staff and patients.

There are 9 further clinical microsystems waiting to start in general practice and some work planned for each cluster development.

Appendix A

Appendix A - PCCC

April 2017.pdf

High quality care for all, now and for future generations

27

All Chief Operating Officers Kent, Surrey and Sussex Delegated Co-Commissioning CCGs

By email

24 February 2017

NHS England 18-20 Massetts Road

York House Horley

RH6 7DE Email: Sarah Macdonald14@nhs.net

Tel: 0113 82 49236

Dear Chief Operating Officers

Re: Delegated Co-Commissioning for 2017-18

Now that your CCG is coming to the end of either its first or second full year of “Fully

Delegated Co-commissioning” I wanted to take the opportunity to set out NHS

England South East expectation for 2017/18 and beyond.

From 1st April 2017 across NHS England South East 15 CCGs are expected to be

fully delegated co-commissioning (Level 3), leaving the remaining 5 CCGs at Level

1. This inevitably means that the role and focus of the General Practice contracting

team is changing. The team will now have an increased responsibility in relation to

assurance including oversight and co-ordination of GP Forward View

implementation.

The level of support provided in 2016-17 by the NHS England GP Primary Care

Team, as detailed in the MOU offer will come to an end on 31 March 2017 and NHS

England South East’s role will become focused on:

• Continuing to commission and contract for General Medical Services in the 5

CCGs who remain at Level 1 co-commissioning

• Supporting the 5 CCGs who will become Fully Delegated co-commissioners in

April 2017 through their first year of transition.

• Supporting the broader strategic and operational development of General

Practice via National Programmes and supporting the implementation of local GPFV

plans.

As such the team’s role in support of your CCG will be as follows:

• Senior Representation at CCG PCCC Meetings.

High quality care for all, now and for future generations

28

• Attendance at CCG PCOG Meetings by the NHS England designated

Contract Officer.

• Provision of technical support for those areas where a CCG decision,

judgment or interpretation of the Regulations (i.e.: practice mergers, branch surgery

closure applications, list closure applications) or contractual performance

management is required.

• Co-ordination of attendance and participation in the NHS England South East

and CCG Primary Care Network Groups.

• Co-ordination and support of CCG input into the range of national

programmes under the GP Five Year Forward View, such as ETTF and GP

Resilience Fund.

• Management and coordination of the DoHs Central Alerting Service for the

cascade of patient safety alerts.

• Managing the Occupational Health Service Contract for GPs on the national

performers list.

For the avoidance of doubt, NHS England South East will no longer routinely deliver

the following functions and consequently the responsibility for these will rest with the

CCGs under their delegation agreement:

• Issuing mandatory and statutory contract variations

• Processing the contract variation paperwork for routine contract variations

(e.g.: partnership changes) which can be processed in accordance with the

Regulations, and which do not require a decision.

• Managing the allocation of patients onto the Violent Patient Scheme

(delegated CCGs were already responsible for the commissioning and contracting

arrangements for this Directed Enhanced Service in accordance with the Delegation)

• For assessing and calculating payments under the SFE in relation to

maternity/paternity leave and sickness

• Facilitation between CCG and Practice discussion via the Premises Group in

order for decisions relating to Premises Costs Directions issues to be made and

communicated.

• Instructing an appointed surveyor (e.g.: the District Valuer) to undertake 3

yearly rent reviews in line with the obligations set out in the Premises Costs

Directions.

High quality care for all, now and for future generations

29

• Management of CQRS including offering of QOF and Enhanced Services as

appropriate. Please note, however, that the CCG will be provided with a 3-month

transition period for the transfer of this until 01.07.2017

• Management of patient allocations. For those elements above that do not

have a transition period NHS England will provide full training and guidance to CCGs

prior to 31st March 2017. I am aware that most CCGs have been undertaking these

functions for some time now, however I did want to be explicit such that there was

not confusion in role going forward. The list above are also key functions that

support contract management, strategic development and direct patient

communication, all of which will provide the CCG with a picture of issues their

General practices are facing.

If you have any queries regarding any of the elements within this letter then please

do not hesitate to contact the Primary Care Lead for your area in the first instance

(i.e. Stephen Ingram – Surrey and Sussex or Richard Woolterton – Kent and

Medway).

Yours sincerely

Sarah Macdonald

Director of Commissioning

NHS England South (South East)

Primary Care Co-commissioning Finance Update

This paper is for: Information

Recommendation: The committee is required to note the financial position of the

PCC budget.

For further information or for any enquiries relating to this report please contact:

Reg Middleton, Chief Finance Officer

Date: 4th April 2017

Reporting Officer: Yin Yau, Deputy Chief Fina nce Officer Agenda Item: 7

Lead Director: Reg Middleton, Chief Finance Officer Version: Final

Report Summary:

The report is a summary of the current financial performance of the Primary Care Co- commissioning budget (PCC) .

FOI status: This paper is disclosable under the FOI Act

Strategic objectives links: E: Sustainable Finances

Board Assurance Framework This paper supports the mitigation of the following links: strategic risk:

E Loss of control over provider activity and system finances could result in the CCG being unable to invest in service development and ultimately breaching its statutory duties.

Identified risks & risk N/A management actions:

Resource implications: N/A

Legal implications N/A

April 2017

NHS West Kent CCG 30

Equality & Diversity Assessment

Has an equality analysis been undertaken?

☐Yes

☒Not applicable

Report history: N/A

Appendices N/A

Next steps: N/A

April 2017

NHS West Kent CCG 31

32

2016/17 Primary Care Co-commissioning Finance update

1.0 2016/17 Finance Update

1.1 The Primary Care Co-commissioning (PCC) budget is forecasting a £1.38m

underspend at Month 11 against the operating budget of £57.9m.

1.2 A summary of the CCG’s financial forecast performance at Month 11 (February 2017)

is detailed below with the comparison to the Forecast Outturn M10 and M8 position

reported to the PCC in the last financial update.

PCC Category of Expenditure

Annual Budget £’000

Forecast Outturn M11

£’000

Forecast Variance M11

£’000

Forecast Variance M10

£’000

Forecast Variance M8

£’000

GP Contracts (GMS, PMS, APMS) 38,118 37,467 (651) (801) (909)

Premises 7,353 7,451 98 100 208 Enhanced Services 3,219 2,600 (619) (124) (83)

QOF 5,597 6,020 423 203 346

Other GP payments 3,616 2,990 (626) (628) (560)

Total 57,903 56,528 (1,375) (1,250) (998)

1.3 Premises - Provisions have been made in the forecast outturn for all known premises

costs that are likely to crystallise in the current financial year eg Rent reviews likely

to result in an increase in reimbursement back dated to the date of review.

1.4 Quality and Outcomes Framework (QOF) – Based on current practice intelligence and

information it is likely that GP Quality achievement rewards would exceed their

2016/17 budget provision. It remains the policy of the CCG to inspire, encourage and

support GP Practices in their quality aspirations.

1.5 During the last 3 months, it has been evident that core contract payments have

increased to practices which impacts upon the increased forecast GP contract

expenditure. Conversely, the CCG has no evidence from payments and claims that

practices are taking up the provision of national enhanced services at the rate

assumed by the CCG earlier on in the year. Eg Extended Hours

33

2.0 Co-commissioning Budget 2017/18 Updates

2.1 The summary budgets for 2017/18 were presented to the PCC in December 2016 as

detailed below:

2.2 The budgets have been updated to reflect increases in premises costs from the

introduction of a change in business rates which may have an impact on some smaller

practices. An allowance for £5,000 to cover the impact of BID levies (affects 5 practices

in West Kent) has already been included as this is funded within the CCGs baseline

allocation for delegated co-commissioning.

2.3 The budget for other payments has been updated to reflect sickness leave

reimbursement which has increased from £1,131.74 to £1,734.18 per week as well the

impact of funding CQC costs and indemnity fee increases.

4.0 Recommendation

4.1 It is recommended that the PCC committee note the following

Financial Update for 2016/17 and the forecast outturn being reported

4.2 It is recommended that the PCC committee note

2017/18 PCC budget set of £59.111m has been revised and that a

there remains an amount of £300,000 which is unbudgeted for and

will be utilised flexibly to either support expenditure that actually

exceeds budget or can been used Non-recurrently during the year to

support GP practices.

PCC Category of Expenditure

2017/18 Annual

Budget provided at Feb 2017 PCC

£’000

Updates and Changes

March 2017

2017/18 Annual

Budget update at March 2017

£’000

GP Contracts (GMS, PMS, APMS) 38,500 38,500

Premises 7,700 7,850

Enhanced Services 3,200 3,200

QOF 6,000 6,000

Other GP payments 3,000 3,250

Premises development – strategy and impact of increase in business rates not allowed for

150

Other GP payments increasing payments for locums and CQC

250

Practices development – infrastructure, premises, IT, practice support

711 -400

Uncommitted funds / contingency 311

Total 59,111 - 59,111

Primary Care Commissioning Committee (PCCC) Risk Register

This paper is for: Discussion

Recommendation: To review and agree the updated PCCC risk register (April 2017).

For further information or for any enquiries relating to this report please contact:

Gail Arnold

Date: 4th April 2017 Reporting Officer: Louise Downs Agenda Item: 8

Lead Director: Gail Arnold Version: Final Report Summary:

As part of the governance processes for the effective operation of West Kent Clinical Commissioning Group, a risk register is required for all major areas of the business. The PCCC is asked to review and update the PCCC risk register in light of any significant changes that may have occurred since its last meeting and agree the PCCC risk register. New risks:

PCCC012 – Failure to support practices with the retirement/replacement of Open Exeter system in 2018 which may affect practices ability to claim payments PCCC013 – Failure of practices to develop robust IT Business Continuity plans PCCC014 – Failure of practices to adequately manage cyber security threat PCCC015 – Failure of practices to manage the correct entry of clinical data into the practice system PCCC016 – Risk that the GP IT budget delegated to the CCG is not sufficient for the level of service practices need resulting in an inadequate IT service given to practices Closed risks: PCCC004 – Failure to adequately manage conflict of interest. Risk removed from primary care risk register as advised by company secretary that this should sit under the corporate risk register PCCC006 – Failure to adequately resource the delivery of the digital roadmap plan. Risk removed from primary care risk register as advised by Chief Information Officer that this should sit under the corporate risk register

April 2017

NHS West Kent CCG 34

Page 1 of 2

FOI status: This paper is disclosable under the FOI Act;

Strategic objectives links: All

Board Assurance Framework links:

Risk Registers underpin the Board Assurance Framework, and all major changes to risk are reviewed on a bi-monthly basis.

Identified risks & risk management actions:

None

Resource implications: None

Legal implications The Policy Book for Primary Medical Services (https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2016/01/policy-book-pms.pdf aims to support a consistent and compliant approach to primary care commissioning across England. It is essential that any decisions relating to primary care confirm to this guide and other statutory regulations and standard operating procedures that are in force.

Equality & Diversity Assessment

Has an equality analysis been undertaken?

☐Yes

☒Not applicable

Report history: N/A

Appendices None

Next steps: Primary Care Operational Group (PCOG) to regularly review and update the PCCC risk register.

April 2017

NHS West Kent CCG 35

Page 2 of 2

36

Initial Current Targe

NHS West Kent CCG Strategic Goals 2014-19 Risk Ref Date added to

register

Risk Description

An explanation of the potential risk.

Con

sequ

ence

Like

lihoo

d

Init

ial R

isk Key Controls in Place

Controls that are in place which mitigate the level

of risk i.e. contracts, action plans, monitoring

arrangements, consultations, meetings with key

staff, training programmes, terms of reference etc.

Internal & External

Assurances on Controls

Evidence that shows that

the controls are working,

for example an audit

report, an inspection

report, an independent

review, national

benchmarking, board

reports, consultations, KPI

reports, NHSLA

assessments, service

reviews, annual reports,

SIC, review of strategies,

incident reports etc.

Con

sequ

ence

Like

lihoo

d

Cu

rren

t R

isk Gaps in Controls

Where key controls in place are

not effective in mitigating the level

of risk. This could be due to a

number of factors such as non-

compliance with policies,

insufficient resourcing, a shift in

priorities, lack or monitoring or

management.

Gaps in Assurances

Where there is no

evidence of assurance

or where the assurance

provided is limited or

gives a negative view

i.e. an adverse external

report.

Action Plan to Mitigate

How the gaps in controls and/or

assurances are being managed

and what measures are being

introduced to affect this.

Con

sequ

ence

Like

lihoo

d

t

Targ

et R

isk

R

isk

Ow

ner

La

st M

od

ifie

d

R

evie

w D

ate

Stat

us

Latest PCCOG/PCCC

Update

Strategic Goal A: Implementation of

Mapping the Future Blueprint

PCCC001 03/08/2016 Failure to develop and embed New

Models of Primary Care (MCP)

4 4 16 Local care in STP process.

Clusters of practices created.

Cluster support teams specifications designed.

Working group established to develop detailed

service specification for Hub and Cluster model.

Engagement session with Members held on 19

July 2016 to discuss Hub and Cluster service.

GP federations have been established as a legal

entity and CCG support has been agreed -

COO, Depty CFO and Head of Medicines

Optimisation aligned to support the

developement of federations. Clusters

identified, working with primary care teams to

identify Hubs. Engaged in the K&M wide local

care workshops. Key funding source to support

the developement of MCP's announced by NHS

England

Monthly report on

contractual issue to

PCOG. PCOG update

report to PCCC. K&M

wide Local care

Workshops report to WK

GB on development of

Federations

4 4 16 1) New Primary Care requires

significant support with MCPs

highly reliant on Federations

developing as organisations;

2) Shortage of staff/capability

to develop and implement

system components for

delivering the Mapping the

Future Blueprint and

supporting the design and

implementation of New

Primary Care.

extent of investment in NPC

necessary to achieve

transformation in

development.

Programme Director for Local

Care recruited.

New Primary Care business

case approved by Governing

Body in November 2016

4 2 8 Gail Arnold,

Chief

Operating

Officer

23/03/2017 23/04/2017 Open

Strategic Goal F: Robust governance PCCC02 03/08/2016 Failure to adequately resource and

discharge duties of delegated co-

commissioning responsibilities

4 4 16 PCCC bimonthly meetings established.

Monthly PCCOG meetings established.

Policies and Procedures relating to key

activities of business adopted.

Regular communication with NHS England, NHS

England representation at Primary Care

Operational Group meeting. Scheme of

delegated PCCC responsibilities to PCOG

approved to ensure effective and timely

management of GMS contract

Monthly report to PCOG

and PCCC regular

feedback to and from

NHS England

4 4 16 Staffing levels and skill mix not

covering all responsibilities -

lack premises and contracting

expertise.

Not all staff in post.

Backlog of work in handover.

Increasing workload

associated with

delegated

commissioning

Recruitment to premises and

contracting roles has

happened but staff will not be

in post until April 2017.

Matrix working across CCG

staff.

8B vacancy in primary care

and deputy COO now in post

4 2 8 Gail Arnold,

Deputy Chief

Operating

Officer

23/03/2017 23/04/2017 Open Once all staff are in

post current risk

rating can be

reduced as agreed at

March PCCC

Strategic Goal C: Improved health

outcomes and reduced health

inequalities

PCCC003 07/11/2016 Failure to address unwarranted

variation and improve practice

performance in primary care

4 3 12 Primary Care Information Packs produced for

the second year and circulated to practices to

show relative peformance.

80% of practice visited and actions discussed.

Electronic referrals focus in March 17.

Clusters established with a part to play in

reducing variation.

Regular data sets to show gaps and

opportunities.

Working with Borough Councils on Joint

agendas to address variation.

CCG lead for dementia appointed.

Utilising sophisticated audit tools (GRASP COPD

& AF) as part of LIS.

New specification and provider arrangements

for diabetes.

Practice visits booked

and undertaken for

2016/17.

Action plans in place as a

result of practice visit.

4 3 12 Practice information packs only

provide a snapshot at a point in

time. Future iterations will

include trend data and

appropriate benchmarking with

increased number of data sets

for a broader view of practice

performace.

Packs are being developed

into dashboards and will be

updated on a quarterly basis.

The first iteration is planned

for May 2017. A working

group has been established to

discuss the dashboard and

make any necessary

amendments before being

issued to practices.

All practices will be offered a

visit every year but visits will

be prioritised in terms of

highest consumers of

resources. All visits are

followed up with individual

practice letter and a log of

actions has been collated

which is updated regularly.

4 2 8 Gail Arnold,

Dr Garry

Singh

23/03/2017 23/04/2017 Open

37

Strategic Goal C: Deliver improved

health outcomes and reduced health

inequalities

PCCC005 01/08/2015 Failure to deliver on the Local

Improvement Scheme (LIS) 2016/17

5 2 10 Practice Engagement Committee (PEC)

subcommittee designed Local Incentive

Scheme (LIS) for 2016/17 and proposal

supported by PEC.

PEC Recommendations Paper agreed by

governing body in March 2016 meeting.

Interim report to Audit Committe

Monthly and quaterly

report from practices to

the LIS Coordinator.

Quarterly GRASP COPD

progress report

4 2 8 Lack of engagement and sign-

up from practices on all

elements of the scheme.

Acheivement on some

elements of the schemes can

not be determined until the

end of the scheme. Lack of

capacity in primary care to

deliver all elements of the

scheme

Communication with

practices to ensure

performance is on

track.

Open communication with

practices. Practical support

offered to practices with

technical issues for GRASP

component.

2 2 4 Gail Arnold,

Dr Garry

Singh

23/03/2017 23/04/2017 Open

Strategic Goal F: Robust governance PCCC008 01/03/2017 Failure of the Primary Care

Commissioning Committee to discharge

its duty as decisions are made

elsewhere in the CCG which affect

primary care

4 3 12 Ensure that decisions made by other

committees affecting primary care are reported

to PCCC

Regular updates

provided and primary

care representation at

relevant meetings where

possible

3 3 9 Capacity for primary care

representation at relevant

meetings. Ensure minutes of

relevant meetings are available

if representation not possible.

PCOG activity reported to

PCCC on a regular basis.

Regular discussions at PCCC

on issues/decisions made at

other POGs/committees

affecting primary care.

There is a governance process

in place to ensure decisions

made at CSG are fedback to

and discussed at PCCC

3 2 6 Gail Arnold 23/03/2017 23/04/2017 Open

Strategic Goal G: Robust Organisational

Competence

PCCC009 01/03/2017 Failure to adequately support the

sustainability of individual practices

4 4 16 Effective management of GMS contracts and

other non-GMS contracts in place affecting

primary care.

Individualised practice visits to gather

intelligence and early warning signs.

Offering microsystems Coaching.

Supporting individual practices and clusters to

ensure sustainability and prevention of practice

failure. Regular

and proctive practice visits and follow up.

Development of Local Care.

There are significant workforce pressures and

West Kent Education Network have been

tasked with the development of a planning

strategy to overcome this.

Business plans need to be developed for the

forthcoming 2 - 3 years due to the extended

training times for healthcare professionals.

Cluster focused planning.

Support given to practices with mergers.

Effective contract

management.

Effective monitoring of

list closures and liasing

with practices where

necessary.

Adequate processes in

place for escalating

concerns to Executive

team.

Close working with

Quality team.

Rolling programme of

practice visits allowing

issues to be addressed.

Reports provided to

PCCC.

4 3 12 Staff member responsible for

contract management not in

post until April 2017.

Staff capacity.

Monitoring of list closures

and ensuring practices are

following correct process.

Liasing with practices that

have advised of termination

of contract and supporting

with contingency options and

mergers if applicable.

Regular meetings with

practices if necessary to

highlight any issues.

Supporting clusters and

federations with issues such

as workload, skill mix and

sharing back office functions.

Bidding for resilence funds to

support practices with the

challenges they face.

New model of care is being

designed to support practices

to become more sustainable.

3 3 9 Gail Arnold 23/03/2017 23/04/2017 Open

Strategic Goal E: Sustainable finances PCCC010 01/03/2017 Failure to ensure an adequate plan is in

place to support the estates (premises)

and finance strategies

4 3 12 Ensure an appropriate plan is in place to

develop a suitable estates strategy

Development of an

estate strategy.

Recruitment to post with

estates expertise

3 3 9 Staff member responsible for

premises not in post until April

2017

No ETTF funds so will

need to find other

resources to support

the development of

suitable estates to

deliver the STP

Support practices to source

suitable premises.

Work with other CCGs and

partners (such as local

authorities) to identify

appropriate estates for

services to be held in/offered

from.

3 2 6 Gail Arnold 23/03/2017 23/04/2017 Open

38

Strategic Goal D: Service quality and

patient safety

PCCC011 01/03/2017 Lack of adequate and appropriate

workforce and skill mix to support the

delivery of the new primary care and

local care agenda

4 3 12 West Kent Education Network (WKEN) have

been tasked with leading the development of a

workforce planning strategy that will

adequately support the new model of care.

CQC reports scrutinised and any areas of

concern investigated and addressed.

Regular reports will be

requested from WKEN.

Clusters to identify gaps

in workforce.

STP Workforce

workstream.

3 3 9 Lack of detail of practice

workforce.

Out of date information from

HEKSS.

Lack of regular

reports to PCCOG or

PCCC on workforce

planning

Regular reports provided by

WKEN will be discussed at

PCOG and PCCC when

necessary

3 2 6 Gail Arnold 23/03/2017 23/04/2017 Open

Strategic Goal E: Sustainable finances PCCC012 20/03/2017 Failure to support practices with the

retirement/replacement of the Open

Exeter system in 2018 which may affect

practices' ability to claim payments

5 3 15 Practices are supported significantly by the

finance team who offer support and will

expedite payments if necessary. There is a

dedicated email address for practices to report

issues.

3 2 6 Practices have reported

concerns that it is difficult to

reconcile payments against

claims on SBS and there are

long delays in the transfer of

patient records.

At this time it is

unknown what

system will replace

Open Exeter.

Chair of PCCC to write to

Capita and NHS England to

raise concerns and seek

assurance on behalf of

primary care.

Practices will require support

and training on new system.

2 2 4 Gail Arnold 23/03/2017 23/04/2017 New risk

Strategic Goal G: Robust Organisational

Competence

PCCC013 20/03/2017 Failure of practices to develop robust IT

Business continuity plans which could

affect practices ability to operate as

they are totally dependent upon IT.

Practices need to ensure capability to

operate when IT is not available. Plans

need to cover server, network, system,

power cut and N3 connection issues. If

an issue affected a number of practices

concurrently this would impact the

CCG.

4 2 8 Support offered to practices by system

software providers.

INPS offers guidance on daily actions practices

should take to ensure effective business

continuity including manual backups, tape

cycles and restoring data. They also offer a

disaster preparation planning user guide and

allow users to access clinical data offline.

Emis offers a business continuity mode which

allows for a limited view of locally based

version of patient data and when business

continuity mode is activated it regularly checks

for restored connectivity and will alert users if

restored.

IT support offered to

practices by CSU.

Support offered to

practices by system

providers.

4 2 8 No process in place to ensure

practices have a plan in place

and to ensure that completed

plans are adequate.

Capacity of practice

staff to develop and

complete business

continuity plan

Overseen by Chief

Information Officer

4 1 4 Andrew

Brownless

23/03/2017 23/04/2017 New risk

Strategic Goal G: Robust Organisational

Competence

PCCC014 20/03/2017 Failure of practices to adequately

manage cyber security threat. If there

was a significant breach this could

affect their ability to operate as they

are totally dependent upon IT.

If a number of practices were

concurrently affected this would impact

the CCG.

5 4 20 Up-to-date software and hardware which are in

warranty.

Up-to-date anti virus and cyber security

packages.

All practice staff to undertake cyber security

awareness training.

Practices need an IT business continuity plan in

place.

IT support offered to

practices by CSU.

Support offered to

practices by system

providers.

3 3 9 No process in place to ensure

practices have necessary

software packages in place,

have undertaken training or

have developed business

continuity plans.

Lack of knowledge

amongst practice

staff around cyber

security.

Overseen by Chief

Information Officer

2 2 4 Andrew

Brownless

23/03/2017 23/04/2017 New risk

Strategic Goal G: Robust Organisational

Competence

PCCC015 20/03/2017 Failure of practices to manage correct

entry of clinical data into the practice

system resulting in the wrong or poor

quality clinical data bein entered which

could result in patients receiving the

wrong clinical treatment.

4 4 16 Correct set up of system.

Staff training offered by CSU on use of system.

Data quality audits.

IT support offered to

practices by CSU.

Support offered to

practices by system

providers.

4 2 8 Capacity of CSU to offer training

to practice staff.

Lack of knowledge

amongst practice

staff around use of

the system.

Overseen by Chief

Information Officer

2 2 4 Andrew

Brownless

23/03/2017 23/04/2017 New risk

Strategic Goal G: Robust Organisational

Competence

PCCC016 20/03/2017 Risk that the GP IT budget delegated to

the CCG is not sufficient for the level of

service practices need resulting in an

inadequate IT service given to practices

3 3 9 Effective budget management and tracking.

Ensure best value for money is obtained.

Lead Provider Procurement - service from CSU.

3 3 9 Lobby NHSE if necessary if

funds are not sufficient.

2 2 4 Andrew

Brownless

23/03/2017 23/04/2017 New risk

Primary Care Commissioning Committee (PCCC) General Practice Premises Condition Survey

This paper is for: Approval

Recommendation: The Primary Care Commissioning Committee is asked to approve the

document.

For further information or for any enquiries relating to this report please contact;

Priscilla Kankam, Lead Pharmacist

Date: 4th April 2017 Reporting Officer: Priscilla Kankam & D Dunn

ebbie Agenda Item: 9

Lead Director: Gail Arnold Version: Final

Report Summary: This paper provides background and information to the Primary Care Commissioning Committee regarding the GP Premises Condition Survey.

FOI status: This paper is disclosable under the FOI Act;

Strategic objectives links: All

Board Assurance Framework

links: All

Identified risks & risk None management actions:

Resource implications: None

Legal implications N/A

Equality & Diversity Has an equality analysis been undertaken? Assessment ☐Yes

☒Not applicable

Report history: N/A

Appendices None

Next steps: N/A

April 2017

NHS West Kent CCG 39

Page 1 of 1

40

General Practice Premises Condition Survey

1. Introduction and Background

1.1. Estate is recognised as key enabler that will support us to deliver new models of care and

develop more innovative ways of working.

1.2. The CCG has established a Local Estates Forum (LEF) the core purpose of which is to consider

and make recommendations on the optimal use of public estate across West Kent health

and social care system; the first meeting is taking place on 26 April 2017.

1.3. This is a whole system forum with membership drawn from West Kent CCG, Kent

Community NHS Foundation Trust, Kent & Medway NHS Partnership Trust, Maidstone &

Tunbridge Wells NHS Trust, Kent County Council, Maidstone Borough Council, Tunbridge

Wells Borough Council, Sevenoaks District Council and Tonbridge & Malling Borough

Council, NHS Property Services Ltd, GP Federations, Local Medical Committee.

1.4. The core purpose of the Local Estates Forum (LEF) is to consider and make

recommendations on the optimal use of the public estate across the West Kent health and

social care system. This will specifically include

Utilising the estate to deliver new models of care, through more integration and a wider range of co-located services from good quality premises

Maximising use of facilities – using the existing estate more effectively (sharing property, particularly with social care and the wider public sector) and reconfiguring the estate to better meet commissioning needs

Improving effective and appropriate utilisation of the estate

Improving the management of the estate by identifying how we can deliver value for money - reducing running and holding costs and disposing of surplus estate to generate capital receipts for reinvestment

Reshaping the estate to support wider service redesign, in particular the shift of services into the community

Aligning the estate to the Kent & Medway STP and Service Delivery Plans

Partnering across organisations to achieve maximum system benefits – supporting the ‘One Public Estate’ objectives

2. General Practice Premises

2.1. To support and inform the continued development of the Local Care plan it is important that

the CCG gathers baseline information regarding current estate across health and social care.

Whilst a lot of information already exists an exercise will be co-ordinated through the Local

Estates Forum to bring this together.

2.2. To enable the provision of baseline general practice premises information as part of the

wider plan it is proposed that a condition survey of all general practice premises is

41

commissioned as a one off exercise. This would exclude those practices that have premises

moves already planned.

2.3. It is proposed that this information be collected through the use of a RAG assessment

framework and the outputs will support more informed and co-ordinated discussions within

practices, clusters and with other providers in West Kent regarding opportunities and

efficiencies to support a new model of local care.

2.4. This information will also allow the CCG to take a more strategic approach to the

identification and allocation of any available S106/CIL funding linked to housing

developments as part of the local care plan.

2.5. The proposed exercise follows the same approach as other general practice premises

surveys already undertaken in Kent & Medway. The objectives of this exercise have been

discussed with a representative of the LMC.

2.6. The CCG has considered this approach against the traditional 6 facet survey and believe that

this will provide more useable information for individual practices, cluster and wider CCG

for the purposes outlined above.

3. Proposed Brief and timeline

3.1. It is proposed that each premises survey will provide up to date and accurate information on

the following areas:

Type of building construction and physical condition

Patient pressure on existing Gross Internal Area

Patient and staff safety and access

Ward depravation factor

Compliance with minimum standards set out in the NHS (GMS Premises Cost Directions) 2013

Potential for further development of the site to provide additional surgery accommodation in line with housing growth trajectory

Potential of the surgery premises to be altered to increase/improve services

Practice views around the ability of the premises to support the practice in service delivery now and in the future

Premises tenure details including notional rent levels

3.2. The exercise must be undertaken in strict accordance with the current NHS (GMS Premises

Cost Directions) 2013

3.3. The high level requirements for the narrative report accompanying the RAG assessment are

detailed in Appendix 1. The CCG expects to discuss and agree a final format with the

42

commissioned provider. The project brief would include the requirement to provide a

completed survey report (practice level) within 2 weeks of the first survey date to ensure it

is of the required standard and in agreed format.

3.4. Excluding those practices where premises moves are planned the CCG has identified 81

premises for inclusion in this exercise.

3.5. The CCG would provide a full list of sites including practice list size and gross internal area

(where known) and the commissioned organisation would make contact with each practice

via the Practice Manager.

3.6. Due to the need to progress this work at pace a waver for full competitive tender has been

supported and five companies would be contacted to provide quotes against a project brief.

3.7. The proposed timeline is as follows:

Requests for quote issued Thursday 6 April.

Clarification calls to take place as required w/c 10 April

Quotes received by 5pm Tuesday 18 April 2017.

Works instructed by Monday 24 for completion by Friday 16 June 2017.

3.8. A summary report providing full results for analysis by the CCG and NHS Property Services

(Strategic Estates support) will be required. The CCG would expect this report to include a

summary at CCG and Cluster level.

3.9. Practice level reports would be shared with individual practices.

3.10. A communication would be issued to general practice providing information

regarding the survey exercise at the same time that the brief is issued to providers

requesting quotes.

3.11. The brief would detail a guide budget of £34,000.

4. Recommendation

The Primary Care Commissioning Committee is asked to consider and support the proposal regarding

condition surveys of general practice premises.

43

Appendix 1 – Summary of requirements & RAG Assessment Tool

A Summary useable report at CCG and cluster level including a summary narrative and appendix with RAG assessment for each practice premises.

A useable report at practice level is required (may include more than one premises); the report should include a completed RAG assessment for each premises (see below).

Item Description Notes

1 Type of building construction. Narrative required

2 Patient pressure on existing Gross Internal

Area

Use list size at 1 July 2016 supplied by CCG.

Use GIA information supplied by CCG, where

not available/known request from practice.

3 Ward deprivation factor Use Index of Multiple Deprivation (IMD) 2015

Available via gov.uk or Kent Public Health

Observatory website.

4 Patient and staff safety and access Narrative required. Please note any obvious

non-compliance issues and recommendations

for improvement.

5 Premises Directions 2004 - Minimum

Standards

Narrative required, including any areas of

improvement.

6 Pressure on existing accommodation from

external factors

Narrative required; linked to local council

housing development plans (available on local

council websites)

7 Suitability of the existing surgery premises for

the longer term

Narrative required

8 Potential for further development of the site

to provide additional surgery

accommodation.

Narrative required

9 Potential of the surgery premises to be

altered/extended to increase services

Narrative required

10 Conclusion & summary overview of premises

(including weighting as per RAG tool)

Narrative conclusion, RAG and suggested next

steps

11 Completed RAG tool As per RAG provided

RAG ASSESSMENT TOOL

Type of building

construction.

Patient pressure

on existing Gross

Internal Area.

Ward deprivation

factor

Patient and staff

safety and

access.

Premises

Directions 2004 -

Minimum

Standards

Pressure on

existing

accommodation

from external

factors

Suitability of the

existing surgery

premises for the

longer term

Potential for further

development of the

site to provide

additional surgery

accommodation.

Potential of the

surgery premises

to be

altered/extended to

increase services

Summary

overview of

premises, ie

score of 1, 2 or 3

x weighting

factor*

Purpose built

surgery

accommodation

post 1998

Low - 12 & under

patients per sq.m

GIA

Ward in top 50%

Compliant with

NHS guidance

and statutory

requirements.

May include

CCTV and other

security features

Minimum

Stardards easily

met or exceeded

Rural area within

an area of

development

restraint

Good design, well

presented and

maintained

premises.

Existing premises

can be extended

without the need

for further land

acquisition.

There is scope for

providing an

extension to the

premises

Premises provide

good quality

facilities.

Purpose built

surgery

accommodation

pre 1998 which

significantly

complies with

NHS guidance.

Medium - 12 - 18

patients per sq.m

GIA

Ward in 20%-

50%

Generally fully

compiant but may

have poorer

design features or

specification. Not

fully compliant

with DDA

requirements.

Some criteria

where Minimum

Standards are

achieved with

reservation

Urban area with

average

population growth

Premises are

considered only

suitable for

providing existing

services

Existing premises

can only be

extended with the

acquisition of

available

adjoining

development

land.

Minor alterations to

the existing

premises would

improve service

potential

Premises are

generally

considered

satisfactory but

some areas of

potential

improvement

have been

identified.

Poorer quality

converted

accommodation

pre 1998 or not

fully compliant

with NHS

guidance.

High - over 18

patients per sq.m

GIA

Ward in bottom

20%

Major

improvement

works required to

bring surgery into

line with NHS

guidance and

statutory

requirements.

Practice premises

has difficulty in

achieving the

Minimum

Standards in

some or all areas.

An area where

sites are

allocated

residential

development

which will result in

significant

population growth

Premises are not

considered to be

suitable for the

long-term.

The physical

constraints of the

site and adjoining

land prohibits

further

development.

No potential for

minor alteration or

extension to the

premises

Premises

considered

unsatisfactory.

There is an

identified need to

improve facilities.

44