NHS NORTH DURHAM CLINICAL COMMISSIONING GROUP … · 2020. 4. 30. · PCC/17/64 Sale and Leaseback...

Official

NHS NORTH DURHAM CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday 26 July 2017 1.00 pm – 2.15 pm

Conference Room, Groundworks, Greencroft Industrial Park,

Stanley, DH9 7XN

AGENDA

Item

Time Documents

PCC/17/52 Apologies for absence Dr Ian Davidson, Mike Brierley

1.00 pm

PCC/17/53 Declarations of Conflicts of Interest A copy of the conflict of interest register for the Committee members is attached.

attached

PCC/17/54 Identification of any Other Business Items

PCC/17/55 Minutes of the Primary Care Commissioning Committee held on 24 May 2017

PCC/17/56 Matters arising from the Minutes of the Primary Care Commissioning Committee held on 24 May 2017

verbal

PCC/17/57 Action log

ITEMS FOR DECISION

PCC/17/58 Dunelm Medical Practice - Application for temporary closure of Framwellgate Moor Medical Centre Director of Primary Care Development and Innovation (non-clinical) - Joseph Chandy

1.10 pm attached

ITEMS FOR DISCUSSION

PCC/17/59 Standing item: Primary Care Finance Report for the three months ended 30 June 2017 Chief Finance Officer - Richard Henderson

1.20 pm attached

PCC/17/60 Standing item: Risk Management Report Chief Finance Officer - Richard Henderson

1.30 pm attached

PCC/17/61 Standing item: Primary Care Development update Director of Primary Care Development and Innovation (non-clinical) - Joseph Chandy In attendance to present the report: Commissioning Manager, North of England Commissioning Support - Gill Smith

1.40 pm attached

PCC/17/62 Standing item: Quarterly Primary Care Quality report (Quarter 4, 2016/17) Director of Nursing - Gill Findley

1.50 pm attached

UPDATES

PCC/17/63 General Primary Care update Director of Primary Care Development and Innovation (non-clinical) - Joseph Chandy Acting Head of Primary Care, NHS England

2.00 pm verbal

2

- Denise Jones

FOR INFORMATION

PCC/17/64 Sale and Leaseback Guidance Chief Finance Officer - Richard Henderson

attached

PCC/17/65 QUESTIONS FROM THE PUBLIC

The Committee will consider pre-notified questions from the public.

verbal

PCC/17/66 Standing Item: Risk Round-up To identify any areas of risk that might need to be added to the CCG’s risk register.

2.10 pm verbal

PCC/17/67 Any other business

Date and time of next meeting The next meeting will be held in September 2017, date to be arranged.

Resolution to Exclude the Public and Press That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest. (Section 1(2) Public Bodies Admission to Meetings Act 1960).

Contact for the meeting: Amanda Coates, Corporate Administrator Tel: 0191 3898592 Email: [email protected]

3

mailto:[email protected]

North Durham CCG: Conflict of Interest Register 1

Job role/title at CCG

Declared Interest (nature of business and organisation) Is the interest direct or indirect?

Action taken to mitigate risk (agreed with line manager where appropriate)

Title First name Surname

Coun

cil o

f Mem

bers

Empl

oyee

Fina

nce

and

Perf

orm

ance

Com

mitt

ee

Gov

erni

ng B

ody

Man

agem

ent E

xecu

tive

Patie

nt, P

ublic

and

Car

er

Enga

gem

ent C

omm

ittee

Prim

ary

Care

Com

mis

sion

ing

Com

mitt

ee

Qua

lity,

Res

earc

h an

d In

nova

tion

Com

mitt

ee

Rem

uner

atio

n an

d Te

rms

of S

ervi

ce

Risk

and

Aud

it Co

mm

ittee

Oth

er

Declared Interest (nature of business and organisation)

Fina

ncia

l

Non

-Fin

anci

al P

rofe

ssio

nal I

nter

ests

Non

-fina

ncia

l per

sona

l

Indi

rect

Is the interest direct or indirect?

Dat

e fr

om

Dat

e to

Action taken to mitigate risk (agreed with line manager where appropriate)

Mr Andrew Atkin Lay Member Yes Yes Yes Yes YesEmployed by Durham Dales, Easington and Sedgefield CCG as Lay Member

Yes Direct 01.02.17 The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.

Mr Andrew Atkin Lay Mamber Yes Yes Yes YesWife is an employee of Durham Dales, Easington and Sedgefield CCG

Yes Direct 01.02.17The person declaring the interest will fully outlined how they might be benefitted as a result of a decision being made by the CCG in relation to that area of conflict of interest. The course of action relating to whether the person should take part in any discussions/decision making would be made on a case by case basis.

Mrs Nicola Bailey Chief Operating Officer Yes Yes Yes Yes YesEmployed as Chief Operating Officer of Durham Dales, Easington and Sedgefield CCG with effect from 01.03.14


Mrs Nicola Bailey Chief Operating Officer Yes Yes Yes Yes Yes Daughter works for NECSU until end of July 2016 08.05.15 31.07.16

Mr Mike BrierleyDirector of Corporate Programmes,Delivery and Operations

Yes Yes Yes Yes Yes YesWife, Sue Brierley works for County Durham and Darlington NHS Foundation Trust (CDDFT)

Yes Indirect 24.05.16Any conflict of interest declared in relation to an indirect interest will be considered on a case by case basis depending on the discussions taking place at the time.

Mr Joseph ChandyDirector of Primary Care Development and Innovation (Non Clinical) - from 1/3/16

Yes Yes Yes Yes YesPartner and provider - Shinwell Medical Group, Jupiter House Surgery Yes Direct 24.05.16 The person declaring the financial interest will not take part in any decision making

relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.


Yes Yes Yes Yes YesPartner - Wheatley Hill and Thornley Practice, Carodoc Practice



Yes Yes Yes Yes YesPremises interest - Peterlee Health Centre, Wheatley Hill Thornley Medical Practice and Shinwell Medical Practice



Yes Yes Yes Yes Yes Partner ME Medical Chambers Yes Direct 24.05.16 The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.


Yes Yes Yes Yes YesTrustee Dr Joseph Chandy Charitable Fund Inc. Roseberry Road



Yes Yes Yes Yes YesPractice is a member of South Durham Health Community Interest Company (GP Federation)

Yes Direct 24.05.16The person declaring the non-financial professional interest will not take part in any decision making relating to the area of interest being declared might may take part in decision making if appropriate.

Dr Ian Davidson Director of Quality and Safety Yes Yes Yes Yes Yes Yes YesGP Partner at Lanchester Medical Centre(formerly Park House Surgery) Yes Direct 09.06.16

The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.

Dr Ian Davidson Director of Quality and Safety Yes Yes Yes Yes Yes Yes YesPractice is a member of Derwentside Healthcare Ltd (GP Federation) Yes Direct 09.06.16

The person declaring the non-financial professional interest will not take part in any decision making relating to the area of interest being declared might may take part in decision making if appropriate.

Dr Ian Davidson Director of Quality and Safety Yes Yes Yes Yes Yes Yes YesWife is employed by North of England Commissioning Support Yes Indirect 09.06.16 25.01.17 Any conflict of interest declared in relation to an indirect interest will be considered

on a case by case basis depending on the discussions taking place at the time.

Dr Ian Davidson Director of Quality and Safety Yes Yes Yes Yes Yes Yes Yes Daughter is employed by Durham County Council Yes Indirect 09.06.16 Any conflict of interest declared in relation to an indirect interest will be considered on a case by case basis depending on the discussions taking place at the time.

Dr Ian Davidson Director of Quality and Safety Yes Yes Yes Yes Yes Yes YesWife is employed by Derwentsude Healthcare Ltd (GP Federation)

Yes Indirect 25.01.17Any conflict of interest declared in relation to an indirect interest will be considered on a case by case basis depending on the discussions taking place at the time.

Mrs Gillian Findley Director of Nursing Yes Yes Yes Yes Yes YesDirector of Magnitas - an environmental consultancy firm

Yes Direct 07.05.16The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.

Mrs Gillian Findley Director of Nursing Yes Yes Yes Yes Yes YesDirector of Nursing for Durham Dales, Easington and Sedgefield CCG Yes Direct 07.05.16


Name Current position(s) heldType of Interest Date of Interest


Mrs Gillian Findley Director of Nursing Yes Yes Yes Yes Yes Yes

Related by marriage to the McCardle family of Helen McCardle Care Homes Yes Indirect 07.05.16 Any conflict of interest declared in relation to an indirect interest will be considered

on a case by case basis depending on the discussions taking place at the time.

Amanda Healy Director of Public Health Yes Yes Form issued 19/7/17 for completion

Mr Michael Houghton Director of Commissioning and Development Yes Yes Yes Yes Yes Yes No interests declared 13.05.16

Mr Feisal Jassat Lay Member - Patient and Public Involvement Yes Yes Yes Yes Yes Yes Trustee Age UK Co. Durham Yes Direct 11.05.16The person declaring the interest will fully outlined how they might be benefitted as a result of a decision being made by the CCG in relation to that area of conflict of interest. The course of action relating to whether the person should take part in any discussions/decision making would be made on a case by case basis.

Mr Feisal Jassat Lay Member - Patient and Public Involvement Yes Yes Yes Yes Yes Yes Wheels 2 work - Trustee (Chester-le-Street) Yes Direct 11.05.16 The person declaring the interest will fully outlined how they might be benefitted as a result of a decision being made by the CCG in relation to that area of conflict of interest. The course of action relating to whether the person should take part in any discussions/decision making would be made on a case by case basis.

Mr Feisal Jassat Lay Member - Patient and Public Involvement Yes Yes Yes Yes Yes Yes Board Member, Area Action Partnership Yes Direct 11.05.1619.04.17 -

removed by FJ

The person declaring the interest will fully outlined how they might be benefitted as a result of a decision being made by the CCG in relation to that area of conflict of interest. The course of action relating to whether the person should take part in any discussions/decision making would be made on a case by case basis.

Mr Feisal Jassat Lay Member - Patient and Public Involvement Yes Yes Yes Yes Yes Yes

Member of the North East Advisory Committee for Clinical Excellence (DOH)

Yes Direct 11.05.1619.04.17 -

removed by FJ


Marianne Patterson Healtwatch Representative Yes No intersts declared 14.10.16

Dr David Smart Clinical Chair Yes Yes Yes Yes Yes Yes GP Principal and Partner in Dunelm Medical Practice Yes Direct 17.05.16 The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.

Dr David Smart Clinical Chair Yes Yes Yes Yes Yes Yes

Practice is member of Central Durham GP Providers Ltd



Trustee of the Ferryhill Station, Mainsforth and Bishop Middleham Aid-in-Sickness charity



Appointed Governor (CCG representative) on Council ofGovernors for Tees, Esk and Wear ValleyNHS Foundation Trust (representing North Durham CCG,Durham Dales, Easington and Sedgefield (DDES) CCGand Darlington CCG Yes Direct 17.05.16



Appointed Governor (CCG representative on the Council of Governors for County Durham and Darlington NHS Foundation Trust (representing North Durham CCG only Yes Direct

17.05.16


Dr David Smart Clinical Chair Yes Yes Yes Yes Yes YesMember (NDCCG representative) Durham County Council, Health and Wellbeing Board


Dr Patrick WrightConstituency GP Lead, Durham andMacmillan Cancer Lead

Yes Yes Yes Yes Yes Yes Yes Capital Stakeholder in Belmont and Sherburn Medical Group Yes Direct 17.05.16 The person declaring the financial interest will not take part in any decision making relating to that area of financial interest is being discussed. They will be asked to leave any meeting where that area is being discussed.


Yes Yes Yes Yes Yes Yes Yes Registered on the GP performers list as GP locum status Yes Direct 17.05.16 The person declaring the non-financial professional interest will not take part in any decision making relating to the area of interest being declared might may take part in decision making if appropriate.


Yes Yes Yes Yes Yes Yes YesAccredited GP with a special interest in the management of make sexual dysfunction via an NHS funded clinic



Yes Yes Yes Yes Yes Yes Yes Committee member of the British Society of Sexual Medicine Yes Direct

17.05.16The person declaring the non-financial professional interest will not take part in any decision making relating to the area of interest being declared might may take part in decision making if appropriate.


Yes Yes Yes Yes Yes Yes YesTreasurer for the Primary Care Testosterone Action Group (PCTAG) (Voluntary post)

Yes Direct

17.05.16The person declaring the non-financial professional interest will not take part in any decision making relating to the area of interest being declared might may take part in decision making if appropriate.



Yes Yes Yes Yes Yes Yes Yes

I have received honoraria from Besin’s Pharmaceutical Company in 2016-17, for attending several advisory board meetings on ‘The management of Testosterone Deficiency’ and for work reviewing a paper on ‘Improving the primary care management of erectile dysfunction and testosterone deficiency in men with or without Type 2 diabetes: findings from the REVITALISE audit’. I also received money for lecturing to an audience of primary care colleagues on 'Testosterone deficiency and the role of testosterone replacement therapy in men'

Yes Direct

17.05.16 updated 26.06.18


Official

Meeting Date: 26 July 2017 Item No: PCC/17/58


Report Title Dunelm Medical Practice - Application for temporary

closure of Framwellgate Moor Medical Centre Author Kelly Wilson, Primary Care Business Manager, NHS England Sponsor Director Joseph Chandy, Director of Primary Care Development and

Innovation (non-clinical) Date of report: July 2017 Name of person presenting the report:

Denise Jones, Acting Head of Primary Care, NHS England

Reason for report ‘ü’ please tick relevant category

· For information · Development & Discussion · For decision ü · For action

Recommendations (i.e. action being sought from the meeting)

The Primary Care Commissioning Committee is asked to: · consider the content of this report and decide on the

preferred option.

Report status ‘ü’ please indicate relevant category (see guidance notes)

· Official ü · Official Sensitive: Commercial · Official Sensitive: Personal

Is this report confidential please delete as appropriate

· No

Procurement Conflict of Interest completed and attached please delete as appropriate (see guidance notes)

· n/a

Potential conflicts of interest

None Identified

Official

Purpose of the report and summary of key issues

The purpose of this report is to provide information to enable NHS North Durham CCG Primary Care Commissioning Committee to consider an application from Dunelm Medical Practice to temporarily close the practice’s branch surgery located in Framwellgate Moor for 4-6 weeks whilst refurbishment work takes place. The practice would like approval to temporarily close the practice premises prior to submitting an application for a premises improvement grant via NHS England. Capacity from Framwellgate will be provided at the practice’s two other sites located in Bearpark and Gilesgate. The practice has advised that, if approved, building works will take place during the summer months 2017 outside of winter pressures. The practice list size is 12,284 as at 1 April 2017. The practice has identified 4,750 patients who access the Framwellgate Moor site. The premises at Framwellgate Moor are owned by the practice. In line with the NHS (General Medical Services – Premises Costs) Directions 2013, consideration can be given to the CCG withholding reimbursement of Rent and Rates whilst the premises are unoccupied. The practice has advised that, should their application be approved, all affected patients will be fully informed of the temporary closure. The majority of patients have access to their own transport and will be able to travel to the two other surgeries. In addition the practice will provide a shuttle bus service.

North Durham CCG consultation and approval route (including outcomes)

Meeting Primary Care Commissioning Committee

Date 26 July 2017

Supporting documents/ Appendices

Dunelm Medical Practice - Application for temporary closure of Framwellgate Moor Medical Centre

Appendix 1 – Project Initiation Document

Official

Impact Assessment and Risk Management Issues Consideration given and action taken in this report relating to impact assessment and risk management issues is detailed below:

(ü) tick as appropriate

Impact area

Does this report identify a risk for the CCG? No.

Does this report impact on the environment/sustainability of the CCG?

No.

Does this report have legal implications? No.

Are there any resource implications – finance and/or staffing as a result of

this report? No.

Has this report taken into account equality and diversity? No.

Does this report impact on Quality, Innovation, Productivity and Prevention

(QIPP)? No.

ü Has there been any consultation/engagement (patient, public, stakeholder, clinical) with regard to the content of the report?

No, there have only been initial discussions with the practice’s Patient Participation Group (PPG).

Are there any clinical quality/patient safety issues identified in this report? Yes.

Does this report impact on any information governance issues? No.

Other implications None.

Official

Dunelm Medical Practice Application for temporary closure of Framwellgate Moor Medical Centre

1. Introduction 1.1 The purpose of this report is to provide information to enable NHS North Durham CCG

Primary Care Commissioning Committee to consider an application from Dunelm Medical Practice to temporarily close the practice’s branch surgery located in Framwellgate Moor to allow building refurbishment work to take place, should their application for a premises improvement grant be approved.

2. Background 2.1 Dunelm Medical Practice is a GMS practice which provides, essential, additional and

enhanced services to a patient list size of 12,284 patients (13,154.55 weighted) as at 01 April 2017. The practice has requested permission to temporarily close their branch surgery located at Framwellgate Moor Medical Centre for 4-6 weeks, whilst refurbishment work takes place, should an application for a premises improvement grant be approved.

The practice applied for a premises improvement grant via NHS England in 2015/16 which was approved, however a stipulation of an improvement grant is that any works must be undertaken within the financial year that the grant is approved. Unfortunately the practice was unable to complete building works within the financial year and therefore the refurbishment was not undertaken at that time. In 2016/17 the practice submitted an expression of interest only, again due to timescales the project would not have been possible to complete within the financial year and the practice withdrew their expression of interest and asked for prior commitment for 2017/18. The practice will apply for funding in 2017/18 when NHS England invites practices to submit applications, which is expected to happen in May/June 2017, with a submission deadline date of 30 June 2017. The Project Initiation Document (PID) submitted in 2016 can be seen in Appendix 1. The practice has advised that NHS North Durham CCG has supported the project in the previous 2 years and have received a commitment to support the project this year. The practice would like approval to temporarily close the practice premises prior to re-submission of their application. This is because if the temporary closure is not approved, the cost of the project will increase by approximately £100,000 to take into account the cost of temporary portakabin accommodation; the portakabins would need to be situated in the practice car park. A significant portion of this money would be for the hiring of a crane to lift the portakabins over the surgery and into the car park.

2.2 The practice has provided the following information;

Official

The practice has three practice sites across Durham city. Two sites, Bearpark Surgery and Gilesgate Medical Centre, have had refurbishments completed over the last two years without the need for closure. The refurbishment at Framwellgate Moor is however, more complex. Discussions with both the architect and builders mean that the practice would need to temporarily close for between 4 and 6 weeks. This is because the practice is situated at the head of a cul de sac in the middle of a housing estate, with limited space, both in the current car park and nearby to allow temporary accommodation without seriously affecting local residents. Any works undertaken within the premises without closure has serious health and safety implications for both staff and patients. The temporary closure would also allow the building works to be completed more quickly. Capacity from Framwellgate will be provided at the two other practice sites located in Bearpark and Gilesgate. The practice has advised that they will provide a shuttle bus service for patients from the Framwellgate Moor surgery to the other two surgeries. The practice has advised that building works will take place during the summer months outside of winter pressures.

3. Issues to consider

3.1 Practice Profile 3.1.1 Practice list size

The practice list size is 12,284 as at 01 April 2017. The practice has identified 4,750 patients that access the Framwellgate Moor practice.

3.1.2 Practice sites The practice has three practice sites;

· Framwellgate Moor Medical Centre, 50 front Street, Framwellgate Moor, Durham, DH1 5BL;

· Bearpark Surgery, Bearpark Medical Centre, 1 Victor Terrace, Bearpark, Durham, DH7 7DG;

· Gilesgate Medical Centre, Sunderland Road, Durham, DH1 2QQ. The distance between the three practice sites by car is as follows;

· Framwellgate Medical Centre to Bearpark Surgery - 3.2 miles (2.1 miles direct) · Framwellgate Medical Centre to Gilesgate Surgery - 2.7 miles (1.9 miles direct) · Gilesgate Surgery to Bearpark Surgery - 4.1 miles (3.4 miles direct).

3.1.3 Opening Hours The opening hours for the three practices sites are as follows; Table 1- Opening hours

Framwellgate Moor Medical Centre

Bearpark Surgery Gilesgate Medical Centre

Contracted hours

Extended hours

Contracted hours

Extended hours

Contract hours

Extended hours

Monday *08:45 – 18:00

*08:30 – 18:00

*08:45 – 18:00

Tuesday 08:45 – 18:00 08:30 – 18:00 08:45 – 18:00 Wednesday 08:45 – 18:00 08:30 – 18:00 08:45 – 18:00 Thursday 08:45 – 18:00 08:30 – 18:00 08:45 – 18:00

Official

Friday 08:45 – 18:00 08:30 – 18:00 08:45 – 18:00 Saturday Closed **08:00 –

13:00 Closed Closed

Sunday Closed Closed Closed Total 46.25 hours 47.5 hours 46.25 hours

* Northern Doctors provide call handling/triage until 08:30/08:45. **Extended hours, 08:00- 13:00 usually provided at Framwellgate Moor. The hours will rotate between Bearpark surgery and Gilesgate Medical Centre during temporary closure. 3.1.4 Services provided

The practice has advised that additional sessions will be provided from the other two practice sites to accommodate the extra patients. The practice will continue to provide 72 appointments per 1000 patients. The practice has confirmed that they have space to accommodate additional patients and will stagger surgery times throughout the day. The practice will use the practice web site and notice boards to update patients on increased surgeries. Framwellgate Moor Medical Centre provides IUCD fittings and minor operations; the practice has advised that these services will be provided at the other practice sites.

3.2 Contractual and Regulatory implications There is nothing in the GMS Contract Regulations or NHS (General Medical Services - Premises Costs) Directions 2013 which refers to the temporary closure of premises; however it is a practice’s responsibility to ensure the premises from which they deliver services are fit for purpose. The premises at Framwellgate Moor are owned by the practice. The rent and rates which the practice is reimbursed for are shown in the table below: Table 2 – Rent and rates 2017/18 Rent Rates Water rates

(estimate based on 2016/17)

Framwellgate Moor Medical Centre

£20,800.0 £3,058.35 £400.0

The NHS (General Medical Services – Premises Costs) Directions 2013 schedule 2 allow for consideration to be given to withhold reimbursement of rent and rates whilst the premises are unoccupied. However, the closure would only be for a short period of time and GMS services will still continue to be provided under the contract, albeit for the other sites. The practice will continue to pay their loans etc in relation to the premises and will also have increased costs of providing a shuttle bus service for their patients. Continuing to pay the rent and rates during the closure would be covered by Part 6 of the Premises Cost Directions - financial assistance in circumstances not contemplated in the directions as detailed below:

Official

3.3 Finance implications

If reimbursement is withheld whilst the practice is closed there would be a saving to the CCG of £2,799 (6 weeks equivalent of rent, rates and water rates), if reimbursement continues there is no perceived financial impact to NHS England or NHS North Durham CCG for the temporary closure. If the temporary closure is not agreed the practice will apply for an additional £100,000 to cover the cost of temporary portakabins as part of the improvement grant application. There is however no guarantee that this would be awarded.

3.4 Clinical staffing levels The practice has confirmed there will be no changes in staffing levels during the temporary closure.

3.5 IT There will be no impact on IT. All sites use one clinical system, SystmOne and have full access to all patient records.

3.6 Medical Records All medical records are held centrally at Bearpark Surgery.

3.7 Patients and Stakeholders 3.7.1 Patients

The practice has stated that all affected patients will receive a letter and text (where a mobile number has been supplied), outlining the temporary closure and access arrangements during the closure. Information will be available on the practice web site. The practice has advised that they will also hold bespoke Q&A patient sessions. The practice has advised that Framwellgate Moor is quite an affluent area and the majority of patients have access to their own transport and will be able to travel to the two other surgeries. In addition the practice will provide a shuttle bus service. The practice’s initial thoughts are to provide the shuttle bus service hourly during clinic times; however the practice would like to speak to patients first to understand what is required before deciding on how the service will be provided.

Official

For any known vulnerable patients, the practice has advised that those patients will also have access to the shuttle bus service but in addition, if deemed appropriate and necessary a clinician will visit the patient at their home. The practice has advised that there will be no change to the care provided at nursing homes. The practice has had discussions with the Patient Participation Group (PPG), who fully support the proposal. The temporary closure will be planned with the PPG.

3.7.2 Stakeholders The practice has advised that all relevant agencies i.e. nearby medical practices, pharmacies and NHS 111will be fully briefed on the temporary closure as soon as closure dates are known. The only community service provided from the Framwellgate Moor practice is the podiatry service. The practice has stated that podiatry provides minimal sessions from Framwellgate Moor and that there is capacity at one of their other practices for the service to move to temporarily. The practice will enter into discussions with podiatry if the temporary closure is approved.

4. Options appraisal Options to be considered; 4.1 Approve the temporary closure Advantages

· The temporary closure is for a short period of time only and will take place in the summer months, when there is less pressure on the practice.

· The overall project costs will be reduced by £100,000 if temporary accommodation is not needed.

· Allows the building work to take place without causing too much disruption to local residents;

· Improved practice premises for patients. Risks · The travelling distance to the other two practice sites is approximately 2.7 – 3.2 miles

when starting at Framwellgate Moor surgery, which may be seen as too far for some patients, particularly those who do not drive. This risk is mitigated by the practice giving patients access to a Shuttle Bus.

· Although unlikely, some patients may choose to register at an alternative practice rather than travel for the temporary period.

Consideration may be given to how long the approval is valid for to avoid works taking place over the winter months. As detailed in section 3.3, consideration can be given to withholding the reimbursement of Rent and Rates whilst the practice is not providing primary medical services.

Official 4.2 Reject the temporary closure Advantages

· Patients will still be able to access services in Framwellgate Moor whilst the building works take place, however this will be from portakabins.

Risks · If the temporary closure is rejected but the improvement grant application approved,

the cost of the project will increase by approximately £100,000. The practice may decide not to progress with the building works.

· This option would be deemed unsupportive of a practice that is applying to improve its premises and therefore may cause reputational damage.

5. Recommendation

5.1 NHS North Durham CCG is requested to consider the contents of this report and decide on the preferred option.

If the temporary closure is approved,

· the CCG would need to decide if the rent and rates reimbursement should cease for the period of closure.

In addition, it is recommended that approval is subject to the following;

· the practice develops a full patient and stakeholder engagement plan for approval by the CCG. This should include a letter for all patients who access services at the Framwellgate Moor practice which informs patients of the following; o how to access the two sites that are remaining open; o information on the Framwellgate Moor site closure and anticipated timetable,

including information on additional clinics that will be put on at the other sites to allay the concerns of patients who attend all sites that access will not be affected at the sites that will remain open;

o transport arrangements, including information about the shuttle bus service and local bus services;

o arrangements for collecting prescriptions. · the practice to ensure that any vulnerable patients are offered additional support

where needed, such as ensuring those patients have access to the shuttle bus service but in addition, if deemed appropriate and necessary, a clinician to visit the patient at their home;

· the practice should address any concerns which may be raised by patients in relation to accessing services at Bearpark Surgery and Gilesgate Medical Centre;

· the practice to confirm, once known, the date the premises will temporarily close from and what date they will reopen.

Official Appendix 1 – Project Initiation Document

NHS England Project Initiation Document

TITLE OF SCHEME

Dunelm Medical Practice Framwellgate Moor Medical Centre Refurbishment

SPONSORING NHS ORGANISATION (S)

Sponsor 1: Dunelm Medical Practice Sponsor 2: North Durham Clinical Commissioning Group/NHS England

CONTACT DETAILS

Provide details of lead sponsor officer for the scheme (name/title/office & mobile phone number/email address) Rachel Shakir, Practice Development Manager Dunelm Medical Practice Bearpark Surgery 0191 373 8402 [email protected]

BRIEF SCHEME DESCRIPTION

Include description of: (a) location (b) scope (c) objectives and benefits – these may be financial and/or non-

financial (d) wider stakeholders and their interest e.g. potential occupants

a) The practice operates across three sites over Durham City;

Bearpark, Gilesgate and Framwellgate Moor. Framwellgate Moor Medical Centre is located in 50 Front Street, Durham, DH1 5BL. Two surgeries, Bearpark and Gilesgate, have already been refurbished with improvement grants at 66% during 2015/16.

b) The scope is to upgrade the Framwellgate premises to ensure

compliance with the Disability Discrimination Act 1995, Equality Act 2010, fire regulations, health and safety and infection control guidelines.

c) The objectives for an improvement grant are consistent with

the findings of the six facet condition plan and practice’s business plan. It will improve the overall level of suitability of premises to access primary care. The proposal will ensure compliance with the Disability Discrimination Act 1995, Equality Act 2010, health and safety fire regulations and infection

Official

control guidelines. The development is key to providing primary care for new build developments at Framwellgate Moor and Aykley Heads identified within The County Plan of Durham County Council.

d) The public and patient participation group has been party to the

discussions with a direct interest as patients who access care, especially improvement of front entrance for disabled patients. The practice is a branch site which works with other health and wellbeing partners including visiting counsellors and attached staff; ie midwife, district nurse, etc. The practice works in partnership with Northumbria University and Northern Deanery in facilitating training of GP trainees and practice nurse trainees. The practice is also a member of the North Durham GP Federation working closely with North Durham CCG on winter pressures work and devolvement of care from hospitals to the community. Framwellgate Moor is experiencing an increase in number of new houses being built on the old fire station site at Framwellgate Moor and Aykley Heads. The increase in the number of households is expected to exceed 200+ households.

STRATEGIC NEED

The proposal is in line with the National NHS England policy ‘Five Year Forward View’; North Durham CCGs’s Primary Care Development Strategy Implementation Plan; Draft Sustainability and Transformation Plan; and draft Estates Strategy The proposal will assist with fulfilling the existing GMS contract and training contracts with both deaneries in the northern faculty. The practice is committed to extending access and has Saturday surgery sessions operating from Framwellgate Moor site. The practice is also committed to avoiding unplanned admissions, frail elderly and ambulatory care sensitive conditions in line with the objectives of the delivery plan of North Durham Clinical Commissioning Group and North Durham GP Federation.

CONSISTENCY WITH COMMISSIONING AND ESTATES PLANS

Include confirmation of whether formal public consultation is required No, formal public consultation is not required Include confirmation of whether any planning permission (including change of use) is required. Planning permission is required Include confirmation that the proposed scheme is consistent with the sponsor organisations clinical and (where appropriate) estate strategies The proposed scheme is consistent with national, clinical and estate strategies of NHS England and North Durham CCG

COST ESTIMATES (Inc. VAT)

15/16 16/17 17/18 Total Total Capital Cost: £N/A £ £N/A £xk Costs as per Quantity Surveyor provided by Howarth Litchfield Architects

Official

Demolition and Alteration Works £15,000 Refurbishment of Existing Areas £178,200 External Works £21,300 Preliminaries @ 12% £25,740 Contingencies @ 10% £24,024 Total 264,264 plus VAT

ANTICIPATED CAPITAL SOURCES

§ NHS England – @ 66% £ § NHS Property Services Ltd £N/A § Community Health Partnerships/LIFTCo £N/A § Other (specify) £ § Total £xk

REVENUE AFFORDABILITY

Net Recurrent Revenue Impact: £ N/A (Outline any additional costs and any planned offsetting savings) Specify funding source for any adverse net impact

ESTIMATED PROJECT DEVELOPMENT COSTS (Inc. VAT)

Already incurred by Project Sponsor(s) £24187.45 Further estimate to achieve OBC/Stage 1 LIFT approval £N/A Further estimate to achieve FBC/Stage 2 LIFT approval £N/A

PROPOSED PROCUREMENT STRATEGY

Where available attach a key milestones plan e.g Date of procurement Planned start of works Estimated completion date Submission of Planning Application: Friday 30th October 2015* *Subject to client sign off of proposed scheme. 3. Planning validation period assumed of one week: Friday 6th

November 2015** **To be confirmed by Durham County Council following submission of planning application. 4. Planning determination period of eight weeks: Friday 15th

January 2016. Design consultants’ quotations to be obtained during the planning determination period for Structural Engineer, Mechanical & Electrical Services Engineers, Asbestos survey companies, etc. 5. Preparation of Building Regulations and tender packages of six week period: To be issued by Friday 26th February 2016. 6. Tender period of four weeks. To be returned by Friday 25th March 2016. 7. Tender evaluation period/Preparation of Contract Documents/Appointment of General Contractor/Pre-Contract Meeting/Site Mobilisation of two weeks.

Official

8. Site commencement: Monday 11th April 2016*** ***Subject to temporary relocation timescales for existing medical centre. 9. Contract period : Six months, (to be reviewed with the prospective tenderers).

KEY RISKS

Non compliance: Infection control guidelines Disability Discrimination Act 1995 Health and Safety Equality Act 2010 Fire regulations Facilitation of training of GP and practice nurse trainees Would not meet strategic plans of NHS England and North Durham CCG Restrict access to primary care to newbuild households in Framwellgate Moor and Aykley Heads

Note: By endorsing the Project Initiation Document below the project sponsor(s) commits to

reimbursing project costs incurred by a third party if the sponsor(s) subsequently decides not to proceed with a viable project.

ENDORSED BY: SPONSOR ORG 1 DIRECTOR OF FINANCE / CHIEF FINANCIAL OFFICER

Organisation Name Signature

Date SPONSOR ORG 2 DIRECTOR OF FINANCE / CHIEF FINANCIAL OFFICER

Organisation Name Signature

Date NHS PROPERTY SERVICES REGIONAL DIRECTOR

Name Signature

Date OTHER (Please specify) Organisation

Name Signature

Date NHS ENGLAND Region

Official

REGIONAL DIRECTOR OF FINANCE

Name Signature

Date

PRIORITISATION (For regional use only)

Official



Report Title Primary Care Finance Report for the three months ending

30 June 2017 Author Barbara Harker, Finance and Performance Manager Sponsor Director Richard Henderson, Chief Finance Officer Date of report: July 2017 Name of person presenting the report:

Richard Henderson, Chief Finance Officer


· For information · Development & Discussion ü · For decision · For action


The Primary Care Commissioning Committee is asked to: · receive the report, · note the current and forecast financial position in respect

of primary care budgets.

Report status ‘ü’ please indicate relevant category



· No

Procurement Conflict of Interest completed and attached please delete as appropriate

· n/a


None identified.


The report presents a summary of the financial position on primary care budgets for three months ending 30 June 2017. This includes those primary care budgets delegated from NHS England and also any other elements of primary care spend within North Durham Clinical Commissioning Group’s (CCG’s)

2

main commissioning budgets.

· The total funding allocation relating to delegated primary care commissioning responsibilities for 2017/18 amounts to £34,103k.

· This funding allocation will reduce by £98k as it was agreed that the budget and costs for needles and syringes, interpretation and clinical waste would be transferred back to NHS England and managed on a regional basis. This is consistent with the prior year and will reduce the total funding allocation to £34,005k.

· The majority of budget values / contracts are relatively fixed in nature and we would not typically expect significant variation in costs.

· Quality outcomes framework (QOF) budgets are showing a forecast overspend which relates to 2016/17 actual achievement. The 2017/18 budget underestimated the potential value of QOF.

· Certain other estimates have been made in areas where limited information is available, e.g. enhanced services;

· Reserves include the required 0.5% contingency and 1% headroom as per national business rules, together with other uncommitted funding. Utilisation of this funding will be confirmed during the year, depending upon performance against budget lines and any further nationally mandated requirements.

· In addition to the delegated primary care budgets, there is also significant investment in primary care services from the CCG’s main commissioning budgets. Although the management of these budgets is not formally delegated to this Committee, it is important for the Committee to understand the full breadth of primary care spend within the CCG.


Meeting/route Primary Care Commissioning Committee

Date 26/07/17

Outcome


· Primary care finance report for the three months to 30 June 2017

3



Impact area

Does this report identify a risk for the CCG? No Does this report impact on the environment/sustainability of the CCG? No Does this report have legal implications? No

ü Are there any resource implications – finance and/or staffing as a result of this report

The report provides a financial update Has this report taken into account equality and diversity? No Does this report impact on Quality, Innovation, Productivity and Prevention

(QIPP)? No Has there been any consultation/engagement (patient, public, stakeholder,

clinical) with regard to the content of the report? No Are there any clinical quality/patient safety issues identified in this report? No Does this report impact on any information governance issues? No Other implications None

4


Primary Care Finance Report for the three months ending 30 June 2017

1. Background The CCG took on full delegation of relevant primary care commissioning responsibilities with effect from 1 April 2015. This report presents a summary of the final financial position on those delegated primary care budgets for the three months ending 30 June 2017. In addition to those delegated budgets, there is also significant investment within primary care services from the CCG’s main commissioning budgets. Although the management of these other budgets is not formally delegated to the Primary Care Commissioning Committee, it is important for the Committee to understand the full scale of primary care services and investment for which the CCG is responsible. The CCG’s overall financial position, including all of the primary care related budgets highlighted in this report, continues to be reviewed and managed on a monthly basis by the Finance and Performance Committee and Management Executive. 2. Delegated budgets

The funding allocation confirmed for primary care delegated functions for 2017/18 is £34,103k. This funding allocation will be reduced by £98k as it was agreed that the budget and costs for needles and syringes, interpretation and clinical waste would be transferred back to NHS England and would be managed on a regional basis. This is consistent with the prior year and will reduce the total funding allocation to £34,105k. Performance against those budgets as at 30 June 2017 is included below. The majority of budget values / contracts are relatively fixed in nature and we would not typically expect significant variation in costs. The majority of the variances shown below relate to the impact of prior year accruals. For certain areas there is limited information available and estimates have been made for these areas such as enhanced services. The Quality Outcomes Framework (QOF) budgets are showing a forecast overspend which relates to 2016/17 actual achievement. The initial 2017/18 budget underestimated the potential value of QOF Reserves include the required 0.5% contingency and 1% headroom in line with national business rules, together with other uncommitted reserves. Utilisation of this funding will be confirmed during the year, depending upon performance against budget lines and any further nationally mandated requirements.

5

Primary Care Delegated Budgets Financial position as at 30 June 2017

Budget Actuals Variance Budget Forecast Variance£000 £000 £000 £000 £000 £000

General Practice - GMS 3,250 3,258 9 12,998 12,998 0General Practice - PMS 2,741 2,741 0 10,964 10,965 1QOF 804 877 74 3,214 3,466 251Enhanced Services 262 249 (13) 1,047 1,029 (18)Premises Cost Reimbursement 964 859 (105) 3,857 3,568 (289)Dispensing/Prescribing Drs 144 144 0 574 574 0Other GP Services 161 164 3 646 689 43Reserves 115 0 (115) 461 472 11Reserves 1% Headroom 85 0 (85) 341 341 0Total Primary Care Delegated Budgets 8,525 8,293 (233) 34,103 34,103 (0)

YTD Annual

At the end of June 2017, there is an expected breakeven position. Below is an overview of expenditure included within primary care delegated budgets:-

• General Medical Services (GMS) is a national contract and payments are in line with the Statement of Financial Entitlement. The slight year to date overspend relates to list size adjustments re demographics which has been offset against GMS investment. This is based on quarter one data and will be monitored during quarter two;

• Personal Medical Services (PMS) is a local contract and payments are in line with the Statement of Financial Entitlement;

• QOF covers clinical and public health, practices can chose to provide this service. The forecast overspend relates to 2016/17 actual achievement currently in Calculating quality reporting service (CQRS). The 2017/18 budget underestimated the potential value of QOF;

• Enhanced Services covers payments made to practices which provide extended hours, minor surgery, learning disability, dementia, extended patient choice and unplanned admissions. The underspend relates to prior year slippage;

• Premises costs relate to rent, rates and water and are paid in line with the GMS/PMS directions. The forecast is based on actual charges with breakeven forecast where no bills have been received. The underspend on rates is the result of a review exercise which has seen significant reductions in rateable values. The underspend on rent relates to historical development funding which is not required this year;

• Other GP services relate to payments for seniority, needles and syringes, interpretation, locums and suspended GPs. At month 3 Care Quality Commission (CQC) figures are £43k higher than estimated;

• As highlighted above, the reserves balance includes the required 0.5% contingency and other currently uncommitted funding, with the 1% headroom shown separately.

It should be noted that the PMS budget line above includes the PMS premium funding which is being released over a transitional period and will be reinvested back into primary care. For 2017/18 this PMS premium funding will be used to contribute to the primary care scheme (previously the Primary Care Value Based Commissioning Scheme), as it was in the previous year.

6

3. Other primary care spend In addition to the delegated primary care budgets outlined above, there are a number of other primary care services commissioned by the CCG. It is important for the Committee to be aware of these and to understand the full breadth of primary care services commissioned. A summary of those other services is shown in the table below, with details of the latest year to date position at 30 June 2017. This includes certain services which have been commissioned on a recurring basis, together with a number of non-recurring schemes commissioned for a specific time period. Other Primary Care Spend Financial position as at 30 June 2017

Budget Forecast Variance£'000 £'000 £'000

Recurring spend:Enhanced services 166 168 2Prescribing incentive scheme 186 186 0Practice based prescribing support 262 265 3Frail Elderly model 225 225 0Out of Hours service 4608 4608 0

Non-recurring spend:Federation development 248 248 0Primary Care Scheme 450 450 0Weekend vulnerable adults scheme 204 204 0Diabetes Training 535 535 0Career start nurses 117 115 -2GPIT services 661 661 0

Total other primary care spend 7,662 7,665 3

Annual

The full forecast spend against the primary care scheme is expected to be £900k. The value shown above reflects that funded via general CCG budgets with the remainder to be funded by PMS premium funding which is currently held within primary care delegated budgets. 4. Recommendations The Primary Care Commissioning Committee is asked to:

· receive the report, · note the current and forecast financial position in respect of primary care budgets.

Official



Report Title Risk Management Report Author Barbara Harker, Finance and Performance Manager Sponsor Director Richard Henderson, Chief Finance Officer Date of report: July 2017 Name of person presenting the report:

Richard Henderson, Chief Finance Officer


For information Development & Discussion ü For action


The Primary Care Commissioning Committee is asked to:

· receive the report, · review those risks allocated to the Primary Care

Commissioning Committee (Appendix1) and consider whether they are accurately assessed,

· review the action being taken to ensure risks are being appropriately managed.




· No


· n/a


None identified.


To provide an update on primary care commissioning related risks facing North Durham Clinical Commissioning Group (the CCG) and action being taken to mitigate these risks. There are two risks on the primary care commissioning (PCC)

2

risk register. One risk has a score of 12:

· conflicts of interest. There has been no change to the Primary Care Commissioning Risk Register since the report presented in May 2017.



Date 26/6/2017

Outcome


· Primary Care Commissioning Committee Risk Management Report

· Appendix 1 Primary Care Commissioning Risk Register Impact Assessment and Risk Management Issues Consideration given and action taken in this report relating to impact assessment and risk management issues is detailed below:


Impact area

ü Does this report identify a risk for the CCG? The report summarises all the risks included on the CCG risk register relating to

primary care. Does this report impact on the environment/sustainability of the CCG? No Does this report have legal implications? No Are there any resource implications – finance and/or staffing as a result of

this report? No Has this report taken into account equality and diversity? No Does this report impact on Quality, Innovation, Productivity and Prevention



3


Primary Care Commissioning Risk Management Update Report 1. Background The purpose of this paper is to set out the current primary care commissioning (PCC) risks facing the organisation, their assessment and the action taken to manage these. Information within the report is based on review and updates to the risk register at 13 July 2017.

2. Discussion, implications and risks Risk Register The number and nature of PCC risks recorded in the CCG risk register are set out in tables 1 and 2 below. This report reflects the risk profile at 13 July 2017. The full PCC risk register and risk details are included in Appendix 1. Table 1: Overall summary of Risk movement of PCC – 2 May 2017

Current (13 July 2017)

Previous (2 May 2017) Movement

Red 0 0Amber 2 2Yellow 0 0Green 0 0Total 2 2 There has been no change to the Primary Care Commissioning Risk Register since the report presented in May 2017. Table 2: PCC Risks Scoring 12 and above – 13 July 2017 Risk Ref. Risk Controls & Actions Rating

1347

Conflicts of Interest There is an inevitable risk of potential conflicts of interest due to the nature of CCGs. This risk is increased through the delegation of primary care commissioning responsibilit ies, both in terms of potential conflicts of clinicians involved in decision making processes, and the ability of the Risk and Audit committee to provide an effective governance and assurance role due to the small number of independent and non-conflicted members of that committee.

- Conflict of interest policy in place and being implemented- Terms of reference for PCC committee ratified- Conflicts of interest log updated on an ongoing basis- Conflicts of interest to be published on CCG website

12

4

CCG Corporate Risks – For information The CCG corporate risk register also holds corporate red risks identified as having the potential to have a significant impact on the CCG corporate objectives, which will be drawn to the attention of the Governing Body. These significant corporate red risks facing the CCG are based upon their residual rating. The CCG now has two corporate risks:

· delivery of the CCG’s financial control total, · delivery of NHS Constitutional Standards.

3. Recommendations The Primary Care Commissioning Committee is asked to:

· receive the report,

· review those risks allocated to PCC (Appendix 1) and consider whether they are accurately assessed,

· review the action being taken to ensure risks are being appropriately managed. Author: Barbara Harker, Finance and Performance Manager Sponsor: Richard Henderson, Chief Finance Officer Date: July 2017

5

NOTE: Risk Assessment Methodology Risks are identified in the CCG Clear and Credible Plan 2012/17, through CCG meetings and also by Commissioning Support colleagues.

The risk register is maintained within a web based integrated Safeguard Incident Risk Management System (SIRMS). SIRMS contains all information related to the individual risks by domain– risk reference, entry date, risk owner, description of risk, controls, risk score, risk assurance, residual risk, update and review dates and progress. The CCG is using a standard risk scoring process that measures the likelihood and severity of each risk and combines them to create a compound risk score. The scoring system works as outlined in Table 1 below:

Table 1 – standard risk scores

All risks scoring 15 or above are automatically escalated from committee risk registers to the corporate risk register. This is reviewed monthly by the Management Executive meeting. Red risks are formally reviewed and reported to the Management Executive and Governing Body together with any action plans where these are required.

Likelihood IMPACT 1 = Rare 2 = Unlikely 3 = Possible 4 = Likely 5 = Almost

certain 5 Catastrophic 5 10 15 20 25 4 Major 4 8 12 16 20 3 Moderate 3 6 9 12 15 2 Minor 2 4 6 8 10 1 Negligible 1 2 3 4 5

RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

ActionsDescription

13/07/2017

North Durham CCG Primary Care Commissioning Cttee Risk Register

Review dateReviewer

- NDCCG Development And Transition

1347

Conflicts of Interest

There is an inevitable risk of potentialconflicts of interest due to the natureof CCGs. This risk is increasedthrough the delegation of primarycare commissioning responsibilities,both in terms of potential conflicts ofclinicians involved in decision makingprocesses, and the ability of the Riskand Audit committee to provide aneffective governance and assurancerole due to the small number ofindependent and non-conflictedmembers of that committee.

30/06/2015 Nicola Bailey

MichaelBrierley

3 4 12 43 12Conflict of interest policy in place and beingimplemented

Conflict of interest is a standing item on allcommittee agendas

Terms of reference for PCC committeeratified

Conflicts of interest log updated on anongoing basis

Conflicts of interest to be published on CCGwebsite

Two additional members who are notconflicted (Joseph Chandy and MikeBrierley)

03/11/2015

RachelRooney

03/05/2016

Nicola Bailey

02/11/2016

BarbaraHarker

02/05/2017

BarbaraHarker

1543

Primary Care resilience andsustainabilty

Challenges in primary care impact inresiliance and sustainability.

03/05/2016 JosephChandy

JosephChandy

3 3 9 33 9Regular primary care team meetings withDirectorsRegular meetings with NHS England to keepup to date on issues via contractingDirectors responsibility for development andmaintaining relationships

Currently working through the GP5YFV toensure that the CCG have a programmedapproach to engaging with GP practices toensure that they are informed of anynational opportunities for support insustainability and resilience. Theprogramme projects will include CCGsupport to practices who express an interestin any of the national initiatives which willrelease resource in primary care.

Primary Care Steering Groups

delivering primary care strategy PC Steering Group

18/07/2016

Juliet Carling

07/02/2017

BarbaraHarker

1PageNDUR RR01

Official

Meeting Date: 26 July 2017 Item no: PCC/17/61


Report Title Primary Care Development Update Author Gill Smith, Commissioning Manager, North of England

Commissioning Support (NECS) Sponsor Director Joseph Chandy, Director of Primary Care Development and

Innovation (non-clinical) Date of report: July 2017 Name of person presenting the report:

Gill Smith, Commissioning Manager, North of England Commissioning Support (NECS)


For information ü Development & Discussion For decision For action


The Primary Care Commissioning Committee is asked:

· to receive the report and note its contents.




· No


· N/A


The general practitioner (GP) members of the Committee would have a conflict of interest as providers of primary care services.


The purpose of this paper is to update the Primary Care Commissioning Committee on the Primary Care Strategy Implementation, key areas:-

· workforce, · out of hospital services, · GP federation development, · General Practice Forward View and impact on the

primary care strategy.


Meeting/route Executives in Common

Date 27/6/17

Outcome

Primary Care Commissioning Committee

26/7/17


Primary Care Development Update



Impact area

Does this report identify a risk for the CCG? No Does this report impact on the environment/sustainability of the CCG? No Does this report have legal implications? No

ü Are there any resource implications – finance and/or staffing as a result of this report?

Funding will be required for the career start GPs Has this report taken into account equality and diversity? No Does this report impact on Quality, Innovation, Productivity and Prevention



3

Primary Care Development Update

Background The purpose of this report is to update members of the Primary Care Commissioning (PCC) Committee on the progress of implementing the North Durham Clinical Commissioning Group Primary Care Strategy since the previous report in May 2017. This report will highlight five key areas and attach as appendices more detailed reports where appropriate. Workforce/GP Career Start GP Career Start:

· Recruited 9 GPs to date and further 2 have expressed an interest. · Attended a recruitment event organised by Northumbria University to promote the

scheme.

Joint posts:

· County Durham and Darlington NHS Foundation Trust (CDDFT) – progressing and will be advertised end of July 2017

· University – 2 GPs working in this role · Public Health

Out of Hospital services

· The Weekend Service for Vulnerable Adults continues. A new service will be designed and aligned to the GP extended access service which is scheduled to go live 25 August 2017.

GP Federation Development

National Direction General Practice Forward View (GPFV)

· North Durham CCG and Durham Dales, Easington and Sedgefield CCG have been successful in receiving a further £100k to support practice resilience and a further bid is with NHS England. The CCGs are currently exploring the opportunity, with GP Federations, to utilise the money to set up a Virtual GP Register to provide support to practices at times of sickness and unexpected absence. The Community Education Provider Network (CEPN) are also working with the CCG to look at hosting arrangements for such resilience projects and also potential workforce projects.

· NHS England launched the 2017/2018 bids for GP Resilience Funding, three bids were successful. A joint bid to NHS England to support workforce and sustainability was also successful.

· North Durham CCG and DDES CCG formed part of a North East wide bid to support international recruitment. The submission has been successful and will move to the next phase. The programme will be run from 2017/18 to 2019/20 and will be a rolling programme of funding over three years.

· Care Navigation and Medical Assistant Training – Scoping work is underway to understand what current systems are being used across primary care. CEPN will take this forward on behalf of both CCGs.

· GP Extended Access – Procurement report is due to be presented to Management Executive (18 July 2017) where a decision will be made on the outcome of the process.

Gill Smith Commissioning Manager July 2017

Official



Report Title Quarterly Primary Care Quality report

(Quarter 4, 2016/17) Author Susan Hepburn, Quality and Development Manager Sponsor Director Dr Ian Davidson, Director of Quality and Safety

Date of report: July 2017 Name of person presenting the report:

Gill Findley, Director of Nursing


· For information · Development & Discussion ü · For decision · For action


The Primary Care Commissioning Committee is asked to: · receive the report for information, · note and discuss the content of the report.


· Official ü · Official-Sensitive: Commercial · Official-Sensitive: Personal


· No


· N/a


Conflict of interest for general practice members of the Committee as providers of the service.


This report provides the Primary Care Commissioning Committee with a summary of the key points in relation to quality assurance in primary care in North Durham in quarter 4 2016/17.

Summary of key points

· The second Primary Care Quality Assurance Sub-Committee took place on 7 March 2017.

· There were no North Durham CCG Performance Triage Group concerns in quarter 4, 2016/17.

· There were two Care Quality Commission (CQC)

primary care medical inspection reports published in relation to North Durham General practices since February 2017:

o Browney House Surgery - was inspected on 6

December 2016, this was a focused inspection to check that the practice had followed their plan for the management of medicines and recruitment. The practice is now rated as good for the ‘safe’ domain.

o Gardiner Cresent Surgery - a desk-based inspection was undertaken on 24 January 2017 by a CQC Inspector and a CQC Pharmacist Inspector. The review of evidence demonstrated that arrangements had significantly improved; the practice is now rated as good for providing safe services.

· All 31 practices have signed up to the 2017/18 Primary Care Scheme.

· The number of North Durham GP Practices that submitted data for February and March 2017 is an improvement on previous months; this is likely to be due to practices accepting the offer of a new Friends and Family Test service on Calculating Quality Reporting Service (CQRS) to allow submission of data.

• The second meeting of the County Durham Community

Education Provider Network took place in April 2017, with a well-attended development session taking place in March 2017. The work plan has been developed and leads for the areas identified.

• The Practice Manager Constituency Leads have recently piloted the Primary Care Workforce Tool; this will be rolled out across practices in summer 2017.



Date 26 July 2017

Outcome


· Appendix 1, Quarterly primary care quality report (quarter 4 2016/17



Impact area

Does this report identify a risk for the CCG? No Does this report impact on the environment/sustainability of the CCG? No Does this report have legal implications? No Are there any resource implications – finance and/or staffing as a result of

this report? No Has this report taken into account equality and diversity? No Does this report impact on Quality, Innovation, Productivity and Prevention


clinical) with regard to the content of the report? No ü Are there any clinical quality/patient safety issues identified in this report? Any key new clinical quality issues to note are outlined in this report.

Does this report impact on any information governance issues? No Other implications None

Appendix 1

Quarterly primary care

quality report (quarter 4 2016/17)

30 May 2017

1

2

Primary care quality assurance and improvement

• The second Primary Care Quality Assurance Sub-Committee took place on 7 March 2017, the 2 North

Durham GP practices highlighted at the January 2017 meeting were discussed. Assurance was provided on the 1 North Durham practice identified in a previous primary care web tool report as having 6 triggers that classes a practice as an outlying practice. Some assurance was provided by the other practice in relation to quality concerns however further assurance is being sought in relation to access.

• There were no North Durham CCG Performance Triage Group concerns in quarter 4, 2016/17 .

• There were 2 CQC primary care medical inspection reports published in relation to North Durham GP practices since February 2017. Further information is provided within the report.

• The Primary Care Web Tool data was updated in January 2017, there are currently no North Durham GP practices with 6 or more triggers.

• The Primary care value-based commissioning scheme 2016/17 is complete and a full update on

progress is provided in a separate report.

NHS England (Cumbria and North East)

• The North East Commissioning Support Clinical Quality Team are awaiting primary care complaints information from NHS England.

3

Primary care quality assurance and improvement

• The second meeting of the County Durham Community Education Provider Network took place in April 2017, with a well attended development session taking place in March 2017, including representation from Higher Education Institutions. The work plan has been developed and leads for the areas identified.

• The Practice Manager Constituency Leads have recently piloted the Primary Care Workforce Tool, this

will be rolled out across practices in summer 2017.

4

CQC primary care medical inspections

• Overall the 30 reports that have been published by the CQC to date in 2015/16 and 2016/17 on North Durham GP practices provide very positive assurance on the quality of care provided by these GP practices. The CQC ratings are outstanding, good, requires improvement and inadequate. An inspection of Bowburn Medical Centre is awaited.

• The reports published by the CQC on North Durham practices since 15 February 2017 are: - Browney House Surgery - was inspected on 6 December 2016, this was a focused inspection to check that the practice had followed their plan for the management of medicines and recruitment. The arrangements for managing medicines across the practice now keeps patients safe and a new recruitment policy has been implemented to cover all necessary employment checks and any checks that were outstanding had been completed. The practice is now rated as good for the ‘safe’ domain. - Gardiner Cresent Surgery - a desk-based inspection was undertaken on 24 January 2017 by a CQC Inspector and a CQC Pharmacist Inspector to check the actions taken by the practice in relation to the management of medicines and policy and procedure availability. The review of evidence demonstrated that arrangements had significantly improved, the practice is now rated as good for providing safe services.

5


Date of inspection visit Date of publication Overall rating for this service Are services safe? Are services effective? Are services caring? Are services responsive to people's needs?

Are services well-led?

CQC Inspections and ratings of specific services

Belmont & Sherburn Medical Group (Sherburn site) 06/10/2015 12/11/2015 Good Good Good Good Good Good Good

Belmont & Sherburn Medical Group (Broomside Lane) Archived 30/06/2016 19/08/2016 Missing Good Missing Missing Good Good N/A

Bowburn Medical Centre N/A N/A N/A N/A N/A N/A N/A

Brandon Lane Surgery 16/02/2016 17/03/2016 Good Good Good Good Good Good Good

Cheveley Park Medical Practice 21/10/2015 26/11/2015 Good Good Good Good Good Good Good

Coxhoe Medical Practice 11/08/2015 15/10/2015 Good Good Good Good Good Good Good

Chastleton Medical Group 22/08/2016 15/09/2016 Good Good Good Good Good Good Good

Dunelm Medical Group 14/09/2016 07/11/2016 Good Good Good Good Good Good

Good for 5 areas and 'Outstanding' for 'people whose circumstances may make them

vulnerable'

The Medical Group 10/11/2016 28/12/2016 Good Good Good Good Good Good Good

West Rainton Medical Practice 17/11/2015 07/01/2016 Good Good Good Good Good Good Good

Claypath & University Medical Group 06/09/2016 16/12/2016 Good Good Outstanding Good Good Good Good for 5 areas and rated

'Outstanding' for 'people experiencing poor mental health'

Chester Le Street Constituency

Bridge End Surgery 22/03/2016 21/04/2016 Good Good Good Good Good Good Good

Middle Chare Medical Group 26/04/2016 23/06/2016 Good Good Good Good Good Good Good

Gardiner Cresent Surgery 24/01/2017 15/03/2017 Good Good Good Good Good Good Good

Great Lumley Surgery 25/08/2016 17/10/2016 Outstanding Good Good Outstanding Outstanding Outstanding Outstanding for all 6 areas

The Surgery - Pelton 05/07/2016 30/08/2016 Good Good Good Good Good Outstanding Good

Sacriston Medical Centre 15/03/2016 10/05/2016 Good Good Good Good Outstanding Good Good for 5 areas and rated

'Outstanding' for 'older people'

Cestria Health Centre 10/11/2016 27/02/2017 Outstanding Good Outstanding Good Good OutstandingGood for 4 areas and outstanding for 'Older people' and 'People with

long term conditions'

Durham Constituency

CQC have not inspected this service yet

6


Date of inspection visit Date of publication Overall rating for this service Are services safe? Are services effective? Are services caring? Are services responsive to people's needs?

Are services well-led?

CQC Inspections and ratings of specific services

Annfield Plain Surgery 15/12/2015 28/01/2016 Good Good Good Good Good Good Good

Browney House Surgery 06/12/2016 25/01/2017 Good Good Good Good Good Good Good

Cedars Medical Group 25/08/2015 15/10/2015 Good Good Good Good Good Good Good

Craghead Medical Practice 01/12/2015 07/01/2016 Good Good Good Good Good Good Good

Dr Lambert & NG (West Road and Lousia Surgeries) 22/12/2015 04/02/2016

GoodGood Good Good Good Good Good

The Haven Surgery 03/11/2015 24/12/2015 Good Good Good Good Good Good Good

Lanchester Medical Centre 08/09/2015 12/11/2015 Good Good Good Good Good Good Good

Leadgate Medical Centre 02/02/2016 22/03/2016 Good Good Good Good Outstanding Good Good for 5 areas and rated

'Outstanding' for 'people with long term conditions'

Tanfield View Medical Group 19/01/2016 18/02/2016 Good Good Good Good Good Good Good

Consett MC 07/06/2016 01/07/2016 Good Good Good Good Good Good Good

Dipton Surgery 16/06/2016 25/07/2016 Good Good Good Good Good Good Good

Oakfields Health Centre 15/06/2016 21/07/2016 Good Good Good Good Good Good Good

Queens Road Surgery 22/04/2016 24/05/2016 Good Good Good Good Good Good Good

Stanley Medical Centre 19/10/2016 16/01/2017 Outstanding Good Good Good Outstanding Outstanding

Good for 4 areas and rated 'Outstanding' for 'people with long term conditions' and 'working age people (including those recently

retired and students)'

Derwentside Constituency

7

Primary care operating model

• GP workforce - 5 career start GPs have been recruited. Progressing recruitment of joint posts with

CDDFT, showing particular interest in care of the elderly. • International Recruitment - a joint bid has been submitted to NHS England to support international

recruitment, potential for £360k financial support. • GP Resilience - a number of practices, Federations and the CCG were successful in securing funding

from the 2016/2017 NHSE resilience fund programme. A large number of bids have been supported by the CCG and submitted to NHS England for 2017/2018 funding.

• Following a review the CCG developed a Primary Care Scheme 2017/18 to replace the 2016/17

Primary Care Value Based Commissioning Scheme. All 31 practices have signed up to the 2017/18 scheme.

• The 3 Federations have been requested to submit assurance documentation and to attend assurance

meetings with the Clinical Chief Officer. The Federations will also attend the Primary Care Commissioning Committee to present how they will deliver on the Five Year Forward View.

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Primary care operating model Out of Hospital services: · All 3 Federations provided out of hours primary care services over the Christmas and New Year,

Easter and May Bank Holidays. Utilisation of appointment slots increased from 30% to over 90% between Christmas and Easter.

· GP Extended Access - the service is currently open to procurement and therefore subject to Purdah

regulations. The closing date was 30 May 2017. · Teams Around Patients (TAPS) - a number of workstreams have been developed to focus on specific

areas essential to the design and delivery of the Teams Around Patients. The workstream task and finish groups will report into the Integration Steering Group. The workstreams are:

- Communication and Engagement - Human Resources and Workforce Development - Finance and Budgets - Performance Outcomes - Access, Referral pathways and processes

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Rapid Specialist Opinion (RSO) • The aim of this service is to ensure patients are receiving the most appropriate treatment for their

condition in the most appropriate place. • Based on the current data 10.86% of the referrals triaged have been returned to practices with advice

for patients as the agreed clinical guidelines suggest that the most appropriate care would be within a Primary Care setting.

• Actual activity data shows an actual reduction in referrals of 18.2% and a reduction in outpatient

attendances of 7.2%. • Feedback from the CCG’s main provider County Durham and Darlington NHS Foundation Trust

(CDDFT) has been positive and they are seeing benefits, in particular when they receive the referrals all documentation is attached to the referral where previously they would often have to chase referral letters and documentation.

• CDDFT have not seen any adverse impact on Referral to Treatment times and have requested that the

CCG includes Colorectal in RSO. Clinical Support Information (CSI) guidelines are being worked on which will allow Colorectal to be include in RSO.

• Consultants using the CSI guidance to review the referrals have commented on the high quality of the

clinical guidelines which have been agreed locally with GPs, hospital consultants and many other relevant practitioners.

• Patients can refuse to have their referral processed through the RSO, Practices are asked to inform the

CCG when this happens. During the first 16 weeks of the scheme the CCG has been made aware of six patients who did not want their referrals to be processed through RSO.

• One practice has opted not to use RSO.

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Patient safety

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SIRMS – GP practice reports per 1000 list size (North East and Cumbria) • The North Durham GP practice reporting rate decreased in quarter 4, 2016/17 with 162 incident reports

in January to March 2017. North Durham GP practices were the seventh highest reporting CCG area across the North East and Cumbria in quarter 4 with a reporting rate of 0.636 for the quarter falling below the NECS mean of 0.768.

• The 2016/17 reporting average is 3.03 incidents per 1000 list size (compared to 3.67 for the year

2015/16) making North Durham 6th highest reported across the11 CCGs; this has fallen and now is just above the regional average of 2.91 incidents per 1000 list size.

SIRMS – GP practice reports North Durham practice reporting in the financial year 2016/17 (771) showed a 17.5% reduction compared to 2015/16 (935); practice reporting across the North East and Cumbria as a whole increased by 9.5%. Reports per 1000 patients was 3.03 for the year to March 2017 compared to a regional mean average of 2.91.

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SIRMS incidents reported by GP practice about other providers in quarter 4 2016/17

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Medication safety • Prescribing engagement scheme for 2017 to 2018 developed to support key areas of prescribing

including antibiotics and respiratory.

• Possible patient safety concerns were raised nationally with regard to patients not using Braltus devices correctly. The Medicines Optimisation Team cascaded a memo detailing the issue and reminding all professionals to demonstrate inhaler devices.

• Non Medical Prescribing data has been analysed and prescribers of red drugs and controlled drugs have been contacted to ask them to review their prescribing to ensure it is in line with their declared competencies.

• The CCG have continued to work with community pharmacies and practices to highlight issues with regard to third party ordering.

• The regular medicines optimisation newsletter has highlighted prescribing safety messages.

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Clinical effectiveness

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Clinical support information (CSI)

• Guidelines covering 13 clinical areas (Cardiology, ENT, Gastroenterology, Gynaecology, Dermatology, Rheumatology, Orthopaedics/Musculo-skeletal, Cancer, Plastics, Mental Health and Ophthalmology, elderly care and paediatrics) have been released since CSI went live in October 2014.

• A further eight areas have been identified for development: palliative/end of life care, respiratory,

colorectal, urology, neurology, pain management, general surgery and diabetes.

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Clinical support information (CSI)

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Clinical support information

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Clinical support information

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Patient Experience

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FFT results

• FFT is a contractual requirement, the FFT must be made available to patients and data submitted to NHS

England each month through the Calculating Quality Reporting Service. The number of North Durham GP Practices that submitted data for February and March 2017 is an improvement on previous months, this is likely to be due to practices accepting the offer of a new Friends and Family Test service on CQRS to allow submission of data.

Practice list size (March 17)Total

responsesPercentage

recommendedPercentage not recommended

Total responses

Percentage recommended

Percentage not recommended

Total responses

Percentage recommended

Percentage not recommended

Total responsesPercentage

recommendedPercentage not recommended

England 89% 6% 89% 6% 89% 6% 89% 6%NHS North East & Cumbria 91% 5% 91% 4% 91% 5% 89% 5%North Durham CCG 186 94% 4% 338 88% 4% 374 90% 5% 203 87% 5%DDES CCG 103 82% 6% 192 96% 1% 262 89% 7% 224 86% 6%Durham ConstituencyBelmont & Sherburn Medical Group 7304 28 100% 0% 23 96% 0% 23 83% 9% 25 92% 8%Bowburn Medical Centre 3989 30 97% 0% 34 100% 0% 24 100% 0%Brandon Lane Surgery 2462 44 98% 2% 20 100% 0% 22 91% 5% 27 89% 4%Chastleton Medical Group 11566 5 60% 20% 6 100% 0% 0 * * 4 * *Cheveley Park Medical Practice 3984 0 N/A N/A 17 71% 6% 0 * *Claypath & University Medical Group 28348 5 100% 0% 197 95% 1% 92 96% 1%Coxhoe Medical Practice 6303 1 * * 0 N/A N/A 2 * *Dunelm Medical Group 12112The Medical Group 23917 2 * * 12 75% 8% 8 100% 0%West Rainton Medical Practice 5750Chester Le Street ConstituencyBridge End Surgery 8733 2 * * 11 91% 9% 8 75% 25%Cestria Health Centre 11957 37 81% 11% 35 77% 6%Great Lumley Surgery 4886 2 * * 1 * *Middle Chare Medical Group 9903 8 100% 0% 28 82% 11% 15 60% 20% 13 77% 0%Middle Chare (Gardiner Cresent Surge 2037 13 92% 8% 8 63% 13% 4 * * 5 60% 20%The Surgery - Pelton 8731 11 73% 9% 10 40% 30% 18 61% 22% 14 71% 14%Sacriston Medical Centre 9962 7 71% 29% 4 * * 9 89% 11% 2 * *Derwentside ConstituencyAnnfield Plain Surgery 3470 1 * * 0 N/A N/A 58 98% 2% 18 100% 0%Browney House Surgery 2689 7 100% 0% 24 100% 0%Cedars Medical Group 5650Consett Medical Centre 19223 4 * * 10 30% 30% 1 * * 4 * *Craghead Medical Practice 2455 No data No dataDipton Surgery 2733 0 N/A N/A 0 N/A N/A 1 * * 0 * *West Road Surgery 5110 5 100% 0%Leadgate Surgery 5782 9 100% 0% 9 78% 0% 3 * *Oakfields Health Centre 4320 0 N/A N/A 0 N/A N/A 0 N/A N/A 2 * *Lanchester Medical Centre 4064Queens Road Surgery 13173 4 * * 0 * * 4 * * 6 100% 0%Stanley Medical Centre 11257 1 * * 2 * * 2 * * 0 N/A N/ATanfield View Medical Group 11452 4 * * 1 * * 3 * *The Haven Surgery 1653 0 N/A N/A 0 N/A N/A 2 * * 0 N/A N/A

January 2017 February 2017 March 2017

No data

No data

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December 16

No data

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FFT results

• In quarter 4, 2016/17 the percentage of patients that would recommend their GP practice were either slightly

above or below the national averages. Most recent published data demonstrates out of 203 responses:

- the percentage of patients that would recommend their GP practice in North Durham is 87% (national average 89%).

- the percentage of patients of North Durham GP practices that would not recommend their practice is 5% (national average 6%).

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Patient, Public and Carer Engagement

· Engagement completed for phase 1 for draft Sustainability and Transformation Plan for Northumberland, Tyne and Wear and North Durham. This included public sessions, targeted sessions with key voluntary and community sector organisations as well as information available electronically through CCG social media profiles and on the website. The write up of the engagement activity and key themes for North Durham events has been shared with the CCG Governing Body.

· Series of engagement opportunities in relation to Improving Access to Psychological Therapies services which

included three public sessions across North Durham locations. An online survey and opportunity to comment was also provided as an alternative for patients, plus a separate online survey was used for staff working in primary care to contribute too.

· North Durham CCG has transferred its voluntary and community sector engagement resource to supporting Teams Around Practices/Community Hubs project. North Durham CCG has committed to continuing to work with these groups and in the future this will be through the CCG Engagement Lead. Contacts for nearly 400 groups have been transferred and initial meetings have been set up with key partners.

· The Patient, Public and Carer Engagement Committee continues to meet and hold North Durham CCG to account in terms of engagement activity. Topics covered in this period include the draft Sustainability and Transformation plan, extended GP access and implementation of the General Practice Forward View.

· The North Durham Patient Reference Group meets on a monthly basis, North Durham CCG are represented

and have a dedicated slot for CCG business. Patient issues highlighted include Community Hubs, draft Sustainability and Transformation plan, Ophthalmology and Musculoskeletal disorders/physiotherapy hubs locally. There were also discussions regarding future support and development opportunities for members which will be implemented from Quarter 1, 2017/18.

· Staff have undertaken training regarding using audio/visual methods to enhance communication and

engagement. Plans in place to produce short video clips and messages to support future engagement and information sharing.

Official



Report Title Sale and Leaseback Guidance Author Richard Henderson, Chief Finance Officer Sponsor Director Richard Henderson, Chief Finance Officer Date of report: July 2017 Name of person presenting the report:

Not required


· For information ü · Development & Discussion · For decision · For action


The Primary Care Commissioning Committee is asked to: · receive the report, · note the guidance on sale and leaseback

arrangements.




· No


· n/a


None identified.

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The report presents guidance for commissioners when considering any proposed sale and leaseback arrangements of primary care premises. The guidance has been developed by the NHS England Cumbria and North East team, in light of the increasing number of sale and leaseback transactions which are now being proposed. This is presented to the Committee for information. Any sale and leaseback arrangements proposed in North Durham will be considered against the guidance before being presented to the Committee for a decision.


Meeting/route Executives in Common Primary Care Commissioning Committee

Date 25/07/17 26/07/17

Outcome


· NHS England Cumbria and North East Guidance for Commissioners, 12 July 2017

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Impact area

ü Does this report identify a risk for the CCG? Potential risks if sale and leaseback transactions are not considered appropriately Does this report impact on the environment/sustainability of the CCG? No

ü Does this report have legal implications? Premises directions must be followed in considering any transactions

ü Are there any resource implications – finance and/or staffing as a result of this report

Lease rent reimbursement will be paid in line with any transactions agreed Has this report taken into account equality and diversity? No Does this report impact on Quality, Innovation, Productivity and Prevention



NHS England CNE - Consideration of Sale and Leaseback Proposals

1

NHS England Cumbria and North East

Guidance for Commissioners

SALE AND LEASEBACK OF SURGERY PREMISES USED FOR GENERAL MEDICAL SERVICES

VALUE FOR MONEY CONSIDERATIONS

IN RESPECT OF APPLICATIONS FOR RECURRENT FUNDING OF LEASE RENT

12th July 2017


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Introduction Practices can make an application for a sale and lease back of their owned surgery premises in accordance with the 2013 Premises Costs Directions (PCD) Part 2, Direction 7. This provides that the responsible commissioner must consider that application but they must not agree to fund any proposal where a contract has been entered into without prior agreement. Also Part 5, Direction 31 provides that; Where a contractor which rents its premises makes an application to the Board for financial assistance towards its rental costs and the Board is satisfied (before the lease is agreed or varied), where appropriate in consultation with the District Valuation Service, that the terms on which the new or varied lease to take effect represent value for money. The Board must consider that application and in appropriate cases (having regard amongst other matters to the budgetary targets it has set itself) grant that application.

However there is no obligation for the commissioner to grant the application and factors such as the following should also be carefully considered;

· The condition of the building and remaining economic life; · Commissioning plans, strategy and future vision of primary care; · Strategic estates planning and future estates developments;

NHS England CNE will carry out the necessary due diligence on behalf of CCGs with reference to the PCD and with independent professional advice from the District Valuer’s Office. Considerations 1. The sale of existing surgery premises and a simultaneous leaseback to

the Partners of the GP practice holding an NHS contract is a recognised method for retiring or other property owning partners to obtain a capital receipt from a previous investment. The surgery premises are often sold to an investor or property developer who acknowledges the strength and security of the lease rent which is underwritten in whole or in part by NHS rent reimbursement. The value for money criteria may equally apply to proposals to extend the term of an existing lease of surgery premises.

2. The capital payment to the practice is maximised when the length of lease

is for a long period and the property holding risk is transferred to the tenant/NHS. Typically, institutional investors look for a lease with a minimum term of 15 years. Conversely, the capital receipt is reduced if the lease term is short and/or the property holding risk is transferred to the landlord. Also, the prospect of securing a long term lease with GP rental


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income from a contractually secure tenant is likely to be highly attractive to a developer. There is therefore potential for both practices and developers to demand lease terms that are disadvantageous to the NHS.

3. NHS guidance for new generation surgery premises is for lease lengths of 15 – 20 years. However lease lengths up to 25 years may be acceptable in certain circumstances. It follows that the appropriate lease length for older surgery premises should be for a shorter period. New leases for non-new build commercial property in England averages about 8 years in duration and this provides a guide as to a typical business tenancy length of term.

4. The length of lease for a GP surgery which would be approved as representing value for money by NHS England would depend on location, age, construction and specification of the surgery premises. A modern purpose built surgery located in an area which fits with commissioning intentions, and which has benefited from a programme of continued and planned premises improvement and or maintenance, might command a relatively long lease without the need for regular break clauses. A surgery which has dated fixtures and fittings that has not benefitted from investment and/or does not meet statutory compliance or Minimum Standards would have a short lease or a lease with regular break clauses, and any approval should be conditional upon defects or non-compliance being addressed.

5. A surgery that requires capital investment would need to agree a planned

programme of upgrade and improvement with the approving commissioner before the new lease is granted. Once a sale and leaseback is completed there is the potential for both landlord and tenant to be reluctant to commit to capital investment, therefore an explicit agreement is required with a reasonable time frame of delivery. According to the Premises Directions reimbursement of rent is subject to premises meeting minimum standards and reimbursement can be withheld if improvements are not carried out within the agreed time period.

6. Agreement to sale and leaseback transactions (subject to lease terms) can result in the location and scope of service provision being restricted for the period of the agreed lease. Commissioners should therefore give careful consideration to strategic commissioning intentions and estates plans to ensure that future relocation of services is not compromised.

7. Where future estates developments may affect the same site/location then consideration must be given to ensure that fair competition and procurement regulations and law are not compromised, or that the developer does not receive an unfair commercial advantage.


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8. General lease terms that should be considered to ensure value for money to the NHS/taxpayer are summarised as follows:

a. Length of Lease: depending upon the location, age, construction

and specification of the surgery as well as the Commissioners strategic needs. A surgery inspection should be undertaken by the NHS or DV and a schedule of works of improvement and repair, including replacement of old fixtures and fittings, and other improvement works necessary to comply with statutory requirements, agreed with the parties.

b. Repairs: internal repair and replacement of landlord’s fixtures and

fittings as they become beyond economic repair would be the responsibility of the tenant. A Schedule of Condition would be agreed at the start of the lease (or after the works of improvement and repair have been completed if these are funded by the landlord) and the tenant would not be obliged to leave the premises in any better state or repair at the end of the lease.

c. External repairs: the replacement of large items of plant and

machinery (eg lift, lift gear, boilers, etc) can either be the responsibility of the landlord or tenant. It is by negotiation and agreement. However, for larger surgeries the value for money consideration would be for the premises risk to be placed where best managed, and this is likely to be with a professional investor/landlord.

d. Insurance: the reimbursement paid by the NHS to the tenant

includes an addition in respect of insurance. Typically the lease will be on FRI terms (Full Repairing and Insuring) where the insurance premium is paid by the landlord but then recovered from the tenant in addition to the lease rent.

e. Rent review: in accordance with the PCD rent reviews for owner

occupied surgeries in receipt of rent reimbursement are undertaken every three years on an upwards/downwards market rent basis. The period would commence at the start of the lease. Therefore to satisfy value for money rent reviews should remain as three-yearly market rent and upward and downward (although a floor of the initial rent could be accepted). Lease terms should avoid any artificial mechanism that links the rent review to maximising the lease rent reimbursement. Tenants should bear in mind the need to act prudently and to exercise the best possible commercial judgment when negotiating lease terms. Any concession from this position (eg upwards only or landlord only trigger) would need to be balanced by a compensatory benefit to ensure the NHS/taxpayer is


5

not disadvantaged and that the directed VFM requirement can be satisfied.

f. VAT: should not be payable on the lease rent, nor should the

landlord be able to opt to tax during the term of the lease.

g. User: the user clause in the lease should reflect the proposed use of the premises. This will be for General Medical Services under a GP contract, but also other users allied to the Practice or in the local health economy. Tenants should avoid user restrictions that limit the services provided in the surgery to GMS only or only services where NHS rent reimbursement applies. The tenant and the NHS require flexibility as to the services to be delivered from the building over the full term of the lease.

h. Alienation: the lease should allow sub-letting of the accommodation

in parts to other service providers, NHS bodies and other users allied to medicine, without the need to obtain landlord’s consent, subject to prior written notice being given to the Landlord and any sub-lease being contracted out of the Landlord & Tenant Act 1954.

i. Assignment: the lease may be assigned to NHS Bodies or a GP

Partnership in receipt of NHS rent reimbursement, without the need to obtain Landlord’s consent.

j. AGAs: there should be no authorised guarantee agreements

(AGAs) on retirement or resignation from the Practice nor to a tenant of equal financial standing or to an NHS Body nor to another partnership comprising practitioners holding an NHS contract.

k. Demise: the tenant will not undertake external alterations to the

premises without the prior consent of the landlord. The tenant should be permitted to undertake internal non-structural alterations to the premises without the need to seek landlord’s consent. Provided the internal alterations are in respect of the tenant’s business, there should be no obligation on the part of the tenant to reinstate the premises at the end of the term.

9. The rent will be exclusive of any estate service charge details of which

should be agreed prior to the Agreement to Lease.

10. There will be a need to have all partners’ signatures on the lease.

11. As well as protecting the position of the NHS/taxpayer there is also a need to ensure that GP Partners negotiate their own protections. For example they would wish to avoid being left holding a lease when they retire or


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resign, or if GP services cease to be commissioned from the premises. Similarly there is a need to avoid any potential for lease terms to affect the future financial viability of the practice through (for example) the possibility of lease rent increasing above reimbursable rent. If the capital equity has been taken by retired partners then any mitigating financial benefit available to remaining or new partners could be restricted. As well as presenting a risk to remaining partners and to service continuity, lease terms that are unfavorable to a tenant may result in failure to recruit future partners to the practice.

Decision Under the Delegation Agreement it will be for the CCG to reach a decision at their Primary Care Committee or appropriate alternative governance arrangement. In doing so the advice provided by NHS England CNE and the District Valuer must be taken into account and decisions must be made in accordance with the provisions of the Delegation Agreement.

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